The C.n-.ll.n Nur..
D8c:ember 1979 55
THE CANADIAN NURSE
The offtCial /Oumal of the Canadian Nurses
Association published In French and English
editions eleverlimes per year
1979
Annual Author, Subject Index
Vol. 75, No.'s. 1-11
January-December
LEGE'D
A -Abstract
'\ V - Audio ual
E - EdilOnaJ
pon - ponrn..it
ACCIDD/TS
A
e"'y present danger {Post. Langford) 4!fa
Helping preschool children learn to be safe (Eifert) 260
AOOLESCE'CE
Pe"'pective (Wheatley) E.
r.;
.\OOLESCE'TGIRL5-HEALTH ,\'0 H\:GIE"E
The smgle mother: can \o\c help'! (Hlllung-Meyer) 26N
AGED
The loneliness ofthe elderly (Griffin) 23"1)
USH. ArleD<
Not an patients need hOllitiplta)s. 2
'1r
ALBERT A ASSOCIA TIO' OF REGISTERED 'l RSES.
A "'l AL MEETI'G
Ncwsbeat: the provinciaJ scene. 9J/-\
.\LBERT A CHILDRE"S HOSPITAL
Ja -Januar)
Fe - Fcbrua.-y
"h - '-larch
Ap -Apnl
M) - Md)
Jc June
J/.\ -Juh/August
S - September
Oc -October
N - November
D - December
Learning aoom the hospitaJ at home (Ferguson. Park.
Ward).44Ja
ALCOCII.. o.nÏS<
Books can help. 52Ja
ALCOHOLlS'\1
Closeup on physicians at n,k. ION
OccupationaJ hea]th nurses auend akoholism
conference. 14D
ALEMA' \:. Helen
Nursing grand-rounds: femoral a)lograft (Ferguson.
Grice. Stuanl320c
.\LLA:-O. '\Iargam
Nursing: fact and fantasy. 31J/A
ALLE'. ""o
ra
U of -\ hO'ljit
VISlllng pTOfe
,or. &Ja
A'\IBlL.\TOR\: C.\RE
Did you know... the Hea)th Care Cenrfe. 9\1r
A'DER!tO'. "loll)
Bk_ rev., 5:!Fe
^'DERSO:'o. Mona
8k. rev..
:!Fe
ANTISEPSIS
Cross infeclion: a new approach to an old problem
(Cragg) 40Fe
Hands that car<: ar< they sare? (Sklar) 100c
APATHY
Frankly speaking: apathy in nursingfRyanJ J lJe
ASSOCIA nON OF Nl RSES 0
PRJ"CE ED" .\RD
ISLA:-OD. A:-O'LAL MEETI'G
Newsbeat: me provincIa) scene. I
J/A
56 D8c:ember 1979
The C.n-.ll.n Nurse
ASS\X'IATIO" ot RE(;I!>TFRED "I RSFS Ot'
"E\\H)l
DI.A'D
ARNN remembe
pa'\t-Iook!!. to the future. lID
Did you know. . 8N
4.STHMA
Childhood asthma: an outpatient approach (0 treatment
(Ferguson. Webbl '6Fe
A TTITl J)F ot' HE.\L TH P"RSO'
EL
F-nmkly speaking: apathy in nursing (Ryan) 3lJe
A\\ARJ)SA'DPRILES
CNA's annual meeting. 1M}
CNF recei\le
k..ellogggranr. 14Ap
Did you know...SI.John Ambulance, "Ap
Janel "-enny Knox. recipient of the Helen Gibson
Memoridl Schola",hip. 49Fe
The Jud) Hill Memorial Scholal'ihip. 49Fe
Thirteen nurse!!. recel\.e .1wdrd
valued at more than
SJO.OOO. 12Uc
-B-
BAILMENTS
Where does the nurse'" respon'\ibility begin and end in
Cdrlng for a p.1tient"!t. belongmg"'! (
klar) 14S
BA ":'III'G. Judith
^'\si!!otant editor (port) 50c
The nurse in thecommumty: infant stimulation. 36N
BAl "IGART. Alie.
Closeup on nursmg networks. 13J/A
BtL4. 'GER. Anne "Iarie
Servmg Si'iòter. "iO-\p
BESII.\RAII. :\1. Ann.
Closeup on coalition for the prevention of handicap
29N
Commentary (POSI) E. ID
PerOiipective. E. 3Fe
Sinner, or !'taints? E. 4Je
The impo
(hle dream? E. 6Ap
BES\\ETHE:RICK, "Iargarot
StdITmg a"'gnmenl. I
My
BIETTE. M. Ga)le Burns
fhe effects of'ielected factors on the older .1dulfs
managment of treatment for hypertension. 550c
RILLL 'G-"It'\:ER. Jo
fhe'i.1ngle mother: can we: help
::!6N
BOt: ". JaM
Bk. rev.. 480c
Closeup On fetal aJcohol syndrome. 35N
New as
i"itant editor (port) SJ/A
Perspective. E. 5S
BOO" RE\ IE\\ S
Adler. DianeC. AACN organization and management
of crihc.1l-c.1re facditic"i (Shoemaker) 430c
Alhane"ie. Jo'\eph A. Nurses drug reference. 440c
AlexdJ1der. Mar} M. Pedlatnc hillitory taking and
physical diagnosi!'t for nurses (Brown) 450c
Axline. Virginia M. Oibs In search of "ielf. 52Ja
Barber. Elsie. The trembling years. SlJa
Barry. Jeanie ed Emergency nursing. 420c
Blackwell. Marian Willard. Care of the mentally
retdrded.41\Oc
Bretz. H. Lee. Donny and didbetes, 5!1a
Brickhill. Paul. Reach forthe sky, 5lJd
Brown. Molly. ed. Reading!'t in gerontology. 52Fe
Bullough. Bonnie ed. Expanding horizons for nurse.;.
(Bulioughl520c
Burrell.Jr.. Zeb L Critical care (Burrell) S2Fe
Butler. Beverly. Light a single candle. 52Ja
Campbell. Claire. Nursing didgnosi"i and intervention in
nu
ing practice. 52Mr
Canadian Council on Children and Youth. Admittance
restricted' the child as a cItizen in Canada. 53D
Canadian Standards Association. Effective sterilization
in hospÎtaJs by the ethylene oxide process. 53D
Canadian Standards Association. Effectivc stenlization
in hospitals by the steam process. S3D
Chaney. Patricia S. ed. Dealing with death and dying.
4'Oc
Chnstopher, Matt. Sink it. Rusl.Y.
2Ja
Clark. Ann L. Childbearing: a nursing perspective
(Alfonso) S20C
Clark. Bellina, Pop-up going to the hospital. HD
C lark. Carolyn Chambers. Assertive skills for nursc
,
5::!Oc
Clarke. Louise. Can't re.1d. can't write. cdn't t.1lk too
good eIther. "'::!Ja
Dahl. Borghdd. Finding my way.
!la
O'Ambrosio. Richard. No language but a cr). 5!1a
De Angells. Catherine. Pediatric primary care. 450c
Olson. Norma. ClinicaJ nursing technique",. 500c
Dizenzo. Patricia. Why me? 'lilJa
Falk. Ann Man. The ambuldnce. J1D
F.mshawe. Elizabeth. Rachel. 53Jd
Fhnt. 8etty M. New hope for deprived children. 51Ap
fnl"i. 8abbl\. k..risty'o;; courage, 53Ja
Fromer. Margot Joan. Communit} health care dnd the
nursing process.
8Oc
Galton. Lawrence The patienf"i guide to "iurgery. 4:!Oc
G.1rdner. Richard. The f.1mily book about minimal brain
dy...function.53Ja
Garfield. James B. Follow my leader. 53Ja
Gn,
um. M.1rlene Womanpower and health care
(Spengler) 5
Oc
Gunther. John. Dea(h he not proud. HJa
Gydal. M,. When Oily went to hospital (Damelsonl 3JD
Haas. Bdrnara Schuyler. The hospital book. HD
Haber. Judith. Comprehens,ive psychiatric nursing let
aU 480c
Haggard. EliZdbeth. Nobody waved goodbye. 53Jd
Halpern. Susan. Rape. helping the victim. 5::!Fe
Hoffman. Therese Lemire. Into aging, a simulation
game (ReiO 5!1e
HolI.:md. Je.1nne M. C .1rdiova"icular nursing:
prevention. intervention o:\ßd rehabilitation. 430c
Hollowa)'. Nancy Meyer. Nursing and the cntlcally III
patient. 430c
Hudak.. Cðro1yn. ed. Critical care nursing (Gailo. Lohn
S2Je
Jessel. Camilla. Paul in hospi(al (Jolly) '3D
"illilea. Mdrie. "aren. 53Ja
k..lein. Normd. What It', aU about. 53J.1
k..nelsl. Carol Ren. Ment.11 heaJth conceph In
medical-surgical nursing: a workbook (Ameo;;)
k..ramer. Mdrlene. Path to biculturalism (Schmalenberg)
540c
Lasker. Joe. He's my bro(her. S3Ja
Lawrence. Mildred. The shining moment. 53Ja
Laycock. S.R. Family living and sex education: a guide
for pdrent"i and youth IC.1ders. 520c
[edch. Penelope. Your bahy & child: from binh to age
Iive.450c
Leininger. Madeleine. Transcultund nursing: concepts.
theories and pr.1ctices. 3:!Mr
Lewio;;. Clara H. Nutrition. 500c
Litchfteld. Ada. A button in her ear. 53Ja
Litchfield. Ada. A cane in her hand. 5JJa
MdcCracken. M.1ry. A circle of children. 53Ja
M.1
...ie. Roben.Journey (Md......iel 53Ja
'11I1er. Michael H. Current per'\pectlves In nUr",mg
SOCid1 issue"i and trends (t-lynnJ 490c
Neufeld. John, Lisa. bright and ddrk. 53Ja
Neufeld. John. Twink. 53Ja
Park. Clara Claiborne. The seige. S3Jd
Plall. "in. Hey dummy. S4Ja
Rey. H .A. C uriousGeorge goc!'t to the hospital (Rey)
JJD
Robinson. J. ed. Givmg c.1rdiova,çul.1rdru
"i \afely.
440c
Robinson. Veronica. David in silence. 34Ja
Samuels. Gertrude. Run Shelley run. 54Ja
Scipien. Gladys M. Comprehensive pediatric nursing
(et al) 440c
Shaw. Charles R. When your child needs help. S4Ja
Silverman. Peter. Who 'ipeak.s for the children: the
plight of the battered child. 450c
Simon. Norma. All kinds of families. 54Ja
Simon. Norma. Wh) am I different. S4Ja
Stein. Sara 80nnett. A hospital story. J3D
Stewart. Mark A. Raising a hyperactive child tOlds)
S4Ja
VaJens. E.G. The other side of the mountain. 54Ja
Vitale. Barbara. ed. A probiem-solving approach to
nursing çare plans (Laue mer. Nugent) S4My
Waite. Helen E. Valiant çompanions. 54J.1
Warner. Carmen Germame ed. Emergency çare.
assessment and intervention. 48N
Weber. Alfons, Elizaheth gels well. HD
Weller. Stella. Easy pregnancy wilh yoga. 54My
Welzenbach. J.F. Wendy Well and Billy Beller say
.. Hello hospitaJ". Visit the hospital see through
machme. Meet the hospital sandm.1n and A"k a
"mdl-yun" hospital questions (Cline) J3D
West. Paul. Words for a deaf daughter. 54Jol
Wisc.1n. Principle
.1nd practice of psychiatriL: nur...lng
(et all490c
Wolde.Lunilld. Thom.1!!. goeo;; to the doctor, 33D
Wolff. LlI'-erne. F-undamentah of nu
mg IWeltzel.
fuer
u
00c
BOOKS
52Ja.
2Fe. 52Mr. SlAp. S4My. S2Je,
2Oc. 4
N. 5'D
BOR"I..\.:'I/IS. Janis
Your gUide to clinical laboratory proçedure\ (Shepherd.
Hynie) 2
S
DOL RQlE. Jean-Gu)
Admini"itrauve M.1nageroftheCNA Testing Servicc.
7J/A
BRADLEY. Christine
HeaJthiest babies pos
ible(Wdmyca. Ros") 18N
BREAST tEEDlNG
Hea1th professlOnd1s le.1rn more dbout late<;jt in mfdnt
nutrition. 12N
BRETT. Kathleen
See MacMillan-8reu. k..athleen
BRIANT. :'I/ora
Bk. rev.. 5
Oc
Bl CH..\. ". Jan.
The deve10pment of .1 genatnc a!!.<ieO;;lIiment mstrument for
long term care f.1cllitie!!!o. 90
-C-
CAD:\I'\"...... FII.n
Evaluation of Alberta nu
mg in!otructor
. A. 47Je
CAI ENDAR
!Ua. 47Fe. 16Ap. 51My. IbJ/A. I
S. 8Oc. 62N. SID
CA:\IERO
. Sheila
O. B. staff dlert. JON
CAMOLINOS. Francine
The much of love. 3U/A
L..\. 'ADA. ATMOSPHERIC E'\ IRON "IE"T SER\ ICE
Did you know.... 46Je
CA'.\DA. HT:'I/ESS AND A"IAITLR
I'ORT IIRA'CH
Measuring up. 8Je
CANADIAN n:s rRE tUROCCLPATlO,..\L HE.\LTH
A:o.DS4.FE:T\
Occupational heaJth centre holds inaugural meeting.
14Ap
<..A'ADI4.' COl,",CILON HOSPITAL
o\CCREDlT.\ TlO:'l/
Did you kno,," __the Hedhh Care Centre. 9Mr
CA:'I/ADI..\N HOSPITAL L"t'E:CTlO" CO'TROL
ASSOCIATlO:'ll
Infeçtion control practitioners. people in the m
ddle.
14D
CA'ADI.\" I'óSTITl'TEOFCHILD HE.\LTH
Guest ednonal. E (Cochrane) 3Ja
C..\'ADlA' I'liSTITl TEOt'CHILDHEALTH
COAUTlO,," t'OR THE: PRE\ E"TlON UF
HANDICAP
N urscs honor children. HM r
CANADIAN ISTRA\E/liOlS "lRSESASSOClATION
I.V. nurseS meet. IWa
CANADlA' "l'RSE
.. ormer C N F editor educator dies In f1onda. 7N
CANADIA' NL RSES ASSOCIA TIO"
A cataJogue of special interest groups (fltzPoltrick\ 9Je
A meo;;sage from the president (Taylor) IOMy
Claire Me k..eogh is the librarian-Archivist at CNA.
7JIA
CNA - whal's it all about? (Prime) bJ/A
Communication
specialists from the eleven CNA
provincia1/territonaJ as
oci.1tion members met in
CNA House (POrt) 6Mr
Cover photo - CNA House. JJ/A
Directory ofCNA assoclaUOn members. life
f-inancial statements and auditors' report. 49Mr
Have you looked at your association lately? (Prime) E.
SJ/A
Gi
èle Loney has been appointed Liaison Officer. 7J/A
Louise Levesque is Director orCNA projects. 7J/A
Pat W.1llace IS Project Director. de
elopment of nursing
practice st.1ndard
. 7J/A
Prop<>sed amendments to CNA bylaw.. liFe
Submits briefto feder.d commr
sion. CMr
The C8n-.ll.n Nur..
D8c:ember 19711 57
(.A".\D1o\" 'IIl"R'\E:S .\SSOCIATlO'. .\'''l.\L
"tEt:TI'G
IMy
Highlights from the
port of the cxccutive director
f\.lussallem)] ]10.1)
National a
sociation holds annual meeting. 12My
CA....ADlA... 'lR!>t:SASSOCIATlOIlo. AIloIlol'AL
MEt:T1'11G. 1979
RNABC submits election resolution. 8Mr
CAIIo.\D1A:\ IIol RSES ASSOCI.\ no". .\RCHJ\.ES
Nursmg past and present. I Mr
CA'O\D1O\.... 'l K
t.S '''!>UCIATlO:\. COS'\"E:'TIO'
1988
Vancouver. here we cornel :!:!D
C A'ADIA" l\iLRSES ASSOCIA TIO
. LlBRAIU
See Library update
CA"ADlA.... NlRSESASSOCIATlOIlo. TAS" GROl PON
"lRSI'G PRACTICESTA"DARDS .
(portl HOe
CAIloADlA.... Nl
"ES .\"SOCIATIO.... ITSTI"l.
SER\ICE
CNA Testing Senice (Prime. Parrott) 44M)
Examination fees to increase in 1980. ION
Jean-Guy Bourque is Administrative Manager. 7J/A
Newly appointed members orCNA's Testing Service
Nursing Assistants 81ueprint Committee met for the
first time. 8Mr
C A'ADlA' "'l"R!>ES FOL "DATlO!\o
CNF receIVes II.ellogg grant. 14Ap
New CNF board of directors. &Ja
CA'ADlA.... ...lRSES FOL'IIDATIO....-SCHOLARSHIPS
Thlneen nurses recei\'e awards \lalued al mOre than
no.ooo. 120e
CA"'o\DL'\.." ORTHOPEDIC IIoLRSES ASSOCIATIO"
Orthopedic nurses set three-day atlendance record.
12Ap
CA'ADlA" SOCIETY OFDlI\LYSIS P"-RFl!>lO"I!>TS
. End stage renal disease: 1979 and beyond. 8N
CANADlA' l"SIVERSlT\ "'lRSI"G STLDE....TS
ASSOCIATlo"
See CUNSA
CA"CER
Canng for the child with cancer. the nurse practitioner
(Price) 48D
Lifestyle crisis (O'Neil) 12Fe
CAPE BRETO" ISLAJIoD-"'II'11I'11G D1SI\STER. 1979
Emergency (Miller) 4bMy
CAPLI'II. Alice
Bk. rev.. 480e
CARDIOLOGY '79
Currents in cardiology attract record crowd. SSJ/A
CARDIO\ ASCLLAR DI!>EASE:S
WPW syndrome: a case study (Manning/ J4D
CARROLL. Po_I.
Bk. rev.. S2Je
CATHOLIC HEALTH ASSOCIATIOr-; OF CANADA
Rev. Everett MacNeil. executive director. 49Fe
CA "E. Sleole
What a liUIe care can do. 381)
CEREBRO'\ ASCVLAR DISORDERS
Frank's story (Halliian. HunU 2bMr
CERTIflCA T10'l
Occupational health nurses establish certification
program.61a
CHALMERS. KBren
CNF schola",hip. 120e
CHEMOTHERAPY
The IV nurse and the chemotherapy patient: a \'ita) role
in emotionaJ support (MacMillan-Brell) 28Je
CHJLD
Helping preschool chddren learn to be safe (Eifert) 2ID
CmLD. EXCEYTIONAL
A chance to grow wmgs for the spirit. IJe
CHJLD ABUSE:
CNJ talks to Lois Dale. PHN (port) 39Ja
Be it resol\'ed...The role of the nursing association in
the prevention of child abuse (MacLean) 40Ja
Finding and helping victims of chdd abuse (Sklar) I Ua
A team approach to child abu
e (I-nzpatnck) 36Ja
A work
hop on child &tbuse. fJa
CHILD BLHA \ lOR
An exploratory study of the beha\'iors of children in
pain (Macintosh) A, 47Je
CHILD CARl"
The National IndIan Brotherhood. ISAp
Nurses honor chlldren. 8Mr
CHILD HEALTH
Did you know...a study conducled by.... 9Mr
CHILD HEALTH tEDlTORIAL!
The impossible dream' (Besharah) E. bAp
CHILDRE""S HOSPITAL DIAGNOSTIC CElio TRE:.
"ANCOl \"E:R
Early diagnosIs in congemtal heanng loss (OahU 17Ja
CHILDRES'S HO"t'ITAL OF E.\".EK'I O,"T ARlO
Audiology programs: another \'Iewpomt (Smith.
Tataryn. Simser) 2IJa
A team approach to child abuse (Fitzpatnck) J6Ja
CHOI-LI\O. Ag.... T.H.
Bridging the gap between education and service
(Logan) 34Mr
CLAR!\.. Kathio \.I.
New education co-ordinator for the RNAO (port) 50Ap
CLO\\. Caroline
A regIOnal program for the management of hereditary
metabolic disease (Reade) 24N
COCHRA'E. W.A.
Guest editorial. E. JJa
COLLEGE OF NLRSES OF ONTARIO
Ontario nUrse
oppose possible internship program for
studenh.6Mr
CO...I...IISSIO!\o 0' INQLlR\ I'IoTO REDL"\DA"CIES
0\1100 LAY-OtT'S IN CA'o\DA'S LABOR FORCE
CNA submits brief to federal commIS
IOn. 12Mr
CO"'I'\IL 'ICABLE: DISEASt:S
The problem of immunizalion in Canada (LeFon) Z6Ja
CO!\l
1l "ICATION
Did you know.... 7Ja
CO
!\Il NITY HEALTH
l RSI'IG
The nUi30e m the commumty: mfant stimulation
(Banmngl36N
CO:\lGRE:SSliS
Communications specialists from (he eleven l.. NA
pro\lincial/territoriaJ association members melln
CNA House (port) 6Mr
Critical care '78. 8Ja
Did you know.... 7Ja
Health happenings. I5Ap
I.V. nurses meet. IOJa
Measuring up, 8Je
NationaJ association holds annual meeting. 12My
Newly appointed members cfCNA's Testing Service
Nursing Assistants Bluepnnt Comnuuee met for the
first time. 8Mr
Occupational health centre holds inaugural meeting.
14Ap
Onhopedic nurses set three-day attendance record.
12Ap
Spotlight on continuing education. &Je
Time is nOw. nurses decide for selling up doctoral
program.6Ja
U ni\'c:rsity of Moncton to host annual CUNSA
congress. &Ja
A ,,"orkshop on child abuse. 6Ja
CO,,"SL '\fER SATISFACTION
Patient's ad \locate - a new role for the nurse? (Sklar)
J9Je
CONTRACEYTION
Perspective (Wheatley) E. 4N
CORRE:. Gioòle
Officer. SOAp
COTto Jacqueline
Serving Sister. 50Ap
CRAGG. Catherine E.
Cross infection: a new approach to an old problem.
40Fe
CRAIG. Dorothy Marlant
The de\'elopment of a nursing audit tool. S70C
CRAIG. J.:nnifu
SI for you and me (PdgeJ ]bl-e
CRAIG. J
nnifer L"nn
The effect of a self-mstructlon<tl module On the level of
questlon
pos-cd by nur
mg m
tructors dunng
post-chnical conference.... 570c
CRA
HORU. M}J1leE.
Bk. rev.. S20e
LRA
HORD. R_mary
A pre
choolers. health cirçus. l4Ja
CROCMR.I:lUMbeth
Bk. rev.. HU
Cl 'l/NINGHAM. Rosell.
Child abuse program: Scarborough Department of
HeaJth.9U
CL:\ISA
U ni\'ersity of MoncIOn to host annUcll CUNSA
congress. HJa
CY!>,IC FIBROSIS
One bred(h at a time (
ms) 205
-D-
DAHL. Marilyn o.
Early diajnosis in congenital heanng 10
!Þ. I7Ja
o 0\LE:. Lnls
CNJ tdlb to LOIs Dale. PHN (port) J9Ja
DA" EY. Keitha
Bk. rev.. S41Jc
DA \ IES. Borbara L}nn
f.:\ctor.t in\lolved in a mother's decl
lon to
eek
antenata) genetic coun
ehng and have dn
amniocentesIs at an advanced materna) age. 5bOc
1)4. \- .....
. folonÐCr Lornlln
Officer. SOAp
UA\\SO!\o,Joao
Spedking out. a national child hedlth policy' 240
DEATH
Sharing the experience (Willetb-Schroeder) J90c
DEBOI:.R, tiw
Sir. I know. 43My
DELI\"E:RY OF HEALTH CARE
Llfes(yle cnsls (O'Neil) 22Fe
Perspective (Besharah) E. 3t-e
StaJT,ngas.ignment (Be.wethenck) ItiMy
DEN'ISO:\l. Ruth E.
Assistant administrator. Holy Cross Hospital in
Calgary. 491-<
DIABETES INSIPIDlS
Coping with diabetes in
lpidu!o (Moens) 18Ap
D1AGSOSIS. LABORI\TORY
Your guide to climcallaboratory procedures (Bormanis,
Shepherd. Hyme) 25S
DIALYSIS
End stage renal dISease: 1979 and beyond. tiN
DOBBS, CyntIùa
Bk" rev.. 420e
DOHERTY. Gillian
The patient in pain: handling the guilt feelings. 31Fe
DO!>,RO"SKY. J.
Understanding the phYSIology ofpdÌnlHedlinl2til-e
DULCET, SfelJo Burton
The young adult's reported perceptions of the effects of
coDgenitaJ heaII disease on his life style. S70e
DO\\N'S SYNDROME
Diagnosis: down's syndrome (Nixon) 33N
DRUG ABI.:SE
Closeup on physicians at risk. ION
DRUG OVERDOSE
Emergency trealment of drug overdose (Erb) 30My
DKLl\lHELLER MEDIl...1 SECURllY INSTITUTION.
HEALTH CAIU:. CENTRE
Did you know ...the Health Care Centre. 9Mr
DURNFORD. Pbylil
Bk. rev..44Oc
DRYSDALE:, A.....n
Received theJudy Hill Memorial SCholarship. 491-e
58 December 1979
The cenedlen Nur..
-E-
EAGLE. D. Joan
Bk_ rev.. 480c
ECO"OMICS-Nl RSING
Nurses from 64 countries attend ICN meeting in Africa.
120
EDl CATION GRADl ATE
MARN appTOvcs emergency nUT'\ing course. IWa
Time IS now. nur'\e'\ decide forseumg up docwrdl
prog.-am. fJa
EULC\rIO'. ...-LRSI"G
The effect of a self-instrucrional module on the level of
questions posed by nursing instructors during
posl-ciinicaJ conference... (Craig) 570c
RNABC sets up nursing education and re...earch
socle,y. I 'Ap
Bridging the gdp between education dnd service
(Choi-Lao. Logan) HMr
EDlCATIO'l/. Nl"RSI'G. BACCALAlREATE
A follow-up study of graduates from the four year B Sc_
program in nursing. University of Alberta (Field)
570c
Frankly speaking: nur'\ing and the degree mystique. Pt_1
(Hurd) 36Ap
Frankly speaking: nursing dnd the degree mystique.
P!.II (Hurd) 36My
EDl.C.-\TIO'li. NLRSI"G. CONTI"'lING
An assessment of selected continui.ng educdtlon
experiences for professional growth and
competence of nurses (MacI ntosh)
7Oc
Nurses want mOre education programs and paid leave
10 allend. 14Ap
Spotlight on continuing education, &Je
EDI!l:ATION. ". RSI'G. DIPLO"lA PROGRA'\IS
Frank)y speaking: nurCiilng and the degree my")tlque. Pt.1
(Hurd) 36Ap
Frankly "ipeaking: nursing and the degree mystique.
Pt.1I (Hurd) 36M)
EDlCATIO'l/. Nl.RSI..G. GRADlATE-NO'\A SCOTIA
Post graduate maternity nursing program: meeting the
need in the Atlantic region (Steele) 240C
EDlCATIO..... "lRSI'G.STA
DARDS
E"aluation of Alberta nurCiiing mstructors (Cadman) A.
47Je
EDUCATlO:>;AL ME!.SURE'\IÐ,T
CNA Te"ing Service (prime. Parrol\} 44M)
ELFERT. Helen
Bk. rev_. 450c
Helping preschool children learn to be safe. ::!6D
EMERGENUES
Emergency (Miller)
6My
Emergency treatment of drug overdose (Erb) 30My
EMERGE"CY Nl RSING
MARN approves emergency nu.....ing cour<iie. IOJd
F"IPATHY
The I V nurse and the chemotherdpy pdtient: a vit.d role
in emotional support (MacMillan-Brett) ::!RJe
E"IPLO\ 'l.IE"T CO"DITIO,,"S
CNA submits brief to federal commission. I ::!Mr
ERB. Hea'her L.
Emergency treatment of drug overdose. JOMy
ETHICS. Nl.RSI...G
Project Ethics: a code forCanddidn nup.es (Rodchl E.
6My
ETHICS. NL RSI'liG (EDITORIAL!
Sinners or saints? (Besharah) E. 4Je
EXAMI'l/ATIONS
Newly appointed membe
of CNA's Testing Service
NursingA
istants Blueprint Committee met for the
first time. 8Mr
E'\:PLOSIO'liS
Emergency (MIller) 46My
-F-
FELLOWSHIPS
See T rammg I\Upport
See Awards and prize
i'EMORAL NEOPLASMS
Nursing grand rounds: femoral allograft (Alemany.
Ferguson. Grice. Stuart) l20c
n:,\\ ICK. Diana
Recel\ed the Judy Hill Memona1 Schola.....hip. 49Fe
FERGl.SO,,". Faye
Learnmgabout the hospital at home (Park. Ward) 44Jd
FERGl'SON. Patrick
Nursmggmnd rounds: femoral allograft (Alemdny.
Gnce. StUdrt) J::!Oc
FERf;l SO". Roy G.
Childhood dsthmd: an outpatient approach 10 treatment
(Webb) 36Fe
FETAL ALCOHOL S\ "iDRO"1E:
Closeup on fetal alcohol syndrome (Bock) 35N
t IELD. Peggy Anne
CNt scholarship. 120c
CountdownonO.B. nurses.18Oc
^ follow-up study of graduate
from the four year B.Sc.
program in nursmg, University of Alberta. 570c
t1"NEGAN. Marlaine
Bk_ rev_.44Oc
f1T7P.\TRIC". bnda
A catdlogue of special intere't groups. 9Je
A team approach to child abuCiie. JfJa
tOL 'IIDA TlONS
A cata10gue of specid1 interest grQups (Fitzpatrick) 9Je
FRENC H. Susan
("Nt scholarship. 120c
t-RY. Jean E.
8k_ rev..
::!Mr
HTl-ROLOG\
Nursing: nineteen-eighty-floor (Nlghtingown) 17Mr
-G-
GASEK. George
Spoiling and helping the learning disabled child
(Jacobson) IIUe
GENETIC COl.NSELLI'l/G
A regional program for the management of hereditary
metabolic disease (Reade, Clow) 24N
Factors involved in a mother's decIsion to seek
antenatal genetic counseling and have an
amniocentesis at an advanced materna) age (Davies)
560c
GE:o.ETlCS
Early diagnosis in congenital hearing loss (Dahl) 17Ja
GEORGE. Theresa
Bk. rev_. S2Mr
GERIATRIC '1/1 RS....L
Caseload: over seventy-five (Gibbon) 20Mr
GIBBo:lo. Mary
Caseload: over seventy-five. 20Mr
GIBSO... Patricia Lynn
Serving Si'ter.
OAp
GILCHRIST, Joan
Named Flora Madeline Sh
,w Professor ofNurCiimg, 4
N
GOLDE...-BERG. DoD)
Bk. rev.. SOOC
GOODCHILD, Audrey May
Serving SICiiter. 50Ap
GREAT BRITAIN. NATIONAL HEALTH SER\ ICE
Not dll patients need hospitdl
(Aish) ::!3Mr
GREES 9 Florence Grace
Attitudes of registered nUr'\es towards consumer rights
and nursing independence, 560c
GRICE. Jean
Nursing grand rounds: femoral allograft (Alemany.
Fergu
on, Stuart) J20c
GRIFFIN, Amy E:.
The lonehne.. of the elderly. 23My
GROSSMAN. Mary
Here a
d there: a look at nursing in France, JOOc
The LeBoyer Method: what does it mean now? 2HOc
GROVE. Jean E.
The unexpected case of tetanus. 26J/A
-H-
HALLIGAN. Frank
Frank's story (Hunt) 26Mr
H \!liDlL-\PPED
Closeup on coa1ition for the prevention of handicap
IBe.harah) 29N
Handicap: a parent's perspective (RdnkinJ 38N
HARRIS, Jand
When babies cry. 32Fe
HARRIS. Patricia M.
Serving Sister,
OAp
H-\RT. Geraldine Angela
SPinal cord injury: carly impact on the patient's
significdnt others. 570c
HARTLE\'. Bonnie
Hypertensive disorders in pregnancy. 4"2J/A
HASLA:\I. Pam
Hypertension: antihypertensives and how they work. 26Ap
HEALTH
A four-member international nursini[ team.
e
HEARIN(;
Audiology programs: another viewpoint (Smith.
Tataryn. Simser) 2IJa
Early diagnosis in congenital hearing loss (Dahl) 17Ja
HEART DEFECTS, CONGENITAL
The young adult.s reported perceptions of the effects of
congenital heart di<iiease on his life style (Doucet)
S70C
HEBERT, Pat
Bk_ rev_. 490c
HEDUII;. Anne
The immune system. 27J/A
Unde"'tanding the physiology of pain (Dostrovsky)
28Fe
HEGADOREN. Kathy
"Problem children" aren't problems anymore. 3IJa
HENRI"Su
. Carole Lee
See Thomson, Carole Lee
HERE'S HO\\
IOAp. S7JIA. 8S, 8D
HOD:>;ETT, EDen
CNF scholarship, 120c
HOLDER. Elizabeth
Bk. rev.. 500c
HOSPITAL EMERGENCY SER VICE
The ro)e of the family in the emergency department
(Nicklin) 40Ap
HOl RIGAN. Eileen
CNF schola",hip. 120c
HOI'SE. R...alind
A trip to the islandCii. 4::!Mr
HO\T, Bonn)
Executive director of N BARN, 49Fe
Hl.MBER COLLEGE. TORO"TO
Critical care '78. tUa
Hl NT. Lori Whillingtoo
Frank's
tory (Hdlligan) ::!6Mr
HI RD. Jeanne Maric L.
Frankly Ciipeakmg: nursmg dnd the degree mYCiitique.
PLI. 36Ap
Frankly Ciipeaking: nursing and the degree mystlque_
1'1.11. 36My
H\ NIE. Ivo
Your guide to clinical laboratory procedures (Bormanis.
Shepherd) 25S
H\ PERTENSION
Hypenensive disorders in pregndncy (Hanley) 4!J/A
The effects of selected factors on the older adult's
managment of treatment for hypertension (Biene)
5SOC
Hypertension: pediatric hypertension - think about it
(LeFonl32Ap
Hypertension: questions and answers (McCulley) 24Ap
HYPERTENSIO'll-DRl'G THERAPY
H ypertenslon: antihypertenslve
and how they work.
(Haslam) 26Ap
HYPERTENSION-'l/lIRSI'IIG
Hypertension: management m induCiitry - an expanded
role for nurses (Milne. Logan) 21Ap
-
The cen-.llen Nurse
a
December 11171 511
-1-
-"1-
IW\1l 'E TOLERANCE
The immune system (Hedlin) 27J/A
l"I"Il'IT\:
The Immune s\ stem (Hedlin) '!7JI A
l"I'Il'IZ'\T10'
Did you know...a study conducted by.... 9Mr
National advisory committee on Immunization:
recommended immunization schedules for infants
and children. 29Ja
The problem of immunization in Canada (LeFon) ::!6Ja
l'D1o\'S "-"0 ES"I"IOS
ursing north of sixty (Roberts. Ross) 26My
l'U.o\"T
The National Indian Brotherhood. 15Ap
When baNes cry (Hams) 3::!Fe
I'Fo\"T. NE\\BOR"
Healthiesl babIes posSIble (Warnyca. Ross. Bradley) 181'1
I'Fo\:>.T'l-TRlTlO'
HeaJth professionals learn more about latest In mfant
nutrition. I::!N
I"F.\"TSTI"RLATlO' PR(){;RA'\I
The nurse in the community: infant Stlmulahon
(Banning) 361'1
I'FECTIO:>. CO'TROL
Infection control practitioners. people in the middle.
14D
INPl-T
Ja. 4Fe. 4Mr. 7Ap. 8My. 6Je. 56J/A. 9S. 6Oc. 61'1. 6D
I:>'TE
Sl\E CARE
Critical care 078. SJa
I"TESSI\E CARE l:>'ITS
Nutritional assessment of the ICU patient (\1acDougall)
39M)
I'TER"ATlO'AL CO" FERE "CE 0' PRI\L.\R\ CARE
The impossible dream? (Besharah) E. 6Ap
I' TER'A TIOSAL COl
CIL OF:IIl RSES
IC,," supports primary heallh care. 7Ja
Nurses from 64 countries attend ICN meeting in Africa.
lID
Nurses honorchddren. 8Mr
I"TER'ATlO'AL 'l RSES DA \
Nurses honor children. 8Mr
l'IER.....ATlO'AL \:"Eo\R OFTHE CmLD. CA' o\D1A:>'
COM"IISSIO'
The National Indian Brothert100d. 15Ap
I'TER'ATIO'AL \:EAR OF THE CHILD. 1979
CNJ's salute. Ua
A chance to grow wings for the spirit. lJe
Commentary (Besharah. Post) E. 10
Nurses honor children. 8Mr
Guest eØitorial. E (Cochrane, 3Ja
.....TER'SHJP. "O'\fEDICAL
Ontario nurses oppose possible internship program for
students.6Mr
-J-
JACK. !>usanna
It's a bird.lt's a plane, It's supernurse! 34J/A
JAC"SO:>.. Cheryl
CNF schola",hip. HOc
JAC08S0
. Mddrod C.
Spoiling and helping Ihe learning disabled child (Gasek)
l8Je
JOWolSON, F.ye
Neonatal jaundice and phototherapy (Tufts) 450
JO'llES. PbyUis
Appointed dean of the Faculty of Nursing. Uruverslty
of Toronto. 45N
-K-
MLLOGG rol "DATIO:>'. BATILE CREEl\..
MICHIGA....
CNF receives Kellogg grant. 14Ap
Health services division receives Kellogg grant. 8N
KELSEY INSTITL 7E
Did you know.... 7Ja
KID'IIE:\:' DISEASES
End stage renal disease: 1979 and beyond. 8N
"I'll ASH, Rose G.
Experiences and nursmg needç, of spinal cord-lI'uured
patients.
7Oc
KL\:'E. Sandra
That's right.I'ma nune. 35J/A
""'0'\. Janet "enny
Recipient of the S 1.000 Helen Gibson Memorial
Schola",hip.49Fe
"0\\ .o\LCHl..... Bolly
Frankly speaking: a challenge in office nursing, 485
-L-
LABOR.\TOR\ TESTS
\' our guide to clinical laboratory procedures (Ðormani
Shepherd. Hynie) 25S
LA"G. Ga.1
Bk. rev.. 5:!Fe
LA 'GFORD. o\.J.
A very present danger (PosU 42Ja
LASGLOIS. '\farcolle
CNF scholarship. 120c
L.\SOR, lIot5y
Time out! J60c
LE.\DERSHIP
Nurses need leadership skills (Spennra(h. Tlive.) J3Je
LEADERSHJP DE:\ELOP"IE:"T \\ORKSHOPS
Nurses need leade",hip skdls (Spennrath. Tiivel) BJe
LEAR'I...G DISORDERS
Spoiling and helpIng the learning disabled child
(Jacobson.Gasek) l8Je
THE LEBO\:ER '\IETHOD
What does it mean now? (Grossman) :!8Oc
LEEC H. Joan
CNF scholarship. 120c
LEFORT. Sandra
Hypertension: pediatric hypertension - think about it.
32Ap
The problem of immunization in Canada. 26Ja
LEGISLA TIO:>'
Error of jUdgment: is it always negligence? (Sklar) 14Mr
Finding and helping victims of child abuse (SkJar) IUa
On trial'/SkJar) 8Fe
Patient's advocate - a new role for the nurse? (Sklar)
39Je
The coffee-break: pmenua] pitfall for nurses (Sklar)
ISMy
Where does the nurse's responsibility begin and end in
caring for a patient's belongings' (Sklar) 14S
LEGISLATION. MEDICAL
Nurses speak out on legal issues in heaJth. S4J/A
LEGlSLATIO,".!'ol RSJ'IIG
Sinners or saints? (Besharah) E. 4Je
LE VESQl E. Loubo
CNA's Task G roup On Nursing Practice Standards
(port) !JOc
Director of CNA projects, 7J/A
L1BRAR\ lPDo\TE
S4Ja. S2Fe. S2Mr. S2Ap. SSMy. S3Je. S7J/A. SOS. S8OC.
L1'DABlRY. VlrgI.... A.
Former CNJ editor. educator dies in Florida. 7N
WGAN. Alexander
Hypertension. management in industry - an expanded
role for nu",es /Milne) 21Ap
LOGA'. '\far,Dg S.
Bridging the gap between education and service
(Choi-Lao) 34Mr
LO' EY . Gistio
Has been appointed CNA Liaison Officer. 7J/A
LO'llG TERM CARE
Improved care urged by RNABC. 8Mr
WWE. Agatb. Gor1rude
Jomed Project HOPE medica} education program In
Natal. Braz
. SOAp
WYER, Mario d.. A_
Officer. SOAp
"IACCLISH. Barb.ra
Visions. J5Fe
"lacDONALD. Joyce
Closeup on Nova Scotla's reproductive Care program.
270c
I
'I O\COO' 'ELL, Susan
A teenage pregnancy epidemic? 22N
"IACDOlGALL. \"erio
Nutritional assessment of the ICU patient. 39My
MACI'TOSH. Allee R...
An assessment of selected continuing education
experiences for professional growth and
competence of nurses.
7Oc
"I %CI' TOSH. Judith
An exploratory studv of the behavIors of children in
pain. A. 47Je
\f.\CLE'\'.Je_
Be it resolved...The role of the nursing association in
the prevention of child abuse. 40Ja
"IACLEOD. Shlrioy
New CNF board of directors. 8Ja
"IAC\fILLAN-BRETT. Kethl..n
The IV nurse and the chemotherapy pahent: a vital role
in emotional support. 28Je
Mac'JEIL. Re"", E"rrett
Executive director of the Catholic Health Association
of Canada. 49Fe
"I'\LCOLM.IIM
Bk. rev.. 490c
\fALPRACTICE
The coffee-break: potential pitfall for nu",es (Sklar)
I5My
Error of jUdgment: is it aJways negligence
(Sklar) 14Mr
Nursmg negligence in the administration of
medication... Could it happen to you? (Sklar) S U/A
On mal! (SkJar) 8Fe
Sinners or saints? (Besharah) E. 4Je
MA "TOBA ASSOCIA T10'll OF REGISTERED IIIl RSES
\1ARN approves emergency nursing course. IWa
Kathleen Scherer joined office, 49Fe
\fA "ITOBA ASSOCIA TIO'll OF REGISTERED '11I:RSES.
.'\":>'J:AL '\IEETI'iG
Newsbeat: the provincial scene. IIJ/A
\IA"I'G. Coloon
WPW syndrome: a case study J4D
MA"SOlR. Penni
Bk. rev.. SOOC
MATHESON.
tM
y
Commander Sister.
OAp
\fCBRIDE. Bo.....ley Høinl5
Babies with necrotizing enterocolitis: what to watch
for. 410
"IcCL LLE\: . '\fary
H ypenension: questions and answers. 24Ap
"IcDO"ALD. \ida
Commander Sister.
OAp
McEACHER". M.rgaret Mary
Serving Sister. SOAp
McKEOGH. Clair.
Librarian-Archivist at CNA. 7J/A
McKEE\ER. PBtriela
Bk. rev _. 450c
\fcKENZIE. Ruth H.
Analysis of the use of a computer generated staffing
schedule On a nursing unit in a general hospital. S
OC
Mc"lASTER l"NIVERSITY . FACULTY OF HEALTH
SCIENCES
Occupational heallh program launched. 7Mr
MeTA VISH. Maureen
The nurse practitioner: an idea whose time has come.
41S
MEDICAL RESEARCH COI"NCiL
U of A host visIting professor. &Ja
.
60 D8c:ember 1979
The cenedlen Nur..
"IEDIC o\TIO' ERRORS
NUI"I)mg negligence in the ddmml
trdtlon of
medlcdlJon... Could it happen to YOu') (Sklar) 31J/A
"IENTAL RET ARDA TlO;';
o B. stalT alert IC dmeron\ 30N
Our c;,pecial children (Peer) 14Ja
METABOLIC DlSEo\SES
4.. regional program for the management of hereditðry
metabolic di'iicase (Reade. Clow) 24N
METRICS\:STE
SI for you and me (Craig. Page) 16Fe
MIDWIFER\
Nur'ie Midv.-ifery: are we ml,..inlE the boat? (Powi",
210c
"IIGRA"F
Did you kno\\ _..4fJe
MILLER. Dorolh
(;ra)
Emergency. 46My
MIL "E. Barbara
Hyperten'lon: mandßcment in mdu'itry - an expanded
role for nUr'iiC\ (Log.in) 21 Ap
MOE:-OS. Jannelte
Coping with diabetcc;, in'iiipidus. 18Ap
MOII.\" " COLLEGE OF APPI lED ARTS A"D
TECHNOLOG\:
A nurse practitioner in a community college setting
(Nelle'i,25Fe
O()RE. Janel
Bk rev..
:!Oc
MOl :>OTSINAI HOSPITAL. TORO:>OTO
An experiment in innovative "raffing (Stuart) 4
S
Sinners or saints? (Bc'iihdrah) E. 4Je
inner.t or -;aints? The legal pCripective Pt I (Skl.u) 14N
Sinners or saint'? The legd1 per"ipective. Pt.11 'Sklar) 16D
\-U'LLEN. Elaine \-..
Bk rev. "'!Ie
Ml.L TIPLE SCLEROSIS
Health happening'. ISAp
Ml'SSAI LE"I. Helen K.
Highllght!!l from the report of the executive director.
liMy
New CNF bOdrd of direclOr,. KJd
Nur,e, "'dnt more educdtlon programs and pdld ledve
to dllend. 14Ap
-N-
SAMES
49f-e. 50Ap. 45N
NATIONAL AD\lSORY CO"nIITTEE ON
1\1
1'''I.fATlON
Recommended Immunization "ichcdule, for mfdnt, dnd
children. 29Ja
"ATlO'.\L CONt..'Rt:SCE Ot OPFR.\TlN(; ROOM
'lRSES
Cover photo. JS
NATIONAL CON FERESCE0" HE.\LTH A'D LAW.
OTTA"A.1979
NUhe
:"IIpedk out on legal i
,ue
in health. 54J/A
'ATlO'l,AL INDIAN BROTHERHOOD
Among SO group.. to receive fund'ì.. I
Ap
'EGLlGÐ.CE
Hands that care: are they .are' (Skldr) IOOc
NEI LES. Diana
A nur!te practitioner in a community col1ege setting,
:!5Fe
NEVITT. Jovce
Has wnllen a history oflhe nu
mg profe
"\lon in
Newfoundland.45N
'olE" BRl 'l/SWIC" ASSOCIA TIO," OF REGI!>TERED
NliRSES
Appointment of Bonny Hoyt. executive director and
Jacqueline Steward. nursing consultant. 49tc
Jacqueline Steward. appointed nursing consultant for
nursing practice (pon) 50Ap
NEW BRL'l/SWICK ASSOCIATION OF REGISTFRED
"l RSE!>. ASNL 0\1. MEFTISG
New"\heat: the provlncldl "icene. 14J/A
NEWS
6Ja, liFe. IIMr. 12Ap. &Ie. 9J/A. 120e. 7N. lID
'IIIC"L1". "end
McKnight
The role of the f""mily in the emerlEency depanmenl.
40Ap
'IIICHOL. Celia
ThaCs no nur"ie...that'.. my mother! 4
Mr
:-OIGHTlNGO" N. Lawrence
Nursing: nineteen-eighty-floor. I1Mr
"IXO'l/. Linda l,
Diagnosis: down's ..yndrome, J1N
:-OORTHt'R'II Sl.RSING
Nursing nonh of ..i,ty (Robens. Ro
s) 26My
"ORTH" EST TERRITORIES
Nursing nonh of Slxt y (Rohens. RO"isl
6M)
M RSE CLINICIAN TEACHERS
Nurse"i need leadership ..kills (Spennrath. Tiivel JJJe
Nl RSE-PATIENT RELATIONS
Life"ityle crisl' (O'Neil) 22Fe
O,B, "alTalert(Camerom30N
Per
pective (Be..harah) E. 3Fe
The IV nurse and the chemotherapy patient: a vital role
in emotiona1 suppon (MacMillan-Brett) :!8.Ie
The patient in pain: handling the guilt feelings (Doheny)
JIFe
"l RSE-PA TlENT REI A TlONSHIPS
Per'pecti"e (Bock) E.
S
!l.lRSE PRo\CTITlO'ER
A nu
e practitioner in a commumty college setting
(Nelles) 2SFe
The nurse practitioner: an idea who...e time has come
(McTavish) 41S
Nl RSF PRACTlTlO'llERS ASSOCIATION OF 0' T,\,RIO
NPAO Executive. 140c " I Lt.
M.RSI"G
Closeup on nur.tmg nelwurks. IJJ/A
Nu..ing fact and fantasy (Allan) 37J/A
That's nght.I'm a nu",e ("Iyne) 35J/A
Nl RSI"G Al DIT
The development of nur
ing audit tool (Craig) 570c
A meS"iage from the pre
ident (faylor) 10M}
Sl RSING /EDITORIAL,
Perspective (Beshdrah) E. -'Fe
Nl RSI'G-IIRI fiSH COLlMBIA
Nurses review health needs of B.C. Corrections
inmates. 140e
'Ill RSI'IIG-CANADA-STANDARDS
CNA's T ð.skGroupon Nur!ting Practice Standards
(port) HOe
I'ollRSING CARE
Bndgmg the gap between education dnd Itervlce
(Choi-Lao. Logan) 34Mr
It's a bird. if's a plane. if'''i supemurse! (Jack) 34J/A
Perspective (Bock) E. 5S
Sinners O( saints? The legal perspective Pt.l (Sklar) 14N
Sinners or saints? The leg
perspective Pt.11 (Sklar)
16D
The touch oflove (Cdmolinosl JlllA
That's right ('m a nu,-"e (KlyneI3SJ/A
"lRSI"G CARE-
THODS
Staffing assignment (Beswetherick) 18My
Nl.RSING CARE-STANDARDS
Frankly speaking: nursing and the degree mystique. Pt.l
(Hurd) '6Ap
I-rankly
peaking: nur"iing dnd the degree my...tlque.
Pt.ll (Hurd) 'liMy
fhe coffee-hreak: potential pitfall for nur"ies (Sklar)
ISMy
A me..sage from the president (faylor) IOMy
Project Ethics: a code for Canadian nurses (Roach) E,
6My
NURSING EDCCA TIO
See education
Nl'RSI!IoG-FRA"CE
Here and there: a look at nur
mg in France (Gro,sman)
'00c
Nl RSI"'G ST AFF. HOSPITAL
AnalysIs of the U!!le of a computer generated "itafTing
schedule on a nursmg unit in a general hO"ipit.tI
(McKenzie) sSOe
An experiment in innovative staffing (Stuan) 45S
Sinners or saints? The legal pe
pective Pt.1 ,Skldr) I..N
Sinnersorsaints?ThelegaJ perspective PI.II (Sklar)
160
Nl'TRITlOI'o
l-aclOr
Influencing the con"itructlon ofa nutrition
knowled.ge te
t for the elderly IThur..ton) 570c
Nutntion and the chrome "ichlzophrenic (Pyke) 40N
Nutrition counseling. 15Ap
Nutritional a<\<õõessment of the ICU patient tMdcDouga:!1)
39My
-0-
OBSTETRICAl Nl RS"G
Clo..eup on Nova Scotla's reproductive care program
(
acDondld) !JOe
CountdownonO.B nur...e, (tleld) 180c
The LeBoyer Method: whatdoe"\ It mean now
(Grossman) 280e
Perspective (Stainton) E, 50e
Post graduate maternity nur"iing program: meeting the
need in the Atlantic region (Steele) 240e
OBSTETRICS
CIO'
eup on coalition for the prevenllon of hdndicap
( Beshdrah)29N
Healthiest babies pO"i..ible (Warnyca. Ro...s. Bradley)
18N
That's no nursc.__thaC4\ my mother! (Nichol>>4S:\-1r
OCCl'PATIOSAL HEALTH
OccupoilionaJ health centre hold"i inaugural meeting,
14Ap
Occupational health program Idunched. 7Mr
OCClPATIOi'io\L HEALTH Sl RSIN(;
Hypenen"iion: management In Indu
try - an expdnded
role for nU['ô.e
(Milne. Logan) 21Ap
Occupational health nurses attend alcoholism
conference. 140
Occupational heð.lth nurses establish certification
program,6Ja
Oft ICE "l RSI'G
frdnkly speakmg: a challenge 10 office nU
lng
IKowalchukl48S
OLSIA". Mar
.rel T.
Bk. rev.. 5lOe
O'NEIL. Theresa
Lire'\ty1e criM!oo. 22Fe
ONTARIO BLUE CRU""
Nutrition counseling. 15Ap
O"T.\RIO. \UNISTR\"Ot.COLLEGE4."D
l M\-ERSITIES
Ontario nur"ies oppose possible intem..hip program ror
students.6Mr
O'l/TARIO NLRSING HOME ASSOCIA TlOS
Nursing home nurose"i work to improve care. I
D
OOLl p. Pilvi
Bk. rev.. 440e
ORDER Ot' CA,"ADA
Edith May Radley. SOAp
ORDER OF ST. JOH,\;
A number of nurses were honored. 50Ap
ORTHoPEDICS
Onhopedic nUr"ie!!l set three-ddY attendance record.
12Ap
OUTPOST Nl RSI:>OG
A trip to the islands (Hou!ooe) 42Mr
-P-
PAGE. Gordon C,
SI for you and me (Craig\ Illfe
PAIN
An exploratory study of the behaviors of children in
pain (Macl ntosh) A. 47Je
^ holistic approach to nursing the patient in pain
(Vaterlaus) 22Je
The patient in pain: handling the guilt feelings (Doheny)
31F-e
Understandmg the physiology of pain (Hedhn.
Dostrov
ky) 28Fe
PARK. Lillian
Learning about the ho
pitaJ at home (Ferguson. Wdrd)
44Jd
The cenedlen Nuree
3
D8c:ember 1979 61
P/\.RRUTT. Eric G
CN -\ festms Service (Pnmc) 44\1\
P.-\S.h.. EJiaDor Grace
A study of the effects of clinical inve
tlgatlons
conducted in the homes of children with mtt,arohc
disorde",. 550c
PATlE'T .\D\OCAC\:
Atutude
of registered nurses towards consumer nght
and nursing independence (Green)
6Oc
P3uent"s advocate - a new role for the nurse'> (Sklar)
19Je
PATlE'TS
Pallent's advocate - a nev. role tor the nurse
(Sklar)
19Je
Where does the nurse's respon\ibility begm and end in
caring for a patient".. belongìngs
(Sklar) 14S
PATlE'TCARE: PLA!I;'I"G
Nursing care plans: a vital tool (Silvcnhorn) 36Mr
PA TIE' TS-EDl C A TlO'
Currents in cardiology attract record crowd. 3SJ/A
PEDIATRIC 'l RSI"G
The nurse in the community: infdnt ..tlmulallon
(Bannmg) 36N
PEDIATRICS
A preschoolers" health circus (Crawford) l4Jd
A study of the effects of clinical invclliugations
conducted in the homes of children with metabolic
disorder.. CPask/ 550c
A team approach to child abuse (Fitzpatrick} '6Ja
A very present danger (Post. Langford} 41Ja
Babies with necrotIZing enterocolitl
: what to watch for
(McBride, 410
Caring for the child with cancer: the nu
e practitioner
(Price)
RO
Childhood asthma: an outpatient dpproach to treatment
(Ferguson. Webb) 36Fe
Early diagnosis in congenital hearing loss (Dahl) 17Jd
Guest editonal. E (Cochrane) 3Ja
Hypertension: pediatric hyperten\ion - think about it
tLeFort} 32Ap
Learning about the hospital at home (Ferguson, Park.
Ward) 44Ja
Our special children (Peer) 14Ja
Neondtal Jaundice and phototherapy (Johnson. Tufts)
450
Preparation oftoddler.. and preschool children for
ho
pilal procedures (Ritchie. J()[)
"Problem children" aren't problems anymore
(Hegadoren) 31la
Spotting and helping .he learning disabled child
(Jacobson.Gasek) l8Je
What a liule care can do (Cave' 380
WPW syndrome: a ca
e study (Manning) '40
PEER.Brigld
Old you know___3 study conducted by.... 9Mr
Our special children. J4Ja
PERSO'i'EL ST AF"FI!I;G A '0 SCHEDlLL'iG
Old you know... Labour Relations Council. 15Ap
Staffïng assignment fBeswetherick) 18M)'
PERSPECTI\ "E:
3Ja. 3Fe. 3Mr. Mp. 6My. 4Je. 5JIA. 5S. 5Oc.
N. 50
PH\:SICIANS
Closeup on physicians at nsk. ION
PINELLI. Janet May
A companson of mother's concerns regarding the
care-taking tasks of newborns with congemtal hedrt
disease before and after assuming their care. 9D
PI'\S. SCHOOL
Key to cover photo. 3Mr
POETRY
Sir. I know (DeBoer) 43M)
Visions (MacCuish) 35Fe
POST. Shirley
A very present danger (Langford) 42Ja
Commentary fBesharah. E, 10
POWIS. Julianne
N urse-Midwd'ery: are we missing the boat? 21 Ck
PREGNA."CY
That's no nurse...that's my mother! (Nichol) 45\1r
PREGN-\NC\: I" -\J)()I.E:SCE"CE
The '\ingle mother: can we help'l CBillung-Meyer. :!fiN
A teendge pregnancy epujemlc? (MacDonnell) 1:!N
PREG"A"('\: TO"E'II-\S
H
per1ensl\.e disorde" m pregnanc) (Hdnle}'1 41J/"
PRE\ENTI\"E: HE-\LTH SER\ tC"'s
Nutrition coun
eling. 15Ap
PRICE. Barbara J.
Caring for the child with cancer: the nurse practitioner,
80
PRIMAR\: HEALTH CARE
ICN supports primary health care. 7Ja
PRI\IE. Bert
CNA Testing Service (Parron} 44
1y
CNA - ",hat's it all about? WIA
Have you looked at your a....ocidtiOn lately? E, 5J/A
PRISO"S-BRITISH COLl'IBIA
Nurse.. review health needs of B.C. Corrections
inmates. 14Ck
PRI\ ILEGEDCOM'\1l "ICATlO'l,
Patient's advocate - a new role for the nurse? (Sklar)
39Je
PROJECT HOPE
IE:D1C -\1 EDl CA TlO' PROGRAM
AgathaGenrude Lowe.jomed the project m Ndtal.
Braz
. 50.-\p
PS\:CHI..\TRIC "lRSI"G
Behaviour.. of patienh de'icnbed by nurses in
medical-
urgical area.... in the initiation of psychiatric
referrals ([homson) A. 47Je
"Problem children" aren't problems anymore
(Hegadoren) 11la
Time out! (LaSon 360c
Pl BUC HF-\LTH:IIl RSI'I,.
A trip to the Is'ands{Hou<iieJ 42Mr
CNJ talk> to Loi.Odle. PHN (port) WJa
Speaking out: a national child hedlth pohcy ! (Dd\\ \on)
140
Not all patient.. need ho\pltals (Aish) 23Mr
PLBUC RELATlO1l;S
Communications specialists from the elevenCNA
provincial/territoridJ as..ociation member.. met in
CNA House (port) />Mr
P\ KE. Jennifer
Nutrition and the chrome schizophrenic, 40N
-Q-
Ql AUT\: OF HEALTH CARE
Frankly speaking: nursing and the degree mystique. Pt.1
(Hurd) 36Ap
Frankly speaking: nursing and the degree mystique.
I'Ll! (Hurd) 36My
-R-
RADLE\:. Edith '\Ia)
The Order of Canada. 50Ap
RAIN" ILLE. Joyce
CNF scholarship. 120c
RANKIN. H..th.r
Handicap: a parent's perspective. 38N
RAl\I....I". Lorna
Bk. rev.. 43lJc
READE. Terry
A regional program for the management of hereditary
metabolic disease (Clow) 14N
REAUTY SHOCK
Whither nu",ing? 3 iliA
REFERRAL ANDCONSI LTATION
Behaviours of patients de..cribed by nur
e
in
medical-surgical areas In the initiation of psychldtnc
referrals IThom\onl A. 47Je
REGISTERED :IIl'RSES ASSOCIATION OF BRITISH
COLlMBIA
Improved care urged by RNABC. 8Mr
RNABC submits election resolution. 8Mr
Sets up nursing education and research society. HAp
REGISTERED NlR!>"E:S ASSOCIATION OF BRITISH
COLUMBIA. ANNUAL MEETING
New
beat: the provincial scene. 9J/A
REGIS'CERED 'il RSES ASSOCIA TlO:o. OF BRITISH
COil MRI-\. I.ABOl R RELA TlO:-'S cm NCIL
Did \IOU know... Labour Relation.. Council. 15Ap
REGIS.I ERED Sl RSJo.S ASSOCIA TIO" OF SO" A
SCOTI/\.
Be it resolved...The role of the nur\mg a
SOcldtlon an
the prevention of child ahu'\e C MacLean) 40Ja
REGISTERED 'l RSES -\sson"no" O..O"T-\RIO
I\...uhle M. Clark. education co-ordinator (pon) 50Ap
Ontano nurse.. oppo..e pos...ihle Internship program for
studentCii.6Mr
REGISTERED Nl RSF!> ASSOnA TIO' OF 0' T .\RIO.
\NNl. AI
IEETI"'L
Ne
"..beat: the provincial '\Cene. 11J/A
.
RH;J!>....ERED "l R!>ES "SSOCIA TION OF "0\ A
SCOTIA. A':IIl AI 'IEFTI"L
New
beat: the pro\.inclaI..cene. I-1J/A
RFGISTERED:IIl RSES rol 'D.\ TIO' OF B.C.
RN .t\BC ,et!i. up nur'\mg education and research
soclety.ISAp
REHABIUT A nON
J-rdnk's !!.tory (HalligcUl, Hunt) 16Mr
REICHE. Linda
CN. schola",hip. 120c
RE!>EARCH
7Je. 55Oc. 90
A compdrison of mother's concerns regarding the
care-tdking tasks of newborns with congenital heart
di
ease before and after a..
uming their care C Pinelli}
90
Andlysis of the use of a computer generated staffmg
schedule on d nuro;;ing unit in d general hospital
IMc....enzie) 5
Ck
An a.....e"'..ment of ..elected continUing education
experience.. for profesc;.ional growth dnd
competence of nurses (Mdcinto
h) 57Ck
Attitudes of registered nur\es towards consumer rights
and nursing independence (Green) 560c
Behaviou
of patients described by nur'\es in
medical-surgical area.. in the initiation of p'!oychiatric
referrals (fhomson) A. 47Je
Child abuse progmm: Scarborough Depar1ment of
Hedlth (Cunningham) 90
fhe development of a geriatnc a..
e"'mem m..trument
for long term Cdre facilities (Buchan) 90
The development of a nursing audit tool (Craig) 4i7Oc
Old you know.... 46Je
The effect of a ..elf-instructional module on the level of
questions posed by nursing in\tructors during
post-clinical conferences (Craig) 570c
The effect
of selected factors on the older adult"s
management of treatment for hypertension (Biene)
550c
E"dJudlion of Alberta nur\lßg instructor.. (Cadmdn) .t\,
47Je
Expenence
and nur..mg needs of ..pinal cord-lrUured
patienls (Kinash.
7Ck
An exploratory study of the behaviors of children in
pain (Macintosh) A. 47Je
Factors influencing the construction of a nutntlon
knowledge test for the tlderly ([hurston) 570c
Factors involved in a mother'.. decision to seek
antenatal genetic coun..eling and have an
ammocente..is at an advanced maternal age (Davie
J
560c
.t\ follow-up study of gradudte
from the four year RSc.
program in nursing. Univer\lty of Alberta (Field)
570c
RN .t\BC sets up nur..ing educdtion and research
society. HAp
Spinal-cord irUury: early impact on the patient's
significant others (Hart) 57Ck
A
tudy of the effects of clinical investigations
conducted in the homes of children with metaÞolic
disorJe", (pask) S50C
The young adult's reported perceptions of the effects of
congenital heart disease on his life style (Doucet)
570c
RIDEOI T. Ehzabeth
Bk. rev.. 420c
RITCHIE. Judith A_
Preparation of toddlers and preschool children for
hospital procedures. 3(1)
ROACH. Slmo...
Project Ethics: a code for Canadian nur'\es. E. 6My
.
82 Oecember 1979
The Canadien Nurse
New CNF board of directors. 8Ja
ROBERTS, Lence W.
Nursing north of sixty (Ross) 26M)
ROK, Adam
Bk. rev.. 480e
ROLE
Patienfs advocate - a new role for the nurse? (Sklar)
39Je
ROSS. Colin A.
N ur"ng north of "Xly ,Roberts) 26My
ROSS, Susan
Healthie" babies possible (Warnyca. Bradley) 18N
ROSSITER. Edna
14th Canadian nurse to receive the Florence
Nightingale A ward from the I ntemauonal Red
Cro".4SN
ROWAT, Kathleen
C N F schola", hi p. 120e
ROY AL. Joøn
Bk. TeV.. 430e
ROYAL VICTORIA HOSPITAL. '\IONTREAL
Nurses need leade",hip skills (Spennrath. Tiivel) HJe
RY AN. Jessica
Bk. rev.. S30
Frankly speaking: apathy in nu",ing. 3IJe
-S-
ST JOIL" AMBVLANCE
Did youknow...St.JohnAmbulance.ISAp
SA MS. Cheryl Ann
One breath at a time. 2 OS
SASKATCHEWAN I:IISTITUfEOF ARTS AND
SCIENCES
Did you know.... 1Ja
SASKA TCHEW AN REGISTERED Nl'R
E:S
ASSOCIATION. ANNUAL MEETING
Newsbeat: the provincial scene. IOJ/A
SA V ARD. Françoise
Officer. SOAp
SCHERER. Kathleen
Jomed office of the Manitoba Association of Registered
N u",es. 49Fe
SCHILLL"G. Karin voo
Bk. rev.. SlAp
Bk. rev.. S3D
scmZOPHRENIA
Nutrition and the chronic schizophrenic (Pyke) 40N
SCRlTBY. Lynn
Winner of the Helen McAnhur Canadian Red Cross
FellowshIp for graduate study.12Oe
SEARLE, Catherine
Tetanus: the costly CUre. 181/A
!;EX EDUCATION
Pe"'pective (Wheatley) E. 4N
SHEPHERD, Frances A.
Y OUf guide to chmcallaboratory procedures CBonnanis.
Hyme) 2SS
SHIFT SYSTEMS
An experiment in innovative staffing (Stuan) 4SS
SILVERTHORN. Alida
Nursingcare plans: a vital tool, 36Mr
SI'\ION FRASER HEALTH UNIT
A preschoole",' health circus (Crawford) 14Ja
SIM!;ER. Jndy
Audiology programs: another viewpoint (Smith,
Tataryn) 2IJa
SKLAR. Corinne
Error of judgment: is it always negligcnce? 14Mr
Finding and helping victims of child abuse. llJa
Hands that care: are they safe? lOOc
Nursing negligence in the admlmstration of
medication... Could it happen to you' SIl/A
On trial! 8Fe
Patient's advocate - a new role for the nurse? 39Je
Sinners orsaints?The legal perspective Pt.I. 14N
Sinnersorsaints?ThelegaJ perspective. Pt.II.IID
The coffee-break: potemial pitfall for nurses. I5My
Where does the nurse's responsibility begin and end in
caring fora patient's belongings? 14S
r.
N
SMIl H, Andrie DurleuJI:
Audiology programs: another viewpoint (fataryn,
Simser) 2IJa
SMOKI"G
Clo"eup on a generation of non-smokers? 12N
SNIDER. Eleanor M.
Serving Sister. SOAp
SOCIAL ISOLATION
The loneliness of the elderly (Griffin) 23 My
SOCIETIES. Nl'RSING
A catalogue of special interest groups lFitzpatnck) 9Je
SPAIN. Doris
Bk. rev.. SOOC
SPECIALTIES. Nl'RSING
A catalogue of special interest groups (Fitzpatnck) 9Je
SPENNRATH. Susan
Nurses need leade",hip skills ([iivell 33Je
SPINAl CORD INJl
RIES
Experience" and nursing needs of spinal cord-ir\iured
patients (Kmashl 570c
Spmal cord ir\iury: early impact on the patient."
significant othe", (Hart) S10e
STAINTON, M. Colleen
Pe"'pective. E. 50e
STEELE. Rosie
Post graduate maternity nursing program: meeting the
need in the Atlantic region, 240c
STE" ARD. Jacqueline
Appoi.nted nursi.ng consultant for nursing practice of
N BARN (port) SOAp
N u",ing consultant of NBARN. 49Fe
STEWART-HES!;EL, Elizabeth
Bk. rev., 4SOe
Bk. rev.. S20e
STRESS
Hypertension: management in Industry - an expanded
role for nurses (Milne. Logan) 21Ap
Hypertension: questions and answers (McCulley) 24Ap
STUART. AlllsonJ.
An experiment in innovative staffing. 4,SS
Nursing grand rounds: femoral allograft (Alemany.
Ferguson. Grice) 320e
Sl'ICIDE. A TTE1\IPfED
Emergency treatment of drug overdose IErb) 30My
SUTHERLAND. Debbie
Bk. rev.. 48N
-T-
TASK GROUP ON "Il RSING PRACTICE STANDARDS
Canadian Nurses Association (port) 13Ck
TATARYN.Karen
Audiology programs: another viewpoint (Smith.
Simser) 2IJa
TAYLOR, Helen D.
A message from the president. IOMy
TECINOLOGY, MEDICAL
Your guide to clinical laboratory procedures (Bormanis,
Shepherd. Hynie) 2SS
TELLIER-CORMIER, Jeanine
Serving Sister. SOAp
TETANUS
Tetanus: the costly cure (Searle) 181/A
The unexpected Case of tetanus (Grove) 26J/A
THE WORKSHOP. BEACON HILL. MONTREAL
U of A hosts visiting professor, 8Ja
THOMPSON. M.
Bk. rev., S4My
THOMSON. Carole Lee
Behaviours of patients described by nurses in
medical-surgical areas in the initiation of psychiatric
referrals. A. 41Je
THVRSTON. Norma E:.
Factors influencing the construction of a nutrition
knowledge test for the elderly, S10e
TIIVEL. Judy
Nu",es need leadership .kills (Spennrathl HJe
TOO. Louise
TRAINING SUPPORT
WHO to award health fellowships. 1Mr
TRANSPLANT A T10N. ALLOGENIC
Nursing grand rounds: femoral allograft (Alemany.
Fergu..on, Grice. Stuart) 32Ck
TUFTS. Frances
Neonatal jaundice and phototherapy (Johnson) 450
-U-
l'NITED NATIONS
Guest editorial. E (Cochrane) 3Ja
L"11\ ERSITY OF ALBERTA
Health services division receives Kellogg grant. 8N
U of A hosts visiting professor. BJa
UNIVERSITY OF MONCTON
University of Moncton to host annual CUNSA
congress. 8Ja
lNIVERSITY OF WESTERN ONTARIO
Did you know...astudy conducted by.... 9Mr
-V-
\ANCOITVER PERINATAL HEALTH PROJECT
Healthiest babies possible (Wamyca. Ross. Bradley)
18N
VA TERLAUS. Emalou
A holistic approach to nursing the patient in pain. 22Je
\ICTORIAN ORDER OF NUR!;ES FOR CANADA
Caseload: over seventy-five (Gibbon) 20Mr
Closeup on the Victorian Order ofNu
es for Canada.
S4J/A
\ IRVS DI!;EA!;ES
Health happenings. HAp
-W-
WALLACE, Pat
CNA's Task Group on Nursing Practice Standards
(port) HOe
Project Director. development of nursing practice
standards.1J/A
WARD. Vera
Learnmgabout the hospital at home (ferguson. Park)
44Ja
W ARNYCA. Jennifer
Healthies babies possible (Ross. Bradley) 18N
WATSON. Ina
Bk. rev.. 440e
WEBB. Anne
Childhood asthma: an outpatient approach to treatment
(Ferguson) 36Fe
WHEATLEY. Shirley
Perspective. E. 4N
WHITE. Leslie J.
Bk. rev.. S4My
WILLETTS-SCHROEDER. Valerie
Sharing the experience. 390c
WINKLER, Joy
CNF sChola",hip. 120e
W.K. KELLOGG FOUNDATION
Time is now, nurses decide for setting up doctoral
program.6Ja
WOMEN
Women as health care consumers. a change and a
challenge. 130
WORKSHOPS
See Congresses
WORLD HEALTH ORGANIZATION
A four-member international nursing team. 8Je
The impossible dream? (Besharah) E. 6Ap
To award health fellowships. 1MT
-X\::Z-
YOL AND THE LAW
I IJa. 8Fe. 14Mr. I5My. 39Je. SIJ/A. 14S. lOOc, 14N
160
ZANIN. Margaret
Bk. rev.. 430c
. Helping the retarded child in
hospital
. A team approach to child abuse
. Dealing with the problem of
immunization
. Learning about the hospital at
home
. Congenital hearing loss
. Preventing childhood accidents
. A new role for the psychiatric nurse
The
Can ian \
Nune r
3
.
JANUARY
1979
...
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JT' 3
The -,
Canacliðn
\ _ t:
.,,-'-'
-
lose
e
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number I
..
\to
I,
Guest Editorial 3 You and the law Corinne Sklar 11 md
Input 5 A preschoolers' health circus Rosemary Crawford 14
News 6 Early diagnosis in congenital
hearing loss Marilyn O. Dahl 17 ;1
Calendar 50 Audiology programs: Andrée Durieux. Karen Tataryn, an
another viewpoint Judy Simser 21 I
Books 52 The problem of immunization
in Canada Sandra LeFort 26 .H
"Problem children"
"ren't problems anymore Kathy H egadoren 31
Library Update 54 Our special children Brigid Peer 34
A team approach to child abuse Lvnda Fitzpatrick 36
CNJ talks to Lois Dale, PHN Lynda Fitzpatrick 39
Be it resolved.n Jean MacLean 40
A very present danger Shirley Posr,AJ. Langford 42
.
Learning about the hospital Fave Ferguson. Lillian Park,
at home Vera Ward 44
'R
:--. The Canadian Nurse welcomes Indexed in International Nursing
. suggestions for articles or unsolicited Index. Cumulative Index to Nursing
manuscripts. Authors may submit Literature. Abstracts of Hospital
, finished articles or a summary of the Management Studies. Hospital
. J ... proposed content. Manuscripts Literature Index, Hospital Abstracts,
"" should be typed double-spaced. Send Index Medicus. The Canadian Nurse :e,
F- ...
' original and camon. All articles must is available in microform from Xerox
I
be submitted for the exclusive use of University Microfilms, Ann Amor,
The Canadian Nurse. A biographical Michigan. 48106.
statement and return address should
'\ accompany all manuscripts. Subscription Rates: Canada: one
'" 4 year, $10.00: two years, $18.00.
Foreign: one year. $12.00; two nof
The views expressed in the articles years. $22.00. Single copies: $1.50
This month's cover is a are those of the authors and do not each. Make cheques or money
necessarily represent the policies of orders payable to the Canadian
celebration in two ways. First the Canadian Nurses Association. Nurses Association. red
of all. it introduces an issue
that is CNJ's salute to the ISSN 0008-4581 Change of Address: Notice should be
International Year of the given in advance. Include previous
of
Child. Secondly. it is our way Canadian Nurses Association. address as well as new. along with
ofweIcoming you to 1979 with 50 The Driveway. Ottawa, Canada, registration number. in a
a new cover design in color. K2P IE2. provincial/territorial nurses
Photo courtesy of Studio association where applicable. Not
Impact in Ottawa, and the "responsible for journals lost in mail
smiling children of Les Petits due to errors in address.
Bouts de Choux Day Care Postage paid in cash at third class rate
Centre in Ottawa, Ontario. Toronto. Ontario. Permit No. 10539. - ,
Canadian Nurses Association. 1978.
..
yesterday. . . today. . . tomorrow
Add1son-Wesley is new to nursing publiShing, but its long-standing tradition of pu lishing
excellence in other professions is recogniZed internationalJy. DiStJ..DguiShed as a publiShe lJ
mathematics and physical/life science textbooks, Addison-Wesley has over twenty Nobel IL,ureates
as authors. In 1976 Addison-Wesley formed its Med1caJ/Nurs1.ng Dtv1s1on. The new nursiDg
program is committed to bringing to nursing the Addison-Wesley tradition of publiShing e
cellence.
The liStS of new and forthcoming publications (see below) reflect AddiSon-Wesley's concern
With meeting the needs for expanded nursing education in a profession that is rapidly grotnng and
changing. As yesterday's pioneers in the health care profession, nurses initiated better h th
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professional areas. 'IbmoITow holds even greater promiSe for the nursmg profession.
AddiSon-Wesley's nursing program is dedicated to publiShmg the books that will help tad s
educators and tomoITow's nurses fulfill that promISe.
oeUJ pub\\ca\\oos
AddiBon-Weøley'B
llurøiDg ....Awnhurt ion B.eview
by SaUy L. l8gerqUlst
464 pp. 12.95
Meðica1 Term1DoJ.ogy:
A Text/Workbook
by Alice Prendergast
279 pp. 9.60
*Politics of PaID. MA'ft
ewnent:
by Shtzuko Fagerhaugh and
Anselm Strauss 323 pp. 8.95
B.eview Mathematics
for Ilurøeø 8D4 Health
Profeøs iftftA1R :
A Text-Workbook on Solutions
&Ild Dosage Ca.lcula.tlons
by Lucllle M. Parks 291 pp. 8.25
AgiDg 8D4 Health:
Biologic &Ild Soc1a.l Perspecttves
by Cary S. Kart" Eileen S. Metress
and James F. Metress
339 pp. 13.96
*People in Crisis:
Understanding &Ild Helping
by Lee Arm Hoff 336 pp. 9.60
A Survey of Human Diseases
by David T. Purtllo 453 pp. 16.95
'.rraDøactioDal ADalysis
in Health Care
by Jean Elder 176 pp. 8.95
Shock Syndrome:
Mecha.n18ms &Ild Ma.n1festa.tlons
by Martha Thompson
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The cen-.llen Nur..
..
Jenuery 11711 3
perspective
. .
Guest Editorial emotional problems in the Immunization: There is an opportune time for all those
preschool child to see that evidence that despite the interested in children to
The United Nations has there are many problems yet availability of safe and initiate or expand their
identified 1979 as "The Year to be solved. effective vaccines. interest and in turn meet the
of the Child". In Canada the In 1977. the Canadian immunization coverage is not special needs of Canada's
government has established a Institute of Child Health was adequate. Children still eight million young citizens.
Canadiag Commission - 1979 founded to act as an advocate develop serious complications The Canadian Institute of
International Year of the on behalf of children. It and handicaps from infectious Child Health looks forward to
Child whose many functions functions as an action group to diseases such as measles, a cooperative relationship
will include promoting public improve the health and rubella. mumps, with the nursing profession,
awareness and encouraging welfare and the quality of life poliomyelitis. diphtheria and and all other professional
ideas from and the of Canadian children. from tetanus. In November. the groups who maintain a
participation of children in the conception to eighteen years Institute took part in commitment to the health and
year's activities and of age. Immunization Action Month well being of Canadian
celebrations. It would seem For the coming year. the and has just published a children.
appropriate that all In
titute has decided to focus National Immunization -W.A. Cochrane, M.D.,
organizations and professional its efforts on five priority Survey with a number of F.R.C.P. (C) Chairman,
groups in Canada examine the areas: recommendations. Board of Directors, Canadian
contribution they might make Accident prevention: Nearly Institute of Child Health.
for improvement in the Prevention of handicap: Of the 4.000 children and youth
general well-being of 330.000 babies born in Canada under 19 years of age suffered EDITOR
Canadian children. each year. about :!5.000 will accident or death from ANNE (HANNA) BESHARAH
In 1973 a conference on be low birth weight and as accidents in 1974. Among
the "Unmet Needs of many as 33.000 will be at risk other measures. the Institute ASSISTANT EDITORS
Canadian Children" was held of handicap. It is estimated is promoting the use of car LYNDA FITZPATRICK
by the Canadian Pediatric that at least half ofthese seats. fire detectors and life SANDRA LEFORT
Society assisted by Ross handicaps could be prevented jackets by asking the federal PRODUCTION ASSIST ANT
Laboratories of Montreal. or the risk substantially government to remove sales GITA FELDMAN
Representatives of various reduced with improved tax on these items.
health caring professions. prenatal and perinatal care. CIRCULATION MANAGER
teachers and government That is why the Institute Care of children in hospital: PIERRETIE HOTfE
officials reviewed many published a report in August Because many hospitalized
outstanding problems existing 1978 entitled. Prnention of children are still being ADVERTISING MANAGER
in the Canadian childhood Handicap:A Case for deprived of care that GERRY KAVANAUGH
population. Topics that were Improved Prenatal and considers their special needs, CNA EXECUTIVE DIRECTOR
discussed included caring for Perinatal Care that described the Institute will be HELEN K. MUSSALLEM
the well child. problems of the problems and suggested establishing a Resource
adolescents and migrant ways to prevent handicap. Centre with books and films to EDITORIAL ADVISORS
youth. special needs oflndian Recently, a coalition of be available on loan. In 1979 MATHILDE BAZINET,
!lnd Eskimo children. health related associations the Institute will sponsor, chairman, Health Sciences
problems of the handicapped. (includingCMA. CNA, along with nursing groups in Department, Canadore College,
the inner city child. CPHA and seven other Ontario and B.C., two North Bay, Ontario.
psychosocial problems of groups) was formed to workshops to humanize care DOROTHY MILLER,public
children and the organization recognize and support the for children and their families. relarions officer. Registered
of child health services. concept of prevention of Child health in the next Nurses Association of Nova
Scotia.
Reviewing the conference handicap. The two-year decade: There is a great need JERRY MILLER. director of
recommendations. it is coalition hopes to promote to examine the changing communication services,
evident that while some public. professional and practices in child health and to Registered Nurses Association of
changes have come about in government education. plan for the future. Currently, British Columbia.
the 5-year interval. the needs develop a standard prenatal the Institute is seeking funds JEAN PASSMORE.ediror.
of Canadian children are not record. complete a number of for a two-year study of SRNA news bulletin. Registered
yet being met in a number of papers on related subjects Canada's nine children's Nurses Association of
areas. We have only to look at such as rubella. RH negative hospitals and six major Saskatchewan.
the dramatic increase in sensitization and screening of pediatric teaching centers. PETER SMITH. director of
publications. National Gallery of
adolescent suicides. teenage newborns. Through mutual It is evident that there is Canada.
pregnancies. venereal disease. cooperation. the coalition ml)ch to be done in focusing FLORITA
the need for improved hopes to affect priorities. attention on the care and VIALLE-SOUBRANNE,
maternal-infant care and the policies and allocation 9f problems of Canadian consultant, professional
need for earlier screening for resources for maternal and children. The International inspection division. Order of
physical, mental and newborn health services. Year of the Child would seem Nurses of Quebec.
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The c.nlKllen Nu...
J,,"uery 11171 II
input
The Canadian Nurse Invites your
letters. All correspondence is subject
to editing and must be signed,
although the author's name may be
withheld on request.
Speaking out make a diagnosis of urinary So, in reply to one of the still angry and upset with the
I wish to express a very infection. articles... nurse. They don't want her
emphatic "Bravo" regarding I find myself angry at the "See the nurse...she has solution. Do they know..the
your October 1978 issue on implied criticism ofthe given up her middle class life nurse drinks the same water?
the multidimensional views on northern nurse. Sure. she's with all its benefits to come The nurse is going home
Native Health Delivery!! retreated behind the doors of and live on an Indian reserve discouraged. Families resent
After reading it I felt the station, probably appaHed to try and help the people. See her interfering with their way
challenged,saddened, and frustrated by the enormity the people resent the nurse of life. Her fight to improve
surprised and hopeful. I of her responsibilities and the because she is: child care and public health _
certainly appreciated apparent hopelessness of the (I) white facilities goes unnoticed. No
presentation of both the native task. She went up there, (2) has running water one knows how hard it is to
and non-native viewpoints; probably as a fairly new (3) lives in the nice clinic keep dentists and doctors
insight was gained as to the graduate. to practice building. coming back.
struggle of both parties. NURSING, which she had The nurse sees the poverty the But the nurse's day is not
The perception that I been taught. Indians live in and realizes yet done. She is on
gained was that freedom of Now she finds herself that if they helped themselves 24-hour-call; it is her job to
speech was not censored to a expected to make a dent in a more things would improve. care for toothaches. runny
great extent and I felt good spectrum of social and See the Indian. He is noses and sore throats
about that. Thanks, again! economic problems sitting doing nothing. There is whether it is 3 p.m. or 3 a.m.
-Cindy Bard)', R.N., symptomized by V.D., garbage in his yard. plastic The nurse is not entitled to a
Calgary, Alberta. alcoholism, dental disease, over his windows, a roof that day offbecause she really
malnutrition. despair, which leaks. and water that needs doesn't work hard hauling
Calling all miracle the most elaborate health care hauling. He can't work water or chopping wood.
workers system in large cities has not because he isn't getting paid Non-Indians have indeed
Many thanks for the been able to stem, let alone for it. Welfare, UIC, and infiltrated the northern
interesting and control. family allowance aren't communities bringing with
thought-provoking October Let's face it, Mr. Wenzel, enough to keep his house, his them both good and bad
issue. After reading it. I found we don't need nurses in the car and two skidoos in a state habits. If the natives want the
myself depressed and North; we need miracle of good repair. "white" value system. then
reflecting on the existential workers - a charismatic. Now the nurse is off to they will have to assume
irony of the nursing situation. empathic blend of the Wizard visit these homes. On the way "white" values.lfthey want
In a large urban teaching ofOz, Wonder Woman and she passes a drunk I ndian but to remain "Indian" and have
hospital. surrounded by every Albert Schweitzer! does she stop to chat?No. their own culture, then they
conceivable electronic and How long are nurses why not? If she does she may will have to divorce
human support system, my going to be expected to clean be subjected to physical themselves from the white
graduate nurse students up all the ills of society and/or verbal abuse. culture and quit making
cannot give prescribed single-handed, or continue to See the house the nurse demands on the whites to
medications unless I. the do somebody else'sjob? visits. It has three rooms and support them with free
instructor, am at their elbow. Anyway, thanks for a two families living there. Why medical care, trappers
They must plead for the thought-provoking issue. are they living together? subsidies, schooling, food.
privilege of doing needed -Jean Jenny. R.N.. School of Because they are waiting for etc.
patient teaching or for Nursing, UnÙ'ersity of the government to build them There is room in the
substituting Aspirin for Ottm,,'a, Ottawa. new houses. Why should they Canadian society for many
Oemerol, when the former IS build their own houses if the cultures. I do not foresee great
required. See the nurse government will build them changes for these people but,
Meanwhile. a thousand I am one of the many for free? in decades to come. the
miles away, surrounded by northern nurses working and See the nurse explain that "powers that be" may realize
needy natives and empty living on an Indian reserve. even though there are so many that the old system of
tundra, a lay community This is the second reserve I people they can still be clean if integrating has failed and a
worker is performing medicai have worked on and my they work at it. While she is realistic look at both sides
procedures. and dishing out feelings about these people eXplaining it grandpa hacks up may result in an improved
Ampicillin on the strength of have changed considerably a gob of blood-tinged sputum Indian-white relationship.
having watched an occasional with the experiences I have and spits it on the floor. -Valerie Walker, R.N., Black
visiting nurse or doctor. An been involved in. See the people complain La/..e, Sas/...
urban nurse may expect a I was extremely upset by to the nurse that they are sick
reprimand for initiating a urine some of the articles in the from the water. The nurse has
specimen for C & S. while the October Canadian Nurse and explained time and time again
northern nurse is examining their negative bias regarding about boiling water and water
urine under a microscope to the community health nurse. purification tablets. They are
I J.nuery 11171
The Cen-.ll... NUrH
news
-
Time is now, nurses decide for
setting up doctoral program
If
High priority should be given
to the development of a Ph.D
(N ursing) program in Canada.
nursing leaders from all parts
of Canada decided at a
seminar in Ottawa recently.
Also at the meeting were
national and provincial
officials and leaders from
health care and education
disciplines. It was the first
time the topic of doctoral
preparation for Canadian
nurses was examined
systematicaIly at the national
level.
"The con
ensus of the
meeting and certainly an
almost unanimous feeling of
all nurses present. was that
development of one or more
programs for doctoral
preparation for nurses within
Canada is an immediate and
urgent need," said Dr. Shirley
M. Stinson, project director of
the seminar and
president-elect of the
Canadian Nurses Association.
"At present no university
in Canada offers the doctoral
degree in nursing. Canadians
who wish to pursue higher
education either take their
studies in an allied field and
adapt their learning to nursing
needs or else leave Canada for
study abroad. usuaIly in the
United States. "
I n Canada. the need for
nurses with doctoral
preparation is immediate and
growing. Dr. Stinson said.
These highly prepared nurses
are needed to develop and
carry out research. as well as
for work as educators. top
night clinical practitioners and
administrators.
Dr. Stinson. professor in
the faculty of nursing and the
division of health service
administration, University of
Alberta. said the need in
research is particularly urgent
e
)'
'I
I
and one reason that the
emphasis on a Ph.D (N ursing)
is considered important.
"Research into distinctly
unique nursing science,
including better ways to use
new technologies, is vital if
high quality patient care is to
be given effectively.
humanely and econo01icaIly."
Dr. Moyra Allen, director
of the nursing and health
research unit in the School of
Nursing at McGill University,
Montreal. outlined a number
of areas in which specifically
nursing-oriented research
could be helpful.
. 'N urses often a
e the
first and the most continuing
contacts with families of
patients during an illness and
they are perhaps the best
prepared to investigate the
reactions offamily members
faced by a sudden and
life-threatening illness in one
member. How do the others in
the family react - and how
can they be helped. say in
hospital situations, with a
minimum of time and cost and
yet in human and helpful
ways?"
"As one delegate put it,
perhaps we are fortunate to
have limited finaocial
resources, for it will force us
to be creative and innovative
in our approach so that nurses
from all parts of Canada will
have access to this type of
education. "
The seminar was held
with the assistance of a
$38.250 grant from the W.K.
Kellogg Foundation of Battle
Creek. Michigan. It was
conducted under the joint
auspices of the Canadian
Nurses Association. the
Canadian Nurses Foundation
and the Canadian Association
of University Schools of
Nursing and attended by
approximately 40 nurses.
COI'ies of the procðledings of
the seminar will be circulated
to health-related organizations
as soon as possible in 1979.
A workshop on chikl
abuse
"Do we wait for physicians to
open the door. or do we care
enough to act now - to
examine, discuss and plan a
course of action in carrying
out our responsibilities as
registered nurses throughout
Nova Scotia?" This was the
challenge issued by Brenda
Clements, chairman of the
RNANS Task Force on
Prevention of Child Abuse at a
November workshop held in
Haliiax for nurses in key
positions to prevent child
abuse. Speaking on "The role
of the nurse in identifying high
risk families". she told the
nurses present. "We do not
have to wait for definite abuse
to take place. further
damaging the parent-chrld
relationship. Our most
important role is early
recognition of parents in need
of extra services."
Dr. John Anderson.
Director, Outpatient
Department, Izaak Walton
KiIlam Hospital for Children
pointed out that the focus of
the workshop was on
prevention and that nurses
have an independent and
responsible role. Dr.
Anderson directed the 1973
Study on Child Abuse in Nova
Scotia.
Members of the SCAN
(Suspected Child Abuse &
Neglect) Committee. an
interprofessional group. had a
panel discussivn and
answered questions on the
team approach to identifying
and helping high risk families.
Films such as "Children
in Peril" and "Cradle of
Violence" were used
effectively and there were
numerous graphic displays.
These had been arranged by
the Block Parent Program, the
Poison Control Centre of the
IWK Hospital, the Children's
Dept. of the Halifax Library,
Health Educator. Dept. of
Health; N .S. Commission on
Drug Dependency; the
Canadian Mental Health
Association and many others.
Seventy-five nurses
attended and participated in
group discussions after the
various presentations. An
equal number applied for
registration but could not be
accommodated as space was
limited. The members of the
task force were so heartened
by this response that they
have now made arrangements
to repeat the workshop in
June, 1979.
Occupational health
nurses establish
certification program
Ontario's occupational health
nurses have decided to
establish a voluntary
certification program for its
members, the ftfst time a
special interest group has
done so in Canada.
Approval of the
certification program - which
will include an initial
examination. continuing
education courses and
periodic renewal- was given
by members at the annual
meeting of the Ontario
Occupational Health Nurses
Association (OOHNA) held in
Kitchener, Ontario in late
October. 1978. The
Educational Conference and
Workshop attracted over 400
participants from Ontario.
across Canada. the United
States and the United
Kingdom.
The objectives of the
certification program are to
improve the quality of
The c.n-.llen Nur..
J.nUllry 11711 7
occupational health nursing in
Ontario. to encourage
occupational health nurses to
continue their professional
development and to give due
recognition and a sense of
identity to those nurses who
have met predetennined
standards in occupational
health nursing. The program
design is expected to be
sufficiently flexible to permit
its extension to nurses in
jurisdictions outside the
proVInce.
The proposed certificate
is not intended to endorse the
competence of the holder as a
"nurse or as an
"occupational health nurse".
nor to exclude any nurse not
holding a certificate from use
ofthe title "occupational
health nurse".
At present. the 1200
occupational health nurses in
Ontario. who care for
employees in the work setting,
have little opportunity for
fonnal training beyond their
initial diploma or degree.
Most nurses have to teach
themselves on the job through
on-the-job-training.
According to Dorothy
Clarke. OOHNA board
member. the program will be
"a pilot project in the
province. Ifwe get it going
successfully, ... it could
become a national program."
she stated. A certification
board. made up of
occupational health nurses
and an advisory board will be
set up during the next year
and it is planned that the
certification program will be
fully operational within two
years.
So far. the association's
plans have received the
support of the Ontario
Ministry of Labor. and the
!\linistry of Colleges and
Universities as well as the
College of Nurses ofOntano.
ICN SUpports
primary health care
The I nternational Council of
Nurses (ICN) has vowed its
committment to "making
primary health care an
effective realit} ".
In September 1978.ICN
representatives told delegates
to the Primary Health Care
Conference in Alma Ata.
USSR that nurses are
committed to effecting
"changes in nursing
education. practice. and
management which are
conducive to the
implementation of primary
health care."
While recognizing that
changes in attitude are
necessary before primary
health care can be fully
implemented.ICN's
spokesmen pointed out that it
has long been recognized that
nursing personnel give the
greater part of health care in
most health care systems.
"N ursing is already
structured to promote health
teaching and supervision,"
they pointed out.
ICN representatives at
the Alma Ata meeting were
Syringa Marshall-Burnett
(Jamaica). member.ICN
board of directors. Winifred
Logan.ICN executive
director. and Doris luebs.
nurse advisor.
The conference.
sponsored by the World
Health Organization and
UN ICEF. stimulated
participants to exchange
information and experiences
on the development of
primary health care within the
framework of comprehensive
health services and systems.
Did you know...
The Canadian government
recently licensed Radio
Reading Service. a closed
frequency radio station
broadcasting exclusively to
the blind and otherwise print
handicapped. The station
plans to read books.
magazines and newspapers to
the visually disabled. Special
receivers are required to hear
the station's signal and these
receivers will only be
available to those who are
demonstrably in need of the
service. The service is
non-commercial and
non-profit and is staffed by
volunteers. It is the first
station of its kind in Canada
while there are over seventy
such stations in the United
States . You can write to the
Radio Reading Service at 1247
Rebecca Street. Oakville,
Ontario. L6L IZ2.
Did you know...
A ten year reunion is being
planned for April. 1979 for the
diploma nursing grads '69 of
the l\else} Institute (formerly
SIAAS) in Saskatoon. Sask.
In order to complete a mail inK
list. please send your name
and mailing addres'i to:
Alumni '69, School of
Diploma Nursing. Kelsev
Institute. Box /520.
Sas/"atoon. Sas/".
Nursin. Jftb Fair 1M
NURSES &
NURSING STUDENTS
Looking for a Job Now or Later?
The First Annual Toronto Area
NURSING JOB FAIR offers...
...Over 5.000 nursing posilionsat65 hospitals and medical cenlers
from all over the U.S. and parts of Canada. The NURSING JOB FAIR
nursing employment convention will be held Feb. 22 through 24 at
Ihe Toronto Harbour Castle Hillon Hotel, One Harbour Square
Toronto. Admission is FREE to all in the nursing profession-LPNs.
RNs with diplomas, AS. BSN. MSN. and all students, administralion
and faculty. An open invitation is provided to all.
Come find out whal kind of nursing pOSitions and opportunities
are available. Learn about living conditions, education reimburse.
ment plans. relocalion assistance and nursing innovations.
The NURSING JOB FAIR runs Ihree (3) days. Feb. 22. 23 (Thursday
& Friday) from 10 am. to 7 p.rn.; Saturday. Feb. 24. from 10 am. to 4 p.m.
Come alone or with a busload of friends, but don'l miss this once.
a-year chance to meet represenlalives from 65 hospitals and medical
centers and discuss your long and short lerm nursing employmenl
interesls and needs.
Hospitals and Medical Centers attending from Ihe U.S. are from
the stales of: Alabama. California. Florida. Georgia. Illinois. Louis-
iana. Maine. Maryland. Michigan, Mississippi, Norlh Carolina. Ohio.
pennsylvania. Tennessee. Texas. Utah, Washington, D.C. Facililies
from Canada are from Toronto.
Sponsored as a service of NURSING JOB NEWS monthly
newspaper for the nursing profession. 470 Boston post Road.
Weston, Mass. 02193. For further subscription and convenlion
informalion call (617) 899-2702 9-5 weekdays. C-- "N,-
OVER 5000 .JOBS
8 J.nUllry 11711
The c.nedl.n Nur..
news
Critical Care '78
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The workshop leaders ofC ardioloRV '78 {Jose for a
photoRraph with Marina Heidman. continuing education
coordinator for nursinR of the Health Science Division of
Humber C olteRe in Toronto. (From left to riRht) M arielte
Vinsant, instrllctor of nursinR research and del'elopmeflt at
Jackson Memorial Hospital in Miami, Florida: Marina: and
Theresa Nu<.um. instructor of nursinR research and
del'elopment and coordinator ofnursinR quality assurance
proRrams at Jad.son Memorial.
For tho
e who attended
Critical Care '78. a two-day
workshop on oxygen and
chemical imbalance in the
critically ill. it was a full two
days.
Workshop leaders.
Marielle Ortiz Vinsant and
Theresa Watson Nw:um,
managed to present a
somewhat difficult and
certainly vast topic in an
understandable and
interesting way. They brought
to the workshop both an
impressive list of credentials
and a skillful. systematic and
forthright teaching manner.
Marielle. an instructor of
nursing research and
development atJackson
Memorial Hospital in Miami
Florida. is also an author of
numerous articles and a
textbook. "A commonsense
approach to coronary care: a
program . and has travelled
widely as a lecturer. Theresa
is an instructor of nursing
research and development and
coordinator of nursing quali
y
assurance programs at
Jackson Memorial and has
been a guest lecturer in the
areas of respiratory and
coronary care.
The first day of the
work<ihop was devoted to the
evaluation of oxygen and
chemical imbalance. On the
second day. delegates broke
into two groups to allow them
to attend a lecture of their
choice. centered on either
cardiovascular or respiratory
interests. I n spite of a very
tight schedule. there was
plenty of time for questions
and practice sessions in
problem solving.
The workshop.
sponsored by the Health
Sciences Division of Humber
College in Toronto was held
twice in order to allow a
greater number of nurses to
attend - about three hundred
nurses in all attended over the
four-day period.
New CNF
Board of Directors
Louise T od. executive
director of the Manitoba
Association of Registered
Nurses. Winnipeg. was
elected president of the
Canadian Nurses Foundation
in November 1978. Shirley
MacLeod, Fredericton. N.B.
is vice-president and other
members of the Board are
Barbara Archibald, Ottawa,
Denise Lalancette.
Sherbrooke. Que. and
Margaret McLean. St.
John's. Newfoundland. Dr.
Helen K. Mussallem,
executive director of the
Canadian Nurses Association
is secretary-treasurer.
The Canadian Nurses
Foundation is the only
Canadian Foundation that
deals exclusively in
supporting nursing scholars.
Almost 200 nurses have been
granted CNF scholarships
since 1962 - many of these
scholars have become leaders
in Canadian nursing as
university faculty,
administrators. researchers
and clinical nursing
specialists.
University of Moncton
to host annual CUNSA
Congress
The national conference of the
Canadian University Nursing
Students Association will be
held February 8-11. 1979 at
the University of Moncton.
Over 500 students from 25
Canadian universities are
expected to attend.
The theme of the
conference is . 'The Nurse as a
Preventive Agent" and the
subjects discussed. from child
abuse to school health, will be
approached with prevention in
mind.
CUNSA is the only
association that brings the
student nurses of Canada
together. This annual
congress aims to promote and
stimulate the interest and
participation of students in the
nursing field. Members of the
association will have the
chance to exchange ideas and
impressions about their
profession. through
educational, administrative
and recreational events. This
exchange allows them to find
out about the nursing
programs of various
universities.
Activities during the
three days will include sports,
as well as social and cultural
evenings. There will be
simultaneous translation of all
the meetings and conferences.
U of A hosts
visiting professor
The first nurse ever to receive
a visiting professorship award
from the Medical Research
Council spent one week this
Fall assisting and giving
advice on ongoing research
projects at the Faculty of
Nursing, University of
Alberta.
Dr. Moyra Allen, national
health scientist and professor
and director of a research unit
in nursing and health care at
McGill University shared the
knowledge from McGill
University - a leader in
nursing research - with both
students and faculty at the
University of Alberta.
As part of her visit. Dr.
Allen presented a public
lecture on one of her ongoing
research projects "The
Workshop - a Health
Resource". The Workshop is
an innovative community
health center, just outside
Montreal. The only one of its
kind in Canada. the health
center is designed to help
individuals and families deal
with situations of day-to-day
living in a healthful fashion.
The Cen-.ll.n Nur.e J.nUllry 11711 1
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METAL FRAMED...Slmiiar to above but mounted In
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1 line IF LESS THAN 110
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10 J.nuery 11711
The c.n-.ll.n Nur..
news
I. V. nurses meet
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The third annual convention of the Canadian Intravenous
Nurses Association was an educational experience for those
who attended, and the lectures were not the only reason.
H ere a group of nurses
'isit one of many interesting exhibits
set up by leading manufacturers of intrm'enous supplies.
Over 200 delegates met at
Toronto's Inn on the Park
Hotel for the Third Annual
Convention of the Canadian
Intravenous Nurses
Association (C.I.N .A.) held in
November. 1978. The meeting
addressed some ofthe
concern,> and learning needs
of the nurses who attended
from all parts of Canada.
Trudy De Vries opened
the first day ofthe meeting
with an account of her
experiences starting an I. V.
team at HolyCross Hospital
in Calgary. Alberta. She
emphasized the benefits of
forming a team. both for the
hospital and for the patients,
and underlined the needs for
standards to ensure safe I. V.
practices.
Dr. R.M. Filler.
surgeon-in-chief at the
Ho'>pital for Sick Children and
professor of surgery at the
University of Toronto. talked
about complications in
pediatric intra venous therapy.
both peripheral and central,
from fluid overload to sepsis.
R.L. Ravin. pharmacy
director at St. Joseph Mercy
Hospital in Ann Arbor.
Michigan. discussed safe and
effective intravenous therapy.
pointing out the importance of
ensuring the safe
administration of I. V. fluids
and medications by making
sure
. that intravenous
administrations are
compatible and stable;
. that additives are diluted
appropriately;
. that the rate of
administration is appropriate;
and
. that the risks of
septicemia are minimized.
He stressed the important
role of the pharmacist in
ensuring safe and effective
therapy and gave nurses and a
number of pharmacists who
attended the meeting a good
deal to think about.
C.I.N .A. was founded in
1975 because of a need for
communication, increased
knowledge and idea exchange
between nurses involved in
I. V. therapy. The third annual
convention provided nurses
with an opportunity to meet
these needs. share concerns.
and visit a number of exhibits
pertinent to I. V. therapy.
MARN approves emergency
nursing course
\ .
The Board of Directors of the
Manitoba Association of
Registered Nurses recently
gave its approval to a
post-graduate course for
registered nurses in
Emergency Departments. The
only one of its kind in Canada.
the course is sponsored by the
Health Sciences Centre in
Winnipeg.
The program has been in
operation since September
1976, and at that time served
five Winnipeg hospitals.
However, provincial fiscal
restraints have reduced its
services to two hospitals -
the Health Sciences Centre
(General and Children's) and
the St. Boniface Hospital.
The course is designed to
provide the client with safer.
more comprehensive nursing
care in sudden, unanticipated
conditions. Effective
communication and expansion
oftechnical skills are stressed,
in order that both the client
and his family receive the
highest possible level of care.
Registered nurses
presently working in the
Emergency Department of the
two hospitals involved are the
only nurses eligible to enrol in
the nine-month course.
Approximately 47 eight-hour
class days are spent in
theoretical training on the
following topics: cardiology,
respirology, neurology,
urology, abdomen, pediatrics,
obstetrics, gynecology,
trauma. life crises and
psychiatric emergencies, and
disaster nursing. As often as
possible, specialists are called
in to teach in their area of
specialty.
I n addition to the theory.
at least one day a week is
spent in the actual clinical
setting of the Emergency
Department under the
supervision of a qualified
teacher. In order to gain
insight and experience in a
variety of areas, three days
are set aside for experience
with the Winnipeg Ambulance
Service and two three-week
rotations are arranged with
two Emergency Departments
in other hospitals.
Because of the support
the program has received,
there is a plan to expand the
course to serve a wider range
ofhospitaIs, both urban and
rural. If sufficient interest is
expressed by Canadian and
United States hospitals. and
by registered nurses, the
coordinators of the program
hope to be able to request
additional funding from
governments and other
hospitals to provide improved
instruction and care in
Emergency Departments.
I nquiries about the
course can be made to:
Barbara Duke, Coordinator,
Manitoba Emergency Nursing
Course, Dep(lrtment of
Nursing, Health Sciences
Centre (General), 700 William
A
'enue, Winnipeg, Manitoba,
R3EOZl.
Editor's Note: Immunization
Action Month ended on
November 3D, but its message
that all Canadians need
protection from
communicable disease will
hopefuIly stay with us for
1979. CNJ thanks the Ottawa
Carleton Regional Health Unit
for pointing out that. in
general, adults do not receive
immunization for diphtheria
(as we stated in our November
issue, 1978. p.8). Routinely,
diphtheria immunization is
given up to the age of 14
years.
I
'
The cenlldl.n NUrH
J."...ry 11711 11
YOU AND THE LAW
Finding and helping
victims of child abuse
Corinne Sklar
.,
--
L_ ...
How can the tragedy of child abuse be prevented? What
position does the law take with respect to both the prevention of
abuse and rehabilitation of children and their parents? What
does the law require of the nurse in the matter of child abuse?
Child abuse has been variously defined in the literature.
The term "battered child syndrome" was first coined by Dr. H.
Kempe in 1962 to describe a clinical condition in young children
who have received serious physical abuse usuaIly by parents or
other guardians including foster parents. The injuries result
from non-accidental occurrences and range from minimal to
fatal injury.1 The definition of an abused child has been
broadened to include the emotionally or psychologically
battered child. While physical abuse can be demonstrated by
X-ray film of injuries and by visual evidence of bums, bites,
bruising and general malnutrition. emotional abuse is more
difficult to demonstrate. Obviously, the latter is also more
difficult to recognize so that det
ction and diagnosis on the
emotionalleve\ are often neglected by professionals.
Child abuse can result from outright battery or from
neglect. The results may be physical or emotional or both.
Neglect may be manifested as failure to thrive from physical or
emotional neglect resulting from ignorance, indifference or
inadequacy on the part of parents or guardians.
In legal terms, the a
sed child falls within the statutory
definition of "neglected child" or "child in need of protection"
Ontario'sChild Welfare Act. R.S.O. 1970. c.64 defines â child
in need of protection as foIlows:
(/)In this Part.
(a) "child" means a boy or girl actually or apparently
under sixteen years of age;
(b) "child in need of protection" means,
(i) a child who is brought. with the consent of the
person in whose charge he is. before a judge to be
dealt with under this Part.
(ii) a child who is deserted by the person in whose
charge he is
(iii) a child where the person in whose charge he is
cannotforanv reason care properly for him, or where
that person has died and there is no suitable person to
care for the child.
(iv) a child who is living in an unfit or improper place.
(v) a child found associating with an unfit or improper
person.
(\'i) Repealed
(vii) a child who, with the consent or connivance of the
person in whose charge he is, commits any act that
renders him liable to a penalty under any Act of the
Parliament of Canada or of the Legislature. or under
an\-' municipal by-law.
(viii) a child whose parent is unable to control him,
(ix) a child who, without sllfficient cause, habitually
absents himselffrom his home or school,
(x) a child where the person in whose charge he is
neglects or refuses 10 pro\'ide or obtain proper
medical. surgical or other recognized remedial care or
treatment necessary for his health or well-heinl? or
refuses to permit such care or treatment to be supplied
to the child when it is recommended by a legally
qualif
d medical practitioner, or otherwise fails to
protect the child adequately,
(xi) a child whose emotional or mental de\'elopment is
endangered because of emotional rejection or
deprivation of affection by the person in whose charge
he is,
(xii) a child whose life, health or morals may be
endangered by the conduct of the person in whose
charge he is;
You wiIl note that the definition is very broad and
encompasses a wide range of situations. This statutory
definition is representative of the definitions found in similar
legislation in the other provinces.
Canadian law dealing with neglect of and offences against
children faIls into two categories, each type enacted with
differing intent. The Canadian Criminal Code deals with
criminal sanctions for offences against children. The intent of
the Code is to prohibit proscribed conduct and to punish
wrongdoers for crimes committed against children. The Code is
primarily punitive rather than rehabilitative in nature. Thus,
sexual mis<.;onduct, criminal negligence, and failure to provide
the necessaries of life are all punishable on proof beyond a
reasonable doubt.
Provincial Child Welfare legislation. on the other hand. is
aimed primarily at protecting children from a hostile.
non-nurturing environment. Its thrust is not to punish parents or
guardians inadequate to the task of child-rearing. but to resolve
problems based on the "best interests of the child". In order to
do so. the full range of available community agencies and
professional services optimaIly should be marshaIled. The
12 J.nUllry 11711
The c.n-.ll.n Nur..
"harshest" punishment under these statutes is removal of the
child or children from the parental home either on a temporary
or. sometimes. on a pennanent basis. Remedial treatment may
be required under supervision oflocal agencies, most often the
Children's Aid Society or local equivalent.
Detecting the child abuser
To combat this growing social problem, early detection and
prevention are essential. Nurses have a primary role to play in
this area; they must be aware of the typical characteristics of
the victim of child abuse who may be brought in to the hospital
emergency room, the pediatrician's office, the local clinic, or
the school nurse's office. Nurses must listen and observe
carefully as they fulfill their duties in routine public health
visits. They must have a working knowledge of the general
profile of the child abuser and be alert to emotional strains to
which these individuals are subjected which trigger abusive
behavior. Child abusers are not limited to anyone section of the
socio-economic scale. While problems of financial distress,
overcrowding, alcoholism, etc. are indeed added stressors,
abusive conduct toward children is not limited to those at the
lower end of the socio-economic scale. The potential child
abuser can be found in all walks of life.
Anyone who looks after children has the potential to be a
child abuser. While studies have shown that there are factors
which tend to recur, it is important to realize that the potential
for such behavior toward children exists in all individuals.
Yelaja 2 describes three categories of abusive parents:
. parents who are wilfully and deliberately abusive and
neglectful;
. parents ignorant of child-rearing;
. parents who are burdened with social problems of poverty,
physical and m"ental illness, alcoholism, etc.
Heins'3 profile finds that females tend to be more abusive
than males.
. Fathers tend to abuse older children.
. Child abusers generally are young. have children early and
tend to have many children.
. They tend to be socially isolated and nomadic. to have few
friends and to be separated from their extended family.
. Many child abusers have been abused themselves as
children.
. Their partnerships tend to be highly unstable.
. Some abusive parents tend to have excessively high
expectations of themselves as parents and oftheir children.
. They may be hostile and immature.
. The spouse or partner is usually passive and tends to
abdicate responsibility for the rearing of the children.
Sometimes the parents are simply highly authoritarian and
punitive in their beliefs and childrearing practices. The profile
of the child abuser varies; there is no set formula. All of these
characteristics serve as danger signals warning of potentially
abusive individuals.
It is important to note that not all children in a family are
abused. Generally, one child bears the brunt of the hostility of
the parent. This may be due to some physical characteristic.
some abnormality, the sex of the child, or some personality or
behavior trait.
Raising children is not a simple task; the frustrations.
problems and costs are heavy, the responsibility is enormous.
Today's highly mobile. "independent" nuclear family often
lacks the emotional supports that a less complex, less detached
society of a few years ago provided. Parents in need of support
and guidance often do not know where to turn for help. As well,
parenting is something "one is expected to know how to do
properly". Generally, one is loathe to interfere with the
child-rearing practices operative within a family. Nurses have
to be aware of their own biases and value systems as well as
their general reluctance to intenere.
Reporting requirements
Generally, provincial legislation requires reporting of ill-treated
children to the proper authorities. Some legislation provides
penalties for failure to do so. It is important for nurses to
familiarize themselves with the provincial statute applicable to
them for its definition of children in need of protection and for
the requisite reporting requirement. In Ontario, the reporting
requirement is as follows:
(1) Every person havinR information of the
abandonment, desertion, physical ill-treatment or
needfor protection of a child shall report the
information to a children's aid society or Crown
attorney.
(2) Subsection 1 applies notwithstanding that the
information is confidential or privileged, and no action
shall be instituted against the informant unless the
giving of the information is done maliciously or
without reasonable and probable cause.
Note that no statutory penalty follows on failure to report.
However, this lack of sanction is now under review in Ontario
since it is recognized that the reporting of suspected or clear
cases of abuse is essential to ensure the protection of helpless
children.
The sanction for non-reporting may apply, however, only
to such behavior as physical abuse and sexual abuse. The
concern of the legislation is the condition of the child (physical,
emotional or both) not the conduct of the person which causes
the condition.
Nova Scotia's new Children's Services Act, S.N .S. 1976
c.8 retains the reporting requirements and establishes a child
abuse register. A child who has been found to be in need of
protection. or is believed by members of the medical fraternity
to be subject to abuse, is to be registered. On the report of a
suspected case of child abuse, an agency is required to conduct
an investigation and obtain a medical statement to determine
whether or not abuse has occurred. Conditions for the removal
of a registered name of a child and the transmittal of information
outside the province are specified. 5
Each province has differing requirements. General
penalties for failure to report are found in the legislation of
British Columbia, Manitoba, Newfoundland, Nova Scotia,
Quebec, Saskatchewan. Ontario does not yet penalize failure to
report. New Brunswick and Prince Edward Island do not
require reporting of cases.
Protection of the informant
The responsibility to report usually carries with it freedom from
ci vii action for breach of confidentiality unless the information
is given maliciously or without reasonable and probable cause.
The identity of the informant is protected from publication to
encourage reporting of cases. Thus, a report to the authorities,
in good faith. where there is reasonable and probable cause for
concern will serve to protect the informant from any subsequent
action by the parents or guardians.
In England recently the House of Lords upheld the right of
the National Society for the Prevention of Cruelty to Children
to maintain confidential the name of its infonnant. The Society
had been informed that the 0 family's baby girl was maltreated
On investigation by the Society and the family's physician. the
child was found to be healthy and well-eared-for. However,
Mrs. D. suffered from depression and ill-health as a result of
this complaint and wanted to sue the informant for defamation.
The Court found that it was in the public interest that such
names should not be divulged, else valuable sources of
information would dry up. Information. tendered in good faith,
will be protected at its source.
The c.n-.ll.n Nur..
J.nUllry 11711 15
. Speech assessment is actually done by the parent,
while the expert otTers guidelines.
. Dental examination and brushing methods are
performed with the child's head on the parents' lap, and
the hygienist teaching procedures to be followed in the
home, and with siblings.
. Experiential learning is emphasized in everything
from mental health to nutrition, with the exception of
immunization which is provided for children who will be
entering schoo).
Although it is the public health nurses who do the hard
work of organizing the da} 's activities and carry out the
necessary follow-up procedures, the event itself has become
(
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Having}oureyes ctwckedby the orthoptist can befun when
you're silling on the lap of PHN cum clown. fan SUllon,
during
'ision screening mthe health circus.
a true expression of community cooperation in positive and
preventative health. Local firemen hang street banners;
merchants supply nutritious snacks; volunteer agencies set
up colorful displays; and school children paint posters and
flags to add to the kaleidoscopic etTect. Altogether about
thirty-five groups and agencies participate in this
worthwhile etTort to maintain a healthy environment and
community.
From a small beginning a few years ago in the offices
of the local public health t:nit, the circus has now escalated
to an event that is eagerly awaited by hundreds of local
children and adults each year. .....
Pholostory by Rosemary Crmlford
,
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Unconcerned and unaware of the physiotherapist carefullv
obserdng her acti\'ities. a young participant jo)fully jumps from
springboard to the mat belol\'.
16 January 11711
The can-.llan Nur..
1
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Little sister opens wide to help this preschooler take her polIO
vaccine from Jean Sellers. PHN.
.. Am I tall enough," is the question in the eyes of the young man
hm'ing his height checked by PHN Trudv Phillips at the
health circus.
Acknowledgement: The author would like to acknowledge the
cooperation and assistance offour public health nurses -
Pauline Dunn. Beverley Hills. Betty-Anne Rogers and Rachelle
Siddall- in the preparation of this article. All except the first of
these nurses (who is now a nursing instructor at Douglas
College) are employed by the Simon Fraser Health Unit.
Rosemary Crawford, author of the photostory, "A
preschoolers' health circus", is regional health education
consultant with the British Columbia Ministry of Health. S he is
a graduate of St. Paul's Hospital in Vancom'er, UnÙ'ersity of
British Columbia School of Nursing in Public Health and an
undergraduate in Education at Simon Fraser U nÙ'ersity.
She has been im'oh'ed in community health education for
the pastfour years and recently has specialized in audio-dsual
with emphasis on educational media.
farly diagnosis in
congenital hearing loss
"I had now the key to all language , and I was eager to learn to use it.
Children who hear acquire language without any pa11icular effort; the
words thalfallfrom others' lips they catch on the wing, as it were,
delightedly. while the Iinle deaf child must trap them by a slow and often
painful process. But whatever the process, the result is wondeiful."
Helen Keller
,
"
...-
,
JlllrilYll O. Dahl
J
Children with congenital hearing loss are
most often born to hearing parent!> who
have no kno'o\ledge ahout congenital
deafness.' Since deafness does not seem
to interfere with the initial bonding
process. the mother often remain"
unaware for many months that the infant
cannot hear. The baby cries. smiles,
babbles. reacts to visual. tactile and
kinesthetic stimuli as does any normal
baby. The mother reacts to the infant's
behavior by increasing her attention to
him and social interaction takes place.
The mere fact that the infant responds to
her, increases the mother's
vocalizations. At this stage. there is no
clue that the baby is not responding to
auditory stimuli.
Until the age of six to nine months.
the deaf baby often sounds exactly like a
normal infant. But. vocalizations will
gradually decrease and by the end of the
first year, the child ma} be making only
the primitive sound. "amah" which
many mothers report as ., mama" .!
When the baby fails to respond to sounds
in a normal way and vocalizations
decrease. the parent-child interaction
pattern is altered. The suspicion and
subsequent diagnosis of deafness may
put an added strain on the parent-child
relationship.
Earl
suspicion and detection
In most cases. parent!> are the first to
"uspect that their child is deaf. The more
'ievere the hearing loss. the earlier the
suspicion and the shorter the delay until
diagnosis. Findings in a study of the
Greater Vancouver area published in
1975-' indicate that on the average. a child
was about ten month" old before parents
presented their suspicions to their
primary care physician and even then
there was an average delay of over eight
and a half months until the diagnosis '0\ as
confirmed. In some cases. parental
!>uspicions '0\ ere disregarded as
'overanxiety': in other cases. parents
were advised to 'wait awhile'.
18 January 111711
The can-.llan Nur..
Current findings indicate that
parents are beginning to suspect
deafness in their child earlier - at about
eight months - and that children are
being referred earlier for evaluation.
It
would seem that professionals are
becoming more aware of the importance
of early diagnosis and treatment.
Risk factors
No statistics are available to indicate the
number of infants born with congenital
deafness in Canada: estimates range
from I: 1000 to 5: 1000:' Unfortunately,
there is as yet no simple test to detect
deafness in the newborn and routine
screening in nurseries must be
considered ineffective in detecting
hearing loss." Nevertheless. there are
identifiable factors that increase an
infant's risk of congenital hearing loss. In
1974, the U.S. Joint Committee on
Newborn Hearing Screening
recommended that "infants at risk for
hearing impairment should be identified
by means of history and physical
examination". 7 As a result ofthis
awareness. newborns may be
categorized on the basis of risk. The risk
factors include:
I. family history of hereditary childhood
hearing impairment
2. rubella or other non-bacterial
intrauterine fetal infection
3. defects of ear, nose and throat
4. birthweight ofless than 1500 grams
5. bilirubin level of greater than
20mg/IOO 011 serum.
Using these factors as a possible
clue in the detection of hearing loss. it
has been estimated that about 60 to 70
per cent of congenitally deaf children can
be identified."The committee further
recommended that infants falling into
this category be referred for in-depth
audiological evaluation within two
months after discharge from the nursery.
Even so, deafness may not be apparent
and it is important that periodic
evaluations be repeated.
Acquisition of language
Why is early diagnosis and treatment of
congenital hearing loss so important?
One of the reasons is that language
acquisition is a time-locked function.
connected to early infancy .HThe first
two years oflife are considered to be a
crucial time for language learning that
can never be regained once this time has
passed. It is also suggested that
prelinguistic vocalizations and
intonations similar to the parents speech
are noted as early as eight months. and
are basic to language development. IU A
child learns to talk by hearing the
constant repetition of words. and ifthe
infant has any residual hearing and is
diagnosed early, he can benefit from the
use of hearing aids and/or amplification
devices coupled with other teaching
approaches.
Communication methods
Regardless of the severity of the hearing
loss, the key to a child's intellectual,
social and psychological development is
the establishment of successful
communication as early as possible. But
how is this to be accomplished? Once a
diagnosis of hearing loss is made, the
parents must select the method of
communication best suited to educating
their child. This will probably be one of
the most difficult decisions parents of a
hearing handicapped child will face since
experts themselves are not agreed about
the best approach. This conflicting
advice from experts can rob parents of
support and precipitate a prolonged
conflict. "
There are two fundamental
dPproaches to educating the hearing
handicapped:
Oral communicarion method: teaches
speech training, lip-reading and utilizes
hearing aids and/or amplification units
but discourages the use of gestures and
sign language. The theory is that if the
child uses sign language. he will not fully
develop his verbal
kills.
Total communication method: trains
children in sign-language, finger spelling.
speech and lip-reading, and uses the
amplification of residual hearing through
hearing aids. The theory is that each
child must "learn according to his
capabilities - that learning to
communicate proceeds from the most
primitive to the more complex and
sophisticated symbol systems that
involve all senso"y modalities-
auditory. visual and kinesthetic" .'2
At this early stage, the parent's
greatest need is for counseling. While
some may experience extreme shock and
grief. others may have a more moderate
reaction. Parents with normal hearing
may have difficulty understanding the
implications and limitations of the
handicap for their child. It is vital at this
stage that they understand what the
handicap will mean and that no false
reassurance is given to them to minimize
their concern.
The Vancouver Program
In the Vancouver area, a child suspected
of having hearing loss is referred to the
Children's Hospital Diagnostic Centre.
Here. the infant is evaluated and the
diagnosis is made. Parents are given
counseling and a full explanation of the
two educational programs available to
them. These are:
a) the oral method at the Vancouver Oral
Centre and
b) the total communication method at the
Diagnostic Centre.
Parents are advised to visit both
programs and to choose one of them for
their child. Both programs offer support
for the family and training for the child.
In choosing. parents must consider
which method will help the child achieve
optimal growth. It is important that it be
their choice because they must feel
willing and motivated to participate.
Oral communication method
Many forces playa part in the decision
that parents will make. * They may have
high expectations for their child and
want him to 'pass' in the normal
speaking world. They may be drawn to
the purely oral approach because it
seems to bypass the handicap and
requires less emotional adjustment, since
it does not require the learning of sign
language. '3 Certainly it is natural for
parents to hope that their hearing
handicapped child will develop the
capacity to communicate with the vast
majority of people who hear and speak.
The Smiths** are an example of one
family who chose the oral method for
their hearing handicapped daughter.
Marie, aged 24 months, is the only child
of Mr. and Mrs. Smith. She has
congenital deafness of unknown cause.
When Marie was 12 months old. Mrs.
Smith suspected that something was
wrong with Marie's hearing. While on
vacation that year, she noticed that
Marie did not react at all to a noisy
environment. Through her family doctor
and ear specialist, she was referred to
Vancouver's Diagnostic Centre.
Looking back. Mrs. Smith felt that
there was nothing in Marie's behavior to
make her suspect deafness. She seemed
normal. She slept soundly but would
react to the vacuum cleaner. Probably
she was reacting to the vibration rather
than the noise. She was an "independent
baby". preferring not to be cuddled.
The parents described their reaction
to the diagnosis as "fairly severe". but
overall, they felt that they have adjusted
well. Mr. Smith felt that he had had a
harder time than his wife.
A number of factors affected the
Smiths in their choice ofthe Oral Centre.
Although Marie has a profound loss, she
has some residual hearing and so can
benefit from hearing aids. At age one
year, she WdS babbling and had advanced
developmental skills. The parents' wish
for Marie was that she be as much a part
of the normal world as pos
ihle.
*In other centers across Canada. such as the
Audiology Department al theChildren's
Hospital of Eastern Ontario in Ottawd,
parents do not choose the type of training for
their hearing impaired child. The staff of
CHEO's program feel that parents do not
have the knowledge and are not emotionally
able to handle this decision at the time of
detection. Instead. an evaluative therapy
program will determine and recommend a
suitable method for each child.
** All names are fictitious.
The oral program has continuity-
infant teaching, preschool. kindergarten.
and possible integration into the public
school system. Because the program has
limited grant money. the parents
themselves must carry out continuing
fund-raising activities to support the
program. The program also includes
parent group meetings and bimonthly
in-home visits from a teacher. By this
Fall. Mrs. Smith and Marie will have a
daily 45-minute drive to the Centre for
pre-school classes.
The program emphasizes specific
parent behaviors to treat the child like a
normal child and to talk to him as often
as possible. As Mrs. Smith said.
"Repetition is the name of the game.
Emphasis now is not on teaching the
child to look at you but to make use of
the residual hearing. So when Marie has
her hearing aid on. I talk to her from
behind. try to encourage her to respond
to my voice and she does. "
Marie wears her aid in a red
corduroy pocket on her chest. with cords
running to molds in both ears. It took her
only a few days to accept the aid. When
the aid is on. she uses words with
intonation. But when it is off. she makes
only a monotone cry.
Cost and maintenance of the aid i
another stress. Ear molds must be
replaced every six months as Marie
grows.
In terms of family support. the
Smiths are receiving some help from Mr.
Smith's sister who lives nearby. She
accepts Marie"s handicap and provides
emotional support. Mrs. Smith's family,
during their occasional visits from
another province. express pity for Marie
and this creates tension.
On the whole, Mrs. Smith feels that
they are coping well with Marie's needs.
She hesitates to use the word "deaf' and
substitutes "handicap" instead. But the
Smith's have decided not to have
another baby. Because they cannot trace
their family tree. and thus cannot make
use of genetic counseling. they feel they
could not cope with having another deaf
child.
Total communication method
The total communication program at the
Diagnostic Centre (the only one of its
kind in Canada) has a different approach.
The Centre's aim is to provide families
with an opportunity for extended
participation in the program by providing
sign language instruction and
parent-child training classes. Parents of
deaf infants are also drawn closer
together to exchange interests and
experiences in child-rearing practices in
the home. It allows children in the family
(both hearing and deaf) to interact with
others in a play setting and introduces
the family to deaf adults and
professionals who work with the deaf.
The c.on-.llen Nur..
As well. a deaf adult visits the family in
the home. providing a role model.
Besides educating the child. the total
communication approach helps to
integrate the child into the family unit by
involving the entire family in
"communicating" .
Effect on the famil
The presence of a deaf infant does not
necessarily have a detrimental effect on
family interaction. In some instances,
brothers and sisters express worry and
concern: but in others. the family
members are drawn closer together.
Members ofthe extended family may
wish to enroll in sign language classes in
the community if the child is using the
total communication method.
The effect of a deaf child on the
family will depend on the health ofthe
family unit. If problems already exist,
coping with the handicap may cause
further strain. However, if all members
can be involved in a common program,
learning new methods of communication
and helping one another. family bonds
may be strengthened.
The case of Nancy Moss" and her
extended family gives us an idea of how
all members can become involved.
Nancy. the youngest of three children,
developed deafness at six months of age
after she had meningitis. Again. it was
her mother. Mrs. Moss, who first
suspected that something was wrong
when Nancy was in the hospital for
treatment. She and her parents were
referred to the Diagnostic Centre for
evaluation.
While both parents experienced
severe shock at first, they feel they have
adjusted to the diagnosis fairly well.
In contrast to the Smiths. Mr. and
Mrs. Moss chose the total
communication method for Nancy. Said
Mrs. Moss. "Well. we thought-she's
deaf. We can't change that. Ifwe put her
in the oral program she'll be with people
she can't hear or talk to. She really won't
have any world. If we put her in the other
program she'll have people she can
communicate with in sign language, and
we can learn it with her. At least then
she'll have a place in her world."
The family has a weekly two-hour
drive to the Centre for sign language
classes and group sharing. A teacher
comes to the house weekly. Mrs. Moss
states that Nancy is beginning to use sign
language and both parents are able to
communicate with her by using speech
and sign simultaneously. Nancy's
three-year-old brother has not reacted to
her hearing loss yet but the six-year-old
has questions. Since Nancy will soon be
fitted with hearing aids. he asks if she
will then be able to hear as they do.
Those in the extended family have
mixed reactions. Mr. Moss' father
Jenuery 1171 111
tended to deny the diagnosis at first by
making statements like, "She heard
that". Now. he comes into the house and
signs to Nancy. "Are you Grandpa's
girl". The maternal grandparents are
gradually showing more support. 'The
schools sent out a questionnaire asking
what people would like taught as a
second language," said Mrs. Moss. "My
mother crossed out all the languages
listed and wrote down 'sign language' ."
All of the family speak of Nancy as "cute
and cuddly".
For the future. Nancy's educational
needs will probably require a move into
the city to be near a suitable school. Mr.
Moss will need to find other work.
Helping behaviors
Parents can be taught behaviors that aid
in bonding. encourage the child's
development and meet the child's great
need for visual stimulation and physical
contact. Parents are taught to look at the
child when speaking and to use good
facial expression. But, at the same time.
they should not "overtalk". Some
parents develop a pattern of talking "at"
their child who will soon weary of this
and stop trying to understand." Parents
are taught to use speech before gesture
or speech and sign simultaneously,
depending upon the educational method
followed. Behaviors are oriented toward
helping the baby to develop a watching
habit - to watch people's faces.
especially the mouth and eyes. These
behaviors must be incorporated into the
ordinary, everyday routines. a practice
that calls for much repetition until the
baby understands the message.
Understanding should be rewarded with
evidence of pleasure and praise.
It has been shown that even though
the deaf child does not have verbal skills
he can conceptualize and has cognitive
skills.'s However, if he is deprived of
successful communication with others,
his social and academic skills will be
affected. The greater the lag until his
training is begun, the greater the lag in
his academic learning and the greater the
potential for the development of
emotional problems. Since the handicap
is a hidden one, the child may be
mislabelled as retarded. uncooperative.
dull or inattentive by those who are not
aware of his handicap. With early
diagnosis and treatment most of these
problems can be avoided.
Nursing implications
Nurses have an important role to play in
the detection of congenital hearing loss.
For example. the nurse working with
newborns can bring the five risk factors
to the attention of the family
pediatrician. Public health nurses are in
an especially good position to detect and
follow up on suspected cases. The PHN
who sees the parents and baby at health
20 Jenuery 1171
The c.on-.llen Nur..
clinics and during home visits often is the
only health Care professional involved
with the family until school age.
On the first post-natal visit to a new
mother. the nurse should take a
comprehensive hi
tory and review the
five factors which identify children at
high risk for deafness. Children with a
history of anyone of these factors should
be placed on a "High Risk Registry" and
be followed closely. The PHN can also
ask the mother questions such as:
. Does the baby react to loud noises?
. Does noise awaken him from sleep
when he is in a quiet room?
. By three months. does the baby
turn his head towards sound?
When the infant is between six and
nine months. the age when hearing loss is
usually detected. it is useful to again ask
the mother about the baby's hearing-
does he. for example. turn his head to a
familiar sound such as the sound of her
voice or the ring of a telephone?
Ifthere is any suspicion of hearing
loss. the child should be referred to the
services available in the area. This may
be the family physician or an audiologist.
The PHN'sjob does not end here
however. If the diagnosis has not been
confirmed. the high risk child should be
followed up since deafness may show up
later. If the diagnosis has been
confirmed. the nurse should check with
the parents to be sure they have been
referred to a treatment program and if so.
which program they have chosen.
If the family is involved in a
program. the nurse should learn what
parent-child behaviors are to be followed
so that she can offer support and
encouragement. She should be aware of
parental stresses during this time - the
conflict in choosing an educational
program. possible feelings of
helplessness. guilt or denial and whether
relatives are giving support to the family
or not.
The nurse will also be able to
observe parent's behavior towards their
child- are they being attentive to him.
cuddling him? Both parents and child are
apt to find the 12-month period hetween
the ages of one and two years a
particularly difficult and frustrating time.
as much repetition will be necessary
hefore the child understands what is
being communicated to him. At this
tage. parents can become frustrated and
so. in turn. can the child. Joyful.
reciprocal communication is not easy in
this situation.
Gaps also exist in educational
programs for the hearing handicapped
across Canada. For example. although
the total communication program at the
Vancouver Diagnostic Centre accepts
children up to the age of three. no
program for preschoolers from three to
five exists owing to a lack of funds.
Education is picked up again when the
child enter
school but valuable time has
been lost. 16
In the community. nurses can also
support positive health programs and
promote public education about hearing
loss. There is also a very real need for
integration and cooperation between all
disciplines to ensure the early diagnosis
of hearing loss and continuity of
treatment that is vital if the child is to
have his rightful place in the family unit
and in society.
"I want to say to those who are trying to
learn to speak and those who are
teaching them: be of good cheer. Do not
think ofto-day's failures. but of the
success that may come to-morrow . You
have set yourselves a difficult task. but
you will succeed if you persevere; and
you will find ajoy in overcoming
obstacles - a delight in climbing rugged
paths. which you would perhaps never
know if you did not sometime slip
backward - if the road was always
smooth and pleasant. ..
The Story of My Life
Helen Keller.
References
I Schlesinger. Hilde. Sound alld
sigll: childhood del{fileSS and mental
health. by... and Kathryn P. Meadow.
Berkley. Ca.. U. ofCal. Pr.. 1973. p.3.
2 Downs. Marion P. Guidelines for
hearing screening of the infant.
preschool and school-age child. In
Detection l
fdel'elopmental prohlems ill
children. Edited by M. Krajicek and A.
Tearney. Baltimore. University Park Pr
1977. p.1I1 ff.
3 Freeman. Roger. Psychosocial
prohlems of deaf children and their
families: a comparative study. by... et
aI.Amer.Alln.Deall:!O:4:391-405. Aug.
1975.
4 MacLean. Dr. CD. Personal
communication. March 3.1978.
5 Fisch. L Causes of deafness in
children. Nurs. Mirror, 143:19:48.
NovA. 1976.
6 Downs. Marion P. Joint statement
on neonatal screening for hearing
impairment. by... et al. Pediatrics
47:6:1971.
7 American Speech and Hearing
Association. American Academy of
Ophthalmology and Otoldryngology. and
American Academy of Pediatrics.
Supplementary statemellt o.{joint
committee Oil illjllllt hearillg KreellillX.
Asha. 16: 160. 1974.
8 Gerber. Stanford E. High risk
registry forcongenitLl1 deafness. In
Hearing Ion ill children. Edited hy
Burton F. Jaffe. Baltimore University
Park Pr.. 1977. p.74.
9 Downs. Marion P. Paper
presented. Nm'a Scotia Conference on
Earl\' I dent
fìcation of Hearing Loss.
Halifax. N.S. Sep. 8-11.1974.
Proceedings. Basel. Switzerland. S
Karger. 1976. p.14.
10 Crystal. David. Linguistic
mythology and the first year oflife. An
edited ver
ion of the 6th Jan
son
Memorial Lecture.
Bri.J.Disord.Commun. 8:29-36. Apr.
1973.
II Schlesinger. op cit.
12 Downs. Marion P. Goals and
methods of communication.I n Hearing
loss in children. Edited by Burton F.
Jaffe. University Park Pr.. Baltimore.
1977. p.7:!8.
13 Freeman. Roger. Psychiatric
aspects of sensory disorders and
intervention. I n Epidemiological
approaches in child psychiatry. Edited
by P.J. Graham. London. Academic Pr..
1977. p.:!87.
14 Freeman. Roger. Personal
communication. Feb.17. 1978.
15 Vernon. McCay. Relationship of
language to the thinking process.
Arch.Gell.Psychiatry. Vol. 16. Mar.
1967.
16 MacLean. Dr. CD. Personal
communication. Mar. 3. 1978
Acknowledgement:TlllWhS go to Dr. R.
Freeman. child p,\'\'chiatrist UBC and
Dr. C.D. MacLean, Children's Hospital
Diagno.Hic Celltre for their assistance in
the preparation of this paper. A further
thanh you goes to Elaille Cart\'. UBC
faculty adl'isor for the stud\'.
'-
A ut/wr Marilyn O. Dahl (R.N.) prepared
this paper during the third year in the
B.SeN. program at the Unil'enit\. of
British Columbia. A.I' part ofher stlllf\' on
congenital hearillg loss. she I'isited two
jámilies in the Vancoul'er area. each
with a deajï,!flwt.
Marilyn is a graduate l
f a three \'ear
diploma program, Victoria Ho.lpital,
Prince Alhert. Smh.. ami has nursed in
Sashatchewall. Ontario and B.C. She is
presently .finishing her B .SeN. degree at
U.B.C.
The Cen-.llen Nur..
Jenuery 1171 21
Audiology programs: another viewpoint
A number of centers in Canada like the one in Vancouver, provide diagnostic and treatment services
and educational programs for the hearing impaired child and his family. But different centers have
varying ideas about the benefits of certain communication approaches. To give you a better idea of
how other programs across Canada operate, CNJ contacted the Audiology Department of the
Children's Hospital of Eastern Ontario in Ottawa. The focus of their program is a little different from the
Vancouver approach.
Andree Durieux Smith
Karen Tataryn
Judy Simser
The aims of the Audiology Program at CHEO are the early detection of
hearing loss and the early habilitation of auditory, speech and language
skills in hearing impaired children. Detection is carried out using
behavioral techniques whereby sounds are presented and responses
observed. In cases where results are uncertain. electrophysiological
procedures are used to record changes in brainstem activity as
responses to sound. (Brainstem Electric Response Audiometry). This
latter procedure enables the identification of auditory dysfunction even in
neonates.
Hearing aids are fitted as soon after detection as possible. Prior to
this, an interpretive session is held with the parents. the audiologist. the
social worker of the audiology team and the aural habilitationist who will
be responsible for the parent guidance program. In the interpretive
session. many important factors are discussed with the parents. These
include test results, the implications of the hearing loss. the
recommendation of hearing aids, the description of the parent guidance
program at CHEO together with the various methods used in training
hearing impaired children.
The early detection of heanng loss in children is essential. However,
detection without training defeats its own purpose. The incidence of
hearing loss requiring amplification is approximately 1 in 1000 and of
these. only 2 per cent are totally deaf. Many severely to profoundly
hearing impaired children can learn to listen and develop effective verbal
communication. The development of auditory skills is possibly one of the
most difficult tasks for these children to accomplish. It is also believed
that the early years of life are critical for using auditory input to develop
speech and language skills.
The aural" habilitation program at CHEO, which is available from
the moment of detection till the child is of school age. aims at teaching
parents to work effectively with their child. It is an individually prescribed
program stressing the participation of all individuals involved with the
child. Sessions are held on a weekly basis and include home visits. The
approach used initially is aural, however the therapy is diagnostic in that
the child and his family are continually assessed to ascertain which
method is most suitable for the child. If after a certain period of time. a
child is not progressing sufficiently with the aural approach, signs are
introduced and again the child's progress monitored. If it is determined
that the child would benefit from a total communication approach he is
referred to another program. A close working liaison is maintained with
existing programs in the area and the child continues to be followed
audiologically at CHEO
Parent groups are held on a regular basis for the parents in the
CHEO program. The sessions are educational as well as providing an
opportunity for parents to identify common concerns and discuss
possible solutions.
Regular conferences are held for all children at six month intervals
The child's progress, both from the parent and professional point of
view. short term and long term goals, and upcoming decisions around
the child's future are openly discussed. As a child approaches school
age, the possible educational alternatives are discussed with the
parents. It is our hope that hearing impaired children will be "integrated"
into normal schools with the help of special support services. However,
in some cases. it may be more beneficial for the child to begin school in a
class for hearing impaired youngsters This does not preclude later
integration with hearing children.
As in our initial interpretive session with parents. all professionals
on our team. voice their opinions about appropriate educational
placement. Each child and his family are unique and all relevant factors
must be considered in our recommendation. However, It is ultimately a
parent's responsibility to arrange the chosen school placement for the
child. The ongoing audiological assessment and parallel therapy
program are closely interwoven at CHEO. We are constantly evaluating
each child's progress and attempting to gear our interventions to the
specific needs of each child and his family. At the same time, we
acknowledge that it is not an easy task for parents to become "teachers"
of their hearing impaired child. We are most supportive of parents'
efforts and provide counseling for those who may be experiencing
abnormal stress.
The aim of the CHEO program is the integration of the hearing
Impaired child in a normal environment whenever possible. We hope to
facilitate this goal by responding to the total needs of each child and his
family.
.Aural communication concentrates on developing a child's auditory
skills using a unisensory approach. i.e. training a child to listen for and
distinguish human speech.
Andrée Durieux Smith (Ph.D. in human communication disorders,
McGill University) is Chief of Audiology, Children's Hospital of Eastern
Ontario. Ottawa.
Karen Tataryn, (M. S W University of Toronto) Social Worker.
Audiology, CHED.
Judy Simser (B. Ed.. McGill University; Dip. Education of the Deaf,
Manchester, England) Senior Aural Habi/itationist. Audiology. CHEO
22 Jenuery 1171
The c.on-.llen Nur..
Aperfeet
eoJUbiuation. . . you
and Mosby texts.
Your skills in the classroom
and our efIectiye texts can assure
your students of the best
in education.
MEDICAL/SURGICAL
A New Book! MEDICAL-SPRGICAL NURSING:
Concepts and Clinical Practice. By Wilma.J. Phipps, R.:-.!..
B.S.. A.1\1.. Ph.D.; Barhara C. Long. R.:-.!.. M.S.N.; and Nancv
Fugate Woods, R.X. :-1.1\:.. Ph.D. Using both a s'\'stems and
conceptual approach, this new text reflects' the mvriad
changes in contemporary medical/surgical nursing.111
first
two parts discuss such general aspects as socio-cultural
perspectives. the nursing process. stress and adaptation, and
PO:-1R. Part III focuses on specific medical/surgical
problems - each includes an assessment of the in'\'olved
system. followed hy a management/intelTention process.
Chapters seldom seen in other texts explore ecology and
health, health care delivery systems, and an epidemiologic
PI
roach to health care. Febmary. 1979. Approx. 1.600 pp..
13., illus. About H27.75.
Xew 6th Edition' .\1exander's C.\RE OF THE
PATlE:VT IN SURGERY. By MarieJ. Rhodes. R.N., n.S.K;
Barbara ,J. l.mendemann. R.X., B.S., :'-1.S.; and Walter F.
Ballinger. M.D.; witll 21 contrihutors. Long respected for its
accuracy and completeness. ilii!' classic text provides a
comprehensive ovef\;ew of safe. efficient OR nursing. More
than 2.000 superb illustrations (half new) augment
forthright discu!'sions including asepsis, positioning,
wound healing. and surgical procedures., June, 1978.904 pp.,
2.146 illus.. including 2 in full color. Price.
30.00.
A New Bo
k! C \lXCER - PathophysioloJ!y. EtioloJ!y.
Mana
ement: Selected RcadiI1
s. By Louise C. Kmse, R.X,
B.S.:-.!.. :-1.A.; ,Jean Reese. R.N.. B.S.X., :-U\.; and Laura Ilart,
R.X., B.S.N.. :-1.Ed.. M.A., Ph.D.; with 20 contributors. This
collection of articles offers VOlU students the latest
infonnation on cancer pre\'ention, detection. treatment,
rehabilitation - including the rc!e\'ant psychological
aspects. Throughout. discussions emphasize the
commonalities of cancer problems. and provide a practical,
positi\-e pcrspecti\'e of care. ,January, 1979. Approx. 448 pp..
35 illus. About t416.7;;.
Xew 3rd Edition! THE VITAL SIGNS WITH
RELATED CLINICAL MEAsrREMENTS. Bv Bettv
McInnes, RX. R.Sc.X..l\l.Sc.(Ed). Use iliis valuabl
textt
teach yourstudentshow to assess measurements made in the
clinical setting. The programmed fonnat arranges factual
material in small. logical steps - progressing from basic
infonnation to the complex. Two new chapters focus on the
he
rt. and
est and lungfuncyons. Fehmary. 1979. Approx.
144 pp., 3., Illus. About
9.7.,.
Xew 2nd Edition! CLINICAL IMPLIC\TIOXS OF
L\BOR.\TORYTESTS. BySarkoM. Tilkian.l\I.D.;I\1arv H.
Conover. R.X.. B.S.KEd.; and Ara G. Tilkian. M.D.. F.A.é.c.
Give your students the infonnation they need to detennine
the clinical significance of major labordtof\' tests. The hook
begins with a section on routine lab tests. a
d proceeds with
sections on tests used to didgnose specific diseases. This
new edition offers new chapters on rheumatoid and
infectious diseases - and boasts the strongest cardiology
':.c
ion of any similar
cxt. Febmary. 1979. Approx. 272 pp.,
4;) Illus. .\bout
HO.7;).
A Xcw Hook! BASIC PATHOPHYSIOLOGY: A
Conceptual Approach. By Maureen E. Groer. R.N., Ph.D.;
and Maureen E. ShekJeton. B.S.N.. M.S.N. The authors of this
useful new text ha\'e organized the '\'ast field of
pathophysiology into major conceptual areas. Included in
students' study of disease are cellular de\'iation. hodv
defenses. physical and chemical equilibrium, and nutrition
1
balance. Each chapter begins with leaming objectives which
can be used to aid the student in self-evaluation. Febmarv,
1979. Approx. 560 pp.. 423 ilIus. About 819.25. .
ew 2nd Edition! l'ROLOGIC ENDOSCOPIC
PROCEDPRES. B
Alicc :-Iorel. R:\.; and Gilbert J. Wise.
l\1.D.. F.A.C.S. An memhers of the urologic team will benefit
from this unique book. It thoroughly details all important
aspects of the sul
ieet - specific procedures. facilit\. and
equipment requirements, and equipment mainten-ance.
Revised and updated. tllis edition includes a new chapter on
urodynamic procedures. and new infonnation on instmment
cleaning and decontamination. March, 1979. Approx. 224
pp.. 258 iIIus. .\bout 81;;.00.
The c.on-.ll'" Nur..
Jenuery 11171 23
Xl.''' 2nd Edition! PI AXXIXG .
VD I)IPLE
IEX-
TTXG XrRSIXG IXTERVENTIOX: Stress and
.\daptation Applied to Patient Care. By Dolores F. Saxton.
R.N.. B.S.. 1\I.A., Ed.D.; and Patricia A. Ilyland. RX. B.S..:\I.5.,
;\I.Ed.. Ed.D. Help your students learn how to measure
patients' physiological and psychological adaptation to stress
- and use t11is infonnation to plan and implement nursing
interwn tion. Part I descrihes theory and Part II shows how to
apply t11ese concepts. Case studies are used throughout.
;\Iarch. 1979. Approx. 192 pp.. 47 mus. About 810.75.
Xew 4th Edition! :\TRSIXG C\RE IX EYE. E.\R.
XOSE, .-\..'XD TIIRo.\T DISORDERS. l3y William II.
Saunders. ;\1.0.; ,,'il\iam II. IIan..ner. 13..\..1\1.1).; Carol Fair
Keith. R.X.. B.S.X.. ;\1.5.; and Gail Havener. R.X. ll1is new
edition will help students increase their understanding of the
pathophysiology. sign ificant signs and symptoms. treatmen t.
and pre\'ention of EEXT disorders. Discussions emphasi.æ
the nurse's growing role in the health caI"(' system. including
outpatient. inpatient and homegoing preparation situations.
Febmary. 1979. .\pprox. 464 pp., 386 illus. Ahout
20.50.
Xc,," Yolume I! CrRREXT PR\CTICE IX XI'RSIXG
C\RE OF THE ILL ADl'LT: Issues and Concepts. By
;\Iaureen 0. Kennedy. R.X.. 1\1..\.; and (;ail ;\Iolnar. This
contempomry new \'olume examines the e\'eryday prohlems
encountered by nurses in the medical-surgical unit. Three
sections cover current practices (assessment. serious
illness). current concepts (patient-nurse interactions. new
tools for nursing). and current issues (nursing diagnosis.
primary nursing). Key professional issues and their
implications arc discussed t11roughout. and many timely
topics arc featured. Febmary. 1979. .\pprox. 320 pp.. 20 illus.
About 814.50 (llardcovcr):.\hout 810.75 (Paperback).
Xc,," Yolume [! CrRREXT PERSPECTIVES IN
REIIABILIT:\TIOX XrRSIXG. Edited bv Rosemarv
1\lurray. ;\I..\.. R.X.; and Jean r. Kijek. 1\1..\.. R.X. Xurse
.
psychiatrists. physical and occupational therapists. speech
pathologists. and other rehabilitation team professionals-
all join fi)rces toprm;de your sludents with valuahle insights
on all facets of this important topic. Particularly noteworthy
chapters deal with cultural implications. biofeedhack. sexual
therapy. and rehabilitation nursing in the ICU. ;\Iarch. 1979.
.\pprox. 256 pp.. 11 illus. About 814.50 (Hardhaek):.\hout
810.75 (Papcrhaek).
.\ Xew Book!APRACTICALM.
'Xr.\L FORPATIEXT
TE.\CHIXG. Edited b.... Karen 5. Zander. R.X.. 8.5.X., ;\I.S.;\;.;
et ai. This new manua(serves as a model and tool for a svstem
of patient leaching and documentation. It presents te
ching
plans and guidelines foranystage of the educational process.
and describes objecti\'C methods for evaluating the patient's
understanding. Each patient teaching fonn encompasses a
purpose. content outline. learner olliectives and e\'aluation.
Special features include a practical punched and peIforated
fonnat. and sample handouts for patients and families.
Septemher. 1 Y78. 412 pp.. 27 illus. Price. 816.75.
MA'IDWAL/ODLD
HEALnt
NeV.' 3rd Edition! MATERNITY NPRSING. By
Constance Lerch. R.N.. RS.(Ed.); and V. Jane Bliss. R.N:.
B.S.!'\.. M.S.X. Emphasizing t11e family aspects ofbirtb. t11is
comprehensive text provides a broad overview of obstetric
and neonatal nursing. Students will benefit from well
illustrated. detailed chapters on reproductive anatomy.
nonnal and high-risk pregnancy, and alleviation of pain.
Timely new material focuseson male and female responses to
pregnancy and birth. maternal-infant bonding, and
congenital heart defects. 1978. 592 pp.. 269 illus Price,
819.25.
4t11 Edition.
IATERXIn' l\lJRSING: A Self Study
Guide. By Constance Lerch. R.N.. B.S.(Ed.); and V. Jan
Bliss. R.N.. B.S.N.. M.S.X. Stimulate class discussion wit11
this helpful workbook! Beautifully correlated with the
chapters in MATERXI1Y l'\URSIXG. it offers students an
excellent vehicle for self-testing or group study sessions.
Incisive questions probe such topics as: family planning,
high-risk pregnancy. and the nonnal put:rpcriulll and ù1e
recovery nursery. 1978. 228 pp.. 60 illus. Price, 89.00.
A Xew Book! l\TITRSIXG CARE OF INFANTS.AND
CHILDREN. By Lucille F. Whaley. R.I'\., M.S. and Donna
Wong. R.I'\.. M.N.. PXA-P. A comprehensive. practical
approach to pediatric nursing. t11is new book focuses on
distributive nursing care. and uses a systems approach from
the medical model. The authors examine care of the ill or
disabled child, and stress promoting the healt11 of t11e well
child. Among t11e highlights. you'\1 find pertinent guidelines
for action. . . communication with children and families. . .
pertinen t lab data and phannaculogy . . . more than 250 tables
and 400 illustrations.. .andanappendixofnonnalvaluesand
assessment tools. April. 1979. Approx. 1.400 pp.. 744 illus.
\bout
24.00.
A ;\Iew Book! CHILDBEARING: Physiology,
Experiences, Needs. By Jayne DeClue Wiggins.R.I'\., B.N.
1.
This new text will help your students learn how to develop
expectant-parent education programs. It views labor as part
of the much larger process of childbearing - and deals with
the entire pregnancy period. prenatal. the actual birth
experience. and postnatal Almost 200 illustrations amplifY
the discussions. May, 1979. Approx. 144 pp.. 192 illus.
About 89.75.
A Xew Book! MEXTAL RETARDATIOX: Xursing
Approaches to Care. Edited by Judith Bickley Curry, R.X..
M.S.; and Kathryn Kluss Peppe. R.N., M.S.; with 23
contributors. Stressing a family-centered, humanistic
approach. this thought-provoking text explores
contemporary concepts in the care of the mentally retarded
and their families. Students will read definiti\'e. original
articles on: methods for maximum family involvement;
developmental assessment; and quality assurance in
residential settings. April. 1978. 258 pp.. 45 illus. Price,
MIO.75.
IVIOSBV
TIMES MIRROR
24 Jenuary 1971
The Can-.llen Nur..
Put our exPertise
to work in
your elassroolU.
CRITICAL CARE
A Xew Book! MOSBrS
1.-t.'\LTAL OF CRITICAL
CARE: Practiccs and Proccdures. Bv Linda Feiwell Abels,
R.X..
1.
. Offer your students clear. c
ncise instructions on
basic critical care techniques witl1 this useful new text.
Emphasizing systems assessment. it details mtionales and
pnxedures necessary for maintenance ofbody homeostasis.
Practical. comprehensi'\'C tables and useful appendices are
included - and margin indicators highlight significant
material thnHl
hout the hook. ;.larch, 1979. .\pprox. 254 pp..
laO illus. .\hnut
12.00.
A Xew Book! MOSBrS l\L-t.,\TUAL OF EMERGEXCY
CARE: Practiecs and Proccdures, By. Janet Miller Barher,
R.X..
I.S.; and Susan A. Budassi. R.N., M.S.X. This hea\ilv
illustrated new book offers your students a quick reference t
assessment skills and specific techniquestè:)r life supportand
stabilimtion of the critically ill or injured. Arranged in a handy
outlined fonnat, disucssions stress: signs and symptoms;
intenelationships of pathological phenomena; and critical
criteria and decision-making. May. 1979. Approx. 455 pp..
404 illus. .\hnut
lü.75.
Xew 2nd Edition! E
fERGEXCY CARE: Asscssmcnt
and Intcn'cntion. EditedbyCannen Gennaine Warner. R.N..
P.II.X.; with 38 contributors. Emphasizing an
interdisciplinary approach. !be new edition of this highly
acclaimed book shares the insights of authorities in all areas
of emergency care. They first describe underlying concepts,
then focus on specific types of emergencies. Students will
benefit from new chapters on child abuse, sexual assault. and
spinal cord injuries. April. 1978. 556 pp., 226 illus. Pricc.
2().:)().
A Xew Book! HANDBOOK OF E)IERGEXCY
PHAR..\L\COLOGY. By Janet :'-1. Barber, R.X.
1.s. This
practical manual will provide your students witl1 concise.
up-to-date infonnation on frequently used emergency drugs.
Detailed sections - organized according to drug action -
outline generic and tmde namcs. adions. incompatihilities.
administrations. adult and pediatric dosages. contraindica-
tions. and ad\'Crsc reactions. Ocwbcr. 197H. 150 pp_ Price.
R:;O.
.\ Xew Book! .\.\CX ORG.\XIZ.\TIOX .\XI>
M.\X.\(
E
IEXT OF CRITIC\L-C\RE F.\C1U fIES.
Edited hy Diane C. Adler. R.:\:., ;'1..\.. CCRX; and Xonlla. L
Shoemaker, R.x.. BSX.; wilh la contrihutors. This unique
new hook is the first to relate OI-gani.tation and management
concepts directly to critical care facilities. Contrihutors
wcll-known in the field dbcuss how to assess the intensi\'c
care unit. plan k)r optimal function. and manage available
resources. Con Slant attention is given to individual
accountahility and the importance of teamwork in the lCU.
.\pril. 1979. .\pprox. 192 pp.. 32 illus. .\bout f415.10.
FUNDAMENTALS
;\íew 10tl1 Edition! TEXTBOOK OF XXATOMY A.
D
PIITSIOLOGY. By Catherine Parker Anthom'. R.I'\.. B.A.,
:'-1.S.; and Gar
.. Arthur Thibodeau. Ph.D. Depend on the
leading text in the field for a precise. comprehensive. and
up-to-date presentation of human anatom\o. The new 10th
edition has heen thoroughly re'\'ised and no
' includes; more
than 200 full-color illustrations; new chapters on
articulation. the immune system, and the endocrine s'\'stem;
and expanded discussions throughout. January. -1979.
Approx. 672 pp.. 570 illus.. including 211 in 4-color. 20 in
3-color; and 238 in 2-color. About
21.75.
Xew 10th Edition! "-t.
ATO)n' .-t.
D PIITSIOLOGY
L\BORATORY :\L-t.'\"'CAL. B\' Catherine Parker Antl10nv
R.X.. B.A..
LS.; and Garv Arthur 111ibodeau. Ph.D. Th
companion lab manual to-Antl1Ony's TEXTBOOK has also
been ù1Oroughly re\'ised - and is the ideal way to give YOl1\'
studcnts firsthand pmctice in applying the scientific method
to anatomy and physiolo/.,'Y. Highlights indude: measurable
olÜectivcs for each exercise; more emphasis on pathology;
and the addition of 20 new experiments! .January. 19ï9.
"\pprox. 240 pp.. 169 illus. About
9.75.
:\:ew 2nd Edition! THE ;\lJRSIXG PROCESS: A
Scientific Approach to Xursing Care. B\' Ann
larriner.
R.X.. Ph.D. The autl10r has compiled 290ut-;'tandingarticles
dealing with each phase of the nursing process -
assessment. planning. implcmentation. and e'\'aluation. Each
group of readings is prefaced by an insightful introduction
and followed by an cxtensive hihliography. .January, 1979.
Approx. 288 pp.. 6 illus. .\hnut
12.00.
ew 2nd Edition! FUXDA..\IENTALS OF OPERA-
TING ROO)I ;\TRSIXG. Bv Shirle'\' M. Brooks. R.X., B.A
Written especially for studénts with no operating room
experience. this valuable text thoroughly details
fundamentals of preoperative. intraoperath'e, and
postoperative care. The book is specifically designed to be
used by students concunently with their rotation in the
operating room. A photo-re\'iew quiz is pro,\oided to aid the
student in evaluating proficiency.
larch, 19ï9. .-\pprox. 21 G
pp.. 2Hl illus. .\hout
1O.2:;.
ew 4th Edition! CLIXICAL
TRSIXG TECH-
'XIQrES. By !\:"onna Dison. R.X.. B.A.. M.A. Guide your
students through basic and advanced techniques in
medical-surgical nursing with tl1e help of the new edition of
this well-recehoed text. They1lIearn procedures step-by-step
from authoritati\.c discussions. augmented hymore than ï03
original line drawings. Principles and purpose are
emphasi.ted rather than disease orhody systems. A teacher's
guide is included .\pril, 1979. .-\pprox. 432 pp., 703 illus.
"\bout
14.:;O.
The c.on-.llen Nur..
Jenuery 1871 25
Xcw 14t11 Edition! PIL\R.\L\COLOGY IX :\TRSIXG.
By Betty S. Bergersen, R.X.. :'-I.s.. Ed.D.; in consultation with
Andres Got11.
1.D. Trust this classic text to pro....ide your
students witI1 the infonnation the.... need to ensure rational
amI optimal drug thempy. 111e auihor has updated all drug
infonnation - and each chapter has been critically rc....iewed
by Andres GoÙl. renowned authority on phannacology.
Highlights include: expanded cm'eragc on drugs for t11e
eldcrly; new infonnation on enzymes and drugs acting on
gastrointestinal organs; and all new chapter summaries.
January. 1979. Approx. 784 pp.. 100 illus. .\bout
20.:;0.
CO
D
TIT
1ßSING
A Xew Book! IXXOYATIOXS IX CO
nlrXI1T
HEALTH :\LJRSIXG: Health Care Delivery in Shortage
Areas. Edited by Anne R. Warner. B
\.; with 23 contributors.
Offer your students a creative approach to community health
nursing. This timely book bridges the gap between the real
and ideal by presenting first-person accounts of the
challenges inherent in inner city and rural practices.
Inno....ati....e solutions to both timeless and new problems are
described. pro....iding an effecti....e demonstration of the
decision-making process in action. March. 1978. 250pp.. 23
illus. Price,
10.25.
Xew Yolume I! CrRREXT pR.\mrE IX GEROX-
TOLOGIC\L XrRSIXG. Edited by Adm'! :'-1. Reinhardt,
Ph.D.; and :'-lildred D. Quinn. R.X..:'-1.S.; with 19contributors.
The politics of care for the aged . sexuality and aging. . .
growing old in thc Black community .. thelawand t11e elderly
- these arejusta few of the many stimulating topics detailed
in this new book of readings. The contributors are all
knowledgeable and experienced - and together they offer
your students a thorough m'erTiew of the sUQject. :'-Iarch.
19ï9. Approx 304 pp. .\hout
14.:;O (Hardhack): -\bout
1O.7:; (Papcrback).
A Xew Book! THE A..'XTHROPOLOGY OF HEALTH.
Edited by Eleanor E. Bauwens, R.X.. Ph.D.; with 23
contributors. Help students better understand the dÎ'\'erse
beliefs of other cultural groups with this new text. Original
papers apply anthropological principles to health care;
explore the relationship of medicine to culture, society and
health carc; survey changing food habits in \'Rrious cultural
groups; and discuss the sociocultural aspects of aging and
d'\ing. Case studies illustrate major concepts. September.
19ï8. 228 pp.. illustralcd. Price.
12.7:;.
ISSUES
'
nm,rns
A Xew Book! :\TRSIXG: A World View. B'\' Huda
Abu-Saad. Ph.D.. :'-I.X. B.S.X Yourstudentswillenj
y-and
benefit from - this unique new text. It pro....ides a worldwide
historical perspecti....e of nursing. co....ering the growth and
de....elopment of the profession in more than 30 countries.
Useful tables summarize de....elopments in '\'Rriouscountries
for quick comparison. :-larch. 19ï9..\pprox.208pp.,14illus.
About
I:;,OO.
.\ Xcw Book! SPECIAL TECHXIQrES IX
.\SSERTIYEXESS TRAIXIXG FOR WOMEX IX THE
HEALTH PROFESSIOXS. By Melodie Chene....ert, B.A.,
I.s. Written with humor and insight into human nature, this
text focuses on learning to be asserti....e in order to impro....e
patient care. Discussions demonstrate ùle significancc of
de....eloping greater self-esteem and stronger leadership roles.
Examples of specific situations clarify key concepts.
Throughout, the author differentiates between effective
asserti....eness and abrasÎ'\'e aggressÎ'\'cness. Xm'ember.1978.
Approx. 128 pp.. 13 illus. About
9.7:;.
Xew \'olume I! CrRREXT PERSPECTIVES IX
:\TRSIXG
L\XAGÐIEXT. Edited by Ann :'--Iarriner. RX,
Ph.D. Twent\ noted nurse leaders ha\'c contributcd
insightful articles focusing on specific infonnation that
beginning middle managers need to know. Students will
benefit from discussions including use of teams in health
scrvÎCcs. planned change. communication. patient
education. continuing education. and political dynamics.
:-larch. 19ï9. .\pprox. 240 pp.. 8 illus. \bOl1t
14.50
(llardback):.\bout
10.75 (Papcrback).
PRA.cnCAL
TßSING
Xew 3rd Edition! BASIC PEDL-\TRIC XrRSIXG. B'\
Persis ;\Iary Hamilton. R.X.. P.H.X. B.S., ;\I.s. Help you"r
students better understand the special needs of their
childhood patients. This useful text pinpoints the spccific
role of the LP/YX in child care. prm'ides comprehensh'e
infonnation on growth and de'\'elopment,examinesdisorders
common to children, and offers a holistic \'iew of the child in
society. Timely. well-illustrated new discussions explore
neonatal care, immunization. and diagnostic tests. February.
1978. 490 pp., 272 illus. Price,
1 a.25.
Xew4th Edition!
L\TERXAL.-\XDCHILD HEALTH
:\TRSIXG. By A Joy Ingalls. R.X, ;\1.s.; and
1. Constance
Salerno. R.X.. :-1.s.. S.X.P. Well-written and effectively
illustrated. this new edition introduces the LP!\'X student to
major challenges in maternal/child health nursing. It
successfully combines obstetric and pediatric nursing - so
\'our students will know what to do, how to do it, and whv.
Thoroughly re'\'ised. this new edition includes more t11an 200
new illustrations - and updated infonnation in all areas.
:-la
, 19ï9. .\pprox. f)ï2 pp.. f)9:
illus .\bout
1 H.OO.
IVIDSBV
TIMES MIRRDR
THE C. V. MOSBY COMPANY, LTD.
B6 NORTHLINE ROAD
TORONTO, ONTARIO
M4B 3E5
Mosby kno
s nursing.
he pr. blem
· f immunizati · n
in anad ·
Sandra LeFort
,
I
\ , \
I
;, ,...
r - J
. . -.
I
. ,
. J
J I I
,
I '"' p
- -
The Cen-.llan Nur..
Januery 11171 77
Few measures in preventive medicine are of such proven
value and as edsy to implement as routine immunization
against infectious diseases. J Over the last three decades.
widespread acceptance of vaccines has dramatically
decreased the incidence of certain communicable disedses
such as poliomyelitis and whooping cough. According to the
World Health Organization even smallpox. the most
devastating disease in history. has been completely
eradicated from all countries in the world.
But with all this success. there is evidence that
immunization may be lagging in Canada and that some
vaccine-preventable diseases such as diphtheria. may
actually be on the increase. Are you aware. for example. that
in Canada in 1975. nine children died from whooping cough.
two from diphtheria. seven from measles and two from
rubella?" Each year. more than 100 babies are born with
serious defects because their mothers had rubella during the
first three months of pregnancy. Why is this still happening
in a highly developed country such as Canada?
Immunization programs have been going on since the
40's. but most parents. and medical per'\onnel for that
matter. have forgotten the tragedy ofthe polio epidemic of
the 50's. As a result. the recurrent need for immunization for
both children and adults does not seem as apparent as it once
did. As the 1977 annual report of the Canadian Medical
Association's Council on Communit} Health stated:
. 'I t is clear that the public is being lulled into a false sense of
security because of the absence of epidemics of the usual
childhood diseases and is neglecting to have young people
receive the recommended immunizations'"
Which leads us to another question ... What is the
recommended schedule of immunizations'? The debate about
"which schedule is best" has been going on for some time
between medical authorities at all levels - at the local.
provincial and national levels. In 1977. a National Advisory
Committee on I mmunizing Agents agreed not on one but
three immunization '\chedules for infants and children. The
rationale for choosing three schedules was that "no single
set of recommendations for the use of these vaccines is
optimal for all situations." At that time. the committee
believed that there was not enough evidence to support one
schedule unreservedly and that all three are equally
effective.
It sounds good. But. according to a recent editorial in
the Canadian Medical Association Journal. there is still a
problem. Apparently. the provincial health departments do
not necessarily follow the recommended schedules. local
public health authorities at times do not follow their own
provincial programs and finally. some individual physician..
establish their own preference in immunization schedules. If
medical duthorities are openly unsupportive of each other. it
is no ..urprise then that the public is in the dark.
'The public is confused regarding what immunization
they have had. should have had or require. A sizable
segment of the health professions is not much better off.
"Adding to the confusion are an increasingly mobile
population moving to and from areas with varying
immunization record transfer and patients who have no
personal record or idea regarding what they or their children
have been immunized for - or their current immunization
status. ..:t
Part of the sol ution. according to the editorial. is the
acceptance of a single immunization schedule by all health
departments and health professionals. Recently. ajoint
committee of the Canadian Hospital Association. the
Canadian Medical Association. the Canadian Nurses
Association and the Canadian Public Health Association
supported ,his idea by proposing that all these agencies
should accept as a high priority the establishment and
promotion of a basic. single. national immunization schedule
and program. CNA's Board of Directors ha.. given its
support to the recommendation.
At a meeting of the National Advisory Committee on
Immunizing Agents held in late October 1978. this
recommendation and others from various groups were taken
into account and now. a single. immunization schedule has
been adopted. (See page 29)
Even so. the main problem of keeping Canadian
children and adult, protected from communicable diseases
remains with us. Media campaigns are trying to keep the
subject of immunizatIOn in the public eye. A concerned
committee has made November "Immunization Action
Month". Its immediate objective is to promote immunization
against vaccine-preventable diseases for all children in
Canada before the age of school entry.
And so. what is your part in all this? By virtue of your
role as a nurse. whether in a hospital. public health unit or a
doctor's office. you are in contact...... ith a great number of
children and parents. Have you taken the time lately to talk
about immunization to them. ih importance to their health?
Have you encouraged primary immunization of all children.
stressed the need to schedule vaccinations and emphasized
why booster doses are necessary? The following
"Immunization Fact Sheet"" prepared for parents by the
Canadian Paediatric Society and the Canadian I nstitute of
Child Health may be of some help to you as a nurse in
pointing out the whys and ho......s of an immunization program
to clients.
21 Jenu8ry 11179
Th. c.on-.llen Nur..
Immunization Fact Sheet
1. A re ÏI!fectious diseases a prohlem in Canada?
It is astoni'ihing that while notahle results have heen
achieved in the control of whooping cough. measles. ruhella.
polio. tetanus. mumps and diphtheria - the major
preventable childhood diseases - infectious disease'i are
still among the four leading caU'ies of hospitalization of
children (with accidents. respiratory problems and
congenital anomalies being the other three). Many of the'ie
infectious disea'ies could he prevented hy immunization.
2. Do children eI'er die from prel'entahle diseases?
Some children 'itill die each year from these diseases and
others develop serious complications such as encephalitis.
pnl?umonia and hearing loss. One study show'i that ahout one
in ten children who have measles develop complications.
3. Where can I Ret m\' child imllll/1/ized?
In thi'i country many places are availahle to provide
immunization and this varies greatly from province to
province. Your child may be immuni7ed in public health
departments. community clinics. hospital clinics. and
schools or thi'i may he carried out hy family physician'i or
pediatricians.
4. Who should I..eep the record?
As a parent. you should keep a written record of the vaccines
that your child receives and the date of the injection. No one
else is going to do this for you. You", ill need this
information if your child is taken to emergency for treatment
of wounds. for example. In this case. the doctor will need to
kno", if the child's tetanus immunization is ddequate.
Immunization information is al'io required when your child
begins school and if immunization i'i part of the school health
program. you will need to know what has already heen given
and when. I t is al'io needed if you move to another locality or
travel ahroad. Recently. a new immunization health record
wa'i prepareu hy the Infectiou'i Di'ieases Service at the
HO'ipital for Sick Children. It will he extensively used and
distrihuted throughout the province of Ontario as a
permanent record for children. (See page 30)
5. W hell should my child hi' Ïlnm/l/liznland fár what
diseases?
I mmunization should be 'itarted hy two or thl ee months of
age and should follow a schedule as recommended by your
puhlic health clinic or your doctor. Booster shOb. given at
intervals following the primary immunization. are necessary
to reinforce the child's immunity.
6. What should I\'e do
{we plan to trlll'el outside Canada?
Because it may take several weeks. be sure 10 check in good
time with your doctor or puhlic health department. Several
immunizations may he needed depending on the country you
plan to visit.
7.1 s immulli;:.ation a mi/ahle jllr all infe( tious diseases?
No. but re'iearch is in progress to provide protection against
diseases such as chicken pox. gonorrhea and infectious
mononucleo'iis.
8.1 s there a way to protect my child aRainH di.\'ea.\es JÓr
It'hieh there i,\' no ,'accine?
In some instances. temporar} protection may be given or the
disease modified. Check with your pediatrician or local
health duthority.
9. What is the risl.. (!{damage to a hahy ({the mother
del'elop.\. ruhella during the }ìnt three month, of the
{lreR/wncy?
Overall. there is approximately a 50 per cent risk (0 the
baby. The earlier the maternal infection occurs during
pregnancy. the more severe the fetal damage. The most
common problems are heart defects. deafness. blindness
and mental retardation. A pregnant woman should not
receive rubella vaccine.
10. ffmy teena,l!e dauRhter has ne"cr heen immunized'/Ór
ruhdlaand la/11uncertain (fshe e"er Iwd the disease. It'hat
.\JlOuld she do? 1.\ it too late for her to he immunized?
No. it's never too late to immunize against ruhella. A simple
hlood test can he done to determine whether vaccination is
necessary.
1 I. ffm," child JIlI,\' Jwd polio \'accine h,' needle and I\'e mm'e
to a place II'liere polio n/ccille is g;,'en h,'. mouth. is it
nece.Hary ami s(dé for the' child to he renlCcillated?
Regardless of whether the fir'it immunization was by needle
or by mouth. if further dO'ies are needed it i'i perfectly safe to
follow the practice of where }ou are living.
12. What should I do (/1 su.\'pect my child hm all ÏI!féctiOlH
di,\' e a.\(' ?
Keep him at home and contact your physician for further
advice. ..,
References
I Routine immuniz,ttion 'ichedules.Call..'11ed.A.,..\..J.
117:6:705. Sep. 17. 1977.
:! Canada, Statistics Canada. Registrie'i Section. Health
Division. IV ot!lìah/c' Diseases - Vital Statistin ami Disease.
3 Geekie. D.A. Promotion and marketing techniques
could helpCanada's disorganiLed immulllzation 'ichedules.
Call.Aled.A.u.J. 119:
:76()-76:!. Oct. 7. 197K
4 11I/1111l11izat;o/1 Fact S 11('('1. Canadian Pediatric Society.
Canadian Institute of Child Health. 1977.
The Cen-.llen Nur..
Jenuery 11171 211
NATIONAL ADVISORY COMMITTEE ON IMMUNIZATION
RECOMMENDED* IMMUNIZATION SCHEDULES FOR INFANTS AND CHILDREN
Immunization carried out as recommended in the following revised schedules will provide good basic protection for most children against the
diseases shown.
With respect to tetanus and diphtheria, the schedules pertain to use of either fluid or absorbed toxoids. but in view of their superior antigenic
properties. the use of absorbed products is to be recommended when such products become available.
Both live and inactivated polio vaccines have been used in Canada with equal success in preventing the occurrence of paralytic poljo, and
either may be used in the schedules presented below.
Tabte 1
Routine Immunization Schedule For Infants And Children
2 months Diphtheria
4 months Diphtheria
6 months Diphtheria
12 months Measles
18 months Diphtheria
4-6 years Diphtheria
11-12 years Rubella I for girls
14-16 years Tetanus and Diphtheria 2
Pertussis
Pertussis
Pertussis
Mumps
Pertussis
Pertussis
Tetanus
Tetanus
Tetanus
Rubella I
Tetanus
Tetanus
Polio
Polio
Polio
Polio
Polio
Polio
Table 2
Immunization Schedule For Children Not Immunized In Early Infancy
For children 1 through 6 years of age
First visit' Diphtheria
Interval after 1 st visit
1 month Measles
2 months Diphtheria
4 months Diphtheria
16 months Diphtheria
At 11-12 years of age Rubella I for girls
At 14-16 years of age Tetanus and Diphtheria"
For children 7 years of age or over
First visit'
Interval after 1 st visit
1 month
2 months
14 to 16 months
At 11 -12 years of age
At 14-16 years of age
Pertussis
Tetanus
Polio
Mumps
Pertussis
Pertussis
Pertussis
Rubella I
Tetanus
Tetånus
Tetanus
Polio
Polio
Polio
Polio
Tetanus and Diphtheria'
Polio
Measles
Tetanus and Diphtheria"
Tetanus and Diphtheria!
Rubella I for girls
Tetanus and Diphtheria 2
Mumps
Rubella I
Polio
Polio
Polio
Notes:
1. Rubella vaccine is recommended either
a) for all infants over the age of one year or
b) for prepubertal girls at about the age of 12 years.
At the present time. insufficient data are available as to which is the more effective program for preventing congenital rubella syndrome.
2. Tetanus and Diphtheria Toxoid. a combined preparation for use in persons over six years of age, contains less diphtheria toxoid than
preparations given to younger children and is less likely to cause reactions in older persons. If it is not available, other combined preparations of
diphtheria and tetanus toxoids (without a pertusis component) may be used in a dose recommended by the manufacturer for the particular age
group.
3. Although not desirable. measles. mumps and rubella vaccines may also be given at the first visit if it is considered likely that a child will not
return for further immunization.
4. Measles vaccine (live, attenuated) may be given either alone. or in combination with rubella vaccine. mumps vaccine or both. In areas where
special epidemiological conditions exist. and particularly where measles occurs frequenlly in the first year of life. measles vaccine may be given
as early as five or six months of age; if measles vaccine is given before 12 months of age. it is imperative that a further dose be given at about 12
months of age. as persisting maternal antibody may interfere with an adequate immune response to the earlier dose.
5. Where more than one preparation is given. whether they be single vaccines or commercially prepared combinations of vaccines. a separate
injection site should be used for each product.
6. Smallpox vaccination is not recommended.
*These recommendations were issued by the National Advisory Committee on October 27, 1978 and have been
endorsed by the Canadian Paediatric Society.
30 Jenuery 1117V
The C.n-.llen Nur..
The Hospital for Sick Children
IMMUNIZATION
AND HEALTH RECORD
Name of Child
Birth Date
RECORD OF IMMUNIZATION
DPT + Polio Vaccine
:
rn B DT + Polio Vaccine
in B
First Dose Date Booster Date
Second Dose Booster
Third Dose Booster
Fourth Dose
Booster Dose
Measles Vaccine
Mumps Vaccine
Rubella Vaccine
Date
Tuberculin Test
Date
Results
Hemaglobin Date Results
Urinalysis
Vision Test Date Results
Hearing Test
Illnesses & Operations Date Past Infectious Diseases Date
Measles
Mumps
Chicken Pox
Whooping Cough
This Record Should Be Retained And Kept Up To Date
The Cen-.llen Nuree
Jenuery 1117V 31
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aren't problems
anymore
At this hospital, there's a nurse in street clothes that nurses,
patients and their families can turn to for help in meeting the
emotional needs of the "problem child" on the general
pediatric ward.
Kathy He[?ll(loren
32 Jenuery 111711
For the past three years our hO'ipital ha'i
been the scene of an interesting and. we
think. successful. experiment aimed at
making sure that. when a child is
admitted to our general wards. not just
his physical. but also his emotional.
needs are looked after. As the "pediatric
psychiatric nursing coordinator" - a
title suggested by one ofthe staff
members - it is my job to provide
leadership in dealing with psychiatric
patients admitted to general pediatric
wards and a,sistance in handling any
other behavior management problems
encountered throughout ourChildren's
Pavilion.
In recent years the trend at our
hospital. as in many others. has been to
admit an increa'iing number of children
with psychiatric diagnoses to general
pediatric wards. More and more
behdvioral problems manife,ted during
medical or surgical hospitalÌ7ation are
al'io being identified on wards. These
children require a consistent therapeutic
regime to meet their 'ipecialized needs
and. while it is sometime'i easy to
identify what a particular child's needs
may be. difticultie, frequently ari'ie in
providing the neceS'iary nursing hours.
Dealing with emotionally distressed
children can be very time consuming and
'itaff tend to give priority to providing
care for the acute medical and surgicdl
conditions. Then too. some nursing staff
are uncomfortable about being involved
with children admitted for psychiatric
help; others are he...tant due to lack of
e'l.pcrience or previous unrewarding
experiences.
It wa'i in response to these concern'i
that the administrative staff and child
psychiatrist decided to create and till the
position of pediatric psychiatric nursing
coordinator - a nUf'\e who would help
The C.n-.llen Nur..
other nurses to find ways of meeting the
emotional needs of their patients. The
job description made 'ieveral points clear
from the beginning:
. The per'ion Wa'i to be employed at
the general duty level to prevent the
necessity of developing a new nursing
category within the hospital.
. Hours of work were left tlexible to
allow the nurse herself to determine
which days she would work and at what
time her tour of duty would begin.
. This person would be directly
responsible to the assistant director and
supervisor of pediatrics and indirectly to
the head nurses of the pediatric units.
When I accepted the position of
pediatric psychiatric nursing coordinator
late in 1975,1 had already worked for
three years in adolescent psychiatry. The
administrative staff. who predicted that
the succe'iS of the program would hinge
on my acceptance by everyone on staff.
planned a very special kind of orientation
for me. We wanted to make sure that all
levels of staff saw me first as a nurse with
tmditional competencies and second a'i a
nurse who could help with specific
p'iychiatric competencies. 1 had to avoid
being perceived as a suspicious looking
"expert" telling others \\hat to do. With
these ol:iectives in mind I began my tour
of duty as psychiatric nursing
coordinalor in uniform. working general
duty on each ward for varying periods.
Different wards demanded different
involvement. A., most of my work would
be with children between 'iix and thirteen
years of age. 1 spent a \\eek on these
wards. I spent three days on wards with
children between the ages of eighteen
months and six year'i and two day'i on
ward., with infants up to eighteen
months. It was more ditlïcult for staff
caring for infants to see much use for a
psychiatric nurse. except in the area of
dealing with parents.
This orientation period provided me
with an opportunity to appreciate
nursing problems at different levels of
treatment. to become acclimatized to
each unit and to sow seeds of
information about how this consultant
role might develop. The orientation
lasted almost two months. and. as it
drew to a close. I found myself eager to
begin my actual work. My eagerness.
however. was coupled with a twinge of
anxiety: as this was a unique position.
there had been no previous experience
from which performance criteria or
expectations could be drawn. At time'i I
wondered "What am I really getting
into?"
All this wa, three years ago and by
now I feel more comfortable about being
the psychiatric nursing coordinator on
pediatrics. I wear streetclothes which
seem to have been readily accepted by
both staff and patients and. although
there have been times of personal
alienation when I felt a., if I didn't
belong. in general. the demand for
p'ychiatric competencies has increased.
Most of the time I feel that my days are
well 'pent. The work varies: the list of
activities I have been involved in is long
and includes:
· C oordinlltion (
"lI11llspects of the
psychiatric trealmem program:
physiotherapy. occupational therapy.
\chool. parents, etc.
. W eeMy coriferences with \'lIrioll.
stajJ in\'OII'('(1 with the child
psychiarri,ft's patients. This meeting is
primarily for planning short and long
term treatment goals. school planning
and discharge planning. A record is kept
of the discus,ion.
. N lining care planning: team
conferences on a/l of the psychiatrist's
patients frequently includmg other
specific behavior management problems
that have been raised by nursing staff. As
a result ofthe'ie conferences. st.mdard
nursing care plans on some common
psychiatric problems have been
developed including h
perkinesis and
school phobia. A guide for developing
behavioral-oriented nursing care plan
has been posted. In addition. a charting
guide for children with behavior
problems has been developed and is in
the process of being accepted a., pan of
the charting manual.
. I nser\'Ìce education: This aspect of
consultant work is usuallv done through
specific ward ses.,ion
but is also an
ongoing process in team conferences. A
growing collection of re'iource material is
available to all interested staff. Staff are
also invited to attend the weekly student
intern seminars given by the child
psychiatrist.
. Student nurst' education: Student!.
are free to attend team conferences and
inservice to gain understanding in this
panicular aspect of care in pediatrics.
Their interest in helping children\\- ith
psychiatric problems is also reflected
through requests for guest speakers in
their training program.
. Liaison wor/.. with parents: Parents
meet one evening a week with the
psychiatrist and ward staff and often
discover that they are not the only ones
with "problem children". Parents of
babies in the Neonatal Intensive Care
Cnit meet twice a week to share their
fears and questions with unit staff. the
pediatric social worker and myself. This
service is unique in that it is abo offered
to mothers who have gone home without
their babies and wish to share their
anxietie
before and after baby comes
home.
. Group therapy: a dailv. two-fold
re
pon.,ibility in that group therapy is a
well e.,tablished form of treatment for
children with psychiatric problems.
serving to teach communication skills
The Cen-.llen Nur..
and to seek out alternate ways to deal
with life's stresses. It is also a teaching
ground used to instruct staff in various
group techniques and group dynamics.
The after-group sessions with staff
provide more teaching opportunities and
a chance to discuss day-by-day
developments.
. Obsen.ation and .mpen'ision oj a
comhined Rym proKram: This is a
relatively new program where the
pediatric psvchiatrist's patients are
grouped with adolescent psychiatric
patients once a week for various sport'>
activities. Our hope is to use this
program to teach better sibling and peer
group understanding.
. Bi-wee/../yfilm entertainment for
preschool and ScllOol-aKe patients: The
National Film Board is our present
,>ource of films but other sources for
children's films are being looked into.
The hospital has agreed to provide some
monies for film rentals in the next year.
. Teacher-coordinator liai.wn: I\lany
of the problems of children with
psychiatric disorders stem in part from
disastrous school experiences. It
becomes the task of the therapeutic team
to help each child cope with <,chool
stresses. Having a close working
relationship with the hospital's special
education teacher. keeping her informed
of daily de\elopments. has improved
communication between ward and
clas
room staff.
. School-community liaison: The
psychiatrist. his intern. the in-hospital
teacher. m}-selfand. when po'isible.
ward staff meet with the involved
teacher; and the parents at the
community schools. There we discuss
what we have learned about a child and
his family. giving teachers more
background. understanding and help in
devising effective long term school
plans.
Jenuery 1117i 33
The future
To me. one of the most challenging
aspects of this position is the idea that it
is
till evolving. I meet regularly with the
assistant director of pediatrics who
provides guidance and assistance a<; well
as feedback on how the job is going. In
the future the role of pediatric
psychiatric nUßing coordinator can take
many directions. One avenue which ha
been looked at with an eye to future
expansion is t.tJat of parents' groups for
patients with common concerns. The'ie
groups might discu'is the art of parenting
or problems associated with failure to
thrive. a'ithma.leukemia or orthopedic
conditions. Post-discharge group
for
parents and children can be valuable in
the promotion of well-being and
prevention of repeated hO'ipitalizations.
Home visiting is also an area ripe for
expansion. My involvement in the area
of child ahuse is still in a very early stage
of development. An ongoing inservice
program for nursing staff. involving the
hospital's psychologist. i
being
established with the objective of teaching
communication .,kills and basic group
techniques. These are only a few of the
directions that might be follo\\-ed.
The creation of the pediatric
psychiatric nursing coordinator is
evidence not only of the recognition of
the emotional needs of children but of a
positive step in the direction of meeting
the'ie need... '"
A t the time of u'ritinK this paper. author
Kath
Hegadoren II'lIS the pediatric
psychiatric nun-inK coordinator.
Children's P(II'i/ion. Royal Alexandra
Hospital. Edmonton. Alherta. Privr tv
tlris position. she \\ as tire coordinaror of
the adolescent psychiatric proRram at
the R.A.H. As o.fSeplember 1978. Kathy
Iras embar/..ed on a new \'entllre in the
neonatal intensÌ\'e care nursery liS a
matemal-Ì1(fa/lf liaison nune
(Ç)(tJJ
(p
(Çru
(b
(Çooruoo
Caring for the retarded child in an acute care setting
BriKid Peer
. A ten-year-old who drools
constantly and needs help to feed
himself
. An adolescent who reacts to
strange faces and surroundings by
"making strange" like a toddler
. A "self-stimulating"
four-year-old who shows no sign of
hearing or seeing you, who refuses
to establish eye contact and snaps
his fingers instead of talking.
Not all retarded children have behavior
problems as severe as those described
above. but there can be little doubt that
in the eyes of the nurse who assumes
responsibility for their care in hospital.
looking after these special children
presents some very special problems.
Estimates place the number of
retarded individuab in the population at
approximately three per cent. Among
those of us who are fortunate enough to
be excluded from this category, mental
retardation evo"e, a variety of
responses. most of them negative.
Nurses. on the other hand. are "not
supposed" to have negative feelings and
so we are apt to be unwilling or unable to
express the dismay we may feel when
confronted with the prospect of caring
for a retarded child in an acute care
etting.
We are frightened of the temper
tantrums of the physically mature
adolescent: we don't know how to react
to the finger-'mapping youngster who
doe
n't seem to know we exist. We
wonder how we're going to find time to
feed the newly admitted ten-year-old
who needs half an hour of our undivided
attention to finish one meal.
Often. the easiest course is to
confine these children to their beds, to
restrain them if they show signs of
resIsting, and to provide them with few
toys and little or no stimulating
interaction with staff and other patients.
We sigh with rehefwhen a parent wishes
to room-in with his child and, after
treatment or surgery. hurry them back to
the home or institution where we feel
they rightly belong, Ifwe are honest with
ourselves. we admit that we are not
comfortable with these special children
and. as a result, their stay in hospital
becomes a traumatic experience for
everyone concerned - nursing staff,
parents and the children themselves.
Piaget has defined intelligence as the
ability to acquire knowledge which
facilitates the adaptation of the
individual to his environment. I.' I tis
obvious that. according to this definition,
the ability of the retarded child to accept
strange surroundings. painful procedures
and changes in routine will be limited.
His needs. however. are the same as
those of the normal child and he is as
sensitive as the normal child to his
environment and to tho'\e who care for
him.
Clearly. what is needed in many of
our acute care settings is a new and more
positive approach to looking after the
hospitalized retarded child.
Admission
Sometimes. when it i.. known thdt a
retarded child is going to be admitted. it
is helpful for the staff members involved
to sit down together and have an honest
discussion about their feelings in canng
for a retarded child. At that time. those
who really do not feel capable of coping
can be identified so that they are not put
into the position of having to care for the
child. One or two ..tatT members may be
chosen or volunteer to be the chief
caregivers for this particular patient.
Since many of the problems
invol ved in caring for the retarded child
in hospital arise out of lack of
understanding. it is important to learn as
much as possible about the child at the
time that he is admitted. Make time to
talk to the parents who. even though
they are undergoing a period of stress,
can often provide real insight and
constructive suggestions. Find out
whether the child likes to be cuddled or
stroked. whether he has a favorite to) or
..pecial feeding or sleeping ritual. I f one
staff member has been chosen to act as
chief caregiver. this nurse should obtain
a very thorough history from the parent
or person who admits the child.
Since the retarded child has
difficulty in adapting to new situations.
all his routines of daily living should be
carefully documented. I n this way. the
only changes that will have to be made
will be those demanded by the medical
regimen and the child will settle more
quickly into the unfamiliar setting.
Whenever possible. a bed should b
chosen for him which is near to the
center of activity. This child needs more
contact with people than a normal child
sincf: he is less able to amuse himself.
His companion in the room should.
preferably. be mobile. able to help his
roommate. and to go for help if it is
needed. If the companion's parents
complain about his being in the room
with a retarded child. an effort should be
made to have them accept the situation.
If they remain adamant. how about
moving the normal child to another
room '? He is better able to adapt to new
The Cen-.ll8fl Nur..
Jenuery 111711 35
surroundings than hi
retarded
roommate. Too often we see the retarded
child shuffled from room to room as
complaints come in. until he ends up
around the corner. down the hall. by
himself. where no one will be bothered
by him.
Nursing assessment
Next. the nurse should make her own
assessment of the child's developmental
level. This should then become her guide
in planning nur
ing interventions. Often.
chronological age has little relation to the
child's capacity to function. In assessing
the retarded child. it is not unusual to
find an irregular pattern of development:
gross motor skills, for example. may be
close to normal while all other areas lag
far behind.
In preparing a retarded child for
surgery or treatments. his developmental
level is again the guide. All children are
entitled to an explanation of what is to be
done to them. Even if you feel you are
'"talking to the wall" go ahead and
prepare him anyway: his comprehension
may far outstrip his expressive ability.
You have nothing to lose and everything
to gain ifhe is prepared. less anxious and
therefore easier to care for. I f one
approach does not succeed. try another.
Sometimes a few extra minutes spent in
gaining the child's confidence before a
painful procedure or new experience can
spell the difference between cooperation
and frustration.
Toys. books and playtime
experiences also must be geared to
developmental level and condition. For
some children. the busy. noisy playroom
may be too confusing and exciting.
leading to seizures. aggressive behavior
or withdrawal. In this case. the child can
be allowed to play in a quieter place. on a
one-to-one basis with an adult.
Volunteers or students can gain much
satisfaction from this type of experience
and the child will certainly benefit. To
leave a retarded child by him
elf for long
periods is to invite non-acceptable
self-stimularory behavior such as head
banging. rocking. masturbation and
finger fluttering. since he is often not
able to use toys in an entertaining
manner.
l'iursing care plan
In an acute care setting. when'the child is
sick or undergoing surgical treatment.
special attention needs to be paid to all
his basic needs.
I. Fluids: The retarded child often
cannot ask for a drink: nor can he obtain
one for himself. He probably does not
understand the need to drink when he is
not thirsty. I t is wise to estimate his daily
fluid requirements and keep an intah.e
and outpllI chart. even when it would not
be necessary for a normal child in similar
circumstances.
2. Respiration: These children are often
very prone to infection. particularly
chest infections. and so pre-and
post-operdtive breathing exercises
become a priority. Here again
pre-operative preparation and practise
will pay off in the post-operative period.
3. Skin care: Skin care i
another
Important area. since many retarded
children have dry delicate skin which can
easily become irritated by contact with
sheets. and hospital gowns. Also these
children tend to be passive and. when
not feeling well. they will not move about
the bed as a normal child will. This
makes frequent turning and skin care
necessary. Incontinence adds anot.her
risk and the diaper area should be kept
clean and dry.
4. Oral hygiene: Mouth care can become
a hassle. as the child is resistant to
intrusive procedures. but it should not be
neglected for that reason. I f you
approach him as though you expect no
trouble you are less likely to run into
difficulties! Many children readily accept
tooth brushing as part of their daily
routine. Others will come to accept it if it
is carried out gently. firmly and
consistently.
Understanding and trust
Often the retarded child is unable to
express pain or discomfort verbally and
it is therefore up to his nurse to recognize
his non-verbal cues. Sometimes the
caretaker can provide a useful
description of behaviors that the child
exhibits to express discomfort. Ifno cues
have been given the nurse should suspect
discomfort in the child who begins to act
out or become increasingly active or
aggressive when this is not his usual
pattern of behavior. The child may also
bang. chew or rub the painful part in an
attempt to remove the pain.
Many parents of retarded children
feel rejected by society. disappointed
and guilty. They are very sensitive to any
suspected criticism or rejection of
themselves or their child. Take time to
establish a trusting relationship with
them. You will need all their help and
cooperation in caring for their child. but
do not let them feel you are opting out
and letting them do your work. Praise
them for what they have accomplished.
and help them to set reasonable goals for
themselves and their child. Accept their
complaints if they are justified and do
something about them. If there are
unjustified complaints. do not just "go
off in a huff': try and find out what the
real problem is. The nur"e does not have
to be all things to all her clients: she
should make full use of services offered
by the hospital, to help her give total care
to the child and his family.
Psychologists. social worh.ers. pa"toral
services. volunteer, and many others
can be called upon for advice and help
with many of the problems you will face
in caring for such a family.
Children are very sensitive to
non-verbal communication and the
retarded child is no different in this
respect. He will sense acceptance or
rejection and behave accordingly.
Because his social controls may not be
well developed. his behavior may be
aggressive if he feels rejected. frightened
or angry. Limits must be set to his
behavior. as with any other child.
'Time-out" in bed or his room may be
effective in helping him regain control.
but the time should be short: in most
cases a few minutes is adequate.
Cuddling. rocking or other physical
contact may be a much more effective
way of consoling a retarded child than
the use of words.
All successful interventions with a
particular child should be incorporated in
his care plan. as should recognition of his
known dislikes. Remember. the staff
must be the one" to adapt since this step
is. for the most part. beyond the ability
of the child.
Our special children are a real
nursing challenge! Each one has his own
special personality and. when you get to
know him. you discover that he can be as
sweet and lovable. or contrary and
mischievous as all the rest. '"
References
I Piaget. Jean. The child and reality:
problems of genetic ps\'chology.
Translated by Arnold Rosin. New York.
Grossman. 1973. p.ll- 13. p.128-133.
2 Mussen.PauIH.Child
de\'elopment alld personality. 3d ed.
New YlJrk. Har.Row, 1969. p.302-306.
Brigid Peer, is assistant professor in the
Faculty of Nursing. U nÌ\wsity of
Western Ontario; affiliate appointmefll
with Children's Psychiatric Research
Institute. LOlldon. She was pre\'iously
coordinator of the Maternal and Child
Health Program at Algonquin College
(Vanier) School of Nursing in Ottawa;
joint appointment with Children's
Hospital of Eastern Ontario.
Born in England. Brigid trained at
St. Thomas's Hospital in London and
worked in Cyprus, Sowh Africa alld
Kenya before joining the RC AF nursing
ser\'Ìce in 1960. She recei,'ed her B .Sc.N
in N ursillg A dmi"ÜtratiOllalld
Educatioll from the U lIi,'ersity ofOttalt'a
a"d her M.Sc.N. in Pedia1ric Nursi"g
from the U ni,'ersity (
/Florida in
G ailles\'ille.
-
.
"
"
.
\,
)
'\'
.....
-
A leam appraach
la child ahuse
Lvnda Fit
patric/..
Jimmy is ten years old. One
evening last summer, he was
brought to emergency with large
bruises on his arms, legs and
buttocks and ahrasions on the left
side of his face. In emergency,
Jimmy remains quiet and
withdrawn, refusing to answer
any questions about what has
happened to him. It is his mother
who answers for him. Jimmy was
beaten by his father as a
punishment for breaking the
zipper on his jacket.
Sharon and Debbie are sisters. ages three
and four respectively. Their mother
calIed the hospital to report that the girls
had ingested some medicine
while she
was napping. The nurse in emergency
instructed the mother to bring her
daughters to the hospital. Instead of
bringing them in immediately. however.
she goes out and buys some beer. The
girls do not arrive in emergency until
some eight hours later. at two in the
morning. Their mother has slurred
speech and smells of alcohol. Sharon and
Debbie tell the nurses in emergency that
they drank the medicine because they
were "hungry".
A young unmarried mother calls the
Children's Aid Society. She is upset and
crying. She says that she is afraid that
she has hurt Bobby. her
two-and-a-half-year-old boy - says she
grabbed him impatiently and roughly as
he was jumping down a flight of stairs.
She seems alarmed at her own rough
behavior and says that she is afraid that
she will hurt her son more. because
. 'things aren't going well" for her. The
case worker talk.; to her for awhile and
tells her to take the child to the hospital
In emergency. Bobby is examined. He is
a healthy. welI-deveioped. and very
active little boy. There are small bruises
on his upper arms where his mother
grabbed him.
The Can-.llan Nur..
Oct_11171 37
Each one of these stories is about a
family in crisis. The details may vary,
but they add up to troubled families and
children at risk. At this point in time,
none of the stories is complete: the
incident that brought each child to
emergency isjust that - an incident.
There is a good deal of searching to
be done before any of these incidents can
be seen in context and plans made to
help the families involved. In many
urban centers in Canada. the work of
searching and of planning is done by a
multidisciplinary group. sometimes
formaJly known as a child abuse team.
One of these operates from Children's
Hospital of Eastern Ontario in Ottawa.
The child abuse team at Children's
Hospital has been in operation for as
long as the hospital has existed. since the
Fall of 1974. For four years now. the
team has been confronted with the kinds
of situations already described and
others. ranging from neglect to beating,
from emotional deprivation to sexual
abu'ie.
Although Jimmy (example one) may
be the only victim of outright abuse.
there are reasons for the child abuse
team to become involved in each of the
hypothetical cases described. The
behavior of the children's mother in the
second example can be seen as neglectful
of their needs. perhaps even dangerous
to their health. At the very least. the
situation needs to be clarified. Bobby's
mom. on the other hand. volunteers that
she needs help. and her desperdtion is
reason enough for knowledgeable and
expert intervention. It is because of a
wide variety of such situations that the
team at Children's uses a broad
operational definition of the term "child
abuse".
Most of the children who come to
the attention of the team do so through
the emergency department of the
hospital. The team at Children's is a
hospital-based team and this is why the
major source of referral comes from
within the hospital itself. Occasionally
the Ottawa Carleton Regional Health
Unit or the Children's Aid Society will
place a child on the agenda for discussion
if they feel:
. that multidisciplinary input is
needed: or
. that coding a child's chart will help
to aJert the hospital staff in case of future
admissions to the hospital.
The children referred to the team
may be abused children or children in
danger of abuse from those who are
re
ponsible for their care. They need
help and their parents also need help.
A team approach
The child abuse team at Children's
Hospital is organized to help families at
risk within the Ottawa-Carleton region.
The team is composed of pediatricians. a
psychiatrist. sociaJ workers and case
workers from the Children's Aid
Society. There are also nurses involved,
from the hospital's emergency
department and from the
Ottawa-Carleton Regional Health Unit.
Each team member comes to the weekly
meetings with as much information as
possible about the cases to be discussed.
The team members personally involved
in an individual case may be limited. but
those who are not directly in touch with
the family in question may add
comments from their own perspective.
As each individual situation is
discussed. the incident demanding
intel vention becomes part of a much
larger picture. Many times. that incident
is not isolated. and there are charts and
records that allow members of the team
to see an evolving pattern. A
multidisciplinary approach ensures that
as much evidence as possible is gathered
from aJl quarters. an approach that helps
in the often difficult task of planning and
decision-making.
Since September of 1974. the child
abuse team at Children's Hospital has
been operating for the purpose of
detection and short-term management of
child abuse in the Ottawa area.
Within the hospital. membe", of the
team are committed to finding. treating
and protecting the child who is the victim
of abuse while investigating the
circumstances that surround the incident
of abuse. The team aims at a plan to
teach and support parents whose care of
their children is less than acceptable.
whose care may, in fact. endanger their
children. Educational efforts are directed
towards the prevention of violence or
neglect of children wherever possible.
and within the hospital. team members
attempt to create an awareness of
children's rights in small ways.
Protecting the children
Child abuse may be reported by a
neighbor. policeman, public health
nurse. teacher or social worker- by any
individual. regardless of whether or not
he serves in a professional capacity. In
fact, Ontario's Child Welfare Act states
that any individual who even suspects
abuse must report it to the Children's
Aid Society. Such reporting is common
in emergency department'i like the one at
Children's. where abused children are
eventually brought for medical
treatment.
What has happened toJimmy is
obvious - there is little doubt that hi'i
injuries stem from a thorough beating.
His mother is in emergency to give a
fairly straightforward account of what
has happened to her son. But not all
cases of abuse are as dramatic or clear
cut and very often parents. afraid of
punishment for their actions. take. pains
to disguise the "reaJ" story from medical
staff. It is therefore important that those
who work in emergency be able to detect
the sometimes subtle signs that sU(!gest
abuse. These signs can be detected
through careful and skilled observation
of the child. his parents and the
interaction between them.
At risk
Eighteen-month-old JiJI was brought in to
the emergency department eight hours
after "she fell out of her crib". The child
is small for her age, remote and detached
from the attentions gi ven to her. Physical
examination reveals a large bruise on the
left side of her forehead and small bruises
on both upper arms; an X-ray shows a
fractured skull. An old chart tells that Jill
is no stran
er to the emergency
department - that she was here three
months ago after another accident.
Jill's mother is in emergency to
describe the accident. Her description of
what happened changes each time she is
asked for information. especially in those
details related to the time oìthe incident
and exactly where the child fell.
Moreover. none of her descriptions
would seem a plausible cause for an
injury as serious as the one Jill has
sutTered. Mrs. M. appears nervous and
uncomfortable, and seems to show little
concern for her daughter's welfare.
At this stage. the evidence is hazy.
but there are indications that Jill' s fall i
more than it seems. The head nurse in
emergency is on the child abuse team;
consequently the nurses in that
department are well aware of the
indicators of a suspicious situation. The
nurse caring for Jill notes the behavior of
both mother and child and fills out the
screening survey used atChildren's
Hospital for children who have
accidents.
She notes that:
. Jill has been in emergency before
\\-ith bruises:
. Jill is below the third percentile on a
standard growth chart:
. the child is detached and
withdrawn:
. Mrs. M. has called this accident and
the trip to hospital "a nuisance";
. Mrs. M. has explained the situation
in a contradictory way - her story
changes each time she tells it;
. Mrs. M. is impatient and seems
detached a'i far as J ill's welfare is
concerned:
. Mrs. M. waited eight hours before
bringing Jill to the hospital.
M rs. M. is also in a great hurry to
leave the hospital. so the nurse quickly
reports her observations to the resident
on call and pages the emergency social
worker. Jill is admitted to the hospital for
observation. a step that is taken in the
event of suspicious accidents regardless
31 Jenullry 111711
The Cen-.llen Nur..
of the extent ofthe child's injury so that
the situation can be investigated and
action taken to protect the child.
Before Mrs. M. leaves, a sociaJ
worker on staff at Children's Hospital
talks to her for a short time to "sound
her out". see how she feels about Jill.
and establish the beginmngs of a
supportive relationship with her. Mrs.
M. repeats that she is anxious to leave:
she tells the social worker that she
doesn't like to leave her other three
children with her husband "who doesn't
know how to take care of them" .
Besides, she confides, she hates
hospitals and wishes thatJill wasn't
"always getting into trouble". At this
stage, Mrs. M. is not confronted with the
suspicions of the hospital staff.
It is also part of hospital protocol to
report suspected cases of abuse such as
Jill's to the Children's Aid Society. A
case worker from the Children's Aid will
normaJly confront parents within 24
hours of the diagnosis of child abuse, but
it will be a gentle confrontation. If the
parents cooperate and accept help from
the Children's Aid Society (as most do).
the case will be opened and CAS will
monitor development in the family and
provide support. If the parents resist,
however, or if the gravity of the abuse
warrants more drastic measures to
protect the child. a court case will
follow. *
Jill's admission gives doctors.
nurses. Children's Aid Society case
workers, and social workers valuable
time. time they need to take a look at the
whole family situation, to document
evidence as it comes together and to find
out the real story. By the time Jill's case
is discussed at a meeting ofthe child
abuse team. members of the team have
been able to reach out to the M. family
and information about the whole
situation has grown considerdbly...
Why Jill?
Jill is the youngest offour children in the
M. family and all the children are under
the age of six years. While she is in
hospital. her mother's visits are few. and
*The Children's Aid Society prefers to
work with the parents rather than in a
climate of adversity. last resort legal
measures of the Children's Aid Society
are:
I order of supervision in which the judge
grants the C AS the power to visit the
family at their discretion:
2 apprehension which grants CAS the
power to remove the child immediately,
with or without warrant, to a place of
safety:
3 temporary wardship in which the
custody of the child usually goes to the
CAS who usually place the child in a
foster home:
4 crown wardship which involves
pennanent removal of parental rights.
during these visits, the nurses notice that
Mrs. M. is gruff and tense. while Jill
remains unresponsive, whiney and
fretful. But it takes more than just these
observations to find out what is really
gomg on.
Ray Helfer. a well-known authority
on the problem of child abuse. has a
great deal to say about its etiology. He
writes, "First there is the potential. then
a particular child and finaJly the
crisis... ". Looking at the M. family and
other families in which abuse occurs, a
recognizable pattern emerges.
First of aJl, there is hardly a case of
abuse discussed by the child abuse team
that does not uncover a revealing story
about the parents' upbringing. So often,
the experiences that they have had at the
hands of their own parents have been
less than satisfactory. It is not
uncommon to hear their growing
experiences described as "horrendous",
involving alcoholism. lack of caring and
outright abuse. The M.'s are no
exception.
Mrs. M. "escaped" from the round
offoster homes she grew up in through
an early marriage. Too soon, she was
also a mother. and lacking effective
guidance on how to be a mother, she had
little to bring to her children but her own
unhappy past experience. The situation
on Mr. M.'s side was not any brighter.
Given their personalities and
experiences, it is little wonder that the
M.'s live fairly isolated lives within their
community. like too many other
families in large urban centers. their
exchange outside an insular family
existence is limited to that which is
absolutely necessary. Mrs. M. admits
that there is really no one that she can
talk to. especially about "trouble".
Within this family, Jill is the special
child. In her first contact with Mrs. M.
the emergency social worker notes the
negative way in which Mrs. M. refers to
her daughter - she is a "nuisance": at
eighteen months, she is "stubborn" and
"always getting into trouble". Further
talk with M rs. M. indicates that Jill
seemed like trouble from the very
beginning. M",. M.'s fourth pregnancy
had been both unwanted and difficult;
then Jill screamed and cried and fed
poorly for months on end - there was
little about the baby that was endearing
in Mrs. M.'s eyes. In a family offour
children. Jill is perceived as different
from her other siblings. as "just plain
difficult" .
What then was the crisis that
brought Jill to the hospital? Although the
family seems to have few resources for
dealing with problems. although Jill is
perceived as a "problem" child. there
are other critical factors that precipitated
Jill's injury. Once Mrs. M. has someone
to talk to. it doesn't take long to find
them out.
Last June, Mr. M. lost his job. For a
few months he remained at home where
he sat, sullen and depressed and drinking
too much. When he found ajob once
more, it was working night shift, so it
was Mrs. M.'s responsibility to keep
everyone quiet while her husband slept
in the daytime hours. Nightwork was
difficult for Mr. M. and grew intolerable
for his family. The strain built up...
Picking up the pieces
The story about Jill as it was known in
emergency has grown. and its details
begin to hint at the ways in which the
child abuse team can help the M. family.
The medical evidence, nurses'
observations and reports of contacts
made by social workers are presented to
those at the Tuesday morning meeting so
that efforts can be made to develop a
helpful plan of action.
In a situation such as this, the
members of the team need to consider
what specific interventions can help the
M. family . Input from theChildren's Aid
Society case worker indicates that the
M. family is willing to accept her help in
dealing with family problems. and so
CAS intervention will continue until
there is no further need. A volunteer
worker is lined up to help Mrs. M. within
her home, giving her someone to talk to
and relieving the isolation that she feels
while her husband is still working night
shift. A plan is also made to introduce
Mrs. M. to a mother's group to give hera
support system and an opportunity to
"get out of the house". A doctor's
appointment is planned to check out her
feelings of chronic fatigue and edginess.
The possibility of helping Mr. M.
consider a more suitable job and aJcohol
counseling is also developed. Through
these plans the M. family is being guided
to better use of the community resources
that can help them in their present
situation.
Outreach
Jill's case is not the 001 y case of abuse to
be discussed at the Tuesday morning
meeting - there may be from four to ten
other cases, and each will tell of parents
who need help and children who need
protection. And there is a meeting every
week. each bringing more families to the
attention of the team. Investigation of
these cases is time-consuming and the
challenge of solving complex problems
requires even more energy. skill and
time.
The work ofthe child abuse team
also involves educational efforts aimed
at the prevention of child abuse before it
occurs. and he early detection of abuse
so that patterns of famil y violence can be
reversed. The team has participated in a
comprehensive inservice education
effort within Children's Hospital itself.
The Cen-.llen Nur..
Jenuery 111711 311
Members have also taken part in
educational programs such as courses at
Carleton and Ottawa universities and
community college refresher programs.
The team has also been instrumental in
training 15 volunteers who will visit local
classes of students in grades II. 12 and
13 and help young people to become
aware of child abuse and what it means.
Service clubs provide another forum
where members of the team can share
what they know about child abuse in
order to create a climate of awareness.
The problem of child abuse is one of
enonnous magnitude and significa'lce.
Professional collaboration - that is,
bringing together the knowledge. skill!>
and perspectives of various involved
disciplines enables the team to begin to
deal with such a problem. The work of
the child abuse team does not end in its
effort to pick up the pieces in those
situations where abuse and neglect has
already begun. 011.
Acknowledgement: The author wishes to
than" the members of the child abuse
team ofC hildren's Hospital of Eastern
Ontario for their assistance in the
preparation of this article. Special
than"-s go 10 Diane Ponee. of the
Departmellt ofS ocial S en'ices. CH EO
(curremly seconded to the C alladian
Commission. International Year of the
Child}. and .....ate Dagg, head nurse ofrhe
emergency department. Borh are
members of the child ahuse team.
References
I Helfer. Ray M. The etiology of
child abuse. I n Symposium on child
abuse. New York University Medical
Center, New York City, June 15,1971.
Pediatrics 51:4 pt 2: 777-779. Apr.. 1973.
Bibliography
I Canada. Parliament. House of
Common!>. Standing Committee on
Health . Welfare and Social Affairs. Child
abuse and neglect. Ottawa, 1976.
2 Helfer. Ray M. Child abuse and
neglect: the family and the community
ed by ... and Henry C. Kempe.
Cambridge, Mass. Ballinger. 197{j.
3 Hepworth, Philip H. Sen'icesfor
abused and battered children. Ottawa,
Canadian Council on Social
Development, 1975.
4 Josten. LaVohn. Out of hospital
care for a pervasive family problem-
child abuse M .C.N. A mer. J. Matern.
Child Nurse 3:2:111-116. Mar./Apr.
1978.
5 Maravchik. Miriam. The child
abusers: the story of one family World
I :8:28-32. Oct. 1972.
6 Ontario. Ministry of Community
and Social Services You and the abused
child. Toronto, 1977.
7 Stainton, M. Colleen.
Non-accidental trauma in children.
Canad.Nurse 71 :10:26-29, Oct. 1975.
8 Symposium on child abuse New
York University Medical Center. New
York City. June 15. 1971. Pediatrics 51:4
pt 2. Apr. 1973.
CNJ talks to
Lois Dale, PUN
What are the ways in \\ hich public
health nurses can be iß\'olved in the
prevention. detection and
management of child abuse? CNJ
talked to Lois Dale. a public health
nurse in the Ottawa Carleton
Regional Health Unit and member of
Children's Hospital of Eastern
Ontario's child abuse team to find out
about the public health perspective on
child abuse.
CNJ:I s there really a role for public
health nurses in the prel"ention of child
ablue?
Løis: Oh yes. there are a number of ways
in which we're already involved. I see a
large part of our preventive role in our
involvement with family planning. After
all. planned children are the lea'it likely
to be abused children. In our prenatal
classes. we are involved with couples.
and I think that is e'ipecially helpful-
we talk about physical and emotional
care of the child and factors that promote
early bonding within the family.
Our post-natal visits also fall into the
category of prevention. At this stage. we
can help the mother to deal with any
fru!>trations that she may have. For
example. ifthe mother is troubled by the
child's constant crying. we help her look
at what is normal for a baby of his age. to
look at why the baby cries so much. and
at the physical measures that she can
take to help her baby and her'ielf too.
We have also established a liaison
with the maternity nurses in all the
hospitals in the Ottawa-Carleton area.
Maternity nurses are in a very good
position to see the early signs of poor
bonding. If they see a high risk situation,
they refer the family to us so that we may
visit them soon after di'icharge from the
ho!>pital. Our weekly conferences with
obstetrical nurses are really paying off-
more sophisticated observations are
being made all the time as we become
more attuned to the indicators of a high
risk situation.
When we visit a family. we try to be
aware of early signs of trouble, to
sensitize ourselves to family dynamics
and be aware of crises - be they
financial. marital. or related to the
family's isolation from the rest of the
community. Because being a public
health nurse means knowing about
community resources, we can also refer
families to helpful services when we
recognize that there are risk factors
involved.
C
J: What do you do if you suspect child
abuse?
Løis: Once we suspect either neglect or
outright abuse. we get involved through
the Children's Aid Society, the Child
Abuse Team. or both. Everybody on the
child abuse team works together to get a
really good grasp of the situation. The
Children's Aid Society case workers are
the key workers once they become
involved. Our specific role on the child
abuse team is con'iultative. We will also
visit families where there is a health
concern that requires nursing
management.
I feel that the public health nurse has
a very special role to play in the area of
child abuse. First of all. we have to
realize that our mandate and expertise
lie'i in the area of health care and not
welfare services. Ifthere is a "health"
reason for our vi!>it, we can be especially
helpful.just because of the way in which
people perceive "the nurse"
C:'oiJ:/s that because you have a
nOli-Threatening role?
Løis: I think so. Ifl visit a family as a
nurse, sometimes just introducing myself
as a nurse allows me to be of !>ervice.
Nurses are seen as helping. caring
people. I feel very strongly that we must
protect that image of being a nuturing
person, because it opens doors and
allows us to use our skills in areas where
the door quite literally is most often
closed. Very often parents aren't abusing
their ch il dren pu rposefull y . . . someti mes
children receive poor care because their
parent'i don't know how to look after
them. or because their situation is very
unstable. They need help. A nurse may
be a non-threatening figure to them.
someone who can be seen as a helping
person.
C
J:That sOllnds li"e a si::.eable job for
\'011.
Løis: It can be. But another good reason
for public health involvement in child
abuse is that the public health nurse
knows her community and its resources,
knows just what is available to a troubled
family in her district- be it the friendly
minister or a formal outreach service.
Sometimes a mother may just need
someone to go shopping with her, or to
take care of her child for an hour or so.
40 Jenuery 111711
The Cen-.llen Nur..
In some communities, these services are
really organized: in others we come to
rely on helpful neighbors. There are
leadership groups being organized in
apartment buildings. There are also
services offered within our city like
marital counseling. credit counseling or
day care services. Ifwe know that the
mother or family wants these !>ervices we
can help by being aware of the services
available and how to get at them.
CNJ: So child ahuse is really a
community prohlem...
Lois: Most definitely a community
prohlem. We're trying to help point that
out too. We have been involved in public
panel discussions - usually with a
multidisciplinary team. Within the Public
Health U nit we also have a lot offormal
and informal discu<;sions about the
problem - we all need to know more. In
high schools we have programs in which
we discuss child abuse. to help students
become aware of the nature of the
problem. People need to know how to
deal with child abuse within their
community; they need to know how
important it isjust to help someone out in
the neighborhood. As nurses, we have
duties as citizens too.
CNJ:As a public health nurse. how do
you see the role of other nurses in
relation to child abuse.
Lois: Since my involvement with the
child abuse team, I've become more
aware that there is hardly any area of
nursing that doesn't have implications
for children. We need to learn to listen to
parents in a defined way - be it during
prenatal classes, during labour and
delivery. or postnatally. in the hospital
or in the home. We can watch for early
signs of bonding. We can help mothers to
care for their young children and help
families when children are ill. We can be
aware as nurses in an adult hospital that
if mom or dad is ill. the children are
affected as well. We have the education
and abilitie<; to take an important
leadership role. We aren't doctors and
we aren't social workers. But we have
developed. and are still developing our
abilities to observe and teach health.
Child abu!>e is one area where nurses can
play an important role by usil1g these
very special skills. 41
.J
"""
Be it resolved...
The role of the nursing association in the
prevention of child abuse
Jcan MacLean
At a time \\hen so many organizations are examining their relevance and effectiveness, is the
prevention of child abuse an appropriate concern for a professional nursing association? Should
organized nursing, in fact, devote some or an
of its scarce resources to the problems of child abuse?
One a'isociation that has answered this question in the affirmative is the RNANS. Here's how Nova
Scotia nurses are meeting this challenge.
The Registered Nurse.. Association of Nova Scotia became
formally mvolved with the prohlem of child abuse in May, 1971,
At that time. Dr. John Anderson. director of Outpatient
Service.. at the Izaa\... Walton "-illam Ho..pital for Children in
Halifax. wrote to the pre..ident ofRNANS reque!>ting the
cooperation of associ.ltion member.. in providing information
fÒr a study on child abuse in Nova Scotia.
In 1973. when the report of the ..tudy' was released. nurses
as well as other group.. were shocked to learn that many cases
of child abu..e. suspected or proven. were not being reported a..
required by law. Indeed, the study indicated that many
physician.. and nurse.. were unaware of provincial legislation
concerning child abuse that hdd been passed in 1968.
Section 19A of the Child Welfare Act reads:
(I) "Erery pen-on hlll'Ù1R Î1!flJr/llation I\'hether cOll..fìdelltial
or pril'ileged (
rthe ahandonml'llt. desertion. phy,Ücal
ill-treatment or need..fÓr protection ofa child shall report the
i,!fÓrmation to a Socien' or the Director.
(2) No action lies aRaÎ11.\1 a penon 1\'1/0 gil'es Ù!(ormation
under suhsection (I) unless the Ril'inR of the i,!fl)mwtion is done
maliciOll.\1v or without reasonable and prohahle cause."
Getting imohed...
The response of our association to the ..tudy findings wa.. ..wift.
Wor\.....hops were quickly organized on the theme of
"Wednesday's children". InfÖrmation about the Child Welfare
Act was communicated to member... At our annual meeting in
June. 1973, a re..olution on child abuse was pas..ed
unanimously:
WHEREAS the result,l' (
rll recent ,\tUl
V indicate that most
cases (
rchild ahuse ami neglect are not reported. and
WH EREAS p1"(
re,Hional nunes are in a ,
trateRic positio/l to
detl'ct ('I'idence of such ahu,le and neglect.
BE IT RESOL
ED 1 HAT thl' memhers (
"the Registered
Nunes A HocÎatio/l ofN (}I'a Scotia use el'ery opportunity to
worh II'ith other conn'1"Iled Rroups in hl'coming Î1!formed ahout
\l'ays to help ami protl'ct children and to help the parents (
r
such children.
The Cen-.llen Nur.e
J.nuery 11171 41
How can 'iuch a re<;olution be translated into meaningful
action'> At a time when Yoe hear murmurs of professional
self-sed.ing and accusations of depersonalized approaches to
nursing care. it has been rewarding to see the response of many
nurses in Nova Scotia to this challenge. Such a response
demonstrates that the caring function which characterized the
early emergence of the nursing profe'i<;ion remains alive and
well.
There ha<; been no difficulty in recruiting bu<;y nurses to
serve on committees and help with projects related to solving
the problems of child abuse. Once the Nursing Service
Committee (one of three major RNANS standing committees)
was well informed about the problems involved. it sponsored
y"orkshops. community meeting<; and seminars to increa<;e the
awareness of other members. A major aim of the Nursing
Service Committee wa<; to help nurses understand their role in
observing. identifying and referring children who were
suspected of needing protection. The term "child abuse" was
taken in it<; broadest possible sense to include neglect and
deprivation. both emotional and physical.
Although most of the activities were taking place at the
branch levels. a good deal of support. including information kit<;
for member'i. was made available through RNA House.
Through its Nursing Service Committee. the association
maintained a close liaison with the professional staff of Family
and Child Welfare. Department of Social Services. and a<;sisted
in developing a standard report form for hospitals and agencies.
In February. 1974. aCentral Child Abuse Registry was
established by the Department of Social Services.
ew
legi'ilation became effective in December. 1976 which stated
that reporting cases of child abuse to the Central Registry must
be done by a "qualified medical practitioner. registered nurse.
or administrator of a hospital or institution".
Within RNANS. special interest groups like the Canadian
Association of Neurological and Neurosurgical Nurses and
Operating Room N ur'ies were including the topic of child abuse
in their own educational ses<;ions.
By this time. it Yo as becoming increasingly apparent that
nur<;es could ta"e a major role in the prel'ention of child abuse.
In 1976 a task force wa<; appointed to stud
possible approaches
to the problem. The Yo or" of the task force. involving nurses
y"ith special expertise in the hospital. the community and
nursing education. has included articles for the RN AN S
Bulletin and an educational display at the as",ociation'<; annual
meeting in 1977.
In October. 1978. the group organized a Yoor"shop for
nurses in key pmitions to prevent child abuse. The goal of the
Yoorkshop was to provide opportunities for nur'ie<; to:
· under<;tand the importance of their role inprel'enting child
abuse .
. improve their ability to identify high-ri<;k familie,,>
. consider the effectiveness of a team approach in helping
high-risk families
. identify needs for additional skills.
Because the workshop could not accommodate all who wished
to attend and the response of the nurses attending wa<; so
positive. the workshop is to be repeated in June. 1979.
-\ speciaJ chaJlenge
l'i it appropriate for our professional a<;sociation to devote
precious re<;ources to the problems of child abuse? Perhap,,> a
statement from One mil/ion children- the C e/dic report is
relevant to this question:
.. Weare c01/l'inced that the "-nowledge and insight!> about
.wcial problem.
. gained through seeing their effects on the Iil'es
of the indiriduaÜ andfamilie.
with whom they 11'01'''-. place a
hem'y responsibility not only on indÏ\'idual professionalJ bllt
also upon the association
of which they are memhers .It i.
not
enough to protect and promote the well-heing qf their own
memhers. or el'en to protect the public from malpractice. The
prq(e.uional associations must alw spea"- out and pro ride
leadership to help bring about the social changes that will
prel'ent the del'elopment ofmany of the problem.
in the first
place. Society hm a right to expect this of its prq(essionals.lf
they prOl'ide this "-ind of leadership. their status and role in
society will remain unchallenged."
Nursing has been de<;cribed a<; ..the major caring
profession". 3 A<; Yo e struggle to define and exert our
independent functions at a time of accelerated change. y"e need
to ensure that this caring function which has been traditionally
ours is retained and adjusted to meet changing needs. We must
also remember that as part of our professional association. we
can be very effective in our influence. hoy,.ever difficult it may
be to measure that influence.
The Registered Nurses A'isociation of Nova Scotia
believes that the prevention of child abuse is a special challenge
requiring the <;pecial skills of nurses. Our definition of nursing.
publi<;hed in 1976. ,>tates that "by collaborating with other
members of the health team. nursing contributes to meeting the
total needs of individuals/families. .., The hard work and
enthusiasm ofRNANS members involved in our child abu,>e
program illu'itrates one important y"ay in which we a'i nurses
may contribute to meeting these health need". ""
References
1 Fra...er. Frederic" :\lurray. Child
ahuse in/VOI'a Scotia: a rðearch project
ahout battered ami maternally depril'ed
children by . . et al. Halifa\. 1973. p.3
.
Commission on Emotional and
Learning Disorders in Children. One
million children. IThe C ELDIC Report
for the Commission) published by
Leonard Crainford. Toronto. 1970.
pp.441-44
.
3 Hall. Catherine. :\1. \\hocontrols
the nursing profession'.' Role of the
professional association Aust. nurses J.
3:
:
9-3
. Aug. 1973.
4 Registered Nurses Association of
Nova ScotiaA framewor"-for the
practice (
( nursing in N ol'a Scotia:
guideline.
and ,Hl",dard.
. Halifa\. 1975.
5 Helfer. Ray. Child abu,
e and
neglect: the family and the communin'
edited by... and Henry C "'empe.
Cambridge. :\lass. Ballinger. 1976.
6 Hurd. Jeanne Marie. Assessing
maternal attachment: first step toward
the prevention of child abuseJ.O.G. \.
.Vurs. 4:4:
5-30. Jul./Aug. 1975.
7 Martin. Harold P. ed. The abused
child: a multidisciplinary approach to
del.elopmental issues and treatment.
Cambridge. :\1ass. Ballinger. 1976.
A uthor Jean :\lacLean i,
currently
,Vursing Sen'ice C onwltant (
(the
Registered Nurses Association ofNOl'a
Scotia. A graduate afVictoria Puhlic
Hospital. Fredericton. Sew Bruns ,,'id
and McGill L' nil'ersin' (8.N.J Montreal.
Québec. Jean has had a ,,'ide range of
erperiences innur.
ing sen'ice and
nursing education. She has also ""(Jr"-ed
closely with the "'ursing Sen'ice
Committee and Tas"- Force on the
Prel'ention o..(Child Ahuse .
t
,
n
e
How do children hurt themselves and what can nurses
_ as individuals and as a profession - do to prevent accidents?
if./ )
.l,1'
.11
f/
,Q;
Shirlev Post
A.J. Lanliford
accounted for 37 per cent of the deaths
among children in this age group. A total
of758.504 hospital days were a direct
result of these accidents.
Is there something that nurses can
do to increase awareness among parents
and the general public of these threats to
the lives of their children? Can nurses
Accident!. are the largest single cause of
death and injury among children under
the age of 19. In 1974 (the latest year for
which complete figures are available)
accidents. poisoning and violence
l -
"\. .'
-
help to prevent accidents through
education? There are indications that
they can.
Nurses are often the first qualified
health person contacted in health care
and service settings: the doctor's office.
emergency wards. health clinics. and
even obstetric wards. All ofthese are
The C.n-.llen Nur..
Jenuery 11171 43
teaching opportunities. Each contact
with a mother. or a future mother. is an
opportunity to inform her of potential
hazards and to gain her support and
cooperation in eliminating them. thus
promoting the well-being of yet another
child.
But. to be successful in educating
others in the means of reducing
childhood accidents. it is essential that
nurses understand the growth and
development of children. know what
accidents are common to which age
group and the preventive measures
required for each age group. By
developing basic teaching skills and
projecting their own feelings and
attitudes toward child safety. nurses can
join physicians in initiating an effective
change in attitudes and influencing
parents to keep their children safe by
means of prevention.
The young child needs constant
supervision and protection. Part of this
protection lies in altering a "normal"
environment to reduce or eliminate
possible hazards. Unfortunately. most
people who care for children need to be
reminded constantly of this and of the
fact that benign items of everyday life.
such as electrical outlets and appliances.
bathtubs. medicines. cleansing agents.
balconies. stairs and cars. can become
dangerous enemies in a child's world.
Toronto's Hospital for Sick
Children. in its 1976 "Causes ofInjury
Report" . pinpoints some of the
problems. In that year:
. 300 children between the ages of
one and four were treated at HSC for
scalds caused by hot liquids (water. tea.
coffee), hot water baths and vaporizers.
. 211 children between two months
and two years of age suffered pulled
arms from being swung or lifted by the
arms.
. 554 children were treated for pedal
cycle i'1iuries; 86 of these youngsters
required hospitalization.
The increased incidence of
accidents occurring while children are
participating in sports or recreation
warrants much closer observation; we
need more accurate data on specific
categories of accidents. such as
skateboard i'1iuries. burns and head
injuries among young children.
Historically. legislation such as the
Hazardous Products Act has proved
beneficial. This act. which controls the
accessibility of certain products to
children and ensures that packages carry
adequate warning to parents of
dangerous contents. was passed in 1969
and since 1970 there has been a steady
decrease in poisonings among children
under four. Under this act. an item can
be judged" hazardous" , not to be
advertised. sold or brought into this
country. Examples include baby rattles
that could choke a child. certain stuffed
animals and a type of baby bottle
propper or holder that permitted the
mother to leave a child unattended while
feeding and could result in asphyxiation
or choking on regurgitated milk. In the
case of this last item. the Canadian
Nurses Association. prompted by
reports from members (especially public
health nurses) of possible dangers
involved in use of the "propper". was
among the groups that pressed for
government action to prevent the sale
and use of the device in Canada.
Under another part of the act the
government may impose regulations to
reduce the probability of accidents.
These regulations may require
child-resistant packaging or specific
labelling; regulated items include toys.
cribs. cots. playpens. pacifiers. rattles.
car seats. matches. flammable materials
used in clothing and a variety of
household items such as turpentine.
polishes and oven cleaners.
Nurses should be aware of this
legislation and make it their duty to
report to the Department of Consumer
and Corporate Affairs (either as
individuals or an organization) any
products that appear to constitute a
safety hazard to children.
One area still requiring legislative
action is the protection of children while
they are passengers in a moving vehicle.
Even though mandatory use of seatbelts
has been demonstrated to reduce
accidents. only four provinces* (Ontario.
Quebec. Saskatchewan. and British
Columbia) have passed seatbelt
legislation. Even in these four provinces.
children under the age of six or weighing
less than 50 pounds, are exempt. A
recent Montreal study found at least half
of all children under ten completely
unr
strained; a further ten per cent were
re:;trained in a manner inappropriate for
the çhild's age and stage of development.
Studies in Calgary. Vancouver and
Toronto have yielded similar results.
The Canadian Institute of Child
Health is presently asking the federal
government to remove the excise tax and
the 12 percent manufacturer's tax from
children's car seats. fire detectors and
life jackets. At the same time. the
provincial governments are being asked
to remove their sales tax on these items.
It is hoped that lower prices on these
items will motivate parents to protect
their children from the three major
causes of death by accident: motor
vehicle accidents. fires and drownings.
*In Nova Scotia. legislation had been passed
but had not yet come into force at time of
wriling.
Accidents can result in permanent
physical and mental impairment: they
can cause social disruptions and
economic difficulties. A child's injuries
bring distress to the entire family.
altering lives and lifestyles. I n many
instances. a heavy emotional and
financial burden is imposed not only on
the family but on the community.
What can nurses do to prevent
accidents? They can make 1979their
Year of Child Safety. As individuals.
they can increase their own awareness of
potential hazards in a child's
environment and use every opportunity
for health education in their homes. their
practice settings. and communities.
As a group. they can act as a strong
political force in influencing
communities to provide safer
environments. businesses to produce
safer products and governments to enact
and enforce regulations that will further
safeguard the lives of our children. 41
Shirley Post, co-author (
f' 'A I'ery
presenr danRer". is I'ice-president of the
Canadian I nstitute (
fChild Health. an
orxani;:,ation she helped to set up in July.
1977. She is a former director ofnursinR
at the C hildren'.
Hospital ofE(utern
Omario in Ottawa.
Audrey Jean Langford, co-author of "A
I'ery present danger", is a graduate of
General Hospital in Calgary, Alberta.
She is presently working part-time ar the
Children's H o.
pital of Ea.
tern Ontario
after a number of years spent in raising
her fil'e children. She is also a I'olunteer
worker with the Canadian lll.
titute of
Child H ealch in Ottawa.
Bibliography
I Canada Safety Council. Accident
fatalitie.
- Canada. Ottawa. 1975.
2 Canada. Laws. Statutes. etc.
Ha;:,ardous products act. RSC 1970
C.H3.
3 Hospital for Sick Children. Causes
o.finjury. Toronto. 1976.
4 Canadian Institute of Child Health.
A ccidents and accident prel'ent;on: 19
year.
and under. Ottawa. 1978.
Unpublished.
I
I
,
44 Jenuary 111711
The Cen-.llen Nur..
Learning about
the hospital at hOllle
Faye F ergu.mn
Lillian Par/...
and Vera Ward
-"
...
"
.:- -1
\
.. ---
'-'=
....,..r-........ .:-
.....
. 1
-..
/'
\
L
-
-
--.:
;
-
"
.'
.
.
-...
-
,
-
.
.
..
III
Pre-admi
sion nurse Lillian Park
("ontacts the parent.
(
r a child
scheduled to be admitted to llOspital.
A.nother member of the pre-admission team,
nurse Vera Ward. receil'es
pre-admission hoo/...ings in her o(fìce.
The Cen-.llen Nur..
Jenuery 111711 45
Mark Taylor is six years old and
ahout to enter Alberta Children's
Hospital to have his tonsils and
adenoids removed. Five days
prior to his scheduled admission,
a nurse who identifies herself as a
pre-admission nurse from the
hospital. contacts his mother.
Since Mrs. Taylor had been given
a letter at her doctor's office
describing this service, she is
expecting this call and is happy to
make an appointment to see the
nurse.
. nursing pediatric history
sheet.
During the completion of this
sheet. the nurse enquires about
recent immunizations or possible
contacts with communicable
disease. She also checks to see
whether there is a family history
of anaesthetic problems or
bleeding tendencies, whether
Mark has been on medication
recently, and whether he has any
physical disability.
...
--
-
-.
assures her that she can stay as
long as she wishes: in fact. she
may even stay overnight if she
wants to.
Following completion of the
various forms, the pre-admission
nurse explains what to expect at
the hospital. She describes:
. the routine admission
hospital tests such as the blood
test and blood pressure and
temperature
. the playroom program
...".
,
-:
-
----"
At the time of the home \isit, the pre-admiuiollllurse helps the
mother to complete the admiuiolls alld cOllsem forms
required b\" the hospital.
listening to the ad\entures of "Emily" . as explailled b,' the
pre-admissioll Ilurse. is a "Jim" way tojìlld oilt more
ahout all impelldillg \'/sit 10 the hospital
In fact. Mrs. Taylor has
many questions about Mark's
hospitalization! They agree that
the appointment ..hould be for
4:30 p.m. so that Mark will be
home from school when the nurse
is there. During her visit, the
nurse completes, with Mrs.
Taylor, the following documents:
. admissions form (name,
address, and other similar
statistical data).
. hospital required consent
forms.
The nurse also takes this
opportunity to ask Mrs. Taylor
whether Mark has any particular
fedrs that might make his
hospitalization more difficult.
Mrs. Taylor tells her that Mark
tends to "get home sick" when
he sleeps away from home and
enquires about whether she can
stay with Mark at the hospital
until he falls asleep the night
before surgery. The nurse
. the visit by the anesthetist
. meals and snacks
. the fasting requirements for
the morning of surgery
. the approximate length of
surgery
. what to expect
post-operatively ("l\lark may
vomit after his operation, but this
is not abnormal. His throat will
be very sore, but it will help if
you can encourage him to
drink" ).
I
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46 Jenuery 111711
The C.n-.llen Nur..
Mrs. Taylor is also advised as
to the time ofMark's admission and what
articles to bring to the hospital. The
nurse tells her about the various
amenities available for her use at the
hospital such as the cafeteria and parent
lounge. Mrs. Taylor is instructed to give
Mark a bath and shampoo the morning of
admission and to collect a urine
specimen.
While she is talking. the nurse gives
Mrs. Taylor plenty of opportunity to ask
questions or express concerns. She gives
Mark a coloring book called "Emily
Goes To Hospitar'. After the nurse and
Mrs. Taylor have finished talking. the
nurse looks at this book with Mark.
explaining each picture and going over
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the experiences of"Emily". a whimsical
kitten who goes to hospital to have her
tonsils out. Mark can keep the coloring
book to show his friends. When he
comes to the hospital. he will see Emily
in a puppet show and after his surgery he
will receive a badge with a picture of
Emily and announcing in large letters "I
had an operation" .
At the end of her visit. the
pre-admission nurse leaves a hospital
pamphlet with Mr!oo. Taylor on which ..he
notes the nurse's name. the date and
time of admission. and reminders about
the.urine specimen. bath and shampoo.
She tells Mrs. Taylor to contact her
physician if Mark develops cold
symptoms. fever. etc.. prior to the
admission.
As ..he leaves. the nurse encourages
Mrs. Taylor to call ifshe has any further
questions. When she says goodbye to
Mark and his mother she leaves them
with the promise that "I'll see you at the
hos pital" .
Admission day
On the big day. Mark and his mother
arrive at the hospital at the agreed upon
time. They are met at the reception area
by the pre-admission nurse. who takes
them to the laboratory. then to the
nursing unit. After a brief tour of the
unit. introductions to the nurses. taking
of blood pressure and temperature
readings, Mark is able to go to the
playroom. The entire in-hospital
admission procedure takes about 15
Admission dav arrhes and the nur.
e
who l'isited th
m in their home Rreets
the child and his mother in the
reception area o/the ho.
pital.
At the start of his hospital visit,
the child and his mother ta/...e
the time to learn ahout the facilities
and ser\'ices thc hospital prm'ides.
minutes and Mark spends the majority of
his first hours m the hospital playing with
other children in the spacious. toy-filled
playroom.
A wa) of coping \\ ith stress
Nurses who work with young children
undergoing a period of hospitalization
are very much aware of how stressful
this experience can be. both for the
children involved and for their parents.
They know that while they are in hospital
many children ..how signs of regressive
or disturbed behavior. These
observations are borne out by research
studie.. which indicate that. in addition to
these obvious problems. hospitalization
has adverse results that may not become
obviou.. until after the child returns
home. The serious nature of these effecto;
has recently been noted in two studies
conducted in Britain"" which provided
strong evidence that one hospital
admission of more than a week's
duration or repeated short admissions
before the age offive years are
associated with behavior disturbances
and learning difficulties as late as
adolescence.
Several authors have provided clues
as to the reasons that hospitalization is
so stressful to children. One important
factor is the idea that the hospital is a
totally unfamiliar and unpredictable
environment for the child. The need to
know and predict one's environment
seems to be a universal human trait. In
health care settings it is becoming
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increasingly evident that the degree of
anxiety an individual experiences is a
function of the accuracy of his
expectations. The old adage of "being
afraid of the unknown" certainly holds
true. I n other words. an individual.
whether child or adult. who knows what
to expect in an unfamiliar o;ituation will
be hetter able to cope and will not feel
helpless.
A second factor involved in the
anxiety-provo\...ing effects of
hospitalization on children is the strong
influence of maternal stress on the child.
For a mother. the hospitalization of a
child is always stressful: her degree of
stress will depend on the amount of
adequate and accurate information she
received about the hospitalization before
The Cen-.llen Nur..
Jenuery 11171 U
it took place. The more predictable the
experience is for her. the better she will
be able to cope effectively and. thus. to
maximaJly support her child. A study of
hospitaJized children conducted in 1968"
provided strong evidence that the
anxiety level of the mother has an effect
on the anxiety level of the child: mothers
who received adequate. accurate
information about the hospitalization and
were encouraged to verbalize fears and
ask questions displayed a lower level of
anxiety. In addition. the children of these
mothers displayed lower anxiety levels.
made more rapid recoveries and
experienced fewer after-effects of the
hospitalization.
\
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I
period of time before the actual
admission to prepare for the experience
in accordance with the infonnation they
have been given.
2. To eliminate the lenRthy admissiom
procedure at the hospital.
By completing admissions documents in
the home. the in-hospital admission
procedure can be shortened
con'iiderably. thereby eliminating what
was often a hurried and unpleasant first
contact with the hospital.
3. To encouraRe mothers to effecti\'ely
support their child durinR
11O.
pitali::.ation .
Through the transmission of accurate
information. it was felt that the mother
would cope more effectively with the
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of Calgary chIldren who are scheduled
for elective admission to Alberta
Children's Hospital will receive a visit
from one of these nurses. Out-of-lOwn
admissions are contacted by telephone.
Effectheness of Pre-Admission \ isiting
Since its introduction four years ago. the
pre-admission program has been
enthusia'itically received by the mothers
whose children were admitted under it.
Nurses. too. have been pleased to
relinquish the "harried" admissions
procedure for which they had originally
been responsible.
The positive effects of the program
on the mothers and children have always
been suspected but it is only recently
that we were able to document them. In
,
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A "3rd nurse ta/...e
the child's admission hlood pressure, one of the \'eryfew
procedures that must be carried out before he is allowed to \'isit the playroom.
Objecthes ofthe PA \ P
It was recognition of the fact that
children and many mothers are not
familiar or comfortable with nonnal
hospital routines. that caused the nursing
department at the AlbertaChildren's
Hospital to set up a Pre-Admission
Visiting Program in 1974. The initial
objectives of the program were as
follows:
I. To pro\'Ïde the child and his mother
with accurate information about the
hospital process in em em'ironment that
is comfortable to them.
We felt that both the mother and child
would be most relaxed in their own home
and therefore better able to absorb the
infonnation. express concerns and ask
questions. A'i well. they would have a
hospital and feel more willing to assist in
her child's care. As well. the
pre-admission visit would be a time to
assure the mothers that their presence in
the hospital is welcomed.
4. To lessen the number of children
admittedfor .wrgery which 't'{I.
later
cancelled because of e>;posure to
communicahle disea.
e or other iIIne.H.
Children who have had such an exposure
would be identified during the
pre-admission visit. thus their surgery
could be cancelled before they ever
reached the hospital.
Over the past three years. the
pre-admission program ha'i striven to
meet these objectives. Two registered
nurses and a clerical assistant comprise
the Pre-Admission Team. The majority
order to do this. we undertook a
controlled evaluative study' of some of
the effects of the program on a group of
8:! children between the ages of three and
seven. All the children were coming to
hospital for tonsillectomies: one half of
them received a pre-admission visit.
while the other half were admitted
directly to the hospital. All were given
exactly the same infonnation by the
same admitting nurse: only the location
and time were different. Ba'iically. the
children all had a very similar hospital
expenence.
The results of the various measures
taken on the children and their mothers
indicated that:
· Mothers who received a
pre-admission visit expressed
41 Jenuery 111711
The Cen-.llen Nur..
considerably more satisfaction with the
care and health teaching they and their
child received in the hospital. Basically.
the pre-admitted mothers were happier
and more satisfied about the whole
experience than were the hospital
admitted mothers.
. All the mothers displayed a high
level of an xiety on the day of admission.
but the mothers who had been
pre-admitted showed a greater decrease
in anxiety. At a post-operative contact.
the pre-admitted mothers displayed a
very low level of anxiety. while the
hospital-admitted mothers showed a
considerably higher level.
. The children who had experienced
à pre-admission visit reported less fear of
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hospital-related thmgs than did the
hospital-admitted children. This
difference in the level of hospital fears
was apparent at the time of admission
and at the pmt-opeHltive contact
(u",ually 7 - 10 days after the ..urgery).
. The children who had experienced
a pre-admission visit displayed a marked
reduction in negative post-hospital
behavior as compared to the
hospital-admitted children. I n other
words. the pre-admitted children showed
fewer behaviors indicative of sleep
disturbances. eating disturbances.
aggression. withdrawal. separation
anxiety and general anxiety following
their hospital experience.
The results of this study have been
very satisfying and have supported what
many nurses have intuitively felt to be
true. One unexpected benefit of the
pre-admission program has heen it,;
effect on the nurses involved in it. The
pre-admission nurses have become
increasingly skilled at interviewing and
have developed new levels of sensitivity
to the concerns and anxieties of the
mothers they talk to. In their constant
evaluation of the information needs of
children. these nurses have observed
that they are becoming more sensitive to
developmental and learning capabilities
of children. The pre-admission nurses
never lose sight of the family as a unit.
and have become appreciative of familial
differences including ethnic and cultural
effects. As well. the continual need for
In the pla
room.
wearing her hero hutton
awarded followillg completioll
o( lahoratory hlood te.
t.
,
is Emi!\'. star ofhoth
the color;"g hoo/..
alld a puppet .
/ww
hlued Oil her Iw.
pital
adl'ellture,
.
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open channel.. of communication
between parent. child and health care
professionals has become an important
goal of the program.
In short. pre-admission visiting is
one way to effectively prepare children
and their mothers for hospital admission.
I t provides both mother and child with
information that may assist them to cope
effectively with what otherwise could be
a strange and frightening experience. OW
References
I Douglas. J. W. Early hospital
admi",sions and later disturbances of
behaviour and learning. Del'. Med.child
Neurol. 17:4:456-480. Aug. 1975.
2 Quinton. David. Early hospital
admissions and later disturbances of
hehaviour: an attempted replication of
Douglas' findings by... and Michael
Rutter. Del'. M ed.C hild N euro.
18:4:447-459. Aug. 1976.
3 Skipper. James K. Children. stress
and hospitalization: a field experiment.
by... and RobertC. Leonard.J. Health
Soc. Behm'. 9:275-287. Dec. 1968.
4 Ferguson. Barbara Faye.
Preparing young childrenfor
/wspitali:ation; a comparisoll o(two
methods. Calgary. 1978. Thesis' (M.Sc.)
-Calgary.
Faye FergusonrR.N., HolyCm.u
Ho.
pital. Calgary; B.Sc.N., The
U Ilil'ersity of Alherta. Edmollton; M.Sc.,
U nil'ersity l
rC algaT}') is education
coordinator at Alherta C hi/dren's
Hospital, Calgary. The study cited in this
article was part of her thesis research
leadillg to a MaHer's degree in
Educatiollal Psychology.
Lillian Park (R.N.. Killgston General
Ho.
pital. Killg.
toll, Ontario) i.
a Ilurse
011 the pre-admi.uion team at Alherta
Childrell's Hospital. Calgary. Prior to
hecomillg a pre-adminion Ilurse she
wor/..ed lU asÚ
tant head Ilursefor a
numher ofyear.
on the .H1rgicalullit at
Alherta Children's Hospital.
Vera \'\ard rR .N., Holy Cmu Hospital.
C algary) i.
a memher l
(the
pre-adminioll team. She was one of the
origillal Ilurses Oil the team alld has been
illtimatel\' ;'lI'oll'ed ill the del'elopmellt of
the Pre-l;dmission Program. She also
performed the admissionsfor all the
childrell examined in the study described
in this article.
,
butter is really the villain responsible
for various common pathologies. . .
,
these very illnesses continue to occur frequently despite
a dramatic decrease in butter consumption over the past thirty years?
.
And did you know that. during this same period
of time. there has been a marked increase in the
consumption of margarine in Canada?
COMPARATIVE DAILY CONSUMPTION RATES OF BUTTER
AND MARGARINE FROM 1948*-1978** IN GRAMS PER PERSON
c
,296 112 I
,
I,
O
18 C I
V V
1948 MARGARINE 1978 1948 BUTTER 1978
For more facts about dairy foods. write to:
Canadian Dairy Foods Service Bureau.
30 Eglinton Ave. E.. Toronto. Ont. M4P 186
*Statlsbcs Canada
** 1978 estimated
consumption
I
J
I
When you look at the facts
you can see the good in butter.
50 J8nu8ry 111711
The Cen-.llen Nur..
calendar
January 1979
Continuing education courses
offered at the Faculty of
Nursing, University of
Toronto:
Curriculum refinement and
revision -Jan. 25-26. $50.
Writing workshop: are you
getting your message across?
-Jan. 31. $25.
Family therapy principles for
nurses-Feb. 7. $25.
The problem of skin disorders
for the adolescent. Feb. 12,
$25.
Care of the disturbed elderly
patient-Feb. 15-16. $50.
Nursing process in mental
health and psychiatric nursing
- Mar. 1-2, $65.
The community as client:
assessing levels of community
health - Mar. 28, $25.
Contact: Dorothy Miles.
Director. Continuing
Education Program, Faculty
of Nursing , University of
Toronto. 50St. George St.,
Toronto. Ontario, M5S IAI.
Continuing Education
Programs offered at the
University of Alberta.
Edmonton: Del'elopment of
political sl..ilIsfor
organi:.atiunal change. Jan.
25-26. $45.
Anatomy and physiology for
nur.
es, Feb. 8-Mar. 22 (7
Thurs. evenings). $35.
CommunicatÙ'e disorders in
children: identification and
referral. Feb. 8-9. $40.
Writing sWlsfor nurses. Feb.
13-14. $60.
Control female
inCClntinence,
naturally
Eschmann Female
Incontinence Device
naturally and discreetly controls stress
incontinence in patients awaiting corrective
surgery and over long-term periods.
Worn internally. the device controls the
opening - naturally - of the bladder neck
The device is comfortable. easily
inserted and removed by the
patient after a simple
demonstration.
--=
Available from leading
surgical supply dealers
or directly from
@ESCH
advancing the cause of good health
Eschmann Canada Limited
Barclay Avenue Toronto, Ontano M8l5S6
(416) 252-2281
Geriatrics symposiumfor
health care professionals.
Mar. 12-14.
Quality assessment of
mother-child relationship.
Mar. 16-17. $45.
Performance appraisal for
nurses. Mar. 22-24.
Nursing aspects of
intrm'enous therapy. Apr. 16.
S elf care framework applied
to nursing practice. Apr.
19-20
Management of pain. April.
Competency analysis profile:
application to nursing. Mayor
June.
Nursing pharmacy workshop.
May 25.
ECG interpretation. June
25-28. $80.
Tests and measurements for
nurses. Aug. 13-14, $45.
Contact: Millie Pasemko,
Faculty of Extension , The
University of Alberta, Corbett
Hall. Edmonton, Alberta.
T6G 2G4.
February
The Canadian Orthopaedic
Nurses Association Second
Annual Meeting to be held
Feb. 6-9. 1979 at the Hotel
Toronto in Toronto. Fee:
members - $20 per day. or
$50 for 3 days: non-members
- $25 per day or $60 for 3
days. Contact: Cheryl
McCulloch, R.N., CONA, 43
Wellesley St. E.. Toronto,
Ontario. M4Y IHI.
Annual Pediatric Seminar-
"Rights of Children in
Hospital". Sponsored by
Calgary Health Agencies and
the Chinook Affiliate of the
Association for Care of
Children in Hospital. To be
held on Feb. 8-9. 1979 at
Foothills Hospital. Calgary.
Fee: $25. Contact: Pat
Powers, Seminar
Chairperson, 6301 Larl..spur
Way, Calgary. Alherta.
T 3E 5P9.
48th Annual Meeting of the
Royal College of Physicians
and Surgeons and the Medical
Surgical Exposition to be held
February 6-9, 1979 in
Montreal, Quebec at the
Queen Elizabeth Hotel.
Contact: Dr. James H.
Graham, Secretary, Royal
College of Physicians and
Surgeons of Canada , 74
Stanley Ave., Ottawa,
KIN IP4.
March
Primary Cancer Care - The
Role ofthe Nurse. A two-day
workshop to be held March
22-23. 1979 at the University
of Calgary. Contact: Faculty
ofC ontinuing Education,
University of Calgary. 292024
Al'e. N.W., Calgary, Alberta,
T2N IN4.
April
Post diploma maternity
nursing course for registered
nurses to be held at the Grace
Maternity Hospital. Halifax,
N .S. A 12-week course
beginning April 2 - June 22 and
Sept. 10 - Nov. 30. 1979.
Contact: Margaret Power,
Director of Nursing
Education. Grace Maternitv
Hm.pital, Halifax, N.S.,
B3H IW3.
Did you know...
The Canadian Lung
Association has a Nursing
Fellowship of $8.500 for
Master's or Post Master's
study in the clinical speciality
of pulmonary nursing. For
further information and
application form please write:
The Canadian Lung
Association, 75 Albert Street,
Suite 908, Ottlll\'a, Ontario.
KIP 5E7. Application
deadline: February 15. 1979.
Clinical .
I I
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order titles on 3O-day approval, enter order number and auth or: Please Print:
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in England: 1 St. Anne's Rd., Eestbourne. East Sussex BN21 3UN
In Auslrella: 9 Wallhem StreeI. Artarmon N.S.W 2984
'\ Drain & Shipley
.J The Recovery Room
i Two leading experts in the field provide clear, accurate coverage
of the recovery room in this valuable new, one-of-a-kind book.
Topics include the physiology of anesthesia, the effects of
various anesthet+c agents. specific care after all types of
operations, and factors that affect recovery from anesthesia in
particular patients.
By Cecil B. Drain. RN, CRNA. BSN. Univ. of Arizona. Tucson, AZ; and
Susan B. Shipley, RN, MSN. Nurse Researcher, Nursing Research
Service. Walter Reed Army Medical Center. Washington. DC. Aboul
350 pp. lIIustd. Ready soon. Order
3186-X.
Sorensen & Luckmann
Basic Nursing:
A Psychophysiologic Approach
The authors of the popular Medical-Surgical Nursing now offer a
comprehensive textbook on basic nursing concepts for the
practitioner. Twenty-eight contributing experts provide special
coverage of important topics such as biomechanics; nutrition;
bowel, bladder, and catheter care; vital signs; respiratory care;
the therapeutic nurse-patient relationship; blood administration
and much more. Particular attention is paid to the role of stress
and adaptation in illness, understanding the existence of the
patient, therapy and rehabilitation, the nursing process, and
the changing role of the nurse.
By Karen Creason Sorensen, RN, BS. MN, Formerly Lecturer in
Nursing, Univ. of Washington; Instructor of Nursing, Highline
College; Nurse Clinical Specialist, Univ. Hospital and Firland
Sanitorium. Seattle. WA; and Joan Luckmann, RN, BS, MA, Formerly
Instructor of Nursing. Univ. of Washington, Highline College, Seattle,
Oakland City College, and Providence Hospital College of Nursing.
Oakland. CA. About 1185 pp.. 435 ill. Ready soon. About $23.00.
Order *8496-X.
Conn
Current Therapy 1979
Current Therapy 1979 will be off press in R!bruary-and this new
edition of Conn offers more clinically usable datd than ever
before! Completely revised by over 335 leading authorities. it
provides Quick access to the most-up-to-date, proven treatment
methods available. Here are just a few of the topics: Leish-
maniasis. Plague, Toxoplasmosis, Bagassosis, Farmer's Lung and
other forms of hypersensitivity. Newer agents in therapy of
bacteremia. and much more!
Edited by Howard F. Conn, MD. With 14 contributors. About 1000 pp
IIlustd. $31.05. Re.wy Feb. 1979. Order *2.64-5.
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Krause & Mahan
Food, Nutrition and Diet Therapy
6th Edition
A strong revision of an already excellenttext, the new 6th edition
of Krause & Mahan is even better suited to your students' needs.
New material includes stress responses, nutrition and cancer,
and the low-birth-weight infant. Assessment of nutritionå
problems and the importance of nutrition throughout the life
cycle is emphasized. Many new iIIust
ations, graphs. and tables
highlight and enhance better understanding of all aspects of
nutrition.
By Marie Y. Krause, BS. MS. RD, Formerly Dietitian In Charge of
Nutrition Clinic and Assoc. Director of Education. Dept of Nutrition.
NY. Hospital; Therapeulic Dietitian and Instructor in Dieletics, Mount
Sinai Hospital. Philadelphia, PA; Therapeulic Dietitian and First Asst.
to Instructor in Nutrition. Dept. of Medicine. Univ. of Chicago Clinics;
and L. Kathleen Mahan. RD, MS, Lecturer, School of Nutritional
Sciences and Textiles, Nutritionist, Child Development and Mental
Retardation Center. Univ. of Washington; Consulting Nutrilionist,
Seattle, WA. About 935 pp. 295 ill. About $19.55. Ready soon.
Order *5513-{).
Keane
Essentials of Nursing:
A Medical Surgical Text
4th Edition
This is a compact textbook for students beginning the study of
medical-surgical nursing. From the more general concepts
related to illness (such as adaptability and immobility and
homeostasis) and those related to nursing, it goes on to discuss
medical-surgical nursing care problems with emphasis on the
nursing process throughout. Student aids include; learning
highlights (similar to objectives); vocabulary lists; summary
tables; and a student study aid section consisting of learning
activities, additional reading, and a study outline.
By Claire Brackman Keane, RN, BS. MEd. Formerly Director of
Nursing Education and Instructor in Medical-Surgical Nursing, Grady
Memorial Hospital School of Nursing, Atlanta. GA. About 600 pp.
lIIusld. About $16.10. Ready soon. Order *5313-8.
--------
CN 1/79
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Signature
All prices differ oUls,de U.S and subject to change
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Philadelphla,pa.19106 _ _ _ _ _ __
52 Jenuary 111711
The Can-.llen Nur..
books
BOOKS CAN HELP
Denise Alcod.
The experiences or sensitive observations of others when shared in the literary form can educate, enhance the reader's insight
and be therapeutic by offering hope and encouragement. This is an annotated bibliography of books which should help the
reader gain a better appreciation of the hardships and realities of living with certain disabilities, both from the personal and
family points of view. Although many of the books are written for school age and young adult readers - with the exception of
picture books - we as professionals can gain valuable insight into the reality oflife for some of our patients and their families.
Also included are some books that deal with the complexity oftoday's social life with its resulting emotional and social
problems for the child or adolescent. The books have been chosen because they can lend a helping hand.
Denise Alcock is the Director of the Child
Life Department. Children's Hospital of
Ew,tern Ontario, Ottawa, Ontario.
Axline, Virginia M.,DIBS In search 0/
self, Boston, Houghton \liffiin Co., 1964.
186 p.
With the hel p of play therapy and Dr.
Axline. a severely disturbed and
withdrawn child discovers his own
potential as an exceptionally gifted
person. The book is based on actual
recordings of weekly therapy sessions
and is an absorbing account ofDibs'
struggle for identity.
Barber, Elsie, The trembling years, N. Y.,
Macmillan, 1949,237 p.
At the age of 17 when life is full of
excitement, Kathy is stricken with
paralytic polio. Her relationship with
people changes, she rebels against her
handicap and feels very sorry for herself
The story deals with how Kathy
struggles to live with her problem and
comes to lead a fulfilling life.
Bretz, H. Lee, Donny and diabetes,
Vancomer, B.C., Tad Publishin
Ltd.,
1973, 55 p.
A pictorial educational guide for children
with diabete!>.
Brickhill, Paul, Reach/or the sky, N. Y.,
Norton, 1954,312 p.
The incredible true story of Douglas
Bader, who lost both legs in a plane
crash yet continued to golf. swim, drive a
car and fly a plane. During World War I[
he was taken prisoner and twice
escaped. A remarkable story of
inventiveness and determination.
I
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disability and the family's struggle as
well. Most informative regarding
problems. treatment methods, resources
and impact of dyslexia on the individual
and the community.
D' Ambrosio, Richard (M.D.), No
language but a cry, Dill Publishing Co.
Ltd., 1970,314 p.
The true story of a physically and
mentally scarred twelve-year-old who
had been abused as an infant by her
parents. It is a story of her rebirth as a
functional human being as a result of the
patience and wisdom of remarkable nuns
and Dr. D'Ambrosio.
Dahl, Borghild, Finding my way, N. Y.,
Dulton. 1962. 121 p.
The autobiography of a determined,
independent woman. who though blind.
maintains her own apartment. travels,
and shares practical ways for blind
people to stay in the mainstream of life.
Butler, Beverl). Light a single candle,
Arch"ay paperhack, 1970,217 p.
About a teenager's acceptance of and
adjustment to blindness which occurs at
14 due to an unsuccessful glaucoma
operation. The fact that the author,
Butler. lost her sight at the same age
contributes to the novel's sensitivity and
authenticity.
Christopher, Matt, Sink it, Rusty, Boston,
Little, Brown & Co., 1963, 138 p.
Rusty uses his handicap as a crutch.
With the help of a former basketball
player whose career was interrupted by
the loss of his left hand, Rusty learns to
adjust and make the most of his
capabilities. Deals with attitudes toward
handicap!>.
Clarke, Louise, Can't read, can't write,
can't talk too good either,N. Y., Walker &
Co., 1973. 2HO p.
A mother's personal document revealing
her child's struggle with severe language
The C..-.llan Nur..
J8nUllry 111711 5.1
Dizenzo, Patricia, Why me' N. Y., Avon
Books, 1976, 139 p.
Examines the loneliness, fears and hurt
of a 15-year-old rape victim.
Fanshawe, Elizabeth, Rachel, London,
England, The Bodley Head, 1975, 29 p.
A picture book which illustmtes how
Rachel who is in a wheelchair is able to
go to school, help at home and at school,
go to Brownies, learn to swim and ride
and choose a career.
Friis, Babbis, Kristy's courage, N.Y.,
Harcourt, 1965, 159 p.
Seven-year-old Kristy is struck by a car.
She has facial scars and her speech is
impeded. Upon return to school,
children laugh at her and tease her. Her
mother is in hospital with a new baby. It
is the story of how a 7-year-old deals
with these problems and how insensitive
people can be to visible handicaps.
Gardner, Richard, (M.D.), MBD The
family book about minimal brain
dysfunction, N. Y., Jason Aronson Inc.,
1973, 185 p.
A two part guide book: part I for parents
and part II for children, dealing with the
most common concerns regarding brain
dysfunction. For parents the book deals
with signs and symptoms, adaptive
reactions, social problems and the
child's future. The second part. with the
help of drawings and clear wording,
gives the reader (or child being read to)
an explanation of brain dysfunction. help
available and most important, a feeling
that somebody understands the problem.
Garfield, James, B. Follow my kader,
N.Y., Scholastic Book Services, 1957,
187p.
A firecmcker thrown by a friend causes
blindness. With the help of a guide dog.
Jimmy learns to become an active social
and happy person instead of the hostile
and dejected person he was just after his
accident.
Gunther, John, Death be not proud, N. Y.,
Harper & Row, 1965, 161 p.
A father's memoir of his teenage son's
battle with a brain tumor and his son's
maturity, courage and good humor in the
face of his terminal illness. It is written
so that others "may derive some
modicum of succor from the unflinching
fortitude and detachment with which he
rode through his ordeal to the end."
Haggard, Elizabeth, Nobody waved
goodbye, N. Y., Bantam Pathfinder, 186 p.
Peter, 16,
annot cope with the discipline
of schoolwork or with responsibility.
This novel reveals the thought processes
and feelings of a rebellious adolescent
who creates unhappiness for those who
love him as well as for himself.
Killilea, Marie, Karen, N.Y.,
Prentice-Hall, 1952,314 p.
Karen. the author's first child, has
cerebml palsy. Much shopping takes
place before Karen's parents are able to
find encouragement and medical help.
Obstacle after obstacle is overcome until
Karen can walk. talk. read and write.
Klein, Norma, What it's all about,
Archway Paperback, 1978, 146 p.
Life for an eleven-year-old with an
adopted Vietnamese orphan for a sister.
a stepfather that her mother fights with a
lot and finally leaves. a father who has
just remarried and whose new wife is
pregnant. and a young gmndmother who
has just remarried. is complex indeed.
The story is a reflection of modern day
family instability and its bewildering
effect on children.
Lasker, Joe, He's my brother, Toronto.
George J. McLeod Ltd., 1974,36 p.
Through excellent illustrations and a
simple story, this book helps young
children understand a sibling or friend
who has a learning disability.
Lawrence, Mildred, The shining moment,
N. Y., Harcourt, 1960, 187 p.
A car accident facially scars a pretty
university student. She drops out of
university, moves in with her
grandmother, and virtually goes into
hiding. Eventually as the scar fades and
she finds ajob, she becomes interested in
local community projects and a young
man. The story emphasizes that intellect,
friendship and interesting work are
better assets than facial beauty.
Litchfield, Ada. A cane in her hand,
Toronto, George J. McLeod Ltd., 1977,
30p.
A picture book about Valerie who is
visually impaired. The story is "intended
to create feelings of understanding and
acceptance toward visually impaired
persons."
Litchfield, Ada, A buUon in her ear,
Toronto, George J. McLeod Ltd., 1976,
28p.
A picture book with a story that helps
children understand the problems and
abilities of their deaf friends who must
wear a hearing aid.
Massie, Robert and Suzanne,Journey,
N.Y., Warner Books, 1973,462 p.
Alternate chapters are written by Robert
and Suzanne Massie whose only son has
haemophilia. It is a compelling story
which deals with the anxieties and the
hardships of the first eighteen years of
Bobby's life. It is also a factual
handbook on haemophilia and a history
ofthe progress and non-progress of
treatment techniques and facilities.
MacCracken, Mary, A circle of children,
Philadelphia, J.B. Lippincott Co., 1973,
221 p.
. 'This is the story of a teacher with a
listening heart who learned how to
understand her children's private hells of
anger. confusion, hurt and tragic
loneliness". (backcover)
Neufeld, John, Twink, N. Y., New
American Library, 1970, 127 p.
Twink has cerebral palsy. The whole
family is affected and involved.
''Twink'' portmys the anxiety, fear,joy,
set-backs, love and survival ofa family
with a member who has cerebral palsy.
Neufeld, John, Lisa, bright and lÙlrk,
N. Y., New American Library, 1969,
143p.
A 16-year-old cannot convince her
parents she needs psychiatric help. Her
teachers are afmid to interfere. Her three
teenage friends offer understanding and
amateur therapy until they can obtain
professional help for her. Lisa's mother
reacts to her hospitalization by hiding
from neighbors in shame.
Park, Clara Claiborne, The seige,
Toronto, Little, Brown & Co., 1967,
280p.
A mother's account ofthe family's
struggle to teach their autistic child to
love and to respond during the first eight
years of the child's life. Some ofthe
incidents this family encountered show
that the helping professionals can be
rude, self-important and insensitive
people.
54 "'nuery 111711
The Cen-.llen Nur..
Platt, Kin, Hey dummy, N.Y., Dell
Publishing, 1971, 171 p.
--
A pamfully sensitive novel about Neil. a
twelve-year-old. who befriends a
thirteen-year-old brain-damaged boy.
The novel portrays the cruelty of the
peer group. the fears of misinformed
adults and the pain such a friendship can
bring. The ending is unexpected but very
real.
Robinson, Veronica, David in
silence,Philadelphia, Lippincott, 1966,
126 p.
The new boy in the neighborhood is deaf.
He laugh<; inappropriately and his words
are unintelligible. Sometimes it is very
difficult for the other children to accept
him but slowly they learn ofDavid'<;
fears and his need for acceptance.
Samuels, Gertrude, Run Shelley run,
N.Y.. New American Librar), 157 p.
Shelley is a teenager who has had a
lifetime of trouble - an alcoholic
mother. a stepfather who tries to rape
her. a neighborhood where sex and drugs
have to be avoided and a training school
which is a prison. Run Shelley run!
Sha
, Charles R. When your child needs
help. l'o. Y., William !\torro
and Co.,
1972, 309 p.
Discusse
the major emotional disorders
of children. Written by a psychiatrist for
parents and teacher!> to enable them to
better understand the disturbed child.
Simon.
orma, All kitrds offamilies,
Toronto. George J. \1cLeod Ltd., 1976,
36p.
With the help of excellent illu<;tration<;
this book enables children to explore in
words and picture... what a family is and
how familie<; vary in makeup and
lifestyles.
Simon, Norma, n hy am I different,
Toronto, George J. McLeod Ltd., 1977.
31 p.
Situation
in this picture book help
children explore differences in growth.
hair color. physical abilities. cultural and
religiou<; background<; and family
structures.
Stewart, Mark A. (M.D., and Sail}
\\'endkos Olds, Raising a hyperactive
child, 1'i.Y., Harper and Row, 1973,
299 p.
The purpose of the book is "to restore
parents' confidence in themselves by
explaining the nature of the problems
presented by hyperactive children and
by describing practical ways to deal with
them. ..
Valens, E.G., The odrer side of the
mountain, N. Y., Warner Books, 1966,
301 p.
The story of Jill Kinmont who in her last
qualifying race before the 1955 Olympic
tryout crashed and was left permanently
paralyzed from the shoulders down. It is
a true story of incredible struggle and
victory.
\\,'aite, Helen E., Valiant companions,
N. Y., Scholastic Book Services, 1964,
279p.
A biography of Helen Keller and also to
some extent. a biography of Anne ,
Sullivan who. as Helen's teacher opened
the door to a full and rewarding life for
the blind. deaf and mute Helen.
West, Paul, Words for a deaf daughter,
"I.Y., Harper & Ro
. 1968. 188p.
Paul West is a professional writer and the
father of a deaf child who describes how
he brings the world to his daughter and
has as a result come to know and
appreciate the world better. Mandy's
presence has become ajoyful celebration
of the richness oflife itself. He
articulately brings to the reader an
awareness of many kinds of
communication apart from words and
also points out the vacuum between the
harassed parent and austere
professional.
library update
Publications recenlly received in the
Canadian Nurses Association Library a.ce
available on loan - with the exception of
items marked R -10 CNA members. schools
of nursing. and other institutions. Items
marked R include reference and archive
material that does nor go out on loan. Theses.
also R, are on Reserve and go out on
Interlibrary Loan only.
Requests for loans. maximum 3 at a rime,
should be made on a standard Interlibrary
Loan form Or by letter giving author. title and
item number in this list.
If you wish to purchase a book. contact
your local bookstore ór the publisher.
Books and Documents
I. Bou\'ier, G. Le nursing en neurologie et
en neurochirurgie. par...Juliana Pleines et
Jacques-CartierGiroux. St-Hyacinthe. P.Q..
Edisem; Paris. Maloine cl978. 313p.
2. Brown, Joan C. Prevention of handicap: a
case for improved prenatal and perinatal care.
A background paper. Ottawa. Canadian
Institute of Child Care. 1978. 57p.
3. Canadian Hospiral Associarion Annual
general meeting. 1978. Ottawa. Iv. (various
pagings)
4. Conférence infernationale sur les soins de
santé primaires, Alma-Ata, URSS 6-11, sept.
1978 Documents. Genève. 1978. 5pts. in \.
5. C onférence sur [' enseignement dans
['administration des services de santé au
Canada, Ottawa. 1977 Les besoins à
satisfaire; enseignement dans I'administration
des services de santé au Canada. Compte
rendu d'une conférence parrainée par la
fondation W.K. KelIoggde Battle Creek,
Mich. Ottawa. ColIege canadien des
\ I directeurs de services de santé. 1978. 144p.
6. Dickason, Elizabeth J. L'infirmière et la
périnatalité. Édité par...et Martha Olsen
Schult Montréal. HRW. cl978. 542p
7. Gougeon, J. L Ïnfirmière en
rhumatologie. Paris, Expansion scientifique
française. 1978. I39p.
8. International Conference on Primary
Health Care, Alma-Ata, USSR. 6-11 Sept.
1978 Non-governmental organizations and
primary health care. Halifax. 1978. A Position
paper prepared for the International
Conference... Sponsored by WHO/UNICEF.
Washington. World Health Federation of
Public Health Associations. 1978. 93p.
9.-.Papers.Geneva. 1978. 5pts. in I. R
10. I nternational Labour Conference. 63rd
Ovol
80
Tablets
Ovol]40
Tablets
Ovol@
Drops
Antiflatulent Simethicone
INDICATIONS
OVOl is indicated to relieve bloating,
flatulence and other symptoms caused
by gas retention including aerophagia
and infant colic.
CONTRAINDlCATlONS
None reported.
PRECAUTIONS
Protect OVOl DROPS from freezing.
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOl 80 TABLETS
Simethicone 80 mg
OVOl 40 TABLETS
Simethicone 40 mg
Adults: One chewable tablet between
meals as required.
OVOl DROPS
Simethicone (in a peppermint flavoured
base) 40 mg/ml
Infants: One-quarter to one-half ml as
required. May be added to formula or
given directly from dropper.
Ð HQRflfR
"
session, Geneva, 1977 Draft programme and
budget 1978-79 and other financial questions.
Second item on the agenda: programme and
budget pmposals and other financial
questions. Geneva. International Labour
Office. 1977. 83p. (/ts Report 2)
II.-.Provisionalrecmd. Sixth item on the
agenda: employment and conditions of work
and life of nursing personnel. Geneva.
International Labour Office. 1977. 3pts. in I.
12.-.Committee on nursing personnel
Pmceedings. Geneva. International Labour
Office. 1977. 9pts. in I.
13. International Labour Organization
Conditions of work and employment of
professional workers. Tripartite
meeting.. .Geneva. 1977. Geneva.
International LabourOffice. 1977. Hip.
14.-Director-General's programme and
budget proposals for 1978-79.Geneva,
International Labour Office. 1976. Iv.
(various pagings)
15. Kesterton, Wilfred H. The law and Ihe
press in Canada. Toronto. McClelland and
Stewart in association with the Institute of
Canadian Studies. Carleton University.
'- cl976. :!4:!p. (fheCarleton Library no. 1(0)
16. MacStrm'ic, Robin E. Determining
health needs. Ann Arbor. Health
Administration Press. cl978. :!68p.
17. N eh' Democratic Party of Ontario.
Health Policy Planning C ommitree Health.
not illness: A green paper for Ontario.
Toronto. 1978. 74p.
18. Organisation mondiale de la Santé
Répertoire mondial des écoles d'agents
d'assainissement. 1973. Genève. 1978. 81p.
-
.,
,. \
. .
I. . '.
....
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.....' I .
L
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/'
THE
LAST
THING HE
NEEDS
IS GAS.
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The Cenedlen Nur..
19. Primary health care. A joint report by
the Director-General of the World Health
Organization and the Executive Director of
the United Nations Children's Fund. Geneva.
World Health Organization; New York.
UNICEF. 1978. 49p.
20. Public Services International Report.
1973-1976. Feltham, Middlesex, 1977. Iv.
(various pagings)
21. Smith, Janet Saskatchewan registered
nurses' perceptions of quality of care. A study
undertaken by Dept. of Social and Preventive
Medicine. Univ. of Saskatchewan...under
contract with Saskatchewan Registered
Nurses' Association. Regina. Reprinted with
a foreword and summary by Sask. Registered
Nurses' Assoc. and with permission of the
Dept....Saskatoon. 1978. 133p.
22. Les soins de santé primaires. Rapport
conjoint du Directeur général de
"Organisation mondiale de la Santé et du
directeur exécutif du Fonds des Nations
Unies pour I'enfance. Genève, Organisation
mondiale de la Santé; New Y mk. UNICEF.
1978. 54p.
23. Teaching and evaluating the affective
domain in nursing programs. Editor Dorothy
E. Reilly. Thorofare. N.J., Charles B. Slack.
cl978. 76p.
24. Vanier Institute of the Family The new
life. Ottawa, 1977. 51p.
:!5.-.Varieties offamily lifestyles: a selected
annotated bibliography. phase I. Ottawa.
197? 98p.
:!6. World Health Or1!anization World
directory of schools for auxiliary sanitarians.
1973. Geneva. 1978.8Ip.
(fiD
eP'"
K!!!!!!i
'" .,,-=
'I',
,
.
..
When a patient can't
move around, gas can be
a problem, and a painful
one at that. So for pa-
tients who are immobile
following surgery or for
post-cholecystectomy
patients. give them extra
strength OVOL 80, the
chewable antifiatulent
tablets that work fast to
relieve trapped gas and
bloating.
,
Jenuery 11171 55
Pamphlets
27. A ssociation des infirmières et infirmiers
du Canada La direction des relations de
travail de I'A.l.I.C. et vous. Ottawa, cl978.
brochure.
28. Canadian Labour Congress By-Laws
governing chartered local unions. Rev.
Ottawa, 1975. 31p.
29.-.Constitution. Rev. Ottawa. 1976. 47p.
30. Canadian NursesAssociation You and
yourCNA Labour Relations Department.
Ottawa. cl978. pam.
31. Congrès du Travail du Canada Statuts
Édition revisée. Ottawa. 1976. 50p.
. 32. L'lnstitut Vanier de lafamille
Déclaralion sur les styles contemporains de
vie familiale. Ottawa. 1977. Iv. (pagination
multiple)
33. Levêque, 8. Comment faire pour que
notre enfant soit vite propre la nuit. par...et C.
Dilain. Paris. Expansion scientifique
française. c1978. 24p.
34. McMurray, David Current economic
and industrial relations indicators. Kingston.
Ont..lndustrial Relations Centre. Queen's
University, 1978. 38p.
35. Munro, John A statement by....Minister
of Labour to the sixty-third session of the
International Labour Conference. Geneva.
Switzerland. Monday. June 13, 1977. 15p.
36. National League for Nursing. Division
of Baccalaureate and Higher Degree
Programs Doctoral programs in nursing.
1978-79. NewYof'k. 1978. (NLN pub.no.
15-448) 5p. R
37. Queen's U niversiry.1 ndusfrial Relations
Centre Collective bargaining and white collar
Ovol"
80
r rGas
C<Itre
IesGaz.
9 HQBJl..sR
a-=..
Product mODOp"'ph
evailable OD req.-t.
!Ie Jenuery 111711
,..- ""'II
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this
patient
needs
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When patients need private duty
nursing in the home or hospital,
they often ask a nurse for her
recommendation. Health Care
Services Upjohn Limited is a re-
liable sourCe of skilled nursing
and home care specialists you
can recommend with confidence
for private duty nursing and home
health care.
All of our employees are carefully
screened for character and
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pendable. professional care.
Each is fully insured (including
Workmen's Compensation)
and bonded to guarantee your
patient's peace of mind.
Care can be provided day or
night, for a few hours or for as
long as your patient needs help.
For complete information on our
services, call the Health Care
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.HaJ
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HCS ee23 1
The Cen-.llen Nur..
employees; a bibliography 1970-1977. municipalities. Ottawa. Minister of Supply
Compiled in the Research Reference Section. and Services Canada. 1978. 80p. Catalogue
Kingston, Ont.. 1977. lOp. no. 94-803.
38.-.Collective bargaining in education in 57.-.Census of Canada. 1976. Vol. 9.
Canada: a bibliography 1970-1977. Compiled Supplementary bulletins: housing and
in the Research Reference section. Kingston, families. family composition. Ottawa.
Ont.. 1977. 6p. Minister of Supply and Services Canada,
39.-.Health care sector unionization and 1978. (various pagings) Catalogue no. 93-831.
collective bargaining; a bibliography 58.-.Health manpower registered nurses,
1970-1977. Compiled in the Research 1976. Ottawa. 1978. 116p. Catalogue no.
Reference Section. Kingston, Ont.. 1977. 9p. \ j!3-220.
40.-.lndex of industrial relations literature j9.-.Nursing in Canada: Canadian nursing
1976-. Compiled in the Research Reference statistics, 1977. Ottawa, 1978. 137p.
Section. Kingston, Ont.. 1977. Iv. 60p. Catalogue no. 83-226.
41.-.Job evaluation; a bibliography 60. Statistique Canada Main-d' oeuvre
1970-1977. Compiled in the Research sanitaire infirmières et infirmiers autorisés.
Reference Section. Kingston. Ont.. 1978. 4p. 1976. Ottawa. 1978. 116p. Catalogue no
(Its Compensation Bibliographies series no.l) 83-220.
42.-.Pay for performance; a bibliography 61.-.Recensement du Canada, 1976. Vol. 5,
1970-1977. Compiled in Ihe Research Activité; taux d'activité selon I'âge et Ie sexe
Reference Section.
ingston. Ont.. 1978. 9p. Canada. provinces et divisions de
(Its Compensation Bibliographies series no. 3) recensement. Ottawa. Ministre des
43.-.Performance appraisal; a bibliography Approvisionnements et Services Canada.
1970-1977. Compiled in the Research 1978. 4Op. Catalogue no. 94-802.
Reference Section. Kingston.Ont., 1978. 16p. 62.-. Recensement duCanada, 1976. Vol. 5.
(Its Compensation Bibliographies series no.2) Activite; tau x d'activité selon I'âge et Ie sexe
44. Vanier Institute of the Family A agglomérations de recensement et
statement on contemporary familial lifestyles. municipalités. Ottawa, Ministre des
Ottawa. 1977. Iv. (various pagings) Approvisionnements et Services Canada.
Government Documents 1978. 8Op. Catalogue no 94-831
Canada 63.-.Recensement du Canada. 1976. Vol. 9,
45. Health and We/fareCanada Summary Bulletins supplémentaires: logementset
of projects approved January 1974 to March families, composition de la famille. Ottawa.
1977. National health research and Ministre des Approvisionnements et Services
development program. Ottawa. 1978. Iv. Canada, 1978. (pagination multiple) Catalogue
124p. " no 93-831.
46. Labour Canada Working:conditions in 64.-.Soins infirmiers au Canada: statistique
Canadianinduslry.1977.0ttawa.1978. 136p. des soins infirmiers. 1977. Ottawa. 1978.
47. Tra
'ail Canada Conditions de travail 137p. Catalogue no 83-226.
dans I'industrie canadienne, 1977. Ottawa. 65. Tramil Canada Grèves et lock-out au
1978. 136p. Canada. 1977. Ottawa. Ministre des
48. Shillington. E. Richard Selected Approvisionnements el Services Canada,
economic consequences of cigarette smoking. 1978.80p.
Ottawa. Dept. of National Health and New Brunswick
Welfare. 1977. I v. (various pagings) 66. Task Force on New Brunswick Health
49.-.Quelquesconséquenceséconomiques Care. Report. Fredericton. 1978. 69p.
de I'usage de la cigan:tte. Ottawa. Ministère Chairman: S. Cassidy
de la Santé nationale et du Bien-être social, 67. Comité d'Étude sur les soins de santé
1977. Iv. (pagination multiple) Rapport. Frédericton. 1978. 69p. Président: S.
50. Lois,statuts etc. Lois sur les stupéfiants. Cassidy
Codification administrative. S.R.. c.N-1 Ontario
modifiée à 1972, c.17 1974. 75-76c.48 etle 68. Ministry of Labour. Research Branch
Règlement sur les stupéfiants établi par C.P. Life insurance and accidental death and
1961-1 \33 modifié àC.P. 1977-2012. Ottawa dismemberment insurance plans in Ontario
Approvisionnements et Services Canada. collective agreements. Toronto. 1977. 12p.
1978. 47p. (Bargaining information series. no. 24)
51. Conseil national de recherches du 69.-.0.H.LP. major medical, prescription
Canada Rapport. 1977/78. Ottawa. 1978. and dental plans in Ontario collective
128p. agreements. Toronto. 1977. 16p. (Bargaining
52. National Research Council of Canada information series. no. 25)
Report. 1977/78. Ottawa, 1978. 128p. 70.-.Paid vacations and paid holidays in
53. Sante et Bien-être social Canada Ontario collective agreements. Toronto. 1977.
Planification familiale; inventaire des 24p. (Bargaining information series. no. 23)
ressources. Ottawa, 1977. 274p. 71.-.Part-time work in Ontario: 1966 to 1976.
54.-.Protection de la Santi Les maladies Toronto. 1976. 24p. (Employment information
liées à I'usage du tabac au Canada: les series. no. 20)
tendances de la mortalité-Ies maladies 72. Ontario Council of Health
ischémiques du coeur. Ottawa. 1976. \3p. Hypertension. Toronto, 1977. Iv. {various
(Son Rapport technique no 5) pagings)
55. Statistic s Canada Census of Canada. Saskatchewan
1976. Vol. 5. Labour force activity; labour 73. Dept. of Continuing Education. Policy
force participation rates by age and sex Planning and Management Information
Canada. provinces. census divisions. Ottawa. Systems Branch First follow-up of the 1977
Minister of Supply and Services Canada. certified nursing assistant. diploma nursing
1978. 40p. Catalogue no. 94-802. and psychiatric nursing graduates from
56.--.Census of Canada. 1976. Vol. 5. Labour Kelsey and Wascana Institutes: Results ofthe
force activity; labour force participation rates special nursing questionnaire. Regina. 1978.
by age and sex census agglomerations and . 25p. R
The Cen-.llan Nur..
'I
Jenuary 11171 57
74.-. Second follow-up of the 1976 certified
nursing assistant. diploma nursing and
psychiatric nursing graduates from Kelsey
and Wascana Institutes: Results ofthe special
nursing questionnaire. Regina, 1978. 3Op. R
75.-.Second follow-up ofthe 1976 graduates
of Kelsey and Wascana Institutes health
science programs. Regina. 1978. 45p. R
76.-Research and Planning Branch First
follow-up of the 1977 health science program
graduate. Regina, 1978. 67p. R
United States of America
77. Dept. of Health. Education and Welfare.
Bureau of State Ser....ices. Tuberculosis
Control Dil.;sion Tuberculosis in the United
States. 1976. Atlanta.Ga.. 1978. 55p. (DHEW
pub. no. (CDC) 78-8322)
78. Dept. of Health, Education and Welfare.
Public Health Sen-ice National Library of
Medicine Classification; a scheme for the
sheIfarrangement of books in the field of
medicine and its related sciences. 4th ed.
Bethesda. Md.. 1978. 390p. (DHEW pub. no.
(NIH) 78-1535)
79. National Institute on Drug Abuse
Research on smoking behavior. Washington,
Superintendent of Documents. 1977. 383p.
(DHEW pub. no. (ADM) 78-581) (NIDA
Research Monograph 17)
Studies in CNA Repository Collection
80. Brooks. Faye Marybelle A study of the
expressed concerns of multiparous mothers.
four weeks after the delivery of an infant.
Toronto, c1977. 93p. Thesis (MScN)- Toronto.
'\
:1. Canadian Conference on Nursing
I Diagnosis I, Toronto. Nov. 24. 25.1977
Proceedings. Toronto. Faculty of Nursing,
University of Toronto. 1977. lOOp. R
82. Cleyle. Theresa Helen Patient's
identification of home care needs. Halifax,
1977. 92p. Thesis (M.N.)-Dalhousie. R
83. Dufour, Nan-Michelle A study of
self-actualization. Vancouver. B.C.. 1978.
55p. Study (M.Ed.)-UBC R
84. Field, Peggy-Anne A follow-up study of
graduales from the four year B.Sc.
programme in nursing. University of Alberta.
1971-1974. Edmonton University of Alberta.
Faculty of Nursing. 1978. 153p. R
85. Ford. James Ellsworth Doing obstetrics:
the organization of work routines in a
maternity service. Vancouver. 1974. 332p.
Thesis-British Columbia. R
86. Herbert. Pearl The relationship between
prenatal classes and care of the newborn.
Halifax, 1978. 98p. Thesis (M.S.)-Dalhousie.R
87. Jackson. Marion Ruth Study of the
modification of a workload index staffing tool.
Vancouver. 1973. 82p. Thesis
l\ (M.S.N.)-BritishColumbia. R
88. Kerr. Janet Catherine Ross Financing
university nursing education in Canada:
1919-1976. Ann Arbor. 1978. 277p.
Thesis-Michigan. R
89. Pine/li. Janet May A comparison of
mothers' concerns regarding the care-taking
tasks of newborns with congenital heart
disease before and after assuming their care.
Toronto. c1978. 127p. Thesis
(M.Sc.N)-Toronto. R
90. Registered Nurses' Association of
British Columbia. Steering Committee to
Identify Essential Manual SJ.ills Essential
manual skills for a new graduate. Report.
Vancouver. Registered Nurses' Association
of British Columbia. c1978. Iv. (various
'\..pagings)
",91. Workshop on Research Method%gv in
Nursing Care, O"awa. 9-11 Nov. 1977
Working papers. 1976-1977. Iv. R
92. Funke-Furber. Jeanette T. Reliability
and validity testing of indicators of maternal
adaptive behavior. Edmonton. University of
Alberta. Faculty of Nursing. 1978. t29p. R
93. Gibbon. Mary Nurse influence on the
quality oflife of elderly patients with chronic
illness, by...and Ellen Stevens. Hamilton,
Victorian Order ofN urses for Canada.
Hamilton-Oundas Branch. 1977. Iv. (various
pagings) R
94. Hart. Geraldine Angela Spinal cord
injury: early impact on the patient's
significant others. Vancouver. 1978. 112p.
Thesis (M.Sc.N.)-British Columbia. R
95. Kleiber. Nancy Caring for ourselves: an
alternative structure for health care. by.. .and
Linda Light. Vancouver. School of Nursing.
University of British Columbia, 1978. 184p. R
96. McRae. Bradley C. A survey of smoking
education given in prenatal classes in Canada,
by. ..et al. Ottawa. Canadian Council on
Smoking and Health. 1977. 35p. R
97. Money. Sheila Student nurses' death
anxiety. death education. evaluation anxiety
and clinical penormance. Toronto. 197'.'. 29p. R
98. Travaux du colloque sur la méthodologie
de la recherche infirmière, Ottawa. 9 au II
novo 1977 Méthodologie de la recherche
infirmière. Ottawa. Association des
infirmières et infinniers du Canada. 1978.
273p. R
99. Tremblay, Marthe Le marriage
encounter (Étude exploratoire d'un service
aux couples). Ottawa. 1978. 145p. R
100. Wells, Thelma Toward understanding
nurses' problems in care of the hospitalized
elderly. Manchester. Eng.. 1975. 370p.
Thesis-Victoria University R
Audio "ïsual Aids
101. Association des medecins de langue
française du Canada Sonomed. série 4, no.
10. Montréal. 1973. I cassette. Contenu:-Côté
A. Bureau, Jules. La place du sexologue en
médecine générale.-Côté B. I. Camerlain,
Monique. L 'Arthrite rhumatoidejuvénile. 2.
Viens. Pierre. Le trichinose. 3. Séguin.
Fernand, L'instinct des saumons.
102.-.Sonomed. série 4. no 12. Montréal.
1973. I cassette. Contenu:-Côté A. Jobin,
Françoise. Principes et pratique de
I'Anticoagulo-thérapie.-Côté B. I. Viens,
Pierre. La toxoplasmose. 2. Séguin Fernand,
Du nouveau sur robésité.
103. Hennes: Ie satellite technologique de
télécommunications son fonctionnement et
ses applications. La Société royale du Canada
de concert avec Ie Ministre des
Communications Canada et I'Administration
nationale aéronautique et spatiale. États-Unis
d'Amérique. Ottawa, La Société royale du
Canada, 1978. 3v.
104. National Library of Medicine
audiovisuals catalog. 1977. Bethesda. Md.,
U.S. Dept. of Health. Education and Welfare.
Public Health Service. National Institutes of
Health. 1978. Iv. (DHEW Publication no.
(NLH) 78-1102)
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51 Jenuary 11171
The Cen-.llan Nur..
Classified
Advertisements
Alberta
DIrector of Nursing required immediately for SG-bed
nursing home in Bonnyville. 165 miles North-East of
Edmonton. Alberta regislration required. An in-
terest in geriatrics. and experience in supervision is
essential. Salary negotiable. Please send resume to:
Mrs. H. Masterson. Parkland Nursing Homes Ltd..
13210-114 Street. Edmonton. Alberta, T.5E .5E2.
The University of Alberta Faculty of Nursing invites
applications for a Cllnlelll Nunr Researeher position.
A senior tenure-track position. Major respon-
sibilities for developing an active clinical research
program; some teaching in M.N. or senior under-
graduate courses; possibility of joint appointment
with clinical agency. Requiremenls: Ph.D. in nursing
or related field. recent clinical experience: research
and/or graduate teaching experience. The University
of Alberta is an Equal Opportunily Employer. Dead-
line for application: I March 1979. Appointment to
be made: I July 1979. Apply to: Dr. A.E. Zelmer,
Dean. Faculty of Nursing, The University of Al-
berta. 3rd floor - Clinical Sciences Bldg.. Edmon-
ton, Alberta. T6G 2G3.
The University of Alberta Faculty of Nursing invites
applicalions to fill full-tIme or part-time teaching p0s-
Itions In undergraduate progrem. ([hese positions
are contingent on funding for an expanded Post-R.N.
baccalaureate program). M
or responsibilities for
teaching senior undergraduate courses in all fields of
nursing. Some opportunities for selected teaching in
M.N. program and clinical jomt appointments to ap-
propriately qualified individuals. Requirements:
Master's degree completed. Preference will be given
to those with university-level teaching expenence
and/or recent clinical experience. The University of
Alberta is an Equal Opportunity Employer. Deadline
for application: I March 1979. Appointment to be
made: I July 1979. Apply to: Dr. A.E. Zelmer. Dean,
Faculty of Nursing. The University of Alberta, 3rd
floor - Clinical Sciences Bldg., Edmonton. Alberta.
T6G 2G3.
The Big Country Health Unit requires a l>lrector to
commence work February I, 1979. Applicant with
Public Health experience required. This is a super-
visory position and applicant should be knowledge-
able in that field. Salary negotiable based on qualifi-
cations and experience. Apply to: Director. Big
Country Health Unit. Box 279. Hanna, Alberta. TOJ
IPO.
British Columbia
Rqlltered and Graduete Nunes required for new
41-bed acute care hospital. 200 miles north of
Vancouver. 60 miles from Kamloops. Limited
furnished accommodation available. Apply: Director
of Nursing. Ashcroft & District General Hospital,
Ashcroft. British Columbia. VOl< IAO.
Challenge and opportunity await the nurse prepared
to accept a position In a 1000bed accredited acute
care hospital in a booming northern city. We will
help the beginning practitioners to expand their
knowledge and skills. Write to: Nursing Director.
Dawson Creek and District Hospital, 1l100-l3th St..
Dawson Creek. British Columbia. VIG 3W8.
British Columbia
Gnera1 DuI, N_ for modem 41-bed accredited
hospital located on the Alaska HiPway. Salary and
penonnel policies in accordance with the RNABC.
Temporary accommodation available in residence.
Apply: DireClor << Nursin.. Fan Nelson General
Hospital, P.O. Boll 60. Fan Nelson. British Colum-
bia, VOC tRO.
Generlll Duty Registered er Graduate Nu....,. -
needed for 2.5-bed acute care hospital in North
Central B.c. Salary and working condition
according to the RNABC CotltraCl. Apply: Director.
Stuart Lake Hospital. Fort St. James. British
Columbia. VOJ IPO or call collect (604)
996-8201/996-730.5 .
Experienced Nunes (eligible for B.C. Registration)
required for full-time positions in our modern
300-bed Extended Care Hospital located just thirty
minutes from downtown Vancouver. Salary and
benefits according 10 RNABC contract. Applicants
may telephone .52.5-0911 to alTange for an interview.
or wrile giving full particulars 10: Personnel Direc-
tor, Queen's Park Hospital. 31.5 McBride Blvd.,
New Weslminster. British Columbia. V3L .5E8.
Eaperiftced Nllww. (B.C. Keaistered) required for
upansion to 463 bed acute. teachina, reaional
referTaI hospitllliocated in Fraser Vlllley, 20 minutes
by freeway from Vancouver, and within easy access
of various recreationlll facililies. Euellent orienta-
tion and continuina education proarammes. Salary:
S 1184.00-S 1399.00 per month (1977 rates). There is
an immediate need tn coronary care. intensive care,
operatina rooms and hemodilllysis because 0(
increased services. OIher clinical areas include
medicine. sUl'lery. obsletrics, pediatrics. emeraency
and rehabililation. Apply to: Personnel, Royal
Columbian Hospital. New Westminster. British
Columbia. VJL JW7.
General Duty Nurses (eligible for B.C. registration)
required for 12.5-bed hospital in the South Okanagan.
RNABC contract in effecl. Reply in writing to:
Director of Nursing. South Okanagan General
Hospital. Box 760. Oliver, British Columbia. VOH
ITO.
Experlencrd ICU/CCU and Operatl", Room General
Duty Nunes required for full-time and summer relief
in a 230-bed accredited hospital in the Okanagan
Valley. Must be eligible for B.C. registration. Salary
$1,30.5 to SI..542 per month, with differential for
special clinical preparation of not less than 6 months.
Apply to: Director of Nursing. Penticton Regional
Hospilal, PenticlOn. British Columbia. V2A 3G6.
Registered Nunes - Required immediately for a
340-bed accredited hospital in the central interior of
B.C. Registered Nurses interested in nursing posi-
tions at Ihe Prince George Regional Hospital are
invited to make inquiries to: Director of Personnel
Services, Prince George Regional Hospital. 2000-
l.5th Avenue. Prince George. British Columbia V2M
IS2.
Wanted Immediately. R.N.'. Generlll Duty. Perma-
nent full-time and part-time. Apply to: R. Billerlich,
Nursing Director, Queen Charlotle Islands General
Hospital, Box 9. Queen Charlotle City. British
Columbia. VIJf ISO. Phone: (604) .5.59-4411, Local
2.5.
British Columbia
Faculty - New Position (I) in 2-year post-basic
baccalaureate program in Victoria. B.c.. Canada.
Generalist in focus. clinical experience is provided in
gerontology in community and supportive exlended
care units. and in community nursing.
Highly-qualified and motivated studenls in a
dynamic academic environment stimulate teaching
creativilY which. with research, is strongly
endorsed. Master's degree. teaching and recent
clinical experience in geronlology/med.-surg./reha-
bilitation preferred. Salaries and fringe benefits
competitive: an equal opportunity employer for
qualified persons. Appointment effeclive July I.
1979. Contact: Dr. Isabel MacRae. DireClor, School
of Nursing. University of Victoria. P.O. Box 1700,
Victoria, B.C.. Canada. V8W 2Y2. Telephone (Area
Code 604) 477-6911 - Local 4814.
Nova Scotia
Teaching Posh Ion Available: Nurse clinician with
master's preparation to teach in the Bachelor of
Science In Nursing program in the area of children
and/or adult nursing. Program enrolment: 100.
Salary commensurate with preparation and experi-
ence. Write to: Chairperson, Department of Nurs-
ing. St. Francis Xavier University. Antigonish.
Nova Scolia. B2G ICO.
Quebec
Cemp Nurses required for childrens summer camp in
beautiful Quebec Laurentians. Mid-June to end of
August. Resident M.D. Contact: Mr. Herb Finkel-
berg. Director of Camp B'nai B'rith. .51.51 Cote SI.
Catherine Rd., Suite 203. Montreal. Quebec. H3W
IM6, or lelephone (.514) 73.5-3669.
Nurses for Children's Summer Camps In Quebec. Our
member camps are located in the Laurentian Moun-
tains and Eastern Townships. within 100 mile radius
of Montreal. All camps are accrediled members of
the Quebec Camping Association. Apply to: Quebec
Camping Association. 2233 Belgrave Avenue,
Montreal. Quebec. H4A 2L9. or phone 489-1.541.
United States
RN'S-CalifornlL Registered nurses interested in a
career in California working in skilled nursing
facilities. Salary is comparable to Canadian wages.
Moving expenses provided. No California examina-
tions are required. Write: M. Cameron. 12.54 Prin-
cess Street. ApI. 17. Kingslon. Ontario, K 7M 3C9 or
telephone (613 1.544-0 170-Evenings or weekends.
Nursing Opportunity - Mississippi Baptist Medical
Center, a ma,jor 600-bed hospital. has immediate
positions available for experienced RNs and recent
nursing school graduates in a variety of specialilies
and medical/surgical areas. Competitive salaries.
liberal benefits. Visa, licensure and relocation
assistance provided. Located in Mississippi's capital
city of Jackson (population 300,(00). MBMC is the
state's largest and most modern privately operated
hospital. For further information write: Mrs.
Johnnye Weber, Nurse Recruiter, 122.5 North State
Street. Jackson. Mississippi 39201; or call collect
601/968-.513.5.
The Cen-.llen Nur..
..
Januery 11171 511
United States
United States
RNII- Aa Exdtlaa Career Awaits You In Las Vqas.
Join Valley Hospital and realize your nursing
potential while e
oying the unique lifestyle of sunny
Las Vegas. Valley Hospital is a progressive,
fully-accredited 277-bed facility nNed for providing
higfl quality personalized medical care. We offer an
excellent salary and benefit package. For more
information, write or call collect: Kalene Ryan,
Nurse Recruiter. CN-I, Valley Hospital. 620
Shadow Lane. Las Vegas. Nevada 89106, (702)
385-3011.
Nanes - RNII - Immediate Openin,lI in
California-Florida-Texas-Mississippi - if you are
experienced or a recent Graduate Nurse we can offer
you positions with excellent salaries of up to 51300
per month plus all benefits. Not only are there nO
fees to you whatsoever for placing you, but we also
provide complete Visa and Licensure assistance at
also no cost to you. Write immediately for our
application even if there are other areas of the U.S.
thaI you are interested in. We will call you upon
receipt of your application in order to alTange for
hoSpital interviews. You can call us collect if you Brf
an RN who is licensed by examination in Canada or
a recent graduate from any Canadian School ct
Nursifli. Windsor Nurse Placement Service. P.O.
Box 1133, Great Neck. New York 11023. (516-487-
2818).
"Our 20th YearofWorJd Wide Service"
The Best Location la the Nation - The world-
renowned Cleveland Clinic Hospital is a progres-
sive, 1020-bed acute care teaching facility committed
to excellence in patient care. Staff Nurse positions
are currently available in several of our 61CU's and
30 departmentalized med/ surg and specialty divi-
sions. Starting salary range is 513.286 to 515,236,
plus premium shift and unit differential. progressive
employee benefits program and a comprehensive 7
week orientation. We will sponsor the appropriate
employment visa for qualified applicants. For
funher information contact: Direclor - Nurse Re-
cruitment, The Cleveland Clinic Foundation. 9500
Euclid Avenue, Cleveland, Ohio, 44106 (4 hours
drive from Buffalo. N.Y.); or call collect 216-444-
5865.
NuninB Opponunities - ProJVessive SOO-bed Medi-
cal Center in West Texas city of Abilene with
population nearly 100.000 is Iookifli for aew
,ndulllft and experienced R.N.'s for positions in
O.B.. Pedialrics. SurBery. E.Jt... ICU. CCU. plus
surJicai and medical floors. Good compelitive salary
and Benerous benefils are provided. Contact: Per-
sonnel Office. Hendrick Medical Center. 19th and
Hickory. Abilene. Texas. 79601.
A....13.
.,
MEDICAL
RE'CRUITERS
OF AMERICA
INC.
MRA recruIts Regls.ered Nurses and recen,
Gradua.es tor hosp"al pOSItions In many
U S clloes We provide comple'e Work V,sa
and Sta.e licensure .ntormaloon
ARLINGTON. Tit. 76011
6" Ryan Plaza Dr SUlle 531
(811) 461-1451
CHICAGO. ILL 60607
500 So RaCine 51 SUile 3.2
13121942."46
FT. LAUDERDALE. FL. 33309
800 N W 62nd 51 SUite 510
(305) 172.3680
FOUNTAIN VALLEY. CA. 92708
17400 BrOOkhurst SUile 213
1714) 964.2471
PHOENIIt. AZ. 85015
5225 N 19th A.ve. SUlle 212
(602) 249-1608
TAMPA. FL. 33607
1211 N Wesishore Bivd. SUI1e 205
18131872.0202
ALL FEES EMPLOYER PAID
lfh
GENERAL
ST AFF NURSES
Operating Room
We require general staff nurses for Ihe
Operating Room of Calgary's largest general
hospital. The successful applicants must be
eligible for registration in Albena and have
experience and or a post graduate course in
Operating Room technique.
The salary range is 51123-51341 per monlh
plus educational allowances and shift
premiums. There is a comprehensive
employee benefit program included.
Please apply with resume of qualifications
and experience to:
Director 01 Personnel
CALGARY GENERAL HOSPITAL
1141 Centre Avenue East
Calgary, Alberta
T2E lOA
Unit Co-ordinator
Reponing to the Assistant Executive Director.
the incumbent will be responsible for managing:
a) Spedal Care unit (4 beds)
b) Emergency Department
c) O.R.. Recovery. N.F.A.
area'of an accredited 100 bed. acute Care hospital
in Nonhern !vIanitoba. These units normally
operate wilh a lotal staff of20-25 people.
We require a nurse who is eligible for
registration with M.A.R.N. as an active
practising member. A nurse who has 3-5 years
clinical experience in a critical area and who has
graduated from a recognized program in I.C. U.
as desired. A BSc. degree in nursing would be a
definite asset. The candidate should also be an
instructor in C.P.R. or be willing to obtain same
and be willing to co-ordinate and participate in
clinical teaching in the critical care area.
This position offers an excellent range of
benefits. including free denlal plan. accident and
health insurance. four weeks annual vacation.
group life insurance and nonhern allowance.
The initial salary will be in excess of 5 16.000 per
year.
Interested parties are asked to submit a complete
resume in confidence to:
R.L.lrvlne
Direc10r 01 Personnel
Thompson General Hospital
Tlaompson Drive South
Thompson. Manitoba R8N OC8
Canadian Nunes - Our 350+ bed full service
community hospital in a city of 70.000 in the piney
woods and lakes of beautiful East Texas wishes to
extend an invitat,C'n to you to practice nursing in a
progressive hospital while you and your family enjoy
the good life atmosphere of smaller city living. Our
special visa sponsorship and licensure program may
be what you have been seeking. We plan a trip to
several cities in Canada to interview and hire soon so
don't delay your response. For more information.
please write or call Jack Russell. 611 Ryan Plaza
Drive. Suite 537. Arlington. Texas. 76011. (817)
461-14S1.
CeDe to Tn.. - Baptist Hospital of Southeast
Texas is a 400-bed growth oriented ol'Janization
lookifli for a few Bood R.N.'II. We feel that we can
offer you the challenge and opportunity to develop
and continue your professional jp"owth. We are
located in Beaumont, a city of 150,000 with a small
town atmosphere but the convenience of the IlU}Ie
city. We're 30 minutes from the Gulf of Mexico and
surrounded by beautiful trees and inland lakes.
Baptist Hospital has a progress salary plan plus a
liberal fringe package. We will provide your immig-
ration paperwork cost plus aiñare to relocale. For
additional intonnation. contact: Personnel Ad-
ministration, Baptist Hospital of Southeast Texas.
Inc.. P.O. Drawer 1591. Beaumont. Texas m04. Aa
amrmlllive adIoa employer.
Excltemeat: Come and join us for year around
excitement on the border. by the sea. an unbeatable
combination. Enjoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed. acute care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opponunities. We have immediate openings in all
areas. Excellent salary and fringe benefils. We invite
you to share the challenge ahead. A"istance with
travel expenses. Write or call eoUect: Joe R. Lacher.
RN. Director of Nurses. Valley Community Hospi-
tal, P.O. Box 4695. Brownsville. Texas 78521; I
(512) 831-9611.
Primary Cbildren's Medical Center in Utah has A
Place lor You. RN's - interested in new born
intensive care-We want you! We've opened our
new 22-bed intensive care center and have positions
available. RN's for Medical. Surgical. Semi-
Intensive Care Units and Nursery. Primary Chil-
dren's Medical is located in a beautiful residential
seclion of Salt Lake City. only minutes from
recreational and skiing areas in the Rockies.
Excellent benefits package include tuition reim-
bursement. Temporary housing Can also be ar-
ranged. For personal interview write or call collect
now: Beverlee Aaron. RN. Nurse Recruiter, 320
121h Ave.. Sal. Lake City. Utah 84103. Phone
1-801-328-9061. Ext. 3S1. E.O.E. M/F.
Switzerland
Wintenhur Can.on (n5 bed) hospital near Zlirieh
needs Operating Room Nurses for the surgery clinic.
Required for immediate or future openings. We offer
pleasant workifli conditions. equitable hours of
work and leisure. Salary and benefi.. in accordance
with the regulations of the Canton of Zürich.
Five-day week. accommodation available. cafe'ena.
Apply in writing to: Sekretariat Pflegedienst. Kan-
tonsspital Win.enhur. CH-1I401 Wintenhur. Swit-
zerland.
Miscellaneous
Africa - Overland Expeditions. London/Nairobi 13
wks. London/Johannesburg 16 wks. "'enya Safaris
- 2 and 3 wk. itineraries. Europe - Camping and
hotel tours from 16 days to 9 wks. duration. For
brochures contact: Hemisphere Tours. 562 Eglinton
Ave. E.. Toronto. Ontario. M4P IB9.
í
10 J.nuery 11171
The C8n-.ll.n Nur..
Wish
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.. .in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand grows every day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples. If you
have the qualifications and can carry more than the
nonnalload of responsibility. " why not find out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career, and it is possible to advance to
senior positions. In addition, there are educational
opportunities such as in-service training and some
financial support for educational leave.
For further infonnation on any, or all. of these career
opporttmities, please contact the Medical Services
office nearest you or write to;
ø........,
I Medical Services Branch I
Department of National Health and Welfare
Ottawa. Ontario K1A OL3
I Name I
I Address I
I City Provo I
I . . Heallh and Welfare Sanfe el B'en-elre socIal I
Canada Canada
..........,
Associate Director - Nursing Service
To be responsible for a number of clinical areas
within Nursing Service of a 1000 bed active
treatment hospital.
Qualifications:
Master's Degree in Nursing preferred, with at least
three years of top nursing management experience.
Skills in day-to-day departmental operations
including staffing.
Experience with various nursing care modalities
highly desirable.
Apply with curriculum vitae to:
Director of Personnel Services
Royal Alexandra Hospital
10240 Kingsway A venue
Edmonton, Alberta
T5H 3V9
Advertising Rates
For All Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
Rates for display advertisements on request.
Closing date for copy and cancellation is 8 weeks prior
to 1st day of publication month.
The Canadian Nurses Association does not review the
personnel policies of the hospitals and agencies
advertising in the Journal. For authentic information,
prospective applicants should apply to the Registered
Nurses' Association of the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
KlPIE2
.
The Can-.llen NUrH
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Registered Nurse in search of a change and a challenge -
look into nursing opportunities at Vancouver General Hospital. B.C.'s
m
or medical centre on Canada's unconventional West Coast. Staffing
expansion has resulted in many new nursing positions at all levels.
including:
General Duty ($1231-1455.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the opportunity
you've been looking for.
For those with an interest in specialization. challenges await in many
areas such as:
Neonatology Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Burn Unit
Inservice Educatiun
Coronary Care Unit
Hyperalimentation
Program
Renal Dialysis & Transplantation
Paediatrics
If you are a Nurse considering a move please submit resume to:
Mrs. J. MIIC:Phail
Employee Relations
Vancouver General Hospital
855 West 12th Avenue
Vancouver, B.C. V5Z IM9
Perinatal Nursing
Specialist
For
Neonatal Nursery
Are you looking for a challenging opportunity where you can use your
clinical expertise. educational and managerial skills? Are you interested in
being a leader in the development of our Neonatal Program working
closely with nursing, medical and paramedical personnel? Would you like
to be involved in the planning of a 60 bed SpecIal Care Nursery in a new
Pediatrics/Obstetric hospital complex and the development of a Family
Centre Perinatal Care Program?
lfyou are. you might be the person we are lookmg for. This IS a newly
created position in which you will help us develop our current Tertiary
Program and plan for its move into the new facilities. Future plans also
involve the development of Regional Program and Perinatal Care. Salary
negotiable, commensurate with experience. Excellent benefits.
Preparatiou Desired: A minimum of at least three years of
Neonatal Intensive Care Nursing and alleasllwo years experience and
preparation as aN urse Educator. Previous experience in administration
desirable but not essential. A Baccalaureate or Master's Degree reqUIred.
Qualified applicants please send your curriculum vitae and names of three
referees to:
Mrs. J. MIIC:Phall
Empioyee Relations
Vancouver General Hospital
855 West 12th Avenlle
Vancouver, B.C. \5Z IM9
Januery I tl7I 111
The Province
of British Columbia
Community Nurses
Applications are invited from qualified persons to form an
EligibiJity List (valid for six months) of community nurses from
which vacancies occurring at various locations in British
Columbia will be filled.
Duties wiJl include providing general public nursing. counselling
and crisis intervention services in the area concerned: to liaise
with health professionals and others providing care. and
encourage appropriate use of available facilities.
Qualifications - University degree in nursing. including public
health training. or equivalent combination of educalion and
experience: preferably some general nursing experience.
including some in directly related duties: registered. or able to
obtain registration. in the RegisteR:d Nurses Associat,ion of
British Columbia: use own car, or government. on mileage basis.
Salary - $16.322 - $19.296 Quote Competition 78:2619-38
Closing Location - Victoria Closing Date - immediately
POSlhooS are open to bOlh men and women
ObtalO and return applicatIons at addres< below unle,s nlherwlse Indicated
Province of British Columbia
Public Service Commission
544 Michigan Street. Vlclona. Be V8V 1 S3
a ;
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Nurses
Applications are invited for appointment on a permanent or
short term basis to the nursing staff of the Cottage Hospi-
tal" Burgeo and Harbour Breton, Newfoundland.
Salary and bonus in accordance with Nurses Collective
Agreement.
Living-in accommodations available at reasonable rates.
also laundry services provided.
Public service benefits apply with annual and sick leave
with pay. provincial statutory holidays and contributory
pension plan.
Applications should be addressed to:
Director of Nursing
Cottage HospitaJs Dh ision
Department of Health
Confederation Building
St. John's. Ne\\foundland
AIC 5T7
112 Januery 1179
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
A V AILABLE NOW
ARIZONA
CALIFORNIA
TEXAS
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISffiATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-5883 OR WRITE TO:
RECRl'ITING REGISTERED NURSES INC.
1200 LA WHENCE A VENUE EAST. Sl;ITE 301,
DON MILLS, ONTARIO M3A ICI
IN
FLORIDA
OHIO
NO FEE IS CHARGED
TO APPLICANTS.
@
Foothills Hospital
Calgary, Alberta
The Department of Nursing and the
Department of Pediatrics. Neonatology.
are offering a five month clinical and
academic programme for Graduate
Nurses:
Advanced Course in Neonatal Nursing
Applications are being accepted for clas-
ses enrolIing each March and September.
Participation in the programme is limited
to eight.
For further Information pt_ write to:
Mr. B. Wrlghl
Coordinator of Eduutional Srrvlc:rs
FoolhlUs Hospital
t40
l9SI. N.W.
Calgary. Alberta
T2N 2T9
Director of Nursing
and
Home Care Services
Poshion A senior management position in
Communily Health Nursing and Home Care
Services.
Location Mount View Heallh Unit - includes
the M.D. of Rocky View. County of Mountain
View and I.D. #8.
Duties Responsible for planning. organizing.
co-ordinating. directing and evaluating all
nursing and co-ordinated Home Care programs.
QualIDcations Minimum qualifications - a
Bachelor of Science in Nursing and
demonstrated administrative skills. This nurse
should have a minimum of 5 years experience in
a supervisory capacity.
Salary Negotiable and dependent on
qualifications and experience_
Appllcallons Send resume to Medical Officer of
Health. Mounl View Health Unit #101. 5421
II th Street N. E. Calgary. Albena T2E 6M4.
The Can-.llen Nur..
Clinical Nurse Specialist -
Psychiatry
required for
Medicine Hat & District Hospital
Applications are invited for the position of
Clinical Nurse Specialist - Psychiatry. for a 247
bed aclive trealmenl and 100 bed extended care
hospital located in southeastern Albena.
Accountable to the Assistant Execulive Director
- Patient Services.
Responsible for continuing development of
psychiatric program.
Master'sDegree preferred Will consider
Baccalaureate Degree with minimum three
years' clinical expenence in psychiatric nursing.
Salary - negotiable.
Submit ResumeTo:
Mrs. Shirley NeWlon
Nursing Director - Slamng
Medicine Hat lit District Hospital
666 FIfth Sireet. Soulh West
Medicine Hat. Alberta
TIA 4H6
Director
School of Nursing
Reponing direclly to the Executive Director.
assumes Ihe responsibility for Ihe organization
and administration of ongoing accrediled
diploma nursing programs.
Quallftutlollll:
Appropriate Master's Degree preferred, but
applicants possessing a Baccalaureate in
Nursing will be considered.
Previous experience in the adminislration of an
accrediled nursing education program a
necessily
Please forward. in confidence. a complele
resume of experience and qualificalions.
including expected salary to:
Mr. T.I. Bartman
Executive Dlrect(,r
Misericordia General Hospllal
99 Cornish A venue
Winnipeg. Manitoba
RJC tAl
High Risk Obstetrics and
Neonatal Intensive Care
Nurses
McMaster University Medical Centre is a
progressive teaching hospital with a
multi-disciplinary team approach to patient care.
M&,jor specialties include Obstetrical Intensive
Care and Neonatal Intensive Care unils. When
openings occur in these areas for Registered
Nurses. we require experienced staff. Inquiries
are welcomed at any time from mature.
responsible individuals who wish to work in a
stimulating environment on a 12 hour shift
system. Preliminary interviews can be arranged
for out of lown nurses with current Ontario
registration if written requests are accompanied
by detailed resumes.
Please apply to:
Ms. Nora Prosser
Personnel Interviewer
McMaster Unive.-si1y Medical Centre
1200 Main St. W.
Hamlhon. Ontario
L8S 4.19
Assistant Nursing Dira:tor
- Operating Room
required for
Medicine Hat & District Hospital
Applications are invited for the position of
Assistant NursingDirector for a six room O.R.
suite and six bed Recovery Room. The hospital
is a 247 bed active trealmenl and 100 bed
exlended care facility located in southeastern
Albena. A new facility is presently being
planned.
Baccalaureate Degree preferred. Post-Graduale
course with minimum of three years' experience
will be considered.
Salary - negotiable.
Submit Resume To:
Mrs. Shirley NeWlon
Nursing Director - Stamng
Medicine Hal lit Dlslrict Hospital
666 flfth Sireet. Soulh West
Medicine Hal, Alberta
TtA 4H6
The Religious Hospitallers of Saint Joseph
of the Hotel Dieu of Kingston
Hotel Dieu Hospital Kingston
requires
Director of Nursing
Applications are invited for the position of
Director of Nursing in a fully accredited 219 bed
general teaching hospital.
Reponing to the Administrator. the Director of
Nursing will be responsible for managing the
Nursing Depanment and maintaining an
excellent standard of nursing care in a leaching
environment. This vacancy is due to the
promotion of the present incumbent.
Extensive experie..ce administering a complete
nursing program. a B.Sc.N. degree and
eligibility for Ontario registration are minimal
requirements. Preference will be given to
applicants possessing a Master's degree in
nursing or administration.
Please forward your resume to:
Sister K. KHvII
Hotel Dleu Hospital
Kingston, Ontann
K 7L 3H6
Applications are invited for
Faculty Positions
in the following areas
Medical-Surgical Nursing
Parent-Child Nursing
Qualifications:
Preference will be given to advanced
preparation in the clinical specialties
Salary and Rank:
Commensurate with education and ex-
perience
Applications Deadline: February 15. 1979
Fot" further information contact:
Miss Kathleen King
Dean
Faculty of Nursing
llniversity of Toronto
50 St. George Street
Toronto. Ontario
'\15S fA f
The Central Registry of
Graduate Nurses
411 Eglinton Avenue East
Suite 500
Toronto, Ontario M4P IM7
A non-profit organization welcomes
candidates for membership in this
prestigious group of nurses specializing
in general and private duty nursing in
hospitals and homes.
Telephone for appoimment 483-4306
Registered Nurses
Louisiana
(two locations)
California
(close to Los Angeles)
Active care accrediled hospitals each
have a requirement for four Canadian
RN's experienced in crilical care. As
the hospilals are only interesled in
persons becoming registered aliens of
the USA. these positions would be of
inlerest to the married RN whose
spouse could not obtain a work permit
under the regulalion covering the H-1
temporary permit. Candidates must,
under Louisiana and California licens-
ing, have written AN's in Canada and
received marks of 350 in all five discip-
lines 10 obtain license by reciprocity.
Apply in confidence to W. P. Dow
& Associates lid., (a Canadian
company), 361 Tenlh Street W..
Owen Sound. Ontario N4K 3A4
(519) 376-6809.
Nurses.. .
Are you interested in rural
extension nursing? There are
openings for you in Africa. Or
would you like to teach in nursing
colleges in Africa, Papua New
Guinea or Latin America?
Qualifications: B.Sc.N. or R.N.
with Public Health or broad
general nursing experience.
Inquiries are welcome at:
CUSO Health-D Program
151 Slater Street
Ottawa, Ontario
K1P 5H5
as an alternative. . . _ . . CUSO
Th. Cen-.llen Nur..
Jenuery 111711 13
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You the Nurse.
Hermann the Place.
Houston the City.
...
Imagine This. The kind of nursing you've always wanted to do.
Nursing the way it should be.. .planning and implementing patient
care in a primary nursing framework that lets you exercise optimum
freedom to carry out your professional goals.
You've Got The Talent It Takes. Hermann Hospital has im-
mediate openings, especially for those of you with specialty train-
ing in surgical areas. We'll assist you financially with your reloca-
tion expenses. You'll find the salary program for RNs is more than
competitive and we offer a comprehensive benefits package which
includes three weeks vacation, nine paid holidays, tuition and rent
assistance, fully paid hospitalization, and more. It's an offer you
can't refuse!
Put Yourself In Our Place. We're in the heart of Houston, where
the excitment of the arts, outdoors, and nightlife abound in the en-
vironment of the city of the future. Compare Houston's cost of liv-
ing with other major cities-it's considerably lower, and the state
of Texas doesn't have a state income tax. All things considered,
Hermann Hospital and Houston are where you've always really
wanted to work and live, so now do something about it.
Pnmary Teaching Hospital lor the
University 01 Texas Medical School at Houston g
HERMANN HOSPITAL
HOUSTON'S LIFE _.. .
FLIGHT HOSPITAL '-:,-
,
:I
An equal opportunity employer, mIl-handicapped
Please contact us for more
information about our ex-
cellent salaries and com-
plete benefits package. Ms.
Beverly Preble, Nurse
Recruiter, (713) 797-3000.
AU: Nurse Recruiter
1203 Ross Sterling Avenue
Texas Medical Center
Houston, Texas 77030
Name
Address
City
State Zip
Phone
Specific Area of Interest
(Circle) RN LVN Student Nurse
&4 Jenuary 1179
The Cen..sJen Nur..
Nursing Consultant,
Occupational Health:
$19,400- $22,100
The MINISTR Y OF LABOUR, occupational health branch. seeks
energetic individuals to: provide consultant services in occupational
healln nursing to Ontario industries. employees. health and safety
personnel. educators. professional and lay groups and government
agencies to ensure quality care for employees at their place of work; assist
in developing standards and criteria through interviews. research and
surveys. Locations: Sudbury (LB 208/78). Hamilton (LB 209178) and
London (LB 210/78).
Qualifications: registration as a nurse in Ontario: recognized cenificate in
occupational health nursing or public health nursing. preferably with a
B.Sc. in nursing: at least three years experience in the field of
occupalional health and nursing with some supervisory experience: good
communication and interpersonal skills: abilily to work independently:
willingness to travel.
Please submit application or resume by January 26. 1979. indicating area
of preference and quoting appropriale file number. to: Personnel Branch,
Ministry or Labour, 400 Unlverslly Avenue, 2nd Floor. Toronto. Ontario.
M7A IT7
'["his position Is open eejUlllly to men and women.
Ontario
Ontario
Public Service
Moving, being married?
Be sure to notify us in advance.
Attach label from
your last issue or
copy address and
code number from it here
New (Name)/Address
Street
City
Prov./State
Postal Code IZip
Please complete appropriate category
o I hold active membership in provincial nurses' assoc.
reg. no./perm. cert./lic. no.
o I am a personal subscriber
Mail to: The Canadian Nurse, 50 The Driveway, Ottawa,
Ontario K2P I E2
Index to
Advertisers
January 1979
Addison-Wesley (Canada) Limited
Canadian Dairy Foods Service Bureau
The Canadian Nurse's Cap Reg'd
Career Dress (A division of White Sister
Uniform Inc.)
The Central Registry of Graduate Nurses
Equity Medical Supply Company
Eschmann Canada Limited
Famolare, Inc.
Health Care Services U pjohn Limited
Frank W. Horner Limited
Mont Sutton
2
49
13
Cover 2
63
9
50
4
56
54,55
9
TheC.V. Mosby Company Limited
NursingJob Fair
Pentagone Laboratories Limited
W. B. Saunders Company Canada Limited
22,23,24,25
7
57
51
Wellcome Medical Division!
Burroughs Wellcome Limited
Westwood Pharmaceuticals
Cover 4
CoverJ
Adt'ertising Manager
Gerry Kavanaugh
The Canadian Nurse
50The Driveway
Ottawa. Ontario K2P 1 E2
Telephone: (613) 237-2\33
Advertising Representatives
Richard P. Wilson
:!l9 East Lancaster Avenue
ArdmOl;e, Penna. 19003.
Telephone: (215) 649-1497
Jean Malboeuf
601. Côte Vertu
St-Laurent. Québec H4L lX8
Téléphone: (514) 748-6561
Gordon Tiffiri
190 Main Street
Unionville. Ontario UR 2G9
Telephone: (416) 297-2030
Member of Canadian
Circulations Audit Board Inc.
mEE1
Before you try the
Alpha Keri *jKeri * Lotion Moisture System
on your patients, try it on yourself.
Experience for yourself the soothing.
moisturizing qualities of Alpha Keri.
Bath Oil or Keri' Lotion. Simply place two
capfuls of Alpha Keri in your evening bath.
and feel the difference the emollient oil
makes to your skin. Alpha Keri cleanses
without the need for harsh drying soaps. In
the morning. massage super-rich Keri
Lotion into hands. legs. and problem dry
areas. Your skin will feel softer. suppler.
more resilient. and initating itching will be
relieved for hours.
The same benefits apply to your
patients. of course. Alpha Keri and Keri
Lotion are indicated for all dry. pruritic
skin conditions and may help prevent
skin breakdown and the possible
fonnation of decubitus ulcers. And bed
bathlOg's never been simpler. Just add
Alpha Ken to water and gently wash the
patient. Soaping and rinsing are
unnecessary. so you save time and steps.
Actions speak louder than words, and
we'd like Alpha Keri and Keri Lotion to
speak for themselves. In a special offer
to the profession only, a 56 ml size of
each will be sent to any nurse who
sends her name and address, and 25(;
to: The Moisture System,
P.O. Box 1538,
Belleville, Ont. K8N 5J2
J
"r.. A In UN<
WESTWOOD
PHARMACEUTICALS
BELLE\.' LLIE ONTA"'O KeN SEI
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Nature gives it. "
Zincofax* keeps it that wa
After every bath, every diaper change and in between,
soothing Zincofax protects baby's nature-smooth skin.
Protects against chafing and diaper rash, against irritation
and soap-and-water overdry.
But Zincofax isn't just for delicate baby skin. It's for
you and your entire family-to soothe, smooth and
moisturize hands, legs and bodies all over.
\Vhat's more, Zincof.n.. is economical, even more
important now with a new baby at home.
,- ,
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FOR BABV'S SIC,II
keeps a family's
smooth skin smooth
----
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5111
...----
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....Zincofa)(
FO
ø
.
Contains Anhydrous Lanolin and 15% Zinc Oxide.
Available in 10 and 50 g tubes and 115 g and 450 gji\cs.
I Wellcome Medical Divisio
Burroughs Wellcome ltd.
laSalle. Qué.
. Helping mothers when babies cry
. How to make sense of the metric
muddle
. Understanding the physiology of
pain
. Preventing cross infection on a
pediatric ward
. Nurse practitioner in a community
college setting
The
Canadian
Nune
FEBRUARY 1979
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The "
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Quality from "T I e Hou ;. · f
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"J
Style No. 42364 - Pant suit
Sizes: 5-15
"Impact Plus" 100% textured
Dacron' polyester with Zelcon
finish
White, Champagne. . .
about $35.00
Style No. 42307 - Dress
Sizes: 3-15
"Impact Plus" 100% textured
Dacron' polyester with Zetcon.
finish
White, Apricot. . . about $34.00
.
,
.
Siste
-......-
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Available at leading department stores and specialty shops across Canada
...
The
Canadian
Nurse
February 1979
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number 2
Input 4 You and the law Corinne Sklar 8
News \l SI for you and me Jennifer Craig. Gordon Page 16
.
Calendar 47 Lifestyle crisis Theresa O'Neil 22
A nurse practitioner in a
Names 49 community college setting Diana Nelles 25
Understanding the Anne Hedlin.
Books 52 physiology of pain Dr. J. DostrOl'sky 28
The patient in pain:
Library Update 52 handling the guilt feelings Gillian Doheny 31
When babies cry Janet B. Harris 32
Visions Barbara MacCuish 35
Childhood asthma:
an outpatient approach RoyG. Ferguson
to treatment Anne Webb 36
Cross infection: a new II
approach to an old problem CatherineE. Cragg 40
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I
The Canadian winter certainly
provides us with many
opportunities for exercise.
February is heart month-
and what better way to
celebrate than cross country
skiing?This month's cover
photo comes to us courtesy of
the National Sport and
Recreation Centre Inc. in
Ottawa. Ontario.
4"
"
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts
should be typed double-spaced. Send
original and camon. All articles must
be submitted for the exclusive use of
The Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
The views expressed in the articles
are those of the alJthors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Canadian Nurses Association.
50 The Driveway, Ottawa. Canada.
K2P IE2.
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medicus. The Canadian Nurse
\ is available in microform from Xerox
I University Microfilms, Ann Arbor,
Michigan, 48106.
f
Subscription Rates: Canada: one
year, $10.00; two years, $18.00.
Foreign: one year, $12.00; two
years. $22.00. Single copies: $1.50
each. Make cheques or money
orders payable to the Canadian
Nurses Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number, in a
provincial/territorial nurses
association where applicable. Not
'responsible for journals lost in mail
due to errors in address.
Postage paid in cash at third class rate
Toronto, Ontario. Permit No. 10539.
Canadian Nurses Association, 1978.
2 Februery 1171
The c.n-.ll.n NUrH
1
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Number one...and still gro""ing!
THE
ELINIU
I
..... ua .A" o".c....oa -"CII.U.
SHOE
k
ÍI\,UJkÄti.@
SOME STYLES ALSO AVAILABLE IN COLORS... SOME STYLES 3Y2-12 AAAA-EE, ABOUT 33.00104800
For a complimentary pair of while shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write:
THE CLINIC SHOEMAKERS . Dept.CN-2. 7912 Bonhomme Ave. . St. louis. Mo. 63105
The Cenedlan Nu...
February 1171 3
perspective
Who took the nurse Nor was the "take a deep realized I had been mistaken worry. It doesn't matter
out of nursing? breath and don't move" lady in assuming that she was an whether it's a new baby or an
in the X-ray room which was RN. Her official title was operation like this, we all get
For the past five and half the next stop on the route. registered nursing assistant. the blues sooner or later. You
years nurses have been at the The pleasant, middle-aged During the ten days of my just climb back into bed and
center of my working life. I lady who showed me up to my hospital stay, I did get to meet have a real good cry. I'll shut
talk with nurses in my office, room reminded me of a several bona fide RN's. There your door and when I come
at meetings, on planes and bellboy in a hotel. She even was the nurse who visited me back in an hour I can
I trains and on the street. I offered to carry my suitcase. the night before the operation guarantee you'll feel better. ..
correspond with nurses, I read "Just push this button to and assured me that she would And, you know what?
the letters. articles and even make your bed go up or down; be looking after me in the She was right. Now, a
poems that they write for here's your radio and phone recovery room. But I never do month later, I can claim to
publication in their journal. I and the bath is right here." remember seeing her again. have some sketchy idea of
write for nurses, I collect The label on her orange smock There were also, I am sure, how patients are treated in
news about them and for them said "Volunteer". plenty of highly qualified hospitals these days, but just
and much of my reading Pretty soon, I thought, as nurses in the OR but I must don't ask me to help you
consists of nursing journals. I puttered around unpacking admit it was the reassuring pat define nursing practice as it
That's why, when I found my toothbrush and notepaper, of my doctor's hand on my relates to patient care.
that I could no longer put off I'll see a real nurse. Finally, shoulder as I was rolled into -
I.A.B.
the surgery that had been even though it was only a little the theatre that comforted me
hanging over my head, I after noon, I put on my nightie most as I waited. EDITOR
decided to look on my hospital and climbed upon the bed. There were RN's on the ANNE BESHARAH
stay as a learning experience. The voice that made me open floor when I began to be
Eight out of every ten nurses, my eyes was friendly. She conscious of my surroundings ASSISTANT EDITORS
I knew, still work in hospitals wore a uniform, carried a set again back in my room. It was LYNDA FlTZPAllUCK
of one kind or another and my of scales and said her name an RN, for example, who SANDRA LEFORT
experience with these was Marcie. Her shave prep, a announced firmly once when I PRODUCTION ASSISTANT
institutions was limited, to say hospital procedure I finally worked up the nerve to GITA FElDMAN
the least - consisting mostly remembered and dreaded. push the buzzer beside my
of a short stay when each of was carried out casually but bed: "No, you can't have CIRCULATION MANAGER
my three children, now carefully and was over before anything for the pain - not PIERRElTE HOTrE
teenagers, was born. I had time to think about it. for another 15 minutes." And
Things have changed a lot While she worked, it was another RN who ADVERTISING MANAGER
since then I reasoned: my ten Marcie confided that just a complained, after three futile GERRY KAVANAUGH
days in hospital would give me year ago she had had the same and painful attempts to CNA EXECUTIVE DIRECTOR
the chance [ always wanted to operation [ was scheduled to re-start my IV, that "all you HELEN K. MUSSALLEM
see for myself what it is that have. "I was so scared," she ladies have difficult veins."
nurses really DO at work, said. "All the old wives tales It was an RN, too, who EDITORIAL ADVISORS
what nursing practice consists I'd heard, working in a switched on the light above MATHILDE BAZINET,
offrom the viewpoint of that hospital and all, and, in the my bed at ten every night just chairman, Health Sciences
all-important person - the end. there was nothing to it. as I was dozing off, handed Department, Canadore Colleje,
patient. I chose a smaller It was Marcie who helped me my sleeping pill and North Bay, Ontario.
hospital this time and, from me fill in the three-page antibiotic and walked out DOROTHY MILLER,public
the first, it seemed friendlier, nursing assessment form. without asking whether I relations officer, Registered
more welcoming I wore an "How do you feel about your needed water to swallow them Nurses Association of Nova
Scotia.
identity bracelet. yes, but I operation?" "Why, of course, and without waiting to turn off JERRY MILLER,directorof
was never left with the feeling you're glad to be here so you the light which was just communication services,
that I had been reduced to a can get it over with and get beyond my reach. Registered Nurses Association c(
disease or a room number. better," was Marcie's breezy Yes, there were RN's but British Columbia.
I knew the chatty lady answer when my doubts it was my husband who said, JEAN PASSMORE,editor,
behind the desk who sorted surfaced again. "Take my arm and we'll walk SRNA news bulletin. Registered
out the details of what I was Her reassurance was also as far as the lounge and Nurses Association of
doing there, where I lived, comforting in a couple of back." It was the Saskatchewan .
worked and was born, etc. other areas: no enema, onl y physiotherapist who said PETER SMITH. director of
was not a nurse. And I was suppositories and, as for the "Have you been coughing and publications, National Gallery of
Canada.
pretty sure, even before I got scar, why you can wear a taking deep breaths today?" FLORITA
a look at the label on her bikini next summer if you And it was Marcie, the RNA, VIALLE-SQUBRANNE,
uniform. that the lady in the want to. It was only when who took one look at me on consultant, professional
lab who was after my blood Marcie called in a nurse to the evening of my fifth day inspection division. Order of
was not a nurse. check her shave prep that I postop, and said, "Don't Nurses of Quebec.
4 Februery 1171
The Cen-.llen NUrH
input
The Canadian Nurse invites your
letters. AU correspondence is
subject to editing and must be
signed. although the author's
name may be withheld on request.
Dear Sir/Madam
My concern is the way in
which the careless use of
language in professional and
other journals can further
entrench women in
stereotyped jobs.
I have searched through
six issues of The Canadian
Nurse and find countless
examples of the unconscious
assumption that a nur.5e is a
female person. It is
undeniably true that at the
beginning of this decade,
approximately 96 per cent of
all graduate nurses were
female and this figure may not
have appreciably diminished
- but is this an irreversible
situation?
I noted many instances
where the problem was
avoided by referring to
"nurses" in the plural,
thereafter using the pronoun
"they". In certain editorial
notes, such as in the "Here's
How" articles, when the
editor suggests "Every nurse
has practical ideas gathered
from his or her
experience...", it is evident
that you are conscious of the
problem, but could the rigid
enforcement of greater
concern in this matter not
become a criterion for
acceptance of material for
publication?
Certainly it is disturbing
to note reference to the doctor
as "he", but equally so is the
use of this pronoun when
speaking of a hypothetical
patient. Even babies and very
young children are assumed to
be male.
Nurses are in the
unenviable position of
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appearing to serve both the
patient and the doctor. An
uncaring society perhaps
considers the nursing
profession to be one of
subservience. Is it not
possible that this unhappy
state will continue to exist as
long as nurses themselves
unconsciously perpetuate the
myth that they are women and
that those whom they are seen
to serve are men?
-Sandra Conrad, A.R.T.,
Montréal, Québec.
Spiritual forgotten
Thank you for the very
well written and helpful
articles on the care of the
dying. (November 1978)
Not once, however, was
the name of God mentioned.
Is this the great "no-no" of
our profession? In our fear of
offending this or that church,
have we abandoned every
expression offaith in the
Creator oflife, the Father of
us all?
We are agreed that a
loving touch, or a cup of tea
with five minutes sharing, is
worth more than a thousand
words. But we surely do need
a holy hope in the life to come,
to offer along with the service
of our hands. Otherwise the
despair in our own hearts will
be only too visible in our eyes.
-Jean M. Heard, R.N.,
Vernon, B.C.
1977 Nobel Peace
prize winner
There are hundreds of
thousands of men and women
around the world who are in
prison because of their race,
religion or political beliefs.
Amnesty International works
for all of them - the sick, the
tortured, the forgotten.
Please help the Canadian
section of Amnesty
International in this work
through your membership or
your financial contribution.
Contributions are tax
deductible. Write today to:
Amnesty International, 2101
Algonquin Avenue, P.O. Box
6033, Ottawa. Ontario.
K2A ITI.
-Rob Robertson, National
Director, Amnesty
International.
N.S. emergency nurses
Members of the
Association of Emergency
Nurses of Nova Scotia were
particularly interested in the
account of the first
interdisciplinary meeting of
emergency personnel in
"News" in the November
1978 issue ofthe Canadian
Nurse.
The AENN S was formed
early in 1977 and now
numbers nearly ninety nurses
from allover Nova Scotia.
Plans are now being made to
hold the annual educational
seminar in June of 1979.
Current president of the
Association is Valerie
Wiggans ofthe Izaak Walton
Killam Hospital for Children
in Halifax.
-Dorothy Miller, Public
Relations Officer, RNANS,
Halifax, N.S.
S.L.E. group
Again, congratulations
and thanks to Bonnie Hartley
for her excellent article
"Systemic Lupus
Erythematosus - a patient's
perspective", and "Now
you're on cortisone"-
February 1978 issue. Not only
interesting, they were most
informative, helpful and
reassuring.
We now have a S. L. E.
group (as yet un-named) in
Montreal, which met for the
first time at the Montreal
Children's Hospital,
November 19,1978. Anyone
interested (S. L.E. not a
prerequisite) may contact:
Margaret Duffy N, 140 - 4th
Ave., Dorion, Quebec, J7V
2Z7. Monthly meetings are
planned.
-Margaret Duffy, Dorion,
Quebec.
The Cenedlen NUrH
....
Febr\lll['L 1979 II
A WISE INVESTMENT FOR
TO DAY'S NURSING PROFESSIONAL
Barnard. Clancy & Krantz
Human Sexuality for Health
Professionals
This multi-disciplinary approach to the field stresses the need
for sex education and sexual counseling, and the importance of
knowledge on the part of all health professionals, with emphasis
on the nurse. Many nursing programs offer courses on the sub-
ject now. Contributions include material from 28 leading author-
ities including physicians, professional counselors, clergy,
psychologists, and nurses.
By Martha Underwood Barnard, RN, MN, Facully-Nurse Clinician.
School of Nursing; Barbara J. Clancy, RN, MSN, Assoc. Prof.,
School of Nursing; and Kermit E. Krantz, MD, Prof. and Chairman,
Obstetrics and Gynecology and Dean of Clinical Affairs; all of Univ
of Kansas Medical Center, Kansas City. 301 pp. lIIustd. Soft cover.
$11.45. April 1978. Order ff1544-9.
Sorensen & Luckmann
Basic Nursing:
A Psychophysiologic Approach
They've done it again! The authors of the popular Medical-
Surgical Nursing now offer a comprehensive textbook on basic
nursing conæpts ofr the practitioner. Twenty eight contributing
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ship; blood administration and much more. Particular attention
is paid to the role of stress and adaptation in illness, under-
standing the existence of the patient. therapy and rehabilitation,
the nursing process, and the changing role of the nurse. You'll
find special features like many new and original illustrations,
important information boxed off in each chapter. key points
highlighted with arrows, an overview and study guide preceed-
ing each chapter, and a two-<:olor format for easy reading.
By Karen Creason Sorensen, RN. BS, MN, Formerly Lecturer in
Nursing, Univ of Washington; Instructor of Nursing, Highline
College; Nurse Clinical Specialist, Univ. Hospital and Firland Sani-
torium, Seattle. WA; and Joan Luckmann, RN, BS, MA. Formerly
Instructor of Nursing, Univ. of Washington, Highline College, Seattle,
Oakland City College, and Providence Hospital College of Nursing.
Oakland, CA. About 1360 pp., 435 ill. Ready soon. About $23.00.
Order ff8498-X.
Keane
Essentials of Nursing:
A Medical-Surgical Text
4th Edition
This is a compact textbook for students beginning the study of
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homeostasis) and those related to nursing, it goes on to discuss
medical-surgical nursing care problems with emphasis on the
nursing process throughout. Student aids include: learning
highlights (similar to objectives); vocabulary lists; summary
tables; and a student study aid section consisting of learning
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By Claire Brackman Keane, RN, BS, MEd. About 720 pp., 125 ill
About $16.10. Ready soon. Order ff5313-8.
I '
Stryker
Rehabilitative Aspects of Acute and
Chronic Nursing Care
2nd Edition
This book will help you implement rehabilitative steps in both
acute and long-term nursing care. Psycho-social aspects of
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with the brain damaged patient.
By Ruth Stryker, RN, MA, Asst. Prof.. Long Term Care Administra-
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$11.50. June 1977 Order ff8637-0.
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Over 1500 drugs are included in this easy to use softcover
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and contraindications.
By Mary W. Falconer, RN, MA; H. Robert Patterson, PharmD, MS;
Edward A. Gustafson, PharmD; and Eleanor Sheridan, RN, BSN,
MSN. 312 pp. Soft cover. $8.60. March 1978. Order ff3568-7.
II
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II Februery 1171
The Cen-.llen NUrH
input
-
Medical care can't do it all Focus on health have both a direct and indirect Concern for continuing ed
I read with much distaste For the last 25 years I influence on the standard of Would it be possible for
your October issue which have worked very closely with health (and employment etc.) The Canadian Nurse to
dealt with native health care. the native people in our of the people. Although the introduce a continuing
Why not tell it like it is, not hospital. I cannot agree with Native Peoples of Canada do education program similar to
just how it looks from an you we white nurses don't indeed live surrounded by one the "Accreditation of
Indian viewpoint. understand the native people of the world's richest Continuing Education in
When I came to"this area and the way they live. economies, they must be Nursing" frequently
to work, I had worked with I drive through the considered a third world presented in the American
and been employed by Indians Reserve of .... , districts of people. Journal of Nursing?
and found them to be fair, new lovely homes with On another point, my Surely C.N .A. can
hard working people. Since fridges, stoves, carpets, collection ofCNJ of the past develop some type of
coming to a town that delivers almost everything in them. two years has been well correspondence instruction
health care to a nearby How does the outside look? received by my Spanish for RN 's in areas not easily
reserve my outlook has Weeds are high, plenty of speaking colleagues. First accessible to major teaching
changed. young energetic teenagers they had me translate different centers.
It's difficult to help around, nothing to do. But articles, then they got to work It is fine to talk of nursing
people who won't help why work?There is oil with the scissors to make good competency, but sometimes
themselves - regardless of money, also easy welfare to use of the many excellent quite difficult to require the.
race. It's hard to see culture in get. Middle-aged men have photographs in teaching up-dating knowledge
lice-infested, drunken, told me, why work? sessions. They've even had necessary to retain it.
tuberculous humanity. Often I go out on their uniforms made from the I look forward to reading
When will people realize ambulance call to the reserve. latest models! my Canadian Nurse each
that medical care can't do it It makes me cry when I see -Alice PurdeyCulbert, month and I am sure it could
all? If there is no pride in a the beautiful homes run down (BSN,UBC 1967), be used more positively for
group of people that inspires in no time. Also I get very Fusagasugå, Cund., continuing education
them to achieve something, frustrated when the call Columbia. purposes with accumulative
even if it is only good health, wasn't even necessary. But credit recognition for nurses
the medical profession can't the Band pays for it. And who Native health in remote areas.
do it for them. Personally I"m pays the Band? The working I would like to comment -JoanE. McLaren, R.N.,
tired of hearing about the poor people and the taxpayer. on the well-published October Iroquois Falls, Ontario.
misunderstood Indian and -FA. Wagner, R.N., 1978 Canadian Nurse Journal
would like to see more articles Wetaskiwin, Alberta. featuring the health of What it's all about
like that by Lucy Chapman Canada's native people. Input I found the article on
which told of trying her Right on from the National Indian Primary Care Nursing by
hardest with the natives, her The October 1978 issue Brotherhood, Indian students, Marlene Medaglia (May, 1978)
failures and frustrations and on Native Health has just held Indian health representatives very stimulating. Although I
how she dealt with them. me completely absorbed. The and Indian nurses (6 out of 12 am currently enrolled in the
-Fran McWilliam, R.N., article "See the nurse" by authors) showed a real Post Basic Program at the
Maple Creek, Sask. Patricia Floyd had most cultural sensitivity. University of Western Ontario
impact. One concern I did have I have had the privilege of
Valued team members She's right. How can a was with the lack of input working with Marlene in her
Thank you for the person of social conscience from community health nurses capacity as a staff nurse and
excellent articles in categorize problems? All are working on reserves. The 1978 head nurse in the c.c. U. at
October's issue regarding inter-related and in order to Health and Welfare statistics the Montreal General
Community Health better the living conditions of show approximately 760 Hospital.
Representatives. the majority of people on this nurses working in Indian and The purpose of my letter
Not .only did the articles earth. we have to look at the northern health facilities, yet is to commend Marlene and
portray the warmth and social origins of these not one of the twelve authors her stafffor the superb care
capabilities of the CHR's but problems (poor housing, were actually practicing they are giving their patients.
recognized their many unemployment, abandoned community health nurses in The nurses seem to work
valuable contributions to the families, alcoholism, poor native settlements. extremely well together and
health care team. health etc.). Apart from that, I felt the are all very knowledgeable
The recognition you As aCUSO volunteer in a general presentation on native and competent in their field.
have given these individuals third world environment, I health was well done. They care for and about each
is richly deserved. have experienced and -Christopher Lemphers, patient who passes through
-Margaret Gauthier, observed at first hand how R.N., Halifax. the unit and that is what
Instructor CHR Program, decisions by governments and nursing is all about.
Alberta Vocational Centre, their representatives, and by -Barbara Lee, London,
Lac La Biche, Alberta. multinational corporations Ontario.
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. Februery 1171
The tan-.llen NUrH
YOU AND THE LAW
On Trial!
..
--
L- ....
Corinne Sklar
No one likes the idea of becoming personally involved in -
litigation proceedings. In spite of our superticial acquaintance
(mostly through the medium of TV) with the trappings of
courtroom dramas - the black gowns of the lawyers. the
stylized ritual of the proceedings and the language - our official
courts oflaw are strange and awesome places for most of us.
Nevertheless. the possibility exists that some day. whether
we like it or not. we may find ourselves caught up in some
aspect oflitigation. Maybe we receive ajury summons in our
mail: maybe we are subpoenaed to serve as a witness or.just
maybe. we find ourselves called upon to defend our
competency to practice as a nurse before ajudge or jury of our
peers.
. - Nurses can be and. in fact. have been named as defendants
in legal actions in courts ofIaw in this country. That's why it is
important that they acquire a degree offamiliarity with their
legal responsibilities in the area of administering patient care.
- . The nurses in the case that is recounted below represent a
variety of areas of nursing: the office nurse. the general duty
nurse, the special duty nurse and the nurse supervisor.
The case I
When the events surrounding this case took place. the plaintiff.
a little girl whom we will call Teresa*. was just five and a half
years old. Some time earlier. her mother had made an
appointment with the family physician forTeresa to receive her
immunization (quad) booster. The office nurse. knowing that
Teresa was frightened of needles and in consultation with the
physician. supplied her mother with a nembutal** suppository
to be administered to the child one hour before their visit to the
doctor's office for the D.P.T. and P. booster. The appointment
was postponed for one day because Teresa was suffering from
the effects of a head cold.
*Although the names of the nurses, physicians and hospital involved in
this case are on record, in my opinion no purpose is served by citing
them here. For this reason, no surnames are included in this account
and the name of the child, "Teresa", is fictitious.
**A registered trade name of Abbott.
The caMdien .......
...
FeÞruery 1171 I
On their return home. Teresa became feverish and
complained of a sore throat. At the insistence of her mother. the
physician made two housecalls: he found his patient to have a
mild fever, a slight reddening ofthe throat with small vesicles
on the soft palate. Her breathing was slightly resonant but there
was no rasping. barking, or wheezing nor were there symptoms
of dyspnea or obstruction.
Later, Teresa was admitted to hospital. Her mother was
upset and worried and while the child's condition had not
deteriorated. neither had it improved. Her mother hired a
special duty nurse. one who knew Teresa personally. even
though the physician, when asked, felt it unnecessary.
While in hospital, Teresa's condition remained the same
until about 2:00 a.m. when her special duty nurse heard her
make a "grunting sound" and then her patient voided
involuntarily. The nurse decided to summon the physician to
the hospital because there had been no improvement. While her
respirations were somewhat more labored. Teresa was not
mouth-breathing. nor showing signs of air hunger or
obstruction. The physician instructed the nurse to prepare for a
tracheotomy; he would come Sf AT.
Shortly thereafter. Teresa awoke and thrashed about.
There was marked air hunger and she became cyanotic. A
convulsion was followed by a period of apnea. Mouth-to-mouth
resuscitation by the physician was begun immediately and
Teresa began to breathe again. Oxygen was given by catheter
and an endotracheal tube was inserted without difficulty. The
physician then performed a traecheotomy and Teresa's
breathing was restored.
Unfortunately, however, the period of anoxia had resulted
in brain damage. Teresa was permanently physically and
mentally disabled. Why had this happened? Was anyone to
blame?
Teresa's parents sued on their own and on their daughter's
behalf. Because they were unable to say whose negligence had
caused their daughter's condition. they named the physician,
the hospital, the clinic and all the nurses. Thus, it was the task
of the Court to determine from the evidence:
. How and why had this tragedy occurred?
. If the result was due to negligence, which ofthe defendants
had been negligent and in what respect?
. The amount of the plaintiffs damages to be paid by the
negligent defendant(s).
The decision
It is important to note the fourteen-year delay in the hearing of
this case. The events related occurred in 1960: the decision of
the trial judge was delivered in 1974. The parties themselves
were not responsible for this delay.
The passage of time "fades memories, and impairs the
ability of witnesses to recall the events of the time with
complete accuracy" .2The trial judge noted the assistance and
value obtained from the use of the notes made
contemporaneously with the events or shortly thereafter:
nursing notes would have provided such assistance. The value
of clear. accurate, concise but descriptive nursing ñotes is
inestimable .1
In this case. the chart would have provided the judge with a
picture ofthe events as they occurred. The record would have
been most helpful especially where conflicting evidence was
gIven.
The triaIJudge found that the plaintiff had failed to prove
that there bad been any negligence on the part ofthe physician.
the nurses or the hospital. The action was dismissed. The Court
of Appeal of Alberta upheld the trialjudge's decision. In their
view, the evidence supported the trialjudge's conclusion.
The law
I 'ln order to support a finding of negligence against a physician,
nurse or hospital. the evidence must show that the care given
the patient was below the standard of care the patient ought to
L have received. The standard of care t(' which nurses are held is
that of a reasonable prudent nurse of like training and
experience:The test applicable to physicians is similar.
"The-test ofreasonable care applies in medical malpractice
cases as in other cases of alleged negligence. As has been said in
the United States, the medical man must possess and use that
reasonable degree of learning and skill ordinarily possessed by
practitioners in similar communities in similar cases. "J This
test, stated in the Supreme Court of Canada in 1956, continues
to apply nearly 30 years later. In Johnston v. Wellesley
Hospital, 4 earlier judgments containing the following statement
of standard are cited with approval:
I
"Every medical practitioner must bring to his task a
reasonable degree of skill and knowledge and must exercise
a reasonable degree of care. He is bound to exercise that
degree of care and skill which could reasonably be
expected of a normal. prudent practitioner ofthe same
experience and standing, and if he holds himself out as a
specialist, a higher degree of skill is required of him than of
one who does not profess to be so qualified by special
training and ability. ..
I
,
,
A hospital is charged with the duty to take reasonable care
in selecting a properly qualified staff to care for its patients and
to provide adequate facilities for the treatment of patients.
In assessing the quality of care delivered to Teresa, the
standard of medical and nursing practice applicable was the
standard that prevailed in 1960, not the standard at the time of
the trial in 1974. some 14 years later.
The evidence of the medical expert witnesses was
significant in this case in order to determine the cause of
Teresa's ultimate condition. Epiglottitis was deemed to have
been the probable cause of her dyspnea and anoxia. In 1960.
however. epiglottitis was not considered by the medical
profession to be a separate clinical condition as it is today.
Thus, the diagnosis of laryngotracheitis made in 1960 would
have embraced what was then known about epiglottitis and a
prudent physician or nurse in 1960 would not have been aware
of the greater danger epiglottitis posed to the patient. Today's
medical personnel would be expected to be cognizant of this
hazard.
Two of the expert witnesses stated that while. in their
opinion, Teresa would have been suffering from a degree of
epiglottitis, probably the cause ofthe convulsion and
subsequent brain damage was not epiglottitis. In their view, the
most probable cause of the convulsion was encephalitis. This
conclusion was consistent with the evidence given of the
observations recorded by the physician on his examination of
Teresa. Even if encephalitis had been diagnosed, there was
nothing that the defendants could have done to prevent the
injuries Teresa sustained.
Supporting the conclusion that epiglottitis was not of a
severe degree, was evidence of the lack of difficulty the
physician had in inserting the endotracheal tube and the fact
that mouth-to-mouth resuscitation almost immediately restored
Teresa's breathing, indicating that the airway was not
completely obstructed. The nursing notes would be most
important here as a record of what was done in response to
Teresa's sudden altered condition. the time at which measures
were taken. and all observations of the patient at the relevant
times.
II
'I
1
,
,
I
10 Febru.ry 1179
The Cenedlen NUrH
\f\\@
u 1follister ostomy pouches
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The Court did not find any evidence substantiating the
allegations of negligence against the nurses. There was an
allegation that the nurses had not properly observed the patient
and that there were delays in summoning the physician. The
evidence did not support this claim. Again, the nursing notes
would have been of value in answering such an allegation.
Where witnesses give conflicting evidence, as in this case,
it is the duty of the trial judge to assess the credibility of the
witnesses and decide which evidence he will believe. When
faced with conflicting oral (viva voce) evidence, supporting
documentation again is most helpful in assessing the truth ofthe
statements made. The trial judge here clearly stated that he was
fully aware of the human frailty ofrationalization and
reconstruction of the events especially given the passage of
time. He was also cognizant ofthe effect of hindsight on the
opinions, especially where the final outcome was known to the
witness.
Conflict arose chiefly over the condition of Teresa at
various times as described by her mother and reported in
telephone conversations and instructions. Generally, the
evidence of the office nurse, the hospital nursing staff, and the
special duty nurse was preferred to that of Teresa's mother.
. A lawsuit is an unpleasant experience for professional staff
at any time; it is particularly tragic when, as in this case, a child
is permanently disabled. For the plaintiff and her family the
results were devastating. The Court's task was to discover
whether it was the conduct of the medical personnel that caused
the child to be injured and, ifso, to fix blame, apportion the
fault and assess the damages to compensate the patient.
The Court found that the defendants had discharged their
duty to the patient without negligence. The case shows that
--nurses can be named as defendants. It reminds us also how
'. important it is to keep complete, accurate records; memories
fade but recorded observations and orders do not. The chart
remains a "living" record ofthe course of care given to a
patient. While the record may serve to indicate fault, it may
also, as in this case, show that there was no negligence in the
quality of care given.
References
I The evenrs which led up to this lawsuit occurred in 1960,
but it was not until 14 years later (1974) that the decision ofthe
Alberta trial court was reported (Tiesmaki et al. v. Wilson et al.,
19744. W. W.R. 19 (Alta.S.C.). One year later, the Alberta
Court of Appeal affirmed the earlier decision 19756 W. W.R.
639 (Alta.C.A.).
2 Id p. 640.
3 Wilson v. Swanson, 1956S.C.R. 804 per AbbottJ., p. 817.
4 19712D.R.103.pp.IIl-Il2.
.....
. --
"-
t ..
"You and the law" is a regular
column that appears each month
in The Canadian Nurse and
L'i'1firmière canadienne. Author
Corinne L. Sklar is a nurse and
recent graduate of the University
ofT oronto Faculty of Law and is
currently articling with a Toronto
law firm.
Th. Cen-.llen Nur..
F-..ery 18711 11
PROPOSED AMENDMENTS TO CNA BYLAWS
The following proposed amendments to CNA Bylaws wllJ be presented to membership at the 1979 annual
meeting, 29 March 1979.
Present
BOARD OF DlRECrORS
Section 8
The affairs of the Association shall be managed by a board of
directors which shall be composed of:
(a)l"he president, the president-elect, the first vice-president
and the second vice-president;
(b) five members-at-Iarge elected to represent respectively
the fields of nursing administration, nursing education,
nursing practice. nursing research and social and economic
welfare;
(c) the representative of each association member elected by
and from that association member.
Section 13
Tenn of Office: Directors under paragraph 8 (a) and 8 (b) shall
be elected for a term of two years. Directors under paragraph
8 (c) may similarly hold office for a term of two years
concurrent with the term of office of the other directors. No
director of the board shall hold the same office for more than
four (4) consecutive years.
Proposed
BOARD OF DIRECTORS
Section 8
The affairs of the Association shall be managed by a board of
directors which shall be composed of:
(a) The president, the president-elect, the first vice-president
and the second vice-president;
(b) five members-at-Iarge elected to represent respectively
the fields of nursing administration, nursing education,
nursing practice. nursing research and social and economic
welfare:
(c) the representative of each association member elected by
and from that association member;
(d) three public representatives appointed by the board of
directors.
Section 13
Tenn of Office: Directors under paragraph 8 (a) and 8 (b) shall
be elected for a term of two years. Directors under paragraph
8 (c) may similarly hold office for a tenn of two years
concurrent with the term of office of the other directors.
Directors under paragraph 8 (d) shall be appointed as soon as
possible following the biennial election of new directors
under paragraph 8 (b) and shall hold office for a term
concurrent with a tenn of office of such directors elected
under paragraph 8 (b). No director from 8 (a), 8 (b) and 8 (d)
shall hold the same office for more than four (4) consecutive
years.
I
II
DIRECTORY OF CNA ASSOCIATION ME
BERS
Registered Nurses Association of British Columbia 2130
West 12th Avenue, Vancouver, B.C. V6K 2N3.
Executive Director - Marilyn Carmack
Alberta Association of Registered Nurses, 10256-1 12th
Street, Edmonton, Alta. T5K IM6. Executive Secretary
- Yvonne Chapman
Saskatchewan Registered Nurses Association 2066
RetaJlack Street. Regina, Sask. S4T 2K2. Executive
Director- Barbara Ellemers
1\1anitoba Association of Registered Nurses, 647 Broadway
Avenue, Winnipeg, Man. R3C OX2.Executive Director-
M. LouiseTod
Registered Nurses Association of Ontario 33 Price Street,
Toronto, Ontario. M4W 1Z2. Executive Director-
Maureen Powers
Ordre des innrmières et innrmiers du Québec (Order of
'\Iurses of Quebec), 4200 Dorchester ouest, bd, MontréaJ,
Québec, H3Z IV 4. Executive Director and Secretary of
the Order - Nicole Du Mouchel
! I
New Brunswick Association of Registered Nurses, 231
Saunders Street, Fredericton, N .B. E3B 1N6Executlve
Secretary - Marilyn Brewer
Registered Nurses Association of Nova Scotia, 6035 Coburg
Road, Halifax, N .S. B3H IY8. Executive Secretary -
Joan Mills
Association of Nurses of Prince Edward Island 41 Palmers
Lane, Charlottetown. P. E.I. CIA 5Y7. Executive
Secretary-) Registrar - Laurie Fraser
Association of Registered Nurses of Newfoundland 67
LeMarchant Road, St. John's, Nfld. AIC6AI.Executh'e
Secretary - Phyllis Barrett
,I,
I\orthwest Territories Registered Nurses Association, Box
2757, Yellowknife, N.W.T. XOE IHO.Executive
Director-Registrar - Mary Lou Pilling.
II
12 Februery 111711
The Cen-.llen Nur..
Why
Spend All
Semester
Looking for
The Right
Texts?
A New Book APPLIED DECISION-MAKING IN NURSING. Give
your students a realistic look at decision-making theory with this
innovative text. Using a step- by- step approach. it slresses the relationship
between values. values clarification and decision-making. Examples of
specific nursing situations provide an excellent opportunity 10 practice
important skills. By JoAnn Garafalo Ford. R.N.. M.S..etaLJanuary: 1979.
Approx. 144 pp.. I iIIus. About $ 9.75.
New I Oth Edition
TEXTBOOK OF ANATOMY AND PHYSIOLOGY
Through 9 successful editions. you and your colleagues have
depended on thiS text for an accurate. comprehensive presentation of this
subject. The new 10th edition retains the features which have made it a
leader in the field: a precise. readable approach: meaningful correlation of
illustrations with discussions: and numerous leaming aids - chapter
outlines. tables. diagrams. outline summanes and challenging review
questions. Extensively revised and updated. this edition offers these
valuable new highlights:
. features more than 500 superb illustrations - over 200 in full
color. Throughout. the use of color is functional.
. reflects an increased emphasis on physiology. expanding
coverage of the endocrine. reproductive. urinary and
cardiovascular systems:
. incorporates a timely new unit on defense and adaptation - with a
new chapter on the immune system and more material on stress:
. features a new chapter on articulations:
. provides a succinct review of chemistry in the first chapter.
By Catherine Parker Anthony, R.N.. B.A.. M.S. and Gary Arthur Thibodeau.
Ph.D. January. 1979. Approx. 672 pp.. 570 iIIus. including 211 in
four-color. About $21.75.
New 10th Edition
ANATOMY AND PHYSIOLOGY LABORATORY MANUAL
Students need to apply the generalized knowledge gained from
lectures and reading to direct laboratory experience. This lab manual is the
ideal way to give students firsthand practIce In applying the scientific
method to anatomy and physiology. The revisions made in this edition
correspond to the extensive changes in the text For example:
. measurable objectives are provided for each laboratory exercise.
Students can now proceed independently to explore scientific
principles and concepts with a minimum of instructor assistance:
. stronger emphasis on physiology now provides a more balanced
coverage between structure and function;
. more than 20 new experiments provide increased flexibility.
. up-to-date new appendixes cover: metric conversion factors,
physical constants; blood types, normal adult blood values;
nutrition data; and solution preparation.
By Catherine Parker Anthony. RN., B.A., M.S. and Gary Arthur Thibodeau,
Ph.D. January, 1979. 270 pp.. 169 iIIus. Pñce. $ 9.75.
A New Book. RESPIRATORYTHERAPV: Basics forNursingand the
Allied Health Professions. An effective synthesis of theory and practice,
this handy guide details therapeutic procedures, specific equipment and
appropriate nursing actions. Noteworthy features include: a
comprehensive chapter on pediatric therapy; an extensive glossary; and a
useful appendix of conditions that alter normal breathing pattems. By
Dennis W. Glover, M.S., RRT. and Margaret McCarthy Glover, B.S., RN.
October, 1978.232 pp., 148 ilIus. Pñce. $10.75.
A New Book
NURSING CARE OF INFANTS AND CHILDREN
A comprehensive. practical approach, this contemporary text
focuses on the care of well, ill and handicapped children. Emphasizing
aspects of growth and development, the authors not only examine care of
the ill or disabled child. but also stress promoting the health of the well
child. Among the many student-oriented highlights, you'li find:
. "Summaries of Nursing Care" which include pertinent guidelines
for action:
. strong emphasis on - and guidelines for - communicating with
children and their families;
. key concepts are clarified with a wealth of tables and illustrations;
. pertinent lab data and pharmacology are integrated throughout;
. an excellent chapter on caring for the terminally ill child;
. an extensive appendix outlines normal values and assessment
tools.
By Lucille F. Whaley,RN., M.S. and Donna Wong,RN.,M.N., PNA-P.April,
1979. Approx. 1.408 pp., 744 ilIus. About $ 24.00.
Th. Cenecl'en Nur..
New Volume II CURRENT PERSPECTIVES IN ONCOLOGIC
NURSING. A broad scope - stressing the nursing process - offers
students a contemporary view of oncologic nursing. Fascinating original
papers focus on professional awareness. therapy. maximizing the quality
of life and rehabilitation. Students will particularly value papers on
nUlritional support. oncology self-help groups and hospices. Edited by
Carolyn Jo Kellogg. R.N.. B.S.N.. M.S.N.. N.P. and Barbara Pelerson
Sullivan. CR.N.. B.S.N.. M.S.N.. N.P.: with 22contributors.April. 1978.204
pp.. 26i11us. Price. $14.00 (C), $10.25 (P).
New 9th Edition. ORTHOPEDIC NURSING. You and your students
can relyon this superbly illustrated classicfor acomprehensiveoverviewof
modern orthopedic nursing - both basic principles and specific nursing
interventions. This edition incorporates a totally new chapter on
emergency nursing care in the orthopedic unit; and current information
on bone tumors. amputations. care of the cerebrovascular accident
patient, and anatomy/physiology of joints. By Carroll B. Larson. M.D..
FACS. and Marjorie Gould. R.N., B.S.. M.S. April. 1978. 508pp.,466illus.
Price. $18.00.
New 7th Edition. CARINI AND OWENS' NEUROLOGICAL AND
NEUROSURGICAL NURSING. Revised to reflect advances in this field
and the nurse's expanded role. this well known text focuses on holistic
nursing care and the rationales for specific nursing actions. Youllfind new
chapters on embryology, functional physiology. sexual integrity. trophic
changes and rehabilitation: an expanded chapter on pain discusses pain
assessment, pharmacologic control. biofeedback. acupuncture and
hypnosis. By Barbara Lang Conway, R.N.. M.S.: with 3 contributors. July.
1978.656 pp., 307 iIIus. with 2 color plates. Price, $ 20.50.
A New Book. PLANNING AMBULATORY SURGERY FACIUTIES.
This long-awaited textservesas both aframeworKand a practical g uide for
planning and maintaining a walk-in surgical facility. Using a clear.
step-by-step approach. it deals with all facets of this subject - including
budgeting. scheduling, personnel, ethics and necessary equipment
Helpful suggestions and guidelines are readily adaptable to meet the
particular needs of any institution. By Reba Douglass Grubb. B.S. and
Geraldine Ondov, R.N.: with 2 contributors. February. 1979. Approx. 240
pp., 62 iIIus. About $ 21. 75.
New 2nd Edition
REVIEW OF PHARMACOLOGY IN NURSING
When you're preparing students for important examinations. tum to
this clinically-oriented text In challenging question/answer fonnat, it
provides an understanding of basic pharmacologic actions. .. emphasizes
major drug categories. . . examines nursing's responsibility for correct
drug administration... and offers a conceptualapproachforfurtherstudy.
The authors have carefully updated and revised all material. and integrated
contemporary research findings and new drugs. Students will particularly
appreciate:
· an outstanding new chapter on drugs that affect sexual response.
the fetus and the nursing infant;
· essential new material on special implications of drug therapy for
the elderly;
· the latest infonnation on CNS drugs, psychotropic drugs. and
drugs affecting the cardiovascular system.
By Betty S. Bergersen, R.N., M.S., Ed.D. and Jurate A. Sakalys. R N.. M.S.
July, 1978. 312 pp. Price. $12.00.
A New Book. lEADERSHIP IN NURSING: Theories. Strategies.
Actions. Centering on nursing leadership as a social process. this
innovative text is organized around the common themes of behavioral
science theory, process. models, concepts, data analysis, research,
education and the future. The author presents a leadership behavior
measurement tool and demonstrates its application in a major study. By
Margaret M. Moloney, RN., Ph.D. May. 1979. Approx. 250 pp., 11 illus.
About $ 9. 75.
A New Book. MCN ORGANIZATION AND MANAGEMENT OF
CRITICAL-CARE FACIUTIES. Noted authorities share their expertise
with all aspects of operating a critical care unit Major sections focus on
initial planning... analyze design and equipment needs... review policies
and procedures . . . discuss staffing and inservice education . . . and
consider factors in patient care. Throughout, the authors stress optimal
patient care and the most efficient use of resources. Edited by Diane C
Adler, R.N.. M.A.. CCRN. and Norma J. Shoemaker, R.N..B.S.N.; with 13
contributors. April, 1979. Approx. 192 pp., 32 iIIus. About. $15.10.
FebrValry 1171 13
New 4th Edition. COMPREHENSIVE CARDIAC CARE: A Text for
Nurses. Physicians. and Other Health Practitioners. Thoroughly revised
and updated. this popular text reflects current advances in cardiac
research/technology and the resulting new approaches to patient care.
Revised discussions of the data collection process. pacemaker therapy
and new technology in patient care highlight this edition: a concise
appendix incorporates data on investigational and experimental drugs. By
Kathleen G. Andreoli. R.N.. B.S.N.. M.S.N.. et al. March. 1979. Approx. 384
pp.. 694 iIIus. About $13.25.
A New Book. MOSBY'S MANUAL OF CRITICAL CARE: Practices
and Procedures. Organized according to a needs approach to
homeostasis. this practical book presents procedures, techniques and
rationales needed for effective intensive care. Initial chapters examine
general considerations and patient assessment. Subsequent chapters
describe and depict such procedures as airway establishment,
hemodynamic monitoring. temperature control and assistance/control
of breathing. More than fifty informative tables summarize key concepts.
By Linda Feiwell Abels. RN.. M.N. March. 1979. Approx. 254 pp., l30illus.
About $ 12.00.
I
ANew Book HOME HEALTH CARE. Home health care - what it is.
who the clients are. and how it is organized and delivered - is the main
focus of this unique text. Using a multidisciplinary approach, it defines
home health care as care of the client at home - not just home nursing.
Topics include professional and support services, methods of financing.
continuity of care and the futureofhome health care. Students will find this
resource particularly helpful for discharge planning. By Jane Emmert
Stewart. B.S., M.S.N. March. 1979. Approx. 208pp.. I Oillus.About $9.75.
A New Book. MOSBY'S MANUAL OF EMERGENCY CARE:
Practices and Procedures, This generously illustrated manual describes
and depicts advanced skills needed to effectively handle classic
emergency problems. For each. students will find flow charts for initial
management along with convenient cross-references to procedures and
drugs. Dental emergencies. cardiac life support, neurological
emergencies. human bites and chest pain are just a few of the
potentially-grave situations explored. By Janel Miller Barber. R.N., M.5.N.
and Susan A. Budassi. R.N.. M.S.N. May. 1979. Approx. 455 pp..493 iIIus.
About $16.75.
New 3rd Edition. NURSING MANAGEMENT AND LEADERSHIP IN
ACTION: Prindples and Application to Staff Situations. This highly
successful text has enlarged its focus from leadership to the broader
spectrum of leadership and management in nursing - whether practiced
in team, primary, functional or case nursing. h delineates a conceptual
frameworK of administrative principles needed by the nurse-Ieader-
manager and demonstrates their application in everyday practice. Atimely
new chapter on management highlights this edition. By Laura Mae
Douglass, R.N., BA, M.S. and Em Olivia Bevis, R.N.. B.S., MA. F AA.N.
April, 1979. Approx. 304 pp., 16 iIIus. About $12.00.
Prices subject to change.
IVIOSBV
TIMES MIRRDR
THE C. V. MOSBY COMPANY, L TO.
B6 NORTHLINE ROAO
TORONTO. ONTARIO
M4B 3E5
14 FeÞruery 111711
The Cen-.llen NUrH
Why
Spend AU
Semester
Looking for
The Rigþt
Texts?
New 2nd Edition. A GUIDE TO NURSING MANAGEMENT OF
PSYCHIATRIC PATIENTS. Bridge the gap between learning clinical skills
and applying them with this valuable workbook! Updated throughout, it
covers all major aspects of psychiatric nursing - providing definitions,
answers and rationales for all questions. This edition features: a new
chapter on the expanded role of the nurse; a rewritten chapter on
substance abuse: succinct chapter overviews; a clinical evaluation tool;
and an instructor's manual. By Sharon Dreyer. RN.. M.A.. M.S.N.. et aL
April, 1979. Approx. 288 pp. About $11.50.
A New Book. STRESS AND SURVIVAL: The Emotional Realities of
Ufe- Threatening OIness. A timely. comprehensive presentation. this text
analyzes stress and survival for caregivers working with patients and
families facing life-threatening illness. Noted contributors explain optimal
ways of providing emotional support and show how that support can
promote quality of life, longevity and. at times. survival. Students will
especially want to read material on psychotherapy, biofeedback and
therapeutic touch. Edited by Charles A. Garfield, Ph.D. March, 1979.
Approx. 400 pp., 9 iIIus. About $15.75.
A New Book. BASIC PATHOPHYSIOLOGY: A Conceptual
Approach. This conceptual approach presents the basic b.iology of
disease from the perspective of alterations of normal phYSiology -
regarding the human organism as an open system in continuous
interaction with the environment. Theauthorsdiscussdiseasesintennsof
models of major concepts, rather than as a compilation of signs and
systems. Each chapter begins with helpful behavioral objectivesand ends
with a detailed glossary. By Maureen E. Groër. RN., M.A., Ph.D. and
Maureen E. Shekleton. RN.. B.S.N., M.S.N. February. 1979. Approx. 560
pp.. 423 iIIus. About $19.25.
A New Book. A PRIMER OF CARDIAC ARRHYTHMIAS: A
Self-Instructional Program. A challenging. programmed fonnat offers
students "hands-on" practice in interpreting cardiac arrhythmias.
Following lucid chapters on such general aspects as cellular physiology
and cardiac monitoring. the core of the coverage focuses on specific
arrhythmias - sinus arrhythmias. atrial arrhythmias. A Vblocksand more.
A useful appendix of practice rhythm strips is excellent for class
discussions. By Cecelia C. Harris, RN.. M.S.N. February, 1979. Approx.
144 pp., 100 iIIus. About $ 9.75.
A New Book. BEHAVIORAL CONCEPTS AND THE NURSING
PROCESS. This incisive text delineates specific behavioral concepts -
e.g. stress. depression, aggression - within the framework of the nursing
process. Detailed case examples following each chapter clarify key
theories and show students how the nursing process can be utilized in
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Trygstad-Durland, RN.. M.S. February, 1979. Approx. 192 pp., 7 iIIus.
About $9.75.
A New Book. GROUP PROCESS FOR NURSES. This valuable text
offers students assessment, intelVention and evaluation tools to assist in
therapeutically using small groups to meet the biopsychosocial health
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and disadvantages of using groups . . _ provide helpful guidelines for
developing and structuring successful groups. . . analyze leadership roles
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Maxine E. Loomis, RN., Ph.D. March, 1979. Approx. 176 pp., illustrated.
About $9.00.
New 2nd Edition. PRIMARY NURSING: A Model for Individua6zed
Care. Explore primary nursing with this comprehensive text. It discusses
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report pertinent research results. This edition provides new data and
guidelines for implementation. altematives for staffing, and comparisons
of primary nursing with other methods. ByGwenMarram, RN., M.S.. Ph.D.,
et aL May, 1979. Approx. 200 pp., 25 iIIus. About $10.75.
A New Book. DEPARTMENT OF EMERGENCY MEDICINE
GUIDEUNE MANUAL: Po6cies and Procedures. This practical manual
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retrieval - to stress management, treatments and responsibilities of
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users to specific information. By Jeffrey R Mac Donald, M.D. and Pat
Kinder, RN. May, 1979. Approx. 400 pp.. 11 iIIus. About $24.80,
New 3rd Edition. CARE OF PATIENTS WITH EMOTIONAL
PROBLEMS. How well can your students meet the emotional needs of
their patients? This authoritative text can help as it studies the roles
emotions play in the human life span - including emotional
development. physical illness, emotional disorders and functional
psychotic illness. This edition features an informative new chapter on
remotivating the emotionally disturbed patient through the use of groups.
By Dolores F. Saxton. RN., M.A., Ed.D. and Phyllis W Haring, RN.. M.S.,
M.Ed. March, 1979. Approx. 144 pp.. 8 iIIus. About $ 7.25.
3rd Edition. COMMUNITY HEALTH. Designed for introductory or
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complete study of the field - emphasizing community health
maintenance, environmental health and health services. You'll find new
infonnation on maternal and infant health. cardiovascular disease,
venereal disease, alcoholism and cigarette smoking. New charts and
graphs augment the text. By C. L Anderson. B.S., M.S.P.H.. Dr. P.H.. et al.
1978. 384 pp., 106 iIIus. Price. $18.00.
A New Book. FETAL MONITORING AND FETAL ASSESSMENT
IN HIGH-RISK PREGNANCY. Questions on fetal monitoring? Students
will find concise answers in this well organized text. It examines all fetal
monitoring methods - biophysical. biochemical and electronic - and
outlines the progression from possible fetal difficulty to intelVention for
fetal distress. Numerous case studies and fetal monitoring strips illustrate
appropriate nursing care. By Susan Martin Tucker, RN.. B.S.N.; with 1
contributor. July. 1978. 172 pp.. 128 iIIus. Price. $12.00.
Th. Cenedl.n NUrH
Februery 11171 15
A New Book PRINCIPLES AND PRACTICE OF PSYCHIATRIC
NURSING. Using a nursing-oriented, conceptual approach, this
well-organized text describes man's adaptation to illness, and explains
nursing diagnoses and specific nursing intelV'entions. Part I discusses
specific nursing diagnoses - anxiety, grief, disruptions in the
communication process. Current therapeutic modalities are the focus in
Part II. Selected bibliographies and the latest research findings assist
students with further study. By Gail Wiscarz Stuart, R.N., M.S., CN. and
Sandra J. Sundeen. R.N.. M.S.; with 15 contñbutors. t-'-.ay. 1979. Approx.
736 pp., 24 iIIus. About 5 17.25.
New 2nd Edition. THE PROCESS OF STAFF DEVELOPMENT:
Components for Change. t-'-.any states are instituting legislation making
license renewal contingent on continuing education efforts. This valuable
resource can help students learn the essentials of designing,
implementing and evaluating the staff development process. New and
updated discussions examine the budgetary process and the relationship
of staff developmentto the overall continuing education effort. By HelenM.
Tobin, R.N., M.S.N., F AA.N. and Pat S. Yoder Wise, R.N., M.S.N. April,
1979. Approx. 224 pp., 26 iIIus. About 5 14.50.
New 2nd Edition. HUMAN SEXUAUlY IN HEAL TIf AND Iu.NSS.
This new edition again explores all facets of the complex phenomenon of
sexuality. Three major units examine the biopsychosocial nature of
human sexuality. . . analyze sexual health and health care. . . and define
clinical aspects of human sexuality. Case examples - presented in review
questions - offer an effective demonstration of theories, principles and
research findings. By Nancy Fugate Woods, R.N.. M.N., Ph.D.; with a
chapter by James S. Woods, Ph.D.; and 7 contñbutors. t-'-.arch, ] 979.
Approx. 320 pp., 11 iIIus. About 5 12.00.
A New Book. FATHERING: Participation in Laborand Birth. Explore
the father's role as an active nurturing participant in the birth process with
this unique book. The authors first examine the father's role in labor and
delivery and provide physicians' feelings on the subject. In section II,
students will read fascinating interviews with the fathers who shared in the
birth experience. By Celeste R. Phillips. R.N.. M.S. and Joseph T.Anzalone,
M.D. t-'-.arch. 1978. 164 pp., 73 iIIus. Price, 5 10.25.
2nd Edition. THE-GROUP APPROACH IN NURSING PRACTICE. A
valuable resource for all nurses, this current edition continues 10 focus on
the underlying concepts of the group process. Dr. t-'-.arram outlines the
scope of group work; discusses vanous theoretical frameworks; pinpoints
nursing's common objectives; and delineates special techniques, roles
and considerations. Students will beespeciallyintrigued with a helpful new
chapter on establishing, maintaining and terminating agroup. ByGwen D.
t-'-.arram, R.N., B.S., M.S., Ph.D. ] 978. 264 pp.. 1 iIIus. Price. 511.50.
New 3rd Edition. CRISIS INTERVENTION: Theory and
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comprehensive overview of the theory and principles of crisis intelV'ention
- from its historical developmentto present use. Tìmelynewdiscussions
examine rape, suicide and old age - and an outstanding new chapter
focuses on dealing with the chronic psychiatric patient on an out- patient,
crisis intelV'ention basis. By Donna C Aguilera, R.N.. Ph.D., F AA.N. and
Janice M. Messick. R.N., M.S., F.AAN. t-'-.arch, 1978. 206 pp.. ] 6 iIIus.
Price. 5 10.75.
New 2nd Edition. MENTAL HEALTH CONCEPTS IN
MEDICAL-SURGICAL NURSING:A Workbook. Thispracticalworkbook
shows how to apply both mental health concepts and the nursing process
in general patient populations. Logically organized sections examine
patients experiencing anxiety, body image alterations, and
psychophysiological dysfunction - each includes theoretical concepts,
clinical applications and review questions. A Student/instructor guide is
available. By Carol Ren Kneisl. R.N.. M.S. and Sue Ann Ames, R.N., M.S.
January, ] 979. 174 pp., 23 iIIus. Price. 51 0.25.
A New Book.
FUNDAMENTALS OF NURSING PRACTICE:
Concepts. Roles and Functions
Presents the concepts. processes and skills essential to all levels of
nursing with this dynamic text. The widely respected authors provide a
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many important roles of the nurse. Well-wntten and easy to understand,
this text:
. offers an overview of the nursing process, physical assessment
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comforter, healer, teacher. and rehabilitator;
. defines and analyzes each role in a separate chapter;
· summarizes nursing procedures in convenient, easy-to-read,
tabular form;
· concludes each chapter with a helpful vocabulary listand selected
study questions.
By Fay Louise Bower, R.N., B.S., M.S.N., D.N.Sc., F .AAN. and Em Olivia
Bevis, R.N.. B.S., M.A., F .AAN.; with 8 contñbutors. January, ] 979. 614
pp., 391 iIIus. Price. 516.75.
A New Book. COMMUNIlY HEALTH CARE AND THE NURSING
PROCESS. An eclectic overview of community health nursing, this
innovative text helps students become change agents in the system. The
author uses a holistic approach to human development, stressing three
basic concepts: the health-illness continuum; humankind as an open
system; and the effects of various situations, health problems and
stressors on the health and development of the individual, family and
community. By Margot Joan Fromer, B.S., M.A., M.Ed.; with 7
contñbutors. January, 1979. Approx. 480 pp., 110 iIIus. About 517.50.
For more Information on these and any other Mosby texts. or to have a
sales representative contact you. write: The C. V. Mosby Company. 86
North&ne Road. Toronto. Ontario. M4B 3E5. A90214
IVI OS BV
TIMES MIRRDR
THE C. V. MOSBY COMPANY, L TO
B6 NORTHLINE ROAO
TORONTO, ONTARIO
M4B 3E5
111 Februery 11171
The C8n-.lI.n NUrH
()P )'()
89 mB
Jennifer Craig and
GordonC. Page
.,
"
PALM
I
CUBIT
Shorter distances were measured by using the lengths of various part.
of the body.
While we were having coffee the other
day, Maria's account of her
altercation with Dr. Super Jock was
interrupted by a groan from Jane,
our inveterate newspaper reader.
"Guess what?" Jane interjected,
lowering the paper to stare at us with
the look of a conveyor of dire news.
"Canada will be completely metric by
1980."
"Gross'" Maria said. (She is a
mother). "Why do they want to do
that? We're OK as we are."
"It's because we're losing
between 1 00 and 200 million dollars a
year in trade, that's why," I replied,
believing myself to be the resident
expert. "All the countries in the
world, except the United States, are
using the metric system or are
converting to it, and Canada can't
afford not to. "
"I've had trouble enough getting
used to temperatures in centigrade
and distance in kilometers," groaned
Jane, "what else is in store for us?
Isn't it time someone warned us?"
"You're right," I said. "I'll
write an article for The Canadian
Nurse and explain how the metric
system will affect nursing."
"Well, for heaven's sake, don't
get too technical," Jane pleaded.
"I won't," I promised. "And, by
the way, the proper name for the
metric system is Le Système
International d'Unités, commonly
referred to as SI."
Th. Cen-.llen Nur..
Februery 11179 17
,\
\
/
I
,."... ......
,-
(
ONE
SAXON
YARD
'OJ I
..-.J
\
The Saxons,for their yard. took the QI'erage distance around the waist of their
kmgs.
History of Our Present Measurements
or
"Wh} We're In the Mess We're In"
Many years ago. lengthy distances were
measured in units oftime. An old
American Indian drawing of a canoe and
three suns represents ajourney lasting
three days. When we say ajourney
downtown is 20 minutes or a hike up a
mountain is eight hours, we are still using
units oftime to measure distance.
Shorter distances were measured by
using the lengths of various parts of the
body; for example. the digit and the foot.
The foot is still being used. of course, but
our twelve inch foot is longer than the
original Greek foot. A glance downward
as you walk around will enlighten you as
to the vagaries of the human foot. If you
were an ancient merchant and wished to
medsure a length of shoddy for a
customer. whose foot would you
choose? Why. the smallest (and cleanest)
available of course!
A set of standard units for
measuring length was developed by the
Romans but these units were lost with
the fall ofthe Roman Empire. By the
Middle Ages. almost every European
town and every different trade guild had
set its own standard units for
measurement. In England, the system
was chaotic. The Saxons, for example.
took the average distance around the
waist oftheir kings for their yard! In an
effort to reduce the chaos, successive
monarchs tried to set specific standards.
Henry I held out his ann and decreed
that the standard yard would be the
distance from the tip of his nose to the tip
Henry I held out his arm and decreed that the standard yard be the diHance from
the tip ofhis nose to the end of his thumb.
ONE YARD
HENRY I . }I
-.....
.
"'
11<' . \
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..
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...x....,. \
of his thumb. In the sixteenth century, an
inch was described as the length of three
round and dry grains of barley laid end to
end. Twelve ofthese inches became a
foot. Elizabeth I then decided that 5,280
feet was to be a mile. The Nuclear Age is
still using measurements based on the
whims of these medieval monarchs.
The history of units for measuring
weight and volume is equally fascinating.
The weight of a grain of wheat, referred
to as "grain" , became the unit of small
quantities. Specific numbers of grains
comprised a Troy and Avoirdupois
pound. Initially, shells. horns, gourds
and other naturally available items were
used to measure volume. Later, the
volume often pounds of pure water was
described as the Imperial gallon. For
convenience. quarter gallon amounts
were used and became known as quarts.
Wine merchants. however, used a
different measure. Queen Anne set
standards for their unit of volume
resulting in a second type of gallon - the
British wine gallon. The United States
adopted the wine gallon as the measure
of volume, while Canada, which
inherited its measurements from Britain.
uses the Imperial gallon. Any Canadian
cook who follows an American recipe
calling for one pint and who uses 20
ounces instead of 16 ounces will ponder
over a supersaturated flop de cuisine.
Special occupations such as
printing, diamond cutting and horse
racing developed their own measuring
units so that we inherited picas and
points. carats and furlongs. Such an
array of measurements. though quaint.
led to confusion and fraud. Something
had to be done!
,
The Metric System
or
"Vive Ie Metre'.
Although Stevin first proposed a decimal
system in 1585, accolades for the
founding of the metric system go to
Gabriel Mouton (1618-1694). His
principal unit of length, the milliare. was
defined as a specific portion (0.000 000
025 to be exact) of the arc or
circumference of the earth. This new unit
oflength was named the metre. From
this one measure. two further standard
units were derived. First the metre was
squared to produce a standard for
measuring area. Secondly, by
constructing a hollow cube with the
standard metre and filling it with water. a
standard for volume was obtained.
Unfortunately. the surveyors ofthe
earth's circumference erred - the metre
did not in fact represent the quoted
figure. Rather than reorganizing the
whole system, a platinum metre was
constructed to serve as a 'itandard for
length. The practice of using natural
origins for units of measurement was
finally overthrown.
I
I
I
1. Februery 11171
Th. Cen-.llan NUrH
The French Revolution upset the
progress ofthe metric system for awhile,
but 1840 saw the adoption ofthe decimal
metric system, or "SI", as the only
lawful system in France. The use of the
system gradually grew. Laboratories to
develop, house and monitor the
standards for the SI units were erected at
Sévrès, near Paris. These laboratories
eventually came under the control of the
Conférence Général des Poids et
Mesures, to which 40 countries,
including Canada, now send delegates.
As the SI system grew, the following
units were added to the metre and
kilogram. the originaJ units oflength and
mass: see Figure one.
These five units, the metre and the
kilogram, form the seven base units of
the InternationaJ System ofVnits or SI.
The International System of Units
or
"SImple When You Know How"
Table one summarizes the seven base
units of SI and gives the symbols for
each unit. In addition to these base units,
there are two supplementary units, the
radian and steradian. They have little
application in nursing and are shown
only for completeness. Aiew non-SI
units are of such practical importance
that they have been retained. These
include the litre, hour and minute.
Each base SI unit is specificall}
defined so that it is reproducible in any
adequately equipped laboratory. For
example, the metre is defined as the
length equal to 1.650,763.73 wavelengths
in vacuum of the orange-red line in the
spectrum of the Krypton-86 atom. I f this
definition overwhelms you, don't give
up. This is not a technical article and this
definition was given only as an
illustration of how the SI base units are
now defined. Those who wish to know
all the definitions of SI units may consult
one of the many books on the metric
system now seen in Canadian
bookstores.
The base SI units may be combined
according to physical laws to obtain
derived units to measure such things as
velocity, acceleration and pressure. For
example, the units of mass. length and
time combine to define the unit of
pressure which has been given the name
pascal. Other derived units are shown in
Table two.
The main advantage of a standard
system of units is simplicity. While
people in different countries or
professions use the same system of
numbers (i.e. the Arabic system), they
do not all use the same system of units.
This lack of unity often makes
interpretations difficult. Although the
names of the SI units will aJterdepending
on the language being used, there is
international agreement on a common set
of symbols.
.
. ,
, .
.
.
, .
. -=
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4 .
ONE
INCH
Elizabeth I decided that 5.280feet be a mile.
Figure one
Date Adopted Unit Name Unit of
1837 Second Time
1950 Ampere Electrical current
1954 Kelvin Temperature
Candela Luminou'i intensity
1971 Mole Amount of substance
The unit oflength, the milliare, was defined as a portion of the arc of the earth.
-'
STEVIN -1585
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MOUTON -1670
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The Cen-.llen NUrH
F_uary 11171 111
LENGTH AREA
VOLUME
metre sq.
metre
cubic metre
The metre was squared to produce a standard for measuring area and cubed to
produce a standardfor measuring volume.
Table one
The SI Base Units and Supplementary Units
Physical Quantity Name of SI Unit Symbol
Length Metre m
Mass Kilogram kg
Time Second s
Electrical current Ampere A
Temperature Kelvin K
Luminous intensity Candela cd
Amount of substance Mole mol
Plane angle Radian rad
Solid angle Steradian sr
The number can be raised to multiples often.
MULTIPLES
1000 met res
kilometre
J
10 metres
decametre
'l'\
---
1 metre
Another advantage of SI is that it is
a decimal system based on the number
ten. The number can be raised to
multiples of ten or reduced to
sub-multiples often. These multiples and
sub-multiples are indicated by a form of
shorthand. the prefix. SI prefixes and
their symbols are shown in Table three.
An example of their use is that instead of
saying 1.000 pascals or ten to the power
three pascals. we say kilopascals. The
rules governing the use of prefixes will
eventually have to be mastered.
When the SI system is introduced
into the health care system, two
measurements will be of particular
importance in nursing. These are the unit
of pressure. the pascal and the unit of
amount of substance, the mole.
The Pascal
or
"Watch Your Blood Pressure"!
At present. we have a confusing array of
units of pressure. Arterial blood pressure
is expressed in millimetres of mercury
and venous pressure in centimetres of
water. What could be more illogical? We
also describe pressure in terms offeet of
sea water. standard atmospheres.
pounds per square inch and inches of
water.
Pressure is defined as force per unit
area. In SI, one pascal is the pressure
exerted by one newton (the unit offorce)
acting on an area of one square metre.
Pressures will be expressed in multiples
or sub-multiples ofthe pascal. For
example, blood pressure, now measured
in millimetres of mercury will be
expressed in kilopascals. The "normal"
BP will be 16/11 kPa. The present
inflation pressure in centimetres of water
and oxygen pressure in pounds per
square inch wiJl become hectopascals of
inflation pressure and megapascals of
oxygen pressure.
You will be pleased to know that
equipment used to measure pressure will
essentially be the same. The gauges.
inscribed with different numbers and
units. will seem strange at first. but
putting up a wall suction and monitoring
a C. V. P. will remain the same familiar
tasks.
j
tolar Units
or
"Is This a Blood Chemistry Report?"
The introduction of the mole as unit of
amount of substance will be one of the
most important. yet most difficult
changes we will encounter. The mole is
not only a new unit but a new concept of
measurement.
The mole is defined as that amount
of substance which contains as many
identical elementary entities as there are
atoms in 12 grams ofcarbon-12, that is,
6.025 23 atoms. You may recall this
number, known as Avogadro's number,
20 F-".ry 11171
The Cen-.llen Nur..
.
from your high school chemistry days. A
mole of any substance contains 6.025 23
entities. Elementary entities may be
atoms. ions. electrons or any other
identical particles - even marbles.
6.02Y" identical marbles may be
described as one mole of marbles and
6.025 2 " identical grain
of sand may be
described as one mole of sand. You will
realize. therefore, that a mole of one
substance can weigh much more or less
than a mole of another substance. A
mole of marbles will weigh much more
than a mole of sand.
As the conversion to SI progresses.
clinical chemistry results will be reported
in molar units rather than mass units:
that is in millimoles per litre rather than
milligrams per hundred millilitres. When
comparing molar quantities we are
comparing numbers of entities.
Currently used units. such as milligrams.
tell us little about the actual quantity of
particles in a substance. Relationships to
other substances must be memorized.
Take cholesterol and urea. A mole of
cholesterol weighs 386 grams and a mole
of urea weighs 60 grams. Very different
weight!>, yet both contain the same
number of molecules i.e. 6.025!.1
molecules. Does it matter? Yes. because
medicine is usually concerned with the
concentration of substances in
physiological fiuids. The relation!>
between these 'iub'itances are more
obvious when measured on the basis of
their relative number. For example.
consider the following laboratory results:
Cholesterol Urea
S.1. llnit 12.16 m mol/I 6.46 m mol/l
Present 250 mg/IOO ml 73 mg/IOO ml
Unit
Looking at the results expressed in
mass units (milligrams per 100
millilitres>. you would think that there is
over three times a
much cholesterol as
urea. The molar units (millimoles per
litre) however. show that there are twice
as many active particles (molecules) of
urea as cholesterol.
Drug dO'iages expressed-Ïn moles
rather than weight became more logical.
At present. there is confusion when a
doctor orders 10 mg of morphine. Does
he want 10 mg of morphine sulphate,
which contain
only 8 mg morphine. or
10 mg of active morphine? Using Slone
mole of morphine, or morphine sulphate,
contains the same quantity of morphine.
Potency between harhiturates ordered
by mass do
es Cdn only be compared
after consultation with the memory or
the drug manual. Molar doses. however.
allow a direct comparison of potency
because we are dealing with the relative
number of molecules.
As Canada "goes metric", nurses
can expect to meet the SI units in their
1 metre
þ
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't
decimetre
1
1õõ metre
centimetre
1
1õõõ metre
millimetre
I
.
SUBMULTIPLES
Or reduced to sub-multiples often
T able two
Some Derived 51 Units
Physical Quantity Name of SI Unit Symbol Definition of SI Unit
Volume Cubic metre - m 3
Force Newton N kg m S-2 = Jm- I
Pressure Pascal Pa kg m-' S-2 = Nm- 2
Work Joule J kg m 2 S-2 = Nm
Power Watt W kg m 2 S-3 = Js- 1
Surface tension Pascal metre - Pa m = Nm-' = kgs- 2
Periodic frequency Hertz Hz S-1
Elementary entities mav be atoms. ions, electrons or anv other identical particles
- e\'en marbles.
even
marblese
l
:
\ . .
p.
. -
025 X 10 23 :i
J.w- m8rbl
-'"
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-
---
-
---
--
op'-
--
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Th. Can-.llen Nurae
F.....u.ry 1 '71 21
. . . or
grains of sand
"--....
6.025 10 23 1
grains
one
mole
"
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.'
6.025!' identical grains of sand may be described as one mole of sand
Table three
81 Prefixes
Fraction SI Prefix Symbol
10. 2 tera T
10 9 giga G
10 6 mega M
10 3 kilo k
102 hecto h
10 deca da
10- 1 deci d
10- 2 centl c
10- 3 milli m
10-<; micro p.
10- 9 nano n
1O-t! pico P
10-1
femto f
10- 18 atto a
A mole of cholesterol weighs 386 grams and a mole of urea weighs 60 grams. Very
different weights yet both contain the same number of molecules . .
1 mole UREA
1 mole
CHOLESTEROL
m
!t
. ..... . .
. . .........
'" .... ..... ..
... . . . . . ...... . .. . ,
... ...
..!Þ...... · ..... ;
....... 386 .....
..:.. .....
>. .. .....
'f!....... ........,
. ..........."
.. .......... .
........ .
... e r
..!àY
- different weights
-same number of molecules
practice. The major changes will be the
introduction of the pascal as the unit of
pressure and the mole as the unit of
amount of substance. The short history
of our customary units of measurements
should have convinced you ofthe need
to adopt a more logical system. Although
it is natural to feel initially clumsy in our
attempts to master the SI units. the effort
to do
o should be repaid by the
increased understanding of the
relationships between pressures. now
expressed in a variety of units, and
between the relative concentrations of
substances in physiological fluids.
Epilogue
When I showed a draft of this article to
Jane and Maria to find out what they
thought. Jane sighed. "I still don't like
the idea. It might seem logical to you, but
I'll never remember all that."
"At least the children are growing
up with it." said Maria. "but I"m too old
to grasp all those tens to the minus some
number prefixes."
Which only goes to show that no one
likes changes! But they are coming! 'iii
Bibliography
Black. Gerald J. Thinking metricfor
Canadians, Toronto. Doubleday, 1975.
Hill. D. W. The application ofSI units to
anaesthesia,B r.J.A naesth.
41:1053-1057, Dec. 1969.
Karnauchow, P.N. Experience with SI
units in biochemistry, by... and L
Suvanto. Canad.Med.Ass.J.
114:6:533-535. Mar.20, 1976.
Qulton. John L Systems of
measurement: their development and use
in medicine.Canad.Anaesth.Soc.J.
23:4:345-356, Jul. 1976.
Padmore. G .R. SI units in relation to
anaesthesia. A review of the present
position. by... andJ.F. Nunn.
Br.J.Anaesth. 46:236-243. Mar. 1974.
Jennifer Craig is a graduate of the
GeneralInfirmary at Leeds, Englandand
obtained her B.S.N. from the V nh'ersity
of British Columhia in /976. She is
currently a graduate student in the
Faculty of Education at the V nil'ersitv of
British Columbia.
Gordon Page, Ed.D. is the Director,
Division of Educational Support &
Del'elopment in the Health Sciences,
V.B.C.
Both authors were im'olred ill the
production of a slide-tape show
".r.,Jediametric s". The artist was Bruce
Stewart. Photographs of his originals are
included with this article and are used
with the permission of the Department of
Biomedical Communications. V.B.C.
Copies of the slide-tape show are
obtainable from this department.
22 Febru.ry 1171
The Cen.dl.n NUrH
'st
. .
criSIS
,
Theresa O'Neil
Three months have elapsed since the
pathology report came back
following the surgery I underwent to
excise a molefrom my right knee.
The verdict: malignant melanoma,
class Ill.
What follows is an attempt to give
you some idea of what it's like to be
"on the other side of the fence" - a
family practice nurse one day, a
patient suffering from what could be
a life-threatening illness the next. It
is based on a diary I started at the
suggestion ofafriend, a staff doctor
who thought this might be. a way for
me to let off steam and relieve some
of the tension during the ordeal
ahead. My diary begins afew days
after I received the news of the
pathology report.
Some of my comments and
impressions are not flattering. I trust
that these remarks will not be
construed as being directed against
anyone hospital or against
individual staff members but will be
understood to focus on the health
care system in general. I believe
that, as health care professionals,
we have a tendency to get caught up
in our desire to keep the system
operating smoothly; when this
happens it is easy to forget about the
needs of the individual patient. I
hope that, as you read about my
experiences, you will see what I
mean.
,
"
\
'-
,
,
.
.
The Cenedlen Nu...
F....ry 1171 23
I finally found the courage to seek
medical advice about the mole on my
right knee following a holiday visit to the
South. The mole had been there for two
years but lately had shown signs of
changing in size and texture. I am not
sure now whether my reluctance to have
it looked at was caused more by fear of
the actual surgical procedure or by the
possibility of a positive pathology report
...1 think the latter.
A few days after the mole was
removed my suspicion was confirmed
with a positive report. I t is interesting
how one reacts in a crisis. The report
that I had been half expecting was now a
reality and yet I refused to believe it.
What a strange feeling: I felt numb all
over, like a zombie but my mind was
racing. "My God, I am going to die! I
will not let them take my leg - whenever
I go. it is going with me." And then the
denial. "I am not going to die. I'm too
healthy. " I remember the doctor who
had a mole like mine removed a couple of
years ago. He is doing fine. just like I
will. But. I also remember the young
seminarian who had one on his finger-
a young, healthy guy, dead two years
later. "Oh God, please don't let me die!"
Telling my family was difficult. The
two people I expected to be overcome by
the news were my husband and my
mother but, instead, they became my
strongest supporters. I did not realize
how much my husband meant to me until
I was faced with a life-threatening illness
or how much I needed him and
appreciated the fact that he was there.
The following morning I saw the
plastic surgeon who assured me that the
picture was not as black as I had thought
My chances of a complete recovery were
good. I was booked for a wide excision
and skin graft - something I did not
question. Just get it over with so I could
be a whole person again.
The weekend was long and full of
anxieties. The thought of spending the
next few weeks undergoing scans,
X-rays, blood work and surgery was
pretty frightening. This was one road I
had to walk alone. I seemed to swing
from high to low. I suddenly realized that
I had not shed a tear since receiving the
bad news. I was experiencing fear and
anxiety but I had to admit that I was also
enjoying the attention I was getting. That
sounds morbid, doesn't it? I began to
wonder why I was saving my money for
a future that might never happen: the
concern of providing for my senior years
was suddenly lifted from my shoulders,
rather a pleasant feeling.
I found the role change very
difficult. I became judgmental of all
health care workers: some were good,
others were not.
Before the liver scan, the doctor in
charge of nuclear medicine talked with
me. His first request: "Tell me what you
know about your problem." This seemed
to me to be a very sensible approach: a
doctor who makes sure that his patients
are knowledgeable must care about what
happens to them.
Liver scan negative. One more
check mark on the wall. While being
scanned, I listened to the staff talking
about their personal lives - parties, the
budget, vacations. etc. I wanted to
scream "Hey guys, get on with it-I've
got a malignant melanoma."
The next hurdle was the Gallium
scan. "Iff get negative on this, I am
home free ... I think!"
Then there was a misunderstanding:
I was booked for a lung scan instead of a
full Gallium scan. I refused to leave until
I got my full scan. Following the scan, I
was ushered into another doctor's office.
His message was clear: "Just because
the scan was negative does not mean that
things are all right: secondaries could
appear any time. " On a scale of one to
ten. he rated only one in my books. Was
I becoming over sensitive?
My family doctor gave me the same
message but with a lot of reassurance
and support. I appreciated his sensitivity
and honesty. One doctor appeared tuned
in to the technical procedure of the scan,
while the other was aware of his patient's
anxiety and need for reassurance.
Both scans and chest X-ray were
negative. Just the surgery to face.
A few days prior to my surgery, my
hus band and I were invited to a party.
Everyone at the gathering had heard of
my illness. They seemed disappointed
when I assured them that things were
looking very positive. Did I imagine this,
or is it a quirk of human nature to always
look for a little excitement to relieve the
monotony of everyday life? I don't
know.
In hospital
I entered hospital on a sunny and
unseasonably warm April day. The nurse
who admitted me took a detailed history
using questions recited from an
admission sheet. An hour later the whole
procedure was repeated by the resident
in plastic surgery.
The big day arrived and after
receiving Communion, I made my way to
the Chapel. How easy it is to pray. and
how near we feel to our Maker when the
chips are down. I hope I will have as
many prayers of thanksgiving when this
IS over.
The O.R. supervisor was very
supportive and stayed with me until I
was asleep. By mid-afternoon I was back
in my room with a painful knee and hip
(donor site). Now I began to find out
what "routine nursing care" is all about.
How different it is to be on the other side
ofthe fence. An hour after my return, my
"full fluids" supper tray arrived.
Although I protested vehemently, I was
urged to consume the contents of the
tray so that the [. V. could be
discontinued. The chicken soup did not
taste any better coming up than going
down. The I. V. was discontinued the
next day.
At 10.00 p.m. I had my Demerol and
my vital signs and dressings were
checked q4h for 48 hours but, somehow,
I found the human element missing.
Routine postoperative nursing care was
carried out with unfailing accuracy; but
good nursing care, where the needs of
the patient rather than the doctor are
met, seemed to be missing. Postop
patients are wakened and checked at
2.00 a.m. and again at 4.30 a.m. (6.00
a.m. is too late to get charts done and
report ready). It is unfortunate that the
comfort of the patient cannot be allowed
to interfere with hospital routine; 4.30
a.m. is an unreasonable hour to wake
postoperative or any patients, for that
24 Febru.ry 11171
The C.n.dlen Nur..
matter. starting their day with vital signs,
bed pans. medications. ice water. and
blazing lights.
I was reprimanded for changing my
mind about the need for pain medication
the first postoperative night: I did not let
it happen again.
Medical and nursing staff advised
me that it was important to keep the
donor site (left hip and buttock) dry to
prevent infection but they did not tell me
how thi" should be done. On the second
day. I was the one who suggested to the
nursing staff that a pillow at my back
would keep my weight off the donor site.
a simple nursing procedure thaI the} had
overlooked.
Today our profession is tuned to
producing a more sophisticated style of
nurse. We use Standard Care Plans and
Problem Oriented Records - both
important tools in implementing good
nursing care - but do we sometimes
neglect our patients because we are too
busy implementing these tools to find out
what their needs really are? I hope that
the nursing profession is on the right
track but I must admit that sometimes I
am concerned.
When I was a patient it wa" difficult
for me to discard my role as a nurse. I
was experiencing intense physical and
emotional trauma: my knee had been
mutilated during the course of treatment
for a life-threatening disease.
Nevertheless. the only problem the
student nurses' clinical supervisor chose
to deal with was constipation. That nurse
and her students missed an invaluable
nursing education experience.
My next hurdle was the pathology
report following surgery. Again, the
report was negative. Everyone was
oveljoyed but instead of uttering a
prayer of thanksgiving. my initial
reaction was "My knee wa
mutilated
for nothing." I could not help wondering
if the surgery had really been nece
sary.
Should I hdve gambled and lived with the
initial mole removal? What would my
chances of
urvival have been? Who
decides how radical an excision to make.
and why? What percentage of reports
come back positive following surgery?
How are these positive reports brolo..en
down into classes (1.2,3.4.5)?The
questions I should have asked
preoperatively were suddenly now going
through my mind. Had the operation
really been neces
ary? Was I being
ungrateful? I had so many questions and
yet I found it difficult to voice them
because I did not want to hurt the people
who had been kind to me.
A nurse clinician brought me back to
reality. She made me realize that I was
looking at things from a selfish point of
view. I have a husband. four lovely
children. and a mother who would not
want me to gamble with my life. I o\\ed it
to them as well as myself to take no
chances on allowing the malignancy to
spread.
Going home
On the tenth day. I was discharged from
hospital, complete with leg splint and
crutches. A week later I was aI/owed a
tub bath - a treat that proved to he a
very humbling experience. Standing
naked in front of my husband with m}
imperfect body, waiting for him to help
me in and out of the bath. I realized how
completely dependent I had become.
This dependency has drawn us closer
together and now we feel that we have
both experienced real emotional growth
over the past three months.
Over the next month I gradually
shed my splint, the dressing, the tensor
bandage and elastic stoclo..ing. A new me
emerged. At first the graft was rather
tight. making climbing stairs difficult and
painful for me. but through perseverence
and determination I have mastered that
obstacle. Small car
are still a problem
but that too is being overcome. Dre"s
styles are longer now so dressing is no
problem. I have been wearing slack"
rather than shorts and I have bought a
new bathing suit that I plan to wear on
vacation. I have accepted my body the
way it is. If people are "hocked at the
sight of my knee, I realize that the
problem is theirs and not mine.
On thinking it o\er
The past three months have given me a
whole new perspective on life. I have
become more aWdre of my own
mortality, of the significance of each
day. of the love offamily and friends. I
discovered too that a temporary role
reversal can be a positive experience.
enabling us as health profes"ionals to
understand the fears. frustrations and
anxieties of our patients and their
families during a crisis situation. I have
come to realize, also, that a crisis like
this can lead to emotional growth and
can strengthen the bonds among family
members.
As nurses. we must put the needs of
our patients at the top of our list of
priorities. We must make sure that. in
our zeal to develop and implement
educational tools and to keep the system
running smoothly. we do not lose sight of
the patient. ..,
Author Theresa O'
eil recei,'ed her R.l\'.
from St. Mar...'s Hospital, Montreal and
a B.Sc.N.from St. Thomas UnÌl'er.rity.
N.B. She jpent the first fell' years
fol/oll'ing graduation in Oh.rtetrical
Nurs;,,!!.
After raising afwnily, she became
illterested in Family Practice Nursing
llnd has spent the last ten years a,r Head
Nurse in St. JÇJ,reph's Hospital Family
Medical Centre, London, Ontario.
Theresa is a clinical lecturer with
the Department of Family Medicine,
U ni"ersit\. of Western Ontario and has
spent part of her time coordinating an
In,ren-ice Education Programme for
Family Practice Nurses wor!..ing within
tlU' Department ofF amil\' Medicine.
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Th. C....-.lI.... NUrH
Februery 11171 25
41 nurse practition
r
in a community college setting
The Health Clinic at Mohawk College of Applied Arts and Technology in Hamilton, Ontario is many
things to many people. For some, it is a first aid station for injuries, accidents and burns; for others, it
functions as a community health center with a part-time physician; and for still others, it provides a
listening ear and a place to seek advice and information on health-related matters. AU in all, it is a
great place for a nurse practitioner to work.
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Diana Nelles
. . We hm'e a man 111 the boo!.. store in
diabetic comu. we thin!.. - please come
down. "
"C ome quickl\'. a student is hm'ing a
com'ulsion and I think he dislocated his
shoulder when he fell. ..
"C un I come in for the morning-after
pill?"
These are just a few of the situations I
encounter in the course of my work as a
nurse practitioner in a community
college health clinic. As you can
imagine. the health clinic, serving a
population of 5.000 students and staff is a
busy, active place. Not only does it serve
as a primary first aid station in cases of
injuries and accidents, but also functions
as a community health center with a
part-time phy!.ician on staff.
Because of the variety of services I
am called upon to provide. I have an
excellent opportunity to use my skills as
a nurse practitioner to their fullest
potential. At time!. this includes the role
of first aid attendant, occupational health
nurse. health counselor, classroom
teacher and drug information giver. I am
able to dispense drugs. prescribe
treatment and perhaps. most important
of all. to teach health education at a
primary level. Health teaching,
preventive medicine, health counseling
and drug information are a very
important part of my role.
...
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The NP-Physician Team
At our clinic, the family physician is
present three mornings a week.
Generally, I do the initial assessment of
all patients who come to the clinic unless
an appointment has been arranged
previously to see the doctor. This is a
good opportunity for me to explain my
role to clients and to emphasize that it is
not always necessary for them to see a
physician for minor complaints.
In this kind of arrangement. the
nurse practitioner and the physician
must work as a team in order to give the
best care possible to the patient. Because
the nurse is functioning in an expanded
role, the physician mu!.t trust the nurse's
judgment and the nurse must know her
own limitations and when to seek advice.
2e February 1171
The Cen.dlen NUrH
The nurse must be confident that the
decision she makes in assessing a patient
is the right one. Open, honest
communication between nurse and
physician ensures good patient care and
minimizes legal problems that might
develop.
The following examples show the
nurse practitioner-physician team in
action.
. A number of young female students
come to the clinic to have a well-female
examination. I initiate and complete a
history including social and family
history, past illnesses and allergies.
Blood pressure, weight and urinalysis
are followed by a pelvic exam, pap smear
and vaginal culture. A demonstration of
a breast examination and a discussion on
birth control is also included. Ifthe
. For the protection of both the
patient and the nurse, the doctor must be
present for allergy injections. Even
though the nurse gives the serum, the
physician must be in the vicinity. In the
past, we have experienced two serious
reactions, and medical treatment was
immediately available.
. The treatment of first degree bums,
removal of sutures, syringing of cerumen
from ears (after examination by the
doctor) and treatment of abrasions and
lacerations are all taken care of by the
nurse, the physician being notified in
case of infection or abnormalities.
. As a team, we have also given
lectures to classes in the college on
subjects such as birth control.
communicable diseases in children and
"recognizing the sick child".
.
\
Although some clients may have had
ba<;ic sex education in school. many of
them have a poor knowledge ofthe
reproductive system and birth control.
Some clients have never had the
opportunity to discuss this topic with a
medical person . Young women, in
particular, often reluctant to visit their
family doctor because he is a "friend of
the family". seem more at ease
discussing birth control in the accepting
atmosphere of the clinic. Maria, a
22-year-old student, is a good example.
She was waiting at the health clinic one
morning when it first opened and was
obviously distraught and very agitated.
After I brought her into the office and
she calmed down, we talked about what
was troubling her. She was convinced
that she had become pregnant the
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patient wants some form of
contraceptive, this is discussed, as well
as any problems or concerns the patient
may have in this regard. This kind of
assessment and teaching forms a large
part of the nurse practitioner's role. If
the patient wishes to take the birth
control pill, she is seen by the physician.
The patient can drop in any time later to
discuss any problems regarding the birth
control method she has chosen.
. Pre-employment physicals and
immigration physicals are done by the
nurse practitioner. This frees the
doctor's time for more serious medical
problems. However, if! suspect an
abnormality or if! am concerned about
any aspect of the examination, the
physician is notified.
The Clients
Because the clinic is conveniently
located on campus, it is well utilized b}
staff and students alike. On the average,
40-50 patients a day come to the clinic
with the physician seeing about .-:!O
patients each morning she is in. The
majority ofvisih are made by students
who range in age from 17-25 years. Many
of them do not make appointments, but
drop in to discuss particular problems
they are having.
Students in this age group often
have concerns about:
. birth control
. urethritis
. venereal disease
. obesity
. acne
. sexual problems.
previous night. However, as we
discussed the situation, she reported that
she did not have intercourse with
penetration and there was no ejaculation.
Maria came from a strict I talian family
and had been very protected. I reassured
her about her concerns but she refused to
believe that she wasn't pregnant.
I saw Maria in the clinic every
morning for two weeks after this incident
and discovered how uninformed she was
about all areas of sexuality and her own
anatomy. During that year, health
teaching and counseling gave Maria a
more healthy and realistic attitude
towards her own sexuality and gave her
enough confidence to break through
some of the restrictive bonds at home.
The Cen-.llan Nurae
Februery 1171 71
Often. younger girls seek guidance
in a group. rather than act alone - a
great chance for health teaching "en
masse" . Students from out oftown use
the clinic as their "family doctor" and
often come to the health center for minor
ailments. But those with chronic illness.
such as hypertension. epilepsy and renal
disease also drop in to talk over the
problems they may be having with
medication and their side effects. If these
patients have their own family doctor. I
always refer them back to their physician
for follow up.
Foreign students are another group
who are often anxious about their health
and who may be homesick. In many
instances. they have no knowledge ofthe
resources available to them. As a nurse.
,
I I
Because the clinic is so convenient.
staff members who might not otherwise
find the time to go to their family doctor.
drop in to the clinic. A good example of
this is Miss D., a 42-year-old faculty
member who visited the clinic because
she had detected a lump in her breast.
She had seldom visited a doctor since
she had always been in excellent health
and she was reluctant to do so even now.
When I examined her. I could feel a hard
mass approximately 3 cm in diameter
under her left breast. We talked over the
implications of this finding and she
agreed to go to a surgeon. Subsequently.
she had a left mastectomy. That was
eight years ago. Today, she is
functioning well, is still teaching and
continues to come to the clinic for
.. J
Conclusion
Case studies like these show that a nurse
practitioner in a community college
health service can provide primary
health care to a large student and staff
population. In a collegial relationship
with a physician, the nurse can use her
skills and judgment to assess patient
problems and to initiate treatment in the
shortest time possible. Health care costs
are reduced, and good preventive and
follow-up care in the form of counseling
and teaching is stressed."
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I am able to provide them with some
support and guidance in many aspects of
day to day living. The Ontario Health
Insurance Plan covers all visits to the
doctor in the clinic and students without
OHIP are treated free of charge. There is
no charge for visits to the nurse.
Of course. staff also utilize the
services of the health clinic. For
example. in the role of an occupational
health nurse. I am responsible for
attending to employees who sustain
injuries on the job. for maintaining
accurate health records and initiating
workman compensation claims.
Employees with drug and alcohol
problems and/or those whose
absenteeism has become a problem, are
interviewed and counseled with
subsequent programs initiated.
periodic checkups.
The convenience of the clinic for
clients was evident on another occasion.
Two days before Christmas. two female
employees, aged 22 and 24. came to the
clinic and expressed concern that a
co-worker had German measles. Both
women had missed a period and
suspected that they were pregnant. They
were unable to contact their doctor and
the college physician was also away. I
completed pregnancy tests on both
women, and both were positive. The
patients were sent to the lab for a rubella
titre and fortunately had levels higher
than I :8. The tests were completed along
with results in less than a day. and a
worried Christmas was avoided. Eight
months later, they delivered normal.
healthy babies.
Diana :\Telles (R.N., Hamilton General
Hospital; Diploma in Primary Care
Nursing, McMaster Vnil'ersitvj is the
Supervisor of Health Services at the
Fennel/Campus, Mohawk College of
AppliedArts and Technology. Diana has
worked at the College for the past ten
years and prior to this time worked in an
emergency department and in a
physician's office.
2e February 111711
The Cen-.llan Nur..
Understanding the physiology of
Anne H edlin
Dr. J. Dostrovs/"y
Wherever you work, you
encounter patients with pain.
These patients expect you, as a
nurse, to relieve their pain.
Knowing about the physiological
and. emotional components
involved can give you a better
understanding of patients'
reactions to pain and how you can
help.
Virtually everyone has experienced pain
of varying intensity and duration but no
one has yet been able to provide an
explanation for the phenomenon of the
pain sensation. Many puzzling questions
can be raised about the mechanisms
involved in the experience of pain. For
instance. why is it that a severely injured
person does not necessarily experience
pain? How is it possible for Indian fakirs
to walk on red hot coals or lie on a bed of
nails without evidence of discomfort?
Why is the needle prick of an injection
absolutely dreaded by some but accepted
calmly by others? How can there be pain
when no evidence of physical injury can
be located? Why does the leg-amputee
complain of pain in the amputated limb?
The failure to discover satisfactory
answers to these and other questions is
not because of a lack of interest. Not
only is "pain" the subject of intensive,
world-wide research, but medical and
nursing personnel devote much time and
effort to alleviating pain resulting from
disease, accidents and surgery. Although
answers cannot be provided for all
questions about pain. certain facts are
recognized.
Pain stimuli
In order to experience a sensation-
whether it be visual, auditory, heat, cold
or pain - impulses must be generated by
a specific stimulus and then transmitted
along a specific pathway to a particular
area of the central nervous system. For
example, impulses that cause a painful
sensation arise from stimuli which have
the potential to produce tissue damage.
([he exception to this rule is found in
some abnormaJ or pathologicaJ states in
which pain can result without evidence
of noxious or tissue damaging stimuli).
These painful stimuli activate specialized
nerve endings which respond only or
primarily to these stimuli. Other nerve
terminals found in the same tissues are
activated by non-painful stimuli such as
hair movement, vibration or cold.
The nerve fibers that transmit the
pain signals to the brain are of small
diameter and have conduction rates of
about 0.5 to about 30 metre/second.
They can be divided into two groups, the
A b fiber group and the C fiber group.
The A B group, composed of nerve fibers
.Myelin - the fatlike substance forming a
sheath around certain nerve fibers.
which are myelinated.. conduct
impulses more rapidly than do those of
the unmyelinated (' fiber group. This fact
may contribute to a dual pain sensation
in many instances. i.e. an initiaJ sharp,
pricking. well-localized sensation
followed by a more prolonged.
well-localized, burning type of pain. The
latter. which is generally more
unpleasant, is mediated by the C fibers.
Transmission of pain impulses
Pain fibers travel together with other
sensory fibers in the peripheral nerves
such as the sciatic nerve and enter the
spinal cord via the dorsaJ roots (or the
trigeminal nerve for pain impulses from
the face). As illustrated in figure one,
these fibers terminate in the superficial
dorsal (posterior) region of the spinal
cord. Here, they excite neurons whose
axons cross to the opposite side of the
spinal cord and travel up to the thalamus
by way of the anterolatera.l regions of the
spinal cord in the spinothalamic tract.
Pain impulses go primarily to the
midline region of the thalamus.
However. it is not known whether pain is
perceived by activation of specific
thalamic pain neurons or whether it is
relayed to the sensory cortex where all
other senses are perceived. Some fibers
originating in the spinal cord enter a
dense network of interconnected nerve
fibers in the brain stem, caJled the
reticular formation. It is believed that
this region also plays an important role in
The Cen-.llen NUrH
F-..ery 11171 21
MIDBRAIN
Nucleus ot Tnge,mna. Spln.1 Tract
MEDULLA
Reticular Fonn.'tOn
Figure one
Pathways for impulses from peripheral sel1sory neurons and the trigeminal nerve (V
cranial nerve). Synapses occur in the substantia gelatinosa of
he spinal cord and in the
thalamus. Collaterals connect these ascending neurons with the midbrain reticular
formation.
the sensation of pain.
But pain is not simply a sensation, it
is an unpleasant sensation. This fact
imparts a distinctly different quality to
pain and distinguishes it from other
sensations such as hearing. touch and
smell. As indicated by Melzack in The
Puzzle of Pain. it "motivates or drives
the organism into activity aimed at
stopping the pain as quickly as possible.
To consider only the sensory features of
pain and ignore its motivational-affective
propenies, is to look at only part of the
problem" . I
The thalamus and cortex are the
main structures involved in pain and
other sensations. Other brain regions are
also involved, in what can be classified
as the motivationaJ-affective dimension
Figure two
Olfactory Bulb
A diagram including the limbic system and related structures which make an important
contribution to the motivational-affective dimension of pain. A-amygdala.
M-mammilIary body, S-septum, TN-thalamic nucleus.
-
of pain and are believed to include both
the brain stem reticular formation and
the limbic system. Exactly how pain
influences these regions is not clear. The
reticular formation, which receives input
from ascending pain pathways, has
connections to most brain regions
including the structures ofthe limbic
system (figure two).
The limbic structures, together with
the hypothalamus. are believed to
mediate emotional behavior. Evidence of
this has been demonstrated by frontal
lobotomy. Severing the connections of
these structures with the frontal cortex
can produce relieffrom pain but at the
expense of profound changes in
emotional behavior characterized by a
marked reduction of emotional
responsiveness. Experimental
stimulation of amygdala. hippocampus
and hypothalamus. has been shown to
induce behavior which is otherwise
associated with painful stimuli. Thus.
behavior in response to or in anticipation
of noxious stimuli is believed to be
mediated by the limbic system and such
structures as the hypothalamus,
thalamus and midbrain reticular
formation.
The type and extent of cerebra!
cortex involvement in the experience of
pain is unknown. Certainly impulses do
reach the cerebral cortex but no specific
area of cortex can be identified as a
"pain center". Perhaps the cortical
contribution is one of cognitive activity.
Factors such as the influence of an
individual's cultural background.
attitude to unpleasant experiences.
emotional stamina, tendency to be
influenced by suggestions etc. could be
fed back from the cortical regions to the
thalamus, limbic system or brain stem
and could modify the experience. This
could account for much of the individual
variation in response. On the other hand,
the cortex may be involved in
localization of pain rather than in
mediating the motivational-affective
dimension of pain. Each area of sensory
cortex receives impulses from a specific
cutaneous region and therefore the origin
of the impulse can be identified.
In addition to the modulation..
which may occur in the brain, it is known
that pain transmission to the brain can be
influenced in the spinal cord. The
gate-control theory proposed by
Melzack and Wall (\965) suggests that
the dorsal horn cells act like a gate which
can regulate the transmission of impulses
to higher centers in the central nervous
system. Whether the gate is open to
alIow pain impulses through or closed to
inhibit impulse transmission depends on
(a) the relative amounts of input from the
uModulation - alteration of response.
30 F.bruary 1171
The C.n-.ll.... Nurae
large non-pain transmitting fibers (e.g.
touch) and the small pain fibers and (b)
on inhibitory impulses descending from
the higher centers. Higher centers which
may be involved include the midbrain
reticular formation and the cortex,
especially the frontal cortex. Through
memories of painful experiences,
emotions and preoccupation with other
activities, these centers may exert
considerable control over the central
transmission cells of the spinal cord. A
modification of Melzack and Wall's
schematic diagram of the gate-control
mechanisms is presented in figure three.
Opiate receptors
For many years treatment of pain has
relied heavily on analgesic preparations,
the most effective agents being morphine
and morphine derivatives. In the past
few years, there has been great
excitement in the field of pain research
following the discovery that the brain
possesses specific receptors for
morphine and moreover that the brain
produces its own morphine-like
compound. The receptors. known d"
opiate receptors, exist in high
concentrations in certain regions of the
brain and spinal cord in a distribution
that suggests a close relationship with
Morphine-like compounds called
enkephalins have been isolated from
brain tissue. Relatively high levels of
these substances are found in the frontal
cerebral cortex, medial thalamus,
hypothalamus, amygdala and
periaqueductal grey matter. In addition
to the enkephalins. other endogenous
morphine-like compounds, endorphins,
have been isolated from the pituitary
gland. The endorphins are fragments of
the pituitary hormone, B-lipotropin.
Both enkephalins and endorphins exert
an analgesic effect. It is proposed that
they act as neurotransmitters (chemical
substances which mediate impulse
transmission at synapses) in pathways
concerned with pain modulation. This
inhibition may be effected through
binding to opiate receptors.
Electrical Stimulation
Recent experiments have shown that
electrical stimulation of the
periaqueductal grey matter can produce
analgesia. This technique is now being
used in a number of hospitals around the
world to treat severe chronic pain. which
cannot be treated by conventional
methods. Stimulation of the brain stem
activates some of the pathways that
Descending Inhibitory Pathways
To Thalamus
---< excitatory synapse
-of Inhibitory synapse
...... inhibitory mterneuron
Hgure three
A modification of Melzack and Wall's schematic diagram ofthe gate control mechanism.
Stimulation of touch fibers and impulses from higher centers can inhibit central
transmission cells and therefore prevent (close the gate to) central conduction of
impulses by pain fibers.
the pain pathways. In the brain. the areas
of high concentration are: the amygdala,
thalamus and hypothalamus (structures
concerned with the
motivational-affective dimension of pain)
and the periaqueductal grey matter of the
brain stem. In the spinal cord and
trigeminal nucleus. the area of high
concentration is the substantia
gelatinosa. It is believed that morphine
produces analgesia by acting on the
opiate receptors found in these areas.
morphine activates. The brain stem
neurons, which have axons extending
down to the spinal cord dorsal horn can
intercept and block the transmission of
pain impulses from spinal cord to the
thalamus. Further investigation of the
anatomy and physiology of these
endogenous pain inhibitory pathways
could lead to the identification of better
methods of activating the body's own
analgesics and thus could provide more
efficient treatment of pain.
Nursing implications
A wareness of the fact that there are
several dimensions to pain is especially
important for nurses. The absence of a
physical basis for pain does not eliminate
the possibility of an experience of pain;
motivational-affective dimension
through emotions, e.g. anxiety and fear,
can aggravate and enhance the painful
experience. Psychological needs of the
individual such as a need for attention
can also contribute to the presence of
pain. Attitudes toward pain vary greatly
and may be influenced by ethnic
background. Some believe that
complaining of pain is an admission of
weakness while others do not hesitate to
display their suffering. Maximum use
should be made of the inhibitory
influence of higher centers. For example,
procedures which can divert the
patient's attention from the painful
stimulus such as back rubs, conversation
etc. can be used as a supplement to pain
relieving measures.
The scope ofapplication of the
growing knowledge of pain is enormous
and. for nurses. an area that they cannot
afford to ignore."
Anne M. Redlin (8.S c.N., University of
Saskatchewan; M.Sc., Uni
'ersity of
SasJ...atchewan; Ph.D., Physiology,
University of Toronto) is a research
associate in the department of
physiology and a lecturer in the faculty
of nursing at University ofT oronto. She
has had experience in general duty
nursing, public health nursing and
nursing education. A nne has published
numerous articles, on blood coagulation
and bloodfibrinolysis, her main area of
research.
Dr. J. Dostrovsky(M.Sc., University
College, London, England; Ph.D.,
V niversity ofT oronto) is an assistant
professor in the physiology department
at the U nh'ersity ofT oronto. His main
area of research is the .
neurophysiological basis of pain.
References
I Melzack. Ronald. The puzzle of
pain: re
'olution in theory and treatment.
New York, Basic, 1973, p.93.
Bibliography
Fields, H. L. Brainstem control of spinal
pain-transmission neurons. by... and
A.I. Basbaum.lnAnnual review of
physiology. Vol. 40. Edited by Ernest
Knobil et al. Palo Alto. Ca, Annual
Review. 1978. p.217-248.
Melzack, Ronald. Pain mechanisms: a
new theory, by... and P.O. Wall.
Science 150:971-979, 1965.
Snyder, Soloman H. Opiate receptors
and internal opiates. Sci.Amer.
236:3:44-56. Mar. 1977.
.,
The patient in pain:
handling the
guilt feelings
Gillian Doherty
Nursing a person suffering
chronic or prolonged pain is a
draining experience often
associated with feelings of guilt.
Learning how to handle these
guilt feelings in a way which is
not harmful to the patient or to
herself is one of the hardest tasks
a nurse has to face.
A nurse's training emphasizes her duty
to relieve suffering. Therefore it is not
'\urprising that few situations cause a
nurse to feel more of a failure than caring
for a per,>on whose pain she cannot
alleviate. Being unable to relieve pain is
frustrating and, as psychological
research has demonstrated, frustration
often turns to anger at the object or
person perceived as responsible, The
anger reaction towards the individual
whose pain will not go away usuall}
causes the nurse to feel guilty. I f the
failure-fru'itration-anger-guilt sequence
is repeated several times in connection
with one particular patient. then the
nurse begins to associate that individual
with unpleasant feelings.
In order to not have to face the
di5comfort that this patient evokes in her
the nurse may begin to avoid him. This
avoidance often originates
subconsciously as an attempt to screen
out unpleasant reality. in this case failure
to alleviate pain and the associated guilt
feelings. As long as the nurse does not
see the patient she can believe he is no
longer suffering. However avoidance
rna} not be successful and may actually
increase the nurse's feeling of guilt when
she realizes what she is doing.
How can the nurse constructively
handle the feelings that are aroused in
her when she cares for an individual
whose pain she cannot alleviate? The
first requirement is that she face the fact
that in some cases it is not possible to
totally relieve suffering. Therefore the
patient's continuing pain does not
automatically mean that the nurse has
failed. Prolonged pain does, however,
signal a need for the nurse to accept
responsibility for assisting the person to
cope with it and this requires some
understanding of pain's psychological
effect.
Ho\\< people react to pain
For the victim, prolonged pain is a
demoralizing experience which thrusts
the individual into the role of dependent
- a person who cannot take care of his
own needs. When this happens the
patient's frustration with the situation
may show itself as anger directed
towards the nurse. Prolonged pain is abo
a frightening experience. As the pain
continues it wears the person down until
he begins to feel that he is in the power of
an alien force which he cannot control. If
others avoid him in his pain he feels
betrayed and abandoned to his fate.
Unfortunately the behavior of an
individual in pain tends to encourage
people to avoid him. Characteristically,
as pain continues. the person becomes
increasingly preoccupied with his
suffering and less responsive to others. It
is important to remember that the
individual in this situation still needs the
comfort of having people spend time
with him even though he probably does
ot indicate that this is the case.
Spending time with a patient does
not mean that the nurse has to attempt to
engage him in light chatter. To do so
when he is in pain is to act a5 if he i5
merely out of sorts and suggests lack of
sensitivity to the individual's experience.
This kind of behavior may even be
interpreted by the patient as denial of his
pain; to deny a person's perception of
the reality he is experiencing is to rob
him of his self-respect.
If the nurse wants to assist the
patient to retain his dignity in the face of
pain, she must verbally acknowledge the
existence of the pain and the patient's
right to feel frustrated"and angry that his
suffering cannot be alleviated. In this
way, the nurse indicates respect for and
empathy with the individual. but this is
not sufficient if the nurse then rushes
away. Non-verbal communication is also
essential to convey real understanding.
This can take the form of turning the
person's pillow or some other physical
action, but it does not have to. In fact
more support may be provided by simply
sitting quietly with the patient. If the
nurse is not engaged in giving physical
care it is more obvious to the individual
that she is taking time to face his pain
with him and that he is not alone.
Therefore. the next time you cannot
totally reheve a patient's pain, try not to
allow yourself to feel guilty but, instead,
take the positive step of recognizing the
comfort that can be provided simply by
your presence. ..,
Gillian Dohert} , author of' The patient
in paÎ1l: handling the guilt feelings". is a
!:raduate of Royal Victoria Hospital in
Montreal. After working as a general
duty nurse she returned to unil'ersit\' to
obtain a Ph.D. in clinical psychology.
The information she shares in this article
is based on her experience obtained
while nursing two family members
through terminal cancer at home. "One
of these people," she writes. "through
his ability to talk openly about what was
happening to him. helped me to realize
the comfort that can be prol'ided to a
patient in prolonged pain by the sheer
presence of another person."
eQ
babies
cry
Janet Harris
It's almost eleven o'clock. The
television news will be on soon
but Joanne is too tired to watch
it. Her day started a little before
six this morning when two-week
old David's persistent cries
wakened her while it was still
dark. After he was fed there was
breakfast to fix, dishes to wash, a
load of diapers to wash, dry and
fold. Before that job was done
there was another feeding and
then David needed a bath.
Time to make formula or
there'll be no two o'clock bottle.
After that a little nap while David
sleeps (the bed isn't made yet
anyway). Something quick and
easy for supper because from five
until seven is David's "fussy"
time.
Why does he always cry
when I want to talk? Does he cry
more than most babies or does it
just seem like it? More than he
should? Maybe there's something
wrong. Is there something I
should know about looking after
him? Maybe he's trying to tell me
something. Now he's had his ten
o'clock feed and he still won't
settle down. What' II I do? He
can't be hungry, can he? I'm so
tired, so mad, I cou Id cry.
And she does.
Does Joanne's
tory sound familiar?
Maybe it reminds you of the first few
weeks you spent getting to know your
firstborn. Or maybe you're a public
health nurse and you've 'ieen a lot of
mothers like Joanne ... mothers who are
frustrated, confused, upset and. yes,
probably, tearful because their
"mothering" skills seem completely
inadequate in the face of the challenge
presented by the small crying stranger in
their home.
Infant cQing
"... discharge day arrives. A fragile and
unfamiliar bundle is placed in the
mother's trembling arms and the
'family', united at last, tries to assimilate
the new intruder into their midst.'"
Of all the problems faced by families
adjusting to a new baby, infant crying is
probably the most common. The
majority of studies examine infant crying
from the point of view of the infant rather
than the mother. We know, for instance,
that:
. over a ::!4-hour period the newborn
will have an average of eight crying
episodes 2
. most of these episodes occur
between si;.. p.m. and midnight"
. four distinct and unique crying
patterns 4 have been recorded:
- the birth cry (not replicated after
birth)
- the pain cry (usually elicited by
painful stimuli o;uch as a heel prick)
- the pleasure cry (not usually heard
until three months of age)
- the hunger cry (a basic rhythmic cry).
Infant crying is considered an
important signalling behavior which
increases the mother's proximity to the
child and releases maternal caretaking
activities."The mother's motor response
Th. Cen-.llen Nur..
Februery 1117i 33
to crying has been studied by several
investigators,"" one of whom found that
infants whose mothers responded
immediately to their cries tended to cry
less at the end of a year than infants
whose cries did not elicit such a prompt
maternal response."
Another investigator furnished
fertile speculation about the mother's
emotional response to crying when she
suggested that the vulnerable state of the
mother in the postpartum period may
cause her to perceive crying as a sign of
failure or rejection." Furthermore.
persistent infant crying has been linked
to later child abuse when the mother
interprets the crying as a criticism of her
efforts and evidence of her own
inadequacy. This is the opposite of the
self-esteem enhancing behavior wanted
from the child.
As a public health nurse visiting new
mothers during the initial adjustment
period at home, I noticed that some
mothers seemed particularly discouraged
and perplexed by their newborn's crying.
I sensed that in these cases the mother's
self-confidence and relationship with her
baby were in some jeopal dy and so I
decided to investigate what crying means
to the new mother and how nurses can
assist her in coping with this rather
conspicuous behavior. I wanted to
contribute to the data base on
neomaternal adjustment and specifically
to draw attention to the nurse's unique
opportunity to promote optimal
maternal-infant relations during this
period.
NEW MOTHERS' INFANT CRYING GUIDE
Crying has been described as an important "signalling" behavior
because it usually brings the parent to the infant. There is no
magic cure for crying but there are a number of simple and
sometimes obvious things that may not occur to a tired and
harassed parent.
HUNGER is the most common cause of crying. The stomach
contracts and causes the same kind of "hunger pains" that a
hungry adult feels. If the baby is crying but ate well an hour
earlier, you can assume that his stomach is not yet empty. If the
baby was fed two or three hours earlier and you are breast
feeding, he may be hungry as breast milk is more quickly
digested than formula and in the early weeks, your baby will
need frequent feedings. If you are not breast feeding, go over in
your mind how much he took during the last feeding and how
long the feeding took. If he took less than usual or the feeding
process was not a lengthy one. he may be hungry. If you're in
doubt, it's a good idea to try some other measures first.
TEMPERA TURE of the room, either too hot or too cold, can
cause the baby to cry. A good rule of thumb is to put the number
of layers of clothing on the baby that you would be comfortable
in and then add a layer, e.g. a blanket or shawl.
THIRST Often we don't think of the baby's need for water. An
ounce of sterilized water in a bottle satisfies his thirst and at the
same time, satisfies the need to suck.
THE NEED TO SUCK is naturally strong in infancy. Sucking
reduces tension and soothes the baby. Experts believe the
pacifier soothes the baby and prepares him for sleep by lowering
the activity level. Often a restless. agitated baby will settle down
when a pacifier is offered. As he reaches three to four months of
age. his need to suck will be reduced and mothers can gradually
decrease the use of the pacifier.
DISCOMFORT Is something hurting the baby? Is he in an
uncomfortable position? Are the diapers dry and comfortable?
Are the baby's clothes pinching or rubbing?
GAS PAINS These are very uncomfortable and may cause
crying. Make sure the baby doesn't take his milk too quickly and
that he burps well before being put down. Holding him against
your body and stroking his back will help relieve the discomfort.
Walking about the room as you do this may provide relief. If
stomach discomfort continues. you may wish to consult the
doctor to make sure he isn't being overfed. Depending on your
baby's size and age, his stomach will not hold excessive
quantities of milk and crying may result from feeling too full.
THE NEED TO BE HELD Sometimes just picking the baby
up and holding him will cause the crying to cease. Because of
this some people believe that picking a baby up will teach him
that crying "pays off". It is important to remember that the first
few weeks outside the uterus are insecure ones for the newborn
infant. Being held against the mother's body provides a sense of
security for the baby at a time when the development of trust
between mother and infant is important.
BOREDOM Sometimes a simple change of position can
relieve boredom. Interesting sights and sounds will distract a
baby if he is close enough to see and hear. Babies can't see
very well out of the corner of their eyes and have to turn their
heads to see something beside them. Even very young babies
can see color and motion. Sights and sounds your baby might
enjoy are:
Sights
Sounds
. Mobiles
· Bright colors especially
red
. Parent's face
. Pictures'
. Mirror
. Rattle
. Toys
. Music
. Metronome"
. Clock
. Parent's voice
. Rattle, bell
. Vacuum cleaner
OVERSTIMULATION Sometimes the baby cries because he
needs rest or sleep. Pick the baby up, pat his back, try rocking
him to sleep Then place the baby face down in the crib (this
position reduces the activity level). stroke the baby's back.
reduce unnecessary noise and lights, talk gently and soothingly
and then quietly leave the room and do not return if possible.
.Infants prefer interesting colorful shapes to grey blobs
"At 60 beats per minute, which resembles the mother's heart rate.
,
34 Febru.ry 1117i
The C8n-.l18n Nur..
The study
What are the new mother's thoughts,
feelings and actions in response to her
infant's crying one month after delivery?
I assumed that:
. crying elicits a maternal response
. mothers can report these responses,
and
. infant crying plays a role in
maternal-infant interaction.
In order to carry out my investigation. I
interviewed a sample of 35 mothers. Two
interviews took place with each of them
- the first in hospital between one and
three days after delivery and the second
at home about four weeks later.
The target population was
primIparous mothers delivering at a large
urban general hospital who
. were between the ages of ] 8 and 35
. could speak and understand English
. had no obstetrical or neonatal
com plications.
Thus. a homogeneous sample with
no apparent high risk characteristics was
assured. To protect against
encroachment on the mother's privacy,
potential subjects were first approached
by a staff nurse who requested written
permission for the investigator to
approach. Two refused. I then
approached the mothers personally to
explain the purpose of the investigation
and to obtain written consent to
participate in the study.
An interview schedule was
developed to obtain the desired data both
in hospital and at home. This instrument
was approved for content validity and
pretested on five mothers who met the
sample selection criteria.
The sample size (35 mothers),
sample setting (two obstetrical units in
one hospital) and the sampling technique
(convenience sampling) did not permit
generalization of the findings.
Findings
Approximately two thirds of the mothers
reported that their infants' crying had
been a major concern to them in the
preceding four weeks. There was a
significant relationship between mothers
who reported high crying frequencies
and mothers who reported major
concern ahout their infant's crying.
The effect of early and extended
postpartum contact between mother and
infant on the mother's responses to her
infant's crying'" could not be analyzed
since nearly all the mothers in the sample
were in contact with their infants for less
than an hour following delivery.
Of significance to nurses working
with mothers in the perinatal period is
the finding that the majority of mothers
were not prepared for the amount the
infant would cry, or, for how the crying
would make them feel. They all indicated
that the infant's crying hdd a powenul
effect on their feelings that ranged from
irritation to frustration to anger (see
Table I). Some mothers said they felt
guilty about their responses. It is
conceivable that these feelings
introduced dissonance for these mothers
in a society that perpetuates an idyllic
picture of motherhood and condemns
unloving treatment of children.
Table 1
REPORTED FEELINGS EVOKED
BY INFANT CRYING
Feelings reported
Number of
Maternal Reports
Frustrated 12
Bothered 5
Nervous 5
Sorry 3
Upset 3
Helpless 3
Wonder what's wrong 3
Irritable 3
Guilty about feelings 3
Heart-broken 2
Hostile 1
Violent 1
Mildly angry 1
Exasperated 1
Underconfident 1
Hurt at first, now indifferent 1
Uptight at first, now resigned 1
Afraid 1
Worried 1
Anxious 1
Concerned 1
Don't know what to do 1
Unloving, unattached 1
Terrible 1
Like killing her 1
Needed 1
Resentlul 1
Confused 1
Fed up 1
Tearlul 1
This study leads me to believe that
nurses can assist the new mother by
helping her prenatally to develop a
realistic picture of infant behavior in
general and infant crying in particular so
that she is better prepared for the
postnatal period. The public health nurse
should make the baby's crying pattern an
essential component of every
postpartum assessment. Whenever
major concern about the crying or high
crying frequencies are assessed, the
nurse can assist the mother to interpret
the meaning of the crying and detennine
the appropriate intervention (See page
33).
Many mothers in the study revealed
uncertainty about spoiling the baby by
responding to every cry. While some
mothers found it difficult to stay away
for long when the crying persisted,
("Letting her cry is bad for both of us,"
declared one mother) other mothers
believed it was best to stay away since
going to the baby reinforced
manipulative crying habits. The study
suggests that mothers need help in
arriving at an approach they feel
comfortable with and that the approach
will vary among mothers.
The mothers' need for reassurance
was evident in the questions they asked
following the interviews, for example.
"What am 1 doing wrong?", "Do other
mothers feel this way?" and "Do
bottle-fed babies cry this much?" (No
significant differences were found
between maternal responses and method
of infant feeding used by the mother).
Five mothers in the study were in
frank despair about the baby's crying.
These mothers had consulted their
physicians and were given prescriptions
for pediatric antispasmodic sedatives.
All expressed ambivalence about the use
of the drug and all but one mother had
discontinued it.
When asked what she did when the
baby's crying persisted, one mother
replied, "I cry. "It is possible that this
kind of response or that of sedating the
baby may not be necessary if mothers
are better prepared for what to expect
and given more assistance geared
towards increasing their knowledge and
confidence as welI as strengthening their
relationship with the baby during this
critical adjustment period. 4r
Author, Janet B. Harris, (M.Sc.N.) has
worked in public health nursing, prenatal
education, outpost nursing and in
nursing education. She wrote, .. When
babies cry..... as part of the
requirements of a Master of Science
degree at the U nÎl'ersity ofT oronto. She
became involved in health care research
while completing studies at U ofT.
References
] Enkin, Murray W.
Fami]y-centered maternity care. Canad.
Fam. Phvs. 19:4:45, Apr. 1973.
2 Rebelsky, F. Crying in infancy. by
... and R. Black.J. Genet. Psychol.
]21:52, Sep. 1972.
3 Bernal. J. Crying during the first
ten days oflife and maternal responses.
Del'.Med. Child Neurol. 14:363.Jun.
1972.
4 Wasz-Hoeckert, O. The infam cry.
A spectographic and auditory analysis,
by... et al. Philadelphia. Lippincott.
]968. pA-7.
5 Bowlby, John. Attachment and
loss. Vol. 1-3. New York. Basic, ]969.
6 Bell, S.M. Infant crying and
maternal responsiveness, by... and
M.D. Ainsworth. Child Del'.
43:1]7]-1]90,Dec. ]972.
7 Bernal, op.cit. p. 362-372.
8 Bell, op.cit. p. 1181.
9 Rubin, Reva. Maternal touch.
Nurs. Outlook 11:11:831. Nov. 1963.
10 Klaus. M.H. Maternal-infant
bonding: the impact of early separation
or/oss onfamily development. by...
J.H. Kennell. St. Louis, Mosby. 1976.
p.53-57.
VISIONS
I'd like to see a streptococcus hemolyticus
on afibrillating circle of atelectasis
I'd like to watch a neurogenic polysaccharide
Fall off a pile of anaerobic ripe formaldehyde.
Or hear the confrontation in a bronchial psychosis
Of a visceral injection and parietal osmosis.
Oh, wouldn't it be something tofeel the plantar flexion
After ketoacidosis and a happy resurrection!
Can youfi/l up your cholesterol and by means ofsublimation
Balance parenteral nutrition and sensory deprivation?
Of all the things I've studied.l think glucose palpitations
Are the ultimate in peristaltic articulations.
P.S. Who says it's as simple as mandibular kyphosis
When your gluteus maximus has osteoporosis?
.
.
--
"
: arbara 'Ill<
MacCuish, author of" Visions",
" an R
is verse. alonR \\'ith "Bahi . (C'ì"J I
ment o( tire
ter, British
It}, "as written
3e Febru.ry 11179
The Cen.dl.n Nur..
[hildhood
Asthma
an outpatient approach to treatment
The word "asthma" is derived from a Greek word meaning
"panting". Simply stated, asthma is a serious but usually
reversible inability to breathe well, and is characterized by
wheezing, shortness of breath, tightness in the chest, coughing
and sudden choking. The inability to breathe results from a
narrowing of the bronchi caused either by muscle spasm, the
swelling of tissue, excessive secretions and dried mucous plugs
or a combination of all three.:.!
The effects of asthma can differ markedly from one
individual to another. Some patients have mild uncomplicated
asthma that produces symptoms only occasionally (e.g. pollen
related asthma), whereas others can have severe life-
threatening attacks. In severe asthma, normal amounts of
oxygen and carbon dioxide are not maintained in the blood and
tissues. 3 The acute attack is the most distressing to the
asthmatic patient and can progress to "status asthmaticus" a
stage in which the patient deteriorates in spite of adequate
treatment.
As with other complex conditions, there is no one factor that
seems to be the cause of asthmatic attacks. Rather, attacks are
usually triggered by some initiating event, factor or combination
of factors such as infection. allergies or psychological stress.
The building block model is one way of conceptualizing multiple
causation in the onset of an asthmatic attack. The Interaction of
the infective, allergic and psychological factors can be
compared to piling blocks one on top of the other until finally one
more block upsets the whole pile. The upset pile is the result of a
cumulative effect. Similarly. in an asthmatic attack. a number of
factors collect and interact until a certain threshold is reached.
When the threshold is exceeded, an asthmatic attack is
precipitated.
There are two basic forms of asthma which have been
described by Rackemann 4 as "extrinsic" and "intrinsic".
. Extrinsic asthma is usually allergy induced. Allergic
substances (allergens such as dust, lint, pollen) that are foreign
to the body combine with specific antibodies within the body to
create an allergic reaction. Allergens can be inhaled, ingested
or simply enter the body through the skin or mucous
membranes. The allergic reaction most often takes the form of
allergic rhinitis, hives, eczema or asthma.
. Intrinsic asthma identifies asthma whose origin is
internal and is usually found in persons who are not allergic to
specific substances. Intrinsic asthma is often secondary to
chronic respiratory infections. The frequency and severity of
attacks are greatly influenced by precipitating factors such as
anxiety, stress, temperature and barometric changes, fatigue
and endocrine changes.
Roy G . Ferguson
Anne Wehb
The time is three in the morning. On a
quiet residential street, the Brown home
is in total darkness. All seems still until
Susie suddenly awakens struggling to get
some aIr.
"OM I'm cho/..ing. / can't breathe- my
chest feels so tight! What can I do? I feel
so scared andfriRhtened and - it's so
dark in my bedroom!! I wonder what /
should do? / know-I'll call Mommy
and she can help me! But- / wonder if
she'll be angry with me for waking her
up? / know she's tired, because she told
me that last night. She's been up with me
n'ery night this week and / feel so bad,
bill gosh! I just can't get any air. Oh-
Mommy, I can't breathe-."
These are some of the feelings of a
7-year-old child who is having an
asthmatic attack. Waking up in the
middle of the night like this isn't unusual
for her- she's been having attacks like
this since she was two years old. But it
always brings with it that awful fear of
not being able to breathe.
Susie's mother. Mrs. Brown. has
come to expect these middle of the night
incidents but not without apprehension
and some frustration.
"/ t is always a shoe/.. to be awakened olll
of a deep sleep by Susie's wheezing and
labored breathing. Usually, / lie still for
only a moment until I realize what is
happening and can hear Susie's panicky
\'oice calling, 'Mommy,1 can't breathe.'
As / jump out of bed and maÁe my way to
her room. I often thin/.. of the number of
frightening, sleepless nights that / as a
parelll ha\'e spent since Susie developed
asthmatic symptomsfh'e years ago. It
seems like an eternity - one of fatigue,
frustration, antiety and at times,
hopelessness. / really need some
answers to those nagging questions in
my mind - when to gh'e my little girl her
medications, how long to wait before I
whis/.. her off to emergency to hG\'e her
symptoms of distress relie\'ed, how to get
more understanding and support from
my husband, John. Just to be able to sit
down and talk with some other parent
with an asthmatic child, could be such a
help and a support."
Th. C8n-.llen NUrH
Februery 117i 37
From the standpoint of everyone concerned - the child, the family and
hospital personnel - there are man} reasons for attempting to treat
childhood asthma on an outpatient basis. At the Alberta Children's
Hospital in Calgary, a treatment program that teaches both parents and
children how to cope with and control asthma has been oþerating
successfully now for five years.
--
-----=
.
,
(1 ..
0
, --:)
\ 'Þ
(
"' ....
--
,
'"
Susie and her parents are not very
different from many other families who
live with asthma. Because asthma is a
chronic condition, it must be dealt with
each day - and that is never an easy
road. Reliable statistics on asthma in
Canada are difficult to find but. in the
United States. asthma has been
described as the number one cause of
school absence due to chronic illness in
children under the age of 17 years. The
financial burden this presents to parents
has also been examined. In Southern
California. it was found that in selected
families. the management of asthma
accounted for from two to thirty percent
of the family income.'
Considering these points. it is clear
that families like the Browns need help to
better handle the problems asthma
presents to them. One way is by early
intervention programs that involve the
whole family. The Asthma Program at
the Alberta Children's Hospital in
Calgary is such a program.
The program
The Asthma Program at ACH has been
in operation in its present form since
1973. It represents a composite of ideas
that developed through reviewing the
recent literature on the subject and by
studying other asthma treatment
programs here and abroad.
At present there are some 350
families involved in the program.
Certainl}. this does not represent all the
children with asthma In the Calgary area
but rather only the small number of
children who do not respond to regular
treatment. In general. the families who
are referred to the A
thma Progrdm tend
to be complex cases that involve a
multiplicity offactor
.
In con'iidering this point further. it
helps to conceptualize illness as
response to disease. The response of
children to asthma is influenced by many
individual factors such as learning, past
experience and anxiety and various
environmental factors such as culture.
society, economics and the health care
system. (See figure one). The children
for whom the program is intended are the
ones whose illness is more complex
because ofa multitude of individual and
environmental factors that playa part in
their response to the disease. In view of
these complexities, our A'ithma Program
was developed on an interdisciplinary
model (See figure two). The expertise
that is provided by many disciplines is
the only way to fully meet the total care
that these children and families need.
Whenever possible the team view
the asthmatic child within the context of
the whole family. The primary focus of
the program is prevention by teaching
the child and parents coping skills and
mechdnisms which enable them to
effectively control and manage the
asthma. In providing familie
with
accurate information about the di
ease
and teaching them effective management
skills. the team attempts to lower anxiety
related to asthma and increa'ie
confidence in their ability to cope.
Through this process, the child and
parents assume more responsibility and
become more independent.
311 Februery 1117i
Th. C8n-.llan Nur..
Medicine
---chemotherapeutic prevention and
intervention procedures
-allergic reaction desensitization
procedures
-treatment ofbacteriaJ or viral
infections relating to asthmatic distress
Nursing
-instruction in allergy producing
substances
-supervision of inpatient
hospitalizations
-examination of home environment
including taking cultures of molds from
various parts of the house
-follow-up contact
Individual
Factors
(learning, past experiences,
anxiety, self-concept. etc.)
Figure one
Response
Environmental
Factors
(culture, society, family,
economics, health care
system, etc.)
Assessment
Families referred to the program are
initially a!>sessed by the asthma team in a
scheduled clinic. Following the various
disciplinary assessments, the team meets
to pool their information and design a
program specifically suited to the
individual needs of the family. The seven
disciplines on the team are not all
necessarily directly involved in the
treatment program. Rather, different
combinations of therapeutic input are
established for each family depending on
their particular needs. The family is
integrally involved in designing the
treatment program.
At specified times each family is
reviewed in the asthma clinic to establish
the efficacy of the treatment program
and to make any modifications which
seem necessary.
Treatment
Generally, the family is treated on an
outpatient basis. The following are some
of the treatment functions provided by
each of the team members.
Physiotherapy
-diaphragmatic breathing
-postural drainage
-postural and breathing exercises
-formal exercise
-inhalation therapy
Psychology
-anxiety reduction through
biofeedback, behavior therapy or
hypnotherapy
-management of disruptive behaviors
occurring during asthmatic distress
-facilitate psychological adjustment to
asthma through individual. group and
family therapy
Physiotherapy
Figure two
Recreation/C hild Life
-increase activity level through
development of recreational skills
-facilitate physical development
through recreational activities
-facilitate social development through
recreational activities
Social Ser
'ice
-encourage parents to allow age-related
independence in child
---correct maladaptive family
communication and interaction patterns
-encourage family to support child's
involvement in peer activities
Dietetics
-nutritional counseling
Special activities designed
specifically for the treatment of the
asthmatic child and his family are also
available. Swimming, for example, is a
regular ongoing activity vital to the
asthma program. Asthmatic children and
their families are invited to participate in
weekly swim sessions that serve to
increase the child's physical capacity
and confidence plus providing an
enjoyable recreational activity for
everyone.
Similarly. progressive-resistant
exercise classes have been held on an
intermittent basis. Again the intention is
to increase the child's physical capacity
while at the same time providing a safe
environment where he can learn just
where his physical limits lie. It is
necessary for the child to know these
limits in order to implement some of the
prevention measures (e.g. diaphragmatic
breathing, relaxation training) before this
threshold is passed.
In the last year the Asthma Program
has operated a summer camp for
asthmatic children. Data collected at the
first camp was very encouraging in
demonstrating the utility of a camp as a
therapeutic extension of the regular
asthma program.
Th. C8n-.llen Nur..
Februery 11179 311
Education
One of the most important functions of
our program is information and
education. It has been our experience
that parents of asthmatic children do not
have accurate information about the
disease. In many cases. the anxiety felt
by children. families and the general
public towards asthma is a fear of the
unknown. Reliable information about the
disease and its treatment is the key to
overcoming misconceptions about
asthma.
We have noted that health
professionals also have a lack of
knowledge in this area. Many of them do
not have recent information on a
thma
and relatively few of them spent much
time on the subject during their clinical
training.
As part of our program to provide
information about asthma to the public
and health professionals, we have
focused on a number of areas:
. Parent group
The parent group consists offour
evening sessions attended by
approximately 16 parents of asthmatic
children. The sessions focus on the
physiological. social. medical. nutritional
and psychological aspects of asthma.
Members of the team present
information to the parents. Later they
have an opportunity to talk over the
material. problem-solve and ask
questions. The groups run continuously
throughout the year and 21 group
have
been completed to the present time.
. W or/..sllOps in rural areas
The asthma team does an average of two
workshops per year in rural areas.
Generally. there are separate session
for parents and for health professionals.
In some of the areas the workshops have
been the stimulus for establishing a local
asthma treatment team so that families in
these areas can receive treatment in their
own community.
. Wor/..slwps in urban areas
Workshops have been developed by the
asthma team for a variety of health
professionals such as psychologists,
physiotherapists. and nurses in Calgary.
Presentations have also been made to
groups such as the Alberta Lung
Association and to schools in the area.
The team is beginning to develop an
in5tructional unit to be included in the
medical school curriculum at the
University of Calgary.
. Educurional resources
As a guide for parents in the asthma
program. the team has developed a
manual and a film called A Child-A
ClwllenRe. The manual is given to the
parent'i as they enter the program and is
intended to be used as a reference for
specific information on asthma. The film
i
shown during parent group and various
other workshops as an educational aid.
Research
With so much energy being expended in
running the Asthma Program there ha..
not been much time available for
research. So far, only one major re'iearch
project which examined the effect of the
parent groups on the participants has
been completed. The results of the data
analysis indicated that involvement in
the parent group significantly increa'ied
levels of knowledge related to asthma.
Similarly. self-report and
psychophysiological levels of anxiety
related to asthma were reduced through
involvement in the parent group.
A second project was more of an
overall program evaluation. Data wa
collected on all of the families involved
in the Asthma Program between 1973
and 1975. The results, showing a 40
percent reduction in inpatient
admissions, indicated that families were
managing the asthma more effectively at
home. Although systematic data is not
yet available. the number of inpatient
admissions for 1976 and 1977 have been
reduced even further.
Cost comparisons
From a clinical point of view there are
many reasons for attempting to treat
asthma on an outpatient basis whenever
possible. But, there are also some
economic factors to consider. For the
period of July I. 1976toJune30, 1977.
we tabulated all outpatient treatment
costs for eleven typical patients in the
asthma program. This sample consisted
of three mild. four moderate and four
severe asthmatics. Computerized
records for each 'ielected family were
reviewed and the total amount of contact
by each team member was recorded. The
average cost of outpatient treatment per
child (including overhead costs) in that
year was $395.84. At an average per
diem cost of$n7.00 this would allow
only 2.9 days of inpatient hospital care.
Compare this to the inpatient record
of one of the children in the sample:
Year Days hospitalized Cost
1975 77 $10.549.00
1976 33 4.521.00
1977 35 4.795.00
It is interesting to note that in this
particular family there were considerable
psychological factors complicating the
asthma. Concentrated outpatient work
(costing $393.64) wa'i done in early 1977
with the family. The number of
hospitalized days for the remaining
ix
months of the year following this
intervention was only eight. It will be
interesting to see if this reduction in
hospitalization is maintained in 1978.
Summary
Asthma is a condition that involves a
large number of children. I n fact. the
prevalence of asthma in recent years
appears to be increasing. The asthmatic
process is a complex one usually
involving all members of the family. In
view of the mult:plicity offactors and
complexity usually involved with asthma
the resources "of an interdisciplinary
team are often required. The Asthma
Program at the AlbertaChildren's
Hospital in Calgary ha
developed this
sort oftreatment model and has found
that, over time, significantly le
s
inpatient treatment is neces5ary for the
350 families involved in the program. In
addition to being considerably less
costly. an outpatient focus to the
management of dsthma allows for more
activity in the area of prevention.'"
.
Ro} Ferguson receil'ed his Ph.D. in
clinical child psycllOloRyfrom the
U /li\'ersity of Alherta. He is director oj
the Department of PsycholoRY at the
Alherta Children's H ().
pital in CalRary
and has been a team memher (
f the
Asthma ProR1"U1I/ since /973.
Anne Webb receil'ed her R.N. diploll/a
.Ii'om the St. Boniface General Hospital
S cllOol ofN ursinR in M anitoha. She 11(1.\"
been the nurs;'lR II/emher of the asthma
team at the Alberta Children's H ospiwl
since /973 and has enjoyed adaptinK the
11111 sinR role to an integrated model of
olttpatient health care.
References
I Asthma, Denver. Colorado,
National AsthmaCentre.
2 Ibid.
3 Ibid.
4 Rackemann. F.M. A working
classification of asthma. Amer. J. Med.
3:601.1947.
-
a new approach to an old problem
\
,
..
Catherine E. Cragg
Recognize Susie Sepsis? Of course that
isn't you in the picture above. YOU
know better. But is she someone you
know? And how many errors can you
spot in Susie's technique?
Cross infection is a problem that is
common to all hospitals; it was a key
factor in making hospitals unsafe for
both patients and attendants in the early
1900' s and. in spite of antibiotic therapy
and sophisticated surveillance progrdms.
it is still around today.
ï
..
.
,
..
. Susie Sepsis' demonstrating incorrect technique.
One of the groups that is most
susceptible to nosocomial (hospital
acquired) infections includes the patients
on the pediatric ward of a general
hospital or in a children's hospital.
Infants who are in hospital for more than
a few days run a high risk of acquiring
infection: they have few immunities, are
already debilitated by disease and may
be exposed to new microorganisms.
)
,
-
At The Hospital for Sick Children in
Toronto. routine ',nfant-technique"
requires gowning and handwashing by
every pero;on in contact with the patient.
Nevertheless. the spread of
gastroenteritis is frequently a problem on
infants' wards, especially during the
winter. At the first sign that a child has
diarrhea he is transferred to the isolation
ward and his former roommates are
placed on "enteric precautions", but in
most instances the disease spreads to
other patients and electron microscopy
reveal!. the same viral agent in all.
Despite clearly defined procedures
of aseptic technique, orientation classes.
and frequent reminders. cutting comers
on technique may become usual practice
rather than the guilt-producing
exception. Breaks in routine are hard to
trace. at least partly because of the delay
caused by the incubation period. When
cross infection occurs it is all too easy to
find a scapegoat: doctors usually blame
nurses; nursing staff blame doctors,
cleaning staff, or visitors, and resent
being expected to police the activities of
others. The lapses that caused the
problem are forgotten in the resulting
suspicion and hard feelings.
In spite of this tendency to "share
the blame". there can be little doubt that
the nurses' role is central in ensuring
maintenance of good aseptic technique
on a ward. Nurses know the correct
procedures, are always on the ward. and
have the most frequent and direct
contact with patients. They are
responsible for teaching visitors the
technique and for protecting their
patients by reinforcing its use by other
staff. Also, they must bear the brunt of
carrying out isolation measures if
infection occurs.
Our imestigation
As educators, our attention was focused
on the question of whether or not an
education program for nurses could
reduce the rate of cross infection on a
pediatric ward. To examine this
question, we developed an education
program that we introduced on two
different wards. On the first of these,
implementation aroused little interest
and resulted in only small improvement.
On the second, where staff had
requested the program and were
prepared to work on the problems. the
improvement was noticeable. We believe
that the different results reflect different
degrees of commitment on the part of
ward nursing staffs.
Our project grew out of a
communication course assignment.
Another student and I decided to plan a
program to persuade people to do
something the}' know is correct but are
failing to do. OUI choice of subject was
the maintenance of good aseptic
technique among nurses on an infants'
ward. My colleague. a non-nurse. relied
on me for technical and procedural
information. We also consulted other
members ofthe class and infection
control (IC) nurses working in the
hospital.
Th. C.n-.llen Nur..
We sought to identify the nurses'
problems in infection control and
demonstrate that improvement is
possible. Also. we wanted to show
nurses the positive consequences of
correct behavior: good technique rarely
brings reward - rather. it is the
occurrence of infection that stimulates
reaction (criticism. and punishment by
isolation duty and extra cleaning).
Criteria for judging success would be:
decreases in the numbers of positive
virology stool reports. transfers to the
isolation ward. and rooms in isolation.
In outlining the program we found
that writing each point on an index card
and posting this on the wall helped us to
keep track of the factors we wanted to
consider. to categorize information and
to recognize gaps. Table one is a
summary of the final organization of our
wall of cards.
"ard One
The two IC nurses and I suggested the
project to the head nurse of an infant's
ward where nosocomial gastroenteritis
often occurs. She agreed that something
needed to be done about the nurses'
technique and the cross infection rate.
We felt that knowledge of correct
technique was probably adequate but
that staff were cutting comers. All four
of us worked together to plan a one-hour
"brainstorming" session to identify
problems. suggest changes. reinforce
technique, and encourage staff to
monitor their own technique.
The session was repeated a
often as
needed to include a majority of the
nursing staff. The program objectives
were posted beforehand in the meeting
room. After a brief introduction we
asked the nurses about ward factors that
contributed to cross infection and
possible solutions. In each group they
expressed frustration about the many
factors contributing to the problem (e.g..
large numbers of visitors. inconvenient
location of supplies) and made some
practical suggestions for improvement.
Many problems were beyond their direct
control (e.g.. screening patients on
admission does not identify all who
already have diarrhea). Topics discussed
included a nurse's right to isolate a
patient and aspects of correct technique.
The ward nurses were interested in
the session hut were not willing to
assume responsibility for further action
nor to monitor one another's technique.
They seemed to assume that we (the
planners) or someone else would follow
through their suggestions: "What are
the\' going to do about it?" The nurses
agreed that an informative brochure for
parents would be valuable. but none was
willing to write it.
F_u.ry 1811 41
The criteria we were measuring
decreased only minimally and we could
provide little positive feedback. We
concluded that our program had had little
effect on nursing behavior or the cross
infection rate.
We felt there were several reasons
for this failure. At some sessions. the
'outsiders' (2 IC nurses. my fellow
student. and I) outnumbered the ward
participants. Also, this ward was
encountering other difficulties - a newly
appointed head nurse. shortage of
nursing staff. and several seriously ill
patients - which probably diffused the
impact of the project.
Ward T\\,o
While we were experiencing this
discouragement. a team leader from
another ward with a poor record of
infection control asked the assistant IC
nurse for help. This time. the assistant IC
nurse and I felt that we should be the
only outsiders involved and that the
ward nurses should assume more
responsibility.
The head nurse and two team
leaders joined us in planning. We
examined the ward nurses' needs. Did all
of them know and understand the
technique?The team leaders thought
that some did not: they had often noticed
errors and heard differences of opinion
about what was correct. They wanted
the assistant IC nurse and I to discuss the
diseases they were encountering and
explain correct methods for preventing
spread of infection among infants. We
agreed to do this. In addition. we wanted
the nurses to identify problems and
suggest solution,> and to plan for
follow-through.
For all this. three one-hour se
sions
seemed appropriate, repeated six or
seven times to reach the more than 40
nurses on staff. These bi-\\'eekly sessions
took the place ofroutine ward
conferences on those days until all staff
had participated. The head nurse
arranged the staff schedule. and the team
leaders made posters, booked a large
room with a sink. provided supplies. and
ensured that staff members attended.
We made
pecific plans for sessions
one and two. For the firs!. to avoid the
stigma of 'the handwashing class' and
make the refresher on technique
interesting, we decided to advertise and
run it as a "fun" session. The second
session was to resemble the presentation
on the first ward.
For each group, the assistant IC
nurse and I were coordinators and at
least one of the interested team leaders
attended.
42 Febru."Y 1871
The C.n-.ll.n Nur..
Table 1
PLANNING A PROGRAM TO REDUCE
CROSS INFECTION
OBJECTIVES
1. To reduce cross infection on an infants' ward.
2. To decrease
. positive stool reports from virology;
. transfers to isolation ward;
. rooms in Isolation on ward
3. To ensure relevant changes in behavior and environment,
Immediately and continuing.
WHA T WE KNOW
Characteristics of ward nursing staff
-40+ RNs and RNAs, all female; experienced and new
-perform aseptic technique to some extent now
--care for infants and older children; are assigned 4-6 patients per nurse
per shift
-ward nurses are supervised by head nurse and team leaders
-work alone in patients' rooms much of the time
Resources
. Infection control nurses
. Nursing education department
. Communication
-personal contact with staff
-dally ward conferences
-videotapes, slides, audiotape cassettes
-print (posters, pamphlets, etc.)
. Statistics on cross infection
. Consultation with and reports from virology and bacteriology
departments
. Ward-staffs knowledge and ideas
Negative Factors
. Lack of positive consequences for correct behavior
. Complexity of desired behavior: physical inconvenience; routine,
drudgery
. Other demands on nurses' time
. Other people Involved. medical, paramedical, and housekeeping
staff, ViSitorS, etc.
. Negative connotations of technique
-policeman/lawbreaker relationship
-handwashlng = "My patien(is dirty" or "I am dirty"
WHAT WE NEED
Factors to be identified
. Amount of staff Interest/commitment to improvement
. Staff's present level of knowledge/conformity with technique
. Present breaks in technique
. Environmental factors contributing to cross infection
. Amount of high-status support: nursing department, infection
control committee, medIcal staff, administration
First Session
As staff came in they were given
numbers for door prizes (for example,
one week without an isolation
assignment. or two weeks with no
patients with Rotavirus). A team leader
introduced the session, and the assistant
IC nurse and I briefly outlined the
objectives of the program. We
Aims
. Set realistic criteria
· Involve all levels of ward staff
· Focus on behavior
· Consider environmental factors
. Reinforce affective elements
· Eliminate or reduce negative factors
· Ensure feedback/recommendation for correct behavior
GOALS AND METHODS
Behavioral Goals
. Increased frequency of handwashing
· Improved disposal of contaminated articles
Methods:
1. Immediate commendation for correct behavior.
2. Rewards for correct behavior (group and individual).
3. Checks on technique (frequenlly, then at longer intervals).
4. Peer monitoring of technique.
5. Staff meetings
--involvement in problem identification
--involvement in decisions
--identification of ways to improve/streamline technique
-nurses to choose their own rewards
Cognitive Goals
. Improved knowledge of correct behavior
. Increased knowledge of sequence and pattern of behavior
Methods:
1. Increase awareness of technique.
2. Review and demonstrate correct technique.
3. Demonstrations by instructed staff.
4. Periodic follow-up.
Affective Goal
. Reinforce that technique is:
important
necessary to protect patients
a professional responsibility
Methods:
1. Involve others: high-status nurses. medical staff. parents.
2. Cross infection scores; compare with last month and last year.
3. Persuasive messages (e.g., "Caring is clean hands").
Reduction in Negative Factors
. Emphasize correct behavior and absence of infection rather than
breaks In technique and occurrence of cross infection
. Reduce inconvenience wherever feasible
. Encourage team work
Methods:
1. Rate correct behavior.
2. Post monthly scores for cross infection.
3. Reward Improvement in behavior and achievement of set criteria.
4. Discuss negative aspects with staff.
5. Involve others: medical, paramedical, and housekeeping staff;
nursing administrators; parents.
6. Persuasive messages.
The room was set up with two
infants' units with dolls as patients. I told
the nurses there was going to be a
demonstration of technique and that they
should record everything the nurse did
right .or wrong. Naturally, they expected
yet another demonstration of correct
technique - but then the assistant IC
nurse appeared as "Susie Sepsis",
presented a slide-tape (provided by the
Chief of Virology) on viral
gastroenteritis, the ward's major cross
infection problem.
->
The Cenden Nune
.
-- ...:
Februery 1871 43
wearing a long blonde wig, rings, watch
and necklace, brown stockings, and dirty
white shoes. Susie's technique included
numerous mistakes: 'pinky-dip'
handwashes,linen dropped on the floor,
movement from patient to patient
without changing her gown or washing
her hands, and, finally, a dirty diaper
pitched across the room, missing the
laundry hamper. From 30 to 40 errors
were included in each five-minute skit.
Invariably, the first mistake, and
sometimes also the second, was greeted
with a gasp. Then giggles broke out.
Comments began.: 'That's me;" "I can't
write this fast." Laughter and applause
greeted the end of the demonstrations.
Comparisons oflists of errors gave us a
chance to clarify differences, establish
nonns, and explain what was wrong with
some practices.
Next, we demonstrated correct
technique, with the group instructing me
in what to do next. When we reached the
point where I was supposed to fold the
gown to hang it, I was embarrassed to
find that I did not know how to do this on
the ward's small hooks since I was used
to larger ones. However, none of the
ward staff did, either. Finally, one of the
team leaders demonstrated an easy way
fiGURE 1
/'
to fold and hang the gown correctly. As
even the "experts" had been ignorant.
everyone felt comfortable getting up and
practicing and helping one another.
When repeating the session for other
groups, we described what had happened
the first time and encouraged everyone
to practice hanging gowns correctly.
Next we distributed a line drawing
of a two-bed room (Figure one) and
asked each participant to color-code the
areas in the room she considered
(a) clean
(b) generally contaminated or
contaminated by pathogens from
(c) Patient A or
(d) patient B.
There were differences of opinion among
the nurses about contaminated areas,
and we had an opportunity to discuss
reasons for certain conventions and to
standardize practice. In preparation for
the next session, nurses were asked to
note factors contributing to breaks in
technique. We ended by picking the
number for that day's door prize.
Second Session
Each group started with blank pieces of
newsprint paper. We asked the nurses to
"brainstonn" about the problems for
WINDOW
_UNO
WINDOW
about half an hour. and then they worked
on solutions. No solution was considered
too crazy or too expensive, but most
were practical and possible. With later
groups, at the end of their session we
commented on problems and suggestions
that were similar to those mentioned by
others. Almost all the participants
appeared interested in the sessions and
contributed to the identification of
problems.
After all the nurses had attended the
second session, we assigned the list of
problems among the following
categories:
. cleaning
. nursing technique
. supplies
· knowledge and application of
technique by other than nurses
. facilities on the ward or in the
patients' rooms
. factors beyond the control of the
ward's nursing staff.
In many-instances the nurses acted
immediately on suggestions. For
example, when they noticed that it was
difficult to keep small amounts of diluted
chlorine bleach for cleaning items such
as scales. stethoscopes in isolated
rooms, someone suggested using spray
02 ..
SU
"
0001
PATIENT.
PATIENT
)
HANDLE
o Clean
o Conta.inatecl for Patient A
OConta.lnGteci far patient.""
o Conta_il\Qteci for all patient. ""
in the roo.
Representation of a two-bed infants' room. The nurses colored the areas
they considered clean and contaminated, and indicated their
color-coding in the boxes (lower right corner offigure).
44 Februery 1971
FIGUR E 1
35
30
25
20
Th. C.n..sl.n Nur..
OCT.
/
/A--;
:
-___A
 '''' STARTED ........
, I " t ....
I I " ....
'" I I " "'r:.
A..., I I ' ...----Â-_
...
I I ,,' --Â
' 'Â"
15
10
5
A 1976-77
 1977-78
VIROLOGY SPECIMENS
-SENT --- POSITIVE RES UL TS
Virology resultsforOctober-ApriI1976-77 and 1977-78 among patients in
the second ward./ n addition to the reduction in positÌ\'e results, durin/(
1977-78 the number of positil'es per individual pathogen decreased
mar/..edly. confirming decrease in cross infection.
hottles from home cleaning products; the
next day, they brought in spray bottles.
Some solutions created new problems.
In one room, diaper-weighing scales and
formulas were kept on the same shelf.
The formulas were moved immediately
but a week later this "clean" area was
reported to be inconveniently located
and the room was rearranged.
By no,"" we had statistics of rates of
infection during the project. On Ward
Two all the indicators had risen
dramatically in the six wed..s before the
program began (mid-January, 1978).
Immediately after it started. they began
to fall. ending up lower than at the same
time the previous year (Figure two). In
addition. per diem nurses who had gone
to the ward for orientation said they had
never 'ieen staff carrying out technique
so well, and team leaders reported seeing
more gown... hung correctly amI hedfing
staff COI rect technique and teach pal ents
more ClJIIsistently.
Third Session
We began planning the third session
when the second was almost completed.
Now we were faced with a problem-
we were a hard act to follow! We feared
that our success might be short-lived and
that cross infection would mount again
as soon as the project ended. We had to
ensure that interest and enthusiasm were
maintained.
Some suggestions from the first two
sessions required further work.
Discussion focused on "Where do we go
from here?" After explaining and
discussing the graphs of results, we
distributed typed copies of the lists of
problems and approaches. We suggested
the formation of committees to divide the
work and continue the project. and asked
for volunteers. The first group of nurses
hecame anxious: for them, the word
"committee" had man} negative
connotations (they defined committee...
as bodies that meet endlessly without
accomplishing much). After that, we
called them "workgroups". and this
term evoked positive reactions.
Although the ward nurses favored
continuing the project no volunteers
came forward: they wanted a chance to
see what each workgroup would do and
who else wanted to be in it. Therefore.
we spent most of the session defining
workgroups and their acti vities (see
Table 2). We posted a sheet listing
groups and suggested responsibilities.
and asked staff to sign up for the
workgroup they preferred. One group
suggested (and others agreed) that ifby a
certain date there weren't enough
volunteers the head nurse should appoint
members.
El'aluation andfollow-up
At the end ofthis session we asked the
nurses to comment on the project. Most
reported they had enjoyed the sessions.
especially the first one; they were more
conscious oftheirown technique. and
felt more comfortable about reminding
others. They were encouraged by the
changes that had already occurred and
by the results. but could still see
problems: there were still some breaks in
technique and rooms were in isolation at
times. On the whole, however. staff
reaction to the program was positive.
8IaI
Table 2
Group
Cleaning
The C.n-.ll.n NUrH
WORKGROUPS
Responsibilities
---
Febru.ry 111711 45
. Identify items cleaned Inconsistently. Determine and ,nform the head nurse which
departments or persons should be responsible for cleaning particular Items (Head nurse to
discuss with heads of other departments who should be responsible for cleaning identified
items)
. Monitor that items are cleaned as agreed
Toys and junk
(had most volunteers)
. Ensure that each patient's toys are labeled with his name and are not handled by other
patients
. Check that eqUipment IS removed from room when no longer needed.
Information for nurses
. Prepare for ward nurses a manual of infectious diseases and correct isolation
procedures Record, and post If necessary, relevant Information: ensure updating
Information for visitors
. Determine best methods to teach parents correct technique and reasons for ItS use
. Make posters and compile pamphlets considered necessary
. Ensure that all nursing staff take responsibility for teaching visitors
Information for other staff
· Construct plan for Informing new medical residents of correct technique
. Remind all non-nursing staff of necessity of performing correct technique
Epidemiology
. Identify sources and common denominators of infection on the ward.
. Make recommendations about preventing recurrences, and follow-up for results
The improvement in all the criteria we
monitored was maintained throughout
the third session.
We waited with interest to see
whether the staff of this ward would
follow through without constant
reminders and were pleased that. during
the remaining winter and spring months.
the commonest time for gastroenteritis.
the cross infection rate stayed down.
Although some other factors probably
contributed to the lower figures (for
example. the ward census was slightly
less and infection rates were somewhat
lower throughout the hospital). much of
this improvement must be attributed to
the project and to the nursing staffs
increased interest and cooperation.
The workgroups were slow to get
under way. For most. members had to be
appointed. Also, because
group-members were on different teams
and shifts. getting together and getting
things accomplished was difficult.
Finally. a chairman was chosen in each
workgroup to coordinate activities.
Now. almost a year later. the groups
are still meeting and working and each
month the assistantlC nurse sends the
ward a graph showing its rate of cross
infection. We plan to meet periodically
with the staff to encourage them and
keep track of the workgroups; some
follow-up sessions will probably be
needed to reinforce technique before the
usual seasonal rise in the gastroenteritis
rate starting in the late Fall.
Conclusion
A program to reduce cross infection on a
pediatric ward was both fun and effective
when nursing staff were willing to invest
the necessary time and energy. We feel
that all nurses who follow up their own
good ideas and make changes In their
habits and environment can achieve the
rewards of positive results and that
methods similar to those applied in this
project could be used with similar
success to tackle other common
wardprobJems. '"
Catherine E. (Bett}) Cragg is a Nurse
Educator in the Ðil'ision of Nursing
Education, The HospitalforSick
Children, Toronto. She recei,'ed her
B .Sc.( N) degree from McGill U ni,'ersity,
Montreal and M.Ed. in Adult Education
from the Ontariolllstitute for Studies in
Education, Uni"ersity of Toronto. She
has held a Ilumber of positions at the
Hospital for Sick C hildrell, including
head nurse of the illfectious disease
wards alld project supen'isor for
introducing the use of problem-oriented
nledicalrecords.
44S Februery 11171
Tne C.necl..n Nur..
m
Open to both Appel
men and women de candIdatures
mixtes
HEAL TH AND WELFARE CANADA
Northwest Territories Region
Frobisher Bay, N.W.T. & Inuvik, N.W.T.
DIRECTOR OF NURSING
2 Positions
Salary: $18,182 - $21,467 Per Annum,(Frobisher Bay)
$19,449 - $23,367 Per Annum, Inuvik
Pluslsalated Post Allowance
Competition Number: 78-E-II736
DUTIES: Great opportunity to wort< with the Inuit
population. Plans, organizes, directs, administers and
evaluates nursing care. Promotes good hospital/com-
munity relationships and promotes continuity of health
care within the area .rviced.
QUALIFICATIONS: Graduate nurse registered in a
province or territory of Canada; Diploma/Certificate or
Baccalaureate Degree in nursing; certificate in Nursing
Supervision, Administration, or Public Health.
OTHER INFORMATION: Frobisher Bey,located on the
southern tip of Baffin Island, has a population of 2500
end lies 1300 air mile. due north of Montreal.
Inuvik, with a population of 3000, is located On the tree-
line 1200 air mile. northwest of Edmonton.
For more information call Ms. Pat Nichols at 403-425-6417.
(lnuvik 608-335-159)
(Frobisher Bay 608-333-030)
How to Apply
Forward completedUApplication for Employment" (Form
PSC 367-4110) available at Post Offices, Canada Manpower
Centres or offices of the Public Service Commission of
Canilda, to: .
V. Mattia, Staffing Officer
Publ ic Service Commission
300 Confederation Building
10365 - Jasper Avenue
Edmonton, Alberta, T5J IY6
Apply as soon as possible on this position.
Please quote the applicable reference number at aI/times.
'.
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Santé et Bien
tre social Canada
Services médicaux, r6gion de. Territories du Nord-Ouest
Frobisher Bay, N.W.T.& Inuvik, N.W.T.
Directrice des services infirmiers -
2 postes
Traitement: $18,182 - $21,467 (Frobisher Bay)
$19,449 - $23,367 (Inuvik)
(Plus prime d'éloi!lnement)
FONCTIONS: Une belle occasion de travailler avec Ie.
Inuit.
labCj!rer, organiser, diriger et évaluer Ie. .rvices
infirmiers. Eteblir de bons rapports entrel'hðpital et la
collectivité, encourager Ie. habitents " prendre les mea.ures
d'hygiène appropriées.
CONDITIONS DE CANDIDATURE: Infirmiére diplðmée,
autoriséø " exercer dans une province ou au Canada;
dipl6me, certificat ou baccalauréat en sciences infirmières;
certificat desurveillence (sains infirmiers), en administra-
tion ou en hygiène publique.
RENSEIGNEMENTS COMPLEMENTAIRES: Frobisher
Bay, è I'extrêmité sud de I'ne Battin, compte 2500 habit-
ants et 58 situe è 1300 milles au nord de Montrêal è vol d'
oi58au.
Inuvik compte une population de 3000 habitants et est
situé è la limite de la végétation arbor85C8nte, 1200 milles
aériens au nord-ouest d'Edmonton.
Pour de plus am pies renseignements, priére d'appelar Mme
Pat Nichols, no 403-425-6417.
Numero Concours: 78-E-II736
(Inuvik 608-335-159)
(Frobishar Bay 608-333-0301
Comment 5e porte, c.ndid.t
Remplir Ie formulaire de demande d'emploi C.F.P. 367-4110,-
on Ie trouve dans les bureaux de poste,les centres fédéraux
de main-d'æuvre, et les bureaux de la Commission de la
fonction publique du Canada, - et Ie faire parvenir à:
V. Mattia, Agent de Dotation, Commision de la Fonction
Publique, 300 Confederation Building, 10355 - Jasper
avenue, Edmonton, Alberta, T5J IY6
Faites votre demande aussitðt q ue possible,
Pri
re de toujours rappeler Ie numéro de référence approprié.
The Cenedlen Nur..
\I...
Februery 11171 47
clllendar
March
Seminar on the Care and
Management of the Ostomate
Patient presented by the
Manitoba Enterostomal
Therapist Interest Group on
March 16, 1979 in Winnipeg,
Manitoba. Keynote speaker:
Bryan Brooke, London,
England. Fee: $30. Contact:
Gene\'Ïei'e Thompson, R.N.,
E.T., Stoma Clinic, Program
Chairperson, St. Boniface
General Hospital, Winnipeg,
Manitoba.
April
National Continuing Education
in Nursing Conference to be
held April 18-20, 1979 in
Winnipeg, Manitoba. Fee: $75
- includes accommodation
and meals. Contact: K. de
Jong, Manitoba Association
Registered Nurses, 647
Broadway A venue, Winnipeg,
Manitoba, R3C OX2.
Continuing Education
Programs offered at the
University of Toronto's
Faculty of Nursing (evening
courses).
The physiology of aging and
its implications for nursing-
Apr. 5 - May 24. 1979. $75.
Anatomy and physiology for
nurses: the respiratory
system. Mar. 29 - May 3. $40.
Management skills for nurses
- Apr. 3 - May 22. $75.
Contact: Dorothy Miles,
Director, Continuing
Education Program, Faculty
of Nursing, Unil'ersityof
Toronto, 50 St. George St.,
Toronto, Onrario, M5S JAJ.
The Third Revolution in
Psychiatry: forensic psychiatr)
and qualit
assurance in
psychiatric care to be held on
April 18-19. 1979 at the
Calgary General Hospital.
Contact: Jocelyn Lockyer,
Continuing Medical
Education, Facultv of
Medicine, The Unil'ersity of
Calgary, Calgary, Alberta
The American Association of
Neurosurgical Nurses Annual
Meeting to be held on April
22-26, 1979 in Los Angeles,
Ca. Theme: the multifaceted
world of the neurosurgical
nurse. Contact: The American
Association of Neurosurgical
Nurses, 625 North Michigan
Ave., Suite 1519, Chicago,
Illinois.
Topics in ischemic heart
disease: an international
symposium. To be held at the
Sheraton Centre Hotel.
Toronto on April 20-21. 1979.
Fee: $100. Contact: Dr. T.
Kavanagh, Medical Director,
Toronto Rehabilitation
Centre, 345 Rumsey Rd.,
Toronto, Onrario, M4G JR7.
Stewart Conference on
Research in Nursing. Theme:
Nursing leadership: survival
and promise. To be held on
April 20-21, 1979 in New
York. Contact: Shaké
Ketefian, Nursing Education
Alumni Association,
Teacher's College, Columbia
Unhwsity, 525 West J20th
St., New York, N.Y. 10027.
May
Arrhythmia and ECG
Workshops for NUrses. An
intensive two-day program
with Leo Schamroth. M.D. on
May 24-25, 1979 at the
Toronto Hilton Harbour
Castle Hotel. Fee: $100.
Contact: Conference and
Seminar Services, Humber
College of Applied Arts and
Technology, p.o. Box 1900,
Rexdale, Onrario, M9W 5L7.
Annual General Meeting of the
Manitoba Association of
Registered Nurses to be held
May 24-26, 1979 at the
University of Brandon,
Brandon, Manitoba. Theme:
Consumers' Rights - Nurses'
Responsibilities. Contact:
MARN, 647 Broadway Ave.,
Winnipeg, Manitoba
Cardiology '79. Sixth Annual
Intensive Coronary Care
S}mposium, to be held on May
26-28, 1979 at the Toronto
Hilton Harbour Castle Hotel.
Sponsor: Humber ColIege.
Fee: $70. Contact:
Conference and Seminar
Sen'ices, Humber College of
Applied Arts and Technology,
P.O. Box J900, Rexdale,
Onrario, M9W 5L7.
m
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Open 10 bOlh
men and women
MINISTRY OF THE SOLICITOR GENERAL
Canadian Penitentiary Service
Drumheller Institution, Drumheller, Alberta
REGISTERED NURSES
I
Salary: $14,145 to $16,184 Per Annum, Plus $500 Per
Annum Penalogical Factor Allowance
Competition Number: 78-E-3747
DUTIES: Requires active cooperation with other mem-
bers of the heølth care team. Responsibilities include
outpatient and bedside nuning, emergency first aid and
counselling for inmates. Nunes employee! will be direct-
ly and indirectly involved in the development of mental
and physical health programs for the inmates. This is
an exciting opportunity for dynamic pØl'sons lØØking
IItisfaction and challenge in a progreaive department.
QUALIFICATIONS: Eligibility for registration as a
registered nur. in a province or territory of Canada.
A knowledge of the English language is essential for
this position.
(608-342-009)
How to Apply
Forward completed "Application for Employment" (Form
PSC 367-4110) available at Post Offices, Canada Manpower
Centres or offices of the Pu/;Jlic Service Commission of
Canilda, to:
V. Mattia, Steffing Officer
Public Service Commiaion
300 Confederation Building
10365 - Jasper Avenue
Edmonton, Alberta T5J IY6
Apply as soon as possible for this position.
Please quote the applicable reference number at all times
41 Fllbru.ry 18711
The C.nedl.n NUrH
"
Saves
you tillle
a..f Pampers construction
.
. helps prevent moisture
from soaking through
and soiling linens, As a
j result of this superior
containment, shirts,
.. ! sheets, blankets and
. J 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 babies have
"- more time to spend on
" other tasks.
PROCTER. GAMBLE CAR.3ZZ
Keel)S
hi 111 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.
t -- -1.(
I . J1
Þ&
Pel's
;
r....
l'
.....
, \
'1
The Cen8dI.. NurH
-..ery 1171 41
names & faces
The Catholic Health
Association of Canada has
recently appointed Rev.
Everett MacNeil as executive
director. Father MacNeil
received a B.A. from St.
Francis Xavier University and
a Master's degree in History
from the Notre Dame
University in Indiana.
Currently, he is a member of
the board of governors of St.
Francis Xavier University and
a member of the board of
directors of the Ecumenical
Foundation of Canada .
Kathleen Scherer (R.N.,
Nightingale School of
Nursing; B.Sc.N., University
of Windsor; M. H. Sc.,
McMaster University) has
joined the provincial office of
the Manitoba Association of
Registered Nurses and will be
coordinating all activities
related to standards of nursing
practice.
Scherer has worked as a
general duty nurse and as an
instructor and coordinator at
the Hamilton and District
School of Nursing. At
McMaster University, she
was researcher associate and
project coordinator of
"Survey of Nurse
Practitioners and their
Associated Physicians" and
as research assistant,
educational development on
"Continuing Medical
Education and Quality of
Care". Since September 1977,
she has held the position of
standards coordinator,
Nursing, at the Health
Sciences Centre in Winnipeg.
The New Brunswick
Association of Registered
Nurses (NBARN) recently
approved the appointment of
Bonny Hoyt as executive
director and Jacqueline
Steward as nursing consultant
for the association.
Hoyt who has been
employed as a part-time
instructor and lecturer at the
University of New Brunswick
Faculty of Nursing since 1969,
is a graduate ofthe U.N. B.
Faculty of Nursing and has
worked at the Sunnybrook
Hospital, Toronto and the
Oromocto Public Hospital,
Oromocto, N. B. From
1970-75. Hoyt successively
occupied the positions of 2nd
and 1st vice-president and
president ofthe N BARN
Fredericton Chapter. She was
subsequently elected to the
N BARN Council in 1976 as
2nd vice-president. Her
appointment as executive
director becomes effective on
May I, 1979.
Steward, a 1974 graduate
of the U.N. B. Faculty of
Nursing, received her nursing
diploma from the Royal
Victoria Hospital School of
Nursing, Montreal. She has
worked at the Victoria Public
Hospital, Fredericton, as a
staff nurse and head nurse of
the coronary care unit. She
was subsequently employed
as a senior clinical nurse on
the intensive care unit at the
Dr. Everett Chalmers
Hospital. Fredericton, until
her N BARN appointment.
Steward assumed her new
post in January, 1979.
Janet Kenny Knox is the first
recipient of the $1,000 Helen
Gibson Memorial
Scholarship, donated by the
Dr. EverettChalmers
Hospital Auxiliary in
Fredericton. New Brunswick.
The scholarship is awarded
yearly to a graduate of the
University of New Brunswick
Faculty of Nursing who is
admitted to a program leading
to a Master's degree in
nursing.
A native of Prince
Edward Island. Knox
graduated from U.N.B. in
1976 and is currently pursuing
her studies at Dalhousie
University, Halifax.
Previously employed at the
Izaak Walton Killam Hospital
for Children, Halifax, Knox's
current area of study is
medical-surgical pediatric
nursing.
Ruth E. Dennison has been
appointed assistant
administrator, patient care
services of Holy Cross
Hospital in Calgary, Alberta.
She holds a baccalaureate
degree in nursing from the
University of New Brunswick
and a diploma in nursing
service administration from
Dalhousie University.
Previously, she was the
associate director of nursing
at the Victoria General
Hospital in Halifax.
Two nurses have been
awarded the 1978Judy Hill
Memorial Scholarshi of
$3,500 to improve their
education for service in the
Canadian Arctic. The
scholarship was established to
commemorate Judy Hill, a
northern nurse who died while
accompanying patients on a
mercy flight in 1972.
Arleen Drysdale of Neepawa,
Manitoba, now employed at
the Selkirk General Hospital,
plans to take a one-year
course in midwifery at the
Queen Mary's Maternity
Hospital in England. Diana
Fenwick ofCoffs Harbour in
Australia is now working in a
spinal injury unit. She plans to
move to Sydney, Australia
where she will study
midwifery at the Crown Street
Women's Hospital.
Control female
inCClntinence,
naturally
Available from leading
surgical supply dealers
or directly from
ESC
advancing the cause of good health
Eschmann Canada Limited
Barclay Avenue Toronto.Onlario M8l556
(416) 252-2281
50 February 1871
The Canadian Nur..
To meet the
expanding responsibilities
of clinical nursing...
Nurses' Drug Reference
Edited by Stewart M. Brooks, M.S.
Everything you need to know about drug actions and their
implications for nursing care is right here in one compre-
hensive, concise volume. Nurses' Drug Reference is a
convenient yet thorough summary of all the drugs
commonly encountered in nursing practice. The most
readily accessible work of its kind, NDR reviews, cata-
logues, and cross-references all the standard drug classes,
then presents alphabetically over 500 pharmacologic
monographs by generic and trade name that detail action
and administration, cautions, adverse reactions, compos-
ition and supply, and legal status. Eleven indispensable
appendices inform on such crucial topics as drug inter-
actions, weights and measures, and pediatric doses. It's for
you, the nurse, from cover to cover. And it's a lot more
than just a reference.
Little, Brown. 623 Pages. 1978.
Paper, $14.00. Cloth, 526.50.
Leadership for Change
A Guide for the Frustrated Nurse
By Dorothy A. Brooten, R.N.; Laura Hayman, R.N.;
and Mary Naylor, R.N.
Effective nursing leadership, the authors maintain, depends
on the nurse's capability to understand change. The unique
objective of this lively and readable new book is to unfold
in concise, logical sequence a sense of the history of change
in nursing, a sense of direction for further change, a
theoretical framework, and a set of practical guidelines for
planning and managing change.
Lippincott. 172 Pages. 1978. $6.00.
Manual of
Neurological Nursing
By Nancy Swift, R.N., with Robert M. Mabel, Ph.D.
Every nurse will welcome the realistic, straightforward
guidance afforded by this much-needed handbook. In a
format facilitating on-the-spot reference, the authors
succinctly and clearly cover every aspect of neurological
nursing, including patient assessment and monitoring,
diagnostic studies, management and assessment of specific
neurological pathologies and dysfunctions, management of
pain, considerations for extended care and rehabilitation,
and the all important psychological aspects of care. An
easy-to-use, comprehensive, and essential work.
Little, Brown. 201 Pages. 1978. $9.75.
Health Care of Women
By Leonide L. Martin, R.N., M.S.
Written from the nurse practitioner's point of view, and
with particular focus on primary ambulatory care settings,
this is the first North American OB/GYN textbook
intended specIfically for nurses. In a succinct, lucid style,
this book emphasizes physical assessment, including history
and exam, physical diagnosis, treatment measures,
indications for consultations with the physician, patient
counseling, and follow-up care. Psychosocial considerations
are as important a part of the book as the physical
considerations; the integration and balance of these aspects
are handled superbly. Detailed coverage focuses on such
matters as identity, self-image, changing roles, sexuality,
meaning of pregnancy, special problems of abortion
patients, and psychological changes in aging and
menopause.
Lippincott. 383 Pages. Illustrated. 1978. $16.75.
Illustrated Guide to
Orthopedic Nursing
By Jane Farrell, R.N.
Richly illustrated with over 500 figures and photographs,
this important manual deals with the major problems
encountered by nurses in the orthopedic unit. Specifically
it focuses on the nursing care of the adult orthopedic
patient; on those factors that influence the patient's
adjustment, behavior, and recovery; and on practical
suggestions for resocializing the patient in his home
environment.
Lippincott. 242 Pages. Illustrated. 1977. $12.00.
Case Studies in
Neurological Nursing
By Suzanne L. Wehrmaker, R.N., B.A.; and Joann R.
Wintermute, R.N., M.A.
Primarily for the professional nurse in clinical practice,
CASE STUDIES IN NEUROLOGICAL NURSING helps
the reader correlate and interpret the fundamentals of
neuroanatomy, physiology, and pathophysiology with
clinical findings in neurology. For each neurological disease,
techniques of assessment and priorities of nursing obser-
vation and care are provided. The authors first review the
functioning of the neuron, sensory system, motor system,
and cranian nerves, and then study in-depth twelve
neurological and neurosurgical cases.
Little, Brown. 190 Pages. Illustrated. 1978. $10.00.
Th. C.n-.llen Nu...
Februery 1871 51
The Lippincott Manual of
Nursing Practice, 2nd Edition
By Lillian S. Brunner, R.N., B.S., M.S.;and D. S. Suddarth,
R.N., B.S.N.E., M.S.N. With 9 Contributors.
This unique book will bring you the latest, most accurate
infonnation available in any single volume! Every chapter
in every area is expanded and up to date. Every phase of
medical/surgical, maternal, and pediatric nursing is covered
in greater detail. . . and in the quick-reference outline
style that made the first edition such a valuable tool to
thousands of nurses every day!
Clinical problems are presented in tenns of causes,
manifestations, possible complications, treatment and
nursing management, and health teaching/patient
education. The infonnation you require is presented in
logical, step-by-step sequence. . . available at a glance .
when you need it for immediate use!
Lippincott. 1888 Pages. Illustrated. 1978. $29.95.
Atlas of Diagnostic and
Therapeutic Procedures for
Emergency Personnel
By James H. Cosgriff, Jr., M.D.
Compact and lavishly illustrated, this superb guide lists and
describes in detail the key diagnostic and therapeutic
procedures essential for clinical personnel in an emergency
situation. It offers in-depth coverage of a wide range of
technical infonnation that is up-to-date and concisely
assimilated in on-= volume. For convenience and practical-
ity, all procedures are arranged in alphabetical order and are
presented in step-by-step fonnat: the procedure is named
and followed by its indications; the equipment needed is
listed in detail; anatomical procedures that the clinician
must adhere to are fully described; and then, clear
instructions appear in outline form.
Lippincott. 315 Pages. Illustrated. 1978. $23.75.
General Systems Theory
Applied to Nursing
By Arlene M. Putt, R.N., Ed.D. With 11 Contributors.
The nurse learns to facilitate patient assessment, planning
for care, teaching, and in-service education by applying the
concepts of general systems theory. Building on the ideas
originally fonnalized by von Bertalanffy and later adapted
to nur
ing by June C. Abbey, Ph.D., the author and 11
contributors explain the components common to all
systems, their functions, and the application to patient care
of those principles underlying total human ecology. This
systematized approach to problem solving promises to
profoundly affect the thinking of all nurses and to increase
their efficiency in the clinical setting.
Little, Brown. 195 Pages. 1978. $12.25.
Lippincott's State Board
Examination Review
for Nurses
By LuVerne Wolff Lewis, R.N., M.A.
In the same fonnat as the licensure examinations
themselves, this unique and useful new book offers 2,568
questions together with answer-recording sheets. Patient
situations are followed by questions framed in a manner
similar to that of the state board exams. The questions are
in a logical sequence and lead the student from point to
point while supplying new infonnation in each question.
Tests cover the five major areas of nursing: medical,
surgical, obstetric, pediatric, and psychiatric. They integrate
the biological social sciences, nutrition and diet therapy,
phannacology and therapeutics, fundamentals of nursing,
communicable diseases, and legal and ethical consider-
ations. Answers and the rationale for each answer are
supplied at the end of each major section.
Lippincott. 745 Pages, plus answer sheets. 1978. $13.00.
Lippincott
Books are shipped to you On Approval; if you are not J. B. LIPPINCOTT CO
IPANY OF CANADA LTD.
entirely satisfied you may return them within 15 days for 75 Horner Ave., Toronto. Ontario M8Z 4X7
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D Illustrated Guide to Orthopedic Nursing, $12.00.
D Manual of Neurological Nursing, $9.75.
D Case Studies in Neurological Nursing, $10.00.
D The Lippincott Manual of Nursing Practice, $29.95.
D General Systems Theory Applied to Nursing, $12.25.
D Atlas of Diagnostic and Therapeutic Procedures for
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CN-2/79.
52 Febnlery 11179
Th. C.n-.llen Nu...
books
Rape: helping the victim by Susan American focus, it lends itself to more modem techniques such as
Halpern. 169 pages, Gradell, N.J. consideration and application if) hemodynamic monitoring make the book
Medical Economics Co. 1978. Canadian society. less useful in a teaching-research
Approximate price: $18.80 The articles for the book were hospital setting.
selected from a variety of disciplines. -Reviewed by Gail Laing, Assistant
Changes in public attitude and in the Those who are familiar with the first Professor of Nursing, University of
legal statutes concerning rape bode well edition will note the addition offour Saskatchewan, Saskatoon,
for more humane and sensitive treatment original articles. A sense of the scope of Saskatchewan.
of the victims of sexual assault. the content may be gained from the
The author of this timely treatment following topics: developmental tasks in
manual provides a specific guide for the elderly, sexuality and the healthy library update
medical, social and legal personnel who elderly, grief in the elderly, suicide and
may have contact with rape victims. aging, functional assessment of elderly
Clearly outlined are practical people. Reference lists follow most
step-by-step procedures to be used by articles.
staff in hospital emergency rooms, rape This book should help the reader Publications recently received in the
crisis centers or other places of contact. control a tendency to stereotype aged Canadian Nurses Association Library are
The procedures deal with the physical, persons. It offers insight and available on loan - with the exception of
psychological, social and legal aspects of understanding that will enhance the items marked- R - to CNA members, schools
care for adults and children in development of an individualized of nursing, and other institutions. Items
preventative and therapeutic terms. approach. marked R include reference and archive
Stress is placed on the importance of I recommend the book to students material that does nor go out on loan. Theses,
special training and/or in service and practicing members of the health also R, are on Reserve and go out on
education for doctors, nurses, social profession, particularly those who give Interlibrary Loan only.
workers. police officers. lawyers or direct care to the elderly. It is easy yet Books and Documents
volunteers who are to work with victims thought-provoking reading and 1. Bureau International du Travail
of sexual assault. This interdisciplinary establishes a challenge for improving the Constitution de "Organisation internationale
manual would be useful for these care of the elderly both now and in the du Travail et règlement de laConférence
purposes. future. internationale du Travail. Genève, 1977. 86p.
The format of the book lends itself 2. Canadian Hospital Association Canadian
to use as a reference which would be Reviewed by Mona Anderson, hospital directory, v.26. Ottawa, 1978. 368p.
valuable for community agencies, Instructor, School of Nursing , Royal R.
3. Cantor, Marjorie Moore Achieving
hospitals. crisis centers, etc. where Jubilee Hospital, Victoria, B.C. nursing care standards: internal and external,
protocol for rape victims is being with chapters by Deborah D. McDougall and
planned or is already in practice. An Critical Care, 3d ed. by Zeb L. Susan W. Kurth. Wakefield, Mass., Nursing
extensive appendix (100 p.) contains Burrell, Jr., and Lenette Queens Resourceslnc.cl978.ISOp.
examples of medical record forms and Burrell, 427 pages, Toronto, Mosby, 4. Clinical ladders and professional
charts, articles on crisis intervention and 1977. advancement; a reader consisting of eight
interviewing techniques and other topics Approximate price: $12.35 articles especially selected by the Journal of
related to the care of the sexually Nursing Administration Editorial Staff.
assaulted person. The authors' stated purpose is to Wakefield, Mass., Contemporary Publishing,
cl977.53p.
"compile basic information and cardinal 5. Disaster aid workshop. Ottawa, April
Reviewed by Molly Anderson, Assistant principles relative to critical illness in 17-18, 1978 Report. Ottawa, Canadian
Professor, McMaster University, School such a manner that it will aid Council for International Co-operation, 1978.
of Nursing, Hamilton. Ontario. practitioners in community hospitals." Iv. (various pagings)
They have attempted to simplify 6. Drugs of choice 1978-1979. Walter
Readings in gerontology edited by complex mechanisms to their essence Modell, editor. St. Louis, Mosby. 1978. 824p.
Mollie Brown. 2d ed. St. Loui!'>, and to explain the rationale of 7. Dubay, ElaineC. Infection: prevention
Mosby, 1978. management. and control, by.. .and Reba D. Grubb. 2d ed.
Approximate price: $7.70 The book meets the above St. Louis, Mosby. 1978. 179p.
8. Farley. Venner Marie An evaluative
objectives. It covers a wide range of study of an open curriculum/career ladder
This little book could be considered clinical conditions succinctly and with nursing program. New York, National League
a "Reader's Digest" on aging. It is not good use of diagrams. I t could be best for Nursing, c 1978. 65p. (League exchange
designed to be comprehensive, but the utilized as part of a ward library for quick no. 118)NLN Pub. no. 19-1728.
editor meets the aim of presenting varied easy review ofthe main points of care for 9. Hamilton, Persis Mary Basic pediatric
and current content specific to the aged. a patient with a particular medical nursing. 3d ed. St. Louis, Mosby, 1978. 4SOp.
This content is presented with the result problem. 10. International LabourCoriference. 63rd
that the reader gains breadth of exposure F or intense study, however, a nurse session. Geneva, 1977 Activities ofthe ILO,
1976. Report ofthe Director
eneral (Part 2).
to the topic. Although the content has an would find the book lacking in detail and Geneva, International LabourOffice. 1977.
depth. The absence of content regarding 70p.
Th. Cen-.llen Nu... Februery 1871 53
II.-.Equality of treatment (social security) Organization, 1978. 51p. (PAHOOfficial .. "
Summary ofreports on convention no.118. document no. 155)
Geneva, International LabourOffice, 1977. 29. Travelbee, Joyce Relation d'aide en
68p. (Its Report 3(2)) nursing psychiatrique. Traduit par Charlotte
12.-.General survey of the reports relating to Tremblay-Duval. Montréal, Editions du
the equality of treatment (social security) Renouveau Pédagogique, c1978. 193p.
convention, 1962 (no. I 18). Geneva, 30. World Health Organization. Expert
International LabourOffice, 19':'7. 9Op. (Its Committee on Public Health Administration
Report 3(4B)) Planning of public health services. Fourth
13.-.Labouradministration: role, functions report ofthe...Geneva, World Health
and organisation. Geneva, International Organization, 1961. 48p. (World Health
LabourOffice, 1977. 126p. (Its Report 5(2)) Organization Technical report no. 215)
14.-. Report ofthe Committee of experts on
the application of conventions and Pamphlets
recommendations (Articles 19,22 and 35 of 31. American Nurses A ssociation By -laws,
the Constitution) Volume A: General report. as amended, June 1978. New York. 34p.
Geneva, International Labour Office, 1977. 32. Association canadienne
301p. (/ts Report 3(4A)) interprofessionnelle du dossier de sUfité 1
15.-.Summary ofreports on ratified Déclaration de principe sur la confidentialité
conventions. (Articles 22 and 35 of the de [,infonnation de santé sanctionnée par Ie
Constitution). Geneva, International Labour Comité de direction a.c.i.d.s.,Ie 5 juin, 1978.
Office, 1977. 119p. (Its Report 3(1)) Oshawa, 1978. 2p.
16.-.Technical co-operation: new prospects 33. Association des irifìrmi
res enregistrées
and dimensions. Report of the du Nouveau-Brunswick Déclaration sur la this
Director-General (part I). Geneva, détermination de la mort. Fredericton, 1978.
International Labour Office, 1977. 96p. Ip.
17. International Labour Conference, 63rd 34. CCPP code d'acceptation de la publicité patient
session, Geneva 1977 Working environment: Toronto, Conseil consultatif de publicité
atmospheric pollution, noise and vibration. phannaceutique, 1978. 17p.
Geneva, I nternational Labour Office, 1977. 35. Canadian Council on Hospital needs
73p. (Its Report 4(2)) Accreditation Voluntary accreditation for
18. International Labour Office long tenn care centres: what's it all about? help
Constitution of th,lnternational Labour Why is a voluntary accreditation program your
Organisation and standing orders of the importantto you? Toronto, 1978. 7p.
International Labour Conference. Geneva, 36. Canadian Health Records Associatiun
1977. 86p. Code of practice approved by Board of When patients need private duty
19. Kalisch, Philip A. Nursing involvement Directors CHRA, 5 June 1978. Oshawa. 1978. nursing in the home or hospital,
in the health planning process by.. .and 2p. they often ask a nurse for her
BeatriceJ. Kalisch. Hyattsville, Md., U.S. 37. Carson,JohnJ. Is the personnel recommendation. Health Care
Dept. of Health. Education and Welfare, administrator an endangered species? Services Upjohn Liniited is a re-
Division of Nursing, 1978. 114p.(U.S. Kingston, Ont., Industrial Relations Centre,
DHEW Pub. no.(HRA)78-25) Queen's University, 1977. 9p. liable source of skilled nursing
20. Marram, Gwen D. The group approach 38. Edwards, Claude Some reflections on and home care specialists you
in nursing practice. 2d ed. St. Louis, Mosby, white collar collective bargaining. Kingston, can recommend with confidence
1978. 247p. Ont., Industrial Relations Centre, Queen's for private duty nursing and home
21. Maternal and infant drugs and nursing University, 1977. 17p. health care.
intervention. Edited by.. .Elizabeth J. 39. L'émotivité et l'enfance. Toronto,
Dickason et aI. Toronto, McGraw-Hili, c1978. ['Association canadienne pour la santé All of our employees are carefully
367p. mentale en coopération avec Santé et screened for character and
22. Murphy, FrankD. Policy and job Bien-être Canada, 1978. 10 brochures. skill to assure your patient of de-
description manual for nursing institutions. 40. Freese, Arthur S. Arthritis: everybody's pendable, professional care.
Toronto, Prentice Hall, c1976. Iv. (loose leaf) disease. New York, Public Affairs Each is fully insured (including
23. Pan American Health Organization Committee, c1978. 24p. (Public Affairs Workmen's Compensation)
Extension of health service coverage based on pamphlet no. 562)
the strategies of primary care and community 41. International LabourCoriference, 63rd and bonded to guarantee your
participation. Summary of the situation in the session, Geneva, 1977 Guide for delegates. patient's peace of mind.
region of the Americas. Washington,I978. Geneva, International LabourOffice, 1977. Care can be provided day or
66p. (PAHO Official document no.156) I3p. night. for a few hours or for as
24. Pavlovich, Natalie Nursing research; a 42. Irwin, Theodore Home health cåre when long as your patient needs help
learning guide. St. Louis, Mosby, 1978. 265p
a patient leaves the hospital. New York,
25. Payne, David A. The assessment of Public Affairs Committee, cl978. 28p. (Public For complete information on our
learning; cognitive and affective. Toronto, Affairs pamphlet no. 560) services. call the Health Care
D.C. Heath, c1974. 524p. 43. Jaffe, Natalie The promise of justice- Services Upjohn Limited office
26. Public education about cancer: recent legal services forthe poor. New York, Public
research and current programmes: an eight Affairs Committee, c1978. 28p. (Public Affairs near you.
series of papers. Edited by John Wakefield. pamphlet no. 561)
Geneva, International Union Against Cancer, 44. New Brunswick Association of
1978. 96p. (UICC Technical report series, vol. Registered Nurses Statement on
31) detennination of death. Fredericton. 1978. Ip.
27. Rural health needs. Report of a seminar 45. Smith, Dm'id C. Economic groups and
held at Pokhara, Nepal, 6-12 October 1977. the consultation process in economic policy. Health Care Services
Edited by Moin Shah et aI. Ottawa, Kingston, Ont., Industrial Relations Centre,
International Development Research Centre, Queen's University, 1977. 9p. Upjohn Limited
1978.64p. 46. Swan, Kenneth P. The search for
28. Special Meeting of Ministers of Health meaningful criteria in interest arbitration; Ihe
of the Americas, Washington, 26-27 Sep. Canadian experience. Kingston,Ont., Vdona. Varo::ANf!I. CoquiUam
1977. Final report and background document. Industrial Relations Centre, Queen's
Washington, Pan American Health University, 1978. 14p. Edmorion. CaIgéwy. WlI1nopeQ. Lorden
51 CathëVines. Ha'Tl,non . Toronto
Ottawa. Montreal. ClJebec. Halifax
... HCS 8823 1 ......
54 Febnlery 11179
Slow-'" folk-
(ferrous sulfate-folic acid)
hematinic with folic acid
Indications
Prophylaxis of iron and folic acid
deficiencies and treatment of
megaloblastic anemia, during pregnancy,
puerperium and lactation.
Warnings
Keep out of reach of children.
Contraindlcatlons
Hemochromatosis, hemosiderosis and
hemolytic anemia.
Adverse Reactions
The following adverse reactions have
occasionally been reported Nausea,
diarrhea, constipation, vomiting,
dizziness, abdominal pain, skin rash and
headache.
Precautions
The use of folic aCid In the treatment of
pernicious (Addisonian) anemia, in which
Vitamin 812 is deficient, may return the
peripheral blood picture to normal while
neurological manifestations remain
progressive
Oral1ron preparations may aggravate
existing peptic ulcer, regional enteritIs
and ulcerative colitis.
Iron, when given with tetracyclines, binds
in equimolecular ration thus lowering the
absorption of tetracyclines.
Dosage
Prophylaxis:
One tablet daily throughout
pregnancy, peurperium and lactation
To be swallowed whole at any time of
the day regardless of mealtimes.
Treatment of megaloblastic anemia:
During pregnancy. puerperium and
lactation; and in multiple pregnancy:
two tablets, in a single dose, should
be swallowed daily
Supplied
Each off-white film-coated Slow-Fe tablet
contains 160 mg ferrous sulfate (50 mg
elemental iron) and 400 mcg folic acid in
a specially formulated slow-release base
Packaged In push-through packs
containing 30 tablets per sheet and
available in units of 30 and 120.
Full Information available on request
References
1 Nutrtllon Canada National Survey A report
by Nutrttlon Canada to the Department of
NatIonal Health and Welfare. Ottawa,
Information Canada. 1973 Reproduced by
permisSion of Information Canada.
2 R R Strelll, MD, Folate Deticiency and Oral
Contraceptives. Jama, Oct. 5. 1970.
Vol 214, No 1
C B A
DORVAL. QUEBEC
H9S IBI
See advertisement on cover 4
C-6026R
Th. C.n-.llen Nur..
Government Documents
Canada
47. A nti-bif7ation Board Compensation
restraints; a general outline. Ottawa, 1976. Iv.
(various pagings)
48. Commission de lutle contre l'inj7arion
Restrictions sur la rémunération; aperçu
général. Ottawa. 1976. I v. (pagination
multiple)
49. Dennis, C.A.R. Les statistiques de
I'assurance-maladie et leur rôle dans la
définition de I'influence de I'environnement
sur la santé, par... et aI. Ottawa, Conseil
national de recherches du Canada, 1978. 149p.
50. Health and Welfare Canada Health
Protection Branch Impaired driving. Ottawa,
1978. 26p. (Its Technical report series no.8)
51. Public Service StaffRelarions Board
Report 1976/77. Ottawa, Minister of Supply
and Services Canada, 1977. I v .
52. Santé et Bien-être social Canada.
Direction générale de la protection de la santé
Conduite avec facultés affaiblies. Ottawa,
1978. 28p. (Son Rapports techniques no 8)
53. Statistics Canada Census of Canada
1976. vol 2. Population: demographic
characteristics. Ottawa, Minister of Supply
and Services, 1978. 5v. Catalogue no. 92-823
to 92-827.
54.-.Census of Canada, 1976. Vol. 3,
Dwellings and households. Ottawa, Minister
of Supply and Services, 1978. 3v. Catalogue
no. 93-802,93-806,93-808.
55.-.Census of Canada, 1976. Vol. 4,
Families. Minister of Supply and Services,
1978. 2v. Catalogue no. 93-821, 83-822.
56. Statistics Canada Census of Canada,
1976. Vol. 5, Labour force activity; labour
force activity by sex. Ottawa, Minister of
Supply and Services. Canada, 1978. Iv.
(various pagings) Catalogue no. 94-801.
57.-.Census of Canada, 1976. Vol. 6, Census
tracts: population and housing characteristics
Ottawa, Minister of Supply and Services
Canada, 1978. 12v.
58.-.Census of Canada, 1976. Vol. 8,
Supplementary bulletins: geographic and
demographic; population, land area and
population density census divisions and
subdivisions. Ottawa, Minister of Supply and
Services Canada, 1978. 92p. Catalogue no.
92-831.
59.-.Census of Canada, 1976. Vol. 8,
Supplemenlary bulletins: geographic and
demographic; specified age groups. Ottawa,
Minister of Supply and Services, 1978. 194p.
Catalogue no. 92-835.
6O.-.Census of Canada, 1976. Vol. 9,
Supplementary bulletins: housing and
families. Ottawa, Minister of Supply and
Services Canada, 1978. 3v. Catalogue no.
93-830,93-832,93-833.
61.-.Census of Canada, 1976. Vol. 10,
Supplementary bulletins: economic
characteristics: labour force participation
rates by sex and level of schooling. Ottawa,
Minister of Supply and Services Canada,
1978. I v. Catalogue no. 94-831.
62.-.Home nursing services (the Viclorian
Order of Nurses for Canada). 1976-Ottawa,
Minister of Supply and Services Canada,
1978. 120p. Catalogue no. 82-214.
63. Statistique Canada Recensement du
Canada, 1976. Vol. 2, Population:
caractéristiques démographiques. Ottawa,
Ministre des Approvisionnements et Services
Canada, 1978. 5v. Catalogue nos 92-823 à
92-827.
p
o
o 5 t:. "i ) ...
Pt:.. \.
"i OÓ
p
c,O
'
POSEY
MODESTY APRON
Help your patients cover up with the
Posey Modesty Apron. Attractive, colorful
prints In nylon jersey material. Waist strap
helps keep them sitting comfortably in
chair. Each apron has a handy pocket.
No. 4550
(
:(j
(j
\
POSEY HEEL PROTECTORS
All the features of higher priced heel pro-
tectors plus a simplified design make this
Posey the most popular heel protector for
the budget minded. Completely ventilated.
Washable.
No. 6121
- -->--
J
'- ..
POSEY COMFORT VEST
Difficult to remove but comfortable to
wear. For use in bed or wheelchairs. Non-
slip waist belt adjustment allows you to
fit the waist belt to the patient quickly
and securely. Sm.. med., Ig.
No. 3614
Health
Dimensions Ltd.
2222 S. Sheridan Way
Mississauga, Ontario
Canada LSJ 2M4
Tél.: 416/823-9290
"',(f
Th. Caned!.. Nu...
Febnlery 1871 55
64.-.Recensement du Canada. 1976. Vol. 3,
Logements et ménages. Ottawa, Ministre des
Approvisonnements et Services Canada.
1978. 3v. Catalogue nos 93-802, 93-806,
93-808 .
65.-.Recensement du Canada, 1976. Vol. 4.
Families. Ottawa. Ministre des
Approvisionnements et Services Canada,
1978. 2v. Catalogue nos 93-821,93-822.
66.-.Recensement du Canada, 1976. Vol. 5.
Activité; Activité selon Ie sexe. Ottawa,
Ministre des Approvisionnements et Services
Canada. 1978. I v. (pagination multiple)
Catalogue no 94-801.
67.-.Recensement du Canada, 1978. Vol. 6.
Secteurs de recensement. Ottawa, Ministre
des Approvisionnements et Services Canada.
1978. 12v.
68.-.Recensement du Canada, 1976. Vol. 8,
Bulletins supplémentaires: géographiques et
démographiques; population, superlicie et
densité de la population - Divisions et
subdivisions de recensement. Ottawa.
Ministre des Approvisionnements et Services
Canada, 1978. 92p. Catalogue no 92-831.
69.-.Recensement duCanada, 1976. Vol. 8,
Bulletins supplémentaires géographiques et
démographiques; certains groupes d'âge.
Ottawa, Ministre des Approvisionnements et
Services, 1978. 194p. Catalogue no 92-835.
70.-.RecensementduCanada, 1976. Vol. 9.
Bulletins supplémentaires: logements et
families. Ottawa, Ministre des
Approvisionnements et Services Canada.
1978. 2v. Catalogue nos 93-830, 93-832.
93-833.
7 1.-. Recensement du Canada, 1976. Vol. 10,
Bulletins supplémentaires: caractéristiques
économiques; taux d'activité selon Ie sexe et
Ie niveau de scolarité. Ottawa, Ministre des
Approvisionnements et Services Canada,
1978. Iv. (pagination multiple) Catalogue no
94-831.
72.-.Soins infirmiers à domicile (Ies
Infirmières de I'Ordre de Victoria du Canada).
1976. Ottawa. Ministre des
Approvisionnements et Services Canada,
1978. 12Op. Catalogue no 82-214.
United States of America
73. Dept. of Health , Education, and
Welfare. Bureau of State Services.
Tuberculosis Control Division. Tuberculosis
statistics: states and cities, 1974-1976.
Atlanta,Ga., 1975-1977. 3v. (DHEW
Publication no. (COC) 77-8249))
74. Renthal, Gerald Medical care planning
in a small urban area. Arlington, Va., U.S.
Dept. of Health. Education, and Welfare
Public Health Service, 1966. 2v. in I.
Contents. -v.I. Medical care
administration-Case study no.l. pt. I.-v .2.
Medical administration-Case study no. I.
pt.2.
Studies in CNA Repository CoDection
75. Charles, Geneviève
L'infirmière...demain. Contribution à une
reflex ion sur les finalités de la profession.
Lyons, 1968. 41Op. R
76. Lanctot, Lise L'infirmière-chefet les
difficultés d'évaluation du personnel.
Montréal.I978.ll3p.Mémoire(M.N.)-
Montreal. R
77. Doucet, Stella Burton The young adult's
reported perceptions of the effect of
congenital heart disease on his life style.
Toronto, cl978. 141p. Thesis (M.Sc.N.)-
Toronto. R
78. Giovannetti, Phyllis Patient
classification systems in nursing: a
description and analysis. HyattsvilIe, Md..
U.S. Dept. of Health, Education. and
Welfare. Division of Nursing. 1978. Il3p.
(U.S.DHEWPub. no. (HRA) 78-22) R
79. Grant, Nancy Kathleen A method of
calculating nursing workload based on
individualised patient care. Edinburgh. 1977.
354p. Thesis-Edinburgh. R
80. McKenzie, Ruth H. Analysis of the use
of a computer generated staffing schedule on a
nursing unit in a general hospital. Halifax.
1978. l77p. Thesis(M.N.)-Dalhousie. R
81. McKeough, Katherine, Sister Content
analysis of verbal interaction between
psychiatric nurses and patients: an
exploratory study. Boston, 1967. 157p. Thesis
(M.Sc.N.)-Boston. R
82. Spooner, Sheila Anne. Sister Evaluation
of the quality of nursing care: a review of
selected literature, 1974-1975. Edmonton.
1976. 21p. R
83. Thurston. Norma E. Factors influencing
the construction of a nutrition knowledge test
for the elderly. Calgary, Alberta, c1978. 129p.
Thesis (M.Sc.}-Calgary. R
Audio Visual Aids
84. Association des médecins de langue
française du Canada Sonomed, série 5, no I
Montreal. 1973. I cassette. Contenu.-Côté A.
SassevilIe, Jean-Louis, L '-environnement et la
santé.-Côté B.I.Delorme, Pierre, Le
traitement de désensibilisation. 2.Séguin,
Femand, L'allergie aux piqûres d'insectes.
85. International T ele-Film Enterprises Ltd.
Film/video hospital training and health care
catalogue. Toronto, 1978? 52p.
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-
58 Februery 1871
Th. Can-.llen NUrH
Classified
Advertisements
Alberta
The Big Country Health Unit requires a Director to
commence work February I. 1979. Applicant with
Public Health experience required. This is a super-
visory position and applicant should be knowledge-
able in that field. Salary negotiable ba.ed on qualifi-
cations and experience. Apply to: Director. Big
Country Health Unit. Box 279. Hanna. Alberta, TOJ
IPO.
Operating Room Supervisor is required for a 185-bed
active and auxiliary hospital complex located in a
city 40 miles south of Edmonton. Responsibility is to
supervise and direct that department in the perfor-
mance of day to day duties as well as other
administrative duties necessary for the operation of
that department. Must have an Alberta registration
(or be eligible for) and recognized P.G. in O.R.
techniques and management. Salary is to commen-
surate with experience, qualifications and in accor-
dance with the AARN Contract. Please contact:
Miss A.M. Morrison. Director of Nursing. Wetaski-
win Hospital District No. 81. 5505-50 Avenue.
Wetaskiwin. Alberta, T9A OT4.
British Columbia
Challenge and opportunity await the nurse prepared
to accept a posilion in a lOO-bed accredited acute
care hospital in a booming northern city. We will
help the beginning practitioners to expand their
knowledge and skills. Write to: Nursing Director.
Dawson Creek and Djstrict Hospital, 1I100-\3th St.,
Dawson Creek. British Columbia. VIG 3W8.
Advertising
rates
For All
Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
Rates for display advertisements on
request.
Closing date for copy and
cancellation is 8 weeks prior to 1st
day of publication month.
The Canadian Nurses Association
does not review the personnel
policies of the hospitals and
agencies advertising in the Journal.
For authentic information,
prospective applicants should apply
to the Registered Nurses'
Association of the Province in which
they are interested in working.
Address correspondence to:
The Canadian Nurse
SO The Driveway .
Ottawa. Ontario
K2P IE2
British Columbia
oeral Duty (R.C. Registered) Nurses required for
expansion to 422 acute care accredited hospital
located 6 miles from downtown Vancouver and
within easy access to various recreational facililies..
Excellent orientation and ongoing inservice prog-
ramme. Salary 51,231.00-51,455.00 monthly. Clini-
cal areas include coronary care. intensive care,
emergency, operating room, P.A.R.R., medical/sur-
gical, pediatrics. obstetrics, orthopedics and activa-
tion units. Positions are also available for general
duty nurses in our modern extended care unit. Apply
to: Co-ordinator-Nursing, Dept. of Employee
Resources, Burnaby General Hospital, 3935 Kincaid
Street, Burnaby, British Columbia. V5G 2X6.
Ge.n1 Duty N_ for modem "I-bed accredited
hospital located on the Alaska Hialiway. Salary and
penonnet policies in accordance with the RNABe.
Temporary accommodation available in residence.
Apply: Direclor cl Nursin., Fort Nelson General
Hospital, P.O. Box 60, Fort Nelson, British Colum-
bia, VOC tRO.
oeral Duty Rqlstered Nu.... - required for
13O-bed accredited hospital. Previous experience
desirable. Staff residence available. Salary as per
RNABC contract with northern allowance. For
further information please contact: Director of
Nursing. Kitimat General Hospital, 899 Lahakas
Boulevard North. Kitimat, British Columbia, V8C
IE7.
Experienced Nurses (ehgible for B.C Registration)
required for full-time positions in our modem
300-bed Extended Care Hospital located just thirty
minutes from downtown Vancouver. Salary and
benefits according to RNABC contract. Applicants
may telephone 525-0911 to arrange for an interview.
or write giving full particulars to: Personnel Direc-
tor. Queen's Park Hospital, 315 McBride Blvd..
New Westminster, British Columbia, V3L 5EII.
Experienced Nurses (B.C. Registered) required for a
newly expanded 463-bed acute. teaching. regional
referral hospital located in the Fraser Valley. 20
minutes by freeway from Vancouver. and within
easy access of various recreational facilities. Excel-
lent orientation and continuing education program-
mes. Salary-1979 rates-51305.00-51542.00 per
month. Clinical areas include: Operating Room, Re-
covery Room. Intensive Care. Coronary Care.
Neonatal Intensive Care. Hemodialysis. Acute
Medicine. Surgery. Pediatrics. Rehabolitation and
Emergency. Apply to: Employment Manager. Royal
Columbian Hospital. 330 E. Columbia St., New
Westminster. British Columbia. V3L 3W7.
oeral Duty Nurses (eligible for B.C registration)
required for 125-bed hospital in the South Okanagan.
RNABe contract in effect. Reply in writing to:
Director of Nursing. South Okanagan General
Hospital, Box 760. Oliver. British Columbia, VOH
ITO.
Experienced tCU/CCU and Operating Room
neral
Duty Nurses required for full-time and summer relief
in a nO-bed accredited hospital in the Okanagan
Valley. Musl be eligible for B.C registration. Salary
51.305 to 51.542 per month, with differential for
special clinical preparation of not less than 6 months.
Apply to: Director of Nursing. Penticton Regional
Hospital. Penticton. British Columbia. V2A 3G6.
Shift Supervisor with previous experience required
for a 1000bed fully accrediled hospital in North
Eastern B.C Must be eligible for B.C registration.
N.U.A. course preferred. Apply: Director of
Personnel, Fort St. John General Hospital. Fort St.
John. British Columbia, VIJ IV3.
British Columbia
neral Duty Registered Nurses reqUIred for a fully
accredited lOO-bed hospital. Apply: Director of
Personnel, Fort St. John General Hospital. Fort St.
John, British Columbia, VIJ IV3.
Registered Nurses - Required immediately for a
340-bed accredited hospital in the central interior of
B.C. Registered Nurses interested in nursing posi-
tions at the Prince George Regional Hospital are
invited to make inquiries to: Director of Personnel
Services, Prince George Regional Hospital. 2000-
15th Avenue, Prince George, British Columbia V2M
IS2.
Applications are invited for teaching positions in
undergraduate and graduate programs. Master's or
higher degree and experience in clinical field
required. Positions open in July, 1979. Candidates
must be eligible for registration in B.C. Send resume
to: Dr. Marilyn Willman, Director, School of
Nursing. University of British Columbia, 2075
Wesbrook Place, Vancouver, British Columbia,
Canada, V6f IW5.
Experienced Nurse, eligible for British Columbia
registralion. required for full time posilion to take
charge of Health Care Department in IIO-bed Polish
tntermediate Care Facility. Knowledge of both the
Polish and the English language necessary. Experi-
ence and post graduate courses in Gerontology
preferred. Salary and benefits as recommended by
the Regislered Nurses Association of B.C Please
telephone the Administrator (604)438-2474 for an
interview or send resume to: 3150 Rosemont Drive,
Vancouver, British Columbia, V5S 2C9.
Manitoba
Applications. including resume and names of re-
ferees are invited for faculty with professional compe-
tence in Community and Mental Health Nursing. Re-
storative Nursing. Ameliorative Nursing and Preven-
tive Nursing (foc... on maternal and child). These
full-time positions will commence September I,
1979. Candidates should have at least a completed
Master's degree with teaching experience and a pub-
lication record. Salary and rank are commensurate
with qualifications. Apply to: Dr. Helen P. Glass.
Director. School of Nursing. University of Man-
itoba. Winnipeg, Maniloba, R3T 2N2.
Ontario
Applications now being accepted by the Onlario
Society for Crippled Children for Registered Nurses,
Graduate Nurses and Registered Nursing Assistants
for their resident summer camps located near Col-
lingwood. Port Colborne. Perth. Kirkland Lake and
London. 9 weeks-late June to late August 1979.
Various positions available-supervisory. assistant
supervisory and general cabin responsibilities. Con-
tact: Camping and Recreation Department. 350
Rumsey Road, Toronto. Ontario. M4G IR8 (416)
425-6220. Ext. 242.
Quebec
Camp Nurses required for childrens summer camp in
beautiful Quebec Laurentians. Mid-June to end of
August. Resident M.D. Contact: Mr. Herb Finkel-
berg, Director of Camp B'nai B'rith. 5151 Cote St.
Catherine Rd.. Suite 203, Montreal. Quebec. H3W
IM6, or telephone (514) 735-3669.
Nurses for Choldren's Summer Camps In Quebec. Our
member camps are located in the Laurentian Moun-
tains and Eastern Townships, within 100 mile radius
of Montreal. All camps are accredited members of
the Quebec Camping Association. Apply to: Quebec
Camping Association. 2233 Belgrave Avenue.
Montreal. Quebec. H4A 21.9. or phone 489-1541.
Saskatchewan
University of Saskatchewan College of Nursing,
with 335 undergraduate students, invites
applications ror term or rrgular appoIntments to fill
anticipated vacancies in an integrated,
conceptually-based baccalaureate nursing program.
Preference will be given to applicants with advanced
preparation in clinical specialties. The successful
applicant will be responsible for leam teaching
theory and clinical supervision of students. Salary
will be commensurate with Qualifications and
experience. Effective date of appoinlment will be
August, 1979 with closing date for receipt of
applications May 31, 1979. Further information may
be received from: Hester J. Kernen. Professor and
Dean, College of Nursing, University of
Saskatchewan. Saskatoon. Saskatchewan. S7N
OWO.
United States
Nones - RNI - Immediate Openings in
Califomia-Florida-Texas-Mississippi - if you are
experienced or a recent Graduate Nurse we can offer
you positions with exceUent salaries cl up to S1300
per month plus aU benefits. Not only are there no
fees to you whatsoever for p1acilll you, but we also
provide complete V isa and Licensure assistance at
also no cost to you. Write immediately for our
application even if there are other areas of the U.S.
that you are interested in. We will caU you upon
receipt of your application in order to IUTlUl&e for
hospttal interviews. You can call us collect if you art
an RN who is licensed by examination in Canada or
a recent Jraduate from any Canadian School '*
Nursina. Windsor Nurse Placemenl Service, P.O.
Box 1133. Great Neck, New York 11023. (5t6-487-
2818).
"Our 20th Year of World Wide Service"
Th. Can-.llen Nur..
United States
Nurslnl Opportunity - Mississippi Baptist Medical
Center. a mlijor 600-bed hospital, has immediate
posilions available for experienced RNs and recent
nursing school graduates in a variety of specialities
and medical/surgical areas. Competilive salaries.
liberal benefits. Visa, licensure and relocation
assistance provided. Located in Mississippi's capital
city of Jackson (populalion 300.(00), MBMC is the
state's largest and most modem privately operated
hospital. For further information write: Mrs.
Johnnye Weber. Nurse Recruiter. 1225 North State
Street, Jackson, Mississippi 39201: or call collect
601/968-5135.
The Best Loatlon In the Netlon - The world-
renowned Cleveland Clinic Hospital is a progres-
sive, 1020-bed acute care teaching facility committed
to excellence in eatient care. Staff Nurse positions
are currently available in several of our 61CU's and
30 departmentalized med/surg and specially divi.
sions. Starting salary range is S 13 .286 to S 15.236,
plus premium shift and unit differential. progressive
employee benefits program and a comprehensive 7
week orientation. We will sponsor the appropriate
employment visa for Qualified applicants. For
further information contact: Director - Nurse Re-
cruitment. The Cleveland Clinic Foundation, 9500
Euclid Avenue, Cleveland, Ohio, 44106 (4 hours
drive from Buffalo. N.Y.); or call collect 216-444-
5865.
C_e to Taal - Baptist Hospital of Southeast
Texas is a 400-bed growth oriented oraanization
lookilll for a few Jood R.N.'I. We feel that we can
offer you the chaUenge and opportunity to develop
and continue your professional JI'Owth. We are
located in Beaumont, a city of 150,000 with a smaU
town atmosphere but the convenience of the larac
city. We're 30 minutes from the Gulf of Mexico and
surrounded. by beautiful Irees and inland lakes.
Baptist Hospital has a progress salary plan plus a
liberal frillie packaae. We will provide your immiJ-
ration paperwork cost plus airfare to relocate. For
additional wonnation, contact: Penonnel Ad-
ministration, Baptist Hospital of Southeast Texas,
Inc., P.O. Drawer 1591, Beaumont. Texas m04. An
alllrmatlft adlon employu_
FebnIery 11171 57
United States
OR Assistant Supervisors-Expanding hospital in the
Harbor City area, located 20 miles south of Los
Angeles near the beach, has full-time day and even-
ing positions available. Minimum of four years
operating room experience with leadership
background. Prefer B.S. degree. Excellent salary
and benefits. Please send resume to: Kaiser-
Permanenter Medical Cenler. Employee Relations,
1100 W. Pacific Coast Hwy.. Harbor City, Califor-
nia. 90710 (213) 325-5111. ext. 1376.
Australia
Fernlty P...ltlons available in under-graduate instruc-
tion in: Medical-Surgical Nursing. Community
Health Nursing and Psychiatric Nursing. Dynamic
program conducted in col\iunction with a University
Hospital. Salary---commensurate with Qualifications
and experience. Senior Lecturer AS20.361-21,808.
Lecturer ASI5,179-19,939. Preference: Master's
degree, teaching and clinical experience. The In.
stitue has allowance schemes covering re-Iocation
expenses, immediate superannuation, insurance
cover and assistance with accommodation. Closing
date for applications: 3 weeks after publication of
this advertisement. Appointees are expected to lake
up duties early in 1979. Curriculum vitae and
transcripts of tertiary work to: Lydia Hebestreit.
R.N. Head. Department of Nursing, Preston Insti-
tute of Technology, Bundoora 3083 (Melbourne)
Australia.
Miscellaneous
Africa - Overland Expeditions. London/Nairobi 13
wks. London/Johannesburg 16 wks. Kenya Safaris
- 2 and 3 wk. itineraries. Europe - Camping and
hotel tours from 16 days to 9 wks. duration. For
brochures contact: Hemisphere Tours. 562 EgJinton
Ave. E., Toronto, Ontario. M4P IB9.
Saskatchewan
Careers
Saskatchewan
Careers
Senior I'ursinl Co-ordinator
Saskatchewan Social Services, Home Care Branch, Regina, requires a Senior
Nursing Co-ordinator to establish and integrate standards of care and eligibility for
services pertaimng to nursing. home making. meals and minor home repairs which
will be delivered by district home care boards. The duties will include assessment
of care needs and development and delivery of training courses for home care
staff.
Applicants should have a Bachelor of Science in Nursing. and preferably a
Master's degree with advanced training in public health. community or
rehabilitative medicine: be eligible for Registration with the Saskatchewan Nurses
Association and possess several years experience with a home care delivery or
related program.
Salary: S20.616 - S25.284 (public Health Nurse 4)
S21,48O- S26.364 (with M.Sc.N.)
Competilion: 604144-8-782 Closing: As soon as possible
Forward application forms and/or resumes to the
Saskatchewan Public Service Commission. Please
quote position, department, and competition
number on all applications and/or inquiries.
.
1111\\
Saskatchewan
Public Service
Commission
1820 Albert Street
Regina, Canada
S4P 3V7
(306) 525-8355
Registered :-'urses (R.!\/. or Graduates)
Saskatchewan Social Services. Valley View Centre. Moose Jaw. invites
applications from Registered Nurses.
Valley View Centre is the largest institution for the mentally handIcapped in the
Province of Saskalchewan. The City of Moose Jaw. wilh a population of 38.000. is
situated on the Trans-Canada Highway 45 miles west of Regina. the provincial
capital.
Applicants must have graduated from an approved school of Diploma Nursing and
will be required to register as a Regislered Nurse in the Province of
Saskatchewan.
Salary: S 12.420 - SI4.400 (Graduate Nurse)
SI3.944 - S16.164 (Nurse I)
Competition number: 604111-8-681- Nurse I
604090-8-68I-Graduate Nurse
Closing date: As soon as possible
Forward application forms and/or resumes to the
Saskatchewan Public Service Commission. Please
quote position, department, and competition
number on all applications and/or inquiries.
.
1111\\
Saskatchewan
Public Service
Commission
1820 Albert Street
Regina, Canada
S4P 3V7
(306) 525-8355
-
51 Febnlery 1871
Career Opportunities
In Mental Health Nursing
Education
Required for a proposed Post-Basic Course in
Mental Health Nursing for Registered Nurses
to begin in September, 1979.
Program Coordinator
Eligible for registration as a nurse in New
Brunswick; Master's Degree in Nursing
Education, Mental Heallh Nursing or related
field: alleast three years recent experience in
Mental Health Nursing: available preferably
May 1st.
Function: to participate in curriculum design,
coordinate, teach and evaluate the educational
program.
Instructor
Eligible for registration as a nurse in New
Brunswick: prefer a Master's Degree in
Nursing Education, Mental Health Nursing or
related field; at least three years recent
experience in mental health nursing; available
preferably June 1st.
Function: to assist the program coordinalor.
Direct inquiries to:
Acting Executive Director
New Brunswick Association of Registered
Nurses
231 Saunders Street
Fredericton, N.S. E3B IN6
Deadline: March 15, 1979
The C.nlldIen Nu...
Clinical Specialist -
Psychiatric Nursing
(Nurse 3, Nursing Educalion)
517,350- 521,500
Applications are invited for the position of
Clinical Specialist - Psychialric Nursing for a
500 bed active treatment psychiatric hospital.
The Position - The Clinical Specialist will be
required to function as a role model consultant
and as an expert praclitioner by providing
leadership to nursing staff in planning patient
care.
Qualifications: Must possess a current
certificate of competency in the Province of
Ontario and a Master's Degree in Nursing is
required.
Please send resume 10:
The Stamng Omcer
St. Thomas Psychiatric H...plta!
St. Thomas, Ontario
N5P 3V9
Want to know
how to get a job
at UCLA MedicarCenter?
I'll be touring the United States and Canada during the next few
months and I want to hear from RNs and L VNs who are interested
in m'aking a career change in either Clinical Nursing or Nursing
Administration.
Call to discuss your future with UCLA and to schedule a job
interview in your local area. I will try to visit many towns that are
usually ignored by other Recruiters, so it is imperative that you
contact me as early as possible.
uclA
Medical
Center
Call Collect:
(213) 825-8141
Mr. Tony Weatherford, R.N.
Nurse Recruiter
UCLA Medical Center
10911 Weyburn Avenue
Los Angeles, CA 90024
Ao Eo""' 0"'0""0'" Em"""" M' í
Registered Nurses
Louisiana
(New Orleans & Lake Charles)
California
(close to Los Angeles)
Georaia
(best area of Atlanta)
Acllve care accredited hospitals each have a
requirement for Canadian RN's experienced
in critical care. As the hospitals are only
interested in persons becoming registered
aliens of the USA. these positions would be
of interest to the married RN whose spouse
could not obtain a work permit under Ihe
regulation covering the H-1 temporary per-
mit. Candidates must have wriUen RN's in
Canada and received marks of 350 in all five
disciplines to obtain license by reciprocity,
Apply in confidence to W. P. Dow & Associ-
ates Ltd. (a Canadian company), SUite 309,
365 Evans Avenue, Toronto, Ontario
MaZ 1K2 (416)259-6052.
Port Saunders Hospital
Port Saunders,
Newfoundland
Requires two Registered Nurses
commencing April 1979 through to
September 1979.
Applicants must be registered or eligible
for registration with the ARNN.
Salary scale: $11,448.00-$13,955.00.
Please forward application, curriculum
vitae and references to:
Mrs. Madge Pike
Director of Nursing
Port Saunders Hospital
Port Saunders, Newfoundland
AOK 4HO
Assistant Supervisor
(Intensive Care Unit)
The successful applicant will be directly
involved in the teaching program and
assisting in administrative duties.
Clinical and teaching experience is
essential. B.sc.N. preferred. Salary
commensurate with qualifications and
experience.
Send resume to:
Personnel Department
Henderson General Hospital
711 Concession Street
Hamilton. Ontario
LSV IC3
The Central Registry of
Graduate Nurses
411 Eglinton Avenue East
Suite 500
Toronto, Ontario M4P 1M7
A non-profit organization welcomes
candidales for membership in this
prestigious group of nurses specializing
in general and private duty nursing in
hospitals and homes.
Telephone for appointment 483-4306
Switzerland
Winterthur Canton (725 bed) hospital near Zürich
needs Operating Room Nunes for the surgery clinic.
Required for immediate or future openings. We offer
pleasant working conditions. equitable hours of
work and leisure. Salary and benefits in accordance
with the regulations of the Canton of Zürich.
Five-day week. accommodation available, cafeteria.
Apply in writing to: Sekretariat Pílegedienst, Kan-
tonsspital Winterthur. CH-8401 Winterthur. Swit-
zerland.
Th. Cen-.llen Nu...
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
A V AILABLE NOW
IN ARIZONA FLORIDA
CALlFOR"IIA OIDO
TEXAS
WE PLACE AND HELP YOU WITH:
STAT.E BOARD REGISTRATION
YOUR WOR"- VISA
TEMPORARY HOUSING - ETC
A CANADIAN COUNSELLING SERVICE
PhOM: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200 LA WRENCE A VENUE EAST, SUITE 301,
DON MILLS, ONTARIO MJA ICI
NO FEE IS CHARGED
TO APPLICANTS
United States
Nursina Opponunities - Proaresaive SOO-bed Medi-
cal Center in West Texas city of AbiJene with
population nearly 100,000 is JookiJijl for ._
........... and experienced R.N.'s for positions in
O.B.. Pediatrics, Suraery. E.R., ICU, CCU, plus
surJical and medical floors. Good competitive salary
and .enerous benefits are provided. Contact: Per-
sonnel Ollice, Hendrick Medical Center, 19th and
Hickory. Abilene, Texas, 79601.
Director of Nursing Practice
The Director will be responsible for the planning.
organization and direction of nursing activities in an
accredited 555 bed active treatment teaching hospital.
The incumbent will assume responsibility for the Nursing
Quality Assurance Program.
Candidates must possess a baccalaureate degree in
Nursing. preferably with a Masters degree in the field of
Nursing. Health Care Administration, or Business
Administration. Should have considerable Nursing
Practice experience, with demonstrated competence in a
senior level Nursing Management position.
Interested applicants may submit a comprehensive
resume, including career objectives and salary
expectations to:
Director of Personnel Sen ices
Misericordia Hospital
16940 - 87 Avenue
Edmonton, Alberta T5R 4H5
Februery 1871 511
.
A V L1.
"
MEDICAL
RECRUITERS
OF AMERICA
INC.
MRA recruIts RegIstered Nurses and recenl
Graduates for hospital posilions on many
U.S CIties We provide complete Work Visa
and State Licensure information
ARLINGTON, TX. 76011
611 Ryan Plaza Dr . SUite 531
(817) 461-1451
CHICAGO. ILL. 60607
500 So Racine 5. . SUite 312
(312) 942-1146
FT. LAUDERDALE. FL. 33309
800 N W 62nd St ,.Su,te 510
(3051 712-3680
FOUNTAIN VALLEY. CA. 92708
11400 Brookhurst. SUite 213
(714) 964-2471
PHOENIX. AZ 85015
5225 N 19th Ave. SUite 212
(602) 24
1608
TAMPA. FL. 33607
1211 N Westshore Blvd. SUite 205
(813) 872-0202
ALL FEES EMPLOYER PAID
Exdte.-nt: Come and join us for year around
excitement on the border. by the sea. an unbeatable
combination. Enjoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed. acute care hospital offers the eJlperi-
enced nurse and the newly graduated nurse an array
of opportunities. We have immediate openings in all
areas. EJlcelient salary and fringe benefits. We invite
you to share the challenge ahead. Assistance with
travel eJlpenses. Write or call coUect: Joe R. Lacher,
RN. Director of Nurses. Valley Community Hospi-
tal, P.O. BOJl 4695. Brownsville. TeJlas 78521; I
(512) 831-9611.
THE DEPARTMENT OF NURSING
LONG ISLAND JEWISH-HILLSIDE MEDICAL CENTER
NEW HYDE PARK, NEW YORK
is sponsoring
QUO VADIS-NURSING?
The First International Nursing Seminar
MARCH 12 - 22,1979
In Israel
Seminar Topics: The Changing Scene in Hospital Nursing in
the U.S.A. -- Health Care System in England and the Role of
Nursing -- A Practical Approach to Nursing Process -- Nursing in
West Africa -- Nurse/Physician Joint Practice -- The Russian
Felcher and the Chinese Barefoot Doctor -- Health Care Delivery
in Iran
This Deluxe 10-day Seminar Tour is approved for CE credit by
the American Nurses Association. Seminars will be held in 5-star
hotels Ibreakfast, dinner & tours included) in Jerusalem, Haifa,
& Tel Aviv. Extension tours to Rome or Athens available. Tax
Deductible) Registration Fee $125.00
All inclusive sample tour price from lIIew York - $1,100.00-
Add on fares from home city to New York available
All fares subject to revision.
Faculty include: Rachel Rotkovitch, R.N., Program Chairman
Allan L. Abramson, M.D., New York
Beverly Bonaparte, R.N., New York
Miriam Hirschfeld, R.N.. Israel
Linda E. Jessup, R.N.. Maryland
Robert K. Match, M.D.. New York
Rheba deTornyay, R.N., Washington
-NOTE: Tour rates are available for participants traveling to the
seminar from outside the U.S.A.
For.lnfo
m
tion: Ann J. Boehme, Clinical Campus, Long Island
Jewlsh.Hlllside Medical Center, New Hyde Park. N.Y. 11042
12121 470-2114
110 Februery 1879
The Child Psychiatry
Service
Allan Memorial Institute
and the Post-graduate
Board
Royal Victoria Hospital,
McGill University
Present
A Two Day Symposium
pril6 & 7,1979
Anorexia Nervosa & Obesity: Recent
Developments
Guest Speakers
Hilde Bruch, M.D., Professor Emeritus
of Psychiatry. Baylor College of
Medicine Texas Medical Center,
Houston, Texas
Arthur Crisp, M.D., Professor,
Department of Psych iatry, St. George's
Hospital Medical School, University of
London, London. England
Paul Garfinkel, M.D., Associate
Professor. Department of Psychiatry.
University of Toronto , Toronto, Ontario
The format will include morning lectures
and panels with small group workshops
in the afternoon.
Meeting Place: Hotel Loews LaCité.
Salle Beauchemin
3625 A venue du Parc,
Montreal, Quehec,
Canada
Fees: Before March 5,1979- $100.00
{Physicians) - $75.00 (Allied
Health Professionals)
After March 5,1979- $125.00
(Phy
icians) - $100.00 (Allied
Health Professionals)
(Registration fees must be paid in
Canadian dollars and it includes 2 lunches
and coffee breaks)
Miss Denise Crépin, Post-Graduate
Board, Royal Victoria Hospital, 687 Pine
A\enue West, Montreal, Quebec
H3A IAI
'lame
Addre"s
City
State
ljp
OM.n.
(specify discipline)
o Allied Health Professionals
(specify)
o Please send me a hotel registration
card
(make cheque payable to: Post-Graduate
Board, Royal ViClorid Hospital)
Th. Can-.llen Nur..
University of British
Columbia
M.Sc. (Health Services Planning) Program
A program leading to M.Sc. (Health Services
Planning) is offered for three groups of
candidates: planners/administrators.
planners/researchers, and medical health
officers. This program is designed especially
for candidates who have been working in the
health services or as managers and, whilst
other candidates are eligible, preference will
be given 10 those with experience as the
instructors will assume that some basiç
knowledge exists. Candidates must be
graduales in health, social or life sciences or
commerce.
It is anticipated that candidates will find
appointments at relatively senior planning and
administrative levels of Canadian health
services, in health care research or
international health care planning and
adminislration. For details write:
Faculty o'Graduate Studies
University of British Columbia
2075 Wesbrook Mall
Vancouver, B.C. V6T IW5
Registered Nurses
Medicine
Surgery
We are cordially inviting applications
from registered nurses for the areas of
general medicine and surgery. These are
permanent, full-time, rotating shift
positions.
Candidates must be eligible for active
Alberta registration. Previous
experience in your area of preference
would be an asset.
Interested candidates are asked to
suhmit a comprehensive resume to:
Personnel Department
Misericordia Hospital
16940- 87 Avenue
Edmonton, Alberta
T5R 4H5
Co-ordinator of Public
Health Nursing Services
A challenging senior position responsible to
the Medical Health Officer co-ordinating all
public health nursing activities in Labrador
and northern Newfoundland served by The
International Grenfell Association. Position is
based in SI. Anthony, Ntld., and involves
considerable travel by aircraft.
Duties involve the planning, admimstering and
evaluatmg of public health nursing activities in
co-ordination with the other members oflhe
health team.
Qualifications: Master or Bachelor Degree in
nursing with major emphaSIs on public health
and administration. Experience in various
supervisory positions in public health nursing.
Salary: 518.478.00 - 523.583.00 per annum.
Vehicle provided for land operations and plane
provided for travel to coastal areas.
Accommodation provided at a reasonable rate.
Travel paid for minimum of one year service.
Apply:
Mr. Scott Smith Personnel Director
International Grenfell Association
St. Anthony, Newfoundland AOK 4S0
Foothills Hospital, Calgary,
AI berta
Advanced Neurological-
Neurosurgical Nursing for
Graduate Nurses
A five month clinical and academic
program offered by The Department of
Nursing SeIVice 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
140319 St. N. W. Calgary, Alberta
T2N 21'9
Guelph General Hospital
(Fully Accredited - 220 Beds)
Requires the SeIVices of An
Assistant Head Nurse for
New Born Nursery
The Obstetrical facilities are new and
modem providing for approximately
1500 deliveries annually.
Primarily work will be on Day Shift; a
B.Se.N. degree, Administrative and
Nursery clinical experience necessary
Applications should be addressed to:
Personnel Officer
Guelph General Hospital
115 Delhi Street
Guelph, Ontario
'lIE 4J4
O.R. Supervisor
Required immediately by an active 100
bed acute care and 40 bed extended care
hospital. Must be eligible for B.C.
Registration. Post graduate training and
experience necessary.
Salary $1,477.00 to $1 ,740.00 per month
(1978 rates).
Apply in writing 10:
The Director of Nursing
G.R. Baker Memorial Hospital
543 Front Street
Quesnel, B.C.
V2J 2K7 (604) 992-2181
February 11171 81
The Cen-.llan Nur..
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Registered Nurse in search of a change and a challenge -
look into nursing opportunities at Vancouver General Hospital, B.C.'s
ml\Îor medical centre on Canada's unconventional West Coast. Staffing
expansion has resulted in many new nursing positions at all levels,
including:
General Duty ($1231-1455.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the opportunity
you've been looking for.
For !hose with an inlerest in specialization. challenges await in many
areas such as:
Neonatology Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Burn Unit
Paediatrics
Inservice Education
Coronary Care Unit
Hyperalimentation
Program
Renal Dialysis & Transplantation
If you are a Nurse considering a mOve please subnut resume to:
Mrs. J. MacPhail
Employee Relations
VanCCHlver General Hospital
855 West 12th Avenue
Vancouver. B.C. V5Z IM9
( OPPæTUNITY A It:rJra
Nurse/Psychiatric Nurse
Graduates from approved Schools of Nursing and with eligibility
for registration with the appropriate Professional Associations in
Alberta, are invited to apply for Psychiatric Nurse I and Nurse I
positions at the Michener Centre in Red Deer. Alberta. Michener
Centre provides residential care and training for approximately
1,700 developmentally handicapped residents. Nurses will
participate in life skills programming for the residents in addition
to providing general duty nursing responsibilities.
Salary $12,804- $15.060 (Currently Under Review)
Competition no. 9184-18
This competition will remain open until a suitable candidate has
been selected.
Apply To:
Personnel Administrator
The Michener Centre
Box 5002
Red Deer, Alberta
T4N 5HI
Phone: 403-343-5610
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"They encour
e responsibili
And that makes me want
to do a better job:'
As a nurse at Saillt Joseph, you are involved.
You are encouraged to fully express your ideas.
To take advantage of your education and experi-
ence. In both team and primary nursing, you are
part of a progressive
system of medical care
that focuses on the patient 'U our fOI future
as a person. To learn all J
about Saillt Joseph Hospital, at SaintJoc>anI, .
salaries, liberal benefits and
ital
I
more - send the coupon. .I
\'PVORTH TEXAS :.}\lg:
-----------------------------------------.
Gay Cole, Nurse Recruiter
Saint Joseph Hospital 1401 South Main Street
Fort Worth, Texas 76104 U.S.A. Phone: 817/336-9371
CN-2-79
Name
Address
City
Phone
State
RND
Zip
Student 0
L________________________________________.
-
12 Februery 11171
School of Nursing
requires:
Program Co-ordinator -
July 9, 1979
Teachers - April 1 and
August I, 1979
Inquiries are invited for these facullY positions
in a hospital based two-year diploma nursing
program which uses an individualized
learning-teaching approach.
Eligible forM.A.R.N. registration. Bachelor's
Degree in Nursing and a minimum of one
year's clinical practice experience required for
teacher positions.
Master's Degree in Nursing with appropriate
experience in program planning, curriculum
development and teaching preferred for
program co-ordinator position.
Apply sending resume to:
Shirley J. Paine
Director of Nursing EducatIOn
School of Nursing
Brandon General Hospital
ISO McTavish Ave. E.
Brandon, Manitoba. R7A 2B3
The Cen-.llan Nur..
Community Health Nurse
A Community Nurse is required to assist in the
developing of a combined primary care and
community health program for the t ndian
people of North Battleford and the
surrounding reserves. The program is being
developed and run by th
community and staff
and will employ a team approach with an
emphasis on health promotion and education.
Candidate should possess a B.Sc. (Nursing)
and some experience or special training in
Public Health. Community Health or primary
care.
Applicants must be sensitive to community and
individual needs and be willing to develop new
approaches to delivery of health care services.
Write or phone in confidence to:
Ron Albert, Executive Director
Battleford's Indian Health Centre Inc.
P.O. Box 250
North Battleford, Saskatchewan
S9A 2YI
Memorial University of
Newfoundland
School of Nursing
Positions are available for the 1979-80 academic year in
. Medical-Surgical Nursing
. Psychiatric Nursing
. Community-Health Nursing
. Maternal-Child Nursing
. Primary Care Nursing
. And also for a Pediatric Nurse Practitioner
Master's Degree in clinical specialty and teaching experience
is required.
Salary commensurate with educational preparation and experience.
Send curriculum vitae and names of three referees to:
Miss Margaret D. McLean
Professor and Director, School of Nursing
Memorial University of Newfoundland
St. John's, Newfoundland AIC 587
Canada
Before accepting any ....
position in the U.S.A.
PLEASE CALL US
COLLECT
We Can Otter You:
A) Selection of hospitals throughout
the U_S.A.
B) ExtenSive information regarding
Hospita
Area. Cost of Living. etc.
C) Complete Licensure and Visa Service
Our Services to you are at
absolutely no tee to you.
WINDSOR NURSE
PLACEMENT SERVICE
P.o. Box 1133 Great Neck, N.Y.
(516) 487-2818
.... Our 20th Year of World Wide Service ...III
Royal Australian Nursing
Federation
(Victorian Branch)
Research Officer
Community Nursing Practice
Applications are invited from interested nurses
to undenake a study of community nursing
practice in Victoria, Australia.
The projec.t will cover areas such as
professional role definition throughout the
range of practice settings: educational
preparation required for practice: terms and
conditions of employment: and career
opportunities.
Research qualifications and experience
essential.
Research grant available.
Further information may be obtained from:-
(Miss) ShirJey M. Maddocks
Secretary
RANF (Vie. Branch)
314 St. Kilda Road
Melbourne, Vie. 3004
Australia
Vancouver, B.C.
Shaughnessy Hospital
Our active 1100 bed teaching hospital has
immediate openings for BC eligible
registered nurses in intensive care
related areas and on medical and surgical
wards.
For further information apply to:
Employee Relations Department
Shaughnessy Hospital
4500 Oak Street
Vancouver, B.C.
V6H 3NI
(604) 876-6767
- ,it. -ute
· " RN '
., ",""".' S · · ·
." l Help Preserve
.. the "Life"
"Life Flight"
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While our Life Flight helicopters are impressive pieces of
medical care equipment, the indispensible part of our program
is our staff. Without skilled and dedicated patient care experts,
our specialty programs would never get off the ground.
If you're a nurse with training in a particular area,
especially surgical nursing, why not take off on a new
career opportunity based on the Primary Nursing
framework-each patient has one nurse who directs,
plans and implements patient care with the physician.
And for nurses without special training, or for recent
nursing graduates looking for a flying start, Her-
mann Hospital will provide additional training with
full pay while you learn.
For further information and details about our com-
prehensive benefits package, please complete and
mail the coupon below. Or call Ms. Beverly Preble.
Nurse Recruiter, (713) 797-3000.
The Cen-.llen Nur..
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Name
Address
City
State
Phone
Specific Area of Interest
(Circle) RN LVN Student Nurse
All: Nurse Recruiter -1203 Ross Sterling
Texas Medical Center - Houston, Texas 11030
Zip
Febru.ry 11171 13
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OOI at Houston s
HERMANN HOSPITAL
HOUSTON'S LIfE .
FLIGHT HOSPITAl
An equal opportunIty employer " I. handIcapped
-
14 Februery 11171
The Cen-.ll.n Nu...
ep
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can go a long way
, ., to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either- because
there are educational opportunities such as in-
service training and some financial support for
educational studies.
For further information on Nursing opportunities in
Canada's Northern Health Service, please write to:
ø........,
I Medical Services Branch I
Department of National Health and Welfare
Ottawa, Ontario K1A OL3
I Name. I
I Address I
I City . Provo I
I .. Health and Welfare Sanlé eI Blen-êlre social I
Canada Canada
,.........,
Index to
Advertisers
February 1979
Abbott Laboratories
Cover 3
Ayerst Laboratories
7
The Canadian Nurse's Cap Reg'd
4
The Central Registry of Graduates Nurses
59
CI BA Pharmaceuticals
54. Cover 4
The Clinic Shoemakers
2
Equity Medical Supply Company
55
Eschmann Canada Limited
49
Health Care Services Upjohn Limited
53
Hollister Limited
10
J. B. Lippincott Co. of Canada Limited
50,51
Long Island Jewish Hillside Medical Center
59
The C. V. Mosby Company LimiIed
12. 13, 14, 15
Posey Company
54
Procter & Gamble
48
W. B. Saunders Company Canada Limited
5
White Sister Uniform Inc.
Cover 2
Adl'ertising Manager
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P I E2
Telephone: (613) 237-2133
Advertising Repre.fentallves
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
Jean Malboeuf
60 I, Côte Vertu
St-Laurent. Québec H4L IX8
Téléphone: (514) 748-6561
Gordon Tiffin
190 Main Street
Unionville, Ontario L3R 2G9
Telephone: (416) 297-2030
Member of Canadian
Circulations Audit Board Inc.
1m.:]
BUTTER FLY *
the ".,ged ill usion set of choice
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folk"
Prophylactic iron and folic acid supplementation recently, a number of physicians have queried the
during pregnancy is now an accepted practice effect of oral contraceptives on serum folate levels
among Canadian physicians. It has also been in women. Dr. Streiff reports: "This complication
established, through the publication in 1974 of (of oral contraceptive. therapy), however, may be
Nutrition Canada!, that many Canadian women recognized more frequently in the future... Folate
may not be obtaining the necessary nutritional deficiency associated with oral administration of
requirements from their diets. For instance, 76.1 % contraceptives does not necessarily require
of adult women (20-39) had inadequate or less than discontinuance of the drug regimen but folic acid
adequate intake of iron and 67.9% were at high or therapy is definitely indicated."2
moderate risk of low serum folate levels. More
CIBA
Dorval, Quebec
woe: 1 R1
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OUi OF Lj:RARY
. Home care, a Canadian study
plus a report from England
. Tips on updating your nursing
care plan format
. Road to recovery, a first person
account by a CV A patient and his
nurse
. Offshore islands beckon nurses
i
The
Can.
Nune
BIBLIOTHEQUE
SCIENCES INFIRMIERES
Ia
.
MARCH
1979
L
SCLf&OL Of I t;1 H' Iv " '1974
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Available at leading department stores and specialty shops across Canad
The
Canadian
Nurse
March 1979
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number 3
Input 4 You and the law Corinne Sklar 14
News 6 Nursing: nineteen-eighty-floor Lawrence N ightingown 17
Books 52 Case load: over seventy-five Mary Gibbon 20
Library Update 52 Not all patients need hospitals Arlene A ish 23
Frank's story Frank Halligan.
Lori Whittington Hunt 26
Bridging the gap between AgnesT. H. Choi-Lao. ,
education and service Marion S. Logan 34
Nursing care plans: a vital tool Alida Sih'erthorn 36
.
A trip to the islands Rosalind House 42
That's no nurse!
That's my mother! Celia Nichol 45
CNA Financial Statements
and Auditors' Report 49
of ....
@
, '1
+ -::" -
.........
. , -:- ril
0 ...
-- ......
CJ . i .
.
Nursing past and present is on
di
play in the CNA Archives.
An important part ofthis
display are the nursing school
pins donated to your
professional association over
the years. The pins on this
March cover were added to
the collection, which now
numbers close to 100 pins,
during the past year. Nurses
wishing to have their school
represented should contact
the Librarian. CNA House.
COVER PHOTO: AI Patrick
Photography Ltd.. Ottawa.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts
should be typed double-spaced. Send
original and carbon. All articles must
be submitted for the exclusive use of
The Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Canadian Nurses Association,
50 The Dnveway, Ottawa, Canada,
K2P IE2.
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medicus, Canadian Periodical
Index. The Canadian Nurse is
available in microfonn from Xerox
University Microfilms, Ann Arbor,
Michigan 48106.
Subscription Rates: Canada: one
year. $10,00: two years, $18.00.
Foreign: one year. $12.00; two
years. $22.00. Single copies: $1.50
each. Make cheques or money
orders payable to the Canadian
Nurses Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number, in a
provincial/territorial nurses
association where applicable. Not
'responsible for journals lost in mail
due [0 errors in address.
Postage paid in cash at third class rate
Toronto, Ontario. Pennit No. 10539.
Canadian Nurses Association, 1978.
Z ..rch 111711
Th. C....dl.n Nur..
CAN
I HE:LP IT IF
I
DE:AUTIFUL?
,
.
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. . .
THE
CLINIC
Yes, I'm proud to be one of your newest Clinic
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I'll bring you the same fit and comfort you've
learned to expect from Clinic, America's Number
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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-3,7912 BonhommeAve.
. St. Louis. Mo. 63105
The Can-.ll.n Nur..
"'rch 11179 3
perspective
(]
o 0 8
80
15 @
0@@ @ø
8e
@@C0
I\.e} to cover photo:
/. Brcmdon General HfJspital
Training School for Nurses,
Brandon. Man.. 19:!0.
2. StrtltfòrdGeneral H ospiral
Stratford,Ont.
3. SailllJohnGeneral Public
H ospiwl, St. John. N. 8..
1888-1930.
4. Jlac/.. Trtlining School,
19:!4. St. Catharines General
and Murine Hospital, St.
Catharines,Ont.
5. Rusumund Memorial
Hospital, Almonte,Ont.,
19:!:!-:!6.
6. Mack Training Schuol,
1950. St. CutharinesGeneral
and M lrine Hospital, St.
Catharines,Ont.
7. Holv Cross Hospital,
Calgary, Alberta.
8. Hópital St. Vincent de
Paul, Sherbrooke, Qué., 1930.
9. SUSki/toon City Hospital,
S cllOOI of Nursing,
Saskatoon, Sask., 1936.
/0. RoyalColumbian
Hospital, New Westminster,
B.C., 1923.
/ /. Victoria General Hospital,
Halifax, N.S., 1974.
/2. Phillips' Training School
of the Homeopathic Hospital
ufMontreal, Montreal, Qué.,
1894-1951.
/3. C harlolle Eleanor
Englehart Hospiral, Petrolia,
Ont., 1911-1935.
/4. Queen Elizabeth Hospital
of the Montreal School of
Nursing, Montreal. Qué.,
1951-1972.
/5. Phillips School of
Nursing. Nichols Hospital,
Peterborough, Ont., 1939.
/6. Hótel-Dieu de Gaspé.
Gaspé, Qué.. 1950.
/7. OtlawaCidc Hospital,
Ottawa, Ont., 1929.
/8. Misericordia Hospital,
Winnipeg, Man., 1925..
/9. Pro
'idence Hospital,
MooseJaw, Sask.. 1920-1970.
20. Onrario Hospital Trtlining
School, 1935.
2/. NeepawaGeneral
Hospital, Neepawa, Man.,
1942.
n. St. Boniface Hospital.
Winnipeg, Man., 1934.
23. York RegionalSchuol of
Nursing. Toronto, Ont.,
1%7-1973.
24. Saint John General
Hospital. St.John. N.B.,
1930-1958.
25. G reat War Memorial
Hospital, Perth, Ont.. 1929.
26. Saskatoon Citv Hospital
SchoulofNursing,
Saskatoon, Sask., 1918.
27. Memorial Hospiral, St.
Thomas,Ont., 1931.
28. JohnH. Stratford
Hospital Training Schoolfor
Nurses, Brantford,Ont.,
1900-1910.
29. JohnH. Stratford
Hospital Training School for
Nurses, Brantford,Ont.,
1888-1900.
30. BrantfordGeneral
Hospital, Brantford,Ont.,
1912-1974
l
Question: What disease is
relatively simple to control.
requires a low cost regimen
and relatively little medical
supervision but nevertheless
continues to rank among the
top killers in this country?
Answer: If you recognized
high blood pressure as the
culprit, you'll want to read
more about this chronic,
serious disease in next
month's Canadian Nurse. The
April issue will feature a
nursing update on a variety of
aspects of high blood
pressure, including a report on
an Ontario study which found
that nurses working in the
business or industrial
community do have a definite
role to play in helping patients
control this disease.
Related features include a
report on an Ontario Task
Force on Blood Pressure
Screening Programs, a review
of current drug therapy and a
look at the part that exercise
and diet have to play in
controlling hypertension.
Don't forget, April is
Hypertension Month across
the country.
In this issue: Noted nursel
researcher Mary Gibbon
reports on the results of a
study she directed in Southern
Ontario on the ways that
community health nurses can
be most effective in the care
that they are able to offer the
growing number of senior
citizens whom they visit
regularly in their homes. Mary
Gibbon is director of the
Hamilton-Dundas Branch of
the V ictorian Order of Nurses
and her report begins on page
20.
EDITOR
ANNE BESHARAH
ASSISTANT EDITORS
LYNDA FlTZPAllUCK
SANDRA LEFORT
.
PRODUCTION ASSISTANT
GITA FELDMAN
CIRCULATION MANAGER
PIERRETIE HOTIE
ADVERTISING MANAGER
GERRY KAVANAUGH
CNA EXECUTIVE DIRECTOR
HELEN K MUSSALLEM
GRAPHIC DESIGN
ACARTGRAPHICS
EDITORIAL ADVISORS
MATHILDE BAZINET.
chairman, Health ScIences
Depanment. Canadore College,
Nonh Bay, Ontario.
OOROTHY MILLER,publlc
r
/ations offic
r, Registered
Nurses Associalion of Nova
Scotia.
JERRY MILLER,dir
ctorof
communication s
rvic
s ,
Registered Nurses Assoctation 0(
British Columbia.
JEAN PASSMORE.f'dilOr.
SRNA news bulletin, Registered
Nurses Association of
Saskatchewan.
PETER SM ITH. dir
ctor of
publications, National Gallery of
Canada.
FLORIT A
VIALLE-SOUBRANNE,
consultant. professional
inspection division Order of
Nurses of Quebec.
-
4 M.rch 1171
The Cen-.ll.n Nur..
input
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed.
although the author's name may' be
withheld on request.
Solving our health inefficiently and not working demonstrate their capable of performing. In this
problems hard enough to meet the responsibility to the patient. respect our press release has
Helen Taylor, president demand for services which The intrusion of a "third met with success.
of the Canadian Nurses obviously exists. An party" scheme is hardly an -Helen Taylor, president.
Association, has stated that over-extended emergency argument; physicians, Canadian Nurses
doctors should be on salary. department is a hospital patients, and insurance Association.
She has also advocated the administrative problem, and companies have enjoyed Still going strong
use of community clinics to the presence of a nearby compatible relationships in Last summer, The
help cluttered hospital community clinic is not going North America for many Canadian Nurse reported in
emergency wards, and I to solve that problem. years. Still, it was that very the News section that
understand that she is 3. The nurse practitioner is a concern about high cost, low McMaster's Educational
advocating wider use of nurse valuable member of the health efficiency, and inequity of Program for Nurses in
practitioners. care team but many nurses care that has provoked Primary Care (Nurse
Let us take these topics politicians to assume greater
one by one: with whom I have spoken control in the direction and Practitioner Program) was
have indicated reluctance to delivery of our health being discontinued.
1. Placing doctors on salary. work in isolation. After all. I am pleased to report to
The physician-patient they will be practicing services. you that the Ontario Ministry
relationship is a subtle one medicine and if things go While it is not being of Colleges and Universities,
and involving a "third party" wrong they are liable to be suggested that physicians' with the support of the
intrudes on a closed and very sued for negligence. In our offices and group practices Ministry of Health, has agreed
special two-party system as society nurses working in the cease to exist, the need is to make funds available to
has been pointed out by Dr. primary care field appear to be apparent for alternative support the program for
facilities where good health
Walter C. MacKenzie, Dean most comfortable working in practices can be learned by another year.
Emeritus of the Faculty of close association with a The concept of the
Medicine at the University of physician. There is a our citizens and illness be program continues to be
Alberta and past president of tremendous amount of good either prevented or detected strongly supported by the
the Royal College of work that the registered nurse early. The nurse has an Faculty of Health Sciences,
especially important function
Physicians and Surgeons of in such a setting can do if the in such settings. Expensive McMaster University.
Canada. Doctors on salary are practitioner is prepared to medical services are -DorothyJ. Kergin. R.N.,
responsible primarily to those delegate work to his nurse. I frequently not required and Ph .D., Associate Dean of
who employ them. I assume would have thought that Health Sciences (Nursing),
that Helen Taylor is Helen Taylor should be the physician is valued greater McMaster University,
where his skills are more
suggesting that the state be the spending her efforts in appropriately utilized. When Hamilton, Ontario.
employer. How naive. when persuading doctors to health and medical Clarification
all the evidence shows that delegate, delegate, delegate, diagnosticltreatment centers The College of Nurses of
state-run enterprises pay little rather than advocating that are sufficiently available, Ontario gives encouragement
attention to cost effectiveness nurses set up shop on their hospital emergency to its registrants to apply the
so that high costs combine own.
with low efficiency. The I doubt very much departments will likewise be College's "Standards of
AuditorGeneral's report is whether the views stated in more effectively used for the Nursing Practice for
further evidence of this. the interview express the purposes they were Registered Nurses and
established. Registered Nursing
2. In most communities there feelings and sentiments of the The November 1978 Assistants" in everyday
are medical professional great majority of the members press release, which elicited practice. The College does not
buildings in which physicians, of her association. Dr. A.G. Dawrant's have specialty registers fór
assisted by their nursing staff, -Dr. A.G. Dawrant, comments endeavored to those who enter special fields
provide service. Usually there president. Canadian interpret nursing to the of nursing, such as
are X-ray and laboratory A ssoâlltionfor Independence Canadian public. Nurses work occupational health nursing.
facilities. I s Helen Taylor in Medicine. in a multiplicity of settings but A news item in the
suggesting that these The president responds: it was not suggested that January issue ofCNJ stated
professional buildings be It is difficult to believe nurses hang out their personal that the plans of the Ontario
phased out and replaced by that a salaried physician could shingles. This has never been Occupational Health Nurses
"community clinics?" The not obtain the same advocated by the Canadian Association (for certification)
emergency department of the confidence and trust of his Nurses Association. have received the support of
local hospital is an appropriate patient as one who provides It has been most the College of Nurses of
place to give first line care on a fee-for-service basis. gratifying to also receive Ontario. I would like to clarify
treatment during the evening An increasing number of reports from the public that the College does not have
and night and any emergency physicians in this country are indicating their interest and the power to officially endorse
rooms which are cluttered are salaried and they, like nurses, new appreciation of the or support certification
probably being run have every opportunity to functions that nurses are programs.
The Can-.llen Nur..
llerch 1171 II
t!I(I
Ii!
.
The staff may give
encouragement to colleagues
in their development of a plan
to upgrade the nursing
practice of a group of
registrants but this should not
be construed as official
support.
--.loanc. Macdonald,
Reg.N., director, College of
Nurses of Ontario.
Oops!
In the November 1978
issue ofThe Canadian Nurse. a
report was printed in the
"News" section on the Ontario
organization of emergency
nurses and a recent
interdisciplinary meeting
attended by them.
The article states that
Ontario has the only organized
group of emergency nurses in
Canada. Actually. this is not
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FORCEPS (Kell,)
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"'IIIIIIIIII!I
In lbe "'a'V'tI.
an accurate statement.
The province of B.C. has
an active. well-organized
group of emergency nurses
affiliated with the RNABC
Our chapter hosted a
well-attended seminar in
October 1978 forthe three
disciplines of emergency
health care. It also featured a
basic CPR certification
workshop.
Our organization may not
boast the longevity of the
ENAO. but we have been a
recognized. organized group
for the past three years.
-K.L. Murray, R.N.,
Kamloops Chapter, E.N.G. of
B.C.
Editor's note: Our apologies
for the editorial oversight.
CNJ would be pleased to hear
from other emergency nursing
groups across the country.
MERCURY TYPE. The ulhme.e In
eccur.ac)' Folc:!a InlO hgl'll but rugged
mer.., c... HN"Y
duly Velcro cull and
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to hi your pocket
121 H compte...
UASES PENLIGHT. Po*ertul beam 'oreumlneuon 01
ttuoal .IC Durable staml..s-sleel case wlln pocket
Clip "".ade In USA NO 28 S5 H comple'. with
bi!.ter1... Economy model wi.tI ctlromeø bras. C&M
t.Jo 29 12 ".
NURSES WHITE CAP CLIPS. Mede In Canaøe tor
Cenad..n nurse. Slro
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NURSES 4 COLOUR PEN lor recOrdlnv ,emþeretunt.
bloo<l pre.aunt, e.e One-tland Op.ratlon S.lecl
,
c.,..cJi blu. or QrH" No 32 12 2t ..d.
Another country
My compliments on your
excellent issue of October.
1978 on the Canadian Indian.
I write from an
acknowledged developing
country (papua New Guinea).
yet I see many parallels to
situations in our own
developed Canada. It is a sign
of maturity for Canadian
people to recognize that there
is as much disparity within our
country as on an international
scene.
Please continue to give
press to these issues so that
we, as health workers, can
give our support to
movements towards justice.
-Gerri Dickson, R.N.,
B.S.N. '69, University of
Sas/...atchewan.
"' NURSES CAP TACS
Gold p'.'ed, hOld. your ap
it alnpe hrmly In place Non-
IWISI'ealur. No 30' RN.
wiltl Cedu
a or No 30"
plain Ceduceua U.e5 I pro
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comp.-.nmenla lor þena.
sCI'eors. elc plus ctlange
poc"'e' and key ctlain
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No 5M11.e5..ctt.
'
MEASURING TAPE
In .Irong plaSlte case
Puatl button lor ap
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r.lurn Med. 01 durabl.
IIn.n Measures 10 18
on one s de. 200 cm on
rewu.. .....5 e.ctI.
Our speciaJ chiJdren
Amen to your January
article on caring for retarded
children in acute care
hospitals by Brigid Peer.
As a parent whose
daughter spent four months of
last year in such a setting. I
feel there is a big need for
good communication between
staff. parent and child. As
they enter hospital both
parent and child experience a
threat to their security.
So. nurses. take a minute
in that rushed and busy day to
lend an ear. It will not be
forgotten; nor will the extra
cuddle that returns a smile
telling you that these children
are indeed "special".
-Sue A nderson, R.N.,
Victoria, B.C.
.
.
No !\I01 ':.
..:,:::====
No 5102 Pr.ctlcal Num
NURSES EA....INGS. For pierced 1010.503 Num-. Akla
ears aalnty C.:ru
U8 in gold p"fa All sa 61 eech
w,th gold IIlled poata BMutlfully
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gl:
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MEMO. TIME". Time tl01 O.cks. tlMI J'
lamp.. par'- m.l.rs Remember 10
check vl.al Signs. g''4 medl
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Llgtllwe;flhl. compacl (1 \Iz ch.) "18 ... to'
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power1ul magnl'Ylng I.ns, 3
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,.. No 308 HI.IS MCI'I.
No 308A As aboYe but in pla.,k: pouctl HI.e5 M.
ENGRAVED NAME-PINS IN 4 SMART STYLES - SIX DIFFERENT COLOURS...
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TOO"DER NAME 'INS . SEND TO EOUITY MEOICAL SUPPlY CO PLEASE
: FILL IN LETTERING POBOX 726--S, BROCKVILLE, ONT K8V 5VI PRINT!
:
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:
; 1aliina _ _ _ _ _ ____________ _ _... _____________ 2lNl1lne_ _ _ _ _ _ _ - - _ -- - - - - -- - -- - -- II. .un 10 enclo.e your name anØ .dd......
: PLEASE PRINT TYPE "LL"'NSH"
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SOLID PLEXIGLASS...Moldftd lrom SOlid PI.k,gla. MOlher .... ... U 2t as.2t
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ALL ITEMS.
CAP STRIPES
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TOTAL ENCLOSED
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..................................................................................... .................................. ...............................
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news
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Communications specialists from the eleven CNA
provincial/territorial association members met in CNA House in
January to share mutual concerns lmd to determine ways of
collaborating in the vital areas of public relations which
includes press cO\'erage ofprm'incial and ntuional e\'e1lts and
the presentation of a united approach in dealing with major
issues. The meeting was chaired bv Bert Prime. CNA's Public
Relations Officer and attended by Jerry Miller,
Communications Officer. RNABC; Brendll Laing, I nformation
Ontario nurses oppose possible
internship program for students
The two presidents of the
licensing body and
professional association for
registered nurses in the
province of Ontario have
issued djoint statement
condemning any possible
move by the Ministry of
Colleges and Universities to
solve the dilemma of nursing
education in that province by
adding a vocational training
period to the existing basic
nursmg program.
Irmajean Bajnok,
president of the Regi
tered
Nurses Association of Ontario
(RNAO). and Helen Evans,
head of the College of Nurses
of Ontario (CNO), made
public their opposition to the
po
sibility of an internship
program for student nurses in
ajoint statement i<;sued in late
January.
The Ontario situation is
characterized by an
acknowledged gap between
the objective!> of educational
institutions to prepare a
competent basic nurse and the
expectations of employers to
hire a more experienced
nurse. It is further
compounded by the rapidly
changing health care delivery
system.
"It is well known that the
Ministry of Health is
attempting to
de-institutionalize health
care. " RN AO president
Bajnok comments. "On the
other hand the Ministry of
Colleges and Universities
appears to want nurses to be
educated with more emphasis
in the care of the acutely ill."
A Review of the
Two-Year Diploma Nursing
Program in Colleges oj
Applied Arts lmdTecllflology
in Ontario. a study
commissioned by the Ministry
of Colleges and Universities
and prepared by ARA
Officer. AARN; Marie LammeI'. Communications Officer,
SRNA; Jean Cummings, Business Manager and Public
Relations. MARN; Carole Elliott , Communications Officer,
RNAO; Jean-Claude Patenaude, Director ofl nformation. The
Order of Nurses of Quebec; George Bergeron, Liaison Officer.
N BA RN: Dorothy Gray Miller, Puhlic Relations Officer.
RNANS; Laurie Fraser. Executive Secretary, ANPEI; Phyllis
Barrett, ExecutÎl'e Secretary, ARNN; and Rusty Stewart.
Public Relations Officer. NWTRNA.
Consultants. was released in
June 1978. Since then. nursing
groups and other groups
across the province have
submitted responses to the
Ministry of Colleges and
Universities so that the
decisions made about diploma
nursing education would
reflect input from professional
health care workers.
The study was
commissioned in order to
determine the effectiveness of
the new two-year graduate. It
found that the educational
objectives are to produce a
graduate who can function as
a competent beginning
practitioner and meets
standards set by the College of
Nurse
. The employer's
dissatisfaction is based on hi<;
perception ofthe graduate's
ability to meet individual
employment setting
expectations.
"Both RNAO andCNO
have stated clearly in their
responses to the study that
programs could be
strengthened by internal
program changes in order to
solve this dilemma," CNO
president Evans observes.
"For example, a
re-organization to lengthen
the pre-graduate clinical
experience is a possibility.
"We at RNAO and CNO
have purposely avoided
suggestions that there be an
internship for students in
diploma nursing programs,"
the two presidents observed.
"A provincially imposed
internship will not solve the
dilemma but will raise many
questions, such as:
What would be the major
objectives of such an
internship? Who will organize
such a component in nursing
education? Will students be
placed under thejurisdiction
of the employer or the
educational institution? Will
such a change really have the
desired effect on the new
graduate's ability to function?
And, indeed. how will such an
effect be measured? How will
the resultant overcrowding in
the clinical settings be
handled?"
''The College of Nurses
registers only those graduates
Tile Canacl..n Nur..
who are competent to
practice," according to
President Evans. "Every
nursing student must undergo
a minimum of 1200 hours of
supervised clinical nursing
experience during the basic
program. No valid data has
surfaced to prove that
additional vocational training
is warranted," she continued.
The two nursing
spokesmen are also concerned
about the financial
implications of an internship.
They ask: What salary would
a nurse intern receive? What
would the yearly influx of
3,000 nurse interns do to the
tight employment situation in
our hospitals?
"Both RNAO and CNO
question that the leadership
and supervisory skills
identified as weaknesses in
the study would be enhanced
by an add-on internship. To
implement additional
vocational training would not
be cost effective. Until all the
questions we have raised are
answered, we strongly oppose
a
top-gap measure. We
believe that strengthening the
two-year diploma program-
without a vocational training
add-on - is the answer. ..
Occupational health
prograrnlaunched
McMaster's Faculty of Health
Sciences is launching a
diploma program on
occupational health and safety
in February, 1979. One of the
first of its kind in Canada, it
will be open to doctors,
nurses, industrial hygienists,
safety engineers and
ergonomists.
Working in an
interdisciplinary program
these health professionals will
continue their normal
employment in the
occupational health field while
developing a rigorous and
analytical approach to the
solution of the problems in the
work place.
Faculty will be drawn
from McMaster University.
the University of Toronto,
industry and government and
includes a number of
well-known experts in the
field.
Students must possess a
university degree or the
equivalent and be employed in
an industrial setting. Much of
the funding is being provided
by the Ontario Ministry of
Labour through Wintario
Funds.
WHO to award
health fellowships
The World Health
Organization is once more
inviting applications from
Canadian citizens engaged in a
professional capacity in
operational or educational
aspects of health care.
The fellowships have a
total value of close to $40,000
and are to be used to provide
the winners with short (two to
three months) programs of
study abroad.
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 they gain during
their fellowship. Final
acceptance will be the
responsibility of WHO.
Persons who are
ineligible for the awards
include workers in pure
research, undergraduate and
graduate students and
applicants more than 55 years
of age.
Requests for information
should be directed to:
International Health Sen'ices,
Brooke Cluxton Building,
Tunney's Pasture, Ottawa,
Canada, KIA OK9.
llerch 11711 7
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Newly appointed members of CNA 's Testing Service Nursing
Assistants Blueprint Committee met for the first time at
CNA House in January, 1979. The purpose of the five-day
meeting was to develop an outline of the content to be used
on the future examination. Above. Chairman Verna Sylvestre
leads the memhers of the committee in discussion.
Committee members include Joan Kennedy, Francis
Johnson, Marie Pittaway, Janet Gray, Freida Marfell, Verna
Steffierand Judith Pemberton.
RNABC submits election resolution
The Registered Nurses
Association of British
Columbia has responded to
the call for resolutions
published in the December
issue of The Canadian Nurse
and L'infirmière canadienne
for presentation to the annual
meeting of the Canadian
Nurses Association on March
29th.
The notice called on
individual members and
association members ofCNA
to submit resolutions to CNA
by February 1st, 1979.
Although no resolutions
submitted by individual or
association members after
that date can be presented to
the annual meeting. voting
delegates may submit motions
pertaining to the business of
the annual meeting during the
course of that meeting.
The RNASC resolution,
which will be considered by
CNA directors before
presentation to the voting
delegates, is as follows:
WHEREAS. one of the most
important responsibilities of
CNA delegates is the election
of the Board of Directors; and
WHEREAS, any given
biennium may be the first for
many delegates. who may be
unfamiliar with the election
process and the candidates;
and
WHEREAS. the candidates for
office. in accepting the
challenges associated with
running for election deserve
an opportunity to present their
platforms;
RESOLVED. that the CNA
Board of Directors make
provision in all future
biennium agendas for each
candidate to address the
delegates prior to the voting
session.
Improved care
urged by RNABC
Government regulations
should be changed to assure
better care for residents of
personal and intermediate
care facilities, according to a
brief submitted in late
December to B.C. health
minister Bob McClelland by
the Registered Nurses'
Association of B.C.
RNABe seeks revisions
of regulations under the
Community Care Facilities
Licensing Act. part of the
government's LongTerm
Care Program. The nurses
recommendations would
mean more professional
supervision of care,
improvements in criteria for
care. and administration of
medications by trained
personnel. Specifically. the
association proposes:
. that staff in intermediate
care facilities be supervised
by persons with
"documentary evidence of
professional (health care)
training acceptable to a
registering body or
professional association of
British Columbia". Presently.
unlicensed health workers can
supervise staff who provide
care. and there is no check on
their qualifications by bodies
like RNABC or the College of
Physicians & Surgeons of
B.C.
. that existing
staff-to-resident ratios be
adjusted according to the
complexity of care actually
required. Presently. the
regulations specify minimal
amounts of time spent with
each resident of a facility,
regardless of the severity of
his or her health problem.
. that residents'
medications be administered
by someone "trained to
perform this function".
Presently. any staff member
may administer medications.
Besides revisions of the
regulations. the nurses'
association recommends:
· that designs for future
personal and intermediate
care facilities take into
account the needs of disabled
persons using wheelchairs and
other appliances.
. that any government
studies of the Long Term Care
Program include evaluations
of staffing criteria.
. that registered nurses
and other health professionals
involved in the LongTerm
Care Program be invited to
participate in government
studies of the program.
The RNABC brief
reflects input from registered
nurses throughout B.C. The
committee preparing the
submission also consulted
LaviniaCrane. B.C. director
of public health nursing. and
Pat Bertles. nursing
consultant to the
government's Community
Care Facilities Licensing
Board.
Without committing
himself to specifics, the health
minister told RNABC
representatives that new
regulations expected in 1979
would reflect the
recommendations in the brief.
Nurses honor children
May 12th. International
Nurses Day. is the day chosen
by the International Council
of Nurses to honor the
children of the world in this
Year of the Child, 1979.
Nurses around the world
are being asked by the ICN to
demonstrate their support for
the International Year of the
Child on the anniversary of
the birth of Florence
Nightingale.
ICN president Olive
Anstey comments: "Nurses
make a major contribution to
child care in all countries:
they are in a frontline position
The Cen-.ll.n Nur..
"'rch 11179 II
I
to identify the unmet needs of CNA is an active member Did you know... Did you know...
children in their communities. of the Canadian Institute of The Health Care Centre at the A study conducted by a
"At the national level. Child Health Coalition for the Drumheller Medium Security University of Western Ontario
nurses' associations are Prevention of Handicap and is Institution became the first professor of nursing indicates
working with other bodies in promoting IYC through its health care centre in the that redhaired children fall ill
developing programs designed eleven provincial/territorial Correctional Service of more often. more seriously
to improve services for member associations, each of Canada to be awarded and for longer periods of time
children. whom have formulated their accreditation status. On than other children. Professor
"At the international own support program for the December 7. 1978. Brigid Peer based her findings
level. ICN is collaborating year. Fernande Harrison. one of two on a comparison of the health
with other organizations to Both The Canadian Canadian Nurses Association histories of 30 redheaded
ensure worldwide cooperation Nurse journal and Representatives on the children and 30 children with
in improving the quality of life L'infinnière canadienne Canadian Council on Hospital other colors of hair.
of children everywhere. .. kicked off IYC celebrations Accreditation. presented a She warns mothers of
The Canadian Nurses with special issues featuring a Certificate of Accreditation to children with red hair that
Association participated in the nursing approach to health Mr. Stan Baird. Senior Health they should be sure that these
establishment of the Canadian care for children in hospitals Care Officer for the children are imm.unized and
Commission on the and in the community. Other Drumheller Institution. The that they should take illness
International Year ofthe articles focusing on the special Centre functions primarily as among these children
Child. It supported the use of health care needs of children an outpatient ambulatory care seriously since they are more
UNICEF greeting cards and will appear in the journals unit. likely to develop
plans to feature IYC in its throughout 1979. complications as a result of
annu:tl meeting program in illness.
March 1979.
A CNA national forum
on nursing education
:\m'ember 13. 14.]5 ]979
IN OTTAWA
Theme: The nature of nursing education
Participants at the Forum will discuss and probe issues and problems related to nursing education
and the practice of nursing - here's a chance to exchange ideas with national authorities and
leading practitioners...
PROGRAM FOCUS - What is "basic" nursing education?
- Diploma or Degree?
. NURSING MODEL. CURRICULUM. NURSING
SPECIALIZATION. ACCREDITATION
OPEN TO ALL REGISTERED NURSES TO A MAXIMUM PARTICIPATION OF 300
REGISTRATION: CNA MEMBERS- $]00 NON-MEMBERS - $]75
ð
Complete program details and registration tear
out in coming issues or from your provincial
association
REGISTER EARLY
Be one of the 300...
Canadian Nurses Association
50 The Driveway
Ottawa. Ontario K2P IE2 Tel(613)237-2133
10 llerch 11179
The Cen-.llen Nur..
FUNDAMENTALS
New 10th Edition TEXTBOOK OF'
ANATOMY AND PHYSiOlOGY. Sharing the
insights of a new co-author, this classIc IS better
than everllt retains the features which have
made It the leader In this field and offers many
additional nlghhghts Coverage of the endocnne,
reproductive, un nary and cardiovascular systems
IS expanded - reflecting an Increased
emphasIs on physiology Completely new units
examine the cardiovascular system. plus defense
and adaptation A timely new chapter on
articulations and a conCise review of chemIstry
also enhance thiS edition By Cathenne Parker
Anthony, R N , B A., M S and Gary Arthur
Thibodeau, Ph D January, 1979 744 pp, 570
Illus Including 211 In full cdor PrIce, $21.75.
New 10th Edition ANATOMY AND
PHYSiOlOGY LABOIlÁTORY MANUAL.
Reflecting current trends In anatomy and
phYSiology, this manual corresponds with the
TEXTBOOK OF ANATOMY AND PHYSIOLOGY
You'" find new exercises In hematology, the
latest information on reproduction and
urinalysis, and new appendix matenals By
Cathenne Parker Anthony, R N, B A, M Sand
Gary Arthur Thibodeau, Ph D January, 1979 270
pp, 1691lfus PrIce, $9.75.
New 2nd Edition Pl.ÀHHIHG AND
IMPLEMENTING NURSING INTIRVENTlON:
Stress and Adaptation Applied to Patient
Care. Offer your students a cogent lOOk at how
stress and adaptation affect humans with this
well-organized text Part I analyzes the concepts
of stress and adaptation, along With their roles In
the human life cycle Part II uses case hlstones to
demonstrate how to apply that theory. For better
student understanding, this edition features
rewntten definitions of stress and adaptation By
Dolores F Saxton, R N , B S, M A , Ed D and
PatnCla A Hyland, R.N., B S., M S, M Ed , Ed D.
Marcr 1979 Approx 192 pp, 47 Illus About
$10.75.
New 2nd Edition COMMUNICATIONS
AND RELATIONSHIPS IN NURSING. The
ablhty to communicate well with patients and
staff members IS paramount In nursing. ThIs
Innovative text offers students helpful gUidehnes
for all aspects of effective commUnication -
essential charactenstlcs, self-awareness,
appropnate language, and poor hstenlng nablts
- then apphes these to specific situations
Sixteen" communications interactions" help
students practice and reInforce the pnnClples
discussed. By Maureen J O'Bnen, R N , M S
Apnl, 197B 260 pp., 28111us. Price, $10.75.
A New Book NURSING: A World View.
Nurture your students' pride In their profession
with thiS long-awaited textllt provides a
worldwide, histoncal perspective of nursing,
encompassing the growth and development of
the profession in over 30 countnes on 6
continents Following a comprehensive look at
nursing, the author discusses and compares
nursing In vanous countnes - Including history,
education and present state of the art. Finally,
you and your students will take a fasCinating look
at the future of nurSing By Huda Abu-Saad,
Ph D., M N., B S N March, 1979 Approx 208
pp., 14111us About $15.00.
New 3rd Edition THE VITAL SIGNS WITH
RELATID CLINICAL MEASUREMENTS. This
Invaluable workbook provides scientific
concepts essential to the understanding and
assessment of vital signs Its programmed format
presents manipulative skills In a practical manner
that eases their Immediate transfer from
classroom to the patient's bedside All aspects
of measurements of body temperature and
cardiac actIVIty are carefully examined. Two new
chapters stress nursing assessment skills By Betty
Mcinnes, R N, B SeN., M.Sc.(Ed.). February,
1979 Approx 144 pp., 35111us About $9,75.
, T'
for a sound
nursing education!
MOSBY TEXTS.
Here's proof...
MEDICAL/SURGICAL
A New Book CANCER: PATHOPHYS-
IOLOGY, ETIOLOGY, MANAGEMENT:
Selected Readings. A multidisCiplinary
approach, thiS exceptional text explores all
facets of the cancer process - prevention,
detection, treatment, rehablhtation and
psychological aspects Throughout, discussions
stress the commonahties of cancer assoCiated
problems and provide a practical, positive
approach SpeCial attention IS given to patient
problems when a cure IS not probable By
Louise C Kruse, R.N., B S N , M A., et al January,
1979. Approx 448 pp., 35 Illus About $16.75.
New 2nd Edition CLINICAL IMPLICA-
TIONS OF' LABOIlÁTORY TESTS. A good
understanding of laboratory test results is
essential for any nurse - and this conCise text
can help USing a step-by-step approach, It
emphasizes the physlologlcallmphcatlons,
variations and Interrelations of laboratory values
Intltial chapters examine the routine multisystem
screening panel. Subsequent chapters discuss
evaluative and speCific tests for suspected
disease entities. Valuable new chapters study
Infectious and rheumatoid diseases By Sarko M
Tllkian, MD., et al February, 1979 Approx 272
pp, 45 ,lIus About $10.75.
New Volume I. CURRENT PIlÁCTlCE IN
NURSING CARE OF THE ILL ADULT: Issues
and Concepts. Students Will be more capable
of unravehng the complexities of modern
nurslrg practice with the help of this
outstanding text Twenty-five original articles .
discuss key professional Issues analyze their
Imphcatlons and present clinical guidehnes
for assessing or Intervening in speCific nursing
situations Alcohol Withdrawal, bioenergetics
and patient-nurse interaction are Just a few of
the tOpICS examined By Maureen Shawn
Kennedy, R N., B S.N., M A. and Gall Molnar
Pfeifer, R N , M A Mf!ý, 1979 Approx 320 pp ,
15111us. Atout $14.50 (C), $10.75 (P).
I
..... A. ....=
CM:eIIB IIIøNI :::
;;r
Parent-child
nursing
NYCHOlOOAL ASPECTS
I
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The Cen-.llen Nurae
M.rch 11179 11
A New Book MEDICAL-SURGICAL
NURSI....G: Concepts and Clinical Practice.
USing both a systems and a conceptual
approach. this new text reflects the mynad
changes In contemporary medical/surgical
nursing The first two parts focus on general
aspects Part III explores speCific
medical/surgical problems - each discuSSion
Includes an assessment of the IrNolved system
followed by a managemer o Intervention
process Students Will be particularly Interested
.In a unique chapter on ecology and health By
Wilma J PhippS, RN, B S., AM, Ph D, etal
February 1979 Approx 1,600 pp 735111us
About $27.75.
2nd Edition INFECTION: Prevention and
Control. Introduce your students to Infeclon
prevention and control With this updated,
logically organized text It prOVIdes a
comprehensive O\Iervlew of various aspects of
epidemiology and the mechanisms of spread
and control of Infection, along with the role of
the Infection control coordinator New chapters
explore personnel health seMce programs
poliCies and procedures for prevention and
control, categones of Isolation, i!nd the reporting
system By Elaine C Dubay, R N, B S and Reba
Douglass Grubb, B S . WlttJ 9 contributors 1978
198 pp., 48 ".us Price, $10.25.
A New Book THE NURSE AI>ID
RADIOTHERAPY: A Manual for Daily Care.
Wnttef'to help nurses better understand - and
meet - t>Je challenging needs of cancer
patients, s comprehen Ive book provides a
po .ve approach ) radiotherapy Begll"\'llng
chapters explore >')e role, effects and delivery of
radiation treatments, subsequent chapter
focus
on ps rhOSOCial ImpliCations and developing
sc.Jnd nursing care plan" D,scuss 'Jns of
poter 11 problems and sol on )ffer a ur =1ue
opportUnity to take a creative look at orx:c oglC
nursing By Irene M Leahy, B A , R '" et al
December, 1978 182 pp 4911 Price,
$12.00.
FI\THERING
T1ONS
AND RELATIONSHIps
IN NURSING
"...."I.. ,..... u,
....,..,....- _ullf.I
':"- "..
;"Itl
Nutrition
In the conUnunlt
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4'.. 1r
New Volume I CURRENT PERSPECTIVES
IN REHABILITATION NURSI....G, Rehabilitation
IS a fundamental, yet cruCial part of nursing
practice Turn to this outstanding volume to help
students better understand thelf role on the
rehabilitation team Timely onglnal articles
discuss rehabilitation In the ICU, cultural
Implications of rehabilitation, biofeedback as a
nursing therapy, the Influence of the paranormal,
making the world accessible and other
Important subjects This IS one text your students
will want to read ' Edited by Rosemary Murrèty,
M A ,R.N and Jean C Kljek, M A , R N March
1979 Approx 256 pp, 11111us. About $14.50
(C), $10.75 (p).
MATERNAL/CHILD
New 2nd Edltlor PARENT-CHILD
....URSING: Psychosocial Aspects.
Reorganized and expanded, this InCISive text
centers on how to alleviate psychologic and
social stress factors that can - and often do -
Interfere With optimal family growth Students
will benefit from forttmght discussions of child
abuse, battered wives, rape and Incest By
Gladys B Lipkin, R N, M S Apnl, 1978 260 pp
43 Illus Price, $10.25.
New 2nd Edition CHilD HEALTH
MAINTINA....CE: Concepts in Family-
Centered Care. USing both a problem-solving
and a conceptual frameworl<. this Important text
explores all facets of holistic pedlatnc nursing
This IIf':VV editIon reflects contemporary
developments In diagnoSIs and quality
assurance; emphasizes critical Skills, and
pinpOints the child's unique needs as gO\lemed
by developmental stages and state of healtl' A
detòl
d new s
tlon on the Integration and
asse
rT)ent of competenCies .s espeCially
valuat"e By Peggy L Chinn, R N . Ph D March.
1979 Approx B96 pp, 377 illus About
$24.00.
New 2nd EditIon CHILD HEALTH
MAINTENANCE: A Guide to Clinical
Aucssmcnt. This learning gUide proVides an
excellent presentation of gUIdelines for nursing
assessmer o of the child-I' story, physical,
behavioral and soCIal development The gUIde IS
designed to stimulate further learn"13 and
expenence I-"he area d health assessme,,'
New chapters corresJ: ld with the revl' ns In
CHILD HEALTH MAINTENANCE Concepts In
Family-Centered Care hO\lllever, the gUide IS
complete enough to stand alone By Peggy L
Chinn, R N , Ph D and Cynthia J Leitch, R N , Ph D
Marcl', 1979 Approx 176 pp, 24111us About
$9.75.
,..
New Volume II CURRENT PRACTICE IN
OBSTETRIC AND GYNECOLOGIC NURSING.
Manifesting a dual concern for Increased
phYSIological/psychosocial knowledge and ItS
resulting nursing care Implications, thiS
noteworthy text examines significant Issues In
modern ob/gyn nursing Well-known authorities
share their expertise With obstetric hemorrhage,
failure to thnve, diabetic pregnancies, fetal
breathing and other VItal subjects A particularly
timely artIcle on human sexuality and the family
IrNestlgates sexual role typing. Edited by Lee
Kester.McNall, RN., M N and Janet Trask
Galeener, R N, M S, WIth 22 contributors Apnl,
1978 252 pp., 20 Illus Price, $14.00 (C),
$10.25 (P).
FA THERI....G: Participation In Labor and
Birth. What do your students think about fathers
In the delivery room? This humanistic text can
help them develop an empathy with the father
and understand his reactions The authors first
discuss the paternal role in labor and delivery
and describe the physloan's feelings. They then
Include aàual,nteMew5 With fathers, offenng
students a fascinating look at a very Important
member of the birth team By Celeste R Phillips,
R N, M S and Joseph T Anzalone, MD 1978.
164 pp, 73 III us Price, $10.25.
2nd Edition. REVIEW OF PEDIA TIUC
....URSING. Turn to this contemporary text for a
challenging review of pediatric nurSing
prinCiples and techniques. Using a helpful
question/answer format, It probes students'
understanding of such key tOPiCS as
psychological aspects, high-risk Infants, and
chronic or açute Illnesses Noteworthy new
features Include. a chapter on family
dysfunction, an Informative section on the role
of nutntlon. and expanded information on
bonding, growth/development, and drug
Wlthdrð\Nalm the neonate By Florence Bright
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HCS811231
The Cen-.llen Nur..
CNA submits brief
to federal commission
The following are highlights excerpted
from a submission prepared by the
Canadian Nurses Association on behalf
of Canadian nurses and tabled with the
Commission on Inquiry into
RedUl1dancies and Lay-offs in Canada's
Labor Force.
CNA 's director oflabor relations.
Glenna Rowsell, and the association's
director of professional services, Rose
Imai. met in Ottawa with representatives
of the commission early this Winter to
present their submission.
The commission has now completed
its hearings and is scheduled to release
its report this month.
Background
. The promotion of social and
economic welfare of nurses is one of the
objects of the Canadian Nurses
Association. This object has been met in
many ways over the years and most
recently, through the establishment of a
Labour Relations Service for the
purpose of collecting information.
analyzing data and conducting labor
education programs.
. The nursing profession remains
predominantly female. For example, in
1976, of 141 .059 registered nurses
employed in nursing, only 0.02 per cent
were males. This presents ramifications
unique to nursing. together with the fact
that the service requires 24 hour
coverage, 7 days a week. Given the
traditional female roles of wife and
mother. and the increasing number of
single parents, staffing becomes an
extremely sensitive and important aspect
in employee-employer relationships.
Where financial restraints result in
cutbacks of staff but not a reduction in
services. the pressures on the remaining
staff could jeopardize patient care. This
has become such a concern that both
professional nurses associatioru; and
collective bargaining groups. recognizing
the need for data. have adopted means to
record and report situations where staff
shortages have led to or are leading to
unsafe nursing care of patients, in their
professional opinion.
Observations
. Practices related to lay-offs do not
necessarily arise from redundancy. At
this time, the major cause of the lay-offs
of nursing personnel in institutions and
agencies arise from budgetary restraints.
. Nurses who are not covered by
collective agreements generally are
bereft of job protection and must rely on
the good faith of the employer to give
them the consideration due to "good
employees" . Nurses who are covered by
a collective agreement, may not. in
effect, be better protected but they do
have recourse through the collective
bargaining mechanisms to have their
case heard. A cursory review of the
existing collective bargaining agreements
demonstrates the lack of job security in
relation to lay-off.
· The employer. represented by the
senior executive. in nursing
administration or. in the overall
administration of the institution. often is
caught by the squeeze from above and
below. And regardless of the squeeze.
the service must be provided to an ever
increasingly articulate clientele whose
expectations continue to rise. In this
particular type of situation, middle
management-and some senior
staff-may be equalIy vulnerable to
lay-off as the staff nurse. Head nurses,
supervisors, coordinators ... may find
themselves being declared redundant as
their positions disappear in the
organization.
· Overriding the mutual and
respective obligations of employer and
employee, is the obligation to the
community for an essential service. To
ensure the provision of the service. joint
decision-making by the employer and
employee is crucial and concomitant to
that. is the need for prior infonnation by
the employee.
(continued on page 48)
Bachelor of Administration
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Applications are now accepted for the program
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Credits toward advanced standing are given
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For information and application forms, please
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Canadian School of Management
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Toronto,Onbno M5SIV5
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By Cecil B. Drain, Major, Army Nurse Corps, RN. CRNA. BSN, Unlv
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They've done it again! The authors of the popular Medical-
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By Karen Creason Sorensen, RN. BS. MN Formerly Lecturer in
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-Basic Human Anatomy and Physiology
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The ideal way to refresh your knowledge of anatomy and
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By Charlotte M. Dienhart, PhD. Asst. Prof. of Anatomy and Assoc.
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This important new book provides a complete learning resource
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-Essentials of Nursing:
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This is a compact textbook for students beginning the study of
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Ready soon Order #5313-8.
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Th. C.nedl.n Nur..
YOU AND THE LAW
......
J _
....
Error of judgment: is it always
negligence?
Corinne Sklar
In discussing negligence and the standard of care required of
nurses, I have often referred to the principle that liability does
not attach to an error of judgment. Recently, a nurse asked what
was meant by an "error of judgment" . This column will focus
on the meaning of this phrase and illustrate its application in
several cases.
In general terms,judgment refers to an opinion. estimate
or conclusion. It also refers to the power or ability tojudge well
or with good sense. In any given situation, once a conclusion or
judgment is made, then one makes a decision based on that
conclusion with respect to the behavioral response deemed
appropriate. For example, Johnnie cuts his forehead: mother
decides to stop the bleeding by applying pressure to the site.
Once the bleeding stops, she decides to take him to the hospital
for stitches because she observes that the cut is wide and looks
deep. This decision is based upon her judgment derived from
her observations and her knowledge of the current situation and
her general knowledge with respect to such injuries.
Nursing decisions and conduct are similarly based on the
nurse's knowledge of the circumstances or facts surrounding a
given situation and the nurse's special knowledge as a
professional nurse. I t is the application of this body of special
knowledge, as well as general knowledge, to the situation the
nurse faces which is involved in the exercise of the nurse's
judgment: the result will be a nursing decision about the course
of action to be followed. The decision may be to take some
specific action, for example, to call the physician or re-position
the patient, or to take no action at all, for example, to continue
to observe the patient.
When no harm befalls a patient, then the nursing care
which was given (resulting from nursing decisions based on
nursing judgments) is not subject to legal scrutiny. Although
nursing care may result directly from a physician's decision
(based on the physician's medical judgment), errors pfjudgment
by physicians are not the focus here; the applicable principles
are similar, however, and the medical negligence cases cited
below are illustrative.
It is important to remember that before he can charge
someone with negligence, the plaintiff must have sustained
injury resultiñi in damage or loss which would not otherwise f
have occured. If the patient suffers no injury or harm, then
there is no loss on which to frame an action in negligence for
compensation. It is possible, therefore.for a nurse to practice at
a level substandard to the nursing profession's requirements
and yet to escape involvement in a legal action. As long as a
patient suffers no harm, the nurse can avoid legal liability to
such a patient, although that nurse may well be answerable to
the professional disciplinary body for professional
shortcomings or misconduct.
Measuring care
The standard of care to which nurses are generally held is that
of a reasonably prudent nurse of like traininf? and experience.
This means that a legal assessment of the quality of care
delivered to a patient will measure that quality according to the
reasonably prudent nurse yardstick. A nurse may deliver a
higher quality of care but to deliver care which falls below thIs
objective standard is deemed negligence.
The nurse is expected to deliver care based on her
utilization of the knowledge and skills of her profession. This
means that, as the profession's body of knowledge expands and
develops, the nurse must keep abreast of generally accepted
professional knowledge, principles and practicè. A reasonably
prudent nurse is not likely, therefore, to consider obsolete
practices appropriate. Similarly, untested innovations, novel
practices not widely accepted by the profession-at-Iarge, may
not be considered part ofthe profession's general body of
knowledgeJThe standard of care required is flexible and
non-static. It is therefore imperative tñat nurses continue to
update their knowledge and skills to keep abreast of the
profession's development.;
The lack of knowledge that today a Court sympathetièally
determines to be "understandable ignorance" might be deemed
negligence if applied to a similar practitioner five years from
now. However, the standard of care applicable is that standard
of care appropriate at the time the injury occurred, and not the
standard of care applicable at the time the case actually comes
to trial (see You and the law, February 1979).
Application ofthe principles of a bod y of knowledge
further involves an asseS'iment ofthe alternatives available and
the consequences attendant upon them. Specific nursing care
may be given automatically in response to a specific set of
symptoms. The underlying process involves the nur!.e's
recognition that a certain set of symptoms requires a specific
nursing action. The nurse should know of the alternative
courses of action available and their attendant consequences
after she has learned that there is a specific professionally
acceptable response to this set of symptoms.
Th. Cenedlen Nur..
llerdl 11171 15
NURSING JOB GUIDE
Ihhe acts incorrectly. or fails to act. either because she
fails to recognize the patient's difficulty or because she does not
know what to do when faced with the symptoms. then her
nursing decision and action/inaction would be the result of
faulty exercise of judgment based on a lack of knowledge.
Because this conduct would fall below the standard of care of a
reasonably prudent nurse, the faulty judgment here would
amount to negligence and liability would attach.
The professional and the patient
In examining conduct which is alleged to have been negligent. a
Court considers all of the facts and circumstances of the case.
The conduct is measured by the objective standard of the
reasonably prudent practitioner. This is established by hearing
evidence of what the standard or accepted practice is in like
circumstances. The Court examines the risk of harm such
conduct presented to the patient since exposing a patient to an
unreasonable risk of hann may constitute a breach of
professional standards. Consideration of such risks involves
weighing the degree of risk and the relative benefit to the
patient. Thus. if the course of action that is selected is of high
risk but was the one considered potentially most beneficial to
the patient, and if this action did not significantly deviate from
generally accepted professional practice. then resultant harm to
the patient may not be deemed to have been caused by
professional negligence.
In delivering health care. professionals do not guarantee
the success of all the care given. Despite heroic measures, the
patient may die.
The professional person presents him/herself to the patient
as possessing and using that reasonable degree oflearning and
skill ordinarily possessed by practitioners oflike training and
experience (objective standard) . It is the duty of the
professional to exercise his/her skill, knowledge and judgment
commensurate with that exercised by his professional peers'.
This was the finding of the Supreme Court of Canada in
Wilson
'Swanson. In that case. a surgeon perfonned a major
resection when the growth found in a patient's stomach was
considered by the pathologist to be probably malignant on quick
section. The surgeon decided to complete the resection rather
than postpone the surgery to await further testing. The growth
was later detennined to have been benign. The patient sued.
The trial judge found that there had been no negligence and
dismissed the complaint. However, the British Columbia Court
of Appeal disagreed and held that negligence was proved. The
Supreme Court of Canada upheld the finding of the trial judge
and ruled that the surgeon had exercised his knowledge and
skills in accordance with accepted surgical practice: the
decision to complete the operation was not founded on a faulty
basis of knowledge.
The following quotation is taken from the judgment of Mr.
Justice Rand in that case:
A n error injuclWllent has long been distinguished from an
lIct of unsÂilfulness or carelessneH or due to lad of
!..nowledge. Although wIÙ'ersally-accepted procedures must
be obserl'ed, thev furnish little or no assistance in resolving
such a predicament as faced the surgeon here. In such a
situation a decision must be made witham dela)' based on
limited known and un!..nownfactors; and the honest and
intelligent exercise ofjudgment has long been recognized as
satisfying the profe.uional obligation.
He went on to say that:
He is not to be judged by the result, nor IS he to be held liable
for an error ofjudgment. His negligence is to be determined
bv reference to the pertinent facts existing at the time o/his
examination and trealment, of which he knew or in the
exercise of due care, should h ll\'e known. It mav consist in a
..
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Th. Cen.dl.n Nur..
failure to apply the proper remedy upon a correct
determination of existing physical conditions, or it may
precede that and result from afailure properly to iriform
himself of these conditions .If the latter, then it mJist appear
that he had reasonable opportunitvfor examination and that
the true physical conditions were so apparent that they could
hm'e been ascertained by the exercise of the required degree
of care find skill. For, if a determination of these physical
facts resolves itself into a question of judgment merely, he
cannot be held liable for his error 2 .
ProfessionaJ judgment
A finding of no liability for an error in judgment was the result in
a recent Ontario case 3 . A psychiatrist and a psychologist had
been treating a patient with a long history of mental illness. The
patient was a chronic schizophrenic who also suffered from
depression. The patient had purchased a gun and, on being
alerted to this, the psychologist saw the patient and then
consulted with the psychiatrist. The decision of both
professionals was that the patient did not manifest sufficient
suicidal intent to warrant hospitalization: this decision was
based on a complete assessment of the patient who surrendered
the weapon to the p
ychologist. The next day the patient
purchased another gun and, shortly afterwards, killed himself.
His wife sued both the psychologist and the psychiatrist.
The trial judge found that the professionals had exercised
the reasonable skill and care required of them: tht>y had
considered all of the relevant factors in arriving at their
diagnosis or judgment. Having done so, there was no negligence
in their care. A psychiatrist or psychologist who makes a
diagnostic mistake or error in judgment does not incur liability
whatever the hann if the standard of reasonable care and skill is
met.
As with physicians, nurses are not liable for an error of
judgment. In the Ontario case of Elverson \. Doctors Hospitals
et al. ,5the patient. in her eighth month of pregnancy, arrived at
the hospital by ambulance. She was accompanied by her
husband. Her condition was poor; she was in severe pain; her
abdomen was rigid: no fetal heartbeat could be heard. The
patient was quickly settled in bed and the defendant nurse
began the administration of oxygen for her patient.
After a brief period, the patient began to hemorrhage. The
defendant nurse decided to elevate the foot of the patient's bed.
She left the room briefly, returning with the blocks and another
nurse. Both nurses attempted to lift the bed to insert the blocks.
This proved difficult, however, and the patient's husband
voluntarily assisted with the lifting of the foot of the bed so that
the blocks might be properly placed. Unfortunately, while
assisting the nurses. he aggravated a pre-existing back
condition. The husband sued the hospital and the nurse for
damages resulting from this injury. He argued that the nurse
was negligent in failing to summon dn orderly to assist in lifting
the bed.
The Ontario Court of Appeal agreed with the trial judge
who had di
missed the action. The Court held that the nurse had
not made an error through negligence. It was. in their view, an
error of judgment for which no liability attached. The elevation
of one end of a hospital bed through the placement of blocks
was found to be a regular occurrence in a hospital and not one
which !>hould have been solely limited to an orderly's
assistance. The only "mistake" made by the nurse was an error
in assessing the relative strength of the nurses to lift the bed and
the patient. Such an error did not amount to negligence in law.
The Court went on to find that even if the nurse had been
negligent, she still would not have been liable for the injury
since the injury to the husband was not reasonably foreseeable
as resulting from the completion ofa routine task.
Assessing negligence
From the foregoing it can be seen that nursing practice in
accordance with professional standards will generally protect a
nurse from a finding of negligence. As long as the nursing care
that is given is in accordance with the objective standard
t exemplified by the reasonably prudent nurse, such care will
confonn to legal requirements. It should be noted, however,
that mere conformity with generally accepted practice will be
no defence to an assertion of negligence if that generally
accepted practice is in itselffound to be below the legally
required standard; for example. blind adherence to a hospital
policy will not be a defence where that hospital's policy fails to
adequately and reasonably safeguard its patients. In such an
instance both the hospital and the nurse might be held
responsible.
Each case turns on its own facts. If, in theElverson case,
the patient had weighed 300 lbs. or if the nurse had rejected the
proffered assistance of an orderly, the outcome might have been
different. The situation would have been different too if there
had been nothing urgent about raising the bed or if the nurse had
asked the husband to help her. Each of these variables would
alter the assessment of the course of action that would have
been taken by the reasonably prudent nurse, the principle
yardstick by which the defendant nurse's action i!> measured.
There is a factor which was not discussed in the judgment
and which in other circumstances might have some relevance:
from earliest student days, nurses are taught about proper body
mechanics and are cautioned about the hazards of back strain or
injury in moving patients and equipment. Such knowledge
would be considered part of that body of special knowledge
which the reasonably prudent nurse would have.
Therefore. it is conceivable that where a nurse invited the
assistance of a non-hospital employee (i.e. visitor or patient) in
moving or lifting something, any back injury accruing to that
person as a result ofthis assistance might be considered to have
been reasonably foreseeable to that nurse in the view ofa
Court. Again, such a finding and any attendant liability, would
depend on all the relevant facts of the case.
The finding of no liability for an error ofjudgment will be
liI..ely if the nurse utili;:es the special "nowledge that she has
I (and ought to hm'e) as a professional nurse. I f she does so with
proper forethought as to the alternatives and their attendant
consequences, then the fact that her decision as to the choice of
alternative is ultimately shown to have been incorrect will not
necessarily result in a finding of negligence.
Nurses do not have to be right all the time: they are not
required to be perfect. The professional exercise of judgment is
the key to the nurse's protection from legalliahility. to
References
1 Wilson V. Swanson [1956], S.CR. 804.
2 Ibid. p. 812.
3 Haine.5 \'. Bellissimo (1978). 180.R. Cd) 177 (H.CJ.).
4 Ibid. p. 191.
5 Elverson \. Doctors Hospital et al. (1975).4 O.R. (2d) 748
(CA.)
-.
"You and the law" is a regular
column that appears each month
in The Canadian Nurse and
L'infirmière canadienne. Author
Corinne L. Sklar is a nurse and
recent graduate of the University
ofT oronto Faculty of Law and is
currently artic/ing with aT oronto
law firm.
."
,
J-
Whether this play is thought to be sarcastic, satirical, caricaturistic, or unintelligible will largely
depend upon the perceptions of the individual reader. It is intended only to be a gentle reminder of the
caring role of the nurse (from a patient's viewpoint) and a warning of the possible shape of things to
come.
RBI
NINETEEN-EIGHTY - FLOOR
-
-
:3
4
5
dlo
Ô
11 Merch 11171
The Cen-.llen Nur..
TIME:
SCENE:
Sometime in the near future
A client monitoring unit on an assessment ward of a large general
hospital. Madge is seated in a swivel chair facing a large console
covered with switches. buttons and meters, somewhat similar in
appearance to the flight deck of ajumbo jet. At eye level there are
five television screens, each displaying a patient in bed.
Surrounding each screen is a series of monitors which are
continuously recording a variety of physiological patient activities.
The monitoring unit is linked to each patient by an intercom
system. Madge is studying the monitors for bed number two. The
patient in this bed is immobile; most of the monitor tracings are flat
or approaching zero. Madge is expertly pressing buttons and
flicking switches.
MADGE:
Muttering to herself. Let me see now, patient unresponsive to all
stimuli. check; flat EKG. check; all vital signs absent, check;
permission for autopsy. check; life-support systems disconnected.
check; nursing care plan closed. check; yes, that seems to be about
it.
With the flick of a sll'itch, the motorized bed moves silently off the
screen. Shortly thereafter, another bed glides into place, occupied
by Mr. Jones. He is a small, elderly man whu is obviously ill and
apparently in some discomfort. He moans gently.
MADGE:
Switching on the intercom to bed number two. Good morning Mr.
Jones. my name is Madge Brown and I am your primary
nurse-monitor. According to your initial computer diagnosis you
have a bladder tumor which we are going to investigate for you. I
understand that you are experiencing discomfort at this time and I
am here to help you.
Mr. Jones groans quietly.
MADGE:
Now Mr. Jones, the discomfort you are aware of is perfectly
normal and controllable. Perhaps you would like to help yourself
by opening that little drawer to your right, marked 'analgesic'.
Inside the drawer you will find a pill and a paper cup of water. With
some difficulty, Mr. Jones complies. That's right; now swallow the
pill with a little water and very soon the discomfort will subside.
Mr. Jones again complies and sinks back in his pillows lVith
another, luuder groan.
MADGE:
Perhaps you are concerned about your family while you are
hospitalized. You are wondering how they will manage with no
income and the possibility oflarge hospital bills to come. We have
arranged for the social counselor to visit your wife and make the
necessary interim adjustments. You can rest assured that they will
be cared for during your stay here.
MR. JONES:
Forcefully.OhGod!
MADGE:
I perceive you are a religious man. Mr. Jones. You will find great
solace in prayer while you are here. I will arrange for the chaplain
to visit you if you wish.
The Cen8dlen Nur..
Mereh 1171 111
MR. JONES:
MADGE:
GERTRUDE:
MADGE:
GERTRUDE:
MADGE:
GERTRUDE:
MADGE:
GERTRUDE:
MADGE:
Desperately. Nurse, help me?
What you are really saying is that you still have some unresolved
anxieties. This is perfectly normal. this being your first
hospitalization. Perhaps if we commence your environmental
orientation you will feel less threatened. Your preplanned diet will
arrive promptly at 0800 hrs, 1230 hrs, and 1700 hrs, with a light
snack before bedtime. If you place your dentures in the little
drawer on your left, marked 'dentures', they will be washed and
hygienized automatically. A disposable bedpan can be found in the
cupboard by your right hand. When you have
finished. _
Madge's counseling is interrupted by a very loud groan from Mr.
Jones. and the arrival of Gertrude in the monitoring unit.
Hi Madge. how's it going?
Not too well. Gert; number two died on schedule but I'm having a
problem with his replacement.
r. Jones.
You mean the bladder tumor? I thought from the computer care
plan that he would be fairly straightforward. How far have you
got?
Let me see now. Presses button and a printed sheet is fed out of
the console. Madge reads from the sheet. Introduction;
patient-controlled analgesia; social service awareness: pastoral
care alert. I have started orientation but I'm still in the early
facilitative phase.
Hov. 's yourT.U .S. ratings?
Scanning the printout. Only about 2.5 so far: I don't think he
understands empathy.
Maybe we should try some confrontation for awhile. A t this
moment. the screen reveals Mr. Goodheart approaching Mr.
Jones. Madge. really! Do you allow those technicians near your
patients without constant monitoring? He's only a baccalaureate
graduate and has no practical T.U.S. experience.
Mr. Goodheart li/ts the sheet covering Mr. Jones.
Mr. Goodheart, what are you doing with that patient?
MR. GOODHEART: Pardon me nurse, but shouldn't v.e be unc1amping this catheter?
The patient appears to be very distended.
The curtain falls.
THE END
La\\re.nce
ightingownis the pen name ofa nursing officer in a large B.C. hospital. Prior to
his present administrative appointment. Mr. Nighting0l1:n held various ward level,
supervisory and clinical teaching positions in a number of hospitals in England and
Canada. Of "Nursing: nineteen-eight y-floor" , the author writes: "I would hate to be
labelled antiscientific or old-fashioned; indeed 1 welcome much that is innovative in our
profession . Yet the uncomfortable feeling persists that we are tending to overlook more
and more our basic function. that of caring; we seem to be getting further andfurther away
from our patients.
"I am highlv suspicious of jargon. words such as Primary Care. Nursing Care
Planning, Therapeutic Use of Self, Quality Assurance and the like. Whether these
supposed imlO\'ations hm'e actually resulted in better care from the-client point of view is.
1 would submit, a moot point. Certainly, they hm'e resulted in more and more nurses
spending less time with their patients."
Setting realistic goals for nursing the elderly is not easy. When the medical prognosis is poor, it helps to
know that "feeling better" is not just a matter of reversing the physical changes that accompany the aging process.
Case load: over seventy-five
Mary Gibbon
By the year 2001, an estimated thirteen per
cent of all Canadians will be over the age of
65. Many of these will be in the group
designated. for obvious reasons, as the
"frail elderly". These over-75's now make
up the fastest growing part of our
population. They are also, by virtue of the
fact that they are the greatest users of the
health services, a group that nurses are
going to encounter more and more
frequently over the next two decades.
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In an effort to find out how visiting
nurses. whose caseloads usually include
many chronically ill patients, can give this
segment of our population more effective
care. the Hamilton-Dundas Branch ofthe
Victorian Order of Nurses in Hamilton,
Ontario organized and conducted a study
involving more than 200 frail elderly in
that community. A total of 29 VON
nurses took part in the project which was
supported by a National HealthGrant
from Health and Welfare Canada and
carried out over a three year period. The
findings are significant in terms of helping
nurses to define and achieve what is
actually a positive relationship with these
patients and also in terms of helping the
health system to cope with what threatens
to become a major problem in the near
future.
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The subjects
A total of201 patients. all of whom were
over the age of65. were admitted to the
study. Almost three-quarters of them (70
per cent) were more than 75 years of age.
The typical patient in the study was
female (77 per cent), widowed (60 per
cent) and lived alone (40 per cent).
When one considers that all these
patients had chronic illness severe
enough to require physical nursing care. it
is easy to see the emerging need for more
support services in the community, such
as friendly visitors. homemakers.
meals-on-wheels. etc. The complexity of
geriatric medicine is reflected in the fact
that doctors had diagnosed each of these
patients as suffering from an average of
3.2 illnesses. Further, only 15 percent of
those for whom the physicians provided a
prognosis were expected to improve in
three months. When we add to this the
The Caned Ie" Nur..
Mereh 1171 21
fact that 40 per cent of the subjects had
poor or limited vision, another 27 per cent
had poor or limited hearing and remember
that in this study mobility problems
increase significantly with aging. it
becomes clear that the setting of realistic
nursing goals for this kind of patient is
never easy and must be done with great
care.
The study
The object of the study was an
examination of the relationship between
nurse/patient characteristics and the
quality of life of our aged patients. In
designing the study, we took into account
our conviction that a great deal of what
the nurse does is often intangible but,
nevertheless, has an overalI effect on the
patient's quality oflife. After a review of
gerontological literature, we decided to
measure three areas where nursing could
be expected to make a difference.
. A ctil'itie s of daily iil'ing (AD L) was
an obvious choice. One ofthe main
emphases in gerontological nursing is
rehabilitation - to help the aged remain
as independent as possible for as long as
possible. The patients were asked about
their ability both in personal care and
household tasks.
. Social contacts. the second area,
was felt to be of particular importance to
community nursing. When the elderly
have mobility problems and/or sensory
deterioration, the ability to get out ofthe
house for additional stimulation is often
affected. making the person in danger of
social isolation with its attendant
complications. Of ten, lack of sufficient
social stimulation can result in depression
which may be mistaken for
pseudodementia. The visiting nurse is
therefore expected to look into the
patient's social support system to note
changes in it and to help the patient obtain
social suppon when indicated. Social
contacts were measured by actually
counting the number of people with
whom the patient came in contact.
. Morale was the third area to be
measured. Morale is especially important
in the elderly because of its close
association with ilIness and also because
illness in the elderly often occurs in
conjunction with other losses such as the
loss offriends and those involved in the
normal changes of aging.
The elderly in our sample had low
morale scores in comparison with results
obtained in studies conducted in
Winnipeg ' . 2 and Chicago"'. a finding that
did not surprise us since our sample
consisted entirely of elderly persons who
were ill. while the subjects in other
studies included both well and ill elderly.
These three areas do not, of course,
exhaust the number of areas affecting
either the quality of life of the elderly or
those where nursing might be expected to
make a difference. But they are crucial
ones.
The design of the study was
longitudinal: our subjects were patients
65 years of age or older, admitted for
visiting nursing service with a diagnosis
of chronic ilIness. Each subject was
interviewed three times over a 10 to
12-week period. Initial measurements
were taken within 24 hours of admission.
Interviews tested for the three areas
described above and were conducted by a
team of trained interviewers from
McMaster University.
Observations
Our findings were, for the most part,
encouraging, particularly in the field of
morale where the greatest degree of
positive change occurred. Our morale
scale contained several subscales:
. mood tone
. zest for life
. depression
· attitude towards one's own aging,
and
. lonely dissatisfaction.
Four subscales - depression. zest
for life, lonely dissatisfaction and attitude
towards one's own aging- showed the
most positive change. These findings tend
to support clinical observations of the
nurse/patient relationship of the elderly
patient at home. indicating that the arrival
of the nurse usually results in a marked
brightening ofthe patient's mood.
All nurses receive orientation in
normal aging and a positive approach to
aged patients and we expect this to be
retlected in the care given. Nevertheless.
it is somewhat surprising, therefore, that
the scale "attitude toward one's own
aging" was one of the areas of greatest
positive change. Perhaps the change in
this scale is related to reliefthat some of
the negative myths with which the aged
have been living are not true.
We were surprised also to discover
that nearly half (47 per cent) of the
patients demonstrated a reduced ability
to perform activities of daily living over
the period of the study. Of course, our
goal with the frail elderly is often
conservative to try to maintain stability
both of physical condition and of
psychological well-being but, even so, the
47 per cent decline was disappointing. In
this connection. it should be noted that
one fifth of all patients were receiving
visits from either physio or occupational
therapists. The decline could retlect
either inadequate use of rehabilitation
techniques (unlikely in light of the rate of
physio/OT referrals) or irreversible
physical changes. In either case. we feel
that it is an observation that is very
significant to those who plan or deliver
health care to the frail elderly in the
future.
North Americans have traditionally
emphasized rehabilitation nursing for the
elderly, probably as a result of our
society's negative expectations
concerning old age. We seem reluctant to
come to terms with the fact that frailty
does occur in many people in later years.
More realistically, perhaps, British
literature does in fact speak in terms of
"comfon" care for those with
irreversible changes. We realize that the
decision as to whether these physical
changes are irreversible or not is, in each
case, an individual clinical one. but the
study has made us more aware of the fact
that there is a point in time when
rehabilitation, while giving the
professional a sense of "doing"
something, can only result in increased
frustration fort he patient. In these cases,
the professional might be better
employed in providing good emotional
support as the patient learns to cope with
increasing dependency.
Because Nonh Americans place
strong cultural emphasIs on
independence, not only the patient. but
also the professional may find it hard to
accept dependency: both are apt to find
the situation frustrating. This observation
is borne out by the results we obtained
from measuring nurse characteristics
during the study. As part of our project.
participating nurses like those who took
part in an earlier study of community
nurses (Highriter. 1969): completed the
California Psychological Inventory .
Nurses in both studies who
demonstrated a high degree of dominance
had significant positive results in
improving the Activities of Daily Living
(ADL) score of their patients. To our
chagrin, however, these same nurses had
significant negative results in the area of
raising patient morale. Several other
attributes that we like to feel describe the
well-prepared nurse, including
sociability, social presence, self
acceptance, also proved important.
Patients of nurses who were high in these
attributes also el'idenced significant
negatÍ\'e morale changes.
We have discussed this finding at
some length with the nurses involved,
who feel that perhaps one reason for this
disturbing result is the immense social
distance between a well-educated.
relatively affluent. energetic nurse and a
frail. poorly educated patient whose
energy supply is low. Such a patient may,
indeed, view her situation very
differently from the way in which her
nurse sees it. This patient probably does
not have the energy to refuse to do what
the dominant. confident nurse asks of
her: therefore she complies but. in doing
so, she becomes unhappy, since her
priorities differ from those of the nurse.
22 Merch 1878
The CaNdia" Nur..
Looking at these results. we are
sharply reminded that the setting of
nursing goals must always be ajoint effort
between nurse and patient. Like the rest
ofthe nursing profession, we had felt that
we were in falòt checking the patient's
perception. But. for the frail elderly
whose situation is so different from ours,
a special effort needs to be made before
we can properly determine the patient's
perspective.
Like Highriter, we failed to find any
significant relationship between nurse
preparation and outcome. The nurses in
our study had varying preparation: R.N..
diploma in public health. B.Sc.N. Four
nurses were prepared as nurse
practitioners. However, since there were
only 29 nurses in the study. there were not
enough in each preparation group to show
valid relationships. There were also the
confounding variables of age and
experience which crossed preparation
lines.
The relationship of service to
outcome is less confusing. Correlations of
lowered morale and the number of nurses
who visited each patient is significant.
This is further verified by the observation
that. when these visits were made by just
one nurse, a positive change in morale
was found. This would seem to point out
the need for administration to ensure
continuity of care for individual patients.
It is especially difficult to maintain
stability of care for very ill patients who
may require visits once or twice daily. We
know that elderly patients do have
difficulty in adapting to too many
changes. Nurses are usually introduced at
a time of health crisis when the additional
stress of adapting to changing staff is less
easily coped with. It is important.
therefore, that the stability of staffing
pattern be maintained as much as
possible.
For each patient admitted to the
study. the physician was asked for a
prognosis as to whether the patient would
improve. remain stable or decline in
general health status within the three
month period. Wefmind that patients
who were expected to decline had the
highest percentage of improvement in all
three outcome measures: ADL, social
contacts and morale; those who were
expected to remain stable showed the
second highest rate of improvement. It
would appear that, even when very little
can be done to change the disease process
per se, nurses can and do have a
measurable effect on the quality ofIife of
the patient. Even though the overall
disease process may not in fact be
changed (and this was not measured
during our study). there are stilI areas that
are responsive and capable of change in
which nursing care can make a difference.
Our findings indicate that care in the
community is one of the factors that can
bring about an improvement in the quality
ofIife of patients whose general health
status is not expected to improve. There
are, in other words, other ways of helping
a patient besides effecting a change in
disease status.
As more highly educated. better
nourished cohorts reach advanced age.
the situation may change but, for the
present. the results of this study help to
underline the issues that are particularly
relevent to caring for the frail elderly.
Interpretation ofthe results must be made
with the knowledge that the findings
apply only to the kind of patient group on
which they are based: the visiting nurse
caseload of ill. elderly patients in the
community. It is among this group.
however. that the contribution of the
nursing profession is particularly and
peculiarly significant. ..
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References
I Havens, B. Social relationships
and degree of isolation of elderly Manitobam
by... and E. Thompson. Presented at the
10th International Congress of
Gerontology. Jerusalem, 1975.
2 Aging in Manitoba; a study of the
needs of the elderly and resources
available to meet needs. Winnipeg,
Manitoba Dept. of Health. Social
Development Division of Research
Planning and Program Development.
1971-74.
3 Cumming. E.Growing old, by...
and W. Henry. New York, Basic Books,
1961.
4 Highriter, Marion. Nurse
characteristics and patient progress
Nurs.Res. 18:6:484-501. Nov./Dec. 1969.
The author of "Caseload: over
seventy-five", Mary Gibbon, is director
of the H ami/ton-Dundas Branch of the
Victorian Order of Nurses. Two years
ago, she was named Woman of the Year
for the City of Hamilton by the Status of
Women committee for "purring more
than 100 per cent effort into her job and
touching the lives of thousands of people
each year. "
Mary Gibbon has had a variety of
experiences in nursing. She spent her first
five years in outpost nursing in northern
Ontario, and then began working as a
staff nurse with the VON in Hami/ron.
She has also acted as regional supervisor
in the H unrsville area, and started a home
care program in the rural areas around
Guelph.
Her most recent interest has been in
the field of geriatrics. Mary spent last
summer conductin!? seminars across
Canada on care for the chronically ill,
and says that one of her main goals is to
help younger people see the elderly as
human beings.
Mary has also found the time to write
two books, olle about her experiences as
an outpost nurse, and one about the
history ofHami/ton mountain.
OFFICIAL NOTICE
Canadian Nurses
Foundation
In accordance with By-law Section 36. notice is given of an
annual general meeting to be held on Friday, 11 May 1979
commencing at 2:30 p.m. at CNA House in Ottawa. The
purpose of the meeting is to receive and consider the income
and expenditure account. balance sheet, and annual reports.
All members of the Canadian Nurses Foundation are
eligible to attend and participate in the annual general meeting.
Helen K. Mussallem
Secretary-Treasurer
Canadian Nurses Foundation
The Caned'... Nuraa
March 1871 23
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The I rth A erican emp I : . .. on mode
I I 1.1- .ke institut I I . I e care of the elderly a I d Q I I nically
s depersonalizing and unsatisfying for man patients.:
ilies. In Britain, the National Health Se'r . ce Pr' . I . S
care for these " .ents in the securitÿ-an I co rt
of their own homes through a district nursing vi
ot all patien s
eed hospita s
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Arlene A ish
If you walk into any general hospital. it
will be evident from even casual
observation that many chronically ill and
elderly patients are occupying beds-
not because they are acutely ill- but
because there is a problem in arranging
an appropriate place for them to go. In
North America. the alternatives for these
patients include nursing homes or
chronic care institutions. It is the lucky
few who are able to be maintained at
home.
In large part. this is due to the trend
in the last few decades to improve acute
care services. unfortunately at the
expense of home care services.
However. this trend is changing. As
health care costs spiral, it is no longer
feasible to maintain the elderly and
handicapped in expensive institurions,
especially when at least some of them
could be at home receiving support
services. Perhaps we are also beginning
to recognize that people "do" better in
an atmosphere that is familiar to them
and where they can have some form of
independence, individuality and family
support.
The British experience
It was with this in mind that I recently
went to England to learn more about how
home care operates there. While on a
sabbatical leave from university. I spent
eight months working as a district nurse
in south west London. The district
nursing service provides care in the
home twenty-four hours a day. seven
days a week through a separate day and
night staff. The type of care given by the
district nursing service is similar to that
provided by the Victorian Order of
Nurses in Canada or the Visiting Nurses
Association in the United States but the
intensity of the service is greater. thus
enabling severely disabled patients to
stay at home rather than in costly
institutions.
In my district, for example. Mrs.
Smith. who has severe multiple
sclerosis. is paralyzed from the neck
down and still lives al home. When her
husband had a heart attack and was no
longer able 10 lift her, the district nurse
made five visits a day to the Smith home.
An early morning visit was made by the
night nurse to change incontinent pads
and give skin care; the day nurse made
three visits - in the morning to dress
Mrs. Smith and get her out of bed. again
at noon. and then late afternoon to place
heron the commode; and the night nurse
returned to put her to bed. This kind of
help enables the Smith's to live together
in their own home.
The team
District nurses sometimes work in
geographically defined areas but in
London's south west district. most are
attached to doctor's offices or
"surgeries". The surgery where I
obtained my experience consisted of a
group practice of four physicians with
two district nurses and two health
visitors attached to the practice. This
team of eight met daily at the surgery to
discuss patient problems. It IS important
to note the difference between the health
visitor and the district nurse. The health
visitor is a nurse with post basic training
in health counseling and preventative
measures and functions much like a
North American public health nurse. She
is involved in the preservation of mental.
physical and emotional health. early
detection, providing support in periods
of stress and health teaching. She does
not. however. actively engage in
technical nursing procedures. Although
priority is usually given to child health,
the health visitor who is attached to a
group practice devotes a lot of time to
the elderly and deals with their
environmental. social and emotional
problems.
24 M...ch 1811
The C.n-.ll.n Nur..
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The district nurses in a group
attachment deal predominantly with the
elderly population. The kind of care
given by the nurse ranges from physical
care such as bathing the patient to
emotional support for the depressed
individual. When the elderly person lives
with a spouse or with children, much of
the nurse's attention is directed towards
helping the family as a whole to deal with
health problem'i. If possible. the nurse
teaches a family member how to give
phY'iical care, and the family member is
reimbursed with an attendance
allowance if he/she would otherwise
have been earning money outside the
home.
The elderly
For the many elderly people who are
entirely on their own. the district nurse is
a frequent visitor. When mental or
physical health breaks down, solitude
becomes a problem. Forgetfulness,
ranging from mild to incapacitating. can
interfere with the elderly person's ability
to cope alone. Furthermore. the elderly
are 'iubjectto many chronic diseases
such as arthritis or cardiovascular
problems which may interfere with
self-care. A minor fall can produce a
broken wrist which makes managing
alone impo'isible.
The role of the nurse in the care of
the elderly at home covers many areas.
The supervision of medications is an
important responsibility. For some
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patients. a weekly or monthly visit \Jy the
nurse to ensure that prescriptions do not
run out will suffice. Others will need aids
(such as having the daily doses of
medication in marked egg cartons) to
remind them to take their medication.
Constipation is a common problem.
solved initially by enemas and in the long
run by teaching the patient about diet
and mild laxatives. Another nursing
procedure done frequently in the home is
ear syringing to remove wax and
improve hearing.
One of the most challenging areas of
working closely with the elderly is the
recognition of risk factors that occur in
everyday life. Winter presents its special
problems. The danger of hypothermia is
very real for many of these elderly
people. Although most homes have the
potential for adequate heat. many elderly
British patients. brought up to suffer the
cold with forebearance. seem reluctant
to turn on the gas or electric heater.
While the rising cost offuel is a factor
that influences some patients. others are
simply too forgetful to turn the heat on or
forget how to work the heater. One
90-year-old patient. for example.
per'ii'ited in trying to light her electric fire
with matches. On the other hand.
because of the tendency to sit close to
the fire. burns are also a risk. Fire from
pots left to boil dry on the stove or gas
fumes from stoves that are turned on but
not lit are other potential hazards.
Many problems experienced by the
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elderly overlap the roles of health visitor
and district nurse and the division of
responsibility will in large part depend on
the particular working relationship
between individuals. In general. if the
district nurse is seeing the patient on a
regular basis for a physical problem. she
will deal with the other social or
emotional problems as well. by making
appropriate referrals to Meals on
Wheels, Home Help, or voluntary
visitors. If there are no physical nursing
needs. the health visitor may follow the
patient and call in the di'itrict nurse as
needed.
Because of the chronicity of their
problems. the elderly place great
demands on the physician's time.
Continuous health supervision is needed
and many times when the patient calls
the surgery about a problem. a visit by
the district nurse will save the doctor a
house call. However. doctors do make
frequent house calls in England. When
both doctor and nu rse see the patient in
his own environment. there is an
increased tendency to view problems in a
similar way and therefore to
communicate more effectively.
The attachment of district nurses
and health visitors to group medical
practices also facilitates communication
among members of the health care team.
enabling them to give a better standard of
care and to do so with less
interdisciplinary friction and more
mutual respect.
The C.nedlen Nur..
.rch 111711 25
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Chronic illness
District nurses and health vIsitors are
also very involved in assessing the needs
of young and elderly patients with
chronic illness. Some of the most
common conditions requiring home
nursing are multiple sclerosis.
rheumatoid arthritis. diabetes. anemia
and cardiovascular disease. Many
patients with these problems need basic
physical care and help with activities of
daily living such as washing. dressing
and assistdnce out of bed, While making
routine daily. weekly or monthly visits.
the nurse has an excellent opportunity to
continually reasses s the needs of her
patient and to be on the lookout for any
new problems. Besides the usual
assessmenttool'i such as thermometer
and blood pressure cuff, technique.. of
physical examination and intervie\\oing
must be used to gain a clear picture of the
patient's problems which can then be
shared with the physician. Other nursing
procedures frequently done in the home
include injections. dressings to chronic
wounds and the collection of blood and
urine samples for diagnostic purposes.
Psychiatric problems. especially
depression and alcoholism. are
commonly seen by the district nurse.
Usually she comes to know these
patients because of their need for help
with a physical problem. Since she is
already providing physical care which
the patient recognizes as helpful. she is
able to establish rapport and offer
.
...
-
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-
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....
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...:. "
t'
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Photos b)' Bob ACclaro. courtesy of the VlclOnan Order of Nurses for Canada. Ottawa
&.
emotional support. When intensive
counseling is needed. the nurse may
refer the patient to a community
psychiatric nurse or to a social worker.
Surgical patients present a variety of
nursing needs. Some. such as colostomy
patients. may need teaching and
emotional support rather than actual
physical care. Other patients with
post-operative complications may need
daily dressings on a long term basis.
Recently. district nurses have been given
the responsibility of removing sutures
from patients who would otherwise have
to be sent back to the hospital casualty
department for this procedure.
ferminall) ill patients
More families in England choose to care
for their dying relative at home than do
families in Canada. This care places
great physical and emotional demands on
the family and it is unlikely they could
cope as well withoUlthe support ofthe
district nursing service. The nurse mdY
make suggestions about the environment
such as moving the patient downstairs.
She can provide aides such as ripple beds
and sheepskins. The family is taught how
to give physical care and encoumged to
participate during the nurse's visit.
Towards the end of the illness. nursing
visits may be made three or four times
daily by day and night nursing staff.
Perhaps her. work with the
terminally ill, while not a large part of the
case load. best illustrates the total role of
the district nurse in providing a high
standard of nursing care in the home. II
involves basic physical care. emotional
support. teaching of the patient and
family. and \\oorking closely with the
patient's physician. '"
Conclusion
A district nursing service such as the one
in south west London enables patients to
stay at home within a familiar
environment and to live their lives as
best they can. As North America looks
towards improving home care services
for its citizens, we might do well to
examine Britain's experience in this
important area of health care.
For the piat lIille v'ears. author Arlene
Aish has beell a teacher at Queell's
U nÙ'enity. ^ illgston. Ontario. Prior to
this appoilltment.
he tauKht at the
Unil'ersi(\ ofNeu Brun.vu'ic".
Frederictoll alld at the Ullil'ersity of
TorOIllU. NunillK practice illdudes tl\'O
yean as a public health lIurse for the city
oj Torollto. a year ofslllff duty at the
V allcoul'erG etleral Hospital and
temporary dun' in Seattle alld San
FrallcÙ"("(J.
Arlelle reeeil'ed a B.SeN. at the
Unil'enity ofBriti
h Columhia. a
lv/aster's ofN un ill/( at the U nil'ersity of
Washillxtull alld a poM-master's vear
wa.\ ta"ell or the Ullil'ersity of
Calijornia. San Frill/cisco Medical
Cellter.
o
\
IQ)
<<
)
In May of 1972. I suffered a massive stroke that left me unable to move or speak. But although I was
bereft of muscular mobilit) from my head to my toes, I retained my senses of hearing and sight and
most important of all, my mental faculties were not impaired in the slightest. I could comprehend
everything that was said and going on around me, but I was physically unable to respond.
At the time. the doctors told me that the
first eight days would be a "wait and
see" period, that the extent of the
damage done was as yet unknown.
Strangely enough. I didn't feel remotely
apprehensive. It never crossed my mind
that I might die during this period.
Instead. I was somewhat impatient for
the eighth day to arrive so that my
recovery could begin. an attitude I
probably owe to my religious
convictions.
On the eighth day, the doctor let me
know that I had made it - I was over the
hill. In the same breath he cautioned me
that the road to recovery would be a long
one, that he would be pleased even ifl
improved at the rate of "an inch a day".
A few days later, a group of doctors
gave me a thorough examination, each
attending to the area of his specialty.
Moments after they had all left. one
doctor returned. patted me on the chest.
and said, "Frank. we'll make a new man
of you". I have often wished that I could
meet this man again so that I could
express in words how grateful I was for
his thoughtfulness. . felt that' was right
on course, that nothing could obstruct
me.
An inch a da}
It wasn't long before I began to develop
leg cramps. I was turned regularly from
my left side, to my right and back again,
but only the prone position afforded me
any relief. In the beginning, I was a'so
allowed injections which eased these
pains for a few hours. Many weeks later,
when I could withstand physiotherapy,
my legs gradually ceased to bother me.
. also had pain in my left arm and
shoulder, an area that was to remain
sensitive for the next three years.
Initially I was treated with hot packs
which relieved the sharpness of the pain;
the rest dispersed very gradually as the
result of therapy.
The Can-.llan Nil...
March 1171 27
In time, my mouth, which initially
seemed to be locked closed. began to
open slightly. Small amounts of pureed
foods had to be forced into me. but my
mouth still had to be pried open wide
enough to insert a spoon. ) managed to
swallow by force of gravity only; the
muscles concerned were still not
working. After each feeding bits of food
would cling to the insides of my mouth
and) began to appreciate much more the
discomfiture implied in the phrase
"jungle mouth"
A few of the nurses neither spoke to
me nor glanced my way. ) suppose that
they assumed that I Was in a severe
comatose state and that it would be an
exercise in futility to attempt any kind of
communication with me. Most of the
nurses would smile and carryon a
one-way conversation, telling me what
they were going to do for me at a
particular time. Their actions filled me
with a sense ofbelonging-) was part of
society once more, however slightly.
My visitors too had various attitudes
towards me. My wife, her brother and
some of my relatives and friends never
spoke down to me: they always talked to
me as though I was recovering from a
routine procedure, like an operation.
They kept me up-to-date and made sure
that I knew what was going on in
day-to-day matters.
There were other visitors, though,
who wore sombre looks, gently patted
my hands (while gazing at the wall),
whispered a few words of sympathy, and
shortly after. departed. ) must confess
that at these times I fervently wished)
had the power to shout out
furiously-"What do you think this is, a
W AKET' ) suppose they meant well.
There came a time when) was able
to emit a few groans and pronounce, in a
very inarticulate way, of course. a
number of words. At first my vocabulary
was lImited to such words as-Yes, No,
Nurse and a few others.
Just before my transfer from the
I.CU., one ofthe nurses made up a set
of cards for me on which were printed
the words most commonly associated
with my needs, words like Yes, No.
Pain, Legs. C ü"m fort able . These cards
enabled the nurses to communicate with
me by pointing to a word, so that) could
signify, by a slight movement of my
head, what it was I needed.
) felt) was progressing. When) was
transferred to a general floor. it came as
a surprise to me that the nurses felt the
mOVe was somewhat premature. ) felt
disillusioned.
) recall another incident that took
place at about the same time. I was being
fed my usual meal of pureed foods. By
this time. ) was capable of rolling my
eyes from side to side. Since my tray was
in close proximity. I kept eyeing the ice
cream andjello in great anticipation. Just
when I was ready, the tray was suddenly
and unexpectedly removed. I felt like a
child must feel when someone steals a
popsicle right out of his mouth. ) mention
this incident only to point out how much
harm a little thoughtlessness can cause
- hO\II important the little things really
are. It was only one incident. but I
remember it well.
The road to recO\ ery
Towards the latter part of June 1972. I
was transferred to a neighboring hospital
for a more intense rehabilitation
program. My speech continued to
improve. But my body from the hips up
remained quite flaccid. so that) was
unable to sit erect and required a
restrainer and built-in wooden tray
which fitted onto my wheelchair to help
me sit up. I still had no real muscle
power - my muscles were not as stiff as
they had been. but they were decidedly
flabby.
I had quite a daily routine -
physiotherapy twice a day - once in the
morning and once in the afternoon. and
morning therapy was followed by
occupational therapy. Around two-thirty
in the afternoon. I had speech therapy.
then my day ended in the workshop.
Gradually. I regained strength. The
staff felt that I was ready to start dressing"
and shaving myself as well as
transferring and maneuvering my
wheelchair. The entire process was very
slow, requiring my endurance and a great
deal of patience from the staff. The most
trying task for me was dressing myself -
I was still in a flaccid condition. My left
shoulder remained painful and my neck
tended to flop downwards. As my right
arm was not fully developed. my electric
shaver felt very heavy. Transferring and
wheelchair dexterity were equally
arduous. In time.) managed.
) developed my speech muscles
through conversations between the
therapist and myself. ) recall that after
my first weekend pass. I could hardly
talk. The therapist told me that) had
probably been trying too hard to speak
above the noise of other conversations. I
was advised to avoid speaking above
other noise and to concentrate my efforts
on one-to-one conversation.
I attempted writing exercises, but
for awhile. found it difficult to write in a
straight line. In the meantime, typing
strengthened mv index finger. For a long
time I had to be fed by someone else.
When for the first time. ) shakily raised a
spoonful of food to my mouth. it was a
welcome sign of progress. I t is also a
memory especially dear to me because)
managed to accomplish it on my wedding
anniversary.
In all things. visitors would offer
their assistance. which I had to refuse for
my own sake. At times the staff would
gently discourage others from offering
their aid.
I remember one evening as I
returned from my dinner, a nurse
stopped me to say how much she would
like me to encourage a few patients who
refused to make any effort towards
improvement. My initial reaction was
one of shock - I had always taken for
granted the fact that everyone was
striving to get better. Then I was angry
- how could people allow themselves to
remain in a state of mere existence?
There was no place for them in
rehabilitation if that was their frame of
mind.
When I analyzed the situation more
calmly. I concluded that I would not
serve any purpose if) confronted these
individuals. and) began to realize that
there were a number of variables which)
would never know that had caused such
an attitude. They might have lost
incentive to maintain the struggle
because of other problems. marital.
financial or family worries.
As far as my own incentive was
concerned: much earlier in my illness)
had developed as my motto a couple of
lines from one of Robert Browning's
poems:
A man's reach should exceed his
grasp.
Or what's a heaven for?
Going home
I was discharged about mid-January of
1973. At home there were still more
obstacles to overcome. I made my way
around the house with a shoe horn brace
for several weeks until I developed foot
drop. necessitating a return trip to the
hospital. ) was fitted for a metal brace.
an approach that also turned out to be
unsuccessful.
Thoughts turned to finding the best
way for me to get outside during the
clement weather. Two people from the
occupational therapy department visited
our house to advise us on the most
suitable place to install a hydraulic lift.
28 U.rch 1878
I am pleased to say that over the
past few years, my condition has
continued to improve, slowly but surely.
I have had periodic setbacks - deep
vein thrombosis, pulmonary congestion
and angina. Now I have begun to
negotiate a few sidelong steps, crouched
over a quad cane and supported by the
therapist. My left leg is a problem; it will
slide to the right and move backwards.
but as yet refuses to move forwards. We
are confident though that this problem
will eventually be overcome.
The attitudes of others towards me
have made a tremendous difference.
During my long rehabilitation period,
neighbors would often stop by for a chat.
When we went outside. there were those
who would steel themselves to gaze
away from me. Others glanced my way
covertly, through the corners of their
eyes. To those who looked me fully in
the face, half smiling, I always made a
point of waving and saying "hi'", to
break down the barrier between us. It is
the children though. who make me feel
most at ease -I have had so many
interesting conversations with them as
they lean on their bicycles.
As for those who have worked with
me for all these years to help me
overcome my limitations. I would like to
paraphrase a line from the book of
Daniel. "Blessed are you who teach how
to rehabilitate. for you shall shine as
stars for all eternity. .,
A Nursing Perspective
There are three primary causes for
cerebral vascular accidents: cerebral
thrombosis. cerebral embolism and
cerebral hemorrhage. It is my opinion
that this is where generalizations should
end, for the results of these insults on the
human body are as variable as the
individuals who suffer strokes. The
degree of recovery for any individual will
depend on many factors - the severity
and location of the lesion. the physical
health of the patient, his age, his will,
and the help and encouragement he
receives from others.
This is why Frank's story is
important - it helps us to remember that
the patient who has a stroke is a unique
individual who needs to be cared for as
an individual.
The C..,-.lI.n Nur..
Frank's admission
Frank Halligan. a 52-year-old school
teacher. was admitted to hospital with
sudden onset nausea and vomiting and a
left-sided weakness or hemiparesis. He
also had a right facial weakness and
slurred speech.
Within 24 hours, Frank had lapsed
into unconsciousness and a couple of
days later, his clinical picture had
become more involved. His left-sided
hemiparesis had become a flaccid
paralysis or plegia and he had also
developed a right-sided hemiparesis.
This progression of presenting pathology
is often referred to as a stroke in
evolution.
A number of diagnostic procedures
were used to find out the cause and
extent ofFrank's C.V.A.:
. Lumbar puncture - revealed clear
cerebrospinal fluid. ruling out the
possibility of cerebral hemorrhage.
. EEG and brain scan - both normal
. Neurological examination-
revealed bilaterally positive Babinski
reflexes and a fine horizontal nystagmus
to the right. The Babinski reflex is
elicited by tactile stimulation of the sole
of the foot. Dorsiflexion of the great toe
and fanning of the smaller ones occur in
the presence of damage to the upper
motor neuron pathways. Nystagmus is
an involuntary rhythmic oscillation of
the eyeball that indicates brainstem
involvement.
. Testing of the cranial nerves-
revealed palsies of the facial and
glossopharyngeal nerves. nerves seven
and nine. Frank's facial weakness and
dry mouth was due to trauma to the
facial nerve. Some sensory fibers for
taste are also located in the facial nerve
which has its cell bodies in the pons and
medulla. Frank's ninth cranial nerve was
also affected. This resulted in decreased
taste in the posterior portion of the
tongue. The motor deficits - decreased
gag reflex and dysphagia (difficulty in
swallowing) presented problems for him
as well.
. Motor examination of the
extremities - revealed slight movement
in the right limbs and no voluntary
motion in the left limbs.
. Sensory examination - showed
marked hypesthesia (decreased
sensation) to pin prick to the right face
and upper extremities.
. Orientation to time, person and
place was intact. Frank could respond by
nodding to questions we asked. Frank
could also answer complex mathematical
problems: he had no problem-solving
difficulties.
Frank's past history was relevant-
he had had a myocardial infarction
twenty years earlier. Neoplasm was
ruled out because of the sudden onset of
the presenting symptoms. A cerebral
embolus was possible, but because of the
probability of cerebral atherosclerosis,
the diagnosis of pontine artery
thrombosis with subsequent
quadraparesis and cranial nerve deficits
was established. The involvement of the
ninth cranial nerve. the
glossopharyngeal, was due to cerebral
edema in the area of the medulla. Pontine
artery thrombosis affects the medulla
because of the proximity of the pons and
medulla. Cerebral edema following
thrombosis of the pontine artery has
profound effects on the medulla as well.
Acute care
The first few days following a stroke are
critical. The most important function of
the nurse at this stage lies in keeping the
patient alive. If he is unconscious,
measures that are routine for every
unconscious patient, i.e. maintaining a
patent airway. nursing the patient in a
semi-prone position and suctioning will
be necessary. In addition, the acute
phase necessitates continual nursing
assessment of the patient. The nurse
needs to be aware of
. changes in the patient's level of
consciousness; does the patient change
in his response to stimulation; does he
resist a change in position?
. the neurological vital signs of the
patient; these need to be monitored at
least every four hours;
. the patient's fluid balance; monitor
intake and output every 24 hours;
. stiffness or flaccidity of the
patient's neck;
. presence or absence of voluntary or
involuntary movements ofthe patient's
extremities.
Following aC.V.A., edema and
necrosis will cause an increase in
intracranial pressure. Function will be
impaired in those parts of the body
normally supplied by the affected vessel.
Spinal shock. exhibited by flaccid
paralysis and the absence of spinal cörd
reflexes is evident during this period of
increased intracranial pressure and
edema. A state of flaccid paralysis may
persist for one to two weeks, after which
time, the skeletal muscles have a
tendency to become spastic.
The C...-.llen Nur..
"'rch 1 871 21
At this time, the patient may not
have bladder or anal sphincter control.
When the patient is unconscious. an
indwelling catheter is used to drain urine,
but as soon as the patient's condition
stabilizes. the catheter should be
removed. Prolonged use of an indwelling
catheter can cause bladder atrophy
resulting in a low threshold and decrease
urethral sphincter muscle tone.
Once the catheter is removed, it is
important to make sure that the bladder
does not become overdistended. as
overdistention may cause dangerous
stretching ofthe neural receptors in the
bladder wall. A bladder routine should
be established as soon as possible.
Failure to establish a routine may
contribute to the necessity of prolonged
bladder management.
Similarly. a bowel routine must be
established as soon as possible. Stool
softeners. high fiber foods and possibly
natural laxatives may need to be used for
satisfactory control of bowel problems.
The patient's immobility may
complicate an already complex situation.
Skin breakdown is one grave
consequence of immobility and a
positioning schedule must be followed
religiously to prevent this problem.
Another side effect of immobility is
muscle spasm: Frank's leg cramps were
alleviated once mobility was resumed.
Feeding the patient will be a concern
if. as in Frank's case, the patient's gag
reflex is diminished or absent. A suction
should be kept at the bedside in case of
aspiration. Thick fluids such as melted
ice cream, thick soups and puddings are
generally swallowed more easily than
other foods. Suctioning and feeding
should always be followed by mouth
care, to prevent what Frank calls "jungle
mouth". In time. mouth care will
become the patient's responsibility.
Because meals are generally
something the patient looks forward to. it
is important to set aside time so that
neither the patient nor the nurse will be
rushed. Mealtime is a good time to
establish a rapport with the patient.
This brings me to one of tbe most
important areas for nurses to consider
when they work with stroke patients -
communicatiOJ1. It is often a difficult task
to communicate with someone who can
speak, but the consequences of a C. V .A.
are often such that the patient's speaking
ability is impaired. Aphasia can be
frustrating for the nurse, the patient and
his family.
, ..
or"" :"\ ,
, ,,- - i' ..4
. ["!
I ;, .
OIl ' . !
.. -:.l!
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Frank's problem was not aphasia
but dysarthria. which is an inability to
speak because of muscle damage.
Trauma of the facial nerve is the
underlying pathology. But although
Frank was unable to answer us, his
comprehension was not impaired at all.
Forthis reason flash cards, pictures and
body movements could be used to
facilitate communication between the
nurses and Frank. The use of these
devices was explained to Frank's family
so that they could take advantage of
them.
Pain may be a problem, as it
certainly was in Frank's case. The use of
analgesics must be considered carefully.
because both psychological and
physiological dependence can occur. I
am not suggesting that medication should
not be used, only that alternatives such
as hot packs or a vibrator be considered
as well as medication, for often the pain
is not short-lived but rather a problem
that will exist for some time.
Hot packs were helpful in the
treatment ofFrank's shoulder pain. Heat
treatment is often used to induce
analgesia. especially when pain is caused
by muscle spasm. Heat causes an
increase in peripheral blood flow,
allowing larger quantities of oxygen and
nutrients to the painful area and relieving
pain.
Position changes dlso afford a
degree of pain relief as well as offsetting
the possibility of decubitus ulcer
formation. In addition the effects of the
patient's anxiety on degree of pain
should be considered: pain is a
multidimensional phenomenon, and
sometimes the cause is not as it appears.
The needs of the patient's family
must not be overlooked because family
involvement means so much to the
recovery of the patient. I f time is taken at
the beginning to explain to the family
exactly what is going on. the time ahead
will be easier for everyone involved. An
explanation of what is involved in the
recovery process may prevent avoidance
or rejection of the patient by his friends
and family.
Once the critical phase of the
patient's illness has passed, efforts must
be channeled towards the rehabilitation
of the patient. As Frank has pointed out
so well. rehabilitation can be a lengthy
process, demanding the patience, hard
work and support of everyone involved.
The rehabilitation period marks a time
when everyone must come to terms with
what is going on: for the patient and his
family. it may mean a greatly altered
lifestyle.
30 Merch 1171
The C.nedl.n Nur..
Beginnings
Much has been said about the team
approach in nursing. In any
rehabilitation effort, a team approach is
absolutely essential. The disciplines
involved in rehabilitation are
physiotherapy, occupational therapy,
speech therapy, nursing, social work,
and medicine. Communication between
all these departments is vital if the
patient is to receive maximum benefits
from the program.
In rehabilitation, the nursing care
plan is not only helpful- it is a
prerequisite for the consistency required
to help the patient improve. I stress
consistency because any change in
routine for a rehabilitation patient can be
detrimental.
Take for example a patient who
requires a great deal of encouragement to
perform at his optimum level. As Frank
pointed out, not all patients are
motivated to the same degree. If the
physiotherapy department is successful
in helping a patient to perform a given
task at a certain level and fails to pass
this information along to the nursing
department. the nurses may assist the
patient where he no longer needs
assistance to the patient's ultimate harm.
For the patient who needs
encouragement to walk, keeping him in a
wheelchair through ignorance or
misunderstanding is detrimental to his
progress.
Family involvement in rehabilitation
is also very important. The aim of
rehabilitation is to return the patient to as
normal a lifestyle as possible, and often
this means returning to his home
environment. If the family's involvement
is encouraged from the beginning. family
members will show less apprehension
and wiII usually be more willing to accept
the patient's return home. Family
support is often the biggest incentive to
getting better.
I t is up to members of the health
team to establish when and how much
family involvement should be
encouraged. Premature involvement
could be hazardous. For example. if a
patient is not yet transferring well from
bed to wheelchair with staff members, it
would be foolish to insist that the
patient's wife take an active role - it
would only frighten her and make her
apprehensive on future occasions. On
the other hand, assisting her to learn her
role when her husband is also ready can
increase her self-confidence and give her
a feeling of satisfaction. .
The nurse's role in rehabilitation
The prime concern of the nurse in the
area of rehabilitation lies in helping the
patient learn activities of daily living-
eating, dressing, hygiene and bowel and
bladder control. Management of
medications, with the eventual aim of
self-administration is also a nursing
responsibility. Psychological support,
helping the patient accept his present
situation while planning realistically for
the future. is a part of daily interaction
between nurse and patient.
A daily routine needs to be worked
out between all disciplines and the
patient. The patient must know what is
expected of him at all times. It is helpful
to post this routine at the patient's
bedside to tell everyone what the patient
is expected to do, and what he needs to
be assisted to do. Such a routine may
read as follows:
Activity - up with walker alone
7 am -am care with minimal assist
8 am - Physiotherapy
9 am - Breakfast in the dining room
9:30 -Activity Class
10:45 - Speech Therapy
11 am -Rest Period
12:30 - Lunch-Dining Room
1 pm -Activity Class
1:30 - Physiotherapy
2 pm -Rest Period
3:30 -Occupational Therapy
5 pm -Dinner-Dining Room
6 pm -Activity Class
I have already mentioned that bowel
and bladder routines should be
established early in the course of
treatment. Rehabilitation seeks to
develop this routine further. Any bladder
routine begins with a determination of
the cause of incontinence. I s it due to
physiological problems such as a urinary
tract infection? Or is it due to
psychological factors such as mental
confusion?
Once the cause has been
established, the patient's drinking and
voiding patterns should be noted. The
nurse should note the time and amount of
fluid intake as well as voiding or
incontinence. A fluid intake of 2000 cc
per day promotes optimum body
functioning. Large amounts of cranberry
and apple juice produce an acidic urine
and are beneficial as a prophylactic
measure against bacterial infection. The
patient should be taken to the bathroom
after the consumption of 250 cc and
every two hours initially until a routine is
established. Once this routine is found to
be satisfactory, strict adherence is
necessary. The voiding process becomes
an automatic behavior and bladder
control is acquired.
I n the initial bladder training stages,
men can use external drainage devices so
that rest is not disturbed. Once daytime
continence has been established.
incontinence at night can be decreased
dramatically. Encourage the family to
take a part in this routine by asking their
assistance in recording and encouraging
fluid intake.
The Can-.llen Nur..
March 1171 31
Bowel training involves the same
principles - assess the cause of
incontinence or constipation. and then
establish a routine. Family assistance
can be especially helpful in this area.
because family members can provide
essential information regarding the
patient's previous habits. Initially,
discontinue all laxatives and enemas and
establish the routine outlined by the
patient or family. Ensure adequate fluid
intake and high fiber content in the
patient's diet. If this approach is not
successful, a mild suppository. stool
softener or bulk increasing laxative can
be given to help establish a new routine.
Frank mentioned the importance of
letting the patient do whatever he can do
for himself. Sometimes it is difficult to
discourage well-meaning visitors from
assisting the patient. but it must be done.
The patient will have difficulty learning
to do things for himself. but the only way
that he can learn is through repetition.
Obviously the problems of dressing.
daily hygiene and eating will provide a
different challenge for each patient.
Depending on the degree of the
patient's disability. dressing will take
time and a good deal of practice. and will
be the source offrustration at the
beginning. The patient will be taught to
dress the affected limb first (and undress
it last), with the assistance ofthe strong
limb wherever necessary. There are
many helpful aids available. including for
example the elastic shoelaces and long
handle shoehorns. An occupational
therapist can be very helpful in this area.
Bath time is important because it
accomplishes increased stimulation and
circulation for the patient. gives the
patient a chance to develop motor skills.
and the nurse a chance to assess'
improvement or change in function.
Very often stroke patients with
hemianopsia - or blindness in half the
visual field - will have a distorted
proprioception, and bathing encourages
the patient to accept changes in his body.
Eating can be a trying experience for
the patient. In hemianopsia. the patient
will only be able to see half his tray. It
will take time for the patient to be able to
coordinate his movements. and it is
important to support him and praise his
progress so that he will not become
discouraged.
If. as in Frank's case the problem is
dysarthria. then chewing and swallowing
may be a slow process. Again it is
important to stress independence, as
eventually the movement will speed up
and independence will be achieved. This
independence is symbolic of control of
one's situation. which is vital in the
rehabilitative process.
Cerebral vascular accidents are
usually the result of a pre-existing
medical condition: the two most
common being hypertension and
diabetes, both diseases affecting the
blood vessels. A common post-stroke
complication, and one that Frank
experienced, is deep-vein thrombosis,
occurring primarily due to immobility
and vessel changes. Thrombosis occurs
in about 80 per cent of all C. V .A.
patients. The use of elastic stockings and
early mobilization and exercise aid in the
prevention of deep vein thrombosis. Pain
in the calf. inflammation. and swelling
are the symptoms that the nurse should
know about.
Patients who have had strokes are
often placed on anticoagulant therapy.
Nurses should be aware that it is
important to avoid giving the patient
ASA containing drugs and intramuscular
injections. Close monitoring ofthe
patient's prothrombin time and partial
thromboplastin time is essential.
Conclusion
These are some of the areas we as nurses
must consider in dealing with patients
who have suffered strokes. The details
add up to a picture of firm and consistent
support to help these patients enjoy as
much independence as possible. In our
teaching, we must be very conscious of
the purpose of the routines established.
never losing sight of the fact that from
the acute stage on. the patient must take
daily steps towards his own
rehabilitation.
Rehabilitation encompasses a wide
spectrum of considerations. Patients like
Frank have to deal with physical trauma
and accept certain limitations,
limitations such as they have never
encountered before. Their lives are
altered. a whole lifestyle ended.
As nurses. we are called upon to use
all the insight and understanding we can
muster if we are to be successful in
helping patients like Frank to help
themselves. That is why understanding
what happened to Frank - from his
point of view - is so important. 40
Bibliography
1 Anthony, Catherine Parker.
Textbook of anatomy and physiology.
9th ed. St. Louis, Mosby,1975.
2 Horoch, Rose Marie. Elements of
rehabilitation in nursing: an
introduction. St. Louis, Mosby, 1976.
3 Brunner, Lillian Sholtis. The
Lippincott manual of nursing practice.
Toronto, Lippincott, 1974.
4 -. Textbook of medical surgical
nursing. 3d ed. By... and Doris Smith
Suddarth. Toronto. Lippincott, 1975.
5 Bladder and bowel retraining.
Rehabilitation Program St. Joseph's
Hospital, Hamilton, Ontario.
Lori Whittington Hunt, (R ..V.) is a
graduate of the Mohawk College Schuol
of Nursing. She is currently working in
the Rehabilitation Vnit of St. Joseph's
Hospital in Hamilton.
Frank Halligan taught in the elementary
separate school system in both Ontario
and Quebec for se
'eral years.
concentrating his efforts in the areas of
athletics. literature and music. A few
years before his illness. Frank was a
teacher librarian in an open concept
system and was attending Brock
Vni
'ersity to obtain a Library Science
Degree.
32 M8rch 1878
The C.n-.llen Nur..
Current, luccinct, reliable ...
ILLUSTRATED GUIDE TO ORTHOPEDIC
NCRSI:\'G
By Jane Farrell, R.N.
Richly illustrated with over 500 figures and
photographs, this important manual deals
with the major problems encountered by nur-
ses in the orthopedic unit. Specifically it
focuses on the nursing care of the adult ortho-
pedic patient; on those factors that influence
the patient's adjustment, behavior, and recov-
ery; and on practical suggestions for resocia-
liÚng the patient in his home environment.
Lippincott. 242 Pages. 550 Illustrations.
1977. $12.50.
LIPPINCOTT'S STATE BOARD
EXAI\II:\'ATION REVIEW FOR NURSES
By Lu Verne Wolff Lewis, R.N., AI.A. With 6
Contributors and 4 Reviewers.
Uniquely designed to incorporate sound teach-
ing methods with an accurate reflection of the
structure and approach of actual state board
examinations, this new review book appears
in tÌ1e same format as the licensure examina-
tions themselves. It offers 2,568 questions
(together with answer-recording sheets just
like those in the examinations) that are also
in the same ratio as will be found in the exa-
mination.
Five tests cover five major areas of nursing:
medical, surgical, obstetric, pediatric and psy-
chiatric. They integrate the basic natural and
social sciences, nutrition and diet therapy,
pharmacology and therapeutics, fundamentals
of nursing, communicable diseases, and legal
and ethical considerations. All answers and
the rationale for each answer appear at the
end of each of the five major sections.
Lippincott. 745 Pages plus Answer Sheets.
Illustrated. 1978. $13.75.
NURSES' DRUG REFERENCE
Edited by Stewart M. Brooks, .''v1.S.
All nurses will welcome this fingertip guide to
drugs, organized specifically with their needs
in mind. It lists alphabetically over 500
generic drugs and describes-in an easy-to-
consult format-each drug's action and use,
dosage and administration, cautions, adverse
reactions, composition and supply, and legal
status. A glossary of drug classifications
affords extensive cross-referencing for quick
referral to hard-to-find information. Impec-
cably organized and absolutely reliable, XDR
will serve as the standard reference for any
health practitioner who dispenses drugs
regularly.
Little, Brown. 500 Pages. 1978. $14.25
(Paper). $27.00. (Cloth).
Nt.:"RSING RESEARCH:
Principles and
Iethods
By Denise Polit, B.A., AI.Ed., Ph.D.; and
Bernadette P. Hungla. R..\'., B.S.N., JI.S.,V.,
M..!.
This new h:xt clearly and logically presents
the essentials of research methudology with
specific regard to nursing. Fundamental re-
search concepts are supported throughout
with practical explanations and numerous
examples.
Lippincott. 500 Pages. 1978. $19.50.
HEALTH CARE 0 F WO
IEN
By Leunide L. ,Hartin, R.,V., ,\l.S.,
Written from the nurse practitioner's point of
\"iew, and with particular focus on ambulatory
care, this is the first combined OB-GYI'\
North American textbook intended specifica-
lly for nurses. In a succinct, lucid style, it
emphasizes physical assessment, including his-
tory and exam; physicdl diagnosis; treatment
measures; indications for consultation with
the physician; patient counseling; and follow-
up care.
Psychosocial considerations are as important a
pdrt of the book as the physical; the integra-
tion dnd balance of these aspects are handled
superbly. Detailed coverage focuses on such
matters as identity, self-image, changing roles,
sexuality, meaning of pregndncy, special prob-
lems of abortion patients, dnd psychological
changes in aging and menopause.
Lippincott. 500 Pages. Illustrated. 1978.
516.75.
J. ß. Lippincott Company of Canada Ltd. 75 Horn(Zr Au(Z., Toronto, Ontario mal4H7
The Cen.dlen Nuree
Merch 111711 33
MANUAL OF NEL'ROLOGICAL Nt'RSING
By Nancy Swzft, R.N., with Robert M. Mabel,
Ph.D.
Every nurse will welcome the realistic,
straightforward guidance afforded by this
much-needed handbook. In a format facili-
tating on-the-spot reference, the authors
succinctly and dearly cover every aspect of
neurological nursing, including patient ass-
essment and monitoring, diagnostic studies,
management and assessment of specific neu-
rological pathologies and dysfunctions, ma-
nagement of pain, considerations for exten-
ded care and rehabilitation, and the all im-
portant psychological aspects of care.
Little, Brown. 201 Pages. 1978. $9.25.
GENERAL SYSTEMS THEORY APPLIED
TO NCRSI
G
Bv A.rlene M. Putt, R.N., Ed.D.
With 11 Contributing Authors
The nurse learns to facilitate patient assess-
ment, planning for care, teaching, and in-
service education by applying the concepts of
general systems theory. Building on the ideas
originally formalized by vun Benalanffy and
later adapted to nursing by June C. Abbey,
PhD., the duthor dnd 11 contributors explain
the components common to all systems, their
functions, and the applicdtion to patient care
of those principles underlying total human
ecolugy.
Little, Brown. 240 Pages. 1978. $11.75.
THE LIPPINCOTT
IANUAL OF NURSIl\'G
PRACTICE, 2nd Edition
By Lillian Sholtis Brunner, R.N., B.S., At.S.N.)
and Doris Smith Suddarth, R.N., B.S.l'''/.E.,
,U.S.N.
This monumental Second Edition of a mod-
em classic-the most comprehensive single-
volume reference on nursing practice ever
published-incurporates massive revision and
updating to offer the latest and most accu-
rate information available. \\'hat this means
is more detailed, substantive. and complete
coverage of every phase of medical/surgical,
maternity, and pediatric nursing!
Lippincott. 1868 Pages.
Illustrated. 1978. $29.95.
Il\'TERPRETATIO
OF DIAGNOSTIC
TESTS: A Handbook Synopsis of Laboratory
Iedicine, 3rd Edition
By Jacques Wallach, M.D.
Extensively revised for its newest edition, this
book continues to be a practical aid in the
proper selection and interpretation of virtu-
all y all clinical laboratory tests. For the first
time, extensive pediatric material is included.
It provides rCddily accessible and reliable data
for maximum efficiency in making an early
diagnosis, determining the stage and activity
of the disease, detecting its recurrence, and
medsuring the effects of therapy.
Little, Brown. 600 Pages. 1978. S 11.50.
Uppincott
- - - - - -j
.-
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Please send me the following book(s) 'on approval:'
o Nurses' Drug Reference, Paper, $14.25.
D Nurses' Drug Reference, Cloth, $27.00.
D Illustrated Guide to Orthopedic Nursing, $12.50.
o Nursing Research, $19.50.
o Lippincott's State Board Examination Review
for Nurses, $13.75.
o Health Care of Women, $16.75.
o Manual of Neurologic Nursing, $9.25.
D General Systems Theory ApVlied to
Nursing, $11.75.
o The Lippincott Manual of Nursing
Practice, $29.95.
o Interpretation of Diagnostic Tests, $11.50.
Lippincott's No-Risk Guarantee
Buoks are shipped to yuu On Approval; if you are
not entirel} satisfied you ma} return them within
15 days for full credit.
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CN379
34 M.rch 1979
The Cen-.ll.n Nur..
oa
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AgnesT.H. Choi-Lao
Marion S. Logan
The differing value systems of the "work
world" and the "school world" can
become a source of great concern to a
new graduate nurse. Much nursing
literature, in particular Marlene Kramer's
Reality Shock, has described how the
service-oriented values of the hospital
and community agency can often be in
direct conflict to the
knowledge-idea-oriented atmosphere of
educational institutions.
No matter where we work, all of us
have experienced the very real feeling
that nursing education and nursing
service are two separate entities running
along parallel tracks even though better
patient care is their common goal.
Although this phenomenon of separation
is well known and numerous efforts have
been made by nurses to correct the
situation, the division remains a reality.
To facilitate greater exchange
between nursing education at the
university level and nursing service in the
hospital and community, the nursing
faculty at the University of Ottawa has
tried a number of tactics - among them
reciprocal membership on standing
committees, joint appointments on the
faculty and in the service sector etc. We
also felt that it was most important to help
nursing students develop some ideas
about the scope of nursing service.
As a beginning step to help bridge the
gap between service and education, a
strategy was developed that utilizes the
inservice department of hospitals and
community agencies. Since quality
inservice is one ofthe multi-faceted
functions of nursing service, it was hoped
that students would achieve a better
understanding of one aspect of the
nurse's work world.
Second year nursing students were
chosen to participate in this educational
experience. By this time. they had
developed a comprehension of basic
nursing concepts and had begun studies in
first level medical-surgical nursing. We
felt that greater exposure to the work
world early in their nursing education
would be meaningful for them.
The Cen.dl.n Nur..
M.rch 111711 35
The strategy
Students were required to attend one
inservice session offered by either the
hospitals or health agencies in our
community. The faculty was responsible
for reviewing the agencies likely to
sponsor presentations in the coming year.
Then. students surveyed the suggested
agencies and obtained further
information about future inservice
programs.
This information was posted on a
bulletin board at the university to
increase everyone's awareness of coming
events and to facilitate students' selection
process. Both students and teachers
assumed responsibility for updating the
bulletin board. The students were to
select a presentation which was
applicable to the content oftheir nursing
course and was of interest to them.
Once an inservice presentation had
been selected, the student was asked to
discuss the chosen topic with a group
discussion leader to assure its relevancy
to the theoretical content. A brief
evaluation was to be submitted by the
student to the group discussion leader
within one week of attending
presentation. The evaluation included the
following points:
. title of presentation
. place of presentation
. persons presenting inservice session
. summary of information gained from
presentation
. impression of presentation -
valuable or not valuable and why?
The inservice programs
Student!. attended a wide vdriety of
in service programs. The scope of
presentations consisted of specialized
subjects. such as malignant hyperthermia
and more common health problems such
as obesity. They ranged in orientation
from moral and controversial issues of
rape to pragmatic discussions on how
parents can care for their asthmatic
children at home. Methods of
presentation included lecture, panel
discussion. debates and audio cassette.
Sessions were held in a variety of
settings. such as hospitals, college and
university campuses. libraries, church
halls and other community agencies.
Students noted the roles of the
speakers, their academic and
professional backgrounds, and their
relationship to the health care team. Since
many of the sessions were jointly
sponsored by members of various health
disciplines. students observed first hand
how human and material resources can be
utilized in an interdisciplinary approach.
The description ofthe audience revealed
information on attendance, composition
and size of audience. Nurse<;. physicians,
other health care professionals,
policemen. social workers. parents and
lay people all had participated in these
in...ervice sessions.
Information sharing
A sharing session was held when all
students of a given discussion group had
completed their inservice assignment.
The students were able to talk about their
own experience and to learn about the
experiences of others. During the
discussion, factors that influenced the
effectiveness of the inservice
presentation such as physical plan. size
and background ofthe audience. methods
of presentation and content were
emphasized. Practical considerations
such as time, finance and personnel were
also assessed. Additional efforts were
made to compare the education for the
student nurse with the continuing
education needs ofthe graduate nurse.
Students readily identified the
responsibility of the graduate as a
self-directed learner and the importance
of continuous learning. They also
acknowledged and expressed
appreciation ofthe role of nursing service
in providing continued education for
nurses, patients and their families and in
promoting quality care.
This sharing of information proved to
be very helpful. Students felt that they
had learned from the experiences of
others and were eager to apply what they
had learned in the clinical setting. This
was particularly evident when swdents
readily shared gained information about
home care for asthmatic children with
parents in both the hospital setting and on
home visits.
Summary
It was clear from the evaluations and
discussions that students increased their:
. depth of knowledge in topics chosen
. awareness of community service
. awareness of variety and number of
inservice presentations offered in the
community
. awareness ofthe variety of methods
of delivery
. awareness of membership on the
health care team
. awareness of importance of
continuing education.
The assignment had been a positive
experience for all concerned. Service
agencies welcomed the participation of
these young students who are to be their
future nurses. The students. in turn,
increased their understanding of nursing
service. According to Kramer. the first
step in bridging the gap between
education and service is for the students
to develop an awareness and appreciation
of the work value system. This awareness
of the difference between the two value
systems is only the first step in this
process. It is hoped that through more
planned activities similar to this
assignment. a better understanding
between nur<;ing education and nursing
service will be developed. 41
Bibliography
I Kramer, Marlene. Reality shock:
why nurses leave nursing. St. Louis,
Mosby, 1974.
2 Kramer, Marlene, Path co
biculturalism, by... and Claudia
Schmalenberg, Wakefield, Ma.,
Contemporary Publishing. 1977.
"
.
Agnes T.H. Choi-Laois an assistant
Professor of nursing, Faculty of Health
Science. University of Ottawa. She
obtained her B .Sc.N.Ed. degree from
the Unil'ersity of Ottawa and her
M.Sc.N. degree from the University of
Western Ontario. She has been the
coordinator of Year II Medical-Surgical
Nursingfor the pastfour years and is
currently active in research and clinical
teaching.
Marion S, Logan, assistant professor,
School of Nursing , Faculty of Health
Science, Unil'ersity of Ottawa obtained
herB.Sc.P.H.N. and M.Ed.jrom the
Univenity of Ottawa. Past work
experience includes staff nurse, public
health nurse, and nurse educator
(diploma and bachelor level). Specific
areas of interest are parent-child and
community nursing.
38 Mere" 1979
The C.nedl.n Nur..
Nursin
care plans:
a
,
Does your nursing Kardex show the total plan of care your patient requires or is it
simply a list of current doctor's orders? Nursing care plans have sparked
controversy within our profession for years. Whatever your situation, nursing care
plans are only as good as the information written on them. Their value depends upon
your input.
Alida Sil,'erthnrn
l'iursing care plans should ensure effective
communication between nurses and other
health care personnel.
I. We all know how important it is to
keep the doctor's orders up-to-date on
the Kardex. Why then do we, as nurses,
so often let each nurse work out her own
plan of action at the time of assignment?
If consistent nursing care is the goal.
then nurses from shift to shift should
have access to the information they need
to provide this care. For example, if a
patient is afraid of being turned on a
circOlectric bed and one nurse handles
the fear successfully, then a note made
on the care plan of both the problem and
its solution will save both the nurse and
patient stress and time.
2. A plan can help coordinate care for
individual patients. For instance,
suppose a physiotherapist has told your
patient with burned hands to exercise his
fingers every two hours. If you have read
this in the care plan then you can praise
the patient for following through on the
therapist's advice. or else question why
he is neglecting his therapy.
3. If new machinery requires particular
safety precautions, or if a new or
unfamiliar drug is ordered, pertinent
information regarding either in the car:e
plan would save time and guard against
unnecessary complications.
4. As the inpatient service draws to an
end. the care plan can be used to show
the nurse what the patient needs to be
taught. how the individual should be
approached, and what arrangements
need to be made before actual discharge
5. The care plan can also prove useful as
a guide to the points of assessment and
care which should be incorporated into
the patient's chart. Because patient
problems are part of the care plan and
can be grouped according to basic human
needs, and because the significant
aspects of assessment and care for each
particular problem are mcluded, the
organization of data can be achieved by
describing all points under one need
before going on to the next.
6. There are other reasons care plans
need to be written. Although complete
care has always been a goal for nurses,
patients have come to expect more for
the rising cost of health care, more
attention, more individual care. In the
case of some hospitals. nursing
departments are required to show a care
plan indicating the patients' individual
needs are being assessed and acted upon
accordingly.
The resistance
One of the main reasons we resist writing
care plans is the time written work takes
away from practical nursing in a busy
clinical setting. If we look at this more
closely we find it isn't really the writing
that takes the time (we find time to
transcribe doctors' orders). it's the
mental effort it takes to arrive at an
individualized plan. Before a plan can be
written, we must assess and analyze the
patient's situation thoroughly. We have
to determine what problems are being
presented and what nursing approach is
to be used.
The C....dlen NUrH
M.rch 11711 37
The format for nursing care plans
has been around for many years. There is
a place for history, objectives or goals,
problems, nursing care and for the
doctor's treatment. The doctor's orders
can be completed most quickly because
the thinking and planning has been done
for us. We simply copy that which has
been written on the order sheet to the
nursing care planr There can be no
denying doctor's orders are very
important but what has happened to the
nursing component of the care? A mental
plan is made by each nurse every time
she works with a new patient but we
don't write our actions down to aid
another nurse in formulating her plan for
the same patient. We have to ask
ourselves if this is really a timesaving
measure.
Nurses may also resist writing care
plans because they see no real purpose in
writing all this information down. "We
do all the nursing anyway so there is no
need to write it all out. " I suggest this
statement is open to question and those
who make it must analyze their care very
closely to see ifit is true.
Resistance to care plans may come
in relation to writing nursing objectives
- some nurses find it difficult to choose
the words that best describe their goals
of care.
There can be resistance to detailed
care plans simply because they mean
change. A more involved assessment
technique needs to be tried if you are to
understand how the data can be used and
how to base judgements on collected
facts. not personal assumptions.
Recent graduates may find it
frustrating when trying to implement the
educational concept of a care plan into a
service setting. It must be understood,
there is a difference in purpose between
the two kinds of care plans. The
educational tool is structured to teach
the student about patient diagnosis,
health problems. nursing actions and
rationale. The care delivery tool acts to
communicate relevant data. rapidly and
efficiently, to other team members.
Formulating a care plan
Collecting data
Assessment is basic to the whole process
of planning care. Not only must the
information be as complete as possible, it
must be factual and free from personal
impressions or assumptions. If, while
assessing a patient, you "feel" there is a
problem but cannot support it factually,
state it in such a way that it shows it's
only a "hunch", then look for more
information to explain, support or rule
out what you have described.
Several factors can influence the
information that an individual nurse
collects and how it is interpreted.
Depending upon these factors,
interpretation of the same event varies
from person to person. These factors
include the nurse's own:
. ability to observe in a systematic,
purposeful manner
. physical and mental state and needs
. cultural and philosophical
background
. experiences in relation to the
present situation
· motivational level or other interests
. knowledge of the situation.
Organizing Data
Data will be more thorough and complete
if it is collected in a systematic manner
and organized into categories. Select a
system which suits you best and use it
for every assessment you do. Your guide
should contain enough detail under each
heading to adequately assess the need or
system. A guide for systematic
assessment on admission of the patient
might be similar to the Nursing Data
Base below:
I
--
-
--
,
=t-
- ..
-
"
....,
=
t
"""I
(....
.
L-.
"
NURSL"IG DATA BASE
A. Reason for admission
B. Duration of this problem: length? affects on
lifestyle?
C. Other illnesses and/or previous experience
with hospitalization: reason? problems?
D. Observations of the patient's condition:
Respiratory system (cough? sputum?
dyspnea?) Circulalory system (edema? pulse?
temperature? bruises? bleeding?
inflammation?) Nervous system (level of
consciousness? orientation? senses?
headaches?) Motor ability (activity?
endurance? range of motion? paralysis?)
Nutritional status (appetite? nausea?
digestion? diet?) Elimination (diarrhea?
constipation?) Skin and body tissue
(integrity?i
mation? color? turgor?
lesions? discharges?) Rest and comfort (pain?
insomnia?)
E. Mental/Emotional Status: mood? anxiety?
expectations? feelings about illness?
language? cooperative?
F. Allergies: food? drugs? type of reaction?
G. Medication: type? dosage? last dose?
reason taken?
H. Prosthesis: hearing aid? glasses or
contacts? cane? false eye? pacemaker?
I. Health Practices: breast self-exam? physical
exam? Pap smear? smoking? practices related
to Ihe patients conditions. i.e. diabetic urine
testing. weight control?
J. Lifest}le: family? housing? occupation?
recreation? financial status? religious
practice? education? ethnic background?
All subject areas should be assessed
thoroughly on the admission Nursing
Data Base not only to point out obvious
problems but also to detect underlying or
hidden problem areas. How much detail
you go into in each area depends upon
the patient's presenting problem. Let us
take. for example, an elderly patient with
arthritis who is unable to cope with all of
the activities of daily living. In this case
you need descriptive data regarding the
patient's housing accommodation (steps,
conveniences) and available resources
(family, income. community housing or
lodges). Once the information is
colIected, whether it be from the Nursing
Data Base interview or on a continual
basis, it should be scrutinized to ensure
that it is factual.
31 Merch 111711
The Can-.llan Nur..
The words "seems" or "appears"
should not exist on the assessment
urness they are supported by reasons.
Describe what you see. Some nurses say
they are not aHowed to write a nursing
diagnosis so the problem is often
described or charted as if they aren't
really sure of what they are observing.
For example, "the patient's wound
appear,s to be infected."
A definite and factual statement would
read "the patient's wound is inflammed.
firm, tender and has purulent drainage
through two 4 X 4 gauze. "
Avoid words like 'good' or 'normal';
they are not very descriptive and could
be interpreted in several ways. Instead,
try to select adjectives which clarify your
meaning. Rather than saying "the
patient's respirations are normal".
describe exactly what you see and hear.
"Full expansion of chest. quiet
respirations. rate 18 per minute."
The writing
Once the data has been collected. either
on admission or on a continual basis, it is
time to draw from your own knowledge
and experience and anal1ze the
information. What are your goals for the
care ofthis patient. what are the physical
and psychological needs which you must
deal with? Are there problems? Why?
Which aspects are in need of clarification
and what nursing action is required? The
care plan is written once these questions
are answered.
The type or size of your
organization will. to some extent,
determine the format of your care plan.
But format aside. each plan should
include: patient history. nursing goals,
patient needs and problems and nursing
actions. .
The plan must be structured in terms
of patient needs and problems to help
nurses systematically improve problem
analysis, general organization of care,
reporting and recording. To begin with
you might consider the highly o;tructured
format on page 40.
An early problem with terminology
arises when you try to state your
thoughts or goals on patient problems, so
write in pencil and start with simple
words which can be revised as the work
progresses. Everyone on the team who
has contact with the patient should be
involved in the process. The creative
energy and original thought which goes
into the task can serve as a challenge
rather than an obstacle.
The completely written care plan
will save time. Trained staff will be able
to select their own assignments from the
plan rather than wait to be assigned.
Each nurse will also be free of the
routine "get acquainted" sessions the
patient hears so often, and be able to
begin the current assessment directly
from the written plan.
Care plans can make the team
conference a time to erase resolved
problems, discuss new ones, and suggest
possible approaches. At the very least
the conference or report will be more
organized and complete with the
discussion centering around the patients'
problems as they have been pointed out
on the care plan.
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Guide to charting
The format on which nurses notes are
documented has changed from nurses
note sheets, to problem-oriented
charting, to common progress notes, to
flow sheets. Whatever the name, these
pages are only as good as the information
the nurse writes. The purpose of nurses
noteo; is to communicate information
about the patient's progress.
A way to ensure the completeness of
your notes is to use as a guide the
patient's problems as outlined on the
care plan and write assessment notes to
describe each area. Write what your
senses tell you - what you see, what
you hear. what you smell. and what you
feel. If your notes are ever questioned or
challenged you can defend them because
you wrote what you observed, not what
you assumed.
Blanket statements like "good
night". "feeling better", "settled to
ward" do not really explain anything to
another nurse. By writing "good night"
do you mean that the patient did not
arouse each time you made qlh night
rounds?
Difficulties in selecting words for
emotional assessment often results in a
note which says "good". Again, think
about what you observed. Did your
patient talk with you easily? What did
you talk about? Was there eye contact?
What was your patient's facial
expression? Did your patient cooperate
with his therapy? A more descriptive
statement than "in good spirits" or
"cheerful" would be "readily converses
on topics associated with his illness,
smiles easily". This is a clear statement
unclouded by one person's
interpretation.
The care plan is also the guide to
recording responses to treatments and
medications. The extent to which
procedures must be documented varies
with different institutions. If you are
legally required to account for all
procedures a form can be designed
stating each procedure (bed bath. mouth
care, back care, etc.) and the nurse can
check each area as the action is
completed. It is important to remember
that the use of a checkmark to indicate
that a bed bath was done or mouth care
given doesn't indicate anything in terms
of patient assessment.
In order to indicate assessment or
response to a procedure, some kind of
mark such as a star (*) could be placed
by the procedure to indicate that more is
written about this action on the nurses
notes page. If the bed bath is checked off
and starred, the notes will add
"reddened area over coccyx. patient
positioned on sides only and changed
q2h."
The Cen.dlen NUrH
118rch 1171 31
The notes I have illustrated are for
on-going data and are found on a nurses
flow sheet. This information is intended
for all health care personnel to read. The
ame information should not have to be
rewritten on any other form for the
convenience of some other professional
to read. The problems are stated. the
assessment is written, and those nursing
actions are stated which are legally
required to be on a medical record.
When common progress notes are
made, some health personnel object to
other health care professional
writing
on "their" sheet. This problem needs to
be worked through. but the important
point is that you must record your
observations and actions to legally
protect yourself from negligence.
regardless of what form is preferred or
used. Some nurses are not writmg on
the
e sheets because they feel their notes
are not significant enough or that they
cannot express what they want to say in
an inte\1igent manner. The care plan
should help overcome this difficulty.
Follow the patient's problems on the
plan and write what you observed and/or
did about it. This is important
information and it is vital if you ever find
yourself involved in a court case.
Again, the form for charting is only
a
good as the written notes. A tick mark
to indicate something about a problem is
meaningless. Watch for what your
knowledge and common sense tells you
and record the data that needs to be
communicated and audited. ..
Bibliography
Marriner. A. The nursing process. a
scientific approach to nursing care. St.
Louis, Mosby 1915. Lewis, L. Planning
patient care, 2d ed.lowa, Brown Co.,
1976.
Documenting patient care responsibility,
edited by Jean Robinson. Hor,>ham, Pa.,
Intermed Communications. 1978.
(Nursing 78 Skillbook Series)
Alida Silverthorn, the author of
. 'Nursing care plans: a l'ital tool". is the
director of surgical nursing at the
University Hospital in Saskatoon. She
wrote this article while teaching
medical-surgical and intensive care
nursing at the University of
Saskatchewan. Alida has worked as a
medical-surgical nurse-teacher with
Project HOPE in Brazil and as head
nurse of a medical unit at Foothills
Hospital in Calgary. She received her
B.S.N,from the University of
Saskatchewan.
Presenting Problem - developed a cold which didn't Diagnosis pneumonia
improve - became congested. rheumatoid arthritis
short of breath and weak
- right arm feels numb and weak Operation
- pain and stiffness in knees
more severe
Consultations
Intravenous therapy Allergies none
Date Medication Dosage Frequency Time Route Remarks Revision
started date
July 31 Ampicillin" 500 mg q6h 06-12-14-22 p.o. watch for Aug. 3
diarrhea
PRN's
July 31 Darvon-N" Caps II q3-4h pm p.o. for arthritic pain
date diagnostic procedures date date specimens date
ordered completed ordered sent
July 31 chest X-ray July 31 July 31 sputum for C&S July 31
31 ECG 31 31 urinalysis
31 Hemat 7 (WBC) SMA 12 31
31 STAT blood culture 31
"Registered trade marK.
40 M.rch 111711
The Cenedl.n Nur..
-------------------
NURSING HISTORY
age 79 birth date Aug. 2, 1899 addressograph
occupation retired schoolteacher
religion United Church, attends regularly, member of U.C. ladies group, contributes to sewing projects.
housing: lives in small house by self, has steps to basement and outside -=-- both have railing,
she states "some difficulty" in getting up and down. No relatives in the community.
next of kin.
economic: manages adequately on government pension. neural: glasses for shortsightedness
- develops a headache without them on. Hears moderate voice tones. comfort: rheumatoid arthritis son - Mr. S. Moore
in knees (10 yrs). Experiences pain and inflammation during weather changes. Doesn't take
medications except occasional ASA, but applies a heating pad. nutrition: cooks for self and buys own Anycity 285-2094
groceries, maintains steady weight, poor fitting dentures. Drinks lots of juices to
prevent constipation. respiratory: non-smoker, gets "colds" frequently.
long-term objectives
- to rehabilitate to independence
of activities of daily living
- to determine capability to live
alone
NURSING CARE PLAN
short term goals to promote improved ventilation and diffusion
to relieve arthritic pain in knees and promote comfort
NEED PROBLEM NURSING ACTION NEED PROBLEM NURSING ACTION
- shortness of breath - semi-fowlers position and - difficulty chewing diet regular, dental soft
due to (I) lower change sides (0 back q2h due to poor fitting fluids 3000 cc/day intake
- deep breathe q 1 h - recoro I
respiration lobe consolidation, resp. rate q4H . - 0 _ at 41 nutrition dentures poor appetite and output, likes fruit juices,
copious secretions due to copious thick observe caloric intake
and cough wl(h humidity' - chest secretions and coughing
phYSIO qld especially (I) side diet for special tests
- potential problem of B.P. q4h
tachycardia and
circulation shock due to hypoxemia T.P. q4h elimination
-elevated temp. due
to pneumonia
- shortsightedness -leave glasses within - dry skin due to high basin q.d., add 1/2 cap
and develops headache easy reach temp. and dehydration, Alpha Keri ** oil
neural without glasses on integument foul taste in mouth due - mouth care a.c. meals
to secretions and pm.
- endurance low due activity *bedrest with BRP - worried about leaving Aug. 1 (days) check with
to dyspnea - help to BR and stay her house empty and Mrs. B. (pres. of
no one to check church group) to inquire
mobility stiffness in knees with pt *physiotherapy for psychosocial for assistance
due to arthritis hot packs qd in a.m.
- weakness (rt) - assist with anything
arm and numb involving hot
safety sensation due to? temp. or heavy object.
comfort offer Darvon q3h.
*means "ordered by Doctor" - pain in knees (R.A.)
NAME DOCTOR ADM ROOM
DATE
Moore. Mrs. Bernice Black July 31/77 624
---------------------
The C.n.dlen Nuree
118rch 1979 41
--------------------
Nurses notes July 31 Aug. 1
1200 - 1530- 2330 -
1530 2330 0730
problem
shallow expansion, productive O! at 41 with humidity started at Breathing easier. Decreased
cough, rusty colored thick sputum 1600 hrs. Breathing deeper, amount of sputum, still greenish
dyspnea & secretions 2-3 times /hr. Chest pain when sputum copious. greenish and
coughing. Any exertion causes thinner, less dyspnea, able to walk
dyspnea. Dr. R. notified at 1500 to bathroom
hrs.
weakness R arm R arm feels numb from elbow and
includes hand
poor appetite took fluids only for lunch. states fluid intake improved. Ate some
too tired to eat. fruit for supper.
pain in knees constant pain, slight relief with no change. Darvon X 2 with slight less discomfort. Darvon X 1 with
Darvon and heat. relief. relief from pain.
Son was notified of pts. admission worried about her empty house
anxiety - he cannot visit for at least 2 and that she won't be able to live
days. Talking constantly about her alone anymore.
illness. Worried expression.
slept in semi-fowlers position
insomnia Awake approx. 5 times with
coughing.
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The Cenedlen Nur.e
....ch 1179 43
For most of us, getting to and from work means driving through the rush hour traffic in our car,
hopping on a bus or ducking into the nearest subway station. But nurses work in some pretty remote
areas of Canada and, for some of them, getting there is half the fun.
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Rosalind House
It's early Spring. The Sydney P. Young,
a 40-foot Longliner, lies waiting at the
dock in the open water at Beachside on
the northeast coast of Newfoundland.
Beachside is 20 miles "up the bay" from
where I work at the outpost nursing
station in Springdale.ln our harbor, the
water is still frozen so the trip across
Green Bay to the islands where our
clinics are scheduled for today will begin
with a half hour drive along the narrow
coastal highway to reach the waiting
boat.
At the dock, the other public health
nurse from Springdale and myself are
joined by a doctor, the nurse who works
with him and the owner of the boat,
Pearce Young. son of Sydney P.
Our destination is the closer of two
small land masses, Long Island and
Little Bay Islands. located about 20
miles farther upGreen Bay from
Beachside. Both islands have
populations of about 200 people. Their
relative isolation is broken mainly by the
government-subsidized ferry that makes
the trip from the mainland once a day.
Various privately owned small craft are
also available to transport anyone-
usually members of the RCMP, fisheries
officers. doctors or public health nurses
- who needs to visit the islands when
the ferry is not available. Helicopters
and twin engine planes also provide a
link with the mainland when the weather
is good but. for the most part. the islands
exist in relative isolation.
As a public health nurse working out
of Springdale. which is the major service
center for some ten or eleven
communities bordering Green Bay and
nearby Notre Dame Bay, I have made
the trip to the islands many times. We
visit the islands at least once a month to
carry out the school health program
(health promotion, immunization, vision
and hearing screening, etc.) and also to
help staff the regular Child Health
Clinics (immunization, development
screening and counseling). During our
trips to the islands we also include as
many "home visits" in our program as
possible.
-
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A doctor from Springdale usually
visits the communities once a week
depending, of course, upon weather
conditions.
The trip to the islands offers a wide
variety of experiences as the seasons
change. Sometimes we sight a couple of
whales, or maybe a school of porpoises.
Sometimes we see the boats with
fishermen out jigging for cod. The work
that we do on the islands certainly
cannot be overlooked but, for me. it is
the trip there and back and the
anticipation of these trips that provides
much ofthe challenge and excitement in
my job.
Today, the morning mist is rising
very slowly and there is a severe chill in
the air. Ice pans float menacingly
everywhere. But it is the icebergs we
have to watch for. As we move further
out the bay we notice several sealing
boats in the sea around us. The water is
quite smooth (due to the slob ice). We
are all peering anxiously through the
window to catch sight of a seal. Suddenly
there are dozens of bobbing heads to
starboard. Approximately 40 seals are
swimming less than 50 feet from the side
of the boat. An incredible sight!
44 Merch 111711
The C.n-.ll.n Nur..
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Farther out a huge iceberg comes
into view... worth another picture!
By 10:00 a.m. we are docking at
Long Island. A taxi (the only one) meets
us and we are off to the one-story frame
building where we will hold our Child
Health Clinic. At noon we go back to the
boat for the best meal of the week! And
then, it is on to Little Bay Islands-
another three quarters of an hour sail.
Going into Little Bay Islands is like
sailing right into a picture. It has a
perfectly protected harbor and the
community just snuggles down around
the shoreline. We walk up to our clinic
(the community hall). The doctor takes
one room in which to see his patients
who are waiting, while I show a film
downstairs to the grades 7, 8 and 9
students who have come over from the
school. The other P.H. Nurse holds a
Child Health Clinic upstairs.
At 4:00 p.m. we pack up and head
back to the boat. The crab canning
factory has sent down a case of
crabmeat, so we open up a tin on our
way back. I take a turn at the helm. The
boat nearly makes a 360 0 turn, so Mr.
Young resumes his position at the wheel.
Two hours later we are back at
Beachside.
It is hard to portray the excitement
of it all, the feel of the salt air and great
satisfaction felt at the end of the day. But
believe me when I say that to be a Public
Health Nurse in Springdale, Green Bay,
Newfoundland, is a wonderful
experience.. .
But what is it like to live on one of
these islands? Are the inhabitants of
Long Island and Little Bay Islands any
less healthy than mainlanders because of
their relative isolation? What is the long
term effect of our intervention going to
be on the health status of these
islanders?
CertainJy, their isolation, in the
sense that people who are living on the
islands rarely leave and very few people
come to settle there, gives the islanders
an advantage "health wise" over
mainlanders: exposure to infectious
diseases, epidemics. etc. is minimal.
Similarly, however, lack of
exposure to any type of health education
program has left the islanders far behind
most mainlanders in their understanding
of the importance of adequate diet,
physical fitness, etc. Limited access to
dental care and medical services has
resulted in serious disability for many
people. It is not uncommon, for
example, to see a youngster of twelve or
fourteen with quite a few of his
permanent teeth missing. Nor to see an
elderly man with cataracts who has
never had his vision checked.
But what happens when we bring
these services to the islands? Are we
conditioning the islanders to the belief
that their physical and mental health
status is a reflection of the extent of the
intervention of health professionals?
Are we encouraging them to believe
that illness is more important than good
health? Many of the 20 or 30 patients the
doctor sees each week in the clinics
attend more from habit than any other
reason. Their "complaints" are largely
the result oflifestyle - hypertension,
aging, "colds". Are we unintentionally
promoting treatment as opposed to
pre
'ention? Is the pressure on health
professionals to look after their clients,
rather than to encourage them to look
after themselves.
Are the islands, if this is the case,
really any different from anywhere else?
When I visit the islands I see people
who are, for the most part, hard working
and happy. They are also friendly and
receptive. I hope that by teaching them
about the benefits of breastfeeding as
opposed to bottle feeding, by
discouraging the consumption of "junk
food" in the schools, by counseling,
screening and immunizing, I can help
them to realize the positive aspects of
health. ..
Rosalind House (RN, BN) graduated
from Memorial University in St. John's,
Newfoundland, in May 1975. Since then
she has worked as a Public Health Nurse
at various locations in that province,
including Springdale, where this story
was set and in C ornerbrook . Rosalind
comments: "I am no longer working in
the Green Bay area but, looking back at
my time there, 1 can quite honestly say it
was a memorable experience ... a happy
and productive time for me."
. .
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The Cen-.llen Nur.. llerch 1871 45
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Celia N ichn/
In keeping with the trend today, my
pregnancy was totally planned and
absolutely wanted; like so many others
today. it also occurred at the worst
possible time. "Who ME? Pregnant?
N ?..
ow.
We had been told in nursing school
that this was how all new mother'i felt
during the first trimester of pregnancy.
Privately, I had considered such
emotions ridiculous in this age of
planned parenthood and had sworn
neverto find myself in that predicament.
And yet. here I was pregnant and just
starting a new job. How embarrassing!
Why couldn't the baby have come last
year so I wouldn't have left my old job?
Or why couldn't I have been offered this
ne", position before I became pregnant,
so I wouldn't be pregnant? Ah. well. I
should have been prepared for this. After
all. I
as a Public Health Nurse. wa!in't I
and didn't I have experience in
counseling pregnant women. laboring
women and new mothers? I understood
how to cope with all the problems.
imagined or real. ofthe childbearing
woman. Right? Wrong, as I found out.
To begin with. there was my
pregnancy. Being an individual who
prided herself on health and physical
fitness. in fact. a person who preached
healthful living to anyone who would
listen, I had always pictured myself as
the glowing, blooming type of expectant
mother. It was therefore more than a
little disillusioning to find myself
nauseous and miserable in the first three
months of pregnancy. It was downright
embarrassing to confess to continued
digestive upsets right up to my ninth
month: particularly when I was always
the type who could eat anything, anytime
- always in healthful moderation of
course. I spent much of my pregnancy
looking wan and pale. The only
advantage of this continued indigestion
which the doctor rea'isuringly told me
could be gallbladder. was that I only had
a modest ",eight gain. This. I
optimistically reasoned. would speed the
return to my maidenly figure.
Another thing that irritated me in
mid-pregnancy was the reddish-purplish
streaks that began to appear on my
abdomen. At first I thought that in my
vain attempt to conceal my advancing
state of pregnancy I had crinkled my skin
by wearing my clothes too tightly. M}
husband. Hal. whom I was trying to
educate into expectant fatherhood.
enlightened me. "Aren't those stretch
marks?'" he asked studiously, recalling
his reading. He added knowingly that
'they' usually appear about now.
Even he was no comfort. however.
when I began to experience alarmingly
persistent right-sided abdominal pain.
"It's my appendix". I diagnosed with
my usually unerring professional
judgement and proceded to worry about
the effect'i of surgery on the baby and
whether I had accumulated enough sick
leave. After twenty-four long hours of
this "discomfort of pregnancy" I called
the doctor. expecting to be summoned
posthaste to the hO'ipital. Much to my
surprise he assured me that this was a
perfectly normal occurrence in
pregnancy and that it was associated
with the stretching of the round ligament
Now why wasn't that taught in nursing
school?
As is usually the case, the nine
months of my pregnancy eventually
drew to an end and Hal and I eagerly
awaited the big event. "Of course first
babies are often late." I cautioned Hal.
"We could go two weeks over the due
date." Bearing this in mind and
determined not to think of the event
uppermost in our thoughts we went out
to a party on the due date. We came
home at midnight and collapsed mto bed.
A few hours later. on one of my
regular trips to the bathroom. I was
vaguely aware that my pajamas were
wet. In fact. 'iO was my bed. Being only
'iemiconscious I thought nothing of this
phenomenon until the next morning
when I awoke to a menstrual-like
backache and found myself even
damper. "Could this be it?" I wondered
but dismissed the thought. After all. this
would be exactly on <}chedule and my
baby was bound to be two week'i late.
Hal didn't agree with me though and
shortly after breakfast whisked me away
to the hospital.
48 Merch 11171
The Cen-.llen Nur..
Once in the Case Room I was
determined to play dumb. No one would
accuse me of being a difficult
nurse/patient. In fact, no one would
accuse me of being a nurse! I explained
In layman terms that my membranes had
ruptured and that I had some show,
pointing out that' 'my bag of waters had
broken and that I had a pink discharge."
"Oh that often happens at the end of
pregnancy:' the nurse laughed
condescendingly. "But we'll examine
you to find out if anything is happening."
I hadn't expected anyone to doubt my
word, nor did I expect the results of the
examination to be inconclusive: perhaps
the membranes had ruptured. Meanwhile
I could walk the halls and see if my
uterus would contract. "My back does
ache..." I began. but stopped. I was the
patient and didn't know.
So we paced the halls, my husband
and I, accompanied by the husbands of
all my laboring sisters. Forward and
back, all day long, interrupted only by
meals and occasional checks with the
nurses, who reassuringly said we'd
probably be going home soon, that is
unless I had begun to have contractions.
"I did have some intermittently regular
back pains and..." Just keep walking,
was the answer.
Finally, eight hours later the
moment of decision was upon us: a
medical examination. Hal and I held our
breaths. "Yes, the membranes have
definitely ruptured:' said my wonderful
doctor. 'The cervix is two centimetres
dilated and... the rectum is full of stool!
Hasn't she had an enema?"
One enema later I began regular
rapid labor. A pitocin* drip was ordered
to "stimulate" my contractions. As I
waited for the nurse to start my I. V.. I
gradually realized I was again becoming
quite damp. 'This is ridiculous," I
reasoned. "I know that the membranes
have ruptured and all the fluid is gone."
Looking around I noticed that the
stopcock of the I. V. tubing had been left
open allowing the needle, not yet affixed
to me to drain fluid into my bed. At first I
was determined not to interfere and
waited patiently. as a good patient
should, for my nurse to return, but as I
grew wetter and wetter I found it harder
to resist the urge to turn that little knob.
Fortunately I was saved by my husband,
who noticed the flood in my bed. "Isn't
that tubing leaking?" he asked, watching
the stream as fascinated as any small
boy. I indicated the offending stopcock
and added virtuously "I don't want to
interfere with the nurse'sjob:' "Oh, for
heaven's sake:' he gasped. "You don't
have to be a nurse to do that; anyone
can." The flood ceased.
*Pitocin is a tradename of Parke Davis.
Finally, with enema over and I. V.
functioning correctly I prepared myself
to embark on that marvellous experience
called "Natural Childbirth". Now we
could put to the test all the breathing and
relaxation techniques we had practised
for so long. For, as I had told Hal.
analgesics used during labor could
depress the baby and an epidural.
although a wonderful pain relief, could
prolong labor and might possibly
necessitate the use offorceps at delivery.
As the effects of the pitocin became
apparent, however. and my contractions
became longer, stronger and very close
together, I rapidly reassessed my
feelings towards childbirth without
anesthesia and decided that I was
chicken after aiL
The epidural did provide a welcome
relief[ had to admit, but I reminded Hal
that it would probably slow my labor
down. Within the hour, however, I was
feeling rectal pressure and voiced some
annoyance over this discomfort,
expecting the anesthetic to block all such
sensations. "Doesn't that mean you're
nearing transition?" Hal asked
diagnostically. It would be nice if he
were correct but "that's rather
unlikely," I retorted although I did
permit him to report my symptom to the
staff. Hal's diagnosis was soon verified
by a vaginal examination which showed
my cervix to be eight centimetres
dilated. Another hour later I was
permitted to begin bearing down and
shortly afterwards I was moved into the
delivery room.
I had practised endlessly at home for
the delivery. I had putfed, panted and
pushed daily, much to Hal's amusement
but now all my efforts were put to the
test. To my delight I felt in perfect
control during the delivery and although
very tired, watched the entire proceeding
with great excitement. My only negative
feelings were induced by my watching
the young intern's catheterization
technique, which I felt was guaranteed to
give me a urinary tract infection. After I
was properly draped and prepped. Hal
was allowed into the room. He entered
red faced. muttering under his breath and
looking quite frantic. 'They wouldn't let
me in," he almost sobbed. "Everyone
kept going in and out and ignoring me. I
thought they had forgotten who I was.
Did I miss it?" At that moment another
contraction began and he was reassured
that some action still remained. We all
worked together for another half hour,
and then. miracle of miracles, our
daughter was born.
Words can't describe the euphoria
Hal and I felt after Christie's birth; we
were both so high. so full of this new
shared joy. It was a memory to be stored
in life's chest of special moments.
Nevertheless. hospital life must
keep moving and soon we left the case
room for the post partum floor. I
couldn't understand why it was so quiet
until Hal pointed out that it was 2:30 a.m.
It seemed incredible that 16 hours had
passed since we had arrived at the
hospital. After Hal had left. the nurse
came in and carried out the post delivery
routine including detailed instructions on
maternity care, visiting hours,
photographers, televisions, telephones
etc., none of which I remembered a
second later despite my good intentions.
'Try and sleep," she advised.
"Your baby win be here at 5:30 a.m. for
her first feeding. ,. Obediently I closed
my eyes, but was too elated for sleep.
Something else was wrong.
Systematically. I checked my body out
and came to the conclusion that I needed
to void - at least I thought so. Normal
sensation was only now returning to my
legs and I wasn't positive. Eventually I
rang for the nurse who supplied me with
a bedpan and left me in privacy.
At this point. panic struck as I began
to recall tales of post partum voiding
problems, catheters and other ghastly
phenomena. Of course, as a nurse I knew
all the techniques to encourage voiding
in recalcitrant patients but, infamy of
infamies, I could not go! Not only that, I
was so uncomfortable that I could no
longer bear to sit on the bedpan. Funny,
I had never "read of this particular post
partum problem in nursing texts.
Perversely though, my body told me
quite plaintively: I must void. When the
nurse came back I asked her if[ could
use the bathroom. "Oh. I don't think
so:' she said. "You're only just back
from the case room."
However, I must have looked
desperate because she weakened and
assisted me to the toilet. I was amazed
how weak and sore I actually felt once on
my feet. But. oh bliss. I voided and
voided and voided: eight hundred cc's...
Once again in bed I lay back exhausted,
trying to sleep. And then that horrible
sensation began again. I needed to void.
Why? Where was all this urine coming
from? Was I diuresing already? After
another arduous trip to the bathroom,
where I again voided a vast amount, I
finally settled down for some much
needed sleep. But not for long. "Here's
your baby," said a cheery voice. handing
me a screaming little pink bundle. The
day had begun.
Thus began a continual round of
activity that lasted throughout my
four-day hospitalization. I devoted
myself to not being a nurse/patient. At
the same time I tried to be the perfect
patient, just in case someone did know I
was a nurse and thought I should know
what to do. A very tricky balance!
The C.n-.llen Nur..
II8rch 111711 47
Things got off to a poor start,
though, when I suddenly became weak
while showering and had to have
someone help me back to bed. I huddled
under the covers for a few minutes and
then looked at the clock, realizing with
horror that I was five minutes late for the
compulsory Sitz bath lecture. By the
time I hobbled down the hall, I had
missed most of the directions so the
nurse patiently repeated her instructions
just for me. That really made me feel
guilty since I already knew how to use
the Sitz anyway.
On my way back to my room, I was
met by a young RNA who glared angrily
at me. "Where have you been," she
asked, sounding like a mother scolding a
naughty child. "I have your baby here
and you're always supposed to be in
your room when the babies come out. "
She thrust my daughter at me. I began to
explain about the Sitz demonstration but
decided to remain quiet, as all good
patients should.
"Now, do you need any help?" she
asked. "No, no I'm fine," I replied even
though I had no idea how I was going to
get into bed, crank it up and get Christie
positioned to nurse. The first was so
painful and the latter. so new. But I
didn't want to cause any more trouble.
Naturally I was very embarrassed when
the same nurse returned a few moments
later and found me standing exactly
where she had left me. She helped me
into a comfortable position, cranked up
the bed and said cheerfully, "Feeding
time is over in five minutes." Then she
departed leaving me trying to wake up
my sleeping daughter.
Meals that first day were another
problem. My appetite. like that of many
post partum women. was gigantic and
yet obviously that ofthe individual who
had ordered my meals was tiny. My
breakfast consisted of a piece of toast
and coffee. Lunch was fish, cake and
lemonade. Not only my appetite, but my
nutrition-conscious conscience was
offended. And I was embarrassed to
keep asking for oddments from other
meal trays. Humbly. I swallowed the
urge to voice disapproval of this poor
example of post partum nutrition.and
took to sneaking past the nursing station
for frequent snacks.
Things went better on the second
day. The large, well-balanced meals
were those I had ordered myself; I
managed all my own post part urn care
without help and was in my room when
the babies were brought out. I also
attended the compulsory bath
demonstration and so was prepared to
start rooming-in on the following day. I
had been told to collect Christie from the
nursery at 9 a. m., an hour which seemed
quite reasonable. In actual practice.
however, I found it a mad rush to fight
my way into the shower, have breakfast,
line up for a Sitz bath, do my exercises
and toast myself under the Baker lamp -
all before 9 o'clock. When I arrived in
the nursery the nurse nodded
significantly at the clock and gave me the
baby, her bassinette, a mound of clean
laundry and several pages of
instructions. Despite this ominous
beginning rooming-in was fun. Christie
was most cooperative, waking only for
feeds and sometimes not even these.
This was fortunate since it provided me
with the time I needed to carry out my
post partum routine. I always swore I'd
find time for a rest but somehow there
never was room in the day for that.
My main difficulty with rooming-in
was completing the numerous forms that
accompanied Christie's departure from
the nursery. I fully intended to record the
appropriate data on these charts,
voidings, bowel movements and minutes
of breast feeding etc., but somehow
something happened to distract me and I
would forget. Coupled with this was the
problem of test weighing the baby before
and after feeds. Since the La Leche
League propaganda that by now I could
recite almost verbatim poohpoohed the
need for this procedure, I think my
subconscious induced me to forget to do
this on purpose. Thus, in the evening I
would approach the nursery in great
trepidation: head low, dirty linen bag
filled and daily forms blank. The first
time this happened. the nurse listened
tolerantly to my apologies and asked me
to guess how many times Christie had
carried out each specified activity. The
next evening. the same nurse smiled a
little grimly, took forms and baby from
me and marched into the bowels of the
nursery as if she no longer trusted me
with my little one. Fortunately I went
home the next morning, otherwise I
might not have been permitted to
room-in for another formless day!
During my last two days in hospital I
had four student nurses assigned to me
which made me wonder if I was
demonstrating myselfto be a poor
mother. Conversely, I did want to
provide the students with a good learning
experience so I spent a lot oftime
thinking up questions to ask them.
Actually, all my questions probably
accomplished was to succeed in having
me labelled as eccentric. Why else would
a young mother ask - what are cord
clamps made of, when all the other new
mothers were asking things like - how
do I look after the baby's cord before it
falls off? Possibly the students thought I
was suffering from a post partum
psycho'iis. Now that certainly would be a
good learning experience.
Suddenly, almost without warning.
homecoming day had arrived. I was
terrified of taking this dependent little
creature home, where there would be no
helpful staff to refer my questions to. I
had felt so confident in hospital, but now
... At least, at home I wouldn't have to
pretend anymore. My husband knew I
was a nurse. And he realized how well
I'd prepared him for our childbirth
experience and trusted my judgement.
At least. that's what I thought. "How
often should we feed her at night?" , he
casually asked the nurse who was
helping us dress her. I blushed and
busied myself trying to tie a bootie on a
tiny wriggling foot.
"I'd ask my wife. she's a nurse you
know," Hal said. "but I need to prepare
myselffor this and so far she's given me
a lot of misleading information." I was
mortified.
"We've given your wife lots of
pamphlets on infant feeding that should
help you with your questions," came the
helpful reply. "After all, when a nurse
works in an operating room for ten years
she often loses touch with things like
infant care. You'll have to help her learn
about them."
Operating room? Ten years? Hal
and I looked at each other. Obviously
this was a case of mistaken identity, but
it seemed pointless at this point to
disillusion her about my actual
professional background.
Oh well, even if we were totally
ignorant of all that was to follow, at least
Hal and I would be equals as we started
out on the great adventure of
parenthood. ..,
..
..
,
Celia
ichol(B.Sc.N.. Ottawa
University) has worked in the
Nephrology and Urology Clinic at the
Children's Hospital of Eastern Ontario.
Ottawa and as a public health nurse with
the Ottawa Carleton Regional Health
Unit and in the Orthopedic Outpatient
Department of Children's Hospital. She
has also acted as a part-time instructor
at Algonquin College, Ottawa in a
"pediatric update" program.
Following the birth of her baby
(May 1978). she began part-time work
teaching prenatal classes for the Health
Unit. Celia comments: "/ am enjoving
this present experience very much and
find that my own recent pregnancy
experience helps me empathize much
more with the prospecti\'e parents."
Celia is als(l the author of
.. Legg-Perthes Disease' '(June 1976) and
"Congenital dislocated hip" (Jul\' 1977).
48 Merch 1878
The Cenedlen Nur..
CNA submits brief (continued from page 12)
Recommendations
. Since the nursing service provided
for the general public is part of the health
care system which is funded by tax
monies, there must be greater
coordination of the allocation offunds to
institutions. In this respect,
regionalization of health services would
be a prerequisite. The provincial
governments would not. under these
circum'itances. study an institution's
proposed budget. but would assess the
proposed budgets of all the institutions
and agencies in a given region, not only
in terms of avoiding duplication of
capital expenditures but also for
rationali7Îng manpower allocation.
. Where changes imply potential
redundancy of positions. employers
should assume responsibility for seeking
assistance to prepare their employees for
the change. This could be carried out
with the cooperation of unions and with
the assistance of professional
organizations, educational institutions.
government services, to name a few.
. Employers should take the
following actions where a lay-off is
Ovol Drops
relieve
infant colic.
I
,
/"
rPAABI
ccpp
1
15m!
Ovol Drops contain simethicone,
an effective, gentle antiflatulent
that goes to work fast to relieve
the pain, bloating and discomfort
of infant colic. Gentle pepper-
mint flavoured Ovol Drops.
So mother and baby can get
a little rest.
(6)Hp
n
R
Oval ffi){)
"
fast
actJng
relief
of Infant
colic I
.Ie
Shhh. Ovol Drops.
Aløo available In tablet fOITn for adulUl
unavoidable:
-provide reasons for the lay-off: (This
should be a mandatory requirement.)
-provide advance information
whenever possible to minimize adverse
effects;
--consult the union, if one is involved. at
the earliest stage;
-inform employees of action already
taken on their behalf to assist them:
-give special consideration to long
service employees;
-provide management employees who
are not covered by a collective
bargaining agreement or legislation. with
safeguards against redundancies and
lay-offs.
. Employees who have been laid off
should be given first priority in rehiring
and their reappointment should be
without loss of seniority or a
probationary period.
If the reappointment is to a lower
position, she should be placed on the
same step of the lower position as she
held on the higher position.
. The Canadian Nurses Association
supports the need to develop a code of
good practice with respect to
redundancies and lay-offs, and would
suggest the inclusion of the measures
suggested in this statement.
Ovol
80
Tablets
Ovol@40
Tablets
Ovol@
Drops
Antiflatulent Simethicone
INDICATIONS
OVOL is indicated to relieve bloating,
flatulence and other symptoms caused
by gas retention including aerophagia
and infant colic.
CONTRAINDICATIONS
None reported.
PRECAUTIONS
Protect OVOL DROPS from freezing.
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOL 80 TABLETS
Simethicone 80 mg
OVOL 40 TABLETS
Simethicone 40 mg
Adults: One chewable tablet between
meals as required.
OVOL DROPS
Simethicone (in a peppermint flavoured
base) 40 mg/ml
Infants: One-quarter to one-half ml as
required. May be added to formula or
given directly from dropper.
Ð HQ
nfR
The Cen-.llen NUrH
Mere .11171 411
Canadian Nurses Association
FINANCIAL STATEMENTS AND AUDITORS' REPORT
Year ended December 31, 1978
Canadian Nurses Association
Balance Sheet
December 3
, 1978
Assets
1977
1978
Current Assets
Cash in bank
Short term deposits-plus accrued interest
Accounts receivable
Membership fees receivable
Prepaid expenses
$ 145,266 $ 115,073
292,545 170.234
\,26.147 37,028
2,844 2,694
22.186 18,690
588.988 343,719
Sundry Assets
Marketable securities - at cost (quoted value
$25.560: 1977 $16.261)
Loans to member nurses plus accrued Interest
Fixed Assets -note 1
C.N.A. land
C.N.A. building
Less Accumulated depreciation
Furniture and fixtures at nominal value
Liabilities and Surplus
148,225
637,343
785.568
393,103
392,465
1
8,044
13,522
21,566
392,466
$1,003,020
6,044
13.420
19,464
148,225
637,343
785.568
361,236
424,332
1
424,333
$ 787,516
Current Liabilities
Accounts payable and accrued liabilities
Deferred revenue
Grants for Special Projects -unexpended portlon-
Note 2
C.N.A. House Expansion Fund - note 3
Surplus
Approved on behalf of the Board:
Helen D. Taylor, President
Dr. Helen K. Mussallem, Executive Director
(See accompanying notes)
$ 53,893
36,400
90.293
3.416
50,000
859,311
$1,003.020
$ 34,903
35,600
70.503
48.421
668,592
$787,516
50 "'rch 111711
The Cen-.llen Nur..
Canadian Nurses Association
Statement of Income and Surplus
Year ended December 31, 1978
1978 1977
Revenue
Membership fees $1,711,153 $1,224,735
Subscriptions 55,243 53,435
Advertising 292,911 317,537
Investment income 46,341 31,390
Sundry income 4,753 4.649
Examination fees 547,214 628,067
2.657,615 2.259,813
Expenditures
Salaries 1,132,468 1,098,926
Printing and publications 361,659 351,647
Design and graphics 20,076 31,770
Postage on journal 175,767 162,486
Computer service 101,343 102,434
Committee travel 62,154 89,776
Commission on advertising sales 35,237 43,599
Affiliation fees - I.C.N. 154,949 106,053
- Canadian Council on
Hospital Accreditation 14,000 14,000
Professional services - consultants 10,645 14,555
- translation 12,292 12,308
Travel- non-committee 18,297 26,337
Office expense 62,188 72,390
Books and periodicals 14,297 14.962
Legal and audit 9,327 8,206
Building expense 136,912 131,029
Sundry 5,275 6,132
Furniture and fixtures 3,549 12.370
Property improvements 19,517 1,200
Depreciation - C.N.A. House 31.867 31,867
Insurance 4,633 2,358
General meeting - 3,255
Contingency for special projects 5,168 14,900
Item writing 31.735 58.615
,
2,423,355 2,411,175
Non-operating expense:
1978 Biennial Convention (6,459) -
2,416,896 2,411,175
Surplus (deficit) for year 240,719 (151,362)
Allocation to C.N.A. House Expansion Fund 50,000 -
190,719 (151.362)
Surplus at beginning of year 668,592 819,954
Surplus at end of year $ 859,311 $ 668,592
(See accompanying notes)
The C.necllan NUrH
Merch 117. 51
Auditors' Report
To the members of
Canadian Nurses Association
Canadian Nurses Association
Notes to Financial Statements
December 31, 1978
We have examined the balance sheet of Canadian Nurses Association
as at December 31, 1978 and the statement of income and surplus for
the year then ended. Our examination was made in accordance with
generally accepted auditing standards, and accordingly included such
tests and other procedures as we considered necessary in the
circumstances.
In our opinion these financial statements present fairly the financial
position of the Association as at December 31, 1978 and the results of
its operations for the year then ended in accordance with generally
accepted accounting principles applied on a basis consistent with that
of the preceding year.
Geo. A. Welch & Company,
Chartered Accountants
Ottawa, Ontario.
January 19, 1979
1.
Fixed Assets
It IS the policy of the Association to
expense purchases of furniture
and fixtures in the year of the
purchase. The CNA House is
being depreciated over 20 years at
the rate of 5 per cent per annum
2.
The Association receives grants
from various government agencies
for special projects. The unex-
pended portion at December 31,
1978 of $3,416 is made up of
Unexpended portion
December 31,1977 $48.421
add:
Grant received in year 90,021
deduct:
Unused portion of
grants returned
Expenditures in year
138,442
4.
Retirement Income Plan
Effective January 1, 1975 changes
were made to the Association's
retirement plan resulting in addi-
tional benefits for past service.
Actuaries have estimated that an
annual amount of $38.500 for the
nexl11 years will be required to
fund the past service benefits.
5.
Lease of Equipment
During the year the Association
entered into an agreement to
lease computer equipment. The
lease provides for monthly pay-
ments of $2,311 until October
1984 al which time the Association
has the right to purchase the
equipment for $12,761.
6.
Comparative Figures
Comparative figures for 1977 have
been restated, where necessary,
10 conform with the presentation
adopted for 1978.
40.929
94,097
135,026
Unexpended portion,
December 31,1978 $ 3,416
3.
CNA House Expansion Fund
In January 1978. the directors of
the Association established a fund
for the future expansion of CNA
House and allocated an initial
amount of $50.000 to the fund.
52 M.rch 111711
The C.n-.lI.n Nur..
books
Transcultural nursing: concepts,
theories and practices by Madeleine
Leininger. Toronto, Wiley, 1978.
Approximate price $17.50
Transcultural nursing is emerging as
a legitimate and viable subfield in
nursing. Madeleine Leininger's timely
book, Transcultural nursing: concepts,
theories and practices, has given crucial
theoretical foundation and direction to
this emerging field. The author professes
that the purpose of the book is "to
provide for undergraduate and beginning
graduate nursing students a substantive,
comprehensive and scholarly book on
the new subfield of transcultural
nursing" and that claim, in my opinion,
has been achieved substantially by the
various articles presented in the book.
The text is organized in four
sections. The first section presents five
different articles. all of them authored by
Leininger herself. The articles deal with
the history of trans cultural nursing,
provide some fundamental definitions
and concepts relevant to the study of the
transcultural nursing phenomena, give
some guidelines in conducting
culturalogical assessment in nursing, and
describe the ethnoscience research
approach and its usefulness in eliciting
beliefs. values and perceptions of the
cultural group under study.
The second section consists of six
articles. The major theme in all of these
articles is the concept of culture and the
significance of applying the cultural
concept in nursing in providing holistic,
humanistic care to clients. The last
chapter in this section deals with the
cultural significance offood and man's
eating patterns. Several universal and
non-universal functions offood have
been presented in the article which
would give some direction and guidance
to nurses in giving nutritional advice to
clients.
The third section presents several
field studies in nursing, both in the
United States and other parts of the
world. These systematic and
comprehensive studies provide the nurse
with rich descriptive and theoretical data
about several cultural groups. Although
none of these groups are specificallY
Canadian, the models used and the
concepts and theories emerging from
these studies would be of value to health
professionals working in Canadian
settings. The last article in this section
"Nursing care of the elderly with a
transcultural focus," written by
Leininger, presents some "major theses
to improve the care of the elderly."
Since we have some 80 different cultural
groups in Canada and in most of these
groups the elderly are the least
assimilated to the Canadian mainstream
of life, a cultural focus in the care of the
elderly seems most appropriate.
The last section provides useful
ideas, concepts, theories and models to
nurse educators who are interested in
incorporating cultural and transcultural
concepts into their undergraduate as well
as graduate nursing curriculum. The
course outlines and the extensive ,
bibliography given at the end of this
section would be especially helpful for
transcultural nurse educators in
organizing and developing transcultural
courses.
In my opinion the book is the first of
this kind - comprehensive, substantive
and scientific - published to-date on
transcultural nursing.
Re
'iewed by Theresa George, R.N.,
M.S.. Assistar.t Professor, School of
Nursing, Unh'ersity of Manitoba ,
Winnipeg, Manitoba.
Nursing diagnosis and intervention in
nursing practice by Claire Campbell.
New York, John Wiley and Sons,
1978.
Approximate price: $2/.95
Nursing diagnosis and intervention
in nursing practice is a comprehensive
work. It has met the author's goal as a
practical source from which to prepare
patient care plans. Its organization is
compatible with the P.O.M.R. system.
Nursing diagnosis ... would be a
valuable book to have in your personal
or hospital library for use as a reference
to confirm or elaborate on your nursing
diagnosis.
It should be emphasized that the
text is intended as a quick reference
only, and that other basic supplemental
texts must be used for rpore complete
information.
Strong points are that nursing
diagnosis is emphasized and a rationale
for each nursing action is included. My
only criticism of the book is that it is
difficult to use. It would seem that a
more logical arrangement of subject
matter would be to follow the section on
nursing action with an evaluation.
In a work as comprehensive as this,
thumb indexing would have greatly
facilitated the speed with which the
reader could locate specific content. It
would also have been helpful to follow
through one specific problem to
demonstrate the book's use.
Nursing diagnosis and intervention
in nursing practice is appropriate for use
by any nurse, graduate or student, who is
actively involved in providing patient
care. It would be equally helpful in
in-patient, community or ambulatory
care settings.
Reviewed by Jean E. Fry, R.N.,
M.Sc.N., Burlington, Ontario.
library update
Books and Documents
I. Ambulatory care evaluation: a primer for
quality review by Marie E. Michnich . . . et
aI.: principal investigator Paul R. Torrens.
Los Angeles, Ambulatory Care Evaluation
Project, School of Public Health, Univ. of
California,cI976.9Sp.
2. American NursesAssociation. Statistics
Department Report of the survey of salaries
of registered nurse faculty in nursing
educational programs. Kansas City, Mo.,
1976, c1977. S7p.
3. Anthony, Catherine Parker Manuel
d'anatomie et de physiologie. 9. ed.
par . . . etJean-Guy Pepin. Toronto, Mosby,
1978.617p.
4. Bauwens. Eleanor E. The anthropology of
health. Toronto, Mosby, 1978. 218p.
S. Bennett, Addison C. Improving
management performance in health care
institutions; a total systems approach.
Chicago, American Hospital Associatil;m,
c1978. 243p.
6. Black, Errol Health care in Manitoba,
1978, by . . . Joy Cooper and Guy Landry.
Winnipeg,CUPE, 1978. 119p.
7. Blake P J. Applied immunological
concepts by . . . and Rosanne C. Perez. New
York, Appleton-Century-Crofts, cl978. IS9p.
8. The British health care system, prepared
by Economic Models Limited of London for
American Medical Association. Chicago,lU..
American Medical Association, 1976. 161 p.
9. Canadian Health Education Society
Directory of training facilities in health
education. Répenoire des ressources en
formation dans Ie domaine de I'éducation
pour la santé. Ottawa, 1977. 7Op. R
10. Canadian occupational safety and health
law, 1978. Toronto, Corpus. IIv (loose leaf) R
II. Canadian V n
on of Public Employees.
Research Department Survey of wages and
working conditions in New Brunswick
municipal agreements. Ottawa, 1976. Iv.
(various pagings)
12. Carner, Donald Charles Management,
physicians and directors. Long Beach, Calif.
ExecutivesCo., 1976. l04p.
13. Conférence Internationale sur les
Tendances en Relations Industrielles et en
Relations du Travail, Montréal, Québec, mai
24-28, 1976. Procès-verbaux. Rédigé par
Frances Bairstow et Sally Bochner. Montreal,
Industrial Relations Centre, McGill
University. 584p.
14. Conference on Education for Health
Services Administration in Canada, Ottawa
1977. Unmet needs; education for health
services administration in Canada.
Proceedings of a conference sponsored by the
W. K. Kellogg Foundation of Battle Creek
Mich. Ottawa, Canadian College of Health
Service Executives, 1978. 124p.
15. Conover, Mary H. Cardiac arrhythmias;
exercises in pattern interpretation. 2d ed. St.
Louis, Mosby, 1978. 267p.
16. Corporation professionnelle des
midecins du Quibec Les fonctions du
médecin omnipraticien. Québec, c 1977. 48p.
17. Critical requirements for safe effective
nursing practice by Angeline Jacobs, et al.
Kansas City, Mo. American Nurses'
Association Council of State Boards of
Nursing,cI978.54p.
18. Curriculum development and its
implementation through a conceptual
framework. New York. National League for
Nursing. 1978. 64p. (NLN pub. no. 23-1723)
19. Davies, Hywel Understanding
cardiology by . . . and William P. Nelson.
Toronto Butterwonhs, c1978. 424p.
20. Dunn, Olive Jean Basic statistics; a
primerforthe biomedical sciences. 2d ed.
TorontoWiley,1977.218p.
21. Emergency nursing edited by Jeanie
Barry. foronto, McGraw-Hili. cl978. 491p.
22. Ewing, David W. Writing for results in
business, government and the professions.
Toronto. Wiley, 1974. 466p.
23. Feuo, Phyllis Health planning and
professional standards review organizations:
two selected annotated bibliography sic
by . . . and Shirley Kressel. San Francisco,
University of California, 1976. 51p.
24. Fortier. Üan-Claude Urologie. 2. éd.
Momréal. Renouveau Pédagogique, cl970.78p.
25. Hardy, Margaret E. Role theory;
perspectives for health professionals
by . . . and Mary E. Conway. New York,
Appleton.{:entury.{:rofts, c1978. 354p.
26. Health implications of nuclear power
production. Repon on a Working Group ,
Brussels, 1-5, Dec. 1975. Copenhagen, World
Health Organization, Regional Office for
Europe, 1978. cl977. 73p. (WHO Regional
publications. European series no. 3)
27. International Conference on Trends in
Induslrial and Labour Relations, Montreal,
Quebec, May 24-28,1976. Proceedings.
Edited by Frances Bairstow and Sally
Bochner. Montreal, Industrial Relations
The CeNldlen Nur..
Centre, McGill University, 1977. 584p.
28. National League for Nursing
Consumerism and health care. New York,
c1978. 58p. (NLN Pub. no. 52-1727)
29. -. Council of Baccalaureate and Higher
Degree Programs Curriculum process for
developing or revising baccalaureate nursing
programs. New York, cl978. 65p. (NLN Pub.
no. 15-17(0)
30. -. Decision making within the academic
environment. New York, cl978. 63p. (NLN
Pub. no. 15-1719)
31. -. Program evaluation. New York.
c1978. 71p. (NLN Pub. no. 15-1738)
32. -. Division of Research State-approved
schools of nursing- L.P.N./L.V.N.: meeting
minimum requirements set by law and board
rules in the various jurisdictions. 1978. 87p.
(NLN Pub. no. 19-1730)
33. Obstetric, gynecologic and neonatal
nursing functions and standards. Chicago,
Nurses Assoc. of the American College of
Obstetricians and Gynecologists. 1974. 61p.
Neonatal intensive care. Supplement, 1978.
9p.
34. Organisation mondiale de la Santi
Activité de rOMS en 1976/77. Rappon annuel
du directeur général à I' Assemblée mondiale
de la Santé et aux Nations Unies. Genève,
1978. 267p. (Ses Actes officiels no 243)
35. -. Neisseria gO'1orrhoeae et les
infections gonococcique. Rappon d'un
groupe scientifique.Genève, 1978. 159p. (Sa
Série de Rappons technique no 616)
36. Pan American Health Organization
Final repon of the 25th meeting of the
Directing Council , Pan American Health
Organization and the 29th meeting of the
Regional Committee at the World Health
Organization, Washington, D.C. 27 Sept.-6
Oct. 1977 WashIngton, World Health
Organization. 1978. 97p. Ilts Official
document no. 152)
37. Perspectives of curriculum evaluation by
Ralph W. Tyler, Roben M. Gagné and
Michael Scriven. Chicago. Rand McNally,
cl967. 102p. (Rand McNally education series)
38. Poulton. Karen R. Evaluation on
community nursing service of Wandswonh
and East Menon teaching district; research
repon. London. Grosvener Wing, St.
George's Hospital, 1977. 77p.
39. Précis de pharmacologie. 2. éd. par
Joanne Bourgeois et al. Montréal, Renouveau
Pédagogique, c1977. 4I3p.
40. Primary care. Edited by Cynthia J.
Leitch. et aI. Philadelphia, F.A. Davis, cl978.
589p.
4t. Professional Corporation of Phvsicians
of Quebec The functions of the general
practitioner. Québec, c1977. 48p.
42. Quinet, Filix Collective bargaining in
the Canadian comext with references to
collective bargaining in the Public Service of
Canada. Don Mills, Onto CCH Canadian
Limited, 197-. 1 V. (various pagings)
43. -.Négociations collectives dans Ie
contexte canadien avec reférences à la
négociation collective au sein de la Fonction
publique du Canada. Don Mills, Ont. CCH
Canadienne Limitée, 197-. Iv.(pagination
multiple)
44. Reedy, Barry L. The new health
practitioners in America; a comparative
study. London, King Edward's Hospital Fund
for London. c1978. 79p.
45. Registered Nurse's Association of
British Columbia Quality assurance manual.
_ch1171 53
Vancouver, 1977. l06p.
46. Soins infirmiers en maternité par Sharon
R. Reeder et aI . . . Montréal, Renouveau
Pédagogique, cl976. 559p.
47. Système d'information médico-sociale:
'étude des cas, par Jean Rochon et aI.
Chicoutimi,Qué..Gaëtan Morin. 1977. 102p.
48. Taurelle, R. L'infirmière en obstétrique.
Paris, Expansion scientifique française,
cl978. 182p.
49 Victorian Order of Nurses for Canada
Repon, 1977. Ottawa, 1978. 81p.
50. -.Repon, statistical supplement, 1977.
Ottawa, 1978. 46p.
51. White, Rosemary Social change and the
development of the nursing profession. A
study
f the Poor Law nursing service
1848-1948. London, Henry Kimpton, c1978.
243p.
Pamphlets
52. American College of Nurse-Midwives.
Research and Statistics Committee
Nurse-midwifery in the United States
1976-1977. Washington, cl978. 43p.
53. American Nurses' As.wciation.
CommISsion on Nursing Senices Roles,
responsibilities and qualifications for nurse
administrators. Kansas City, Mo., c 1978. 16p.
54. L 'Association des irifirmières
enregistrées du Nou\'eau-Brunswick
Deuxième sou mission sur les services
d'hygiène mentale présentée au Sous.{:omité
du Conseil Consultatif des Services de Santé
du Nouveau-Brunswick sur les Services
d'hygiène mentale. Frédéricton. fev. 1978. 8p.
55. Canadian Institute of Child Helath
Prevention ofhdndicap: a case for improved
prenatal and perinatal care. Strategies for
action. Ottawa, 1978. 8p.
56. Canadian Medical Association The
Canadian Medical Association and abonion.
Ottawa, 1978. 4p.
57. Corporation professionnelle des
médecins du Quibec. C omiti ad hoc. La
gériatrie. Rapport du Comité ad hoc presenté
auComité administratif de laCorporation
. . . Montréal. 1978. 24p.
58. DartnellCorp. What a supervisor should
know aboul getting a full day'
work out of his
people. Chicago. c 1978. 24p.
59. Dickman. I n'ing R. Where older people
live: living arrangemems for the elderly,
by . . . and Miriam Dickman. New York,
Public Affairs Committee. cl978. 28p. (Public
Affairs pamphlet no. 556)
60. The French health care system,
prepared by Economic Models Limiled of
London for the American Medical
Association. Chicago, III.. American Medical
Association, 1976. 45p.
61. I nrernational Labour Conference. 63rd
session. Genem. /977 Summary of
information relating to the submission to the
competent authorities of conventions and
recommendations adopted by the
International Labour Conference. (Article 19
of the Constitution) Third item on the agenda:
information and reports on the application of
conventions and recommendations Geneva.
International Labour Office, 1977. 15p. (/ts
Repon3(3))
62. / son. Terence G. The dimen
ion
of
industrial disease. KingslOn,Ont. Industnal
Relations Centre, Queen's University, 1978.
24p. (Queen's University. Industrial Relations
Centre. Research and Current Issues serie
no. 35)
54 .....ch 111711
63. Koestler, Frances A. Jobs for
handicapped persons a new era in civil rights.
New York, Public Affairs Committee, c1978.
28p. (Public affairs pamphlet no. 557)
64. Librarian's guide to the new copyright
law. Chicago, American Library Assoc.,
1976. lOp.
65. Lynch, Eleanor A. Evaluation:
principles and processes. New York, National
League for Nursing, cl978. 32p. (NLN Pub.
no. 23-1721)
66. National League for Nursing The A.D.
graduate: excellence in practice - fantasy or
reality? New York, cl978. 26p. (NLN Pub.
no. 23-1737)
67. -.The AD graduate: from student to
employee. New York. cl978. 26p. (NLN Pub.
The Cen-.ll.n Nur..
no. 23-1734)
68. -.A.D. graduates: can they fit your
system's needs? New York, cl978. 4Op.
(NLN Pub. no. 23-1736)
69. -.Home health agencies and
community nursing services accredited by
NLN/APHA, 1977. New York, 1977. 6p.
(NLN Pub. no. 21-1645)
70. -.One step beyond: shock Or reality?
New York, c1978. 26p. (NLN Pub. no.
52-1724)
71. -.Dh'ision of Baccalaureate and Higher
Degree Programs Masters education; route to
opportunities in modem nursing. New York,
1978-79. 25p. (NLN Pub. no. 15-1312) R.
72. National League for Nursing. Division
of Diploma Programs Criteria for the
rete ast
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evaluation of diploma programs in nursing.
5th ed. New York, c1978. 22p. (NLN Pub. no.
16-1370)
73. -.Education for nursing the diploma
way-I978/79. New York, 1978. 29p. (NLN
Pub. no. 16-1314) R.
74. -.Role and competencies of graduates
of diploma programs in nursing. New York,
cl978. 3p. (NLN Pub. no. 16-1735)
75. New Brunswick Association of
Registered Nurses Reaction to RepoI1 of the
Task Force on New Brunswick Health Care.
Submitted to Department of Health.
Fredericton, 1978. 19p.
76. Ogg, Elizabeth PaI1ners in coping:
groups for self and mutual help. New York,
Public Affairs Committee, c1978. 28p. (Public
affairs pamphlet no. 559)
77. Ontario Occupational Health Nurses
Association Guidelines for the occupational
health nurse in Ontario. Toronto, 1977. 14p.
78. Organisation mondiale de la Santi.
Bureau rigional de I'Europe Le rôle des
services infirmiers dans les soins aux
personnes ågées; rappOI1 sur la réunion d'un
groupe de travail, Berlin (ouest) 29 nov.-3
déc. 1976. Copenhague, 1978. 27p.
79. Primary nursing: a reader consisting of
eight articles especially selected by the
Journal of Nursing Administration Editorial
Staff. Wakefield, Mass., Contemporary
Publishing, c1977. 44p.
80. Waters. Verle H. Distinguishing
characteristics of associate degree education
for nursing. New York. National League for
Nursing, c1978. 9p. (NLN Pub. no. 23-1722)
Government Documents
Alberta
81. Alberta. Dept. of Advanced Education
and Manpower T ask Force on Nursing
Education Summary of responses to repoI1.
Edmonton, 1978. 50p.
Canada
82. Bibliothèque nationale du C unada
Thèses au Canada: guide sur les sources
documentaires relatives aux thèses
complétées ou en cours de rédaction, compIlé
par Susan (Jacques) Bruchet et Gwynneth
Evans. Ottawa, Ministre des
Approvisionnements et Services Canada,
1978. 25p. R
83. Human Rights Commission Human
rights kit. Ottawa, 1978.6 pts. in I.
84. Commission canadienne des droits de la
personne Documentation. Ottawa, 1978. En 6
parties.
85. Commission des relations de tral'ail
dans lafonction publique Rapport 1976/77.
Ottawa, Ministre des Approvisionnements et
Services Canada, 1977. Iv.
86. Health and Welfare Canada. Social
Service Programs Branch Social Services
legislation kit. Ottawa, 1978. 6 pts. in 1.
Contents.-The proposed social services
financing act.-Summary of the principal
components of the social services financing
bilJ.-Questions and answers; the federal
legislalion on financing social
services-1978-Bill C-55, 1st reading.-News
release 1978-72..(:ommuniqué 1978-72.
87. LabourCanada. Collecti,'e BargaininR
Division. Labour Data Review, wage
developments resulting from major collective
bargaining settlements (construction industry
excluded) (incorporating 1976 revision) 1977.
Ottawa. Minister of Supply and Services
Canada, 1978. Iv.
88. Santé et Bien-être social Canada.
Direction génerale des programmes de
se,,'ice social Jeu de documents sur la
législation fédérale sur les services sociaux.
Otlawa, 1978. En 6 parties. Projet de loi sur Ie
financement des services sociaux.-Sommaire
des principaux éléments du projet de loi sur Ie
financement des services sociaux.-Questions
et reponses; la législation fédérale sur Ie
financement des services sociaux-I978.-Bill
C-55, lère lecture.-Communiqué
1978-72.-News release 1978-72.
89. TramilCanada. Di\'ision de la
négociation collecti\'e. Donnie s sur/e rramil
Revue, évolution des salaires dans Ie cadre
des grandes conventions collectives (excluant
I'industrie de la construction) (incorporant la
révision de 1976) 1977. Ottawa, Ministre des
Approvisionnements et Services Canada,
1978. Iv.
90. National Librarv of Canada Theses in
Canada: a guide to sources of information
about theses completed or in preparation,
compiled by Susan (Jacques) Bruchet and
Gwynneth Evans. Otlawa, Minister of Supply
and Services Canada, 1978. 25p. R.
91. Statistics Canada Report of notifiable
diseases, 1963-1972.0tlawa, 1965-1973. IOv.
in I. Catalogue no. 82-201.
92. -.Vital statistics. Otlawa, 1978. 2v.
Contents.-v.I.Births 1975-76: Catalogue no.
84-204.-v.3 Deaths 1976. Catalogue no. 84-206.
New Brunswick
93. Task Fora on New Brunswick Health
Care Report. Fredericton, 1978. 69p.
Chairman: S. Cassidy.
94. Comité d'ttude sur le.
soins de Santé
Rapport. Frédéricton. 1978. 69p. Président:'S.
Cassidy.
Ontario
95. Ministry Labour. Research Branch
Sickleave plans and weekly sickness and
accident indemnity insurance plans in Ontario
collective agreements. Toronto, 1977. 14p.
(BaÍ'gaining information series no. 26)
Studies in CNA Repository CoUection
96. Craig, Dorothv The development of a
nursing audit tool. Toronto, c1978. 140p.
Thesis(M.Sc.N.)- Toronto. R.
97. Darling, Grace C. Behavioursof
autistic-schizophrenic children that
influenced mothers to seek help. Toronto.
c1975. 76p. Thesis(M.Sc.N.)- Toronto. R.
98. Laliberté, Marie Thirèse Elfets d'un
nursing basé systématiquement sur les
fonctions expressive et instrumentale sur les
réactions à la douleur des opérés. Montreal.
1977.313 p. Mémoire (M.N.)- Montréal. R
99. Macintosh, Alice Ross An assessment of
selected continuing educalion experiences for
professional growth and competence of
nurses. Fredericton, 1978. 56p. Thesis
(M.Ed.) - New Brunswick. R.
100. Moore, Jannice Evaluation of the
quality of nursing care: a beginning review of
the literature. Edmonton, 1975. 43p. R.
101. Payer, Thérèse. Soeur Organisation et
rôle de cliniques de diagnostic au sem de
I'hôpital général. Montréal. 1964. 92p. Thèse
(M.A.H.) - Montréal. R
Audio Visual Aids
102. Association des Médecins de Langue
française du Canada Sonomed. série 5, no 2.
Montréal, 1973. I cassetle. Sommaine. Côte
A.!. Murray ,Gilles. Principes généraux de
I'antibiothérapie. 2. Séguin. Femand, L'elfet
biologique des ions négdtifs de I'air.-Côte B.
Marchand, Claude. Les médicaments à valeur
discutable.
Th. C.Nldlen Nur..
"'rch 111711 55
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You the Nurse.
Hermann the Place.
Houston the City.
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Imagine This. The kind of nursing you've always wanted to do.
Nursing the way it should be...planning and implementing patient
care in a primary nursing framework that lets you exercise optimum
freedom to carry out your professional goals.
You've Got The Talent It Takes. Hermann Hospital has im-
mediate openings, especially for those of you with specialty train-
ing in surgical areas. We'll assist you financially with your reloca-
tion expenses. You'll find the salary program for RNs is more than
competitive and we offer a comprehensive benefits package which
includes three weeks vacation, nine paid holidays, tuition and rent
assistance, fully paid hospitalization, and more. It's an offer you
can't refuse!
Put Yourself In Our Place. We're in the heart of Houston, where
the excltment of the arts, outdoors, and nightlife abound in the en-
vironment of the city of the future. Compare Houston's cost of liv-
ing with other major cities-it's considerably lower, and the state
of Texas doesn't have a state income tax. All things considered,
Hermann Hospital and Houston are where you've always really
wanted to work and live, so now do something about it.
Primary Teachmg Hospital for the University of
Texas Medical School at Houston
HOUSTON'S LIFE
FLIGHT HOSPITAL
An equal opportunity employer, mlf-handicapped
-- . - . rlIC.
....r'
I
I::.:""'
,.
Please contact us for more
information about our ex-
cellent salaries and com-
plete benefits package. Ms.
Beverly Preble, Nurse
Recruiter, (713) 797.3000.
AU: Nurse Recruiter
1203 Ross Sterling Avenue
Texas Medical Center
Houston, Texas 77030
Name
Address
City
State Zip
Phone
Specific Area of Interest
(Circle) RN LVN Student Nurse
56 "'rch 111711
The Can-.llan Nur..
Classified
Advertisements
Alberta
Director of Nursing required for a 45-bed general
hospital. Applicants must have R.N. (Alberta
Registration or eligible). with post graduate training
and experience in Nursing Administration. Apply to:
Administrator, Athabasca Municipal Hospital, Box
240. Athabasca. Alberta, TOO OBO. Phone: (403)
675-2261.
Registered Nurses required immediately in a 68-bed
active treatment hospital located in Northeastern
Alberta. Accommodation is available in Nurses'
Residence. Salary and benefits in accordance with
the negotiated provincial agreement. Apply in
writing to: Director of Nursing. Lac La Biche
General Hospital, Box 507. Lac La Biche. Alberta,
TOA 2CO.
Operating Room Supervisor is required for a 185-bed
active and auxiliary hospital complex located in a
city 40 miles south of Edmonton. Responsibility is to
supervise and direct that department in the peñor-
mance of day to day duties as well as other
administrative duties necessary for the operation of
that department. Must have an Alberta registration
(or be eligible for) and recognized P.G. in O.R.
techniques and management. Salary is to commen-
surate with experience. qualifications and in accor-
dance with the AARN Contract. Please contact:
Miss A.M. Morrison, Direclor of Nursing, Wetaski-
win Hospital District No. 81, 5505-50 Avenue,
Wetaskiwin, Alberta, T9A OT4.
British Columbia
General Duty (R.C. ReJistered) Nunes required for
expansion to 422 acute care accredited hospital
located 6 miles from downtown Vancouver and
within easy access to various recreational facilities.
Excellent orientation and ongoing inservice prog-
ramme. Salary $1,231.00--$1,455.00 monthly. Clini-
cal areas include coronary care, intensive care,
emergency. operating room. P.A.R.R., medical/sur-
gical, pedtatrics, obstetrics, orthopedics and activa-
tion units. Positions are also available for generlll
duty nUnes in our modern extended care unit. Apply
to: Co-ordinator-Nursing. Dept. of Employee
Resources, Burnaby General Hospital, 3935 Kincaid
Street. Burnaby, British Columbia. VSG 2X6.
Challenge and opportunity aW811 the nurse prepared
to accept a position in a lOO-bed accredited acute
care hospital in a booming northern cily. We will
help the beginning practitioners to expand their
knowledge and skills Write to: Nursing Director.
Dawson Creek and District Hospital, 1II00013th St.,
Dawson Creek. British Columbia, VIG 3W8.
Opportunily - Assistant Director of Nursing re-
quired for a 241-bed hospital on Vancouver Island.
Major duties would be those of co-ordinaling
orientation in-service and continuing education
programs for Nursing Personnel. Applicants must be
registered or eligible for registration in B.c. and
preferably have experience in a senior Nursing
Administrative position. Apply: Director of Nursing,
Cowichan District Hospital. Gibbins Road, Duncan.
BritishColumbia V9L IE5.
GneraJ DIll)' N_ for modem 4t-bed accredited
hospitaltocated on die Aluka HiJhway. Salary and
personnel poIic:iel in accordance widl die RNABe.
Tcm
açeommodation avJilabk in rclidenc:c.
Apply: DU'Cc:lor d Nunin;, Fort NellOlt Genen!
HOlpital, P.O. Boll 60, Fort NellOn, Britilh Colum-
b... VOC IRO.
British Columbia
Shift Supervisor with previous experience required
for a 1000bed fully accredited hospilal in North
Eastern B.C. Must be eligible for B.C. registration.
N.U.A. course preferred. Apply: Director of
Personnel, Fort St. John General Hospital, Fort St.
John. British Columbia, VIJ IY3.
Generlll Duty Registered Nunes required for a fully
accredited 100-bed hospital. Apply: Director of
Personnel. Fort St. John General Hospital, Fort St.
John. BrilishColumbia. VIJ IY3.
GenIOn! Duty Nune for modem 35-bed hospital
located in southern B.C. 's Boundary Area widl
ellcellent recreation facilities. Salary and penonnel
policies in accordance with RNABC. Comfortable
Nune's home. Apply: Director of Nursing, Bound-
ary Hospital, Grand Forks, British Columbia, VOH
IHO.
Nurse Practitioner required immediately for well
equipped. one doctor, government sponsored,
community health clinic at Madeira Park. B.C.
Attractive rural coastal area. Hours 9-5 Mon.
through Fri. with sharing of weekday evening stand
by duties. Salary: $16.332.,4 weeks annual holiday.
car allowance. Apply to: Secretary. Pender Harbour
and District Health Centre Society. P.O. Box 308,
Madeira Park. British Columbia. YON 2HO. Tel.:
(604) 883-2764.
Experienced Nurses (B.C. Registered) required for a
newly expanded 463-bed acute, teaching, regional
referral hospital loc3ted in the Fraser Valley. 20
minutes by freeway from Vancouver, and within
easy access of various recreational facilities. Excel-
lent orientation and continuing education program-
mes. Salary-I979 rates-$1305.00--$1542.00 per
month. Clinical areas include: Operating Room. Re-
covery Room. Intensive Care, Coronary Care.
Neonatal Intensive Care. Hemodialysis. Acute
Medicine, Surgery, Pediatrics, Rehabilitation and
Emergency. Apply to: Employment Manager. Royal
Columbian Hospital. 330 E. Columbia St., New
Westminster, British Columbia, V3L 3W7.
Experienced Nurses (eligible for B.C. Registration)
required for full-time positions in our modern
300-bed Extended Care Hospital located Just thirty
minutes from downtown V dncouver Salary and
benefits according to RNABC contract. Applicants
may telephone 525-0911 to arrange for an interview.
or write giving full particulars to: Personnel Direc-
tor. Queen's Park Hospital, 315 McBride Blvd.,
New Westminster. British Columbia. V3L 5EII.
Generlll Duty RN's or Graduate Nurses for 54-bed
Extended Care Unit located six miles from Dawson
Creek. Residence accommodation available. Salary
and personnel pólicies according to RNABC. Apply:
Director of Nursing. Pouce Coupe Community
Hospital. Box 98. Pouce Coupe. British Columbia or
call collect (604) 786- 5791 .
Experienced ICU/CCU and Operating Room General
Duty Nunes required for full-time and summer relief
in a 23(}'bed accredited hospital in the Okanagan
Valley. Must be eligible for B.C. registration. Salary
$1.305 to $1.542 per month, with differential for
special clinical preparation of not less than 6 months.
Apply to: Director of Nursing. Penticton Regional
Hospital. Penticton. British Columbia. V2A 3G6.
British Columbia
Repotered Nunes - Required immediately for a
34(}'bed accrediled hospital in the central inlerior of
B.c. Registered Nurses interested in nursing posi-
tions at the Prince George Regional Hospital are
invited to make inquiries to: Director of Personnel
Services, Prince George Regional Hospital, 2000-
15th Avenue, Prince George, British Columbia V2M
IS2.
Generlll Duty Nunes required for an active, 103-bed
hospital. Positions available for experienced R.N.'s
and recent Graduates in a variety of areas. RNABC
contract in effect. Accommodation available. Apply
to: Director of Nursing, MilIs Memorial Hospital.
4720 Haugland Avenue, Terrace, British Colum-
bia VIIG 2W7.
Applicalions are invited for teKhlng positions in
undergraduate and graduate programs. Master's or
higher degree and experience in clinical field
required. Positions open in July, 1979. Candidates
must be eligible for registration in B.C. Send resume
to: Dr. Marilyn Willman, Director, School of
Nursing, University of British Columbia, 2075
Wesbrook Place, Vancouver, British Columbia,
Canada, V6T IW5.
New Brunswick
Faculty members required with teaching and clinical
experience for an integrated undergraduate program.
(I) Community Helllth Instructor to work. with team
who teach in the third year. (2) Co-ordinator of
Pediatrics, for students in second and third years.
Master's degree desired. baccalaureate essential.
Salary based on qualifications and experience.
Apply to: I. Leckie. Dean. Faculty of Nursing.
University of New Brunswick. Fredericton. New
Brunswick E3B 5A3.
Ontario
Applications now being accepted by the Ontario
Society for Crippled Children for Repstered Nurses,
Graduate Nurses and Registered Nursing Assistants
for their resident summer camps located near Col-
lingwood, Port Colborne. Perth, Kirkland Lake and
London. 9 weeks-late June to late August 1979.
Various positions available-supervisory. assistanl
supervisory and general cabin responsibilities. Con-
tact: Camping and Recreation Department. 350
Rumsey Road, Toronto. Ontario, M4G IR8 (416)
425-6220. Ext. 242.
Quebec
Nurses for ChUdren's Summer Camps In Quebec. Our
member camps are located in the Laurenlian Moun-
tains and Eastern Townships, within 100 mile radius
of Montreal. All camps are accredited members of
the Quebec Camping Association. Apply to: Quebec
Camping As.ociation, 2233 Belgrave Avenue.
Montreal. Quebec. H4A 2 L9. or phone 489-154 J.
Saskatchewan
R.N.'s and R.P.N.'s (eligible for Saskatchewan
registration) required for 340 fully accredited ex-
tended care ho.pital. For further infonnation.
contact: Per.onnel Department. Souris Valley Ex-
tended Care Hospital. Box 2001. Weybum. Sas-
katchewan S4H 2L7.
2 Registered Nurses are required for 27-bed ho.piial
located 90 mile. East of Regina on No. 48 Highway.
Salary as per S.H.A. - S.U.N. agreement. PI
a.se
send resume tn: Mrs. Sandra Hextall. Admln"-
trator. Kipling Memorial Union Ho.pital. Box 42U.
Kipling. Sa,katchewan SOO 2S0.
United States
Crillcal Care Nurses - EI Camino Hospital. a
464-bed acute care facility has excellent oppor-
tunities for full-time or part-time or Per Diem nurses
on 3-11 PM or 11-7 AM shifts in the following areas:
ICU - new l6-bed med-surg (includes adult open
heart patients). CCU - 12-bed new urnt equipped
with H.P. arrythmia detection monitors offering
patient teaching program and nursing research. TCU
(fransitional Care Unit) - 25-bed unit equipped
with telemetry for 12 patients. Offers unique
cardio-vascular nurse/client teaching program. ER
- new spacious area providing a complete range of
basic emergency service to 3000 patients per month.
The RN staff is certified in Advanced Cardiac Life
Support. All these units offer the latest in innovative
staff development. patient teaching programs. edu-
cational opportunities and a time-saving Com-
puterized Medical Information System. Salary S1363.
(Staff II Step II) shift differential S.55Ihr. 3-11 and
S.75/hr. 11-7. For information. call Patti Aalgaard,
RN. Coordinator. Nurse Recruitment at (415)
968-8111, Ext. 44543 or write EI Camino Hospital.
2500 Grant Road. Mountain View. California 94042.
An Equal Opportunity Employer MIF IH.
Callfornbo - SometImes you have to go a long way
to find home. But. The White Memorial Medical
Center in Los Angeles. California, makes it all
worthwhile. The White is a 377-bed acute care
teaching medical center with an open invitation to
dedicated RN's. We'll challenge your mind and offer
you the opportunity to develop and continue your
professional growth. We will pay your one-way
transportation, offer free meals and lodging for one
month in our ultra-modem nursing residence and
provide your work visa. Call collect or write: Ken
Hoover. Assistant Personnel Director, 1720 Brook-
lyn Avenue. Los Angeles. California 90033: (213)
269-9131, ext. 1680.
Nursing Opportunity - MissisSippi Baptist Medical
Center, a major 600-bed hospital, has immediate
posi1ions available for experienced RNs and recent
nursing school graduates in a variety of specialities
and medical/surgical areas. Competitive salaries.
liberal benefits. Visa, licensure and relocation
assistance provided. Located in Mississippi's capital
city of Jackson (population 300.(00). MBMC is the
state's largest and most modern privately operated
hospital. For further information write: Mrs.
JOhnnye Weber. Nurse Recruiter. 1225 North State
Street, Jackson. Mississippi 39201: or call collect
601/968-5135.
R"s - Enjoy the unique lifestyle of sunny Las Vegas
while expanding your nursing career! Pay no state
income tax. contmue your education. see the finest
entertainment anywhere or enjoy a variety of
cultural and recreational activIties. Join Valley
Hospital. a 276-bed. fully-accredited acute care
facility. Write or call collect: "-alene Ryan. Nurse
Recruiter. Valley Hospital. 620 Shadow Lane. Las
Vegas. Nevada. 89106. (702) 385-301].
N.rlles - RNs - Immediate Openinls in
California-Fiorida-Texas-Mississippi - if you are
ellperienced or a recent Graduate Nurse we can offer
you positions with excellent salaries or up to SI300
per month plus all benefits. Not only are there no
fees to you whatsoever for placing you, but we also
provide complete Visa and Licensure assistance at
also no cost to you. Write immediately for our
application even if there are other areas of the U. S.
that you are interested in. We will call you upon
receipt or your IIpplication in order to lUTanae for
bospi1111 interviews. You can cllli us collect if you an
an RN who is licensed by examination in Canada or
a recent Induate from any Canadian School t1
Nursina. Windsor Nurse Placement Service, P.O.
Box 1133, Great Neck, New York 11023. (516--487-
2818).
"Our 20th Year of World Wide Service"
Nursina Opportunities - Prosressivc SOO-bed Medi-
cal Center in Welt Texal city 01' Abilene with
pOpulation nearly 100,000 is IooItina for M_
.......... and ellperienced R.N.'s for positions in
O.B., Pediatrics, SurICry, E.R., ICU, CCU, plus
sDrJical and medical floors. Good compcli1ive salary
and lenero"s benefits are provided. Contact: Per-
IOnnel Ollice, Hendrick Medical Cenler, 19th and
Hickory. Abilene, Texas, 7960t.
The Cen-.llan Nur..
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
A V AILABLE NOW
ARIZONA
CALIFORNIA
TEXAS
WE PLACE AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WOR"- VISA
TEMPORARY HOUSING - ETC".
A CANADIAN COUNSELLING SERVICE
Phorw: (416) 449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1200 LA\\RENCEAVENLE EAST, SLTfE 301.
DON MIU.s, ONTARIO MJA ICI
IN
FLORIDA
OHIO
NO FEE IS CHARGED
TO APPLICANTS.
TIle BesI LoaItlon In tbe Nation - The world-
renowned Cleveland Oinic Hospital is a proil"es-
sive, I02O-bed acute care teaching facility committed
to excellence in eatient care. Staff Nurse positions
are currently available in several of Our 6 ICU' sand
30 departmentalized medJsurg and specialty divi-
sions. Starting salary ranle is SI3,286 to SI5,236,
plus premium shift and unit differential, proaressive
employee benefits program and a comprehensive 7
week orientation. We will sponsor the appropriate
employment visa for qualified applicants. For
further information conIact: Director - Nurse Re-
cruitment, The Cleveland Clinic Foundation, 9500
Euclid Avenue, Cleveland, Ohio, 44106 (4 hours
drive from Buffalo, N.Y.); or call collect 216-444-
5865.
Excitement: Come and join us for year around
excitement on the border. by the sea. an unbeatable
combination. El\ioy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed, acute care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opportunities. We have immediate openings in all
areas. Excellent salary and fringe benefits. We invite
you to share the challenge ahead. Assistance with
travel expenses. Write or call collect: Joe R. Lacher.
RN. Director of Nurses, Valley Community Hospi-
tal, P.O. Box 4695, Brownsville, Texas 78521: I
(512) 831-9611.
.
AVO.
"
MEDICAL
RECRUITERS
OF AMERICA
INC.
MRA recrUIts RegIstered Nurses and recent
Graduates for hospital posItions in many
U S. cIties We provIde complete Work VIsa
and State LIcensure InformatIon
ARLINGTON, TX. 76011
POBox 5844
(214) 647-0077
AUSTIN, TX. 78761
POBox 14745
(5121459-3235
CHICAGO, ILL. 60607
500 So Racme St . SUIte 312
(312) 942-1146
FT. LAUDERDALE, FL. 33309
800 N.W 62M St.. SUIte 510
(305) 772-3680
TAMPA, FL. 33607
1211 N Westshore Blv".. SUIte 205
(813) 872-0202
ALL FEES EMPLOYER PAID
Merch 111711 57
United States
C_ Ie T_ - Bllptist Hospilal 01'. Southeast
Tellas is a 400-bed growth oriented OIJanization
lookina for a few I->od R.N. '.. We feel thaI we can
offer you the challenge and opportunity to develop
and continue your professional II'Owth. We are
located åt Beaumont, II city 01' 150.000 with II smaIl
town atmosphere but the convenience 01' the laI'Ie
city. We're 30 minutes from the Gulf oI'Muico and
surrounded by beautiful trees and inland lakes.
Bllptist Hospital has a prOiress sillary plan plus II
liberal fri."e packaae. We will provide your immil"
ration P :r rwork cost plus airfare to relocate. For
addition information, COllIact: Personnel Ad-
ministration, Baptist Hospilal 01' Southeast Tuas.
Inc., P.O. Drawer 1591. Beaumont, Tuas m04. A.
.mna.ttYe.... _pIoyn-.
Switzerland
Hospital of Canton Zürich at Winterthur (725 bed
hospital near Zürich) needs Operating Room Nurses
for the surgery clinic. Required for immediate or
future openings. We offer pleasant working condi-
tions. equitable hours of work and leisure. Salary
and benefits in accordance with the regulations of
the Canton of Zürich. Five-day week. accommoda-
tion available. cafeteria. Apply in writing to:
Sekretariat Pflegedienst. Kantonsspital Winterthur.
CH-8401. Winterthur. Switzerland.
Miscellaneous
Africa - Overland Expeditions. LondonlNairobi 13
wk!. London/Johannesburg 16 wks. Kellya Safaris
- 2 and 3 wk. itineraries. Europe - Camping and
hotel tours from 16 days to 9 wks. duratIOn. For
brochures contact: Hemisphere Tours, 562 Eglinton
Ave. E., Toronto, Ontario, M4P IB9.
Interested In Electrolysis Career? Must be an R.N.
Successful practice available. Instructions. Write or
call: Margot Rivard. R.N.. 1396 St. Catherine Street
West. Suite 221. Montreal. Quebec. H3G 1P9.
Telephone: (5141861-1952.
Bermuda Hospitals Board
Applications are invited for the position of
Operating Room Supervisor in our 320 bed
general hospital. which is accredited with the
Canadian Council on Hospital Accreditation.
The appointee would be responsible for the
management and supervision of a busy Operat-
ing Room and Recovery Room suite. undertak-
ing some 6000 operations per year.
Applicants should be Registered Nurses. who
have a minimum offive years Operating Room
experience. two years of which were in a
management role. Bachelor's degree desirable.
Demonstrated ability in management of per-
sonnel and coordination of medical staff
activities required. Experience and ability in
budget preparation and cost control systems
would be an advantage.
I nterested applicants should apply in confi-
dence. submitting resume and statement of
desired salary to:
Director of
ursing
King Edward VII Memoriat Hospital
P.O. Box 1023
Hamilton 5. Bermuda
56 lIerch 111711
Nursing Instructors
Required
If you ar
:
. Imdgmatl"e. creative dnd mtere..ted in pro-
fe"lonal fulfillment
. looking for a chdllenge in nursing educ.uion
. 'dtj..fied \\-lIh nothing ..hurt of eu-ellence
. student
enlered
. intere!'lled in edrning d good '\alary
If you ha
e:
. a
1
t!\oler'. or Baccalaure.ue Degree In
NUT'lng
. dion.a) pracllce experti..e
If )OU set'k a nursing program Ihal:
. promutes both per<i.onal dnd profe'<i.lonal
de\oelopment of ,.udents
. i'\ dynamic and evolving
. graduates nurses who are current and hct.ve
the capacity for grO\Hh
C OOldCI:
:\Uss LiDian Douglass
Director of Nursing
'\1edicine Ha. <-'ollege
'\Iedicine Hal. AI
r1.
TlA 31'6
(4031 527-7t41
Senior Clinical Nurse
Required for a 34 bed Special Care Unit in a
new modem. 485 bed fully accredited Regional
Ho'pital. SalaryGN-4 $12.886.00- $14.445.00
Applicants must have post basic training in
Critical Care nursing and at least two years
recent experience in a critical care selling.
Abo a minimum of two years recent experi-
ence in a leadership or teaching role in nursing
and be able to a"i,t primary nurse, to develop
as profe"ional practitioners.
Mu,t be actively regIstered or eligible for
registration in New Brunswick.
Please forward application and resume to:
æ!
The Nurse RecruItment Officer
Dr. Everett Chalmers Hospital
P.O. Box 9000
Fredericton, N.B. E3B SN5
Telephone (506) 452-5177
International Grenfell
Association
invites applications for position of
Director of Nursing
for an accredited l60-bed general hospital in
SI. Anlhony. Newfoundland. Travel Ex-
pen,es borne by Association on minimum of
one-year service. Other fringe benefits.
Applicants ,hould have administrative ex-
perience dnd be eligible for registration in
Province of Newfoundldnd. Preference
given to candidate with a B.Sc. or masters
in nursing. Salary in accordance with
provincial government scale. Apply 10:
Mr. Scoll Smith
Personnel Director
Curtis Memorial Hospital
St. Anthony, Nnd.
AOK 4SO
The C.n-.llen Nur..
Supervisor of
Nursing (days)
Applications are invited for the above position
in a 90 bed accredited Hospital.
The successful applicant must be prepared to
take over the position of Director of Nursing
within one year.
Qu
ifications:
e Must be registered in the Province of Nova
Scotia
. B.Sc.N. would be preferred or University
Diploma in Nursing Service Administration
essential
. Experience in Nursing Administration and
Supervision essential.
Apply to:
Miss Muriel M. Smitb
Director of Nursing
Digby General Hospital
DIgby, Nova Scotia
BOV IAO
McMaster University
Educational Program
For Nurses In
Primary Care
McMa,ter University Schoul ofNuf\-
mg in conjunction ",ith the Schoorof
Medicine. offe" .I program fur regi,.
tered nUf\e' employed in primdry
care ,ellings who are willing to
assume a redefined rule in the primary
health care delivery team.
Requirements Current Canadian Re-
gistration. Sponsorship from a medi-
cal co-practitioner. At least one year
of work experience. preferably in
primary care.
For further information writ" to:
Mona Callin, Director
Educational Program for Nurses
in Primary Care
Faculty of Health Sciences
McMaster Uni.ersity
Hamilton, Ontario L8S 4J9
Director of
Patient Care Services
Applications are invited for the position of
Director of Patient Care Services for a 48
bed active treatment hospital to be opened
in the fall of 1979
The successful candidate will be a member
of the management team and be responsible
for establishing departmental regulation,
dnd procedure,. developing dnd executing
departmental objectives and other related
duties.
Candidates should be eligible for registra-
tion with the Registered Nurses Associdtion
of Nova Scotia. A B.Sc.N. is an dsset and
supervisory experience is essential.
Please apply in writing to:
The Administrator
Strait-Richmond Area Hospital
P.O. Box 2013
Port Hawkesbur}, N .s.
BOE 2VO
Dalhousie University
School of Nursing
Applications are invited for the following post
for the academic year commencing July 1979:
Coordinator of the Basic Degree Programme for
July 1979. Applicants sbould ban a Doctoral or
Masters degree and experience in teaching,
curriculum planning and evaluation in a Uni-
versity Faculty ISchool of NursIng. Evidence or
organizational and leadership abilities are also
required for this senior appointment.
level of appointment and salary will be ba,ed
on qual!fications and previous experience.
Applications should be addressed to:
Dr. Margaret Scott Wright
Director
School of Nursing
Dalhousie University
5963 CoUege Street
Halifax, Nova Scotia
B3H 4H7, Canada
Intensive Care Nurses
We have 4 vacancies In our Inten,ive Care
Unit and offer regi,tered nurses an opportunity
to either: expand your nursing experience base
if you have not worked in an 1.c. U nit or an
opportunity to share your previous I.c. U.
experience with our patients.
Nurses must be eligible for regIStration In
Sa,katchewan.
Sdlaries are in accordance with qualifications
and experience.
Our Patients Need You!
Plea,e apply to.
p.,nonnel
partment
St. Paul'. Hospital
(Grey Nun.') of Saskatoon
1702 - 20th Street West
Saskatoon, Saskatchewan
S7M OZ9
"
.
T
HAVE A PAP TEST
THE CANADIAN I
CANCER SOCIETY +
Before accepting any
position in the U.S.A.
PLEASE CALL US
COLLECT
w. Can Offer You:
A) SelectIon of hospitals throughout
the US.A
B) Extensive information regarding
Hosplt
Area. Cost of living. etc
C) Complete licensure and Visa Servtce
Our Services to you are at
absolutely no tee to you.
WINDSOR NURSE
PLACEMENT SERVICE
P.O. Box 1133 Great Neck. N.Y.
(516) 487-2818
Our 20th Year 0' World Wide Service .......
8
Foothills Hospital
Calgary, Alberta
The Depanment of Nursing and the
Depanment of Pediatrics. Neonatology,
are offering a five month clinical and
academic programme for Graduate
Nurses:
Advanced Coune in Neonatal Nursing
Applications are being accepted for clas-
ses enrolling each March and September.
Participation in the programme is limited
to eight.
For further IBfonftatloB pI_ wrlt
to:
Mr. B. Wrlpt
Coontlntor of Educatlooal Servkel
FoodtUls HoopItlll
1403-29 St. N.W.
CllillWY. Allterta
T2N In
Nurses.. .
Are you interested m rural
extension nursing? There are
openings for you in Africa Or
would you like to teach in nursmg
colleges in Africa, Papua New
Guinea or Latm America?
Qualifications: B.Sc.N. or R.N.
with Public Health or broad
general nursing experience
Inquiries are welcome at:
CUSO Health-D Program
151 Slater Street
Ottawa, Ontario
K 1 P 5H5
as an alternative. . . . . . CUSO
The C.n-.llan Nur..
McMaster University
Faculty of Health Sciences
Experienced nurse educator required as
Chairman. Undergraduate Nursing Prog-
ram (B.Sc.N.). Appointment to School
of Nursing which is an integral pan of a
Faculty of Health Sciences. Rank and
salary in accord with qualifications.
Qualifications:
Master's or Doctoral degree, with clini-
cal expenise.
Application. with a copy of curriculum
vitae and 3-4 references to:
Dr. D. J. Kergin
Associate Dean of Health
Sciences (Nursing)
McMaster University School of 'l/ursing
Health Sciences Centre
1200 Main Street West
Hamilton. Ontario L8S 4J9
Nurses
Try Canada's
Northland
Infirmières
Découvrez
les Terres
Septentrionales
du Canada
JOin the team provldmg health
care to the reSidents of the
Northwest Territories
For more Information wnte 10
Personnel Administrator
Medical Services
Northwest T erntories Region
Health and Welfare Canada
141h Floor. Baker Certre,
10025 - 1 06 Street
Edmonton, Alberta TSJ 1 H2
m
Applicant
!:?n
2
!.wo_n
IIIerch 111711 51
Are you the nurse
we're looking for?
We're a 135 bed. fully accredited. acute
general hospital consisting of eight floors and
two medical clinics. offering a full range of
patient services including Psychiatry. Obstet-
rics and Gynaecology. Paediatrics. Medicine.
ICU. Surgery. out patient services such as
Radiology. Laboratory. Physiotherapy. and an
active Emergency. Out Patient Department.
Our hospilal is situated in the town of
Caroonear on the east coast of Newfoundland,
some seventy miles by paved road from St.
John's. the capital city of the province. While
the town itself has a population of about 7.000
people. we have in our environs 40.000 people
who look to our hospital for medical services.
Our town has full church facilities for any
denomination. and the living conditio
pro-
vide modem amenities. The sportsminded can
enJoy unrivaled opportunities.
Our salaries are good and there are excellent
employee benefits.
If you're looking for a change and a challenge.
talk to us. For further infonnation. write or
call:
Gordon G. PIke
Director of Personnel
(709) S96-SOS t, extension 140
Carbone... General Hospital
P.O. Box 20
Carbon.,.,., N
wfoundland
Canada
AOA no
tf you applied in response to our June 78
announcement in this publication. there is no
need to re-apply.
. r
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oj! (\.2
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JOlgnez-vous å I eqUipe medlcale
qUi sOigne les habltanls des
T emlOlres du Nord-Ouest
Pour de plus amples
renselgnements pnère d écnre a
I adresse sUlvante
L administrateur du personnel
SerVIces medicaux
Region des T erritolres du
Nord-Ouest
Sante et Bien-etre SOCial Canada
14e etage. Centre Baker
10025 -106e Rue
Edmonton (Alberta) TSJ 1 H2
Répertoire
de candidatures
A
I de C.ndidilliures mla.e.
80 Merch 111711
The Cen-.llen Nur..
Judy Hill Memorial Scholarships
Applications are being received for two annual Scholarships details
of which are as follows:
Value: Up to $3,500.00 each.
Purpose: To fund post-gmduate nursing training (with special
emphasis on midwifery and nurse practitioner training) for a period
of up to one year commencing July 1st. 1979.
Tenable: In Canada. the United ....ingdom. Au'tralia & New
Zealand.
Applicants should possess the fOllowing qualifications:
. Fluency in English;
. *R.N.Diploma.orequivalent:
. A desire to work for the Govemment of Canada or one of its
Provinces at a fly-in nursing stalion in a remote area of Northem
Canada for a minimum period of one year fOllowing completion of
the ,cholarship year (Details of this work will be forwarded on
request).
Required:
. A resume of academic and nursing career to ddte. together with a
brief statement of the applicant's oulside interests;
. Copies of the educational qualifications submitted on entry to
nursing school:
. A statement as to d..te of birth. marital status, dependent' (if any)
and citizenship;
. Verification ofR.N Diploma. or equivalent:
. The proposed course of study:
. Acceptance and/or preferences for place of study:
. Two character reference letters. One of these should be from a
Health Service Professional familiar with the Applicant's nursing
experience. In reaching ,heir deci.ion. the Trustees attach
considerable tmportance to the advice of the referees.
Appl, To: Mr. PhilipG.C. Kelchum
Chairmdn. The Board of Trustees
Judy Hill Memorial Fund
15325 Whitemud R(\ad
Edmomon. Albena. Canddd (f6H 4N51
ClasinK Date: May 31st, 1979
. The
holar
hlp I" I..ontmgcnl on th
'iucccssful apphcant Þemg I'"eglstl'"able by a nursing
3'ì.Soclailon In one of the Canadian p...o.....nces and bemg a Canadian Citlzcn or able to
meet currcnt Canadian rCQUIrements rorcmploymcm with the Public Service ofCBnada.
Applications are invited for a Visiting Educator in
the Clinical Specialty of Cancer Nursing.
The appointment is for six months commencing
September I, 1979, and is primarily to initiate a
program designed to increase the knowledge of staff
on concepts and trends in Nursing Care of the
patient with Cancer. in all phases.
The applicant should have broad preparation in
Nursing with a minimum of Post Basic Certificate in
the clinical aspect of the specialty.
Preference will be given to applicants who possess a
Bachelor's or Master's Degree and a minimum of 5
years' experience in the Clinical Specialty of
Cancer Nursing.
Applications and Curricula Vitae should be
submitted to:
Director of Nursing
Kingston General Hospital
Kingston, Ontario, Canada
K7L 2V7
Applications are. invited for
Public Health
Nursing Supervisor
Qualifications: Bachelor of Science in nursing,
leadership ability, a minimum of three years'
experience in a generalized Public Health program.
Position available: May 5, 1979.
Application
with curriculum vitae should be
suhmitted to:
Mr. R. Dick
Personnel Officer
Waterloo Regional Health Unit
8th Floor, Marsland Centre
20 Erb Street West
Waterloo, Ontario
N2J 4G7
Belleville General Hospital
Unit Co-ordinator
ICU/P ARR and Emergency
Applications are invited for the above position to be
available in June 1979 by this 450 bed accredited general
hospital.
Duties:
Responsible for the overall management functions of the
above noted units.
Qualifications:
Must be currently registered in Ontario. Post graduate
preparation in the above hospital areas as well as related
practical experience is preferred.
Preference given a B.Sc.N. and/or the completion of
management courses.
Apply in writing by April 6. 1979. stating experience and
salary expected to:
Director of Personnel
Belleville General Hospital
P.O. Box 428
Belleville, Ontario
K8N 5A9
Southern California Nursing:
Three Who Made The Change
" It was a big step to move from Southwestern Ontario to an
entirely new job and surroundings in California. but everyone on the
staff at S1. Francis made me feel very welcome. They're all so warm
and friendly - I really feel like an integral part of their team.
"S1. Francis is more than I ever expected. but for me Labor and
Delivery is the most exciting. Along with my helpful coworkers, the
advanced monitoring equipment. and delivery room techniques. I've
found my unit a great place to advance my knowledge.
"I am proud to be a part of S1. Francis Medical Center. It's a
great place to work... come and see for yourself."
Shirley Allin, RN
..
-.
..
"I'm from Prince Edward Island, Canada. and have been
employed by S1. Francis Medical Center for one year now. I spent four
months trying to obtain my visa to Southern California - S1. Francis
obtained it for me in one week.
"S1. Francis is located within a short distance from the beach
and mountains. offering you a wide choice of social recreation.
"I am really enjoying my nursing experience with S1. Francis and
have found the staff especially friendly and helpful."
Patricia Macleod. RN
" I came to S1. Francis from Calgary. Alberta Canada The atmos-
phere at S1. Francis is warm and personal and the people never
hesitate to make me feel at home.
"S1. Francis provides many channels for growth The staff is
always available for help.
"The knowledge and experience I am gaining through living and
working in a different country are limitless. I have met many new
people and seen many new places thanks to 51. Francis "
Colleen McPhail. RN
,
\
...................................
: St. Francis Medical Center is located just outside of Los Angeles. in the city of Lynwood. Facilities . .
embrace a complete range of medical-surgical services. including open-heart surgery, intensive and
. coronary care, definitive observation. acute and renal dialysis, neurostroke, inpatient psychiatry. in/out .
. patient rehabilitation, intensive newborn care, diagnostic and therapeutic radiology including cobalt and .
. ultrasound, and a 24-hour Emergency Department. The 524-bed hospital has a nursing staff of .
approximately 700.
. Make the change to a hospital that lets you be what you want to be. Write us for more information or .
. call Brent Nielsen, RN. Nurse Recruiter, collect at (213) 603-6083. .
. 0 Please send me a brochure about St. Francis Medical Center. .
· Name St Francis ·
:
:
ss Sta'e Zip
H
er :
. Phone ( - ) RN 0 Student 0
Lynwood. California 90262 .
. Area of Interest An equal opportunity employer _N-37g .
...................................
112 March 111711
The Cen-.llen NUrH
Quality Patient Care
- Interested? -
To ensure that the quality of patient care at the Medical Centre is
maintained at the highest level possible, we are seeking a
Quality Assurance Manager
- Nursing.
RepoI1ing to the Director of Nursing, the successful candidate
will assume responsibility for the design and implementation of
procedures to assure continued quality care. Actins as a resource
to other senior nursing personnel. the candidate will monitor and
update systems as required.
If you would be interested in this type of staff position and can
demonstrate through several years of past nursing experience an
innovative approach to your work. write to us. While a Master's
degree is preferable. candidates with a baccalaureate are also
invited to apply. Current registration in Ontario is essential
Please send your.cesume in confi dence to:
Mr. R. E. Capstick
Manager. Employment and StaIT Relations
McMaster University Medical Centre
1200 Main St. W.
Hamilton, Ontario
LSS 4J9
The University of Western Ontario
Faculty of Nursing
Bachelor of Science in NursIng
Prepares Ihe graduate for professional nursing practice in a
variet y of settings
I. Four year Basic Program for students with Ontario Year V (or
equivalent) OR universi(y preparation
2. Three year Post Basic Program for Registered Nurses
Master of Science in Nursing (Education)
Prepares B.Sc.N. graduates with experience for positions as
teachers in schools of nursing
Master of Science in Nursing (Administration)
Prepares B.Sc.N graduates with experience for administration
in one of Community Health Nursing. Nursing Educalion.
Hospital Nursing
Inquiries:
Dr. Beverlee Cox, Dean
University of Western Ontario
Faculty of Nursing
LONDON, Ontario
'l/6A SCI
I
QPPORlU\JITY Æm
Nurse
AlbeI1a Social Services and Community
Health. Local Health Services requires a
registered nurse for the Municipal Nursing
Station in Worsley. This small community is
located approximately 150 miles NoI1h West
of Peace River. Duties involve providing
primary care and community health nursing
service to individuals and families in the area.
This position is temporary.
Qualifications: Graduation from an approved
School of Nursing and eligible for registration
with the appropriate Nursing Association in
AlbeI1a, plus considerable nursing experi-
ence.
Salary $14.184 - $17.376
Competition #9185-2
This competition will remain open until a
suitable candidate has been selected.
Apply to:
AlbeI1a Government Employment Office
5th Floor, Melton Building
10310 Jasper Avenue
Edmonton. AlbeI1a
T5J 2W4
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Registered Nurse in search of a change and a challenge -
look into nursing opportunities at Vancouver General Hospital, B.c. 's
ml\Ïor medical centr
on Canada's unconventional West Coast. Staffing
ellpansion has resulted in many new nursing positions at all levels,
including:
General Duty ($1231-1455.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the opportunity
you've been looking for.
For those with an interest in specialization. challenges await in many
areas such as:
Neonatology Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Burn Unit
Paediatrics
Inservice Education
Coronary Care Unit
Hyperalimentation
Program
Renal Dialysis & Transplantation
If you are a Nurse considering a move please submit resume to:
Mn. J. MacPhail
Employee Relations
Vancouver General Hospital
1I!5 west 12th Avenue
Vancouver, B.C. V5Z IM9
The Cen-.llen Nu...
RN'S
The CENTRAL MAINE
MEDICAL CENTER
Lewiston, Maine
One of Maine's largest. progressive regional refer-
rals medical centers is located in Lewiston, a
colIege community of approximately 40.000 in south
central Maine. The ocean. lakes and mountains are
alI nearby making the area attractive for 4-season
living.
· more than 80 active medical staff members
· 800 support professionals
· 125.000 patient visits each year.
WE ARE SEEKING:
· qualified RN's to join our progressive health
care team providing quality health care for
those we serve.
· fulI and part time positions are now open on alI
shifts and/or rotating shifts
· every other weekend off scheduling
· salary range: $10,000-13,200
PLUS a 10% evening or night differential
PLUS additional stipend for charge nurse
assignment
Temporary housing available in the nurses resi-
dence upon arrival. If you are seeking excelIent pay
and fringe benefits as welI as opportunities for
professional development, CALL COLLECT
Margaret Ross. Director of Nursing
(207) 795-2333
(Personal intenie"s "ill be arranged in
our area)
An Equal Opportunit
Employer
Merch 11171 13
Wish
ere
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...in Canada's
Health Service
--.,
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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
!>ervices to Canada's Indian and Eskimo peoples. If you
have the qualifications and can carry more than the
nonnalload of responsibility... why not find out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing v"hich in-
cludes counselIing and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career. and it is possible to advance to
senior positions. In addition. there are educational
opportunities such as in-service training and some
financial support for educational leave.
For further infonnation on any. or all. of these career
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
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I
I Name
I Address
I City
I . . Health and Welfare Sante et Bien-élre socIal
Canada Canada
,........
Prov
"" "erch 117i
The Cen-.llan Nur..
Clinical Nurse Specialist
Psychiatry
As an active member of an interdisciplinary psychosocial
programme. the incumbent will act as a nursing consul-
tant on psychosocial aspects of patient care in a variety of
clinical settings with particular emphasis in out-patient
and in-patient psychiatry.
Candidates must be registered in the Province of Ontario
and must have current clinical experience in psychiatry as
well as experience in teaching.
While preference will be given to those with a Master's
Degree in Nursing. those with a baccalaureate degree are
also invited to apply.
Please send your resume in confidence to:
:\-lr. R. E. Capstick
Manager, Emplo} ment and StafT Relations
Mc!\'laster Universit} Medical Centre
t200
ain St. W.
Hamilton, Ontario
L8S 4J9
Assistant Editor
The Canadian
urse. a monthly journal published by the
Canadian Nurse,,' Association. 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 travel
Location: Ottawa
Qualified applicants are invited to send their complete
resume to:
The Editor
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2P tE2
Index to
Ad vertisers
March 1979
Canadian Dairy Foods Service Bureau
The Canadian Nurse's Cap Reg'd
Canadian School of Management
The Clinic Shoemakers
Designer's Choice
Equity Medical Supply Company
Health Care Services U pjohn Limited
Hollister Limited
Frank W. Horner Limited
J .B. Lippincott Company of Canada Limited
TheC.V. Mosby Company Limited
Nordic Pharmaceuticals Limited
Nursing Job Guide
W. B. Saunders Company Canada Limited
Schering Canada Inc.
Cover 3
15
12
2
Cover 2
5
12
7
48
32,33
10,11
54
15
13
Cover 4
Ad\'ertising Manager
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa. Ontario K2P I E2
Telephone: (613) 237-2133
Ad\'erti.
ing Representatives
Jean Malboeuf
60 I , Côte Vertu
St-Laurent, Quebec H4L IX8
Téléphone: (514) 748-6561
Gordon Tiffin
190 Main Street
Unionville, Ontario L3R 2G9
Telephone: (416) 297-2030
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
Member of Canadian
Circulations Audit Board Inc.
m!EI
no relationship has been established
between dietary intake and heart disease
in the normal healthy adult* . . .
so many Canadians pass up the natural
good taste of butter?
*The 20-year Framingham Study,
conducted by the U.S. National Heart,
Lung and Blood Institute, shows no
significant relationship between dietary
variables and CHD. The more conservative
position taken by the A.MA. advocates
dietary manipulation only for persons
with specific lipid profIles.
When you look at the facts
you can see the good in butter.
Canadian Dairy Foods Service Bureau
,
.'
..
I
C\
..
When friends or patients ask your
advice concerning relief of cold
symptoms consider the advan-
tages offered by the CORICIDIN
family of cold products. The
various CORICIDIN*preparations I
are formulated to provide effec-
tive relief of specific groups
of symptoms that generally I
accompany colds. Regular
CORICIDIN (antihistamine,
analgesic, caffeine com-
pound) is intended for use
at the first sign of a cold ! I
where congestion is not a
problem or when decon- G
gestants are cQntraindi-
cated. CORICIDIN 'D' is
formulated for use when S Et
pronounced.
For your younger patients CORICIDIN ,
is available as CORICIDIN Pediatric MEDILETS* anjj
CORICIDIN 'D' MEDILETS, both chewable tablets. and
pleasant tasting CORICIDIN Pediatric Drops for infents or
very young children.
Free Booklet Offer
We've attempted to answer many questions about colds,
their causes, effects and relief in an informative booklet
entitled "How to Nurse a Cold". It's yours. free of charge, if
you'll simply fill in and mail the coupon on this page.
Iflill
HOW / I I I ( I I
I r I I TO NURSE! I I I I I I I
I. I I , I I I /1 /1 OU'I
,I
I
'I
Mail to:
Schering Canada Inc.
3535 Trans Canada
Pointe Claire, Quebec
H9R 184
Please send me my free
copy of your booklet "How to Nurse a Cold",
Additional copies only available upon written
request.
Name:
(Please print)
Address'
City:
Postal Code
. Reg. TM
Provo
. Hypertension - sorting out the facts
. Antihypertensives and how they
work
. Pediatric hypertension - think about
it
. Are nurses victims of the degree
mystique?
. Family involvement in emergency
care
The
Canadia
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APRIL 1979
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01
VTt-,jD VM'V 110-
IN3
nlnJ SlVI
HS
13SSIMON VMVI1J
O ^ I
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3l0
LS3
nl
')öZ
THE "NO UNIFO
in beautiful Dacron. pol E
sively ours, of course
-
,
,
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-
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-
A) Style No. 2742 - Skirt suit
Sizes: 6-16
"Royale Shantung"
80% textured Dacron' polye
20% cotton
White, Peppermint. .
about $40.00
"
B) Style No. 2749 - Skirt suit
'-I>
. G-i6
-Hoyale Sensation:'
100% textured Dacror,'" poly
White. Yellow. . about . 4f)
.
---
A.
-
B.
, ,
, ,
_.. A Div on of
White Sister Uniform c
. .
Available at leading
epartment store and specialty shops across I anad'a.
Nature gives it.
Zincofax* keeps it that wa
o
I'
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 de1ica te ba by 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.
\.
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" Zinë'ofa
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OR BABY 5 sltlll _ 50 I
"Q -
Zinc,fa)(
,
FORS
S
keeps a family's
smooth skin smooth
Contains Anhydrous Lanolin and 15% Zinc Oxide.
Available in 10 and 50 g tubes and 115 g and 450 gjars.
I Wellcome Medical Division
Burroughs Wellcome Ltd.
laSalle. Qué.
-Trade Mart
W-8005
CONTINUE YOUR STUDIES WHILE YOU WORK,
WITH THESE OPPORTUNITIES FOR
SENIOR
HEAL TH SERVICE EXECUTIVES:
I
I
I
I
,
.
I
I
I I
.
.
I
.
ea services
. . .
a miDIs ra Ion
As admission criteria, degree requirements,
and courses vary at each educational institu-
tion, interested executives should write directly
to the following:
Professor J. Nicholson
Department of Administrative Studies
Atkinson College. York University
4700 Keele Street
Downsvlew. Ontario. M3J 2R7
Professor Frank Silversides
College of Commerce
University of Saskatchewan
Saskatoon, Saskatchewan. S7N OWO
Dr. G. Blam
Directeur
Department d' Administration de la santé
Université de Montréal
C.P. 6128 Montréal, Québec
General information is available from: Canadian College of Health Service Executives
410 Laurier Avenue West. Suite 805
Ottawa. Ontario. K1 R 7T3
The
Canadian
Nurse
April 1979
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number4
Input 7 Coping with diabetes insipidus Jannette Moens 18
HYPERTENSION
Hypenension management Barbara Milne.
Here's How 10 in industry Alexander Logan 21
News 12 Questions and answers Mary McCulley 24
Antihypenensives and
Calendar 16 how they work Pam Has/am 26
Pediatric hypenen sion- -
Names 50 think about it Sandra LeFort 32
FRANKLY SPEAKING
Nursing and the
Books 51 degree mystique Jeanne Marie L. Hurd 36
The role of the t\un ily
Library Update 52 in the emergency depanment Wendy McKnight Nicklin 40
The Canadian Nurse welcomes
suggestions for anicles or unsolicited
manuscripts. Authors may submit
finished anicles or a summary of the
proposed content. Manuscripts
should be typed double-spaced. Send
original and camon. All anicles must
be submitted for the exclusive use of
The Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
A healthy child, a sure future is the
theme for World Health Day - April
7th - this year and on our cover this
month. a nurse who is working
towards that objective. Photo
counesy of Health and Welfare
Canada.
The views expressed in the anicles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Canadian Nurses Association,
50 The Dnveway , Ottawa, Canada,
K2PIE2.
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medicus, Canadian Periodical
Index. The Canadian Nurse is
available in microform from Xerox
University Microfilms, Ann Amor,
Michigan 48106.
Subscription Rates: Canada: one
year, $10.00; two years, $18.00.
Foreign: one year, $12.00; two
years, $:!2.00. Single copies: $1.50
each. Make cheques or money
orders payable to the Canadian
Nurses Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number, in a
provincial/territorial nurses
association where applicable. Not
responsible for journals lost in mail
due to errors in address.
Postage paid in cash at third class rate
Toronto, Ontario. Permit No. 10539.
Canadian Nurses Association, 1978.
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Professionals prefer to use
precision instruments.
That's understandable. A neurosurgeon can't
spend time worrying about whether his or her
equipment will adequately handle the precise
function of a brain probe. He has to know that his
instruments will perform without fail so that he can
concentrate on technique.
Precision instruments are equally important in the
area of LV. catheters. When as a professional, you
use a B-D I. V. CA TH, you are using a fine, delicate
instrument with greater flexibility than most
catheters on the market. With the trend to shorter
length and smaller gauge catheters that can still
deliver maximum flow rates, the B-D I. V. CA TH
easily rises to the top of the class. These
advantages allow you to concentrate on your
technique to a greater degree, resulting in in-
creased patient comfort and confidence in the
therapist.
[6.Q]
,.
Start Kit
.
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Our precision Catheter has been incorporated
into this Professionall
Start Kite
I We know that in emergency (or just every day)
situations, you don't have time to go searching for
all the components to start I.V. therapy. That's the
reason for the popularity and success of the B-D
I.V. Start Kit. All the components for a safe aseptic
I.V. start are at your fingertips. . . exactly when
you need them.
Each component is guaranteed sterile while
package integrity is maintained. Affording maxi-
mum patient protection, the B-D I. V. Start Kit is
ideal for use in isolation wards and burn units. It is
designed for single-patient use only.
All B-D I. V. CA THS in Start Kits are the same preci-
sion instruments as those sold individually. We
make them that way so you can concentrate on
technique with the ultimate comfort and safety of
your patient in mind.
The B-D I.V. Start Kit contains all of these
essentials:
1 B-D I.v. CA TH
1 - tourniquet
1 - roll 3/4" x 24" tape
3 - 2" x 2" gauze pads
1 - isopropyl alcohol swab - 70%
1 - povidone - iodine prep swab
1 - adhesive bandage
1 - povidone - iodine ointment
BECTON
J1ICK1NSON
Becton Dickinson Canada,
Hospital/Medical Products,
2464 South Sheridan Way,
Mississauga, Ontario,
L5J 2M8
6 April 1979
The Cenedlen Nurse
perspective
The impossible dream?
,
'
'- ,
I
World Health Day is observed
around the globe on the
seventh of April each year, a
date chosen to coincide with
the anniversary ofthe creation
of the World Health
Organization. In 1979,31
years after the WHO
constitution came into force,
the theme is the well-being of
the child; the slogan is: "A
healthy child, a sure future".
The director general of
WHO describes April 7, 1979
as "an occasion to rouse the
social conscience to the plight
of millions of the world's
children." He points out that
by the turn of the century, one
third ofthe world's population
will consist of children born
between now and the year
2000 and reminds us that the
first few years of life are
crucial in laying the
foundation of good health and
improving the quality of life
for these children.
As things stand now,
most of these children (more
than 80 per cent of them) will
spend these first crucial years
- providing that they survive
the hazardous perinatal period
- battling against tremendous
odds. These are the children
for whom malnutrition,
infection, poor housing, lack
of safe water and sanitation,
and inadequate health care are
the accepted norm.
The family health division
of WHO comments: . 'Health
cannot be achieved where
poverty and misery abound,
where food and safe water are
scarce, where housinf? is
inadequate, and where public
and community services are
lacking orrudimentary./n
such conditions,faced by two
thirds of the world's people, ill
health and premature death
are the rule of the day.
Most sel'erely affected bv
such environmental risk
factors are the childbearing
women and the children
themsell'es. Because of their
speciall'llinerability, they pay
a hem'y price in terms of
death, morbidity, retarded
growth and disability."
WHO cites some
depressing statistics to back
up their claim, for example:
. one baby out of 12 born
around the world this year will
die before its first birthday.
. the infant mortality rate
in developing countries is
generally from 10 to 20 times
that of developed countries -
as high as 200 per 1000 live
births in some countries.
. in developing countries,
maternal mortality ranks
among the main causes of
death in women between the
ages of 15 and 45; forty per
cent of all deliveries fall in
high risk categories.
In the face of these
statistics, the commitment of
the nations of the world - at
the thirtieth World Health
Assembly and, more recently,
at the International
Conference on Primary Care
in Alma-Ata- to the goal of
"health for all by the year
2000" must be regarded as
somewhat utopian, if not
actually unrealistic.
Unless drastic measures
are taken to stamp out
poverty, hunger and
ignorance around the world,
the survivors of to day's
adverse environmental
conditions will all too soon
give birth to another
unhealthy generation.
Children in our affluent
societies are not without their
share of problems too. WHO
reminds us, for example, that
about four per cent of the:! I
million Low Birth Weight
(small for date) babies born
annually around the world are
born to mothers in dneloped
countries. LBW is the single
most important factor
determining survival chances
ofthe child. Its frequency is
closely related to the
nutritional status ofthe
mother and, in developed
countries, the frequency is
higher among mothers who
smoke during pregnancy.
Canadian nurses are
aware of other problems
adversely affecting the health
of the children they care for.
Not all children in this country
start off life with the same
advantages. Some of them are
the victims of poverty and
ignorance too. Some are
handicapped from birth. Some
are physically or emotionally
abused. Some are neglected.
Some are not immunized
against the common diseases
of childhood.
There is no room for
complacency in
contemplation of the task
ahead. Nor can nurses opt out
of this task. Whether they are
practicing in Canada or
abroad, it is the essential
elements of health for a11-
antenatal, natal and postnatal
care, including family
planning; infant and
childhood care. including
nutritIOnal support;
prevention and control of
locally endemic diseases:
immunization against
infectious diseases; water,
housing and sanitation that
permit cleanliness and safe
consumption: education and
information on health
problems - that are at the
core of that practice.
Health for all by the year
2000 will never be more than a
catchy slogan unless we start
now to make sure that all of
our children the world over
ARE healthy... in every sense
of the word. Nurses can't do it
alone but, on the other hand,
without nurses it almost
certainly can't be done.
-M.A.B.
EDITOR
ANNE BESHARAH
ASSISTANT EDITORS
LYNDA FITZPA llUCK
SANDRA LEFORT
PRODUCTION ASSIST ANT
GITA FElDMAN
CIRCULATION MANAGER
PI ERRElTE HOlTE
ADVERTISING MANAGER
GERRY KAVANAUGH
CNA EXECUTIVE DIRECTOR
HELEN K. MUSSALLEM
GRAPHIC DESIGN
ACARTGRAPHICS
EDITORIAL ADVISORS
MATHILDE BAZINET,
chairman, Health Sciences
Department, Canadore Colleae.
North Bay, Ontario.
DOROTHY MI LLER, public
relations officer. Registered
Nurses Associallon of Nova
Scotia.
JERRY MILLER. director of
communication services,
Registered Nurses Association of
British Columbia.
JEAN PASSMORE. editor,
SRNA news bulletin, Registered
Nurses Associalion of
Saskatchewan.
PETER SMITH. director of
publications. National Gallery of
Canada.
FLORIT A
VIALLE-SOUBRANNE,
consultant, professional
inspection division. Order of
Nurses ofQ'lebec.
input
"..-- )
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Between friends
...It is refreshing to see
our nursing organizations
become involved in providing
leadership in. and practical
assistance for. community
health issues and problems
("Be it resolved: the role of
the nursing association in the
prevention of child abuse" .
January 1979).
The Colorado Nurses
Association has had a drastic
decrease in membership in the
past two years. We are
looking for reasons for this as
wen as solutions to this
problem.
Our membership task
force is interested in looking
at other nursing organizations
to see what kinds of programs
they are providing for the
community and their
membership and how their
organizations are faring in this
time of decreased professional
interest.
-Judith M. Paez. R.N.,
Colorado Nurses Association.
Dem'er. Colo.
fly gals
Air stewardesses hired
between 1938 and 1958 were
required to be nurses and. for
this reason. they may wen be
readers of The Canadian
Nurse.
We would be most
appreciative of any help you
may be able to give us in
attempting to track down
these "old fly gals" so that we
can proceed with plans for a
reunion we are planning to
hold in Toronto in May.
Anyone interested should
contact: Gretchen Marsh
(Aird). 8 Skye Place. Guelph.
Ontario, N IG IM6.
-Gretchen Marsh. Guelph.
Ontario.
Curiouser and curiouser
One ofthe pictures on page 45
of the January issue ofCNJ
depicts a stuffed toy by the
name of "Curious George". 1
thought you might be
interested in knowing that the
lettering on George"s chest
has been done with a
lead-based paint.
A concerned parent who
suspected this might be the
case brought herGeorge to
our hospital for X-ray. Sure
enough. the lettering was
radio-opaque on the X-ray
film.
I feel this is a potential
hazard for the many children
who own a . 'Curious
George" .
-Brenda Price. RN. CFB
North Bay. Cornell Heights.
Ontario.
Editor's note: The
manufacturer of' 'C urious
George" mluntarily recalled
all of these stuffed toys in
mid-/978. Refunds .....ere
offered to customers and a
new toy that does not contain
any radio opaque dyes is now
on the market.
Critical care nurses
A group of concerned
Registered Nurses in the
Region of Niagara are in the
process of organizing a
Southern Ontario Critical Care
Nurses Association in
affiliation with R.N .A.O.
Anticipated target groups
include Intensive Care,
Coronary Care. and Recovery
Room Nurses.
Proposed basic objectives
are:
· continuing education
· professional
accountability
· promotion of nursing
research
. development of resource
centre.
Please direct your
comments. suggestions, and
enquiries to: Kileen O
'enden
B.Sc.N.. Reg. N.. Staff
Education Courdinator, Purt
ColburneGeneral Hospital.
260SugarloafSt.. Port
Colborne. Ontario, UK 2N7
1
Sphygmomanometer
Aneroid sphygmomanometer with an
adult armlet and a velcro closing (three
year warranty) blue or grey colour
Stethoscope
Single or double head stethoscope
(Littman type) silver, red, blue, green,
gold and grey colour.
Dressing scissors
Stainless steel dressing scissors (Lister
type) .
To obtain our apparatus, please sene
your cheque or money order to:
A.B.C. Medical Instruments Inc.
2200 Le Corbusier Blvd. suite 100.
Chomedey. Laval H7S 2C9
Tel.: (514) 687-4050
Price list:
Grey Sphygmomanometer
Slue Sphygmomanometer
Single head stethoscope
Double head stethoscope
Dressing scissors
29.30
33.70
6.60
9.75
3.50
do not forget to include the Provincial sales tax
For the C.O.D. orders.
All orders under $20.00 add $1.35
All C.O.D. orders over $20.00 add $2.25
All our A.S.C. diagnostic apparatus are madE
of first quality materials and carry an uncon-
ditional warranty against all fabrication
defaults
.
weight-conscious patients often give up
the good taste of butter for a less palatable
spread in the belief they are cutting calories. . .
,
they are not aware that margarine has exactly
the same caloric density as butter?
MARGARINE
kca1: 36
kilocalories
per 5 grams
BUTTER
kca1: 36
Butter, consumed in moderation,
is an appropriate food for patients on
reducing diets.
When you look at the facts
you can see the good in butter.
DaIry Bureau of Canada.
input
Nutrition for nurses
...especially enjoyed the
details Dr. Schaeffer's article
on nutritional advantages of
the traditional native diet
(October, 1978).
I would be most
interested in seeing more
articles on nutrition - with
emphasis on the nurse's role
in re-educating first herself
and second the community on
the importance of reducing
refined and processed and
other "junk foods" in the diet.
Thank you for your
stimulating articles.
-Rosemary Paige Plummer,
R.N., TelegraphCreek,B.C.
ANF Scholar
Word has recently been
received that Dr. Muriel
Uprichard has been named an
American Nurses Foundation
Scholar in recognition of her
contribution to research in
nursing.
Friends in nursing will be
genuinely pleased that Dr.
The Cenadlen Nur..
Uprichard's ability to develop
and promote a high standard
of nursing education ha<; been
recognized in thìs manner.
Dr. U prichard was
Director, School of Nursing,
University of British
Columbia from 1912 to 1977.
-Margaret MacLachlan. Life
Member, New Brunswick
Association of Registered
Nurses.
One more revolution
...1 must point out that
Avogadro's Number ("SI for
you and me", February 1979)
is incorrectly quoted as
6.0252 3 which, in scientific
notation, is 8.690 X 10". The
correct number is actually
6.025 X IOl.l. I hope that
neither number is
representative of the turns
A vogadro has made in his
grave.
-BrianJ. Shaheen, R.T.
(CSLT)B.Sc., Halifax, N.S.
Editor's note: Webster's Third
I nternational Dictionary begs
to differ and cites A \'ogadro' s
number as 6.023 X 10 23 .
UWO Scholarship
The Senate Scholarship
Committee of the Faculty of
Nursing of the University of
Western Ontario has
approved an award in memory
of Donna Cairns Wright, a
recent graduate of the faculty
of nursing of that university.
Donna gr.iduated from
the Diploma Program in
Nursing at St. Joseph's
School of Nursing, Hotel Dieu
Hospital in Kingston and
following graduation practiced
as a general staff nurse at the
Hotel Dieu Hospital and at St.
Mary's Hospital in that area.
Following her general
staff nurse experience. she
enrolled in the BN program
offered by Dalhousie
University in 1973. She
enrolled in the BScN Program
for Registered Nurses offered
by the University of Western
Ontario in September. 1974.
At the time of her death, she
was a staff member of the
Department of Nursing,
University Hospital, London.
The student must
demonstrate the attributes of
Aprl11979 9
caring, excelle:lce and
commitment to nursing. The
value of the award is up to
$450. Further information
regó.rding the award can be
obtained from the Faculty of
Nursing; donations to the
endowment fund can be
forwarded to the University of
Western Ontario.
-Edna L. Oudot, associate
professor. coordinator. BScN
program, Faculty of Nursing,
U nÏl'ersity of Western
Ontario, London, Ontario.
Northern news
A thousand cheers for
Vah
rie Walker. R.N. at Black
Lake (Input, January). I used
to live and work on that
reserve long before Valerie
came, and all she said is true.
People who have never
lived and worked up North
have no right to criticize
Northern nurses as they don't
know what they have to put
up with.
-Dorothea LeCain, R.N.,
Saskatoon, Sask.
SPHYGMOMANOMETERS
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wlugttt binaural., ha. bolh \ 'j
diaphragm and bell with non- ..
chili rlna- Choo.. Blle1l. Red. \1' I
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SIN OLE-HEAD TYPE Aa aboye \ .
but w1111Q1J1 bell Sam.larg. \i
(lIaphfagmfoftllgh.anaUlvllï No 5078A'14.'5.a. 'L'
ECONOMY IIODEL STETHOSCOPES. Similar to aboy. ,
bu1 no, TYCOS brand. Same 2 y..r guarani.. Complele
Sli
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I::r:80m.
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P.
Dual-HMCf No. 11D'17.a..
LISTER BANDAOE SCISSORI
Manufactured oilinesl .1..1. A
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No Sfi, 4
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No 700 5'h"
NO. 702: 7-..
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FORCEPS IK.uy)
Id..1 lor clamping
olf lubing. etc.
Doz.n. 01 1.1..5
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locking type 5YJ:.
long
P420 .'r.lgh1......
POC22 CUI'"Yed SC.II
MERCURY TYPE. The ulllm.te In
accuracy FOlde Inlo IIghl bul rugged
mel.1 case He. y )'
duty Vetero cull and
mflallon syslem
MII..5 aach.
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ANEROID T"YPE
Rugged and dep.nð.ble 10
year guarant.. 01 accurac)' to
3 m m No Slop-pm 10 hide
.rrors H.ndsome zipp.red case
to ,,' wour pockel
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GOld plated, hold. yoUI' cap
1r slllp.llrmly In placa Non-
twi.lle.lura No 301 RN'
with Ceduceus or No 304
plain Caduceus 13.'5/ pro
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[:j r .1.
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:;:.ln
companmenlS lor pens.
eci..ors. MC . plus changa
pockel and key chain
\. Whil. call Plaalatude
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11'5"ch.
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MEASliRINO TAPE .
In alrong p1astrc caee ..>
Pu.h bullon lor aprin .
r.1urn M.dll 01 durab
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IIn.n M...ure. to 7e.
on on. .'de 200 em on ,
raverse .....5-.ct\.
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NOTE: WE SERVICE AND
STOCK SPARE PARTI FOR
ALl. ITEMS
CAP STRIPES
S.II-.dh.sl.... type r.mOyabl. and
r.uaeble No 522 RED No 520 BLACK
No 521 BLUE. No. 523 GREY AU 15
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Le;
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<<'oC.) 12 .Iripes per carø
.s- ENAMELLED PINS.
V a......tdully de"çn.ø to 8how
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J.w.lry Qualily In 1'I..
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NliRSES EARRINOS. For pierced No. 503 Nun.'. Ald.
..rs Dalnly CadUC....1I In gold plat. All ... 5. ..ch.
with gold ruled poete. Beauillully
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gl" box" No 325. I1Utl.,.
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MEMO-TIllER Time 1"101 p.Cks, hNt
lamp.. pat1l. m.'.r. Rem.mber 10
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made '13 a ..ell. .
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No 308A Ae abow. bulln pla.tlc pouc:h 151..5...
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ENGRAVED NAME-PINS IN {I SMART STYLES - SIX DIFFERENT COLOURS...
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PLEAIE PRINT TYPE :
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fNA::CI( IA
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; Pric. Amount:
NURSES PENlIOHT..Pow.rlul beam lor examination 01
Ihroat .IC Duraþl. .1.lnla'.-III..1 caee wlll'I pod::el
clip Mad. In USA No. 28 a... complete willi
belt
.s. Econom)' mod.' wlll'l c....romed bra.. ç...
No 2Q .2....
NURSES WHITE CAP CLIPS Mede In Canada lor
Canedi..n nur... Stro
51..1 bobby pins wilh nylon
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blood pr'ssur.. elc. Dne..hlind opera,lon Mleclt
bleck, þlu. Or green No 32 12 21 ..Ch.
SOLID PLEXIGLASS.hMolded Irom eOIt' PI..lgl..
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ADD 50c HANDLI
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.2" ...... IF LESS THAN $10
COD ORDER ADO $2 ()()
13.11 .. .. NO COO ORDERS FOR NAME.PINS
TOTAL ENCLOSED
"0 CHECUE CASH
.... 16.11 ASI( A_OUT 001': OfNEI':OUS OUANTITY orscOUNTS FOR
14.71 17." CLASS GIFTS, OfiOUP PUACHASfS, FUNP IIAISINO ETC
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MtTAl FRAIIEÐ...S'mll.r to .bow.but mounted in
polt.hed m.tellram. wlll'l rounded edg.. and
corn.r. EngraYed In..11 c.n be ch..nged or
r.plac.d Our .man.s, and n..t..t d..lgn
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USE A SePARATe S....EET OF PAPEFI. IF" NECESSAFI....
10 Aprt11979
Th. C.nedlen Nur..
Here's How
Every nurse has practical ideas gathered from
his or her experience on how to make life a
little easier for nurses and for.patients. Here's
How is a column for you and your ideas. If
you have an original and practical suggestion
that you think might help other nurses to
improve any aspect of patient care, why not
share it with other nurses? We'll send you
$10. for any suggestion published. Let's hear
from you. Write: The Canadian Nurse, 50 The
Driveway. Ottawa. Ontario, K2P IE2.
Put on a happy face!
At theChildren's Hospital of Eastern
Ontario in Ottawa the I. V. team tries to
take the "sting" out of blood-taking by
putting "happy face" bandages on the
site of the puncture.
The nurses on the team use their
spare minutes to draw the faces on both
the round and long bandages in red or
blue ink. The child is given a choice of
color and is thereby immediately
distracted from the unpleasantness ofthe
blood-taking experience.
-Carole Fraser, R.N.,I.V. Team,
Children's Hospital of Eastern Ontario,
Ottawa, Ontario.
Emergency Pockets
For easy intubation during an
emergency. we have the laundry make
up a cloth with pockets of various sizes.
We label each pocket with the name of
the object to be placed inside. The cloth
rolls up conveniently and fits in the
arrest cart. During a respiratory
emergency, it can be unrolled quickly
and placed at the patient's head. and the
doctor can find his equipment quickly
and easily.
-Patricia MacFarlane, HeadNurse,
Coronary Care Unit, Ottawa Civic
Hospital.
Postop constipation
For patients who are constipated
postoperatively and on a full liquid diet,
here's a solution that really works. Give
the patient a glass of prune juice followed
by tea or coffee every morning. Your
patient will have good results without
medication.
- Marie B. Turcotte, S an Francisco,
California.
Nipple, Medicine Dropper, or Spoon
The following describes a procedure
used at the Sainte-Justine Hospital in
Montreal for children with uncorrected
cleft lip and/or palate.
The use of an ordinary, moderately
soft. rubber nipple is recommended for
feeding. It is sometimes necessary to
pierce the nipple by making two
well-defined cuts in the shape of a cross
( + ) at the level of the opening to
facilitate sucking and swallowing. It
should be noted that children with cleft
lip and palate learn to drink in spite of
their problem, that, not knowing
anything else, they adapt normally to the
situation.
Cleft lip is corrected at the age of
three months. When the child returns
home, we advise that medicine dropper
or spoon be used for feeding for about
one month. No nipple of any kind may be
used during this period. Parents receive
an information booklet as a guide for
home care before an<.! after the
operation. Further information may be
obtained from the Sainte-Justine
Hospital cleft palate clinic, Montreal.
-Hélène Delorme, Instructor, Nursing
Care, Hôpital Sainte-Justine, Montréal,
Québec.
Emergency Teaching
In the emergency department where I
work, we use printed sheets on various
subjects - for example, cast care, suture
care, crutch walking etc. - as a
supplement to our patient teaching.
So often, the patient in emergency is
under a great deal of stress in a busy
environment. and may only remember a
small portion of what the nurse explains
to him. The instruction sheet offers the
patient a tangible reference when he is
discharged from the department.
-Maureen Morrice, R.N., Winnipeg,
Manitoba.
A uthor Corinne Sklar is on
holidays. You and the Law
will return in May.
5 anty) *
Collagenase ointment
Description: Collagenase IS an enzymatic debndlng agent
derived from the fermentation 01 C1ostnOlum hlstolytlcum "
possesses the unique ability to digest native collagen as well
as denatured collagen
Action: Smce collagen accounts for 75 c 'O of the dry weight of
skin tissue. the ability of Collagenase to digest collagen In
the physIOlogical pH range and temperature makes It particu-
larly effective In the removal of detritus Collagenase thus
contributes toward the formation of granulation tissue and
subsequent epithelization of dermal ulcers and severely
burned areas
Indications: Santyl Ointment IS indicated for debndlng
dermal ulcers and severely burned areas
Contraindication.: Application IS contraindicated In
patients who have shown local or systemic hypersensitivity
to Collagenase
Precautlona: The enzyme's optimal pH range IS 7 t08 Lower
pH conditions have a definite adverse effect on the enzyme s
acllvlty. and appropriate precautions should be taken
The enzymatic activity IS also adversely affected by deter-
gents and hexachlorophene and heavy metal Ions such as
mercury and sliver which are used In some antiseptics When
It IS suspected such matenals have been used. the site should
be carefully cleansed by repeated washings with normal
saline before Santyl Ointment IS applied Soaks containing
metal Ions or aCidic solutions such as Burow s solution
should be avoided because of the metal Ion and low pH
Cleansing matenals such as hydrogen peroxide or Dakin s
solution do not Interfere with the actIVIty of the enzyme
Deblhtated patients should be closely monitored for
systemic bactenal infectIOns because of the theoretical pos-
Sibility that debndlng enzymes may Increase the nsk of
bacteremia
The Ointment should be confined to the area of the lesion In
order to avoid the nsk of Irritation or maceration of normal
skin
A slight E:rythema has been noted occasionally In the sur-
rounding tissue particularly when the enzyme ointment was
not confined to the lesion ThiS can be readily controlled by
protecting the healthy skm with a matenal such as lassar s
paste '"
Smce the enzyme IS a protein. senSitization may develop with
prolonged use although none has been observed to date
Adverse Reaction.: Adverse reactions to Collagenase have
not been noted when used as directed
Do....ge I: Administration: Santyl Ointment should b..!
applied once dally (or once every other day In the case of
outpatients) In the following manner
(1) Pnorto application the lesions should be gently cleansed
with a gauze pad saturated In normal saline. buffer (pH 70-
7 5) or hydrogen peroxide to remove any film and digested
matenal
(2) Whenever Infection IS present. as eVidenced by positive
cultures. pus inflammation or odor. It IS desirable to use
an appropriate topical antibacterial agent Neomycln-
Bacitracin-Polymyxin B (Neosponn) has been foundcompat-
Ible with Santyl Ointment This antlbloltc should be applied to
the lesion In powder form or solution prior to the apphcatlon
of Santyl ointment Should the infection not respond.
therapy with Santyl ointment should be discontinued until
remiSSion of the Infechon.
(3) Santyl Ointment should be applied (using a wooden or
plastic tongue depressor or spatula) directly to deep
wounds. or. when dealing with shallow wounds. to a stenle
gauze pad which IS then applied to the wound The wound IS
covered with sten'e gauze pad and secured with clear tape or
Kling bandage
(4) Crosshatching thIck eschar wIth a #10 blade " helpful
It IS also desirable to remove as much loosened detntus as
can be done readily with forceps and SCissors
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12 April 19711
The C.nadlen Nur..
news
Orthopedic nurses set
three-day attendance record
Close to 600 nurses and allied
health professionals met in
Toronto in early February to
attend the second Annual
Conference of the Canadian
Orthopedic Nurses
Association. For three days,
the nurses. who came from all
across Canada - from British
Columbia to Newfoundland-
heard an impressive list of
speakers discuss the most
recent advances in orthopedic
surgery, medicine and nursing
care.
A platform of more than
20 speakers, described by one
participant as the "Who's
Who" of orthopedic surgery
in Canada, discussed a wide
variety of topics including:
. hand and wrist surgery
. management of open
fractures
. bone tumors
. thrombo-embolic
complications
. routes of infection in the
OR
. Dwyer and Harrington
instrumentation
. Wagner resurfacing
procedure of the hip joint
. new techniques in
radiology
. the future and
bioengineering.
Physicians speaking to the
group related their areas of
expertise to nursing,
emphasizmg points of
particular importance to
nursing Cé\re.
The nurses who
addressed the audience
included: Susan Gilmore, staff
nurse in the pediatric unit,
Princess Margaret Hospital,
Toronto, who talked about the
nurse's response to cancer;
Ann Campbell, Inservice
Education Supervisor at the
Ontario Crippled Children's
Centre, Toronto, who
presented a lively film about
the role of the nurse in
pediatric rehabilitation:
Sandra Matthews, currently
on the faculty of George
Brown College in Toronto,
who updated and reviewed the
anatomy and physiology of
bone: and Phyllis Jones of the
Faculty of NUT sing,
University of Toronto who
discussed a research project
on nursing diagnosis.
Also enthusiastically
received by the audience was
a discussion on the nurse and
the law by Alan J. Lenczner, a
practicing lawyer with the
College of Nurses of Ontario.
The meeting provided
many opportunities for the
audience to ask questions
following each address: Time
was also allowed for nurses to
study the over 20 exhibitors'
booths displaying the latest in
orthopedic equipment and
other related products.
CONA
Injust five years, the
Canadian Orthopedic Nurses
Association has grown from a
small interest group into a
national association with 478
members and five charter
chapters located in Montreal,
Ottawa, Toronto,
Peterborough and Hamilton.
And it's still growing.
The emphasis of the
Association is on establishing
a vehicle for continuing
education in order to promote
the highest standards of
practice in orthopedic
nursing. The annual meeting is
one avenue for keeping nurses
informed about the most
recent developments in
orthopedic nursing. Norma
Haire, CONA president and
head nurse in the OR at the
Orthopedic and Arthritic
Hospital in Toronto, states,
"the Association is doing
things that will be of value to
nurses working in the field."
Members of the board of
directors of the Canadian
Orthopedic Nurses
Association are: (back, left to
right), Heather Reuber,
chairperson of continuing
education, St. Michael's
Hospital, Toronto; Valerie
Dubrovskis, S unnybrook
Medical Centre; Joan
(}Sborne,secretary,
Orthopedic and Arthritic
Hospital. Toronto; Laurel
Wallace, vice-president,
Toronto General Hospital;
Barbara Burnett, chairperson
Within the past year,
CONA has established a
continuing education
committee dedicated to
providing nurses with a library
of clinical resource material to
help solve orthopedic
problems they may be
experiencing in their center. A
library of teaching aids such
as films, slides etc. will soon
be available to nurses and
hospitals as learning tools.
To keep members
informed of advances in the
field and to give members a
voice, the association has a
new officialjournal- the
CONAjournal- to be
published four times a year. In
addition, continuing education
meetings are held by chapters
approximately 10 times a
year.
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of bylaws committee,
Orthopedic and Arthritic
Hospital. Toronto; Marion
Marshall, chairperson in
charge of membership; (front,
left to right) Rosanna Norden,
treasurer, Toronto General
Hospital; Norma Haire,
president, Orthopedic and
Arthritic Hospital. Toronto;
Kathryn Hancock, Toronto
General Hospital. Toronto;
Cberyl McCulloch, editor of
CONAjournal, St. Michael's
Hospital, Toronto.
Two members of the
association were honored at
the conference as Orthopedic
Nurses of the Year. The
awards, sponsored by Dillon
manufacturing, went to Joan
Jones, St. Joseph's Hospital in
Peterborough and to Janice
McAdam, Royal Victoria
Hospital in Montreal, both of
whom were instrumental in
the development of chapters
in their area.
Membership in CONA is
open to all nursing personnel
and other health professionals
interested in the field of
orthopedics. Anyone
interested in becoming a
member or in organizing a
local chapter can contact: The
Canadian Orthopedic Nurses
Association, 43 Wellesley St.
East, Toronto. Ontario.
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14 AprI11979
The C....dl.n Nur..
news
Occupational health centre told the Commission of Dr. Mussallem said that
holds inaugural meeting Inquiry on Educational Leave the very nature of the
and Productivity in a brief profession and the continuing
presented in early February. need for nurses to keep
"Industrial accidents in the collaboration of industry, Executive director, abreast of new and changing
Canada total almost 4,000 a business,labor and the Helen K. Mussallem, said that knowledge demands that the
day and range from abrasions provincial and territorial the association places great Canadian Nurses Association
to amputations," says J .H. governments. " emphasis on the promotion of strongly support the need for
Currie, chairman of the The Centre has the education programs required systems of paid leave for
Council of Governors, objective of promoting the to achieve high standards of educational purposes.
Canadian Centre for physical and mental practice and the promotion of CNF receives
Occupational Health and weIl-being of Canadians at high quality nursing care for
Safety. He adds that 40 to 45 work by providing a national the people of Canada. Kellogg grant
per cent of work-connected focus for information and data "There are problems
accidents are serious enough coIlection on all matters within the present practices of The Canadian Nurses
to require time off and affecting health and safety paid or unpaid educational Foundation is among eight
anything that gives rise to a in the workplace. leave: changes and Canadian associations in the
claim for compensation Boudreau said that the improvements are needed in areas of health and education
suggests that there is Centre will have the the continuing education awarded grants by the W.K.
something wrong in the responsibility of exposing an programs already in existence KeIlogg Foundation of Battle
workplace. unhealthy or unsafe work and there is need for more and Creek, Michigan, for lectures
The inaugural meeting of environment and it will varied systems," she or other presentations dealing
the Governors of the Centre, encourage federal, provincial commented. with critical problems in
an autonomous corporation and territorial jurisdictions to Dr: Mussallem said that it modem society.
reporting to Parliament use appropriate suasions and has become increasingly Titled the W.K. KeIlogg
through Labour Minister sanctions for the difficult for nurses, Foundation 50th Anniversary
Martin O'ConneIl, was held in establishment of high particularly general duty Lectureships, the
Ottawa in February. A grant standards of occupational nurses, to receive paid or presentations will be made at
of $385,000 was voted by safety and hygiene. unpaid leave of absence. The the associations' annual
Parliament to launch the A representative on the majority of nurses work at the conferences or other
Centre; the location and Employers' Associations bedside and are on rotating important sessions during
president will be announced section of the Council of shifts. 1979 and 1980.
later this Spring (Ottawa, Governors is Margaret R. The CN A believes that all AIl of the lectures will
Winnipeg or Toronto have Charters, Assistant nurses should have the consider contemporary ways
been proposed). Administrator, Nursing and opportunity of participating in of applying existing
The chairman said that Patient Care Services, programs of continuing knowledge to current or
more man days are lost to Hamilton Genenil Hospital, education and it recognizes emerging problems - a theme
Canadian industry because of Hamilton, Ontario. Huguette the need for developing reflected in the KeIlogg
accidents than through strikes LabeIle, Assistant Deputy systems of leave for Foundation's half century of
and lockouts. He estimated Minister, Corporate Policy, educational purposes which support for pilot projects
that the cost to industry is $1 Department of Indian Affairs will meet the requirements of which focus on the application
biIlion a year. and Northern Development nurses. of knowledge to the problems
Emile Boudreau, member and a former president of the Eight specific of people.
of the Council and Canadian
urses Association, recommendations with Other Canadian
representing workers' is among federal respect to public policy or associations which will
organizations, said that representatives on the policies that might be adopted receive lectureship grants
Canada is the 29th or 30th Council. by labor and management as (valued at $2,500 each)
country to establish aCentre. may seem appropriate, were include the Association of
He sees this as an advantage Nurses want more presented to the Commission. Canadian Community
in that Canada can benefit education programs Recommendations made Colleges, Association of
from the experience of other by the association include Canadian Medical Schools,
countries. "We have a long and paid leave to attend asking employers to budget to Association of U ni versities
way to go to catch up. An Act provide for paid educational and CoIleges of Canada,
of Parliament isn't enough: a The prime purpose of leave; educational programs Canadian Hospital
Centre like this is not created educational leave for that consider the needs of Association, Canadian
by law, rather the people of continuing education is to nurses and reintroduction by Medical Association,
Canada must want it and its assist the nurse in improving Labour Canada of financial Canadian Public Health
findings must be made care and service to clients, assistance programs to post Association, and the
available to the community. representatives of the secondary colleges and International Council on
The Centre is the product of Canadian Nurses Association institutions. Adult Education.
The C.ned... Nur..
AprIIII71 15
news
RNABC sets up
nursing education and
research society
The Registered Nurses
Association of British
Columbia is establishing a
non-profit society whose
prime objective wiJl be to
promote nursing education
and research in that province.
To be known as the
Registered Nurses
Foundation of BC, the new
society should be operational
bý mid-1979, according to
RNABC executive director,
Marilyn Cannack who notes
that the major reason for
starting the RNF is to create a
channel for more private
funding of nursing education
and research.
RNF will administer the
association's education loan
program as well as operation
of a new RNABC funding
program for development of
clinically oriented post-basic
continuing education. New
funding for these ventures
amounts to $200.000 for 1979
and the foundation will also
receive all repayments of
education loans made
previously by the association.
Health happenings
Distemper virus is considered
to be a "prime candidate" for
causing multiple sclerosis
according to a New Jersey
neurosurgeon. Dr. StuartD.
Cook told the audience
attending the recent February
meeting of the Royal College
of Physicians and Surgeons of
Canada that studies done in
the Orkney and Shetland
I slands off northern Scotland
suggest that close human
contact with dogs increases
the rate ofM S in a population.
Distemper virus (CDV) is
closely linked to measles
virus; researchers have long
theorized that measles virus
may cause MS by lying low
for a number of years before
damaging the central nervous
system. Dr. Cook suggests
that CDV or some similar
virus may also commonly
infect man with MS as a rare
complication.
Nutrition coumeling by a
qualified registered
professional dietition is now
included in the extended
health benefits available
through Ontario Blue Cross.
Eligible subscribers will now
be able upon referral of a
medical doctor to obtain
individual counsel that will
pennit them to adjust their
daily food intake to meet their
personal health requirements.
The move. according to
the president of the Ontario
Dietetic Association, is a
milestone in preventive health
care. "We belIeve provision
of nutrition counseling
services will be an important
factor in lowering escalating
costs of provincial health care
services.. .too many acute
care hospital beds are
occupied by patients with
nutritonally related diseases."
The National Indian
Brotherhood is among 50
groups to receive funds from
the Canadian Commission for
the International Year of the
Child in the first stage of its S 1
million grant program.
The Brotherhood will
undertake a $4000 fact-finding
study to establish areas of
need in Indian infant and child
care. Funds for the program
are being made available
through Health and Welfare
Canada.
Of the 400 patients who get
meningitis in Canada each
year. 25 per cent of them die
of the disease. The reason for
the high mortality rate lies in
the speed of bacterial attack
(death can occur in 48 hours).
But soon, meningitis may be a
scourge of the past thanks to
Dr. Harry Jennings and Dr.
Paul Kenny of Health and
Welfare Canada. They have
fonnulated a broad-spectrum
vaccine which protects
laboratory animals from all
strains of Neisseria
meningitidis. Testing on
humans has already begun.
Did you know...
The St. John Ambulance has
been able to assist 39
volunteers so far this year
through nursing bursaries
totalling $19,600. The majority
of these bursary recipients are
St. John Ambulance Cadets
and Crusaders who have been
motivated to enter nursing
through their volunteer work
with St. John Ambulance.
Did you know...
The Labour Relations Council
of the RNABC has authorized
the employment of a
consultant on a fee-for-service
basis to help with the
preparation of staff rotations.
Under the provincial
hospital agreement, the
Labour Relations Division is
to assist in developing
rotations when employers and
nurses disagree on staff
scheduling.
In a related development.
the RNABC Executive
Committee has approved a
step-by-step set of guidelines
to preparing 8-hour rotations.
These will be published in
conjunction with guidelines
for 12-hour rotations. which
are being written.
Students & Graduates
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16 Aprtl111711
The Cenedlen Nur..
calendar
May
Operating Room Nurses of
Greater Toronto Eleventh
Conference. To be held on
April30-May 2. 1979 at the
Skyline Hotel in Toronto.
O.R. and R.R. nurses
welcome. Contact: Doris
Calvery, Convener, Publicity
Commillee, 644 Sheppard
A
'e. East, Apt. 325,
Willowdale, Ontario,
M2K 1C1.
Alberta Association of
Registered Nurses AnnuaJ
Meeting. To be held on May
8-11'- 1979 at the CaJgary Inn,
Calgary. Alberta. Contact:
AARN, 10256 -112 St.,
Edmonton, Alberta,
T5K 1 M6.
Registered Nurses Association
of Ontario AnnuaJ Meeting to
be held at the Royal York
Hotel in Toronto on May 3-5.
1979. Contact:RNAO, 33
Price St., Toronto, Ontario,
Registered Nurses Association
of British Columbia AnnuaJ
Meeting to be held on May
9-11. 1979 in Harrison Hot
Springs. B.C. Contact:
RNABC, 2130 West 12thA
'e.,
VancOlH'er, B.C., V6K 2N3.
Saskatchewan Association of
Registered Nurses AnnuaJ
Meeting to be held on May
9-11. 1979 atthe Hotel
Saskatchewan in Regina.
Theme: Children - our
resource and our challenge.
Contact:SRNA,2066
Retallack St., Regina, Sask.
SECOND NATIONAL CONFERENCE
ON HEALTH AND THE LAW
organized by the
CANADIAN HOSPITAL ASSOCIA nON
IN CO-SPONSORSIßP WITH THE:
CANADIAN BAR ASSOCIATION
CANADIAN LAW REFORM COMMISSION
CANADIAN MEDICAL ASSOCIATION
CANADIAN NURSES ASSOCIATION
CANADIAN PU BLiC HEALTH ASSOCIATION
To provide most up to date information. background
material and guidelines to governments. the health
care industry and professions with a view to legislative
and administrative decision making.
Consent to treatment (concerning 3rd pørties)
Medicine vs the state
Communicable diseases. immunization
Human organs and blood donations
Death and dyinR
OTT A W A, MAY 2-4, 1979
For further information write to:
SECOND NATIONAL CONFERENCE
ON HEALTH AND THE LAW
Canadian Hospital Association,
410 Laurier Avenue West,
Ottawa, Ontario K I R 7f6
Telephone: (613) 238-8005
InternationaJ Association for
Enterstomal Therapy - 11th
AnnuaJ Conference to be held
on May 8-10. 1979 at the Hotel
Vancouver. B.C. This
education program focuses on
inflammatory bowel disease.
Contact: Marie Burroughs.
R.N., E.T., 3650Edgemont
Blvd., North Vancom'er,
B.C., V7R 2P7.
MaternaJ and perinatal care
1979. To be held at Mount
Sinai Hospital. Toronto on
May 18-19. 1979. Fee: $80.
Contact: S. Roblin, M.D.,
Co-director, Obstetrical
Anaesthesia, Mount Sinai
Hospital, 600 U nh'ersity A
'e.,
Toronto.
Manitoba Association of
Registered Nurses 64th Annual
Meeting to be held May 24-26.
1979 at the University of
Brandon. Brandon, Man.
Theme: Consumer's rights-
nurses' responsibilities.
Contact: MARN, 647
BroadwavAve., Winnipeg,
Manitoba,R3C OX2.
The 1979 NationaJ ProvinciaJ
Education Conference of the
Canadian Institute of Public
Health Inspectors to be held
on May 27 to June I. 1979 at
the Banff Centre, Banff.
Alberta. A short course on
epidemiology will be given.
Public health and
occupational health nurses
invited. Contact: Kenn Blom,
Conference Chairman, Box
1000, Coaldale, Alberta.
June
Canadian Association of
Neurological NeurosurgicaJ
Nurses AnnuaJ Meeting to be
held on June 13-15. 1979atthe
Chateau Halifax. Halifax,
N.S. Contact: Juliana
Pleines, 1005 - 3601 Sainte
Famille, Montreal, P.Q.,
H2X 2L6.
Canadian Public HeaJth
Association's 1979 AnnuaJ
Meeting to be held in
Winnipeg. Manitoba on June
18-22, 1979. Theme: Public
Health in Canada 1909-1979.
Those interested in presenting
papers at the meeting are
asked to submit an abstract
before January 31. 1979.
Contact: Canadian Public
Health Association, 1335
Carling A
'e., Suite 210,
Ollawa, Ontario, K IZ 8N8.
1979 InternationaJ Childbirth
Education Association
Canadian Conference. "Rights
of parents and children
exploring alternatives". To be
held on June 28-30, 1979 at the
Harbor Castle Hilton in
Toronto. Contact: Childbirth
Education Association, 33
Price St., Toronto, Ontario,
M4W 1Z2. ,
Association for the Care of
Children in Hospital 14th
AnnuaJ Conference. "Caring
for children in the health
world". To be held in Los
Angeles, C al. in June 4-7.
1979. Contact: 1979 ACCH
Conference Office, Wright
Institute Los Angeles, 1100
South Robertson Bh'd., Los
Angeles, Cal., 90035.
70th Annual Meeting of the
Registered Nurses Association
of Nova Scotia to be held June
6-8, 1979 in Bridgewater, N .S.
Theme: The nursing
profession -Its influence on
health in Nova Scotia.
Contact:RNANS, 6035
Coburg Rd., Halifax, N.S..
B3H IY8.
The Canadian Dietetic
Association "Conference 79"
to be held at the Metro
Centre, HaJifax, Nova Scotia
on June 24-28,1979. Contact:
Elizabeth Lambie, Associate
Professor, Faculty of Health
Professions, Dalhousie
University, Halifax, N.S.
(continued on pøge 481
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16 Aprtlll11i
The CBnedlen Nur..
calendar
May
Operating Room Nurses of
Greater Toronto Eleventh
Conference. To be held on
April30-May 2, 1979 at the
Skyline Hotel in Toronto.
O.R. and R.R. nurses
welcome. Contact: Doris
Calve,...,', Convener, Publicity
Committee, 644 Sheppard
A
'e. East, Apt. 325,
Wi/lowdale, Ontario,
M2K ICI.
Alberta Association of
Registered Nurses Annual
Meeting. To be held on May
8-11.' 1979 at the Calgary Inn,
Calgary, Alberta. Contact:
AARN, /0256 -ll2 St.,
Edmonton, Alberta,
T5K I M6.
Registered Nurses Association
of Ontario Annual Meeting to
be held at the Royal York
Hotel in Toronto on May 3-5,
1979. Contact:RNAO, 33
Price St., Toronto, Ontario,
Registered Nurses Association
of British Columbia AnnuaJ
Meeting to be held on May
9-11, 1979 in Harrison Hot
Springs, B.C. Contact:
RNABC, 2/30 West J2thA
'e.,
Vancou
'er, B.C., V6K 2N3.
Saskatchewan Association of
Registered Nurses AnnuaJ
Meeting to be held on May
9-11, 1979 at the Hotel
Saskatchewan in Regina.
Theme: Children - our
resource and our challenge.
Contact: SRNA , 2066
Retallack St., Regina, Sask.
SECOND NATIONAL CONFERENCE
ON HEALTH AND THE LAW
organized by the
CANADIAN HOSPITAL ASSOClA nON
IN CO-SPONSORSIDP WITH THF.
CANADIAN BAR ASSOClAT
CANADIAN LAW REFORM (
CANADIAN MEDICA L ASSC
CANADIAN NURSESASSCX:
CANADIAN PUBLIC HEALT
International Association for
Enterstomal Therapy-11th
AnnuaJ Conference to be held
on May 8-10, 1979 at the Hotel
Vancouver, B.C. This
education program focuses on
inflammatory bowel disease.
Contact: Marie Burroughs,
R.N., E.T., 3650Edgemont
B/I'd., .'Vorth Vancoul'er,
B.C., V7R 2P7.
MaternaJ and perinatal care
1979. To be held at Mount
Sinai Hospital, Toronto on
May 18-19, 1979. Fee: $80.
Contact: S. Roblin, M.D.,
Co-director, Obstetrical
Anaesthesia, Mount Sinai
Hospital, 6()() Unil'ersitl' A I'e.,
T oroll1o.
Manitoba Association of
Registered Nurses 64th Annual
Meeting to be held May 24-26,
1979 at the University of
Brandon. Brandon. Man.
Theme: Consumer's rights-
nurses' responsibilities.
Contact: MARN, 647
BroadwayA
'e.. Winnipeg,
Manitoba, R3C OX2.
Canadian Public Health
Association's 1979 Annual
Meeting to be held in
Winnipeg. Manitoba on June
18-22, 1979. Theme: Public
Health in Canada 1909-1979.
Those interested in presenting
papers at the meeting are
asked to submit an abstract
beforeJanuary 31. 1979.
Contact: Canadian Public
Health Association, /335
CarlingAve., Suite 2/0,
Ottawa, Ontario, KIZ 8N8.
19791nternationaJ Childbirth
Education Association
Canadian Conference. "Rights
of parents and children
exploring alternatives". To be
held on June 28-30. 1979 at the
Harbor Castle Hilton in
Toronto. Contact: Childbirth
Education Association, 33
Price St., Toronto, Ontario,
M4W IZ2. .
Association for the Care of
Children in HospitaJ 14th
Annual Conference. "Caring
for children in the health
world". To be held in Los
AnJ!e1es. Cat. in June 4-7
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Jannette Moens
Diabetes insipidus
This relatively rare condition is caused
primarily by an interruption of the work
of the hormones of the neurohypophysis
the posterior lobe of the pituitary gland.
This gland is made up of many nerve
fibers whose cell bodies are located in
the hypothalamus directly above.
Normally, when blood sodium
levels rise. the hypothalamus gets the
message and in turn sends nerve
impulses to the neurohypophysis to
stimulate the production of antidiuretic
hormone (ADH), or vasopressin. ADH
increases the permeability of the distal
convoluted tubule of the kidney,
permitting greater reabsorption of water
from the tubule into the bloodstream.
This is how the concentration of sodium
in the blood is reduced to normal levels
while the concentration of urine is
increased.
Diabetes insipidus can be caused by
any interference in this chain of events.
There are two types ofthe disease:
. central diabetes insipidus-
resulting from abnormality or injury in
the region of the pituitary gland or the
hypothalamus and caused by tumor,
inflammation from basilar meningitis. or
head injuries; or
. nephrogenic diabetes insipidus -
having its origin in the kidney itself,
where for some reason the renal tubules
are not responsive to ADH and therefore
do not reabsorb water as they should.
For Tara and her parents, a
frustrating time had begun. Tara voided
vast quantities, wetting the bed several
times every night. Trying to limit her
fluid intake in order to control
bed wetting was impossible, because she
suffered from a constant and insatiable
thirst. She would fill a quart canning jar
three-quarters full of water and
announce "I'll bet I can empty this
without stopping".
Before the wondering eyes of a
half-circle of brothers and sisters, Tara
would raise the jar, tip back her head,
and the water would seem to flow
straight down without a swallow. Then
she would put down the glass and say
. 'There's nothing better than water-I
just love it" Well, anyone could see
that.
And of course, all that went in came
out in great volumes of pale urine. Tara
was always scissor-stepping her way to
I
the bathroom in a great hurry. and at
night she wet the bed several times. Her
behavior won her the ingloriou'i title of
"Pee-er" among her siblings.
Symptoms
In diabetes insipidus. lack of ADH at the
site of reabsorption in the kidney tubules
means that water concentration in the
urine is high. Instead of being absorbed
back into the blood stream. it is passed
on for excretion. This means loss of
excessive amounts of dilute urine - as
many as 15 to :!9litres every day.
Polydipsia and other symptoms of
dehydration occur as a result of this
water loss. The patient loses weight.
energy and appetite, and constipation
becomes a problem.
Tara was admitted to hospital for
investigation of possible diabetes
insipidus. In hospital her intake and
output was monitored as closely as
possible. This proved difficult for her
nurses, for after every little nap, Tara
came toddling up to one of them with the
same confession - "I'm wet again".
Urinalysis revealed a specific gravity of
1.001, and Tara was severely anorexic.
When Tara was given an injection of
Pitressin*, her symptoms decreased,
while the specific gravity of her urine
reached 1.010 and 1.016. The following
week, when she didn't receive the
injection. her symptoms began once
more. This pattern led to a tentative
diagnosis of diabetes insipidus. Her
doctor felt that more comprehensive
studies could be done to confirm this
diagnosis at a later date.
Tara was terrified of injections, and
for this reason her doctor ordered a nasal
spray of aqueous pituitary extract for the
treatment of her syptoms. The spray had
the same results; Tara's intake and
output was still above normal. but it was
significantly reduced.
When she was discharged, Tara was
given the nasal spray to be her constant
companion. She was required to sniff the
medication every hour, which eventually
made her nose sore, and put a burden on
her mother from the start. Both her
parents found it hard to accept Tara's
diagnosis - it had such long-term
implications. Explanations of the
condition and its treatment were very
important to them. After some months,
Tara was admitted to a larger center for
further testing under the care of a
specialist.
.
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l'ara'
dial!no
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/\ diagno...i'i of diahete... in...ipldu'i ma} he
made in \ie\, ofth
patient''i ...ymptom...
:,nd a large urine volume \\;ith a "'peÓfic
gravity helo\\; 1.0 I 0 and osmolarity less
than that of plasma. But 'iuch a diagnosis
demands indefinite replacement therapy
and 'ihould not he made without c<lreful
elimination of other pO'isihilitie.... The
following prohlems mu
t he ruled out:
psychogenic polydipsia or hahitual water
drinking: chronic nephriti'i: diahete...
mellitu'i: alkalosis hecau'ie of low
erum
chloride levels: or high serum calcium
levels due to overactive parathyroid'i or
vitamin 0 intoxication.
P'iychogenic polydipsia is mO'it
difficult to differentiate from diahetes
insipidus. 1\10st of the other prohlem'i
listed are eliminated as possihilities
through urinalysi'i. hlood studies and
renal function tests. In diabetes
insipidus. there is no albumin in the
urine: the patient's blood urea nitrogen
level is normal and kidney function te'it'i
show normal results. For further
differentiation. one or more of the
following tests can he carried out:
· Fluid deprivation - Fluid'i are
withheld for eight to I:! hour'i and then a
urinalysi'i is carried out. Normally. and
in patients with psychogenic polydipsia.
fluid deprivation results in an increase in
the specific gravity of the urine and an
increase in urine osmolarity. In diahetes
ino;ipidus and chronic nephritis.
however. the patient is unable to
concentrate urine to any extent.
· I.M. Pitressin -I ntramuscular
Pitressin can be given in small amounts
every three to four hours. These
injections will give the patient with
diahetes insipidus and the patient with
psychogenic polydipsia relieffrom his
symptoms. Patients with chronic
nephritis will not respond to this test.
· I. V. nicotine - The function of the
neurohypophysis can also be tested.
Intravenous nicotine injections given to a
patient in a hydrated state will normally
cause a decrease in urinary output and an
increase in urine creatinine, chloride and
total ...olute concentration
. /\ patient
\\;ith full hlown di,lhete... in'iipidu... \\;ill
have no antidiuretic re...pon'ie; if the
patient ha... re...idual <lctivitv of the
neurohypophysis. he will have a slight
re"'ponse.
· HÌl'ke
- Hare tl'chniqlll.>-
Va...opre"in i... given. after \\ hich the
patient \\;ith diahete... in...ipidu... \\ ill
. ..
I 511 I
re...pond \\ ith ,llllar\..cd antidiurcric
clTect. rhen. \\ hen the \ a...opre......in ha...
returned the \,ater le\eI to normal. the
patient i... given an infu...ion ofh\ pertonic
...:lIine ...olution. The patient \\ ith diahete'i
in...ipidl.... \\ ill sho\\ no change in output.
\\ herea... the patient with p...ychogenic
pol}dip...ia (or the normal individual) \\ ill
...hlm a pronounced antidiuretic effect.
I-'\ce......ive drin\..ing i... prohihited during
this te...t. hecau'ie it \\;ould cau...e dilution
of ...:lIine in the ...y...tem.
rhe...e three procedure... help the
physici,tn differentiate het\\;een diahetes
in'iipidu'i and other conditions and al'io
help to pinpoint the cause of diahete...
in'iipidu'i - whether it originates from a
di'iturhance in the hypothalamu'i. in the
o'imoregulators. or in the renallllhuies
themselves.
It wa'i a major event for Tara to he
hrought many miles away from a
protected home to a 'itrange large
hO'ipital. The tests she had to undergo
may have heen for her henefit. hut they
were. nevertheless. a traumatic
expenence.
During the water deprivation tests.
all fluids were withheld and all taps
carefully guarded. Tara saw these
measures as a war waged upon her little
soul. Her nur'ie tried to divert her
attention and to provide some relief by
moistening her mouth. She also watched
carefully for vasomotor collapse and
recognized that Tara hecame clinically
dehydrated in no time. Her temperature
went up to 38 0 C , she was nauseated and
flushed. had severe headaches. and after
the test. the scales revealed that she had
lost about five per cent of her hody
weight.
What the test also revealed,
however. was that Tara was able to
concentrate urine to 1.027. which is quite
high for a patient with diabetes insipidus.
This indicated that Tara was able to
produce enough ADH to see her through
a short term situation if necessary. but
that it would put a considerable strain on
her system.
After the test came the moment of
release; Tara was allowed all the water
she could drink. And drink she did. while
her nurses smiled and 'ihared in her
relief. But when fluids had to be withheld
again. Tara became extremely upset and
hostile, crying "you're doing that on
purpoo;e" - to tease her. she thought.
Many patient (child-size) explanations
were necessary.
I
Life was happy for Tara.
As the sixth child in a
close-knit family of nine,
she had all the love and
companionship a little
girl could want. But
when she woke up one
May morning, there was
a lot to dampen her
spirits. For one thing, it
was raining outside, and
to make matters worse,
her bed was wet, and it
wasn't the roof that was
leaking either. The
incident was shrugged
off. After all, the salt cod
the family had enjoyed
for dinner the night
before had made
everyone thirsty, and a
five-year-old's accident
was nothing to get upset
about. But although no
one knew it at the time,
life had taken a different
twist for little Tara - she
was beginning to show
the symptoms of
diabetes insipidus.
20 April 1979
The Cenedlen Nurse
Tara responded to the tests in the
classic manner of the patient with
diabetes insipidus. but showed some
evidence of ADH activity. small though
it was. An intravenous pyelogram
showed a pos"ihle ahnormality of her
urinary tract. But although her skull
X-ray was negative. Tara's diabetes
insipidus was eventually established as
central. Her EEG results were abnormal.
consistent with a midline functional
disturbance. Two years before the onset
of her symptoms, Tara had fallen from
her bicycle, landing hard enough to
fracture her clavicle and knock out two
teeth. The doctors weighed the
possibility that this accident was the
cause of the disturbance, that it could
have caused a basal skull fracture. They
felt, however, that the symptoms would
have begun sooner if this accident had
been the cause. A pneumo-
encephalogram may have provided
further clues, but the doctors were
reluctant to put Tara through an
ordeal they felt wasn't necessary at the
time. It was decided to treat Tara with
Pitressin tannate in oil injections, then
re-evaluate her at a later date.
Treatment
Treatment of diabetes insipidus involves
either the correction of the underlying
cause or maintenance of the patient's
flUid halance through medication.
Pitressin tannate in oil is the replacement
injection of choice þecause it has
prolonged hormonal action; it is usually
effective for 24 to 72 hours (in contrast
with plain Pitressin. which only lasts for
three to four hours). Nasal insufflations
or sprays are also available and are more
easily administered. hut have a tendency
to produce chronic rhinopharyngitis or
even stomach upsets due to swallowed
powder.
Pitressin tannate must he
administered properly to be efTective.
Examination of a vial of Pitressin tannate
shows the active particles settled to the
bottom; for this reason. it is most
important to shake the vial thoroughly.
Warming the vial before use can he
helpful. Because Pitressin is in an oily
hase. the patient "hould lie quietly for a
few minutes after admini"tration and be
watched for any oozing. The drug can
also cause occasional vasopressin
resi"tance. usually due to development
of an allergy to the hormone or to the oily
medium. but also caused hy low serum
potassium and high calcium level" which
inhibit the action of ADH.
Chlorthiazide has also heen u..ed to
increase water absorption but is usually
not totally effective for central diabete"
insipidus - the patient often requires
some replacement therapy, as well as
potassium supplements to compensate
for the potassium loss caused by the
medication. Hypoglycemics are
sometimes used for patients whose tests
reveal that they are capable of releasing
..mall amounts of ADH. These drugs
increase the effectiveness of the residual
hormone. They also have side effects.
such as gastrointestinal disturbances.
weakness, headache. tinnitus and
alcohol intolerance.
Tara became known as "the pincushion"
in the doctor's office. Twice weekly, she
sat waiting impatiently for her injection.
Now a year older, she was quite
accustomed to the previously dreaded
needle. She turned very pale after her
injection because of the vasoconstricting
action of P'tressin. But if anyone other
than family members asked what was
wrong, she made a point of evading the
issue. It was nobody's business that she
required a needle so that she wouldn't
have to void so much!
A t home. it was a different story.
The effectiveness of Pit res sin is
diminished under any kind of stress.
especially after emotional outbursts. If
Tara had a squab hie with one of her
sisters. all she had to do was make a fuss.
The argument had to be settled then and
there. and Tara got her way. because if
she cried too hard. her needle "wouldn't
work" .
And it didn't always work anyway.
Any carelessness in administration of the
injection - for example. if the vial
wasn't shaken properly - caused Tara
"hamefully wet nights and time lost from
"chool. There weren't many who took
kindly to Tara's advice to "shake it
better" .
Tara al"o had to learn to cope with
her symptoms when they returned a day
or two before her next injection was due.
At first, it was hard for her. She had
special permission at school to go to the
bathroom without asking. and that
caused difficult questions. It didn't help
much when a group of boys in her class
decided to hold her back one day when
the teacher wasn't around - Tara cried
to see a puddle growing at her feet.
Unlike other cla'osmates. "he
couldn't "pend the night with one of her
friends. Her sense of ..hame was
accentuated hy the fact that her parent"
insi..ted that no one know of her
condition; thi.. made it even harder for
Tara herself to accept.
G rowing up
But as she grew older. her sense of
humor took over and she viewed most
inconveniences from the light side. an
attitude that helped when she took her
fir"t trip to Furope. Tara and her sister
'otayed at the home of relatives who were
not only light sleepers but who also had
their bedroom adjacent to the bathroom.
No problem - Tara found a big old
garbage can that she faithfully spirited to
her room each evening. Her "ister got
used to waking up in the middle of the
night to a loud drumming on the bottom
of the pail. In the morning Tara would
empty her pail before anyone was up.
She didn't want to chance meeting
anyone as she crept stealthily through
the house with a large bucket of gently
sloshing urine.
Tara's most uncomfortable session,
however, came when she was admitted
to hospital for knee surgery. Because of
the stress of the operation, her Pitressin
injection had no effect and she wasn't
able to fend for herself. The nurses
looking after her had to be patient and
understanding of what it means to have
diabetes insipidus.
Later on, Tara began to develop a
resistance to the injection. It proved to
be a blessing in disguise; her doctor
finally decided to switch her from the
injection to an oral hypoglycemic agent.
This change had such good results for
Tara that today she is virtually
symptomless and leads a completely
normal life. So when she returned to
Furope to work there for a year, she
didn't need her garbage pail.
Tara displayed none of the side
effects that accompany hypoglycemic
drugs except for one - intolerance to
alcohol. At first she was unaware of it.
but she caught on quickly; even a small
glass of wine caused her face to turn
bright red. In fact. after tasting a few
drops that spilled on her fingers at the
restaurant where she worked. the boss
asked her how many drinks she had had
herself. She cautiously peered into a
mirror and there she was, glowing like a
neon sign to the tips of her ears. All
foreign languages left her at the sight.
But that is a small price to pay for
regained normalcy. And
twenty-five-year-old Tara is once again
leading a happy and normal life . ..,
Bibliography
I Berger"en. Betty S. PlllIrmacoloRY
innursinR. by... and AndresGoth. nth
ed. St. Louis. Moshy. 1976.
2 Chaffee. Fllen E. Basic physioloRV
and anatom.\'. hy ... and Esther 1\1.
Grei..heimer. )d ed. Toronto. Lippincott.
1974.
) Harrison. Tinsley Randolph ed.
Principle.l. (!f intertlal medicine. edited by
... et al. 7th ed. New York.
ML-Graw-Hill. 1974.
4 Shafer. Kathleen Newton.
M edical-surRicalnursinR. by ... et al. 6th
ed. St. Louis. Moshy. 1975.
.Pitressin is a registered trade mark of
Parke. Davis and Co.
Jannette Moens author ofC opinR with
diabetes insipidus. Rraduated from Galt
School ofNursinR in LethbridRe.
Alberta. She spent her working days in a
small hospital and later a clinic which
pro
'ided her with a \'ariety of nursinR
experiences.
Hypertension:
management in industry -
an expanded role for nurses
Barbara Milne
Alexander LORan
Hypertension
.
screening programs
have enjoyed
considerable
popularity in recent
years but detection
alone is simply not
enough to ensure
good blood pressure
control. Individuals
with high blood
pressure must be
thoroughly
evaluated, treated
and followed up to
ensure compliance
and control. Authors
Barbara Milne and
Dr. Alexander
Logan found that
nurses working in
business and
industry have a big
part to play in
helping patients
manage blood
pressure problems.
Uncontrolled hypertension is recognized
as one of the major causes of death and
disability in North Amenca. Surveys
have revealed that approximately five to
'iix per cent of the population has
hypertension, defined as a diastolic
blood preS'iure of9O mm Hg or greater
after two successive screenings. I
The present system of health care
may be effective in dealing with most
acute medical problems, but it has not
been successful in getting more than 30
per cent of the total hypertensive
population under good blood pressure
control. e In spite of the availability of
effective antihypertensive therapy. poor
blood preS'iure control continues to be a
significant community health problem.
Blood pressure screening programs
have enjoyed con'iiderable popularity in
recent years, but detection alone is not
enough to ensure good blood pressure
control. It must be followed up by
evaluation, treatment and patient
compliance. The gap between detection
and good blood pressure control is a
large one and the reasons for such a gap
are understandable.
A patient may be detected by a
screening program, but fail to seek
further medical evaluation. When
medication is prescribed, patients are
often reluctant to take it because of the
asymptomatic nature of hypertension in
its early stages. Furthermore. therapy is
sometimes accompanied by unpleasant
side effects; the patient may actually feel
worse after initiating treatment. Add to
these deterrents the inconvenience of
physician appointments. the cost of
medication and the need for life-long
treatment and follow-up and the
motivation to continue therapy rapidly
dissipates. What type of program. then.
would ensure an emphasis on blood
pressure control within the community?
Nurses have long proven effective in
major clinical responsibilities, both in
specialty areas in hospitals and in the
community. Therefore. an expanded role
for nun,es to provide long-term care to
hypertensive patients under physician
supervision in an ambulatory setting
would appear to be a reasonable
alternative. To demonstrate this idea. we
decided to study the role of the nurse in
the detection, evaluation and long-term
management of hypertension in the
business community.
The program
The objectives of the trial were to detect
untreated hypertension in the business
community, to link it to an evaluation
and treatment program and to compare
health care delivery from two sources:
. a specially trained nurse at the work
site; and
. employees' family physicians within
the community.
The comparison was to be made in terms
of clinical effectiveness and medication
compliance.
Two nurses were chosen to provide
patient care at the worksite. One had
extensive experience in cardiovascular
22 April 1979
Th. C.nedlen Nur..
nursing in an acute care setting, the other
had practiced puhlic health nur
ing in the
community. Both nurse
were
accustomed to making independent
nur'iing decision.. and had received
pecial training in physical a'i..e..sment
and hi'itory taking.
During the period from Octoher
1975 to July 1976. approximately 22.000
employees from 41 different business
'iettings in Metro Toronto were screened
hy trained blood pressure technicians. A
variety of businesses were represented,
including hoth white and blue collar
workers (e.g.. those from hanh,
government offices and factories). Those
individuab who showed an elevated
hlood pressure after two screenings and
who met our admission criteria were
invited to participate in the program with
the approval of their family doctor.
Blood pre'isure entrance criteria
were:
. a diastolic hlood pre....ure of
95
mm Hg: or
. a diastolic blood pressure of91 - 94
mm Hg plus a systolic blood pressure of
141 mm Hg.
A total of 457 individuals elected to
participate in the program and their tlow
through the various stages of the project
is shown in Figure one.
In order to exclude individuals with
potentially curahle forms of
hypertension, all members of the study
population received an investigative
work-up for hypertension where they
worked. The work-up was done by the
two nurses and included measurement of
hemoglohin. WBC. serum pota'i..ium.
serum creatinine and urinalysis. In
addition. blood 'iugars, 'ierum
cholesterol and 'ierum uric acid were
measured to assess concomitant risk
factors, and an FCG wa'i done to detect
target organ damage. The results of the
initial a'i'ie'isment were sent to each
patient's family physician.
At this point the study population
was randomly allocated into either the
community (physician-treated) or the
worksite (nurse-treated) group. All
participants in the community group
were asked to see their family physician
at least once. Follow-up appointments
for the worksite group were arranged by
the nurses who were suhsequently
responsible for their care.
The nurses, hased at Mount Sinai
Hospital. visited each work'iite once or
twice a month for one year. Their
respon'iihilities included:
. complete history using a pretested
highly structured questionnaire and
physical examination of all work'iite
group participants. This was reviewed by
the supervising physician.
. initiation and adjustment of
medication according to a Stepped Care
Protocol developed for the study (Figure
two).
. weekly conferences to review
patients' charts held at the hospital with
the supervising physician.
. measurement of blood pressure,
pulse and weight at each patient
encounter.
. management of the side effects of
medication.
. ..upervision of drug-induced
FLOW DIAGRAM FOR SELECTION OF STUDY POPULATION
Figure one
Business Community
Metropolitan Toronto
Primary Screening
Suspected Hypertensives
Secondary Screening
Hypertensive Evaluation
Not Hypertensive
Ineligible Hypertensives
biochemical changes (e.g. hypokalemia,
hyperuricemia).
. patient education about
hypertension and the treatment regimen.
. counseling in lifestyle modification
for concomitant risk factors (i.e.
"moking. obesity. dietary habits).
. supportive counseling for tho'ie
patients who responded to their
diagnosis with hostility, denial. anxiety.
or depression.
After six months in the program.
participants in both groups were
interviewed hy a trained observer at the
worksite who took a blood pressure
measurement. determined whether the
patients were on medication. and
assessed medication compliance hy
direct questioning. Those individuals
who stated that they were taking their
medications received a home visit to
confirm their compliance by pill
counting. Those taking less than RO per
cent of their medications were
considered to be non-compliant.
In spite of our fears that patients
would view this procedure as an invasion
of privacy, most accepted the home visit
and realized that a compliance check was
a necessary part of research.
Meeting the goal
For our study, goal pressure was defined
as a reduction in diastolic hlood pressure
to less than 90 mm Hg in those with an
initial diastolic pressure greater than 95
mm Hg or a reduction in diastolic blood
pressure of at least six mm Hg in those
with an initial diastolic pressure of95
mm Hg or less. What did our results
show?
At six months, significantly more
patients were at goal blood pressure in
the nurse-treated group. Similarly, the
overall mean reduction in diastolic blood
Figure two
STEPPED CARE PROTOCOL
step
one
THIAZIDE DIURETIC
step
two
(if needed)
PROPRANOLOL/METHYLDOPA
step
three
(if needed)
HYDRALAZINE
pressure was significantly greater in the
,-"orksite group.
Although mo"t patients in both
groups were considered to have a blood
pre
sure problem, patienh in the
nurse-treated group were more likely to
be placed on drug therapy than patients
in the physician-treated group.
Physicians were much more likely to u!>e
non-drug therapy !>uch as weight
reduction. salt re!>triction. cessation of
cigarette smoking. exercise, and/or
reduction in life !>tIe
"es a!> the sole mode
of treatment.
In addition, compliance ,-"ith
antihyperten"ive therapy was
significdntly better in the nur!>e-tredted
group. Thus the difference in clinical
effectl\-eness in the two groups ma} have
been due to better compliance with
medication. Another possible
explanation for the difference was that
more nurse-treated patients were on
medication. However. when only those
on drug therapv in the two group!> '-"ere
compared. the nUlse-treated group
continued to ha\-e significantly more
patients at goal blood pressure.
Comparison of the drop-out rates in the
two groups will be made at the end of the
program.
Discussion
Crucial elements in effective blood
pressure control programs are keeping
patients in treatment and ensuring
adequate compliance with
antihypertensive medications. Under
usual treatment conditions over 50 per
cent of hypertensive patient!> drop out of
therapy entirely within a year of starting
it. 'Ofthose who remain under medical
care, about 40 per cent fail to take
enough medication to achieve
therapeutic benefits. .Thus high
treatment drop-out and low compliance
with medication erode most of the
benefits of care.
Attemph to overcome the problems
are encouraging. Many investigators
have reported the use of allied heaJth
personnel to help physicians control
hypertension and reduce patient
drop-out from therapy. For example.
Wilber was able to keep significantly
more patients in treatment and improve
blood pressure control in a ruraJ setting
by the use of home follow-up by the
Public Health Nurse. s
More recently. Alderman reported
on his successful experience of using a
health team guided by a physician to
detect and treat hypertension at the
worksite. 60ther programs include using
nurses in special hypertension clinics in
both urban and rural settings 7.8 and on
mobile units." In each instance more
patients were kept under care and there
was improved blood pressure control.
Our study. in addition to providing
convenient care at the worksite, is also
The Cened... H......
evaluating the use of specific behavioral
techniques to improve compliance.
Those patients whose blood pressure
was not under control and who were
found to be non-compliant at the
six-month evaluation were started on
compliance intervention manouvers
which included:
· Linking pill-taking to "ignificant
events or routines during the day.
· Use of a home brood pressure cuff
for daily blood pressure monitoring as
instructed by the nurse.
· Recording of daily blood pres"ure
readings and pill inge
tion on special
charts.
· Increase in the frequency of visits to
the nurse for blood pres!>ure monitoring.
.a,
.1
II
If
4
-
I
Conclusions
The concept of managing hypertension at
the worksite would appear to have a
number of advantages:
· It automatically links case-finding
with follow-up care.
· There is a minimum of waiting time
and loss of employee time from work.
· The time of visits is less severely
regulated, allowing more time to
communicate with patients about their
concerns.
· Patients can be kept under close
supervision -those who miss
appointments are promptly followed up.
· The "stepped care" approach
provides for logistical increases in
medication that a nurse can initiate
without m<\Ïor medical decision-making.
In conclusion, the preliminary
results of our study suggest that specially
trained nurses under physician
supervision are clinically more effective
in terms of achieving good blood
pressure control and improving
compliance with medication. ...
AprIl tl7t 23
"'2
References
*1 Hypertension Detection and
Follow-up Program Cooperative Group.
The hyperten
ion detection and
follow-up program. Prel'.Med.
5:207-215.1976.
*2 National Heart, Lung, and Blood
Institute. National high hlood pres.Wlre
education program info. memo.
Bethesda, Md., May 197R (No. 13).
3 Caldwell, J.R. The dropout
problem in antihypertensive treatment
A pilot study of social and emotional
factors influencing a patient's abihty to
follow antihypertensive treatment. by...
et aLl. Chronic Dis. 22:579-592, Feb.
1970.
4 McKenney, J.M. The effect of
clinical pharmacy services on patient
with essential hypertension, by . . et al.
Circulation 48: 1104-1111, Nov. 1973.
5 Wilber, J.A. Reducing elevated
blood pressure. Experience found in a
community, by... andJ.S. Barrow.
Minn.Med. 52:1303-1306. Aug. 1969.
6 Alderman, M.H. Detection and
treatment of hypertension at the
worksite, by... and E.E. Schoenbaum.
N.Eng.J.Med. 293:2:65-6H. JuLIO. 1975.
*7 Hames. C. Hypertension
intervention in a bi-racial rural
community, by _ . .et al. Circulation 52:
Suppl. 2: 193. 1975.
8 Stamler, R. Adherence and
blood-pressure response to hypertension
treatment. by . . .et al. Circulation 52:
Suppl. 2:95. 1975.
9 Runyan. John W. The Memphis
chronic disease program. Comparisons
in outcome and the nurse's extended
role.l.A.M.A. 231:3:264,Jan. 20.1975.
*Not verified by CNA Library
Barbara Milne, R.N. B.Sc.N.. graduated
from the University ofT oronto School of
Nursing and has spent most ofher
career in public health nursing. She is
currently employed as a nurse
practitioner in the Hypertensi&n
Detection and Treatment Programme at
Mount Sinai Hospital in Toronto,
Ontario.
Dr. Alexander Logan, (Unil'ersity of
Toronto) is a nephrologist at Mount
Sinai Hospital as well as medical
director of (he Hypertensiun Detection
and Treatment Programme.
Acknowledgements: Wendy Campbell.
Christine Achber, Prudence Kupka.
Hypertension:
questions and answers
--
Mary McCulley
Hypertension and its control pose a worldwide health
problem. Until two years ago, when several national
and provincial health bodies - public, voluntary and
scientific - sponsored the formation and operation of
a number of hypertension task forces and study
committees, I answers to many basic questions
regarding the disease had yet to be answered.
Recognizing that any recommendations made in
answer to these questions could result in lifelong
hypertensive treatment for a million or more
Canadians, these bodies felt a grave responsibility not
to advocate any intervention, however
well-intentioned or plausible, unless it had been
proven effective in rigorous trials.
It is not surprising that these bodies, which
shared overlapping terms of reference, some common
membership and common data sources, asked many
of the same questions and, in the end, produced
identical sets of recommendations.
What follows are some of the questions that these
committees asked about hypertension; the answers
are based on recommendations cited in the
Hypertension Task Force Report of the Ontario
Council of Health. 2
I. Does the treatment of hypertension do more good than
harm?
In the case of malignant hypenension (diastolic pre
sure in
excess of 130 mm Hg and papilledema). treatment does indeed
do more good than harm. Left untreated, all malignant
hypertensives die usually within a year of detection. Iftreated,
a majority are alive one year later.
With less severe hypenension, I andomized trials show that
hypenensive patients randomly a,>signed to receive active drugs
suffered two/thirds fewer "hypenensive" complications (first
stroke, hean failure, retinal or renal deterioration) than did
control hypenensive patients who received inen placebos.
Re
ults were less clear for the" atherosclerotic complications"
such as MI.
In general. the Hypenension Task f'orce of the Ontario
Council of Health concluded that:
. Antihypenensive drug therapy should be initiated among
all adults whose fifth phase diastolic blood pressures are
consistently at or above 105 mm Hg. This finding must be
evident on two or more separate examinations by a clinician
two weeks or more apan.
. Therapy should be initiated in adults (over 18) with lower
diastolic BP (90-104 mm Hg) when evidence oftarget organ
damage is present. Target organ damage includes one or more
of the following: hypenensive retinal damage. renal damage,
dyspnea of cardiac origin on ordinary activity, angina pectoris.
prior myocardial infarction, left ventricular hypertrophy on
ECG, cardiac enlargement on chest X-ray. prior stroke or
transient ischemic attack.
2. How much uncontrolled hypertension exisls?
Data provided by the Nutrition Canada Survey. an
epidemiologic survey of Newfoundland communities and
community screening programs conducted in Edmonton.
Albena and Hamilton, Ontario show that a substantial ponion
of hypenension (averages for all ages in these surveys range
from 7-14 per cent) goes undetected. untreated or uncontrolled.
Although one-third to one-half of those individuals found to be
hypenensive on a first examination will reven to normal
pressures on a repeat examination. these and other data led the
ta
k forces to conclude that large numbers of Canadians have
hypertension which. unless brought under control. will continue
to add to an already enormous burden of unnecessary disability
and death.
3.ls C011ll1/unity screening ofl'alue;n the detection of
hypertemion?
In an effort to apply the law of "mas
action" to the
hypenension problem. many groups have suggested that
hypenension detection be carrièd out at every opportunity: in
the shopping plaza, dentist's office. pharmacy, emergency
room. and so on. However. in their recommendations. the task
force either rejected or substantially restricted these
approaches. A review of the shopping center screening
programs revealed that, even when extremely well organized
and staffed and continued for as long as SIX months, they
scanned less than one tenth of the local adult population. and of
those screened. the m<ijority had already undergone a recent
examination.
The c-.. H......
As well. although hypenensive individual<; may be easy to
detect. they are often difficult to successfully link to a
ource of
dinical care and treatment.
The task force recommended that any community based
hypenension program focus upon public and profes
ional
motivation rather than upon blood pres<;ure screening.
4./s it ofbene.fìt to tell an indil'idual that he has hyperrension?
Recent research in both Canada and the United States has
shown that labeling a person as "hypenensive" leads to at least
short term disadvantages for the hypenen<;ive individual. The
Harris Poll community survey of hypertension discovered that
those who stated that they had hypenensiori reported missing
twice as many days from work as those who were either
normotensive or not aware that they "ere hypenensive.
Funher. the psychological well-being and reports of physical
health in the U.S. Health and Nutrition Examination Survey
were significantly lower among people who were aware that
they had hypenension ( regardless of whether they were treated
or controlled) than among those who were normotensive.
Moreover, absenteeism among Canadian steelworker., has
been found to increa<;e dramatically after they are labeled
hypenensive. regardless of whether they are even put on
treatment. Thus. the detection and labeling of hypenension
lead
to short term disadvantages for the hypertensive patient
and these cannot be taken lightly. especiall} when the
subsequent stages in hypenension control are not carried out by
those who do the initial screening.
Thus it was recommended that hypenension detection be
only attempted when linkage to a source of clinical care is
guaranteed and priority given to the evaluation of methods for
guaranteeing this linkage from other potential detection sites
(encounters with public health and social agencies, employee
health programs. emergency rooms. contacts with other health
professions ete.) and sources of ongoing clinical care. Much
research is also needed into the extent of. causes for and
strategies for preventing or alleviating the "labeling"
phenomenon in hypenen'iion.
5. To what eHellt are hypertensil'e Canadians aware o/their
condition?
Although one-third to one-half of individuals having
hypenensive readings in community screening surveys report
unawareness of their condition. some of these will be
normotensive on subsequent reddings. This value may be
spuriously high as well due to the fact that some of these
individual's clinicians may be aware of the blood pressure
elevation but have elected for a variety of reasons not to tell
them.
6. Where and how can hvpertensil'es be detected?
The International Collaborative Study of Medical Care
Utilization discovered that three-quaners of Canadians have
seen a physician in the last year. Most ofthese visits are to
primary care. a hypenension detection setting that possesses
two distinct advantages. First. ifhypenension is found. linkage
to a source of clinical care has already occurred and the
hypenensive is already at the site of assessment, treatment and
follow-up. Second. the hypenensive individual detected in
primary care is likely to be "labeled" only if the decision has
been made to treat. For both of these reasons. the shon term
undesirable effects of labeling will be overshadowed by the long
term benefits of therapy.
7. Whar role can nurses assume in the work-up o/the
hypertensil'e patient?
There is now sufficient experience both in Ontario and
elsewhere to confirm that specially trained-and appropnately
supervised nurses can carry out the clinical assessment of the
hypenensive patient. The task forces recommended a
AprIlltn 25
pared-down work-up on the basis of the data from previous
<;tudies which 'ihowed that curable hypenension is rare.
I n a clinical history, the work-up of a known hypenen.,ive
patient should include answers to such questions as:
· Is the pati
nt currently being treated for hypenension or
has he been treated for the disease in the past?
· Has the patient suffered a heart attack. angina pectori<; or
symptoms of heart failure?
· I s the patient taking estrogens (whether for contraception
or for menopausal symptoms) or producing large amounts of
estrogens (e.g. recent pregnancy)?
· Has the patient ever complained of abdominal or flank pain
or has he had renal surgery in the past? (This may be indicative
of renovascular hypenension).
· Does the patient experience pounding headaches.
sweating, palpitations and/or anxiousnes
? (These may be signs
of pheochromocytoma).
I n a physical examination the repon suggests that, besides
blood pressure measurements. the following step
be taken:
· examination of the retina for hemorrhage, exudate. and
papilledema which could indicate malignant hypenension
· auscultation ofthe lungs for basilar rales, and other sign<; of
congestive hean failure such as pitting edema
· examination of the heart for size, rate. rhythm and
murmurs to rule out target organ damage to the hean
· auscultation of the subcostal bruits
· simultaneou., palpation of radial and femoral pulses for
fullness and rate
· examination for signs of endocrine diseases such as:
Cushing's syndrome, myxedema. acromegaly.
In a laboratory assessment, a serum potassium, serum
creatinine and a urine dipstick test for glucose and protein
should be completed.
8. What role can nurses assume Ifl the drill( treatment of
hypertension?
The task forces recommended a step-care regimen which can be
managed by
pecially trained. appropriately supervised nurse
in a primary care setting and pointed out that little evaluation of
the usefulness of treating hypenension at the worksite or in
other non-traditional settings has heen carried out and priority
.,hould be given to such studies. '"
References
I H ypenension Task Force of the Ontano Council of
Health. Committee on H ypenension of the Canadian H ean
Foundation and the Canadian Cardiovascular Society. Group of
Expens on H ypenension of Health and Welfare Canada.
2 The repons and common recommendations of the
H ypenension Task Force of the Ontario Council of Health and
the Committee on H ypenension of the Canadian Heart
Foundation and the Canadian Cardiovascular Society were
identical and the Group of Expens on Hypertension endorsed
the Hypenension Task Force repon. Copies of the full repon
can be obtained by writing to theGOI'ernmellt o/Ontario
Bookstore, 880 Bay Street, Toronto, Ontario, M5S /Z8. cheque
or money order payable to the Treasurer of Ontario.
Mary McCulle) (B .Sc.N., Unil'ersity of Toronto) collected the
material for' 'Hypertension: question:; and answers" from a
summary of the Report of Ihe Hypertension Task Force of Ihe
Ontario Council ofH eallh. She was a nurse member o/the task
force from /975-77.
Mary has had eXlensil'e nursing and teaching experience.
She has worked as a nurse praclitioner allhe SI. Georl(e Hea/lh
Centre in T oronlo, and was coordinalor of Ihe nurse
practilioner prol(ram at the U flÎI'ersil)' ofT oronto. She has a/so
taughl medica//surl(ical nursinl(. Current/)', she is nllr.
ing part
lime in T oronlo.
Hypertension:
Antihypertensives
E9
and how they work
Pam Haslam
There is no doubt
that antihypertensive
drug therapy lowers
blood pressure and
prolongs life. And
chances are that if
your patient knows
about his drugs, he
will stay on drug
therapy. How much
could you tell your
patient about his
"blood pressure
pills"?
About a year ago. Danny T. arrived at
the emergency room of a large Toronto
hospital. He looked pale and complained
of dizziness and "terrible.headaches".
His blood pressure was 170/105.
At 22 years of age, Danny has
hypenension. In some ways he may be
fonunate - he had symptoms which
made him uncomfortable enough to seek
help. Unlike Danny, most patients with
hypenension are asymptomatic: they
look and feel fine. Unless someone takes
their blood pressure, their disease may
go undetected for years. In fact. the
Canadian Hean Foundation reports that
only half of those with hypenension are
aware of it. and of those who know about
their disease, only one in four are
receiving adequate treatment.
Blood pressure - how high is high?
Hypenension is defined as a blood
pressure that is higher than that expected
in the normal population. But how high is
high?
First of all. we are dealing with two
figures - a systolic and a diastolic
pressure:
. systolic pressure is determined by
the amount of blood ejected with each
contraction of the hean. the speed of
ejection and the elasticity of the aortic
wall.
. diastolic pressure, on the other
hand. is the lowest pressure occurring
just before the next contraction or
systole. The diastolic reading gives us an
estimate of the degree of peripheral
vascular vasoconstriction. The patient's
hean rate influences the diastolic
reading; a rapid hean rate shonens the
diastolic period. aHowing less time for
the pressure to fall before the next
systole.
The 'normal' anerial blood pressure
is commonly taken to be 120/80 mm Hg.
At best, this is an approximate figure. for
there are a number of variables affecting
systemic pressure. In normaJ subjects.
for example. anerial pressure will
diminish by more than 20 mm Hg during
sleep. From early morning until dinner
time. it tends to rise progressively by
about 15 to 20 mm Hg. It is lower when
the patient is lying down. and somewhat
higher if he hasjust eaten or exercised.
Arterial pre
sure also tends to increa.,e
with body weight. Both systolic and
diastolic blood pre
sure increase with
age. giving us different normal values for
different age group
.
What is normal pressure then?-
probably a systolic of90 to 120 mm Hg
with a diastolic of 60 to 80 mm Hg. High
blood pressure i'i defined by the World
HeaJth Organi7ation as aperÚ
tent
elevation of blood pressure above 140/90
mmHg.
What causes hypertension?
Although hypenension is relatively easy
to diagnose, its causes remain. for the
most pan, obscure. In about five to ten
per cent of all patients, elevation of
blood pressure is associated with a
recognizable disease state. such as renal
disease. disorders of the adrenal gland.
or specific cardiovascular disorders.
such as coarctation of the aorta. But in
the vast m<\iority of cases. the
development of hypenension cannot be
explained. at least at the present time.
Essential hypenension is the term
applied to high blood pressure which
cannot be attributed to a specific lesion.
This form of hypenension has been
variously attributed to overactivity of the
autonomic and higher levels of the
nervous system, release of hormones by
the kidney and adrenal gland, smooth
muscle hypertrophy in resistance vessels
and increased sodium intake. One
researcher has proposed a "mosaic"
. theory. which acknowledges the
interaction of these contributing factors.
as well as many others.
The C.n-.llen Nur..
Aprl118711 27
The consequences
Although the cau!>e!> ofh}perten,ion
remain ob,cure. there i
no doubt about
the con!>equences - they are alarming.
The ri..." of coronary disea
e in Pdtients
\\-ith diastolic pressures of 105 mm Hg
and higher i!> four times that of the
normal population. The shearing !>tresses
from increa!>ed intravascular pressure
can result in damage to the arterial wall
that will, in turn. accelerate the
deposition of lipids and calcium salt
.
The vascular lumen narrows and the
intimal lining roughens. cau!>ing
thrombu!> formation. If this proce"s
occurs in the brain. it leads to
cerebrova
cular thrombosis or
hemorrhage. Ifit takes place in the heart,
coronary thrombosis and myocardial
infarction will re!>ult. And in the renal
vesseb. the atherosclerotic process may
predispose the patient to renal ischemid
and failure.
The consequences of hypertension
are reflected in the relationship between
diastolic pres!>ures and mortality rate!>.
When the diastolic pre!>!>ure ranges from
95 to 104 mm Hg. the mortality rate is 60
per cent higher than that of the normal
population. The m<ûor impact occurs,
however, when dia
tolic pressures
exceed 105 mm Hg. At this level. the
mortality rate is three times greater than
normal.
All causes of hypertension, whether
essential or resulting from an identifiable
lesion. can be classified as either beni!:n
or mt/ligna",. The blood pressure of a
patient with benign hyperten
ion will
elevate slowly and progressively over a
period of }ears. Complications develop
somewhat insidiously.
In a small percentage ofthe!>e
patients. the hypertension becomes
malignant or rapidlv progressing.
Characteristic vascular changes in the
retina of the eye appear early in this
pha!>e of the disease. and kidnev function
often become!> rapidlv impaired. Patients
with malignant hvpertension have a very
limited life expectancy. usually
succumbing \\-ithin a few months. but
occa.,ionally !>urVI\ ing one or two years.
Ho\\ is h) pertension treated'!
Since patients with essential
hyperten"ion exhibit no identifiable
cause for their disease. therapy has been
largelv directed to\\-ards reduction of
blood pressure by various means.
Treatment is usually considered for
patient!> oi any age with diastolic
pre!>sures consistently greater than 95
mmHg.
The physician has several options in
planning a treatment program for his
patient. He must take into consideration
the patient's weight and salt mtake. A
\\-eight reducing low sodium diet may be
prescribed. Other factors. such a!>
cigarette smoking. stres!>es in the
patient'!> lifestyle and exerci!>e pattern!>.
must also be considered. And if the
patient's arterial pressure remains
consistently high. the physician will
resort to a drug treatment program.
There i
no doubt that drug
treatment lowers blood pres
ure and
prolong!> life. The problem with this type
of therapy lies in the fact that many
patients fail to adhere to their treatment
program. Why?
The disease. for many, is
asymptomatic. The patient. who feels
well. may have a great deal of difficulty
understanding that he has a problem.
And the drug!> he i!> told to take have
unpleasant and even dangerous side
effects. He may actually feel worse on
medication. But failure to continue
taking this medication will result in a
rapid return of arterial blood pressure to
his previous hypertensive level.
Accurate blood pressure measurement
The range of a patient' s blood pre ,ure.
as well as the factor!> atfecting that
pre...!>ure. underlie the importance of
taking successive readings. It is common
to obtain an ele\oated reading in ten
e and
hyperactive patienh. particularly at the
early stages of a ph} sical examination.
Subsequent readmgs \\-ill often be
substantially lower than the initial
reading. A more accurate reading would
probably be obtained in an environment
familiar to the patient, such as hi., own
home.
For the most accurate re.,ulh. vou
should kno\\- when to take your patient's
blood pressure, and ho\\- to eliminate
technical errors that might give }ou a
falsely elevated reading. First of all. your
patIent should be in a !>table relaxed
position for at least five minute
. Ideally,
he should not have eaten or exerci...ed
within the last half hour.
J....eep the patient's arm at heart le\oel
""hen you take his BP. and make
ure
that the cuff is wide enough - it
hould
be at least
O per cent greater thdn the
diameter of the extremit} that you are
lI!>ing to measure hi., pressure. If the cuff
is too narrow. it will only compress the
deep arterie., when the cuff pre
!>ure
greatly exceeds arterial pressure.
If you apply the cuff too loosely. It
becomes rounded before exerting
pressure on the ti.,sues. resulting in a
fabelv high reading. And if you deflate
the cuff too .,Iowly. the venou.,
congestion in the extremity will give you
a falsely high readi'lg.
And finally, if you are using a
mercurv sphygmomanometer, make sure
the mercury column i
at e}e level. Ifit i
higher than eye level. you may again
obtain a falsely high reading.
Table one COMMON ANTIHYPERTENSIVE DRUGS
GENERIC NAME TRADE NAME DOSAGE RANGE COMMON SIDE EFFECTS
THIAZIDE DIURETICS
CHLOROTHIAZIDE Dluril 0.5 G 10 1 G p.O. dally.n single or divided Side effecls common 10 Ihls group of
doses. Dosage Increased or decreased drugs Include.
Hydrodlunl according 10 Ihe blood pressure
erum eleclrolyle disturbances.
HYDROCHLOROTHIAZIDE EsKlnx 50 - 100 mg p o. dally as single or dIvIded dizziness. fatigue. G.!. disturbances
Hydrozlde dose. Dosage Increased or decreased hyperuricemia. hyperglycemia.
Hydro-Aquil according to blood pressure hypotension. blood dyscraslas Use with
Neo-Codema caution with women 01 childbearing age
since thiazldes cross the placental
BENZTHIAZIDE Benzthiazlde Initially 50 - 100 mgp.o. dally In divided barner
Exna doses alter breakfast and IUrlch Adjust
maintenance dose 10 minimum effective
level
BENDROFLUMETHIAZIDE Naturelin 5 - 20mg p 0 daily.
POTENT DIURETICS
FUROSEMIDE Lasix 20 - 40 mg p.o. for 1000Iation of therapy Orthostatic hypotension when used with
F uroside and maintenance. II this dosage range other anllhypertensives. Electrolyte
Norosemide does not produce satisfactory results depletion (dIzzIness. fatIgue. lethargy.
other antihypertensives musl be added muscle cramp
) dermatitis. dehydration.
ETHACRYNIC ACID Edecrln 40 mg p.o b I.d. adjusted to blood Electrolyte depletIOn. vertigo tinnitus and
pressure. deafness. gaslrointestlnal
ellects(nausea. vomiting. diarrhea)
21 April 1879
The C.nedlen Nur..
Understanding antihypertensive drugs
Where do you fit into the picture? As a
nurse. you are panly responsible for
helping the patient adjust to his
treatment program. I n order to teach him
how to cope with the medications he
must take. you must have a working
knowledge of the common
antihypenensives. This mean
knowing
how the drugs work and what side effects
to expect from them.
Although there are many
antihypenensive drugs available. the
way in which they act allows them to be
divided into three major classes:
. diuretics:
. drugs that inhibit the activity ofthe
sympathetic nervous system: and
. drugs that act directly on vascular
smooth muscle.
Diuretics
Unless specifically contraindicated.
diuretics are the first line of defence in
controlling mild to moderate essential
hypenension. The patient treated
initially with only a diuretic may have a
diastolic pressure of over 110 mm Hg,
but will show few or no secondary
changes in the brain, retina or kidney.
For many patients in this group, an oral
diuretic may be the only drug required to
control hypenension. The thiazides are
the most popular diuretic, a popularity
enjoyed because they are safe and
effective.
What do they do? Thiazides block
the reabsorption of electrolytes and
water by the renal tubules. resulting in a
decreased extracellular fluid volume and
consequently a decreased blood
pressure. It is felt that an additional
hypotensive effect occurs because these
drugs dilate vascular smooth muscle.
When the patient begins taking a thiazide
diuretic, his blood pressure falls initially
because of a decrease in blood vol ume.
Even when his blood volume returns to
its pretreatment levels, however. his
blood pressure remains lower.
A doctor generally stans the patient
on a small dosage ofthe drug. then
slowly increases the dosage to a level
which controls the patient's blood
pressure with a minimum of side effects.
Some of the side effects that you may see
in patients on thiazides are hypokalemia.
dizziness, gastroenteritis and an increase
in blood urea nitrogen levels.
Hypokalemia impairs efficient
functioning of both skeletal and
gastrointestinal smooth muscle. You
should begin to suspect its presence
when the patient complains of weakness,
a 'feeling of fullness' . and constipation.
Often the patient's doctor will prescribe
an oraJ potassium supplement to offset
such complications, but if the patient is
not receiving supplements, he should be
advised to include potassium rich foods
in hIs diet - trUits such as oranges,
bananas and apricots, and juices like
orange or tomatojuice.
Under cenain circumstances. the
doctor may choose to use a more potent
diuretic than those in the thiazide group.
Two preparations used are furosemide
(Lasix*) and ethacrynic acid CEdecrin*).
These drugs inhibit cellular activity both
in the ascending loop of Henle and
elsewhere in the nephron. The result is
that they prevent the kidney from
reclaiming large amounts of water and
electrolytes and thus cause a powerful
diuresis. Because these diuretics seem to
increase renal blood flow, they may he
used if the patient with hypenension has
an associated renal disease. The long
term effects of potent diuretics have yet
to be fully studied.
It is essential that you as a nurse
make cenain that the patient knows why
he is taking diuretics. and how the drugs
act on his disease. You should also
determine whether or not the patient has
been told when to take his diuretics.
Often a patient is told to take his
medication once or twice a day. But he
should not take diuretics at bedtime: the
last dose of the day should be taken in
the late afternoon. Dosage ranges and
side effects of both the thiazides and
potent diuretics are summarized in Table
one.
If diuretics do not bring the patient's
blood pressure within a satisfactory
range, the physician may add a drug that
inhibits sympathetic nervous system
activity. To understand exactly what this
group of drugs does, it is necessary for
you to familiarize yourself with the
structure and function of the sympathetic
nervous system.
How s)mpathetic inhibitors work
Nerve fibers can be divided into two
categories, depending upon whether the
organs they deal with are under the
control of the will or not. That ponion of
the nervous system which is autonomous
or functionally independent is called the
autonomic nervous system. There are
two divisions of the autonomic nervous
system, sympathetic and
parasympathetic. It is the sympathetic
nervous system that activates our "fight
or flight" response. Under sympathetic
stimulation, the hean rate accelerates,
the bronchi dilate and pans of the
peripheral vascular system
v asocons trict.
All autonomic motor nerves
descend from the central nervous system
in two stages. The first set of fibers
extends from the central nervous system
to a collection of nerve cell bodies called
ganglia located outside the spinal cord.
The ganglia act as relay stations. From
them a second set of fibers are sent out,
and these fibers lead to the target organs.
In sympathetic fibérs, the chemical
norepmephrine conducts impulses from
the nerve ending to the target organ. In
addition, sympathetic target organs have
at least two different receptor sites that
can accept norepinephrine: the alpha
receptors and the beta receptors. The
ways in which body organs or structures
respond to sympathetic impulses
depend upon the type of receptor heing
stimulated. For example, the heart,
which has only beta receptors. responds
to the release of norepinephrine by
increasing in rate and vigor of
contraction, whereas cutaneous vessels,
which have alpha receptors, respond by
vasoconstricting.
Antihypenensive drugs that depress
the activity of the sympathetic nervous
system act in different ways. For
instance, some drugs successfuly reduce
blood pressure by intenering with the
formation of norepinephrine. Others
depress sympathetic centers located
within the central nervous system. There
are even drugs that block both
sympathetic and parasympathetic
systems at the autonomic ganglia. And
there are more specific drugs that will
block either the alpha or beta receptor
sites, preventing norepinephrine from
making contact with these receptors.
Propranolol
One drug with antihypertensive
propenies that is frequently prescribed is
propranolol (Inderal*). Propranolol is a
sympathetic beta blocker that is used
along with other drugs to treat almost
every degree ofhypenension. This drug
is panicularly compatible with thiazide
diuretics. The full mechanism of the
antihypenensive effect of propranolol is
still not established. It is known that
because it blocks beta receptors in the
heart, both hean rate and muscle
contractility diminish, lowering cardiac
output. For this reason, the drug must be
used with caution in diabetics. since it
masks the tachycardia and tremors that
indicate possible insulin-induced
hypoglycemia.
The chief advantage of propranolol
is that it has few side effects. Unlike
other antihypenensives such as
methyldopa and reserpine, it causes
vinually no postural hypotension. Some
patients, however, have reported
lethargy, fatigue and gastrointestinal
irritation. The drug may also cause a
severe bradycardia, and so must be given
with care to patients who have
pre-existing myocardial disease. as it
could precipitate congestive heart
failure.
The maximum decrease in the
patient's blood pressure may not occur
until he has been on propranolol for SIX
to eight weeks. Point this out to the
patient and encourage him to keep up his
visits to the doctor until optimum control
has been established.
The Cen-.llen Nur..
Aprtl1878 211
Methyldopa
Another drug that \\-orks \\-ell for Pdtients
\\- ith moderate hypenension is
methyldopa (Aldomet*).It is believed
that methyldopa inteIfere
with the
formation of norepinephrine. thereby
depre
sing sympathetic transmission in
the peripheral nerves. Methyldopa is
mo
t often u
ed in cOJ1Ïunction with a
diuretic. since its antihypertensive action
is variable when it is used alone.
In addition to causing anerial
dilation. methyldopa causes
venodilation. Blood pools in the enlarged
veins. resulting in some reduction in
cerebral and coronary blood flow. This
effect is accentuated when the patient is
in the standing position. and may cause
him to have episodes of dizziness and
fainting.
The patient is more likely to
experience po
tural hypotension with
methyldopa than with some of the other
antihypenensive drugs. He should be
cautioned to change his position slowly
and to repon any incidence of dizziness
or fainting to his physician.
Many patients experience
drowsiness when they begin to take
methyldopa. but it usually di.,appears
after the first few days of treatment.
Other adverse effects that the Pdtient
may suffer are dryness of the mouth.
nasal stuffiness. gastrointestinal upsets.
fever, reversible jaundice, impotence
and depression. The patient should be
encouraged to tell his doctor about these
symptoms; the physician then has the
option of recalculating the dosage of
methyldopa or using different drugs
entirely.
Clonidine
Clonidine (Catapres*) is one of the newer
antihypenensive drugs that acts on the
central nervous system to inhibit
sympathetic activity. The
antihypenensive potency of clonidine is
comparable to that of methyldopa. And
like methyldopa. clonidine is used in
combination with other drugs to treat
mild to moderate hypenension.
If your patient is being treated with
clonidine. he should be advised ne\'er to
skip or discontinue the prescribed
dosage. for the consequences could be
very serious. If the drug is stopped
abruptly. restlessness. insomnia. nausea,
sweating and chills sometimes occur. In
addition, the patient's blood pressure
may overshoot to higher than
pretreatment levels. It is felt that this
reaction is triggered by a sudden release
of norepinephrine-like chemicals.
Consequently, it is most imponant that
clonidine dosage is withdrawn graduaJly.
Like other antihypenensives,
clonidine produces some side effects.
The patient may complain of drowsiness
of a more severe and persistent nature
than that caused by methyldopa.
Constipation. dry mouth. dizzmess.
impotence and fluid retention may also
be problems. Patients with a known
history of depression should be
supervised if they are being treated with
clonidine.
Reserpine
Reserpine (Serpasil*) is yet another
compound that the physician may
choose to give (with an oral diuretic)
when management of mild to moderate
hypenenslOn has proven to be
ineffective with other drugs. This drug
achieves its antihypenensive effect by
depleting the storage sites of
norepinephrine-like chemicals in the
brain. and by preventing the release of
norepinephrine at the sympathetic target
organs. It also ha., a tranquilizing effect
on the central nervous system, an effect
that benefit'> hypenensive individuals
who are tense and anxious.
Reserpine. however. has a high
incidence of undesirable side effects, and
for this reason is often used by the
physician as a last reson to control
hypenension. Because severe mental
depres
ion can result with the use of this
drug. the patient's family should be
alened to the early warning signs of
depression such as lassitude. early
morning insomnia and loss of appetite.
Like methyldopa. reserpine may also
induce drowsiness. The patient should
be advised to be cautious about driving
or carrying out other tasks that require
concentration. Other adverse effects of
reserpine include gastric hyperacidity.
nausea, vomiting. bradycardia.
angina-like symptoms, impotence and a
parkinsonian rigidity.
Many patients on reserpine complain
ofnasaJ stuffiness and dryness of the
mouth. These effects are more annoying
than serious, but if the patient finds them
troublesome. he should be encouraged to
draw them to his doctor's attention.
Guanethidine
Guanethidine (lsmelin*) is a poweIful
antihypenensive drug which acts chiefly
by inhibiting the release of
norepinephrine at the junction between
the sympathetic nerve and its target
organ. It is one of the agents used in the
management of severe hypenension, but
it may be prescribed for patients with
mild to moderate hypenension whose
disease is not adequately controlled by
other drugs.
One of the worst side effects of
guanethidine is posturaJ hypotension.
The patient must be cautioned to avoid
sudden rising. panicularly early in the
morning. Postural hypotension will be
aggravated by prolonged standing,
alcohol ingestion, hot weather, and
heavy work. If the patient feels dizzy or
faint, he should stop what he is doing and
rest, preferably in a sitting or lying
position. Patients on guanethIdine may
also experience severe diarrhea after
meals. fluid retention, fatigue. loss of
sexual potency and bradycardia.
To keep the required dosage down
to minimum levels. guanethidine may be
given in conjunction \\-ith an oral diuretic
and a sympathetic inhibitor such as
propranolol or methyldopa.
Drugs acting directl
on \<ascular smooth
muscle
Hydrala
ine
Hydralazine (Apresoline*) relaxes
vascular smooth muscle thereby
reducing peripheral resistance; it very
effectively decreases blood pressure
without significantly reducing renal
blood flow. However. hydralazine also
produces so many unpleasant and
possibly adverse side effects that it is
usually combined with other drugs and
administered in its smaHest most
effective dose.
Annoying side effects, such as
headaches. palpitations. flushing. dry
mouth. nausea. vomiting and possibly.
postural hypotension, may appear within
the first few days oftreatment. Some
adverse effects are delayed for several
weeks. but necessitate a prompt
withdrawal of treatment; these include a
general rheumatoid syndrome, an aching
and stiffness which may progress to a
lupus erythmatosus-like ailment if the
drug is not discontinued.
The hypotensive action of
hydralazine may also trigger a reflex
tachycardia. This is offset if the drug is
combined with a beta blocker like
propranolol. which acts directly to
reduce hean rate.
HydraJazine is of value in the
treatment of an acute hypertensive
crisis. It is the patient in crisis that you
will most likely see in a hospital setting;
he will have a soaring blood pressure and
acute cerebrovascular complications
such as hypenensive encephalopathy.
Other vascular smooth muscle relaxants
such
sodium nitroprusside (Nipride*)
and diazoxide (Hyperstat*) are also used
in an acute treatment program.
Pra<.osin
Prazosin (Minipress*) is a relatively new
antihypertensive agent which lowers
blood pressure by a direct action on
vascular smooth muscle. With this drug.
vasodilation occurs primarily in the
anerioles and not in the veins, so
posturaJ hypotension is minimized.
Physicians are beginning to use prazosin
in combination with other agents in those
situations wherein the patient cannot
tolerate hydraJazine or sympathetic
inhibiting drugs.
A number of cases of 'first dose'
hypotension with dizziness have been
reponed with the use of this drug. To
counteract this effect, prazosin is usually
30 April 1879
The Can-.llen Nu...
Table two COMMON ANTIHYPERTENSIVE DRUGS
- -
GENERIC NAME TRADE NAME DOSAGE RANGE COMMON SIDE EFFECTS
- -- -- -
SYMPATHETIC INHIBITORS
PROPRANOLOL Inderal 80-320 mg p 0 dally In divided doses Nausea vomiting light-headedness
depression bradycardia eplgastnc
distress
MET:WLDOPA Aldomet 500 mg-2G p 0 dally In divided doses Initial drDwzlness. postural hypotension
Dopamet weakness. dlzzmess nasal congestion
Novomedopa dryness of the mouth. depressIon
Impotence Patient may have a positive
Coombs Test
CLONIDINE Catapres o 2-1 2 mg dally. p 0 In divided doses Drowzmess dryness 0' the mouth
constipation fluid retention rash
RESERPINE Reserpine o 1-0 25 mg p 0 dally Administer with G I disturbances depression.
Serpasll food or milk droWZlness. angma-flke syndrome
Reserpanca arrhythmias dlzzmess. headache.
Neo serp Impotence. postural hypotension nasal
Reser'la stuffiness. dry mouth
GUANETHIDINE SULFATE Ismelm 25 50 mg p 0 dally In divided doses Postural and exertlonal hypotension.
characterized by dizZiness weakness.
lassitude and syncope G I disturbances
bradycardia. fatigue. Impotence nasal
stuffiness dry mouth. fluid retention
SMOOTH MUSCLE
RELAXANTS
HYDRALAZINE Ap,esonne Increased gradually to a maximum of 50 TachycardIa. postural hypotension
mg p 0 q I d Dosage kept to lowest headache. G I upsel nasal congesllon
effective levels angina
SODIUM NITROPRUSSIDE Nlpnde Administered In an I V Infusion with 5 per G I dIsturbances. headache
cent dextrose In water Infusion rate at restlessness. agItatIon. muscle tWltchmg
o 5-8 0 mcg/kg/mm diaphoresIs. chest pain. palpitations
DIAZOXIDE Hyperstat 300 mg In rapid I V dose Slow Inlectlon Sodium and water retention G I
may fall to reduce blood pressure disturbances. headache sweatIng
Repeal In 30 mln Repeat allnlervals of postural hypotension. angina.
4-14 hours arrhythmias
PRAZOSIN Mlnlpress Initial dose 0 5 mg bid - t I.d P 0 Postural dlzzmess nausea. drowzlness.
Increased gradually up to a maximum of headache. palpitations dry mouth.
20 mg o.d weakness
administered in increments. Dizziness
has also been reponed even when other
drugs have been added to prazosin.
Because of this the patient should be
closely monitored when drug therapy IS
initiated_ Caution him to contact his
physician if he experiences any episodes
of dizziness.
Table two summarizes the dosage
range and common side effects of both
the sympathetic inhibitors and smooth
muscle relaxants.
Finding the right drug
It is easy to see that many of the drugs
available for the treatment of
hypenension have side effects that range
from mildly annoying to serious in
nature. It must always be remembered
that hypenensive patients are individuals
who vary in response to individual drugs.
A therapeutic trial is usually necessary to
determine the best combination of drugs
for each patient - that is, a combination
that will maintain effective control ofthe
patient's blood pressure with the least
number of side effects. Such a trial may
or may not take place in the hospital:
very often the patient makes repeated
visits to the doctor's office until a drug
treatment program is found satisfactory.
Unless the patient's hypenension is
severe or he has complications like
coronary insufficiency, the doctor
u!'>ually tries the patient on one drug at d
time. evaluating the effectiveness of each
drug or combination. The thiazide
diuretics are usually the first drugs used.
and often they are sufficient to control
the patient's blood pressure
satisfactoril y. If his blood pressure does
not respond to an oral diuretic after a few
weeks, a second drug such as
propranolol or even methyldopa may be
added. And if the patient fails to respond
to gradually increased levels of these
drugs. he will be placed on a third agent,
usually hydralazine. By adding drug!'> one
at a time, minimal dosages can be
calculated, and side effects.observed.
This approach is known as a Stepped
Care Protocol and is illustrated in Table
three.
A suitable treatment program for an
individual patient is best established by a
dialogue between that patient and his
doctor. For optimum success, the patient
must be encouraged to bring any
annoying side effects or adverse
reactions to his doctor's attention.
For many patients, drug treatment
brings blood pressure under control
quickly and effectively. And it will stay
in control as long as the individual
follows his therapeutic program. Let's
get back to Danny and see how he got
along with his antihypenensive therapy.
Danny's blood pressure was initially
brought under control with a thiazide
diuretic and propranolol. His symptoms
- severe headaches and diLziness -
abated. and he felt fine. But six months
after staning therapy, Danny moved to
take up a new job in a different city.
Because he felt well. he did not bother to
refill his prescriptions when his
medication ran out. And so, a year later,
when an oral surgeon took his blood
pressure before a dental extraction,
Danny's blood pressure was IH5/120.
Naturally, he was surprised: aside from a
few headaches, he had been feeling fine.
He wondered where he had gone wrong.
Nursing implications
The key to keeping patients like Dann}
on medication is education. And no
matter what antihypenensive drug the
patient is taking, there are several poinb
that we as nurses can emphasize
concerning drug therapy:
. The patient should take the drug as
prescribed. He must be told ne\'er to
alter the dosage or skip a dose.
. The patient should be encouraged to
discuss the use of any non-prescription
drugs with his doctor or pharmacist.
. He should be encouraged to adhere
to his diet and should not drink alcohol
without first checking with his doctor.
. I f the patient is under the care of
The C.ned... ........
Table three AN EXAMPLE OF A STEPPED CARE PROTOCOL
Add or substitute:
Guanethidine
Add: Hydralazine Step 4
Alternatives: Prazosin
Q)
1ií
:::J
<ii
>
w
Add: Propranolol Step 3
Alternatives:
Q)
Methyldopa 1ií
:::J
Clonidine <ii
Reserpine >
w
Step 2
Q)
1ií
:::J
<ii
>
w
Thiazides
Step 1
other doctors. he !>hould be told to
inform them that he is taking
antihypertensive drugs. especially if an
anesthetic or surgery is contemplated.
. The patient needs to know that he
should report to hIs doctor any
symptoms that appear after he start!>
taking antihypertensives.
If your patient is taking methyldopa,
reserpine, hydralazine, prazosin or
guanethidine, he may experience some
postural hypotension. Tell him that he
should stand up slowly from a lying
position to prevent dizziness. and to
avoid standing for long periods of time.
Methyldopa, reserpine and
clonidine may produce drowsiness, a
feeling that will disappear in time. But
caution your patient to proceed with care
if he must peIform tasks that require
mentaJ alenness.
If your patient knows about his
drugs, chances are that he wiJl stay on
drug therapy . You can help him comply
by encouraging him to put up with minor
.,ide effects such as dry mouth and nasal
stuffiness, effects that are more
unpleasant than serious. If he is taught to
take his blood pressure at home, he may
be able to relate adherence to his
treatment program with effective control
of his blood pressure. And if he is taking
several doses of medication each day,
and has difficulty remembering what to
take when, encourage him to associate
piJl-taking with the significant events of
each day, such as meals or bedtime.
There is no doubt that effective
control of blood pressure and recognition
ofcomplications will enable your patient
to live a longer and more satisfying life.
I f education is one of the keys to
improved medication compliance, your
teaching can go a long way in helping an
individual live successfully with his
hypertension. ..
a
II
II
..
-..
L
Bibliography
1 Asperheim. Mary Kaye. The
pharmacologic basis of patiem care, by
... and Laurel A. Eisenhauer. 3d ed.
Philadelphia. Saunders, 1977.
2 Benditt, Earl P. The origin of
atherosclerosis. Sci. Amer. 236:2:74
passim, Feb. 1977.
AprIl 1171 31
3 Berne. Roben M. Cardiol'Uscular
physiolo!(y. by . _. and Mathew N. Levy.
3d ed. St. Louis. Mosby, 1977.
4 Assessing I'italfunctions
accurately. (Nursing Skill book Series)
edited by P.S. Chaney. Horsham Pa.,
Intermed Communication.,. 1977.
5 Gilles. Dee Ann. Patient
assessmell1and managemem by the
nurse practitioner, by... and Irene B.
Alyn. Philadelphia. Saunders. 1976.
6 Kosman. Mary Ellen. Evaluation
of a new antihypenen!>ive agent:
prazosin hydrochloride (Minipress).
JAMA 238:2: 157-159. Jul.l I. 1977.
7 Mcintosh, Henry D. Hypenension
- a potent risk factor, by . _ et al. H ea rt
Lun/? 7: I: 137-140. Jan./Feb. 1978.
8 Drug.
of choice /978-/979. Walter
Modell. editor. St. Louis. Mosby. 1978.
9 Page.I.H. Arterial hypenension in
retrospect Circ.Res. 34: 133-14:!, Feb.
1974.
lOG il'ing cardiOl'ascular drugs
safel\', eN ursing Skillbook Series) edited
by J. Robinson. Horsham Pa.,lntermed
Communications, 1917.
II Compendium of pJwrmaceuticllls
and specialties. edited by Gerald N.
Rotenberg. 13th ed. Toronto. Canadian
Pharmaceutical Association. 197H.
I:! Rushmer. Roben F.
Cardiol'llsculardynamics 4th ed.
Toronto. Saunders, 1976.
13 Schroeder, John Speer.
Techniques in bedside hemodynamic
monitoring, by... and Elaine Kiess
Daily. St. Louis. Mosby, 1976.
14 Repon of the Joint National
Committee on Detection, Evaluation and
Treatment of High Blood Pressure: A
Cooperative Study.JAMA ,
237:3::!55-:!6I.Jan.17.1977.
*Registered trade mark.
.
Pam Haslam, (R.N.. Toromo Western
Hospital, Toronto. Omario, B.N.Sc.
Queen's Unil'ersity, Kingston, Ontario.
W.S., Boston College, Boston,
Massachusetts) author of
"Amihypertensil'es and how they wort....
is a former instructor of coronary care
nursing at Algonquin Colle!(e in Ottawa.
Pam is a co-author of a textbook on
interpretation of the electrocardiogram
and has had articles published by
Nursing Clinics of North America and
the Canadian Council ofCardiOl'ascular
Nurses.
,
-
-
Hypertension:
Pediatric hypertension
think about it
1. What is the incidence of hypertension in children and
adolescents?
Statistics on pediatric hypertension are difficult to compile. In the
United States, investigators believe that as many as one million
children and adolescents are affected - approximately 2 per
cent of the school-aged population. I Canadian estimates range
from less than 1 per cent to just over 2 per cent of the child and
adolescent population.
2 Considering that the incidence of hypertension in the adult
population is about 15 per cent, is it worthwhile checking for
pediatric hypertension when the incidence is so small?
Emphatically, yes. Some studies suggest that children destined
to have essential hypertension may have higher blood
pressures than their peers at a very early stage of life. If these
children can be picked up early, then intervention by dietary
modification, relaxation training, exercise and other
non-pharmacological methods can be started. Early treatment of
hypertension can dramatically reduce the incidence of
complications that will occur in later life.
In the case of secondary hypertension in youngsters or
adolescents, the cause of the elevated blood pressure can be
found and treated.
3. What are the causes of pediatric hypertension?
In about 80 per cent of prepubertal children, hypertension is
secondary to renal disease such as chronic pyelonephritis,
glomerulonephritis, congenital malformations and renovascular
lesions.
Other associated conditions include coarctation of the
aorta, obesity, endocrine dysfunctions and the use of drugs such
as glucocorticosteroids, amphetamines and oral contraceptives
(in the adolescent).
In general, only after all secondary disorders have been
ruled out. can the diagnosis of essential or primary hypertension
be made.
4. At what age Should a child have his blood pressure
checked?
Most authorities suggest that a child should have a blood
pressure check starting at three years of age and annually
thereafter. However, because elevated blood pressures are
being found with increasing frequency in youngsters, some
physicians are recommending checking it as early as two years
of age.
5. How do you take a youngster's blood pressure?
As you can imagine. this isn't the easiest thing to do with a
squirming, non-cooperative child. Try to keep the youngster as
calm and relaxed as possible. If he is old enough to understand,
explain what you are doing. If the baby cries, or if a young child
is very restless and fitful, wait until he settles down. It is
important for the child to be as quiet and relaxed as possible for
an accurate reading. If the child does not seem to be calming
down, let it go until the next visit.
· Take readings with the child either supine or sitting with the
heart at arm level.
. Make a note of the position and use the same position for
subsequent readings. A change in position can make a
significant difference.
· Cuff size is extremely important Make sure the cuff covers
about two-thirds the length of the upper arm. A cuff that is too
narrow produces a false high reading; if too wide, a false low
reading. So instead of automatically reaching for the infant or
child-size cuff, be guided by the actual size of the child.
· Remember that sometimes, it is difficult to measure a
young child's BP accurately. Errors can be generated in
Korotkoff sounds by heavy pressures on the stethoscope held
in the anti-cubital space.
6. What is considered high blood pressure in a child?
When dealing with children, remember that they do not have the
same baseline blood pressure as adults. Blood pressure rises
with age and it is not until adolescence that a child's blood
pressure approaches that of an adult. Besides this, a child's BP
is very labile.
If the pressure is higher than 120/75 mm Hg in a child age
3-9 years, or above 130/80 mm Hg in a child ten years or older,
take two additional readings five or ten minutes apart. If the
blood pressure is still elevated, the child may be anxious (check
for increased pulse, sweating, dilation of pupils) or it may be
indicative of true hypertension.
If you suspect hypertension, the child should have three
follow-
p readings at different times to confirm that the blood
pressure is elevated.
7. How is high blood pressure treated in children?
Children or adolescents with continued, mildly elevated
hypertension may only need to make a change in their lifestyle
- changes in such activities as diet. exercise. smoking and oral
contraceptive use. For those with more severe hypertension,
medication may be necessary. Hypertensive medication is used
Tile ee.-.n NUrN
Aprtlll71 33
only wnen the supine diastoliC pressure is persistently over 90
mm Hg and where there are other known risk factors - suCh as
a strong family history of hypertension. obesity, high cholesterol,
etc. A pediatrician who is a specialist in the area of hypertension
should be consulted before any child is put on hypertensive
medication.
Drugs must be given with a great deal of caution since there
have not yet been sufficient studies of the long term effects of
these drugs on children. .
Three groups of drugs are used:
1. Diuretics such as chlorothiazide are often used initially. This
group is the cornerstone of all hypertensive therapy. If a child is
taking diuretics, both the parents and child must be aware of the
need for an increase in potassium (bananas, dried apricots,
tomatoes, oranges). Oral potassium supplements may be
needed as well.
2. Drugs that affect the adrenergic nervous system (such as
methyldopa) are used if a diuretic alone is ineffective. These
drugs may cause fatigue and lethargy, but the symptoms
generally disappear with continued use. Children on this group
of drugs must be watched carefully.
3. A vasodilator may be added to the regimen if neither of the
above are successful in maintaining a normal or near normal
blood pressure. Again, a child on one of these drugs must be
carefully monitored.
In the case of secondary hypertension, treatment of the
underlying cause usually results in a return to a normal blood
pressure.
B. Is diet an important factor in children with hypertension?
For about 50 per cent of children with mildly elevated pressure,
obesity is a factor in hypertension. A reducing diet for these
children is tremendously important.
Salt intake must also be reduced. For teenagers, this can
be very difficult, so emphasize cutting down salt rather than
cutting out. The child's mother needs to be aware of the
importance of a reduced salt and decreased caloric intake for
her child, so this will necessitate some change in how she
cooks.
9. Can hypertensive children benefit from exercise?
Of course. Some children are extremely active, and they can be
encouraged to continue in their activities. Others are much more
lethargic and will need to be started on a regular, progressive
exercise program. Walking, jogging, cycling, calisthenics and
swimming are all beneficial to the cardiovascular system.
Many teenagers need a lot of positive feedback about how
they are doing - from physicians, nurses and their parents.
These children should be seen at least every three months for
monitoring and for encouragement.
10. Have any studies been done on pediatric hypertension in
Canada?
At least three studies have been done since 1975.
..I.' One study
of a high school population in Edmonton" indicated that
approximately 2.2 per cent (350) of 15.594 students had
hypertensive readings when taken at school. The parents of the
hypertensive adolescents were advised by letter to have a
further evaluation by a physician. Six months after the initial
reading. only 67.2 per cent of the hypertensive group had visited
a physician. Of these, 19 cases of hypertension were confirmed
by the physician.
Why so few? The report suggests that physicians did not
use pediatric cuffs when they should have (a cuff that is too wide
gives a false low reading). Another possibility is that readings
were only taken on one occasion. It is suggested that three
separate readings at different times be taken before
recommending a physician visit.
11. What can nurses do about pediatric hypertension?
School nurses are in an ideal position to screen for pediatric
hypertension. Talk to your health unit or medical officer of health
and plan what can be done in your area.
If you are a nurse in a doctor's office. you have all kinds of
opportunity. Does the physician have pediatric and adult size
cuffs? Are they both in easy reach? Does the physician need a
reminder to monitor blood pressure in children? If he/she is too
busy, make it your responsibility to check the blood pressure of
children and adolescents who come to the office.
If you are a nurse practitioner with your own caseload. it's in
your hands.
And all nurses who are in contact with children and their
parents can do some counseling about obesity, diet and
exercise.
o.A fourth group of drugs may abo be pre
crjbed. They are the
anti-renin drugs such as propranolol. This group inteneres with
the release of renin which activates angiotensin. a very potent
vasoconstrictor. It is especially useful in tho
e situation
where
high levels of circulating renin are present in hypertensive
patients. ...
References
1 Buckley. Kathleen. Why hypertensive teenagers accept
our treatment program. RN 40:5:49, May 1977.
2 Hart, Paul L. Blood pressure in a sample of Canadian
school children, by... et al. Canad.Fam.Phys. 24:1 :64 passim
Jan. 1978.
3 Biron, Pierre. Blood pressure values in 116
French-Canadian children. by... et al. Canad.Med.Ass.J.
114:5:432, Mar. 6, 1976.
4 Silverberg. Donald S. Screening for hypertension in a high
school population, by... et al. Canad.Med.Ass.J.
113:2:103-108, Jul. 26.1975.
5 Ibid.
Bibliography
1 Gellis, Sydney S. Current pediatric therapy, by... and
Benjamin M. Kagan, Toronto, Saunders. 1968. p.390-392.
2 Loggie, Jennifer M.H. Add HBP to your list of childhood
ills, by... et al. Patient Care 12:20:16-24, Nov. 30.1978.
3 McLain, Larry G. Therapy of acute severe hypertension in
children. JAMA 239:8:755-757. Feb. 20. 1978.
4 Vogel, Martha A. Hypertension in children. Pediat.Nurs.
3:6:37-39. Nov.lDec. 1977.
Acknowledgment: Thanks go to Bonnie Maloney, R.N.,
Sandy Hill Health Centre and to Norman Wolfish, MD.,
Children's Hospital of Eastern Ontario in Ottawa, Ontario for
their help in the preparation of this article.
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34 April 19711
The Cenedlen Nur..
Today's texts
for Tomorrow's nurses
Fundamentals
FUNDAMENTALS OF NURSING, 6th Edition
By Lu Verne Wolff, R.N., M.A.; Marlene H. Weitzel, R.N.,
Ph.D.; and Elinor V. Fuerst, R.N., M.A.
l\lassively revised, reorganized, and updated with much new
material and artwork, the 6th edition of this leading text is
heavily patient-oriented and emphasizes the role of the
family. It is well-suited for conceptual curricula.
Nursing is viewed as a process in which the nurse works
with patients instead of doing for them without
explanation.
Lippincott. Abt. 725 Pages. March, 1979. Abt. $16.50.
NURSES' HANDBOOK OF FLUID BALANCE,
3rd Ed ition
By Norma Milligan lHetheny, B.S.N., M.S.N., Ph.D.; and
W. D. Snively, Jr., M.D., /i.A.C.P.
The purpose of the book is to clearly and concisely present
the fundamental physiology involved in body fluid distur-
bances, employing a systematic yet simple approach to
classification and diagnosis.
Lippincott. Abt. 400 Pages. March, 1979. Abt. $14.50.
A GUIDE TO PHYSICAL EXAMINATION,
2nd Edition
By Barbara Bates, M.D.
Several entirely new chapters on interviewing and history-
taking- together with a wealth of expanded and updated
material-mark the second edition of this comprehensive
guide to physical assessment for beginning health practi-
tioners. Detailed yet succinct, the Second Edition serves
as an excellent working reference for interviewing and
examination; fOT assessment of health status; and for
differentiation among abnonnal findings.
Lippincott. Abt. 425 Pages. March. 1979. Abt. $25.00.
COMMUNICATION FOR HEALTH
PROF ESSIONALS
By Voncile M. Smith, Ph.D.; and Thelma A. Bass, M.A.
This timely book identifies and describes problem situa-
tions stemming from communication breakdowns that
commonly affect health care personnel.
Lippincott. Abt. 200 Pages. March, 1979. Abt. $9.00.
...
Pharmacology
PHARMACOLOGY AND DRUG THERAPY IN
NURSING, 2nd Edition
By Mortun J. Rodman, B.S., Ph.D.; and Dorothy W. Smith,
R.N., AI.A., Ed.D.
The second edition has been so exhaustively revised that it
is virtually a new textbook, yet it retains the lucid and read-
able style, and the comprehensive coverage, that put the
first edition in a class by itself.
In addition to massively revising the contents of all chapters
carried from the first edition, the authors have added
several entirely new chapters and have expanded some
first edition chapters into complete sections.
Lippincott. Abt. 9UU Pages. April, 1979. Abt. $18.00.
NURSING PHARMACOLOGY: A SYSTEMS
APPROACH TO DRUG THERAPY AND
NURSING PRACTICE
By Alvin K. Swonger. Ph.D.
With the increasing responsibilities placed on today's
nurse and the growing complexity of drug information,
there exists an urgent need for a comprehensive, logically
organized pharmacology text written specifically for the
student nurse. NCRSING PHARMACOLOGY meets this
challenge head-on.
Little, Brown. 329 Pages. Illustrated. 1978. $12.00.
MATHEMATICS FOR HEALTH
PRACTITIONERS: Basic Concepts and
Clinical Applications
By Lawrence Verner, B.A., Ph.D.
The text is organized in three parts. Part One, "The Build-
ing Blocks," deals with the basic mathematics concepts of
fractions and decimals. Part Two, "Tools of the Trade," is
devoted to the metric system, the apothecaries system, and
conversion between these systems. It develops a simple
approach to conversion called the "equation method,"
which is the key to all of the medical applications. The
method is easy to understand and involves no memorization
of proportions or formulas. Part Three, "Medical Applica-
tions," discusses dosages and solutions, including oral
dosage, parenteral dosage, preparation of solutions, and
pediatric dosage.
Lippincott. 165 Pages. Dec. 1978. $7.50.
Th. Cenedlen Nur..
April 197V 35
Maternal-Child Health
MATERNITY NURSING, 13th Edition
By Sharon R. Reeder. R.N.. Ph.D.; Luigi Mastroianni, Jr.,
\I.D., F.A.C.S., F..I.CO.G.; I.eonide L. .\lartin, R.'v', M.S.:
and Elise Fit::patrick, R.N.. .\1..1.
This comprehensi\e edition of an outstanding text reflects
the most recent advances in knowledge and changes in
famil} life styles. It integrates nursing assessment of both
physical and emotional facturs, applies evaluation and
diagnostic skills, and provides thorough coverage of current
concepts in maternity nursing.
Lippincott. 706 Pages. 1976. $20.00.
NURSING CARE OF CHilDREN, 9th Edition
By Eugenia H. Waechter, R.N., Ph.D.; Florence G. Blake,
R.N., .\I.A.; and Jane P. Lipp, M.D.
Completely revised and expanded, this edition is without
peer as an in-depth studv of pediatric nursing. rhe text is
organiLed by age groups, from infancv to adolescence, with
emphasis on ph}sical and psvchosocial growth, develop-
ment, and health care planning for each age.
lajoT revi-
sions reflect increased nursing responsibilities in assessment
and management of the well child, children at risk, and the
ill child.
Lippincott. 834 Pages. 1976. $21.00.
NURSING CARE OF THE GROWING FAMilY:
A Child Health Text
By A Pillitteri, R.N., B.S.N., .\I.S.N., P.'v'A.
In this exceptional textbook for child health and pediatric
nursing courses, prospective nurses will find the infor-
mation they need to become competent and compassionate
child health nurses. Clearly and engagingly-written, this
text is unique in its emphasis on the social and psycholo-
gical components of normal growth and development, the
important role of the family in child health care, and the
child health nurse's rapidly growing responsibilities, partic-
ularly in planning and implementing programs of well
child care.
Little, Brown. 834 Pages. Illustrated. 1977. $22.25.
NURSING CARE OF THE GROWING FAMilY:
A Maternal-Newborn Text
By A. Pillitteri, R.N., B.S.N., M.S.N., P.N.A.
This comprehensive text meets head-on the needs of the
nursing student - and the practicing nurse - for a lucid,
completely up-to-date source of infonnation and prac-
tical guidance in one of the most rapidly changing fields of
nursing today, maternal and child care. It gives careful
consideration to the psychological and emotional aspects
of expectant motherhood and fatherhood, and equally
important, emphasizes the nurse's expanding role in
as
essing, delivering, monitoring, and overseeing the
health care of the expectant mother and newborn infant.
Little, Brown. 445 Pagt:s. Illustrated. 1977. $19.75.
Medical-Surgical
TEXTBOOK OF MEDICAL-SURGICAL
NURSING, 3rd Edition
By Lillian Sholtis Brunner, R.^'., B.S., Jl. S.; and Dorzs
Smith Suddarth, R.N., B.S.N.E., .\I.S..V.
Outstanding in its depth of scientific content and in the
practicality of its application, this leading text has been
heavil} revised and updated, with much new material.
Throughout the text the pathophysiologic basis of disease
is discussed as well as the psychosocial aspects of nursing
care. Kursing management in various clinical situations is
frequently outlined in tabular form. To further aid the
student, the authors have added a content guide at the
beginning of each chapter; detailed bibliographies, and an
appealing two-color format that highlights the chapter
openings, special table titles, and many illustrations.
Lippincott. 1,156 Pages. I1Iustrated. 1975. $27.25.
Review
LIPPINCOTT'S STATE BOARD EXAMINATION
REVIEW FOR NURSES
By Lu Verne Wolff Lewis, R.N.. .\1...1. With 6 Contributors
and 4 Reviewers.
Uniquely designed to incorporate sound teaching methods
with an accurate reflection of the structure and approach
of actual state board examinations, this new review book
will delight students and teachers alike. It appears in the
same fonnat as the licensure examinations themselves,
and offers 2,568 questions (together with answer-recording
sheets just like those in the examinations) that are also
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Five tests cover five major areas of nursing: medical,
surgical, obstetric, pediatric and psychiatric. They integrate
the basic natural and social sciences, nutrition and diet
therapy, phannacology and therapeutics, fundamentals of
nursing, communicable diseases, and legal and ethical
considerations. All answers and the rationale for each
answer appear at the end of each of the five major sections.
Lippincott. 745 page
plus answer sheets. I1Iustrated.
1978. $13.75.
Lippincott
J. B. LIPPI
COTT COMPANY OF CANADA LTD.
Serving the Health Professions in Canada Since 1897
75 Horner }he., 1oronto. Ontario !\t8L 4X7
Prices subject to change without notice.
-
'"
Frankly speaking
Nursing
and the degree mystique
......
A university degree for every nurse may be a worthwhile goal in view oftoday's
emphasis on higher education. But what happens when the professional elite proceeds
t6 penalize the silent majority of nurses - those who do not yet possess university
degrees - and all in the name of quality care? In part one of a two part article, author
Jeanne lvlarie Hurd takes a long hard look at the degree mystique and the disruptive
influence it may have on nursing as a whole.
Jeanne Marie L. Hurd
We have all seen the adverti"ement
many times in popular magazines.
What it shows is a svelte, sophisticated
and ultra-modern woman holding a
cigarette which is obviously intended to
exemplify the same characteristics.
The caption, "You've come a long
way, baby", epitomizes the distance
modern woman has travelled to achieve
relative equality in today's society. It is
left to the reader to determine whether
the cigarette in her hand has helped her
achieve this equality, or whether her
achievement in itself has earned her the
right to smoke. But the distinction is of
small consequence. What is important
is the cigarette's impact as a status
symbol. which is, of course, exactly
what the advertisement intends.
Nursing too ha
come a long way,
especially in the past few decades. The
preface to a classic history of nursing
written over thirty years ago comments
that "the nurse is a mirror in which is
reflected the position of women
throughout the ages". I And
considerable progress can be traced
both in women's rights and in the
nursing profession since these words
were written. The question I am asking,
however, is this: has modern nursing,
in the process of change, acquired a
new status symbol that shares some
significant characteristics with the
cigarette just described?
Professional status symbols
The nurse's cap, once the cherished
symbol ofa proud profession, has long
ince been shelved by many of those
entitled to wear it. The school pin has
likewise been eclipsed by a new
professional status symbol, one that
cannot be worn, but must instead be
displayed on a wall. The new symbol is
of course, the university nursing
degree, which nursing's modern avant
garde is striving to make an essential
requirement for the professional nurse.
The aim of this well-established
movement, which is to improve the
product through higher quality
education and thus to upgrade the
profession, is a sincere and laudable
one. And the movement's ultimate
objective - a university degree for
every nurse - is quite understandable
in view oftoday's emphasis on the
importance of the degree as an
admission ticket to the professions.
That nurses are able to pursue a
university education in nursing is of
particular significance to the
profession, because, unlike medicine,
nursing's roots are outside of the
academic system.
How then, could a symbol as
worthy as a university degree be
compared to the cigarette in the
advertisement? Even the most
dedicated smoker will admit that the
cigarette is the vehicle of an expensive
and dangerous addiction, causing
among other things, bad breath, stained
fingers, a hacking cough, serious illness
and even death.
Th. Cenlldlen Nur..
April 197V 37
Although it is obvious that the
analogy cannot be pushed too far. there
are. I think. significant similarities
between the cigarette and the nursing
degree as status symbols. The mystique
surrounding the degree itself has begun
to take on characteristics that are by no
means free of pollution. If this
mystique continues to develop
unchecked, with less and less
relationship to the real meaning of a
university education. the consequences
for nursing itself as well as for the
public may be at best serious, at worst
disastrous.
The degree mystique
What is the degree mystique? And what
is its effect on those who come under
its spell?
A university education may be
variously viewed as a privilege. an
opportunity. a challenge. or a
necessity. But however it is perceived
at the outset. only the unusual student
fails to realize by the time he has
graduated that the knowledge he has
acquired is infinistesimal in proportion
to what he does not know. Any serious
and responsible student will recognize,
at least to some degree, the limitations
of his achievement. Few feel equipped
to stand on the summits of their
respective disciplinary mountains. nor
would their faculty advisors dream of
encouraging them to do so. Most are
happy to have climbed a few foothills.
In other words. the university
graduate's most important achievement
may be the acquisition of a sense of
humility.
Now let us look at what university
nursing is currently telling the
baccalaureate nursing student.
"Because you have chosen the best
pathway to nursing - that is, a
university program - when you pass
the qualifying examination, you will be
aprofessional nurse. whereas your
colleagues who pass the same
examination from a hospital or
community college base wiJl be merely
technical nurses."
This distinction is explained in
tenns of the greater breadth. depth and
scope of the baccalaureate student's
education. On the surface. it may
sound both reasonable and logical. But
such a stance has other implications
which result in judgments being made
- not between two types of
educational programs, but supposedly
between two types of students.
To those influenced by the degree
mystique. a student who selects a
university program is
. of higher calibre than one who
selects a community college or hospital
program:
. more highly motivated; and
. more intelligent.
Other circumstances that may
affect the student's choice - financial,
geographic. cultural, personal - are
seldom considered. Once the choice is
made. it is obvious to those
mesmerized by the nursing degree that
the baccalaureate student is exposed to
an education so superior to the others
that her mind, abilities, clinical skills
and judgment expand much faster
accordingly. Regardless of individual
differences, unique personal qualities,
or varying balances of strengths and
weaknesses, the university graduate is
frequently considered better than -
not merely, according to the current
euphemism - "different from" the
hospital or community college
graduate.
Fortunately. the stuff that a nurse
is made of usually detennines to a large
extent how she will perfonn, regardless
of her educational affiliation. I am
fortunate to know a number of superb
nurses. some of whom happen to hold
one or more degrees, while the others
have diplomas and certificates instead.
I find it ironic that. should a diploma
nurse decide to work for a nursing
degree, she is almost always treated as
a second class citÎzen in the university
environment - a phenomenon
reflecting a variety of "you can't get
there from here" syndrome. The
implication is that because she made
the wrong choice to begin with, she is
now "too rigid" to be able to function
at the true baccalaureate level. As part
ofthe "lost tribe" she never quite
attains the priesthood, even if she
eventually achieves a Ph.D.
It is still a truism however. that the
diploma nurse, especially the
hospital-trained diploma nurse. often
has a decided advantage over the
degree nurse immediately following
graduation, in tenns of perfonnance
ability and resulting ego strength.
Employers generally rate her highest
on initial ability to function,
presumably because of her greater
familiarity with nursing's -clinical skill
.
Spinning straw into gold
Now the baccalaureate nurse is caught
between two opposing forces. On the
one hand. her employers ask for at least
a modicum of initial clinical and
administrative skills. Her university
instructor insistS, however, that
because of her superior cognitive skills,
she should not have to practice, or in
some instances, even learn, many of
nursing's traditional and potentially
obsolescent procedures.
The university graduate is thus
placed under unreasonable pressures to
perfonn. These pressures are partly
due to clinical imperatives that cannot
wait for her to acquire the necessary
experience. But they are also due to the
attitude of her school, which like the
miller in the story of Rumplestiltskin
(who insisted that his daughter could
spin straw into gold), has assured the
baccalaureate nurse that she is
equipped to function at a beginning
level in all areas, whether she can or
not.
Particularly ironic is the strident
insistence of many university nursing
schools that their graduates are now
equipped to do primary care nursing.
Such a claim is based on the inclusion
in the curriculum of a prescribed
amount of theory, with small
-
-----
38 April 1979
Th. Canadian Nurse
opportunity for practice. It is
frequently implied and often stated
outright that these new graduates are
more legitimately equipped to handle
primary care than are qualified and
experienced nurse practitioners whose
intensive clinical training ha
followed
a diploma rather than a degree
progmm.
I t would be interesting to see what
would happen if. for instance, medicine
were. to follow university nursing's
present example. To do so, it would
have to cut out clinical clerks hips and
internships, substituting for both a few
hours a week of carefully protected
clinical practice under the supervision
of physicians who carry no patient care
responsibilities. Then, on the stl'dent's
graduation from medical school, he
could immediately be turned loose on
the public as a qualified beginning level
general practitioner.
EtiolollV ofa mystique
How has the degree mystique managed
to become so all-pervasive in recent
years? Is nursing going through a
developmental stage - its adolescence
perhaps - in which its search for
identity is reflected in exaggerated
claims? Or is the enchantment with our
new status symbol due to the fact that it
holds out the hope ofreal equality in
the professIonal world?
Perhaps a look at the process of
planned change would help us
understand what is happening as
nursing education transfers from a
hospital to a university base. Edgar
Schein. an organizational psychologist
at the Massachusetts Institute of
Technology has developed a planned
change model which he applies to
educational systems. In his book
Professional education: some new
directions. 2 he describes a three stage
process necessary for successful
change. the stages of unfreezing.
changing. and refreezing.
His thesis is that before change can
take place, motivation to change must
be induced through a proper balance of
I) forces that arouse discomfort.
tension and threat and
2) forces that create sufficient
psychological safety to make
motivation to change possible.
For change to occur then.
individuals and/or systems must be
made to question traditional beliefs,
attitudes and values or behavior
patterns to the point that they reach a
state of "guilt-anxiety" through
comparison of actual with ideal states.
Once this happens. enough unfreezing
has taken place for change to occur.
after which refreezing must be begun
through a process of stabilization and
integration of the new attitudes, values
etc. into the rest of the system.
What does this have to do with
nursing? I would suggest that nursing
education is following this model very
closely in effecting the ideological
transfer from hospital to university. In
the long run. this important change
will. no doubt. be successful, and in the
twenty-first century. it may well be
common practice for a high school
graduate with nursing ambitions to go
to university for her education.
My purpose is not to argue against
the need for change or the benefits that
may accrue from it, but to recognize
the increasingly evident problems
accompanying the unfrt;ezing stage of
the change process - that stage in
which Schein's disconforming forces
induce sufficient guilt-anxiety to
produce change. The deliberate
induction of guilt-anxiety within a
population targeted for change
obviously requires a certain amount of
ruthlessness. To some degree,
ruthlessness appears to be a necessary
factor in the change process.
But what happens when .the
ruthlessness required to motivate
change is unchecked, and like the genie
in the bottle, begins to dominate the
process it is intended to serve? In
nursing education. unchecked
ruthlessness can not only destroy the
much needed unity of society's largest
group of health professionals. but more
subtly. in its massive upheaval of the
status quo, it can submerge the original
objectives of the change process so that
they are lost. The process itself
becomes all important.
I would suggest that the dynamics
of the current movement to relocate
nursing education within the university
reflect both a high level of unchecked
ruthlessness, which in itself contains a
significant potential for backlash, and a
goal which is increasingly perceived in
terms of its form rather than its
substance. It is the unÎl'ersity degree
that is becoming important. rather than
what it represents - a unÎl'ersity
education.
No doubt, these dynamics have
developed as a re
ult of largely
unconscious forces. I believe,
however, that we must recognize the
dynamics for what they are. and take
decisive steps now to mitigate the
problems they are causing. This is the
only way to ensure a successful
relocation of nursing education.
The professional/technical split
Nursing has always prided itself on
being a helping profession. It would
appear however from the behavior of
the degreed elite towards the
non-degreed majority of nurses that
charity in nursing does not begin at
home. As one wag has put it "some
people get worse by degrees" - and
unfortunately there are too many
degree nurses who put themselves into
this category when they use their
achievement, consciously or
unconsciously, to devalue their
colleagues whose preparation has been
different from theirs.
Th. Cenedlen Nur..
April 197V 39
More and more. nurses are being
evaluated not on the basis of their
respective abilities and achievement.
but in terms of their possession of
either a diploma or degree. While the
general rule of thumb seems to be that,
all things being equal. the degree nurse
should be given job preference. what in
fact usually happens is that.\.whether or
not "things are equal". the degree
nurse gets thejol\
The persistent use of the terms
technical and profe'isional is another
attempt at differentiation which
unfortunately has derogatory
overtones. The degree nurse is
professional. the diploma nurse only
technical. even though the same
functions are frequently expected of
both. Such an attitude is indeed ironic
in view of recent statistics indicating
that roughly 90 per cent of all nurses in
Canada currently hold diplomas rather
than degrees."This same 90 per cent is
of course eligible for membership in
nursing's national and provincial
professional nursing associations. And
this important group obviously carries
approximately 90 per cent of the
associations' costs. Yet influential
spokesmen within the remaining 10 per
cent continuously press for recognition
of the degree nurse alone as the true
professional. What would happen to
other disciplines' professional
associations if 10 per cent of their
memberships were to attempt to
demote the other 90 per cent to
non-professional status?
In the United States, the split
between the two groups is widening
dangerously. RN Magazine
centlY
conducted a poll to discove how
nurses feel about an Americ Nurses
Association resolution designating 1985
as the point at which a bachelor's
degree wiJI be required for entry into
professional practic
. Of the ten
thousand nurses who responded to
RN's poll, the overwhelming majority
(72.7 per cent) opposed the proposed
professional/technical split.' And the
bare statistics were buttressed by the
published comments of the poll's
respondents, revealing an even more
appalling division within nursing over
this issue.
Mystique in motion
I f a profession as a whole is to have a
constructive impact on society. it must
enjoy a positive self-image. The current
attempt to treat the future of nursing
(an era when university preparation
will be the norm) as if it were already
here merely fans the flames of internal
frustration and discontent.
Furthermore, it fails to recognize the
important achievements of today's
nursing majority which has worked just
as diligently and well via the diploma
route as will tomorrow's nurses in the
university setting.
It is one thing for a minority to
raise a standard and lead a discipline
toward a worthwhile goal. It is quite
another thing for this minority to raise
the standard and then. without
allowance for lead time, proceed to
penalize the remainder of the discipline
for not having already reached the goal
toward \\0 hich the few are supposedly
leading it.
What the nursing elite is doing to
the rank and file of registered nursing
is. in my view, both demoralizing to
nurses themselves and subtly
antithetical to optimal patient care. The
public deserves to be served by a
profession that is psychologically
whole. not torn apart by internal
attempts to de-professionalize its own
majority. Nursing might be currently
described as "its own worst enemy".
May we as a profession recognize this
before it is too late. ...
References
I Robinson. Victor. White caps,
the story of nursing, Philadelphia,
Lippincott, 1946.
2 Schein,EdgarHenry.
Professional education; some new
directions, by... with the assistance of
Diane W. Kommers. New York,
McGraw-Hili, 1972.
3 Canada. Statistics Canada.
Nursing in Canada: ('anadian nursing
statistics, 1977. Ottawa, Information
Canada, 1978. Table 2. p.21.
4 Lee, Anthony. No! Seven out of
ten nurses oppose the
professional/technical split. RN
42: I :83-93, Jan. 1979.
Jeanne Marie Hurd(B.A., Ohio
Wesleyan Uni\'ersity; M.A., Columbia
Unh'ersitv; M.N., Yale Universitv) has
taught nursing in both Canadian and
American unÌ\'ersit;e.{. Prior to mewing
to Ottawa, she was a senior program
consultant with Manitoba's
Department of Health and Social
De\'elopment. She is currently engaged
in writing, teaching and consulting (the
latter in the area of maternal and child
health).
T
The role of the family
in the emergency department
Do family members waiting in an emergency department want to be kept informed of
the patient's progress? Would they like to see the patient at the bedside? Could these
relatives take a more active role in emergency? Do they want to be more involved in
the patient's care? Author, Wendy McKnight Nicklin takes a look at these questions
and comes up with some suggestions for nurses who work in an ER.
Wendv McKnif!ht Nick/in
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The Cenedlen Nurse
Aprl11979 41
. 'I tOO/... my friend up to the hMpital
yesterday. He had had .{tomach pains
and plloned me for ad\';ce abolll what he
should do to Ret rid (
fthem.1 felt that lie
should go to the emergency room, so 1
dro\'e him O\'er. Do you /...now. 1 waited
for three hours and not onre did anyhody
tell me whllt was lIappening.1 was
worried. Not only that but 1 missed
supper and a dentist's appoi"'ment.
There's got to be a better way."
Sound familiar? Compare it to the story
of:\frs. F. She brought her husband to
emergency after he had experienced his
first bout of renal colic. Mrs. F. states:
"They are wonderful at that hospital.
The nurse kept me informed of what wa<;
happening and I was even allowed to see
George. I was sure relieved to know that
he was promptly given a drug to lessen
the pain. The doctor spoke with me later
when we were about to leave' and
explained everything. Wejust hope the
pain doesn't return. ,.
From these two incidents. it appears
that the degree of satisfaction
experienced by a friend or relative during
an emergency room visit depends largely
on the nature of the contact he has with
the patient and the health care personnel
in that hospital. Whether the visit is
anxiety-provoking or anxiety-relieving
would appear to be influenced by
whether or not he feels involved in or
informed of the patient's care and
progress. How does the friend or
relative acquire this information? How
much and what kind of information does
he need? How can we best assist the
family while a patient is being treated in
the emergency department?
Present role ofthe
family in acute illness
It is clear that the family plays an
'important role in the pre-hospital phase
of a patient's illness. Individuals who
become ill usually experiment with a
treatment such as aspirin that they can
take at home to relieve their symptoms.
If the remedy is ineffective and their
condition persists or worsens, a relative
or friend is often called upon for advice.
This "consultant" may suggest another
remedy and. failing that, may suggest
that the patient contact his doctor or
proceed to the nearest emergency
department. The decision to go to
emergency is seldÇ)m made by the patient
alone. Following this interaction, the
relative u<;ually drives or accompanies
the patient to the hospital.
Once at the emergency department
however. the role of this "helper" is
minimized and the hospital takes over
meeting the patient's needs. This may be
a welcome relief for many family
members who are only too willing to
relinquish the responsibility of caring for
a sick relative to tmined personnel. But if
the patient's condition does not require
hospitalization and he is discharged. the
family is once more in a position of
responsibility. Too often. relatives leave
an emergency department without
having had an opportunity to speak with
a nurse or doctor about the patient's
condition or treatment regime. But it is
the relative who may initiate some form
of treatment and offer reassurance to the
patient if his symptoms reappear. or if.
for example. the prescribed antihiotics
do not immediately reduce the patient'<;
fever.
It is evident that relatives and close
friends of the patient playa large part in
the patient's welfare both pre and post
hospital visit. Bearing this in mind. is
there potential for a more active role for
relatives in the emergency room? Can
these relatives serve to increase their
0\\ n satisfaction with the patient's care?
Do they want to be more involved in the
care?
The potential role of relathes
I. Historian
Family members can prove to be a
source ofvaluable information about the
patient. But this will only be discovered
if the relative is permitted at.the patient's
bedside or if nurses and physicians take
the time to talk to relatives. The patient
may not be able to provide a complete
medical history or information about his
present illness because of his physical
condition and his anxiety level. Relatives
might be able to fill in the details. As
well. they may have observations to
share about the patient's health or
illness. observations that the patient may
have forgotten or consider insignificant.
The case ofMr. and Mrs. A. serves
to illustrate how helpful a relative can be:
Mr. A., a 54-year-old married
executÌ\'e, was brought to the emergency
room by a co-worker at !3oo hours. He
had de\'eloped numbness in his left arm.
a symptom which made the doctors
suspect a cardiac condition. H owe\'er,
an ECG and blood tests did not support
their diagnosis. His past history did not
put him at 'high risk 'for cardiac disease.
By 17oo hours, the doctors were still
pu;:z/ed and hesitant to discharge Mr. A.
until the diagnosis could be made. At
that point, his w{fe was permitted at his
bedside and chatted with her hushand.
After an hour, DoctorT. returned and
told Mr. and Mr.L A. that "in all honesty
1 am really stumped". Then Dr. T. said,
"Are you sure you'\'e ne\'er had a diJC
prohlem with your neck in tile past?"
.'vir. A. emphatically replied, . '/'\'e nner
had that at a:l. 1 told you that hefore. "
Mrs. A. interrupted her husband and
said, "Bill Joe, don't you rememher. 15
\'ean ago, when you fell down the stairs
and had to wear a nec/... collarfor se\'eral
weeks?" Mn. A. was the indh'idual who
found the missing piece of the pu;:z/e.
2. Supporti\'e role
The significant supportive role which the
family can fulfil for the patient i<; well
documented. Brouse attributes this to
the fact "that the family is concerned
and acknowledges that the patient is in
trouble. '" I n a discus<;ion of cri'iis
theory. Robi'ichon considers the family
as the most outstanding force in the
individual's environment. 'The presence
ofa <;upportive relallve at the patient's
bed<;ide can reduce the patient's anxiety
level and this might ultimately enhance
the effectiveness of the treatment
regime. e.g. the more relaxed the patient.
the more effective the analgesic.
3. Aide to nurse.{
A relative at the bedside may be able to
assist in meeting some of the patient's
basic needs, thus leaving the nurses free
for other patient assessments. For
instance. while the nurse is caring for
other patients. this relative may assist
the patient in ohtaining his Kleenex. eye
glasses or perhaps making a phone call
for him if desired. Further. if the
patient's symptoms worsen or change
(e.g. he becomes nauseated or
lightheaded) the relative may prove to be
most helpful if he in turn reports this
change to the nurse.
It appears that the family could be
more involved in patient care - an
involvement that could benefit the
patient, family and the staff. The degree
of involvement could vary from simply
being kept informed of the patient's
condition by the staff to being permitted
to be with the patient for periods of time.
In either case, relatives will increase
their awareness of what is going on-
through di<;cussions with the nurse or
doctor. by discussions with the patient.
or by making direct observations of the
patient and his surroundings when at the
bedside.
However. does the family want to
be more involved? Do they want to be
kept informed of the patient's progre<;<;
and/or to see the patient? Or. are these
false assumptions?
42 April 197V
The Cenedlen Nurse
The needs of the fami!}
in the emergency room
Recently, 1 conducted a study into the
needs of the family in emergency room
waiting areas. The sample consisted of
60 relatives, 30 from each of two
emergency department waiting rooms.
These relatives were approached about
participation in the study one hour after
their arrival with a patient at the hospital.
1 contacted those who agreed to
participate by telephone the following
day and asked them to respond to a
question naire.
The results indicated that all waiting
relatives want [0 receive information
about the patient's progress. It was
interesting to note as well that 51 of these
relatives (85 per cent) wanted some
degree of personal contact with the
patient during the emergency room visits
- to be at the bedside even for just a few
minutes. A significant finding, however,
was that even though all relatives wanted
to be kept informed, only 27 (45 per cent)
of them initiated action to obtain
information about the patient. For these
relatives, certain factors seemed to
transform this 'want' for information into
a 'need'.
Perhaps by understanding the
factors that influence relatives to
actively request information, we might
better understand our role in conveying
information about the patient and the
importance of involving the relatives as
much as possible. On the other side of
the coin, if conveying information serves
no useful purpose except ensuring that
individuals are satisfied, then is it worth
our time and energy?
Factors influencing the
need for information
The study results indicated that a
relative's first encounter with an
emergency department results in a
greater need for information than on
subsequent visits. The first exposure to an
emergency room setting serves as a
learning experience for the relative, so
that subsequent waits in emergency,
regardless of who the patient is, do not
seem to elicit as great a need for
information as that first visit.
During this initial visit, the
uncertainties associated with how the
emergency department operates and
what to expect may be
anxiety-provoking, resultÍng in a "need"
to obtain mformation to decrease the
degree of unknown. During future visits,
this same relative may still desire
information. However, he is now
famiJiar with the overall routine and
process of delivering emergency care so
that his need for information is slightly
less than during the first visit. The
following case illustrates this finding:
:.-......... 111
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Mrs. R. brought her 45-year-old
husband to the hospital. He was pale,
diaphoretic and complaining of a
'pressure 'feeling in his chest. He was
immediately ta!..en into the treatment
area. After registering her husband,
Mrs. R. waited quietly in the emergency
department waiting room. She remained
standing for the next hour but did not
once seek information about her spouse.
After an hour and a half, a nurse
informed her that Mr. R. would be
transferred to the Coronary Care Unit
momentarily.
The following day, J contacted Mrs.
R. in order to ascertain her feelings
about the visit. She explained that she
did not askfor information because,
"/','e been through this before. My
husband had a heart attack a year ago
and J know what is likely happening.
They'll tell me when they can." Mrs. R.
had wanted information during the "is it
yet her familiarity with the environment
permitted her to cope with the unmet
need.
....
The more acute the patient's
condition, the greater the need for
information. In other words, the relative
accompanying the patient sutlering from
an asthmatic attack is more likely to need
information than the relative
accompanying the patient with a bad
cold.
Relatives who accompany patients
with a condition of a vague nature such
as abdominal pain also tended to seek
out information about the patient's
progress. Conditions like thi., often
necessitate a wait of two or three hours
and usually require a number of
diagnostic tests before a differential
diagnosis can be made. Perhaps the
nonspecific nature ofthe symptom is
anxiety-provoking for relatives and
consequently the need for information is
high in order to lessen the associated
degree of anxiety.
A third factor influencing the need
for informatior: was the environment in
which the family must wait. The study
revealed that a waiting room which
meets the basic needs of the users (i.e.
easily accessible and visible washrooms,
vending machines and telephones)
tended to reduce their anxiety level and
thus their need for information. This kind
of environment seemed to lessen the
uneasiness associated with the
emergency visit, thereby enhancing their
ability to cope with the experience.
Within this setting, the visible presence
of a nurse who could give them
information also seemed reassuring.
In contrast to this, another
emergency department where
washrooms, vending machines and
telephones were difficult to find, the
registration process confusing and clerks
the chief source of information, proved
to be anxiety-provoking for relatives.
This second setting seemed to increase
the relatives' need to obtain information
about the patient.
/' Although three separate factors -
past experience, the nature of the
patient's condition, and the environment
- appear to have influenced the family's
level of anxiety and the need for
information, in
ssence it is the
interrelation of all these factors that
determined the coping abiJity of relatives
and friends.
/ The results of the study indicate that
a relative's need for information
increases in direct proportion to his level
of anxiety. This anxiety is related to the
degree of 'unknown' inherent in the
situation. Thus, attempting to obtain
information (to feel involved in the
situation by being aware of what is
happening) either verbally from a nurse
or doctor or by making observations at
the patient's bedside is a strategy used
by relatives to lower their anxiety level.
The Cønedløn Nurse
,
April 111711 43
What does all thie; mean? I t has been
shown that the family hae; a potential role
to play in the patient's care. It is also
evident that most relatives want to be
more involved in the care - at least, to
be kept informed. Receiving
information. no matter how little, will
likely serve to decrease the level of
anxiety experienced by relatives.
As previously stated. since the
relatives will possibly be caring for the
patient after discharge, the more they
understand about the patient's condition
and the prescribed treatment regime. the
better they will be able to ae;sist the
patient during the recovery phase. It has
been noted that relatives or close friends
can be "just as re<;pon<;ible for the
patient's not following doctor's orders or
not returning for further treatment ac; are
the cessation of symptoms and the
patient's personal opinions about proper
treatment..'"
As nurses working in the emergency
department, how can we help to develop
a role for the family based on their need
for involvement?
Some suggestions
Not all individuals who are waiting for
patients in an emergency department
desire the same type or amount of
information. Some relatives may be
satisfied with a brief explanation of the \
patient's condition: others may want an
in-depth explanation of the treatment
regime. while still others may want no
explanation at all. They may just want to
be at the patient's bedside. Therefore. in '
attempting to develop a role for the
family in emergency care, it is important
to assess each case individually and not
to stereotype the needs of all relatives.
Consider the case of M rs. B. She
accompanied her 72-year-old husband to
hospital in the ambulance. He I\'as in
respiratory distress due to Chronic
Obstructil'e Lunl? Disease and had
I'Üited the emergency department and
clinics many times before. On arrival to
hospital. Mrs. B. sat quietly outside of
the treatme11f area and after half an
hour, a nurse in the area informed her of
her husband's condition. During the
c01!l'ersation Mrs. B. explained her
husband's illness history to the nurse. At
that poi11f the nurse asJ..ed her if she
wished to see her husband or not. Her
reply was' 'N 0, thank vou. I will go and
wait in the waiting area. We have been
through this many times before and my
presence does not allow him to relax. As
long as you tell me what is happenin!?
and that he J..nol\'s I am here, I'll be
C011fe11f in the waiting room." This
woman J..new better than the staff what
her husband's reactions to her presence
might be.
Thus the first step in conveying /
information to the family i<; to briefly
a<;sess their need for involvement. What
do the\' want to know? Find out if they
understand what ha<; been explained to
them and note how they interpret the
situation. You may be surprised to hear
the various erroneous interpretations
given to a supposedly simple
explanation. Attempt to meet the
relative's expressed need for
information. This need not be a
time-consuming interaction - quality of
explanation. not quantit} is the essential
ingredient.
If the patient's treatment regime and
condition permit. ask the relative
whether or not he wishes to see the
patient. In Mrs. B.'s case, she did not
want to <;ee her husband. Conversely.
ask the patient if he desires the
encounter. Ifboth parties want to see
each other. then the ensuing encounter
will likely be therapeutic and lessen
anxiety. The supportive ability of the
relative should also be assessed. The
hysterical wife will be of little support to
her sick husband. However. the rational
and calm individual may be of definite
value in assisting the patient to cope with
his illness.
Before the patient is discharged. it is
essential that the emergency room <;taff
involve the relatives in discharge
teaching. As mentioned earlier, relatives
need to obtain information about the
patienCs condition and his treatment in
order to help him at home. When Mrs.
S.. a waiting relative. was asked why she
thought the family should be involved in
the treatment process. she replied. 'The
ramily must understand. We have to care
for the patient after he leaves the
hospital. His illness affects our whole
family'"
It is interesting to note that during
discharge teaching, the relatives often
ask important questions about the
treatment or <;upply information about
conditions at home that ER staff might
not have previously considered. When
giving explanations to the family and
patient, try to be simple and concise.
Anxiety interferes with an individuars
ability to understand and remember
details, so the simpler the explanation
the better.
Following discharge teaching. ask
the relative and/or patient to repeat what
has just been explained to them. By
using this technique. you can partially
assess their comprehension of the
discharge instructions. Typed handout
sheets with instructions are useful.
providing that time is taken to ensure
that the information is understood.
These sheets should not be used as an
excuse for decreasing the teaching time
required: they are only helpful if the
information is explained at the patient's
level of understanding.
Conclusion
In conclusion. if our goal i" to improve
the quality of patient care and if we
believe that the family can play an
important role In patient care. then the
responsibility falls on the nur<;es caring
for these patient<; and families to begin
involving the relatives to a greater degree
in the care being delivered.
Conveying information is not a time
consuming proce...s. As this becomes an
integral part of our care. it will become
as important and as automatic to u,; as
taking vital signs. In consideration of the
family's role in illne<;... - pre-hospital.
potentially during the hospital visit. and
post-hospital- it behooves us to deepen
our understanding of and involvement
with these significant indi"iduals. 40
References
I Brose. Carolyn. Theories offamily
cri<;is.1 n Family amI health care, edited
by Debra P. Hymovich and Martha
Underwood Barnard. Toronto.
McGraw-Hili. 1973. p.
gO.
2 Robischon. P. The challenge of
crisi<; theory for nursing. In Family
centred community nursing: 1I
socio-cultural frameworJ.., edited by
Adina Reinhardt and Mildred D. Quinn.
St. Louis, Mosby, 1973. p.
46.
3 Freidson, Eliot. Patient ,'iews of
medical practice. NY: Ru<;sel Sage
Foundation. 1961. p.147.
Bibliograph}
McKnight, Wendy. A descriptil'e study
of the information seeJ..ing behm'iour of
relatil'es in emergency room n'aitin!?
areas. Montreal. 1978. Research Paper
(M.Sc. (App.)) - McGill.
Author, Wend} Mcknight Nicklin
!?raduated from the Ottawa Ci\'Ïc
Hospital School of Nursing in /970 and
from McGill Unil'ersity in Montreal with
a B.N. degree in 1972. After I\'orking as a
staff nurse in the emerl?ency department
of the Ottal\'a Civic Hospital for a "ear,
she became im'olved with nursing
education both at Algonquin C ol/e!?e in
Ottawa and at Queen's UnÍl'ersit\, in
Kin!?ston.
The article, "The role of the family
in the emergency department" is based
on a research paper she completed for a
M.Sc. (A) degree from McGill in 1976.
Curre11fly, Wendy is worJ..in!? as a
clinical specialist in the emer!?ency
departme11f of the Ottawa Cil'Íc
Hospital.
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. expanded mformation on administration of drugs to t L -
elderly;
. chapter summaries that review key concepts in the
discussions
. new material on enzymes and drugs acting on gastromtpstinal
organs.
By Belly S. Bergersen. R.N., Ed.D. January, 1979. Approx.
784 pages. 100 illustrations About $20.50.
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3rd Edition
NUTRITION AND DIET THERAPY
Since publication of the first edition. this text has been a
leader in its field. This current edition continues - and exceeds
-that tradition of excellence. It focuses on the role of nutrition
in public health. in the basic health care specialties. and in the
clinical management of disease - all in the context of human
needs. Students will be particularly mterested in these new
items:
· authoritative sections on behavioral approaches to weight
control and utilizing the problem-oriented medical record:
· expanded information on minerals in the body, with emphasis
on zinc;
· new and revised tables, including the latest RDA.
By Sue Rodwell Williams, M.P H., M.R.Ed., Ph.D. 1977.741
pages, 134 illustrations. Price, $20.50.
New 2nd Edition
CLINICAL IMPLICATIONS
OF LABORATORY TESTS
When students ask questions on the significance of
laboratory test results. offer them this concise resource. Using
an effective. step-by-step approach, it first examines the routine
multisystem screening panels - routine unnalysis and
hematology screening and sequential multiple analyzer tests.
Subsequent chapters focus on evaluative and specific tests of
suspected disease entities. Throughout, the authors emphasize
physiological implications, variations, and interrelationships of
laboratory values.
New features:
· offers handy sections on patient preparation, instruction. and
aftercare;
· replaces the chapter on serodiagnostic tests with two new
chapters on rheumatoid and infectious diseases;
· provides an extensively revised chapter on gastroenterology;
· reflects the latest research m the table of normal values.
By Sarko M. Tilkian, M.D.. Mary Boudreau Conover, R.N.,
B.S.N.Ed.: and Ara G. Tilkian. M.D., F.A.C.C. January. 1979. 334
pages, 45 illustrations. Price, $10.75.
<:$
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A New Book
MEDICAL-SURGICAL NURSING:
Concepts and Clinical Practice
Uniting the benefits of both a conceptual and a systems
approach, this new text will be the best choice for your studentsl
The authors have organized information in a way to make It
easily accessible and have emphasized total patient care
throughout. A few key features of this important text are:
· a systems approach within a conceptual framework -
meaning your students will be able to locate important
information quickly and better understand how specific medical
details relate to total patient care;
· a beginning section on "Perspectives for Nursmg Practice"
offers a useful look at many issues your students will face;
· a vital section on stress and adaptation;
· a nursing process format is used in each clinical section-
where the authors first present a chapter on general assessment
of the involved bOdy system, then discuss specific management
techniques in a separate chapter
By Wilma J. Phipps. R.N., Ph.D.; Barbara C. Long. R.N.,
M.S.N.; and Nancy Fugate Woods, R.N., Ph.D. February, 1979
Approx. 1,600 pages, 735 illustrations. About $27.75.
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TIMES MIRROR
A New Book
BASIC PATHOPHYSIOLOGY:
A Conceptual Approach
The authors of this useful new text have organized the vast
field of pathophysiology into major conceptual areas. Your
students will study various disease entities as they relate to such
concepts as cellular deviation, body defenses. physical and
chemical equIlibrium. nutritional balance, reproductive and
endocrine integrity, and structural and motor integrity. Specific
noteworthy dIscussions investigate:
. immunopathology:
. aging as a genetic process;
. atherosclerosis;
. diabetes and obesity:
. immune viral organisms of human cancer.
Each chapter begins with learning objectives which can be
used to aid the student in self-evaluation.
By Maureen E. Groër. R.N., Ph.D. and Maureen E.
Shekleton, R N., M.S.N. February, 1979. Approx. 560 pages, 423
illustrations. About $19.25.
HEALTH ASSESSMENT
Written by nurses for nurses, this well-illustrated guide
provides practical methods for obtaining a complete history and
performing a thorough physical examination. Students will
especially benefit from discussions which:
. detail beneficial techniques for appraising client function;
. examine nutritional assessment, sleep-activity patterns,
and the use of clinical laboratory skills.
By Lois Malasanos, R.N, Ph.D.; Violet Barkauskas.
R.N.,C.N.M., M.P.H.; Munel Moss, R.N., M.A.; and Kathryn
Stoltenberg-Allen, R.N., M.S.N. 1977.538 pages, 769
illustrations. Price, $26.00.
A New Book
NURSING CARE OF INFANTS
AND CHILDREN
Using a systems approach, this new book provides a
comprehensive. practical look at pediatric nursing. The authors
not only examine care of the ill or disabled child, but also stress
promoting the health of the well child. Among the highlights
you'll find:
. pertinent guidelines for action,
. a distributive nursing care approach;
. lab data and pharmacology information;
. emphasis on and guidelines for communicating with children
and their families;
. an appendix of normal values and assessment tools.
By Lucille F. Whaley, R.N.. M.S. and Donna L. Wong, R.N.,
M.N., P.N.P. April, 1979 Approx. 1,408 pages, 746 illustrations
About $24.00.
Team up
with Mosby.
Basic
pathopbysiology
A CONCEPT JAl AI
Groer and 8ft
CD
C>
r
MATERNITY CARE:
The Nurse and The Family
Both contemporary and humanistic in approach. this
important volume can help the student function more effectively
as a maternity nurse in today's changing society. Following the
chronologie order of childbirth. it discusses the biopsychosociaJ
aspects of human sexuality, then proceeds to family planning,
pregnancy, interferences with normal pregnancy, labor and its
complications, the post-partum period, and both normal and
high-risk infants. Throughout. the authors:
. integrate diagnostic, therapeutic. and educatIOnal objectives;
. present intervention plans;
. combine clinical and psychosocial aspects.
Timely discussions explore such key topics as genetics.
legal factors, fathering, and P.D.M.R.
By Margaret Duncan Jensen. R.N., M.S.; Ralph C. Bensen,
M.D.; and Irene M. Bobak, R.N., M.S.; with 2 contributors. 1977.
784 pages, 684 illustrations. Price, $24.00.
",.
w 2nd E:.dltlcn
CHILD HEALTH MAINTENANCE:
Concepts in Family-Centered Care
Students will benefit from the integrat _n t.f at....
approach. a problem-solving framework. and a stron1.,rr
on the holistic person of the child, in this new E" jihon , fan
exciting text. It reflects contemporary advances in dlagno_ .> _fJd
quality assurance as It examines such tOpiCS as problems of
single parent families, care of the terminally ill child, high risk
infants. nursing assessment, and specific health problems. This
new edition also offers:
e a definitive section on competencies - physical, learning.
social, and inner;
e major sections on health promotion and prevention of illness;
e revised discussions of the family unit;
e an expanded chapter on high risk infants - including
cardiopulmonary disorders, mfection, and GI disturbances;
e thought-provokmg discussions of Juvenile and adolescent
rape victims.
By Peggy L. Chmn, R.N., Ph D March,1979 Approx 896
pages, 377 illustrations. About $24.00.
New 2nd Edition
CHILD HEALTH
MAINTENANCE: A Guide
to Clinical Assessment
This concise text serves as both a student-oriented learning
guide for comprehensive health assessment and as a source of
information for effective pediatric care The authors present a
wealth of information on developmental differences observed
from birth through adolescence - indicating possible
deviations and their health care implications. This edition also
incorporates these valuable new insights:
e an authoritative chapter on assessment of learning, thought.
social. and inner competencies;
e a detailer! chapter on norms and standards for nursing
assessment and intervention providmg nOrmal
growth/development charts. recommended schedules for
Immunization and laboratory procedures;
e a new chapter on assessment tools and case audit gUides-
suggesting guidelines for family. mfant. child. and play
assessment
By Peggy L. Chinn, R.N., Ph.D. and Cynthia J. Leitch, R.N.,
Ph.D. March. 1979 Approx. 176 pages. 24 illustrations. About
$9.75.
".
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,
Child healÖ1
malrrtenance
.
,
.
.
,
A New Book
PRINCIPLES AND PRACTICE
OF PSYCHIATRIC NURSING
Using a nursing-oriented conceptual approach to
psychiatric nursing. this text describes man's adaptation to
illness. and identifies nursing diagnoses and specific nursing
interventions.
· Part I is organized according to specific nursing diagnoses-
anxiety, disruption in the communication process, and grief, for
example;
· Part" exammes various therapeutic modalities presenlly in
use;
· throughout, the authors stress nursing interventions and the
application of the nursing process.
By Gail Wiscarz Stuart, R.N., M.S., C.N.: and Sandra J.
Sundeen. R.N.. M.S.: with 15 contributors. May. 1979 Approx
736 pages. 24 illustrations. About $20.50.
A New Book
COMMUNITY HEALTH CARE
AND THE NURSING PROCESS
Help your students stay mformed of the exciting new
changes in community health nursmg with this comprehensive
text. Its timely discussions provide a holistic view of human
development by stressing three basic concepts: the health-
illness continuum: humankind as an open system that always
relates to and interacts with its environment; and the effects of
various situations, health problems. and stressors on the health
and development of the individual, family. and community.
Student-oriented features include:
· an eclectic approach to community nursmg;
· up-to-date discussions - both m concept and content
· fascinating case studies to develop the thinking process and
stimulate the ability to make creative Judgments;
· the insights of noted contributors.
By Margot Joan Fromer, B.S., M.A.: with 7
contributors. January, 1979 484 pages, 110 illustrations Price.
$18.00.
IVIDSBV
TIMES MIRRDR
THE C. V. MOSBY COMPANY, LTO.
86 NORTHLINE ROAO
TORONTO. ONTARIO
M48 3E5
A90430
43 Aprl/1979
(continued from page 16)
Ad\ances in research and
ser\ices for children \\ith
special needs. An international
conference to be held at the
University of British
Columbia, Vancouver, B.C.
on June 18-19, 1979. Conract:
Dr. Geraldine Schwllrt
.
Conference C o-ordifllltor.
ChiÌdren'sHospital,l50 West
59th AI'e., VlInco/ll'er. B.C.,
V5X IXl.
Annual Meeting of the
Canadian Lung Association.
Canadian Thoracic Society and
the Canadian Nurses
Respiratory Society to be held
at the Sheraton Centre Hotel.
Toronto. Ontario on June
25-27,1979. Contact: Huhert
Drouin, Executil'e Secretary,
ClInlldian Lung A.uodation.
75 Alhert St., Suite 90B,
Ottall'a. Ontario. KIP 5E7.
Canadian Physiotherapy
Association Congress '79 to be
held in Victoria. B.C. on June
12-16,1979. Contact: c.P.A.
Congress '79,30 Beach Dr.,
Victoria, B.C., VBS 2L2.
The Canedlen Nurae
New Brunswick Association of
Registered Nurses Annual
Meeting to be held on June
5-7, 1979 in Moncton, N.S.
Contact:NBARN,231
Saunders St., Fredericton,
N.B., E3B IN6.
Association of Nurses of Prince
Edward Island Annual
Meeting to be held May 30
in Charlottetown. Contact:
ANPEI. 41 Palmers Llme,
Charlottetoll'fl, P.E./.. CIA
5V7.
August
Chautaugua '79. Continuing
education symposium to be
held in Vail. Colorado. August
4-11. 1979. Contact: Colorado
Nunes Association, 5453 Ellst
EI'lIns Place, Delll'er, Co.
l?Ol22.
September
Atlantic Operating Room
Nurses Conference to be held
at the Confederation Centre in
Charlottetown, P.E.I. on
Sept. 24-26, 1979. Contact:
When a person is get-
ting on in years, constipa-
tion may become a
problem, The bowel
needs a little gentle
encouragement. Why not
recommend a laxative that
works slowly, gently and
effectively. That's the
Metamucil way.
IEJ1 D æJÆJTIf
L" ':^ê. 1
Metamucil is made
)
from (gluten-free) grain, fv'{) (
I
providing fiber that '1....
produces soft, fully formed
stools to promote regular
bowel function. Metamucil
powderislowinsodium r;, I
and may be preferred for r r .
the treatment of constipa- I v
tion in geriatric and ........
cardiac patients.
Available as a powder (low m 2 \ ( \
sodium) and a lemon-lime flavoured . ",-' \ ) "....,
Instant Mix (low in calones). C
Why not give your patients our
helpful booklet about constlpatlOn? .
Metalnuåf
ii\ _
II .,
PAAB
ccpp
-
-,-
. .
Marilyn Driscoll. R.N.,
Charlottetown Hospital,
Charlottetown, P.E./.
Ontario Assembly of
Emergency Care 2nd Annual
Meeting to be held at the
Skyline Hotel in Toronto on
Sept. 23-26, 1979. Contact:
R.H.L.Ga//il'er, M.D.,
Department of Emergency
Medicine, St. Joseph's
Hospital, 30 The Queell.nmy,
Toronto, Ontario, M6R IB5.
10th International Conference
on Health Education to be held
in London, England on Sept.
2-7,1979. Theme: Health
education in action -
achievements and priorities.
Contact: The Conference
Centre, 43 Sf. Charles St.,
Ma)iair, London, WIX 7PB,
England.
October
Association of Registered
Nurses of Newfoundland
Annual Meeting to be held on
Oct. 1-3. 1979. Contact:
ARNN,67 LeMarchant Rd..
St. John's, Newfoundland.
AIC 6AI.
Second National Symposium of
the Canadian Infection Control
Association. To be held in
Toronto on October 18-20,
1979. Original papers are
invited for presenration.
Contact: Elaine Magder, 586
Merton St., Toronto, Omario,
M4S IB3.
Ontario Public Health
Association 30th Annual
Meeting to be held at the
Constellation Hotel. Toronto
on Oct. 14-17,1979.Contact:
Kae Sutherland, Office
Secretary, OPHA, 7Carlis
Place, PorrCredit, Ontario,
L5G lAB.
Did you know...
Nurses' selfstudy programs
covering a variety of topics
are available for both
individuals and groups.
Contact: Continuing
Education, Faculty of
Eaension, The Unil'ersity of
Alherta, Corbett Hall,
Edmonton, Alberta, T6G 2G4.
v
.'
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The laxative most recommended by Physicians.
ONE-STOP
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ate 20% Solution
d-spectrum antiseptic
Jerative patient
3ral disinfectant use.
. antiseptic line lives up to a
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;e. More and more Canadian
T their prime source of
mation. If you would like to
f these products, contact your
Implete and retum this coupon.
AYERST LABORATORIES [ - . .
ision of Ayerst, McKenna & Harrison limited A
Quol
t hos tu t
Montreal, Canada '7 '-Þ I
I I no SUI>> I e
["M"cl
_
*Reg'd
ilBITANE and SAVlON made on Canada by arrangement with IMPERIAL CHEMICAL
NDUSTRIES LIMITED
\
SAVLON* Hospital Concentrate
a detergent antiseptic combining the
bactericide HIBITANE with the detergent
properties of cetrimide B.P. for the majority
of hospital antiseptic requirements.
SONACIDE*
potentiated acid glutaraldehyde 2%, a
disinfecting and sterilizing solution for
processing respiratory and anesthetië
equipment.
,--------------
TO AYERST LABORATORIES
I 1025 Laurentian Blvd., Montreal, Quebec. H4R 1J6
I
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I NAME
I ADDRESS
I NO
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I would like to receive information on:
- Hibitane* Skin Cleanser r Savlon * Hospital Concentrate
Sonacide*
(PLEASE PRINT)
STREET
48 April 1979
(continued from page 161
Ad'\ances in research and
senices for children "ith
special needs. An international
conference to be held at the
University of British
Columbia, Vancouver. B.C.
on June 18-19, 1979. Contact:
Dr. Geraldine Schll'art
,
Conference Co-ordinator,
Children'sHo
pital, 250 West
59th A \'e., 1/1lI1Coul'er, B.C.,
V5X IX2.
Annual Meeting of the
Canadian Lung Association,
Canadian Thoracic Society and
the Canadian Nurses
Respiratory Societ) to be held
at the Sheraton Centre Hotel,
Toronto. Ontario on June
25-27.1979. lontact:Huhert
Drouin. Executil'e Secretary,
Canadian Lung A ssoC'Ïation,
75 Alhert St., Suite 908,
Ottm\'([, Ontario, KIP 5E7.
Canadian Physiotherapy
Association Congress '79 to be
held in Victoria, B.C. on June
12-16,1979. Contact: c.P.A.
Congress '79,30 Beach Dr.,
Victoria, B.C., 1/8S 2L2.
The Cenedlen Nurs.
New Brunswick Association of
Registered Nurses Annual
Meeting to be held on June
5-7. 1979 in Moncton, N.S.
Contact: NBARN, 231
Saunders St.. Fredericton,
N.B., E3B IN6.
Association of Nurses of Prince
Edward Island Annual
Meeting to be held May 30
in Charlottetown. Contact:
AN PEl. 41 Palmers Lane,
Charlottetoll'n, P.E.I., CIA
51/7.
August
Chautaugua '79. Continuing
education symposium to be
held in Vail. Colorado. August
4-11, 1979. Contact: Colorado
Nurses Association. 5453 Ea.
t
EI'tl1l.l" Place, Delll'er, Co.
80222.
September
Atlantic Operating Room
Nurses Conference to be held
at the Confederation Centre in
Charlottetown, P.E.1. on
Sept. 24-26, 1979. Contact:
When a person is get-
ting on in years, constIpa-
tion may become a
problem. The bowel
needs a little gentle
encouragement. Why not
recommend a laxative that
works slowly, gently and
effectively. That's the
Metamucil way.
'íjì ,
-- \ .. -
,-
PAAB
CC PP --=====-
. .
Marilyn Driscoll, R.N.,
Charlottetoll'n Hospital,
C Iwrlottetoll'n, P.E.I.
Ontario Assembly of
Emergency Care 2nd Annual
Meeting to be held at the
Skyline Hotel in Toronto on
Sept. 23-26, 1979. Contact:
R.H.L.Gallil'er, M.D.,
Department of Emergency
Medicine, Sr. Joseph's
Hospital, 30 The Queensway,
Toronto, Ontario, M6R IB5.
10th International Conference
on Health Education to be held
in London, England on Sept.
2-7,1979. Theme: Health
education in action -
achievements and priorities.
Contact: The Conference
Ce1!tre, 43 St. Charles St.,
Ma:\,fair, London, WI X 7PB,
England.
October
Association of Registered
Nurses of Newfoundland
Annual Meetin
to be held on
Oct. 1-3, 1979. Contact:
ARNN, 67 LeMarchant Rd.,
Metamucil is made
from (gluten-free) grain,
providing fiber that
produces soft, fully formed
stools to promote regular
bowel function. Metamucil
St. John's, Newfoundland,
AIC 6A1.
Second National Symposium of
the Canadian Infection Control
Association. To be held in
Toronto on October 18-20,
1979. Original papers are
invited for presentation.
lontact:Elaine Magder, 5R6
Merton St., Toronto, Ontario,
M4S IB3.
Ontario Public Health
Association 30th Annual
Meeting to be held at the
Constellation Hotel, Toronto
onOct.14-17,1979.Contact:
Kae Sutherland, Office
Secretary, OPHA, 7Carlis
Place, Port Credit, Ontario,
DG IA8.
Did you know...
urses. self study programs
covering a variety oftopics
are available for both
individuals and groups.
Contact: C o1!tinuing
Education, Faculty of
Eaension, The Unil'ersitv of
Alherta, Corbett Hall,
Edmo1!ton, Alherta, T6G 2G4.
;;:tJ
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V1
m
Available as a powder (low in 2 \ (
sodium) and a lemon-lime fl . avoured .
\
Instant Mix (low in calories). C
Why not give your patients our
helpful booklet about constipation? .
Metaln1
The laxative most recommended by Physicians.
ONE-STOP
SHOPPING
for most
of your
antiseptic
needs
.
-
,;t
,--
I"
t-
...
I
-'"
.._;; "
.......--!J!!. J
-"
'
J, j
Jil
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.
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,
-
HIBITANE* Skin Cleanser
a sudsing, antiseptic cleaning solution
containing 4% w/v chlorhexidine gluconate
for preoperative scrub-up and general hand
washing.
HIBITANE* Gluconate 20% Solution
:l multipurpose, broad-spectrum antiseptic
::;öncentrate for preoperative patient
preparation, and general disinfectant use.
=ach product in the AYERST antiseptic line lives up to a
Nell-earned reputation for quality which is backed by
I\YERSrS technical expertise. More and more Canadian
,ospitals are making A YERST their prime source of
mtiseptic products and information. If you would like to
mow more about any or all of these products, contact your
WERST representative or complete and return this coupon.
AYERST LABORATORIES
,sion of Ayerst, McKenna & Harrison limiled A
. Quoli
t hos t t
Montreal, Canada '7
no SUI>> I U e
.....AC)
. R ' d
_. eg
ilBITANE and SAVLON made ,n Canada by arrangement with IMPERIAL CHEMICAL
NDUSTRIE LI I ED
4W 4
4,
f4
\,
.....
"
..,
.
...
..
" :;I..:;
......f """....
t
I
SAVLON* Hospital Concentrate
a detergent antiseptic combining the
bactericide HIBITANE with the detergent
properties of cetrimide B.P. for the majority
of hospital antiseptic requirements.
SONACIDE*
potentiated acid glutaraldehyde 2%, a
disinfecting and sterilizing solution for
processing respiratory and anesthetië
equipment.
,--------------
TO AYERST LABORATORIES
I 1025 Laurentian Blvd.. Montreal, Quebec. H4R 1J6
I
I 0 Hibitane" Gluconate
I 20% Solution
I NAME
I ADDRESS
I NO
I CITY
I would like to receive information on:
-= Hibitane* Skin Cleanser r Savlon * Hospital Concentrate
Sonacide"
- ( PLEA SE PR INT)
STREET
50 April 1979
The C.n-.llen Nur..
names & faces
Kathie M. Clark was recently
appointed as the new
education co-ordinator for the
Registered Nurses
Association of Ontario. She
will be responsible for
associations and agencies, and
developing briefs and
statements in response to
issues relating to nursing
education.
Clark graduated with her
BScN from the University of
Toronto and worked at the
Clarke Institute of Psychiatry
in Toronto as an assistant
head nurse and clinical
instructor. In 1968 she moved
to British Columbia where she
worked in a variety of
teaching and clinical settings
at the University of British
Columbia. She then
completed her Master's
degree in adult education at
UBC focusing on self directed
learning and nurses'leveis of
participation in continuing
education.
planning RNAO workshops
and conferences,
co-ordinating continuing
education courses with allied
CNA NATIONAL FORUM
ON NURSING EDUCATION
13, 14, 15 November 1979
SKYUNE HOTEL- OTTAWA
Theme: The nature of nursing education
Focus: What is basic nursing education? Diploma or degree?
ð
.
. Nursing model and the Curriculum
. Nursing specialization
. Accreditation
OPEN TO ALL REGISTERED NURSES
- MAXIMUM OF 300 . . .
CNA Members -$100
Non-Members - $175
Complete program details and registration fonn in coming
issue or write The Canadian Nurses Association, 50 The
Driveway, Ottawa, Ont. K2P IE2. Tel. (613) 237-2133.
PLAN AHEAD AND REGISTER EARLY
Edith May Radley, a Manitoba
nurse who has spent most of
the last 30 years providing
health care to the Umbundu
people of central Angola in
Africa, will be among 64
Canadians to be invested with
this country's highest
distinction, The Order of
Canada, at a ceremony this
Spring. A graduate of Dauphin
General Hospital, Radley also
attended the University of
Manitoba in Winnipeg and
Seneca College in Toronto.
A number of nurses were
honored by being invested in
the Order of St. John in late
1978. They include:
In the Grade of Commander
Sister
Margaret Mary Matheson,
Stellarton, N.S.
Vida McDonald, North
Battleford, Sask.
In the Grade of Officer
Gisèle Corre. Montréal, Que.
Florence Lorraine Davies,
Ottawa, Onto
Marie des Anges Loyer,
Ottawa, Ont.
Françoise Savard, Montréal,
Que.
In the Gr-dde of Serving Sister
Anne Marie Bélanger, OMM,
CD, Ottawa, Ont.
Jacqueline Côté, St-Bruno,
Que.
Patricia Lynn Gibson, Miami,
Man.
Audrey May Goodchild,
Victoria, B.C.
Margaret Mary McEachern,
Edmonton, Alta.
Eleanor M. Snider, Fonthill,
Onto
Jeanine Tellier-Cormier, Trois
Rivières, Que.
Patricia M. Harris, Orillia,
Onto
The order of St. John is an
ancient order of chivalry and
the investiture of nurses is
reserved for those who have
served in the brigade as
nursing officers for a period of
time on a voluntary basis.
Agatha Gertrude Lowe, a
native of Barbados, West
Indies, and a long-time
resident of Hamilton, Ontario,
has recently joined the Project
HOPE medical education
program in Natal, BraziL She
will conduct a training
program in community health
nursing.
Lowe received her
nursing degrees from the
University of Western Ontario
and the University of Toronto.
She also holds a master's in
health education from The
Pennsylvania State
University.
Prior to joining Project
HOPE, Lowe was assistant
professor of nursing at
McMaster University in
Hamilton. She will serve with
HOPE in Brazil for -
approximately two years.
'"
Jacqueline Steward has been
appointed nursing consultant
for nursing practice - with
the 7000 member New
Brunswick Association of
Registered Nurses.
Steward, who is a
graduate of the Royal Victoria
Hospital School of Nursing,
Montreal and the University
of New Brunswick (BN) will
act in a consultative and
advisory capacity to nurses
employed in the provincial
health care delivery system.
Beforejoining the
N BARN staff, Steward
was head nurse in the special
care unit of the Doctor
Everett Chalmers Hospital,
Fredericton.
The C.nedl.n Nur..
April 111711 51
books
New hope for deprived children. by
Betty M. Flint. 200 pages. Toronto,
University of Toronto Press, 1978.
Approximate price-$/2.50.
Although basicaJly a report on the
conception, planning. implementation
and outcome of a longitudinal study of a
group of severely deprived children, this
book conveys more than that. It speaks
of dedication to a belief that each human
being has worth and potential for
development. and that professionals
have the knowledge, understanding and
personal resources to provide and
facilitate the nurturing environment from
which severely deprived,
institutionaJized infants can gain the
strength to master developmental tasks
and become contributing members of
society; in this lies the message of hope
for deprived children.
This book is of interest to a wide
range of professionaJs, including nurses,
who work with children and families
and/or have a concern about their growth
and development. The study design and
its therapeutic programmes are
sufficiently described and documented to
aJlow researchers in the field of child
development to assess the validity of the
theoreticaJ framework and the variety of
measurements used in documenting
developmental progress. The Security
Theory as developed by Dr. W.E. Blatz
and his colleagues at the Institute of
Child Study in Toronto was selected and
consistently applied throughout the
phases of the study; this theory provides
a central theme in the publication. Those
who work with children are usually
familiar with the security concept and
can derive meaning and encouragement
from a theory which can be applied in
simple behaviouraI terms.
The book is easy and interesting to
read. In spite of a strong focus on
research method and findings (often
illustrated with tables and graphs) the
human element. conveyed in case
descriptions and behavioural records,
keeps the children and their destiny close
to the reader's heart.
The organization of content is
somewhat confusing. Chapter headings
do not appear to follow a logical
sequence (which is either research
oriented or developmentally derived).
Yet to report an extens.ive, complex
study with considerable clarity and some
attention to detail within 200 pages is
quite an accomplishment.
It's encouraging to note that
recognition is given to the person who
played a significant and instrumental role
throughout the length of the study. A full
chapter is devoted to the role of the child
care worker, yet the reader is acutely
aware throughout the book that the
success - the actuaJ hope for deprived
children -lies with people like Mary
Kilgour, who through their sensitivity in
human relations and their willingness to
offer themselves can apply their
knowledge and professional expertise to
the fullest.
A similar message is apparent in the
postlude where the author summarizes
the research project and its implications
for current child care practices. Here
again, the significance and value of
"care-takers" of children is emphasized:
the author pleads for proper preparation
and recognition of aJl who care for
children, people who mold character and
influence development towards healthy
outcomes.
Much can be learned from this book
about the effects of institutional care on
young children, about efforts in
therapeutic intervention which can
relieve serious developmental
deficiencies and. about the significance
of knowledge coupled with personalized.
individualized care to give new hope to
deprived children.
.r-
Re,'iewed by Karin ,'on Schilling,
Associate Professor, School of Nursing,
McMaster University, Hamilton.
Ontario.
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library update
Publications recently received in the
Canadian Nurses Association Library are
available on loan - with the exception of
items marked.R- to CNA members, schools
of nursing, and other institutions. Items
marked R include reference and archive
material that does not go out on loan. Theses,
also R, are on Reserve and go out on
Interlibrary Loan only.
Requests for loans, maximum 3 at a time,
should be made on a standard Interlibrary
Loan form or by letter giving author, title and
item number in this list.
lfyou wish to purchase a book, contact
your local boohtore ór the publisher.
NOTE: Readers are reminded
that they should check first with
the li
rary of their provincial
nurses association, university or
college, to determine whether
they may obtain the publication(s)
they require from this source.
Books and Documents
I. Alexander. Edyth L. Nursing
administration in the hospital health care
system. 2d ed. Saint Louis, Mosby, 1978,
289p.
2. Anderson, Norma J. Pediatric nursing; a
self-study guide. 3d ed. Toronto, Mosby,
1978. 221p.
3. Association of Universities and Colleges of
Canada A Canadian directory to foundations
and granting agencies. 4th ed. Edited by Allan
Arlett. Ottawa, cl978. Iv. (various pagings) R
4. Benchimol, A. Noninvasive techniques in
cardiology for the nurse and technician.
Toronto, Wiley, c1978. 316p.
5. Birminf(ham, Jacqueline Joseph The
problem-oriented record; a self-learning
module. Toronto, McGraw-Hili, cl978. 161p.
6. Chatenay, Henri Paul Echoes of silence.
The chronicles ofW.G. Mainprize, M.D.,
1911-1974, 75th anniversary edition. First
Baptist Church and town of Midale. Sask.
1903-1978. Midale, Sask., Printed by Alberta
Handicapped Forum Ltd., cl978. 127p. R
7. The collective agreement and its
administration. A revision of Chapter 7 and
the 2d ed. of Labour relations law. Revised by
Bernard Adell. Kingston, Ont., Industrial
Relations Centre, Queen's University, 1978.
186p.
8. Commonwealth Caribbean Regional
Nursing Body Annual General Meeting.
Sixth, Kingston. St. Vincent. 15-19Aug.
1978. Report. Iv. (various pagings) R
9. Dunkel, Patty L. CUJ:Ticulum for educators
in health care institutions. Summary of the
proceedings of a conference held on Jan. 6-7,
1977. Chicago, Hospital Research and
Educational Trust, cl978. 85p.
10. Feldman, Silvia Choices in childbirth.
New York. Grosset and Dunlap, cl978. 267p.
II. Gordon, Richard The private life of
Florence Nightingale. London. Heinemann,
cI978.233p.
12. Griffith, John R. Measuring hospital
pelformance. Chicago Blue Cross
Association, 1978. 86p.
13. H amonet, C I Abrégé de rééducation
fonctionnelle et de réadaptation par. . . et
J.N. Heuleu. 2. ed. revue et corrigée. Paris,
Masson, 1978. 242p.
14. Inlernational Conference on Primary
Health Care. AlmaAta. USSR. 6-12 Sept.
1978 Primary health care. Report of
the. jointly sponsored by the World Health
Organization and the United Nations
Children's Fund. 79p.
15. International Labour Conference, 63rd
session, Geneva. 1977 Working environment:
atmospheric pollution, noise and vibration.
Fourth item on the agenda. Geneva,
International LabourOffice, 1977. 61p. (Its
Report 4 (I))
16. Jungers. Paul The essentials in
hemodialysis, by. . .andJohannaZinf(raff,
Nguyen K. Man and Tilman Drueke. Boston,
MartinusNÿhoff,1978.102p.
17. Kohnke, Mary F. The case for
consultation in nursing; designs for
professional practice. Toronto, Wiley, c 1978.
185p.
18. McKeown, Thomas The role of medicine;
dream, mirage or nemesis? London, The
Nuffield Provincial Hospitals Trust, 1976.
18Op.
19. National League for Nursing Protct
every child; childhood immunization
community action kit. New York, 1978. 95p.
(NLN Pub. no. 52-1717)
20. Nursing: levels of health intervention.
Edited by Ann Wolbert Burgess. Toronto,
Prentice-Hall, cl978. 809p.
21. Obstetric, gynecologic and neonatal
nursing functions and standards. Chicago,
Nurses Assoc. of the American College of
Obstetricians and Gynecologists, 1974. 61p.
22. Pan American Health Organization
Extension of health service coverage based on
the strategies of primary care and community
participation. Summary of the situation in the
region of the Americas. Washington, 1978.
66p. (P AHO Official document no. 156)
23. Primary care. Edited by Cynthia J. Leitch
et aI. Philadelphia, EA. Davis, cl978. 589p.
24. Putt. Arlene M. General systems theory
applied to nursing. Boston. Little Brown.
c1978. 195p.
25. Roberts, Phyllis Adams Regional blocks
for nurse anesthetists; a technical manual.
Springfield, III. Charles C. Thomas, c1978.
HIp.
26. Sloan, FrankA. Equalizing access to
nursing services: the geographic dimension;
health manpower references. Hyattsville, Md.
U. S. Dept. of Health Education and Welfare,
1978. 252p. (U.S. DHEW Pub. no. (HRA)
78-5 \)
....,j
Luckmann I
. ensen
Sorensen
TEXTBOOK 0 f Luckmann
t MED1CAL -
SURGICAL BASIC NURSING
URSING I AI'!. cI>CJp'1\.JOIogIC
2nd Edition
.
They've
done
it . I
again.
Sorensen & Luckmann
BASIC NURSING: A PSYCHOPHYSIOLOGIC APPROACH
and coming soon-
Luckmann & Sorensen
TEXTBOOK OF MEDICAL-SURGICAL NURSING
2nd edition
Sorensen and luckmann now offer BASIC
NURSING, a comprehensive textbook/refer-
ence based on the concepts of stress, adaptation,
and homeostasis. You'll find expert coverage of
the nursing process, physical examination, legal
concepts, basic and advanced clinical considera-
tions, and important nursing techniques that are
spelled out step by step with accompanying
scientific rationales.
Helpful study guides preceding each chapter,
objectives, vocabulary aids, many original draw-
ings, and an easy-to-read, two-color format add
to a long list of valuable features.
Ideal as a textbook for students or a reference
for practitioners, BASIC NURSING in combina-
tion with the forthcoming revision of TEXTBOOK
OF MEDICAL-SURGICAL NURSING is a must
for every nurse's library.
By Karen Creason Sorensen, RN, BS, MN, Formerly Lecturer
in Nursing, Univ. of Washington; Instructor of Nursing, Highline
College; Nurse Clinical Specialist. Univ. Hospital and Firland
Sanitorium, Seattle, WA; and Joan Luckmann, RN, BS, MA,
Formerly Instructor of Nursing, Univ. of Washington, Highline
College, Seattle, Oakland City College and Providence
Hospital College of Nursing, Oakland College, CA About
1285 pp. 435 ill. Just ready. About $25.00 (Canada $30.00).
Order #8498-X.
-............-
I NSG 4/78 CN 478
Please send on 3D-day approval: I
I ] Sorensen & Luckmann I
I BASIC NURSING: A PsychopsysiologicApproach
#8498-X. I
I o check enclosed-Saunders peya postage
I
I
e::;trnÖ[rC
Ö[}
n
. I
: DM"""Owge'
DG:IJQ]]crn :
I Expiration Date Interbank # DrlCIJ I
Please PrInt.
I I
I Full Name
I I I
I Position and AffIliatIon (If Appllcabte) Home Phone Number I
I Home Address I
ZIP I
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I
I
I
.
I City
.
State
. SIgnature
All prices dIffer outsIde U S and subject to change.
.
I W.B. saunders Company
.westWashington Square Philadelphia, Pa. 19105
In Canada: 1 Goldthorne Ave.. Toronto, Ontario M8Z ST9
In England: 1 SI Anne's Rd., Easlboume. East Sussex BN21 3UN
In Auslralia: 9 Waltham Slreel. Artarmon N.S.W 2964
54 April 111711
Th. C.n.dlen Nur..
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Os
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Comfortably prevents patients from slid-
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Get the added plus of shoulder loops and
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Sm.. med., Ig.
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Health
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2222 S. Sheridan Way
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Canada L5J 2M4
Phone: 416/823-9290
27. T ask Force on Concerns of Physically
Disabled Women Toward intimacy: family
planning and sexuality concerns of physically
disabled women. 2d ed. New York, Human
Sciences Press, c1978. 63p.
28. Taylor, MalcolmG. Health insurance and
Canadian public policy; the seven decisions
that created the Canadian health insurance
system. published forThe Institute of Public
Administration of Canada. Montreal.
McGill-Queen's University Press, c1978.
473p.
29. Weller, Stella Easy pregnancy with yoga.
Vancouver. Fforbez EntelJ'rises, c1978. 187p.
30. World Health Organization International
classification of procedures in medicine.
World Health Organization, Geneva, 1978. Iv.
Pamphlets
31. American Nurses' Association
Accreditation of continuing education in
nursing: the site visit process. Kansas City.
Mo., c1978. 23p.
32. Canadian Medical Association Guide for
physicians in detennining fitness to drive a
motor vehicle. revised December 1977.
Ottawa, 1978. 41p.
33. Criterion measures of nursing care
quality, August 1978. Hyattsville, Md..
National Center for Health Services
Research. 28p. (NCI-:(SR Research summary
series) (U.S. DHEW publication no. (PHS)
78-3187)
34. Manitoba A ssociation of Registered
Nurses Standards for the approval of diploma
schools of nursing in Manitoba. Winnipeg.
1956. 6v. R
Government Documents
35. Agence canadienne de développement
international Rappon. 1977/78. Ottawa. 1978.
48p.
36. Canada Institute for Scientific and
Technical Information Scientific and
technical societies of Canada. Ottawa
National Research Council of Canada. 1978.
I3lp. R
37. Canadian Government Specifications
Board: Role and operations. Ottawa. 1976.
24p.
38. Canadian International Development
Agency Review, 1977/78. Ottawa, 1978. 48p.
39. C01iférence nationale sur la condition
physique des employés, Ottawa, 2,3 et4 déc.
1974 Recommandations. Ottawa, Santé et
Bien-être social. 1975. 9p.
40. Conseil privé. Comité spécial d'examen
de la gestion du personnel et du principe du
mérite. La gestion du personnel et Ie principe
du mérite; un document de travail. Ottawa.
Ministre des Approvisionnements et Services
Canada. 1978. 412p.
41. Health and Welfare Canada Canada
health manpower inventory. 1977. Ottawa,
1978. 254p.
42. InstitutCanadien de ['information
scientique et technique Sociétés scientifiques
et techniques du Canada. Ottawa. Conseil
national de recherches Canada, 1978. I3lp. R
43. Labour Canada, Collective Bargaining
Division. Labour Data Branch Calendar of
expiring collective agreements. 1979. Ottawa.
Minister of Supply and Services Canada.
1978. I J3p.
44. -. Legislative Research Human rights in
Canada, 1978. Ottawa. Minister of Supply and
Services Canada. 1978. 93p.
45. L 'Office des normes au gouvernement
canadien: son rôle et ses activités. Ottawa.
1976. 24p.
46. Privy Council. Special Committee on the
Review of Personnel Management and the
Merit Principle Personnel management and
the merit principle; a working paper. Ottawa.
Supply and Services Canada. 1978. 384p.
47. Santé et Bien-être Social Canada
Répenoire de la main-d'oeuvre sanitaire au
Canada, 1978. Ottawa. 1977. 254p.
48. Statistics Canada Census of Canada.
1976. Vol. 2 Population: demographic
characteristics; five-year age groups. Ottawa.
Minister of Supply and Services Canada 1978.
Iv. (various pagings) Catalogue no. 92-823
Studies in CNA Repository CoUection
49. Anderson, Joan The effects of the
patient's diagnosis on professionals and
students in a psychiatric setting: a labeling
perspective.
50. Registered Psychiatric Nurses
Association of British Columbia. Committee
on Nursing Education and Practice. Repon
on minimal level of competencies expected of
the graduate psychiatric nurse. Burnaby.
B.c.. 1978. 98p. R
51. Thille, Mary, Sister Follow-up study of
graduates of the Saint Boniface School of
Nursing. St. Boniface, Manitoba. 1931-1955.
SI. Louis. Mo.. 1957. 118p. Thesis (M.Sc.
N.E.)-St. Louis. Untversity. R
Audio Visual Aids
52. A ssociation des Médecins de Langue
française du Canada Sonomed, série 5. no 4.
Montréal.1973. I cassette.Contenu.-Côté
A.L Emanuel. Elliott. L'environnement et
les maladies mentales. 2. Chicoine. Luc.
L'emploi des antibiotiques en prophylaxie.-
Côté B. Weber, Michel. Bronchiolites.
laryngites épiglottites.
53. -. Sonomed. série 5. no 3. Montréal.
1973. 1 cassette. Contenu. -Côté A.L
Myre, Maurice. L'embolie pulmonaire. I re
panie: physiopathologie. 2. Seguin. Fernand.
Le fléau de lamalaria. -Côté B.Grégoire,
Jacques. Les lentilles cornéennes.
54. Mecque, Ie marché des moyens
d'éducation par Ie cinéma et I'audiovisuel au
Québec. Répertoire '78. Montréal, vac offset.
1978. Iv. (sans pagination)
Bachelor of Administration
(Health Services)
Degree Program
Applications are now accepted for the program
combinirIJI independenl study with tutorials on
weekends in Toronto, as well as for the
competency based, external degree internship
option offered for students at a distance.
Credits toward advanced standirIJI are given
for managerial experience and prior education
includirIJI B.Sc.N., R.N. and H.O.M. Certifi-
cate.
The School is a member of the Association of
University Programs in Health Administration
and is supported by the Kellogg Foundation
grant.
For infonnation and application fonns, please
write to:
CIIIIUlIIII Scboot of Mllllaaemeal
S-425. OISE BuUdIaa
151 Bloor St., West
Toronto, Oatario MSS JV5
The Cen-.llan Nur..
Aprllll171 55
Classified
Advertisements
Alberta
Retl*red Nunes required for acute care general
hospital, expandinø from n beds to 300 beds.
Clinical areas include: medicine. surgery, obstetrics,
paediatrics, psychiatry. activation and rehabilita-
tion. operating room. emergency and intensive and
coronary care unit. Must be eligible for Alberta
registration. Personnel policies and salary in accor-
danee with AARN contract. Apply to: Personnel
Administration. Fort McMurray Regional Hospital,
7 - Hospital Street, Fort McMurray, Alberta, 1'9H
IP2.
Registered :'\Iurses required immçdiately in a 68-bed
active Ireatment hospital located in Northeastern
Alberta. Accommodation is available in Nurses'
Residence. Salary and benefils in accordance with
the negotiated provincial agreement. Apply in
writing to: Director of Nursing. Lac La Biche
General Hospital. Box 507, Lac La Biche. Alberta.
TOA 2CO.
British Columbia
Gneral Duty (R.C. RexIstered) NUne8 required for
expansion to 422 acute care accredited hospital
located 6 miles from downtown Vancouver and
within easy access to various recreational facilities.
Eltcellent orientation and ongoing inservice prog-
ramme. Salary SI,231.00---SI.455.00 monthly. Clini-
cal areas include coronary care, intensive care,
emergency, operating room. P.A.R.R., medical/sur-
gical. pediatrics, obstelrics, orthopedics and activa-
tion units. Positions are also available for lftIeral
duty DUI'RS in our modem extended care unit. Apply
to: Co-ordinator-Nursing. Dept. of Employee
Resources. Burnaby General Hospital, 3935 Kincaid
Street. Burnaby. British Columbia, V5G 2X6.
Challenge itnd opportunity aWait the nurse prepared
to accept a position in a 1000bed accredited acute
care hospital in a booming northern city. We will
help the beginning practitioners to expand Iheir
knowledge and skills. Write to: Nursing Director,
Dawson Creek and District Hospital. 1l100-l3th St.,
Dawson Creek. British Columbia, VIG 3W8.
GeDeral Oaty NIIIWI for modem 41-bed accredited
hospital located on the Alaska Highway. Salary and
personnel policies in accordance with the RNABC.
Temporary accommodation available in residence.
Apply: Director of Nursing, Fon Nelson General
Hospital, P.O. Box 60, Fort Nelson, British Colum-
bia, VOC IRO.
Gnenl Oldy RepIemI N...- - required for
l3G-bed accredited hOlpital. Previous nperience
desirable Staff residence available. Salary as per
RNABC contract with northern allowance. For
further information please contaCl: Director c:A
Nursin&. Kitimat General Hospital, 899 Lahaku
Boulevard North, Kitimat, Brittsh Columbia, VSC
IE7.
Nurse PractItioner required immediately for well
equipped, one doctor, government sponsored.
community health dinic at Madeira Park. B.C.
Anractive rural coastal area. Hours 9-5 Mon.
through Fri. with sharing of weekday evening stand
by dulies. Salary: S16.332.. 4 weeks annual holiday.
car allowance. Apply to: Secretary. Pender Harbour
and District Health Centre Society. P.O. Box 308.
Madeira Park. British Columbia. YON 2HO. Tel.:
(604) 883-2764.
Ellperlenced Nunes (eligible for B.C. Registration)
required for full-time positions in our modem
300-bed Extended Care Hospital located just thirty
minutes from downtown Vancouver. Salary and
benefits according to RNABC contract. Applicants
may telephone 525-0911 to arrange for an interview,
or write giving full particulars to: Personnel Direc-
tor, Queen's Park Hospital, 315 McBride Blvd.,
New Westminster. British Columbia. V3L 5E8.
British Columbia
Experienced I'unes (B.C. Registered) required for a
newly expanded 463-bed acute. teaching. regional
referral hospital located in the Fraser Valley. 20
minutes by freeway from Vancouver. and within
easy aCCess of various recreational facilities. Excel-
lent orientation and continuing education program-
mes. Salary-I979 rates-SI305.00---SI542.00 per
month. Clinical areas include: Operating Room. Re-
covery Room. tntensive Care. Coronary Care.
Neonatal IntensIve Care. Hemodialysis. Acute
Medicine. Surgery, Pediatrics. Rehabilitation and
Emergency. Apply to: Employment Manager. Royal
Columbian Hospital. 330 E. Columbia SI.. New
Westminster. British Columbia. V3L 3W7.
Experknced ICU/CCU and Operallna Room General
Duty Nurses required for full-time and summer relief
in a 23G-bed accredited hospital in the Okanagan
Valley. Must be eligible for B.C registration. Salary
SI,305 to SI.542 per month. with differential for
special clinical preparation of not less than 6 months.
Apply to: Director of Nursing, Penticton Regional
Hospital, Penticton. British Columbia. V2A 3G6.
Director of Nurslna - Applications are invited for
the position of Director of Nursing in a 150 bed
accredited general hospital located on central Van-
couver Island. The Position - The Director of
Nursing is a member of the hospital's senior
management team, and as such is involved in the
development and implementation of all aspects of
hospital policy. The successful candidate will be
hired with a view towards an evolving Direclor of
Patient Care concept. This vacancy is being created
by the retirement of the currenl Direclor of Nursing.
The Penon - Applicants should possess suitable
academic preparation; have an established record at
a senior administrative level with a strong clinical
background; and be eligible for R.N .A.B.C. registra-
tion. Please send confidential resume indicatina
Qualifications, experience. date available, and salary
eltpected to: Administrator. West Coast General
Hospital, PortAlberni. B.C. V9Y 4S1.
Genual Duty RN's or Graduate Nurses for 54-bed
Extended Care Vnitlocated six miles from Dawson
Creek. Residence accommodation available. Salary
and personnel policies according to RNABC. Apply:
Director of Nursing. Pouce Coupe Community
Hospital. Box 98. Pouce Coupe. British Columbia or
call collect (604) 786-5791.
Ellperlnced GeDerai Duty Nunes required for
12G-bed hospital. Basic salary S1305 00 - SI542.00
per month. Policies in accordance with RNABC
Contract. Residence accommodation available.
Apply in writing to: Director of Nursing, Powell
River General Hospital, 5871 Arbutus Avenue,
Powell River, British Columbia, V8A 4S3.
ReJlstered Nunes - Required immediately for a
340-bed accredited hospital in the central interior of
B.C. Registered Nurses interested in nursing posi-
tions at the Prince George Regional Hospital are
invited to make inquiries to: Director of Personnel
Services. Prince George Regional Hospital. 2000-
15th A venue, Prince George. British Columbia V2M
IS2.
R
red N...... required immediately for perma-
nent full time positions at I G-bed hospital in B.C.
Salary at 1978 RNABC rate plus northern living
allowance. Recognition of advanced or primary care
education. One year experience preferred. Apply:
Director of Nursing, Stewart General Hospital, Box
8, Stewart, British Columbia. VOT IWO. Telephone:
(604) 636-2221 Collect.
GeDeral Duty Nu.... required for an active, IOJ-bed
hospital. Positions available for experienced R.N.'s
and recent Graduates in a variety of areas. RNABC
tontract in effeCl. Accommodation available. Apply
to: Director of Nursing, Mills Memorial Hospital,
4720 Haugland Avenue, Terrace, British Colum-
bia VSG 2W7.
.
British Columbia
St. Paul's Hospital invites applications from R.C.
Rqiltered Nunes for full and part time positions in
all areas of the hospital. St. Paul's is an acute referral
teaching hospital located in downtown Vancouver.
1979 R.N. rates S1305.00 - SI542.00. Generous
fringe benefits. Apply to: St. Paul's Hospital,
Personnel Department. 1081 Burrard Street. Van-
couver, British Columbia. V6Z IY6.
Rq\ltered Nunes, casual and full-time. required for
227-bed general hospital with progressive policies,
located approltimately 35 miles south of V ancouver.
near the V nited States Border. Demonstrated
competence in surgical, medical, obstetrics. I.C.V.
or E.C.V. functions required. Apply: Personnel
Officer, Peace Arch District Hospital, 15521 Russell
Avenue. White Rock, British Columbia, V4B 2R4.
New Brunswick
Faculty members required with teaching and clinical
experience for an mtegrated undergraduate program.
(1/ Community Health Instructor to work Yo ith team
who teach in the third year. (:!) Co-ordinator of
Pedietrics. for students in .econd and third years.
\taster's degree desired. baccalaureate e.sential.
Salary based on Qualifications and experience.
Apply to: I. Leckie. Dean. Faculty of Nur'Ing.
Uni\ersity of f'iew Brunswick. Fredericton. N.:w
Brun."ick E3B
A3.
Northwest Territories
The Stanton Yellowknife Hospital. a 72-bed accre-
dited, acute care hospital requires registered nurses to
work in medical, surgical. pedIatric. obstetncaJ or
operating room areas. ExceUent orientation and
in service education. Some furnished accommoda-
tion available. Apply: Assistant Admimstrator-
Nursing, Stanton Yellowknife Hospital. Box 10.
Yellowknâe. N.W.T.. XIA 2NI.
Ontario
Childrens summer camps in scenic areas of Northern
Ontario require Camp Nunes for July and August.
Each has resident M.D. Contact: Harold B.
Nashman. Camp Services Co-op, 825 Eglinton
Avenue West, Suite 211, Toronto. Ontano, M5N
IE7. Phone: (416)789-2181.
Co-ed camp ages 14 A 15, Northern Ontario - RN
for 6 wks., attractive salary. pnvate room A board.
approx. 70 campers, June 25 10 Aug. 14.
Write/phone: Camp Solelim, 588 Melrose Ave..
Toronto. Ontario, M5M 2A6 (416) 781-5156 or
635-5410.
Quebec
RqIotered Nune required immediately in Co-ed
Boarding School in country. Applicant must live in
and share duties with another resident nurse.
Apartment with maid service provided. Excellent
working conditions. Liberal holidays. Applications
statin, Qualifications and experience 10: Comptrol-
ler. Blshop's College School, Lennonille, Quebec,
JIM IZS.
Saskatchewan
R.N.'s and R.P.N.'s (eligible for Saskatchewan
registration) required for 340 fully accredited ex-
tended care hospital. For further information.
contact: Personnel Department. Souns Valley Ex-
lended Care Hospital. Box 2001. Weyburn. Sas-
katchewan S4H 2L7.
-
58 Aprllll171
The C.nedlen Nur..
---
Saskatchewan
Regiltered Nunes needed for IO-bed Outpost Hospi-
UII in native community 400 miles north of Saska-
toon. Contact: Director of Nursing, St. Martin's
HospiUII, La Loche, Saskatchewan, SOM IGO.
United States
Cllllfomla - Sometimes you have to go a long way
to find home. But. The White Memorial Medical
Center in Los Angeles, California, makes it all
worthwhile. The White is a 377-bed acule care
teachirIJI medical center with an open invitation to
dedicated RN's. We'll challerlJle your mind and offer
you Ihe opportunity to develop and conlinue your
professional growth. We will pay your one-way
transportation, offer free: meals and 10dgirIJI for one
month in our ultra-modem nursirIJI residence and
provide your work visa. Call collect or write: Ken
Hoover, Assislant Personnel Director, 1720 Brook-
lyn Avenue, Los Angeles, California 90033; (213)
269-9131, ext. 1680.
Critical Care Nurses - EI Camino Hospital, a
464-bed acute care facility has excellent oppor-
tunities for full-time or part-time or Per Diem nurses
on 3-11 PM or 11-7 AM stufts in the following areas:
ICV - new l6-bed med-surg (includes adult open
heart patients). CCU - 12-bed new unit equipped
with H.P. arrythmia detection monitors offering
patient teaching program and nursing research. TCV
(Transitional Care Vnit) - 25-bed unit equIpped
wilh telemetry for 12 patients. Offers unique
cardio-vascular nurse/client teaching program. ER
- new spacious area providirIJI a complete range of
basic emergency service to 3000 patients per month.
The RN staff is certified in Advanced Cardiac Life
Support. All these units offer the latest in innovative
staff development, patient teaching programs, edu-
cational opportunities and a time-saving Com-
puterized MedIcal InformatIon Srstem. Salary $1363.
(Staff II Step II) shift differenllal $.55/hr. 3-11 and
$.75/hr. 11-7. For information, call Patti Aalgaard.
RN, Coordinator, Nurse Recruitment at (415)
968-8111. Ext. 44543 or write EI Camino Hospital.
2500 Grant Road. Mountain View. California 94042.
An Equal Opportunity EmployerMIFIH.
Florida Nunl.. OpportWlltIa - MRA is recruitirIJI
Registered Nurses and recent Graduates for hospilal
positions in cities such as Tampa, St. Petersburg,
and Sarasota on the West Coast; Miami, Ft.
Lauderdale and West Palm Beach on the East Coast.
If you are considerirIJI a move to sunny Florida, .
contact our Nurse Recruiter for assistance in
selecting the right hospiUII and city for you. We will
provide complete Work Visa and State Licensure
infonnation and offer relocation hints. There is no
placement fee to you. Write or call MedkaI
ReeraltenofAmerlca,IDC.(ForWestCoast) 1211 N.
Westshore Blvd., Suite 205, Tampa, FI. 33607 (813)
872-0202; (For East Coast) 800 N.W. 62nd St., Suite
510, Ft. Lauderdale, Fl. 33309 (305) 772-3680.
RN's - Boise, Idaho - How would you like a
rewardirIJI career in an environment which offers you
immediate access to uncongested recreation areas
with rivers, lakes and mountains? Do you erijoy
tennis, golf, racketball, campirIJI, hiking. skiirIJI and
horseback ridirIJI? Sound excitirIJI? It is. And there
are many opportunities for satisfying work at one of
Idaho's largest and most progressive medical
complexes. St. Alphonsus, located in Boise, is a
229-bed facility offering "you positions in
orthopedics, ophthalmology, dialysis, menUil health,
neurosurgery and trauma medicine. Excellent
salary, generous benefits and job security. StartirIJI
salary adjusted for experience; benefits include
travel assistance, shift rotation, and free: parking.
Write or call collect: Employment Supervisor,
Penonnel Office, St. Alphonsus Hospital, 1055
North Curtis Road, Boise, Idaho 83704, (208)
376-3613. EOE.
Nun", Opportllllltia III New OrIaIaI, LoaUIua -
MRA tS recruitirIJI Registered Nunes and recent
Graduates for severalleneral and teachina hospitals
in the exciti", New Orleans area. OpenirlJls in many
specialties and most Canadian Registered Nunes
can qualify for licensure endonement in Louisiana.
Contact our Nurse Recruiter for infonnation about
the hospiUlls and their relocation and tuition
assistance plans. We will provide complete Work
Visa and State Licensure infonnation. There is no
placement fee to you. Write or call MedIal!
RKraJten of A_rica, Dc., 800 N. W. 62nd Street,
Suite 510, Ft. Lauderdale, Fl. JJJ09. (J05) 772.3680.
United States
Nursing Opportunity - Mississippi Baplist Medical
Center, a mllior 600-bed hospital, has immediate
positions available for experienced RNs and recent
nursirIJI school graduates in a variety of specialilies
and medical/surgical areas. Competitive salaries.
liberal benefits. Visa, licensure and relocation
assistance provided. Located in Mississippi's capital
city of Jackson (population 300.(00), MBMC is the
state's largest and most modem privately operated
hospital. For further information write: Mrs.
Johnnye Weber, Nurse Recruiter, 1225 North State
Street, Jackson, Mississippi 39201; or call collect
601/968-5135.
Nurses - RNs - Immediate Openings in
Califomia-Florida-Texas-Mississippi - if you are
experienced or a recent Graduate Nurse we Can offer
you positions with excellent salaries of up to $1300
per month plus all benefits. Not only are there no
fees to you whatsoever for placirIJI you, but we also
provide complete Visa and Li6:ensure assistance at
also no cost to you. Write immediately for our
application even if there are other areas of the V.S.
Ihat you are interested in. We will call you upon
receipt of your application in order to arrarlJle for
hospital interviews. You can call us collect if you are
an RN who is licensed by examination in Canada or
a recent graduate from any Canadian Scbool of
NursirIJI. Windsor Nurse Placement Service, P.O.
Box 1133, Great Neck, New York, 11023. (516 -
487-2818).
"Our 20th Year of World Wide Service"
TM Bert LocatIon In tbe Nadon - The world-
renowned Cleveland Clinic Hospital is a progres-
sive, I02O-bed acute care teachirIJI facility committed
to excellence in eatient care. Staff Nurse positions
are currently available in several of our 6 ICV' sand
30 departmentalized med/surg and specialty divi-
sions. StartirIJI salary range is $13,286 to $15,236,
plus premium shift and unit differential, progressive
employee benefits program and a comprehensive 7
week orientation. We will sponsor the appropriate
employment visa for qualified applicants. For
further information contact: Director - Nurse Re-
cruitment, The Cleveland Clinic Foundalion, 9500
Euclid Avenue, Cleveland, Ohio, 44106 (4 hours
drive from Buffalo, N.Y.); or call collect 216-444-
58M.
Canadian Nunes - Our 350+ bed full service
community hospital in a city of 70,000 in the piney
woods and lakes of beautiful East Texas wishes 10
extend an invitation to you to practice nursing in a
progressive hospiUII while you and your family erijoy
the good life atmosphere of smaller city living. Our
special visa sponsorship and licensure program may
be what you have been seeking. We plan a trip to
several cities in Canada to interview and hire soon so
don't delay your response. For more infonnation,
please write or call Jack Russell, 611 Ryan Plaza
Drive, Suite 537, ArlirlJlton, Texas. 76011. (817)
461-1451.
The Eyes of Teus beckon RN's and new grads to
practice their profession in one ,of the most
prosperous areas of the U.S. We represent all size
hospiUlls in virtually every Texas and Southwest
V.S. city. Excellent salaries and paid relocation
expenses are just two of many super benefits
offered. We will visit many Canadian cities in March
and April to interview and hire. So we may know of
your interest won't you contact us today? Ms.
Kennedy, P.O. Box 5844, Arlington, Texas, 76011
(214) 647-0077 or Ms. Candace, P.O. Box 14745,
Austin, Texas, 76011 (512) 459-0077.
C_ to Tnu - Baptist HospiUII of Southeast
Texas is a 400-bed growth oriented organization
lookirIJI for a few IIOOd R.N.'s. We feel that we can
offer you the chalTerlJle and opportunity to develop
and continue your professional growth. We are
located in Beaumont, a city of 150,000 with a small
town atmosphere but the convenience of the large
city. We're 30 minutes from the Gulf of Mexico and
surrounded by beautiful trees and inland lakes.
Baptist HospiUII has a progress salary plan plus. a
liberal frin&e package. We will provide your immIg-
ration paperwork cost plus airfare to relocate. For
additional infonnaIion, contact: Personnel Ad-
ministration, Baptist HospiUII c:A Southeast Texas,
Inc., P.O. Drawer 1591, Beaumont, Texas 77704. An
alftnllllllft...... employer.
McMaster University
Educational Program
For Nurses In
Primary Care
McMasler University School ofNur
-
ing in conjunclion with the School of
Medicine. offers a program for regis-
tered nurses employed in primary
care
eltings who are wIlling 10
assume a redefined role in the primary
health Cdre delivery team.
Requirements Current Canadian Re-
gistration. Sponsor
hip from a medi-
cal co-practitioner. A( least one year
of work experience. preferably in
primary care.
For further information write to:
Mona Callin, Director
Educational Program for Nurses
in Primary Care
Faculty of Health Sciences
McMaster University
Hamilton. Ontario L8S 4J9
Port Saunders Hospital
Port Saunders,
Newfoundland
Requires two Registered Nurses
commencing April 1979 through to
September 1979.
Applicants must be registered or eligible
for registration with the ARNN.
Salary scale: $11,448.00-$13,955.00.
Please forward application, curriculum
vitae and references to:
Mrs. Madge Pike
Director of Nursing
Port Saunders Hospital
Port Saunders, Newfoundland
AOK 4HO
Laurentian Ualvenhy
Sc:boo1 of Nunlal
Sudbury,Ont.
Applications are invited for
Faculty Positions
In The Following Areas
Psychiatric, malernal child and community
nursirIJI, NursirIJI Research
QuaIIlkIII...:
Preference will be given to applicants with
master's and/or docloral preparation in the
areas noted, and to applicants nuent in French
and EnaIish.
Salary and rank commensurate with education
and experience.
For information contacl:
Wndy Gerhard
DIrector
Sc:boo1 of Nun".
Laure.d. Ualftnlty
SudlMary, o.tarIo
P3E lC'
The Cenedlen Nur..
- ----..
Aprll1879 57
....
AV
"
MEDICAL
RECRUITERS
OF AMERICA
INC.
MRA recrUlls Registered Nurses and recent
Graduates for hospital positions in many
U.S. cities. We provide complete Work Visa
and State licensure information
ARLINGTON. TX. 76011
P.O Box 5844
(214) 647-0077
AUSTIN, TX. 78761
P.O Box 14745
(512) 459-3235
CHICAGO, ILL. 60607
500 So. Racine St.. SUite 312
(312) 942-1146
FT. LAUDERDALE, FL. 33309
800 N W 62nd St . SUite 510
(305) 772-3680
TAMPA, FL. 33607
1211 N Westshore Blvd.. Suite 205
(813) 872-0202
ALL FEES EMPLOYER PA/D
The International Grenfell
Association
requires Regional Nurses on perma-
nent or short-term basis for nursing
stations as well as hospitals.
Salary in accordance with nurses
collective agreement.
Accommodation, fringe benefits,
group life insurance.
Travel paid for minimum of one-
year service.
Apply to:
Mr. Scott Smith
Personnel Director
International Grenfell Association
St. Anthony, NOd.
AOK 4S0
University of Victoria
School of Nursing
Applications are invited for the position of
Director, School of Nursins, University of
Victoria.
The School of Nursins presently has one
baccalaureate (BSN) program for Registered
Nurses. Planning for undergraduate (basic)
and graduate programs is in progress.
The School of Nursing is part of the Faculty of
Human and Social Development which also
includes the Schools of Social Work, Child
Care, and Public Administration.
Experience in administration in the university
settins as well as appropriate professional
Qualificalions and experience are required.
Preference will be given to candidates with a
doctoral delVcc. Appointment level and salary
will be commensurate with Qualifications and
experience. Applications with C.V. and three
referees should be sent to:
De.. of* Fwulty of Hum_
a_ Soda! DeY
U"ftnlty of VIdorI8
P.O. Box 1'711
VldorIa, R.C.
VIW 1Y1
United States
RNs - AD Excltl"ll Career Awaits You 10 Sunny Las
Vex..! Join Valley Hospital, a 28
bed, fully-
accredited hospital and increase your nursing skills
while enjoying the unique lifestyle of Las Vegas.
Contact: Kalene Ryan, Nurse Recruiter. Dept. C-4,
Valley Hospital, 620 Shadow Lane, Las Vegas,
Nevada, 89106, (702) 38.5-3011.
Excitement: Come and join us for year around
excitement on the border. by the sea, an unbeatable
combination. Er\ioy the sandy beaches of So. Padre
tsland or the unique cultures of Old Mexico. Our
new 117-bed, acute care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opportunities. We have immediate openings in all
areas. Excellent salary and frinse benefits. We invite
you to share the challenge ahead. Assistance with
travel expenses. Write or call collect: Joe R. Lacher.
RN, Director of Nurses. Valley Community Hospi-
tal, P.O. Box 469.5. Brownsville. Texas 78.521: I
(.512) 831-9611.
Nunes - RN. - A choice of locations with
emphasis on the Sunbelt. You must be licensed by
examination in Canada. We prepare Visa fonns and
provide assistance with licensure at no cost to you.
Write for a free job market survey. Marilyn Blaker,
Medex, .580.5 Richmond, Houston, Texas 770.57. All
fees employer paid.
ReJløtered Nunes, Uceued Voclltlo.... Nu.... aDd
Nunes Aida needed to work at the Kerrville State
Hospital in Kerrville, Texas. Kerrville is approx. 6.5
miles north of San Antonio in West Central Teltas. It
is a noted recreational area, with the Guadalupe
River, many camps and open areas for hiking.
Benefits include forty hour work week, sick leave.
paid vacation, holidays, good retirement benefits
and free group insurance. Starting salary for
Registered Nurses is 51,141.00, for Licensed Voca-
tional Nurses 5768.00 and for Aides 5.5.52.00 (per
month). Nurses and L. V. N.'s are required to have a
current Texas license and Aides are required to .be
high school graduates. We are an Equal Opportunity
Employer. Apply to: Box 1468, Kerrville, Texas
78028.
Come to Coastal Tell.. - We are located in a resort,
retirement and farming community one mile from the
Gulf of Mexico. We are a small friendly hospital in a
small friendly community just two hours from
Houston. We offer you a rounded career develop-
ment program: medical, sU'1lical, OB, nursery and
emergency room. We are fully accredited. Rapid
advancement to Head Nurse startins at 513,000 plus
shift differential, call pay and liberal fringe benefits.
New nicely furnished tWD-bedroom apartments are
reserved for ' ou. Share one with a Canadian RN
companion 0 your choosins, if you like, for 51.50
each includins gas and water. We will pay immigra-
tion, licensins and relocation transportation ex-
pense. Openinss are limited-four at this writing.
Contact: Personnel Department, Wagner General
Hospital, Box 8.59, Palacios, Texas 7746.5; or call
Athlyn Raasch,
.512-972-2.511 collect.
Switzerland
Hospital of Canton Zürich at Winterthur (72.5 bed
hospital near Zürich) needs Operati"ll Room Nurses
for the surgery clinic. Required for immediate or
future openings. We offer pleasant w,!rking condi-
tions. equitable hours of work and leISure. Salary
and benefits in accordance with the regulations of
the Canton of Zürich. Five-day week. accommoda-
tion available. cafeteria. Apply in writing to:
Sekretariat PIlegedienst. Kal'tonsspital Winterthur.
CH-840I. Winterthur, Switzerland.
Miscellaneous
Africa - Overland Eltpeditions. LandonJNairobi Ü
wkl. London/Johannesburg 16 wks. KeIIya Safari.
- 2 and 3 wk. itineraries. Eorope - Campins and
hotel tours from 16 days to 9 wkl. duration. For
brochures contact: Hemisphere Tours, .562 ElI1inton
Ave. E., Toronto, Ontario, M4P 189.
Interested 10 Electrolysis Career? Must be an R.N.
Successful practice available. Instructions. Write or
calJ: Margot Rivard. R.N.. 1396 St. Catherine Street
West. Suite 221, Montreal. Quebec, H3G 1P9.
Telephone: (.514) 861-19.52.
r'" Before accepting any
position in the U.S.A.
PLEASE CALL US
COLLECT
We Can Offer You:
A) Selection of hospitals Ihroughout
the U S.A.
B) ExtenSive information regarding
Hospital-- Area. Cost of Living, etc.
C) Complele licensure and Visa Service
Our Services to you are at
absolutely no fee to you.
WINDSOR NURSE
PLACEMENT SERVICE
P.O. Box 1133 Great Neck. N.Y.
(516) 487-2818
Our 20th Year of World Wide Service ....
Foothills Hospital, Calgary,
AI berta
Advanced N eurological-
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)
Beainn....: MJlrch, September
Limited to 8 participants
Applications now being accepted
For further Information, pleue write to:
Co-ordinator of In-service Education
Foothill. Hospital
140329St. N.W. Calpry, Alberta
T2N 2T9
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
A V AILABLE NOW
IN
ARIZONA
CALIFORNIA
TEXAS
WE PLACE AND HELP YOU WITH:
STATE BOARD REGtS"ffiATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-.58\13 OR WRITE TO:
RECRUITING REGISTERED NURSFS INC.
1100 LAWRENCE A VENUE EAST. SUITE 301,
DON MILLS, ONTARIO M3A ICI
FLORIDA
OHIO
NO FEE IS CHARGED
TO APPLICANTS
58 "prlll!!7!! The Canedlen Nur..
University of British Columbia Government of Canada
Teaching Positions HEALTH CARE OFFICERS
Applications are invited for teaching positions in
undergraduate and graduate programs. Master's or
higher degree and experience in clinical field
required. Positions open in July, 1979. Candidates
must be eligible for registration in B.C.
Send resume to:
Dr. Marilyn Willman
Director, School of Nursing
University of British Columbia
2075 Wesbrook Place
Vancouver, British Columbia Canada
V6T lW5
Psychiatric Nursing Co-Ordinator
(Assistant Director of Nursing level position) for 80
- 100 beds of Psychiatry in a 450 bed accredited
General Hospital.
Qualifications:
Registered Nurse with Baccalaureate Degree and
current clinical experience in psychiatric nursing.
Experience in nursing administration also neces-
sary.
Salary and benefits commensurate with qualifica-
tions.
Write, giving qualifications and experience to:
Catherine E. Smith
Executive Director of Nursing
Owen Sound General & Marine Hospital
12016th Ave. West
Owen Sound, Ontario
N4K SH3
Canadian Penitentiary Service
Various Locations - Lower Mainland-
including Fraser Valley
This competition is open to both men and
women who are residents of the province
of British Columbia.
Salary:
$16,347 - $18,974 per annum
Plus Penological Factor Allowance
Clearance Number: 709-004-004
Duties:
The successful candidates will assist the medical
staff in examination and treatment, provide direct
nursing care to inmates and counsel staff and
inmates on matters of health and hygiene.
Qualifications:
Applicants must be eligible for registration as a
registered nurse in a province or territory of Canada
and have several years experience in implementing
nursing practices and techniques. Willingness to
work in an institutional environment on a shift
rotating basis is also required. Knowledge of
English is essential.
Send your application form and/or resumé, quoting
Reference Number 79-V-CPS-2 before April 30,
1979 to:
C. Pinhey
Regional Staffing Officer
Public Service Commission
P.O. 11120, Royal Centre
500 - 1055 West Georgia Street
Vancouver, B.C.
V6E 3L4
Th. Canedlen Nur..
April 1979 59
ATTENTION: NURSES, PSYCHIATRIC
NURSES, REGISTERED NURSES AND RECENT
NURSING GRADUATES
If you are a graduate nurse or obout to graduate from an approved school of
nursing thinl
about starting your coreer at The Alberta Hospital. Edmonton. This
is a progressive psychiatric treatment facility which presently has positions avail-
able for general duty and psychiatric nurses to work on a rotating basis. In
addition to an excellent starting salary. the opportunity exists to expand your
psychiatric nursing qualifications through on-the-job experience. Management
programs are offered periodically to those interested in professional advance-
ment.
An Accredited Hospital
A facility of Alberta Social Services and Community Health. the Alberta Hospital
is a dynamic regional centre with three (3) year accreditation status.
Exceptional Benefits
The Alberta Hospital offers a pleasant nurses residence with attractive staff
facilities. You'll enjoy twelve (12) paid holidays. three (3) weeks annual
vacation (rising to 4 weeks after 10 yeors) and a very attractive employee
benefit package. Fringe ßenefits include uniforms. laundry and free porking.
Job Satisfaction
Since staff are encouraged to use their own initiative as part of a concerned
inter-disciplinary team. morale is high and nurses enjoy a pleasing sense of job
satisfaction.
If you re serious about your nursing coreer and want to advance here is the
ideal place to pursue your goo Is. Immediate vacancies now exist for graduate
nurses and Head Nurses. Relocation ossistance is offered to applicants at senior
levels.
Qualifications
Graduation from an approved
school of nursing Must be eligible
for registration with the respective
professional Alberta Associations
Salary
$13.608.00 to $15,996.00.
Starting salary within this range will
depend on qualifiCations and ex-
perience. NOTE: Salary scale does
not reflect additional increments for
forensic work and shift differential
Apply To:
PERSONNEL ADMINISmATOR.
ALßERTA HOSPITAL. ßOX 307.
DMONTON, ALßERTA T5J 2J7.
Quating Competition No. 9184-3
This competition will remain open
until suitable candidates have
been selected.
All:øra
60 April 1979
The Cenedlen Nur..
Applications are invited for
Public Health
Nursing Supervisor
()ualifications: Bachelor of Science in nursing.
leadership ability. a minimum of three years'
experience in a generalized Public Health program.
Po"ition available: May 5. 1979.
Application
with curriculum vitae should be
",ubmitted to:
Mr. R. Dick
Personnel Officer
Waterloo Regional Health Unit
8th Floor, Marsland Centre
20 Erb Street West
Waterloo, Ontario
N2J 4G7
Registered Nurses
1200 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
. Bums and plastics
. Neonatal intensive care
. Renal dialysis
. Neuro-surgery
Planned Orientation and In-Service Education programs.
Post Graduate clinical courses in Cardiovascular-
I ntensive Care Nursing and Operating Room Technique
and Management.
Apply to:
Recruitment Officer - Nursing
University of Alberta Hospital
8440 - tl2th Street
Edmonton, Alberta
T6G 287
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Regislered Nune in search of a change and a challenge-
look into nursing opportunities at Vancouver General Hospital, B.C.'s
lru\Ïor medical cenlre on Canada's unconventional West Coast. StaffirIJI
expansion has resulted in many new nursing positions at all levels,
includirIJI:
General Duty ($1231-1455.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the oppl'rtunity
you've been 100kirIJI for.
For those with an interest in specializaIion, challenges await in many
areas such as:
Neonatology Nursing
Inservice Education
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Burn Unit
Coronary Care Unit
Hyperalimentation
Program
Renal Dialysis & Transplantation
Paediatrics
If you are a Nurse considering a move please submit resume to:
Mn. J. MacPbaII
Employee Relations
Vancouver General Hospital
855 West 12tb Avenue
Vancouver, H.C. V5Z IM9
[l]@
University of
Alberta Hospital
Edmonton, Alberta
o
The Cenedlen Nur..
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can go a long way
, . . to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either - because
there are educational opportunities such as in-
service training and some financial support for
educational studies.
For further information on Nursing opportunities in
Canada's Northern Health Service, please write to:
ø........,
I Medical Services Branch I
Department of National Health and Welfa,.
Ottawa, Ontario K1A OL3
I Name I
I Address.. I
I City Provo I
I .+ Health and Wella", Sanlé el Blen-.lre lIoclal I
Canada Canada
,........
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Open to both
men and women
HEALTH CARE OFFICER
(508-326-006)
Salary: $15.117to$16.986
Aef. No: 79.PSC/SOL.().A2 ICNI
Solicitor General Canada. Correctional Service of Caneda
Prince Albert. Saskatchewan
Duties
Requires active co-operation with other members of the
health care team. Responsibilities include out-patient and
bedside nursing. emergency first aid and counselling for in-
mates. Nurses employed will be directly and indirectly in-
volved in the development of mental and physical health
programs for the inmates. This is an exciting opport,mity
for dynamic persons seeking satisfaction and challenge in
a progressive department.
Oualificlltlons
Eligibility for registration as a registered nurse in a province
or territory of Canada. Knowledge of English is essential.
For further information contact, K. S1nclair at (2041
..949-2463. Winnipeg.
How to Apply
Send your application form and/or résumé to:
K. Sinclair. Staffing Officer
PubUc Service Commission of Canada
500 Credit Foncier Building. 286 Smith Street
Winnipeg. Manitoba A3C OK6
Please quote the applicable relerence number at all times.
......
62 April 1878
Th. Cenedlen Nurs.
University of Western Ontario
Faculty of Nursing
Faculty positIon available July I, 1979, or by
arrangement. Rank open. Master's degree or
doctorate required. Teaching and research In
various areas of nursing.
Salary in accordance with the University of
Western Ontario policies.
This appointment is subject to funds being avail-
able.
Applications should be forwarded to:
Dr. 8everlee Cox, Dean
Faculty of Nursing
Health Sciences Centre
The University of Western Ontario
London, Ontario
N6A 5Cl
Director of Nursing Service
Required for
Wetaskiwin General Hospital
Applications for the above position are invited on or
before June 1, 1979. The Wetaskiwin General
Hospital is a 135 bed active treatment hospital and
is located in a small city just 35 miles south of
Edmonton. The facility is part of a complex which
operates a 50 bed auxiliary hospital and a 50 bed
nursing home.
The successful applicant should ideally have ex-
perience in the administration of a nursing program
and possess a B.Sc.N. Degree, but, equivalent
combination of formal education and experience
will be accepted.
Position will open on retirement of present incum-
bent. Address all inquiries in writing together with a
complete resume to:
P.O. Langelle
Administrator
Wetaskiwin Hospital District
5505 - 50 Avenue
Wetaskiwin, Alberta
T9A OT4
General Duty Nurses
The Royal Alexandra Hospital, 970 Bed teaching
hospital requires:
General Duty R.N.'s
for temporary vacation relief posttlons in most
clinical areas. Positions vary in duration between 9
weeks and 20 weeks, depending on clinical area.
Employment date -July 2, 1979.
Applicants must be eligible for Alberta registration
with A.A.R.N.
Please direct inquiries to:
Mrs. R. Tercier
Director of Nursing Personnel - Administration
Royal Alexandra Hospital
10240 - Kingsway Avenue
Edmonton, Alberta
T5H 3V9
Registered Nurses
Come to work in scenic Corner Brook for the
summer months.
Summer-relief registered nurses are needed for this
250-bed regional general hospital with detached
60-bed Special Care Unit serving the West Coast of
Newfoundland.
The area offers many facilities for summer activities
and sports including swimming, sailing, camping,
and hiking.
One-way Air-fare to Corner Brook will be paid.
Salary scale: Presently under negotiation;
$11,448.00 - 13,955.00 per annum. Service credits
recognized. Residence accommodation available.
Apply:
Director of Personnel
Western Memorial Regional Hospital
P.O. Box 2005
Corner Brook, Newfoundland
A2H 6J7
Telephone: (709)634-5101 Ext. 367.
The Cenedlen Nur..
April 1979 83
Southern California Nursing:
Three Who Made The Change
" It was a big step to move from Southwestern Ontario to an
entirely new job and surroundings in California. but everyone on the
staff at S1. FrancIs made me feel very welcome. They're all so warm
and friendly - I really feel like an integral part of their team.
"S1. Francis is more than I ever expected. but for me Labor and
Delivery is the most exciting. Along with my helpful coworkers, the
advanced monitoring equipment. and delivery room techniques. I've
found my unit a great place to advance my knowledge.
'" am proud to be a part of S1. Francis Medical Center. Irs a
great place to work _.. come and see for yourself."
Shirley Allin, RN
.
.
.
...
\
"I'm from Prince Edward Island, Canada, and have been
employed by S1. Francis Medical Center for one year now _ I spent four
months trying to obtain my visa to Southern California - S1. Francis
obtained it for me in one week.
"S1. Francis is located within a short distance from the beach
and mountains. offering you a wide choice of social recreation.
"I am really enjoying my nursmg experience with S1. Francis and
have found the staff especially friendly and helpful "
Patricia MacLeod, RN
,
" I came to S1. Francis from Calgary. Alberta Canada The atmos-
phere at St Francis is warm and personal and the people never
hesitate to make me feel at home.
"S1. Francis provides many channels for growth. The staff IS
always available for help.
"The knowledge and experience I am gaining through living and
working in a different country are limitless. I have met many new
people and seen many new places thanks to St Francis."
Colleen McPhail, RN
II
I
\
...................................
: S1. Francis Medical Center is located just outside of Los Angeles, in the city of Lynwood Facilities . .
embrace a complete range of medical-surgical services, including open-heart surgery, intensive and
. coronary care, definitive observation, acute and renal dialysis, neurostroke, inpatient psychiatry, in/ out .
. patient rehabIlitation, intensive newborn care, diagnostic and therapeutic radiology including cobalt and .
. ultrasound. and a 24-hour Emergency Department. The 524-bed hospital has a nursing staff of .
approximately 700.
. Make the change to a hospital that lets you be what you want to be. Write us for more information or .
. call Brent Nielsen. RN, Nurse Recruiter, collect at (213) 603-6083. .
. 0 Please send me a brochure about SL Francis Medical Center. .
· Name St Francis ·
:
:
ress Slale Z;p
H
r:
. Phone (-) RN 0 Student 0
Lynwood California 90262 .
. Area of interest An equal opportunity employer CN 4-79 .
...................................
114 April 1878
Th. Cenedlen Nurs.
Uncoln Institute of Health Sciences
School of Nursing
Lecturer: Post Registration Courses
The Lincoln Institute's School of Nursing invites applications
from suitably qualified and experienced nurses for the above
position. The position will involve teaching post registration
nursing students undertaking degree and diploma courses, which
include major components of advanced nursing practice.
Qualifications: Comparatively recent expenence of study in an
area of clinical nursing or in nursing research, and experience in
nursing education. A formal qualification in teaching and a
degree in a discipline relevant to nursing practice would be an
advantage.
The Lincoln Institute of Health Sciences is a tertiary education
institution fully funded by the Commonwealth Government. It
offers degree or diploma courses in a number of the health
sciences. The total student population in 1979 will be approxi-
mately 1500. Some 250 of these will be undertaking nursing
programmes.
Salary range: Lecturer II $A 15,786-$A 18,050; Lecturer I
$AI8.474-$A20,736. The position is for a fixed term appointment
of three to five years, or a continuing appointment would be
considered. For an overseas appointment, his/her fare would be
met, and there would be an allowance for baggage expenses; as
well, the Institute would contribute towards fares and baggage
costs for dependents. Applications in writing, including full
curriculum vitae together with the names of three professional
referees, should be addressed to Assistant Registrar, Lincoln
Institute of Health Sciences, 625 Swanston Street, Carlton,
Victoria 3053 Australia.
Advertising Rates
For All Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
Rates for display advertisements on request.
Closing date for copy and cancellation is 8 weeks prior
to 1st day of publication month.
The Canadian Nurses Association does not review the
personnel policies of the hospitals and agencies
advertising in the Journal. For authentic infonnation,
prospective applicants should apply to the Registered
Nurses' Association of the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
KlPIE2
.
Index to
Advertisers
April 1979
Cover 4
Abbott Laboratories
A.B.C. MedIcal Instruments Inc.
The Apothecary Service (A Division
of Shoppers Drug Mart)
Ayerst Laboratories
Becton Dickinson, Canada
Canadian College of Health Service Executives
7
51
49
4,5
2
8
15
54
Canadian Dairy Foods Service Bureau
The Canadian Nurse's Cap Reg'd
Canadian School of Management
Career Dress (A Division of
White Sister Uniform Inc.)
Encyclopaedia Britannica
Publications Limited
Equity Medical Supply Company
Health Care Services U pjohn Limited
Hollister Limited
J. B. Lippincott Company
of Canada Limited
TheC.V. Mosby Company Limited
Pentagone Laboratories Limited
Cover 2
17
9
52
13
34,35
44,45,46,47
10,11
54
Posey Company
W.B. Saunders Company Canada Limited
53
48
G .0. Searle & Company Canada Limited
Simpsons-Sears Limited
Wellcome Medical Division (Burroughs
Wellcome Limited)
Cover 3
Advertising Manager
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P I E2
Telephone: (613) 237-2133
Advertising Representatives
Jean Malboeuf
601, Côte Vertu
St-Laurent. Québec H4L IX8
Téléphone: (514)748-6561
Gordon Tiffin
190 Main Street
Unionville, Ontario UR 2G9
Telephone: (416) 297-2030
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215)649-1497
Member or Canadian
Circulations Audit Board Inc.
Iæ1:J
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You." a",,'ec;ate the fine
fit and easy upkeep of our
smart uniforms. Both are in
a Dacron" polyester warp
knit, Zelcon
-treated to
'breathe' mOre like a
natural fabric, and to
release soil easily when
machine-washed. Comfort-
able 'action back' lets
you move freely. 8 to 18.
Shirt dress with 2 patch
pockets, detachable belt.
White. 31 R 002 302 A. $25
2-pc. pant set has button-
front top with 2 pockets.
Pull-on pants. Mint Green,
White. 31 R 002 393 B. $30
.Reg'd Can. T.M.
II
I
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i
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Sears
,
Simpsons-Sears Limited,
These and other uniform fashions can be found in our Sears retail stores, and our 1979 Spnng and Summer catalogue
I:--
BUTTERFLY *
the winged infusion set of choice
I J
L
,.
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'RO T.M
. Caring for the suicidal patient
. Nutrition and the ICU patient
The
Canacl
Nune
. Northern nurses speak out
. Cape Breton mining disaster -
how nurses helped
. Annual meeting highlights
BIBlIOTHEQUE
SCIENCES INFIRMIERES
M AY
A I
9 l O {9'
.
I : RARY
MAY 1979
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Sizes: 3-15
"Impact Plus
100% textured Dacron" polyest
with ZelconiR> finish
White, Peppermint. . . about $3
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)izes: 8-18
i'lmpact Plu ..
100% textured Dacron" polyester
lVith Zelcon" finish
Nhite, Pink, . . about $32.00
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The
Canadian
Nurse
May 1979
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number 5
Input
You and the law
Calendar
8
COVER STORY
CNA's 1979 annual meeting
STAFFING ASSIGNMENT
A review of past and current
systems of nursing care delivery
The loneliness of the elderly
10
Margaret Beswetherick 18
Amy E. Griffin 23
Lance W. Roberts
Colin A . Ross 26
Heather L. Erb 30
Jeanne Marie L. Hurd 36
Valerie MacDougall 39
Lise DeBoer 43
44
Books
Library Update
15
51
54
Nursing north of Sixty
Emergency treatment of drug
overdose
55
FRANKLY SPEAKING
Nursing and the degree mystique
Nutritional assessment
of the ICU patient
Sir, I know
CNA Testing Service
EMERGENCY
A special report on the
Cape Breton mining disaster
and the nurses involved
Dorothy Gray Miller
46
;(
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.- .... r ...
I
The Rt. Hon. Edward Schreyer was
an honored guest at CNA's annual
meeting this year. Two nurses who
have special reason 10 remember the
occasion are Dr. Moyra Allen. (far
right) professor of nursing and
director of research at MdJiII
University in Montreal, and
Huguette Labelle. (second from left)
assistant deputy minister. Corporate
Policy. Department of Indian and
Northern Affairs, Ottawa, recipients
of the 1979 CNA awards to
outstanding nurses. C O\'('r photo
and com'ention co"erage bv AI
Patrick Photography Ltd.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts
should be typed double-spaced. Send
original and carbon. All articles must
be submitted for the exclusive use of
The Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
The views expressed in the articles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Canadian Nurses Association,
50 The Driveway, Ottawa, Canada,
laP IE2.
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medicus, Canadian Periodical
Index. The Canadian Nurse is
available in microfonn from Xerox
University Microfilms, Ann Arbor,
Michigan 48106.
Subscription Rates: Canada: one
year, $10.00; two years, $18.00.
Foreign: one year, $12.00; two
years, $22.00. Single copies: $1.50
each. Make cheques or money
orders payable to the Canadian
Nurses Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number, in a
provincial/territorial nurses
association where applicable. Not
"responsible for journals lost in mail
due to errors in address.
Postage paid in cash at third class rate
Toronto, Ontario. Pennit No. 10539.
Canadian Nurses Association, 1978.
Team up
with Mosby
to make sure your students
get the most current
and authoritative nursing texts.
A New Book
FUNDAMENTALS OF NURSING PRACTICE:
Concepts, Roles, and Functions (
Two widely respected nursing authors collaborate to
provide a unique introduction to nursing fundamentals_
Emphasizing holistic care, their book.
. I on the h alth c..tre de (f>ry_
e , ...
-.
J P oce!'
e 'onng the dlf1
lanne r J:- _ __ _ (m 11 >rter
coord na'or-coP'lbora,or
. L ,nt nas relr vant t e fL. Ire f nlJrring
. n ow how _pply to
.,
6
.
New 14th Edition
Fundamentals
of nursing
practice
. J W aporopn
By Fay Louise Bower, R.N_. D.N.Sc., F.A.A.N. and Em Olivia
Bevis, R.N., MA, FAA N.; with 8 contributors January. 1979
614 pages, 391 illustrations Price. $16 95.
c. ""'\"l t "1'" roC.)1 t..... '\F'.1111 'l 11\ .
...
PHARMACOLOGY IN NURSING
Ih"'\IKA'I1.)Ht".-.
The latest edition of this classic will help you guide your
students in providmg rational and optimal drug therapy_ Clear
and complete discussions focus on basic mechanisms of drug
action, indications. contraindications, toxicity, side effects, and
safe therapeutic dosage range_ Highlights in this new edition
include:
.
In adrr
allan f drug
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.'1at review key ('')n-
pt., m the
. r, NIT' 'nlymf>S and d,..!" ar "
on 'lastromt"'stmal
- 1ars
By Betty S Bergersen R.N., Ed D. January, 1979 Approx.
784 pages. 100 illustrations. About $20.50.
3rd Edition
NUTRITION AND DIET THERAPY
Since publication of the first edition, this text has been a
leader in its field. This current edition continues - and exceeds
-that tradition of excellence. It focuses on the role of nutrition
in public health. in the basic health care specialties. and in the
clinical management of disease - all in the context of human
needs. Students will be particularly interested in these new
items:
· authontative secllons on behavioral approaches to weight
control and ulolizmg the problem-onented medical record;
· expanded mformatlon on mmerals m the body with emphasl
on zinc;
· new and revised tables mcluding the latest RDA
By Sue Rodwell Williams. M.P.H., M.R.Ed.. Ph.D. 1977. 741
pages, 134 illustrations. Price. $20.50.
New 2nd Edition
CLINICAL IMPLICATIONS
OF LABORATORY TESTS
When students ask questions on the significance of
laboratory test results, offer them this concise resource. Using
an effective. step-by-step approach, it first examines the routine
multisystem screening panels - routine urinalysis and
hematology screening and sequential multiple analyzer tests.
Subsequent chapters focus on evaluative and specific tests of
suspected disease entities. Throughout, the authors emphasize
physiological implications. variations, and interrelationships of
laboratory values.
New features:
· offers handy sections on patient preparation. mstructlon, and
aftercare;
· replaces the chapter on serodiagnostiC tests with two new
chapters on rheumatoid and mfectlous diseases.
· provides an extensively revised chapter on gastroenterology.
· reflects the latest research in the table of normal values
By Sarko M. Tilkian. M.D.; Mary Boudreau Conover, R.N..
B.S.N.Ed.: and Ara G. Tilkian, M.D., F.A.C.C. January, 1979.334
pages, 45 illustrations. Price. $10.75.
q'
''/0
,
.
.
<:::::;
<::>
A New Book
MEDICAL-SURGICAL NURSING:
Concepts and Clinical Practice
Uniting the benefits of both a conceptual and a systems
approach. this new text will be the best choice for your studentsl
The authors have organized information in a way to make it
easily accessible and have emphasized total patient care
throughout. A few key features of this important text are.
· a -ý-'-ms approach wlthm a conceptual framework - -
meanrng your s _dents will be able to locate Important
Information qUickly aõ1d better undrrstand how specIfic medical
details relate tr total patl nt care
· a begmnrng set Ion on "PerspectlvPs for Nur!..ng Practice
offers a useful look at many issues your students will face,
· a vital section or strE'-, and adaptation
· , nurs ng process format .> u ..:d m E..lch clinical section -
where the authors first present a chapter on general assessment
of the involved body system. then dlf- -- specific management
trchr qucs m a separate chapter
By Wilma J. Phipps. R.N.. Ph.D.: Barbara C. Long. R.N..
M.S.N.; and Nancy Fugate Woods. R.N., Ph.D. February. 1979.
Approx. 1,600 pages, 735 illustrations. About $27.75.
.
""
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A New Book
BASIC PATHOPHYSIOLOGY:
A Conceptual Approach
The authors of this useful new text have organized the vast
field of pathophysiology into major conceptual areas. Your
students will study various disease entities as they relate to such
concepts as cellular deviation, body defenses. physical and
chemical equilibrium, nutritional balance, reproductive and
endocrine integrity, and structural and motor integrity Specific
noteworthy discussions investigate:
. immunopathology:
. aging as a genetic process:
. atherosclerosIs:
. diabetes and obesity;
. immune viral organisms of human cancer.
Each chapter begins with learning objectives which can be
used to aid the student in self-evaluation.
By Maureen E. Groër, R.N.. Ph.D. and Maureen E.
Shekleton. R.N.. M.S.N. February, 1979. Approx 560 pages, 423
illustrations. About $19.25.
HEALTH ASSESSMENT
Written by nurses for nurses, this well-illustrated guide
provides practical methods for obtaining a complete history and
performing a thorough physical examination. Students will
especially benefit from discussions which:
. detail beneficial techniques for appraising client function
. examine nutritional assessment. sleep-activity patterns
and the use of climcallaboratory skills
By Lois Malasanos, R.N, Ph.D.; Violet Barkauskas,
R.N.,C.N.M., M.P.H.; Muriel Moss, R.N., M.A.: and Kathryn
Stoltenberg-Allen, R.N., M.S.N. 1977.538 pages, 769
Illustrations. Price, $26.00.
A New Book
NURSING CARE OF INFANTS
AND CHILDREN
Using a systems approach, this new book provides a
comprehensive, practical look at pediatric nursing. The authors
not only examine care of the ill or disabled child, but also stress
promoting the health of the well child. Among the highlights
you'll find:
. pertinent guidelines for action,
. a distnbutlve nursmg care approach:
. lab data and pharmacology mformatlon;
. emphasis on and gUidelines for communicating with children
and their families,
. an appendix of normal values and assessment tools.
By Lucille F. Whaley, R.N., M.S. and Donna L. Wong, R.N.,
M.N., P.N.P. April. 1979. Approx. 1,408 pages, 746 illustrations
About $24.00
Team up
with Mosby.
Basic
pathophysiology
A CONCEPTUAl AP
Groer and Shakl
.
éS
.
MATERNITY CARE:
The Nurse and The Family
Both contemporary and humanistic in approach, this
important volume can help the student function more effectively
as a maternity nurse in today's changing society. Following the
chronologic order of childbirth, it discusses the biopsychosocial
aspects of human sexuality, then proceeds to family planning,
pregnancy, interferences with normal pregnancy, labor and its
complications, the post-partum period, and both normal and
high-risk infants. Throughout, the authors:
. integrate diagnostic. therapeutic, and educational objectives,
. present intervention plans:
. combine clinical and psychosocial aspects
Timely discussions explore such key topics as genetics,
legal factors, fathering, and P.O.M.R.
By Margaret Duncan Jensen. R.N.. M.S.; Ralph C. Bensen,
M.D.; and Irene M. Bobak, R.N., M.S.: with 2 contributors. 1977.
784 pages, 684 illustrations. Price, $24.00.
New 2nd Edition
CHILD HEALTH MAINTENANCE:
Concepts in Family-Centered Care
Students will benefit from the integration of a conceptual
approach, a problem-solving framework. and a strong emph<-_ _
on the holistic person of the c
ild, in this new edition of an
exciting text. It reflects contemporary advances in diagnosIs and
quality assurance as It examines such topics as problems of
single parent families, care of the terminally ill child. high risk
infants, nursing assessment, and specific health problems This
new edition also offers:
· a defmitive section on competencies - physical. learnmg
social. and Inner.
· major seclions on health promotion and prevention of illness.
· revised discussions of the family unit;
· an expanded chapter on high rrsk Infants - mcluding
cardiopulmonary disorders infection, and GI disturbances.
· thought-provoking diScussions of Juvenile and adolescent
rape victims.
By Peggy L. Chinn, R.N., Ph.D. March, 1979. Approx. 896
pages. 377 illustrations. About $24.00.
New 2nd Edition
CHILD HEALTH
MAINTENANCE: A Guide
to Clinical Assessment
This concise text serves as both a student-oriented learning
guide for comprehensive health assessment and as a source of
information for effective pediatric care. The authors present a
wealth of information on developmental differences observed
from birth through adolescence - indicatmg possible
deviations and their health care implications. This edition also
incorporates these valuable new insights:
· an authorrtatlve chapter on assessment of learnmg. thought,
social, and mnercompetencles;
· a detailed chapter on norms and standards for nursmg
assessment and mtervention providmg normal
growth development charts recommended schedules for
immunization and laboratory procedures
· a new chapter on assessment tools and case audit gUldes-
suggesting gUidelines for family. infant. child. and play
assessment.
By Peggy L. Chinn. R.N.. Ph.D. and Cynthia J. Leitch, R.N.,
Ph.D. March, 1979. Approx. 176 pages, 24 illustrations. About
$9.75
Child healö1
maintenance
\ i'
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.......
A New Book
PRINCIPLES AND PRACTICE
OF PSYCHIATRIC NURSING
Using a nursing-oriented conceptual approach to
psychiatric nursing. this text describes man's adaptation to
illness. and identifies nursing diagnoses and specific nursing
interventions.
· Part lis organized according to specific nursmg diagnoses _
anxiety. disruption in the communication plocess. and grref. for
example;
· Part II examines varrous therapeutic modalities presenlly m
use;
· throughout the authors stress nursing interventions and the
application of the nursing process
By Gail Wiscarz Stuart. R.N., M.S., C.N.: and Sandra J.
Sundeen, R.N.. M.S ; with 15 contributors. May 1979. Approx
736 pages. 24 Illustrations About $20 50.
A New Book
COMMUNITY HEALTH CARE
AND THE NURSING PROCESS
Help your students stay informed of the exciting new
changes in community health nursing with this comprehensive
text. Its timely discussions provide a holistic view of human
development by stressing three basic concepts. the health-
illness continuum; humankind as an open system that always
relates to and interacts with its environment: and the effects of
various situations, health problems, and stressors on the health
and development of the individual. family, and community.
Student-oriented features inc:ude:
· an eclectic approach to communrty nursmg
· up-to-date discussions - both in concept and content;
· fascmatmg case studies to develop the thmking process and
stimulate the ability to make creative Judgments
· the insights of noted contrrbutors
By Margot Joan Fromer. B.S., M.A.; with 7
contributors. January. 1979. 484 pages. 110 illustrations. Price.
$18.00.
IVI OS BV
TIMES MIRRDR
THE C. V. MOSBY COMPANY, LTD.
86 NORTHLINE ROAD
TORONTO, ONTARIO
M48 3E5
A90535
. May 11171
The Canadl.n NUrH
perspective
Project Ethics:
a code for
Canadian nurses
In October 1978, acting on a
resolution proposed and
accepted by CNA
membership, directors of this
association agreed to proceed
with development of a
Canadian Code of Ethics for
nurses. Since then, directors
have approved the
appointment of Sister Simone
Roach, CSM, Ph.D.,
chairman of the nursing
department of St. Francis
Xavier University in
Antigonish, N.S. as director
of Project Ethics.
-
, .
Sister Simone Roach
Nurses have always been
concerned about ethics - the
rules and principles which
guide the practice of nursing.
The scope and applicability of
these rules and principles
have varied, just as the
practice of nursing itself has
varied during successive
periods of its history.
A Code of Ethics reflects
an ethos; that is, it emanates
from the specific
characteristics and values of a
particular group or society.
But it also says something to
that group, for a code is built
upon more enduring principles
than constantly changing rules
or judgements. Ethics provide
standards based on
fundamental moral principles.
Today, as people in every
culture and discipline question
the moral basis of their
respective structures,
activities, and patterns of
behavior, the nursing
profession is seeking to
articulate, with renewed
clarity, the fundamental
principles which provide
support for, and give direction
to. its specific mandate.
Concern about ethical
issues in health care,
mounting in Canada over the
past number of years, was
expressed by the nurses of
Canada at their last biennial
meeting. That we are now
committing ourselves to the
development of a Code of
Ethics is a further expression
of this concern.
The task of developing a
Canadian Code of Ethics is a
complex undertaking; it
represents a challenge to
nurses across the country.
As project director, I
solicit your input. As a
suggestion, you might like to
identify:
. the principles which you
believe ought to be the basis
for a Canadian Code of Ethics
. general content areas
which ought to be considered
. areas of ethical conflict
which you are presentl y
experiencing
. the kind of help you
would hope to derive from
having our own code.
Please address your
communications to:
Project Ethics
Canadian Nurses Association
50 The Driveway
Ottawa, Canada
K2P IE2
herein
This month, Dorothy Gray
Miller, public relations officer
with the Nova Scotia Nurses
Association, shares with us
the exciting and untold story
of the part that nurses played
in the February mining
disaster in that province when
12 miners were trapped by an
underground explosion.
In aCNJ exclusive
feature report, beginning on
page 47, she tells us about the
nurses who went down into
the pit, waited at the Mine's
nursing station and helped to
care for the six survivors in
hospital outpatient
departments and bum units.
It all goes to show
something that we've
suspected for some time:
nurses in this country are
taking on some pretty
challenging and unusuaIjobs
these days. They're moving
out of our hospitals, into the
community - into outpost
clinics, northern nursing
stations, offices, schools and
factories. They're bringing
health to the people where
those people live and work
and learn.
We'd like to share more
of these stories with you. If
your job presents this kind of
challenge, or if you know of a
nurse whose work demands a
special caring quality, why not
let us know.
Next month, Thomas Edison
and Albert Einstein are
recognized the world over for
their contributions to human
knowledge and the
advancement of scientific
understanding. What is less
well known is the fact that
both Edison and Einstein
were "learning-disabled"
children, later diagnosed as
being dyslexic.
Difficulty in learning to
read or write (dyslexia) is one
of many perceptual motor
processing deficits which can
turn children into
under-achievers. Next month,
a professor of speech
pathology and a nurse who is
herself the mother of a
learning disabled cbild discuss
how nurses can work with
parents, teachers,
psychologists, and other
professionals to recognize and
obtain help for children with
learning disabilities.
EDITOR
ANNE BESHARAH
ASSISTANT EDITORS
LYNDA FITZPATRICK
SANDRA LEFORT
PRODUCTION ASSISTANT
GIT A FELDMAN
CIRCULATION MANAGER
PJERREITE HarrE
ADVERTISING MANAGER
GERRY KA V ANAVGH
CNA EXECUTIVE DIRECTOR
HELEN K. MUSSALLEM
GRAPIßC DESIGN
ACARTGRAPHICS
EDITORIAL ADVISORS
MATHILDEBAZINEf,
chairman, Health Sciences
Department, Canadore College,
North Bay, Ontario.
DOROTHY MI LLER, public
relations officer, Registered
Nurses Association of Nova
Scotia.
JERRY MILLER, director of
communication services,
Registered Nurses Association
of British Columbia.
JEAN PASSMORE,editor,
SRNA news bulletin, Registered
Nurses Association of
Saskatchewan.
PEfER SMITH,directorof
publications, National Gallery
of Canada.
FLORIT A
VIALLE-SOUBRANNE,
consultant, professional
inspection division. Order of
Nurses of Quebec.
arpen yo ù r c lI nIcal expertIse
with these Saunders books.
Ariz. Moncrief & Pruitt
Burns: A Team Approach
This up-to-date manual provides comprehensive coverage of
thermal injury and its complications. Organized chronologically
according to treatment, the book details everything from the
pathophysiologic consequences of thermal injury to rehabilita-
tion, to reconstruction. Special emphasis is plaæd on: organ and
systemic response to thermal injury; early care-first aid, trans-
portation, emergency room and outpatient care; local wound
care including wound excision techniques: definitive grafting
procedures; burn treatment for specific critical areas;
and much more
By the Late Curtis P. Artz, MD. FACS. John A. Moncrief. MD. and
Basil A. Pruitt. Jr.. MD FACS. 583 pp. 402 ill. $40.80 Feb 1979
Order #1418-3.
Tilkian & Conover
Understanding Heart Sounds and Murmurs
Here's an exciting new, inexpensive package that provides a
basic familiarity with normal heart sounds and allows recognition
of life-threatening disorders manifested by abnormal sounds.
Clear and concise. it's the first package of its kind available to
nursing professionals. Order now! Package includes C-60
cassette plus soft cover book.
By Ara G. Tilkian, MD. FACC. and Mary Boudreau Conover. RN.
BSN, Ed. Package: Order ff8878-0. Book only: about 120 pp. Illustd.
Soft cover. Aboul $21.60. Ready soon. Order ff8869-1.
tv1ar1ow
Textbook of Pediatric Nursing
5th Edition
Because pediatric nursing has come a long way, so has Marlow.
The fifth edition of this highly respected work maintains a
tradition of detailed coverage of child care, while offering
detailed information on everything from necrotizing enterocolitis
to genital herpes to child care in the emergency room.
By Dorothy R. Marlow. RN. EdD. 949 pp. 382 ill. (plus 4 color plates).
$21.55. August 1977. Order .,,6099-1.
Klaus & Fanaroff
Care of the High Risk Neonate
2nd Edition
Patterned after the highly successful first edition, this new
rigorously revised and updated second edition further bridges
the gap between the physiologic principles and clinical man-
agement in neonatology. Popular features, such as critical
comments on controversial points, case material, and Question-
answer exercises that apply and amplify information from each
chapter, have been retained.
By Marshall H. Klaus. MD and Avory A. Fanaroff, MB (RAND).
MRCPE About 415 pp Illustd Ready 500n. Order fi5478-9.
Reece
Reece-Chamberlain Manual of
Emergency Pediatrics
2nd Edition
Indispensable as a Quick source of pertinent life-saving and
pain-lessening information, this new edition has been revised
to include many additional contributors. more detail. and to
emphasize actual emergency situations. Completely reorgan-
ized, it alphabetically lists problems in five sections: true
emergencies, neonatal emergencies, presenting complaints in
emergency room pediatrics, specific diagnostic entities, and
procedures and therapeutics.
Ediled by Robert M. Reece, MD. With 37 contnbutors. 721 pp.
lIIustd. Soft cover. Spiral bInding $19.15. July 1978. Order "'7498-4.
I
..
'j-' -
.......
"\
,
.....
,
'\
Smith. Bierman. & Robinson
The Biologic Ages of Man
From Conception through Old Age
2nd Edition
The biggest change in this exællent revIsion IS the inclusIon of
psychological data by Nancy Robinson. a nationally known
authority on mental retardation. Other significant additions
include sections on young adulthood and middle life, and new
material on death and dying, including legal and e.thical
implications.
Edited by David W. Smith, MD; Edwin L. Bierman, MD; and Nancy M.
Robinson, PhD. 279 pp. 146 ill. Soft cover. $11. 95. Nov. 1978.
Order fi8409-2.
Drain & Shipley
The Recovery Room
Two leading experts in the field provide clear, accurate coverage
of the recovery room in this valuable new, one-of-a-kind book
Topics include the physiology of anesthesia, the effects of
various anesthetic agents. specific care after all types of opera-
tions, and factors that affect recovery from anesthesia in
particular patients.
By Cecil B. Drain, RN, CRNA. BSN and Susan B. Shipley. RN
MSN. 608 pp., 167 ill. $20.35. Ready 500n. Order fi3186-X.
r-............-w
I To order the following titles on 3D-day approval
enter Order # and Author: CN 5/79 I
I I Dcheckenclosed-Saunderspøysposlage
I
We accept Visa and Mastercharge.
I
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I I I
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in England: 1 Sf. Anne's Rd.. Eastbourne. East Sussex BN21 3UN
in Australia: 9 Waltham Street. Artørmon N.S.W 2964
I Moly 111711
The Cenedlen NUrH
input
The Canadian Nurse invites your
letters. All correspondence is subject
to editing and must be signed,
although the author's name may' be
withheld on request.
Back to basics interestingly interpreted in Summary Nursing is caring
"Who took the nurse out terms of human energy, "Hands on" care is indeed an Three cheers for you (M.
of nursing?'., our editor, frequently being labeled as essential component of Anne Besharah) and Theresa
turned patient asks. Despite bioenergetics. While it nursing. The uniqueness of O'Neil for having the courage
all of our professional efforts remains "a little understood nursing quite conceivably to tell it like it is! "...don't ask
to achieve and excel, many of enigma of a signally human results from the fact that me to help you define nursing
us are uncomfortably aware interaction,' eastern cultures nursing directs a continuously practice as it relates to patient
that something is indeed interpret the basis for this interacting biopsychosocial care." (February 1979) I
missing. interaction to be a state of art and science at assisting the couldn't agree more.
In attempting to answer matter called prana, a vitality holistic, complex, You can take all your
her question, one readily or vigor of which the healthy biopsychosocial being in models and theories and
identifies one major change individual has an maintaining homeostasis in all definitions and it means
that has occurred over the overabundance which can be realms. No other helping absolutely nothing if that
years. Much of the traditional transferred to another person profession interacts with the caring factor isn't there. I too
"hands on" physical care of if one has the intent to do SO.2 recipient of care in the same have been on the receiving
the patient has been delegated Therapeutic touch is complex fashion. end of that care and I could
to someone lower in the differentiated from the simple Failure to capitalize on tell you a few stories but they
hierarchy. touch required in routine every opportunity to provide make me ashamed to say I'm a
"Even an aide can readily nursing procedures in and enhance nursing through nurse. The good stories are
learn to give a backrub or Krieger's research into the the use of "hands on" care few and far between. What is
wash a patient's hands and impact of therapeutic touch on detracts from all efforts to wrong with a practice
face!", we say. "Why pay a mean hemoglobin values. 3 provide biopsychosocial discipline that makes "good"
baccalaureate nurse to do However. one might deduce nursing care and ultimately nurses want to leave the
something a diploma nurse from her findings that varying results in the provision of bedside?
can do? Or a diploma nurse, to amounts of caring touch inferior nursing care. Recently the wife of one
do something that a nursing occurring in the process of Continued failure of the of my patients called me at
assistant can do? Or a nursing providing "routine" nursing profession to recognize the home because she was upset
assistant, to do something that care would have a positive significance of simple "hands about something happening
a student nurse or aide can correlation to the therapeutic on" care may severely impede with her husband. She hadn't
do?" is a question every nurse effects observed in the our progress toward the been able to get what she
administrator must answer in recipients of such "hands on" recognition we seek as needed from the ward nurses
these days of economic care. professionals. and her daughter had said:
constraints. If we believe that man is a Our editor has every right . 'Call Leslie, if anyone can
"How can one allocate so holistic, complex to ask "Who took the nurse help you, she can. " Words
much time to basic physical biopsychosocial being, we out of nursing?" We must can't express how I felt when
care when there is so much would have to conclude that take this question seriously she told me this a few days
more indepth knowledge to be there are probably and examine carefully the later...1 hadn't been there
learned?" is a question every psychological and social direction in which our when she needed me.
nurse educator must ask when components also involved in profession is moving. The I want to say to you and
structuring curriculae into the therapeutic laying on of preceding theoretical many others that there are
program timetables. hands, and that these. explanation of the importance nurses who care. We get very
"What are the patient's components are probably of the most basic component tired trying to compensate for
priority needs and which of interacting simultaneously. of nursing perhaps provides all those who don't, and we
these can be met by care All this assumes, of the sOphisticated sanction we can't be everywhere for
delegated to the nursing course, that the nurse does seem to require to advance everybody all the time.
assistant, the student, or the have psychological and social without losing sight of our -Leslie Key, Reg.N.,
aide?" is a question every energies, as well as physical purpose. London,Ont.
practising nurse must ask. energies, in overabundance to -Carole L. McWilliam,
Caught up in our efforts transfer. This would be chairman, School of Nursing, Let us hope that
to develop professional evidenced by that caring Fanshawe College, concerned nurses do not deny
sophistication, we appear to attitude we all so highly value Woodstock,Ont. the evidence...Are nurses so
have lost sight of the very in a nurse. In the absence of References busy attempting to upgrade
essence of our art. The this caring, it is believed that I Krieger, Dolores. their profession that they have
therapeutic comforting effects the nurse would not achieve "Therapeutic Touch: The forgotten what nursing is?
of simple "hands on" care are this transfer of energies in the Imprimatur of Nursing". It appears that this may
perhaps so much a part of our performance of physical American Journal of Nursing, be the case and before long, if
practice that we have become nursing care. Vo1.75, No.5, May 1975, we are not alert, the Marcies
all but indifferent to them. p.784. of this world will have taken
Therapeutic touch by the 2 Ibid., pp.785-6. our place. They appear to be
laying-on of hands is also 3 Ibid., P.786. the ones effective in
The Cenecllen Nu...
"'y11179 .
responding to the patients'
needs, which we so blithely
discuss but rarely nowadays
seem to do anything about.
h would be nice to think
that the writer's experience
was an isolated incident but in
our heart of hearts we know
this is not so.
The patient is the only
reason for the existence of a
health service. Perhaps we
should be looking at what they
want from a nurse, rather than
at what we think they should
want.
-MarionJ. Boyd, Edmonton,
Alia.
I certainly hope that
your generalization is not the
rule. I don't consider myself a
super nurse but I do take a
very active interest in all
of\
3ÑG
eE.
ÑGE.
Ct-\
aspects of my patients' care. I
see nurses all the time who
also show an honest interest in
the well-being of their patients.
I do not deny that
because of the degree of
specialization occurring in
hospitals today, coupled with
the RN to patient ratio. a
nurse is hard pressed to keep
on top and involved in all
aspects of her patients' care.
I find a round in the
morning to introduce myself
and tell the patient what to
expect during the day helps to
relieve the frustration of being
shuffled from department to
department.
Then, sometime later in
the day, I make another round
to see how the day has been
and how they felt they did in
their activities. This afternoon
round only takes minutes per
patient but it is worth a lot and
helps to show my patients that
I trul y care.
I work a twelve-hour
routine which allows me extra
time to devote to my patients.
I used to go home frustrated
and mad; everything was so
rushed that I didn't have time
to stop and listen or even hold
someone's hand. I empathize
with RN's that still work a
73/4 hour day: it's really
tough to be good under
today's condition.
Were your nurses truly
uncaring? Or did they leave
emotional needs until they had
a spare moment - a moment
which never came because of
their workload?
-Dianne SuI/ivan, Nanaimo,
B.C.
The last chapter
I feel it may be of interest
to you and perhaps many
readers ofthe article hMy
fight for life" (November,
1978) to know that Linda
Walker was admitted to the
Sherbrooke Hospital for the
final time in January and died
on January 15th.
Bob, her faithful friend
and his mother were with her
at the time of her death.
Linda had pre-arranged
that her body should go for
medical research, which it
did, but several of the hospital
taff attended her memorial
service which she had helpeJ
to plan and it was a very
meaningful and comforting
service.
-Lily Suggitt, Sherbrooke,
Quebec.
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The Cenedl.n Nur..
A message from the president
Among all the professionals in the nurse and of medicine will undoubtedly the establishment of such conditions is
caregiving field. nurses have the most be in flux over a long period of time. not sufficient. When standards ofnursmg
regular, frequent, and intimate physical, Standards for nursing practice will be practice are enunciated by the profession
psychological and social contact with equally fluctuant. In fact, unless nursing there must be a committment to the
clients and families, and we have a more believes that standards must change realization of the objectives that
detailed knowledge of their day-to-day constantly in order to keep pace with maintenance of the standards is
activities of living and working. But we alterations in societal and professional supposed to achieve. The individual
are equally aware that we must take goals and with opportunities for practitioner must also detennine her own
initiatives to change certain aspects of excellence, no one is served by the operative standards for one cannot
our practice. This must be change by enunciation of any type of standard. As impose a standard on another; the
choice rather than change by chance or the nature of nursing practice changes individual nurse must be answerable for
for the sake of change alone. New roles over time, so must our sta,ndards change. her own acts and for the consequences of
are demanding new skills which must be Many factors that detennine the such acts. In order to build and maintain
purposeful rather than haphazardly manner in which nursing is carried out, professional credibility. nurses must
prescribed, but at the same time nurses or will be carried out in future, are determine the quality of practice to be
are recognizing the need for innovation decided far from the patient' s bedside. achieved. organize a system for
and experimentation. Regardless of the These factors may not even be improving the practice through the
new directions nursing might take, it is recognized for the role they play when interpretation of collected data, and
imperative to be ready and able to such decisions are made which continuously monitor that practice. The
answer for the quality of our practice. ultimately affect nursing practice. It is goal of review is not the accumulation of
Society's expectations in 1979 place for this reason that nurses are becoming vast quantities of impressive documents.
more responsibility for superior more alert to the health care decisions but rather education of our members so
performance on the nurse than ever which are made in their own practice that discrepancies are corrected and the
before. Never has there been greater areas. to governmental laws and quality of care is upgraded. To be
pressure from within and without the regulations, to changes in the economy, accountable and responsible to our
profession for systematic assessment advances in medical technology and the clients means that we will protect them
procedures which will enable nurses to like. Nurses increasingly realize the need from incompetent practitioners and that
become more accountable and to be concerned with health care delivery we will assume responsibility for
responsible in regard to patient care. The problems and the health needs of society improving the practice of other nurses.
beliefs of society about health care in as a whole. If we are to advance as a We must also strive harder than we have
general influence what the nurse does, profession these issues must be our in the past to reward excellence of
how she does it, how she is prepared to concerns. Failure to respond could well practice. Peer review. therefore,
do it, and what is expected of her. result in other disciplines or services becomes an important sequel in the
It has become clear that nurses dictating nursing care practices. thereby adoption of nursing practice standards.
across the country are investing setting the standards to which nurses The review system that focuses on the
significant amounts of time and energy would be expected to adhere. We must recipients of our services, generally
developing procedures and tools to not abdicate our responsibilities for known as the nursing audit, is becoming
measure the quality of nursing care. In controlling nursing care and we must widely acknowledged whereas the
addition. several provincial/territorial recognize the consequences of review that focuses on the individual
associations have made great strides in relinquishing our prerogatives in the professional and seeks to evaluate the
the development of standards for nursing pursuit of short-term goals. Such practice of that individual is far less
practice. The Canadian N U1
es trade-offs in the name of efficiency. cost common. The way in which nurses at all
Association has, as one of its objects, the restraints, or bureaucratic structure can levels will view accountability for their
promotion of standards required to well lead to low standards of nursing own actions and for those of others who
achieve a high quality of perfonnance perfonnance and patient care in our share their responsibilities will go a long
among its members and the best possible institutions and in society at large. way toward determining the kind of
care to our citizens: In light of this goal The proposed CNA standards for standards of care that are likely to be
CNA directors have affirmed their nursing practice may serve to adopted and maintained.
decision to proceed with the supplement and perhaps complement The issue of accountability to our
development of nursing practice those standards which individuals and consumers. to our peers, to our students.
standards. For to be accountable means groups have already adopted. or they and to our profession remains an
to be willing to seize responsibility, not may be exclusively adopted by nursing important challenge m 1979. If we are to
to wait until it is thrust upon us. practitioners who believe they enunciate adequately meet that challenge it is
Professional groups in the past have what their nursing practice should be. imperative that our nursing practice
tended not to achieve adequate The adoption of standards. however, standards are developed within the
standards of health care unless required does not guarantee that high-quality care profession and that the individual
to do so by some body that can impose will in fact be provided. While the practitioner assumes a personal measure
penalties for failures. It is never profession can propose the ofresponsibility for the maintenance of
inappropriate or iII-timed to detennine establishment of conditions that would those standards.
standards for the profession. For increase the likelihood that high-quality - Helen D. Taylor. President.
concepts of health care, of the role of the nursing care will be provIded to patients, Canadian Nurses Association.
The Cenecllen Nur..
..., 1171 11
Highlights from the report of the executive director
Helen K. Mussallem
The eight months since the last annual
meeting in Toronto last June have
been characterized by intensive
planning an,d initiation of goals and
priorities set for this biennium. In
addition. some programs, projects
and activities from previous
bienniums have continued and some
new ones have been added.
Priorities for 1978-80
I. Definition of Nursing Practice and
Development of Standards for N ursinI(
Practice: On March 2 Patricia Wallace of
Edmonton accepted CNA' s offer to
become director of this project.
Immediately prior to this date, Louise
Levesque of the Faculté de sciences
infirmières of the Université de Montréal
accepted CNA' s offer to become
directorofCNA projects. She will be
responsible for ongoing supervision of all
current projects.
2. N ational Forum on Nursing
Education: The Forum will be held at the
Skyline Hotel in Ottawa. November
13-15, 1979. A tentative program has
been prepared and confirmation of
speakers is expected shortly. The
chairman of the planning committee is
CNA member-at-Iarge for nursing
education, Margaret McCrady.
3. Canadian Code ofEthícs: Sister M.
Simone Roach. chairman of the
Department of Nursing at St. Francis
Xavier University in Antigonish. Nova
Scotia. has accepted CN A' s offer to
develop a Canadian Code of Ethics for
Nurses. Sister Roach began the project
with a visit toCNA House in February.
The goal is to have the final draft to
the association members before the end
of 1979. Provincial/territorial nominees
for the project as well as other experts,
will be considered as an advisory panel
(see also page 06).
4. National Accreditation Program for
Nursing Education: CNA officers met
with officers of the Canadian Association
of University Schools of Nursing
(CAUSN) and the Association of
Canadian Community Colleges (ACCC)
with a view to developing a plan of
action.
The president. executive director
and director of professional services met
with Dr. Dorothy Kergin. president of
C AU SN and the chairman of the
CAUSN committee on accreditation. Dr.
Kergin acknowledged that the Canadian
Nurses Foundation grant to CAUSN had
assisted them in the development of
accreditation and advised that an initial
plan of their program was tested in three
university schools of nursing. Contmued
collaboration between CAU SN and
CNA is anticipated.
The president and executive
director also met with their counterparts
at the ACCC. CNA has been advised
that ACCC does not intend to develop an
accreditation program for diploma
schools of nursing within community
colleges. ACCC would cooperate or
collaborate under specified conditions
should CNA proceed with development
of a national voluntary accreditation
program. f
5. Public Relations: In the fall of 1978. on
direction of the board, public relations
became a priority. It was named
"Operation Visibility" and was launched
with a Canadian Press interview with the
president.
· Promotion ofthe CNA Journals.
beginning with the special issues on
native health care. will continue.
· In a three month period. some 75
print media in Canada carried a CNA
feature and there were numerous radio
interviews with the president and the
executive director.
· Activities of the president and
executive director, as spokesmen for
CNA, are being monitored to develop
public relations opportunities nationally
as well as all CNA liaison with other
organizations.
· Press conferences have been
planned for several events throughout
the year.
· Plans are underway to involve
several of Canada's national magazines
in features about the nursing profession.
· Feature articles on aspects of
CNA's work are being developed for use
in the CNA Journals and will be used in
other ways following publication.
· The public relations officer met with
the eleven counterparts at CNA House
in J anùary and will continue to do so on
an individual basis throughout the year.
6. Comprehensii'e Examination:
Although this was a 1976-78 priority. it is
included here because the target date has
been set for 1980 and it is a high prioritý
project.
7. Doctoral Preparation in Nursing:
"Doctoral programs in nursing" has
been identified by the board of directors
as a priority for implementation in the
fall of 1979 ( see below).
1978 Annual Meeting Resolutions and
Motions
I. National Conference on Nursing
Education and N ativnal Accreditation
Program for Nursing Education
(Resolutions I and 3): Accepteø as
1978-80 priorities.
2. V se of Language Proficiency Tests by
V.S. Jurisdictions (Resolution 2):
Continues to be pursued actively through
visits and correspondence with the
relevant U.S. bodies.
3. CNA Views on Health Promotion,
View of Nursing Profession Regarding
Health Related Issues (Resolution 4):
Public relations counterparts met with
the public relations officer early in
January. A number of recommendations
that came from this meeting will be
implemented in 1979 or incorporated into
the "Operation Visibility" CNA PublIc
Relations plan. The meeting explored
plans with considerable exchange of
information and an overall intent to
maintain closer contact through the year.
4. CBC Educational Program in Health
Maintenance and Promotion (Resolution
5): The executive director. past president
Huguette Labelle and the public
relations officer met with Albert
Johnson, president ofCBC. Johnson was
most encouraging and among several
suggestions he presented for
(continued on page 13)
12 ...,1171
The Cenedl.n Nur..
National association holds annual meeting
.
March 29th was nurses' day in Ottawa-
the day the Oueen's representative paid
tribute to the work and dedication of
Canadian nurses in this country and
abroad and bestowed special honors on
two outstanding representatives of the
profession,
. the day Canada's Minister of Health
and Welfare promised the nurses of this
country that her party would fight tooth
and nail in the coming election to
preserve national health care plans, and
. the day nurses came face to face
with representatives of our publicly
owned national broadcasting system and
stated the case for more health-oriented
programming and an end to perpetuation
of the handmaiden image of the nurse on
television screens.
The occasion was the 1979 annual
meeting of the Canadian Nurses
Association and the 200 nurses at
Ottawa's Skyline Hotel had travelled up
to 2000 miles to represent their provincial
or territorial member association.
A highlight of the day-long meeting
was the visit by His Excellency, the Right
Honorable Edward Schreyer, Governor
General of Canada, and Mrs. Schreyer.
In his address the Governor General
extended greetings to all of the nurses
represented by the delegates in the
audience and congratulated the two
nurses honored during the special
ceremony that followed on winning the
respect and admiration of their
colleagues.
Tributes to the two outstanding
nurses, Dr. Moyra Allen and Huguette
Labelle, were read by the presidents of
the provincial associations which
nominated the successful candidates for
the honors, Jeannine Tellier-Cormier
(0110) and Valerie Ayris (AARN).
\, t
.. \
,
Ç;;J
J
\
-
A dialogue with cae
CNA delegates and members took
advantage of the opportunity provided by
a visit from representatives of the
Canadian Broadcasting Corporation, the
deputy head of English TV and radio
network programming, Peter Herndorff,
and science and medicine reporter, John
Blackstone, to achieve some nursing
input into health programming.
Their message: "stop emphasizing
the 'blood and guts' aspect of illness and
disease and concentrate on prevention;
take health care out of the hospital, into
the community; show nurses working
independently in health centers, in
outpost clinics, in homes and schools; in
short, remember that nurses - both men
and women - are real people working to
help other people stay healthy."
-
.
..(
. Ii '0':
"
I
Health plan vital to care
More than any other group, Canada's
health care plan has special meaning for
nurses, Monique Begin, Minister of
Health and Welfare Canada, told the
nurses in her audience. "It has in effect
given you the means to reach towards
giving the best possible care to every
single Canadian who needs it. It must
continue to do so."
Speaking to a large and enthusiastic
luncheon gathering, Begin said that she
had intended to speak about the
department's involvement in International
Year of the Child and, more specifically,
the importance of perinatal care and .
prevention of handicap. Since her
invitation to the meeting, however, a
major threat to Canada's health care plan
required her to explain the situation more
fully to nurses, who form the largest
grol,lp of health care workers in the
country.
She called the threat to universal
medicare a "grave social issue" and said
that "the poor, the old, people faced with
medical disasters and people living in our
least developed regions" would suffer
most from compromises to the plan. She
underlined the importance of ensuring
that Canada's health care program,
which has provided Canadians with "the
best health care in the world", must meet
certain requirements - "it must be
Canada-wide, universal, accessible,
portable, publicly-operated and financed
mostly through the public tax system".
Begin said that it is the success of
this system that has allowed Canadians
to consider the broad approach to health
care that is necessary to deal with the
issues raised during the International
Year of the Child. She pointed out also
that programs for the prevention of
perinatal handicap and reduction of
perinatal risks make a universal
medicare system a necessity today.
Membership concerns
Association election procedures,
availability of research funds and tax
exemptions for continuing education
were among the concerns of
membership brought to the attention of
delegates. Four resolutions presented by
committee chairman Ginette Rodger
were approved by voting delegates who
also passed two motions brought to the
floor during the meeting.
One successful resolution directed
the association to make provision in each
future biennial agenda for candidates (or
proxies) to address delegates prior to the
voting session, so that delegates might
learn more about these candidates. A
motion was also passed concerning
election procedure, resolving that the
report of the committee of scrutineers
include specific information about the
ballots cast fqr each candidate (yes. no
or spoiled) so that unsuccessful
candidates might consider these results
before deciding to accept future
nominations for national office.
Other resolutions directed the
association to:
. encourage nurses to submit
research grant applications to funding
agencies such as Medical Research
Council, Social Science and the
Humanities Council and Canada Council,
as well as to the National Health
Research and Development Program
. promote a more active role for
nurses in governmental elections through
the questioning of candidates on their
position concerning issues related to
health care and nursing research
. press for changes in the federal
Narcotics Control Act to allow information
obtained under these regulations to be
communicated to the statutory body
registering nurses in each province or
territory.
As a result of a motion approved by
delegates, CNA will begin worl<
immediately on a brief to be submitted to
the Minister of Finance providing
information supporting a tax exemption
for education costs incurred by nurses
seeking to maintain their practice
competency.
Consumers to sit on CNA Board
Delegates also approved an amendment
to the association bylaws which will
permit the addition of three public
representatives to the existing
20-member board of directors. The
appointments will be made in 1980.
Frontier project
"There's no place like home for health
care" is the title of a new multi-media
education tool which has been developed
over the past two years as a joint St. John
Ambulance/Red Cross project. Details
on the project, now nearing completion of
national field testing, were explained to
CNA members by project director,
Marjorie Hayes, who urged nurses to
make use of this resource to help the lay
public help themselves to better health
care. A certificate of appreciation for the
support provided by CNA during the
developmental stages of the project was
presented to the association's executive
director by Hayes.
The CenedIM N&ne
. (continued from Pa&e 11)
consideration by CNA was that of having
associations communicate directly with
regional program producers. Staff have
maintained contact with the CBC in
developing the feature presented at the
1979 annual meeting.
5. Income Tax Deduction forC ontinuing
Education (Resolution 6): The executive
director. director of professional
services and the director of labor
relations services met with the officials
from the Tax Policy - Legislation Branch
ofthe Canada Department of Finance in
January.
With respect to Resolution I from
the 1977 annual meeting. "that the CNA
strongly urge the Government ofC anada
to permit Canadian nurses to include
costs of professional journals and texts
as income tax deductions," officials
informed us that all taxpayers are eligible
to deduct three per cent of their net
income. up to a maximum of$500.. as an
employment expense. This covers
employment expenses such as texts,
journals and other expenses related to an
individual's work.
With respect to Resolution 6 from
the 1978 Annual Meeting. "that the
Canadian Nurses Association request
the Department of Revenue to amend the
provisions of the Income Tax A ct in
order that nurses and other salaried
persons be granted lax exemption for
monies spent infurthering their
education in accordance with
requirements for continuance in
practice." officials outlined the tax
deductions available to aU students.
They also indicated that the deductions
were the same for all taxpayers whether
they are employees or self employed.
In further discussion CNA
representatives asked ifthe Income Tax
Act could be amended to provide tax
deductions for nurses requested to enrol
in a continuing education program as a
requirçment for continuance to practice
(the province has the authority to
determine which schools are educational
institutions).
The Tax Policy - Legislation Branch
representatives replied that pharmacists,
doctors. engineers, teachers and
chartered accountants have aU made
representation to the department on this
Issue.
CNA was invited to present a
submission to the Minister of Finance.
The paper should be well documented
and provide information on how nurses
differ from others or if they are unique in
their role as a nurse. Problems related to
the Adult Training Act and its
implications for nursing should also be
included.
..., 1W11 UI
6. Home Deliveries of Newborns: CNA
is continuing to collaborate with the
National Committee of Nurse-Mid wive".
Views were expressed and discussed at
the CHA/CMA/CNA/CPHA Joint
Committee meeting in October 13.
Assistant Deputy Minister. Maureen
Law, has advised that "although
members of the Health Services and
Promotion Branch of Health and Welfare
Canada have no present plans to revise
the publicationRecommended
Standards for Maternity and Newborn
Care, should such an issue be considered
a necessary priority item. we would be
pleased if you and members of your
association would be available to
participate in any such revision. ..
Dr. A.L. Swanson. Canadian
Council of Hospital Accreditation has
advised that the CNA motion was
brought to the attention of the Program
and Standards Committee of the CCHA.
He said that it was the feeling of the
committee that the motion was most
timely and that it would be kept in miIJd
in future revisions of Guide to Hospital
Accreditation and its accompanying
questionnaire.
7. Support for Nurses at Vancouver
General Hospital (Motion 2): Directives
regarding communications with
government and officials of the
Vancouver General Hospital were
transmitted and acknowledgements
received.
8. Clinical Training Programs (Motion
3): The CNA motion was discussed at an
October meeting ofthe CAUSN Council
with the result that the four regional
presidents were asked to take the motion
back to their regions, review the CNA
statement and send their comments to
the CAUSN executive secretary.
Because the regional associations meet
only two or three times a year, it will be
some months before CAUSN can
respond to the CNA on behalf of the 22
university schools of nursing. A letter
was received from the Atlantic Region of
CAU SN asking for clarification of the
CNA statement on the Nurse in Primary
Care. This has been included in the
annual reexamination of the CNA
Position Statements.
9. Doctoral Preparation in Nursing
(Motion 4): The seminar held in
November determined that high priority
should be given to the development of a
Ph.D. (Nursing) program in Canada.
Proceedings of the seminar have been
sent to all participants for comment. Dr.
Shirley Stinson. CNA president-elect,
was project director; the project was
funded to $38.250 by the W.K. Kellogg
Foundation.
'lcontinued on page 14) .
14 ..., 1171
L
Decubitus Ulcers
An audio-visual
presentation available
on loan, free of charge
This presentation describes tteat-
ment and dressing techniques for both
simple cutaneous and deep decubitus
ulcers, using BenOxyl 20% (benzoyl
peroxide) Lotion.
The taped narranve, by W.E. Pace,
M.D., M.Sc., F.R.C.P.(C) and Heather
Hanson, R.N., runs 'for approximately
30 minutes and is supported by a series
of before-and-after illusttative colour
slides.
To complement the slide-tape pre-
sentation a folder illusttating the dress-
ing techniques is available in quantity.
For any of the above material,
including a complete script, please
write to:
Scientific Services Dept.
Stiefel Laboratories
(Canada) Ltd.
6635 Henri-Bourassa Blvd. W.
Montreal, Quebec H4R tEt.
To Canadian Nurse
Readers
There are a few English and
some French CPS, 12th and 13th
editions, (for reference only)
available to Students on a 1st
come 1st served basis, at $6.00.
The Compendium of
Pharmaceuticals and Specialties
is a valuable reference used by
all health professionals.
Send your orders to CPS (Nurse),
175 College Street, Toronto,
Ontario MIT IP8, include
cheque or money order for $6.00
- a fine offer, should you prefer
the 14th edition CPS'79. Price
$28.50.
The CIInlKll.n Nur..
. (continued from page 13)
10. CNA Support of Improvement of
Patient Care Settings (Motion 5): The
board has directed "that any request
from registered nurses seeking CN A
support to improve patient care settings
in order to provide safe, competent
nursing care shall be made to CN A
through the provincial/territorial
professional nurses' associations." This
confirms the process in use by CNA.
Liaison Activities
-
. National Health and Welfare: In
response toCNA views on family
planning budget cuts. the Minister said
that the available funds will be allocated
on the basis of provincial requests to
continue or improve the family planning
services for which they are primarily
responsible. A significant portion of the
funds will again be dis
ursed in the form
of sustaining grants to the national
voluntary agencies.
. Canadian C entre for Occupational
Health and Safety: The inaugural
meeting of the Governors of the Centre
and a press conference were held in
Ottawa. Both events were attended by
CNA representatives. CNA efforts to
have nurses on the governing council
were realized with the appointments of
Huguette Labelle and Margaret
Charters. A grant of$385,OOO was voted
by Parliament to launch the centre. A
president may be announced later in the
Spring. CNA staff will continue to work
closely with this agency and will advise
of any further developments.
. The Law Reform Commission: The
expert panel of nurses selected by CN A
to assist with the Commi'ision's
Protection of Life Project was called to
Ottawa on March :!9 to provide further
advice for the commission.
. Health and We(fare: Ministers of
Health and Welfare and Finance as well
as the president of the Treasury Board
were a'iked to reconsider proposed cuts
in research grants and awards within the
department. The pre
ident ofthe
Treasury Board replied. in part. as
follows: "One of the many difficult
decisions the government had to make in
view of the need to reduce federal
expenditures substantially was the
extent to which health research would be
affected. We were particularly conscious
of the valuable work that is being
supported by the National Health
Research Development Program. as well
as by the Medical Research Council. The
necessity for restraint. however. affects
all programs. and it was necessary to
reduce the 1979-80 budget of the
National Health Research and
Development Program by $2 million. and
that ofthe Medical Research Council by
$0.5 million. The total reduction of$2.5
million represents 3.4 per cent ofthe
total $74.3 million grants and
contributions allocated for these
programs in 1978-79. Although this
reduction is not trivial. it is significantly
smaller than the cuts imposed on many
other government programs and, as
such, reflects our intention to maintain a
high level of support to these programs.
which are so important to the future
health of Canadians. ..
. Statistics Canada: CNA was
advised by Statistics Canada in
September that the Bureau would
experience a $13.5 million cut
diminishing the budget of Health
Manpower Statistics section by more
than 25 per cent. As a result, several
surveys were cut completely. but the
annual inventory of registered nurses
wilrcontinue unaffected for 1979. It is
anticipated that in two years' time the
RN survey will probably be conducted
on a biennial basis rather than annually
(i.e., 1980 and 1982). This speculation is
based on current budget restrictions.
"Nursing in Canada: Canadian Nursing
Statistics 1977" based on 1976 data has
just been released.
. Canadian Nurses F ollndation: CNA
continues to maintain its close working
relationship with CNF. Although it is a
separate corporation with Letters
Patent. CNA's executive director. by
resolution ofthe CN A board. continues
to act as secretary-treasurer. The five
directors met In November at CNA
House to elect Louise T od (MARN)
president and Shirley MacLeod
(NBARN) vice-president.
. National C olfference on C ontinlling
Education in Nursing, Winnipeg, 18-20
April 1979: Notices regarding this
conference have been widely distributed
by the conference planners. Their
application for funding to the office of
the Coordinator on the Status of Women
was supported by a letter of
recommendation from CN A. Planners
have also been in continuing
communication with the CNA planning
committee for the National Forum on
Nursing Education.
. Canadian Council on Hospital
Accreditation: Ct-JA was requested to
nominate two members to the CCHA
Board of Directors for 1979-80. In
consultation with the president. who
expressed her wish not to be
renominated. Fernande Harrison
(AARN) was invited to continue on the
board for another year and Ginetle
Rodger, (OllQ)CNA member-at-Iarge,
nursing administration, was invited to be
the second nominee. Both have agreed to
serve.
The CllnecIIen NUrM
"'y 1171 111
---.0.
L-- -----'" .\
YOU AND THE LAW
The coffee-break:
potential pitfall for nurses
Corinne SJ../ar
The "coffee-break" is an accepted and expected event in the
nurse's regular working day. In fact. it is considered a workday
institution. However, the absence of personnel while on
"coffee break ., can result in liability for harm befalling a patient
during that time. The following three cases illustrate the reality
of this legal result and the Courts' reasoning in their finding of
liability.
Nurses are responsible for the quality of nursing care they
deliver to their patients. They are responsible for the patient"s
general safety and well-being as well as the specific care the
patient requires. If the unit is inadequately staffed. then the
quality of patient care may suffer. A shortage of professioné)l
nursing staff should always be reported to the appropriate J
administrative personnel of the hospital so that immediate
remedial steps may be taken.
Such reporting is necessary since the hospital has a legal
duty to employ competent personnel in sufficient numbers to
deliver patient care. The patient has the right to expect that a
hospital will be adequately staffed so that his health care and
personal well-being will be reasonably safeguarded.
Responsibility for maintaining adequate unit staffing is a
continuing one and must be discharged even during those
intervals when staff. in rotation, absent themselves from the
unit: usually for the "coffee" and meal breaks.
The three reported cases - in each of which harm to the
patient occurred while the nurses were taking their coffee break
- resulted in lawsuits brought against the hospitals involved
and their nurses. In all three cases the chart was admitted into
evidence. The record of the events written in the chart was
important in determining the presence or absence of liability,
another reminder of the necessity for complete and accurate
charting.
A rmding or no liability
In the case of Child v VancoliverGe'leral Hospital et al.' no
liability was found, a decision subsequently affirmed by the
Supreme Court of Canada. 2
The patient had been admitted for surgical correction of an
ulcer condition. A subtotal gastrectomy was performed and. a
few days later. the patient developed peritonitis. The patient
was then moved to a private room and special nursing care was
ordered. The nurse named in this action was one of the
hospital's special nurses attending the patient.
The patient was delirious. extremely restless and suffered
from hallucinatory periods. On the morning of the patient"s
injury he was' 'restless, jumpy. anxious. hallucinating vividly" .
This had been recorded in the night nurse's notes. While the
nurse was administering the usual a.m. care to the patient, he
attempted to get out of bed. The nurse had no difficulty in gently
resisting this effort. She telephoned his surgeon. requesting his
attendance and reported the patient's restlessness. The patient
was quiet and lucid during this time and remained so during the
surgeon's visit one hour later. The nurse left her patient resting
quietly and apparently sleeping while she went for coffee. She
informed a nurse on duty at the nursing station that she was
leaving the unit. She was gone about fifteen minutes.
During that time, the patient climbed out of bed, removed
the tubes from his body. and tied two sheets to the leg of a chair.
In his attempt to lower himself out of the window, he fell to a
roof two floors below injuring himself severely.
Were the hospital and the nurse negligent in their duty to
the patient? Should the nurse have foreseen that the patient I
would have a period of irrationality again and therefore declined
to take her coffee-break?
The jury determined that this nurse was not neglIgent m
leaving her patient. Twenty-four hour surveillance of the patient
had not been ordered so that there was no duty upon the nur..e
not to leave him alone at any time.
Had the nurse used rëasonable care in leaving her patient?
Was the risk of harm to the patient so real a danger that a
reasonably prudent nurse would have foreseen such a risk and
not left her patient alone? I n this case, the jury, after hearing
and weighing the evidence, decided that this nurse's conduct
did not amount to negligence. Her conduct did not result in the
harm that befell the patient. Her assessment that her patient,
whom she had observed to be resting comfortably, would be
safe while she went for coffee was accepted
Finding or liability
In the next two cases. the injury to the patient occurred
post-operatively in the recovery room while the nurses assigned
to the recovery room were absent during their coffee-break. In
both cases, the
were instrumental in determining what
had occurred a
hat time.
In Laidlaw v Lions Gate Hospital et al. , a 44-year-old
post-cystectomy patient suffered irreversible brain damage as a
result of respiratory arrest while in the recovery room. The
delay in observing the arrest and acting to correct it was held to
have been the legal cause of the patient"s injuries. The
negligence of the hospital and its nurses in failing to adequately
maintain the recovery room staff was determined to have
caused this delay in observation.
The recovery room, in this case. was usually staffed by
three nurses but, on the day in question. only two nurses were
on duty. When one nurse went for coffee. the other was alone in
the recovery room with two patients. Shortly thereafter a third
patient arrived. The nurse's care of that patient was interrupted
by the arrival of the plaintiff. Before the nurse could complete
an assessment of the plaintiffs immediate condition, yet
another patient arrived accompanied by his anesthetist who
ordered the nurse to give this patient a STAT injection of
Demerollll>. The nurse, still alone with all five post-op patient...
went to carry out the order. After domg so, she al!.o took a
telephone call before returning to the plaintiff. Mrs. Laidlaw.
I' "'y 1179
The Clin.dl.n NUrH
...
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On her return. the nurse observed that Mrs. Laidlaw was not
breathing and put through a calI for assistance to another
anesthetist. At about the same time another patient was brought
to the recovery room and another physician was summoned.
The absent nurse returned about this time.
The function of the recovery room is to provide highly
specialized care to patients immediately post-op. The trial judge
described the necessity for frequent and careful observation of
patients still under the influence of the anesthetic:
"Respiratory arrest is not an uncommon occurrence in the
PAR room (post-anesthesia recovery) and. therefore. the
personnel in this room must be watchful and alert at all times in
order to protect patients in this labile and vulnerable stage. The
nurses in this room are there for the purpose of promptly
recognizing any respiratory problem. cardiovascular problem
or hemorrhaging. They are expected to take corrective action
and/or to summon help promptly. "4
In the judge's view. the recovery room is the most
important room in a hospital precisely because of the potential
dangers to the patient during the post-anesthetic period.
"This kno....n hazard curries with it in my opinion a high
degree of duty owed by the hospital to the patient. As the
dangers or risks are ever-present there should be no relaxing of
vigilance if one Ü to comply with the standard of care required
in this room." 5
The trial judge based this conclusion on the evidence ofthe
witnesses and. in particular. on the evidence of the physicians.
He further found that in order to meet the standard of care
required in a recovery room. there should be always a minimum
of two registered nurses present with a staff/patient ratio of one
registered nurse for every three patients.
Here the hospital had assigned the appropriate number of
registered nurses to duty in the recovery room. The negligence
occurred when appropriate substitutional relief was not
obtained so that the nurses on duty could absent themselves
from the unit.
The trial judge found the charge nurse negligent in
I) failing to provide the required observation for the patient.
2) permitting the other nurse to leave for coffee at a time when
other patients were expected or ought to have been expected
from the OR. Relief assistance should have been arranged. From
her knowledge of the surgery organized for that morning, the
nurse was negligent in failing to make adequate arrangements
for patient care.
"These items constitute in my
'iew more than mere errors
injudgment.1 am mindful that the standard demanded by law is
not that of perfection; but an anesthetized person is entitled to
expect a high degree of performance, diligence and ob.5ervation
on the part of the nurses in the PAR room because of the great
risk of an obstruction or other trouble developing." 6
The other nurse was found negligent in leaving the
recovery room without considering the needs of the patients
therein and the further anticipated arrivals from the OR. The
hospital was found liable for the negligence of its nurse
employees.
In this case. the trial judge concluded that the "necessity
for watchfulness had given way to carelessness."7 A
lackadaisical attitude had developed with respect to
coffee-breaks. This should have been i:orrected by the hospital
through its nursing supervisor.
Decision: negligence
The decision in the Laidlaw case was referred to in Krujelis et
al. v Esdale et al. sHere. a ten-year-old boy suffered irreversible
brain damage post-operatively while in the recovery room. He
died shortly thereafter. The inaljudgt found that there had been
no negligence on the part of th.' surgeons or anesthetists. The
patient had been admitted for su.-gical correction of
over-prominent ears. When he left the OR he was in "excelIent
condition" .
The C.n-.ll.n "ur..
"ey 11178 17
The patient arrived in the recovery room at about 9:45 a.m.
when his vital signs were recorded and entered. His condition
was found to be satisfactory. Six other patients were already in
the recovery room at the time of his arrival.
At approximately 10: 13 a.m.. one of the nurses returning
from coffee-break went to examine the child. The patient was
cyanotic. She found no vital signs. The patient had suffered a
respiratory obstruction followed by cardiac arrest. His
condition had been unobserved. The damage was done.
Five nurses were on duty that morning. Three of these
nurses had gone for coffee before the arrival of this patient and
they had returned at about 10: \3. after his cardiac arrest. Two
nurses were present in the recovery room during this time.
The trial judge found that the injury to the patient resulted
from inadequate observation of his condition by the nursing
staff. This inadequacy was the direct result of the absence of
three of the nursing staff for coffee during the busiest time of
day for the recovery room. The hospital was found liable for the
negligence of its nursing staff in the course of their regular
duties.
Standard of care
Nurses owe to their patients a duty to safeguard their health and
well-being. The standard of care required applies not only to the
actual physical care delivered to the patient but also to proper
observation of the patient's condition. Adequate observation
requires adequate numbers of competent staff to properly fulfill
this duty.
That is not to say that nurses are to be denied meal and
coffee-breaks. What is required of the professional nurse is
discharge of the responsibility of ensuring that. in one's
absence, patient safety and well-being are properly
safeguarded.
As these cases illustrate, failure to do so may amount to a
breach of duty and may result in a finding of negligence and
liability where harm befalls a patient.
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When your patient has
hemorrhoids, constipation
should be avoided. The
bowel may need a little
gentle prompting to begin
functioning normally
again, and that's where
Metamucil can help. Why
not recommend a laxative
.,jj\ at works slowl)\
, gently and
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. . the Metamucil
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References
I (\%9), 2 D.L.R. (3d) 533 (B.C.C.A.)
2 (1969), to D.L.R. (3d) 539 (S.c.c.)
3 (1969) 8 D. L.R. (3d) 730 (B.C.S.C.)
4 Ibid., 737.
5 Ibid., 737.
6 Ibid., 738.
7 Ibid.. 739.
8 (1971). :!5 D.L.R. Od) 557 (B.C.S.c.)
Legislative update
Readers are reminded that legislation - both prOl'incial and
federal- is continually changing: existing acts are amended or
repealed. others are newly enacted. Because of the lapse of
time bet....een research and publication of each"Y ou and the
la...... column, legislati
'e enactments which come into force
during these weeks cannot be included in the pertinent column.
The allthor welcomes informationfrom readers who
become aware of changes in their prOl'inciallegislation so that
this information can be passed along in subsequent columns ./n
this ....ay. the profession can assist in keeping its members
up-to-date on changes in legislation that affect nursing
!..nowledge and practice.
A case in point is a communication from George Bergeron.
communications officer. New Brunswick Association of
Registered Nurses. concerning the "You and the law" column
dealing with child abuse (January, /979). George informs us
that a recent amendment to the New Brunswick Child WelfarJ
Act now ma!..es the reporting of child abuse mandatory in that
prOl'ince.
"You and the law" Is a regular column that appears each month in
The Canadian Nurse and L'lnfirmlère canadienne. Author Corinne
L. Sklar Is a nurse and recent graduate of the University of Toronto
Faculty of Law and Is currently artlcllng with a Toronto law firm.
Metamucil is made
from (gluten-free) grain,
providing fiber that
produces soft, fully formed
stools to promote regular
bowel function.
Available as a powder (low in
sodium) and a lemon-lime flavoured
Instant MIx (low in calones).
Why not give your patients our
helpful booklet about constipation?
@
Met
,
The laxative most recommended by Physicians.
\
:areview of past and
current systems of
nursing care delivery
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"A system for delivery of services must incorporate methods that provide to
patients and staff members the security of a structured, purposeful day's
responsibility. Without this, the average nurse expresses afeeling of
powerlessness. She feels she is unable to provide salisfactory nursing
care. ,,*
The ideal system of delivering nursing
care is one that satisfies both the nurse
and the patient. It is a goal that every
nursing service administrator pursues -
with more or less success depending
upon her skill in matching up the heeds
of the people concerned with the
resources at her disposal. It is a goal that
administrators everywhere have
struggled with for close to half a century.
Today, rising costs and higher rates of
consumption of health care services are
forcing directors of nursing to make even
more strenuous efforts towards
productivity, efficienc y and economy. In
attempting to predict the direction that
the resulting changes will take, it is both
interesting and enlightening to take a
look at the major trends of the past 50
years.
In the beginning, the choices made
by nurse managers were intuitive; their
decisions were based on their own
experience and on a social order founded
on a rigid class system and a military
type of discipline. But as time passed and
behavioral and social theorists began to
have an impact on the work setting,
nurse managers quickly assimilated this
new knowledge into the practice of
nursing. Nowhere was this assimilation
more evident than in the changing
patterns of staff assignment.
*Faye G. Abdellah. "New directions in
patient-centered nursing", pAl.
Margaret B eswetherick
In the quest for an ideal staffing
model, beginning with the functional
method of the early thirties, right up to
the present day concept of primary
nursing, some half dozen patterns have
been employed or modified to fit a
myriad of work settings. The process has
been a metamorphic one, moving from
functional nursing, in which the nurse
was viewed as having limited talents and
abilities, through team nursing. in which
the work group and the group process
maximized individual personnel talents,
up to and including primary nursing
where the focus is on the individuality of
the patient and the professional
attributes of the nurse. Other models
such as group assignment, patient
assignment, case assignment,
progressive care and unit assignment are
part ofthis metamorphic process and
also deserve consideration.
Each staffing pattern was developed
around a set of basic premises and beliefs
about patients, nurses and nursing and it
is these governing premises which make
each model or method of assignment
unique. The value of historical review is
derived from objectively ascertaining
whether there are enduring
characteristics which might assist
today's nurse manager in arriving at a
solution to this most fundamental,
difficult and ongoing administrative
challenge.
Functional assignment
Functional or efficiency method of
assignment was based on the work of
F.W. Taylor, father of scientific
management. I His management concepts
were first made public in 1910 in an effort
to bring "rationality" and "efficiency"
to the workplace. 2Taylor's theory of
management was based on the premise
that managers were people who are
capable ofthinking and planning; the
worker was viewed as a person needing
close supervision and constant direction.
Because ofthis all activities and tasks
were rigidly controlled by management:
rules and regulations were highly
structured; activities were task oriented;
workers were matched to jobs; workers
were viewed as working best alone or in
small groups and managers were
considered experts with specific zones of
influence.
Table one
1900
Major Periods of Influence for Nine Staffing Modalities from 1910 to 1978.
1910 1920 1930 1940 1950 1960 1970
1980
-
..
Intuitive
Functional
Group
I
I
I
- I
Patient
Progressive
Friesen
Team
Primary
Unit
Period of Influence
None
Rigid and simplistic as this approach
to management may seem, it influenced
nursing for three decades in the guise of
functional nursing. During this period the
"charge" nurse was the supreme
authority on her ward. Rigid sets of
rules, regulations and procedures were
strictly adhered to. The focus was on
tasks and duties.
The charge nurse was responsible
for the assignment of bed making, baths,
temperatures, dressings and similar
tasks. These tasks were assigned in
accordance with status and level of
competency of the individual nurse.
Probationary student nurses were
generally assigned housekeeping duties,
morning washes and bed making.
Intermediate students cared for the
patients' physical and hygenic needs;
they were responsible for duties such as
bed baths and simple treatments like hot
fomentations. Senior students and
graduate nurses were assigned the more
complex and demanding tasks of
medications and dressings. The charge
nurse practiced close supervision and
made all decisions related to the care of
the patients on her ward. All of the
nurses reported directly to the charge
nurse when their work was finished; she
would inspect their work and then assign
additional tasks.
Nurses were allowed limited leeway
in carrying out their duties and routines.
Perusal of the procedure books used at
this time reveals minutely detailed
Minor
instructions for each task, beginning
typically with" ... wash your hands and
pull the curtains. " Finally, the charge
nurse functioned as the communications
center within and outside her unit,
reporting to and receiving instructions
from the physician.
As time went on, there was a
growing realization among
administrators that the patient might be
better cared for if he were looked after
by a single nurse rather than by many
nurses. The outcome of this change in
thinking was a gradual move towards
group nursing assignment.
Group, patient and case assignment
methods..
The late forties were characterized by
growing concern about "continuity of
care" - a concern intensified by the
gradual change from the twelve-hour day
to the eight-hour day. This concern
resulted in a move toward group nursing
assignment. an approach that was still
task-oriented and continued to embody a
functional approach, but was based on
the premise that a single nurse could
**A review of the literature can lead to
confusion when attempting to
differentiate between group. patient and
case assignment staffing methods. For
the purpose of this article, the author has
made an arbitrary differentiation in an
attempt to highlight the subtle changes in
the beliefs governing staffing modalities.
Major
provide a better level of care to a small
(four to six) group of patients when she
herself carried out all the treatments,
medications and basic care. The head
nurse remained supreme in that she
established the grouping of patients and
the level of care to be provided. Again
the graduate nurse and the senior student
were assigned the most difficult care.
Ward or unit routines were still an
important part of the assignment. Nurses
continued to report to the head nurse
who wrote the "day report" and
continued to communicate with the
doctors.
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The patient assignment method, as
indicated by its name, was based on the
selection and assignment of patients in
accordance with the severity of their
illness and the presenting signs and
symptoms. Under this system, an
attempt was made to optimize the
nurses' skills and talents so as to fully
benefit the patient.
De-emphasizing task orientation
brought about a corresponding change in
20 "ey 111711
The CIIn-.ll.n Nur..
attitude towards the nurse who was seen
to possess intellectual as well as manual
skilIs and was therefore capable of
providing a knowledgeable level of care.
With this change in focus there was a
move away from rigid time schedules
and routines; the nurse was made
responsible for her own recording and
reporting and she began to communicate
directly with the physician.
The case assignment method took
staffing patterns a step further in the
metamorphic process. The basic
components were the same as those in
patient assignment, but in order to
provide real continuity of patient care
the nurse was assigned a case load, that
is, she was assigned a number of patients
for the duration of their hospital stay.
When a patient was discharged and
another admitted, the nurse assumed
care for the newly admitted patient.
Using this approach, patient flow was
seen as the key to patient assignment.
Random selection, however, also meant
that an experienced nursing staff with
well rounded skills and abilities had to be
available if the patients'lot were to
improve.
Nursing in transition
At about this time, nursing was
confronted with the realities of World
War II. Nursesjoined the armed forces
and acute staffing shortages were
experienced throughout the country. As
these shortages worsened and student
nurses could no longer fill the void, the
problem was solved by the introduction
of a new category of worker - the
"nursing assistant". The nursing
assistant was regarded as having limited
skilIs and was to function at the task
level in much the same way that, under
the functional method of assignment. the
probationary or intermediate student had
performed. Her work was assigned and
supervised by nursing.
This change might have gone
unnoticed except for the fact that the
nursing assistant was only one of a
growing number of workers, including
clinical dieticians, physiotherapists,
respiratory therapists, social workers
and a variety of technicians , who were
becoming directly involved in patient
care. Because of this proliferation of
workers directly involved in patient care
and services, the coordinating function
of the nursing profession took on new
meamng.
Following World War II there was
an outflow of research dealing with
individual and group behavior; individual
differences and needs; motivation and
leadership. Toward the mid 1950's and
the early 1960's, these studies made an
impact on nursing. There was a move
from a task orientation towards a human
needs orientation. It was at this time
Abraham Maslow's "hierarchy of
needs" ordered individual needs and
provided a model for rational
discussion. 3 I t was also at this time that
the National League for Nursing
Sub-committee on Records ordered
patient needs in the form of' 'twenty-one
nursing problems" .. Crystalizing
insights caused a surging movement
towards "total" or "comprehensive"
patient care. These terms implied
meeting all of the patients' needs-
physical, emotional, spiritual,
socio-economic and rehabilitative needs.
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The nurse was not only responsible for
providing care, but greater stress was
placed on her planning, coordinating and
teaching functions. There was a similar
surge to achieve "individualized" or
"patient-centered" care. This approach
included the concept of comprehensive
care but again went one step further in
that care was to be provided on a
personal level. The patient was
considered as a member of a family and a
community. It was essential then that
both the patient and his family be
included in the planning for his care and
discharge. Community services were
seen as an extension of care facilities and
were to be used to the fullest.
Progressive patient care
A combination of three factors resulted
in the search for more innovative
approaches to the provision of care:
I. A rapid escalation of knowledge in the
medical and technical field culminated in
a sharp increase in the demand for
personnel equipped with this special
knowledge and skills.
2. A parallel increase in the demand for
complex equipment. especially life
support and monitoring equipment,
occurred.
3. I ncreased concern for patient safety
prompted the establishment of
post-anesthetic recovery rooms and, a
little later, intensive care units.
Costs for both equipment and
personnel began to spiral and it became
apparent that changes were necessary.
One answer to the growing problem was
the development in the late fifties of
progressive patient care.
According to this approach, total
hospital services are organized around
patient needs; "special" nursing units to
which patients are assigned in
accordance to degree or severity of
ilIness are established with the object of
having the" ...right patient in the right
bed with the right service at the right
time".5 Staff is assigned in accordance
with abilities and skills in a specialty
area. These areas are designated
according to the severity of illness:
intensive care, intermediate care, self
care, long-term care, home care and
outpatient care. 6The patient is then
moved from one level of care to another
as his condition changes. Assessment
criteria, standards and policies must
govern patient admission to each level of
care. In point offact success is clearly
dependent on a patent patient flow from
one level of care to another.
Progressive patient care met with
opposition on the grounds that the
patient was denied continuity of care. If
the nurse was to be successful she had to
be versatile in that she cared for patients
in all age groups and with all disease
entities. TfJis method of assignment also
served to highlight the high cost of
providing professional services
particularly in the intensive care area
.
As a result non-nursing functions were
graduaIly reassigned to appropriate
departments - housekeeping, dietary,
pharmacy and stores departments. Ward
clerks took over many of the mundane
administrative tasks but for the most part
the head nurse retained major
administrative functions. In many
settings this pattern continues to the
present day but there was a
breakthrough in the early 1960's when
the "unit manager" , in partnership with
the head nurse, took full charge of
administration of the non-nursing duties
on the nursing unit.
Progressive patient care addressed
the problem of matching patient needs to
the physical plant, resources and
personnel but it was the Friesen Concept
of hospital design that was to be
instrumental in providing a unique
approach to this match. There remained
the problem of assigning staff in each
specialty area: old patterns were
employed but there was a growing
interest in the team approach.
The Friesen Concept of nursing
Toward the end ofthe 1940's and early
1950's an architect, Gordon A. Friesen,
concerned himself with the effect of
hospital design on the professional
practice of nursing. He envisioned the
patients' bedside as the end point of the
supply and communication system. In
this way total hospital services could
respond immediately to nurse
requirements based on individual patient
needs. He also saw the professional
nurse as the key provider of care. With
this in mind he designed a patient care
unit that allowed the nurse to spend the
major portion of her time with her
patients. Supply technicians are
responsible for maintaining adequate
standard of supplies at each patient unit.
Administrative communications clerks
are responsible for" ...traffic control,
non-nursing communications and
non-patient related physician
interaction..... 7
One author describes the changes
involved in this concept in the following
way:
"Two aspects of the Friesen Plan have
particular implications for nursing. One
is the replacement of Central Supply by a
highly systematized Supply, Processing
and Distribution Service, popularly
known as the SPD, that is intended to
carry the maximum responsibility
possible for the functions indicated by its
name. The other is the replacement of
the traditional nursing station by a
secretarial office, and the construction
of an area in each patient room where
the requisite supplies and equipment can
be provided and removedfrom the
corridor by SPD, where the patient
record and a telephone are at hand, and
where the nurse does her charting. Thus
a nursing team concentrates its attention
on that portion of the floor assigned to
it. "8
The team nursing approach is an
integral part of the Friesen Concept and
the physical layout reflects this. The
nursing unit is "zoned" into 20 bed
units. Each unit is assigned to a team and
contains a Team Conference Center
which serves as a meeting place for team
conferences and for physician-nurse
discussion. 9
For the nurses who work in them, the
total freedom from non-nursing
responsibilities that is part of the plan
provides an opportunity to experience.
for the first time. the full scope and true
impact of nursing practice.
Team nursing
The year 1951 serves as a bench mark in
the nursing literature devoted to team
nursing. It was in that year Viola
Brendenberg's book Nursing Research:
Experimental Srudies With the Nursing
Team was published. to Since then,
numerous authors have addressed
themselves to the virtues and problems
inherent in team nursing.
The CIIn-.llen NUrH
In team nursing the central focus is
on the work group or team which is made
up of both professional and
non-professional nursing personnel. It is
believed that each member of this team
makes a valuable contribution towards
patient care and this is particularly so
when work arrangements and patient
assignments are coordinated by the team
itself. A sound understanding of group
dynamics and individual behavior is
essential. This includes an awareness of
group norms, rules of conduct, goals,
identity, cohesiveness and especially
leadership. ,f;
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The team leader must possess the
ability to lead patient-centered
conferences and must be able to plan for
patient care. The team leader must also
be skilled in quickly assessing patients'
needs and implementing the necessary
nursing measures. The leader is
responsible for coordination of team
efforts and she is also responsible for
evaluation ofteam performance.
Because of the expectations
surrounding the leadership role. and
because of a constant patient flow,
expert leadership and stable staffing
patterns are crucial elements if team
nursing is to flourish. Yet in many
instances, stafTturnover and rotating
shift coverage dIctate the need for a
rotating leadership. When this happens
the essential "esprit de corp" and
smooth group functioning are mitigated;
under these circumstances team nursing
is minimally successful.
Unit assignment
The mid-sixties saw a renewed search for
a more efficient match between patient
needs and nursing services. For the most
part nurse/patient ratios were arrived at
intuitively. based on past experience but
this type of approach did not
accommodate the peaks and valleys of
patient care demands. In order to control
costs and provide a satisfactory standard
of care, an answer to this problem was
required.
One suggestion was a return to
categorization of care similar to that
established in the progressive care
approach. characterized this time by an
attempt to link these categories to a
time-based index. The search moved in
two directions: employment of
computers as an aid to efficient planning
and decentralization of wards into' 'units
of care". Attempts to computerize care
"'y 1171 21
planning have met with limited success,
mostly because of the numerous and
changing variables presented by each
individual patient and by fluctuations in
the staffing component caused by high
rates of turnover. The second approach
is embodied in the unit assignment
method of staffing, according to which a
unit consists of the number of patients
that can be cared for effectively by a
registered nurse. provided she has
adequate back-up services. The focus is
on patient needs and requisite care.
Units are categorized as: intensive care;
above-average care; average care; and
minimal care. Unit size depends on
patient classification and patients are
moved from one classification area to
another as their condition changes.
A work load index tool is employed
to determine numerically the number of
stafTneeded. Each unit has a
standardized portable supply and
communication station. lI This allows for
expansion or decrease in relation to unit
size.
The unit assignment concept is
based on efficiency and economy, that is
a fair day's work for a fair day's pay.
This method seeks to achieve equity in
the distribution of work loads. a search
that is complemented by adequate
back-up services in the area of supplies
and administration. A strong point in its
favor is the flexibility and optimum
utilization of nursing personnel
permitted under the unit assignment
method.
Primary nursing
Recently, a changing social climate has
succeeded in re-ordering a number of
basic premises within nursing; key
factors are the changes in nursing
education. the place of women in
society, and a clearer definition of
nursing as a practice and as a profession.
These changes. coupled with others that
have occurred over the past forty years.
have resulted in a changing belief
system. The outcome is highlighted in
the primary nursing method of
assignment, first introduced in 1968 on a
trial basis on a 24-bed medical unit at the
University of Minnesota Hospitals in
Minneapolis, Minnesota.
Primary nursing resembles the case
method of assignment but the crucial
difference is its focus on the nurse as a
professional practitioner and provider of
care. As it was originally conceived.
primary nursing called for a registered
nurse (later changed to an RN with
baccalaureate preparation) to assume
responsibility and accountability for the
care of two or three patients over a
24-hour period throughout their hospital
stay. The result is highly individualized
care provided by one nurse and the
22 U.Y 111711
Th. C.n-.ll.n "ur..
establishment of the basis for a
one-to-one nurse/client relationship.
The primary nurse is responsible for
all facets ofthe nursing process:
. assessment of patient needs
. development of a care plan focusing
on patient-centered goals
. implementation of nursing
interventions
. supervision of other workers who
assist in the care
. evaluation of nursing actions based
on achievement of patient -centered
goals. The primary nurse assumes
responsibility and accountability for the
outcome of care and nursing actions and
must therefore be free to act
independently in areas designated as
nursing prerogatives.
Primary nursing can flourish only
where the organization is prepared to
accept the nurse as a full-fledged
professional capable of self-direction and
self-discipline. This requires a change in
the hospital philosophy, structure and
process to accommodate the basic
elements of primary nursing.
Organizational policies must reflect this
acceptance by enhancing the autonomy
of the nursing staff. Personnel policies
governing hours of duty and time
scheduling must be flexible. Staff
evaluation procedures must focus on job
performance as it relates to patient care.
Self evaluation, continuing education
and collegial sharing must be planned
and carried out. This requires budgetary
provision for study leaves and an
interchange of experience with other
professionals. Charting and report
procedures must reflect the key steps in
the nursing process. Patient histories,
patient care plans and goals. patient
orders, and patient care and intervention
notes must become essential
components of the patients' chart.
Many observers today are
convinced that primary nursing is the
key to maximum development of a
professionally based nursing assignment.
Conclusion
There is no doubt that the search for
economical and efficient methods of
providing care will continue for many
years to come. Added knowledge and
more sophisticated methods of dealing
with that knowledge will continue to
reshape belief systems that govern
nursing practice. In view of this fact, it is
essential that our commitment to anyone
particular approach or modality remain
tentative and that, as a profession, we
maintain a flexible attitude towards the
development of new and improved
methods of providing satisfactory
nursing care.
References
1 Taylor, Fredrick W. Scientific
management, comprising shop
management, the principles of scientific
management and testimony before the
Special House Committee, 3 Vols. New
York, Greenwood, 1947.
2 Kanter, Rosabeth Moss, Men and
women of the corporation New York,
Basic, 1977. p.20-23.
3 Maslow. Abraham H. Motivation
and personality New York, Har-Row,
1954. p.97.
4 Abdellah. Faye. Patient-centered
approach to nursing, by... et al. New
York. Macmillan, 1960.
5 Haldeman, Jack. Elements of
progressive patient care In Progressil'e
patient care: an anthology, edited by
Lewis E. Weeks and John R. Griffith.
Ann Arbor, Mi., Health Admin. Pr.,
1964.p.1.
6 Ibid. p.2-3.
7 CHI Systems Inc. The Friesen
no-nursing station concept: its effects on
nurse staffing Ann Arbor, Mi., 1970.
pA-5.
8 Brown, Esther Lucille, "Nursing
reconsidered - a study of change" Pt. 1,
the professional role of the nurse.
Philadelphia, Lippincott, 1970. p.M.
9 Op cit. p.lO.
10 Brendenberg, Viola Constance,
Nursing service research: experimental
studies with the nursing service team.
Toronto, Lippincott. 1951.
11 Sjoberg, Kay B. Unit assignment:
a patient-centered system. Nurs.Clin.
NorthAm. 6:2:340-34 I. Jun. 1971.
Bibliography
1 Abdellah. Faye, Patient-centered
approach to nursing, by... et al. New
York, Macmillan. 1960.
2 Symposium on toward the
professional practice of nursing. Nurs.
Clin. North Am. 6:2:271-362. Jun. 1971.
3 Brendenberg, Viola Constance,
NursinR service research: experimental
swdies with the nursing service team.
Toronto, Lippincott, 1951.
4 Ciske, K.L. Primary nursing: an
organization that promotes professional
practice.J.NursAdmin.4:28-31,
Jan./Feb. 1974.
5 CHI Systems Inc. The Friesen
no-nursing station concept: its effects on
nurse staffing Ann Arbor, Mi., 1970.
6 Haldeman, Jack, Elements of
progressive patient care In Progressive
patient care: an anthology, edited by
Lewis E. Weeks and John R. Griffith.
Ann Arbor, Mi., Health Admin. Pr.,
1964. p.I-B.
7 Hall, Lydia E. A center for
nursing. Nurs.outlook 11: 11 :805-806,
Nov. 1963.
8 Kanter, Rosabeth Moss, Men and
women of the corporation. New York,
Basic, 1971.
9 Maslow, Abraham H. Motivation
and personality. New York, Har-Row,
1954.
10 Taylor, Fredrick W. Scientific
management, comprising shop
managemènt, the principles of scientific
management and testimony before the
Special House Committee, 3 V ols. New
York, Greenwood, 1947.
Margaret A. Beswetherick, the author of
.. StaffinR assignment", is associate
professor (Nursing Administration) at
the University of Alberta, a position she
assumed after a term as nursing adl'isor
to the Registered Nurses Association of
Nova Scotia. She is the author of several
reports published by the RNANS and
has contributed to the Newsletter of the
Alberta Association of Registered
Nurses and to the Canadian Nurse.
A graduate of Vancouver General
Hospital School of Nursing,
Beswetherick received her Diploma in
Clinical Supen'isionfrom the University
of British Columbia and her Bachelor of
Nursing and Master of Science (Applied)
from McGill Unil.ersity.
..ç
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The C.n-.ll.n Nu...
118)' 111711 23
The loneliness of
ee
er
Amy E. Griffin
The realit
of the other person is not in "hat
he reveals to you, but in what he cannot reveal
to you. Therefore if
ou would understand him,
listen not to what he says,
but rather to what he does not say.
Kahlil Gibran
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You and I know that to be alone is not
necessarily to be lonely; as individuals
we vary greatly in the amount of solitude
that we seek or can tolerate. In much the
same way, being with others does not
always preclude or overcome loneline!>:>.
"Togetherness" can be a source of
isolation. especially if you feel alienated
by your own personal circumstances
from the people around you.
Must the circumstances that
surround the aging process always
culminate in loneliness? I think of the old
people I know who live alone, isolated
by their growing physical infirmity, by
the loss of friends and family through
death or other circumstances. I think of
the elderly who are "alone" in the midst
of friends, family or care givers because
they are hard-of-hearing or slow of
speech and these people, after a few
perfunctory remarks, either
inadvertently or deliberately exclude
them from their conversation. I think of
all the factors that can precipitate this
kind of loneliness and I wonder what we
can do to prevent it.
I think first of Sarah, a spinster with
an atypical track record in this migratory
age. Sarah has lived 8:! of her 87 years in
the same house. has never worked
outside her home. nor lived with anyone
other than her family. Her parents died
:!O years ago, her sister 10 years ago.
Since that time she has lived alone. Her
house, on the outskirts of the city, is
something of a landmark, nearby houses
having disappeared along with her close
neighbors. She has considered leaving
her home but says, "I'd be a stranger in
an apartment complex, I'd know no one
and I hesitate to make new friends." Still
the old house. with its narrow steep
stairs presents a problem. For one thing,
it has only cold water and even that must
be hand-pumped to the second floor. So
the kitchen, with its sofa for a bed, really
constitutes "home" and the bathroom
upstairs is quite inaccessible to her,
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especially since she suffered a fractured
hip and the onset of congestive heart
failure about a year ago. Her regular
visitors comprise a distant cousin and his
wife who come in once or twice a month,
a couple from her chutch who try to see
that she attends sabbath service, a friend
in a nearby nursing home who
telephones every morning at the same
time and one of my colleagues who
provides voluntary personal support and
health monitoring.
Compared with many older people
that seems like quite a few interested
folks, doesn't it? But most days and
nights are interminably long and the
hours of actual human contact are few.
Sarah talks now and then of leaving the
home that she has lived in for a lifetime
to go to B.C. and live with a cousin. Or
she mentions having an unknown
"someone" come to live with her. Both
of these arrangements, for one reason or
another, seem prohibitive and
undesirable to her. My colleague finds
her alert but very indecisive. Her hands
could be busy with crafts but she has no
way to obtain the materials she needs
and no one to provide her with
instructions.
Last winter, in the town where we
live those of us who are ambulatory and
motorized were completely snowbound
three times. When this happened, radio
announcers commented on the perils of
"cabin fever" with its various
consequences, including violence.
Sarah, by contrast, was never out of her
home from November to April. Winter
comes every year and for Sarah the
prospects never seem inviting. What to
do?
,.. ...
...
24 ".Y 18711
The Cen-.llen Nur..
r-
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And what about George who is 20
years younger than Sarah, divorced but
with several grown-up sons and
daughters. This could be good, were it
not for their alcoholism and rather
frequent, if brief, jail confinements. One
daughter could perhaps be described as
"half-way reliable" but his childrens'
visits in the acute care hospital are
haphazard at best and often seem
prompted by the hope of a hand-out.
either to replenish their liquid stores or
to extricate them from their current
predicament. It is really little wonder
that George complains if they visit and
complains if they don't. George has
chronic emphysema which has
necessitated several hospital admissions
for artificial pneumothorax. He seems
unable to accept the chronicity and
progression of his disease, becomes
hysterical if anyone near him smokes, is
discontented with his doctors. It takes
little provocation for him to lash out in
bitterness and anger at anyone and
everyone - and the social distance
between him and others imperceptibly
lengthens. Unable at this point to get up
in a chair. he is facing likely transfer to a
chronic hospital rather than a return to
his bachelor apartment in a senior
citizens' complex. I wonder! How much
has George created his own
circumstances? How much have they
created him? How do we help him
change either?
Now let me briefly introduce you to
John, aCarmdian Indian who has been in
a nursing home for the last four years.
Circumstances preceding his head injury
and double leg amputation in a collision
with a train are unclear. People who try
to communicate with John now
recognize that they will have to persist
many times if he is to remember from
one time to another - even that his
roommate is not his brother Jim.
f.:I" 0
Interestingly enough. if his nurse takes
the time to show him, for example, how
to make flowers out of Kleenex@ to
decorate a parade float, he takes great
delight in producing masses of them.
Indeed, John does reach out. When other
people's visitors are around, he is right at
the door in his wheelchair to greet them
- and they respond to his happy
disposition with remembrances such as
birthday gifts etc. But John misses his
own culture and his own people. He sees
his common-law wife from the reserve
100 miles away perhaps three times a
year, his two children never and the
other folks back home just seem to have
forgotten.
Nursing home personnel have good
intentions but little time and somehow
volunteers haven't provided the answer
for John or others. Their early
enthusiasm often peters out in a few
weeks and the potential pool of
volunteers in this small town just doesn't
suffice. I wish I could have offered
helpful suggestions to the young
ambitious director of the nursing home
who talked to me recently about John.
Meanwhile, I guess he'll just have to
borrow his friends from others and hope
their interest in him persists.
Have I selected from all the elderly
people in our community only those with
particularly unfortunate circumstances
or inept coping mechanisms? Have I
presented only exaggerated examples?
What really is the norm in the human
condition? Certainly it is true that
fortune seems to smile more kindly on
some than on others and there are
intrinsic as well as extrinsic factors
which govern anyone individual's
circumstances and their reaction to
them. But many elderly people live in
perplexing milieus that present complex
problems requiring adjustments both in
themselves and their surroundings.
These people need varying degrees of
help, at different times if they are to
achieve either short or long term
solutions to their problems.
o. O. O. ,'0
Sarah, George and John are all part
of the puzzle of the elderly - in their
own homes, in nursing homes or in
hospitals - people who face a
continuing illness, handicap or gradual
deterioration in their general health. But
what of the countless old people who are
thrust abruptly into briefer episodes of
markedly changed circumstances,
stripped of their usual social contacts yet
surrounded by a throng of strangers with
whom they must interact?
On two occasions last year I sat with
my sister during the hours preceding a
cataract operation and then accompanied
her to the operating room. On her second
visit to the hospital, Anna shared her
room with an 80-year-old lady. This dear
soul was scheduled to undergo the same
operation as my sister at four o'clock
that afternoon. Unfortunately, her only
relative within easy commuting distance
was a daughter with two school-aged
children. School was in progress so she
waited alone, some eight hours of
arduous waiting. She could not read to
pass the time; she could not even tell the
time of day. I conversed with her as
much as I could and sensed her fear and
uncertainty over her impending surgery.
It wrung my heart when, more than
once, she said to me "Your sister is
lucky to have you."
My heart went out. as well, to two
particular patients I nursed on a terminal
care unit last summer. Betsy was literally
"a little Chinese doll". In all my years of
nursing I have seen no more pathetic
person: extending carcinoma of the
vulva is not nice. Betsy was a Second
World War bride from Hong Kong
whose husband had died, leaving her
with one son and one daughter. When I
met Betsy her daughter had just returned
to England where she no\\ lives. Betsy
was quiet and subdued in her grief at her
daughter's departure. We noticed that On
his rather infrequent visits. her son
rarely went close to her bed and never
touched her. He almost seemed afraid
that his mother's cancer might be
"catching" .
The C.n-.ll.n Nur..
M8y 111711 25
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f!ItH
In spite of these problems, it was
really rather wonderful to see the
serenity that came over Betsy when
someone took the time to hold her hand,
to feed her gently. to place her rosary
between her fingers or to play the
Chinese music thoughtfully provided by
the music therapist. I never heard
Betsy's voice but her eyes were
eloquent. I know her days were
numbered but I was thankful that the
kind folks there would never let her walk
alone in the final steps of life's journey.
On that ward, Betsy's quietness was
offset by Bill's explosiveness.
Concomitant with caring for him I had a
whole new course in blasphemy. Violent
outbursts alternated with periods of total
withdrawal when Bill disappeared under
the bedclothes and effectively shut the
door on everyone. I noticed that these
"hide and seek" episodes often
coincided with the happy times of the
patient opposite him. Russell's wife
arrived daily as regular as clockwork.
sometimes accompanied by his son or
daughter, his grandchildren or his
favorite dog.
It \\-asn't always easy to be nice to
Bill: perhaps he epitomizes what
unthinking professionals have come to
call "the difficult patient" _ I wonder!
Putting myself in Bill's shoes. I wonder
how I would behave - a chronic
"bouty" alcoholic who knows my
spreading cancerous neck lesions are
close to my carotid artery and could
invade it at any time? How would I
respond to the spasmodic visits of a son
whom I had not been close to for a long
time? How would I feel. day after day.
with no other visitors. no former buddies
to talk about better times? What would I
do in these cramped quarters, coping
with a hospital routine. even a "liberal"
one, when all I've ever wanted was to be
a free spirit and "do it my way".
Well, this episode. however
difficult, was relatively brief for Bill. It
ended shortly after I arrived on the unit
and. ifloneliness was his final lot, was he
unique? I find myself hoping that St.
Peter understood the sublime hidden
behind Bill's blasphemy, that he had a
few good tales to swap with him and that
perhaps he even offered Bill a nip of his
favorite brandy - Bill's, that is!
What does all this mean? What are
people like Sarah. George, John, Betsy
and Bill telling us? Many things, but
perhaps mostly they are pleading with us
to look beyond what they do, to hear
more than they say. to really take in their
human condition and not "pass by on the
other side". When a friend says to me, as
she often does, "I guess I can stand a lot
of my own company". does she mean
that she prefers to be alone? Is she
"whistling to keep her courage up"? Or
does she insist that she is self-sufficient
because there is likely to be no one there
most of the time anyway?
Is there a link between loneliness
and physical. mental or emotional illness
which may trigger its onset or confound
its curative or rehabilitative aspects? I f I
encounter submissiveness. withdrawal.
depression. hostility. irritability,
loquaciousness. silence. stoicism, anger
or a host of other manifestations. what
do I think?
Isn't all behavior centered in the
individual who portrays it and in his
human condition? Isn,'t loneliness one of
those factors which finds its expression
in many divergent ways and which, if we
really want to help the elderly as we say
we do, we discount at our peril?
Have you seen loneliness lately in
your friends or your family. in your
co-workers or your neighbors, in those
whom you serve. or even yourself'? Hov.
do you and they cope? And is there a
better way?
Acknowledgement: This article is based
on a presentation by the author to the
Canadian Association on Gerontology in
Edmonton, Alta., in October. 1978.
Photo by Canadidn Govcrnment Photo Centre
Amy E. Griffin, the au thor of' '7 he
loneliness of the elderly", is professor of
nursing administration in the Faculty of
Nursing of the Uni\'ersit\' of Western
Ontario. Formerly director of research in
the School of Nursing , she has also
sen'ed as coordinator of graduate
programs at UWO and was until recently
assistant dean (academic).
A graduate of Hamilton General
Hospital School of Nursing , she receh'ed
her B.A. and Certificate in Nursing
Educationfrom the Unh'ersity of
70ronto before continuing on to Jt ayne
State University where she recei\'ed her
Waster of Science in Nursing and to
Columbia U ni\'ersity where she was
awarded her doctorate in education.
During the Second World War Dr.
Griffin ser\'ed in Europe with the Royal
Canadian Army WedicalCorps. Since
then she has accepted short-term
assiR/lfnents for the World Health
OrRanization to India and the
Philippines where she assisted in
curriculum de\'elopment of nursinR
programs in these countries.
Dr. Griffin is actÌ\'e in the Canadian
Association ofUnÏ\'ersity Schools of
'V ursinR, the Canadian Nurses
Association and the Registered Nurses
Association of Ontario.
ze M.y 111711
The C.n.dl.n Nur..
,.
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ixty ,
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Lance W. Roberts , I ,
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Colin A. Ross ;
Have you ever thought .....
of packing it all in,
getting on a plane and
flying off into the sunset
to start a new life as a
nurse on Canada's last
frontier - north of the
60th Parallel? If you
have, and even if you
haven't, you may want
to read what nurses
working in the
Northwest Territories
have to say about the
rewards and frustrations ..
of practicing north of ... -.
Sixty. - -
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The Can8dlan Nu...
May 11171 27
Is northern nursing more challenging
than practicing in the south? Are
northern doctors as good or better than
southern ones? Why do some nurses
leave after a few months while others
stay for years? The information that
follows was obtained by the authors
during a preliminary investigation into
the perceptions of northern medical
needs by nurses working in the
Northwest Territories. Fifteen nurses
responded to a questionnaire we sent out
to 44 nurses working in the I nuvik Zone.
Although the results are not statistically
significant because of the small size of
our sample, some of the comments that
we received are interesting.
L
The setting
Inuvik was built in the 1950's on a
location known as E3 in the MacKenzie
Delta. The site was chosen by
engineering consultants, and although
gravel, water, docking facilities and
building sites are plentiful, moving to
Inuvik meant a disruption for the native
peoples. From Inuvik you can see the
Richardson Mountains to the west
beyond Aklavik; it is in these mountains
that the natives hunt caribou.
Unfortunately a native living in Inuvik
cannot travel easily to the mountains for
a caribou hunt. Nor is the hunting and
fishing good in the region surrounding
Inuvik. Since Inuvik was built in order to
replace Aklavik as the area
administrative center. and since many
native people have moved to Inuvik, the
choice of site has helped to sever native
connections with the land. By northern
standards I nuvik (population 4(00) offers
big city lights and fast living: not
surprisingly the native people of Inuvik
have problems with alcohol and
unemployment.
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We saw something of Inuvik's
alcohol problem in the answers to our
questionnaire. The ten Inuvik nurses
estimated, on average, that 65 per cent of
the patients they see have
alcohol-caused or alcohol-related
complaints. Nurses in the smaller
settlements. though, estimated that only
15 per cent of their patients present
problems directly related to alcohol. The
social breakdown experienced in the
North is most acute in Inuvik and it is
our experience that I nuvik is a less
pleasant place in which to live than the
smaller settlements. This opinion was
confirmed in an indirect way by the
nurses: the ten I nuvik nurses have spent
an average of 6.6 years in the Northwest
Territories while the nurses in the
smaller communities. on the other hand,
have spent an average of 15.2 years in
the North. It seems that a real
commitment to the North is more likely
to occur in a smaller community,
something that a southern nurse thinking
of a move North might bear in mind.
What sort of person moves North.
then stays for 15 years? Although we
don't know enough to provide a
definitive answer to this question, our
results do supply some facts about
northern nurses. I n both I nuvik and the
other settlements, more than half (60 per
cent) of the respondents were single:
most of these nurses were between the
ages of 25 and 35 years. none were over
55 and none under 20. All but two have
their RN's: they received their training in
every region of Canada, with Alberta and
Ontario most heavily represented. Only
two nurses received their training
outside Canada. What does this mean for
the nurse thinking of a move North?
Simply that age. marital status, and
present place of residence in themselves
appear to have little influence on the
decision to go North, or on the length of
stay and a nurse thinking about
transferring to the I nuvik Region need
not worry about being too young, too
old, married, single, or living too far
away for he or she is likely to find
colleagues with similar backgrounds
there.
,
"
Work and colleagues
We also asked the nurses whether.
overall, they found northern nursing
more challenging and rewarding than
nursing in the South. Eighty per cent of
the nurses in the smaller settlements said
yes: the remainder stated that it is hard
to compare the two. The Inuvik nurses
were more divided in their opinion:
about two thirds said that northern
nursing is more challenging. while the
remaining third were split three ways
between responding that "northern and
southern nursing are about the same",
"working in the South is preferable",
ze M.y 111711
The Cen-.ll.n Nu...
-
and "it is difficult to compare the two
nursing environments". This suggests
that the southerner who moves North
will be unlikely to find her work dull.
especially if she moves to a nursing
station outside Inuvik. Also. it seems
likely that nurses leave the North after a
relatively short period, not because they
dislike their work. but for other reasons.
I n small northern communities there
are usually two or three nurses but no
resident doctor. The medical facility is a
nursing station. not a hospital. Doctors
from Inuvik do visit the smaller
communities on a regular basis.
however. and phone consultations are
common. Under these conditions we
wondered whether the nurses in the
settlements perceived northern medical
needs differently from their colleagues in
Inuvik. Table one shows the responses
of the 15 nurses to a question about what
medical areas they would like more
money spent on in their community. We
asked them to rank five funding areas
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Table one: Average ranked responses of nurses to the question, "Please indicate
which of the following areas you would like to see more money spent on
in your community. "*
Area deserving funding
public health education
treatment of alcoholism
training outpost nurses
medical equipment and facilities
more doctors' visits
Nurses
in Inuvik
1.9
2.4
2.9
3.2
4.5
Nurses
outside Inuvik
1.8
2.4
2.8
3.6
4.4
*Ranked on a five point scale with 'I' as the highest priority.
The Can8dlan Nur..
May 111711 211
that the needs in Inuvik, as perceived by
nurses, are very similar to those in the
smaller settlements.
We were not surprised to find that
funding for treatment of alcoholism
received the second highest priority
since the Inuvik nurses estimated that 65
per cent of their patients arrive at the
hospital for reasons directly related to
alcohol. Clearly the fact that public
health education was given the highest
priority is related to both the concern
with alcoholism and the general northern
need for the greater practice of
preventive medicine by a more informed
public. Greater training of outpost nurses
and the need for more medical
equipment and facilities were ranked as
of moderate, but not of pressing,
importance. Finally it is interesting to
note that the nurses rated more doctors'
visits as of lowest priority. This ranking
probably reflects the relative
independence enjoyed by nurses
practicing in the North.
We also asked the nurses to list in
order of priority five areas in which they
v.ould like to receive extra training.
There was no trend at all in their replies
to this question: it appears that the
responses reflected the nurses' areas of
personal interest more than they
indicated deficiencies in present
northern medical needs. Training in
public health and nurse practitioner
courses were, however, mentioned more
often, and with higher priority, than the
other areas. The general feeling was that
a broad training with emphasis on a fev.
areas of particular interest would "fit the
bill". Such training is readily available to
southerners contemplating a career in
northern medicine.
I n a remote settlement one hears a
great deal of smalltown gossip, much of
it malicious. Nurses and doctors are the
subject of a great deal of this gossip and a
southerner who moves into northern
nursing will soon learn that in Fort
Norman, or Fort Good Hope, she is the
nurse 24 hours a day. This can make
northern nursing difficult. During our
time in the North we heard much gossip
about medical matters. General
practitioners in the Inuvik Region have
on more than one occasion been referred
to as "horse doctors". We wondered
what the nurses in the region thought of
northern doctors. and asked a number of
questions to find out. We discovered that
these nurses considered northern
doctors as good or better than southern
ones.
Asked to compare the level of
competence among northern GPs with
that of southern doctors. 80 per cent of
the nurses stated that the two are equal.
and the other ::!O per cent claimed that
northern GPs are superior to southern
general practitioners. When we asked,
"How adequately do you feel that
doctors are trained for northern
service?", almost 75 per cent of the
nurses stated that general practitioners
are adequately trained for northern
practice. When we asked, "Hov.
necessary is it that doctors receive
special training for northern service?" ,
60 per cent replied "somewhat
necessary", 27 per cent replied "very
necessary", and 13 per cent did not
answer. Taken together, these findings
suggest that northern nurses are quite
satisfied with the standards of general
practice in the North.
In one of our open-ended questions
we asked, "In what ways do you think
nurses have trouble adjusting to northern
conditions?" Here are some of the
replies:
. I hm'e more respolUibility,
insufficient staff
. most nurses come from big
hospitals and are used.to one brand of
medicine: in the North they han' to work
in all areas
. accepting cultural differences, i.e.
complacencv of many nati"es re tal..inf!
prescribed medications, keeping
appointments, etc.
. do not understand cultural
d(f/erences and attitudes toward health;
some hm'e trouble with climactic and
em'ironmental differences
. I found no trouble adjusting other
than worl..;ng in a new em'ironment but
this was no different from changing jobs
in the south
.
,
\
. social life is somewhat restricted,
the terrain is rugged - suitable only to
those who enjoy the outdoors
. the way the children are neglected
- and when they get sick - the parents
seem unable to follow simple
instructions to help their children get
well
. er:pected to handle ICV cases
without adequate training
. isolation from urban cent
r, lacl.. of
recreational facilities -unable to go off on
weekends, etc.
These comments provide a mea'iure
of insight into why some nurses leave
after a few months, while others stay 20
years. As one northern nurse pointed
out: "those with a feeling for the bush.
the river, the ptarmigan, the power and
beauty of the northern landscape will
have more reason to stay in the north."
Adjusting to the differences, however, is
often not an easy task. Another nurse
said to us: "I don't think they (nurses)
have trouble adjusting:' they don't try to
adjust, instead they bring their personal
problems with them. They are here to
escape. They are only here for the kicks
- just up for a short period for the
experience. Only one nurse in 20 is really
interested." That's a radical statement,
and it tells us a lot about the problem of
white transiency in the North.
The North is the last Canadian
frontier but even now disruptive
development activity, caused by the
South's insatiable demand for oil and
mineral resources, is rapidly changing
the social and physical landscape. Since
nur
es hold central positions in most
northern communities, they must deal
with the physical and mental
consequences of industrial expansion. It
follows that the future of northern
nursing is likely to be filled with new
experiences and challenges. As
researchers who have lived in the North,
we think that life north of Sixty,
especially in the health professions, can
be very rewarding and we hope that this
brief sketch of northern nursing will be of
int
rest to southern nurses considering a
move to the Northwest Territories.
"Nursing North ofSixt
... was
co-authored by Lance W. Roberts,
Ph.D., a professor with the Department
of Sociology of the Vni,'ersitv of
Jfanitoba, and Colin A. Ross, a medical
student attending the V nh'ersitv of
Alberta.
PholOS coune
y Health and Welfare Canada
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ergency treatment of drug overdose
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The individual who takes an overdose of drugs needs
expert physical and psychological care in the
Emergency department. Author Heather Erb
bikes a look at treatment measures,
psychological assessment and steps that the
emergency nurse can take to ensure that the suicidal
patient receives the best care possible.
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To most people, drug overdose means
attempted suicide. Assumptions.
however. can be misleading: overdose
may be suicidal or it may be accidental in
nature. Often individuals are not aware
of drug interactions and so they combine
the wrong medications or they take more
than the recommended number of pills.
thinking that "if one works. two will
work better". The result may be
accidental overdose. Children are
particularly susceptible to accidental
overdose or poisoning: they may ingest
medications or household products out
of curiosity. totally. oblivious of the
consequences.
The nurse working in emergency
will no doubt deal with both deliberate
and accidental overdose. Although
treatment measures are similar for both.
teaching, support and patient education
follow different routes entirely.
depending upon the circumstances. Let's
take a closer look at suicidal overdose
with both medical and psychological
considerations in mind.
I t is very important for emergency
nurses to know how to help those who
are suicidal. whether the patient has
already attempted suicide or shows the
potential to do so. We are very often the
patient's first contact with health
professionals and so our task is a large
one. We must provide basic life support;
we must recognize the signs of the
patient's distress and give him immediate
psychological support; andjust as
important, we must take definite steps to
ensure that the patient does not leave the
emergenc department without first
Deliberate or accidental?
When a patient is admitted to the
emergency department following an
overdose of drugs, we must do all that
we can to find out the circumstances
surrounding the event. Many of those
who attempt suicide leave a note or try to
make contact with someone - their's is
a cry for help. and they may perceive
that a suicide attempt is the only way to
get that help. There are others who are
discovered strictly by chance; a relative
or friend returns to the individual's home
quite unexpectedly to discover the
victim unconscious. Even in these
circumstances, it cannot be assumed that
the patient did not intend or want to be
discovered. Keep an open mind: the
patient may have been unable to reach
the phone in time.
Patients with an altered mental
health status often possess medications
that can be used in overdose. Such an
overdose may not be an attempted
suicide however - it may result from the
patient's confusion or lack of orientation
to his surroundings. Never jump to the
conclusion that an individual presenting
with signs of an overdose is attempting to
end his own life. Patients have been
admitted to emergency with an assumed
overdose that turned out to be another
illness entirely. I t is important that you
as a nurse make every attempt to verify
the cause of the patient's signs and
symptoms. Jumping to conclusions can
have a negative effect on the patient's
ultimate health.
4
Heather L. Erb
1
-
There are certain valuable clues
which can alert you to both the causes of
an attempted suicide and to the potential
for such an attempt. Being aware of
these clues enables you as an emergency
nurse to make appropriate referrals so
the patient can receive further help. fhe
following individuals may require help:
. the individual who has recently
suffered a loss through the death of a
relative or a close friend:
. the adolescent who is having
parental problems, peer problems or
boyfriend/girlfriend problems:
. the individual who innocently asks
"1 wonder how many of these pills it
would take to do someone in?"
. the individual who shows signs of
depression:
. a person who is living alone:
. one who demonstrates overt
hostility;
. one who complains of poor appetite
and sleep habits;
. the individual who is preoccupied;
. one who expresses helplessness.
unworthiness or worthlessness:
. one who expresses direct or
suggestive expressions of self harm.
Take a look at what is happening in
the patient's life. For some people.
losing ajob or moving to a new house
causes unresolvable problems. If the
individual cannot resolve conflicts or
feels his burden is too great. he may
consider suicide for any number of
circumstantial reasons. I n emergency,
we can be alert to all these factors to find
out ifthe patient requires further help.
"""
Treatment of drug overdose
1 Induced emesis
Syrup of Ipecac IS the drug most commonly used to induce vomiting. It
should only be used if:
e the patient is awake:
e the patient has not taken an antiemetic or drugs with antiemetic
properties:
e coma and lethargy are unlikely to occur.
Ipecac acts on the medulla (chemoreceptor trigger zone) and thus ItS
effects will not be seen for 20 to 25 minutes. The drug should be
repeated only once as protracted vomiting may occur if the patient IS
given too much. Fluid should be given after the patient takes Ipecac. In
our emergency department. we hnd that warm water and orange or
apple JUice work well with the Ipecac (we give about two eight ounce
glasses of flUid).
Dosage range: age 9 months to two years - 15 ml
age 2 years to 10 years - 20 ml
age 10 years and older - 30 ml'
2 Gastric lavage
Gastric lavage is the treatment used for patients who are comatose or
may become comatose Endotracheal intubation IS recommended to
prevent aspiration. A gastric lavage tube is passed through the mouth
and Into the stomach. then Irrigation with water or saline is done until the
returns are clear. Lavage is done in order to remove the Ingested drug.
After lavage. activated charcoal,s often passed through the tube and
Into the stomach.
3 Adsorbing agents
Activated charcoal IS the most common adsorbant used. Charcoal
attracts most drugs to itself. with the exception of cyanide. I: is supplied
,n 500 ml plastic bottles containing 50 grams of charcoal - 400 ml of
water is added to the charcoal' The patient may drink the charcoal. but It
is most commonly given through the gastnc lavage tube. If the patient
has already received an emetic. make sure that it has worked before
giving charcoal. as charcoal will bind to the emetic as well
4 Purgatives
Purgatives are also given in the emergency room In order to speed the
elimination of the drug through the Intestines The most commonly used
purgatives are castor oil (30 to 60 ml) and sodium sulphate (30 to 60 ml
of a 50 per cent solution).' If you give a purgative In emergency. be sure
to chart it so that the nurses recelv,ng the patient on a ward will be aware
that they should watch for results.
5 Antidotes
Antidotes are used to reverse or diminish the effect of the drugs
Ingested An antidote IS useful In specific cases only. The following IS a
list of toxic agents and their antidotes.
Toxic Agent
Opiates (NarcotiCS)
Insulin
Cholinesterase Inhibitors
Methanol
Iron
Atropine" or scopolamine
Warfann
Arsenic or mercury
Lead
Cyanide
Carbon monoxide
Antidote
Narcan "
Glucose
Atropine' and pralldoxlme
Ethanol
Sodium ferrocyanide and
deferoxamlne mesylate
Cholinesterase inhibitors
(physostigmine)
Vitamin K
Dimercaprol (BAL).
Ethylenediamine tetra-acetic aCid
(EDTA)
Nitrites and sodium thiosulfate
Oxygen or hyperbanc oxygen
6 Increased fluid intake
The more fluid the patient takes In the more he will excrete. hastening
the speed with which the ingested drug 'eaves the body.
Contralndlcallons to forced flUid therapy Include renal insufficiency.
pulmonary edema and cardiac insufficiency
7 Dialysis
Dialysis is a last resort measure In the treatment of drug overdose - it is
used in very severe cases. when all else has failed This procedure is
not carned out In our emergency department. but when Indicated. IS
performed by expenenced renal personnel.
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Drugs
commonly used
in overdose
The following drugs are
commonly used in an
overdose or attempted
suicide. Treatment varies
according to the
condition of the patient
- obviously I a patient
who walks into
emergency talking
coherently and breathing
well does not require
intubation.
Knowledge about
the drugs used most
commonly in overdose is
important because it
enables you to watch for
and anticipate what may
happen to the patient.
Complications or other
illnesses that the patient
has will necessitate
changes in the course of
treatment. Basic life
support is always the first
priority.
The CPS is a good
reference for the toxic
doses of each drug. It is
also important to be
aware of the poison
control center in your
area. I n cases where it is
impossible to determine
what the patient has
ingested, treatment is
given according to the
presenting symptoms of
the patient.
(/) Drugs
W 222's
, ASPIRINGÞ, ANACINGÞ,
BUFFERIN
, DRISTANGÞ
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Therapeutic uses
analgesic. antipyretic, anti-inflammatory
Therapeutic dose
0.6 g every three to four hours (adult)
Fatal dose
0.4 g to 0.5 g/kg body weight
Absorption and excretion
rapidly absorbed from stomach and
duodenum. Rapid excretion from kidneys
- this explains large and frequent
therapeutic doses
Effects of overdose
acid-base disturbance
kidneys excrete increased amounts of
potassium, sodium bicarbonate and
retain chloride (trying to compensate)
hypokalemia
hypothrombinemia
hyperthermia
gastroenteritis
tinnitus
sweating
spontaneous bleeding
twitching
dehydration
flushed face
uremia
inconstant pulse
initial rise, then fall in blood pressure
depression
convulsions
pulmonary edema
death from respiratory failure
Diagnostic tests
e artenal blood gases
e blood salicylate levels: take one
specimen on admission. and another in
two hours. If the second one is higher, it
shows that the drug is still being
absorbed - repeat again in two hours. If
the second level taken is lower, drug
absorption is on the decline.
e blood urea nitrogen - if the urinary
output is not adequate
e electrolytes - to pick up
hypokalemia
e vital signs - at least every hour
e urinalysis - mayor may not give
true reading of glycosuria or ketonuria
Treatment
e emetic jf conscious, cooperative and
not in danger of coma
e gastric lavage if unconscious,
confused; follow with activated charcoal
e intravenous therapy to correct
acid-base imbalance, electrolyte
imbalance
e sponge baths to reduce fever
e whole blood or platelet transfusion if
hemorrhage occurs
. dialysis for extremely toxic levels of
salicylates if renal insufficiency or failure
is present
Comments
Depending on the severity of the
overdose, an emetic may be all that is
needed in treatment. If the patient fails to
respond to the emetic more active
treatment is called for.
Aspirin is commonly found in most
households, readily available for
ingestion in a suicide attempt. Many
people feel that aspirin is harmless and
may overdose (not wishing to die).
unaware of its potential. However,
serious illness and death can result from
salicylate overdose. Aspirin is sometimes
taken in conjunction with other
medications; do not overlook the effects
of aspirin just because the other drugs
seem more lethal.
Z Drugs
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Therapeutic uses
analgesic, antipyretic, commonly used in
place of salicylates, no anti-inflammatory
effect
Therapeutic dosage
325 to 650 mg four times daily
Lethal dose
can be fatal in doses from 10 to 15 g
Absorption and excretion
absorbed rapidly from the GI tract
rapidly metabolized in the liver, small per
cent excreted unchanged in the urine
Effects of overdose
nausea
vomiting
upper abdominal pain
drowsiness progressing to coma due to
hepatic necrosis
death
Diagnostic tests
e liver enzymes - will show gross
elevation
. bilirubin level- will be elevated
e prothrombin time - prolonged
. blood sugar - will show
hyperglycemia or hypoglycemia
Treatment
e Ipecac-induced emesis
. activated charcoal
. dialysis
e Mucomyst'" (experimental)
Comments
Acetaminophen causes severe liver
damage - if the liver receives more of
this drug than it can handle, the drug
binds itself to the liver macromolecules
and kills the cells. The result is hepatic
damage. Treatment is similar to that of
other drug overdoses with the exception
of using Mucomyst. which is being used
experimentally to prevent liver damage.
Mucomyst is administered orally or by
intravenous' -It inactivates the
by-products of acetàminophen and thus
prevents liver damage
Drugs
AMYT AL I!'). SECONALI!').
NEMBUTALI!'). LUMINALI!'),
PHENOBARBITALI!')
-
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Therapeutic uses
used for insomnia. calming and sedation.
convulsions. anesthesia. pre-operative
medication. and for obstetrical and
psychiatnc purposes
Therapeutic dosage
varies with the drug used. II is Important
to find out which drug the patient
ingested.
Minimum lethal dose
short acting barbiturates (Nembutal and
Seconal) 3.5 mg 11 00 ml blood level: long
acting barbiturates (Luminal and
Phenobarbital) 8.0 mg/1 00 ml blood level
or approximately 15to 20 times the
therapeutic dose
Absorption and excretion
short acting barbiturates are absorbed
and excreted rapidly. while long acting
barbiturates are slowly absorbed and
excreted and may have a cumulative
effect. If the barbiturate is a sodium salt. it
is more rapidly absorbed than the free
acids in barbiturates. Barbiturates
undergo some change in the liver and
may be excreted partly unchanged and
partly altered The more slowly the drug
is altered. the more slowly it is excreted.
Effects of overdose
Mild effects: drowsiness
mental confusion
headache
Severe effects: hyporeflexia
shallow. slow respirations
delirium
circulatory collapse
cold clammy skin
pulmonary eclema
dilated. non-reacting
pupils
stupor
decreased blood
pressure
rapid. weak pulse
coma and then death
Diagnostic tests
. arterial blood gases
. blood levels of the drug taken on
admission and later to determine if the
level is increasing or decreasing. If it is
increasing. blood tests will have to be
repeated until results reach therapeutic
levels.
. electrolytes
. urine for toxic screen
Treatment
. emetic to induce vomiting. ob&erve
until patient alert
. oropharyngeal airway if the patient
is unconscious and gastric lavage is not
being done
. endotracheal tube should be
inserted if gastric lavage is to be done or
if respiratory failure is imminent or
apparent. Gastric lavage is followed by
acti\lated charcoal.
. intravenous therapy -take care not
to overload the Circulatory system as
pulmonary edema is a danger with
barbiturate overdose. In case of shock.
an IV line should be available to maintain
blood pressure with plasma or extra
fluids.
. catheterize patient to monitor
urinary output
. vital signs. mental status. skin color,
lung bases. reflexes and sensations at
regular intervals (at least every one to
four hours depending on patient's status)
. dialysis may be necessary in severe
cases
Comments
Barbiturates are frequently used for
psychiatric purposes. Thus they provide
patients under psychiatric care with a
means to attempt suicide. Very often.
patients drink alcohol prior to taking
barbiturates. and the combination of
alcohol and barbiturates is deadly.
Alcohol potentiates the effect of
barbiturates
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Drugs
VALlUM
, LlBRIUMI!'). SERAXI!').
ATARAXI!')
Therapeutic uses
used to allay moderate anxiety states
and relieve muscle tension associated
with psychomotor agitation
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Therapeutic and lethal dose
depends upon the drug used
Effects of overdose
similar to the barbiturates in their effects
on the body. Alcohol also potentiates the
effects of these drugs
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PHENERGAN(!!), STELAZINEI!'),
STEMETIL I!')
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Therapeutic use
antipsychotic
Therapeutic and lethal dose
depends upon the drug used
o
Effects of overdose
see minor tranquilizers
myocardial depression with EKG
changes
severe hypotension due to central
nervous system effect, direct myocardial
depression and vasodilation
seizures may occur as phenothiazines
lower the seizure threshold
extrapyramidal effects
Treatment
. see barbiturates
. cardiac monitor with life support
drugs and equipment available
. control seizures cautiously with
phenobarbital
. treat extrapyramidal effects with
Cogentin
or Benadryl'!t
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ELAVILI!'). TOFRANILI!'), AVENTYLI!')
Therapeutic uses
potent antidepressants, mild sedatives
Therapeutic and lethal dose
varies according to the drug used
Effects of overdose
anticholinergic. atropine-like.
antihistamine. and antiadrenalin actions
arrhythmias
dry mouth
thirst
dilated pupils
agitation
delirium
coma
decreased respirations
Treatment
. induce emesis if patient alert
. intubation before gastric lavage or if
there are respiratory difficulties. Gastnc
lavage followed by activated charcoal
. intravenous therapy - so a route is
established if necessary
. cardiac monitoring along with vital signs
. physostigmine may be of some use
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Drugs
BENZEDRINE
, DEXEDRINEI!')
METHEDRINEI!')
I- Therapeutic uses
W mild depressive states (non psychotic)
::J: depress appetite in the treatment of obesity
Q. narcolepsy
Therapeutic and lethsl dose
depends on drug used. refer to CPS
Excretion
excreted in acidic urine. will be
reabsorbed in alkaline urine
Effects of overdose
stimulation of the central nervous system
visual. tactile. auditory hallucinations
mood elevation
tachycardia
dyspnea
chest pain
hypertension
arrhythmias
dilated pupils
blurred vision
respiratory failure
Diagnostic tests
. blood and urine for toxic screens
. urinalysis to determine pH
. EKG
. any other tests applicable to the
particular situation
Treatment
. induce vomiting if patient alert
. gastric lavage if patient
unconscious. followed by activated
charcoal
. purgatives are useful
. monitoring vital signs with a close
eye for respiratory depression
. cardiac monitor for arrhythmias
. intravenous therapy -to have a
route established in case arrhythmias
occur and drugs must be administered
. atlemptto acidify the urine to
shorten effect of druq
34 ".Y 111711
The Cen.dl.n Nur..
A threat of suicide should never be
taken lightly. Most people who
communicate in some way that they
intend to kill themselves make an
attempt to do so. This holds true for
children and adolescents as well; suicide
in these groups is on the upswing. "The
common protestation that the patient is
too cowardly to harm himself means
nothing in practice as bravery and
cowardice have little relevance to
suicidal behavior." t
Many patients express regret soon
after the suicide attempt - they may
apologize for being foolish and promise
that it will not happen again. The
temptation in emergency may be to
discharge these individuals without
psychiatric assessment and follow-up.
but it is highly unlikely that they have
resolved any of their problems; each
patient needs follow-up.
The following is a guide to help you
assess the suicidal patient, whether he
has already attempted suicide or shows
the potential to do so.
Assessment guide
When you assess a suicidal patient, your
attitude and the manner in which you
approach the patient are most important.
The patient does not need your reproach.
judgment or condescending behavior. It
is important in following this guide to
show genuine interest in the patient's
welfare and not just curiosity. Find out:
Vital statistics: the patient's name, age,
address, phone number. marital status,
significant others (family. boyfriend,
girlfriend etc.)
If the patient has alread} attempted
suicide the following information is
relevant:
Wethod: overdose of drugs. gun. rope;
what did the patient use to attempt
suicide?
Location: was the patient alone or with
someone? Did he attempt to reach
someone by phone?
Time of day: was there apt to be anyone
around at the time?
Intention: what did the patient hope to
accomplish? Did he expect to die? If the
nature of his act was manipulative. has
his expectation been met?
A ttiwde: is the patient angry. sad.
resentful. depressed. etc.?
Social circumstances: what triggered
this attempt - family situation, friend.
job, etc. ?
Past history: has the patient been treated
for a psychiatric problem? Has he (or a
family member) made an earlier suicide
attempt?
Other patients may indicate a potential
for attempting suicide, although they
have not yet made a direct attempt.
Often an individual presents in
emergency with the simple admission
that he wants to take his own life; he may
state that he is depressed or agitated; or
he may be brought in by a worried
relative or friend. In assessing the patient
with suicidal potential. the following
approach is helpful:
. show interest in what is happening
to the patient, but talk generally with him
and get to know him before asking
specific questions about suicide;
. find out about the patient's current
social circumstances. attitude. and past
history (as above);
. find out what is making the patient
feel the way he is feeling. or what he
thinks is the cause of his feelings;
. don't be afraid to ask the patient if
he has thought of taking his own life.
Your question will give him the
opportunity to express his feelings. Note
his verbal and non-verbal response to
your question. If his answer is yes. find
out if he has plans about how he would
do it;
. ask the patient if his feelings about
suicide are related to something that has
happened or is happening - his wife.
job, money, etc.;
. ask the patient about his alcohol and
drug consumption.
Once you have gathered the
information that answers these questions
you will be able to assess the patient's
emotional status, discuss your findings
with the physician and determine an
appropriate course of action. It must be
remembered that this is only a guide-
certain issues will naturally be discus!.ed
that are pertinent to the patient or
situation he is presenting. If you feel that
you need help with the patient or his
problem, consult with the doctor. Many
suicidal patients need psychiatric care;
although there is no time in emergency
for therapy. there is room for assessment
and referral for further care. Remember
that before the suicidal patient is
discharged from emergency, something
positive must have happened: something
must have changed for him. Otherwise,
you will be seeing him again. And the
next time may be too late.
Recognizing your biases
If we as nurses are to have a positive
effect on the suicidal patient. we must
provide emotional support. But before
anyone of us can intervene effectively
with the patient who has taken or may
take an overdose. we must take steps to
identify and come to terms with our own
feelings.about suicide. As members of
the "helping profession". many of us
find it difficult to understand why we are
treating an individual who is trying to
end his own life. when so many other .
people must struggle in order to live. We
may find ourselves looking at those who
attempt suicide as worthless individuals
who are simply wasting time, time we
could be spending with those who want
desperately to live.
These kinds offeelings are projected
onto the patient, evident both in our
speech and in our actions. Undoubtedl}
they affect the care that we give. And the
person who deliberately takes an
overdose of drugs often has a low
self-esteem to begin with: if we add to his
feelings of unworthiness, we are hardly
helping him.
At one time. attempted suicide was
against the law and had to be reported to
the police as an offence. Perhaps the
roots of our attitude problem lie here.
While we provide support to the woman
who has lost her husband. we justify
holding back from the individual who has
attempted to take his own life. I feel that
it is about time we examined the way we
react to those who attempt suicide and
improved the quality of care we offer
them.
Nurses are not alone in their
negative attitudes towards those who
overdose; physicians also have a great
deal to learn. We must work together as
a team to change attitudes. There is no
doubt that basic life support is a priority
when the patient is first admitted, but
once he is stable, we can all begin to help
him psychologically, instead of merely
checking his vital signs every hour,
offering minimal human contact.
It is one thing to give lip-service to
the idea of psychological support and
altogether another to give it. But
remember that any individual who is
admitted to emergency after an
attempted overdose is vulnerable. and
his visit to emergency is the time to help
him recognize his need for further help.
Almost every suicide attempt can be
associated with a specific incident in an
individual's life. Although this fact may
not be evident in the emergency
department. the patient needs to deal
with it in interviews and therapy that can
be arranged by those who meet him in
emergency.
Obstacles to care
Attitude is far from the only obstacle to
quality care of the suicidal patient. We
must spend time to discover other
barriers to thorough treatment with the
aim of instituting a better system of care.
The Cen-.ll... Nur..
".Y 1871 36
One of the obvious obstacles is
related to staffing limitations in the
emergency department. Emergency
rooms are servicing an ever increasing
numher of patients today with no
compensation in the number of staff
members needed to deal effectively with
this patient load. How is it humanly
possible to spend all the time necessary
to help the patient who has attempted
suicide because his problems are too
much for him to handle? Perhaps we
should consider organizing volunteers,
trained in crisis intervention. to fill that
need. Volunteers would have the time to
sit and talk with patients, free from the
burden of responsibilities that doctors
and nurses carry. They could also help
pass the time with patients who are
awaiting admission or test results.
Secondly. there are definite
knowledge needs for those who care for
suicidal patients. Hospitals should be
providing inservice programs for staff
members who deal with these patients.
For example. certain drugs are used to
overdose more than others within a given
geographical area - your hospital can be
aware ofthe drugs most commonly used
in its area as well as antidotes used in
treatment. Public education is also
important; information posters in
outpatient and emergency departments
are helpful. On the posters. include a li
t
of agencies where further help can be
found.
Physicians within the community
should be encouraged to question why
they persist in giving certain drugs, for
example. antidepressants. They need to
consider preventive medicine - tallo..ing
to the patient to find out why he is
depressed, and what can be done to
change the patient's situation, rather
than merely giving out medication.
Follow-up is another neglected area
in the treatment of overdose patients.
Too often, the patient is simply patched
up and discharged. with no concrete
effort made to provide follow-up care.
Studies show that once a person has
attempted suicide, chances are that he
will try again. "This fact underlies the
necessity for follow-up care.
Many emergency departments
discharge an overdose patient with a
note in his pocket for an appointment
with a Mental Health Clinic. But how
many of these patients actually keep that
initial appointment or return for
subsequent appointments?
Those who overdose often use their
own prescription drugs. Follow-up could
be ensured if the patient's family doctor
were notified by phone or mail that his
patient was seen in the emergency
department following an overdose, and
strongly underlining the need for
follow-up. With some support in the
community. the patient may not feel the
need to attempt suicide again.
Unless we as nurses take time to
talk to the patient. he may not feel
encouraged to seek help available to him
in the community. If you have little time
to spend with him. and he is to be
discharged from emergency after
treatment, arrange with someone in the
social services department to visit him in
his home.
All of these attempts to arrange
follow-up have the potential to set the
patient in the right direction. Not all
patients who overdose are admitted to
the hospital. nor are they evaluated by a
psychiatrist. With good physical and
psychological support and careful
attention to the details offollow-up care.
nurses in emergency can playa part in
ensuring that the suicidal patient
receives the help he so desperately
needs.
References
I Bridges, P.K.Psvchiatric
emergencies: diagnosis and
management. Springfield. III.. Thomas.
1971. p.88.
2 Perlin. Seymour. A Iwndhoo/..for
the study of suicide. Toronto, Oxford
University Press. 1975. p.154.
3 Cosgriff. James H. The practice of
emergency nursing. by... and Diann
Laden Anderson. Toronto, Lippincott.
1975. p.158.
4 Dreisbach. Robert H. Handhoo/.. of
poisoning: diagnosis and treatment. 8th
ed. Los Altos. Ca.. Lange, 1974. p.16.
5 Cosgriff. op. cit. p.160.
6 Ibid.. p.161.
*7 Reversing Acetdminophen OD.
EmerKency Medicine. Feb. 1978. p.109.
8 Cosgriff. op. cit. p.163.
*References not verified in CNA Library
Bibliograph
I Bellack. Leopold. EmerKency
psychotherapv and brief psycJlOlogy. by
... and Leonard Small. New York.
Grune. 1965.
2 Bergersen, Betty. Pharmacology
innur.
ing. 12th ed. St. Louis, Mosby.
1973.
3 Bridges. P.K. Psychiatric
emergencies: diagnosis and
management. Springfield. III.. Thomas,
1971.
4 Cosgriff. James H. The practice of
emergency nursing, by... and Diann
Laden Anderson. Toronto. Lippincott.
1975.
5 Dreisbach. Robert H. Handhoo/.. of
poisoning: diagnosis and treatment. 8th
ed. Los Altos. Ca., Lange. 1974.
6 Geolot, Denise. The emergency
nurse practitioner. Nurse Pract.
3:3: 12.28, May/Jun. 1978
7 Glick. Robert A. Psychiatric
emergencies. edited by... et al. New
York,Grune, 1976.
*8 Graber. Richard F. Treating the
acute overdose victim. Patient Care,
Jan. 15. 1977, p.76-103.
9 Macey. Anne M. Preventing
hepatotoxicity in acetaminophen
overdose. A mer. J. Nul's. 79:2:301-303.
Feb. 1979.
10 Mennear, John H. The poisoning
emergency. Amer.J. Nul's. 77:5:842-844,
May 1977.
II Perlin. Seymour. A handhoo/..for
the study of suicide. Toronto. Oxford
University Press. 1975.
12 Prentice. Glen. Evaluating suicide
potential. Nurse Pract. 2:5:30-31,
May/Jun. 1977.
13 Rosenbauer, Audrey. Suicide
prevention and the emergency room
nurse. Heart Lung 7: I: 101-104.
Jan./Feb. 1978.
14 Suicidology: contemporary
del'elopments, edited by Edwin S.
Schneidman. New York,Grune. 1976.
15 Stevens, Barbara C. Preventing
fatal overdose. Nul's. Mirror.
145:24:47-48, Dec.15. 1977.
16 Sumner, Frances. A nurse for
suicide patients, by... and Theresa A.
Gwozdz. Amer.J.Nurs. 76: II: 1792-93.
Nov.1976.
17 Yowell. Sharon. Working with
drug abuse patients in the ER. by ... and
Carolyn Brose.Amer.J.Nurs.
77: I :82-85, Jan. 1977.
Others
* I Tricyclic overdose: the lab can
help. Emergency Medicine. Mar. 1978-
p.144.146.
*2 Verge of death. Emergency
Medicine. Mar. 1978. p.39. 44-45.
*3 Poisons. C urrent Medical
ÐiaKnosis and Treatment. 1976.
p.928-956.
*References not verified byCNA
Library
Heather L. Erb, author of Emergency
treatment of drug ol'erdose is a graduate
l
fthe Saint John School of Nursing,
Saint John. New BmnswicÂ. Following
graduation. she worked for two years in
the emergency department at the Saint
John General Hospital. Currentlv
enrolled in McMa.
ter U nÎl'ersir.;' s
Educational Program for Nurses in
Primary Care. Heather is receÎl'inK
clinical experience in emergency at Saint
John's Hospital.
Frankly speaking
Nursing
and the degree mystique
Nursing now has a place on the
university campus, but has it reall)"
freed itself from the shackles of its
hospital past? In part two of Nursing
and the Degree Mystique, author
Jeanne Marie Hurd looks at what
nursing otTers to those who are
seeking a university education.
Jeanne Marie Hurd
There is an urgent need in nursing today
for expanded minds to keep pace with
the profession's expanding role. Now
that the university school of nursing
appears to symbolize nursing's relative
equality with the other health
professions, it is usually assumed that
the nursing degree represents the
ultimate opportunity for academic and
professional mind expansion in nursing.
But does it really? Or is the parochialism
inherited from the profession's
hospital-dominated past insidiously
choking out both the intellectual
curiosity and the freedom of thought
essential to the attainment of a real
university education.
Parochialism. or narrowness of
vision, can cripple a developing
profession to a dangerous extent. Its
symptoms are highly visible in
contemporary university nursing
education. with both practical and
historical reasons contributing to the
etiology of these symptoms. To begin
with the practical, it is obvious that
university nursing is currently faced with
a very real dilemma - it must combine
both basic university preparation and
professional education within the
increasingly limited confines of an
undergraduate program.
Nursing's medical counterpart has
escaped this dilemma by placing its
professional education at the graduate
level. thus permitting medical students to
be regular university students during
their undergraduate days. In recent
years, moreover. medical schools have
increasingly encouraged their aspirants
to major in something other than
"pre-med" at the baccalaureate level.
Recognizing that professionaJ education
is by definition highly specialized. they
base their recommendations on the
premise that a medical student must gain
exposure to the liberal arts and sciences
if he is to achieve a well-rounded
university education. And such exposure
is possible onJy before his professional
education begins.
Nursing does not have the luxury of
this type of separation. The university
school usually makes a valiant attempt at
offering both liberal and professional
education within the scope of one
degree. but the pattern of the past fe\\-
years shows professional content
steadily encroaching on the liberal arts.
From a nursing viewpoint, the
reasons for this encroachment are quite
logical. First. there is increasing pressure
on university schools of nursing from
employers who complain that
baccRlaureate graduates lack basic
clinical competence. presumably .
because of their abbreviated clinical
experience. Naturally. since nursing
faculties are anxious to turn out
"superior products". an increasing
proportion of student time is thus
devoted to nursing courses.
Furthermore, hecause the nurse's
role is rapidly expanding in today's
world. it is incumbent on faculty to
incorporate a growing number of new
concepts and skills into basic nursing
preparation. And it must be remembered
that a university nurse is expected to be
qualified as a beginning level practitioner
in all areas the day she graduates. It is
small wonder that many university
schools of nursing. which but a few years
back were not beginning nursing courses
until the student's third university year.
are now introducing professional content
at the first vear level.
The Cenedlen NUrN
II., 1171 37
While such programming
undoubtedly enriches the student's
professional preparation, it also cuts
back significantly on the liberal arts
portion of the curriculum. Supposedly,
providing adequate opportunity for
exposure to the liberal arts was a major
reason for moving nursing education to
the university in the first place. Without
such an intent, the move was hardly
justifiable, as the clinical facilities are
certainly much hetter in the hospital.
Defenders of the trend toward an
increasing percentage of professional
content will no doubt point to the sizable
proportion of physical and social
sciences woven into the nursing
curriculum. The crux of the matter,
however, is that the student's curriculum
is increasingly programmedfor her in
terms of what the faculty feels is
appropriate. While most universities
now include a given number of elective
courses as part of their requirements,
electives are not a priority in university
nursing. More important, the-philosophy
behind the availability of elective
courses - that is. the encouragement of
the student to pursue truth wherever it
may lead him - is certainly not a
university nursing priority, especially
when the student's concept of truth and
what she would like to learn conflicts
with the faculty's preconceptions. And
the fact that most nursing students
accept this state of affairs without
question attests to the success of the
programming from the standpoint of
protecting and promoting professional
content.
The 'liightingale s
ndrome
While the practical reasons for nursing's
retreat into itself are readily identifiable,
there is a deeper reason for the
parochialism that often dominates the
university nursing scene today. This
reason relates directly to the profession's
history. Until recent times, nursing was
content to accept a basically subservient
role, seeing itself as a facilitator of the
decisions of others and giving little
thought to the generation of ideas,
theories and concepts of its own. But
while passive and subservient vis-à-vis
other professions. nursing began to
compensate by becoming rigid and
authoritarian in its dealings with its own
members. This phenomenon gained high
visibility in the era of Florence
Nightingale, whose amazing ability and
forceful personality teamed up with the
British military system to establish the
framework for modem nursing. ", 2
I would suggest that this rigid,
authoritarian and hierarchical framework
is by no means past history. It has simply
moved from the hospital to the university
campus as nursing has changed its base
of operations. Instead of presenting as an
overt characteristic of nursing's
management structure, however, it
exists now beneath the surface - and is
thus doubly dangerous. Most university
nurse educators are probably unaware of
its existence, having convinced
themselves that nursing has liberated
itself from its past and now operates
flexibly, with a scholar's approach to
disciplinary content. But has the leopard
really changed its spots?
A large percentage of today's nurse
educators and nursing school
administrators were themselves
"trained" in diploma programs and then
went on to acquire university degrees.
These nurses are often the first to
criticize hospital-based programs for
training rather than educating nurses,
yet the very characteristics they deplore
in diploma programs have become part
of the unspoken modus operandi of many
university schools. Graduates of these
schools continue to perpetuate the
system under the illusion that it is
completely free of the "training school"
approach.
There are understandable and very
human reasons for this development.
The phenomenon might be likened
clinically to the battered child syndrome
in which children who have been
battered become battering parents in
turn - and so the cycle repeats itself
endlessly unless skilled intervention
occurs to break it. Nurses trained under
auspices affected by the "Nightingale
syndrome" (which few modem nursing
schools completely escape)
unconsciously become its victims and
just as unconsciously perpetuate it in the
next generation of nurses. Without both
recognition of the problem and conscious
intervention, there is no end to it in sight.
The circle game
There is a commonly accepted premise
in modem professional practice that
carefully protects nursing's absolute
right to perpetuate its own internal cycle
without any threat of interference. I refer
to the concept of peer review.
It is fascinating to note that
university nursing schools perceive their
peers in terms of other university schools
of nursing - not in terms of other
schools, faculties and departments on
their own campuses. Peer review for
each school then, must not only come
from outside its own university, but from
another university nursing school. This
means that most university
administrators have little idea of how
their own nursing schools operate,
functioning largely as passive bystanders
and granting pro forma approval when
the accreditation reports prepared by
other nursing experts are presented.
The idea of inviting criticism from
outside nursing is unthinkable: after all,
only nurses are qualified to comment on
nursing. Each university school of
nursing is evaluated and recommended
for accreditation by experts from other
schools whose philosophies and
operational styles are similar to its own.
It is not surprising, then, that there is
little basic criticism forthcoming. Nor
could such a practice be expected to
review nursing as it relates and compares
to the other disciplines with which it
shares the university campus. In a world
of increasing interdependence, nursing
seems to prefer to maintain its isolation
within the university as if afraid of
competition with or contamination from
sources outside itself.
Let me cite one example to illustrate
the type of results to be expected from
peer review, narrowly defined. The
entire third year class of a certain
university nursing school, completely
frustrated by the use of programmed
learning and independent study to the
virtual exclusion of all other teaching
methods, decided to express its concerns
in what the students had been taught to
believe was a professional manner.
Following numerous unsuccessful
individual and small group attempts to
gain a hearing for their concerns, they
prepared a brief which respectfully
requested a more balanced mix of
38 May 111711
The Cenadlan Nur..
teaching techniques. The brief was
phrased in decidedly positive terms: the
students had made every attempt not to
appear critical. They requested direct
contact with and input from their faculty
who they felt had the wisdom and
experience to provide them with the
guidance they felt they needed. Although
the brief was presented to the faculty by
the entire class, it was greeted with a
mixture of hostility and ridicule by the
instructors, while the school's
administrator chose not to attend the
meeting. As one student sadly remarked
afterwards, "They listened, but they
didn't hear us."
Some time later, at a regional
student nurses' conference, the school's
student association officers shared their
disillusionment over what had happened
with officials from the national
accrediting organization. "We are urged
by our faculty to become change
agents," they lamented, "but if we try to
follow their advice, we're promptly
beaten down."
The officials strongly urged the
students to take their case to the
headquarters of the national accrediting
body, which the students did in spite of
their keen awareness of the possibility of
reprisal. Since their school was
preparing for an accreditation visit by
two prominent professors of nursing
from other universities, the students
were advised by headquarters' officials
to discuss their grievances with the
visiting accreditors. This was done at a
<;pecial meeting requested by the
students.
Before leaving the campus, the
accreditors presented their preliminary
report at a meeting including nursing
faculty and administrators, the dean of
health sciences and the university's
vice-president for academic affairs. A
glowing account of the academic health
of the school was presented, with special
kudos for the programmed learning and
independent study program.
Finally, a special commentary on
student participation in the accreditation
visit \\-as included. The accreditors had
concluded that, because the students had
been so vocal, clear and incisive in
outlining their concerns anti criticism, it
was obvious that the school was in the
habit of promoting free and open
expression on the part of its student
body. Naturally, no change was
recommended.
The faculty was of course delighted
with a report that so neatly reversed the
facts. The university administrators were
assured that all was well within their
school of nursing. And the students?
Having survived their first major bout
with the Nightingale syndrome, they had
learned a fundamental lesson in the
theory and practice of nursing. Perhaps
the lesson can best be summarized like
this: it is both futile and self-destructive
to question the ideas or authority of
those above one in the nursing hierarchy,
no matter how rational the argument or
how just the cause.
A need for vision
Important as its implications ilre for
nursing's future, the transition from
hospital to university cannot be expected
to confer on nursing immediate academic
maturity. Such maturity wiII come only
after a long period of growth - growth
that must be enriched by a
cross-fertilization of ideas resulting from
active involvement with the other
disciplines on the university campus. To
assume immediate academic equality
with those disciplines whose university
traditions are much longer merely serves
to cloud realistic self-awareness. And to
expect to maintain this assumed equality
in relative isolation from all other
disciplines is both fatuous
nd
dangerous.
Furthermore, the abiding presence
of the rigid authoritarianism on which
modern nursing is based must be fully
recognized if the profession is to free
itself of the shackles of the past.
University nursing ignores the need to
rid itself of this spectre at its own peril.
Unfortunately, the power it has gained
with its new status can be, and has been.
used to demand conformity from its
students and from the profession at large
- in the best tradition of the Nightingale
syndrome. Short-term objectives can
perhaps be reached this way, but the
long-term goal of making nursing a highly
respected, truly academic profession will
most certainly be short-circuited if
power and authoritarianism are treated
as synonyms.
The expanded minds needed to
guide nursing's future can develop best
in an atmosphere of freedom to think, to
question existing va1ues, and to debate
ideas with other disciplines. Such an
atmosphere should be the environment
of a university education. Without the
nurturance of such an environment, a
profession may exist on a university
campus but fail to be a part of it.
The need for the mind expansion so
necessary today is often most apparent
among those who have had the maximum
rather than the minimum exposure to
modern nursing educational methods. In
itself this may be the most telling
criticism of contemporary higher
education in nursing. The pharisaism
frequently visible in the powerful group
emerging from university nursing stands
in stark contrast to the collective career
decisions being made by an
increasing number of today's bright
diploma nurses. Seeking the intellectual
fulfillment promised them at the
university, they are discovering that they
cannot find it within nursing. As these
nurses continue to swell the ranks of
social work, psychology, medicine,
education and many other disciplines, is
it not time for nursing to reassess its
future in terms of what is happening to its
present?
References
1 Woodham-Smith, Cecil, Florence
Nighting'ale, New York, McGraw-Hili,
1951.
2 Bollough, Vern L. The emergence
ofmodern nursing, by . . . and Bonnie
Bollough. Toronto, Macmillan, 1969.
Jeanne Marie Hurd (B.A., Ohio
Wesleyan University; M.A., Columbia
University; M.N., Yale University) has
taught nursing in both Canadian and
American universities. Prior to moving
to Ottawa, she was a senior program
consultant with Manitoba's
Department of Health and Social
Development. She is currently engaged
in writing, teaching and consulting (the
latter in the area of maternal and child
health).
.,.
Nutritional
assessment
of the
ICU
patient
My first encounter with Sam Dunn took
place the day before he was scheduled
for aorto-coronary bypass surgery and a
mitral valve replacement. Sam was in his
mid-50's and he struck me as a friendly,
warm man. handsomely graying, robust
and healthy. although somewhat
overweight.
As a second-year nursing student. I
was assigned to look after Sam in the
post-operative period. I knew, of course,
that his appearance would change
considerably after his surgery, but I
wasn't prepared for the change I saw in
the recovery room. Four days after
surgery. he was stilI semi-comatose, pale
and weak. Sam had a long and gruelling
recovery period. He spent four weeks in
the intensive care unit as a result of the
complications that developed.
Afterwards, he spent four additional
weeks in rehabilitation.
I nursed Sam for the first three
weeks he was in ICU. At the beginning
of the second week his appearance was
almost that of an old man - he was thin.
weak and lethargic; he had lost 24
pounds.
Because of the many complications
Sam had developed. including internal
bleeding, cerebral anoxia. pulmonary
edema and arrhythmias, he required a
great deal of expert nursing care. But as I
went through the daily routines, the area
that was virtually neglected. as is often
the case for ICU patients, was a
Valerie MacDougall
nutritional assessment. With all the other
life-threatening problems, nutrition was
low on the priority list. Sam was so weak
and thin. however. that I decided to
evaluate his current nutritional status
and needs in this area.
Nutritional status
My first step in the assessment was to
take a 24-hour record of Sam's average
intake' (see table one, two and three) and
his average energy expenditure (see table
four). Then, I examined his nutritional
needs and devised a plan of care in order
to help him gradually regain his strength
and his pre-operative nutritional status.
A second goal was to increase his
knowledge of his nutritional needs,
knowledge that would affect his dietary
choices in the future.
Sam's dietary intake
According to Canada's Food Guide, a
person should select foods from each of
four food groups each day. The
recommended daily intake for adults is:
· milk and milk products - 2 servings
· meat and alternate - 2 servings
· bread and cereals - 3-5 servings
· fruits and vegetables - 4-5
servmgs.
In comparing Sam's darly intake to
Canada's Food Guide, it was obvious
that he was deficient in many {lreas. He
ate only one serving from the milk and
milk products group. instead of the
recommended two. He had one and one
half servings from the meat group; and
he was certainly not receiving enough of
his caloric and nutrient intake from the
bread and cereal group. He was eating
only one and a half servings instead of
3-5. Only in the fruit and vegetable group
was Sam eating according to the
recommended dietary intake.
Intervention
It was obvious that Sam needed
encouragement and teaching to enable
him to regain a sufficient daily nutrient
intake and prevent further weight loss.
By the thirteenth post-op day, his mental
alertness had increased and he was much
more aware of what was happening
around him.
I found out from Sam that he wasn't
pleased with his meals at all. so each day
we went over the menu and I helped him
choose foods that would be both
nutritious and pleasing to him. I reported
his likes and dislikes to the dietary staff
so that they would be alerted to his
preferences. Then I made his trays as
attractive as possible to increase his
appetite. and gave him only small.
frequent meals at first since he
complained that the sight of a full tray
made him nauseous.
At each mealtime, I encouraged him
to eat more and talked to him about
which foods were rich in the nutrients he
needed (see table three). I spoke to him
about how the nutrients would work in
his body to gradually improve his
nutritional and health status.
-
40 "'y 111711
The Cenedlen Nur..
Nutritional Needs
Calories
The body needs energy to perform all
life-sustaining functions. When we eat,
our bodies convert the ingested
foodstuffs into energy - whether these
foodstuff
be carbohydrates,fats or
protein.
In looking at Sam's caloric intake, it
was clear that he was receiving an
inadequate number of calories for the
energy he was expending in:
a) daily activities such as washing. eating
etc.
b) coping with pulmonary edema and
pneumonia, both of which lead to an
increase in the basal metabolic rate and
therefore an increase in caloric needs. 2
On his 13th post-operative day, Sam
had loss of muscle tone, muscle mass, a
weight loss of 24 pounds and he was
experiencing weakness and fatigue - all
indicative of a caloric deficit.
Protein
Man must have an adequate source of
protein in order to grow and maintain the
body's integrity. Protein forms the bulk
of muscle and tissue and is constantly
heing utilized to maintain hodv cells,
tissues and fluids. Of the 22 amino acids
that make up protein, eight or nine of
them are considered essential because
they cannot be synthesized bv the body.
They must be present in the diet.
Sam had experienced the normal
catabolic response to surgery with a loss
of protein in the form of lean body mass
and loss of body fat. Post-operatively, he
was semi-comatose and had an
endotracheal tube. Forthe first week. he
was NPO and received 5 per cent
dextrose in water intravenously. He was
also in negative nitrogen balance with a
low serum protein of 5.9g/dl on the 9th
post-op day. A negative nitrogen balance
occurs in the presence of inadequate
protein and caloric intake, increased
utilization of protein and nitrogen loss in
the catabolic response to surgery. 3.4
To correct this situation, Sam was
given Amigen, a protein hydrolysate that
supplied him with the proteins he needed
to:
. rebuild his body tissues
. regulate his body processes
. form antibodies to fight infection
. build hemoglobin.
The Amigen. plus the protein in his food,
raised his serum protein levels to 7.8g/dl,
well within normal limits.
Carbohydrates
Carbohydrates are the most important
sources of energy for the body. Because
thev are very easily digested, they have a
protein sparing effect, all effect that
allows protein to be usedfor growth and
repair rather than for energy.
Carbohydrates are also necessary for the
utilization offats.
As Sam's appetite slowly increased,
and with an awareness of why he needed
certain foods. he began to choose high
carbohydrate foods such as breads,
potatoes. fruits and vegetables - all of
which provided him with calories and
energy.
Fats
Fats are aform of stored energy in man.
They serve multiple functions including
helping with the absorption offat soluble
vitamins A, D, E and K; for protecting
parts of the body; andfor supplying
essential fatty acid.
to the body. 5
With increasing nutritional
knowledge, Sam began to choose foods
more wisely and to receive more of his
energy needs from fats and
carbohydrates. Foods containing fat are
whole milk. butter. meat, whole milk
cheese, nuts and salad dressings.
In Sam's case, fats greatly
contributed to his total caloric intake.
They also served to prevent protein
catabolism and further weight loss.
Calcium
Calcium is necessary for the formation
of bone and teeth, for the maintenance
of a normal heart beat, healthy nerve
function and good muscle tone. I t also
aids in normal blood c1ottillg. 6
Because Sam had undergone
aorto-coronary bypass surgery, a good
supply of calcium was necessary to aid in
the healing of his sternum. Foods which
contain ample amounts of calcium are
cheese, whole milk, and milk products
such as custard and ice cream.
Knowing that prolonged bed rest
and a high calcium intake could put Sam
at risk for calculi, I encouraged
mobilization as early as he could tolerate
it.
Iron
/ron is vitalfor the formation of
hemoglobin ill red blood cells alld ill the
functioning of certain enzyme systems.
Table one
24-hour dietary intake on 13th post-op day
Table two
Medications on 13th post-op day
Breakfast - 11 2 cup grapefruit Juice
1/2 cup puffed rice
7 ounces whole milk
112 slice white toast
1f 2 tsp. butler
1f 2 tsp. jam
Lunch - 1f4 cup cream of tomato soup
2tbsp.peas
1 ounce hamburger
2 tbsp. tomato sauce
80 cc. black tea
11 2 cup strawberry jello
Supper - 4 leaves lettuce in vinegar
3 ounces broiled chicken
1f2 small boiled potato
1/4 cup green beans
112 diet pear
1 cup coffee
20 cc cream
Snack - 1 cup gingerale
10% KCL. 20 cc p.o. Tid
provides: 23.4 mg of potassium chloride
2. 5% Amigen in D5W with 10 mEq KCL, 1200 cc/24 hours
provides: protein - 60 9 - 240 calories
sodium - 0.97 9
potassium - 1.089 9
calcium - 0.120 9
3. D5W, 1200 cc/24 hours
provides: 240 calories
potassium chloride - 0.47 9
4. Thiamine 100 mg 1M bid
provides: 200 mg of thiamine
The Cen-.llan Nur..
May 11171 .1
Table three"
Constituents of
daily intake
calones
protein (g)
CHO (g)
fat (g)
calcium (mg)
iron (mg)
Vitamin A (IU)
Vitamin C (mg)
thiamine (mg)
riboflavin (mg)
niacin (mg)
sodium (mg)
potassium (mg)
phosphorus (mg)
magnesium (mg)
folacin (mEq)
"ThIS Includes nulTlen\8lrom both dlelary and medoca
on sources
..For a moderately acllve 154 pound man.
Total nutrient
intake of Sam Dunn'
1303
107
162.5
28.5
512
5.35
2975
82
200.2
0.808
12.12
610.8
2047.4
847.3
71
105.16
Canadian recommended
nutrient Intake"
2300
56
50-60% caloric intake 1S
30% caloric intake ,.
800
10
5500
30
1.4
1.7
18
800
300
200
Since Sam had lost blood
post-operatively and consequently had
low hemoglobin and hematocrit levels.
he needed encouragement to eat foods
such as liver. red meats and green
vegetables. In addition, I knew that a
source of Vitamin C taken close to meals
would increase the iron absorption. so
fruit juices were offered to him near
mealtime. 7
II itamin A
Vitamin A is essential to healthy skin and
membranes and is necessaryfor t'ision in
dim light. 8
Sam's intake of Vitamin A was a
little less than the recommended daily
levels. However. since Vitamin A is
stored in the body, he had sufficient
supply to meet his immediate needs.
Foods with moderate amounts of
Vitamin A such as dark leafy vegetables,
yellow fruits. liver and whole milk
cheeses helped to maintain his body
stores.
ViÚlmin C
One of the main functions oft'itamin C is
the formation of collagen, a protein
substance that cements cells together. It
is important for maintaining the integrit.....
of blood vessel walls. promoting IHJund
healing and helping tissue formation. Y
Although Sam was receiving more
Vitamin C than is recommended. any
excess was excreted in the urine since it
is a water-soluble vitamin. It is found
predominantly in fruits and vegetables.
especially citrus fruits. strawberries.
cantaloupe and raw leafy vegetables. It is
also found in milk and in meats
Riboflavin, thiDmine and niacin
These vitamins are involt'ed in energv
metabolism. Riboflavin helps in the
maintenance of good appetite and
normal digestion, healthy skin and eyes,
and functions to maintain the nervous
system. Thiamine, which may also
promote appetite, is inl'Olved in the
normal functioning of the nen'ous
S'l.'stem and has an action in the
metabolism of carbohydrates. Niacin
also helps to maintain the normal
function oftheGI tract and ne/1.'OUS
system. 10
Foods rich in these vitamins are
milk and milk products (except butter),
liver. fish. green vegetables. cereals.
legumes. and nuts. In addition to these
foods. Sam was receiving a thiamine
supplement which is thought to act as an
appetite stimulant.
Sodium
Sodium acts to regulate the water
balance within the body, helps to
maintain acid-base balance, transmits
nerve impulses and relaxes muscles. It is
also neededfor glucose absorption and
for the transport of other nutrients
across cell membranes. II
Sam was on a restricted one gram
sodium diet to help reduce his pulmonary
edema and thus the workload on his
healing heart tissue. Since sodium holds
water within the body. restricting sodium
intake is an attempt to decrease fluid
retention.
A week post-operatively, his plasma
level was 161 mEq/L (the normal range
falls between 137-148mEq/L *). Sam told
me that he was aware of why his sodium
was restricted since he had been on a
no-added salt diet before his surgery. I
checked his tray before he ate to make
sure there was no salt present and also to
check what foods he was served. As
well, his fluid intake was restricted to
1800 cc/day to control blood volume,
therefore to lessen the workload on the
heart and also to lessen his pulmonary
edema.
Potassium
Adequate levels of potassium are
necessaryfor normal heart muscle
actÎ\'ity. Potassium reduces the
conduction velocity in the heart and
shortens the refractory period. It also
reduces the heart's automaticity.
H.....pokalemia can lead to heartbeat
irregularities as well as muscle ...'ea"ness,
pain, drowsiness, dizziness and
confusion. Hyper"alemia can lead to
intrat'entricular heart bloc". 12
Sam had been receiving potassium
supplements since his operation to
promote heart muscle activity. He also
needed K'" supplements to replace the
potassium loss in the urine. a loss that
resulted from taking a diuretic. His
potassium level was 4.1 mEq/L. which
was within the normal range of 3.75-5.5
mEq/L *. Foods rich in potassium
include bananas, citrus fruits. meat. fish.
potatoes and milk.
*Normallevels at Royal Victoria Ho
pital.
Montreal.
42 May 111711
The Canadian Nur..
Phosphorus
This mineral facilitates the absorption
and transport of nutrients , regulates the
release of energy and is necessary for
bone formation.
In eating foods such as meats, fish.
poultry. eggs. nuts, milk and cheese.
Sam was receiving adequate amounts of
phosphorous to meet his needs,
especially to aid in bone formation of the
sternum.
Magnesium
Magnesium is a constituent of bone and
is necessary for the metabolism of
calcium and phosphorus. It also helps in
the regulation of muscles and nerves and
acts as an enzyme in energy producing
systems.
Sam needed adequate levels of
magnesium to help in the repair of his
sternum. Food sources are cocoa, nuts,
whole grains. spinach. liver and clams.
Folic acid
Fdic acid is necessary for the formation
of red blood cells in the bone marrow. By
increasing the level ofRBC's,folic acid
or folacin helps to promote good cellular
nutrition, respiration, growth and
healing. 13
Sam received folic acid in foods
such as asparagus. bananas. liver and
spinach.
Other ideas
In formulating Sam's nutritional
assessment. I talked to the senior
dietician at the hospital. Together we
came up with some suggestions that
could be useful in promoting a more
adequate dietary intake in patients like
Sam. For example:
. add one third cup skim milk powder
per 8 ounces of milk; the patient can
receive up to twice the nutrients in the
same amount of fluid.
. high protein milkshakes with fruits
blended in (such as bananas and
strawberries) can increase potassium,
Vitamin A and folic acid intake.
. eggnogs are an excellent source of
Vitamin A, calcium, protein.
. blend yogurt with fruit, or ice cream
with fruit or custards to give the patient
an increased carbohydrate intake along
with niacin. thiamine, riboflavin,
calcium. protein etc.
. make meal trays as attractive as
possible. Take an active interest in your
patient's eating habits - encourage.
motivate and explain.
. communicate with the dietician and
dietetic staff concerning the patient's
likes. dislikes. progress. dietary
problems. etc.
In talking with the dietician. I
realized how valuable she or he can be to
the nursing staff and to the patient. If we
are concerned about the nutritional
status of our patients, we can make the
problem known to the dietician and
together an assessment and a plan can be
implemented.
At home
In Sam's case, a good dietary intake and
an increased knowledge of nutrition
proved to be extremely helpful to his
recovery. and to his nutritional status
after discharge . Two and a half months
after his discharge. I spoke with Sam.
His appetite had improved gradually and
his weight had increased from his
post-operative weight of 157 pounds to
168 pounds. His daily nutrient intake
corresponded with the recommendations
ofCanada's Food Guide for a
moderately active adult. He told me that
he had improved his eating habits, that it
helped to know which foods were good
for him. Gradually. he had been building
up his activity level by walking, working
in the garden and painting. He said he
felt "great".
References
I Both Canada's FoodGuide and the
Canadian Recommended Daily Nutrient
Intake were used in the nutritional
assessment. The Daily Nutrient Intake.
which sets standards for feeding groups
of healthy individuals, was used to
illustrate how one individual's dietary
intake is affected by his health status and
to show how nurses may intervene to
promote good nutrition and health.
2 Luckmann, Joan. Medical-surgical
nur.
ing: a psychophysiologic approach
by ... and Karen C. Sorenson,
Philadelphia, Saunders, 1974. p.953.
3 Bistriam. Bruce R. Protein status
of general surgical patients. JA MA,
230:6:858-860, Nov. II. 1974.
Table four 17
Energy expenditure in 24 hours on 13th post-op day
Time Activity Duration Energy Total/24 hours
(min) (kcal/min) (kcal)
Mornmg sleeping 480 1.0 480
(12PM-8AM)
ate breakfast 15 3.0 45
up in chair 90 1.5 135
washed and shaved 30 3.5 105
lying at ease 55 1.4 77
slept 60 1.0 60
Afternoon ate lunch 15 3.0 45
lying at ease 95 1.4 133
slept 210 1.0 210
Evening ate supper 15 3.0 45
lying at ease 95 1.4 133
slept 300 1.0 300
1768 kcal
4 O'k..et:fe. S.J.D. Catabolic loss of
body nitrogen in response to surgery.
Lancet by... et aI. 7888: 1035-1037, Nov.
2,1974.
5 Canada. Health and Welfare
Canada. Health Protection Branch.
Educational Services Division. Selected
nutrition teaching aids. 1976. p.ll.
6 Ibid. p. 13.
7 Ibid.
8 Ibid, p.11.
9 Ibid, p.12.
10 Ibid.
II Luckmann, op. cit. p.638-640.
12 Ibid, p.23:!-234.
13 Robinson. Corinne H . Normal
and therapeutic nutrition by... and
Marilyn R. Lawier. 15 ed. Toronto,
MacMillan, 1977. p.187-188.
14 Canada. Health and Welfare
Canada. Health Protection Branch.
Educational Services Division, op. cit.
15 Williams. Susan R. Nutrition and
diet therapy, St. Louis. Mosby. 1977.
p.I:!.
16 Ibid, p.30.
I7 Canada. Health and Welfare
Canada. Health Protection Branch.
Educational Services Division, op. cit.
Valerie \lacDougall is currently a third
year student in the B.Sc.N. prof(ram at
McGill University. She wrote,
"Nutritional assessment of the ICU
patient" u'hile in her second year.
Valerie u'rites, "I would like to
express my sincere thanks to two special
people:first of all, to Susan Zuijdwijk,
formerlecturer in nursing at McG ill
University who encouraf(ed me to try to
publish this paper and 10 Ka) Watson,
dietician in Dietetic Education at the
Royal Victoria Hospital in Montreal,
who helped me to ralidate the material in
this paper. "
..
-
-
The Cen-.ll.n NUrH
"'y 1171 43
SIR, I KNOW
Can you see me?
Do you know that I'm here?
Wake up, sir.
Here's your breakfast.
Wake up.
You're 92 today.
It's your birthday.
Do you know?
Can you hear?
Ready for your breakfast?
Do you know I'm here?
Here's your porridge.
Come on, sir
Open up
It's your porridge.
Close your mouth, sir.
It's dribbling down your chin.
Oh, sir! Do you know what's going on?
Oh! I hope not.
How degrading It is
to be fed
and bathed.
Do you want to go on the bed pan?
Oh, I see.
You couldn't help it.
Yes, I know, it's okay.
Oh, sir, please don't cry.
Don't you see
I understand
I've been told what's going on.
And I know
you know
what's going on.
You're not cute
or sweet.
You're a MAN.
And sir, remember
I know it.
Lise DeBoer
About the author - Lise DeBoer is a first year student in the two-year
associate degree program at Douglas College. Surrey, B C. She wrote
"Sir, I Know" after completing her first clinical rotation in Extended Care
and her introductory experience in caring for geriatric patients.
[DR' sting Servile
The Canadian Nurses Association
Testing Service is now in the fmal
stages of development of a
comprehensive examination for nurse
registration/licensure: the
exam will be introduced for
use in 1980 and is the result of
many years of hard work by a large
group of dedicated nurses across
Canada. The event will mark the end
of the present five-part examination
and in fact, Canada is likely to
become the first country in the world
to use a comprehensive examination
for nurse registration on a national
basis. It is also noteworthy that for
the first time, a national registration
examination is being developed in
English and in French.
The comprehensive examination
is being developed around examples
of a number of nursing situations
commonly found in practice. Each
situation will result in between 20 and
40 test items that will focus on the
basic and important nursing concepts
one would expect the beginning
practitioner to know and understand.
The examination will be general in
nature and test items will be
intermingled rather than grouped by
clinical subject areas.
CNA's public relations officer
Bert Prime, interviewed the director
of CNA TS, Dr. Eric Parrott, for the
Canadian Nurse. Dr. Parrott
commented: "CNA TS touches every
nurse when he or she writes the
exams and every working day
thereafter since the exam is one
measure of a candidate's eligibility
to become a professional nurse. "
Dr. Parrott talked about the
significance of the comprehensive
examination and what it means to
the future of the nursing profession.
,
BP: Where does the content knowledge
comefrom?
Dr. Parrott: It comes from the
representatives of the eleven
jurisdictions, who are involved in all
phases oftest construction through
membership in blueprint committees,
objectives committees, item-writing
groups and jurisdictional appraisal
committees.
\
BP: What is the composition of the
various committees involved in the
phases of creating a blueprint and in
item writing?
Dr. Parrott: Committee involvement
comes from all parts of Canada totalling
approximately 200, all of whom are
nurses. English committees work on the
BP: What is it exactly that the CNA
TestinR Sen'ice does?
Dr. Parrott: I t develops and administers
a series of examinations that measure
knowledge and theory necessary for
basic nursing practice. It supplies the
expertise needed to produce statistically
sound tests that measure mental traits,
abilities and processes.
Questions most frequently asked about the Canadian Nurses Association Testing
Service
Q. How many candidates are tested at the different times of the year?
A. Candidates write the RN examination at three times during the year: January, June
and August. The numbers tested at each administration varies. They also vary a little
from year to year - in the last two or three years they have been decreasing.
Approximately 8,500 to 10,000 candidates write during the year. Most RN candidates
write in August- approximately 5,000 to 5,500. Another 2,000 to 2,500 write in
January and about 1,500 to 2,000 in June.
Q. Are most of them in Ontario?
A. Yes - approximately 50 per cent of the candidates are from Ontario.
Q. What is the passlfail ratio?
A. The failing rate seems to be affected by a number of factors. It may vary a little from
year to year, and may also vary from one writing to the next or from region to region.
It's difficult to give a meaningful overall figure. CNA TS believes the failing rates are at
least comparable to those in other professions.
Q. What kind of recourse do the student nurses have if they feel a mistake has
been made?
A. She or he has the right to appeal to the provincial jurisdiction and request that the
examination score be rechecked. The provincial jurisdiction will then refer the request
to CNATS. Particular attention is paid to ensuring that there are no errors in computing
scores. Since it costs the candidate money to have the score checked, and since great
care is given to ensuring the accuracy of scores in the first place, candidates are not
encouraged to spend their money needlessly on such a request. If, however, the
candidate feels he or she wc>uld be more satisfied with a reread, this will be done.
Q. Is there a time frame for appealing? Is it strict? Why? Why not?
A. Yes, a candidate must appeal within a year of writing the examination. This is fairly
strict because it is not possible to store all failing records indefinitely. It also puts
responsibility on the candidate to take action within a reasonable time. Candidates
know the limitations. They must make up their mind within the specified time if it is felt
that an appeal is justified. If there were no time limit, it would be very difficult to decide
how long records should be kept and a system would have to be introduced that might
be expensive and that might impose an additional financial burden on candidates.
The Cenedlen NurH
..." 1171 45
English examinations and French
committees work on the French
examinations. The English and French
examinations are developed from the
same blueprint and the same nursing
situations: they test the same content
areas even though the test items may
differ.
BP: What is a blueprint?
Dr. Parrott: As it says in the blueprint for
the comprehensive examination, a
blueprint is both a guide and a
prescription for those who", ill be using
it. As a guide. it otTers a flexible
framework within which the examination
can be developed. As a prescription, the
blueprint determines the components of
the examination and specifies how they
are to be used. It then describes the basic
elements of the nursing situations around
which the examination will be
structured.
The technique used to classify the
cognitive abilities required ofthe
candidates is described and the.
relationships among the various
components are combined to form a
single document - the blueprint for the
,
,.
,,'
i
..J4.J"
..
-'
, - .
....
examination. The basic elements of the
blueprint are those variables relating to
man which must be considered in all
nursing situations. These elements are
growth and development. lifestyle
patterns and unanticipated events.
Nursing competencies needed to provide
adequate anticipatory and therapeutic
care are identified: assessment,
planning. implementation and evaluation
and professional responsibilities that are
legal. ethical, collaborative or
administrative in nature.
BP: What is the definition of the
comprehensi,'e examination?
Dr. Parrott: The Committee on Testing
Service has developed the following
definition: "A comprehensive
examination tests candidates" cognitive
abilities by requiring them to
demonstrate the integration of the
elements of knowledge basic to a
discipline in solving problems presented
in a: series of situations." You can see
from this definition that a comprehensive
examination is viewed as one that will be
global in nature...It will test the
candidate's ability to solve nursing
problems and require the integration and
application of knowledge and abilities
derived from nursing and other related
disciplines. We believe that an
examination of this type supports the
philosophy that basic nursing programs
preparing candidates at the beginning
level of practice are general in nature.
This type of exam will focus on the
nursing process and allow for a more
reasonable "weighting"" of examination
content.
1
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the disease process. whereas the focus
should be on a "nursing model"' and on
health rather than on illness.
To make the registration/licensure
examination more relevant for nursing,
it was decided to develop the com-
prehensive examination. Nursing
education in Canada has experienced
and undergone considerable change in
recent years. Diploma programs in which
most RN's are prepared at the basic level.
have in many cases been shortened from
three to two years. They have moved out
of the hospital settings into community
colleges. institutes of applied arts and
technology. or independent schools. In
addition. curricula are being integrated
and emphasis is being placed on health
promotion rather than on curing disease.
BP: Who will u'rite the comprehensi,'e
examination?
Dr. Parrott: The comprehensive
examination will be written by
candidates who have successfully
completed a basic nursing program in
Canada and wish to enter the nursing
profession. It will also be written by
1
-
...
-
,---- candidates who have obtained their basic
nursing education in a foreign country
and are requesting registration/licensure
in Canada in accordance with the
requirements of a registering/licensing
.
. body.
.
-
,
,
BP: Why is it necessary to hm'e a
comprehensi,'e etamination?
Dr. Parrott: The present examination
used in Canada on a national basis is
divided into clinical areas: medical.
surgical. obstetric. children's and
psychiatric nursing. This division of
content is not considered appropriate
today for a qualifying examination for
candidates being prepared to enter
nursing at a level of general practice. It
puts too much emphasis on what is
thought of as a "medical model" and on
BP: What are the implications of this
comprehensh'e examination for future
candidates entering the profession?
Dr. Parrott: We believe the
comprehensive examination will be a
better measure of a candidate's nursing
knowledge than the present examination
It is designed to be closer to the realities
the nursing practitioner will experience
when she enters the profession. A major
function ofthe CNA Testing Service is to
find better ways to measure a
candidate's potential to enter practice
and we believe the comprehensive
examination is a step in that direction.'"
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A special feature report on the part that nurses played
in a mining disaster that made headlines
across the country last February.
Dorothy Gray Miller
It is four-thirty on a misty Saturday
morning in February, in Glace Bay,
Nova Scotia. Suddenly the phone rings
in the one-storey building about 100
yards from the entrance to No. 26
colIiery. a coal mine that goes down 760
meters and extends eight kilometers
under the sea. Carol Sheriff, the nurse on
duty in the mine's nursing station,
answers and is told by the pit dispatcher
to calI the underground manager to the
pit immediately. He offers no
explanation.
Ten minute!> later he calls again to
ask that the Devco Manager be notified
([he Cape Breton Development
Company is the crown corporation
which operates the mines). Smoke is
coming from 12 South, but
communication with that area seems to
have broken down.
The Cenedlen Nu...
..." 11171 47
The next call comes within a fe\\-
minutes. It is one of the underground
emergency technicians from the first aid
station who says that there has been an
explosion at 12 South. that possibly
seventeen men have been injured and
she must get all medical help possible.
He thinks this may be a "capacity
disaster" involving 15 or more
casualties.
Carol goes into action. She phones
the Devco director of health services.
Dr. Albert Prossin, who declares a
"capacity disaster". Now Carol knows
exactly what to do. She calls nursing
supervisor Brenda Penny and the
number two staff nurse on her list. This
starts a chain reaction: each person in
turn calls another with the statement:
"Capacity disaster declared at No. 26.
You are required for duty. Answer yes or
no."
Next Carol calIs the doctor nearest
the colIiery. Dr. J. B. Tompkins, and
alerts the two Glace Bay hospitals. the
Community and the General. and the
ambulance services.
Carol knows that she has at least an
hour before casualties start to arrive at
the nursing station. since 12 South, the
scene ofthe accident. is the furthest
"wall" in. Medical personnel may take
as long as 45 minutes to get to the site of
the disaster: it will be difficult getting
stretchers through and then there is the
long way back. She starts moving
furniture to set up for receiving
casualties. As yet she is not sure what
kind of injuries to expect.
One of the station nurses. \fyrtle
CampbelI. who lives close by. arrives.
She immedIately gets into her pit clothes.
and checks to see that she has all
equipment in her emergency bag which
when fully packed weighs 25 pounds.
She also checks the portable ventilator.
Dr. Tompkins. accompanied
by Father Robert Floyd. Who
has been calIed by management. checks
in and they both go directly to the pit.
The two remaining station nurses,
Rita Butts and Annunciata Rogez. also
arrive. Although they all want to go
down into the pit. only Myrtle wilI go.
The others wilI help Carol ready the
station. These nurses are "pit wise".
They travel the pit at least once a month
and go down whenever their help is
needed by the underground emergency
technicians who man the first aid station
at the pit bottom. Carol has made three
trips down earlier on her shift. just for
minor injuries.
Dr. Prossin and Dr. M. R. Rajani
arrive and get into their pit clothes. With
Myrtle. they go down to the pit bottom.
The nursing supervisor has arrived and is
now calIing in extra nurses: 12 nurses
report in between five and six o'clock.
The phone rings again. It is one of
the underground emergency technicians
on the direct line from the first aid station
to the nursing station. He says that they
should expect at least six bum cases.
The rest are probably dead.
The station set-up now features a
bum area. a cardiac and respiratory area.
a fractures and minor injuries area and a
holding area. A nearby repair shop has
been designated as a temporary morgue.
A call comes in from the pit bottom
where Myrtle and the two doctors have
set up for triage in an open area. There is
some light here and Mvrtle has found
benches to use for the emergency
equipment. dressings. etc. There is
further information. Dr. Tompkins is at
the mine face atl2 South. He will be
sending the casualties by stretcher to the
triage team at pit bottom. As each man is
treated the nursing station will be
advised of the extent of injuries. the
treatment given and the deployment. An
ambulance and one or two nurses are to
stand by to convey each man to hospital.
The station contacts the outpatient
departments at both hospitals. relays the
information and then assigns ambulances
and nurses to the pit head to accompany
each man coming up.
In alI. six badly burned men are
brought to the surface and taken to the
Community hospital five minutes away.
An emergency plan is also in effect at the
General but there are no more victims:
the rest are dead.
Now that the living have been
attended to. the task of bringing up the
dead begins. The nurses at the station
will help to identify and tag the bodies.
Transportation to the Community
Hospital temporary morgue is arranged.
Suddenly it is all over. Six and a half
hours have elapsed, and it is II a.m. The
nurses gather at the station to drink
innumerable cups of coffee and relive it
all. They come to the full realization of
what has happened here on this February
morning. They know all these men -
they have relatives, friends and
neighbors at No. 26. Most of them have
fathers. brothers, uncles who have been
mmers.
They worry about miners like the
one who appeared at the mine head
checking each injured man as he came up
and then each body. "One of my young
fellows was down there, .. he says by
way of explanation. But he cannot find
his son, aged 23.
The nurses know that as
occupational health nurses. they will
have to deal with the aftermath of this
tragedy - to listen to the miners who
will come to the nurses to talk out their
fears. to get help in dealing with deep
depression.
Glace Ba} Communit} Hospital
An hour after the first word ofthe
tragedy has filtered to the surface, the
staff at the outpatients department of
Glace Bay Community Hospital are at
work preparing to receive the casualties.
From the seaward windows of the
hospital an observer can spot No. 26
colliery.
By the time director of nursing Betty
Dowe arrives from her nearby home.
night supervisor Florrie Paruch has
mobilized the resources ofthis 140-bed
hospital and alerted the OPD. Betty
starts calling in the OR and ICU nurses
and all her supervisors and head nurses.
She also calls the hospital's in-service
director, Peggy Bonner. chairman of the
disaster committee.
When Peggy arrives. they meet with
the chief of medical staff. Dr. John
:\<lacNeil and the hospital's
administrator. David Marchand.
Together they decide to put a modified
version of the hospital's disaster plan
into effect. The first call from No. 26
informed them only of an accident but
they know they have a certain amount of
time before casualties will arrive. They
call in department heads - stores. lab.
pharmacy. X-ray.
As more information comes from
No. 26. decisions are taken as to the use
of the OPD. the number of nurses to be
assigned to each patient, the number for
standby. Extra bottles of Ringers lactate
will be needed. The Glace Bay police and
the RCMP take on the duty of collecting
these from other hospitals in the area.
41 May 1171
The Cenedlen Nur..
The Victoria General in Halifax is
notified that they will be receiving the
bum patients after their condition has
stabilized. Weather conditions do not
permit an airlift, so they will go by
ambulance.
The first patient arrives and the
team goes to work. Fluids are given,
bums dressed, sedation given, and the
difficult process of identification goes
on. Some of these men have bums
covering 80 per cent of their bodies.
Ambulances are readied, each with three
bottles of Ringers , a respirator and
drugs. The nurses who have volunteered
to go in the ambulances wait, with their
coats on, in the backup room.
Stout doors divide the OPD from the
main part of the hospital where activity
of another kind is going on. The families
of the dead and injured start to arrive at
about 7:30a.m. They know only that
there has been an accident. The
Students & Graduates
Assembly Room has been set aside for
them and nurses and other staff members
assigned to look after them. Dietary staff
provide coffee and food. Members of the
local clergy also help.
These people are stricken, but very
quiet. Because of the difficulty in
identifying the dead and injured, and the
fact that many miners have stayed
underground to help with the victims.
information is hard to come by. The
families are assured that they will be
given information as soon as possible.
They accept this. Families of the injured
are told that they should go to Halifax.
Underneath the Assembly Room, a
classroom has been turned into a
morgue. The time has come to give out
the names of the dead. A group of nurses
stands ready, one to a family, to help in
whatever way they can. These are nurses
who have grown up in a mining town.
They know and have experienced the
tragedies that have happened through the
years. But. for most of them, this is the
first time they have felt the impact of
grief en masse. It is a tangible thing.
There is shock. bewilderment. but there
is also courage.
The trip to Halifax
At 8:45 a.m. the first ambulance starts
for Halifax, 290 miles away. The sixth
and last leaves Glace Bay at ten o'clock.
Some of the nurses who go with the
ambulances are still not certain whether
someone close to them may be dead.
Cathy Briggs and Anita Macinnes
are in one of the first ambulances to
leave. Their patient is relatively stable
and conscious. The weather is not good
- foggy and some snow as far as the
Causeway that links Cape Breton to the
mainland, and freezing rain on the
mainland. At times they find the going
rough but they manage to hold on to the
IV bottle and there are no complications.
Their ambulance covers the trip in just
under four hours.
When they arrive at the Victoria
General "everything goes like one. two.
three," says Cathy. They report into
Emergency and then go up to the Bum
Unit and help get their patient into bed.
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The CenedWI NurM
..." 1171 41
Special arrangements have been made to
keep the hospital cafeteria open after
hours for the Glace Bay nurses, so they
wait until all the ambulances anive and
then sit down together for some food
before starting back to Cape Breton.
Cathy goes back to her hospital
where all is quiet. Cathy is 23. She finds
it hard to realize how much has
happened since she reported in at 7:30
that morning for her regular duty in the
Pediatric Ward. She has heard the news
on the radio and now knows the names of
the dead and injured. She goes home to
her widowed mother and together they
face old memories; Cathy's father was
killed in No. 26 when she was five.
Nina MacDonald was on duty at the
Glace Bay Community Hospital shortly
before six a.m. She is a nurse in the
Special Care U nit and her skills are
needed. With a doctor and another
nurse, she works on one of the first
patients to anive. This man is in very
bad shape and they work on him until
nearly ten o'dock. Nina and a
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respiratory technologist go with him in
the ambulance to the VG. Theirs is the
last ambulance to leave. Along the way,
they have to stop several times to fill the
ice bags for the patient's neck with snow,
but they make the journey in little more
than three and a half hours.
Eight hours later Nina is back home
in Glace Bay. She sits down and cries.
She is glad that somehow she has coped,
that her skills were equal to the occasion.
She thinks of one of the dead men, a
good friend and neighbor; Nina's father
and her uncles have all been miners.
Late in the afternoon Betty Dowe
goes home. In the days to come she and
the Disaster Committee will evaluate
their disaster plan and pinpoint possible
improvements. But for now Betty is
satisfied with the performance of the
hospital staff. She is proud of their
response as nurses and as people. To her
the most affecting experience has been
dealing with the relatives. These are the
people that the best thought-out disaster
plans sometimes forget. Today they were
not forgotten.
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Halifax Victoria General
At the Victoria General in Halifax Sheila
Fraser is the administrative supervisor
(Nursing), on the 7 to II a.m. shift. An
hour into her shift she gets a can from
Dr. Jim Ross to tell her that the bum
cases from the Glace Bay disaster will be
arriving shortly.
Sheila alerts the director of nursing,
Marlene Grantham. Marlene. in turn,
calls Doris MacMaster, an assistant
director who lives nearby, and then
alerts executive director, Dr. M.R.
MacDonald. She then leaves
immediately for the hospital.
When she arrives she finds
everything under control. Sheila has
done a fine job of organization. The
patient area on Seven North where the
Bum Unit is situated is being evacuated.
Chris Heggelin, head nurse of the unit.
has been called in and is now at work
coordinating the activities. getting ready
to receive patients. calling back staff.
Seven North holds twelve plastic surgery
patients, and the Bum Unit is full with
four patients.
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clip M.d. In USA No 28 . II C04DfIIiIMe with
balterin. Economy moOt'l WII" chrome(J b.... CAN
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IiO MII,II71
The CIIn-.ll.n "'ur..
At 10: 15 Marlene calls Betty Dowe
in Glace Bay and learns that six patients
are on their way by ambulance; she
learns their names and the extent of
injuries. With the assistance and
cooperation ofthe RCMP, radio
communication between the VG
emergency department and the
ambulances en route is set up. VG will be
alerted when the ambulances are one
hour away from the hospital.
The Emergency OR is made ready in
case it may be needed but preparations in
Seven North are completed just as the
first ambulance arrives at 12:45 p.m.
Fifteen nurses are ready on Seven North
to look after the six arriving patients. as
well as four bum cases presently in the
area. There is a team for each room -
doctor, nurses and respiratory
technologist. At about I p.m., as soon as
the first two patients have been admitted
to the unit, they start their assessment.
Eight hours later, at 9 p.m., they are
finished.
News ofthe casualties spreads
quickly through the hospital. The
administrative director. the medical
director and the director of nursing
briefly consider putting the hospital's
disaster plan into action but decide that
all is under control. Each administrative
supervisor (N ursing), on each shift has
picked up a function and all is running
smoothly. Offers of help come in from
every department in the hospital and
nurses have volunteered to work extra
shifts to free staff for the unit or to work
in the unit.
A plan to handle relatives and the
press is devised in the office ofthe
director of nursing. The press is
promised a statement at 3:30 p.m. and
one person is detailed to handle inquiries
which are coming in from all over
Canada and the United States, as well as
locally.
Conference Room 1-093. directly
opposite the nursing department office,
is set aside for the families of the
patients. This is seven floors away from
the Bum Unit. but close to the people the
relatives can trust to give them
information.
The hospital's chaplains are asked
to come to this room. and a social service
worker is detailed to handle the calls
coming in from the public offering
accommodations for the families and
blood and even skin for the patients.
By eight o'clock, close to 50
relatives have gathered in 1-093..Coffee
and sandwiches are ready for them and
nurses and clergy are on hand to look
after them. As they arrive, the chaplains
come to the nursing office to see whether
it is possible for the families to see the
patients.
Administrative supervisors
(N ursing), Mary Conrad and Shirley
Wall who are on the 3 to II p.m. shift,
put the plan into action. They are joined
by Ann McGray, who comes on at 9 p.m.
All three work through the night. After
checking with the Bum U nit a nurse
escorts each patient's wife up to the unit
and stays with her. Eventually, fathers,
mothers, brothers and sisters are also
taken up one by one. Family members
who get upset are comforted by the
nurses and clergy detailed to look after
them.
As none of the relatives want to
leave the hospital. the supervisors
arrange to have OR stretchers brought
down and linen provided. Another
conference room next door is opened up
and the waiting families can stretch out if
they wish. At midnight fish chowder is
brought to them and the coffee urn is
kept constantly fiHed. Visits to the Bum
Unit continue through the night.
In the meantime the other 700
patients in the hospital are receiving care
as usual. Between 3 and 5 a.m. the
supervisors make their rounds with
apologies for missing the earlier round
and thanks that there have been no calls
for assistance from any of the floors.
On Sunday morning. the day
following the disaster. the nurses take
the families to the cafeteria for breakfast
and later to services in the chapel. The
OR stretchers are used again on Sunday
night. but on Monday morning they have
to be returned and the women in the
group help the nurses to clear the rooms.
Some of them will stay in the ballroom of
the nurses residence; some will be
returning to Cape Breton and others
have found accommodation outside the
hospital.
In the Burn Unit 24 extra nurses for
each 24-hour period are provided in
addition to the regular staff. This will
probably be continued for the next two
months.
Chris Heggelin. the unit's head
nurse. has been recording on tape
everything that has happened for
evaluation and future planning. This is
the second bum disaster from Cape
Breton handled by the unit within two
years. "We learned a lot from that one,
which wasn't as severe. and we have
learned from this one as well." says
Chris. "After the fIrst one we realized
we needed to have back-up staff. So we
developed through the continuing
education department a four-week Bum
Unit Program. Nursing staff. who work
in other areas of the hospital. take this
course and come back and do a shift or
two in the unit from time to time. Then,
when we have a disaster such as this. we
can call on people who have had some
experience. ..
As the director of nursing and the
supervisors finally find time to evaluate
the emergency, they are at one with Ann
McGray when she says "It made me
proud to be part of this hospital. .. They
agree also that one of the most important
things is to have one group of nurses
looking after the families with sympathy
and compassion. This makes all the
difference and frees the nurses in the
Bum U nit to get on with their work.
". think we really lived up to the
philosophy of our hospital." says
Marlene. "We proved we care about our
patients and our staff as people. The
patients and their families received super
care. not only from the nurses and the
doctors but from the whole hospital. ..
Since this account was written. one of the six
sun'ivors has died.
About the author: Dorothy Gray Miller is
public relations officer for the Registered
Nurses Association of Nom Scotia. She
is also one of five members of the
editorial advisory board of The
Canadian NUrse.
The Cllnecllen Nur..
lie,. 1171 111
calendar
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June
Canadian Pediatric Society
56th Annual Meeting to be
held at the Four Seasons
Hotel. Edmonton, Alta. on
June23-27, 1979. Contact:
Canadian Pediatric Society,
Centre hospitalier
unil'ersitaire de Sherbrooke,
Sherbrooke, Que.,J1H 5N4.
Western Infection Control
Symposium to be held on June
8, 1979 in Edmonton, Alta.
Contact: Susan Davis,
Infection Control Nurse.
Misercordia Hospital, 16940-
87 Al'e., Edmonton,Alta.,
T5R 4H5.
September
Nursing explorations: the
experience of suffering. A
one-day program sponsored
by McGill U niversity's Centre
for Continuing Medical
Education. To be held Sept.
28, 1979 in Place Ville Marie,
Montreal. Quebec. Contact:
Centre for Continuing
Medical Education, McGill
Unh'ersity,IIJOPineAl'e.
West, Montreal. Quebec,
H3A lA3.
Instrumentation in health care.
A course in the basics of
electricity, circuits,
measurements, cells,
electrophysiology etc. This
course is suited to nurses and
others working with
electro-medica] equipment.
To begin Sept. 10. 1979 in
Ottawa. Contact: The Division
of Continuing Medical
Education, Unh'ersityof
Ottawa. Ottawa. Ontario.
Sixth Annual Conference of the
Ontario Psychogeriatric
Association. To be held on
Sept.IO-12,1979attheInnon
the Park Hotel. Toronto. Ont.
Contact: Ontario
Psychogeriatric Association,
856 Safari Dr., Kingston,
Ontario, K7M 6N3.
October
Ontario Occupational Health
Nurses Association Eighth
Annual Conference. To be
held in Toronto, Ontario on
Oct. 22-26. 1979. Theme:
Creative caring. Contact:
Helen Krafchik. R.N.,
Chairman,OOHNA,
W arner-Lambert Canada.
Ltd., 2200EglintonAve. East,
Scarborough, Ontario,
MIL 2N3.
Did you know...
The Whitby Psychiatric
Hospital in Whitby. Ontario is
offering a l6-week post
diploma certificate program in
psychiatric nursing. Theory
and clinica] experience are
combined for optimum
learning. Next program to be
given in September 1979.
Contact: Educational S en'ices
Coordinator, Whitby
Psychiatric Hospital. p.o.
Box 613, Whitby, Ontario,
UN 5S9.
Did you know...
Saskatoon City Hospital
Alumni Reunion to be held in
Cãlgary on May 29-31. 1979.
Contact:S.C.H.Alumni, p.o.
Box 873, StationG. Calgary,
Alberta, TJA 2G6.
Reunion planned
Tt)e fina] class of the nursing
program at Mount Saint
Vincent University. Halifax,
N.S. will graduate in the
Spring. 1979. A reunion for all
graduates of the basic and
post-R.N. programs is
planned for June 8-10, 1979.
The celebration will include
an educational day and social
activities. If you are a
graduate and your current
name/address is not on file at
the Mount, please contact:
Michael Rankin, Alumnae
Officer, Mount Saint Vincent
University, Halifax, NOl'a
Scotia, B3M 216. Come and
renew old friendships and
memories.
.
.........
" \..-.,
...1
'Ý",
/
NURSES (General Duty)
(609-009-104)
S.I.ry: $14,673 - $16.874 (plus Educ8tion Allow.nee
if .pplic.blel
Ref. No: 79-E-91
Nlltion.1 He.lth .nd Welf.r.
Ch.rl81 C.ml8l1 Hospit.1
Edmonton. Albert.
WE HAVE A CHALLENGING POSITION FOR YOU AT
THE CHARLES CAMSELL HOSPITAL
JOIN the health care team at the Charles Camsell Hospital,
a 402 bed active treatment hOlpitallocated in N.W.
Edmonton. In addition to serving the Edmonton commu-
nity, we maintain our rola as a referral and resource centre
for native peoples and northern residents. Positions are avai-
lable in various areas.
Qu.1 ific.tions
Eligibility for registration as a Nurse in any province or
territory of Canada. Knowledge of the English is assential.
For more information contact:
Personnel Administrator
Charles Camsell Hospital
12815 - 115 Avenue
Edmonton, Alberta
Telephone: 452-8770 Ext. 500
How to Apply
Send your application form and/or résumé to:
Public Serviee Commillion of C.n.dII
300 Confecfer.tion Building
10355 Jasper Av.nua
Edmonton. Albert. T6J 1Y6
Closing e.te: M.y 31, 1979
Please quote the applicable reference number at a/l times
To meet the
expanding responsibilities
.
of clinical nursing...
Nurses' Drug. Reference
Edited by Stewart M. Brooks, M.S.
Everything you need to know about drug actions and their
implications for nursing care is right here in one compre-
hensive, concise volume. Nurses' Drug Reference is a
convenient yet thorough summary of all the drugs
commonly encountered in nursing practice. The most
readily accessible work of its kind, NDR reviews, cata-
logues, and cross-references all the standard drug classes,
then presents alphabetically over 500 pharmacologic
monographs by generic and trade name that detail action
and administration, cautions, adverse reactions, compos-
ition and supply, and legal status. Eleven indispensable
appendices infonn on such crucial topics as drug inter-
actions, weights and measures, and pediatric doses. It's for
you, the nurse, from cover to cover. And it's a lot more
than just a reference.
Little, Brown. 623 Pages. 1978.
Paper, $14.00. Cloth, $26.50.
Leadership for Change
A Guide for the Frustrated Nurse
By Dorothy A. Brooten, R.N.; Laura Hayman, R.N.;
and Mary Naylor, R.N.
Effective nursing leadership, the authors maintain, depends
on the nurse's capability to understand change. The unique
objective of this lively and readable new book is to unfold
in concise, logical sequence a sense of the history of change
in nursing, a sense of direction for further change, a
theoretical framework, and a set of practical guidelines for
planning and managing change.
Lippincott. 172 Pages. 1978. 56.00.
Manual of
Neurological Nursing
By Nancy Swift, R.N., with Robert M. Mabel, Ph.D.
Every nurse will welcome the realistic, straightforward
guidance afforded by this much-needed handbook. In a
fonnat facilitating on-the-spot reference, the authors
succinctly and clearly cover every aspect of neurological
nursing, including patient assessment and monitoring,
diagnostic studies, management and assessment of specific
neurological pathologies and dysfunctions, management of
pain, considerations for extended care and rehabilitation,
and the all important psychological aspects of care. An
easy-to-use, comprehensive, and essential work.
Little, Brown. 201 Pages. 1978. $9.75.
Health Care of Women
By Leonide L. Martin, R.N., M.S.
Written from the nurse practitioner's point of view, and
with particular focus on primary ambulatory care settings,
this is the first North American OB/GYN textbook
intended specifically for nurses. In a succinct, lucid style,
this book emphasizes physical assessment, including history
and exam, physical diagnosis, treatment measures,
indications for consultations with the physician, patient
counseling, and follow-up care. Psychosocial considerations
are as important a part of the book as the physical
considerations; the integration and balance of these aspects
are handled superbly. Detailed coverage focuses on such
matters as identity, self-image, changing roles, sexuality,
meaning of pregnancy, special problems of abortion
patients, and psychological changes in aging and
menopause.
Lippincott. 383 Pages. Illustrated. 1978. $16.75.
Illustrated Guide to
Orthopedic Nursing
By Jane Farrell, R.N.
Richly illustrated with over 500 figures and photographs,
this important manual deals with the major problems
encountered by nurses in the orthopedic unit. Specifically
it focuses on the nursing care of the adult orthopedic
patient; on those factors that influence the patient's
adjustment, behavior, and recovery; and on practical
suggestions for resocializing the patient in his home
environment.
Lippincott. 242 Pages. Illustrated. 1977. 512.00.
Case Studies in
Neurological Nursing
By Suzanne L. Wehrmaker, R.N., B.A.; and Joann R.
Wintermute, R.N., M.A.
Primarily for the professional nurse in clinical practice,
CASE STUDIES IN NEUROLOGICAL NURSING helps
the reader correlate and interpret the fundamentals of
neuroanatomy, physiology, and pathophysiology with
clinical findings in neurology. For each neurological disease,
techniques of assessment and priorities of nursing obser-
vation and care are provided. The authors first review the
functioning of the neuron, sensory system, motor system,
and cranian nerves, and then study in-depth twelve
neurological and neurosurgical cases.
Little, Brown. 190 Pages. Illustrated. 1978. 510.00.
The Lippincott Manual of
Nursing Practice, 2nd Edition
By Lillian S. Brunner, R.N., B.S., I\I.S.;and D. S. Suddarth,
R.N., B.S.N.E., I\I.S.N. With 9 Contributors.
This unique book will bring you the latest, most accurate
infonnation available in any single volume! Every chapter
in every area is expanded and up to date. Every phase of
medical/surgical, maternal, and pediatric nursing is covered
in greater detail. . . and in the quick-reference outline
style that made the first edition such a valuable tool to
thousands of nurses every day!
Clinical problems are presented in tenns of causes,
manifestations, possible complications, treatment and
nursing management, and health teaching/patient
education. The infonnation you require is presented in
logical, step-by-step sequence. . . available at a glance
when you need it for immediate use!
Lippincott. 1888 Pages. Illusuated. 1978. $29.95.
Atlas of Diagnostic and
Therapeutic Procedures for
Emergency Personnel
By James H. Cosgriff, Jr., M.D.
Compact and lavishly illustrated, this superb guide lists and
describes in detail the key diagnostic and therapeutic
procedures essential for clinical personnel in an emergency
situation. It offers in-depth coverage of a wide range of
technical infonnation that is up-to-date and concisely
assimilated in one volume. For convenience and practical-
ity, all procedures are arranged in alphabetical order and are
presented in step-by-step fonnat: the procedure is named
and followed by its indications; the equipment needed is
listed in detail; anatomical procedures that the clinician
must adhere to are fully described: and then, clear
instructions appear in outline fonn.
Lippincott. 315 Pages. Illustrated. 1978. $23.75.
General Systems Theory
Applied to Nursing
By Arlene 1\1. Putt, R.N., Ed.D. .1eith 11 Contributors.
The nurse learns to facilitate patient assessment, planning
for care, teaching, and in-service education by applying the
concepts of general systems theory. Building on the ideas
originally fonnalized by von Bertalanffy and later adapted
to nuning by June C. Abbey, Ph.D., the author and 1]
contributors explain the components common to all
systems, their functions, and the application to patient care
of those principles underlying total human ecology. This
systematized approach to problem solving promises to
profoundly affect the thinking of all nurses and to increase
their efficiency in the clinical setting.
Little, Brown. 195 Pages. 1978. $12.25.
Lippincott's State Board
Examination Review
for Nurses
By LuVerne ",olff Lewis, R.N., M.A.
In the same fonnat as the licensure examinations
themselves, this unique and useful new book offers 2,568
questions together with answer-recording sheets. Patient
situations are followed by questions framed in a manner
similar to that of the state board exams. The questions are
in a logical sequence and lead the student from point to
point while supplying new information in each question.
Tests cover the five major areas of nursing: medical,
surgical, obstetric, pediatric, and psychiatric. They integrate
the biological social sciences, nutrition and diet therapy,
pharmacology and therapeutics, fundamentals of nursing,
communicable diseases, and legal and ethical consider-
ations. Answers and the rationale for each answer are
supplied at the end of each major section.
Lippincott. 745 Pages, plus answer sheets. 1978. $13.00.
Lippincott
Books are shipped to you On Approval: if you are not J. B. LIPPI:'<JCOTT CO
IP A
Y OF CA
AOA LfO.
entirely satisfied you may return them within 15 days for 75 Horner Ave., Toronto, Ontario :\18Z 4X7
:u
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75 Horner Ave., Toronto, Ontario M8Z 4X7 (PI d h dl . h )
us postage an an mg c arges.
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LIPPINCOTT'S NO-RISK GUARANTEE
o Nurses' Drug Reference, Paper, $14.00.
o Nurses' Drug Reference, Cloth, $26.50.
o Health Care of Women, $16.75.
o Leadership for Change, $6.00:
o Illustrated Guide to Orthopedic Nursing, $12.00.
o Manual of Neurological Nursing, $9.75.
o Case Studies in Neurological Nursing, $10.00.
o The Lippincott Manual of Nursing Practice, $29.95.
o General Systems Theory Applied to Nursing, $12.25.
o Atlas of Diagnostic and Therapeutic Procedures for
Emergency Personnel, $23.75.
o Lippincott's State Board Examination Review for
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CN-5/79.
54 Mey 11711
The Cen-.ll.n Nu...
books
Easy pregnancy with yoga by Stella
Weller, 175 pages. Vancouver.
Fforbez Enterprises
Approximate price: $4.95
I feel especially pleased to have the
opportunity to review this text, a book
written by a nurse. One reason is that I
am always looking for information on
easier pregnancy for patients and
another is that as a committed student of
Yoga. I realized the benefits it provides.
The purpose of this book. the author
says. "is primarily to provide pregnant
women with a selection of easily
adaptable bodily movements. positions
and breathing techniques which they can
use for conditioning throughout
pregnancy. Any woman. however, who
wishes to improve herself will find this
information most helpful."
"Childbirth preparation classes
usually offer the opportunity for
conditioning the body in preparation for
labor, but this preparation only lasts for
about eight to ten weeks." The author
feels that by utilizing the advantages of
preparation classes plus techniques of
Yoga. which are ba'\ed on sound
anatomical and physiological principles.
the conditioning process can be
maintained for a longer period of time.
The author's belief is "that
pregnancy is not an illness but a natural
function". and many would strongly
agree. But because of the added
demands at this time. the dividing line
between good health and illness is finer
than during the non-pregnant state. As
the body needs physical activity to
remain healthy, it should be exercised
regularly and correctly. As an aid in the
latter half of the text, a complete
program of well-illustrated Yoga poses
may be followed. so that the woman can
approach childbirth with increased
confidence. which ultimately improves
her mental health.
Numerous practical suggestions to
improve eating and sleeping habits and to .
care for the breasts, hands and feet are
included. The value of good nutrition in
pregnancy. breast feeding and in the
health status ofthe family is emphasized.
As a reviewer, I agree with the
author when she cautions that Yoga does
not provide the key to a painless
childbirth. but that it can make the
experience easier. She states that the
Yoga regime should be undertaken
prenatally and postnatally only with the
approval of a physician. According to the
author - if exercises are continued in
the postnatal period the figure will be
regained and in some cases even a better
figure is acquired.
In summary, "Yoga meets the needs
of the pregnant woman, whether these
needs be physical. mental or emotional."
I am pleased to recommend this volume
to teachers of prenatal care or women
preparing for childbirth.
Re\,iewed by M. Thompson, Lecturer,
College ofNlIrsing, UnÏ\'ersity of
Saskatchewan.
A Problem Solving Approach to
Nursing Care Plans, 2d. ed. by
Barbara Vitale. Nancy Latterner
and Patricia Nugent. Saint Louis.
Mosby, 1978. Approximate price:
$9.25
. 'The nursing care plan as a tool is
worthless unless perceived and
exercised properly according to a
specific method." In this book. the
authors' purpose is to provide students
of nursing with basic knowledge of
systematic problem solving. This
knowledge. they argue. is essential to the
formulation of effective,
patient-centered nursing care plans.
The authors have succeeded in
creating a very well-organized
programmed instruction text. which
should be of value not only to beginning
student nurses but to graduate nurses for
review and for use with inservice and
continuing education workshops.
In this book, problem solving in
nursing is conceptualized as dynamic
process. consisting of seven steps:
. data collection
. data classification
. deductions
. nursing diagnosis
. nursing hypothesis
. hypothesis implementation
. evaluation.
Following a general introduction to
the problem solving process and the
nursing care plan. chapters address each
of the seven steps in order. Programmed
instruction is a particularly helpful way
for learning the large volume of
terminology associated with problem
solving and nursing care planning.
One of the major strengths of this
book is in its application of problem
solving principles to both adult and
pediatric acute care medical-surgical
example and case studies. The focus for
almost all of the cases is the patient in
hospital. Several core examples are
carried through the problem solving
sequence and referred to in each chapter.
Thus. the learner applies the new
knowledge contained in each chapter to
cases which are already familiar.
Each chapter concludes with several
review questions which are keyed to
specific number frames in the text for
quick reference. After ans.wering the
review questions, the learner is provided
with two case studies designed to be
used in practicing the newly acquired
skills. Standard health histories and
Kardexes are used as practice tools. The
learner then compares his/her effort with
the completed forms provided in the
tex t.
The chapter on "Making
deductions" is particularly well written.
In the experience of this reviewer. the
skill of making deductions from data is
often difficult for the learner to acquire.
Here. the authors have given very clear
examples of how the nurse combines her
knowledge of theory and the patient with
clinical judgment to arrive at logical
deductions about patient needs.
Nurses who are familiar with the
first edition ofthe book will note several
small additions. Appendix A lists
"PhysièaI Assessment Factors" which
might be used by the nurse to collect data
about the patient's physical, mental and
emotional status. Appendix B includes
-annotated bibliographies on three
organizational systems which may be
used for assessment and care planning.
Although the bibliography is
selective rather than extensive. it does
include important references on the
subjects of care planning and nursing
process. In summary, this book is a
valuable addition to the literature on
systematic problem solving as a method
for development of flexible and effective
nursing care plans.
Reviewed by Leslie J. White, Assistant
Professor, Chairman of 4th year Basic
Degree Program. Dalhousie University
Sclwol ofNlIrsinR. Halifax. Nova
Scotia.
library update
Books and Documents
I. American Librarv Association Handbook
of organization 1978/79. Chicago, 1978. 129p.
2 Anthony , Catherine Parker Textbook of
anatomy and physiology. by . . . Gary A.
Thibodeau. 10th ed. St. Louis. Mosby. 1978.
731p.
3. Barber, Janet M. Handbook of
emergency phannacology. Toronto, Mosby.
1978. 139p.
4. Bergeret, Claude Passeport pour la vie:
pour une medecine globale sans peurs et sans
tabous. avec la collaboration d'Andrée
Bergens. Paris. Pierre Horay. c1976. 225p.
5. Bower. Faye Louise Fundamentals of
nursing practice; concepts. roles and
functions, by. . and Em Olivia Bevis.
Toronto,Mosby.cl979.602p.
6. Clark, Carolvn Chambers Mental health
aspects of community health nursing.
Toronto. McGraw Hill, c1978. 275p.
7. Conference Internationale sur les SOlOS de
santé primaires. Alma-Ata. USSR, 6-12 sept.
1978. Rapport.lv(feuilles mobiles)
8. Families across the life cycle: studies for
nursing. edited by Kathleen Astin Knafl,
Helen K.Grace. Isted. Boston. LIttle
Brown. c1978. 38Op.
9. Fontaine, Guy The e,sentials in cardtac
pacing. by. . . and Yves Grosgogeat and
Jean-Jacques Welti. Boston, Martinus
Nijhoff, 1978. 80p.
10. Glm'er, Dennis W. Respiratory lherapy;
basics for nursing and the allied health
professions, by . . . and Margaret McCarthy
Glover. Toronto. Mosby, 1978. 221p.
II. Halpern. Susan Rape, helping the
victim; a treatment manual. Oradell. N.J.
Medical Economics. cl978. 169p.
Bachelor of Administration
(Health Services)
Degree Program
Applications are now accepted for the program
combining independent study with tutorials on
weekends in Toronto. as well as for Ihe
competency based. external degree internship
option offered for students at a distance.
Credits Iowan! advanced standing are given
for practical managenal experience and prior
education including B.A., B.Sc.. B.Sc.N.,
R.N.. R.T., H.O.M Certificate and University
or College Courses.
The School is a member of the Association of
Umversity Programs in Health Administration
and is supported by the Kellogg Foundalion
grant.
For information and application forms. please
wnteto:
Canadian School of :\tana.
nt
S-425, OISE Building
252 Bloor St., West
Toronto. OnI8rlo M5S IV5
Thec...- N_
12. Interdisciplinary approaches to human ....
services. edited by Peter J. Valletutti and
Florence Christoplos. Baltimore. University
Park Press. cl977. 442p.
13 International conference on primary
health care. Alma-Ata. USSR. 6-12 Sept.
1978. Report. Iv (looseleaf)
14. InterprofessionalTask Force on Health
Care of Women and Children Joint position
statement on the development of ,
family-centered maternity/newborn care in
hospitals. Chicago. 1978. lOp. ,
15. Kellogg Foundation. Battle Creek,
Mich. Report, 1978. 64p.
16. Leininger, Madeleine M. Transcultural
nursing; concepts. theories and practices.
Toronto, Wiley, cl978. 532p.
17. Mason, Elizabeth J. How to write
meaningful nursing standards. Toronto,
Wiley.cl978.355p.
18. Mottier, Georgette L 'ambulance du
docteur Alexis Carrel. telle que l' ont connue
celles qui soignèrent les blessés 1914-1919. this
Lausanne. La source. cl977. 17Op.
19. National League for Nursing. Di,'ision
of Research Nursing data book; statistical patient
information on nursing education and newly
licensed nurses. New York, 1978. 86p (NLN
Pub. no. 19-1751) needs
20. Nursing auxiliaries in health care. Edited
by Melissa Hardie and Lisbeth Hockey.
London. Croom Helm. cl978. 217p. your help
21. Organisation mondiale de la Santé
Incapacités liées à la consommation d'alcool.
Textes présentés parG. Edwards, et aI. When patients need private duty
Genève. 1977. 163p. (OMS Publication offset
no 32) nursing in the home or hospital,
22. Peters, Maxine Ward Foundations of they often ask a nurse for her
phannacologic therapy, Contributors Maxine recommendation. Health Care
Ward Peters. Eleanor Shendan.Gloria Services Upjohn Limited is a re-
Strandquist, consultant. Joan Thiele.
Toronto. Wiley. c1977. 167p. liable source of skilled nursing
23. Psychotropic drugs and nursing and home care specialists you
intervention. Edited by Patricia Duggan can recommend with confidence
Irons. Toronto. McGraw-Hili. cl978. 154p. for private duty nursing and home
24. Reith, Edward J. Textbook of anatomy health care.
and physiology, by . . . and Bertha All of our employees are carefully
Breidenbach. Mary Lorene. 2d ed. Toronto.
McGraw-Hili. cl978. 453p. screened for character and
25. Roncari, J. I sobel Dawson Nursing and skill to assure your patient of de-
health care in the future; a position paper on pendable, professional care.
the future of health care. assu mptions about Each is fully insured (includiflg
that future and nursing projected into that Workmen's Compensation)
future. Submitted to Registered Nurses' and bonded to guarantee your
Association ofOntaIio by . . . . Toronto.
Registered Nurses' Association of Ontario. patient's peace of mind.
1977. Sip. Care can be provided day or
26. Saxon. Sue V. Physical change and night, for a few hours or for as
aging; a guide for the helping professions, long as your patient needs help.
by. . . and Mary Jean Etten. New York,
Tiresias Press. cl978. 192p. For complete information on our
27. Steffl, Bernita M. Discharge planning services. call the Health Care
handbook. by . . . and Imogene Eide. Services Upjohn Limited office
Thorofare, N.J. Charles B. Slack. cl978. 81p. near you.
28. Task Force on Concerns of Physically
Disabled Women Within reach: providing
family planning services to physically
disabled women. 2d ed. New York. Human
Sciences Press, c1978. 48p.
29. Van Stolk, Marv The battered child in
Canada. Revised ed. Toronto. McClelland Health Care Services
and Steward. cl978. 178p. Upjohn Limited
30. World Congress on Mental Health,
Vancouver, B.C.. August 21-26, 1977 Today's
priorities in mental health: knowing and
doing; proceedings. Editors Morton Beiser et VICIona. Va<lOOUVel" .
aI. Miami Flo.. Symposia Specialists. cl978. Eånor'IÞ1. CaIg<rý. wrnpeg . Lorden
417p. St. CaIhén'Ies . Hæ1IIon . T oronIo
Ottawa . Montreal. Quebec . Halifax
II.. HCS8123 1 ...4
541 ..., 1178
31. World Health 0 rganization Personnel
for health care: case studies of educational
programmes, edited by F .M. Katz andT.
Fulop. Geneva, 1978. 26Op. (Its Public HeaJth
papers, no. 70)
Pamphlets
32. Association of Registered Nurses of
Newfoundland Brief to the Commission of
Enquiry on Educational Leave and
Productivity. St.John's. 1979. 14p.
33. Queen's University./ ndustrial Relations
Centre Compensation administration: a
bibliography 1970-1978. Compiled by the
Research Reference Section. Kingston. Ont.,
1978. I3p.
The Cenedl.n NuI'M
34.-.Compensation theory: a bibliography
1970-1978. Compiled by the Research
Reference Section. Kingston.Ont.. 1978. 6p.
35.-.Employee benefits; a bibliography
1970-1978. Compiled by the Research
Reference Section. Kingston. Ont.. 1978. 12p.
36.-.Employee stock options and employee
stock ownership plans: a Bibliography
1970-1978.7p.
37.-.QuaJity of working life; a bibliography
1970-1978. Compiled by the Research
Reference Section. Kingston.Ont.. 1978. 17p.
38. Ogg, Elizabeth Partners in coping;
groups for self and mutual help. New York,
Public Affairs Committee, c1978. 28p. (Public
affairs pamphlet no. 559)
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39. Stockdale, A.M. Administering wage
and salary programs; some problems and
issues. Kingston. Ont., IndustriaJ Relations
Centre, Queen's University, 1978. lip.
Government Documents
Canada
40. Statistics Canada Census of Canada,
1976. Vol. 5. Labour force activity. Ottãwa,
Minister of Supply and Services Canada,
1978. 2v. Catalogue no. 94-807, 94-808.
41.-Census of Canada 1976. Vol. 6, Census
tracts: population and housing characteristics.
Ottawa. Minister of Supply and Services
Canada. 1978. 15v. Catalogue no. 95-800,
95-803-95-809,95-811,95-813,95-814.95-820,
95-824.95-827,95-829.
42. Statistics Canada Census of Canada.
1976. Vol. 8. Supplementary bulletins:
geographic and demographic; mobility status
and general population characteristics.
Ottawa. Minister of Supply and Services
Canada, 1978. Iv. (various pagings) Catalogue
no. 92-834.
43.-.CensusofCanada, 1976. Vol. 9,
Supplementary bulletins: housing and
families: general characteristics of economic
families. Ottawa, Minister of Supply and
Services Canada. 1978. 6p. Catalogue no.
93-835.
44.-.Therapeutic aborti
s. 1976. Ottawa.
1978. 138p. CataJogue no. 82-211.
45. StatistiqueCanada Avortements
thérapeutiques. 1976. Ottawa, 1978. 138p.
Catalogue no 82-211.
46.-.Recensement du Canada, 1976. Vol. 5,
activité. Ottawa, Ministre des
Approvisionnements et Services Canada,
1978. 2v. CataJogue no 94-807.94-808.
47.-.Recensement du Canada, 1976. Vol. 6,
Secteurs de recensement; caractéristiques de
la population et du logement. Ottawa,
Ministre des Approvisionnements et Services
Canada, 1978. 15v. Catalogue nos 95-800,
95-803-95-809,95-811,95-813,95-814,95-820,
95-824,95-827,95-829.
48.-.Recensement duCanada, 1976. Vol. 8,
Bulletins supplémentaires géographiques et
démographiques; statut de mobilité et
caractéristiques générales de la population.
Ottawa, Ministre des Approvisionnements et
Services Canada, 1978.lv.(pagination
multiple) Catalogue no 92-834.
49.-. Recensement du Canada, 1976. Vol. 9,
Bulletins supplémentaires: logements et
families; caractéristiques généra1es des
families économiques. Ottawa, Ministre des
Approvisionnements et Services Canada,
1978. 6p. CataJogue no 93-835.
50. Travail Canada. Recherches surla
législation Droits de la personne au Canada,
1978. Ottawa, Ministre des
Approvisionnements et Services Canada,
1978.96p.
Studies in CNA Repository Collection
51. Co/loque sur la recherche irifìrmière.
Montréal28-30 mars, /973 Actes. MontréaJ,
McGill University, School of Nursing, 1974.
3v. R
Audio Visual Aids
52. Association des Médecins de Langue
française du Canada Sonomed. série 5, no 5.
MontréaJ, 1973. I cassette. Contenu.-Côté A.
Myre, Maurice, L'embolie pulmonaire, 2e
partie-clinique.-Côté B.I.P'An Alice, La
pollution de I'airet la santé. 2.Dubé, Ide, Les
banques d'yeux.
The Canecllan Nur..
Classified
"ey 1171 117
Advertisements
Alberta
The Drumheller Health Unit requires a Supenbor or
Nunes with experience and qualifications in Public
Health for supervision of a staff of eight district
nurses in preventive programs of community health
to a population of 28.000 in an area of 4000 square
miles. Main office is located in Drumheller. popula-
tion 6,000, 85 miles from Calgary. For information or
application forms please reply, giving curriculum
vitae to: Agnes E. O'Neil. M.D., D.P.H., Medical
Officer of Health. Box 1180. Drumheller, Alberta.
TOJ OYO.
Reabtered Nunes required for acute care general
hospital, expanding from 75 beds to 300 beds.
Clinical areas include: medicine, surgery, obstetrics.
paediatrics, psychiatry, activation and rehabilita-
tion, operating room, emergency and intensive and
coronary care unit. Must be eligible for Alberta
registration. Personnel policies and salary in accor-
dance witli AARN contract. Apply to: Personnel
Administration, Fort McMurray Regional Hospital.
7 - Hospital Street, Fort McMurray, Alberta, 1'9H
IP2.
R.N. required by 20-bed active treatment hospital.
Must have AARN registration or be eligible for
registration. Salary &: benefits according to
A.H.A.-A.A.R.N. contract. Apply: Director of
Nursing, Myrnam Municipal Hospital, Myrnam,
Alberta, TOB 3KO. Telephone no.: (403) 366-3870.
British Columbia
Registered and Gnduate Nurses required for new
41-bed acute care hospital, 200 miles north of
Vancouver, 60 miles from Kamloops. Limited
furnished accommodation available. Apply: Director
of Nursing. Ashcroft &: District General Hospital,
Ashcroft. British Columbia. VOK IAO.
Gmerlll Duty (B.C. Registered) Nunes required for
expansion to 422 acute care accredited hospital
located 6 miles from downtown Vancouver and
within easy access to various recreational facilities.
Excellent orientation and ongoing inservice prog-
ramme. Salary SI.231.00-$I,455.00 monthly. Clini-
cal areas include coronary care, intensive care,
emergency, operating room. P.A.R.R.. medical/sur-
gical, pediatrics, obstetrics, orthopedics and activa-
tion units. Positions are also available for general
duty nunes in our modern extended care unit. Apply
to: Co-ordinator-Nursing, Dept. of Employee
Resources, Burnaby General Hospital, 3935 Kincaid
Slreet, Burnaby. British Columbia, VSG 2X6.
GeDerlll Duty Nunes for modern 41-bed accredited
hospital located on the Alaska Highway. Salary and
personnel policies in accordance wilh the RNABC.
Temporary accommodation available in residence.
Apply: Director of Nursing, Fort Nelson General
Hospital, P.O. Box 60, Fort Nelson, British Colum-
bia, VOC IRO.
EKperienced Nunes (B.C. Registered) requIred for a
newly expanded 463-bed acute, teaching, regional
referral hospital located in the Fraser Valley, 20
minutes by freeway from Vancouver. and within
easy access of various recreational facilities. Excel-
lent orientation and continuing education program-
mes. Salary-I919 rates-S1305.00-$1542.00 per
month. Clinical areas include: Operating Room, Re-
covery Room. Intensive Care. Coronary Care,
Neonatal Intensive Care, Hemodialysis, Acute
Medicine. Surgery, Pediatrics. Rehabilitation and
Emergency. Apply to: Employment Manager. Royal
Columbian Hospital, 330 E. Columbia St., New
Westminster, British Columbia, V3L 3W7.
British Columbia
Experienced Nurses (eligible for B.C. Registration)
required for full-time positions in our modern
300-bed Extended Care Hospital located just thirty
minutes from downtown Vancouver. Salary and
benefits according to RNABC contract. Applicants
may telephone 525-0911 to arrange for an interview,
or write giving full particulars to: Personnel Direc-
tor. Queen's Park Hospital. 315 McBride Blvd..
New Westminster. British Columbia. V 3L 5E8
EKperlenc:ed Generlll Duty Nunes reqUIred for
120-bed hospital. Basic salary SI305.00 - SI542.00
per month. Policies in accordance with RNABC
Contract. Residence accommodation available.
Apply in writing to: Director of Nursing. Powell
River General Hospital, 5871 Arbutus Avenue.
Powell River, British Columbia, V8A 4S3.
RegiSiered Nunes - Required immediately for a
340-bed accredited hospital in the central interior of
B.C. Registered Nurses interested in nursing posi-
tions at the Prince George Regional Hospital are
invited to make inquiries to: Director of Personnel
Services, Prince George Regional Hospital. 2000-
15th Avenue, Prince George. British Columbia V2M
IS2.
Rqiltered Nunes required immediately for perma-
nent full time positions at IO-bed hospital in B.C.
Salary at 1918 RNABC rate plus northern living
allowance. Recognition of advanced or primary care
education. One year experience preferred. Apply:
Director of Nursing, Stewart General Hospital, Box
8, Stewart, British Columbia, VOT I WOo Telephone:
(604) 636-2221 Coll-x:t.
St. Paul's Hospital invites applications from B.C.
IteJløtered Nunes for full and part time positions in
all areas of the hospital. St. Paul's is an acute referral
teaching hospital located in downtown Vancouver.
1919 R.N. rates S1305.00 - SI542.00. Generous
fringe benefits. Apply to: St. Paul's HOSpital,
Personnel Department, 1081 Burrard Street, Van-
couver, British Columbia, V6Z IY6.
Manitoba
Experienced Realstered Nu.... required for a fully
accredited 200-bed Health Complex located in
Northern Manitoba. Must be eligible for registration
in Manitoba. Salary dependent on experience and
education. For further information contact: Mrs.
Mona Segum. Personnel Director. The Pas Health
Complex Inc.. P.O. Box 240. The Pas, Maniloba,
R9A I K4.
Northwest Territories
The Stanton Yellowknife Hospital, a 72-bed accre-
dited, acute care hospital requires registered nurses to
work in medical. surgical, pedtatnc'- obstetrical or
operating room areas. Excellent orientation and
inservice education. Some furnished accommoda-
tion avlulable. Apply: Assistant Administrator-
Nursing, Stanton Yellowknife Hospital, Box 10,
Yellowknife, N. W.T., XIA 2N I.
Ontario
Childrens summer camps in scenic areas ofNonhern
Ontario require Camp Nu.... for July and August.
Each has resident M.D. Contact: Harold B.
Nashman, Camp Services Co-op, 825 Eglinton
Avenue West, Suite 211, Toronto, Ontano, M5N
IE7. Phone: (416) 789-2181.
-
Ontario
EKperlenc:ed Nunes (eligible for Ontario Registra-
tion) required for full time positions in a 6O-bed
accredited hospital - recently relocated in brand new
facilities. Only applicants with 2 or more years
experience will be considered. Preference will be
given to applicants wilh experience in Obstelrics
and/or c.C.U. - I.C.U. Salary and benefits accord-
ing to ONA conlract. Applicants may telephone to
arrange for an interview or write giving full
particulars to: Nursing Personnel Dept., The Lady
Minto Hospital at Cochrane, P.O. Box 4000, 241-8th
St., Cochrane, Ontario. POL ICO - or telephone
(705) 272-5761.
Quebec
Registered Nune for summer camp in the Lauren-
tians. mid-June to end of August. Congenial sur-
roundings. Resident doctor. Contact: Myron Good-
man. Executive Director, YM-YWHA Wooden
Acres Camp, 5500 Westbury Avenue, Montreal.
Quebec. H3W 2W8. Telephone: (514) 737-6551,
Local 33.
Saskatchewan
General DUly Registered Nurses - Two Generlll
Duty Nunes are required immediately for a 32-bed
general hospital. Must possess a current registration
m Saskatchewan. Please send resume to: Adminis-
trator, St. Joseph's Hospital, Gravelbourg, Sas-
katchewan. SOH IXO.
R.N.'s and R.P.N.'s (eligible for Saskatchewan
registration) required for 340 fully I'ccrediled ex-
tended care hospital. For further information.
contact: P
rsonneI Department. Souris Valley Ex-
tended Care Hospital. Box 2001. Weyburn. Sas-
katchewan S4H 2L7.
United States
RN'S-Calirornla. Registered nurses interested in a
career in California working in skilled nursing
facilities. Salary is comparable to Canadian wages.
Moving expenses provided. No California examina-
tions are required. Write: M. Cameron, 1254 Prin-
cess Street. Apt. 11. Kingslon, Ontano. K7M 3C9 or
telephone (613)544-0170-Evenings or weekends.
Critical Care Nurses - EI Camino Hospital. a
464-bed acute care facility has excellent oppor-
tunities for full-time or part-time or Per Diem nurses
on 3-11 PM or 11-7 AM shifts in the following areas:
ICU - new l6-bed med-surg (includes adult open
heart patients). CCU - 12-bed new unit equipped
with H.P. arrythmia detection monitors offering
patient teaching program and nursing research. TCU
(Transitional Care Unil) - 25-bed unit equipped
wilh telemetry for 12 patients. Offers unique
cardio-vascular nurse/client teaching program. ER
- new spacious area providing a complete range of
basic emergency service to 3000 patients per month.
The RN staff is certified in Advanced Cardiac Life
Support. All these units offer the latest in innovative
staff development. patient teaching programs. edu-
cational opportunities and a time-saving Com-
puterized Medlcallnrormatlon S)'stem. Salary $ 1363.
(Staff II Step I\) shift differenhal S.55/hr. 3-11 and
S.75/hr. 11-7. For information. call Patti Aalgaard,
RN, Coordinator. Nurse Recruitment at (415)
968-811 I. Ext. 44543 or write EI Camino Hospital.
2500 Grant Road. Mountain View, California 94042.
An Equal Opportunity Employer M/F /H.
R.N.', - Our Florida Hospitals need you. We will
provide the work visa, help you locate a position,
find housing, arrange your relocation. No rees. Call
or write: Medklll Recrulten or America, 1211 N.
Westshore Blvd., Suite :!05, Tampa, Florida 33607
(813) 872-0202.
51 Mey 1171
Are You an R.N.
Considering
a Career Move?
Our clients have positions - mostly in
Georgia, Texas, Louisiana, California,
and Florida, but in other places, too -
for which we are seeking nurses.
Write and tell us about your education,
your nursing career so far, what you
would like to do next, and where you
would like to do it.
Hospitals pay us to help nurses make
sound career moves. Some days we
enjoy it so much we feel guilty about
taking the money. On the other days we
do our billings.
Nurse RecruIter
Wood, Watson Professional Search
Suite 207, 1962 Yonge Street
Toronto, Ontario
M4S1Z4
ø
Foothills Hospital
Calgary, Alberta
The Department of Nursing and the
Department of Pediatrics, Neonatology,
are offering a five month clinical and
academic programme for Graduate
Nurses:
Advanced Course in Neonatal Nursing
Applications are being accepted for clas-
ses enrolling each March and September.
Participation in the programme is limited
to eight.
For furtber Information please write to:
Mr. B. Wright
Coordinator of Educatlonlll Services
Foothills Hospltlll
1403-29 St. N.W.
ClIlllary, Alberta
T2N 2T9
MANIT
BA
Depanment of Health and Community Services
The School of Psychiatric N ursinI,
Selkirk Mentlll Health Centn
Is ofrerlnll a Post. Bask Course In
Psychiatric Nursing
Rellistered Nurses currently licensed in Man-
itoba or elillible to be so licensed, with
University credits in Introductory PsycholollY
and tntroductory SociolollY.
The course is of nine months duration Sep-
tember throullh May, and includes theory and
clinical experience in hospitals and community
agencies, as well as four weeks nursing of Ihe
mentall y retarded.
Successful completion of Ihe program leads to
elillibility for licensure with the R.P.N.A.M.,
as a Registered Psychiatric Nurse (R.P.N.).
For funher information please write:
DtftCtor of NunADI EducaUon
School ofPlychlatrk f\tIIunlnl
Bo._
Selkirk. MultolNl RtA 2B5
The Can-.llan Nur..
United States
ClIllfomla - Sometimes you have to 110 a lonll way
to find home. But, The White Memorial Medical
Center in Los Anlleles. California, makes it all
wonhwhile. The While is a 377-bed acute care
teaching medical center with an open invilalion to
dedicated RN's. We'li challenge your mind and offer
you the opponunity to develop and continue your
professional growth. We will pay your one-way
transponation, offer free meals and lodllinll for one
month in our ultra-modem nursing residence and
provide your work visa. Call collect or write: Ken
Hoover, Assislant Personnel Director, 1720 Brook-
lyn Avenue, Los Angeles, California 90033; (213)
269-9131, ext. 1680.
FlDrida Nunlnl Opportunities - MRA is recruiting
Registered Nurses and recent Graduates for hospital
positions in cities such as Tampa, St. Pelersburg,
and Sarasota on the West Coast; Miami, Fl.
Lauderdale and Wesl Palm Beach on Ihe East Coast.
Ir you are considering a move to sunny Florida,
contact our Nurse Recruiter for assistance in
selectinll the rillht hospital and city for you. We will
provide complete Work Visa and State Licensure
information and offer relocation hints. There is no
placement fee to you. Write or call Medical
Recrultenof America, Inc. (For West Coast) 121t N.
West shore Blvd., Suite 205, Tampa, FL 33607 (813)
872-0202; (For East Coast) 800 N.W. 62nd SI., Suite
510, FI. Lauderdale. Fl. 33309 (305) 772-3680.
Nunlnl Opportunities In New 0rIeaDI, LouiIIana -
MRA is recruiting Rellistered Nurses and recent
Graduates for severalleneral and teachinll hospitals
in the exciting New Orleans area. Openings in many
specialties and most Canadian Rellistered Nurses
can qualify for licensure endorsemenl in Louisiana.
Contact our Nurse Recruiter for information about
the hospitals and their relocation and tuition
assistance plans. We will provide complete Work
Visa and State Licensure information. There is no
placement fee to you. Write or call Medklll
RKruiten of America, Inc., 800 N.W. 62nd Street,
Suite 510, Fl. Lauderdale, FI. 33309. (305) 772-3680.
Nurses - RNs - Immediate Openinlls in
California-Florida-Texas-Mississippi - if you are
experienced or a recent Graduate Nurse we can offer
you positions with excellent salaries of up to S 1300
per month plus all benefits. Not only are Ihere no
fees to you whatsoever for placing you, but we also
provide complete Visa and Licensure assistance at
also no cost to you. Write immediately for our
application even if there are other areas of the U.S.
that you are interestt'd in. We will call you upon
receipt of your application in order to arrange for
hospital interviews. You can call us collect if you are
an RN who is licensed by examination in Canada or
a recent llraduate from any Canadian School of
Nursing. Windsor Nurse Placement Service, P.O.
Box 1133, Great Neck. New York, 11023. (516 -
487-2818).
"Our 20th Year of World Wide Service"
McMaster Universit
.
Educational Program
For Nurses In
Primar) Care
McMa
ter Univer_ity School ofNurs-
ing in conjunction with the School of
Medicine. offers a program for regi
-
tered nUr
e
employed in primdry
Cdre selling
who are willing to
a
sume a redefined rule in the primary
he.llth care delivery tedm.
RelJuirement
Current Can.ldian Re-
gistrdtion. Spon
or,hip from a medi-
cal co-practitioner. At ledst one year
of work experience. preferably in
primary care.
for funher information write to:
Mona Callin, Director
Educational Prol(ram for "Iurses
in Primar} Care
Faculty of Health Sciences
McMaster UnÏ>er
ity
Hamilton, Ontario L8S 4.19
Vernon Jubilee Hospital, a
258-bed acute and extended care
hospital in the Sunny Okanagan
requires immediately a
Head Nurse - Psychiatric
Unit
Previous clinical and administra-
tive experience required. Post
graduate courses, administrative
education, or BSN preferred.
Must be eligible for B.c. regist-
ration.
To commence immediately.
Personnel policies in accordance
with RNABC contract.
Apply sending complete resume
to:
Director of Personnel
Vernon Jubilee Hospital
Vernon, British Columbia
VlT 5L2
Advertising
rates
For All
Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
Rates for display advertisements on
request.
Closing date for copy and
cancellation is 8 weeks prior to 1st
day of publication month.
The Canadian Nurses Association
does not review the personnel
policies of the hospitals and
agencies advertising in the Journal.
For authentiC information,
prospective
pplicants should apply
to the Registered Nurses'
Association of the Province in which
they are interested in working.
Address correspondence to:
The Canadian Nurse
SO The Driveway
Ottawa, Ontario
K2P tE2
..
United States
RN's - Bolle, ldabo - How would you like a
rewarding career in an environment which offers you
immediate access to uncongested recreation areas
with rivers, lakes and mountains? Do you eqjoy
tennis. golf. racke1ball, camping. hiking. skiing and
horseback riding? Sound exciting? It is. And there
are many opportunities for satisfying work at one of
Idaho's largest and most progressive medical
complexes. St. Alphonsus. located in Boise. is a
229-bed facility offering you positions in
orthopedics. ophthalmology. dialysis. mental health.
neurosurgery and trauma medicine. Excellent
salary, generous benefits and job security. Starting
salary adjusted for experience; benefits include
travel assistance, shift rotation. and free parking.
Write or call collect: Employmenl Supervisor.
Personnel Office. St. Alphonsus Hospital. 1055
North Curtis Road. Boise. tdaho 83704, (208)
376-3613. EOE.
Nunlng Opportunity - Mississippi Baptist Medical
Center, a ml\ior 6O(}.bed hospital. has immediale
positions available for experienced RNs and recent
nursing school graduates in a variety of specialities
and medical/surgical areas. Competitive salaries.
liberal benefits. Visa. licensure and relocation
assistance provided. Located in 'iississippi's capilal
cily of Jackson (population 300.(00). MBMC is the
state's largest and most modern privately operated
hospital. For further information write: Mrs.
Johnnye Weber. Nurse Recruiter. 1:!25 North State
Street. Jackson. Mississippi 39201; or call collect
601/968- 5135.
Tbe Best Loc:.lion in the '.tion - The world-
renowned Cleveland Clinic Hospital is a progres-
sive. 1020-bed acute care teaching facility commiued
10 excellence in patient care. Staff Nurse positions
are currently available in several of our 6ICU's and
30 departmentalized med/surg and specialty divi-
sions. Starting salary range is 513.286 to 515.236.
plus premium shift and unit differential. progressive
employee benefits program and a comprehensive 7
week orientation. We will sponsor the appropriate
employment visa for qualified applicants. For
further information contact: Director - Nurse Re-
cruitment. The Cleveland Clinic Foundation. 9500
Euclid Avenue. Cleveland, Ohio. 44106 (4 hours
drive from Buffalo. N.Y.); or call collect 216-444-
5865.
C....dlan Nunes - Our 350+ bed full service
community hospital in a city of 70.000 in Ihe piney
woods and lakes of beautiful East Texas wishes to
extend an invitation to you to practice nursing in a
progressive hospital while you and your family enjoy
the good life atmosphere of smaller city living. Our
special visa sponsorship and licensure program may
be what you have been seeking. We plan a lrip to
several cities in Canada to inlerview and hire soon so
don'l delay your response. For more infonnation.
please wrile or call Jack Russell, 611 Ryan Plaza
Drive. Suite 537, Arlinglon. Texas. 76011. (817)
461-1451.
The Eyes or Tex.. beckon RN's and new grads to
practice Iheir profession in one of the most
prosperous areas of the U.S. We represent all size
hospitals in virtually every Texas and Southwest
U.S. city. Excellent salaries and paid relocation
expenses are just two of many super benefits
offered. We will visit many Canadian cities in March
and April to interview and hire. So we may know of
your interest won't you contact us today? Ms.
Kennedy. P.O. Box 5844, Arlington. Texas. 76011
(214) 647-0077 or Ms. Candace. P.O. Box 14745,
Austin. Texas, 76011 (512) 459-0077.
Come to Tn.. - Baptist Hospital of Southeast
Texas is a 400-bed growth orienled organization
looking for a few good R.N.'s. We feel that we can
offer you the challenge and opportunity to develop
and continue your professional growth. We are
located in Beaumont. a city of 150.000 with a small
town atmosphere bUI the convenience of the large
city. We're 30 minutes from the Gulf of Mexico and
surrounded by beautiful trees and inland lakes.
Baptist Hospital has a progress salary plan plus a
liberal fringe package. We will provide your immig-
ration paperwork cost plus aiñare to relocate. For
additional infonñation, contact: Personnel Ad-
ministration. Baptist Hospital of Southeast Texas,
Inc.. P.O. Drawer 1591, Beaumont, Texas 77704. An
.mnnlllive action employer.
The C.n-.ll.n Nur..
Before accepting any
position in the U.S.A.
PLEASE CALL US
COLLECT
We Can Offer You:
A) Selection 01 hospitals throughout
the USA.
B) ExtenSive information regarding
Hospita
Area. Cost 01 living. etc.
C) Complete Licensure and Visa Service
Our Services to you are at
absolutely no fee to you.
WINDSOR NURSE
PLACEMENT SERVICE
P.O. Box 1133 Great Neck, N.Y.
(516) 487-2818
Our 20th Year of World Wide Service .....
Nurses
Required
For Fogo Island HospItal
Salar) :
As per experience in accordance
with Union Agreement.
Applications in writing should be
addressed to:
Personnel Director
James Paton Memorial HospitaJ
125 Trans Canada High"a)
Gander. Ne"foundland
Al\lP7
U
ITED STATES
OPPORTt::\ITIES
FOR REGISTERED NURSES
AVAILABLE NOW
I'
ARIZO'A
CALlFOR'I-\
TEXAS
\\E PL>\CE AND HELP YOU WITH
ATE BOARDREGtSffiATION
\OLJR WOR"- VISA
TE
PORARY HOUSING - ETC
A C >\NADIAN COL
SELLING SERVICE
PhoM: (416) 449-58R3 OR WRITE TO:
kECRllll'liG REGISTERED Nl'RSES "c.
1200 L-\ \\'kE'liCE -\\"E:'\ol E EAST. SUTE JOI,
00'
ILLS, ONTARIO \f3A ICI
FLORID-\
OHIO
NO FEE IS CHARGED
TO APPLICANTS
..., 1171 51
United States
N..... - RNs - A choice of locations with
emphasis on the Sunbelt. You must be licensed by
examination in Canada. We prepare Visa fonns and
provide assistance wilh licensure at no cost to you.
Write for a free job market survey. Marilyn Blaker,
Medn. 5805 Richmond, Houston, Texas 77057. AU
fees employer paid.
Exdtemrnl: Come and join us for year around
excitement on the border, by the sea. an unbeatable
combinalion. El\Îoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed. acute care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opportunities. We have immediate openings in all
areas. Excellent salary and fringe benefits. We invite
you to share the challenge ahead. Assistance with
travel expenses. Write or ClOD coDed: Joe R. Lacher.
RN. Director of Nurses. Valley CommunilY Hospi-
tal. P.O. Box 4695. Brownsville. Texas 78521; I
(512)831-9611.
red N...... Uce
Vocatloaal Nu... and
N..... AIdes needed to work at the Kerrville State
Hospital in Kemille, Texas. Kemille is approx. 65
miles north of San Antonio in West Central Texas. It
is a noted recreational area, with the Guadalupe
River. many camps and open areas for hiking.
Benefits include forty hour work week. sick leave,
paid vacation, holidays, good retirement benefits
and free group insurance. Starting salary for
Registered Nurses is 51.141.00, for Licensed Voca-
tional Nurses 5768.00 and for Aides 5552.00 (per
month). Nurses and L.V.N.'s are required to have a
current Texas license and Aides are required to be
high school graduates. We are an Equal Opportunity
Employer. Apply to: Box 1468, Kemille. Texas
78028.
Come to COMIai Tens - We are located in a resort,
retirement and farming community one mile from the
Gu! f of Mexico. We are a small friendly hospital m a
small friendly community just two hours from
Houston. We offer you a rounded career develop-
ment program: medical, suraical, OB, nursery and
emergency room. We are fuUy accrediled. Rapid
advancement to Head Nurse starting at 513,000 plus
shift differential, call pay and liberal fringe benefits.
New nicely furnished two-bedroom apartments are
reserved for you. Share one with a Canadian RN
companion of your choosing. if you like, for 5150
each including gas and water. We will pay immigra-
tion. licensing and relocation transportation ex-
pense. Openings are limited-four at this writing.
Contact: Personnel Department, Wagner General
Hospital. Box 859. Palacios, Texas 77465: or call
Athlyn Raasch, 0-512-972-2511 collect.
Switzerland
Hospilal of Canton Zürich at Winterthur (725 bed
hospital near Zurich) needs Openting Room Nurses
for the surgery clinic. Required for immediate or
future openings. We offer pleasant working condi-
tions. equitable hours of work and leisure Salary
and benefits in accordance with the regulations of
the Canton of Zürich. Five-day week. accommoda-
tion available. cafeteria. Apply in writing to:
Sekretarial Pflegedienst. Kantonsspital Winterthur.
CH-8401. Winterthur. Switzerland.
Miscellaneous
AI'riaI-Overland Expedilions. London/Nairobi 13
wks. London/Johannesburg 16 wks. Kenya Safans
- 2 and 3 wk. itineraries. Europe - Camping and
hotel tours from 16 days to 9 wks. duration. For
brochures contact: Hemisphere Tours, 562 Eglinton
Ave. E., Toronto, Ontario. M4P I B9.
Cherokee Lodge, Lake Rosse.u, near Pori Sandfteld.
A small friendly lodge. catering to adults who want a
quiet relaxing holiday. Open May 24 10 Thanksgiv-
ing. Good deepwater swimming, boating and walk-
ing. Golfing. dancing, riding a short drive away.
Rales and folders on request. Write or phone: The
Turleys, (705) 765-3601, R.R. 2, Port Carling,
Ontario. POB IJO.
80 Mer 111711
Required
Associate Director of Nursing
- Patient Care
Duties:
Responsible for setting the slandards for
quality of care in the Department of Nursing,
and see that these slandards are implemented
and evaluated on an on-going basis.
Quallllcatlons:
Graduation from a recognized school of
nursing.
Clinical background experience, preferably in
diversified fields, at a managemenl or instruc-
lor's level.
Post-graduate studies in nursing administra-
tion.
Baccalaureate degree in nursing preferred but
not essential.
Or any equivalent combination of experience
and training.
SalllrySCllJe: $16,760-21,390
Applications in writing should be addressed to:
Penonnet Dlrectot
James Paton Memorial Hospital
Gander, Newfoundtand
AIV 1P7
School of Nursing
Nursing Instructors
required for July 1979
in a 2 year English language
Nursing Diploma program.
Qualifications:
Bachelor of Nursing with experi-
ence in teaching and at least one (l)
year in a Nursing Service position,
courses in Teaching Methods and
eligible for registration in New
Brunswick.
Apply to:
Harriett Hayes
Director
The Miss A.J. MacMasler
School of Nursing
Postal Station" A" , Box 2636
Moncton, N.B.
EIC 8H7
Telephone: 506-854-7330
Diploma in
Occupational Health and
Safety
The Occupational Health Program al McMas-
ter University, Hamilton, Ontario, Canada
offers two programs each year for this Dip-
loma. A full-time program starts in September
catering 10 those who wish to complete the
course in three months. A part-time program
starts in February through to November. and
is designed so Ihat sludents may continue their
normal employment.
Special interest relevant to health and safety
problems in particular industries will be
encouraged. Physicians. nurses, industrial
hygienists and related professionals engaged in
industrial settings are invited to apply. A
relevant university degree or equivalent is
required.
For further information please contact:
Miss Helen Fulton
McMaster Unlvenlty, H.St.C.
1100 Main Street West
Hamilton, Ont. Canada
L8S 4J9
Tel: 416-525-9140 Ex. 2333
The Cen-.llen Nur..
Registered Nurses
Career Development Opportunities in Vancouver
If you are a Registered Nurse in search of a change and a chaUenge, look into
nursing opportunities at Vancouver General Hospital, B.C. 's major medical
centre on Canada's unconventional west coast. Recent changes in both budget
and organization have resulted in many new general duty nursing positions.
Salary range of: $1,305 - $1,542, plus educational premiums.
Recent graduates and experienced professionals alike will find a wide variety of
positions available which, together with planned professional and career
development programs, could provide the opportunity you've been looking for.
For those with an interest in specialization, challenges await in many areas such
as:
Neonatology Nursing
Intensive Care (general and neurosurgical)
Inservice Education
Cardiothoracic Surgery
Coronary Unit
Burn Unit
Hyperalimentation Program
Pediatric
Renal Dialysis and Transplantation
If you are a Registered Nurse considering a move please send resume to:
Mrs. J. MacPhail
Vancouver General Hospital
855 W. 12th Avenue
Vancouver, B.C.
V5Z IM9
Nurses Wanted
Jobs:
Permanent or temporary (two to four months in hospital or nurs-
ing station).
Requirements:
Member of the Order of Nurses of Quebec
Wishful :
. excellent knowledge of French
. experience: two (2) years
. post-graduate in public health
. be able to accept isolation
P.S.
Excellent occasion to see a typical part of the country and be able
to appreciate it. Increase your knowledge ofthe French language.
To live a unique experience in an isolated region. Facility to visit
Newfoundland.
For more information, please contact:
Notre Dame Hospital
Personnel Director
Lourdes de Blanc Sablon
Co. Duplessis (Québec)
GOG 1 WO
Telephone: (418) 461-2144, Ext. 219
The Can-.llan Nur..
The University of British Columbia
Applications are invited for teaching positions in
undergraduate and graduate programs in nursing.
Master's or higher degree in nursing required as
well as experience in the clinical field. Openings
available in all clinical areas including Rehabilita-
tion nursing. Candidates must be eligible for
registration with the Registered Nurses Association
of British Columbia.
Competitive salaries and good fringe benefits
dependent on qualifications.
Send resumes to:
Dr. Marilyn Willman
Director
School of Nursing
University of British Columbia
2075 Wesbrook Place
Vancouver, British Columbia
Canada V6T lW5
Mey 1171 11
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Registered Nurse in search of a change and a challenge-
look inlo nursing opportunities at Vancouver General Hospital, B.C. 's
ml\Îor medical centre on Canada's unconveritional West Coast. Staffing
expansion has resulted in many new nursing positions at all levels,
ancluding:
General Duty ($ 1305. - 1542.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the opportunity
you've been looking for.
For those with an interest in specialization. challenges await in many
areas such as:
Neonatology Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Burn Unit
Paediatrics
Inservice Education
Coronary Care l'nit
Hyperalimentation
Program
Renal Dialysis & Transplantation
If you are a Nurse considering a move please submit resume to:
Mrs. J. M""Phall
Employee Rea-lions
Vancouver General Hospital
855 West 12th Avenue
Vancouver, B.C. V5Z 1\19
International Nursing
What A Challenge!
The opportunities offered in International nursing are unlimited and include the chance to share
your skills and knowledge, the chance to grow personally and professionally and the chance to see
the world. The King Faisal Specialist Hospital and Research Centre in Riyadh, the capital city of
Saudi Arabia, can offer you all of these things and more. The Hospital, managed by the Hospital
Corporation of America group, is a 250-bed referral and specialist medical center staffed with
professionals from the United States, Europe and the Middle East.
Current R.N. openings include NICU, CVICU, Peds and O.R. Other positions available
periodically. Requirements include minimum three years current experience in an acute care
hospital. current R.N. license in Canada and fluency in written and verbal English.
Salary is excellent with furnished lodging, 30 days paid vacation, bonus pay and leave and other
exceptional benefits.
Interested. qualified candidates should forward a resume with salary history to:
Kathleen Langan, R.N.
Senior International Representathe
Hospital Corporation International
One Park Plaza
:'oIashville, TN 37203
l:
A
HOSPITAL
CORPORAnoN
II"-=-ii: " 6">'"'
'>I.
Equal Opportunity Employer
112 ..., 11711
The Canadian Nur..
Director of Nursing Service
Required for
Wetaskiwin General Hospital
Applications for the above position are invited on or
before June I, 1979. The Wetaskiwin General
Hospital is a 135 bed active treatment hospital and
is located in a small city just 35 miles south of
Edmonton. The facility is part of a complex which
operates a 50 bed auxiliary hospital and a 50 bed
nursing home.
The successful applicant should ideally have ex-
perience in the administration of a nursing program
and possess a B.Sc.N. Degree, but, equivalent
combination of formal education and experience
will be accepted.
Position will open on retirement of present incum-
bent. Address all inquiries in writing together with a
complete resume to:
P.D. Langelle
Administrator
Wetaskiwin Hospital District
5505 - 50 A venue
Wetaskiwin, Alberta
T9A OT4
General Duty Nurses
The Royal Alexandra Hospital, 970 Bed teaching
hospital requires:
General Duty R.N.'s
for temporary vacation relief positIons in most
clinical areas. Positions vary in duration between 9
weeks and 20 weeks, depending on clinical area.
Employment date -July 2, 1979.
Applicants must be eligible for Alberta registration
with A.A. R.N.
Please direct inquiries to:
Mrs. R. Tercier
Director of Nursing Personnel- Administration
Royal Alexandra Hospital
10240- Kingsway Avenue
Edmonton, Alberta
T5H 3V9
Nurse Clinician/Operating Room
Applications are invited for the above position in
the Operating Room of the Vancouver General
Hospital, an active teaching and tertiary referral
hospital for the province. The Department consists
of 30 theatres involved in all surgical discipline.
Duties involve providing clinical expertise and
leadership in the delivery of care standards in the
development of staff in collaboration with the O.R.
instructor and head nurses.
Applicants must be registered nurses, preferably
with a B.S.N. degree, and Post Graduate Course in
Operating Room Techniques or equivalent. Salary
$1,500 - $1,772. Benefits according to R.N.A.B.C
contract.
Please submit resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
855 W. 12th Avenue
Vancouver, B.C.
V5Z IM9
The Abbie J. Lane Memorial Hospital, Halifax
requires a
Director of Nursing
Applications are invited for the position of Director of Nursing in
a fully accredited psychiatric teaching hospital with 90 in-patient
beds, 50 day treatmenl places and a large outpatient service.
Reporting to the Administralor, Ihe Director of Nursing will be
responsible for managing the Department of Nursing and
maintaining a high standard of nursing care in a teaching
environment. This position will be available in June, 1979.
II is expected that the applicant will have a degree at the Master"s
level, psychiatric nursing experience, and be eligible for
registration with the R.N.A.N.S.
The applicant should be able to demonstrate skill in administra-
tion. and exhibit a potential to guide a progressive department in
new directions.
Please forward your resume to:
Mr. Stephen Jenner
Administrator
Abbie J. Lane Memorial Hospital
5909 Jubilee Road
Halifax, Nova Scotia
B3H 2E2
The Cenedlan NUrM
Ryerson Poly technical Institute
Nursing Department
Presently Offers a General
Post-Diploma
Intensive Care Program
Running Twice Consecutively From
September - December &
January - April
A 15-week course. beginning in Sept. '79 & Jan. 'SO
aimed at producing general staff nurses qualified to
work in medical, surgical or general intensive care
areas.
Emphasis is placed on pathotht:rapeutics and as-
sessment skills and an integrated clinical experience.
Clinical experience offers ample opportunity for
immediate application of new knowledge and testing
of hypotheses.
For further infonnation. contact Admissions Office.
Ryerson Poly technical Institute. 50 Gould Street.
Toronto, M5B lES. or telephone Nursing Depart-
ment. (416) 595-5191.
Registered
urses
I
OO heJ ho...pital aJjal.:enr to Univer'\itv of
-\Iherta I.:ampu... offer... empkn ment in
meJil.:ine. ",urger
. peJiatril.:.... oh...tetric....
p"'
chiatr
. rehahilitation anJ e\tenJeJ care
induJing:
.Inren...i\el.:are
. C oronar
oh...ervation unit
. CarJiova'\ollar ...urger
. Burn... anJ pla...til.:'"
· ..... eonatal inten...i\ e I.:are
. Renal Jial
...i...
. '\,euro-...urgen
Planned ()nenlallon and I n-"\cn i\:e FduGItion program....
p,,,, (,raduate dinical cour....:... in (.ardlO\ ,!'cular-
Inten...j\c Care "'ur...ing ami Opcla'ing Room r e\:hnique
.tnd \tanagemenl.
\ppl
to:
Recruitment Officer - 'ur...inJ:
l nÌ\er...it
ot -\I
rta Ho'pital
X
II- 112th
treet
Edmonton. -\I
rta
[M;2ß7
118y 1171 83
.
UNIVERSITY OF WINDSOR
SCHOOL OF NURSING
The University of Windsor, School of Nursing
invites applications for one (1) year term
appointments for the 1979-80 academic year.
Qualifications:
Master's Degree in Community Health
Nursing
Work experience in community health nursing
Teaching experience
Current Ontario Certificate of Competence
or eligibility for same
Send curriculum vitae and names and addresses
of three references to:
A. Temple
Director
School of Nursing
University of Windsor
Windsor, Ontario, N9B 3P4
[2]@
University of
Alberta Hospital
Edmonton. Alberta
')
Wish
ere
.JI
,
@. -:,,'
--
,....;
'"
"ct
f
<-I
:
.. .in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand gro\\ s every day.
Take the North for example. Community Health
Nursing is the major role of the nurse in bringing health
services to Canada's Indian and Eskimo peoples. If you
have the qualifications and can carry more than the
normal load of responsibility... why not find out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing \\hich in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career, and it is possible to advance to
senior positions. In addition, there are educational
opportunities such as in-service training and some
financial support for educational leave.
For further information on an), or all. of these career
opportunities, plea'ie contact the Medical Service!>
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 . . Health and Welfare Sante et Bien-élre social I
Canada Canada
.
Index to
Advertisers
May 1979
Canadian Dairy Foods Service Bureau
The Canadian Nurse's Cap Reg'd
Canadian Pharmaceutical A
sociation
Cover 4
48
14
Canadian School of Management 55
Equity Medical Supply Company 49
Health Care Services Upjohn Limited 55
Hollister Limited 16
J.B. Lippincott Company of Canada Limited 52,53
The C.V. Mosby Company, Limited 2,3,4,5
Nordic Pharmaceutical Limited 56
Pharmacia (Canada) Limited 9
Public Service Canada 51
W.B. Saunders Company Canada Limited 7
G.D. Searle & Company Canada Limited 17
Smith & Nephew Inc Cover 3
Stiefel Laboratories (Canada) Limited 14
White Sister Uniform Inc Cover 2
Advertising Manager
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P I E2
Telephone: (613) 237-2133
Advertisinf: Representatives
Jean Malboeuf
601. Côte Vertu
St-Laurent. Québec H4L IX8
Téléphone: (514) 748-6561
Gordon Tiffin
190 Main Street
UnionviIle, Ontario UR 2G9
Telephone: (416) 297-2030
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
Member of Canadian
Circulations Audit Board Inc.
IæE
I
,1.1.
Why c
dressings
several times a day
when once a week is plenty1
This is an Op-site dressing for non-infected ulcers.
When it goes on, it stays on... for a whole week.
Because Op-site is an adhesive, transparent dressing
that breathes and sweats with the skin. So you can keep
your eye on the entire healing process without the
interruptions of frequent dressing changes.
Op-site is easy on the patient too. It's neat, not bulky.
Patients can take regular baths or showers without
discomfort because Op-site is water-proof. Op-site is
also bacteria-proof, protecting the ulcer from
contamination.
Because Once a week is plenty, Op-site means fewer
dressing changes. And that's less work and more time
for you.
--------------------
I Op -Sit e '"J Forf';lrtherinforma
ion,!
ut I I
I Op-slte ulcer dressmg, fill In
the ultimate wound dressing and mail this coupon. I
I I
: Name I
I I
I Address I
I I
I City Prov._Code I
I Mail to' Ej ----. SmIth f, Nephew Inc. 2100.52ndAvenue I
. : Stlf Medical Division Lachine. Qué., Canada I
I '.. -.: H8T2Y5
--------
-----------
butter is really the villain responsible
for various common pathologies. . .
,
these very illnesses continue to occur frequently despite
a dramatic decrease in butter consumption over the past thirty years?
.
And did you know that, during this same period
",(time. there has been a marked increase in the
consumption of margarine in Canada?
COMPARATIVE DAILY CONSUMPTION RATES OF BUTTER
AND MARGARINE FROM 1948*-1978** IN GRAMS PER PERSON
I
'\
000
180 I
V V
1948 MARGARINE 1978 1948 BUTTER 1978
For more facts about dairy foods, write to:
Canadian Dairy Foods Service Bureau.
30 Eglinton Ave. E.. Toronto, Ont. M4P IB6
L_
'\ 296
=:J
112 I
When you look at the facts
you can see the good in butter.
*Statistics Canada
** 1978 estimated
consumption
. Are you a nursing leader?
. A guide to special Interest
groups
. When your patient says It hurts
. The nurse and the learning
disabled child
. The IV nurse and the
chemotherapy patient - a
special relationship
The
Can-
Nurse c 00
BI8L10-:-
!:,'" :
SC"[NC
S I.-u IR...IERES
;;
o 1 (3.
.
I
..
I
NOT TAKE
ll!JRARY
JUNE 1979
s
L)j
V./!.U Av J
dIl l:t
lt
OPl
l]}>J\ll I V
\lll'
I 1 \J3
n=, ", I: =3
"'V ll l::fJJlHl
C;ff.Q9 7 IÇ;L
1
----.-
-
1
Style No. 42728 - Dress
Sizes: 3-15
"Royale Shantung"
80% textured Dacron ll polyester,
20% cotton
White, Pink. . . about $35.00
I'
. "
A Division of
White Sister Uniform Inc,
DRESS UP F' · S P RI NG
in beautiful Dacron';;: polye ter and cotton blend.
Exclusively our of course
..
-
"
.,
tyle No. 1 - Dress
izes: 6-1 .
'Royale Si otta"
0% textu
0% cotton
hite. k... about $3-
Available at leading department stores and specialty shops across anada
\\
\ \
.-:
...
CNA NATIONAL FORUM ON NURSING EDUCATION
13,14,15 NOVEMBER 1979 SKYLINE HOTEL OTfAWA
ð
ç:;:'
OF
THEME:
THE NATURE
NURSING EDUCATION
ð
ç:;:'
PROGRAM:
KEYNOTE SPEAKER: ALICE J. BAUMGART,
DEAN, FACULTY OF NURSING, QUEEN'S UNIVERSITY
REACIlON PANEL: Jocelyn Hezekiah, Cécile Lambert, Dorothy Kergin, Ann Hilton
SESSIONS:
Nursing Model
Evelyn Adam
Basic Nursing Service
Mary Cruise, Lucille Parent
Marie White, Ginette Rodger
Reality Shock
Heather Smith
Margaret Edmonds
Pat Stanojevic
Specialization
Madeleine Blais
Nursing Skills/Competencies
Margaret Steed
Accreditation
Myrtle Crawford
SPEAKERS AND PARTICIPANTS WILL DISCUSS WHAT IS BASIC IN NURSING EDUCATION
AND PRACTICE IN SESSIONS AND OPEN DISCUSSIONS - ALL NURSES CAN GEf
INVOL VFD . . . OPEN TO ALL REGISTERED NURSES TO A MAXIMUM OF 300.
NOTE: CNA has reserved a block of rooms at the Skyline Hotel, 101 Lyon Street, Ottawa, KIR 5T9, at a
special convention rate of $4 1.00 single and $47.00 double occupancy.
Please make your reservations directly with the Skyline indicating you are participating at the Canadian
Nurses Association National Forum on Nursing Education and request the convention rate quoted above.
Name ..........................................
Address _ _ _ . . . _ .. _ _ _ _ _ . _ _ _ _ _ _ . _ _ _ _ _ _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postal Code . ......................................
Telephone (Business) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rome ......... . . _ . _ _ . . . . .
Place of Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CNA Member 0 0 (Ontario nurses who belong to RNAO are members ofCNA)
Yes No
(Province of 1979 Registration)
(Registration number)
FEE: CNA Member- $100.00 0
Non-<::NAMember-$17.5.00 0
Check which applies
Cheque payable to: Canadian Nurses Association,
50 The DrIveway,
Ottawa, Ontario.
K2P lE2
T
ephone:(613)237-2133
Cancellations pennitted until November I $2.5.00 processmg fee deducted.
c5ì1 ica's
number shoe
,
for ]6ung women
in white!
THE
LINI
SHOE
pk
Ìll.IIJ'nMi.
\
. .
\. ' .
. -
. .... ,
. ..
.
.......
...,
..
...
I
.
.... ."
.
..
. .
. .
.........
SOME STYLES ALSO AVAILABLE IN COLORS. . . SOME STYLES 3%-12 AAAA-E, 30.00t053.00
For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write:
THE CLINIC SHOEMAKERS. Dept. CN-6, 7912 BonhommeAve. . St. Louis. Mo. 63105
The
Canadian
Nurse
June 1979
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number 6
Input 6 A catalogue of
special interest groups Lynda Fitzpatrick 9
News 8 Spotting and helping the MiidredC. Jacobson
learning disabled child George Gasek 18
You and the law 39 A holistic approach to
nursing the patient in pain Emalou Vaterlaus 22
Research 47 The IV nurse and the
chemotherapy patient: a vital
role in emotional support Kathleen MacMillan-Brett 28
Books 52 FRANKLY SPEAKING
Apathy in nursing Jessica Ryan 31
Library Update 53 Nurses need leadership skills Susan Spennrath
Judy Tiivel 33
.
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts
should be typed double-spaced. Send
original and carbon. All articles must
be submitted forthe exclusive use of
The Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
A chance to grow wings for the
spirit is how IYC officials
describe this month's promotion
of the special needs of those
children who are "the same but
different". Exceptional children
are bound to find the going
rough but they deserve a real
childhood. To achieve this, they
need special care and attention.
As nurses we can make sure that
they get it. Cover photo:
National Film Board of 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
Canadian Nurses Association,
SO The Driveway, Ottawa, Canada,
K2P IE2.
Indexed in International Nursing
Index, Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medicus, Canadian Periodical
Index. The Canadian Nurse is
available in microfonn from Xerox
University Microfilms, Ann Arbor,
Michigan 48106.
Subscription Rates: Canada: one
year, $10.00; two years, $18.00.
Foreign: one year, $12.00; two
years, $22.00. Single copies: $1.50
each. Make cheques or money
orders payable to the Canadian
Nurses Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number, in a
provincial/territorial nurses
association where applicable. Not
responsible for journals lost in mail
due to errors in address.
Postage paid in cash at third class rate
Toronto, Ontario. Pennit No. 10539.
Canadian Nurses Association, 1978.
4 June 1979
The Cen.dl.n Nur..
perspective
Sinners or saints?
The gavel has descended. The Ontario
Division Court has upheld the ruling of a
three-man arbitration board that found in
favor of the employer, Mount Sinai
Hospital in Toronto, and against three
ICU nurses employed by that hospital.
The nurses in question refused to
accept a work assignment because they
felt their existing workload made it
unsafe for them to 'care for another
patient. They were subsequently
disciplined for insubordination and,
failing satisfactory resolution of the
grievance procedure, the matter
proceeded to arbitration.
The situation on the night of
February 27, 1976 was one that many
nurses will recognize - six ICU nurses
charged with the responsibility of caring
for eight seriously ill patients, five of
whom were on ventilators and required
one-to-one nursing. Two of the six were
relief nurses. For one of them this was
her first shift in ICU; for the other it was
her first time in this unit. The night was
"the busiest ever" and the workload was
such that nobody took time out for lunch
or coffee breaks during the shift which
lasted 12 hours and 4U minutes.
I nformed of the imminent arrival of
another patient from Emergency, One of
the six nurses responded that "no nurse
feels capable of accepting the
responsibility of another ventilator
patient". It was their subsequent failure
to "accept a report and patient from the
nurse who had transferred a critically ill
patient from the Emergency
Department" as well as to provide any
significant assistance to the doctors
caring for this patient which became the
basis for disciplinary action against three
of the nurses.
The arbitration board found the
hospital had "just cause" for the
discipline imposed on the grievors. The
courts have upheld this ruling and, for
now, that is where the matter rests.
Whether or not another ruling is
forthcoming, I believe it is incumbent On
nurses everywhere to give careful
consideration to some of the questions
raised during the arbitration hearing.
These are issues which are fundamental
to the direction offuture growth and
autonomy within our profession. For
example:
. Can nurses, if they feel the
circumstances warrant it, challenge the
propriety of a work assignment? Can
they refuse to carry out an assignment
and then raise the legitimacy of that
order as a defence against the charge of
insubordination?
. Are the recognized exceptions to
the "obey and grieve" rule (i.e. where
recourse to the grievance procedure will
not adequately protect his/her interests)
too narrow to afford adequate protection
to the nurse? to the patient?
. What effect does the introduction of
patient interests have on the application
ofrecognized principles of arbitration?
. Can a hospital setting be compared
to an industrial plant? Where
relationships are of a professional
character, as in a hospital, is it desirable
to accord greater respect to the
employee's judgment (as to the wisdom
or necessity of a work instruction) before
instituting disciplinary action for
insubordination?
Where do professional judgment,
responsibility and accountability - all of
the current buzz words - fit into the
scheme of administrative authority? The
right to direct the work force and to
make work assignments has always been
a management prerogative. To allow an
exception to the "obey and grieve" rule
like the disputed claim - i.e. that in
being asked to accept yet another
patient, to "cope" . the nurses were
being required to carry out a task that
was either unsafe or iIIegal- would. in
the words of the award, "effect a
substantial inroad" into this
management right.
It could also pave the way for future
negligence suits against the hospital. As
the award notes:
"The employer as a hospital is under a
statutory obligation to provide care for
patients admitted into the hospital.
Moreover, the employer may well be
liable both originally and vicariously for
damage which results to patients while in
the institution. That circumstance
requires that the employer be put in a
position in which it can effectively insist
that certain instructions be carried out. If
the employer were unable to so insist and
were put in the position of having to
defer to the superior professional
judgment of its employees it would be
placed in an intolerable legal position,
One in which it could not protect itself
from legal liability ."
The nurse, it would appear, is
caught between the legal consequences
of the overriding interests of her
employer, and the dictates of her own
professional conscience and disciplinary
body. In a dilemma like this, according
to Principal Nursing Officer Dr. Jo
Flaherty who testified on behalf of the
three defendents, the choice is obvious:
"As professionals they (registered
nurses) are accountable for their
behaviour rather than accountable to
someone in a hierarchy. And, as persons
who are accountable for their
professional behaviour, they must make
judgments about the appropriateness of
their nursing actions.Irat any time they
believe that an order is questionable
those nurses are obliged by the ethical
code governing nursing and by the
contents of and the regulations under
The Health Disciplines Act of Ontario to
refuse to carry out questionable orders
until they satisfy themselves that the
carrying out of the orders would not be in
conflict with their professional ethics and
with their commitment to excellence in
the practice of their profession. ..
Nurses at Mount Sinai (1ike those at
half a dozen other Ontario hospitals) now
have a "professional responsibility"
clause written into their collective
agreement providing for referral of
nursing and workload problems to an
impartial panel of outside nurses. The
hospital has also increased its full-time
staff. But the question posed in his
dissenting judgment by arbitrator
William Walsh remains:
"How does such a predicament arise?
How do those in authority allow a
situation to arise where experienced ICU
nurses, caring for very sick patients
earnestly conclude they require help for
patients already under their care and
cannot attend to still an additional
critically ill patient without further
endangering those already in their care.
Surely if this intolerably wretched
circums tance is the result of some failure
in management, then the people at the
bottom of the ladder, the hardworking
professional nurses, should not be made
the scapegoats. "
There are strong overtOnes in
Walsh's observation reminiscent of a
warning issued by president Sue
Rothwell to members of the Registered
Nurses Association of British Columbia
last year.
"Quality of care in practice settings,"
she told nurses then, "is the single most
important issue facing us today."
She described the contentious
situation that existed at that time at
Vancouver General Hospital as "only
the tip of the iceberg" and predicted that
"the coming year will bring one crisis
after another in nursing care, not just in
B.C. but right across the country."
Unfortunately. time has proved her
right and today, three years after the
Mount Sinai incident, no province, no
hospital. no nurse charged with
providing care can contemplate the
future with any degree of equanimity.
- M.A.B.
herein
When Jessica Ryan agreed to
write this month's Frankly
Speaking, she thought the job
would be relatively simple.
"After all. I'm one nurse who
does have strong feelings
about this topic. I get very
uptight about inaction and
apathy among nurses.
"But to say this to all the
nurses of Canada sort of
scares me. In any case, I'm a
nurse - at the bedside and
very active in my profession
- and this is the way I feel. ..
Jessica's opinion column
which appears on page 31 of
this issue is the first of a
series of contributions that
EDITOR
ANNE BESHARAH
ASSISTANT EDITORS
LYNDA FITZPATRICK
SANDRA LEFORT
PRODUCTION ASSISTANT
GIT A FELDMAN
CIRCULATION MANAGER
PIERREITE HarrE
ADVERTISING MANAGER
GERRY KAVANAUGH
CNA EXECUTIVE DIRECTOR
HELEN K. MUSSALLEM
GRAPIßC DESIGN
ACARTGRAPHICS
EDITORIAL ADVISORS
MATHILDE BAZINET.
chairman. Health Sciences
Department, Canadore College,
North Bay. Ontario.
DOROTHY MILLER,public
relations officer, Registered
Nurses Association of Nova
Scotia.
JERRY MILLER, director of
communication services.
Registered Nurses Association
of British Columbia.
JEAN PASSMORE,editor,
SRNA news bulletin. Registered
Nurses Association of
Saskatchewan.
PETER SMITH. director of
publications, National Gallery
of Canada.
FWRlTA
VIALLE-SOUBRANNE.
consulrant. professional
inspection division. Order of
Nurses of Quebec.
CNA members-at-large wtll
be making to the Frankly
Speaking page. Next Fall
Margaret McCrady,
member-at-large for nursing
education, will give her
views on some of the
concerns that currently face
nursing educators in this
country.
The past ten years have seen a
dramatic growth of special
interest groups in nursing -
from local groups that meet
the needs of small numbers of
interested nurses. to national
and international
organizations that serve a
variety of needs of a large
body of nurses. across Canada
and the world. These groups
have a vital role to play in
your professional
development. Find out about
what they have to offer to you
on page 9.
A reminder...this year as in
1978 theJuly and August
issues of your journal are to be
combined and will appear in a
single edition that will go into
the mails J ul y 31 st.
Watch for our special
feature presentation in the
July/August issue - A Report
from the Provinces - on
what's going On across the
country in the organized
nursing profession. CNJ staff
and special reporter Bert
Prime. CNA public relations
officer, will visit eight
provinces and report to you
on the concerns and issues
brought by membership to
their annual meetings this
Spring.
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France Clavet, R.N. (Hôtel Dieu - Chicoutimi, affiliafe of
laval University) has the exclusive rights for this formula in
Canoda. Studio Clovet Inc., nho has been serving Canadians
for yeors in Montreal, is currently recruiting nurses interested
in increasing their income by becoming owners of a studio.
Studio Clovet Inc. hos qualified professionals who are ready
to train you to become specialists in this field.
If you have approximotely 7 years nursing experience and
wish fo discover new horizons, please con fact :
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I June 111711
The Canadian Nur..
input
A nurse Is a nurse Is a... The interdependent Down with apathy year internship of pure clinical
Some comments 0\1 the functions are carried out as Three cheers for Jeanne experience (not unpaid)
letter from Dr. A.G. Dawrant, the Qurse works with patients Hurd. I have long felt that the before being licensed as
president of the Canadian and other health care workers apathy of the 90 per cent of registered nurses?
Association for Independence in the planning and the members of ()ur
oanAnderson, R.N., B.N.
in Medicine (Input, March)... implementation of health care associations will be our (retired), Vananda, B.C.
Dr. Dawrant does not for patients. downfall. Unless we want to
seem to understand the The dependent functions be classified as technical Recipes anyone?
function ofthe primary care involve the carrying out of nurses, now is the time to The Charlottetown
nurse in the health care instructions from other health register our protests. Chapter of the Association of
system. Primary care nurses care workers, including Perhaps degree nurses Nurses ofP.E.1. has recently
have been involved in health physicians, and the carrying should fonn their own published a cookbook
care in Canada since the days out of the policies and association if they are so containing recipes ofIsland
of Jeanne Mance. Some of practices ofthe agency in obviously dissatisfied with the nurses. The proceeds will be
them refer to themselves as which the nurse is employed. R.N. associations. After all, used for the education of
nurse practitioners. Many A t no time is a nurse free as Jeanne points out, we do nurses and to help furnish the
members of our profession, to carry out orders, policies or pay the m<\Ïority ofthe costs, Association office. The
however, believe that any procedures unthinkingly. and I feel very strongly about cookbook costs $3.50 and is
nurse who practices is a Canadian nurses are bound by this blatant attempt to available from: Rosemary
practitioner and they law, by professional "declass" the diploma nurse. Herbert, 29 Birch Hill Dr.,
therefore prefer the tenn standards and by the ethics of Let your associations Sherwood, P.E.l. Our chapter
"primary care nurse". the nursing profession to know how you feel! is still small, but growing, and
Relatively few primary question orders, directions, -Kathie Lillyman, R.N., we are quite excited about this
care nurses work in complete policies and practices about Winnipeg, Man. project.
isolation. Even primary care which they have doubt. -Rosemary Herbert,
nurses practicing in Careful study of Helen Practice makes perfect Sherwood, P.E.l.
underpopulated parts of our Taylor's comments reveals I wish to express my deep
country, who are physically that she and the association of appreciation to author Jeanne An idea that works
isolated from other health care which she is president have Marie Hurd (April, 1979) for As a nursing student
workers, usually have the never recommended that her presentation of a problem whose interest revolves
opportunity for contact by nurses "set up shop on their that has caused anxiety to around preventive health care
phone and/or radio as well as own" as Dr. Dawrant many in the nursing and health education of the
occasional visits from other suggests. As a member of the profession. Even as a young pediatric client, I would like to
health care workers. Canadian Nurses Association, student, I was utterly appalled congratulate the Simon Fraser
Dr. Dawrant needs to be I would be disturbed indeed if at the common practise of Health Unit on their ingenious
reminded that primary care my president urged physicians university nursing programs, idea of the health circus.
nurses practice nursing and to delegate to nurses rather Le. to graduate students with I agree that being healthy
are accountable for their than work with nurses as an extremely limited clinical begins with teaching and that
professional nursing practice. equal members of the health experience to serve the public teaching is retained when it
If they are negligent in this care team. as licensed R.N.s while they becomes an enjoyable activity
practice they can be charged Physicians have no right were still inept at the for the child and his parents.
under the statutes governing to delegate the practice of necessary nursing technique. What better way to relate to
the practice of nursing. medicine to members of Many of us have made the pediatric client as he
I disagree with Dr. another profession that is the same comparison Hurd becomes the center of health
Dawrant that there is a governed by separate statutes makes, that the medical screening procedures and the
tremendous amount of good and that is accountable to its profession with its taxing educational process than that
work that the registered nurse own statutory body for its academic program also of a health circus!
in such a setting could do "if practice. I wonder if, in his provides an equally taxing -Rae helle Sapp, East
the practitioner is prepared to efforts to promote clinical program which Tennessee State University,
delegate work to his nurse". independence in medicine, involves peIfonnance in the Johnson City, U.S.A.
Nursing practice involves Dr. Dawrant recognizes the clinical area during the
independent, interdependent need for independence for academic program and for at Correction: the fly gals
and dependent functions. The other professions in their own least one year post graduate. reunion for formerT .c.A.
independent functions involve practice and I urge him to So most physicians do at least stewardesses (April Input)
decision-making by nurses infonn himself better about 2 years internship and some as will take place a year from
regarding nursing the purpose, functions and many as 5 years at great now, in May 1980, rather than
interventions. Sound nursing scope of the nursing economic risk. Is it asking too this year.
decisions are based on profession in this country. much of the university nursing
observations by the nurse, -M. Josephine Flaherty, program to specify at least one
application of theory and Principal Nursing Officer, (continued on page 48)
practical experience. Health and Welfare Canada.
What's New?
TEXTBOOK OF HUMAN SEXUALITY FOR NURSES
By Robert C. Kolodny, M.D.; William H. Masters, M.D.; Virginia
E. Johnson; and Mae A. Biggs, R.N., M.S.
While nurses fully realize that sexual health is an important com-
ponent of the overall well-being of their patients, the effeas of
health problems on sexuality are less apparent. To explain the
biologic and psychosocial impacts on sexuality of a variety of
medical and surgical conditions, the authors of TEXTBOOK OF
HUMAN SEXUALITY FOR NURSES draw on 25 years of
clinical experience and research from the Masters & Johnson
Institute. From its opening chapter, Sexuality as a Clinical
Science for Nurses, to its closing pages of questions and answers,
this text effectively incorporates human sexuality into nursing
practice at a level that can be understood by both practicing and
student nurses.
Little, Brown. 450 Pages. Illustrated. 1979. Paper, $15.00.
Cloth, $21.00.
GERONTOLOGICAL NURSING
By Charlotte Kopelke Eliopoulos, R.N., B.S., M.S.
This practical new book provides a comprehensive review of the
medical, surgical, and psychiatric problems associated with aging,
accompanied by related nursing interventions. Specific coverage
is given to measures designed to promote good respiration,
elimination, and activity to compensate for age-related changes
interfering with these functions. CommQn diseases of each body
system and their unique features in the aged are discussed in
detail.
Harper & Row. 384 Pages. Illustrated. 1979. $15.00.
A GUIDE TO PHYSICAL EXAMINATION,
2nd Edition
By Barbara Bates, M.D.
New chapters on interviewing and history-taking, and much
expanded and updated content mark the new edition of this
outstanding guide to physical assessment for health practi-
tioners. Detailed and concise, it's an excellent on-the-job
reference for interviewing and examination; for assessment of
health status; and for differential diagnosis among abnormal
findings. There are now more examples of abnormalities, more
information on the cardiac chapter, a new section on the
stuporous or comatose patient and revised chapter on the
pediatric examination.
Lippincott. Abt. 425 Pages. 1979. $25.00.
NURSES' HANDBOOK OF FLUID BALANCE,
3rd Edition
By Norman Milligan Metheny, B.S.N., M.S.N., Ph.D.; and W.O.
Snively, Jr., M.D., F.A.C.P.
Almost totally rewritten and revised, with a wealth of new
material, this edition is twenty percent larger than the previous
one! It presents basic knowledge of body fluid balance distur-
bances, with emphasis on practical application. New material
and major revisions include: new knowledge of homeostasis;
a summary of the latest information on nutrition; an expanded
section on real-life case histories; greatly increased emphasis
on acid-base disturbances; and greater coverage of elemental
diets, tube feedings, diuretics, and adrenocortical steroids.
Lippincott. Abt. 400 Pages. 1979. Abt. $15.00.
NURSING MANAGEMENT FOR PATIENT CARE,
2nd Edition
By Marjorie Beyers, R.N., Ph.D.; and Carole Phillips, R.N.,
M.S.
In this second edition, the authors live up to the impeccable
reputation established by NURSING MANAGEMENT FOR
PA TlENT CARE. Important new features include reports on
recent theories of management, a deeper explanation of the
nurse manager's relationship with staff members, an enlarged
chapter on the plan of care, and timely discussions of the
expanding role of the nurse manager, including her function in
health-care organizations other than hospitals and in disputes
with unionized employees.
little, Brown. 292 Pages. Illustrated. 1979. $10.75.
COMMUNICATION FOR HEALTH PROFESSIONALS
By Voncile M. Smith, Ph.D.; and Thelma A. Bass, M.A.
This timely book identifies and describes problem situations
stemming from communication breakdowns that commonly
affect health care personnel. It relates the importance of
communication to the maintenance of public confidence in
health care institutions and personnel, and explains skills
necessary to communicate effectively with patients and clients,
co-professionals, supervisors, and subordinates.
Lippincott. Abt. 200 Pages. 1979. Abt. $8.50.
Lippincott
J. B. LIPPINCOTT COMPANY OF CANADA LTD.
Serving the Health Professions in Canada Since 1897
75 Horner Ave., Toronto, Ontario M8Z 4X7
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.
re
;
:
-------
o KOLODNY: Textbook of Human Sexuality for Nurses,
Paper, $15.00.
o KOLODNY: Cloth, $21.00.
o ELIOPOULOS: Gerontologicll Nursing, $15.00.
o BATES: A Guide to Physical Examination, 2nd Ed., $25.00
o METHENY: Nurses' Handbook of Fluid Balance, 3rd Ed.,
$15.00.
o BEYERS: Nursing Management for Patient Care, 2nd Ed.,
Abt. $15.00.
o SMITH: Communication for Health Professionals,
Abt. $8.50.
o Payment enclosed (postage & handling paid)
o Bill me (plus postage & handling)
Name
Addres5
City
Postal Code
Provo
Prices subject to change without notice.
CN6/79
-
8 June 111711
The Cenedlen Nur..
news
Spotlight on
continuing education
More and more, continuing
education is recognized as a
necessity for the safe and
competent practice of nursing;
but there are stiII many
unknowns. How do we, for
example, identify the real
educational needs of nurses?
Do we want to see continuing
education become a
mandatory requirement for
relicensure?Oo we have any
proof of the effectiveness of
programs currently being
offered? Do they improve the
quality of care provided? Are
they cost effective?
These are only a few of
the many questions addressed
at the first National
Continuing Education in
Nursing Conference held in
Winnipeg, Manitoba on April
18-20, 1979. The meeting,
supported by the Manitoba
Association of Registered
Nurses, attracted over 70
nurses from all ten provinces
and the North West
Territories. They came
together to discuss concerns
and problems and to share
their ideas and expertise about
continuing education in their
own locales.
The participants came
from a wide variety of work
setti ngs:
. inservice education
departments in hospitals
. continuing education in
community colleges and
universities
. professional associations
. federal and provincial
governments
. nurses in service settings,
ego directors of nursing, staff
nurses, community health
nurses.
After three days oflively
discussion, the group
unanimously agreed on a
three-fold plan of action:
I. to hold a second National
Conference on Continuing
Education for Nurses in
Vancouver in conjunction
with the Canadian Nurses
Association biennial meeting
inJune 1980;
2. to submit a resolution to the
CNA indicating the need for a
position paper on continuing
education for registered
nurses in Canada;
3. to improve communication
about continuing education
for nurses by various means
available, ego "talking up" CE
to colleagues; sensitizing
provincial nursing
associations about the
concern for quality continuing
education programs; utilizing
the provincial association
bulletins and The Canadian
Nurse journal to inform
nurses ofCE issues and
programs.
Four speakers provided the
impetus for many animated
and provocative group
discussions. The first speaker,
Margaret Steed, associate
professor and director of
continuing education in
nursing at the University of
Alberta looked at the issue of
program evaluation.
Although she
acknowledged the current
popularity of continuing
education for nurses, she
asked the audience to
consider whether the
information being taught in
many CE programs is
"useful" to nurses. She posed
the question: "Do nurses use
the information to improve
their nursing practice and the
quality of nursing service?"
Steed suggested that
continuing education in
nursing must provide proof of
its effectiveness in order to
(continued on page 46)
...........'".""'""..-
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A four-member international
nursing team visited CNA
House in late February as
part of a cross Canada tour to
promote the theme "Towards
the Year 2000", a theme
derived from the World
Health Organization
resolution "Health for all in
the year 2000". Pictured
during their Ottawa visit are
(left to right): Syringa
Marshall-Burnett of the
Faculty of Nursing,
University of We
t Indies
o
-
Measuring Up: Nancy
Williamson (right) of the
Northwest Territories, shown
above with fitness examiner,
Carol Lindsay. was one of 24
nurses from across Canada
who took part in a one-week
fitness and lifestyle workshop
at Geneva Park, Ontario, in
February. The workshop,
sponsored by the Fitness and
Amateur Sport Branch of
Health and Welfare Canada,
was designed to give
participants - all of whom
were chosen by their
provincial or territorial
....-
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Jamaica; Dr. Nita Barrow,
Director, Christian Medical
Commission, World Council
of Churches, Geneva,
Switzerland; Dr. Aleya
El-Bindari Hamad, Program
Leader, Primary Health Care,
World Health Organization,
Geneva; and Verna Huffman
Splane, honorary lecturer at
the University of British
Columbia and a
vice-president of the
International Council of
Nurses.
/.
" ,
þ
ÿ
i
-
r ':
t
professional ussociation -
basic information on fitness
and to acquaint them with
programs they might use in
their agency. The workshop
was the last in a series of three
funded. planned and staffed
by Health and Welfare
Canada. The first. for nurse
educators, was coordinated
by the Canadian Nurses
Association. The two
remaining workshops,
coordinated by the Victorian
Order of Nurses, were
designed for occupational
and community health nurses.
A catalogue of special
interest groups
Lynda Fitzpatrick
How do nurses keep up with what is going on? There's
inservice education, grand rounds and, o
in awhile, a
lecture from a visiting doctor. Sometimes an article from a
nursing journal gets pinned on the bulletin board, or the
clinical nurse specialist brings in a new idea or two.
But do you ever wonder if nurses in other units, hospitals
or even o
her parts of the country are doing things differently?
Perhaps you've been told that your unit is unique, but do you
know why?
There are exciting ways to keep up with rapid changes in
nursing practice, to share your ideas about nursing care, and
to develop your contribution to.the nursing profession-
through special interest groups in nursing. If you have
attended meetings in a specialty area. then you already know
what it means to get a broad view of what is going on in your
specialty - what you take back to your unit is a new way of
looking at things, new life and purpose.
These are the special interest groups - international,
national, provincial and local - available for your
professional development. Whether you are an orthopedic
nurse. a nurse interested in pursuing research, or the member
ofan LV. team, they have much to offer. Find out about them.
They have a vital role to play in your professional practice.
..-'
10 June 111711
NATIONAL ASSOCIATIONS
CANADIAN ASSOCIATION OF
NEUROLOGICAL AND
NEUROSURGICAL NURSES
If your area of special interest is
the field of neurological and
neurosurgical nursing, then this
may be the group for you.
Founded by Jessie Young in 1969,
its objectives are:
. to promote the highest
standards of practise in the field;
. to foster continuing
professional education of
members;
. to establish methods of
sharing this knowledge; and
. to establish lines of
communication between nursIng
and other disciplines practising in
the field of neurological sciences.
The association offers a
stimulating annual meeting held in
conjunction with the Canadian
Congress of Neurological
Sciences. Councillors are elected
at the annual meeting to represent
each province; together these
counciUors form the association's
board of directors. The
association is affiliated with the
Canadian Nurses Association and
the Canadian Congress of
Neurological Sciences.
President:
Pauline Weldon
27 Lawson A venue
Dartmouth, Nova Scotia
B2W 1Z2
CANADIAN ASSOCIATION OF
PRACTICAL AND NURSING
ASSISTANTS
In May of 1972, a meeting of
provincial associations was held
in Thunder Bay, Ontario, to form
a national association of nursing
assistants. CAPNA is made up of
all nursing assistants who belong
to their provincial associations
across Canada.. The group was
formed because of a need for
improved health care for
Canadians and the recognition
that training programs should be
the same in all provmces.
CAPNA holds annual
meetings in conjunction with the
annual meetina of the host
province. The group's primary
concern is education, including
post-graduate training for
registered nursing assistants.
Sec:retary-treasurer:
Joan Hayman
R.R.4
St. Stephen, New Brun
wick
E3L 2Y2
President:
Inez M. Smith
The C.n.dlan Nur..
CANADIAN ASSOCIATION OF
UNIVERSITY SCHOOLS OF
NURSING
CAUSN exists to provide an
organized national body to
promote the advancement of
nursing education in universities
The association dates back to
1942, when eight university
schools of nursing met to form a
provisional council to determine
standards for university schools
of nursing and to support the
development offuture schools.
Since 1942, 15 additional schools
of nursing have been establi5hed
and are members ofCAUSN, so
that the association now
represents 23 university schools.
r
Membership in CAUSN is by
institution only; the association is
supported by fees from
constituent universities. Fees
remain within the four regions
(Atlantic, Quebec, Ontario and
Western Regions) to support
regional activities. The objectives
of the organization are:
. to develop criteria for
ulllversity education in nursing;
. to promote research in
nursing;
. to promote the interchange of
nursing knowledge among
members;
. to represent the views ofthe
association to educational,
professional and other
appropriate bodies; and
. to promote understanding by
the public that university
education in nursing contnbutes
to the development of health
services in Canada.
CAUSN is the official
accrediting agency for university
nursing programs in Canada. It
holds two national meetings a
year. The association assisted in
the planning and presentation of
the recent Kellogg-sponsored
Conference on Doctoral
Preparation for Nurses in Canada
and offers assistance of a
consultative nature.
The group is affiliated with
the Association of Universities
and Colleges of Canada (AUCC)
and thus has a national forum for
discussion of issues in higher
education.
President:
Dr. Dorothy J. Kergin
McMaster University
Hamilton, Ontario
L8S 4J9
Executive Sec:retary:
Kathy Lauzon
216 Avenue des Fondateurs
Aylmer, Québec
J9J 1M3
CANADIAN COUNCIL OF
CARDIOVASCULAR NURSES
Cardiovascular nursIng has come
a long way, along with recent
advances in coronary medicine
and cardiac surgery. If you are
interested in any aspect of
cardiovascular nursing, be it
continuing education, research, or
idea exchange, this association
holds a number of benefits for
you.
The association began in
April of 1973 with some 200
members, the culmination of a
series of meetings of interested
nurses which began at the
Canadian Heart Foundation's
Annual Meeting in Calgary in
1966. In March of this year, the
association's membership stood
at 1.085.
In Canada, members pay a
$10 fee ($15 as of September I,
1979). Among the benefits of
membership are:
. the oppol1unity to attend the
annual meeting and scientific
sessions of the Canadian Heart
Foundation, Canadian Council of
Cardiovascular Nurses and
Canadian Cardiovascular Society;
. receiving the quarterly
Bulletin, written and published by
the CCCN, containing
educational articles, news
happenings and courses offered
across Canada;
. eligibility to attend seminars
and workshops at the provincial
level;
. a voice in the election of
national and provincial
representatives;
. free subscriptions to three
official journals of the American
Heart Association - Modern
concepts of cardio
'ascular
disease. Cardiovascular nursing
and Current concepts of
cerebrovascular disease:
. a nursing research fellowship
for nurses seeking advanced
preparation at the masters or
doctoral level;
. reduced fees for
Council-sponsored programs.
Write:
Canadian Council of
Cardiovascular Nurses
c/o Canadian Heart Foundation
Suite 1200
I Nicholas Street
Ottawa, Ontario
KIN 7B7
Chairman:
Glenys Whelan
3 Marigold Place
St. John's, Newfoundland
AlA HI
CANADIAN INTRAVENOUS
NURSES ASSOCIATION
There is so much to know about
intravenous therapy - from how
to set up an I.V. team in a small
hospital to safe administration of
intravenous medication. CINA
was founded in 1975 with the aim
of promoting higher standards of
intravenous therapy through
communication, idea exchange
and continuing education. The
association is concerned with
setting up flexible standards for
intravenous care, and with
working together with other
nurses, pharmaci5ts and drug
companies, to give the best I.V.
care possible.
Association membership:
425. CINA has a lively annual
meeting; all presentations pertain
to the many aspects of I. V .
therapy and approximately 25
exhibitors attend, adding further
dimension to the educational
nature of the meeting.
Fees for active members:
$17. Members receive the
Americanjournal oflY. therapy
every two month,>, as well as a
bimonthly new'iletter which is a
vehicle for communication,
advice and problem sharing. Due
to the many requests received for
standards and -guidelines in I. V .
therapy, the association acts, with
limitations, as a resource center.
CINA has chapters in
Windsor, London and Toronto,
with Ottawa and Hamilton under
consideration.
Write:
CINA
4433 Sheppard Avenue East
Suite 200
Agincourt, Ontario
MISIV3
President:
Barbara Hill
Toronto East General Hospital
825 Coxwell Avenue
Toronto, Ontario
M4C 3E7
CANADIAN NURSES
FOUNDATION
The Canadian Nurses Foundation
(CNF) is the only Canadian
foundation that deals exclusively
in supporting nursing scholars.
Since 1962, close to 200 nurses
have benefited fromCNF
scholarships These nurses in turn
have contributed a great deal to
nursing as leaders on university
faculties, as administrators,
researchers ånd clinical nurse
specialists.
.
r
I
CNF solicits and holds funds
to provide scholarships for nurses
undertaking graduate studies in
nursing and to provide grants in
aid of nursing research. The
Foundation has an elected
voluntary board of directors
chosen every two years from
among its membership.
Since 1967, the Foundation's
entire source of revenue has been
from nurses through individual
membership or personal
donations or bequests or from
provincial nurses associations. As
of November of 1978, the
Foundation had a total of 404
members. Fees: regular
membership 510; sustaining $50;
patrons $500 and $100 annual fee
Applicants for an award must
be a member of their provincial
nurses association and have
gained acceptance into graduate
school. They must identify the
practice area in which they wish
to study and have definite career
goals.
Write:
Canadian Nurses Foundation
SO The Driveway
Ottawa, Ontario
K2P IE2
President:
LouiseTod
Sec:retary-treasurer:
Dr. Helen K. Mussallem
CANADIAN NURSES
RESPIRATORY SOCIETY
If you are a nurse involved in the
prevention, treatment or
rehabilitation of respiratory
disease, the Canadian Nurses
Respiratory Society has a great
deal to offer you. This group is a
section of the Canadian Lung
Association and is affilialed with
the Canadian Nurses Association
as a special interest group.
Membership is open to
nurses who have been registered
in Canada who are enjaged in or
interested in alleviating the
problems associated with
respiratory disease. Membership,
August, 1978: 160 members.
Payment of an annual
membership fee provides
members with two official
publications of the Canadian Lung
Association - the quarterly
Bulletin and the bimonthly
The C.nedlen Nur..
Canadian Lung Association
Newsletter. Among the group's
objectives:
. to contribute to the
promotion of health of Canadians;
. to funher the objectives of
the Canadian Lung Association
within the scope of the nursing
profession and in conjunction
with other related professional
organizations;
. to encourage members of the
nursing profession to keep up with
advances in the prevention,
treatment and rehabilitation of
respiratory diseases;
. to act in an advisory capacity
to nursing and allied professional
groups on matters pertinent to
respiratory care;
. to encourage nurses to
engage in research related to
respiratory health and disease
(research grants and funding
available).
Write:
Nurses Section
Canadian Lung Association
75 Albert St.
Suite 908
Ottawa,Ontano
KIP 5E7
President:
HeatherDiane Stewart
Instructor
Nursing Program
George Brown College
Toronto Western Hospital
Campus
399 Bathurst St.
Toronto, Ontario
MST :!S8
CANADIAN ORTHOPEDIC
NURSES ASSOCIATION
In just five years, this group has
grown from a small interest group
into a national association with
525 members and five charter
chapters (Montreal, Ottawa,
Toronto, Peterborough and
Hamilton). The group exists to
provide a vehicle for continuing
education in orthopedics in order
to promote the highest standards
of practice in orthopedic nursing.
And although relatively
young, it has done a great deal to
meet this objective. The first
volume ofthe CONAjournal. the
association's ofl'lcialjournal, was
published in December 1978, and
will continue to be published four
times a year. Within the past year,
CONA has established a
continuing education committee
dedicated to providing nurses
with a library of clinical resource
material to help solve orthopedic
problems. CONA also has an
annual conference and monthly
chapter meetings of an
educational nature.
Fee $10. Membership is open
to all nursing personnel and other
health professionals interested in
the field of orthopedics.
Interested?
Write:
The Canadian Orthopedic Nu rses
Association
43 Wellesley Street East
Toronto, Ontario
M4YIHI
President:
Norma Haire
CANADIAN UNIVERSITY
NURSING STUDENTS
ASSOCIATION
University nursing students
across Canada can share their
interests through CUNSA. the
only association that briftgs
student nurses from east and west
together. The association aims
. to provide a communication
link between Canadian university
students;
. to act as the official voice of
university nurs
students;
. to provide a medium through
which students can express their
opinions on issues in nursing;
. to encourage participation in
professional and liberal
education;
. to provide liaison with other
organizations concerned with
nursing;
. to assist in and/or initiate
nursing research.
CUNSA has over 5000
members from 22 universities.
Students registered in a program
of basic nursinl or post basic
studies at aCanadian university
become members by joining the
nursing student association of
their own university.
Membership fees are paid by
member universities. The fee is
$1.00 a year per student So that
the university pays a fee
according to student enrollment.
CUN SA is divided into four
regions: Atlantic, Quebec,
June 1171 11
Ontario and Western regions.
Each has a regional chairperson
and research representative.
Annual meetings provide
members with time for sharing
ideas, concerns and information
CUNSA is aßUiated with
CAl'SN.
National chairperson:
Cindy Telfer
Lakehead University Residence
Thunder Bay, Ontario
P7B 5EI
NATIONAL COMMITTEE OF
CANADIAN NURSE MIDWIVES
This group has a loose structure
and is composed of
representatives from three
nurse-midwife associations:
Atlantic, Ontario and Western.
Formation of a national
association of nurse midwives is
still under discussion. September
of 1978 saw four Canadian
nurse-midwives representing
Canada at the International
Congress of Midwives. Concerns
of the group include education for
nurse-midwives, recognition of
the nurse-midwife role,
humanizing hospital births and
home births.
ChairlDlIn:
Patricia Hayes
Faculty of Nursing
University of Alberta
Edmonton, Alberta
TfG 2G3
NATIONAL CONFERENCE OF
OPERATING ROOM NURSES
This group is the newest ofCNA's
atTtJiates. On a national level, its
structure is still a loose one, as
each province is relatively
autonomous. Operating room
nursing groups are active in every
Canadian province. Every second
year the national group meets in
the host province. The National
Conference of Ope rating Room
Nurses is chiefly concerned with
continuing education forO.R
nurses with high standards of care
in theO.R., and with increased
opportunities for communication
betweenO.R. nurses.
National Chairman:
Jean Mitchell
12 June 11179
President
Operating Room Nurses of
<Jreater1roronto
North Yort<Jeneral Hospital
4001 Leslie Street
WiUowdale, Ontario
M2K lEI
NURSING SISTERS
ASSOCIATION OF CANADA
After World War I, nursing sisters
in several Canadian cities
organized clubs or groups to
continue friendships begun
overseas and to assist those in
need of help. Nurses in Edmonton
were the first to form a group in
April of 1920, and subsequently
clubs formed in Montreal,
Calgary, Winnipeg, Brandon,
Halifax, St. John and Toronto,
Vancouver, Victoria, London and
Hamilton. The National
Association of Overseas Nursing
Sisters was formed at the
International Congress of Nurses
held in Montreal in July 1929. The
name was later changed to the
Nursing Sisters Association of
Canada and its members include
all nursing sisters honorably
discharged from the three military
services.
The objectives of the group
are:
. to stimulate friendship among
members;
. to wort for national unity and
international peace; and
. to give aid and comfort to
nurses in need.
The association has 850
active fee-paying members, plus
honorary members from World
War I who do not pay fees. Each
provincial unit operates
independently and the National
Association holds biennial
meetings during the Canadian
Nurses Association biennial
conventions. The association is
affiliated with the National
Council of Veteran Associations
of Canada.
The association supports the
Agnes Campbell NeiU Memorial
Award, awarded through the
Canadian Nurses Foundation
every two years.
President:
<JraceClarke
4759 Piccadilly Road South
West Vancouver, B.C.
V7W U8
Secretary-treasurer:
Eileen Shaw
8500 Francis Road
Richmond, B.C.
W6Y IA6
PSYCHIATRIC NURSES
ASSOCIATION OF CANADA
The Psychiatric Nurses
Association of Canada exists for
nurses whose primary concern is
mental health. The group has a
The C.nlldl.n Nur..
current membership of 5,000 and
is made up of an almost equal
number of men and women. Any
psychiatric nurse who is a
member of a provincial
psychiatric nurses association
affiliated with PNAC is also a
member of the national
association.
The association has a
national office, a bi-monthly
publication - The Canadian
journal ofpsychÜJtric nursing-
and sponsors research and
meetings aimed at improved
national standards of psychiatric
care.
The national association had
its beginnings in 1950, when
representatives of the B.C. and
Saskatchewan associations met
and made plans to form the
Canadian Council of Psychiatric
Nurses (The name was changed to
its present form in 1965). After the
195 I founding conference,
attended by delegates from B.C.,
Saskatchewan and Alberta,
Manitobajoined in 1960, Ontario
in 1971 and Nova Scotia in 1974.
Northwest Territories was
admitted as an associate member
in 1977.
President:
Aurelia Rust
871 Notre Dame Avenue
Winnipeg. Manitoba
R3E OM4
REGISTERED NURSES OF
CANADIAN INDIAN
ANCESTRY
August 1975 marked the first time
in history that professionals of
native ancestry in Canada met for
a national assembly. It was in
International Women's Year that
RNCIA began as 43 nurses of
Canadian Indian Ancestry met to
explore the issues surrounding
Indian health.
Among the objectives of the
group:
. 10 act as an agent in
promoting and striving for better
health for the Indian people;
. to conduct studies and
maintain reporting on Indian
health. medicine and culture;
. to encourage and facilitate
Indian control ofindian health.
involvement and decision-making
in Indian health care;
. to actively develop a means
of recruiting more people of
Indian ancestry into the medical
field and health professions;
. to generally develop and
maintain on an ongoing basis a
registry of Registered Nurses of
Canadian IndiaÍ1 Ancestry .
President:
Tom Dignan
No.5 Chateau Court
Hamilton, Ontario
L9C .5P3
VICTORIAN ORDER OF
NURSES FOR CANADA
The YON has a long history of
providing health care in Canada.
It was formed in 1897 by Lady
Aberdeen. the wife of
<Jovernor-General Aberdeen, at
the request of Canadian women.
The association was begun so that
nursing care could be extended
into the home in days when
individuals could not reach a
physician or hospital for care.
The first 12 nurses were
admitted to the YON agency in
November of 1897; five months
later. four nurses reached the
Klondike gold fields to help care
for injured and ill miners . Today,
the agency serves Canadians
through 73 branches which
employ 725 full-time nurses.
YON nursing programs are
structured according to the needs
of the individuals of each
community served. Nursing care
is given mainly in homes, but also
in schools, child care centers,
immunization clinics and in
industry .
The agency is a volunteer and
non-profit organization. Finances
are received from patients who
pay fees according to their means,
from health insurance coverage.
government health assistance
plans and public gifts and
contributions. In 1978, the YON
served 87,924 patients who
received as many as 1,503,121
visits.
Write:
Victorian Order of Nurses for
Canada
5 Blackburn A venue
Ottawa, Ontario
KIN 8A2
NaoonaJ Director:
Ada MacEwan
President:
R.<J. Smethurst
INTERNATIONAL
ASSOCIATIONS - CANADIAN
DIVISIONS
AMERICAN ASSOCI
TION OF
CRITICAL CARE NURSES
CANADIAN CHAPTER
With a membership of over 33,000
nurses in 200 chapters, the
American Association of Critical
Care Nurses is the world's largest
nursing special interest group.
The philosophical framewort of
the group centers on a holistic
approach to caring for the critical
care patient. Its aims include:
. high standards of critical
care;
. continuing education;
. setting educational standards
of critical care personnel;
. establishing a vehicle for
effective communication between
nurses and others involved in
critical care; and
. promoting scientific
investigation in critical care
nursing.
Canada's chapter of this
group is Toronto-based and has
been growing since 1975; there are
now 102 Canadian members.
Fees: Canadian members pay $35
per year, and American members,
$30. Members receive the
publication Heart and Lung,
self-assessment guides, Focus, a
bimonthly newsletter. and a core
curriculum of critical care nursing
at reduced cost. They may attend
a yearly five-day teaching seminar
that is educational in nature.
Contact:
June Williams
Toronto Chapter
P.O. Box 37, StationZ
Toronto, Ontario
M5N 2Z3
ASSOCIATION FOR THE CARE
OF CHILDREN IN HOSPITALS
ACCH is an international
interdisciplinary organization
focusing on the psychosocial
needs of children and their
families in health care settings.
Founded in 1965, the association
has more than 2000 members,
including 200 Canadians.
Members include individuals in
the fields ofadministration,
architecture, child life activities,
dietetic. education, medicine,
nursing, occupational therapy.
psychiatry, psychology.
recreation. rehabilitation, social
work and others, as well as
parents and concerned
consumers. Full individual
membership costs $30. Members
receive a quarterly journal
containing research articles, a
bi-monthly newsletter, an
opportunity for multidisciplinary
interaction and legislative input,
current publications available at
minimum fees and eligibility to
attend study sections that focus
On specific issues. There is also an
annual four-day conference, held
this year in Los Angeles.
Members of ACCH beCome
members oflocal aft-.liates,
whenever a neamy affiliate exists;
these local groups have
educational meetings, raise issues
of community interest and
propose solutions specific to that
region.
Cootac:t:
Cathy Morrioh
Six South Medical
lsaaj. Walton Killam Hospital for
Children
P.O. Box 3070
Halifax. Nova Scotia
B3J JG9
INTERNATIONAL
ASSOCIATION OF
ENTEROSTOMAL
THEÀAPISTS (CANADIAN
DIVISION)
In 1968 this association began to
bring together the few trained
entorostomal therapists who were
attempting to rehabilitate those
who had had ostomy surgery. The
only training school at the time
was at Cleveland Clinic in Ohio.
The association now has about
1.000 members. mostly in the
United States and Canada.
The group aims to facilitate
contact between members. to
encourage continuing education,
to influence the medical
community and manufacturers of
ostomy supplies. and to ensure
effective enterostomal therapy
around the world. The group
offers members eligibility to
attend the annual conference and
meeting. continuing education,
the E.T. journal. a quarterly
publication soon to become
bimonthly. and scholarships for
E.T. training. Current fee: S40 per
year. This fee covers subscription
to the journal and a return onlO
to the region.
IAEf has 12 regions: II in
the U.S. and one in Canada. The
Canadian region has 75 active
practicing enterostomal
therapists. its own executive. an
annual membership meeting and
mid-year board meeting usually
held with a seminar. and a
newsletter"The Link" published
every two months.
President:
Aileen E. Barer
Canadian Association of
Enterostomal Therapists
Enterostomal Therapy Centre
Royal Jubilee Hospital
Victoria. B.c.
V8R U8
The C.necllMI NurM
NURSES ASSOCIATION OF
THE AMERICAN COLLEGE OF
OBSTETRICIANS AND
GYNECOLOGISTS
The purpose ofNAACOG is to
promote. in conjunction with the
American College of
Obstetricians and Gynecologists.
the highest standards of obstetric.
gynecologic and neonatal nursing
practice and education; to
cooperate at all levels with
qualified physicians and nurses;
and to stimulate interest in
obstetric. gynecologic and
neonatal nursing.
There are eight geographic
districts, divided into sections
which are comprised of separate
states and Canadian provinces. all
organized to make continuing
education readily accessible to
members. The association has
more than 17.000 members in the
U.S. and Canada. Fees: $36 per
year.
Director:
Ruth Young
1 East Wacker Drive
Suite 2700
Chicago. Illinois 60601
U.S.A.
Canadian contact:
Doris Sampson
5821 University Avenue
Grace Maternity Hospital
Halifax. N.S.
B3H IW3
or
Dorreen Jordan
North Health Unit
1720Grant St
Vancouver. B.C.
VSL2Y7
June 11179 13
PROVINCIAL, TERRITORIAL AND
LOCAL AS S OCIATIONS
BRITISH COLUMBIA
British Columbia Emergmcy
Nurses Group (RNABC Affiliate)
Pt?sident: Patricia McGuire
Contact: Fran Wyatt
Corresponding
Secretary
P.O. Box 86824
North Vancouver. B.C.
V7L 4L3
British Columbia NuniDg
Supervisors Group (RNABC
Affiliate)
President: Susan Wiebe
I I 764-83A Avenue
Delta. B.C.
V4C ZTI
British Columbia Occupational
Health Nunes Interest Group
(RNABC AffIliate)
Chairman: Mary Chambers
440 Fairway Street
Coquitlam, B.C.
V3K4G2
Secrerary: Jo Bruce Thomas
British Columbia Ucen!led
Practical Nurses As8odation
President: A. Magnone
P.O. Box 646
Ladysmith. B.C.
VOR 2EO
British Columbia OperatiDg Room
Nurses Group (RNABe AffIliate)
President: Mary Heal
S321-IOA Avenue
North Delta. B.C.
V4M IYS
Community Health Nunes Group,
British Columbia (CHNG)
Contact: Joey Williams
20Coote Street
Chilliwack. B.C.
V2P6B3
Feminist Nurses
2822 West King Edward Ave.
Vancouver, B.C.
V6L 11'9
Nursing Administrators
Auodation of BrItish Columbia
President: Maude Dolphin
Director of Nursing
Maple Ridge Hospital
Maple Ridge. B.C.
V2X XìS
Registered Psychiatric Nurses
AssocIation of British Columbia
7790 Edmonds Street
Burnaby. B.C.
V3N I B8
Executive Director: D.L.
Wenham
ALBERTA
Alberta ASMM:Iadoa of Rql5lered
Nunina AIsIstaots
1143S-I07th Avenue
Edmonton. Alberta
TSH OY6
President: Mary-Ellen Rl\Ïotte
Alberta Community Health Nunes
Society
President: Pat Netzer
Public Health Nurse
City of Edmonton
Edmonton, Alberta
I '!formation Officer:
Dorothy Chisholm. P.H.N.
Faculty of Nursing
University of Calgary
Calgary. Alberta
TIN IN4
Alberta Occupational Health
Nurses Assoc:iatlon
President: Ruby Meunir
c/o Occupational
Health Services
Red Deer Health Unit
4749-32 Street
Red Deer. Alberta
T4N SVI
COllSOrtium of Nurse Educators,
Alberta (COSNE)
Chairman: Shirley Shantz
Coordinator - Nursing
Red Deer College
Red Deer. Alberta
T4N SHS
Emergency Nurses Interest Group
of Alberta
Contact: Glenda Wade
8520-134 Avenue
Edmonton. Alberta
TSE IH2
Infection Control Nurses, Calpry
Group
Contact: Ursula Ruskouski
Infection Control &
Staff Health Nurse
AlbertaChildren's
Hospital
1820 Richmond Road
S.W.
Calgary, Alberta
TZT SC7
Infection Control Nurses of
Edmonton
ChaIrman: Ellen Brobery
c/o Charles Camsell
Hospital
12815-115 Avenue
Edmonton. Alberta
TSM 3A4
North Central Operating Room
Nurses of Alberta
Contact: Mrs. Shewchuk
RR3
Sherwood Parle. Alberta
14 June 1171
Operating Room Nurses of Alberta
Pre sident: Dorothy Orr
Provincial Executive
Committee
Box 535
Brooks, Alberta
TOJ OJO
Orthopedic Nuning Interest
Group, Alberta
c/o AARN
10256-112 Street
Edmonton, Alberta
TSK IM6
Contact: Mary Bekker
Station 46
University of Alberta
Hospital
84 Ave. & 112 St.
Edmonton. Alberta
TfG 2G3
Psychiatric Nurses Association of
Alberta
Secretary: Mrs. E.L Sarkany
P.O. Box 755
Ponoka. Alberta
TOC 2HO
Executive Director:
Eldon I. Neufeldt
Western Midwives Association
Pre.fident: Judy Friend
c/o School of Nursing
University of Alberta
Edmonton. Alberta
TfG 2EI
SASKATCHEWAN
Infection Control Nurses,
Saskatchewan
Contact: Laura Black/Jean
Harper
Continuing Medical &
Nursing Education
Plains Health Centre
4500 Wascana Parkway
Regina, Saskatchewan
S4S 5W9
Saskatchewan Nuning Assistants
Association
2066 Retallack Street
Regina, Saskatchewan
S4T 2 K2
PresIdent: Velma Frey
Saskatchewan Psychiatric Nurses
Association
6-1651- IlthAvenue
Regina, Saskatchewan
S4P OH5
Executive Director:
H. Beauregard
President: Nancy Redekop
The Cenedlan Nur..
MANITOBA
Association for the Care of
Children in Hospitals (Manitoba)
President: Ruth Kettner
Director of Child Life
Health Sciences
Centre
Children's Centre
685 Bannatyne A venue
Winnipeg, Manitoba
R3E OWl
Cardiovascular Nqrses (Manitoba)
Contact: Erna Schilder
Faculty of Nursing
University of Manitoba
Winnipeg, Manitoba
R3T 2N2
Directon of Nuning Education
(Manitoba)
Chairman: Jessie Hibbert
Director
School of Nursing
Health Sciences
Centre
700 William Avenue
Winnipeg. Manitoba
R3E (JT2
Infection Control Interest Group
(Manitoba)
Contact: Lynn McClure
48 Cordova St.
Winnipeg, Manitoba
R3N OZ8
Manitoba Association of Ucensed
PracticaJ Nurses
5-130 Marion Street
Winnipeg, Manitoba
R2H OT4
President: D. Vuel
Manitoba Health Care Inservice
Contact: Diana Warrington
Director,lnservice
Education
Deer Lodge Hospilal
2109 Portage A venue
Winnipeg, Manitoba
R3J OZ9
Maqitoba Indian Nurses
Association
Contact: Jocelyne Bruyere
500-275 Portage A venue
Winnipeg. Manitoba
R3T 2N2
Manitoba Operating Room Study
Group
President: Charlotte Sutton
c/o S1. Boniface
General Hospital
409 Taché Avenue
Winnipeg. Manitoba
R2H 2A6
Nurse Practitioners Interest
Group. Province of Manitoba
Chairman: Margaret Nixon
33 FerndaleAve
Winnipeg, Manitoba
R2H 1T7
Profe IOnal development hw. many face Ail as ociation.. of
profe' ...mal nurse:. In Canada strive to promote health and to
ek conditions conducive to the best possible patient care. But
the leading role in this endeavour is taken by the Canadian
Nur
"
..ociàûon and its 11 member associations. What these
W''òoclations offer io: a chance to influence the shape of nursing
now and in the future through shared concerns about the
qualit} and quantity of nurses available to the health team,
standards of preparation and performance of profeSl>ional
nurses. social and economic welfare ofnurse!t, advancement of
knowledge techniques and competence within the profession,
and promotion of understanding, unity and good professional
citozenship among its members.
Nuning Administration
(Manitoba)
Chairman: Minnie Janzen
Box 207
Blumenort. Manitoba
R3E (JT2
Occupational Health Nurses
(Manitoba)
Dorothy Creek
923 Dugas St.
Winnipeg, Manitoba
R2J OZ9
Personal Care Homes Interest
Group
Middlechurch Home of Winnipeg
Balderstone Rd.
Middlechurch, Manitoba
President: Beryl Wales
PhiUipplne Nur!ie'i Association,
Manitoba
Winnipeg Municipal Hospital
Nurses Residence
3d Floor, Modey Ave. East
Winnipeg, Manitoba
President: Victoria Nicholas
Registered Psychiatric Nurses
Association of Manitoba
871 Notre Dame Avenue
Winnipeg. Manitoba
R3E OM4
Executive Director:
Mrs. A.Osted
RespiratolJ' Interest Group,
Winnipeg, Manitoba
Contact: Margaret Thomas.
Chairman
Physiotherapist
Canadian Arthritis and
Rheumatism Society
825 Sherbrook St.
Winnipeg, Manitoba
R3G2L3
Winnipeg Association of Critical
Care Nurses (W ACN)
President: Ruth Seimsky
Grace General
Hospital
Intensive Care Unit
300 Booth Dr.
Winnipeg, Manitoba
R3J 3M7
ONTARIO
Association of Nursing Directon
and Supervisors of Official Health
Agencies (ANDSOOHA)
President: J. Keslick
176 Valley Road
Willowdale. Ontario
M2L IG4
Association of Nuning Executives,
Metropolitan Toronto
Chairman: C. McGregor
Central Hospital
333 Sherbourne Street
Toronto. Ontario
M5A 2S5
Clinical Nurse Specialist Interest
Group (RNAO Affiliate)
Chairman: Judith C. Britnell
38 Strathgowan Ave.
Toronto, Ontario
M4N IB9
Community Mental Health Nurses
Association of Ontario (RNAO
Affiliate)
President: Vi Spooner
235 Baseline Road East
London, Ontario
N6C 2N6
or
c/o London Psychiatric
Hospital
London, Ontario
N6A 4HI
Emergency Nurses Association of
Ontario (RNAO Affiliate)
President: Sandra L. Easton
Contact: Mary Arntfield
Business Secretary
36-1764 Rathburn Rd
Mississauga, Ontario
L4W 2N8
Registered Nurses -\s..ociation
of British Columbia
:! 130 We..t I :!th A venue.
V,lßcouver. B.C Vf>", :!N3
Execlitil'e Director - Mdrilyn
Carmack
Memht>nhip - IfI.f>9'\
AI
rtÐ Association of
Registered Nurses
1O:!56 - 112th Street.
Edmonton, Alta.. TS'" IM6
Execlitil'e Secreltlry -
Yvonne Chapman
Membership - 13.6f>1
skatchewan Registered
Nurses Association
2066 Retallack Street
Regina. Sa..k.. S4T :!K:!
Execlitil'e DireOor - Barbara
Ellemers
Membership - 7,373
As!>OCialion of "I/urses of Prmce
Edward Island
41 Palmer; Line.
Ch"rlolletown. P.E.I
CIA SY7
ExeclIti\'e Set retllr\'-ReJ(iltmr
- Laurie Fra
er
.'I,lembership -967
Registered "I/urses A,sociation
of Ontario
33 Price Street. Toronto.
Ontario. M4W In
Ereclitil'e Director-
Maureen Powers
Wembership - 14.00:!
Northwest Territories
Registered Nurses Association
Box 2757, Yellowknife,
N.W.T.,XOE IHO
Execlltil'e Director-Rej!istrar
- Mary Lou Pilling
Membership-219
CANADIAN NURSES ASSOCIATION
The spokesman at the national and international level for
professional nursing in Canada, CNA is a federation of eleven
member associations and is financially supported by membership
fees collected by these associations.
As members of their provincial/territorial association, nurses
are entitled to the following services from CNA:
LIBRARY
Canada's only national nursing library now contains more than
12,000 books and documents and close to 500 periodicals. Also
housed in the library are the nursing archives and national repository
collection of nursing research studies.
INFORMATION
The Canadian Nurse and L'i'lfirmière canadienne boast a combined
circulation of more than 137,000 and are distributed in
approximately 100 countries of the world.
LABOR RELATIONS
Data collection and analysis, information and education programs
and research activities are carried out by this unit ofCNA staff.
bringing together information provided by professional associations,
collective bargaining conference members. federal and provincial
labor departments, national unions and other sources.
NATIONAL TESTING SERVICE
Machine-scored objective-type examination. in English and French
are prepared and processed for registering and licensing authorities
for both nurses and nursing assistants wishing to enter the
profession.
LIAISON
CNA maintains liaison with most departments of the federal
government as well as more than 100 Ottawa-based health-related
agencies and organizations. A member of the International Council
of Nurses, CNA represents the nurses of Canada at the international
level and communicates with other international organizations
active in the health field
I
Registered Nurses AssocIation
of Nova Scotia
6035 Coburg Road
Halifax. N.S., B3H IY8
Executil'e Secretary -Joan
Mills
Membership -6,518
"IIew Brunswick Association of
Registered Nurses
231 Saunders Slreet,
Fredericton, N.B., E3B IN6
Executil'e Secretary -
Mari!yn Brewer
Membership -4,871
!\-lanitoba Association of
Registered Nurse!>
647 Bro,ldway Avenue.
Winnipeg. Mdn.. R3C OX:!
Ereclitit'e Director-
M. LouiseTod
Membenhip -7.f>93
Ordre des inlirmières et
inlirmiers du Québec
4:!00 Dorchesler ouest. bd.
Monlreal, Quebec. H37 IV4
E-.:ecutil'e Director lInd
Secretan' of the Order-
Nicole Du Mouchel
Membership - 45,782
Association of Registered
Nurses of Newfoundland
67 LeMarchant Road, St.
John's, Nfld., A IC 6A I
Executive Secretary - Phyllis
Barrett
Membership -3,715
18 June 111711
Gerontological Nuninl
A_ociation or Ontario
P.O. Box 368
Postal StatIon K
Toronto, Ontario
M4P 1G7
President: Barbara Jensen
Ontario Association of Registered
Nursing Assistants
112 Merton Streei
3rd Floor
Toronto,Ontwño
M4SIAI
President: Mrs. M. McDavid
Ontario Community Mental
Health Nunes Association
President: Lynda Hessey
2 Farnham A venue,
Apt.69
Toronto, Ontario
M4V IH4
Ontario HospltaJ Association,
Nursing Administration Section
Chairman: Jean Pain
Director Nursing
Service
Brantford General
Hospital
200 TerTaCe Hill Street
Brantford,Ontwño
N3R IG9
Ontario Lulll Association, Nunes
Section
President: Jean BuIler
Sr. Nurse
Epidemiologist
Borough of East York
Health Unit
550 Mortimer Ave.
Toronto, Ontario
4J 2H2
Ontario Nurse Midwives
Association (RNAO Affiliate)
President: May Toth
9 Richmond St.
Hamilton, Ontario
LSP 4J3
Ontario Occupational Health
Nunes Association
President: Grace BlackweIl
Contact: Sylvia Matchett
3209 Rymal Rd.
Mississauga, Ontario
L4Y 388
Operating Room Nurses or Greater
Toronto
President: Jean Mitchell
North York General
Hospital
4001 Leslie Street
Willowdale, Ontario
M2K lEI
The Cenadlan Nur..
HamUton Area Intenst Group or
Orthopedic Nunes Asøodation
President: Irene Cummings
Hamilton, Ontario
Contact: The Canadian
Orthopedic Nurses
Association
43 Wellesley Street East
Toronto,Ontwño
M4Y 1H I
HospltaJ Health Nurses Group,
Southwest Ontario
Chairman: Gwen Carville
clo Our Lady of
Mercy Hospital
100 Sunnyside Ave.
.Toronto, Ontario
M6R 2N8
Lakehead Operating Room Nurses
Association (LORNA)
Contact: Valerie Laakkonen
O.R. Nurse
General Hospital of Port
Arthur
Thunder Bay, Ontano
P7A 4X6
Metro Toronto In-Service
Educators Association
Secretary: N. Geddes
Ontario Crippled
Children's Centre
350 Ramsey Road
Toronto, Ontario
M4G IR8
Northern Ontario Operating Room
Nunes
Contact: Mrs. Perry
O.R. Supervisor
Kirkland &District
Hospital
145 Government Road
E.
Kirkland Lake, Ontano
P2N IR2
Northwestern Ontario
Occupational Health Nurses
Association
Contact: Monica McComber
Confederation College
P.O. Box 398
Station F
Thunder Bay, Ontario
P7C4WI
Nurse Practitioner Association of
Ontario (RNAO Affiliate)
President: Suzanne Finnie
Membership Chairman:
Jenny Rypma
10 First Ave.
Burford, Ontario
NOEIAO
Nunes for We
Contact: Marilyn Marcotte
clo Obstetrics Unit
St. Joseph's Hospital
London,Ontwño
N6A 4V2
Nursing Administrators Intenst
Group, Ontario (NAIG)
Contact: Dorothy Wylie
Vice-President, Nursing
Toronto General
Hospital
101 CoIlege Street
Toronto, Ontario
MSG IL7
Psychiabic Nunes Asøodation of
Ontario
P.O. Box 2103
Station B
Scarborough, Ontario
MIN 2E5
Executi"e Director: M. Oke
Psychiatric Nllrsing Interest
Group, Ontario
2350 Dundas St. W.
Apt. 2703
Toronto, Ontario
M6P 4BI
Chairman: Anne Harris
PubUc Health Nunes Interest
Group (RNAO AffI1iate)
Secretary: Diane Bean
304-11 Oriole Parkway
Toronto, Ontario
M5P 1G9
Registered Nunes In Private
Practice (RNAO Interest Group)
Chairman: Leonida Hudson
509-810 Edgeworth
Ave.
Ottawa, Ontario
K2B 5LS
Toronto Area Interest Group or the
Orthopaedic Nurses Association
40 Holmwood Ave.
Apt. 102
Toronto, Ontario
M4Y 2K2
President: Heather Reuber, O.R.
St. Michael's Hospital
Toronto. Ontario
Secretary: Miss J. Osborne
Toronto Area Nursing Education
Administrator Group (RNAO
A ffI1iate)
Chairman: Susan Reimer
clo Sheridan School of
Nursing
2186 Hurontario St.
Mississauga, Ontario
LSB IM9
QUEBEC
Association des inftrmlères
Uceodees pour øervlce prlvé en
nursing, Le réglstre VIIIe-Marie
Inc. de...
IIH8 est, rue Sherbrooke
Montréal, Québec
H2K I B3
Prisidente, Lucille Hétu
Association des infirmlères et
Inftrmlers en santé du travaU du
Québec Inc.
Présidente: Germaine G.
Painchaud
Case Postale 218
Succursale
Outremont
Montréal, Québec
H2V 4M8
Association des
infirmières-sages-femmes du
Québec
Présidente: Madame F.G. Cooper
526-39th Ave.
Lachine, Québec
HST 2EI
Comlté des sages-femmes
c.P. 121
Succursale St. Martin
Montreal, Québec
H7V 3P4
Corporation professionneUe des
inftrmières et inftrmiers auxUiares
du Québec/Professional
Corporation of Nursing Assistants
of Quebec
1980 ouest, rue Sherbrooke
Suite 920
Montreal, Québec
H3H IE8
Présidente: Mme C. O'Rourke
Infirmlères hatlennes de Montréal
Contact: Lucille Charles or
Ghislaine Télémaque
2204, Chemin Oka
Deux-Montagnes,
Québec
J7R IN7
Oncology Nursing SocIety,
Montreal Area
President: Jennie E. MacDonald
Oncology Day Centre
Royal Victoria
Hospital
687 Pine Ave. W.
Montreal, Quebec
H3A IA I
Operatmg Room Nurses Group or
Quebec/Le groupe des inftrmières
des salles d'opération du
ébec
ContaCl: Mrs. J. Veronneau
Montreal General
Hospital
Operating Room
1650 Cedar Ave.
Montreal, Quebec
H3G IA4
(continued on page 50)
,'f' ,
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several times a day
when once a week is plenty!
This is an Op-site dressing for non-infected ulcers.
When it goes on, it stays on... for a whole week.
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interruptions of frequent dressing changes.
Op-site is easy on the patient too. It's neat, not bulky.
Patients can take regular baths or showers without
discomfort because Op-site is water-proof. Op-site is
also bacteria-proof, protecting the ulcer from
contamination.
Because once a week is plenty. Op-site means fewer
dressing changes. And that's less work and more time
for you.
--------------------
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ix?ut I I
I Op-slte ulcer dressing, fdlln
I the ultimate wound dressing and mail this coupon, I
I Name I
I
I Hospital Affiliatio n I
I
I Address I
I City Prov._Cod e I
I Mail to. [8] '--", Sm'th&Nephewlnc 2100.52ndAvenue I
. : S
II' Mediclill Division Lachine. Qu
. CZ!lnllda I
I .'. .' HaT 2Y5
--------------------
18 June 1979
The Ce...dlen Nur..
Spotting and helping the
learning disabled child
We are all different. We are all the same
Mildred C . Jacobson
George Gasek
Margaret S. is a public health
nurse with a regional health unit
in one of our large Canadian
cities. Five mornings a week she
works out ofthe nurse's office of
one of the elementary schools in
"her" area of the city. On this
particular Tuesday morning her
first appointment is with one of the
21 first-graders at the largest of
these schools.
Ronnie's teacher is concerned
because he can't seem to keep up
with the other children in his class.
She complains that he daydreams,
he acts younger than the other
children in the class and now,
after almost a year in grade one,
he still can't read even simple
words and when he tries to print
he gets the letters all mixed up.
From talking to his parents,
Margaret knows that they are
worried and puzzled, too. Until he
started school last Fall, Ronnie
seemed peñectly normal,
brighter, even, than his two older
sisters. Now, obviously upset and
frustrated by his inability to learq
like the other children in his class,
Ronnie is becoming more and
more withdrawn, preoccupied and
sullen.
Margaret is puzzled too. She
knows that Ronnie's general
health is good. His hearing is
satisfactory. He eats well and gets
adequate rest. Why then can't he
"catch on" like the other children
. I his class?
If Ronnie is lucky, Margaret
will remember hearing or reading
about the learning disabled child.
She will recall that between 10 and
15 per cent of all children are
thought to sutTer some form of
learning disability. She will kno\\-
too that, although the range of
disabilities is wide, the end result
for many of these children is the
same - failure to realize their
cademic potential.
Margaret will realize that the
kind of assessment which will help
Ronnie to conquer his learning
problems can only be carried out
by a team that includes
psychologists, remedial teachers,
and his parents as well as health
professionals. Ronnie is going to
need all the help he can get, not
just for the next few months, but
probably into his adolescence.
Reading, spelling and arithmetic
are going to present a major
challenge to him. Literacy
sometimes takes years for these
children to achieve and many
continue to read slowly and
laboriously even as adults.
Most of all, though, Ronnie is
going to need support,
understanding and
encouragement from his parents,
his classmates and school officials
so that he can make the most of
whatever potential he has to
become a well-adjusted and
self-confident person.
The Cen.dlen Nur..
June111711 19
Not so long ago. underachievers like
Ronnie were given short shrift in our
educational system. They were labelled
"dull" or "lacking academic potential"
or some similar term and relegated.
usually. to the back of the classroom.
Today. although there is still much to be
discovered about learning disabilities -
how they occur and how to deal with the
problems that result - educators and
psychologists have begun to find some of
the answers to helping these children
overcome their handicap.
What is a learning disabled child? In
looking at this question it may help, first
of an. to determine what he is NOT He
is not. for example. retarded,
emotionally disturbed. lazy.
unmotivated or stupid. Nor is he
necessarily poorly coordinated or
hyperactive. The term learning disabled
is applied to a child who is average or
above average in general intellectual
abilities but who presents with specific
learning and behavioral disabilities. One
Canadian author describes it this way:
" ...a permanent difficulty in
perception. conception or motor
expression, both with verbal and
non-verbal material. which
inteneres with normal academic
learning. Children with these
types of handicaps usually
cannot profit very much from
normal teaching methods, and
the permanence of their disability
suggests an existing physiological
abnormality that impairs normal
neurological function.
Neurological damage or
dysfunction can be identified in
about half of underachievers. ..t
Researchers still cannot agree on what
causes these on-going disorders in the
child's brain or central nervous system
The United States Department of Health
Education and Welfare comments:
"These aberrations may arise
from genetic variations.
biochemical irregularities.
perinatal brain insults, or other
illnesses or injurie.i sustained
during the years which are
critical for the development and
maturation of the central nervous
system, or from unknown
causes. "2
Among the physiological or organic
factors that have been implicated in
learning disabilities are: brain damage or
dysfunction, genetic defects. endocrine
gland dysfunction. malnutrition. lead
poisoning. radiation stress, sensory
defects. maternal drug consumption.
smoking and drinking. 3
For the nurse who is concerned
about spotting the child with a learning
disability, identifying his problem and
helping to involve him in some type of
remedial program. the nine clinical
syndromes described below may provide
the clue she needs to recognize a learning
disabled child:
I. Visual disability: These children
typically have reading problems because
they are unable to discriminate between
similar looking letters and numbers, for
example. p, b, d. 9. Similar difficulties
occur with geometric shape
discrimination. Thus, they will be unable
to differentiate between squares.
rectangles, triangles, etc. Many of these
children also have problems with visual
memory; that is. remembering visually
presented information.
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2. A uditory disability: These children
frequently misunderstand what is said to
them because they cannot discriminate
between similar sounding speech
sounds, for example. p and b. t and d.
Consequently, they may hear the word
buy as pie or two as do. There is also a
problem with auditory memory for many
of these children that results in an
inability to correctly remember a series
of things said to them.
3. Eye/hand incoordination: These
children an
seen as being somewhat
clumsy. They spill thing" easily, have
difficulty catching a ball, are unable to
write or color within the lines, cannot
copy words or pictures from a
chalkboard onto a piece of paper.
4. Spatial disorientation: These children
cannot discriminate between right and
left, up and down, under and over,
around and through. etc. Because they
are unsure of their spatial relationship to
other objects, they tend to bump into
things and trip over objects.
5. Temporal disorientation: These
children have a poor concept of time.
They do not know the relationship
between seconds, minutes and hours or
days, weeks, months and years. They
have difficulty injudging the duration of
activities.
6. Hyperactivity: These are the children
who seem to be in perpetual motion.
They are fidgety. restless. distractable
and inattentive. They have short
attention spans and talk constantly.
Much of their behavior is impulsive and
leads to antisocial acts such as hitting
and stealing.
7. Speech and language disabilities:
These children may have difficulty in
formulating the message they want to
express or they may express their ideas
very ungrammatically and immaturely.
On the other hand. they may have a great
deal of difficulty in making sense out of
what is being said to them. In addition to
such language problems, these children
may also have speech problems where
they misarticulate sounds to the point of
being totally unintelligible.
8. Perseveration: These children have a
great deal of difficulty in shifting or
moving from one activity to another.
Because of this they are often seen as
being hypoactive and generally slow
moving.
9. General motor incoordination: These
children are very clumsy in both fine and
gross motor ability. They have difficulty
in running, skipping, hopping, block
building, walking straight lines, etc.
-
20 June1171
The Cened.n ......
Living with their handicap
In addition to these specific disabilities,
learning disabled children often develop
a number of secondary emotional
problems. Because they know they are
different from other.children, that they
cannot learn as fast as their peers, these
children become convinced that they are
stupid and inadequate. They lose their
self-confidence and self-esteem. This is
further compounded by the teasing they
must often put up with. They become
frustrated and anxious about their social
and academic inabilities and,
consequently, get no feeling of
accomplishment. Eventually, many are
so demoralized that they develop
delinquent tendencies and a distrust of
adults, even those closest to them.
The children themselves are not the
only ones adversely affected by their
disabilities. Very often their parents are
also victimized by their children's
learning disabilities. Because learning
disabilities are frequently not recognized
for what they are, the parents are
accused of being ineffectual, poor
disciplinarians, and uncaring. When they
seek help and understanding for their
children's "peculiar" behaviors, they
are labeled aggressive, overanxious and
neurotic. When, on the other hand, a
diagnosis of learning disability has been
made, the parents are often regarded as
being unrealistic in their expectations for u
their children. Many parents feel guilty
and wonder where they went wrong in
their child rearing; often this guilt is
reinforced by relatives and
professionals. Because professionals
cannot agree about these childrens'
problems, the parents frequently find
themselves in the frustrating position of
receiving different and even
contradictory information and advice
from them.
Cause and effect
Although the exact cause of learning
disabilities is not known for certain, it is
generally assumed that these disabilities
are associated with a functional
deviation of the central nervous system.
The fact that almost all the synonyms for
learning disability in common use today
(minimal brain dysfunction or damage,
neurological, perceptual or educational
handicap. for example) are neurologic
labels is certainly indicative of this
assumption. Actually, in most cases of
learning disabilities, no neurologic i'!iury
or damage can be found. Rather, this
assumption is based on the observation
that these learning deficits are very
similar to those seen in children who do,
in fact, have known brain damage.
h has also been suggested that
learning disabilities may be related to
nutritional deficits. Malnutrition in
mothers prior to and during pregnancy
has been shown to affect the learning
abilities of their children. 4 We are what
we eat, as one observer has noted, and
the learning ability and behavior of
children certainly reflects the quality of
their diet. Good nutrition, however, is
more than just three meals a day and
several investigators have found mineral
and vitamin deficiencies (manganese,
iron, zinc, sodium, potassium, vitamin
C) in the diets of many learning disabled
children. 5 Moreover, when these
deficiencies were corrected, many of
these children showed improvement in
their learning and behavior.
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The community health nurse is the
logical person to act as the uniting force
on such a team:
. she has easy access to the child, his
family and school;
. she knows what community
resources are available;
. she is able to communicate
effectively with physicians and to
effectively relay information between
physicians, parents and teachers.
In addition to her potential role as a
team leader, the nurse can make specific
contributions in the areas of prevention
and management of learning disabilities.
Prevention: Within this area the nurse
can provide:
. counseling to teenagers, especially
girls, regarding proper nutrition;
. pre-natal counseling regarding
proper nutrition;
. a follow-up program to children
born at high-risk including, children born
to rubella-exposed mothers; prolonged
labor babies; instrument-delivered
babies; children born to mothers who
had serious health problems during
pregnancy; children born into families
with histories of learning disabilities. etc.
Management: Within this area. the nurse
can:
. evaluate the health and
developmental history of children who
seem to be having learning and
behavioral problems;
. screen such children for possible
visual, auditory, perceptual, motor,
speech and language and nutritional
problems;
. refer children who fail these
screening tests to other agencies or
professionals for more in-depth testing;
. monitor a child who is on drugs; for
example, Ritalin@ for hyperactivity. and
report to parents, teachers, and
physicians about the effectiveness ofthe
drug on his learning and behavior;
. counsel the learning disabled child
about his problems and reinforce the
notion that he is not stupid or lazy;
. counsel the child's parents about his
problem and allay any unnecessary fears
they may be having about him;
. educate the public about learning
disabilities - what they are and are not
and what can be done to prevent and
manage them.
Certain learning disabilities like
dyslexia (the inability to read) are
thought to be genetically derived. For
example, parents commonly report that
they know of other family members with
learning disabilities similar to those of
their children who had difficulty in
learning to read or spell.
Prevention and management
(diagnosis. remediation and counseling)
of learning disabilities require a
comprehensive program involving a
number of disciplines and including, for
example, medicine, education, social
services, speech pathology, occupational
therapy, psychology. Unfortunately,
most services to these children and their
families are fragmented, with
overlapping in some areas and gaps in
others. What is needed is a consolidation
of professional services with a team
approach to caring for these children.
TIle c....... NurM
......1
Z1
A plan of action
The year 1979 has been declared the
International Year of the Child. It is a
year in which governments.
organizations and individuals are being
given the opportunity to focus on the
various needs of children and to develop
programs to adequately deal with these
needs.
Learning disabled children, like
their more fortunate peers. have the right
to be helped to reach their maximum
potential so that they can look forward to
adulthood with confidence and
optimism.
Nurses can and should see 10 it that
they get this chance. ..
Mildred C. Jacobson,B.N., R.N., is the
mother of three children. A graduate of
Jewish General Hospital in Montreal
and Dalhousie U nh'ersity, she is now
completing a Master of Science degree
in speech pathology at Dalhousie
University.
George Gasek, Ph.D., is assistant
professor of speech pathology at
Dalhousie University. He is a graduate
of the University of Denver (B.A.) and
received his Master of Arts and Doctor
of Philosophy degrees in speech
pathology from the University of
Washington.
References.
I Gaddes. W.H. Learning
disabilities: the searchfor causes.
Montréal. Québec. Association for
Children with Learning Disabilities,
1978. p.3.
2 U.S. Dept. of Health. Education
and Welfare. Terminology and
identification./ n Pearson. Hugh.
Physical is fundamental. p.l.
3 Gaddes, op.cit. p.4-7.
4 Are learning disabilities really
hidden medical disorders. The Post.
Dec. 1975. p.2.
5 Ibid.
*References not verified in CNA Library
TO PARENTS
who bear the ultimate responsibility for making decisions:
TO PROFESSIONALS
who try to help the parents make those decisions, sometimes with conflicting
advice, and
TO FRIENDS, RELATIVES AND NEIGHBOURS
who want to help but do not always know how:
REMEMBER
Not everything is curable. Sometimes the best thing we can do about a disability
that proves to be permanent is to prevent it from becoming the most important
influence on the child's or the family's life.
Love your child, and because you love him, help him understand about
limits and self-discipline. Help him develop skills for meeting the demands of the
world he lives in. Help him enrich his life with appreciation of the beautiful and
interesting things around him. Help him maintain his curiosity about how things
work. Help him develop an interest in people. Help him learn how to find friends
and keep them. Help him feel secure about his own worth and about the warmth
and support of his family.
Help him live as normal a life as possible.
Enjoy the positive things about him and he will, too.
Reproduced with the permission of the Canadian Association for Children with learning
Disabilities, "The Earliest Years", by Elizabeth S. Freidus. The Gateway School of New
York.
FOR FURTHER INFORMATION
The Canadian Association for Children with
learning Disabilities
Kildare House
323 Chapel Street
Ottawa, Ontario
K1N 7Z2
Provincial associations
Alberta A.C.L.D.
201,10180 - 108 Street
Edmonton, Alberta
TSJ 113
British Columbia A.C.L.D.
14673-108Ave.
Surrey, B.C.
V3R 1V9
Manitoba A.C.L.D.
Room 5 - 1070 Clifton St.
Winnipeg, Manitoba
R3E 2T7
New Brunswick A.C.L.D.
P.O. Box 1363
Postal Station A
Fredericton, N.B.
E3B 5E3
Nova Scotia A.C.L.D.
P.O. Box 604
Halifax, N.S.
B3J 2R7
Ontario A.C.L.D.
60 St. Clair Avenue E.
Suite 202
Toronto, Ontario
M4T 1N5
Prince Edward Island A.C.L.D.
P.O. Box 1081
Charlottetown, P.E.I.
C1A 7M4
Quebec A.C.L.D.
4820 Van Horne Ave.
Suite 8
Montréal, Québec
H3W 1J3
Saskatchewan A.C.L.D.
Room 308, College Bldg.
University of Sask.
College and Scarth
Regina, Sask.
S7N OW9
Yukon A.C.L.D.
P.O. Box 4884
Whitehorse, Yukon
Y1A 4N6
22 June 1979
The Cen.dlen Nur..
A holistic approach
to nursing the
patient in pain
Emalou Vaterlaus
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How do you feel about patients who
continually ask for pain medication? Do
you suspect that you are being used, that
these patients are tat-..ing advantage of
you? Do you sometimes, in your own
mind or aloud, dismiss certain patients as
complainers or malingerers? Are there
patients that you feel don't deserve or
need the pain relief that has been
prescribed?
I
..
Take Mrs. Shale, for instance. S
is 46, one of Dr. Mac's patients, admitted
four days ago for treatment of chronic
'ow- back pain. This morning, after she
refused her bath, you saw her walking in
the hall with her husband and heard her'
laughing on the phone. Mrs. Shale's
requests for pain medication occur with
lockwork regularity - every three
hours almost to the minute- but you'rê
beginning to think she's putting you on.
YOI don't think she hurts that much: she
just likes the attention she gets when she
complains. She's always being admitted
for this problem. You wonder why she
doesn 'tjust go home and stay there!
. ,
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.
You are the head nurse on this ward.
When Mrs. Shale's light comes on and
she asks for something for pain, what is
your reaction? Do you offer some excuse
and make her wait? Do you go into her
room and try to evaluate her pain? Or, do
. you take the medication she requests to
her promptly? If your feelings in a
situation like this are decidedly negative,
you are not alone. I felt like that, too,
until I came to terms with the fact that
judgment has no place in the treatment of
pain. There are no good or bad values
attached to pain. Pain is a personal,
The Cen.cllen Nur..
June 19711 23
private sensation of hurt. It is whatever
the person who is experiencing that pain
says it is. It makes no difference what the
nurse believes about the pain a patient
describes or about the patient himself.
The important thing is to recognize,
when a patient complains of pain, that
pain does exist for him at that time.
And this is where effective and
conscientious nursing care must begin-
with logical analysis and knowledgeable
interventions leading to control and
management.
What is pain?
Pain is perceived by the sensory part of
the nervous system and arises from
harmful or destructive stimulation of any
organ of the body. Although pain
appears to originate at the site of this
stimulation, the sensation is registered
and interpreted in the brain. Pain
impulses are carried by either A or C
nerve fibers to the spinal cord, up the
spinothalamic tract. to the thalamus.
From the thalamus, these impulses are
relayed to the cortex or master computer
where the sensations are integrated and
interpreted with the result that the
person perceives pain.
Pain impulses travelling this route
can, however. be blocked or intercepted
before they reach the thalamus by
activating what is known as the gate
control mechanism. When this gate is
"open". unpleasant stimuli relayed by
the thin, unmyelinated C fibers activate
the motor mechanism made up of aU the
brain areas that contribute to overt
behavioral response. But when activity
takes place in the thicker, myelinated A
fibers. which have a lower threshold and
respond to touch or light pressure,
negative feedback occurs along the way.
This blocks transmission of the pain
impulses and, in effect, closes the gate to
all neural traffic. The pain inhibitory
pathways which are activated by the gate
control mechanism thus permit raising of
the pain threshold.
Types of pain
In attempting to control and relieve pain.
the nurse may come to recognize three
types or varieties: acute, chronic and
progressi ve.
. Acute (or superficial) pain may last
for minutes, hours or days but is always
temporary in nature. The cause may be
traced to trauma such as an external
injury Oaceration) or an internal injury
(MI). Mr. Alvarez, for example. a patient
who has just undergone surgical repair of
a hernia, is probably experiencing acute
pain. This type of pain serves as a
warning. It mayor may not be
accompanied by anxiety. Tissue damage
is usually present. A reaction from the
sympathetic nervous system causes an
increase in the blood pressure. pulse and
respiratory rate. The patient can usually
describe with relative accuracy the
sensation involved and the location of
this pain.
. Chronic pain, on the other hand,
may last for months, years or until the
patient dies. The illness which causes
this pain is not life-threatening and the
pain is not constant nor progressive but
the patient is not able to predict when a
flare-up will OCcur or a remission begin.
Betty S., a 37-year-old rheumatoid
arthritis patient, has suffered chronic
pain off am' on since this incurable
disease began to affect the connective
tissues of her joints ten years ago.
Permanent relief from the discomfort and
impaired mobility that she suffers is not
possible, so Betty concentrates on
controlling the symptoms of pain and
inflammation - particularly the pain.
Chronic pain such as that
experienced by Betty S. or by Mrs. Shale
no longer serves a useful function as a
warning sign to the patient and his
physician. This type of pain is often
accompanied by depression. Tissue
damage is not always present. Usually,
there is no noticeable increase in vital
signs because this type of pain wears out
the sensory nervous system. Many
chronic pain patients have difficulty in
describing their pain; they may refer to it
as being "like a nightmare" . The patient
with chronic pain does not control that
pain but rather the pain controls that
person's life.
. Progressive (or terminal) pain is
constant, persisting until the death of
that patient. It occurs in conjunction
with a life-threatening illness and can
shorten life. Although the intensity of
this pain may vary, and nursing
measures may result in relief or
reduction, it cannot be "cured". This
pain may warn of changes but is not
generally useful. Patients with
progressive pain often show symptoms
of anxiety or depression or both. Tissue
damage mayor may not be actively
present and, again, the pain is difficult to
describe and not easily delineated.
Approximately half of all cancer patients
suffer progressive pain during the last
stages of their illness.
Reactions to pain
Although the perception of pain is a
phenomenon of the senses, reaction to it
is physiologic. Studies have shown that
the pain threshold - the point at which
an individual begins to perceive pain-
is relatively uniform for almost
everyone. Tolerance levels, however,
are strongly influenced by psychic
factors and vary greatly from one person
to another. Apprehension and attitude,
including anxiety and depression, can
make an individual more susceptible to
pain. Culture and race also have a
bearing on pain tolerance levels.
Only the person who is experiencing
that pain can actually "feel" it. Nurses
and others who are involved in caring for
someone who says that he is in pain,
must rely on the patient to help them find
the answers to questions they have about
the intensity and cause of that pain. In
your assessment, it is important to try to
determine some ofthe psychological and
social components that determine
individual reaction to pain. In a hospital
setting, it is often the cleaning lady who
gets to hear the details of a patient's
description of the pain that he is
experiencing. Next in line for listening
are friends and the hospital chaplain.
Where are we when we are needed?
Patients with chronic pain, like Mrs.
Shale with her "bad back", present a
real challenge to successful interaction.
Many of them have developed ways of
camouflaging the pain that they have.
They are accustomed to managing their
own medication. Previous
hospitalizations and nursing care may
have conditioned them to "fear the
worst" .
Chronic pain is debilitating. It
weakens the person who experiences it
and it can also destroy the relationships
between members of a family. Mrs.
Shale's teenaged daughter, for example.
planned a slumber party for her birthday.
When the day came, she had to cancel it
because her mother was in such pain.
Mr. Shale, too, made arrangements a
month in advance to take his vacation,
but was unable to leave town on that date
because Mrs. Shale couldn't stand the
long drive. She had pain; fear and
anxiety made that pain worse.
Can you imagine the quality of the
relationship that exists between Mrs.
Shale, her husband and daughter?
5 es t
talk
about
How many of these facts
about butter,
margarine and fat
do your
patients know?
act . Just 6% of the
. recommended daily
caloric intake is contributed
by butter.
Many health professionals mistakenly
believe that butter is a major contributor
to the over-consumption of fat by Canadians
which is considerably higher than the 35%
of total caloric intake recommended by
Health & Welfare Canada. In point of fact,
Canadians eat more margarine than butter
as well as many other fat-contributing foods
such as meat, fish, poultry, eggs, cereal
products, salad oil and cooking oil.
act . The correlation be-
. tween the consump-
tion of hydrogenated ve , etable
oils and the incidence 0 colon
and breast cancers has been
widely publicized.
Results of a research study conducted by a
team of scientists headed by Dr. Mark Keeney
of the University of Maryland, and published
in the summer of 1978, produced compelling
evidence of a possible link between the con-
sumption of hydrogenated vegetable oils and
the incidence of colon and breast cancers.
act . The hy
rogenation of
. marganne changes
the molecular structure of
vegetable oils.
Hydrogenation is the process which solidifies
liquid vegetable oils into margarine, making
it "spreadable", and giving it longer shelf
life in the store. This process changes the
chemical composition of the vegetable oils. . .
and it also "saturates" fats which, for what
it is worth, were originally polyunsaturated.
act . Cholesterol is an
. essential substance,
naturally present in the human
system... and is a problem only
to patients with specitic lipid
prof'des.
Such unsatisfactory conditions cannot be
significantly changed by dietary manipulation.
act . Butter has exactly
. the same number
of calories as margarine.
Weight-conscious patients, in the belief that
they are cutting calories, often give up the
good taste of butter for a less palatable
spread. . . an unnecessary sacrifice.
act . Canadians, on a per
. capita basis, consume
just haIfan ounce of butter per day.
This is just a fraction of the amount generally
believed by many health professionals to be
the per capita consumption of butter by
Canadians.
When you look at the facts,
you can see the good
in butter.
DAJRY BUREAU OF CANADA
act . Approximately 3% of
. butter is linoleic acid
- the ingredient which many
scientists believe to be the
moderating, beneticial factor in
the diet-heart relationship.
The idealleve1 of linoleic acid in fats
intended for human consumption is not yet
agreed upon.
act . Data exists which
. show a definite
correlation, in certain cultures,
between the high level of animal
fat consumption and the low
incidence of CHD.
The Masai and Innuit cultures indicate just
such a correlation. Interestingly, so, too,
does the Irish whose butter consumption,
though markedly greater than their lrish-
American counterparts, have a much lower
incidence of CHD.
SOURCES:
Mary C. Enig, Robert J Munn and Mark Keeney_ DIetary
fat and cancer Irends-a critique FederatIon Proceedmgs
37.2215-2220.1978
Mann. C.V. and Spoerry. A Studies of a surfactant and
cholesteremia in the Masal.Amer.J Oin_ NutL 27464,1974
Gershon Hepner. Richard Fried, Sachea, 5t Jeor. Lydia
Fusetli, and Robert Monn HypocholesteroJe:nic etfeCl of
yogurt and milk Am_ J CIin. NUIr., 32019-24, 1979
Dairy Farmers of Canada
Dairy Facts and FIgures at a Glance 1978
2e June 1979
The C.n.dlen Nur..
If Mrs. Shale requests a pain pill and
you get to her room and she's asleep,
what do you do? It's a standing joke with
the public that patients are awakened for
sleeping pills. Chronic pain patients
suffer fatigue and do not sleep well.
Nevertheless, fatigue and pain are
vicious circles: wake her up and give her
her medication. Do not allow the pain to
peak because when it does peak it may'
take the next two or three doses of
medication to bring the pain back down
to the level it was at when the medication
was first requested. Save your patient
added hours of suffering.
Like most chronic pain patients,
Mrs. Shale has learned to modify her
behavior. She has gotten rid of her facial
grimace; she no longer rubs the part that
hurts; her nail beds don't turn white
anymore; her blood pressure and pulse
don't even go up. She exhibits no
physical evidence of pain. It took her
two years and a great deal of practice to
accomplish this feat. When Mrs. Shale
says, "I am in pain", what would you
like her to do to prove it? Don't wait for
her to show you. Medicate her! Believe
her! Go into herroom. Take the time to
sit down and talk to her. Make a verbal
contract, telling her what you will do for
her. She may test you, but then she'll
know that you are someone who cares
and will help her make it. If, on the other
hand, you do not want to become
involved with the patient, do not allow
her to ventilate her feelings, bringing all
the pain to the surface.
Counteracting and controlling pain
When a patient complains of pain do you
instinctively check first to see when the
last shot was administered and how
soon, within the limits of prescribed
medication, that patient can have
another shot? If you do, you may be
neglecting some of the nursing comfort
measures that have a direct bearing on
the psychosocial welfare of your patient.
Minimizing pain through nurse/patient
interaction can be, in some situations, as
hel pful as offering relief through
medication.
. Disassociation encourages the
patient to detach himself from the
perception of pain by concentrating on
other sensations. A patient who is having
a tube inserted, for example. can be
encouraged to concentrate on the feeling
of pressure rather than the pain involved.
In OB.labor proceeds more smoothly
when the mother-to-be concentrates on
pushing rather than pain. Children
undergoing allergy tests can be
encouraged to concentrate on the
sensation of coldness and the itchy
feeling rather than pain. It helps a patient
whose dressing is being changed to
concentrate on the sensations of cold or
warmth that are involved rather than
pain.
· Distraction or diversion can take the
patient's mind off pain and turn it to
another occupation. Some of the
activities which can distract a patient
whose pain is not too intense include:
-reading
-watching television
-needlework, knitting. etc.
-talking on the phone with a friend.
When it seems appropriate, talk
with your patient about his family.
Encourage a husband or wife to bring in
pictures that the patient can put in an
album, talk about and show off to other
patients, staff and friends. Ifit is
available, a metronome can distract a
patient during a myelogram - watching
and counting offer a welcome diversion.
Often it is the patient's need for
distraction that makes him want you to
remain in his room. Human contact, or
"presence" can be an effective defence
against pain, even if that person is not
actively taking steps to relieve the pain.
. Reassurance and encouragement
can also have a noticeable effect on pain
tolerance levels. Surgical floors.
especially between the hours of noon and
four p.m., tend to be extremely busy
places but effective pre-op teaching pays
dividends in terms of better nurse/patient
relations the following day. Patients who
know what to expect - the
comparatively short duration of
incisional pain. for example - are
reassured by that knowledge and
therefore less demanding. They require
less medication and often are able to
leave hospital earlier.
Patients can als
be taught to
recognize sensations such as pulling,
stretching or burning and to distinguish
these from pain. A cholecystectomy
patient. for example, is reassured by
being told that his incision will not "pop
open" even though it feels that way.
Remember that inco"ect
information. ignorance and fear work
together to lower pain tolerance.
. Relaxation exercises can be used
profitably to induce a state of tranquillity
in the patient. Yoga, biofeedback and
hypnosis are among the techniques
currently employed to reduce muscle
tension and anxiety, thereby making the
patient less aware of the sensation of
pain. Nurses can improvise on these
techniques to achieve similar results.
You can, for example, adopt a
step-by-step approach to relaxation that
will teach the patient to tense and relax
the various parts of the body (fingers,
hand, wrist, lower arm. upper arm), one
at a time until his entire body is involved.
Your goal should be to train the patient
to relax his muscles at will. Teach the
patient to relax before the pain becomes
too severe. Have him assume a
comfortable position, preferably lying
down, before beginning. Earphones that
allow him to listen to tape recorded
music are often an aid to relaxation, as
are movies. Encourage him to imagine a
restful setting and a sensation such as
floating. Deep breathing is also an aid to
relaxation. For best results, teaching
should be carried out pre-operatively
ather than post-op.
Nursing interventions
Of all the modes of pain relief available,
including drugs, surgery, electrical
stimulation, counseling, etc.. some of the
simplest and best are still the ones that
every nurse recognizes as basic to her
practice. These include:
. non-judgmental listening
. skillful body positioning
. splinting an incision when a patient
coughs or turns
. supplying rational explanations for
practices and procedures
. taking steps to ward offanticipated
pain so that the patient does not need to
fear loss of control
. educating the patient in how to use
his medication effectively. how to
achieve pain control, how to recognize
side effects and who to call if he needs
someone
. pacing medication to minimize the
pain involved in ambulation
. and. last but not least, the comfort
measures involved in good nursing care:
a clean bed, smooth sheets, a back rub
with a smile.
Remember. keeping a patient
comfortable is a skill that you develop
over years of practice; share your
experience with younger nurses.
TIM Cenadlen Nur..
Pain management
The more you know about a patient, the
more successful you will be in helping
him to control and manage his pain.
Priorities differ. Maybe aU Mrs. Shale
wants is to be able to get up in the
morning, prepare a nice big breakfast for
her daughter and husband, and then see
them off with a good start on the day. If
so, sit down with her and re-schedule her
medication and activity plan so that she
allows for a rest period after they leave
the house.
Maybe Mrs. Shalejust wants to
keep up a good appearance in front of her
friends and relatives. Schedule her pain
medication before visiting hours: help
her to fix her hair and dress in something
attractive. Continuing sexual relations
with her husband may also be one of
Mrs. Shale's priorities. If so, you can
help her by suggesting a position that will
allow maximum comfort.
When a chronic pain patient is
admitted to your care, find out that
patient's particular pain pattern - what
medication he takes at home and how
often. Enquire also about the other
measures he uses to provide relief -
heat, cold, massage, pressure,
movement, lying still, distraction, etc.
What makes his pain tolerable? WhiJ,t
increases his pain? Does pain affect hIs
ability to sleep? What words and phrases
does the patient use to describe his pain?
Pain should be recorded in order to
help diagnosis. It helps also to determine
causative factors in relation to pain-
incision pain from trauma to the tissues
or gas pain with return of bowel
functions, etc. Find out the reaction
component (what meaning the pain has
to the patient) and have the patient
identify the pain by comparing it to
something else to help you assess and
evaluate it better.
When a surgical patient requests
pain medication post-op be sure to find
out where the pain is. Know the location
and intensity. This will help you to avoid
situations such as the one in which a
post-op woman was medicated for pain
that the nurse assumed was caused by
her surgery. Not long after, the doctor
made rounds only to find the patient was
having an MI.
Always as!.. and then document it.
I have learned the value of walking
rounds: IV's are on time and patients are
medicated prior to the change of shift
rather than having to wait until after
report. Walking rounds increase the
rapport between patient and nurse and
keep the patient informed about his
progress.
Other interventions
Transcutaneous electrical stimulation is
another method of pain management
currently being used in certain cases.
Success depends on many variables, one
of the most important of which is the skill
of nursing staff in teaching the patient to
care for and understand these implants.
Medication is, of course, the
intervention which comes to mind first.
Measuring the efficacy and comparing
cost and safety factors of the various
analgesic drugs is made more
complicated by the subjective nature of
pain itself. Comparisons are further
complicated by the realization that as
many as one third of all patients
complaining of pain will respond
favorably to administration of a placebo.
. Am
ng the most commonly
prescribed analgesics are: acetyl salicylic
acid (ASA), acetaminophen, codeine,
propoxyphene, pentazocine, morphine
and meperidine (pethidine or Demerol
).
When administering any of these drugs,
nurses should check to see for
themselves the effectiveness of the
dosage and method of administration
route. They should also be aware of and
watch for possible side effects. In acute
pain, an analgesic in combination with an
antianxiety drug may prove most
effective. In chronic pain, the analgesic
and antianxiety drugs may be combined
with an antidepressant for optimum
relief. Terminally ill patients may receive
orally administered opiates (Brompton's
Cocktail). This mixture usually consists
of morphine, cocaine, alcohol,
chloroform water and a flavoring syrup
and may be administered routinely or
PRN. Advantages include keeping the
patient alert and well-oriented so that he
maintains a good relationship with his
family right up until death occurs.
A little knowledge, a little understanding
Eventually Mrs. Shale will go home from
the hospital, only to return later to ask
for further help in controlling her pain.
Don't you be the nurse who says, "Oh,
not.her again," or "Please send her to
another floor, we get her all the time!"
Maybe during this hospitalization
you can help her find other methods to
help control her pain. If you do, you will
be the light in her life that she's been
waiting for. .
Be someone who takes the time to
help her attain enough control to be able
to pursue certain activities at home.
She's not making such a bad job of
living! Most of the time she fools a
lot of people into thinking she doesn't
hurt and it's only when the pain is
unbearable that she comes to the
hosl.'tal. When she smiles and says, "I
a
pain. Can I have something?"
B'i.:,,'e her. I do! Won't you? ..
June 1979 27
About the autbor:Emalou Vaterlaus
attended Carroll College in Helena,
Montana and graduated from St.
Vincent's School of Nursing in Bi/lings,
Montana. Now living in Williston, North
Dakota, and working at the
Craven-H agun Clinic, her areas of
nursing experience include medical,
surgical,lCU and emergency room
department nursing. She is a state and
national registered emergency medical
technician-ambulance (EMT) and a past
president of Upper Missouri District No.
8 Nurses Association.
Acknowledgment:The author would like
to gratefully acknowledge the assistance
of two of her colleagues -J oA nn Eland,
RN, BSN. MA, and Marion Johnson,
RN, BSN, M SN, - in the preparation of
this article.
-
The role of the intravenous nurse in the emotional support of the chemotherapy patient cannot
be overrated. It may, in fact, be crucial to the holistic management of the patient and his disease.
By synthesizing the ideas and observations of co-workers and current literature on emotional
support, author Kathleen MacMillan-Brett provides IV therapists with a new focus on their role
in chemotherapy.
The IV nurse and
the chemotherapy
patient:
Nursing's primary concern is always for
the patient and his needs. In the case of
chemotherapy patients, a host of
emotional complexities are at play.
Sooner or later, these patients must deal
with body image changes, the presence
of pain, the spectre of death and a
number of other very real concerns in
their lives. All members of the health
team who interact with these patients
have a part to play in helping them to
cope with their feelings but sometimes
IV nurses - who are also members of
the health team - overlook the
opportunities that arise for providing
emotional support. Their contacts with
these patients are frequent - starting
IV's, starting blood transfusions,
administering antibiotics, IV drugs and,
in some hospitals, giving
chemotherapeutic agents - and the
chances are many.
As an IV therapist, I feel that there
are three factors that can help us to
maximize our role in providing emotional
support to this group of patients:
. we must have a good working
knowledge of chemotherapeutic agents
. we must have a close working
relationship with both nursing and
medical staff and
. we must be able to understand and
accept individuals.
Chemotherapy
The IV nurse must know, first of all,
what chemotherapy is, what it hopes to
accomplish for each patient, how the
agent works and what its side effects are.
When a patient in our hospital is about to
begin a chemotherapy treatment, the IV
nurse starts an intravenous infusion with
5 per cent dextrose solution. She does
not, however, inject the antineoplastic
drug; this is done by the doctor in most
cases or by the staff nurse in the case of
5FU (5 Fluorouracilll\)) which is mixed in
solution.
Kathleen MacMillan-Brett
I
\ \
a vital role in
emotional
support
At our hospital, IV therapists are
also involved in an outpatient
chemotherapy unit which handles
approximately 30 patients per week.
These patients are probably the largest,
single group that we deal with on a
regular basis and this kind of contact
means that we can get to know the ones
who return regularly for treatment.
The chemotherapy unit is essentially
a well-patient clinic. The atmosphere is
relaxed - IV's are often started with
patients lying down but once the IV is
running well, they can sit in a chair to
chat with a friend over a cup of coffee
until the doctor arrives. Close bonds are
formed among these patients and they
often have a deep understanding for one
another's experiences.
Our IV therapists try to insert the IV
needle as painJessly as possible. A local
anesthetic of I per cent Lidocainell\) is
injected intracutaneously and 20 g
catheters are used for all cases except
when a blood transfusion is to be given.
We also take care to pick sites that will
produce the fewest complications. All
these measures provide comfort for the
patient and a caring attitude tends to
increase trust between the patient and
the IV nurse. This trust is particularly
important in establishing a relationship
with a patient who has over-used veins, a
patient who has come to be frightened of
the whole procedure.
Just as we try to get to know each
patient as a person, we feel it is
important for them to know each of us as
a person. We always introduce ourselves
by both first and last names. This gives
the patient an opportunity to establish a
first-name relationship with the nurse if
he wants to.lfhe requires a more formal
structure and uses last names, that is fine
too. He is letting us know what form of
address makes him most comfortable.
The c....... NIne
.....1171 21
In the outpatient unit, we constantly
help to interpret the patient's particular
reaction to the chemotherapy and to
provide an ear for his distress from
adverse reactions. These are particularly
hard for the patient to accept especially if
he has felt relatively well before
beginning the chemotherapeutic regime.
The nurse's attitude to the treatment is of
vital importance if she is to support the
patient in this situation.
Working relationships
At our hospital, we see the IV nurse's
role as closely approximating that of a
patient ombudsman, both because of our
unique relationship to the nursing and
medical staff and because of our
continuing relationship with the patient.
IV nurses see the patient in the initial
post-op period, for his initial
chemotherapy in the hospital and later in
the outpatient chemotherapy unit. This
enables us to function as an interpreter
between the patient and his doctor,
filling the patient in about his treatment.
We have the opportunity to get to know
our patients and their families and to
communicate our insights and
observations to the staff on the floor.
It is my feeling that IV nurses are in
a unique position to relate to the patient
because we are not involved in an
invasion of privacy to the same degree as
the nurse who gives physical care. In
addition, since the procedure is a
technical one, once the skill is mastered,
the nurse is free to interact with the
patient on a personal basis. I n other
words, the procedure is separate from
our relationship with the patient.
We also operate as liaison
personnel, carrying information back
and forth between the chemotherapy unit
and the floor: between staff and patients.
If one of the patients in the outpatient
unit has been hospitalized, the others
want to know how he or she is doing; if
there are no objections, we relate the
information as best we can. Sometimes.
the news is not good but we feel that
being as honest as possible under the
circumstances is important if we wish to
maintain a trusting relationship with
them.
Understanding individuals
This is the most exacting of the three
functions that I see for the IV therapist.
As human beings. we must all face the
fact that we have cultural biases. The
strong negative feelings that we may
have about some patients' attitudes
towards their illness are based on our
own bias about what is appropriate or
acceptable. If we can keep that thought
foremost in our minds then we can
accept the fact that these people are
experiencing illness according to their
own illness practices. in the framework
of their own cultural system. Any
attempt that we might make to have them
conform to our ideas of "how one is ill"
will only add stress to our relationship
with that particular patient. And stress is
the last thing the patient needs.
There are times however when we
know that we are not getting along with a
patient on a personal level. In this case,
it is in the patient's best interest for us to
recognize the situation and bring it to the
attention of other members of the IV
team. Another nurse may have much
more success with this patient and may,
in fact, be able to build a trusting
relationship with him. The patient will
likely cooperate if he likes and trusts the
nurse who must start his IV. In the end,
it will mean fewer frustrations on all
sides.
Part of understanding an individual
is learning about him through
communication. by encouraging him to
talk and express his feelings. In a
nurse/patient interaction, one of the
most effective ways of promoting open
communication is by the use of
open-ended statements and questions.
This non-directed technique does not
influence the patient's response - he is
able to express in his own way his ideas
and feelings. For example:
Situation 1
A) Patient: I'm getting so manv
treatments but I don't seem
to be feeling better.
Nurse: You haven't beenfeelini( too
well, Jim? Can you tell me
more about it?
B) Patient: /' m getting so many
treatments, but I don't seem
to be feeling any better.
Nurse: That's too bad, but the
treatments are important.
Situation 2
A) Patient: Oh, not another IV. I'm so
tired ofbeini( poked and
prodded.
N urse: You seem to be on edge
today, Mrs. Smith. Is there
something troubling you?
B) Patient: Oh, not another IV. /' m so
tired of being poked and
prodded.
Nurse: Sorry, Mrs. Smith, but your
doctor ordered the IV.
Interaction A, in both situations I
and 2, consists of the nurse inviting the
patient to share more of his feelings and
ideas with her. Interaction B. on the
other hand, demonstrates answers by the
nurse that do just the opposite.
Remember too that talking with
relatives provides a valuable opportunity
for information sharing and a chance to
find out more about the patient from
those who know him or her well.
The ability to maintain control of a
situation is very important for some
people and we try to accommodate this
need. I remember one man, with his own
business, who really let us know of his
need for comrol. He always had to make
a last-minute trip to the bathroom,
change his gown or finish his coffee
before he would let us start his IV.
Occasionally he would ask us to return
after lunch. We started to consult with
him early in the morning about when he
would like his treatment and where he
wanted the cannula placed. We learned
to tolerate the other delays when we
realized that to him. his behavior was a
way of maintaining control in a very
difficult situation. Our relationship with
him blossomed over the seven years he
was our patient.
We have found also that it is usually
beneficial to let patients decide about
possible IV sites, and whether or not
they would like armboards. Generally,
chemotherapy patients guard their IVs
very carefully and know what is most
comfortable for them. Patients also
participate in decision-making by
deciding the time for their IV to be
started and the time when they feel able
to have their infusions discontinued.
Emotional support
We all know that as nurses we are
supposed to provide patients with
emotional support. It is at the bottom of
every article on every aspect of nursing
care. But it is only lately that the term is
being defined, explained and outlined.
Empathy is not innate: it is a learned
response which we acquire by listening.
30 June 1979
The C.nedl.n Nur..
Our brains, like computers, must have
intake before they can give any valuable
output. Emotional support does not
require that you have all the answers; it
does require that you listen. Remember
how important it is to use open-ended
conversation techniques and to ask
questions. Just being there.allows the
patient the opportunÌty to discuss his
fears. This can be just as important as
visible physical care. There are times
when it is more important to sit beside a
patient and talk than it is to answer the
beeper immediately. In other words,
holding a crying patient is just as
necessary as starting an infusion.
Being an effective nurse means
involvement. We can sit down with a
patient and his family over a cup of
coffee; in some circumstances, small
gifts such as a flower from the garden can
mean a great deal to a patient who fears
losing his identity to his disease.
Extending a relationship outside the
hospital is one way of being involved for
some nurses. One patient that I
remember well was determined to live to
see her only son get married. Three
weeks before the wedding she became
very ill with a fungal pneumonia and,
when she expressed fear of missing the
ceremony, I offered to take her if her
doctor consented. We went and it gave
me a great deal of satisfaction to see her
so happy. Three days later she died.
Another technique that is helpful in
dealing with patients is to ask them if
there is anything else that you can do for
them. Little things such as positioning a
pillow, pouring a glass of water, or
pinning the call bell in place, take only a
second but they say a lot about caring.
What about the IV therapist and
non-verbal communication? Such things
as facial expression, posture and
pupillary reaction can reveal a great deal
about the true feelings of an individual.
The IV nurse is in a unique position to
communicate through touch. We deal
with hands and can therefore establish
contact which is friendly, normal and
comfortable. Holding hands is
acceptable social contact. When
preparing to insert an IV, grasp the hand
firmly, use a gentle touch and avoid
giving unnecessary discomfort.
The patient's reaction to an IV is
often negative. At these times it is
helpful for us to remember that we often
see the patient when he is at his lowest
ebb, when he has been ill all day, unable
to tolerate fluids, or requires a blood
transfusion or antibiotics. Or, he may
have had to take a day off work to come
in for treatment. The tears of frustration
and anger or the outright rage that
sometimes greet the IV nurse can be a
rare opportunity to establish a trusting
relationship. Comments like, "Did it
help to get it all out" or "It seems you
are feeling pretty upset today" go a long
way towards showing acceptance and
stimulating trust. Then you can sit down
with a patient, touch his shoulder or hold
his hand.
It has been my experience that
patients will communicate their feelings
to the IV nurse if she is open. A patient
may have a long-standing relationship
with a particular IV nurse from the
chemo unit, or he may simply recognize
that s he is not a member of the floor
staff. Sometimes a patient feels more
free to discuss personality conflicts with
staff or other patients or just to express
his feeling that the staff doesn't know or
care about him to nurses he considers
"neutral". Armed with these bits of
information, the IV nurse may be able to
help by acting as a go-between with the
staff.
Conclusion
Looking at the role that the IV nurse
plays in emotional support, it is evident
that a registered nurse is the most
appropriate professional to fulfil the
three functions outlined. I n this era of
budget constraints, the suggestion is
sometimes made that IV nurses be
replaced by technicians.
I couldn't disagree more. I feel that
the IV nurse has a vital role to play
precisely because she is a nurse first and
a technician second. Communication
skills are the key. As a nurse, the IV
therapist is in a special position to offer
emotional support, particularly to
patients with whom she can establish a
trusting relationship. Fulfilling this
function only adds to the satisfaction that
this branch of nursing brings. ..
Bibliography
I Collins, Mattie. Communication in
health care. 51. Louis, Mosby, 1977.
*2 Davis, Judy. Administration of
chemotherapy - the IV therapists
responsibilities. Amer. J.lntrm'enous
Therapy. by... and Candise I. Pillow,
4:4,July, 1977, p.15.
3 Rinear, Eileen E. Helping the
survivors of expected death. Nurs. 75.
5:3:60-65, Mar. 1975.
*Not verified byCNA library.
Author Kathleen MacMillan-Brett
presented' 'The IV nurse and the
chemotherapy patient: a vital role for
emotional support" to a group of
intravenous nurses at a chapter meeting
of the Canadian Intravenous Nurses
Association in Toronto. She is a 1970
graduate of the Toronto East General
and Orthopedic Hospital School of
Nursing. Since graduation she has
worked in medicine and as an IV nurse.
Currently she is working part-time on the
IV team at the Scarborough General
Hospital, Scarborough. Ontario. She is
also afull-time student at the University
ofT oromo studying anthropology and
biology.
Kathleenfeels strongly about the
role that the IV nurse can play. She
states: "It occurred tome that many
people will consider it (my paper)
idealistic. and impractical in the face of
the heavy and often frenetic schedule of
the IV nurse. Although this is true to
some extent, we do make it work at
Scarborough. and I think it is due to both
cooperation and commitment.
The commitment factor is
important. The girls that I work with are
proud to be nurses. and unlike some
hospitals. the IV Team at Scarborough is
orl(anized under the auspices of the
Nursing Department. Because of this I
think the commitment to patient care is
more obvious than it would be if the team
were under the laboratory or pharmacy
as it is in some hospitals.
The other factor is cooperation. We
are a team in the true sense. By this I
mean that we help each other when
necessary. rather than just seeing that
ollr own work is done. This means that if
one of those opportunitiesfor
communication present themselves, we
can ask someone else to take our calls
forafew minutes ifit is at all possible.
Without this type of staff the ideas
which I have presented would be very
difficult to put into practice, and I would
like to credit my co-workers. and my
head nurse, Jean Downer, with some of
the ideas, and with the opportunity to
practice them."
..
. I
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The Cenecllen Nur..
Frankly speaking
June 1979 31
Apathy
.
In
.
nursing
JessIca Ryan
These days, you don't have to look very
far afield to encounter apathy: it occurs
in every walk of life, every possible
setting.lfit is true that people can be
divided into two groups - the doers and
the sayers - then, it is also true that the
sayers have finally come to outnumber
the doers.
Take politics, for example.
Everyone criticizes politicians but when
it comes time to attend a meeting or
convention or to allow their name to
stand for office, where are these people?
Everyone has disappeared. This makes a
mockery of selection or election of the
best qualified person to fill a position; it
becomes a case of take it or leave it and,
often, the best person does not end up in
a position because the best person just
couldn't be bothered.
In a noble profession such as
nursing, you might expect that this
situation would not occur. Everyone
knows that nurses are "selfless", putting
the needs - the health and welfare - of
others ahead of their own. Within the
past 20 years, however, apathy has
become the name of the game in nursing
just as it is in other groups. Out of tOO
"typical" nurses, only about ten can be
expected to attend a nurses' union
meeting; fewer than that will show up at
their provincial association's annual
meeting and only about five will bother
to attend a regular chapter meeting.
Unless they are going to get a day
off to make up for it, or unless their way
is paid, most nurses don't take advantage
of the seminars and workshops that are
available to them in their area. On their
days off they prefer activities not related
to professional development. In other
words, unless they can see some tangible
reward, most nurses just don't get
involved in more than the bare
necessities of knowledge and experience
they need to do their job.
Is this because they really "don't
have time" or because they are "just too
tired"? If you think that's the answer,
consider the number of these same
nurses who spend their free Friday
evenings or Saturday mornings working
at fund-raising events like bake sales,
card parties or handicraft sales. There
they are in droves, donating their
precious time off and the money they
earned by nursing to all sorts of
worthwhile but nevertheless non-nursing
activities and functions.
None of these activities, all of which
involve hard work, contribute in any way
to advancement or enhancement of their
chosen career of nursing. Faithful
attendance at chapter meetings, on the
other hand, keeps a nurse up-to-date
about what is happening in nursing
today. Attendance at union meetings
ensures that she understands the issues
involved in her social and economic
welfare. And yet, it costs nothing to
attend these meetings - no baking, no
effort, no membership fee - oftenjust a
little time and attention. Perhaps that's
where the problem lies: it's too free, it's
too easy. All that is required is to listen
and to learn.
The same thing happens when
nurses are required or invited to sit on
hospital committees such as nursing
records, nursing audit or nursing
techniques. They find it difficult to
attend and even more difficult to be
interested. They do not seem to realize
that, at this level, they have a lot to say
about influencing nursing in their
hospital. Every time a nurse does not
appear at a meeting or conference, the
administration of that hospital assumes
that nursing is not interested. Pretty soon
nursing stops being invited and finally
administration is dictating to nursing and
to nurses on duty. Then nurses complain
and become more and more unhappy in
their work.
It is apathy that does this. Nurses
must stand up and be counted. The
opinion of the nurse at the bedside is
invaluable: these are the nurses who are
with the patients: they are caring: they
are communicating. In other words, the
bedside is where it's at and where it must
stay - in the hands ofregistered nurses.
This creeping apathy about professional
meetings, union meetings, unit meetings,
staff meetings and hospital committees
must be stopped. It must not only be
stopped but it must be reversed from
apathy into caring.
Nursing must become, once more,
more than just ajob. It must become the
proud profession that people on the .
outside looking in believe it to be. To do
this,
. nurses must make nursing their first
interest, their first love, their first ideal.
They must understand what they are
voting about before they vote.
. nurses must read and know what
new things are developing in nursing.
. nurses must understand that they
belong to one of the largest and most
powerful health groups in the country as
well as the largest women's organization
in Canada.
Together nurses can turn the tide of
apathy. They can become a cohesive
force of interested caring, sharing men
and women. The price is simply
enthusiastic attention to nursing affairs,
participation in professional and union
meetings, attendance at educational
conferences, reading and continuing to
educate oneself either at the bedside or
at school. Continuing education is not for
the few, it is for the masses, whether it is
done on a grand scale or as an individual
effort.
It must be done. We must continue
to grow and to become more aware.
Nursing is changing, nurses must
change. There are needs that must be
met and nurses must be ready to meet
these needs. If nurses continue to be
apathetic and to let others govern their
work life and their professional life, then
eventually these others will fill the gap,
meet the needs and take over nursing. '"
Jessica Ryan, author of this month's
Frankly Speaking, was elected
member-at-large, nursing practice, at
the /978 annual meeting of the Canadian
Nurses Association. She is head nurse,
pediatrics, at Chaleur General Hospital
in Bathurst, New Brunswick.
Jessica has been an active member
of the New Brunswick Association of
Registered N ursesfor several years and
is also a member of the board, Bathurst
Schoo! of Nursing and president ofT he
Atlantic affiliate of the Associationfor
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Nurses need
leadership skills
Susan Spennruth
Processionary caterpillarsfeed upon pine
needles. They mo
'e among the treesin a
long procession, one leading and the
othersfollowing - each with his eyes
half closed and his head snugly fitted
against the rear extremity of his
predecessor.
Jean Henri Fabre, the French
naturalist, tried an experiment with these
caterpillars. He enticed them to the rim
of a large flowerpot. where he succeeded
in getting the first one connected with
the last one, thus forming a complete
circle which started modng around in a
procession that had neither beginning
nor end.
Fabre expected that after awhile
they would catch on to the joke - get
tired of their useless march and start off
in some new direction. But not so.
Through sheer force ofhabit. the
living, creeping circle kept mm'ing
around the rim of the pot- around and
around, keeping the same relentless
pace for seven days and seven nights-
and would doubtless have continued
longer but for exhaustion and starvation.
An ample supply offood was close
at hand. and plainly visible, but it was
outside the range of the circle, so they
continued along the beaten path.
They were following
instinct.. . habit .. . custom .. . tradition. ..
precedent...past experience...they
mistook activity for accomplishment.
They meant well- but they got nowhere.
( ,
Judy Tiivel
If you were asked to describe the
qualities a person needs to give the best
possible nursing care, what adjectives
would you use? Some have said that a
good nurse must be "nurturing, caring,
tender, compassionate, and able to
intuitively relate welI with others and be
supportive of their needs" . I There is no
doubt that these qualities are essential
for good patient care.
But are these the characteristics that
we find ourselves needing most when we
take on nursing leadership roles? As
charge nurse on night duty coping with
overwork and staff shortages; as team
leader on days planning team
assignments, coordinating care plans or
dealing with physicians who disregard
nursing decisions; as head nurse working
on staff rotations, staff evaluations, or
implementing new concepts on her unit;
as nursing director guiding her staff to
form a dynamic team or working on
detailed ward budgets?
Don't we also need to be decisive.
objective, creative, rational. persistent,
resourceful, courageous and motivating?
The answer is obvious: good nursing
management requires, even demands,
these qualities. The unfortunate thing is
that many of us simply are not given the
opportunity to develop those
characteristics before being placed in a
leadership role.
-
/-,
J
i:í
..
....
J
--.........
'-
\
I
,
I
34 June 1979
The CeNldlen Nur..
Shaky situation
Within a few months of graduation,
many new staff nurses find themselves in
charge of their units on evenings and
nights. These and other leadership duties
continue throughout their nursing career.
The Royal Victoria Hospital in Montreal,
for example, is a busy, acute care
hospital in a multicultural and
multilingual city. Nursing units are of a
highly specialized nature and most new
staff are recent graduates of community
colleges or university schools of nursing.
Nursing staff turnover rates are high, up
to 40 per cent annually so the new staff
nurse quickly becomes a senior nurse-
usually within six months to a year.
As Nurse Clinician Teachers (Ncr)
at the Royal Victoria, we work closely
with the nursing staff - orienting them
to the c1inicaJ area, increasing their
knowledge of a nursing specialty,
evaluating and identifying their learning
needs. It has been our observation that
there is a great need for staff nurses to
develop leadership skills, to be more
confident and capable when in charge of
a team or a unit and therefore, less
apprehensive about their own abilities -
in short, better leaders.
What to do?
Having recognized that leadership is a
neglected area in nursing education, we
(the NCfs) decided to present a series of
Leadership Development Workshops.
The first workshop was presented in
March 1977 to a group of 32 team leaders
and other interested nurses at our
hospital. Having tried several methods of
presenting leadership and management
skills, we decided to use experiential
exercises as our method of teaching.
Experiential learning has been used
with great success in a variety of settings
- universities, business and industry.
We felt that the time was ripe for
hospitals as well to start experimenting
with this method, especially in teaching
leadership skills.
Experiential learning -
what is it?
In its simplest terms, experiential
learning is "learning by doing". The
exciting factor in this model of learning is
that the responsibility for learning rests
with the individual. Participants must be
active and assertive and must set their
own goals ifIearning is to take place.
"Experiential learning is based upon
three assumptions:
. that you learn best when you are
personally involved in the learning
experience
. that knowledge has to be discovered
by yourself ir-it is to mean anything to
you and
. that committment to learning is
highest when you are free to set your
own goals and actively pursue them
within a given framework. "2
We felt that the workshop approach
was best suited to our needs.
Objectives
The main objective of our workshop was
to expose the participants to a series of
exercises designed to promote effective
leadership. These exercises emphasized:
. understanding group dynamics,
especially the components of respect,
trust and acceptance
. recognizing the vital importance of
communication and feedback
. understanding what it feels like to be
a new member of a group - a new staff
member on a floor or unit or a relief
nurse who encounters new situations all
the time
. realizing the need for expression of
minority or unpopular viewpoints
. comparing the results of group
decision-making with individual
decision-making
. recognizing the value of planning as
the key to effective leadership.
The exercises allowed the
participants to take a look at themselves
- how they function in a group, how
sensitive they are to their own needs and
then to the needs of others. Experiential
exercises also gave them an opportunity
to discuss and evaluate the dynamics of
their interaction in a non-threatening and
sharing environment.
The workshop
The first workshop was two days in
length and was held in the hospital well
away from patient areas. We wanted to
make it as informal as possible so the
participants and the facilitators (NCfs)
came in street clothes, addressed each
other by firs t names and had lunch
together at an outside restaurant.
Because we limited attendance to 32
participants, there was time for each
nurse to express herself and to
experience both the observer and
participant roles. On the first day, the
nurses worked in groups of six or seven;
on the second day, the members of one
group were asked to join an already
established group. These "displaced"
persons experienced how it feels to be a
"new" team member and at the end of
the day shared their feelings about this
with the group.
Prior to attending the workshop,
participants had been asked to complete
a self-evaluation of their leadership
characteristics. These replies remained
anonymous and at the end of the session
they completed a duplicate form and
then compared and measured their
change in self awareness over the two
days. We also supplied them with several
articles and asked them to read these
before attending the workshop (See
suggested reading list).
The exercises.
Six experiential learning exercises that
covered six aspects ofIeadership were
completed during the two-day workshop.
Members of each group were given
handouts describing the exercise and
received further instructions as needed.
After each exercise, there was time for
group feedback and then short lectures
were presented on the theory that had
been illustrated by the exercise.
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Exercise 1
BROKEN SQUARES
Purpose: To develop a team approach to
problem-solving and to show the
difference in results between a
cooperative and competitive attitude.
I nstructions: Participants are given
envelopes containing jumbled pieces of
cardboard that when put together form
squares. Only parts of the pieces for
forming the five squares are in each
envelope. The task of the group is to
form one square in front of each
member. The exercise has two goals: the
individual is to form a square in front of
himself as fast as possible; and the group
goal is to have squares formed in front of
every member of the group as fast as
possible.
A person may give a cardboard
piece to another person but no talking or
signalling of any kind is allowed. Noone
may ask for a cardboard piece.
The Cenedlen NUrH
June 1117V 35
The groups are not given identical
instructions. Some are encouraged to
take a competitive attitude while others
are given cooperative guidelines.
Outcome: It became readily apparent
that successful completion of the task
was much more rapid when all members
of the group were cooperative and placed
their team goals above their individual
goals. Even if the participants were given
competitive instructions rather than
cooperative ones, all the nurses without
exception became cooperative in order
to get the job done quickly.
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Exercise 2
THE DIALYSIS
I.ACHINf.
Purpose: To study problem solving
procedure in groups and to examine the
impact of individual's values and
attitudes 01' group decision-making.
I nstructions: The group is told that they
are members of a hospital committee
who must select one of five candidates
for placement on a hemodialysis
program. There is only one vacancy and
the group must give its unanimous
agreement to the selection of the
individual. (The other four candidates
are not likely to live if denied access to
the machine). The group is given a brief
biography, including sociological and
psychological data on each candidate.
The five patients come from a wide
variety of backgrounds and the group
must decide their own criteria for
selection. They have one hour to make
their choices.
Outcome: This exercise clearly
illustrates the difficulty of objective
decision-making when data is of a
subjective nature. Discussion was very
heated, and because the nurses in each
group were from varied backgrounds,
each placed different values On
sociological, psychological, economic,
moral, religious and academic standards.
Rarely did two groups come to the same
decision for similar reasons.
There were interesting consistencies
among the nurses in the groups. Without
exception. a high value was placed on
marital status and number of
dependents. If the patient was married
and had several young children. the
majority of participants felt that these
factors should be given priority. They
placed very low value on the needs of a
single professional woman in her
mid-thirties. and patients with
"problems" such as suicidal tendencies
were almost never chosen.
Prejudices and 'labeling' were
obviously at work here. Why were
nurses, educated in a caring and helping
profession, so ready to label and reject
people needing psychological and
sociological help and understanding?
After the exercise was completed.
the nurses discussed the importance of
recognizing prejudice and the role of
prejudice in decision-making - a subject
of considerable significance to nurses in
their professional life - whether they sit
on ethics committees, abortion
committees or selection committees -
or when they must cope with their
attitudes towards patients and
colleagues.
Exercise 3
SUR VI V AL I!'ol THE WINTER
Purpose: To compare individual
decision-making with group
decision-making.
Instructions: Participants are asked to
imagine that they are survivors of an
airplane crash. They are in a wilderness
area, 80 miles from the nearest town, and
the last weather report indicated
temperatures of _25 0 . Each person is.
given a list of 15 items salvaged from the
wreckage and asked to rank these items
in order of importance to their survival.
They are given 10 minutes to complete
the task individually and then the group
is given one hour to reach a team
decision on the importance of the various
items. I n the last phase of the exercise,
individual and team answers are
compared to answers prepared by a
wilderness survival instructor.
Outcome: In the majority of cases, it was
readily apparent that the group scores
were better than the individual scores
when compared to the expert answers. If
an individual had done better, the group
discussed why she hadn't been able to
convince the others and why they had
disregarded her answers. Why didn't
they utilize the expertise that was readily
available to them? In groups which had
done well, every member had
participated enthusiastically and shared
her knowledge or logical reasoning to the
benefit of the group.
In studies of the group
decision-making process, the
overwhelming conclusion is that group
decision-making is much better than
individual decision-making. The
resources of all members are pooled,
errors are detected more easily and hlind
spots corrected. (I t is always easier for
us to see other people's mistakes than it
is to see our own). Group discussion
stimulates idea.'i that might not otherwise
occur to the individual working alone.
Finally, there is more security in taking
risks in group decision-making than in
individual decision-making. 3
Participants discussed these factors
and were quick to see the many ways
that this theory can be applied in the
nursing world - care planning. the team
approach to health, staff appointments,
changes in ward routines - can all be
more innovative and effective when
several people pool their ideas.
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Exercise 4
HOLLOW SQUARES
Purpose: To focus on the tasks of
planning and implementation.
Instructions: The goal of this exercise is
to arrange 16 pieces of cardboard so as to
form a large square with a hole in the
middle. Each group is divided into two
teams. The first team is given a diagram
ofthe finished square; they are not
allowed to touch the cardboard pieces.
Their task is to plan how to instruct the
second group in assembling the square as
quickly as possible.
The second group waits until the
first team plans their strategy and then
receives their instructions on how to
assemble the square. Once the
instructions have been given by the first
team. no further communication is
permitted between the two groups. The
second team goes ahead with the
implementation of the plan.
31 June 1171
TIM Canecl"n NurM
Outcome: This task brought out many
frustrations. The implementers had to
wait for an hour while the planners
planned; they worried about what the
task would be, whether they would be
given adequate instruction and whether
they would be able to accomplish what
was asked of them. They sent notes to
the planners which were ignored or
answered in a condescending way -
"Can't you understand that you're
interrupting the very important process
of planning?"
During the instruction phase, the
planners explained their carefully
thought-out instructions and, at the
signal to start, stood back to watch the
implementers carry out the "easy" task
offollowing their directions. But it didn't
quite work out that way. The
implementers didn't find the instructions
clear at all- in fact, they were quite
confused. Well, perhaps they had better
ignore their incomprehensible
instructions and put the pieces together
by using their own logic and ability. But
it wasn't that easy and they ran into
trouble. The planners meanwhile, unable
to communicate, were chewing their
fingernails and pacing up and down. It
was painful and frustrating to watch their
carefully thought-out plans being
misinterpreted or, even worse, ignored.
They felt a lot of anger towards the
implementers for letting them down and,
by the end of the exercise, neither the
planners nor implementers had good
feelings about each other.
What went wrong? The pitfaHs are
similar to many "real world" ward level
situations. When the hospital-
administration hands down a directive
that appears stupid, when a procedure is
changed in what seems an unrealistic
way, when a nursing care plan is made
and then promptly ignored by the staff,
when a head nurse stays overtime and
the stafffeeis that she doesn't really
think them capable of using that new
piece of equipment - someone has made
the same sort of mistakes that were made
in the Hollow Squares exercise.
Planning can be so interesting and
absorbing that planners can forget that
implementers become anxious and
nervous about their responsibility.
Implementers usually develop some
feelings of antagonism or hostility
towards their planners while they are
waiting for their instructions. This
antagonism increases if they are given
complex instructions in a short amount
of time and they are left confused as they
take responsibility for finishing a task. 4
The participants learned that time
spent planning, and time spent
communicating is time well spent. They
also learned that the implementers
should be invited to observe a planning
meeting since the committment to
implement a task is usually built through
the planning process. They became
aware that there is considerable
frustration in planning something that
others are responsible for carrying out.
Through this exercise and the
ensuing discussion, the teams developed
a deeper understanding of each other's
needs, anxieties and capabilities.
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Exercise 5
MOON TENTS
Purpose: To explore aspects of
motivation and its role in leadership.
I nstructions: Each participant in the
group is given diagramatic instructions
on how to make tents out of paper,
allowed to practice and then asked to
estimate how many she could make in six
minutes. All participants are timed and
their tents inspected for quality. They
are then able to see if their estimate is
realistic and their work satisfactory.
Next, the group as a whole makes an
estimate of the number of tents the group
can make and works as a team to reach
this goal. No extra marks are given for
manufacturing more tents than has been
projected.
Outcome: After the exercise, the
participants were asked why they made
the estimates they did. Did they use
feedback? Were they aware ofthe
estimates of others when setting their
Own goals? How did they define the
objectives of the game, e.g. beating the
rest of the group, competing with their
own goals, making a lot of marginal
quality products or a few high quality
products? In other words, what
motivated them?
The way individuals perform is
affected by what motivates them, and
researchers have been able to identify
three broad categories of identifiable
human motives - the need for affiliation
(n-Aft), the need for power (n-Pow) and
the need to achieve (n-Ach). Most people
are influenced by each of these motives
but in different degrees. Obviously, the
way that these needs are arranged affects
the leadership style of any individual. 5
The high n-Achievement person for
example has three characteristics that
facilitate her effectiveness in goal
achievement and problem solving: 8
l. She strives to define situations in such
a way that she has personal
responsibility for the outcome of the
situation. She does not like to gamble.
She wants to be involved.
2. She is good at calculating the realistic
risk to be taken in a situation. She takes
risks that are challenging but attainable.
3. She seeks feedback on the effects of
her actions. She does not like situations
where she is not accountable for
outcomes. She treats both her failures
and successes as learning experiences
and as opportunities to improve herself.
The discussion that followed this
exercise revealed that nurses in charge
positions want to know more about
motivation and that one of their greatest
challenges, and at times frustrations, lies
in motivating their staff. This exercise
gave them somé insight into their own
motivating forces and the forces that
motivate others, insight that is necessary
for good. effective leadership.
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Exercise 6
THE LEGOX' MAN
Purpose: To diagnose the dynamics of an
intact group in terms of role-taking,
leadership style, developing alternatives,
dominance and submission within teams
and distribution of the work and
resources.
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17
Instructions: Each team is given a set of
48 Lego
Building Blocks that are a
variety of sizes and colors. The task is to
assemble the pieces into a "man" ,
identical to a model placed on a central
table. The model cannot be handled in
any way and the blocks cannot be
touched until the team is ready to start
assembling them.
The team is free to structure their
time and resources in any way they find
useful. During the planning phase, team
members, one at a time, can take a look
at the model as often as they wish. They
can take all the time they want to
prepare. An observer keeps a record of
the time spent planning and the time
spent in assembling the Lego man.
Outcome: Although at first glance this
seemed to be an impossible task, the
assembly was correctly accomplished by
almost every group. Most groups took a
long time to plan and a relatively shorter
time to actually carry out their goal-
the correct assembly of the Lego man.
Pfeiffer and Jones" suggest that
there are three main types of working
groups and that by measuring the time
spent planning vs. the time spent
assembling or completing a task, it is
possible to place most groups into one of
these categories (See table one).
Table one
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Fragmented
Conflicted
Group Type
Smooth
. In the fragmented group, decisions
tend to be made rather quickly without
making good alternate plans. Autocratic
leadership tends to prevail and openness
is not the norm. This group exhibits
minimal effort and minimal gain.
. The conflicted group is cautious and,
while considering alternative plans, is
seldom able to move towards concensus.
Members tend to use majority vote,
usually a desperate move, and there is
little committment to the plan or
outcome. They exhibit maximal effort
and minimal gain.
. The smoothly functioning group
tends to be trusting, cohesive and
exhibits high interaction and sharing.
Individuals in this group are committed
to the plan and outcome. They are
characterized by minimal effort and
maximum gain.
Most people can identify some
committee or ward within their hospital
setting that fits into the "fragmented" or
"conflicted" grouping. Nurses in the
workshop who could identify with these
groupings shared common complaints of
frustrations, irritations and minimal
satisfaction in the completion of the task.
Workshop groups enjoyed this
particular exercise the most. They had
expended tremendous energy in the
previous exercises and had learned a lot
from their mistakes. For this task, they
were able to put into action all that they
had gleaned from the workshop. They
used their listening skills,
communication skills. organization and
planning, good division oflabor, utilized
all their team members to best advantage
and demonstrated individual and group
committment to the goals.
As health professionals, these skills
are invaluable to us to achieve a
smoothly functioning group. Hopefully,
the added benefit of increased job
satisfaction will be accomplished at the
same time.
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Winding down
To end the workshop, the nurses
completed a questionnaire about their
leadership styles identical to the one they
had filled out before the course began,
and then compared the two. Evaluations
told us that they had developed a great
deal of insight into their own leadership
styles and were grateful for the feedback
from the other participants. Groups
exhibited a growth in cohesiveness
during the two-day course. Groups
which did not do well in the exercises on
the first day invariably did better on the
second day. Bonds were formed and
util ized at a later date.
-..
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... -
The role of "observer" was also
appreciated. Participants found that by
fIJling this role they were able to start
developing the analytic and feedback
skills that are also necessary for effective
leadership.
Results
The experiential learning experience
proved to be tremendously exciting for
the nurses involved: they went back to
their wards with many innovative ideas.
One ward, dissatisfied with its current
team system, used the group decision
approach to design a totally new
approach to team nursing which is now
working well. Team leaders are also
participating in some interview sessions
with job applicants and are giving
evaluations.
On a more personal level, several
nurses felt ready to apply for more senior
positions: others decided that they
needed further self-development and
postponed plans to try for promotion.
Because the response from the
participants was so favorable, we were
asked to repeat the workshop for head
nurses and directors of nursing. A third
workshop was also offered to nurses
from other hospitals in the city with the
added bonus of strengthening
interhospital ties.
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Another exciting offshoot was an
invitation to participate in the orientation
period for staff of a newly opened
Plastics Unit. Head nurse, staff nurses,
orderly, ward secretary and nurse
clinician teacher all worked together on
some problem-solving and
decision-making exercises that enabled
them to better understand each other's
strengths and weaknesses. They were
able to build a strong team in the
classroom before the umt opened and
before they were all required to work
different hours.
38 June 11179
The Cenedlen Nur..
It was the excitement generated by
these workshops that prompted us to
share these experiences with a larger
audience. Our nursing department
answered our original question as to
whether nurses need to develop the skills
of good managers with a resounding
"YES". We have demonstrated that
nurses are eager to learn organizational
skills, that they are willing to come on
days off to develop these skilIs. that they
were able to readily implement what they
had learned and most gratifying to us -
we all had fun learning! ..,
*Complete instructions to the exercises
are not given here. They can be found in
the following references:
I Broken Squares.
Johnson, David W. Joining together:
group theory and group skills, by... and
Frank P. Johnson, Englewood Cliffs,
N.J., Prentice-Hall, 1975.
2 Dialysis Machine.
Pfeiffer, J. William. The kidney machine:
group decision-making. Nineteen
seventy-fourannualhandbookforgroup
facilitators. ed. by... and John E. Jones,
La Jolla, CA, University Associates.
1974.
3 Survival in the Winter Exercise.
Johnson, op. cit.
4 Hollow Square.
Ibid.
5 Moon Tent.
Kolb, David. Organizational
psychology: an experimental approach.
by... et al. Englewood Cliffs, N.J.,
Prentice-Hall,1974.
6 Lego Man.
Pfeiffer, J. WilIiam. Nineteen
sel'enty-two annual handbook for group
facilitators, ed. by... and John E.Jones.
La Jolla, CA, University Associates,
1972.
References
I Heide, Wilma Scott. Nursing and
women's liberation - a parallel.
Amer.J.Nurs. 73:5:824-827, May 1973.
2 Johnson, David W.Joining
together: group theory and group skills,
by... and Frank P. Johnson. Englewood
Cliffs, N.J., Prentice-Hall, 1975. p.7.
3 Ibid., p.75.
4 Ibid., p.35.
5 Kolb, David A. Organizational
psychology: an experimental approach,
by ... et al. 2d ed. Englewood Cliffs,
N.J., Prentice-Hall, 1974. p.67.
6 McClelland, David C. Achieving
society. New York. Halsted Press, 1976.
7 Pfeiffer,J. William. Nineteen
seventy-two annual handbookfor group
facilitators, edited by ... and John E.
Jones. La Jolla, CA, University
Associates, 1972. p.39.
Recommended Reading
* I Argyris, Chris. Interpersonal
barriers to decision-making.
Harv.Bus.Rev. Mar./Apr. 1966, p.84-97.
*2 Blake, R. Robert. Reaction to
intergroup, by... and Jane Mouton.
Manage.Sci. 4: July 1961.
3 Grissum, Marlene. Woman power
and health care, by ... and Carol
Spengler. Waltham. MA, Little Brown,
1976.
*4 Hall,J. Communication revisited.
Calif.Manage.Rev. Spring 1973, p.56-57.
5 Hanson, PhillipG. Giving
feedback: an interpersonal skilLin
Pfeiffer, J. William. Annual handbook
for group facilitators, edited by ... and
John E.Jones. La Jolla, CA. University
Associates, 1975.
6 Harris, Thomas A. I'm O.K.-
you're O.K. Boston.G.K. Hall,1974.
7 Henning, Margaret. The
managerial woman. by .. .and Anne
Jardin. Garden City, N . Y., Doubleday,
1977.
*8 Janis, Irving L. Group think.
Psychology Today. Nov. 1971.
9 Kolb, David. Organizational
psychology: an experimental approach,
by ... et al. Englewood Cliffs, N .J . ,
Prentice-Hall. 1974.
*10 Lawrence, Paul R. How to deal
with resistance change. Harv.Bus.Rev.
May/Jun. 1954.
II Likert, Rensis. The nature of
highly effective groups. I n Likert,
Rensis. New patterns of management.
New York, McGraw-Hili. 1961.
* 12 McClelland. David C. That urge
to achieve. Think magazine. 1966.
13 Y ura, H. Nursing leadership:
theory and process. New York,
Appleton-Century-Crofts, 1976.
*References not verified in CNA Library
Photos courtesy oro. Tetreault. Royal Victoria Hospital.
Montrea] .
Susan Spennrath(R.N., Central
Middlesex Hospital, London, Eng.;
certified urology nurse; CMBI: certified
CPR instructor) is a nurse clinician
teacher at the Royal Victoria Hospital in
Montreal. Her previous nursing
experience includes day and night
supervision, urology,lCU, private duty,
midwifery, outpatient department, and
industrial nursing.
Judith C. Tiivel is a teacher in the Staff
Development Department at the Toronto
General Hospital. She obtained herR.N.
from the Royal Victoria Hospital and
B.N. degree from McGill University,
Montreal. Past work experience includes
staff nurse , head nurse, industrial nurse,
nurse clinician teacher. Areas of interest
include developing programs to assist
nurses to increase their skills in
leadership, interviewing, and patient
teaching.
",;
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The Cenedlen NUrH
June 1117V 311
YOU AND THE LAW
Patient's
advocate
-
a new role
for the nurse?
The primary goal of almost all persons who are hospitalized is to
regain and/or maintain their health. As long as they are sick,
patients do not usually assert their rights with the same force as
they might in a healthy and independent state. But once
embarked on the road to recovery. it is a different story:
patients today can no longer be considered passive recipients of
health care, accepting whatever comes their way with an
uncritical eye. They see themselves as consumer recipients of
health care services and. as such. bring the critical attitude of
the consumer to bear on their assessment of the nature and
quality of care that they receive.
As consumers, these patients frequently find that they are
dissatisfied with the product that is offered. They express their
dissatisfaction through the medium of published stories, articles
and interviews and also through the formation of patients' rights
associations, the goals of which are to apprise other
consumer/patients of their rights and to encourage and assist
these individuals in enforcing these rights.
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Corinne Sklar
The need for advocacy
Nurses know that many people find the experience of
hospitalization both depersonalizing and dehumanizing.
Patients frequently complain to them of inadequate
communication between the members of the institution staff
and the patient and his family. They may consider the quality of
care delivered by this staffto have been inadequate or even
substandard. Their complaints are not limited to physical
ministrations by physicians and nurses; frequently it is the
affective or interpersonal component that is the target of their
complaint. Patients report that staff behaved rudely, derisively,
brusquely or with indifference in dealing with them. Such
behavior tends to be accentuated in an environment which
requires and oftentimes fosters the physical and emotional
dependency of the patient-consumer. Under these
circumstances, patients are vulnerable and may be acutely
sensitive to the attitudes of the staff and tht: atmosphere in
which their care is delivered.
40 June 1919
The Cenedlen Nur..
When patients believe that they have reason to be
dissatisfied with the care that is available to them - both in
quality and the manner of its delivery - to whom can they turn?
Who will enforce their rights on their behalf? It is in this context
that the special role of the "patient's rights advocate" has been
advanced. This individual, according to one authority, is a
person whose primary responsibility it is to assist the patient in
learning about, protecting, and asserting his health rights within
the health care context. I In the opinion of that authority, such
an individual will perform an adversarial function in assisting
the patient. The advocate will be concerned with the care of the
patient as delivered by the total system: the hospital, the
physician, the nurse.
Others view the advocate's role more restrictively. In some
institutions, a patient representative handles patient complaints
but only those of an administrative nature. Grievances
concerning the quality of care delivered by medical and nursing
staff remain outside the representative's function. Here, only
complaints related to patient comfort and convenience are the
representative's concern.
I n the light of such a sweeping definition of the role of the
patient's rights advocate, it is not surprising that many members
of the nursing profession have adopted the view that patient
advocacy is an integral part of their function. However, before
we can decide on whether or not nurses are taking on a new role
in accepting this function, we should determine just what these
legal rights consist of, either as they are asserted by the patient
or by others on his behalf.
Patient rights
The rights of the individual around which COncern has been
focused can be divided into three categories:
. considerate care
. consent
. confidentiality.
Looking at these three concerns it becomes obvious that they
are united by the common thread of "communication".
As stated earlier, there is no legislated list of specific
patient rights. There have been, however. pronouncements of
expected standards from many bodies. One of the most widely
distributed statements is that of the American Hospital
Association, published in 1973. 2 While called aBill of Rights,
this statement is One of standards or guidelines and is of no legal
effect. It does, however, reflect the classes of concern referred
to above.
In Canada, there is no list of these rights enacted by
specific legislation but, as we shall see, our laws do cover the
rights asserted. The effectiveness of the legal protection
afforded by rights governed by Common law or legislation is
considered inadequate because of the difficulties of
implementation or enforcement of these rights by patients.
The public is protected generally by provincial legislation
governing the standards of practice of professionals in order to
ensure the delivery of care by duly qualified practItioners. As
well, there is legislation in each province with respect to the
standards under which hospitals and other similar institutions
must operate. Therefore, the general right of the public to
receive competent health care is legally safeguarded. The
purp05>e and intent of the A.H.A. statement and other similar
pronouncements is to bring about more effective patient care
and more satisfaction for the patient and those delivering
patient carë through observance of the enumerated rights.
. Consideration
The right to considerate and respectful care is the first right
enumerated in the American statement. That such a "right" has
to be officially promulgated is a sad commentary on the quality
of the relationship that exists between the patient and the
helping professions. We cannot legislate tenderness, kindness
or respect in their positive form. Instead, the negative aspects
of human behavior are enjoined. Thus, it is deemed professional
misconduct to abuse a patient verbally or physically. The
positive qualities of behavior are promoted in professional
codes of ethics such as the I.C.N. Code of Ethics for Nurses,
for example, which states:
"The need for nursing is universal. Inherent in nursing is
respect for life, dignity and rights of man. It is unrestricted by
considerations of nationality, race, creed, colour, age, sex,
politics or social status".
Under the heading 'Nurses and People" the I.C.N. Code
continues: "The Nurse's primary responsibility is to those
people who require nursing care. The nurse, in providing care,
promotes an environment in which the values, customs and
spiritual beliefs of the individual are respected."
By bringing to their nursing care the essence ofthe Nursing
Code of Ethics, nurses will safeguard the right of the patient to
respectful and considerate nursing care.
. Consent
The patient's right to information and participation in the
decision-making process is the area of major COncern of
patient's rights groups. This concern is also reflected in the
A.H.A. Bill in which six of its twelve articles deal with consent,
two focusing primarily on consent in the context of the
physician-patient relationship. The right to informed consent is
most important. Similarly, the right to refuse treatment to the
extent permitted by law must also be safeguarded. Where the
patient is to be involved in research. experimentation or
teaching, the right to sufficient information and the right to
refuse to participate must also be safeguarded.
The law has always protected the inviolability of the human
body from invasion without consent or legal justification. The
requisite elements of consent must be present for there to be
valid consent in law. 3
While information for consent to major surgical and
medical interventions is the responsibility of the physician,
nevertheless, consent is an important element in the delivery of
nursing care as well. Explanations to the patient of what is
happening, or what to expect are appropriate even in the most
simple terms. "I am going to change your dressing now" or
"This may feel cold or sting a little" - minor communications,
but their expression to an individual demonstrate the nurse's
delivery of care to a person rather than "just a body".
No doubt the lack of information given to patients during
the course of their treatment lies behind the impetus for the
right to access to medical records. Generally the view is that the
chart "belongs" to the physician or institution while the
information contained therein "belongs" to the patient. Policies
and practices vary with respect to the patient's access to his
record (unless of course the record is subpoenaed, i.e. required
to be delivered by law). It may well follow that by increasing the
quantity and quality of the information a patient receives and by
facilitating the patient's participation in his care and treatment
the demand for such access might well be decreased (/ tis
beyond the scope of this column to discuss the pros and cons of
this issue per se).
The Cenedlen NUrH
. Confidentiality
The right ofthe patient to professional confidentiality is
unquestioned. Failure to exercise discretion in disclosing
confidential information about a patient is considered to be
professional misconduct for which disciplinary action by the
professional body may result. Further. a breach of
confidentiality is in violation of the I.C.N. Code of Ethics:
"The nurse holds in confidence personal information and uses
judgment in sharing this information".
Confidentiality applies to information written in the chart
or received orally from or about the patient. 'I t is the duty of the
professional nurse to maintain confidentiality and safeguard this
responsibility to the patient.
The nurse as 8 patient advocate
It is my opinion that the responsibility ofthe nurse to protect
these rights of patients is not new. Nor does this responsibility
constitute a new role and function for nurses. Basic to nursing
education is discussion of the needs of patients: identifying.
recognizing. anticipating and meeting these needs is an integral
part of delivering patient care. Communication and observation
are important elements in fulfilling this aspect of nursing care.
To extend the role of the nurse as a patient advocate to one
of advising and assisting aggrieved patients who wish to take
legal or administrative action. as has been suggested by some
authors. might well strain the position ofthe nurse. Such a role
could also result in conflict between the nurse and her
co-workers (i.e. nurses. physicians etc.) or between the nurse
and her employer (i.e. the hospital or other institution).
It is important that nurses be aware of the rights of patients
and of their own responsibility in safeguarding these rights.
Such awareness is the first step in effective implementation and
enforcement ofp
tient rights.
Nurses who put into practice the basic and ethical elements
of patient care are. in my opinion. already functioning as
advocates of the rights of their patients. ..,
References
I Annas, GeorgeJ. The Rights of Hospital Patients. New
York. Avon. 1975. p.21O.
2 Ibid.. p.25.and for a discussion of the need for a Canadian
Patients' Bill of Rights, see also Rozovsky. L.E. A Canadian
patient's bill of rights. Dimem. Health Sen'. 51: 12:8-10. Dec.
1974.
3 Sklar. c.L. legal consent and the nurse. Canad.Nllrse
74:3:34-37, Mar. 1978.
4 Sklar. C. L Unwarranted disclosure. C an ad . N llrse
74:5:6-8. May 1978.
"You and the law" Is a regular column that appears each month In
The Canadian Nurse and L'lnflrmière canadienne. Author Corinne
L. Sklar Is a nurse and recent graduate of the University of Toronto
Faculty of Law and Is currently artlcling with a Toronto law firm.
--
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Selecting texts for next
semester?
Look to Mosby - for many
choices in every nursing specialty.
Medicall Surgical
".1
I
i
ORTHOPEDIC I i9
NURSING 1;\
l'iUJROLOGICAL AND
NEUROSURGiCAL Nl;RSINC'
New 7th Edition. Carini and
Owens' NEUROLOGICAL AND "
NEUROSURGICAL NURSING.
t I
ð_'
By Barbara
ng Conway. R.N., M.S.: \\ . y:
WIth 3 contributors. Extensively revised ,
D 4. "
and updated. the new edition of this widely '
\..
4
adopted text .refI.ects both innovations in the "" {I,
" ... Co
fiel
a.nd nursing s expanded role. It emphasizes
tL
"'\:
holIStic nurs
ng ca
and the rationales for 'q
speCific nursing actions. Three major : · (
sections focus on anatomy and ì ..,. "
physiology of the nervous system. disorders \ . \\'
of neurologic structures. and care of specific ,\l, r--\
disorders. You'll find important new
' \l
chapters. on embryology. functional physiology. '\.1..Ü
neurological assessment. sexual integrity. trophic
\ f
changes. and rehabilitation. July. 1978.656 pp., -
307 iIIus.. with 2 in color. Price. $2050.
2nd Edition. ADULT AND CHILD CARE: A Client
Approach to Nursing. By Janet Miller Barter.
R.N., M.S.; Lillian Gatlin Stokes. R.N.. M.S.; and
Diane McGovern Billings. R.N.. M.S. Focusing on the
patient as client. the second edition of this popular
text integrates both adult and child care.according
to basic human needs (safety and security. activity
and rest. sexual role satisfaction. need for oxygen,
nutrition. and elimination). The authors present
much in-depth information on pathophysiology
and discuss all aspects ofnursing care. 1977. 1,050
pp.. 738 iIIus. Price. $24.00.
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.,
Sc.M.Hyg.: Edna Ufgren Beck, R.N.. M.A.: and
Wilma J. Phipps, R.N.. A.M.: with 28 contributors.
The 6th edition of this classic text continues to
focus on individualized care of the total patient.
Throughout. you will find increased emphasis on
physiology. pathophysiology. and nursing
assessment. Particularly noteworthy chapters
discuss cardiac disease. family planning. counseling.
ecology and health. neurologic disease.
musculoskeletal disorders. and injuries. 1975.
1.048 pp.. 608 illus. Price, $26.00.
9th Edition. ORTHOPEDIC NURSING. By Carroll
B. lÄrson. M.D.. F AC.S.: and Marjorie Gould. R.N.,
M.S. Turn to this classic text for an up-to-date.
comprehensive overview of orthopedic
fundamentals. It describes - and graphically
illustrates - the basic skillsand principles essential
for planning and implementing holistic patient
care. New student-oriented features include: a
definitive chapter on emergency nursing in the
orthopedic unit; a detailed section on anatomy and
function of joints; and revised material on bone
tumors. amputations. and caring for the
ærebrovascular patient. 1978.508 pp., 466 iIIus.
Price, $18.00.
New 2nd Edition. HUMAN SEXUALITY IN
HEALTH AND IllNESS. By Nancy Fugate Woods.
R.N.. Ph.D.: with 7 contributors. This new 2nd
edition again explores all facets of the complex
phenomenon of sexuality. Three major units
examine the biopsychosocial nature of human
sexuality. analyze sexual health and health care, and
define clinical aspects of human sexuality. You'll
find 4 new chapters: assessment of sexual health;
roles for professional nurses in thedeliveryofsexual
health care: sexuality. fertility. and infertility; and
sexuality and mental health. March. 1979.412 pp..
11 iIIus. Price, $12.00.
PATIENT CARE STANDARDS. By
Susan Martin Tucker. R.N.. B.S.N..
P.H.N.; Mary Anne Breeding. R.N.; Mary
M. Canobbio. R.N.. B.S.N.: Gloria D.
Jacquet. R.N.: Eleanor H. Paquette. R.N.:
Marjorie E. Wells. R.N.; and Mary E. Willmann,
R.N. This book presents patient care standards to
help the student plan, implement. and evaluate
nursing care. A clear. concise outline format
stresses the observation. management, and
teaching required in individual patient situations.
Every aspect of effective care is explored: the
patient's physical. psychosocial. and emotional
needs: medical conditions; surgical interventions;
diagnostic procedures: chemotherapeutic agents;
and supportive mechanical equipment. 1975.442
pp.. 71 iIIus. Price.518.00.
6th Edition. Alexander's CARE OFTHE PATIENT
IN SURGERY. By Marie J. Rhodes, R.N., B.5.N.;
Barbara J. Gruendemann. R.N.. M.S.: and Walter F.
Ballinger. M.D.: with 21 contributors. long
respected for its accuracy and completeness. this
classic text provides a comprehensive overview of
safe. efficient OR nursing. More than 2.000 supertJ
illustrations (half new) augment forthright
discussions of asepsis. positioning. wound healing,
surgical procedures. and other important subjects.
1978.904 pp.. 2. 146 iIIus., including 2 in full color.
Price, 530.00.
MOSBV
TIMES MIRRDR
THE C. V. MOSBY COMPANY. L TO.
B6 NORTH LINE ROAO
TORONTO. ONTARIO
M4B 3E5
Review
9th Edition. MOSBY'S COMPREHENSIVE
REVIEW OF NURSING. Edited by Dolores F.
Saxton. R.N.. Ed.D.; with Patricia M. Nugent, R.N..
A.A.5.. M.S.; and Phytlis K Pelikan, R.N..A.A.S.. MA.
assistant editors; with 1 0 contributing authors.
The latest edition of this widely acclaimed volume
is clear. concise.andcomplete.ltreviewsall nursing
and nursing related areas essential to any inserviæ
or refresher program. All content has been field
tested for accuracy, reviewed, and updated to
answer today's nursing needs. You'll appreciate
important matenal on psychosomatic disorders.
parent<hild health, rehabilitation. and Canadian
nursing. 1977.624 pp.. 17 iIIus. Pr1ce, $15.75.
MAbltALL H. KI..\1J!o
JOHN ø. KI:'
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n._
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Maternal-infant bonding
.f'f
Maternal I Child
Health Nursing
MATERNAL-INFANT BONDING: The Impact of
Early Separation or Loss on Family
Development By Marshall H. Klaus. M.D.: and
John H. Kennell. M.D.: with 3 contributors and 8
critical commentators. This timely book explores
the ear1iest physical and sensory relationship an
infant develops with his parents. and factors that
enhance or inhibit this relationship. Interviews
with parents. comments and contributions from
experts. statistical data. and the authors'
observations provide a complete perspective.
1976. Z75 pp.. 49 iIIus. Price, $1450 (H); $1150
(P).
4th EditIon. MATERNnY NURSING: A Self-
Study Guide. By Constanæ Lerch. R.N.. B.S. (Ed.):
and V. Jane Bliss. R.N.. M.S.N. An ideal review for
important examinations, this practical wori<book
covers in depth AU. phases of obstetrical and
neonatal nursing. Discussions include thought-
provoking questions on preparation for parent-
hood. diagnosis of pregnancy. fetal/maternal
anatomy. normal and high-risk neonates. and other
key topics. 1978. 228 pp.. 60 iIIus. Price, $9.00.
COMPRB
CARD/AC
ENS/VE
.:w,
""ARE
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a
.
.
Cñtical Carel
Emergency Care
New 4th Edition. COMPREHENSIVE CARDIAC
CARE: A Text for Nurses. Physicians. and Other
Health PractItIoners. By Kathleen G. Andreoli,
R.N.. M.S.N.; Virginia Hunn Fowkes, R.N.. 8.S.N.;
Douglas P. Zipes. M.D.: and AndrewG. Wallace. M.D.
This new edition will give }Qur students the
information they need on all aspects of cardiac care
- anatomy and physiology: coronary artery
disease; assessment of patients; complications;
electrocardiography; and pacemakers. New
material covers risk factors in coronary artery
disease: Interview. physical examination. and
common laboratory tests for patients with
coronary artery disease; and current pacemaker
therapy. March. 1979. 406 pp.. 698 iIIus. Price.
$13.25.
3rd Edition. CRITICAL CARE. By Zeb L Burrell.Jr..
M.D., F AC.P.: and L.enette Owens Burrell, R.N..
M.S.N. Recognizing the cooperative efforts
required of all members of the critical care team.
this outstanding text clear1y presents the essential
information your students will need to understand
and react to the changing conditions of critically ill
patIents. It is organized according to body systems
- each section first reviews anatomy and
physiology. then details specific clinical problems
related to the organ-system. Each problem area
includes details on clinical findings. pathogenesis.
treatment. patient education. and psychosocial
aspects. 1977.440 pp.. 161 iIIus. Pr1ce, $18.00.
2nd Edition. EMERGENCY CARE: Assessment
and Intervention. Edited "V Carmen Germaine
Warner. R.N.. P.H.N.; with 3I:s contributors. In this
acclaimed edition. authorities in varied areas of
emergency care present a realistic. multidisci-
plinary approach to the assessment and
management of emergency situations. New
chapters discuss the role of the emergency
department nurse: triage and assessment: sexual
assault; child abuse; and spinal cord injuries. 1978.
556 pp., 226 iIIus. Price, $2050.
2nd Edition. CARDIAC ARRHYTHMIAS:
Exercises In Pattern Interpretation. By Mary H.
Conover. R.N.. 8.5. This edition features pracbcal
exercises in interpreting arrhythmias. It offers new
and expanded material on laddergrams.
arrhythmias diagnosis. ECG mechanisms and
pathophysiology of arrhythmias. The final chapter
contains test tracings for student self-evaluation.
1978. Z78 pp.. 256 ECG tracings. Price, $12.00.
Rely on these texts to help students
perform with optimum results.
Mental Health
A New Book. S'ffiESS AND SURVIVAL: The
Emotional Realities of Life-Threatening IDness.
Edited by Char1es A. Garfield. Ph.D. A most
comprehensive presentation. this text analyzes
stress and survival for health care wori<ers dealing
with patients and families facing life-threatening
illness. Noted contributors identify the sequenæ of
major emotional events encountered by the
professional and the patient from diagnosis
through cure or death. Optimal means of giving
emotional support are closely examined to show
students the ways in which they can be
instrumental in promoting quality of life. longevity.
and. at times. survival. March. 1979. 406 pp.. 9
iIIus. Price, $16.75.
New 2nd Edition. A GUIDE TO NURSING
MANAGEMENT OF PSYCHIA'ffiIC PATIENTS.
By Sharon Dreyer, R.N.. M.S.N.: David Bailey. Ed.D.;
and Wills Douæt. M.Ed. This wori<book covers all
mèjjor aspects of psychiatric nursing and bridges
the gap between leamingclinicalskillsandapplying
them. Updated throughout, this edition features: a
new chapter on the expanded role of the nurse; a
totally rewritten chapter on substance abuse:
chapter overviews which provide an orientation to
the subject matter following; and an instructor's
manual. April, 1979.266 pp. Price, $12.00.
10th Edition. ESSENTIALS OF PSYCHIA'ffiIC
NURSING. By Dorothy A. Mereness, R.N.. Ed.D.:
and Cecelia Monat Taytor. R.N.. MA Updated,
revised and reorganized, this comprehensive text
emphasizes the community health movement -
and discusses the nurse's expanded role in various
mental health settings and interpersonally based
treatment modalities. It includes timely
information on crisis therapy. intervention. and
psychosomatic illness. Two revised chapters help
students better understand the psyd1odynamicsof
observed behavior. 1978. 614 pp.. 11 iIIus. Price.
$19.25.
7th Edition. PSVCHIA'ffiIC NURSING. By Mary
Topalis. R.N.. Ed.D.: and Donna Conant Aguilera,
R.N., Ph.D., F.AAN. This comprehensive text
reflects the growing emphasis on community
mental health and explores the nurse's expanded
role. Two important chapters consider modem
psychotherapeutic techniquesl applicationsand
patients with antisocial behavior patterns.
Students will also find valuable material on crisis
intervention, community psychiatry. and suicidal
behavior, along with helpful case studies. 1978.
460 pp.. 4 iIIus. Price, $16.25.
3rd Edition. CRISIS INTERVENTION:Theoryand
Methodology. By Donna C. Aguilera, R.N., Ph.D..
F AA.N.; and Janice M. Messick. R.N., M.S.. F AAN.
This widely used text thoroughly descnbes the
evolution of crisis intervention methodology and
uses: explores differenæs in psychotherapeutic
techniques: and provides an overview of
therapeutic groups. The authors also discuss
sociological factors adversely influencing the
psychotherapeutic process; the problem solving
process: stressful events precipitating crises: and
changes during maturation. New material covers
rape, suicide. and old age. 1978. 206 pp.. 16 illus.
Price, $10.75.
ALCOHOLISM: Development. Consequences
and Interventions. By Nada J. Estes. R.N.. M.S.:
and M. Edith Heinemann, R.N.. MA: with Zl
contributors. How well do your students
understand the problems facing alcoholics and
their families? Using a multidisdplinary approach.
this important text offers contemporary insights
into alcoholism. It discusses developmental
perspectives on explores pathophysiological effects
... focuses on special groups (teenagers. women,
native Americans) ... and examines various
therapeutic approaches. 1977. 344 pp.. 7 iIIus.
Price. $ 13.25.
THE
NURSIN(
PROCESS
I
I
I
I
,
I
'" I
Fundamentals
New 1 Oth Edition. TEXTBOOK OF ANATOMY
AND PHYSIOLOGY. By Catherine Pari<er Anthony.
R.N.. M.S.: and Gary Arthur Thibodeau, Ph.D. The
new edition of this classic is even better. It not only
retains the valuable features that made it the
leader in its field, but also offers many added
highlights. Revised. and sharing the insights of a
new co-author, this is the most graphiceditionyetl
Of the more than 650 illustrations included. over
200 are in four colors. Throughout, the use of color
is functional - vividly pointing out various
systems, organs. and important features of
structure and function. January. 1979.744 pp.,
570 iIIus.. including 211 in 4-<:010r. 20 in 3-<:010r,
and 2.38 in 2-<:010r. Price, $21.75.
New 10th Edition. ANATOMY ANDPHVSIOLOGY
lABORATORY MANUAL. By Catherine Pari<er
Anthony. R.N., M.S.: and Gary Arthur Thibodeau,
Ph.D. January. 1979. ZlO pp., 169 iIIus. Price.
$9.75.
-- Anatomy and
Phyalology
CRISIS -.
InTERuEnnon
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New 2nd Edition. THE NURSING PROCESS: A
Scientific Approach to Nursing Care. By Ann
Marriner, R.N., Ph.D. Twenty-nine selected
readings explore the theory undertying the four
phases of the nursing process - assessment.
planning. implementation. and evaluation.
Student-Ðriented features include: a brief analysis
preceding each group of readings: extensive
biblioglëlphies concluding each chapter: and an
important chapter defining the nursing process.
FIVe new readings highlight this edition. January,
1979. 2B8 pp.. 2 iIIus. Price, $12.00.
8th Edition. SCIENTIFIC PRINCIPLES IN
NURSING. By Dorothy Elhart. RN.. M.5.: Sharon
Cannell Firsich. RN.. M.S.: Shir1ey Hawke Glëlgg,
RN.. 8.S.N.. M.RE.: and Olive M. Rees. R.N.. M.A.:
with 4 contributors. This text provides
physiological. psychological and sociological
concepts for effective patient-<are planning. It
stresses Sister Callista Roy's adaptation model,
which describes four areas of human responses:
physiologic needs, self -<:oncept. role function. and
interdependence relations. 1978. 710 pp.. 141
iIIus. Price. $13.25.
New 4th Edition. CLINICAL NURSING
TECHNIQUES. By Norma Dison. RN.. M.A. A step-
by-step approach - complemented with more
than 700 exællent illustrations - offers }Qur
students a precise guide to basic and advanced
techniques in medical-surgical nursing. Focusing on
prindples and purpose. the author emphasizes
nursing action rather than equipment -
encoulëlging adaptation and modification of
techniques. This edition features a ludd new
chapter on such fundamental proædures as bed-
making. 0IëI1 hygiene procedures. and bed baths. A
teacher's instruction guide isavailable.April, 1979.
Approx. 432 pp., 701 iIIus. About $14.50.
2nd Edition. KEY CONCEPTS IN THE STUDY
AND PRACTICE OF NURSING. By Marjorie L
Byrne. 8.5.N.. M.5.: and Uda F. Thompson. S.5.N..
M.S. This text presents a woli<ing model for
assessing client needs and predicting nursing care
effects. Discussions emphasize understanding
regulatory behaviors. structulëll variables. concepts
of role and position. and developing thelëlpeutiC
nurse-<:Iient relationships. 1978. 164 pp.. 17 iIIus.
Price, sa.50.
Leadershipl
Research
BasIC -=-:--==
maternity nursing
,.,
,"
I
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.
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."
New 3m Edition. NURSING MANAGEMENT AND
LEADERSHIP IN ACTION: Principles and
Applications to Staff SItuations. By L'lUIëI Mae
Douglass. RN.. M.s.: and Em Olivia Bevis. RN..
M.A.. F AA.N. This 3m edition has a broader
perspective - of leadership and management in
nursing. whether plëlcticed in team nursing,
primary nursing. functional or case nursing. This
volume presents a conceptual flëlmework of
administrative principles for use by the nurse-
leader-manager and demonstlëltes their
application in everyday plëlctiæ. March. 1979.302
pp.. 16 iIIus. Price, $12.00.
MANAGEMENT FOR NURSES: A Multidisci-
plinary Approach. Edited by Sandlël Stone. M.S.:
Marie Streng Berger. M.S.: Dorothy Elhart. M.S.:
Sharon Cannell Firsich. M.s.: and Shelley Baney
Jordan. M.N. Selected readings examine
management and organization theories in nursing.
Ð!ch of the three sectJonscontain material relevant
to the organization asa whole and to the individual
in a leadership or management position. including
details on structure. personnel. and economic
factors. 1976.292 pp.. 24 iIIus. Price, $12.00.
NURSING RESEARCH: A Learning Guide. By
Natalie Pavlovich. RN.. Ph.D. Covering every phase
of the research process. this condse workbook
helps students identify basic concepts and apply
knowledge and skills. Eight well-organized
chapters disruss: the problem: review of literature:
hypothesis: research methodology: data collection:
data analysis: conclusions and recommendations:
and final report. You'li appreciate the many helpful
leaming aids - including glossaries. selected
readings. and discussion questions. 1978.274 pp.
Price, $9.75.
Practical
Nursing
New 4th Edition. MATERNAL AND CHILD
HEALTH NURSING. By A. Joy Ingalls. RN., M.S.:
and M. Constance Salemo. RN.. M.S.. S.N.P. Give
}Qur LP NN students an effective introduction to
modern maternal-child nursing with this
generously illustrated text. Meticulously revised, it
offers the latest information on hormones.
matemal malnutrition. fetal monitoring. family
planning. high-risk infants. genetic counseling. and
other pertinent topics. Highlights include: a
stronger emphasis on thepsychosodal needs of the
family: a unique chart summarizing fetal
development; and research results on nutrition.
growth. and development - and medications.
May. 1979. Approx. õ72 pp.. 609 iIIus. About
$18.00.
New 4th Edition. BASIC MATERNnY NURSING.
By Persis Mary Hamilton. RN.. P.H.N.. M.S.
Stressing family-centered aspects. this
outstanding text again presents the knowledge
and skills LP/VN students need to provide top-
notch matemity care. Extensively revised chapters
explore human sexuality. embryology. and normal
and abnormal aspects of pregnancy and infant care.
Students will particular1y value timely new
material on such key topics as ultrasonoglëlphy.
amniocentesis. the oxytocin challenge test and
parent-<:hild bonding. February. 1979. 256 pp..
1 õ7 iIIus. Price. $ 11.25.
4th Edition. THE ARITHMETIC OF DOSAGES
AND SOLlfTIONS: A Programmed Presenta-
tion. By L'lulëI K Hart. R.N.. Ph.D. This expanded
edition will help students develop the skills for
acculëlte drug calculation. In a proglëlmmed
format this guide allows students to proceed at
their own pace. and master practical problems
they'll encounter in daily wort<. 1977.82 pp. Price,
sa.OO.
Prices subject to change.
A90570
MOSBV
TIMES MIRRDR
THE C. V. MOSBY COMPANY. l TO.
B6 NORTH LINE ROAO
TORONTO. ONTARIO
M4B 3E5
48 June 1979
The CanadIan Nur..
news
(continued from page 8)
justify continuing interest.
need and support. In this time
of competition for resources
(both financial and physical)
and public accountability.
program evaluation is no
longer a frill or policy option
but an administrative
necessity, she said.
Rita Lussier, consultant
in continuing education for
rOrdre des infermières et
infenniers du Québec, spoke
about approval mechanisms of
CE programs. She pointed out
that persons involved in
continuing education for
nurses in Canada could learn a
great deal from their
American counterparts.
In the United States. the
nursing profession has
developed a very complex and
sophisticated system for
approving and accreditingCE
programs for nurses through
CEARP (Continuing
Education Approval and
Recognition Program) and the
National Accreditation Board
for Continuing Education for
Relicensure. The American
Nurses Association has taken
a strong stand supportingCE
and in 1978 professional
nursing associations in ten
states required mandatory
continuing education for
relicensure. However, some
states such as California are
having second thoughts.
In Lussier's opinion "a
lot of energies and money are
spent to operate those
systems which are far
removed rrom the immediate
consumer". There is no doubt
that life-long learning for the
nurse is necessary for
maintenance of safe and
competent practice but
Lussier questioned the
validity of a hierarchical
system that fails to meet the
individual learning needs of
nurses.
Although she stated that
she strongly supports
voluntary CE in Canada, she
also expressed a beliefthat
continuing education for
Pharmacotherapy
with emotionally disturbed children
4th Annual Symposium
September 20 - 21, 1979
Skyline Hotel, Toronto
Sponsored by:
Thistletown Regional Centre
Guest Speakers
Dr. Magda Campbell
Associate Professor of Psychiatry
and Director of the ChiJdren's
Psychopharmacology Unit
New York University Medical Centre
School of Medicine
Dr. James M. Perel
Associate Professor of Clinical
Pharmacology and Chief of Research
New York State Psychiatric Institute
Columbia University
PHARMArOTHERAPY
,
4f'>
, ,.
.\ 197.
"j
1
. I. lutl. II' holdl'( 11
Dr. C. Keith Conners
Professor of Psychiatry
Department of Psychiatry
Western Psychiatric Institute
and Clinir
University of Pittsburgh
School of Medicine
Dr. Gabrielle C. Weiss
Clinical Director
Department of Psychiatry
Montreal ChiJdren's Hospital
For IftCIft information write to:
The Secretary
1979THISTLETOWN SYMPOSIUM
51 Panorama Court, Rexdale
Toronto, Ontario. M9V 4L8
nurses must be revised. She
urged nurse educators to
develop mechanisms
adaptable to individual nurses
and their learning needs.
In conclusion, she
stressed the need for the
development by the CNA of
more specific standards on
continuing education for
nurses in Canada.
With the rapid change in
health care technology and the
abundance of information
available. how do nurse
educators even begin to
identify the learning needs of
nurses? This was the question
posed by Margaret McCrady,
the third speaker on the
agenda. Currently the
member-at-Iarge for nursing
education on the CNA board
of directors and also the
director of education services
at the Health Sciences Centre
in Winnipeg, McCrady
discussed the identification of
learning needs.
She mentioned a number
of techniques to identify real
learning needs from other
categories of needs or from
perfonnance problems. She
encouraged the use of
advisory groups. interviews.
informal communication,
questionnaires. brainstonning
sessions, pre and post tests,
analysis of management
records and reports. and
surveys of professional
literature to help the nurse
educator identify real
educational needs of nurses.
McCrady warned that it is
unrealistic to hope to meet all
the learning needs of nurses
and that educators must
identify learning priorities.
The final speaker,
Josephine Flaherty, Principal
Nursing Officer, Health and
Welfare Canada. discussed
the problem of record keeping
and recognition of continuing
education crf'dits. The
objective of her talk was to
sensitize nurses to the
complexity of the issues
involved and to pose
questions for the audience to
consider. For example: Are
records ofCE necessary?
What infonnation should be
kept? Who should keep
records: the individual. the
employer. the educational
institution, the statutory
body?
When considering the
recognition ofCE credits,
Flaherty asked, "What are we
recognizing?" Are we looking
at attendance, sponsorship,
content. skills or marks?
When a nurse receives CE
credits, does this warrant a
change in pay, job
responsibility. or privilege?
Flaherty's message came
through loud and c1ear-
nursing must carefully think
about these issues before
making decisions about
continuing education for
nurses in Canada.
Background
In the past. a number of
attempts have been made to
organize a national meeting on
continuing education for
nurses. It was not until last
year, however. at theCNA
meeting in Toronto in lune.
that 78 concerned nurses met
to discuss the issue. From this
group, a core planning
committee was developed,
composed of: Helen Niskala,
RPNABC; Kathy Clarke,
RNAO; Mary Hammond. U
of Alberta; Ruth Burstahler,
RNABC; Rita Lussier. OIlQ;
Marina Heidman. Humber
College, Toronto: and Kay de
long. MARN. The audience
acknowledged that it was to
the credit of the pldnning
committee that this first
national meeting was a
learning experience for all
concerned.
Did you know...
A research project to examine
a link between migraine
headaches and weather will be
conducted jointly by the
Atmospheric Environment
Service of Environment
Canada and The Migraine
Foundation. The project will
study the so far unproven
belief that certain kinds of
weather can trigger or worsen
migraine attacks which affect
at least 20 per cent of the
population. '"
Th. C....dl.n NUrH
Jun. 1979 47
research
Resumes are based on studies
placed by the authors in the CNA
Library Repository Collection of
Nursing Studies.
Behaviours of Patients behaviors on only a few Evaluation of Alberta use of practices to d irectl y
Described by Nurses in occasions, and most often Nursing Instructors. observe the nursing instructor
Medical-Surgical Areas in from the families of patients. Edmonton, Alta., 1977. and the possibility of
the Initiation of Two-thirds ofthe nurses Thesis (M.Ed.), constructing evaluation
Psychiatric Referrals. reported delays in the referral University of Alberta by instruments based upon
Toronto, ant., 1976. process. The major reason Lee Ellen Cadman. criteria which were identified
Thesis (M.Sc.N .), was that physicians were This study was designed to as important.
University of Toronto by often not convinced that the examine the perception of
Carole Lee Thomson reported behaviors did in fact nursing instructors in Alberta An Exploratory Study of
(H endrikson). exist. Patients were able to regarding I) actual and the Behaviors of Children
This study was a descriptive present acceptable behaviors preferred evaluators 2) data in Pain. Montreal,
survey of a group of forty to the physicians while nurses gathering practices and 3) Quebec, 1977. Thesis,
nurses who were interviewed saw and reported other criteria for assessing the (M.Sc. (Applied) in
in medical-surgical areas to behaviors. The nurses said effectiveness oftheir Nursing), McGill
detennine what patient that their contacts with teaching. A questionnaire, the University by Judith
behaviors had stimulated resource personnel did not Nursing Instructor Evaluation Macintosh.
them to request psychiatric delay the consultation process Instrument, was distributed to The purposes of this
consultation referrals within to any significant degree. On those teaching nursing in exploratory study were to (I)
the past year. It also sought to only one occasion was the diploma or basic validate the pattern of
identify the other resource suggested referral mentioned baccalaureate programs. behaviors observed during
personnel contacted to to a patient before the request Personal and professional fieldwork with school-aged
improve communications with was made. Only rarely did infonnation and the actual and children experiencing pain,
patients before consultations physicians observe patient preferred importance of 12 and (2) verify that this pattern
were requested. An interview behaviors; usually, they data gathering practices and of behaviors occurs regardless
schedule of closed and learned of them through 30 evaluation criteria were of the amount of pain
open-ended questions was nurses' notes and progress requested and a statistical experienced.
used. notes, Kardex rounds, or analysis was done. A pattern of six behaviors
The patients most reports of nursing care Senior administrators and in four phases was observed in
frequently identified as conferences. immediate supervisors were fieldwork. These were:
requiring psychiatric The m
ority of nurses seen by the teacher as the Phase I: crying or sobbing:
consultation by the nurses expressed the viewpoint that most important evaluators but Phase 2: (a) calling out to
were those who were they should be actively they would prefer that others to relieve the pain,
uncooperative in their involved in initiating instructors themselves and (b) describing the sensations
responses to nursing care or psychiatric referrals, that they immediate supervisors be felt as painful;
treatment or were a physical and the physicians needed to most important. Master's Phase 3: (a) making
threat to themselves or others. be more aware of patients' level prepared instructors and suggestions about how care
Less frequently identified psychological problems, and those teaching in may be conducted more
were patients who did not that they should collaborate baccalaureate programs had comfortably. (b) cautioning
directly express their more effectively. The the strongest preference for others to treat the injured area
psychological distress or recommendations included: peer evaluation. They also gently;
needs. Nurses referred (l) the creation of a direct saw and preferred more PhasE: 4: requesting specific
patients for psychiatric nursing referral system to a student involvement in the care and diversional activities
consultations from various mental health psychiatric evaluation process than did Thirty-three children,
medical-surgical areas. No nursing consultant through other Alberta nursing between five and twelve years
predominant medical which nurses in instructors. The instructors old composed the sample. A
conditions accompanied the medical-surgical areas could preferred that a broader range five point scale was selected
behaviors for which nurses make infonnal requests for of data gathering practices and as a pain estimate for children.
initiated consultations. Other help with patients in criteria be utilized in Each child rated his pain on
reasons for psychiatric psychological distress; (2) evaluating their teaching this scale for three-five days.
referral were the nurses' more regular collaboration effectiveness especially At the same time, the
concern about patients' among resource personnel; practices involving the direct investigator observed and
diagnoses, and their need to and (3) closer liaison between observation of the teacher; recorded each child's
plan for care or discharge. nurses in medical-surgical criteria involving evaluative behavior on a behavioral
Nurses contacted resource areas and nurses in and communicative skills observation schedule. While
personnel primarily to have. community health when were considered important. no significant trends were
them solve patient problems planning for the patient's There is a need for further established, there was a
rather than for assistance in readjustment to the assessment of the roles tendency for the children to
coping more effectively with community. various personnel might play follow in the pattern of the six
patient behaviors. Nurses in Alberta nursing instructor listed behaviors. 'j,
sought clarification of patient evaluation, development and
48 June 1979
The Cenedlan Nur..
input
(continued from P38e 6)
A reply
To the nurse who writes
that she has worked 25 years
with Indian patients in the
Wetaskiwin Hospital
(February CNJ), I have
worked ten years among the
people on this reserve which
is populated by approximately
4,500 people who are lucky
enough to be among the
Albertans who have had oil
discovered on their land - I
repeat, their oil on their land.
These native people have
been able to build many lovely
homes with the royalties from
this resource. I have been in
virtually every home in my
area of the reserve. I could
count on the fingers of my
hands the poorly cared for or
dirty homes. The remainder
are clean, tidy and most
attractively furnished.
Like the farming
population a generation ago,
vegetables are their priority.
You can't eat flowers! The
people are, however,
beginning to take a real
interest in a more attractive
yard. It's only lately. that there
has been water available to
establish nice lawns.
You insinuated that
Indians would rather live on
oil money and welfare than
work. Have you talked to any
unskilled young people lately
who are trying to enter the
work market? I think not, or
you would have a more
realistic view as to the
impossible employment
situation. A large percentage
of the people on the reserve
do hold jobs. Indians
receiving oil money do not
receive welfare. The bands
are, in effect, paying their own
welfare with oil revenues.
Native people have both
strong points and faults. Like
the rest of us they aren't
perfect. They are individual
human beings, and deserve
respect and consideration.
-Beth Mason, Community
Health Nurse, Hobbema
Reserve, Alberta.
A gradual process
Ms. Walker\ one-sided
letter (Input, January) left a
very bad taste in my mouth.
Having worked on two
reserves for more than four
years, I can appreciate her
frustrations. But changing
attitudes and health practices
is a long and difficult process
in any community and I think
she forgets that she is dealing
with people whose culture
goes back many years and
whose contact with health
education is, by comparison,
very recent.
There is some truth in
what she writes but she
forgets the positive aspects of
working on a reserve and with
Indian people. I agree that
changes are needed. Perhaps
her attitude might be a place
to start or perhaps she should
consider working elsewhere.
-Patricia Foster, RN, BScN,
Nursing Station, Big Trout
Lake, Ontario.
Say it isn't so
Surely no public health
nurse would advocate a
hospital patient being meek,
submissive, uninformed and
totally accepting of poor and
unsympathetic care.
I refer to the March
article, "That's no
nurse...that's my mother!" A
good patient should not
accept things such as a leaking
I. V., an inadequate diet for a
nursing mother or criticism for
arriving late when the lateness
is due to feeling weak.
1 realize the article was
written from a human interest
point of view. However, the
concept of the only good
patient being one who
questions nothing is one
which should have been
dropped years ago.
A well-informed,
involved patient will progress
far better and make nursing a
more rewarding career.
-Kay Cunningham, P.H.N.,
Guelph, Ontario.
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50 June 1979
A catalogue of special
interest groups
(continued from page 16)
Orthopedic Nnrses Association,
Montreal Chapter
Contact: Mrs. J. McAdam
9 West
Royal Victoria Hospital
687 Pine Avenue West
Montreal, Quebec
Société du Timbre de Noel du
Quebec, Inc,/Quebec Christmas
Seal Society, Inc., Nurses Section
Présidente: Liliane Beaudry
c/o 264 rue Chénier
Québec, Québec
GIKIR2
NEW BRUNSWICK
Association of New Brunswick
Registered Nursing
Assistants/ Association des
infirmières auxiUares enreglstrees
du Nouveau Brunswick
39 Coventry Road
Fredericton, N.B.
E3B 4P4
New Brunswick InfediQn Control
Practitioners Group
President: Joline Voye
Carleton Memonal
Hospital
P.O. Box 400
Woodstock, N.B.
EOJ 2BO
New Brunswick Occupational
Health Nursing Group
(NBOHNG)/Groupe de
Spécialisation du Nursing de la
Santé au Nouveau Brunswick
(GSNSNB)
President: Pamela Innes
West Saint John
Community Hospital
Prince St. West
Box 3610
West Saint John, N.B.
E2M 4X3
New Brunswick Operating Room
Nurses Group
(NBORNG )/Groupe d'infirmières
des Salles d'opération du Nouveau
Brunswick (GlSONB)
Contact: Donna Goodin
c/o New Brunswick
Association of
Registered Nurses
231 Saunders Street
Fredericton. N .B.
E3B IN6
The Cenedlen Nur..
Respiratory Interest Group,
Fredericton Onterdisciplinary)
Chairperson: Margaret Irwin
Physiotherapist
Victoria Public
Hospital
Contact: Alma Leclerc
Program Director
New Brunswick
Tuberculosis &
Respiratory Disease
Association
Box 1345
Fredericton, N.B.
E3B5E3
NOVA SCOTIA
Ambulatory Care Nurses Interest
Group, Nova Scotia
Contact. Louise Corbett
Dalhousie Family
Medicine Centre
Dalhousie University
Halifax, N.S.
B3H 3J5
Atlantic Maternal & Newborn
Nurse-Midwives Association
Contact: LyndaDavies
MacDonald
School of Nursing
Dalhousie University
Halifax, N.S.
B3H 3J5
(forN .5. & P.E.L)
Contact: Hope Toumishay
School of Nursing
Memorial University
St. John's, N fld.
A Ie 5S7
(for Nfld. & Labrador)
Directors of Nursing Service, Nova
Scotia (RNANS Affiliate)
Coordinator: Yvonne Nichols
Director of Nursing
Western Kings
Memorial Hospital
P.O. Box 490
Berwick, Nova
Scotia
BOP I EO
Emergency Nurses Association of
Nova Scotia
PresIdent: Marilyn MacVicar
12A Owen Drive
Dartmouth, N. S.
B2W 3L9
Evening and Nigbt Supervisory
Gronp, Nova Scotla/Gronpe de
SurveiUance de Soirée et de nuit,
Nouvelle-Ecosse
Chairman: Kay McGuire
SI. Rita Hospital
409 King's Road
Sydney, Nova Scotia
BIS IB4
Gerontological Association of Nova
Scotia
Contact: Jean MacLean
c/o RNANS
6035 Coburg Road
Halifax, N.S.
Bm IY8
Nova Scotia Certified Nursmg
Assistants Association
12 Marvin Street
Dartmouth, N.S.
B2Y 2M I
President: Albert Mad ntyre
Nova Scotia Operating Room
Nnrses
PresIdent: Bernice Frances
c/oO.R. Plastic
Service
V ictoria General
Hospital
Halifax, N.S.
B3H 2Y9
Occupational Health Nurses
Association of Nova Scotia
President: Ann MacMullen
Crossley Karastan
Willow Street
Truro, N .S.
B2N 4Z5
Psychiatric Nurses Association of
Nova Scotia
4 Christopher Avenue
Dartmouth, N.S.
B2W 3G3
Secretary: E.I. Shortt
PRINCE EDWARD
ISLAND
Licensed Nursing Assistants
Association of Prince Edward
Island
President: Debra Thistle
Contact: Mrs.-J.E.V. Bolger
Depl. of Health
P.O. Box 1253
Charlottetown, P.E.I
CIA 7M8
NEWFOUNDLAND
Infection Control Association,
Newfoundland
President: L. Case
c/o General Hospital
Health Services Centre
Prince Philip Drive
St. John's, Nfld.
AIB3V6
Newfoundland Nursing Assistant
Advi!lOry Committee
P.O. Box 8234
St. John's, Nfld.
AIB3N4
NORTHWEST
TERRITORIES
Registered Psychiatric Nurses
Association of the Northwest
Territories
President: Sheila Duff
Box 2580
Yellowknife, N.W.T.
Acknowledgement Thanks go to
the staff of the CNA Library for
their assistance in the research of
this article and to the national
associations and interest groups
whose enthusiastic responses
helped to paint a clearer picture
of what is offered through
association membership.
Tilkian & Conover
Understanding
Heart Sounds and
Murmurs
Here's an exciting new pack-
age that provides a basic
familiarity with normal heart
sounds and allows recogni-
tion of life-threatening
disorders manifested by
abnormal heart sounds. Pack-
age includes G-60 cassette
plus soft cover book.
By Ara G. Tilkian, MD, FACC and Mary
Boudreau Conover, RN, BSN, Ed.
Packaqe. $16.95 Order #8878-0.
Book only. About 120 pp. lIIustd Soft cover
$895. Ready soon. Order #8869-1.
The
1979
Saunders
Winners
Circle
Drain & Shipley
The Recovery Room
Two leading experts provide clear, accurate coverage
of the recovery room in this exciting new book. Topics
include the physiology of anesthesia, the èffects of
various anesthetic agents, specific care after all types of
operations, and factors that affect recovery from
anesthesia in particular patients.
By Cecil B. Drain, RN, CRNA. BSN; Major. Army Nurse Corps.,
and Susan B. Shipley. RN, MSN; MaJor. Army Nurse Corps
608 pp.. 167 ill $1695. March 1979 Order #3186-X.
Dienhart
Basic Human Anatomy
and Physiology
3rd Edition
The new third edition of an already popular text has
been revised with special attention to the chapter on the
nervous system and includes expanded coverage of
cytology and histology, an expanded glossary and
outstanding new illustrations.
By Charlotte M. Dienhart. PhD 311 pp. 171111. $9 95. Soft cover
Ready soon. Order #3082-0.
Krause & Mahan
Food, Nutrition and Diet Therapy
6th Edition
Featuring new material on stress responses, nutrition
and cancer and the low-birth-weight infant, this strong
revision is even better suited to your needs. Many new
graphs, illustrations and tables highlight and enhance
better understanding of all aspects of nutrition.
By Marie V. Krause, BS, MS, RD and L. Kathleen Mahan, RD, MS.
963 pp., 254 ill $18.50. Jan. 1979. Order #5513-0.
Bleier
Bedside Maternity Nursing
4th Edition
This new edition includes new and updated material,
a new chapter on economic and social problems of the
modern family and current issues in maternity care.
By Inge J. Bleier, RN. BS, MS. About 360 pp., 160 ill. Soft cover
Ready soon. Order #1743-3.
Watson
Medical-Surgical
Nursing 'and
Related
Physiology
2nd Edition
Thoroughly revised, this new
edition includes the latest infor-
mation on topics ranging from
patient's rights, response to
illness and physical assessment
to immunologic response, shock
and much more The chapters on
cardiovascular disease and the
nervous system have been extensively
revised. An excellent choice for those
preferring a smaller medical-surgical text.
By Jeannette E. Watson, RN. MScN About 1010 pp 175 ill.
About $19.50. Ready soon Order #9136-6.
Keane
Essentials of Medical-Surgical
Nursing
You'll find coverage of the general concepts related to
illness and nursing as well as medical-surgi
1 nursing
care problems in this introductory text. Student aids
include: learning highlights; vocabulary lists; summary
tables; and a student study aid section consisting of learn-
ing activities, additional readings, and a study outline.
By Claire B. Keane, RN, BS, MEd. 721 pp., 187 ill. About
$19.95. Ready soon. Order #5313-8.
-...............
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I W.B. Saunders Company
. West Washington Square Philadelphia, Pa. 19105
in Canada: 1 Goldthorne Ave., Toronto. Onlario M8Z 5T9
In Englend: 1 SL Anne's Rd., E..lboume, Eesl Sussex BN21 3UN
In Austrella: 9 Weltham Slreet, Arlarmon N.S.W 2964
State
52 June 1979
The C.nadl.n NUrM
books
Into aging, a simulation game by
Therese Lemire Hoffman and Susan
Dempsey Reif. 90 pages. Thorofare,
N.J.. Charles B. Slack, 1978.
Approximate price: $12 .50
I nto Aging, a small paperback
manual, describes a unique simulation
game developed by two nurse educators
for the purpose of sensitizing players to
the issues cQnfronting those over 65. The
manual would be of value to anyone
wishing to provide experiential learning
about aging to groups oflay persons,
skilled personnel or professionals. I feel
it has particular value for use with
students who are or will be encountering
the elderly in their practice but would
recommend that the teacher/facilitator
already possess a knowledge of the aging
process and well-developed group
leadership skills.
The simulation game outlined in the
manual is introduced by a foreward, a
preface, an introduction and an
overview. Shirley Smoyak, author of the
foreward. notes that the game was
well-researched in its development; I
feel, however, that one weakness
throughout the manual is the lack of
documentation and supplemental
references. The preface is a loose
clarification of the premises underlying
the game UInto Aging" and describes
such factors as the potential harmful
effects of inappropriate stereotypes of
aging and the value of simulation games
for learning. The introduction raises the
reader's awareness of key societal issues
such as life expectancy and social
structure, retirement, physical changes
of aging and the need for public
education. The overview describes the
format ofthe game "Into Aging" and
outlines briefly the physical and human
resources needed to play the game.
The next section of the book is
entitled, "Playing the Game"; it is
written in extra large print, giving it the
appearance of a first grade reader. The
required physical layout of the room is
diagrammed and the specifics of the
game are outlined. Players will pass from
an identity table on through stages of
independent to dependent living, based
on the instructions they receive in
selecting life event cards, which are
included in the appendix. Also included
in the appendix are detailed lists of the
materials required at each table. Having
played the game through, I found the
instructions to be adequate and the cost
of the needed materials to be less than
$10. The discussion which followed my
use ofthe game was lively and
meaningful and addressed many of the
issues outlined in the section of the book
entitled "Debriefing". The 4 game facil-
itators had mixed reactions to enacting
the prescribed roles since the instructions
clearly require them to be stereotyped
and powerful in their interactions with
game players.
While bearing some of the fun
associated with the playing of Ugames" ,
this manual affords educators an
opportunity to provide a serious
re-evaluation of basic attitudes and
practices in the care of the elderly.
Indeed, "Into Aging" is a creative
contribution to nursing literature.
Reviewed by Elaine M. Mullen, R.N.,
M.S.N., Assistant Professor. Faculty of
Nursing, Lakehead University, Thunder
Bay, Ontario.
Critica) Care Nursing, 2d ed by
Carolyn Hudak, BarbaraGallo, and
Thelma Lom, New York,J.B.
Lippincott, 1977.
I have found this an excellent text of
core information, useful both to the
nurse starting in a critical care setting
and to the nurse with critical care
experience. Texts dealing with specific
areas of critical care (ie. coronary care)
would be more useful to a nurse
interested in a particular aspect of
critical care, but, as a basic text this
book is a good choice.
This second edition has been revised
and updated. based on the premise that
role functions will continue to expand
"particularly for the critical care nurse
practitioner, and will involve the
incorporation of more highly technical
and intellectual skills to match the
increasing responsibilities in the patient
care arena" . The text uses current
theory and information with an emphasis
on technical skills as well as theory.
A chapter dealing with the
psychosocial aspects of critical illness
for the patient, the family, and the nurse
includes a useful approach for dealing
with sensory input emphasizing planning
and" quality of stimuli in the external
environment" .
Each ml\Ïor body system is dealt
with in a separate chapter, preceded by a
review of the relevant anatomy and
physiology. Frequently encountered
problems and "management modalities"
or interventions used in the critical care
setting are covered in relation to each
body system.
The sections on assessment are
presented clearly and contain much
useful information. Sections on
arrythmias and hemodynamic pressure
monitoring (including the use of
pulmonary catheters) cover the theory
and the skills involved. In depth
coverage of blood gases and acid-base
balance meets the need for greater
understanding of this area, a need
commonly felt by critical care nurses.
The neurological assessment covers the
important points, emphasizing the
importance oflevel of conciousness as
the most reliable reflection of
neurological status.
The "Management modalities"
covered are easily understood and
include helpful hints the authors have
gained from experience. The text covers
a range of implementations from
positioning the spinal cord iQjured
patient to the use and management of
cardiac pacemakers, with a well
organized, clinically-oriented
presentation. Looking to the future, a
review of endotracheal intubation is
included but coverage of the
management of ventilators is limited.
The section on C.P.R. continues to
recommend the use of precordial thump
in a critical care setting.
Exercises in the accompanying
workbook cover" a range of critical care
concepts from anatomy and physiology
to the emotional aspects of a critical care
environment" . The question methods
used encourage application of the
material as well as assessment of
knowledge.
Reviewed by Pamelq Carroll,lnstructor,
Royal Jubilee Hospital School of
Nursing, Victoria, B.C.
library update
Books and Doc:uments
1. Bar/cns, J. L. Protecting yourself against
crime. New York, Public Affairs Committee,
c1978. 28p. (Public Affairs pamphlet no. 564)
2. Bradley, C. F. The Vancouver Perinatal
Health Project: a summary report, by . . . et
aI. Vancouver, Vancouver Perinatal Health
Project, 1978. 42p.
3. Bur
au int
rnational du Travail Annuaire
des statistiques du travail, 1977. Genève,
Organisation internationale du Travail, c 1977.
909p.
4. By
rs, VirginiaB. L'infirmièreet
I'observation. 3. ed. Paris, Maloine, 1978.
128p.
5. Canadian Council on Childr
n and Youth
Task Forc
on th
child as a citiz
n. R
port.
Admittance restricted, the child as a citizen in
Canada. Ottawa, Canadian Council on
children and youth, 1978. l72p.
6. Canadian Nurs
s A ssociation Brief to the
Commission of Inquiry on Educational Leave
and Productivity. Ottawa, 1979. 2Op. R
7. Cournoy
r, Mauric
Notions
élémentaires de pathologie médicale. 2d ed.
rév. par Noël Verschelden. Ottawa, Editions
du Renouveau pédagogique, c1968. 201p.
8. Cr
ason,NancyS. Effects of external
funding on instructional components of
baccalaureate and higher degree nursing
programs. New York. National League for
Nursing, c1978. 74p. (League exchange no.
119) (NLN Pub. no. 15-1732)
9. Federer. Marge Nursing is a "human"
profession not a "female" profession.
Milwaukee, 1976. 23p.
10. International Seminar on Health
Education, Hamburg, 1969 Behaviour change
through health education: problems of
methodology; reports on fundamental
Bachelor of Administmtion
(Health Services)
Degree Progmm
Applicalions are now accepled for the program
combining independent study ..ith tutorials on
weekends in T oroDtO, as well as for the
competency based, external depu inlernship
option offered for students at a distance.
Credits loward advanced standing are given
for practical managerial experience and prior
education includina B.A., B.Se., B.Se.N.,
R.N., R.T., H.O.M. Cenificate and University
or CoIleøe Courses.
The Sehool is a member of Ihe Association of
University Prosrams in Health Administralion
and is supported by the Kelloa Foundation
grant.
For information and applicalion forms, please
write to:
Cuadlaa School of Mauaemeat
8.425, OISE BulJdlq
252 Bloor St., West
ToroBto, Ûlltario M5S IV5
The C.nedlen NUrN
research in health education, presented at
the . . . (communication, media comparison,
evaluation) March 1969, Hamburg, Federal
Republic ofGennany. 2d ed. Geneva,
International journal of health education,
cl979,1978.272p.
II. Ison, TerenceG. Human disability and
personal income. Kingston, Ont. ,Industrial
Relations Centre, Queen's University, c1977.
33p.
12. Jones, Dorothy A. Medical-surgical
nursing: a conceptual approach by . Claire
Ford Dunbar and Mary MarmoU Jirovec.
Toronto, McGraw-Hill, cl978. 1418p.
13. Leduc A. Le drainage Iymphatique;
Theorie et pratique. Préface du Pr. R. Vanden
Driessche. New York, Masson, 1978. SOp.
14. Meyer, DIane Grasp; a patient
infonnation and workload management
system. Rev. Morganton, N.C.M.C.S.,
cl978.2I1p.
15. National League for Nursing Concepts
and components of effective teaching. New
York, cl978. 86p. (NLN Pub. no. 16-1750)
16. -. Dept. of Diploma Programs
Charting a course for future action for
diploma programs in nursing; papers
presented at the 1978 annual meeting of the
Council of Diploma Programs, held in New
York during April 1978. New York, 1978. 42p.
(NLN Pub. no. 16-1741)
17. -.Dept.ofHomeHealthAgenciesand
Community Health Services Publicity for
your community health 88ency. New York,
1978. 37p. (NLN Pub. no. 21-1748)
18. Practical Manual for patient-teaching,
edited by Kara S. Zander et aI. Toronto,
Mosby, 1978. 394p.
19. Queen's University. Industrial Relations
Centr
Cafeteria, deferred and flexible
compensation; a bibliography 1970-78.
Compiled by the Research Reference Section.
Kingston,Ont., 1978. 4p.
20. Queen' s University. I ndustrial Relations
Centr
Executive and management
compensation. Compiled by the Research
Reference Section. Kingston,Ont., 1978. 26p.
21. - . Profit sharing; a bibliography
1970-1978. Compiled in the Research
Reference Section. Kingston, Ont., 1978. 5p.
22. Registered Nurses' Association of
Ontario Community health nursing. Toronto,
1978. I3p.
23. - .Guide to responsibilities and
qualifications of nurse educators in
universities, colleges and nursing assistant
programs. Toronto, 1978. 27p.
24. - . Statement on the role and function
of the nurse practitioner. Toronto, 1978. 2Op.
25. Ro
mer. Milton I. Health manpower
policies under five national health care
systems. Insights for the United States from
the experience of Australia, Belgium, Canada,
Norway and Poland, by . . . and Ruth
Roemer, Los Angeles, Ca. School of Public
Health, University of California, 1977.
Reproduction. Springfield, Va., National
Technical Information Service. 229p.
26. Saltman, Jules Immunization-protection
against childhood diseases. New York, Public
Affairs Committee, cl978. 21p. (Public Affairs
pamphlet no. 565)
27. Trainex Corporation Trainex health
education catalogue. Garden Grove, Ca..
1978. Iv. (loose-leaf)
June 1179 53
p
o
S E
) "f
p 0 E . \.
'l ð
(jO
'
\
\
POSEY FINGER CONTRACTION
CUSHION
Separale fingers WIth this high strength
palm grip. 100% texlured polyester filled
Wllh synlhellc fur One size fits all hands.
Atlracllve blue color
No. 6560
POSEY SAFETY BElT
A genlle but effecllve reminder to Ihe
pallent not to get out of bed Reslrain
pallents from thrashing about and poss-
Ibly hurting themselves while sleeping
Sm, med, Ig
No 1322
...
. · f"""""-
POSEY MISSION VEST
Help prevent slumping forward or sliding
down In wheelchairs May be crossed on
patient's back or behind the chair for
additional support. Ideal for bed use or
in wheelchairs
No. 3137
Health
Dimensions Ltd.
2222 S. Sheridan Way
Mississauga, Ontario
Canada LSJ 2M4
u
Phone: 416/82
9290
54 June 1979
Slow-
foIk.
(ferrous sulfate-folic aCid)
hematinic with folic acid
Indications
Prophylaxis of iron and folic aCid
deficiencies and treatment of
megaloblastic anemia, dunng pregnancy,
puerpenum and lactation
Warnings
Keep out of reach of children
Contraindlcatlons
Hemochromatosis, hemosiderosIs and
hemolytic anemia.
Adverse Reactions
The following adverse reactions have
occasionally been reported. Nausea.
diarrhea, constipation. vomiting,
dizziness. abdominal pain, skin rash and
headache.
PrecauUons
The use of folic acid in the treatment of
pernicIous (Addisonian) anemia. in which
Vitamin 812 is deficient. may return the
penpheral blood picture to normal while
neurological manifestations remain
progressive
Oral1ron preparations may aggravate
existing peptic ulcer, regional enteritis
and ulcerative colitis
Iron, when given with tetracyclines, binds
in equimolecular ration thus lowering the
absorption of tetracyclines
Dosage
Prophylaxis:
One tablet daily throughout
pregnancy, peurperium and lactation.
To be swallowed whole at any time of
the day regardless of mealtimes.
Treatment of megaloblastic anemia
During pregnancy, puerperium and
lactallon; and in multiple pregnancy.
two tablets, In a single dose, should
be swallowed daily.
Supplied
Each off-white film-coated Slow-Fe tablet
contains 160 mg ferrous sulfate (50 mg
elemental iron) and 400 mcg folic aCid in
a specially formulated slow-release base
Packaged in push-through packs
containing 30 tablets per sheet and
available in units of 30 and 120
Full information available on request.
Relerences
1 \ Nutntoon Canada Natoonal Survey A reporl
by NutritIon Canada to the Department of
Nal'onal Health and Welfare. Ottawa,
InformatIon Canada, 1973 Reproduced by
permIsSIon oflnformaf,on Canada
2 R R Stre,ff. MD Folate DefIcIency and Oral
ContraceptIves Jama. Oct 5. 1970,
Vol 214 No 1
CIBA
DORVAL QUEBEC
t<9S IBI
See advertisement on cover 4
C 6026R
The Cenadlen Nurse
Pamphlets
28. American Nurses' Association
Certification - assurance of quality. Kansas
City, Mo., 1978. pam.
29. -. Self-directed continuing education
in nursing. Kansas City, Mo., 1978. 14p.
30. -. Commission on Nursing Education
Statement on graduate education in nursing.
Kansas City, Mo., 1978. 7p.
3l. -. Division on Maternal and Child
Health Nursing Practice Standards of
pediatric oncology nursing practice, approved
by, . and Association of Pediatric Oncology
Nurses. Kansas City, Mo., 1978. 7p.
32. Canadian Council of Cardiovascular
Nurses Invitation to membership. Ottawa,
1973. pam.
33. Conseil canadien des injìrmières(iers) en
nursing cardim'asculaire Invitation. Ottawa,
1973. pam.
34. National LeagueforNursing Program
for accreditation of home health agencies and
community nursing services. New York,
1978. pam. (NLN Publication no. 21-1505)
35. -. Division of Measurement Test
services for schools of nursing 1978-79. New
York, 197?lv. 32p.
36. Ontario Occupational Health Nurses
A ssociation Guidelines for the occupational
health nurse in Ontario. Mississauga, Ont.,
1978. 14p.
37. Vancouver Perinatal Health Project.
Vancouver, 1978. IIp.
Government Documents
Canada
38. Labour Canada. Collective Bargaining
I '!formation Centre Collective bargaining
information sources. Ottawa, Minister of
Supply and Services, 1978. Iv. (various
pagings)
39. Santi et Bien-être social Canada.
Assurance-hospitalisation et sen'ices
diagnostiques Rapport, 1976. Ottawa,
1976-77. 15p.
Saskatchewan
40. Committee on Rights in Relation 10
Health Care in Saskatchewan Report.
Regina, 1977. 49p.
United States of America
41. Dept. of Health. Education. and
Welfare. Public Health Service. Di,'ision of
Nursing Methods for studying nurse staffing
in a patient unit. A manual to aid hospitals in
making use of personnel. HyattsviJIe. Md.,
1978. 222p. (DHEW Pub. no. (HRA) 78-3)
42. MAST Interagency Executive Group
Program manual for MASf programs.
Washington, Dept. of Transport, 1978, 1977
2Op.
Studies in CNA Repository CoUection
43. Allen, Moyra Framework for the study
of nursing practice and outcomes for
client/families during the period of participant
observation prior to evaludtion. The
Workshop - a health resource/L'atelier à
votre santé. PointeClaire/Beaconsfield,
Montreal, McGill University School of
Nursing, 1978. 7p. R
44. Andrews. Heather A. Educational needs
of registered nurses: a report commissioned
by the Alberta Association of Registered
Nurses. Ad Hoc Committee to Study Ways of
Promoting Post-Basic Degree Program
Studies in Alberta. Edmonton, Alberta
Association of Registered Nurses. 1978. l06p.R
45. Biette. M. Gayle Burns The effects of
selected factors on the older adult's
management of treatment of hypertension.
Toronto, 1978. 145p. Thesis
(M.Sc.N.)-Toronto. R
46. Cutshall, Patricia Monitoring and
maintaining competence of health
professionals. Vancouver, c1978. 23Op.
Thesis (M.A.)-U.B.C. R
47. Ferguson. Barbara Faye Preparing your
children for hospitalization: a comparison of
two methods. Calgary, c1978. 89p. Thesis
(M. Sc. )-Calgary. R
48. McDowell, Edith M. Report of "Project
65". The Saskatchewan study of the
Centralized Teaching Program for Nursing
Students and the participating hospitals and
schools of nursing. Saskatchewan, Sask.,
Centralized Teaching Program for Nursing
Students, 1966. 117p. R
49. McTavish, Maureen Louise The
underutilization of the nurse practitioner.
Calgary,Alta.,1976. 48p. R
50. Ponak, Allen M. Registered nurses and
collective bargaining: an analysis of job
related goals. Madison, Wi., 1977. 197p.
Thesis-Wisconsin R
51. Registered Psychiatric Nurses
A ssociation of British Columbia. C ommiltee
on Nursing Education and Practice Report on
a survey of inacti ve membership interest in a
refresher course in psychiatric nursing.
Burnaby, B.C., 1978. 17p. R
52. -. Task Committee on Forensic
Nursing Report on competencies and skills
required of nurses working in forensic areas.
Burnaby, B.C., cl978. 122p. R ...
Challenging Career
Opportunity for Registered
Nurses in Canada's North
A 100 bed acute care hospital in
Northern Manitoba which services
Thompson and several small
communities in the surrounding area has
immediate vacancies in Pediatrics,
Medicine/Surgery. Obstetrics and
Critical Care.
This opportunity will appeal to nurses
who want to increase their existing skills
or develop new skilJs through our
comprehensive inservice program. Many
of our nurses have become experienced
in flight nursing.
Candidates must be eligible for
provincial registration as active
practicing members. We offer an
excellent range of benefits, including free
dental plan, accident, health and group
life insurance.
Salary range is $1,078 - $1,340 per
month dependent on qualifications and
experience plus a remoteness allowance.
Apply in writing or phone:
Mr. R,L.Irvine
Director of Personnel
Thompson General Hospital
Thompson Manitoba R8N OR8
Phone: (204)677-2381
,- ,
The Cenedlen Nur..
June 111711 55
Classified
Advertisements
Alberta
The Drumheller Health Unit requires a Supervbor of
N..,.. with experience and quaJifications in Public
Health for supervision of a staff of eight district
nurses in preventive proarams of community health
to a population of 28,000 in an area of 4000 square
miles. Main office is located in Drumheller, popula-
tion 6,000, 85 miles from Calaary. For information or
applicatioo forms please reply, lIivina curriculum
vilac to: AJP1es E. O'Neil, M.D., D.P.H.. Medical
OfrlCer of Health, Box 1780, Drumheller, Alberta,
TOJ OYO.
RqIIIend N...... required for acute care lIeneral
hospital, expandina from 75 beds to 300 beds.
Clinical areas include: medicine, suraery, obstetrics,
paediatrics, psychiatry, activation and rehabilita-
tion, operatina room, emeraency and intensive and
coronary care unit. Must be eliaible for Alberta
reaistration. Personnet policies and salary in accor-
dance with AARN contract. Apply to: Penonnel
Administration, Fort McMurray -Reaional Hospital,
7 - Hospital Street, Fon M
urray. Alberta, T9H
tP2.
Big Country Health Unit reqlllÎres a D1nctor to
commence worlc. as soon as
ssible. Applicant must
be a Rellistered Nurse With some experience in
Public Health. This is a supervisory posilion and
applicant needs to be knowledaeable in the manage-
ment field. 'Salary nellotiable based 00 qualifications
and experience. Please apply in writina to: Director,
Bill Country Health Unit, Box 279. Hanna, Albena,
1"OJ IPO.
R.N. required by 2()"bed acti ve treatmenl hospital.
Must have AARN rellistration or be eligible for
rellistration. Salary & benefits accordinll to
A.H.A.-A.A.R.N. contract. Apply: Director of
Nursina, Myrnam Municipal Hospital, Myrnam,
Alberta, TOB 3KO. Telephone no.: (403) 366-3870.
RqIIIered N...... required for part-time and full-
time employment. Must be elillible for registration
with AARN. Salary and benefits as per U.N.A.
contract. Residence available. Apply in writina to:
Director of Nursina, Wainwright Hospital Complex.
Wainwright, Alberta, TOB 4PO, or phone (403)
842-3324.
British Columbia
Ex
rleoced General Duty Graduate Nunes required
for small hospital located N.E. Vancouver Island.
Maternity experience prefened. Personnel polide
accordina to RNABC contract. Residence accom-
modation available $30 monthly. Apply in writina to:
Director of Nursina, St. George's Hospital, Box 223,
Alen Bay, BrilishCoIumbia, VON IAO.
General Duty (B.C. reaJstered) Dunes required for
expansion to 422 acute care accredited hospital
located 6 miles from downtown Vancouver and
within easy access to various recreational facilities.
Excellent orientation and on-going inservice prog-
ramme. Salary: $1.305.00-$1.542.00 monthly. Clini-
cal areas include coronary care, intensive care,
emergency. operatinll room. P.A.R.R., medical/sur-
lIical, pediatrics, obstetrics, onhopedics and activa-
tion units. Head Nurse position also required for our
critical care unit, effective immediately. Candidates
must have had at leasl two year's related experience
and should have a demonstrable record of manage-
rial skill. Apply to: Co-ordinator-Nursinll, Dept. of
Employee Resources. Burnaby General Hospital,
3935 Kincaid Street, Burnaby, British Columbia,
V5G 2X6.
Head None aDd Regbtcred Nunes for a ncwly
renovated 8-bed Coronary/Intensive Care Unit.
Registration or eligibility for rellislration in B.C
required. Experience in Coronary/Intensive Care
Nursing preferred. Experience and/or administrative
training preferred for the Head Nurse position.
Apply to: Director of Nursing, Cowichan District
Hospital, Gibbins Road. Duncan. British Columbia,
V9L IE5.
British Columbia
GfteraI o.y N..,.. for modem 41-bed accredited
hospital located on the Alaska Highway. Salary and
personnel policies in acc:ordance with the RNABC.
Temporary accommodation available in residence.
Apply: DU"ector of Nunina, Fon Nelson General
Hospital, P.O. Box 60, Fort Nelson, British Colum-
bia, VOC IRO.
General Duty Nunc for modem 35-bed hospital
located in southern B.C.'s Boundary Area with
excellent recreation facilities. Salary and personnel
policies in accordance with RNABC. Comfortable
Nurse's home. Apply: Director of Nursina, Bound-
ary Hospital, Grand Forks. British Columbia. VOH
IHO.
Experlcuced Nunn (eliaible for B.C. Registration)
required for full-time posilions in our modem
300-bed Extended Care Hospital located just thirty
minutes from downtown Vancouver. Salary and
benefits according to RNABC c:ontract. Applicants
may telephone 525-0911 to arranlle for an interview,
or write givina full particulars to: Personnel Direc-
tor, Queen's Park Hospital, 315 McBride Blvd.,
New.Westminster. British Columbia, V3L 5E8.
Experienced Nunes (B.C. Regislered) required for a
newly expanded 463-bed acute, leachina, reaional
referral hospital located in the Fraser Valley, 20
minutes by freeway from Vancouver, and within
easy access of various recreational facilities. Excel-
lent orientation and c:ontinuinll education proararn-
meso Salary-I979 rates-$130H)()-$1542.00 per
month. Clinical areas include: Operatina Room, Re-
covery Room, tntensive Care, Coronary Care,
Neonatal Intensive Care, Hemodialysis, Acute
Medicine, Surgery, Pediatncs, Rehabilitation and
Emergency. Apply to: Employmem Manqer, Royal
Columbian Hospital, 330 E. Columbi
SI., New
Westminster, Bntish Columbia, V3L 3\\ .
AppticatioDs are invited for the position of Director
of N........ for a hospital situated in the South
Okanagan Valley, havina 45 acute and 75 extended
care beds. Applicant II\IIst be eliaible for B.C.
rellistration and should possess a combination of
sUitable experience and academic prepara ioD, with
post graduate dearee preferred. Shall assist the
Nursina Administrator in planninll, orpnizina.
directina and supervisina nursina services. Send
complete resume to: Mrs. D. Bonnett. Nursinll
Administrator, South Okanaaan General Hospital,
Box 760, Oliver. British Columbia, VOH tTO.
Expcrlcuccd GfteraI Daly N...- required for
t20-bed hospital. Basic salary 51305.00 - $1542.00
per month. Policies in accordance with RNABC
Contract. Residence accommodation available.
Apply in writina to: Director of Nursinll, Powell
River General Hospital, 5871 Arbutus Avenue,
Powell River, British Columbia, V8A 4S3.
Rcp.tered N..,.. required immediately for perma-
nent full time positions at I()"bed hospital in B.C.
Salary at 1978 RNABC rale plus nonhern livinll
allowance. ReCQgnition of advanced or primary care
education. One year experience preferred. Apply:
Director of Nunina, Stewart General Hospital, Box
8, Stewart, British Columbia, VOT tWO. Telephone:
(604) 636-2221 Collect.
St. Paul's Hospital invites applicallons from B.C.
aep.tend N..,.. for full and part time positions in
all areas of the hospital. St. Paul's is an acute referral
teachina hospital located in downtown Vancouver.
1979 R.N. rates $1305.00 - $1542.00. Generous
frinae benefits. Apply to: St. Paul's Hospital,
Personnel Department, tOllI Burrard Street, Van-
couver, BntishColumbia, V6Z tY6.
Manitoba
ExpcrieDCed Jlallltered N...- required for a fully
accredited 2()()..bed Health Complex Iocatod in
Nonhern Manitoba. Must be cliaible for reJÍstration
in Manitoba. Salary dependent on experience and
education. For further information contact: Mn.
Mona Seguin, Personnel Director, The Pas Health
Complex Inc., P.O. Box 240, The Pas, Manitoba,
R9A I K4.
Athletic Camp Nunn required for four one week
sessions commendnll AUII. 4, 1979. The camp is
situated in the International Peace Gardens and
includes instruction in Soccer. Volleyball. Sailina,
Basketball, Track & Field, Equestrian. and Gymnas-
tics. R.N., L.P.N.. and/or student nurse applica-
tions arc invited. Please send resume or contact for
further information: A.M. Hunt, Director Health
Services, Apt. 1003-690 Kenaston Blvd., Winnipell,
Manitoba, R3N IZ3. Tel.: 475-1701.
Northwest Territories
The Stanton Yellowknife Hospital, a 72-bed accre-
dited, acute care hospital requires reJistered nurses to
work in medical, surgical, pedlatnc, obstetrical or
operatina room areas. Excellent orientation and
inservice education. Some furnished accommoda-
tion available. Apply: Assistant Administrator-
Nursina, Stanton Yellowknife Hospital, Box 10,
Yellowknife, N.W.T., XIA 2NI.
Ontario
RN, GRAD or RNA, 5'6" or over and strona,
without dependents. non smoker, for t75 lb.
handicapped, retired executive with stroke. Able to
transfer patient to wheelchair. Live in 1/2 yr. in
Toronto and 1/2 yr. in Miami. Wqes: $200.00 to
$250.00 wkly. NET plus $80.00 wkly. bonus on most
weeks in Miami. Write: M.D.C., 3532 Eglinton
Avenue West, Toronto, Ontario, M6M IV6.
Childrens summer camps in scenic areas of Northern
Ontario require Camp N...- for July and AUlLust.
Each has resident M.D. Contact: Harold B.
Nashman, Camp Services Co-op, 825 Eglinton
Avenue West, Suite 211, Toronto, Ontario, Mm
IE7. Phone: (416) 789-2181.
Saskatchewan
R.N.'s and R.P.N.'s (eligible for Saskatchewan
registration) required for 340 fully accredited cx-
tended care hos f ital. For funher information,
contact: P.:rsonne Department. Souns Valley Ex-
tended Care Hospital, Box 2001, Weyburn, Sas-
katchewan S4H 2L7.
United States
Nurses - RNs - Immediate Openinlls in
California-Florida-Texas-Mississippi - if you arc
experienced or a recent Graduate Nurse we can offer
you positions with excellent salaries of up to $1300
per month plus all benefits. Not only are there no
fees to you whatsoever for placina you, but we also
provide complete Visa and Licensure assistance at
also no cost to , ou. Write immediately for our
application even i there are other areas of the U.S.
that you are interested in. We will call you upon
receipt of your application in order to arranae for
hospital interviews. You can call us collect if YDU are
an RN who is licensed by cxaminatioD in Canada or
a recent llraduate from any Canadian School of
Nunina. Windsor Nurse Placement Service, P.O.
Box 1133. Great Neck, New York, 11023. (516-
487-2818).
"Our 20th Year of World Wide Service"
58 June 18711
United States
C.uromla - Sometimes you have to 110 a lona way
to fmd home. But, The White Memorial Medical
Center in Los Anlleles, California, makes it all
worthwhile. The White is a 377-bed acute care
teachina medical center with an open invitation to
dedicated RN's. We'll challenae your mind and otter
you the opportunity to develop and continue your
professional growth. We will pay your one-way
transportation, offer free meals and lodgina for one
month in our ultra-modem nursina residence and
provide your work visa. Call collect or write: Ken
Hoover, Assistant Personnel Director, 1720 Brook-
lyn Avenue, Los Anaeles, California 90033; (213)
269-9131, ext. 1680.
FlDrkIa NanIq OpportMItIB - MRA is recruitina
Reaistered Nurses and recent Graduates for hospital
positions in cities such as Tampa, St. Petersbu...,
and Sarasota on the West Cout; Miami, Ft.
Lauderdale and West Palm Beach on the East Couto
U you are consideri 1 a move to sunny Florida,
contaA:t our Nurse ecruiter for assistance in
selectina the riabt hospital and city for you. We wtll
provide complete Work Visa and State Licensure
information and offer relocation hints. There is no
placement fee to you. Write or call MedIcal
Rec:ndten.,
rica,IK. (For West Coast) 1211 N.
Westshore Blvd., Suite 20
, Tampa, Fl. 33607 (813)
872
202; (For East Cout) 800 N. W. 62nd St., Suite
IO, Ft. Lauderdale, Fl. 33309 (30
) 772-3680.
Nurslnll Opportualtlella New Orleua,
uJslu. -
MRA tS recruitina Reaistered Nurses and recent
Graduates for severalleneral and teachina hospitals
in the excitina New Orleans area. Openinas in many
specialties and most Canadian Reaistered Nurses
can qualify for licensure endorsement in Louisiana.
Contact our Nurse Recruiter for tuition assistance
plans. We will provide complete Work Visa and
State Licensure information. There is no placement
fee to you. Wrile or call Medical Recruiters or
America, IDe., 800 N.W. 62nd St., Suite SIO, Ft.
Lauderdale, Fl. 33309. (JOS) 772-3680.
Nunlnll Opportualty - Mississippi Baptist Medical
Center, a ml\Ïor 600-bed hospital, has immediate
positions available for experienced RNs and recent
nursina school araduates in a variety of specialities
and medical/surgical areas. Competitive salaries,
liberal benefits. Visa, licensure and relocation
assistance provided. Located in Mississippi's capital
city of Jackson (population 300,000), MBMC is the
state's largest and most modem privately operated
hospital. For further information write: Mrs.
Johnnye Weber, Nurse Recruiter, 122S North State
Streel, Jackson. Mississippi 39201; or call collect
601/968- S 13 S.
Ceaadlan Nunes - Our 3S0+ bed full service
community hospital in a city of 70.000 in the piney
woods and lakes of beautiful East Texas wishes to
extend an invitation to you to practice nursing in a
progressive hospital while you and your family enjoy
the llood life atmosphere of smaller city livina. Our
special visa sponsorship and licensure prollram may
be what you have been seekinll. We plan a trip to
several cilies in Canada to interview and hire soon so
don't delay your response. For more information,
please write or call Jack Russell. 6tt Ryan Plaza
Drive, Suile S37, Arlinaton. Texas, 76011. (817)
461-14SI.
Come 10 T_ - Baptist Hospital of Southeast
Texas is a 400-bed growth oriented orllanization
lookina for a few 1l00d R.N.'s. We feel that we can
offer you the challenae and opportunity to develop
and continue your professional growth. We are
located in Beaumont, a city of IS0,OOO with a small
town atmosphere but the convemence of the large
city. We're 30 minutes from the Gulf of Mexico and
surrounded by beautiful trees and inland lakes.
Baptist Hospital has a proaress salary plan plus a
liberal frinae packqe. We wtll provide your immill-
ration paperwork cost plus airfare to relocate. For
additional information. contact: Personnel Ad-
ministration, Baptist Hospital of Southeasl Texas,
Inc., P.O. Drawer IS9t, Beaumont, Texas 77704. An
.mrmall.c Kt.... employer.
The Cenedlen Nur..
Before accepting any
positìon in the U.S.A.
PLEASE CALL US
COLLECT
w. Can Offer You:
A) Selection of hospItals throughout
the U.S.A.
B) ExtenSive information regarding
Hospit
Area. Cost of living, etc.
C) Complete licensure and Visa Service
Our Services to you are at
absolutely no fee fo you.
WINDSOR NURSE
PLACEMENT SERVICE
P.O. Box 1133 Great Neck, N.Y.
(516) 487-2818
Our 20th Year of World Wide Service ...
R.N. 's
Nursing opportunities are
available in the Cardiovascular
Unit at the Holy Cross Hospital.
Active experience preferred in
Medicine. Pediatrics and/or
Surgery.
Previous experience preferred.
Interested applicants must be
eligible for Alberta registration.
Please apply to:
Personnel Department
Hospital District #93
940 - 8th A venue S. W.
Calgary, Alberta
T2P IH8
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
AVAILABLE NOW
FLORIDA
OIDO
IN ARIZONA
CALIFORNIA
TEXAS
WE PLACE AND HELP YOU WITH:
sr
T.E BOARD REGISTRATION
YOUR WORK VIS^
TEMPORARY HOUStNG . ETC.
A CANADIAN COUNSELLING SERVICE
Phone: (416) 449-S883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
1:ZOO LAWRENCE AVENUE EAST, SUITE JOI,
DON MILLS, ONTARIO M3A ICI
NO FEE IS CHARGED
TO APPLICANTS.
United States
'nit _,. .f T_ beckon RN's and new IIJ'IUIa to
practice their profession in one of the most
prosperous areas of the U.S. We represent all size
jlospitals in virtually every Texas and Southwest
U.S. city. Excellent salaries and paid retocation
expenses are just two of many super benefits
ottered. We will visit many Canadian cities in March
and April to interview and hire. So we may know of
your interest won't you contaA:t us today? Ms.
Kennedy, P.O. Box 5844, Arlinaton, Texas, 76011
(214) 647-0077 or Ms. Candace, P.O. Box t474S,
Austin, Texas, 7601 I (SI2) 4S9-0077.
E"dtcpICIII: Come and join us for year around
excitement on the border. by the sea, an unbeatable
combination. Eqjoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed, acute care hospital offers the experi-
enced nurse and the newly araduated nurse an array
of opportunities. We have immediate operunas in all
areas. Excellent salary and frinae benefits. We invite
you to share the challenac ahead. Assistance with
travel expenses. Write or all coIled: Joe R. Lacher,
RN, Dtreclor of Nurses, Valley Community Hospi-
tal, P.O. Box 469S, Brownsville, Texas 78S21; t
(SI2) 831-9611.
N_ - aNs - A choice of locations with
emphasis on the Sunbelt. You must be licensed by
examination in Canada. We prepare Visa forms and
provide assistance with licensure at no cost to you.
Write for a free job market survey. Marilyn Blaker,
Mcda, S80S Richmond, Houston, Texas 770S7. All
fees employer paid.
......nð N_, IJc:eMed Voe...... Nann u4
N_ Aw. needed to work 111 the Kerrville State
Hospital in Kerrville, Texas. KerrviIle is approx. 6S
mites north of San Antonio in West Celltral Texas. It
is a nOled recreational area, with the Guadalupe
River, many camps and open areas for hiltina.
Benefits include forty hour work week, sick leave,
paid vacation, holidays. 1l00d retirement benefits
and free group insurance. Startinll salary for
Rellistcred Nurses is $t,14I.OO, for Licensed Voca-
tional Nurses $768.00 and for Aides $SS2.00 (per
month). Nurses and L.V.N.'s are requiTed to have a
curn:nt Texas license and Aides are re
ired to be
high school araduates. We are an Equal portunity
Employer. Apply to: Box 1468, Kerrv' Ie, Texas
78028.
C_ to c..taI T_ - We are located in . resort,
retirement and farmina community one mile from the
Gull of Mexico. We arc a small friendly hospital in a
small friendly community just two hours from
Houston. We otter you a rounded career develop-
ment proaram: medic81, su...ical, OB, nursery and
eme...ency room. We are fully accredited. Rapid
advancement to Hcad Nurse startinll at $13,000 plus
shift differential, calt pay and tiberal frinae benefits.
New nicely furnished two-bedroom apartments are
reserved for , ou. Share one with a Canadian RN
companion 0 your chaosina, if you like, for $ISO
each includina lias and water. We wtll pay immiara-
tion, licensina and relocation transportation ex-
pense. Openinas are limited-four at this writina.
Contacl: Personnel Department, Waaner General
Hospital, Box 8S9, Palacios, Texas 7746S; or call
Athlyn Raasch, o-St2-972-2S1 I collect.
Miscellaneous
Africa -Overland Expeditions. LondonfNairobi I3
wks. London/Johannesburg 16 wks. KellY. Safaris
_ 2 and 3 wk. itineraries. Europe - Campina and
hotel tours from t6 days to 9 wks. duration. For
brochures contact: Hemisphere Tours, S62 Ealinton
Ave. E., Toronto,-Ontario, "d4P IB9.
Cherokee LocI., L8U
u, Dear Port SaacltIcld,
A small friendly lodlle, caterina to adults who wan
a
quiet relaxina holiday. Open May 24 to ThankslltV-
ina. Good deepwater sWimmina, boatina and walk-
ina. GoUina, dancina. ridina a short drive away.
Rates and folders on request. Write or phone: The
Turleys, (70S) 76S-360I, R.R. 2, Port Carlina,
Ontario. PUB IJO.
Interested In EIectroly.s Career? Must be an R.N.
Successful practice available. Instructions. Write or
call: Margot Rivard, R.N., 1396 St. Catherine Street
West. Suite 221, Montreal, Quebec, H3G 1P9.
Telephone: (SI4) 861-19S2.
School of Nursing
Nursing Instructors
required for July 1979
in a 2 year English language
Nursing Diploma program.
Qualifications:
Bachelor of Nursing with experi-
ence in teaching and at least one (I)
year in a Nursing Service position,
courses in Teaching Methods and
eligible for registration in New
Brunswick.
Apply to:
Harriett Hayes
Director
1be Miss A.J. MacMaster
School of Nursing
Postal Station" A" , Box 2636
Moncton, N.H.
EIC 8H7
Telephone: 506-854-7330
Foothills Hospital. Calgary,
AI berta
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
FoothiUs Hospital
1403 29 St. N. W. Calgary, Alberta
T2N 21'9
Grande Prairie Hospital Complex
Assistant Directors
of Nursing
Extended Care Acute Care
Two challenging management positions
required for our 230 bed Acute Care
Hospital, Auxiliary Hospital. and
Nursing Home with planning and
construction underway for a 457 bed
complex to open Spring 1983. Upward
mobility within the organization
possible. Nursing and management
experience required. Bachelor's or
Master's Degree in Nursing and/or
Administration desirable. Salary based
on qualifications.
Apply to:
Mrs. D. O'BrIen
Director of Patient Services
10409 . 98 Street
Grande Prairie, Alberta
TSV 2E8 or Phone: (403) 532-7711
The Cen-.llen NurH
Director of Nursing
Applications are invited for the Director
of Nursing position for our 330 bed acute
care general hospital.
The Director will report to the Assistant
Executive Director (Patient Services)
and will be responsible for planning,
organizing, directing and evaluating the
activities of the Nursing Department to
ensure the highest standards of patient
care are provided. The Director will be a
member of the senior management com-
mittee.
The Director of Nursing must possess a
Master's Degree or B.Sc. Degree in
Nursing and have extensive experience
managing a nursing department.
Applicants must be registered or eligible
for registrat.ion in Saskatchewan.
The salary is commensurate with qualifi-
cations and experience. Fringe benefils
are in accordance with our out of scope
policies.
Please forward applications to:
Personnel Director
St. Paul's Hospital
Grey Nuns' of Saskatoon
1702 - 20th Street West
Saskatoon, Saskatchewan
S7M OZ9
Offers R.N. 's
An UNUSUAL OPPORTUNITY.
A.II.!. Will FURNISH One Way AIRLINE TICKET 10 Telas
Ind 5500 Inltlll LIVING EXPENSES on a Loan Basis.
AIIlr Onl Var's Slrvlce, TIlls LOin Will be Cancelled
MI American Medical Intemational Inc.
. HAS 50 HOSPITALS THROUGHOUTTHE u.S.
. lIow A.II.!. Is Recnllltøg R.II. '1IDr HDlp1b11 in TII.I.
Immldill. Open'.... S.lsry R.ng. 111.000 ID 116,500 per V....
. You can enloy nursing In General MedIcIne. Surgery ICC
CCU. Pediatncs and Obstetncs
. A M I provIdes an excellent ollentallOn program.
,n-servlce training
r------------..
I . I
. U.S. Nurse Recruiter I
. P.O. Box 17778. losAnAeles. Calif. 90017 I
I . W,thoul obhgatlon. please send me more .
InformallOn and an Apphcatlon Form I
. NAME
. AOOR ESS =========== I
. DTY____ IT.___ZIP___I
TELEPHONE 1_ _1_ _ _ __ _ _ __
I LlCEIISES:___________1
. SPECIALTY:_ _______ -_-I
VEAR OIlAOUATEO:_ _ _ ITATE: _ _ __
'-____________rI
June 111711 57
MANIT
BA
Civil Senice Commis!iion
This po.ition is open to both mtn and
women. Appl) In writing rtftmng to
COmpetItion NumberC"'-14t.
Imnvchat.ly.
As.",islant DirKtor of'ul"\lnK F..ducllhon
Tht D<p.artment of Health & Communit.
Senices. Institutional Servlct\. Brandon
Mtnlal Htallh Ctntrt. reqUIre. a person
to
rtspon
lblr 10 Dirrclor. Nursing
Eduf;:3tion for planning. Implrmrntation.
and asstssmenl of a P"ychiatnc Nursing
DIploma program. Dutit. Includt
coordinating aclivllir\ for hoth
classroom and clinical tx.penence. and
committee work dot middle management
Itnl
BdccaJaureatt degree In nursing with
teaching expenence Extensive
background in pS}Chlalnc nur'\mg.
preftrably with RN dnd RPN hctnct.
S.lery Rang., SI7.086--S
].
R9 ptr
annum <<under reView),
Chil
ni<< CommiSSIOn
.\.10 . 9th Stl'ftl
Brandon, '\Ianitobll
R7A6C2
Infection Control Officer
A vacancy txisls for a .uilable per.on 10 pdrticipatt
In Iht Inftcllon Control Progrdm oflhi
I
OO bed
hospItal. Some exptrltnct in ho.pilal epidtmiologv
and computer ttchnolog} would be advdntdgtOUS.
The .ucce..ful cdndidate would jOin a ledm of two
InftClionConlrol Nursts dnd Ihrtt \ledicdl
\licrobiologtslS.
Saldry commtnsuratt wilh qUdlificdtlon' and
ex peritnce.
Please submitltntr of applicdlion to:
tmployee Relations
Vancouver General Hospital
855 W. 12th Avenue
Vancouver, British Columbia
V5Z IM9
Registered Nurses
Applications are being accepled for Staff
Nurses. by this 100 bed, fully accredited
General Hospital.
Benefits & SalaIJ :
According to the Nurses' Agreement for
the Province of Newfoundland.
Applicants must be eligible for
registration in the Province of
Newfoundland.
Applications, giving full particulars, as to
qualifications and experience, should be
forwarded to:
Personnel Officer
Sir Thomas Roddick Hospital
514 Ohio DrIve
StephenviUe, Newfoundland
A2N 2V6
58 June 19711
The C.nedlen Nur.e
The Province
of British Columbia
Hospital Consultant & Inspector
For H uspital Consultation & Inspection Division,
Hospital Programs, Victoria, to act as consultant and
carry out on-site inspection work for acute, rehabilitation,
extended care and lic
nsed private hospitals, advising on
efficiency/nursing care, and submitting
reports/recommendations; to participate in special
surveys and other related duties. Considerable travel.
Qualifications - Recognized degree in nursing or other
appropriate university degree, or acceptable combination
of training and experience; eligible for, or registered in
R.N .A. B.C.; three years' recent experience at senior
hospital administrative level.
Salary - $18,024 - $21,228 Quote Competition 79:969-38
(under negotiation)
Closing Location - Victoria Closing Date - Immediately
Pos,tIOr.s are open to both men an
women
Ohtarn an
return applicatIOns at a
res' helow unle" otherwISe ond'cate
@)
Province of British Columbia
Public Service Commission
544 Michigan Street. Vlctona. B C V8V 1 S3
Director of Nursing Services
t\\
f
J'
'AfOID I" ,",
Setting:
A Children's Hospital in transition to a Regional
comprehensive Child Health Centre. Construction of new
facilities will be completed in 1980.
Position:
Responsible for the planning, organizing and directing
services for all inpatients - 128 beds. Coordination and
continuity of care involving multidisciplinary services
both within the Child Health Centre and with other
community organizations and services in Southern
Alberta. Will be responsible for the overall quality of the
c
ild/family oriented care.
Qualifications:
A nurse with, or eligible for, Alberta registration.
Preference will be given for candidates with post-graduate
training (Master's Degree), experience in paediatric
centres, management and leadership ability.
Please submit resume and references to:
Executive Director
Alberta Children's Hospital
1820 Richmond Road S. W.
Calgary, Alberta
T2T5C7
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Registered Nurse in search of a change and a chaltenge -
look into nursing opportunities at Vancouver Generat Hospital, B.C.'s
ml\Ìor medical cenlre on Canada's unconventional West Coast. Staffing
expansion has resulted in many new nursing positions at all levels,
including:
General Duty ($1305. - 1542.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent IIraduates and experienced professionals alike will find a wide
variety of positions available which could provide the opportunity
you've been looking for.
For those with an interest in specialization, challenges await in many
areas such as:
NeonatoJogy Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Inservice Education
Coronary Care Unit Burn Unit
Hyperalimentation Paediatric
Program
Renal Dialysis & Transplantation
If you are a Nurse considering a move please submit resume to:
Mrs. J. MacPhell
Employee Ret8llons
Vancouver General Hospital
855 West 12th Avenue
Vancouver, B.C. V5Z IM9
Associate Director of Nursing
Associate Director of Nursing required for an accredited
204 Acute plus 87 Chronic bed Hospital in Southern
Ontario.
The Position:
As a member of the Nursing Administration T earn, this
nurse needs 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 programs.
Minimum Qualifications:
Candidate must be currently registered in the Province of
Ontario, and possess a,Baccalaureate Degree in Nursing,
with demonstrated competence ami ability in a senior
level nurse management position.
I nterested applicants may submit a comprehensive
resume. including career objectives and salary
expectations to:
D.W.Sherin
Director of Personnel
St. Thomas-Elgin General Hospital
St. Thomas, Onto
N5P 3W2
The Cen-.llen Nur..
The Province
of British Columbia
Lommunity Nurses
Applications are invited from qualified persons to
form an Eligibility List (valid for six months) of
community nurses from which vacancies occurring
at various locations in British Columbia will be filled.
Duties will include providing general public nursing,
counselling and crisis intervention services in the
area concerned: to liaise with health professionals
and others providing care. and encourage
appropriate use of available facilities.
Qualifications - University degree in nursing,
including public health training, or equivalent
combination of education and experience:
preferably some general nursing experience,
including some in directly related duties: registered,
or able to obtain registration. in the Registered
Nurses Association of British Columbia: use own
car. or governmert, on mileage basis.
Salary-$16.3:!:! - $19.296
Quole Competition 78::!(,J9A-38
Closing Location - Victoria
Closing Date - Immediatel)
POSIIIOr.S are open 10 1101
men and women
Oblaln and relurn applocabons al addres< helow unle<s nlMrwlse ,nd,caled
Province of British Columbia
Public Service Commission
544 Michigan Street. Vlctona. B C vav 1 S3
Registered Nurses
I :!OO bed hospital adjacent to University of
Alberta campu
offers employment in
medicine. surgery. pediatrics. obstetrics.
psychiatry. rehabilitation and extended care
including:
. I ntensive care
. Coronary observation unit
. Cardiovascular surgery
. Burns and plastics
. Neonatal intensive care
. Renal dialysis
. Neuro-surgery
Planned Orientation and In-SeIVice Education Programs.
Post Graduate Clinical Courses in Cardiovascular-
Intensive Care Nursing and Operating Room Nursing.
'\ppl
to:
Recruitment Officer - 'ursin
l nÏ\ersit
of Alberta Hospital
8440- 112th Street
Edmonton. Alberta
T6G 287
June 111711 511
Nursing Consultant
Occupational Health
$19,400 - $22,100 (under review)
The Ministry or Labour seeks a qualified individual to provide
consultant seIVices to Ontario industries. employees, health and
safety personnel, educators. professional and lay groups and
government agencies to ensure quality care for employees; assist
in developing standards and criteria through inteIViews, research
and sUIVeys. Location: Toronto.
Qualifications: Registration as a nurse in Ontario; recognized
certificate in occupational health nursing or public health
nursing, preferably with a B.Sc. in nursing; at least three years
experience in occupational health field and nursing with
supeIVisory experience; ability to communicate and work in
groups and independently; willingness to travel.
Please submit application or resume by June 29. 1979 quoting file
LB 49/79 to Ministry of Labour, Personnel Branch. 400
University Avenue. :!nd Floor, Toronto, Ontario M7A 117.
Equality of Opportunity for Employment.
Ontario
Ontario
Public Service
[l]@
University of
Alberta Hospital
Edmonton. Alberta
o
110 June 1879
The Cenedlen Nur..
RN's & '79 GRADS
Looking south to build a career?
Then consider Georgia. where the climate is gentle, the
lifestyle has a dash of old southern charm, and the health
care system is modem and expanding.
Think about:
Piedmont Hospital in Atlanta, a 450 bed general hospital
which offers career-expanding opportunities in a pleasant
city setting.
Coweta General Hospital- 143 beds serving Newnan, a
bright. active community of \3,000 thirty miles south of
Atlanta - has challenging positions in several clinical
areas.
Sam Howell Memorial Hospital. 6:! beds rn Carlersville,
thirty miles north of Atlanta in the scenic north Georgia
mountam
. which offers the variety of nursing experience
only available in a small acute care facility.
Phoebe Putney Memorial Hospital. 450 bed busy general
hospital in Albany. a city of 97.000 in the soulh east of the
slale. where nur
es have the encouragement and facilitie
10 grow professionally.
Patterson Hospital. 40 beds. in Cuthbert - a historic town
of9.0oo. fifty miles north east of Albany - where a nur..e
ha
the chance to build her skills in severdl different
directions.
To con
iderGeorgia. call us at 416-4!ì:!-:!:!3/ì or write:
Nurse Recruiter
Wood. "ahon Professional Search
Suite 207, 1962 YonRe Street
Toronto. Ontario :\14S I/.4
(Sure. write to the listed hospitals direct if
ou wish. but tell
them Wood. "atson sent you.)
Lincoln Institute of Health Sciences
School of Nursing
Lecturer in Community
Health Nursing
Short Term Appointment
Applications are invited from suitably qualified and experienced
nurses for the above position in the Lincoln Institute's School of
Nursing.
The position wiJI involve teaching post-registration nursmg
students undertaking degree and diploma courses which include
major components of advanced nursing practice. Qualifications:
comparatively recent experience, study or research in an area of
community health nursing. Experience in nursing education and
preferably a formal qualification in teaching.
Salary ranges: Lecturer II $AIS,786 - $AI8.050; Lecturerl
$A 18,474 - $A20.736 depending on qualifications and relevant
ex perience.
A short term appointment of twelve months is required
commencing I September 1979.
Applications in writing. including full curriculum vitae together
with the names of two professional referees, should be addressed
to Assistant Registrar, Lincoln Institute of Health Sciences, 625
Swanston Street. Carlton 3053, Victoria. Australia.
Closing date: 2 July 1979.
Director of Nursing
Winnipeg Municipal Hospital
Winnipeg Municipal Hospital is a 401 bed Geriatric
Rehabilitation Extended Care facility.
Applications are invited for the position of Director of
Nursing.
Responsible to the Administrator for the management of
the Nursing Department. the incumbent is required to
plan, organize and direct the activities of an innovative
Nursing Department including concerns such as
professional standards of nursing practice, and to work in
colJaboration with a multi-disciplinary team.
Candidates should possess a Baccalaureate degree in
nursing preferably with a Master's Degree in Nursing,
Health Care Administration or Business Administration
and/or combination of suitable experience and academic
preparation. Must have an established record at a senior
administrative level with a background in progressive
nursing experience.
Salary: $24,804 - $29,978 per annum.
Interested applicants are requested to submit a current
resume outlining experience and educational history to:
Mrs. June R. Roberts
Personnel ()f6cer
Winnipeg Municipal Hospital
1 Morley A venue
Winnipeg, Manitoba
R3L 2P4
[
rrv dI_
Unit Supervisor
Alberta Social SeIVices and Community Health. Eric Cormack
Centre, Edmonton, has an opening for a Unit SupeIVisor who is
responsible for the direction of a specific 24 bed unit. on a shift
rotational basis and be responsible to assist the Resident Care
Co-ordinator in the performance of general supeIVisory and
administrative duties. Duties include providing direction to unit
personnel regarding resident care and programming, assisting
staff in the initiation and development of each resident.
Qualifications: Graduation from a recognized School of Nursing
(R.N., R.P.N., M.D.N.,. Eligible for registration in A.A.R.N. or
other appropriate professional organization. Considerable
experience in nursing, some of which should be in a supeIVisory
capacity; multi-handicapped nursing experience an asset.
Salary up to $17,376 (Dependent upon qualifications presented)
Competition #9177-4
This competition will remain open until a suitable candidate has
been selected.
Apply to:
Alberta Government Employment omce
5th Floor, Melton Building
10310 Jasper A venue
Edmonton, Alberta
T5J 2W4
The Cen-.llan Nur..
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can go a long way
. . . to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'li 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:
........,
I MedIC81 Service. Bnlnch I
Depertment of Netlonel Health end Welfere
OtUIwe, Ontario K1A OL3
I Name I
I Address I
I City . Provo I
I .+ Heellh end Wellen, Sent6 el Bien-lire lIoclel I
Cenllda Cenllda
........
June 1979 111
The Province
of British Columbia
Assistant Director of Nursing
For Riven'iew Hospital, Essondale. to direct/co-ordinate
administrative and clinical nursing activities during hours
of 000 1 to 0810; to manage total nursing services, assess
programs/activities. interpret philosophy, objectives and
regulations to staff. assign staff. keep records. submit
reports. liaise with other departments. maintain current
knowledge of nursing procedures. participate in
seminars/conferences and deputize for superior.
Qualifications -Current active registration in RNABC
and/or RPNABC: university degree in nursing Or related
fields; adminstrative and supervisory experience.
Salary - $19.188 - $22.476 Quote Competition 79:804-38
Closing Location - Burnaby
Closing Date -
POSIIIOr.S are open to Dol
men ana women
/)hla,n and return applIcatIons al addres. helow unle" ol
erwlse IndIcated
@
Province of British Columbia
Public Service Commission
544 Michigan Streel Victoria B C vav 1 S3
[
OPPORTUNITY Æn
Team Leaders
The Eric Cormack Centre, which provides residential
accommodation and developmental opportunities for 92
dependent multi-handicapped children and young adults
from the Edmonton Region. requires individuals to
supervise and direct a team providing health maintenance
needs of residents on a 24 bed unit. Emphasis is placed on
establishment of developmental programs and
supervising and co-ordinating established on-going
programs. Shift assignments involving days with evening
relief as well as permanent evenings are available.
Qualifications: Graduation from a recognized school of
nursing; eligibility for registration in appropriate
professional organization; a strong desire to develop
health maintenance and developmental nursing skills in
the multi-handicapped field. Experience in the field of
Mental Retardation would be an asset. Some supervisory
experience is desirable. Strong interpersonal relations
will be stressed.
Salary $13,608 - $15,996
Competition #9176-7
This competition will remain open until a suitable
candidate has been selected
Apply to:
Alberta Government Employment Office
5th Floor, Melton Building
10310 Jasper A venue
Edmonton, Alberta
TSJ 2W4
112 June 1979
The Cenedlen Nur..
[
Nurse Clinician/Operating Room
Applications are invited for the above position in
the Operating Room of the Vancouver General
Hospital, an active teaching and tertiary referral
hospital for the province. The Department consists
of 30 theatres involved in all surgical discipline.
Duties involve providing clinical expertise and
leadership in the delivery of care standards in the
development of staff in collaboration with the O.R.
instructor and head nurses.
Applicants must be registered nurses, preferat ly
with a B.S.N. degree, and Post Graduate Course in
Operating Room Techniques or equivalent. Salary
$1,500 - $1,772. Benefits according to R.N.A.B.C
contract.
Please submit resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
855 W. 12th Avenue
Vancouver, B.C.
V5Z IM9
The University of British Columbia
Applications are invited for teaching positions in
undergraduate and graduate programs in nursing.
Master's or higher degree in nursing required as
well as experience in the clinical field. Openings
available in all clinical areas including Rehabilita-
tion nursing. Candidates must be eligible for
registration with the Registered Nurses Association
of British Columbia.
Competitive salaries and good fringe benefits
dependent on qualifications.
Send resumes to:
Dr. Marilyn Willman
Director
School of Nursing
University of British Columbia
2075 Wesbrook Place
Vancouver, British Columbia
Canada V6T lW5
OPPORTUNITY Æn
Senior Community Mental Health Nurse
Alberta Social SeIVices and Community Health, Fort
McMurray, has a challenging opening for an experienced nurse,
who, as a member of a multi-disciplinary treatment team, is
responsible for the planning, development, and supeIVision of
the delivery of community Mental Health SeIVices.
Responsibilities include acting as supeIVisor of community
psychiatric nurses, and consultant and educator to other
therapists and professionals in the clinic and community. Duties
include assigning caseloads, assuming a limited caseload,
evaluating staff peJformance, and consulting with the clinic
director of effective means of meeting seIVice objectives.
Qualifications: Graduation from a recognized school of nursing,
considerable related experience, and eligibility for registration
with the appropriate nursing association;
Salary $16,608 - $20,604 (Salary level commensurate with
education and experience)
Competition #9186-2
This competition will remain open until a suitable candidate has
been selected.
To obtain further information and application forms regarding
the above position please apply to:
Alberta Government Employment omce
5th Floor, Melton Building
10310 Jasper A venue
Edmonton, Alberta
T5J 2W4
University of British Columbia
Health Sciences Centre
Director of Nursing - Acute Care Unit
Applications are invited for the position of Director of
Nursing for the 240-bed Acute Care Unit, Health
Sciences Centre, University of British Columbia. This
medical-surgical unit will be part of the 6OO-bed university
health sciences centre complex.
A major emphasis of the position is clinical and
educational development within the Nursing Division, as
well as collaborative planning with colleagues from
Nursing and other disciplines throughout the Health
Sciences Centre. An appointment in the School of
Nursing accompanies this position.
Qualifications:
Candidates should have a Master's degree in Nursing
with considerable administrative and clinical experience
in acute care settings. Candidates must also be eligible for
licensure in British Columbia. Salary wilI be
commensurate with qualifications aß(
experience.
Please apply to:
The Chairperson
Search Committee
c/o Mr. Lloyd Detwiller
Administrator, Health Sciences Centre
University of British Columbia
Vancouver, B.C.
Position open to male and female applicants
Southern California Nursing:
ThreeWho MadeThe Change
" It was a big step to'move from Southwestern Ontario to an
entirely new job and surroundings in California, but everyone on the
staff at St. Francis made me feel very welcome. They're all so warm
and friendly - I really feel like an integral part of their team.
"St. Francis is more than I ever expected. but for me Labor and
Delivery is the most exciting. Along with my helpful coworkers, the
advanced monitoring equipment, and delivery room techniques. I've
found my unit a great place to advance my knowledge.
'" am proud to be a part of St. Francis Medical Center. It's a
great place to work... come and see for yourself."
Shirley Allin. RN
..
...
..
.
,
"-
""
,
" It was an experience moving from Ontario, Canada to the Los
Angeles area, but the entire staff of St Francis Medical Center made
me feel welcome and right at home.
St. Francis is a very good medical center. I work on Definitive
Observation which is both challenging and a good place to advance
your knowledge. "
Mary Jane Grant, RN
" I came to St Francis from Calgary. Alberta Canada The atmos-
phere at SI. Francis is warm and personal and the people never
hesitate to make me feel at home.
"SI. Francis provides many channels for growth. The staff is
always available for help.
"The knowledge and experience I am gaining through living and
working in a different country are limitless. I have met many new'
people and seen many new places thanks to SI. Francis. "
Colleen McPhail. RN
II
\
...................................
: St Francis Medical Center is located just outside of Los Angeles, in the city of Lynwood. Facilities - .
embrace a complete range of medical-surgical services, including open-heart surgery, intensive and
. coronary care, definitive observation, acute and renal dialysis, neurostroke, inpatient psychiatry, in/out .
. patient rehabilitation, intensive newborn care, diagnostic and therapeutic radiology including cobalt and _
. ultrasound, and a 24-hour Emergency Department. The 524-bed hospital has a nursing staff of _
approximately 700.
. Make the change to a hospital that lets you be what you want to be. Write us for more information or .
. call Brent Nielsen, RN, Nurse Recruiter, collect at (213) 603-6083. .
. 0 Please send me a brochure about St Francis Medical Center. .
: Name St Francis :
Address
Medical C nt
· City State Z. e er .
. Ip 3630 E. Imperial Highway .
. Phone (-) RN 0 Student 0 . Lynwood, California 90262 .
. Area of interest An equal opportunity employer .
CN-6-79
...................................
84 Jun. 1879
Th. CBnedlen Nur..
Assistant Head Nurse
Surgery
Applications are invited from Registered Nurses interested in
the above position. The successful applicant will be
responsible for the review, development and maintenance of
nursing practice and standards of care as well as providing
clinical guidance and supervision of personnel involved in
nursing practice. And for the delivery of direct patient care
within the unit.
Experience in proven clinical expertise in the specified area
essential.
Salary and benefits as per RNA BC contract.
Please send resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
855 W. 12th Avenue
Vancouver, British Columbia
V5Z IM9
University of Alberta Hospital
Nursing Supervisor
(Nephrology)
Responsibilities:
Over-all nursing administration of in-patient renal dialysis and
home training units, as well as nephrology in-patient services.
Will be involved in planning and developmental activities related
to current programs and those planned for the Health Science
Centre which is presently under construction as well as the
on-going activities in the nursing division.
Requirements:
Will possess a B.Sc. or Masters Degree in Nursing with
ex tensive clinical background in dialysis and other aspects of
nephrology nursing. Well developed interpersonal and
consultation skills are essential.
Opportunities for participation in educational and research
activities are available.
Apply to:
Recruitment Officer - Nursing
University of Alberta Hospital
8440 - 112th Street
Edmonton, Alberta
T6G 2B7
Index to
Advertisers
June 1979
Abbott Laboratories
Ayerst Laboratories
CNA National Forum on Nursing Education
Canadian Dairy Foods Service Bureau
The Canadian Nurse's Cap Reg'd
Canadian School of Management
Career Dress (A Division of
White Sister Uniform Inc.)
CIBA Pharmaceuticals
Cover 3
49
1
24,25
5
53
Cover 2
54, Cover 4
The Clinic Shoemakers
Dow Chemical of Canada Limited
Equity Medical Supply Company
Hollister Limited
2
32
48
41
J. B. Lippincott Company of Canada Limited 7
The C. V. Mosby Company Limited
Posey Company
W. B. Saunders Company Canada Limited
42,43,44,45
53
51
Smith & Nephew Inc.
Studio Clavet I nc.
Thistletown Regional Centre
17
5
46
Advertising Manager
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P I E2
Telephone: (613) 237-2133
Advertising Representatives
Jean Malboeuf
601, Côte Vertu
St-Laurent. Québec H4L IX8
Téléphone: (514) 748-6561
Gordon Tiffin
190 Main Street
U nionville, Ontario UR 2G9
Telephone: (416) 297-2030
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
Member of Canadian
Circulations Audit Board Inc.
DE1EJ
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ßoth may benefit from Slow-
folic.
Prophylactic iron and folic acid supplementation recently, a number of physicians have queried me
during pregnancy is now an accepted practice effect of oral contraceptives on serum folate levels
among Canadian physicians. It has also been in women. Dr. Streiff reports: "This complication
established, through the publication in 1974 of (of oral contraceptive therapy), however, may be
Nutrition Canada!, that many Canadian women recognized more frequently in the future... Folate
may not be obtaining the necessary nutritional deficiency associated with oral administration of
requirements from their diets. For instance, 76.1 % contraceptives does not necessarily require
of adult women (20-39) had inadequate or less than discontinuance of the drug regimen but folic acid
adequate intake of iron and 67.9% were at high or therapy is definitely indicated."2
moderate risk of low serum folate levels. More
C I B A
Dorval, Quebec
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. Toxemia In pregnancy
. Tetanus: treatment and cure
. How the Immune system works
. Where Is nursing headed?
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50n Flowing 5klrt Suits
in our beautiful new
ROY' SPUN-COTTA
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Style No. 43948 - Skirt Suit
Sizes: 3-15
Royale Spun-Cotta
Spun Textured Dacron
Polyester Knit
White, Apricot. about $39.00
Style No. 43945 - Skirt Suit
Sizes: 5-15
Royale Spun-Cotta
Spun Textured Dacron
Polyester Knit
White, Yellow . about $38.00
The
Canadian
Nurse
July/August 1979
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, I'< umber 7
CNA-What's it all about? 6 Tetanus: the costly cure Catherine Searle 18
News 9 The unexpected case of tetanus JeanE. Grove 26
Calendar 16 The immune system Anne Hedlin 28
\ou and the law 51 The touch of love Francine Camolinos 31
It's a bird, it's a plane,
Input 56 it's supernurse! Susanna Jack 34
Here's how 57 That's right.I'm a nurse SandraKlyne 35
Library update 57 Nursing: fact and fantasy Margaret Allan 37
Hypenensive disorders in pregnancy Bonnie Hartley 42
::>
::>
The Canadian Nurse welcomes
'"' ,4 .' Indexed in International Nursing
.D :.
.. suggestions for anicles or unsolicited Index, Cumulative Index to Nursing
. manuscripts. Authors may submit Literature, Abstracts of Hospital
r - finished anicles or a summary of the Management Studies, Hospital
.. .....
-
proposed content. Manuscripts Literature Index, Hospital Abstracts,
.' ....:..,
should be typed double-spaced. Send Index Medicus,Canadian Periodical
.. .
original and carbon. AII anicles must Index. The Canadian Nurse is
.. be submitted for the exclusive use of available in microform from Xerox
The Canadian N drse. A biographical University Microfilms, Ann Arbor,
..
statement and return address should Michigan 48106.
accompanyalI manuscripts. Subscription Rates: Canada: one
year, $10.00; two years, $18.00.
The views expressed in the anicles Foreign: one year, $12.00; two
are those of the authors and do not years, $22.00. Single copies: $1.50
COVERPHOTO-CNA House. necessarily represent the policies of each. Make cheques or money
ndtional headquaners for the Canadian Nurses Association. orders payable to the Canadian
Canada's nursing profession, was Nurses Association.
built by the nurses of Canad a for I SSN 0008-4581 Change of Address: Notice should be
the nurses of Canada and given in advance. Include previous
officialIy opened in 1967 by the Canadian Nurses Association, address as weIl as new, along with
then Gove rnor GeneraI. the Rt. 50 The Dnveway, Ottawa, Canada, registration number, in a
Hon. Roland Michener. Photo by K2P IE2. provincial/territorial nurses
John Evans Photography Ltd., association where applicable. Not
Ottawa. responsible for journals lost in mail
due to enors in address.
eCanadian Nurses Association,1979.
c!jlmerica's
number 1 shoe
for Yðung women
in white!
THE
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The Cenedl... NUrN
Julyl AUfluet 11171 S
perspective
HA VE YOU LOOKED AT Without a national and a An association needs EDITOR
YOUR ASSOCIATION provincial association there involvement by all its ANNE BESHARAH
LATELY? would be no free voice of members in order to make its
nursing. It may tackle any programs and services ASSIST ANT EDITORS
Recently, I have talked with subject, any issue - it may relevant to the fast changing SHARON ANDREWS
JANE BOCK
many nurses, not as a patient state anything in which it needs of its members and the SANDRA LEFORT
but as a communicator, an believes as an objective. It general public.
observer and a friend. I have presents a united front with An association can only PRODUCTION ASSISTANT
been privileged to see and considerable clout - if it has be as strong as its membership GITA FELDMAN
hear nurses working outside the support of all its makes it collectively. Each CIRCULATION MANAGER
of their clinical caring role as membership. member, by virtue of PIERREITE HarrE
business professionals, As a recognized social belonging, has a responsibility
planning, rejoicing at institution, associations make and a commitment to ADVERTISING MANAGER
progress, sometimes damning an important contribution to participate and to speak out. GERRY KAVANAUGH
it, but always looking ahead the continuous give and take I can't help feeling that a CNA EXECUTIVE DIRECTOR
into the future. The setting for which constitute the political lot of work is being done by HELEN K. MUSSALLEM
these observations has been power structure of too few people. I can't help
the annual meetings of the contemporary society. They asking some 38,500 nurses if GRAPlßC DESIGN
professional associations in provide their members with a they have looked into their ACARTGRAPHICS
the provinces. forum which serves the dual provincial and their national EDITORIAL ADVISORS
Without a seat mate on purpose of disseminating association lately? MATHILDE BAZINET,
one of my return trips, I began ideas and helping to reach a -Bert Prime, CNA Public chairman, Health Sciences
to reflect on alii had seen and
onsensus on contemporary Relations Officer Department, Canadore College,
heard in various parts of Issues. Nonh Bay,Ontario.
Canada. My focus was on the An American social DOROTHY MILLER,public
association. What is it? What scientist has described the relations officer, Registered
does it mean? How valuable is function of the association in herein Nurses Association of Nova
Scotia.
it? What have I learned? this way: . 'F or most of the JERRY MILLER, director of
Studying pages of notes, profound issues of our commu nication services,
seeking some answers, I common humanity, associated Registered Nurses Association
discovered that the three action is preferable to of British Columbia.
annual meetil1gs I had individual action. From the JEAN PASSMORE,editor,
attended representated a point of view of the political SRNA news bulletin, Registered
collective membership of community, voluntary Nurses Association of
almost 40,000. Attendance at associations provide that Saskatchewan .
these three meetings added up pluralism of meaning and PETER SMITH, director of
to not quite 1.500. purpose on which the - publications, National GalIery
I asked myselfifit could community depends for its of Canada.
FLORITA
be possible that 38,500 vitality of richness. From both VIALLE-SOUBRANNE,
registered nurses had to be on these standpoints, voluntary consultant, professional
duty, had responsibilities or associations have a vital role inspection division. Order of
so few resources that they to play in constituting our This month, CNJ welcomes a Nurses of Quebec.
could not attend these annual public life." new member to the journal
meetings. Is it apathy or lack Associations must have staff - assistant editor Jane
of understanding that keeps the active participation of Bock. Jane is a graduate of the Correction:
professionals from attending their members. They need this Toronto General Hospital The editorial in the June issue
association meetings? Do we cooperation to define their School of Nursing and has a refers to testimony during
as members of professional needs. to establish priorities B.A. in English literature from hearings into "the Mount
associations take the time and for meeting these needs and to the University of Toronto. Sinai incident" by Principal
effort to find out what is being find the most efficient and Jane's clinical experience is
dOne on our behalf? satisfactory way of varied and includes staff Nursing Officer, Health and
I"m not going to attempt determining what their nursing in thoracic surgery at Welfare Canada, Josephine
to answer all the questions. I requirements are likely to be TGH and the urology service Flaherty. Dr. Flaherty
am going to respond to one ... in the future. at the Wellesley Hospital reminds us that she appeared
(Toronto); she has as an expert witness rather
participated in a drug research than on behalf of any ofthe
study as well. She has had contestants and that, on April
several articles published and 29th, 1977, she was still Dean,
has previous editing Faculty of Nursing, the
experience. University of Western
Ontario.
II Julyl AUfluet 11171
The Cenedlan Nur..
CNA - WHAT'S IT ALL ABOUT?
Bert Prime
For 71 years, the Canadian
Nurses Association, by
addressing the concerns and
interests of registered nurses
has stimulated professional
development. This page is
simply an overview ofCNA
activities and the people
involved in these activities: in
the next six months we
propose to deal in more detail
with CNA's priorities. (Watch
"Close Up" next month for
an interview with Louise
Levesque, director ofCNA
projects and Pat WalIace,
project director, development
of nursing practice standards.)
The structure of the
23-member CN A board is
such that there can be no
regional disparity - no lack of
representation and/or
involvement by members
separated by vast distances or
by cultural differences.
During this 1978-80
biennium, priorities being
implemented are:
. development of a
definition of nursing practice
and national standards for
nursing practice
. convening of a National
Forum on Nursing Education
. national accreditation
program for nursing education
programs
. development of a
Canadian Code of Ethics
. completion of a
comprehensive examination
for use by alIjurisdictions
. increased visibility as an
association of more than
121 ,000 registered nurses
concerned about health care
maintenance and services for
Canadians.
Other areas of immediate
concern are:
. support for improvement
in patient care settings
. CN A views on health
promotion
. colIaborating with CBC
to provide educational
programs in health
maintenance and promotion
. income tax deduction for
continuing education
. home deliveries of
newborns
. doctoral preparation in
nursing
. International Year of the
Child
. proposed model for
consent for sterilization.
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The executive director
and staff provide assistance to
the board which has the
responsibility and the
authority to establish policies,
to revise policies in the light of
changing circumstances and
beliefs and to ensure that
these policies are
implemented.
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The national pilot project
to evaluate the diploma
schools of nursing resulted in
a new approach to the
education of nurses. CNA
took a firm stand against the
introduction ofthe physician's
assistant and was successful.
In recent months, the
association has been
outspoken regarding funding
for health care programs and
services; salaries and working
conditions of public health
nurses; layoff and
redundancies; educational
leave; continuing education;
health delivery systems;
health care programs;
confidentiality of patient
health records; health services
for native peoples; continuing
education for nurses and
involvement of nurses in the
political process. There are
other issues that have been
dealt with either through the
national media, the
association, publications or
directly in briefs to Royal
Commissions or in
communications with
governments at alIlevels.
There will be many in the
future.
,
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Professional/administrative
staff - (left to right) Claire
McKeogh, Rose Imai, Gisèle
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Testing service -seated (left to
right) Lorraine Bourque, Gladys
Jones, Eric Parrott, Lise
Chevrette; standing Shirley-Ann
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Library and editorial staff -
seated (left to right) Monique
Bissonnette, Marie Lalonde,
Claire Bigué, Suzanne Joannisse,
Loney. Helen Mussallem, Bert
Prime, Beryl Darling, Darcie
Clarke, Louise Lévesque.
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Service to members
Development of the CN A
Testing Service, initiation and
support of the Canadian
Nurses Foundation and the
continued co-sponsorship of
the Extension Course in
Nursing Unit Administration
have figured significantly in
the strengthening of
professionalism and service.
As the national voice for
nursing, CNA maintains
liaison, affiliation and
membership with many
departments of the federal and
provincial governments and
more than 100 health-related
organizations or agencies.
Liaison involves
representation to external
committees, conferences, task
forces and working
Parent, Lynn Forcier, Jean-Guy
Bourque, Catherine Renaud,
Danielle Legault. Aileen Rooney.
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Sandra LeFort, Candis Done;
standing Gita Feldman, Ginette
Dessureault, Sharon Andrews,
Claudette Gauthier, Jane Bock.
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The Canedl., Nurse
Jutr' quilt 1171 7
committees, consultation on
request, presentation of briefs
and submissions to
governmental and
non-governmental agencies,
membership participation in
various national and
international organizations as
well as joint meetings and
sharing of information and
ideas with related professional
associations that have similar
interests and concerns about
health care in Canada and
abroad.
C
A achie\emenLs
CNA has demonstrated
leadership over the past
decade by grappling with
nursing issues such as salaries
and working conditions -
establishing a labor relations
department as a positive
program and a continuing
service to members. The
collection and processing of
national data on nurses and
nursing education - a first for
the health professions -
provides assistance in
manpower planning. The
statistical unit also collects
and analyzes national data on
collective agreements for all
jurisdictions.
CNA's executive director
meets regularly with her
national counterparts in the
Canadian Medical
Association, Canadian
Hospital Association and
Canadian Public Health
Association as well as with the
interprofessional group of 15
chief executi ve officers of
health-related national
professional associations. She
also meets and maintains
communication with key
elected and senior
governmental officials in
several federal departments.
As a member of the
International Council of
Nurses, CNA is responsible
for representing Canadian
nurses at the international
level and for communicating
with other international
organizations active in the
health field.
...
yo. ,
I t
Support staff - seated (left to
right) Shirley Dormuth, Nancy
Wallace, Lyne Leduc. Brenda
Mallett, Jo-Anne Beauchamp;
"L.
standing Darlene Houde, Susan
Graves, Debbie Cadieux, André
Latour, Tina Lobin, Debbie Arnold,
Hélène Roy, Brenda Kropp.
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The national journals
have a combined circulation
of 130,000; they feature the
activites, interests and
developments that affect the
professional lives of nurses in
Canada, as well as providing a
platform for beliefs and
opinions. Public relations is a
priority - developing a long
term program to achieve
national visibility for the
profession and emphasizing
concerns about health care.
The CNA library is the
only recognized nursing
library in Canada providing
services in both official
languages - it also houses an
archives that is of great
historical interest and value.
In the final analysis, the
actions and involvements of
CNA has an effect on the
individual member - aware
of it or not, each CNA
member is a participant in the
work of the national
association.
\
Circulation and advertising -
(left to right) Susan Vann, Manelle
Lafrance, Maureen Ghosh,
Pierrette Hotte, Dawn Baker,
Gerry Kavanaugh.
ew faces at CNA
Louise Lé
esque is Director of
CNA projects. She has a
master's degree in nursing
from McGill University. and a
diploma in social
administration and
community work from York
University (England). Her last
position was associate
professor, teaching nursing
education and community
nursing, at the Faculty of
Nursing, University of
Montreal. She was also
involved in research
activities.
Claire McKeogh is the
Librarian-Archivist at CNA'
McKeogh obtained her '
Bachelor's degree in library
science from McGill
University, and went on to
acquire her Master's degree in
1971. She is fluently bilingual
and has much eXl'erience in
library administration. She
was with several Montreal
libraries and most recently
with Algonquin College.
Pat Wallace is Project
Director, development of
nursing practice standards. A
native of Fredericton, N .B.,
Pat is a graduate of the
Montreal General Hospital
School of Nursing, and has a
B.N. from Dalhousie
University. She obtained her
master's degree in health
services administration from
the University of Alberta. In
addition to her experience
teaching nursing
administration at the
University of Alberta she has
been most recently
administrative assistant and
Director of Nursing Service at
the Royal Alexandra Hospital
in Edmonton.
Jean-Gu) Bourque is
Administrative Manager of
the CNA Testing Service; he
comes toCNA with more than
nine years of administrative
experience in health services.
He has a Bachelor of
Commerce degree from
Carleton University, Master
of Health Administration from
Ottawa U ni versity and a
diploma in Business
Administration from
Algonquin College. He was
mOst recently executive
assistant (nursing) at the
Ottawa General Hospital.
Gisèle Loney who has been
with the Testing Service has
been appointed CNA Liaison
Officer. She is a diploma
graduate from Hôpital St.
Luc, Montreal and has a B.A.
Administration from the
Université de Québec (Hull).
Photos by John Evans
I
,
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'(
. Developments
in Nursing
, 'I guarantee that this book will sweep the nation! It
is rare in my career that I have seen such a superior
book. It is leagues above all other texts in readability,
easy flow of writing style, and depth of content. It is
appropriate for both two and four-year programs. , ,
(Teacher in large urban program)
I
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Used alone or as a companion to Medical-Surgical
Nursing, this remarkably detailed volume encom-
passes the full range of nursing fundamentals- from
global concepts of humanness-to health and ill-
ness-to a thorough introduction to basic nursing
practice and the more advanced techniques.
The broad coverage is enhanc
by the use of a
unique feature-36 detailed procedures found
throughout the text which set up basic guidelines for
effective nursing care. Included as well are topics on
stress, adaptation, the nursing process, legal and
ethical issues, plus important separate chapters
on care of children, care of the elderly and care of
the grieving and dYing.
As a carefully organized, psychophysiologic ap-
proach, BASIC NURSING draws students actively
into the I
arning experience Boxed materials, tabula-
tions, chapter overviews and selected vocabulary
only begin the long list of study aids in each chapter
An Instructor's Manual is available.
1311 pp. 408 ill. $34.80
March 1979.
Order *8498-X.
A
Sorensen & Luckmann
BASIC NURSING:
A PSYCHOPHYSIOLOGIC APPROACH
and coming soon
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Send on 3D-day approval: CN 8179 .
. .
. 0 Sorensen & Luckmann: BASIC NURSING .
. #8498-X $34.80 .
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· MEDICAL-SURGICAL NURSING ·
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. PO. Box 207. Philadelphia. PA 19105 .
( St Anne.sRoad. Eastbourne. East Sussex. BN213UN. England I
9 Waltham Street. Artarmon NSW 2064 Australia
...................
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MEDICAL-SURGICAL
NURSINO,
A PSYCIIOPIIYSIIlOIIC APPIIOACII
Luckmann & Sorensen
MEDICAL-SURGICAL NURSING:
A PSYCHOPHYSIOLOGIC
APPROACH. 2nd edition
If you hked the first edition. youlllove the second' Updated.
revised and expanded. it keeps pace with the needs of
today's nurse. All the features you liked in the first edition;
clear organization, the instructor's manual, study guides,
boxed matenal, and tables, have been retained. There is a rigorously revised section on
shock, and entirely new units on psychosocial and physical assessment. emergency and
disaster nursing, and dependency on alcohol and other substances are included. Particular
attention has been given to the rewriting, updating and expansion of the sections on the renal
and liver and male reproductive systems. In addition, the opening chapters emphasize the
importance of nursing as an art process and many new illustrations provide a balance with
the textual material.
By Joan Luckmann, RN, BS, MA, formerly, Instructor of Nursing, Unlv. of Washington,
H,ghline College, Seattle; Oakland City College and Providence Hospital College of Nursing,
Oakland, CA. and Karen Creason Sorensen, RN, BS. MN, formerly, Lecturer in Nursing,
Univ. of Washington, formerly, Instructor of Nursing, Highline College; formerly, Nurse
Clinical Specialist. University Hospital and Firland Sanatorium, Seattle. About 1600 pp. Ready
soon Order "5806-7.
2111 BITDI
The Cenedl.. NurM
Julyl AUfluet 1171 .
NEWSBEAT: THE PROVINCIAL SCENE
BRITISH COLUMBIA and treatment programs for ALBERTA
children in B.C.: and a brief
presented to the Motor
Vehicle Task Force which The "V ear of the Nurse"
"How is it that British involved recommendations
Columbia has a nursing . aimed at reducing the deaths drew to an end in Alberta as
shortage? Where are the and injuries caused by motor almost 1200 members
nurses if they are not working vehicle, cycle and pedestrian gathered at the Calgary I nn for
in nursing?" Sue Rothwell, '\. accidents. the 62nd annual convention of
president of the Registered the Alberta Association of
Nurses A!>sociation of British Registered Nurses held May 8
Columbia in her address to the Voting on resolutions through II.
annual meeting said that these Several of the resolutions Revolving around the
are questions the RNABC Rothwell said that there approved by membership theme "Concerned, Qualified,
executive and board have has been a marked change in dealt with various aspects of Prepared to Care" , the tone of
raised and ones which need to official attitudes toward nursing education programs as the convention was set by
be answered quickly and with nursing and a new willingness they exist and are developing each speaker's emphasis on
a unified professional voice. to listen on the part of in the province. As a result of accountability, rights and
"It is not simply a question of government officials. She said these resolutions, the RNABC responsibilities.
supply and demand. that the government now will: Outgoing president,
Registration, which is the seeks advice on policy, the . urge the B.C. Valerie Ayris, spoke on the
keystone of professional health act, and proposed government to consider a provincial association's
regulation, is also a very changes in health services in province wide, coordinated responsibility to ensure that
strong economic lever," she longtenn care to remote areas health education program as a Alberta's nurses are indeed
said. of the province. school curriculum qualified and prepared to care.
Rothwell noted that in the requirement: The convention's
area of professional affairs, Membership growing . urge the Ministry of keynote address was
the most outstanding Executive director Marilyn Education and Universities in presented by Dr. Elizabeth
association activities recently Cannack reported that the province to investigate the Carnegie, editor emeritus of
have been in relation to the RNABC membership has implementation of external Nursing Research and
safety to practice increased by close to 40 per B.S.N. programs andlorother president of the American
conferences. The initial round cent over the past five years flexible and accessible Academy of Nursing. Dr.
of these conferences was - approximately 8 per cent methods of obtaining B.S.N. Carnegie addressed the
geared to nurse and hospital annually. She cited as major preparations: concerns of the public as
administrators on the areas of concentration of . conduct a feasibility discerned by nurses - the
assumption that if they were effort the work being done by study into the provision of desire for the consumer to
uninfonned or recalcitrant, two of the association's i nternshi pi residency have quality nursing care
implementation of efforts to committees - one established programs for new graduates in given by qualified, competent
improve and evaluate nurse to study the future of nurse nursing: a position statement and professional nurses. She
perfonnance or patient care midwifery in BC and another to be developed following went on to say earning
settings would meet with set up to consider revisions to completion of the study to credentials is vitally important
resistance or at least less than the Community Care serve as a basis for the orderly in order to prove our
enthusiastic acceptance. Facilities Licensing Act planning of educational competence to the public.
"There has been a fair Regulations. programs and employment Other speakers at the
amount of concern from Describing RN ABC provisions for new graduates: AARN convention included:
members over the fact that the accomplishments during the . collaborate with the Phyllis Kritek, associate
initial approach was not past year, Cannack reported Registered Psychiatric Nurses professor, University of
directed to general duty on an inquiry into uranium Association of British Wisconsin - Milwaukee, who
nurses and I think this mining: a change in the B.C. Columbia and the Licensed asked "Qualified - will you
concern is legitimate. I can Building Code to ensure that Practical Nurses Association be?" and Shirley Stinson,
answer that the work on all highrise public buildings in the preparation of ajoint professor at the University of
reporting nursing problems have elevators of a sufficient statement for public relea
e Alberta and president-elect of
and perfonnance evaluation size to accommodate a which defines the provisions the Canadian Nurses
has proceeded as well as the stretcher: reconsideration of for registration, licensing and Association who traced the
development of learning the proposed Family and monitoring of competence of historical development of the
resources on care plans. This Child Legislation and altering each of its members and profession and challenged the
coupled with the plan for it to ensure the children's which defines the tenn nursing profession of the
orderly implementation of rights to good health are "graduate nurse" in orderto future to be actively involved
safety to practice will payoff protected; investigation of the clarify the titles and roles for in the health concerns of
in the long run." situation of alcohol education consumers. society.
ß
10 Julyl Auguet 1171
The Cen-.llen Nu...
--
As a tribute to the
International Year ofthe
Child, well-known
personality, Art Linkletter,
author of Kids say the
darndest things, addressed
the conference on Wednesday
evening. 'The world's
children: their needs and
rights" drew laughter and
tears from the audience as
Linkletter used touching
anecdotes to demonstrate the
plight of the world's children
and the awesome task being
attempted during the
International Year of the
Child.
.
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The 1979 "Nurse of the
Year" award was presented
during the convention to
Margaret "Gerry" Seymour,
the acting coordinator of
nursing at Red Deer College.
This annual award is designed
to honor and recognize AARN
members who participate in
community affairs.
Referring to Gerry one
colleague said, "She is the
kind of person a young nurse
aspires to be: thoroughly
professional yet humorous:
knowledgeable but never
self-important: practical but
warmly human."
Two prominent Alberta
nurses received honorary
AARN life memberships.
Honored were Winnifred
Shandro, regional supervisor,
of the Jasper Place Clinic in
Edmonton and acting director
of the North Eastern Alberta
Health Unit and Claudia
Tennant, volunteer worker
with the United Nations
Development Program in
Yemen.
The official closing
ceremonies saw retiring
president Valerie Ayris turn
the gavel of the presidency
over to president-elect,
Jeanette Pick.
SASKATCHEWAN
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with honesty, openness and
communication, we are
adding to these people's
problems rather than helping
them. "
Child life workers,
according to Kettner, can and
do provide an important
support team for nursing and
play an invaluable role in the
hospital setting by serving as
non-threatening
intermediaries between
parents and children. nurses
and doctors.
Nonsense and
commonsense approaches to
two important areas of child
development - bonding and
parenting - were the subject
of a two-part presentation by
Dr. Kenneth McRae, director
of the child development
clinic at the Children's
Hospital in Winnipeg. He
warned nurses that they can
look forward to having to deal
with larger numbers of
children hospitalized for
treatment of emotional and
social problems as the census
of acutely ill children falls and
the number of referrals for
behavior problems grows.
Among the most common of
these in his practice are
feeding difficulties,
aggression. hyperactivity,
lying, stealing. and school
entry readiness problems.
Dr. McRae described a
number of "societal realities"
as factors contributing to
breakdown of the attachment
process between children and
parents. These included:
mothers whose own
backgrounds left them without
nurturing capabilities, alcohol
abuse by family members. the
physical separation of parents
and babies for health reasons
'-
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(particularly common among
the native population) and the
tendency of child care
workers and agencies to keep
shifting children from one
substitute "mother" to
another more suitable one.
Getting baby ofT to a
better start with the latest and
best in infant nutrition was the
subject of Elaine Scott's
presentation. Scott, who is a
provincial nutritionist with the
Saskatchewan Department of
Health, described the results
of a recently completed
survey on breastfeeding
practices among a sample of
more than 1000 women in
rural Saskatchewan. One in
five of these mothers
breastfed their babies until
they were more than six
months old.
The four members of a
panel discussion on the rights
of children - in hospital. in
school. and in the community
- were: Helen Grimm of the
emergency department of
Pasqua Hospital in Regina;
Eldon Gritzfeld, a Regina
lawyer: Terry Russell,
psychologist with the
Saskatchewan Department of
Health and Bea Williams,
public health administrator in
Rosetown. Agnes Herd,
chairperson of the Health
Sciences Department of
Wascana Institute of Applied
Arts and Sciences, served as
moderator of the discussion
and introduced the
participants.
Membership concerns
SRNA members attending the
meeting approved a total of 16
resolutions as well as three
changes in the association
bylaws. As a result of these
amendments nurses in the
I
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New SRNA life members pIctured
with CNA president Helen Taylor
(far left) and SRNA president
Betty Hailstone (farright) are:
(from left to right) AgnesGunn,
Elizabeth Cullen, Winnifred
Evans. Patricia Mfurath,
Frances Copeman, Jean
Armstrong and Laura Webster.
Children - in hospital, at
home, in the community,
children of all ages, sick or
well- were the center of
attention at this year's 62nd
annual meeting of the
Saskatchewan Registered
Nurses Association. Close to
400 members attended the
meeting which took place May
9, 10, and II at the Hotel
Saskatchewan in Regina.
The program for the
meeting was planned around
the theme "Children - our
resource, our challenge" and
a total of seven speakers.
including a pediatrician, the
director of a child life
program, nutritionist. lawyer,
psychologist, public health
nurse and staff nurse in a
hospital emergency
department, contributed their
special expertise to nursing's
look at the child in society
today.
A special plea for
absolute honesty and more
open communication in
dealing with both the
hospitalized child'and his
parents was directed to the
nurses in her audience by one
of these speakers. the director
of the child life program at
Winnipeg Children's Centre,
Ruth Kettner. She urged
nurses to ask themselves
"what if! were that patient?"
and to remember that "unless
we deal with stressful
situations as they come along
province will pay a slightly
higher fee for membership in
their provincial association in
each of the next two years.
Registration fees will be $90
(up from $75) in 1980 and $100
in 1981.
The resolutions covered a
wide range of subjects. Many
were intended to promote the
level of health care services
available to the general public
in Saskatchewan. Among
these were resolutions
suggesting:
. adoption by the proper
authorities of more
informative labelling of
prescription drugs.
. creation of public
education programs in the
symptoms of a heart attack
and how to gain entry to the
emergency care system;
. adoption ofthe universal
emergency telephone number
(911) to gain access to the
emergency medical system;
. development of
community support programs
for individuals receiving
cancer treatment and their
families;
. high priority be given by
governments to increa'ied day
care facilities. particularly for
children undertwo;
. strengthening of "the
generalized public health
nursing service" provided
through provincial and
municipal go'/ernments as
fundamental service to
families.
A number of resolution!>
were concerned with
improving educational
opportunities for nurses
already registered in the
province. Of these, one of the
most important was a
resolution authorizing the
SRNA to create a trust fund.
to be known as the
Saskatchewan Nurses
Foundation. to provide
financial assistance to
association members for
continuing education.
lVIembers also authorized
the association to carry out an
investigation into "the current
status of continuing
education" in the province
and the implications for the
nursing profession of
mandatory versus voluntary
continuing education as a
requirement for maintaining
practicing membership.
The Cenedl.n NUrM
President's addre'is
SRNA president, Betty
Hailstone. reporting to
membership on action taken
on their behalf during the past
year. touched on a number of
significant accomplishments.
,including completion of an
addition to the SRNA
headquarters and described
some of the long-range plans
ofthe association. New
membership services include
a phone-in consultation
service. a multi-media
resource center and a special
outreach program for nurses
employed in northern portions
ofthe province.
"In the immediate
future." Hailstone noted.
"the Council has identified
quality nursing practice as a
high priority and plans to
implement a five-year plan for
quality assurance in nursing."
CNA president Helen
Taylor, who brought greetings
from the national association.
congratulated Saskatchewan
nurses on several "firsts" in
Canada. including:
. nurse practitioners
. community health
centers
. relocation of all nursing
education programs in
educational institutions rather
than hospitals
. a higher ratio of
baccalaureate to diploma
nurses than in other
provInces.
New Council members
Delegates elected the
following officers to serve as
members-at-Iarge: Doreen
Cheetham, North Battleford;
Bonnie Rushowick, Ituna;
Susan Ward and Phyllis Wise.
Regina. Members of the
nominating committee are:
Cecile Hunt. Melfort; Irene
Murphy. North Battleford;
Ina Watson, Saskatoon.
Life memberships
Seven nurses received special
recognition from the SRNA
for outstanding service to the
people of the province. Those
cited were: Jean Armstrong
and Frances Copeman of
Moose Jaw; Elizabeth Cullen.
Weyburn; Winnifred Evans.
Cabri; Agnes Gunn.
Lloydminster; Pat McGrath.
Saskatoon; Laura Webster.
Unity.
MANITOBA
In an opening address to the
65th Annual Meeting of the
Manitoba Association of
Registered Nurses. the
Honourable L.c. Sherman,
Minister of Health and
Community Services in
Manitoba. specified
government endorsement of a
six-month clinical practicum
for student nurses as one
method of providing job
orientation. Following media
reports and delegate protests.
the Minister communicated
that there would be no
interference by government in
the nursing education system.
that the practicum should take
the form of paid
job-orientation for a period as
yet not finally determined but
certainly not to exceed six
months. He said that any
practicum must not be
exploitive but must be
designed to benefit the
nurse-graduate. the health
facility and the consumer.
Keynote speaker at the
annual meeting was June
Menzies. head of the National
Farm Products Marketing
Council. Speaking to the
theme. Consumers' Rights-
Nurses' Responsibilities. she
said that nurses have fought
for. and won. professional
status in the health care field.
"You have won the right
to control the education and
training of those who have
chosen to enter the
profession. to !>et standards
and to discipline your
members. This is an important
achievement. but one which
brings with it additional
responsibilities. not only to
yourselves and your fellow
health professionals, but to
consumers for whom the
health care system was
developed," she reminded her
audience. Menzies, who until
recently served as vice
chairman of the national
Anti-inflation Board. said that
nurses can give practical
support to consumer rights
and that the emergence of
"patient power" should not
be seen as a threat, but
ultimately as a means to
improve the health care
Julyl Auguet 1171 11
system to meet the needs of
those it was designed to serve
She noted that nurses can
playa major role in informing
and educating the consumer
on how to stay healthy; where
to seek help when ill and what
services are available; how to
get the full benefits of the
health care system.
. 'The patient wants to
know what diagnosis and
treatment of the illness entails
and how to care for herself."
Menzies believes that the
nurse's responsibility
concerning patient teaching is
also connected to the
consumer's right to be
respected as the person with
the ultimate responsibility for
his own care: he must know
how to care for himself and he
must have guidance. She
called on nurses to learn all
they can about consumer
rights by having this subject
included in the curriculum
along with related subjects
such as law, ethics, sociology
and health administration.
Nurses at the forefront
Professor Jan Storch, Division
of Health Services
Administration, University of
Alberta, said that professional
associations must:
. seek to educate their
membership about human
rights and consumer rights in
health care;
. speak out against
violations of these rights;
. support their members
who "risk" to speak out or to
try to change systems to
accommodate consumer
rights; and
. seek to find innovative
approaches in health care to
assure patient rights.
Professor Storch
emphasized the potential
nurses have to effect change,
to gradually change the health
care system so that consumers
are respected. maintain
autonomy or freedom, and
maintain their integrity. As
"front line" workers, nurses
are "experts" in speaking
about those actions, policies
and situations which enhance
or violate patients' rights.
Reporting to the membership,
President Mollie Willard said
that in determining a course of
12 Ju1y/Augu8l1171
action for the past year, ten
objectives were established.
Commenting on some of these
objectives she said that
MARN will continue to
develop. implement and
evaluate broad and specific
standards of nursing practice
in Manitoba; to seek
immediate introduction and
passage of the proposed R.N.
Act in the legislative assembly
and to promote continuing
education for registered
nurses and the establishment
of a masters in nursing
program at the University of
Manitoba as well as support
the concept of a second
baccalaureate program in
nursing in Manitoba.
Among the resorutions
approved by the meeting were
directions from the -
membership that MARN
conduct a comprehensive
study of the perfonnance
expectations of new registered
nurse practitioners and that
the Board of Directors of
CNA study the issues inherent
in continuing education for
nurses and produce a position
paper on continuing education
for registered nurses in
Canada during the 1980-1982
biennium.
ONTARIO
The voice of professional
nursing in Ontario will operate
on a new frequency following
restructuring of the Registered
Nurses Association of Ontario
according to a completely
revised set of bylaws.
Ratification of the more
than 100 association bylaws
was a major accomplishment
of delegates to the 54th annual
meeting and convention of the
RNAO at the Royal York
Hotel in Toronto. May 3, 4
and 5. It was the first major
revision of the RNAO bylaws
in 12 years.
Chief among the changes
is the reduction in size of the
board of directors from its
fonner 64 members to
nineteen voting members.
These include the president,
president-elect, 12 regional
representatives and five
members-at-Iarge.
The Cen-.ll.n Nur..
I n her report to
membership. executive
director Maureen Powers
commented on the reasons for
the restructuring, pointing out
that the changes are
"intended to facilitate wise
decision-making, rapid
identification of nursing
issues. rapid response to these
issues. an increase in regional
activity and the vitality and
relevance ofRNAO in today's
world. ..
One proposed bylaw
which would have shortened
the term of office of the
president and president-elect,
making it one year instead of
the present two years. was
defeated. Instead. under the
tenns of a resolution passed at
the annual meeting, a task
force will be set up to study
the demands placed on the
president and president-elect
during their terms of office in
the light of the need to find
desirable alternatives.
Working together
Retiring president Irmajean
Bajnok, in her address to
delegates, referred to "the
many problems of a
threatening nature that the
profession is currently
experiencing. .. Among these
she included high
unemployment. impending
changes in the process of
certification for competency.
diversification of health care
requiring changes in the
education process. and new
demands for accountability
from clients.
"Given the budgetary
restraints. many a nurse is
attempting to do the work of
three nurses and. on top of
that. to explain to the
uninfonned patient the
rationale for other cost-saving
practices in the system. The
reality of the system is that
until nurses speak with a
unified voice and learn the
political process, we will not
become part of the
decision-making pro'cess."
Bajnok challenged nun,es
to work together to develop a
sense of colleagueship within
the profession. "If we as
nurses can begin to talk to,
support, use. advise and
challenge each other in a
respectful way, we can
strengthen the profession and
thereby strengthen the
contribution we can make."
She urged nurses not to
resort to professional
in-fighting, not to give in to
the tendency to "scapegoat"
the two-year graduate for all
of the weaknesses in the
health care system. to offer
support to other women
working in male-dominated
areas. and to resist the
"anti-intellectual tendency"
in our profession by refusing
to "put-down" nurses who
have and attempt to use added
education.
"Somehow," Bajnok
said. "we have to convey to
each other that as nurses, it is
okay to be different, okay to
be angry, okay to be good at
something. okay to have
limitations, okay to need
others. and okay to be
educated. "
Membership concerns
Directors of the association
met at the conclusion of the
annual meeting to begin work
immediately on implementing
some of the many resolutions
approved by membership. As
a result. nurses in Ontario can
look forward to several new
developments. including a
meeting of consumer groups
and nursing organizations
interested in maternity care,
with a view to legalization of
the practice of midwifery.
Work will also begin on a
resolution calling for the
association to "propose
action plans for the education
of nurse midwives in Ontario
as recommended by the
RNAO Working Party on
Nurse Midwifery."
Two priorities were
identified by membership and
referred to the national
association for action. These
were continuing education for
nurses and national
accreditation of nursing
education programs. As a
result, RNAO will press CNA
for representation on the
national association's ad hoc
committee on accreditation
and urge that high priority be
given to work on this project.
RNAO will also request the
national association to
develop a position paper on
continuing education for
registered nurses in Canada
during the next two years.
Other resolutions
approved during the annual
meeting are intended to
promote:
. sensitizing of the nursing
profession to the needs of the
elderly
. development of strategies
for the provision of temporary
bed accommodation for
vacation relief and/or social
emergencies for longtenn
patients being cared for at
home as an alternative to
longterm institutionalized care
. better understanding
between members of the
nursing profession working in
various agencies and between
nursing and other
health-related professions
. public education
concerning the roles and
responsibilities of registered
nurses and registered nursing
assistants
. facilitation of public
education programs in
parenting
. passage of legislation
preventing discrimination
against disabled persons in the
area of employment where the
disability is unrelated to
ability to perfonn the duties
required
. implementation of pilot
projects demonstrating
various models of diploma
nursing education programs
designed to prepare graduates
for current and future practice
'
-
JÞ;...
....
,
o. .t
"
.-
t"
,---
Colleagues honored
One of the highlights of the
meeting was a brief ceremony
during which an honorary life
membership in RNAO was
conferred on Blanche
Duncanson, associate
professor, Faculty of Nursing,
University of Toronto. and
Kathleen R. (Kay) Lewis.
(above) was made an
honorary member of the
association. Lewis was
fonnerly associate director of
The Cen-.llen Nur..
the RNAO employment
relations department and is
now associate executive
director of the Ontario Nurses
Association.
\
Neft president
Incoming president. Jocelyn
Hezekiah, commenting on the
need for nurses to take an
active role in influencing and
improving the health care
system. encouraged the
readiness of nurses to move
into community and health
promotion work.
"The determination of
the ministry of health to
increase community health
facilities and to stem the
growth of hospitals wilI open
opportunities for more nurses
to move into the community.
RNAO is encouraged by this
direction. It remains for
nurses to face the chalIenge."
\'-
""
"
Hezekiah, who has been
president-elect since May
1977. is chairman of basic
nursing programs at Humber
ColIege of Applied Arts and
Technology. Toronto. She
holds an M.Ed. from the
Ontario Institute for Studies in
Education and a B. Sc. N. from
McGilI University. Montreal.
Closeup on
Nursing Networks
Nurses should be looking beyond individual conscious-raising to the
larger issue of reforming the structural constraints imposed by society on
their behavior. It is organizations - not people - who must change,
according to the dean of Queen's University's School of Nursing in
Kingston, Ontario.
"Right now nursing services. especially in hospitals. are organized
along the classic sexist model of women's place, women's work," Alice
Baumgart told delegates to the 54th annual meeting of the Registered
Nurses Association of Ontario. "The ways in which nursing services are
organized and how these systems can be modified to provide more
opportunifies, more power and improved quality of work life needs our
urgent attention."
Baumgart described social support networks in nursing as "an idea
whose time has finally come" and urged nurses 10 overcome their
cultural conditioning and learn how 10 help each other to gain access to
the persons, information and resources they need to attain their
professional aspirations.
Nurses, Baumgart says, need to establish a system of informal
information channels in order to continue the development of a stronger
role in determining the destiny of their profession and in voicing opinions
on health care policies. These nursing networks would actually help
nurses achieve their professional goals by providing task-oriented
assistance, emotional support and. more specifically, information,
advice, guidance. contact and protection.
That is not to say that nurses have never had networks. Baumgart
assured listeners, but in the past the problem has been that the networks
that did exist often motivated nurses to work in ways that were actually
antithetical 10 both individual and collective professional goals. In other
words, she said, nurses tend not to help one another succeed. A good
network of information sources need not be seen as a sort of 'good 01'
boy' system such as is frequenlly seen in male dominated professions
and occupations, because this sort of network is often narrow-minded
and exclusive. However, nurses do need to look at this sort of
organization and utilize the same principles in order to form a useful
professional network.
Commemorative plaque
CNA president Helen Taylor.
who addressed the meeting
during the opening
ceremonies. thanked RNAO
members for their gift of a
bronze plaque which has been
mounted at the entmnce to
CNA House in Ottawa. The
plaque commemorates the
official opening of the national
association headquarters in
1967.
Professional deulopment
The concluding day of the
convention was devoted
largely to professional
development. A panel
discussion on patient teaching
was presided over by Dorothy
Wylie. vice president.
Nur"ing, Toronto General
Hospital. Members of the
panel were: Patricia Kirkby.
head of nursing programs at
,
.
.
.'11 "-
-
,
. ",.. -
. .,
I \t V
-,.
.
July/Auguet 1171 13
Cambrian ColIege of Applied
Arts and Technology in
Sudbury; Susan Gilmore. a
staff nurse in pediatric
oncology at Princess Margaret
Hospital in Toronto; and
Elinor Graham. educational
coordinator with the
Middlesex -London Health
Unit.
Five concurrent
education sessions were
offered. Speakers were:
Shirley Post, vice president of
the Canadian Institute of
Child Health; Mary Bawden,
team leader, rheumatic
diseases unit. University
Hospital in London; Mary
ay Harrison. professional
nursing consultant; Alice
Baumgart. dean. Faculty of
Nursing, Queen's University.
Kingston; and Janet
McChesney. career planning
consultant, Toronto.
Baumgart stressed that nurses must look realistically at the
profession and realize that nursing is still a sort of 'female job ghetto'. "II
has become fashionable," she said, "to admonish nurses for not sticking
together. for being competitive rather than co-operative, and for thinking
of nursing as a job rather than a career." She stressed that this blame
placing does no good and nurses would be better to look at how
traditional definitions of sex roles and appropriate behavior has made it
difficult for nurses to maintain long term associations. For years, she
pointed out, women's principal ties were to home and family, and their
professional identity was often subordinate to the other important female
roles of wife and mother. Another negative effect has been the perceived
prejudice of women toward other women: for too long women have felt
that professional men were more competent than their female
counterparts. Fortunately, some of the worst of these attitudes are
beginning 10 disappear, and nurses can now look realistically at how to
build informal information and support systems to reinforce professional
identity.
Baumgart gave examples in her talk on how this was happening in
Ontario with the growing number of special interest groups (see CNJ
June 79), unionization, and the expansion of opportunities for
continuing education. The positive effects of continuing education and
special interest groups is easily understood but Baumgart clarified the
importance of nursing unions by saying that they were part of a step to
develop strong professional organization. Groups like hospital
associations have a vested interest (that IS to say, economic) in
preventing such strong nursing networks; she said such groups use
'divide and rule' tactics, and often have a 'keep them barefoot, pregnant
and down on the farm' attitude.
In a summary of her talk. Baumgart noted that success in an
occupation or profession is no longer considered deviant behavior' for
women, and that consequently the idea of informal social networks for
support and information is one whose time has finally come. But, she
predicted. the road will be long and difficult and fraught with problems.
14 Julyl Auguet 1871
The Cen-.llen NUrM
--
NEW BRUNSWICK that if nurses don't define membership - among the nationally as a member of the
standards of practice, then the recommendations approved board of directors of the
government would gladly were: Canadian Nurses Association
Unless the nursing profession oblige us - to a more . a third public member be and a former president of the
can explain what it does, what ominous stage where added to the board of Canadian Nurses Foundation.
and how it affects the patient, governments are legislating directors as a consumer of Robichaud, who recently
there will continue to be an practice acts. " health care (not a civil retired as director of public
erosion of nursing, said Scherer said that at a time servant) and that this person health nursing with the
Kathleen Scherer, keynote of escalating health care costs, be named by the Ministry of provincial department of
speaker at the 63rd annual when nursing salaries account Health health, was a member of the
meeting of the New for such a high percentage of . four nurse members- N BARN Council for ten years
Brunswick Association of the health care dollar, we at-large be elected and president from 1971 to
Registered Nurses. The must be prepared to justify by N BARN members to serve 1973.
meeting was held June 5-7 in these expenditures. on the board for a two-year
Moncton. "Cost (>onscious tenn NOVA SCOTIA
Scherer is nursing administrators do well to raise . NBARN create a new
consultant, standards, the the question: why not hire staff position of administrative
Manitoba Association of three registered nursing officer
Registered Nurses. She said assistants instead of two . and. in addition to other Responsible participation by
that with the advent of other RN's? I four response to that evaluation methods, in two or nurses in extending the
health professions and query is simply: well the three years feedback be traditional boundaries of the
paraprofessions the role of the quality of care would diminish sought from the public and profession, a stronger voice in
registered and baccalaureate - then we can understand consumer groups on nursing exploring and meeting the
nurse in health care has why the administrator and the NBARN philosophy health needs of society and
become blurred. chooses the RN A . s. If our and objectives, and whether new roles for nursing
"Accountability, that is reply is: there would be no NBARN is meeting the needs practitioners within the
the acceptance of patient teaching - then we of the people ofN.B. systems and programs they
responsibility for our actions had better be prepared to . the possibility of an help to develop, are all part of
and inactions. is the major document patient teaching N BARN foundation for the exciting challenges for the
impetus in the development of and patient outcomes funding education and future foreseen by the
standards. The formalization associated with patient research. president of the Canadian
of standards is one method of teaching. For it remains (EarIierthis yearCNA's Nurses Association.
demonstrating accountability insufficient to plead need, director of administrative "N urses should lobby
as a profession." rather we must demonstrate services. Beryl Darling, was more for social change, for a
Scherer said that nurses need, effectiveness and cost asked to make political system based on
are under pressure to develop benefits. " recommendations to the human need, not solely on
standards from within the committee for the economic need," Helen
profession. "In the past, we Fee increase development of administrative Taylor told Nova Scotia
performed our functions with NBARN membership changes.) nurses meeting in Bridgewater
a degree of certitude. Now we approved a bylaw change that New president early in June to celebrate the
have pediatric nurse will allow the annual During the meeting, Anne 70th anni versary of the
practitioners, enterostomal membership fee to increase Thorne, director of the Saint founding of the Registered
nurse therapists and clinical from $65 to $95 for practising John School of Nursing, was Nurses Association of that
nurse specialists. members and $15 from $10 for installed as the 21st president province. "We must learn to
"There is a lack of clarity non-practising members of the New Brunswick assist in the planning,
within the profession," said effective 1980. A motion for Association. Thorne, who was development and
Scherer. "How do we further increase in 1981 was elected by the general implementation of new fonns
differentiate between an defeated. membership earlier this year, of care in a changing society
expanded role and that of a Among the resolutions will hold office for two years. which encourages client or
nurse physician?" carried are that NBARN She replaces Judith Oulton as patient involvement and
Scherer said that there is investigate the feasibility of president. where the total demand for
a real need for nurses to extension courses leading to a During the meeting, two services will always be greater
communicate with each other, Bachelor of Nursing degree nurses, Jean Anderson and than we can satisfy with our
to define what it is they do and being offered in the various Appolline Robichaud, both of limited economic and
what effect this has upon the health regions of the province Fredericton. were awarded manpower resources."
recipients of their care. in accordance with the life memberships in NBARN Taylor's address on
"Another pressure languageCs) that meet the in recognition of their present trends and future
brought to bear on nurses to needs of the region. outstanding service and directions set the stage for
develop standards arises from The professional contributions to nursing in three days of discussion by
consumers of health care. association will also look at New Brunswick. A life the RNANS members on the
Consumers have verbalized the feasibility of setting up a membership was also awarded theme of 'The nursing
that nursing has failed to meet formal post-basic course in earlier this year to Doris profession: its influence on
their needs and their intensive care nursing in N.B. Grieve of Fredericton. Only health in Nova Scotia". It also
persistent vocalization has 32 nurses have received life paved the way for approval at
paid off," she said. memberships in NBARN the conclusion of the meeting
"The government exerts Structure and function during the last 60 years. of a motion calling for the
pressure upon us to develop A report on the structure and Anderson, who served as association to study ways and
standards. We have long since function of the association both executive secretary and means of making individual
passed from the inference two years in the making was president of the provincial nurses more politically aware
state, where it was implied presented to N BARN association, was also active and active in facilitating
change within the health care
system. Results of a
demonstration project
conducted by members of the
RNANS Research Committee
during the meeting indicated
that only about one third of
the nurse respondents
considered themselves
"politically aware" and that
even fewer felt prepared to
take action to influence health
policy.
The CNA president
reminded her audience that
Canada still lacks "a
continuing measure of the
health or sickness of the
population" and that the
absence of this "elementary
marketing infonnation"
makes it difficult to define the
overall objectives of
education for the various
health professionals and to
detennine the best balance of
facilities and services. She
described the role of the
professional association as
one of responsibility for
monitoring trends.
accumulating infonnation and
making predictions regarding
relevant health and social
issues.
"Nurses' groups." she
said. "can establish priorities
and initiate local and general
programs to best respond to
these issues. Nurses need to
operate at all levels and
echelons of the system. We
must be planners.
administrators. specialists.
generalist practitioners.
teachers. evaluators and
researchers. "
The nurse of the future.
according to the CN A
president. will need new
conceptual maps and a new
compass to serve as a guide in
unfamiliar territory. She must:
. maintain the essential
caring role while, at the same
time, assuming increased
responsibility as a provider of
primary care
. take increasing
responsibility for coordinating
care. promoting contimùty of
care and intervening in
situational and developmental
crises
. be prepared to grapple
constructively with
individual, family and
community crises
The Cllnedien Nu....
. learn new community
skills such as consultation,
community organization,
convening of service
networks, monitoring
unwholesome networks,
collecting and communicating
feedback information
. understand the
significance of suppoI1ive
forces within the population
(for example. self-help groups
such as Alcoholics
Anonymous and single parent
groups) and learn how to work
with them
. be prepared to function in
a variety of settings,
maintaining traditional clinical
roles at the bedside and also
contimùng to extend life
saving and life sustaining
functions in highly specialized
units.
I n order to acquire these
new skills and meet the
demands of these new roles,
nurses will need to work
together as members of a
professional association,
clarifying common goals,
avoiding duplication of costly
projects and providing each
other with mutual SuppoI1 in
the interests of providing
improved health care to the
population.
Retrospective re\ie\\
A special feature of the 70th
anniversary meeting was the
historical exhibit organized by
RNANS life member and
fonner executi ve secretary.
Frances M. Moss. The display
commemorated 70 years of
nursing history in Nova Scotia
-dating from the
incorporation of the Graduate
Nurses Association of Nova
Scotia in 1910 (the first of its
kind in Canada) to the present
- and included original
photos. documents and other
memorabilia from every
school of nursing which ever
existed in the province, as
well as other aspects of the
association's history.
"A look back to see
where we are going", was also
the theme of three special
presentations by
representati ves of three
RNANS committees: nursing
education, nursing service and
social and economic welfare,
under the direction of Jean
Hughes. Geraldine Webber
and Winnifred Kettleson.
Organizational stud)
An interim repOI1 on a review
of the organizational -
objectives, policies and
procedures of the RNANS
currently being carried out by
a six-member committee
appointed in April. ]977, was
presented to membership for
infonnation and discussion.
Preliminary results of an
opinion survey on
membership awareness and
perceptions of the RNANS.
conducted by a management
consulting finn as part of the
larger study. were also
reported to members.
- .
.J
-
...
Lif
s,yl
award w;nn
r Ma'6ar
t Br;"
11
Action on resolution
Six resolutions. on subjects
ranging from dissemination of
voting results to voluntary
retirement benefits and
penalties, were approved by
membership. One resolution
- that the RNANS study the
issue of mandatory continuing
education as a requirement for
renewal or registration - was
approved by a majority of one
vote.
Another motion
indicating membership
support for study at the
national level of the issues
involved in continuing
education and preparation of a
position paper on this subject
by the Canadian Nurses
Association, was also
approved. A motion providing
financial backing to the extent
of$IOOO for the province's
student nurses association
(one of the few still existing in
Canada) was also passed. A
report from SNANS infonned
members of plans by the
students for a camping
jamboree and election of a
new president, Donna
Haverstock, of Halifax
Infinnary School of Nursing .
JuIy/AIIfIU-' 1171 111
Life Member
A fonner member of the
faculty and assistant director
of the School of Nursing at
Dalhousie University in
Halifax, Jean Church was
selected to receive a life
membership in the RNANS
on the occasion of the
association's 70th
anni versary. A fonner
president of the provincial
association. Church was also
a member of the nursing
education committee of the
Canadian Nurses Association
and RNANS representative
on the first CNA Testing
Service Board.
PRINCE EDWARD
ISLAND
The 58th annual meeting of
the Association of Nurses of
Prince Edward Island
attracted more than 120
nurses to Charlottetown on
May 30 to discuss issues and
concerns in health care.
Keynote speaker, Dr.
Marvin Clarke, deputy
minister of health for Prince
Edward Island spoke to his
audience about new directions
in health on the island and the
new organization of the health
department to meet these
needs. ]n particular, he
stressed that the community
and the individual must
assume more responsibility
for their own health care.
The assembly of nurses
discussed and voted on a
number of resolutions
concerning continuing nursing
education and new provincial
employment regulations
among other topics Members
also approved a $15 fee
increase. bringing the current
practising fee (including the
premium for professional
liability insurance) to $85,
effective next year.
Five nurses were elected
to membership on the AN PEl
Council. They are: Juanita
MacDonald Lechowick.
vice-president; Vernita
Gallant and Deborah
MacDonald-Connolly.
Charlottetown district council
members; Shirley Murray
Williams, West Prince county
district.
(continued on page 54)
11 Julyl AUflUIt 1171
The Cenadl.n"urN
calendar
September
Programs in continuing
education for nurses to be held
at the University of Toronto,
Toronto, Ontario:
Nursing process in mental
health and psychiatric
nursing. Sept. 17-18, 1979.
$65.
Care of the disturbed elderly
patient. Sept. 20-21,1979.
$50.
Stress relieving strategies:
nurses in managemenl
positions. Sept. 26, 1979. $25.
Understanding adolescents.
Oct. 3, 1979. $25.
Geneticsfornurses. Nov.
28-29, 1979. $25.
Evening courses
Quality assessment using the
nursing audit. Oct. 2-N ov. 6.
$75.
Cardiac anatomy and
physiology for nurses. Oct. 4-
Nov. 22,1979. $65.
Contact: Dorothy Miles,
Director, Continuing
Education Programme,
FaculfY of Nursing,
University of Toronto, 50 St.
George St., Toronto, Ontario,
M5S /A/.
Management of the patient
with amyotropic lateral
sclerosis (ALS). To be held at
the Inn on the Park Hotel,
Toronto. on Sept. 20, 1979.
Papers on: management of
upper and lower limb
weakness, bulbar problems,
respiratory muscle weakness,
nutrition, biofeedback, speech
and non-verbal
communication. Tuition: $45.
Contact: Doreen Konradis,
MARY DOE R. N.
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Executive director, ALS
Society of Canada, 1
Eccleston Dr., Suite 4/5,
Toronto, Ontario, M4A / K/.
Third North East
Canadian! American Health
Conference. To be held on
Sept. 26-28, 1979 at St.
Andrews, New Brunswick.
Theme: Painful choices for
tomorrow. Contact: North
East Canadian/American
Health Conference, Box /4/8,
Fredericton, N.B.. E3B 5E3.
October
Competency-based education,
self-learning packages and
values clarifications
workshops. A three-day
workshop with Dorothy del
Bueno and Diane Uustal. To
be held on Oct. 29-31, 1979 at
the Hotel Toronto in Toronto.
Contact: Ruby Browne, Nurse
Educator, Dept. EO, /2
Lakeside Park, Wakefield,
MA,O/880.
Continuing nursing education
programs presented at the
School of Nursing. Dalhousie
University, Halifax, N.S.:
Workshop on crisis
intervention, Fall 1979.
Caring for children: a nursing
update, Oct. 15-16. 1979. Fee:
$45.
Occupational health nursing:
ritual or reality?, Nov. 1-2,
1979. Fee: $45.
Contact: Denise Sommerfeld.
Assistant professor,
Chairman, Continuing
Education, Office of the
School of Nursing , Dalhousie
University, Halifax, N.S.
Operating Room Nurses Group
of Quebec 18th Annual
Conference. To be held on
October 30-N ovember I, 1979
at the Queen Elizabeth Hotel
in Montreal. Contact:J.
Verronneau, R.N., Operating
Room, The Montreal General
Hospital,/650CedarAve.,
Montréal, Québec, H3G /A4.
The rehabilitation of the
traumatic brain-injured aduit:
an international conference.
To be held at the Royal York
Hotel, October 13-14, 1979.
Sponsored by Centennial
College, U. ofT.. and Ashby
House Rehabilitation Centre
Contact: Roy Del Bianco,
Co-ordinator, Astonbee
Coriference Centre,
C entennial College, 65/
Warden Ave., Scarborough,
Ontario, M/L 3Z6.
Ontario Occupational Health
Nurses Association Eighth
Annual Conference. To be
held at the Holiday Inn
Downtown, 89 Chestnut St.,
Toronto, Ontario on Oct.
22-26, 1979. Contact: Helen
Krafchik, Chairman,
OOH N A, Warner-Lambert
Canada Ltd., 2200 Eglinton
Ave. East, Scarborough,
Ontario, M/L 2N3.
Association of Registered
Nurses of Newfoundland
Annual Meeting to be held
Oct. 1-3. 1979 in Cornerbrook,
Newfoundland. Contact:
ARNN, 67 LeMarchant Rd.,
P.O. Box 4/85, St. John's,
Newfoundland, A/C 6A/.
Respiratory care educational
update seminar. To be held on
October 25, 1979 at the Royal
York Hotel, Toronto in
conjunction with the Ontario
Thoracic Society Annual
Conference. Contact: Eleanor
Ross, York-Toronto Region
Respiratory Care Society, J4
WilgarRd., Toronto, Ontario,
M8X lJ4.
A Conference on Pediatric
Respiratory Care in the
Community. To be held on
Oct. 1-2, 1979 in Winnipeg,
Manitoba. Contact: The
Manitoba Lung Association,
629 M cDermot A ve.,
Winnipeg, Manitoba,
R3A IP6.
The Cllnedien NurM
.luly/Auguet 1171 17
for professional growth...
1 MANUAL OF PEDIATRIC
NURSING CAREPLANS
Department "of Nursing, The Hospital for Sick Children,
Toronto.
The authors cover the entire spectrum of pediatric disorders
and present two sets of interrelated care plans: one based on
the hospitalized child's age; the other on his or her specific
disease. Throughout, the manual emphasizes the parents'
Important role in the treatment program and offers specific
guidelines for their involvement.
little, Brown. 320 Pages. 1979. $13.00.
2 GERONTOLOGICAL NURSING
By Charlotte Kopelke Eliopoulos, R.N., B.S., M.S.
This practical new book provides a comprehensive review of the
medical, surgical, and psychiatric problems associated with aging,
accompanied by related nursing interventions. Specific coverage
is given to measures designed to promote good respiration,
elimination, and activity to compensate for age-related changes
interfering with these functions. Common diseases of each body
system and their unique features in the aged are discussed in
detail.
Harper & Row. 384 Pages. Illustrated. 1979. $15.00.
3 NURSES' DRUG REFERENCE
Edited by Stewart M. Brooks, M.S.
All nurses will welcome this fingertip guide to drugs, organized
specifically with their needs in mind. It lists alphabetically over
500 generic drugs and describes-in an easy-to-consult format-
each drug's action and use, dosage and administration, cautions,
adverse reactions, composition and supply, and legal status. A
glossary of drug classifications affords extensive cross-referencing
for quick referral to hard.to-find information. Impeccablyorga-
nized and absolutely reliable, NDR will serve as the standard ref-
erence for any health practitioner who dispenses drugs regularly.
little, Brown. 500 Pages. 1978. Paper, $14.25. Cloth, $27.00.
4 THE LIPPINCOTT MANUAL OF
NURSING PRACTICE, 2nd Edition
By Lillian Sholtis Brunner, R.N., B.S., M.S.N.;and Doris Smith
Suddarth, R.N.., B.S.N.E.,"M.S.N.
This monumental Second Edition of a modern classic-the most
comprehensive single-volume reference on nursing practice ever
published-incorporates massive revision and updating to offer
the latest and most accurate information available. What this
means is more detailed, substantive, and complete coverage
of every phase of medical/surgical, maternity, and pediatric
nursing!
lippincott. 1868 Pages. Illustrated. 1978. $29.95.
LIPPINCOTT'S NO-RISK GUARANTEE
Books are shipped to you On Approval; if you are not entirely
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5 PERSPECTIVES ON ADOLESCENT
HEALTH CARE
By Ramona Thieme Mercer, R.N., Ph.D.
With 12 Contributors.
Counseling adolescents on their optimal growth and health
requires a wide range of specialized knowledge and skill. Here at
last is a text that not only presents the major ideas and issues
on this subject; it offers valid, practical suggestions that can be
put to use in a variety of clinical settings.
Ramona Thieme Mercer together with twelve contributing
authorities, develops several major themes in relation to specific
perspectives on adolescent health. These themes include the
special psychosocial needs of the adolescent, the interrelation.
ships of his or her family members, and the effects of larger
society on the adolescent's evolving adult identity.
lippincott. 420 Pages. May, 1979. $15.50.
6 OPERATING ROOM TECHNIQUES
FOR THE SURGICAL TEAM
Edited by Lois C. Crooks, R.N., B.S.Ed.
The first two chapters deal with aseptic technique and sterili.
zation and with the anesthetized patient. The emphasis is on the
underlying principles, as shown by the concentration on the four
sources of contamination in the chapter on aseptic technique.
The remaining ten chapters of OPERATING ROOM TECH.
NIQUES FOR THE SURGICAL TEAM are devoted to precise
descriptions of anatomy, disease entity, diagnostic measures,
surgical techniques, and nursing responsibilities for the most
frequently performed surgical procedures.
little, Brown. 459 Pages. Illustrated. 1979. $21.00.
Lippincott
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etanus:
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The Cen-.llen NUrH
Julyl "uguet 11711 11
On October 26. 75-year-old l\fr. Graham arrived at a small
hospital close to his home. He had caught his hands in a baler,
sustaining deep friction burns to both hands and traumatic
amputation of three fingers on his right hand. When he arrived
at the hospital, he received tetanus antitoxin lec and was
started on oral Ampicillin.@ His injuries were cleaned and
debrided. A long ordeal of debridement and skin grafting was
expected; the development of tetanus was not.
Fifteen days after his injury, Mr. Graham began to
complain of difficulty swallowing. This problem was initially
attributed to intubation, necessitated because his wounds were
debrided under a general anesthetic. Within four days,
however, he was also complaining of stiffness in his arms, legs
and neck, difficulty breathing and choking spells. A diagnosis
of tetanus was made, and he received tetanus immune globulin
5000 units; intravenous doses of penicillin G were begun.
Mr. Graham was admitted to our intensive care unit on
November 13th.
It is a sad fact that in this day and age.
and in a country where medical facilities
abound. we still see the occurrence of
tetanus: a totally preventable disease.
Tetanus is a severe.life-threatemng
illness. Although the incidence of the
disease is on the decline. cases like those
ofMr. Graham still occur, and when they
do, they cause pain and suffering to the
patient. difficult problems in medical and
nursing management. and high cost in
both fmancial and human terms. The
disease is easy to prevent through
immunization. Once contracted,
however, its management is never easy.
The disease
Tetanus is a self-limiting disease - if the
patient can be kept alive throughout the
course ofthe infection, he will recover.
Its causative organism is an anaerobic,
spore-forming rod known as Clostridium
tetani. In the vegetative form,
Clostridium tetani stains gram positive
and is susceptible to heat and a variety of
disinfectants. The spores. however. are
highJy resistant to a number of agents,
including boiling and autoclaving at
I20"C for 15 to 20 minutes. They can
survive in soil, if not exposed to sunlight.
for months to years. Spores can also be
found in the feces of some horses, cattle,
sheep, dogs, cats, guinea pigs, rats,
chickens and humans; or in operating
room dust, household dust and heroin.'
The clinical manifestations of
tetanus are a result ofthe exotoxin
produced by Clostridium tetani, an
exotoxin called tetanospasmin. This
exotoxin is liberated at the site of injury
by vegetative forms of the organism and
is a potent neurotoxin.
"Clostridium tetani is usually
introduced into the injured area as a
spore. Disease. which does not develop
until the spores are converted to the
toxin-producing vegetative form, does
not occur simply as a result of residence
in tissue. Trauma. introduction of a
foreign body or the development of
suppuration. by reducing local
oxidation-reduction potential. causes the
vegetative forms to appear and to
produce toxin. "2
The organism belongs to a very
potent family. Clostridium. a family
including the organisms responsible for
gas gangrene and botulism. With the
exception of botulinum toxin.
tetanospasmin is the most powerful
poison known. It acts on four areas of
the nervous system:
. the motor end plates in skeletal
muscles,
. the spinal cord.
. the brain. and
. the sympathetic nervous system.
The toxin apparently interferes with
neuromuscular transmission by
inhibiting acetylcholine at the nerve
terminals in muscles, producing a
progressive interference with inhibition
of nervous transmission. Its effects on
the spinal cord lead to dysfunction of the
polysynaptic reflexes. resulting in
inhibition of antagonists. This action
accounts for the tetany ofmuscles. 3
Disturbances in the sympathetic
nervous system may show themselves in
many ways including labile
hypertension. tachycardia, peripheral
vasoconstriction, cardiac arrhythmias,
profuse sweating. hypercarbia and
increased urinary excretion of
catecholamines. ·
The usual incubation period of the
disease lasts from three to 21 days,
although the spores may lie dormant for
much longer periods. The greater the
distance of the site of infection from the
central nervous system. the longer the
incubation period will be. Neither the
incubation period nor the time of onset
(measured from the beginning of
muscular rigidity to the occurrence of the
first spasm) can be relied upon to
indicate the severity of the infection.
However. the occurrence of
characteristic spasms within 48 hours
after the onset of rigidity suggests severe
infection. 5
Classification
Local tetanus
Local tetanus is characterized by
persistant unyielding rigidity of the
groups of muscles close to the injury.
This rigidity may last from several weeks
to months. and may progress to
generalized tetanus. 8
Generalized tetanus
This is the most common form of
tetanus; management varies according to
the severity of the disease.
. There may be only a small amount
of generalized stiffness in mild tetanus,
with greater stiffness in the injured limb.
Trismus (tonic spasms of the jaw
muscles) may be intermittent and is not
severe.
. Patients with moderate generalized
tetanus exhibit dysphagia, and
generalized stiffness with moderately
severe trismus and head retractions.
. Patients with sel'ere tetanus
frequently show opisthotonos and
generalized spasms with cyanosis as well
as signs of sympathetic nervous system
involvement. Persistent trismus
produces the characteristic facial
expression known as sardonic smile.
Vise-like constrictions of the chest
muscles and intense spasms of the back
result in opisthotonos. 7
A typical tetanic seizure is
characterized by a sudden burst of tonic
contractions of muscle groups causing
opisthotonos. flexion and adduction of
the arms, clenching ofthe fists on the
thorax and extension ofthe lower
extremities. The patient is completely
conscious and experiences severe pain
dunng these seizures. Muscle spasms
can be powerful enough to fracture
bones. Laryngospasm along with severe
contractions of chest muscles results in
cyanosis and asphyxia. 8 Ideally, medical
intervention should occur before this
point.
20 July/AUfluet 11711
The C..-Ilan Nur..
Cepluúic tetanus
This is an unusual form oftetanus and
occurs following head injuries. The
incubation period is very short, and its
prognosis is very poor. Features include
dysfunction ofthe 3rd, 4th, 7th, 9th, 11th
and 12th cranial nerves, singly or in
combination.
Management
The treatment of all types of tetanus
should be directed towards several
goals: 9
I Circulating toxins must be
neutralized before they reach the
nervous system. Human antitetanus
serum, given after the onset of
symptoms, significantly reduces
mortality. The recommended dose is
3000 to 6000 units intramuscularly.
2 Wound excision is important.
Animal studies have shown that there
may be many times the lethal dose of
toxin at the site of infection even after
the onset of symptoms.
3 Anticoagulation is recommended;
without it, the chance of death from
pulmonary emboli is five percent.
4 Penicillin orTetracyclineaÞ in large
doses is effective against the vegetative
fonns of Clostridium tetani.
5 Measures to ensure the
maintenance of sufficient caloric intake
as well as fluid and electrolyte balance
are important.
The patient with mild tetanus needs
to be cared for in a quiet, dark room with
minimal stimulation. Because there
exists a definite possibility of upper
airway obstruction due to the heavy
sedation used in his management, the
need for close observation is apparent.
Ideally the patient should be in a setting
where there are facilities for immediate
intubation with intensive and constant
nursing care.
The patient's level of sedation
requires continual assessment. The most
effective level of sedation occurs when
the patient lies quietly without
convulsions and very close to sleep, but
responds definitely to stimulation.
ValiumaÞ and barbiturates have been
recommended and used successfully.
The patient with moderate tetanus
requires larger and more frequent doses
of sedative drugs. Arterial blood
pressure measurements as well as blood
gas assessment become increasingly
important as the severity oftetanus
increases. If the possibility of upper
airway obstruction becomes a real
threat, a tracheostomy, performed after
orotracheal intubation, is recommended.
If at any time the patient develops
hypertension, arrhythmias or acidemia,
he is treated for severe tetanus.
The patient with severe tetanus is
managed through the use of a
neuromuscular blocking agent such as
PavulonaÞ and mechanical ventilation. A
high tidal volume may be necessary
initially because of the patient's
increased metabolic rate. Although
sedation and paralysis control the
muscular manifestations of tetanus, and
prevent death from hypoxia, an
appreciable number of patients develop
severe cardiovascular disturbances
compatible with overactivity of the
central nervous system. Prolonged
sympathetic stimulation has been shown
to cause myocardial damage, ventricular
failure and damage to systemic and
pulmonary blood vessels. 10
The increased peripheral resistance
caused by increased catecholamine
release seems to be controlled by
morphine. Large doses of morphine
decrease the hypertension of severe
tetanus and should be continued
throughout the period of sympathetic
overactivity.1I Ifmorphine is not
successful in blocking sympathetic
nervous system overactivity, beta
blockers, like propranolol (and possibly
alpha blockers) should be considered. t2
Mr. Graham - a case study
On November 13th, when he was
admitted to our LC.U., Mr. Graham was
fully awake and oriented. He knew that
he had "lockjaw" and expressed
concern over whether or not he would
live. On staff, we were well aware of the
ordeal he would have to go through and
knew that encouragement and
reassurance would play a m
or role in
his care.
Central nervous system assessment
On examination, Mr. Graham
complained of difficulty swallowing and
said that he felt his tongue was "too big"
for his mouth. He also complained of a
stiff neck; indeed, he was generally rigid
- his arms were flexed in spasm and all
reflexes were hypertonic. He was having
painful contractions in the muscles of his
legs, spasms that were brought on by any
stimulation, even air currents. At the
time of admission these spasms were
being controlled by Valium LV. 10 mg
q.i.d. Noise and stimulation were kept to
a minimum.
By morning, Mr. Graham's
condition had deteriorated - suctioning
had become necessary to clear
secretions, and severe laryngospasm
followed this procedure. He was
subsequently intubated and a regime of
Pavulon, Valium and Morphine had
become necessary to control spasms. By
November 15th, Mr. Graham's total
daily sedation included 30 mg Valium, 75
mg Morphine and 28 mg Pavulon, all
given intravenously.
Nursing care of a patient so heavily
sedated and "paralyzed" offers specific
challenges aside from those associated
with a totally immobilized patient. Mr.
Graham was certainly immobilized, but
we had to make a conscious effort to
remember that he was awake and in a
semi-conscious state. Because noise was
to be kept to a minimum, we had to rule
out the use of a radio for orientation. We
tried to reinforce reality by telling Mr.
Graham the day, date and what was
going on around him. His family was
kept fully informed about what Was
happening to him and we encouraged
them to talk to him. We also explained all
procedures to him, told him about
position changes before we turned him
and tried to encourage him continually
through information about his progress.
"Paralyzing" the patient
Neuromuscular blocking agents, such as
PavulonaÞ (pancuronium bromide) or
Tubarine aÞ (tubocurarine chloride) are
used to control the severe and potentially
fatal muscle spasms characteristic of
tetanus. Pavulon relaxes all skeletal
muscles including the diaphragm and for
this reason, mechanical ventilation is
essential to maintain the patient's
respiratory function. The dosage used
depends upon the body weight of the
patient; generally 4mg IV is given as a
loading dose followed by 1 to 2 mg IV pm
(every half to one hour). The need for
repeated doses is judged by the return of
movement, the earliest signs being the
eyelid and eyeball twitch, tongue
fasciculations and toe fasciculations
which precede diaphragmatic movement
and the patient's ability to trigger the
ventilator.
Neuromuscular blocking agents
interfere locally with nerve transmission
between the motor end-plate and the
receptors of the skeletal muscles. They
do not, however, affect consciousness or
sensation, and their use, without
adequate sedation, can be very
frightening and uncomfortable for the
patient. If the patient's leg is
uncomfortable, for example, he can
neither move it nor tell you about it. The
pavulonized patient is able to feel pain
and anxiety but he is unable to respond
even by blinking his eyes. Thus sedation
and analgesics must be given to keep the
patient as comfortable as possible.
Assessment of the patient's level of
sedation is judged by variations in his
vital signs (i.e. tachycardia or an
increased BP) and sedation is given as
well in anticipation of treatments or
procedures.
The C8lWdlen NUrM
Julyl "Ufluel11171 21
Pavulon is only used in this manner
in facilities such as intensive care units,
and is only given by specially-trained
staff who have written authorization to
give the drug. The patient must be
ventilated and the immediate availability
of an anesthetist is mandatory wherever
this drug is being used. Patients who are
pavulonized must never be left alone; if
for any reason there are problems with a
ventilator, the patient has respiratory
paralysis and cannot breathe on his own.
Alarms on ventilators must be turned on
at all times. In addition an ambu bag must
be available in case of accidental
dislodgement of the E-tube or
mechamcal failure of the ventilator The
constant care of qualified and observant
staff is of utmost importance when a
neuromuscular blocking agent is in use.
Always remember that despite his
appearance. the pavulonized patient is
not comatose. Talk to him and explain all
procedures. Let him know about his
surroundings (his vision is also impaired)
and orient him. Ask his family to help. It is
also very necessary to give the patient
constant encouragement and moral
support to keep him fighting to get well.
I n order to assess Mr. Graham's
progress. periodic reversal of the
Pavulon and withholding of sedation was
necessary. When we first attempted this
measure, Mr. Graham's spasms were
severe and tetany occurred with minimal
or no stimulation: his blood pressure and
pulse would also increase dramatically.
As time passed. and days became weeks,
we could see that his spasms were
gradually becoming less severe. He
required less Pavulon and less sedation.
By December 5th, Pavulon was no
longer required to control seizures:
Valium was sufficient to control rigidity
and there were no more tremors or
spasms. Mr.Graham was able to
respond to his nurses now and to answer
simple questions by blinking his eyes
"yes" or "no". His vital signs were also
stable. Morphine was still required
before dressing changes but in smaller
amounts, and it was easy to assess Mr.
Graham's pain by his facial grimaces. By
December 7th, he required no sedation.
He had the occasional diaphragmatic
contraction, but no tremors. Morphine
was required approximately once a day
for pain. At this point we were eager to
begin weaning Mr. Graham from the
ventilator and wanted as little hindrance
from sedation as possible.
December 12th was an exciting day
for us and for Mr. Graham as well. He
was fully weaned from the ventilator and
a fenestrated trach tube was inserted -
Mr. Graham could talk now. But in spite
of our attempts to communicate with him
during his paralyzed state, our patient
was slightly confused - he did not know
where he was or what day it was and the
need for orientation was apparent. He
was still afraid to sleep in the dark and
wanted a light on at all times.
In time he began to express his
reactions to the trauma to his hands. He
was depressed and needed a great deal of
encouragement to face the ordeal that
still awaited him - more skin grafting
and further rehabilitation. We began to
get him up for walks in the unit to build
up his strength. In spite of his caloric
intake and the passive exercises that we
had continued over the past weeks, Mr.
Graham was quite weak although keen to
increase his activity.
C ardiol'ascillar Assessment
When we admitted Mr. Graham to the
unit. his cardiomonitor showed that his
heart was in sinus rhythm at a rate of 90
beats per minute. At this point he
showed no ectopic beats. According to
the natural history of the disease,
however, we knew we could expect
arrhythmias. After four days, Mr.
Graham developed occasional premature
ventricular ectopics and discussions
began as to whether he should be treated
with lidocaine to control them. He then
had an episode of coupled premature
ventricular contractions. X ylocaineaÞ 100
mg was given intravenously on two
separate occasions 24 hours apart, but
Mr. Graham was not started on a
continuing anti-arrhythmic because he
had no further PVC's. His
electrocardiogram remained normal.
On admission, Mr. Graham's blood
pressure was slightly elevated at 155190
(left arm) and 140/85 (right arm). An
arterial line was inserted into his femoral
artery for the continuous monitoring of
his arterial blood pressure. The
cardiovascular effects of tetanus -
increased pulse rate and labile
hypertension - continued throughout
Mr. Graham's stay in LCU. until the
point when his tremors were minimal and
he required very little sedation. His pulse
rates ranged from 100 to 130 beats per
minute and blood pressure reached
200/80 to 160/80 when sedation was
wearing off. With appropriate sedation,
however, both his pulse and BP settled
down. Because his vital signs were
maintained at reasonable limits while he
was being sedated, it was not necessary
to consider beta blockers or other
medications to control the sympathetic
overactivity of tetanus.
Mr. Graham had good peripheral
pulses, all palpable and of good volume
His skin was warm, dry and
well-perfused. Assessment of skin and
perfusion is important for any ill patient,
especially if he is being ventilated. The
observation is even more important in
the care of patients with tetanus, because
changes in skin blood flow and evidence
of vasoconstriction with profuse
sweating suggest the overactivity of the
sympathetic nervous system t3 and the
need for close observation of other signs.
Initially Mr. Graham was
maintained on an intravenous infusion of
5%D 1/2 Saline at 175 cc per hour.
Because he was clinically dehydrated.
his I. V. fluids were increased to a rate of
200 cc per hour. Because of a slight
hypokalemia. 30 mEq potassium
chloride was added to each liter of fluid
until he had stabilized. Other electrolytes
and blood tests remained normal. As his
status improved, his intravenous rate
was slowed, then eventually decreased
so that just enough fluid was run to keep
a vein open for administration of
medications. Mr. Graham was tolerating
tube feedings of 5%D/W àt this point.
Every 12 hours, Mr. Graham
received low dose heparin administration
subcutaneously to prevent deep vein
thrombosis and pulmonary embolus. In
spite of this prophylactic measure and
possibly related to his arterial line, he did
develop thrombophlebitis over the
medial aspect of his left ankle. All lines
were removed and cultured and another
arterial line was inserted in the right
groin. This was in place until it was no
longer functioning, at which time he was
stable enough to do without one.
I ntegllmentary as.{essment
Because Mr. Graham was immobilized
for a considerable period of time.
thorough skin care was absolutely
essential. The nursing care that we gave
was effective in preventing the
development of any pressure sores.
The care of his injuries, however,
provided unique problems. Upon
admission he was seen by our plastics
service and the service of infectious
diseases, both of which followed him
througout his stay in hospital. Tetanus
toxoid levels were drawn as necessary
and swabs were sent routinely for
culture.
Mr. Graham had already undergone
many debridement procedures of both
hands; it was decided to make an attempt
to save his hands rather than amputate.
H is wounds were treated with
continuous saline compresses, changed
every four hours, and splints were
applied to hold his wrists in extension.
Because he was "paralyzed" for most of
his stay in the unit, we were concerned
about his inability to let us know when
we were hurting him, so Morphine 5mg
was given intravenously prior to each
dressing change. Periodically, he was
escorted to the operating room for
22 July' Augu8t 1171
The C8lWdlen Nur..
further debridement, cleansing and skin
grafting to his hands. Routine
debridement was done daily on the unit.
as the dead tissue on his hands loosened
and sloughed off.
On November 30th, Mr. Graham
received an additional 3000 units of
tetanus immune globulin as he was
requiring increased amounts of sedation
to control his tremors and the possibility
of infection from dormant spores was
suggested. He remained on penicillin for
a total of three and one-half weeks. At
one point. his cultures revealed
pseudomonas growth, which was treated
accordingly. Contrary to usual findings
with tetanus, Mr. Graham was for the
most part. afebrile. He had a fever for
three days only, during the resolution of
the disease, and his fever was then
attributed to a chest infection.
Respiratory assessment
When Mr. Graham was admitted, his
respirations were very shallow. and
although his chest sounded clear, air
entry was decreased throughout. At the
time, his respiratory status was not an
immediate problem; gas exchange was
adequate and he was able to clear
secretions on his own. He was started on
oxygen at three liters per minute by nasal
prongs. a regime of hourly I.P.P.B.
treatments. hourly four-point turning and
chest physio. Suction equipment was
available at his bedside.
By the morning. however, Mr.
Graham's cough was weak. and
suctioning had become necessary to
clear secretions. When we suctionned
him. severe laryngospasm and
pharyngospasm resulted. A chest X-ray
revealed a complete right upper lobe
collapse and a mediastinal shift to the
right. That was when Mr. Graham was
intubated and mechanical ventilatiop
was begun. A bronchoscopy was done
and his chest was cleared of a large
amount of very thick, clear secretions.
His arterial blood gases and chest X-ray
showed remarkable improvement
following bronchoscopy. Such a rapid
response to bronchoscopy and
ventilation indicates that the nature of
his problem was mechanical rather than
infectious. 14
Before intubation. dehydration and
shallow respirations make it difficult to
assess the respiratory status ofthe
patient with tetanus by auscultation
alone.'s Mr. Graham's laryngospasm
alerted us to the imminent possibility of
sudden airway obstruction; the need for
maintaining a patent airway and
controlling spasms necessitated paralysis
with Pavulon, sedation and mechanical
ventilation.
Although paralysis with mechanical
ventilation is not without complications,
it is a measure that does prevent anoxia,
cerebral and myocardial damage due to
hypoxia. aspiration. retention of
secretions and exhaustion. Although this
form of management abolishes the
muscular symptoms of tetanus. it
substitutes a new set of problems -
those of an immobile. non-breathing
patient completely dependent upon the
respirator and the medical and nursing
stafffor survival. 16
Prevention of atelectasis:
"big breaths" and four-point turning
The routine use of mechanically-given
"big breaths" seems to be a controversial
subject. Some institutions prefer the use
of small levels of PEEP (positive end
expiratory pressure) for those patients at
high risk of developing atelectasis.
Others use mechanical big breaths
routinely on all ventilated patients who
are not on PEEP. The reasons for using
"big breaths" are physiological. Normally
man sighs frequently, perhaps five to 15
times an hour. By increasing alveolar
volume and surface area to a near
maximum level, mechanical big breaths
mimic natural sighs; they rejuvenate the
surfactant layer' which plays an
important role in the prevention of
atelectasis and surface resistance.
The use of four-point turning is very
effective in the prevention of stasis
atelectasis. What it does is to use the
effects of gravity not only to promote the
drainage of secretions but also to
influence alveolar ex
ansion.
Four-point turning refers to hourly
sequential turning which utilizes all
possible positions, from the semiprone
position on one side to semiprone on the
opposite side. Because of this routine, all
bronchial segments are allowed to drain
and the lungs fully expand. The patient is
never positioned horizontally on his back
as part of the turning routine since back
lying is the position required for many
procedures.
Because Mr. Graham was immobile,
meticulous chest care was vital in the
prevention of pneumonia and atelectasis.
Posturizing, pummeling and four-point
turning continued on an hourly basis, as
well as suctioning. mouth care and care
of the endotracheal tube. Mr. Graham
was maintained with a tidal volume of
1000 cc. a rate of 10 per minute. an F 102
of 30 per cent and 10 big breaths per
hour. Air entry was equal bilaterally and
the only adventitious sounds were
occasional inspiratory creps that cleared
with suctioning. Mr. Graham's arterial
blood gases remained good.
Seven days after intubation, a
tracheostomy was performed due to the
anticipated length of time necessary for
ventilation. A double-cuffed,low
pressure tube was used, to prevent
tracheal necrosis associated with
long-term intubation. Routine trach care
was established; we sent swabs and
tracheal secretions for culture three
times a week, and Mr. Graham did not
develop any tracheal infection during his
stay with us. In spite of vigorous
prophylactic chest care, however,
including masks during suctioning and
respiratory care and sterile suctioning
and trach care, Mr. Graham did develop
a chest infection as he approached his
third week with us. This was
successfully treated with intravenous
gentamycin.
Each day, Mr. Graham was
assessed by the reversal of the
neuromuscular blocking agent (Pavulon)
and the withholding of sedation to assess
the degree of muscular spasms. By the
5th of December, Mr. Graham was
requiring minimal sedation; he had no
further tremors or spasms, and rigidity of
his extremities only. Weaning
parameters were good but because of his
chest infection, weaning was postponed
until his chest cleared. We began
weaning him from the respirator on
December 8th, and on the afternoon of
December 12th, a fenestrated trach was
inserted. His tracheostomy was closed
on the following day; his blood gases on
room air were acceptable but we
continued to administer oxygen by nasal
prongs.
Gastrointestinal assessment
Disturbances of the gastrointestinal tract
have been widely reported in tetanus,
some of the problems being an increase
in stomach aspirate during a critical
period and occasionally, paralytic ileus.
These effects could perhaps be attributed
to the sympathetic effects 17 ofthe
neurotoxin produced by Clostridium
tetani.
On admission, Mr. Graham's
abdomen was flat and rigid; faint bowel
sounds could be heard. A nasogastric
tube was passed and hourly feedings of
50cc 5%D/W were started and
well-tolerated. On the following day. Mr.
Graham's gastric secretions had a pH of
6.8 and tested positive for blood.
Because he was a prime candidate for a
stress ulcer, we began to give him
Gelusil(!i) everyone to three hours per
nasogastric tube. As blood was already
present in his levine aspirate, cimetidine
was crushed and administered per
nasogastric tube to inhibit gastric acid
secretion. Gastric pH was checked q4h
to assess the effectiveness of treatment.
The C81*11.... "UrN
Julyl AUflUalll171 23
R semlprone
The patient is turned with his right side
down; the right arm is brought out from
under the body and the shoulder is
moved outwards so the patient is not
resting on the dependent shoulder. The
patient is supported in this position by a
large hrm pillow rolled under the chest
and the left shoulder.
The semi prone position requires
precaution - the patient must be
observed for a patent airway
(endotracheal tube or tracheostomy
tube) and unobstructed lines (IVs) and
the nurse must always be prepared for
suctioning. By draining posterior and
lower segments of the lungs, this position
results in copious secretions. so that the
nurse must always be alert for
When he was able to tolerate
full-strength standard feeds and the
aspirate no longer tested positive for
blood, both Gelusil and cimetidine were
discontinued as they were no longer
necessary.
Good nutrition is mandatory for
patients with tetanus, to correct the state
of starvation that the patient has been
forced into due to fear of choking. to
prevent negative nitrogen balance which
is a direct effect of starvation. and to
prevent infections and skin breakdown
due to immobilization. Mr. Graham as an
individual had sustained considerable
trauma to his hands and had little
subcutaneaous fat to rely on, so good
nutrition was a major concern.
Because he had good bowel sounds
and feedings were well-tolerated, they
were increased gradually and maintained
at 200 cc of full strength feedings every
two hours, giving Mr. Graham a caloric
intake of 2400 calories every 24 hours as
well as adequate fluid intake.
The possibility of aspiration of tube
feedings is always considerable
especially in a paralyzed and heavily
sedated patient. This risk is offset by the
use of a cuffed endotracheal tube. and by
administering feedings with the patient's
head elevated. We fed Mr. Graham
every two hours instead of hourly to
allow chest care and four-point turning to
be done with minimal fear of
regurgitation. He tolerated this regime
very well; he had no episodes of
regurgitation.
A presentation of four-point turning
obstruction The semiprone position also
allows the abdomen to fall by gravity.
thus promoting expansion of the lower
lobes of the lungs and minimizing the
effects of a distended or large abdomen
on the diaphragm. 2
R sldelylng
L sidelying
The utilization of these two positions
alone is referred to as "side to side"
turning. Despite the fact that the patient is
turned from side to side, the bases of the
lower lobes of the lung posterior1y are
always in a dependent position relative to
the anterior chest - thus. the need for
the semiprone positions. which allow the
lungs to drain.
To ensure that he was tolerating his
feeding. the nasogastric tube was
aspirated every four hours, and aspirate
refed. Bowel sounds were auscultated
frequently during the shift and we kept a
careful record of Mr. Graham's bowel
movements, for constipation is
frequently a complication of tetanus.
Laxatives were given each day per
nasogastric tube and disempaction was
done as necessary. Bowel activity was
stabilized; Mr. Graham had a good bowel
movement two to three times per week
Mr. Graham's levine tube was
changed weekly and reinserted in the
other nostril to prevent nasal sores.
Nasal care was given each shift as
necessary .
Genitourinary system
Urinary retention is a problem with
tetanus; Mr. Graham was catheterized
on admission to our unit. An accurate
assessment of his urinary output was
also necessary because he was
dehydrated. When his fluid volume had
been replenished and he had stabilized so
that the volume and quality of urine was
satisfactory. we removed his urinary
catheter.
We implemented a bladder routine
for Mr. Graham similar to the one we use
in the management of quadraplegic
patients. This involves straight
catheterization under sterile technique
every six hours. At this time we would
do a bladder wash of 30cc of Neosporin
irrigation solution. We catheterized Mr.
L semiprone
See right semiprone position. only this
time the left side is dependent. In all of
these positions. the head of the bed can
be lowered or horizontal (flat). Both these
positions if tolerated. can aid the effects
of gravity in draining the lungs of
secretions. It will also help chest
physiotherapy.
*1 Henderson, D.lnfectious disease
emergencies: the clostridial syndromes.
Western J. Med Aug. 1978. 129:2:112.
*2 Ibid., p.113.
Graham more frequently if his urinary
volume was over 500 cc or if he was
incontinent of urine. This method of
bladder management maintains good
bladder tone and also cuts down on the
incidence of bladder infection that
happens commonly with continuous
foley drainage. One gram of
Mandelamine,aÞ was also given every six
hours per nasogastric tube as a
precautionary measure against urinary
tract infection.
As time progressed. Mr. Graham
was able to empty his bladder effectively
in spite of Pavulon and sedation. We
measured his urine after each void to
make sure that he had voided
adequately. We continued to give him
Neosporin bladder irrigations every six
hours. a measure that was also useful
because it allowed us to assess residual
urine volume.
Reco,'ery
On December 15th, 33 days following
admission to our unit Mr. Graham was
discharged to the ward. His ordeal was
not yet over, but he had come a long
way.
Close relationships had developed
between the nurses in our unit and Mrs.
Graham. who visited the unit daily
throughout his long stay. It is his wife
who remembers everything that
happened. Mr. Graham says he
remembers nothing about the accident,
-
24 July/AUflualll78
The C8l*1lan Nur..
about the 19 days before he came to our
unit or about his entire stay in the I.c.ú.
Even those days after his trach was
closed, days when we carried on
coherent conversations with him. are a
total mystery to him.
Perhaps he cannot remember his
experience because oflorlg term
sedation. perhaps his forgetfulness is a
coping mechanism. Whatever the reason
he survived tetanus and is doing well.
Mr. Graham remained in hospital for an
additional two months, not because of
complications ofthe disease or oflong
tenn immobilization, but due to the
extensive work that was required on his
hands.
However. it may not be over yet.
One author writes "The combination of a
specific action of tetanus toxin at
inhibitory sites, the fact that synaptic
changes occur and the fact that most
patients with tetanus undergo repeated
convulsions suggests that survivors
might be unusually susceptible to later
neurological disturbance." t
A study of25 survivors of tetanus
revealed interesting results. Symptoms
such as irritability. mild memory
disturbance, sleep disturbance, fits and
myoclonus and E.E.G. changes were
found on follow-up of these patients.
These symptoms seemed to be
self-limiting; the duration of fits or
myoclonus was less than two years from
the date of recovery from tetanus. The
results seem to indicate that patients who
recover from tetanus should be treated
with anticonvulsant drugs for two
years. 19
A word about prevention
Since 1971. a total of 42 cases of tetanus
and 19 deaths from the disease have
occurred in Canada. 20 Difficulties in
reporting make these figures low
approximations at best.
When we consider that tetanus is an
agonizing and life-threatening illness
along with the fact that it is totally
preventable through immunization, we
must also recognize our part in the
prevention of unnecessary suffering. It is
easier, cheaper and so much less
traumatic to ensure that individuals are
effectively immunized against the
disease.
It is recommended that every adult
be immunized with one ml of tetanus
toxoid every five years after the initial
series of injections. People must be
encouraged to be aware of their own
immunization record and to contact their
public health unit or family physician
when boosters are necessary.
Summer is here and millions of
Canadians are outside and exposed to
tetanus during summer activities. As
nurses, we know about patients like Mr.
Graham. and we know what tetanus
means. Why not encourage others to
update their immunization now? OW
Catherine Searle is a graduate of the
Wellesley Hospital School of Nursing,
Toronto, Ontario. She worked on a
chest/GI medical ward at the Wellesley
for two-and-a-halfyears before moving
to Winnipeg, Manitoba. In Winnipeg,
Catherine was involved in a year-long
intensive care unit course at the Health
Sciences Centre and then worked there
for an additional ten months. It was in
the intensive care unit that Catherine
met "Mr. Graham". She now works as a
staff nurse in the medical intensive care
unit at Wellesley Hospital in Toronto.
References
I Weinstein, L. Tetanus. New Eng.
J. Med. 289:1293-1296, Dec. 13, 1973.
2 Ibid.
3 Ibid.
4 Kerr,J.H.Involvementofthe
sympathetic nervous system in tetanus.
Studies on 82 cases. by... et al. Lancet
2:236-241, Aug. 3. 1968.
5 Weinstein, op. cit. p.1294.
6 Ibid.
7 Hedley- White. J. Applied
physiology of respiratory care, by... et
al. Boston, Little Brown, 1976. p.261.
8 Weinstein. op. cit. p.1294.
9 Ibid.
10 Prys-Roberts, C. Treatment of
sympathetic overactivity in tetanus, by
...etaI.Lancet 1:542-545,Mar.15, 1969.
II Rie, M.A. Prolonged morphine
therapy for control of sympathetic
hyperactivity and elevated peripheral
resistance during severe tetanus, by...
and R.S. Wilson. Abstracts of scientific
papers. Annual meeting of the American
Society of Anaesthesiologists,
Washington, D.C., Oct. 12-16. 1974.
12 Corbett,J.L. Cardiovascular
disturbances in severe tetanus due to
overactivity of the sympathetic nervous
system. by... et al. A naesthesia
24:2:198-212, Apr. 1969.
13 Kerr, op. cit.
14 Corbett. op. cit.
*15 Kloetzel, K. Clinical patterns in
severe tetanus. JA MA Aug. 17, 1963.
16 Ibid.
17 Kerr, op. cit.
18 IIIis, L.S. Neurological and
electroencephalographic sequilae of
tetanus, by... and F.M. Taylor. Lancet
1 :826-830, 1971.
19 Ibid.
*References not verified in CNA Library
20 Communication with Dr. Stanley
Acres, Chief, Communicable Disease
Division, Bureau of Epidemiology,
Laboratory Centre for Disease Control,
Health Protection Branch, Health and
Welfare Canada.
Bibliography
1 Cole, L.B. An attack oftetanus, by
... et al.Lancet 2:567-568, Sep. 7,1968.
2 Corbett, J. L. Cardiovascular
disturbances in severe tetanus due to
overactivity of the sympathetic nervous
system, by... et al.Anaesthesia
24:2:198-212,Apr.1969.
3 Edsall,G. The inexcusable
disease.JAMA 235:1:62-63, Jan. 5, 1976.
4 Hedley-White, J. Applied
physiology of respiratory care, by... et
al. 1st ed. Boston, Little Brown, 1976.
*5 lUis. L.S. Neurological and
electroencephalographic sequilae of
tet,anus, by ... and F .M. Taylor. Lancet
1:826-830, 1971.
6 Kelty, S. Ra. Catecholamine levels
in severe tetanus, by... et al. Lancet
2: 195, Jul. 27, 1968.
7 Kerr,J.H.Involvementofthe
sympathetic nervous system in tetanus.
Studies on 82 cases, by... et al. Lancet
2:236-241,Aug. 3,1968.
8 Kravitz. Melva. Management of
the mechanically ventilated patient
receiving pancuronium bromide, by...
and Nathan Leon Pace. Heart Lung
8: 1 :81-86. Jan./Feb., 1979.
*9 Kloetzel. K. Clinical patterns in
severe tetanus. JA MA Aug. 17, 1963.
10 Nicholson, D. Tetanus - still a
therapeutic challenge Heart Lung
5:2:226-227, Mar./Apr. 1976.
II Peters, S. Physiological and
psychological aspects oftetanus; report
of acase, by... et al.Heart Lung
5:2:597-600. MaL/Apr. 1976.
12 Prys-Roberts, C. Treatment of
sympathetic overactivity in severe
tetanus. Lancet 1:542-545, Mar. 15.
1969.
* 13 Purkins. I. E. Severe tetanus: its
complications and management. by...
and J.E. Curtis. Canad.Med.AssJ. 93,
Dec. 4, 1965.
* 14 Rie, M.A. Prolonged morphine
therapy for control of sympathetic
hyperactivity and elevated peripheral
resistance during severe tetanus, by...
and R.S. Wilson. Abstracts of scientific
papers. Annual meeting ofthe American
Society of Anaesthesiologists,
Washington.D.C. Oct. 12-16. 1974.
15 Westlund, D. Tetanus: a case
study.Canad.Nurse 70:7: 17-21. Jul.
1974.
16 Weinstein, L. Tetanus. New Eng.
J. Med. 289:1293-1296. Dec. 13.1973.
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Richmond Hill. Ontario L4C 5H2
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21 JUly/Augual111711
The Cenecllan NUrM
The young woman lying in the hospital bed was thin and very
pale. She was unable to open her mouth more than a fraction
of an inch and she hadn't eaten for two days, but could drink
easily. She appeared frightened and tense. She had good
reason to be - she had been admitted to our medical ward
with a possible diagnosis of tetanus.
Janine's husband Frank sat with her for long periods and
translated for her because she spoke no English. Janine,
who was of Asian extraction, had been in Canada only nine
months. As yet, they had no children but had a very
supportive extended family. Frank was employed at a peat
processing plant and Janine worked at home.
Frank told us that Janine had complained of a headache
and increasing pain in her jaws for four days prior to her
admission. She also had pain in both sides of her neck and
upper mid-back. On admission, her vital signs, including
temperature, were normal. Complete blood count and
differential count were also normal but her sedimentation rate
was elevated to 115mm/hr indicating a severe infection.
(Normal sed. rate is 20 mm/hr in women.) Her routine urine
test was normal.
Janine told us (via her husband) that nine days before
this admission she had had a spontaneous abortion. She had
been less than two months pregnant and had seen her doctor
at that time. The doctor recommended a dilation and
curettage if further bleeding occurred. So far this had not
developed and Janine had no vaginal discharge when she
was first admitted to hospital. She denied any other recent
injuries but said that she had been treated for malaria just
before coming to Canada.
During her first two days in hospital, Janine remained
unchanged. But, on the third day her condition deteriorated.
She began having generalized muscle spasm with some
opisthotonos positioning and a grinning expression called
risus sardonicus caused by facial muscle spasm. At the same
time, Janine developed a foul, dark-colored, vaginal
discharge. It was suspected that the uterus was badly
infected with clostridium tetani, the causative spore-forming
organism of tetanus.
Although tetanus usually gains entrance to the body
through a puncture wound, it may also follow elective
surgery, burns, otitis media, dental infections, pregnancy and
in this case, abortions or miscarriages. Surprisingly, no
detectable lesion is found in about 20 per cent of tetanus
cases. 1
Janine's treatment
As soon as the diagnosis of tetanus was confirmed, we
started some initial treatment procedures before sending her
to the intensive care unit. Janine was given tetanus toxoid
1 milM to initiate active immunity and an antitoxin, tetanus
immune globulin, 3000 milM for passive immunity. (The
antiserum does not neutralize tetanus toxin that is already
fixed in the central nervous system, but is thought to reduce
the fatality rate. 2 ) An intravenous line was started with vitamin
and potassium supplements added to the IV solution.
Penicillin, the antibiotic of choice against tetanus bacillus,
was started at 1 million units every six hours IV.
Muscle relaxation is imperative to therapy and a variety
of drugs are used according to the severity of the tetanus.
Barbiturates and phenothiazines control milder spasms while
a neuromuscular blocking agent such as tubarine (curare) is
necessary for severe spasms. Because curare paralyzes the
patient it can only be used where personnel and facilities are
available to provide artificial ventilation. Diazapam and
narcotics are also used with curare to calm the anxiety of the
patient. Even though patients are paralyzed, they are often
conscious and aware of what is happening.
CJbe
unexpected
case
of
tetanus
Jean E. Grove
At this early stage, Janine was given valium
10 mg
every four hours and phenobarbita/@ 60 mg every eight hours
either orally or intramuscularly for sedation.
Once this initial treatment was begun, she was admitted
to the intensive care unit to a separate, darkened room. Since
physical, visual and even emotional stimuli can trigger
muscle spasm, a quiet, darkened environment is less likely to
cause muscular rigidity and spasm. An ECG was taken to
assess her cardiac status and a foley catheter no. 14 was
inserted for accurate urine output. A record was also kept of
Janine's hourly vital signs.
Throughout the first night in ICU, Janine had twitching of
her extremities with some opisthotonos. She also complained
of low abdominal pain. Frank, who knew how ill his wife was,
stayed with her during the night and explained nursing
procedures to her. She was very frightened and the nurses
were all thankful that she had the support of her husband.
In the morning just before her scheduled surgery, Janine
had a severe seizure. At this time the doctors felt that a D and
C would not be adequate to stop the spread of infection and a
hysterectomy was planned.
Post operative care
When Janine returned to the ICU from the operating room,
she had a tracheostomy and was on a ventilator. She was
ordered curare 3 mg q2h, demerol aÞ 5 mg and valium 2.5 mg
every hour, all by intravenous to control her tetanic seizures.
However, even with this medication, the nurses looking after
Janine observed that she was still experiencing frequent
muscle spasms. The dosages were increased to curare 6
mg, valium 5 mg and demerol1 0 mg every hour. Her dose of
penicillin was also increased to one million units q4h. The
following day, the spasms were still evident and the curare
was again increased to 9 mg every hour; this was enough to
control almost all the muscle spasms and keep Janine
comfortable.
Janine was a heavy nursing load and required constant
attention and observation for possible complications. She
was ventilated on an automatic volume controlled respirator
and the settings were checked frequently and charted hourly
Vital signs and urine output were also monitored hourly.
Janine had two episodes of tachycardia, a frequent
complication of tetanus. Her heart rate of 120 beats per
minute was controlled with inderol@ 10 mg, four times a day
by nasogastric tube.
The Ceneclan .......
ilhe
JulJ/Augual11171 31
.
nu sin.
Fmocio_Camolioo,
A nurse must, first and
foremost, treat the patient as a
human being. If she cannot do
.t this, she should not be working
,'\r in a hospital.
Theories about nursing - about ,he
rightful role of the people who work
in it and therefore about what
nurses themselves can expectfrom
the profession they work in -
abound. Afew years ago, when
interdisciplinary was a word that
was just beginning to find its way
into the vocabulary of people
working in hospitals, it became
fashionable to compare nursing to a
sheet of cookie dough. For every
category of worker added to the
system, for every function assigned
to another person, there was one
more hole stamped out of the sheet.
What was left, according to the
pessimists, was afragile tradition
without substance or purpose - a
profession in name only.
l-
.
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Optimists, on the other hand,
looked on the process as
demonstrating just how important
nursing is to the health care scheme
of things. They said this proved that
nursing holds the key to the whole
"care, cure process". The
implication was clear: a "good
nurse" could put the Humpty
Dumpty support system back
together again and, in the long run,
ensure that patients received better
care.
Unfortunately, the results left
a great deal to be desired in terms of
both the personal and professional
The touch
of love
e
expectations of many nurses. Tight
budgets, reduced staff, short
tempers and higher patient
expectations have further added to
the frustration of what has always
been an especially demandingjob.
Reality shock today is no joke.
How the nurse handles it depends
very much on her individual
interpretation of the situation.
What follows are four intensely
personal reactions to what has
happened to nursing in the
seventies and where it is going as
we get ready to move into another
decade.
As student nurse!> we are taught to
take care of patients with love and
understanding.
I know this and yet. after two
summers as nurse's aide in a hospital. I
wonder whether any ofthe nurses
working there had ever learned these
basic principles. The nurses caring for
chronic patients in the prolonged care
section ofthat hospital left me
completely disillusioned.
They tied patients to their beds
because it was a nuisance to have them
walking around the halls; they put the
call button somewhere the patient
couldn't reach; they even closed the
door to a patient's room when that
patient disturbed everyone by crying too
much because he wanted comfort. I
.
t
about ere
How many of these facts
about butter:
margarine and fat
do your
patients know?
act . Just 6% of the
.Ii . recommended daily
caloric intake is contributed
by butter.
Many health professionals mistakenly
believe that butter is a major contributor
to the over-consumption of fat by Canadians
which is considerably higher than the 35%
of total caloric intake recommended by
Health & Welfare Canada. In point of fact,
Canadians eat more margarine than butter
as well as many other fat-containing foods
such as meat, fish, poultry, eggs, cereal
products, salad oil and cooking oil.
ad . The correlation be-
.Ii . tween the consump-
tion of hydrogenated ve , etable
oils and the incidence 0 colon
and breast cancers has been
widely publicized.
Results of a research study conducted by a
team of scientists headed by Dr. Mark Keeney
of the University of Maryland, and published
in the summer of 1978, produced compelling
evidence of a possible link between the con-
sumption of hydrogenated vegetable oils and
the incidence of colon and breast cancers.
'C aet - Hydrogenation
_ changes the molecu-
lar structure of vegetable oils.
Hydrogenation is the process which solidifies
liquid vegetable oils into margarine, making
it "spreadable", and giving it longer shelf
life in the store. This process changes the
chemical composition of the vegetable oils
and it also "saturates" fats which, were
originally unsaturated.
faet - Cholesterol is an
_ essential substance,
naturally present in the human
system...and is a problem only
to patients with specific lipid
profiles.
Such unsatisfactory conditions cannot be
significantly changed by dietary manipulation.
'C aet - Butter has exactly
_ the same number
of calories as margarine.
Weight-conscious patients, in the belief that
they are cutting calories, often give up the
good taste of butter for a less palatable
spread. . . an unnecessary sacrifice.
'C aet - Canadians, on a per
_ capita basis, consume
just haIr an ounce of butter per day.
This is just a fraction of the amount generally
believed by many health professionals to be
the per capita consumption of butter by
Canadians.
When you look at the facts,
you can see the good
in butter.
DAIRY BURFAU OF CANADA
'C aet - Approximately 2 to
_ 3% of butter is linoleic
acid - the ingredient which many
scientists believe to be the
moderating, beneficial fador in
the diet-heart relationship.
The ideal level of linoleic acid in fats
intended for human consumption is not yet
agreed upon.
'C aet - Data exists which
_ show a definite
correlation, in certain cultures,
between the high level of animal
fat consumption and the low
incidence of CHD.
The Masai and Innuit cultures indicate just
such a correlation. Interestingly, so, too,
does the Insh whose butter consumption,
though markedly greater than their lrish-
American counterparts, have a much lower
incidence of CHD.
SOURCES:
Mary C Enig. Robert 1- Munn and Marl< Keeney DIetary
fat and cancer trends - a cnllque FederalJon Proceedings
372215-2220. 1978
Mann. C.V. and 5poeny. A 51udies of a sutfactant and
cholesteremia m the Masal. Amer J Om Nutr .27 464.1974.
Gershon Hepner. RIchard Fned. Sachea. 51 Jeer Lydia
Fusetti and Robert Monn Hypocholesterole'nic effect of
yogurt and mill<. l\m 1- Om Nutr.. 32:19-24. 1979
rÆliry Farmer.; of Canada
rÆliry Fads and Rgures al a Glance 1978
34 JuIy/Augu.ll17t
The Cenecllan N_
began to think twice about becoming an
RN. I asked some of these nurses what
made them so hard. They answered:
"Vou become hardened over the years.
It seems to me that. this is impossible
for it is through experience that your
abilities increase. After years of practice
a nurse should be better able to cope
with illness, all the while providing more
and more comfort to the patient.
If she cannot do this, perhaps
he
should go back to her schoolbooks to see
how to treat patients physically and
It's a bird,
it's a plane,
it's
supernurse!
Susanna Jack
"Who took the nurse out of
nursing?" is by now a familiar
lament. What has become of, if
indeed she ever existed, the
warm and attentive nurse, the
ideal "nursely" nurse, who
takes the time to really nurse,
nurturing he patients
physically and psychologically?
Lately, I have started to wonder
about this question which has been
sounding in my ears since my nursing
school days more than 10 years ago. I
have begun to say to myself: if something
continues to be notably not-there for so
long perhaps what is wished for is not
possible. Perhaps the questioner must
examine her wish instead of constantly
reproaching reality as she finds it.
The day of the fatherly country
doctor who knew all about you and
would always come to see you has
pas
ed.1t may be that the time of the
motherly nurse who cared for you with
devoted tenderness is gone too and
presentday nurses must assess what it is
that they now can do appropriately and
well. There is no doubt that when ill we
all long for mother and father. not as they
actually were, maybe, but as we wi<;hed
them to be - caring and powerful.
emotionally. Or perhaps she should even
consider leaving nursing for awhile.
Anything rather than further decrease
the morale of her patients, even lower,
that is, than it already is.
As a student nurse I understand that
I still have years in front of me to really
learn how to cope with patients in every
situation But surely love is not learned;
it is innate. And I believe that one rule of
thumb in caring for patients should be
always to ask yourself "How would I
feel if I were in his place?"
But nurses and doctors are not
mother and father although these roles
devolve upon them by analogy both in
their own and in their patients' fantasies.
Nurses have trouble extricating
themselves from this situation. The
ideology oftheir profession supports
the<;e ideals; what is not taken into
account is the fact that this ideology was
developed in an era when the moral and
social climate was quite different and
when nursing tasks were much less
technologically demanding. There is
need for a reexamination in light of the
current nursing environment.
Nurses are expected to be both
caring and technically competent and yet
they are persistently obstructed in these
aims. The staff nurse usually has a
patient assignment of such size that to
give basic physical care require
the full
shift; she has to attend to the demands of
many people at once and cannot afford to
focus her attention totally on one person
for any length of time since other
patients under her care cannot safely be
forgotten. An individual really in need of
special attention to his emotional state
often becomes a source offrustration,
guilt and, ultimately, anger.
Also, it can be hard to feel really
competent and autonomous as a nurse.
De<;pite all attempts to make nurses feel
proud of their unique occupation it is
nonetheless apparent that in the eyes of
the staff and patients with whom they
constantly interact. theirs is a lesser
statu
warranting less respect than that
of the medically better trained doctors.
Having le!>s respect from others, it is
easy to have less respect for oneself and
what one does.
I t seems to me that nurses are very
much in the position of housewives a few
years ago before the wave of feminism
made clear the ab
urdity of their
assumptions. Many women felt that they
should be perfect housekeepers, mates,
mothers. and career women
simultaneously. Similarly, staff nur<;es
are encouraged to take on increasingly
demanding technical tasks, to be
Maybe then we will see what a true
nurse IS.
Francine Camolinos,SN, has now
completed her second year of nursing at
Dawson College in M onlreal after
working for two years as a nurse's aide.
She notes that she has worked in
'arious
departments, including the chronic care
section,lCU and also emergency.
n
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nurturing to their patients using great
interpersonal skills, and at the same
time, to maintain their emotional balance
in the emotional hothouse of the busy
hospital ward. They are told that if they
organize their time properly it is quite
possible.
I believe strongly that people who
are ill need sensitive psychological
attention from those caring for them. I
have also concluded that this is not
available often from nursing staff
because of the limits of their training in
interpersonal skills and the limits of"their
working situation. Their energy is
directed to the tasks that have a more
obvious priority and to maintaining their
own emotional equilibrium.
In other cultures it is expected that
the family will assume the work of
emotional support and to a degree give
physical care to the sick person. In our
milieu the current atrophy of social
supports is actually made worse by
hospital regulations until the nurse does
seem truly responsible for "total patient
care ..
The Canadian Nuree
Jul)'/AuDU
11171 36
Most nurse'ì I know try hard to look
after their patients decently but they are
not able to live up to the fanta
y of the
perfect nurse. Patients have every right
to ordinary kindness but it is not realistic
to expect the nurse to take over the task
belonging to family and friends.
Although the literature spurs them on,
most nurses' have worked with are not
willing to involve themselves deeply with
more than a few patients; they don't
have that kind of emotional energy. They
That's right,
I'm a nurse
Sandra Klyne
I am unlike the advocate of an
alternative lifestyle or radical
philosophy seeking an
understanding or sympathetic
ear. My lifestyle is more
traditional - I am a nurse.
But I am writing in the
same spirit as the organic
fanner or the "new woman in
the boardroom" . I want you to
understand.
I am troubled by the public - and
particularly the feminist - view of the
nursing profession. If hatred doesn't
exist, certainly there is an air of
antipathy and perhaps a little contempt
towards nursing and indeed all of the
so-called "pink collar" jobs.
The women's movement has done
much in recent years to point out the
inequalities in the workplace between
women and men. The stereotyping of
both sexes injob orientation has also
been discussed. But' believe insufficient
attention has been paid to those who
have made a conscious choice for the
traditional profession and to the social
usefulness of women in these
occupations.
The choice
. chose to be a nurse. . was not
"steered" into it by well-meaning
parents or counsellors who thought I' d
find a doctor and settle down. My
mother would probably have liked me to
be a secretary, if only because she had
been one and loved it. My father saw me
are willing to do a competent job of
implementing the hospital"'i physical
support system and to be plea'ìant about
it. They are willing to tolerate and work
around the sick per
on's emotionalup
and downs as long as he i
not too
disruptive of their accompli'ìhing their
nursing tasks.
Unless the hospital environment
changes dra
tically. . wonder if
demanding more from most nurse
i'ì
realistic?
o
a
a doctor one moment and as a lawyer
the next. But the important point is
neither of them imposed their opinion on
me.
This is nOl to say that I've never
wanted to be anything ebe. Like most
children' sometimes dreamed of being a
dentist. a cowgirl (cowperson?), an
entertainer, a teacher or a writer. But I
always came back to nursing.
. chose nursing for a very corny
reason.' wanted to "help out"
Assisting people regain or maintain their
health fascinated me a'ì much then as it
does now. Think, for example, of a
mother who has just given birth by
Caesarian
ection. The morning after
surgery she is ill: she is fed by
intravenous drip, she has a catheter in
her bladder and pain from her incision.
She is allowed neither food nor drink.
She is feverish and irritable. By the
afternoon of the same day. she is sitting
up. drinking juice, going to the
bathroom. and spending time with her
baby. Much of this is due, not to
medicine. but to nursing interventions.
Nursing is doing things for other
people that they would do for them
elves
if under the circumstances it were
possible. This includes everything from
the administration of a vaccine, to the
maintenance of basic life support.
Nursing takes knowledge, skill,
compassion and a willingness to keep
learning and growing for a'ì long as one
practices. A nur
e who has not made a
Susanna Jack (R.N., Nightingale School
of Nursing, Toronto; M.A., counseling,
McGill Unil'ersitv) is currently a
psychiatric nurse consultant at the
Montreal G eneral Hospital. Montreal.
Quebec. Prior 10 this appointment. she
wor/...ed as a staff nurse and then later as
the head nurse of the department of
psychiatry at MGH. She has also had
experience in medicine, gynecology,
ohstetrics and psychiatry.
-
,
,
.-
deliberate choice in this direction cannot
urvive the demands of my profession.
Doctors and nurses
Many people think of a nurse as a
handmaiden -or slave - to the doctor
This is. quite simply. not so.
Nursing and medicine share a body of
knowledge that belongs exclu
ively to
neither. These subjects include anatomy,
physiology. pathology, microbiology and
pharmacology.
Each profession also has its own
body of knowledge. I make no apologies
for the fact that' cannot remove
somebody's gallbladder. It isn't my job
to do so. But I do have skills that
physicians and surgeons do not.
I clearly remember hearing a lot of
bangs. crashes and groans from a
patient's room one day not long ago. A
well-meaning doctor had tried to
mobilize a post-stroke patient for the
first time. The tangle of tubes, bottles,
bedrails and limbs was ex traordinary.
That would not have happened if a nurse
had helped the patient. The doctor was
to blame for doing something for which
he was not trained. Fortunately, no one
was hurt. An act such as this by an
unskiIled person can bejust as dangerous
as surgery performed by an unskilled
person.
The handmaIden public image of the
nurse could be the result of the phrase
"doctor's orders". Actually a doctor's
order is a medical prescription but the
341 Julyl AUDU
11171
The CenMilen Nu....
words are often understood by those
outside nursing to mean a military
command barked by a polished higher-up
to his cowering underling.
A doctor's order is written,just as a
prescription would be for a pharmacist if
the patient were at home, and carried out
by the nurse as it would be by the
pharmacist. Except in dire emergency it
is illegal for a nurse to act on a verbal
prescriptionjust as it is illegal for a
doctor to prescribe orally. I wonder - is
the doctor-pharmacist relationship
considered master-slave?
Most of a nurse's day-to-day
activites do not require prescription.
Prescriptions are needed only for
medications and certain invasive
procedures or treatments such as the
drawing of blood or the introduction of a
urethral catheter. For the most part
nursing care is given according to the
nurse's assessment of the patient's
individual needs. The types and methods
of hygenic intervention, mobilization,
comfort, rehabilitation and health
education (to mention onJy a few) are all
based upon independent nursing
judgements. Even procedures which
require prescription are carried out by a
nurse because nurses have the
knowledge of sterile technique, patient
comfort and safety that are outside the
realm of the physician.
In the average day the nurse can
often make more decisions regarding
patient care than the doctor.
Decision-making
The decision-making process in the
health care system varies from country
to country, province to province and in
many places, hospital to hospital. This is
because government and private
involvement in the health field differs
wherever you go. In some jurisdictions
there are no private health services at all,
in others, none are public. "Public" may
imply federal, provincial or municipal
control. "Private" may refer to a
company-owned general hospital, a
small-group clinical practice or one
person running a nursing home. But in
almost all of these cases more and more
nurses are becoming involved in the
decision-making process.
I will use Quebec as my most
familiar example. The boards of public
hospitals (public meaning provincial) are
made up of elected representatives from
all health professions (medical and
non-medical), non-professional
employees, users (patients) and
members of the community. Most
hospitals are public and all significant
changes in operation must pass these
boards.
In the day-to-day running of most
institutions nurses sit on virtually every
committee that plans changes and sets
policy, The mandates of committees
range from determining the manner of
record-keeping to describing methods of
procedure: from quality care assurance
to the hospital's plan for accommodating
disaster victims. The people invol ved on
these committees are not only
management nurses but regular staff as
well.
There are two other nursing groups
that come to mind in any discussion of
decision-making. The first is a small but
growing core of nurses employed by all
levels of government to act as
consultants in health care matters. The
second is the professional association
which acts, either locally or nationally,
as a pressure group on their
corresponding level of government.
Professional competence
Unfortunately there are members of the
"medical establishment'" who are
incompetent, or contemptuous of their
clients, or both. Fortunately I believe
they are in the minority.
It has been my observation that
professionals who are going to heap
scorn do so in direct proportion to:
- social class of the client (the lower the
class, the greater the contempt)
-degree of client c1eanJiness (dirty
equals worthy of contempt)
-apparent intelligence (the lower the
perceived intelligence, the higher the
professional"s level of contempt)
-degree of the client's tendency to ask
questions (to "be a bother").
Nurses, lawyers, social service
workers, all professions contain a small
core of people whose attitude to others
leans this way. But th
majority of
!.
-
-
professionals are decent, hard-working,
humane folk who should not have to take
the lumps for their less-desirable
colleagues. Perhaps they could be more
aggressive about participating in weeding
out the dead wood but that is another
matter.
Health care for women
The feminist argument that women will
be respected consumers of health care
services only when more women are
doctors is not entirely satisfactory.
Improved health care for all people
depends not upon the number of womèn
in anyone health profession, but upon
the quality, availability and variety of
services offered to the client.
We tend to think of nur
es caring for
the critically ill at the hospital bedside.
But nursing has a great responsibility in
keeping the population well and this has
to be one of our priorities for the future.
In schools the nurse can assess both
the physical and social problems that
impede learning. For example, the
performance of some female students in
subjects like math can be influenced by
environmental factors. The nurse is also
helpful in providing practical information
and reassurance in guiding youngsters
through the physical and emotional
changes of adolescence.
I n well-being clinics the nurse can
promote awareness of the normal
functioning of the body and teach her
clients how to maintain that normalcy
and detect problems. This would include
teaching women breast self-examination
and promoting the understanding of the
reproductive system, as well as
instruction in nutrition, hygiene and
other health care basics.
The nurse has a role to play in family
planning clinics. The use, benefits and
risks of the various methods of
contraception can be explained by the
nurse who can also act as a
sounding-board for women who are
making family planning decisions.
Let us not forget nursing and the
new parent. It is a function of the nurse
to teach care of the newborn as well as to
promote parent/child bonding.
In so many health issues - the
problems of aging, the non-medical use
of drugs, venereal and other contagious
diseases - nurses perform vital
functions by participating in prevention
programs, counseling, referring and
supporting their patients.
These are special skills that nurses
have acquired by looking at themselves
as health maintainers as well as
providers of care to the sick. This is an
image that has been adopted by our
educational institutions at both the basic
and graduate levels. Education acts to
enhance the nurse's ability to deal with
these new responsibilities.
The CUledlen Nu..e
Julyl Auguet 1179 37
Nursing is for both sexes
A
much as we speak of a
male-dominated medical establishment
we should remind ourselves that the
nursing establishment has been unkind to
male practitioners.
Until the early seventies men were
barred from nursing practice in Quebec.
Even where men have been active in
nursing for some time, their roles have
been stereotyped. They have been
steered into psychiatry (where
presumably all you need is muscle) and
urology (tote those buckets). Society has
also been unkind to the male nurse with
patients of both sexes often refusing care
from a man. Promotion to managerial
status has been slow for many men.
All of this is changing, partly as a
result of human rights legislation, but
also due to human enlightenment. Men
now work in such diverse areas as
neonatology, pediatrics and surgery.
More men are pursuing advanced studies
in nursing which often leads to
promotion. They are becoming more
active in professional associations. Most
importantly, the notion that a man
cannot be gentle, compassionate and
supportive is disappearing.
Nursing: fact
and fantasy
Margaret Allan
Do you remember why you
decided to be a nurse? Do you
remember making a promise to
yourself as you graduated? "I
will take the time to be
reassuring and understanding.
The patient is my first
concern. " Over the years have
you lived up to that
commitment? Was it, then or
now, a realistic goal?
Most people, when they think of a nurse,
visualize an efficient, yet compassionate.
woman in a white uniform and cap.
However for many of these people,
hospitalization comes as something of a
shock: many nurses do not wear white
uniforms or caps, some nurses are not
An apology?
So if you think I "doth protest too
much" I regret your interpretation. but
not a word of what I have written. To me
nursing means providing every
individual who seeks my care with all of
the skill and compassion I have. Sex
does not influence a person's skill.
As a professional body largely made
up of women we are in a position to
promote public health. I am concerned
that my profession is all too often passed
off with a wink as "pink collar"-
somehow degraded and made light of by
those who can most benefit from it.
Women who have decided to become
nurses don't need sympathy -we know
our true value.
Sandra KI
ne, a graduate ofthele....ish
General Hospital School of Nursing in
Montreal, has had a l'ariety of....orl..ing
experience that includes staffnursing in
neonatalog...., orthopedics and pril'ate
duty. Currently, she is clinical
coordinator of ambulatory' .
er\'ices at
the le....ish General. KI\'ne also holds a
B.A. degree from SirGeorge Williams
U nh'ersity (no.... C on cordia Uni
'ersitv)
in Mof/treal.
women and, most significantly, some
nurses are not compassionate. Efficient.
a term more often applied to robots, may
be the only word that really seems to
suit.
But nur
es are not robots with levels
of performance standardized at the
factory, nor are they white angels
floating through hospital corridors and
doorways. Nurses are human beings in
constant interaction with other human
beings.
It is unfortunate that the qualities
that make nurses human, such as
concern and compassion, are the very
qualities most susceptible to the
pressures of constant interaction. These
pressures vary from the anxiety of saving
lives to the irritation of changing one bed
eight times a shift. Different activities
require different emotional responses
and each response must vary with every
patient. Time and repetition may
improve the nurse's efficiency but the
capacity for caring is often drained by
the numerous demands that are made
upon it.
To the demands of the patient you
have to add the effects of the nurse's
co-workers - the doctors and
administrators. The net result of all of
this? Some of the nurse's personal
qualities are strengthened, some are
eroded and some get buned under a
hard, protective coating of apparent
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unconcern. Nursing change
the nurse
and compa
sion is only one of the
qualities affected.
The changes are gradual but they do
not go unnoticed by nurses them
elves.
A nurse told me that she caught her;elf
one night "treating a person like an . it" . I
had to shake myself and try to remember
that this uncon'icious patient was a
normal person like my
elfwhojust
wasn't alert at that time. ,. Most nurses
would nod their head appreciatively at
this statement, but the mythic image of
the nurse as a perfect white angel
persists.
Why') Perhaps it is because this
flattering picture i
so often painted by
someone outside the profession that
nurses don't want to mar it with truth.
Attitudes change
The rosy picture of a caring angel i
dangled in front of the student nurse
throughout training. The reality of
regular hospital nursing comes as a rude
shock to the idealistic new graduate. As
one young graduate said, "I thought that
I would always be sweet, reassuring and
patient...but some day
you're grumpy
and the situation is not exactly as I had
imagined. .,
Another recent graduate said she
entered nursing because of a curiosity
about the human body but left general
duty nursing because "the job of nursing
31 July/Auguet 11171
The Canadian NUf811
---
is tied up in bedpans. It got me down."
Both nl,lrses had professional
expectations which were not fulfilled on
wards. One of them said she was
"disillusioned by the whole medical
scene. No one cares." In four months
she changed the image she had of herself
as well as the image she had of nursing.
She wonders if in two years she will
become like those who "are more
interested in coffee breaks and a
cigarette than in the patients?"
Although this graduate had to alter
her own expectations others still expect
certain things of her. One nurse said the
high standards that others expected
caused her to retain and renew her
medical knowledge both when she
worked and long åfter s he retired.
Some expectations do not have such
beneficial results. Nurses who trained in
hospitals prior to the mid-sixties were
expected to fill the traditional role of the
cnsp professional at all times. It was the
image of the nurse that was important
not the relationships that were set up. A
natural interaction between human
beings was impossible under this
expectation of strict professionalism.
Those who trained as nurses before
the early sixties were also expected to be
unquestioning servants to doctors. A
research study conducted throughout the
I%O's found that "nurses as a group
share the common characteristics of
submissiveness and dependency."'The
nurse's relationship to the doctor Was
based on the premise that "he's God
almighty and your job is to wait on
him."2 Every nurse one researcher
interviewed felt that "making a
suggestion to a physician was equivalent
to insulting and belittling him.' '3
That was 1968. The nurses who have
trained since then are more assertive-
at least they don't stand at attention
when a doctor approaches the desk -
but the nurses who trained earlier still
feel the subservient effect of their
training.
Tired legs, aching back
Although expectations vary with the
times, the one force that remains
constant in nursing is the effect of shift
work. Most nurses feel that shift work
hinders their family and social life, limits
their friendships to those also working
shifts and exhausts them. Re
earchers
know that shift work disrupts all body
rhythms,
but the knowledge of this fact
doesn't help the nurse who struggles to
stay awake at five in the morning or to go
back to sleep at noon. As one nurse said,
") never get enough sleep (when) 'm
working) nights. ) 'm not as efficient
then, yet that's when)'m really needed
because that's when people die."
Because they are tired and restricted
by shift work, most nurses remember
only negative effects but there are
positive aspects as well. Shift work
allows nurses with small children to
work without worrying about babysitters
or daycare. Other nurses find the
evening and night atmosphere on wards
relaxed and more conducive to closer
patient relationships. One nurse even
reported an enhanced marital
relationship due to shift work - her
husband began to appreciate her more.
Nurses admit there are some
advantages to shift work but they would
be hard pressed to find anything good to
say about the heavy physical work
nursing involves. Although some wards
are more difficult than others most
nurses would agree with the graduate
who said, "When I work) only work. I
ha ve no time or energy for anything
else." The constant walking, running,
bending and lifting induces a fatigue that
affects the nurse's relationships with her
patients, co-workers and family. This
exhaustion combined with shift work
1
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prompted one nurse to say, "N ursing
becomes a lifestyle...1 don't see how a
person can remain nOnTIal while working
full-time. ..
The weariness nurses experience
can be seen as a short-term result of shift
work and heavy labor but there is also a
10ng-tenTI effect. The nurse's field of
interest is narrowed. ")'m too tired to
even read; I'vejust got enough energy to
look after myself' and so the nurse is
forced to lead a very circumscribed life.
both physically and intellectually. In
addition to this, shift work and the
attitude of most hospital administrators
make it nearly impossible for one to
enroll in any kind of class or to sign up
for any sports acti vities.
Updating
The working nurse also faces stagnation
within the profession. One recent
graduate pointed out, ") 'm not as smart
now as when) was a student. .. One of
several reasons for this is that, even
when the hospital provides classes for
nurses, they don't provide the time to
attend them. "It's a drag attending
in-service education," said one
disgusted nurse, "because you sit
thinking of all the work you left behind.
And if the classes are held on your days
off you don't come back because your
time off is too precious. "
The new graduate also said she felt
she wasn't as "smart" because she
missed the stimulation of the new and
different infonTIation that books and
wards had given her in training. Nurses
seldom rotate on wards. This means that
very few have new learning experiences
after their first months on their assigned
ward. One author wrote, "Maybe the
patients, who eventually do leave the
institution, are better off than the
employees who may acquire dulled
intellects as well as feelings of
unimportance from...the routine of their
work. "5
Besides mental and physical
exhaustion nursing also arouses feelings
,
.
f --
/
of anger and frustration. As all nurses
emphatically agree their deepest
frustration stems from the shortage of
staff which administrators seem to ignore
or dismiss with the eternal words
"budget cutbacks". (Those words ring in
our ears while administrators spend
money to replace bottles of Airwick
with expensive little gadgets that release
deodorizer at timed intervals.)
The frustration of nurses arises, not
from the increased work load produced
by staff shortages, but from their
inability to provide good nursing care no
matter how hard they work. There just
isn't enough time. One nurse said that
although almost everyone meets this
kind of frustration on their job, leaving a
column of figures unadded is different
than leaving the needs of patients unmet.
Not only is a nurse dealing with human
beings, she is dealing with human beings
whose needs are immediate. Tomorrow
might be too late.
Racing the clock
The frustration of those without the time
The Cenedlen "UrN
July/Augu
11171 311
to fulfill the needs of their patients has
caused many good nurses to leave their
profession. One nurse left because she
never had enough time to comfort the
crying children on the pediatric ward.
Another nurse marched down to the
Nursing Office and said. "I refuse to be
responsible if something goes wrong."
The Nursing Office ignored her req uest
for help and so. in frustration, she quit.
Yet another nurse summed up her
frustration with stafTshortages by
saying, ". didn't need that kind ofs.... so
. quit."
There is frustration due to a gap
between the patient's needs and the
nurse's time. But there is also frustration
with doctors who often seem not to care
(especially fortheirelderly patients) and
with a "system" that insists that ice
water be passed out to patients at
five-thirty in the morning even if the
rattling of carts, buckets and jugs wakes
every patient on the ward. Fruitless
attempts to change such stupid routines
have caused many nurses 10 quit their
jobs or stop complaining and join the
ranks of those who "take the easy way
out. ..
Frustration. experienced by all
nurses, has also caused some to adopt a
hardened approach. Many of the nurses I
spoke with felt their changed attitude
should more correctly be called
"controlled". This control allows these
nurses to protect themselves from too
much pain. They said it also gave them a
certain sense of command of the
situation although many added they
often paid for their control with
emotional stress later.
Some nurses admitted they had
become at least a little hardened and in
order to feel real compassion they had to
imagine a loved one in the same situation
as their patient. One nurse said, "I used
to worry about my patients. now. just
think about them." Perhaps this
decreased emotional involvement is due
as much to emotional exhaustion a
it is
to physical fatigue, frustration and
day-to-day routine. One nurse
speculated. "Maybe wejust run out of
compassion." Another confessed.
"Sometimes I just get tired of complaints
all day'" But she went on to add, ". get
mad when I catch myself not responding
properly." At least some nurses are
aware of the hardening process and can
say. "I still cry over some deaths. And
I'm glad I'm still able to."
Getting to know death
Although many say that they have
"come to terms with death" crying
remains one way of coping. Most nurses
do not accept the idea of their own
eventual death or that of a loved one any
easier than they did before they nursed.
"Coming to terms with one's own death
is not necessarily the result of
cumulative experience with death and
dying. "6This is illustrated by the nurse
who worked on a cancer ward; she faced
at least one death a week but said. "I'm
still afraid to die."
They may still be afraid to die but
the majority ofnu....es are more
comfortable with the dead ar dying
than is the generdl public. The working
experience of nurses has forced them 10
think and talk about death. Some nurses
have been prompted 10 ponder the
metaphysical aspects of their eXistence;
one nurse I spoke with said that death
made her "realize the living body is more
than just a heart and blood" while
another spoke of the "presence" of the
living body.
Although many nurses are stIli
depressed by deaths on wards, some find
working with the dying intensely
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gratifying. One nurse who had worked
on a cancer ward said, "I gained
somethmg from the experience. I really,
really felt like I was doing something
worthwhile." But she went on to say.
"There is only satisfaction in working on
a ward like that if there is sufficient staff.
If there isn't it is the most fru'itrating
place in the world." Thi'i woman had
worked on another cancer ward which
she said was "ugly" because it WdS
short-staffed. "You gave all you could in
physical care and there was nothing left
for emotional care."
And so. even a discussion of death is
reduced to a recital of frustrations due to
staff shortages. That is part of what
nursing is all about. Mixed with the
grand mysteries of birth and death are all
the down-to-earth matters of bedpans.
sore feet and frustration.
Some nurses do "run out of
compassion". One nursing instructor
said, "It happens to them. It.s not that
they're taught that way" Of course not
The overwhelming experience of general
duty nursing - the satisfaction,
frustration. wonder.
orrow.joy and
initation - affects the whole being. not
just the intellect, of the nurse. Not all
change is positive but change itself is an
ongoing process and a neceS'iary part of
growth.""
References
I Muhlenkamp. A.F. Characteristics
of nurses: an overview ofrecent research
published in a nursing research
periodical. by... and J.L. Parsons.J.
Vocational Beha\'. 2:261-273, JuI. 1972.
2 Stein, Leonard .. The doctor-nurse
game. AmerJ.Nurs. 68: 1:101-105, Jan.
1968.
3 Ibid.
*4 Luce, Gay Gaer. Bod\' time.
Toronto. 1973. p.8.
5 Brandner. Patty. Are nurses
unique? Supen'.Nurse 7:1 1:34.37-38.
Nov. 1976.
6 Popoff, David. What are your
feelings about death and dying? Pt. I.
Nursin[< '75 5:8:15-24, Aug. 1975.
*7 Intervie\-\s with six individual
nurses and one group of nurses, all of
whom prefer not 10 be identified. Regina,
Nov 1978.
*References not verified in CN A Library
'\-largaret Allan. the author of "Nursing:
fact andfantas\" , !'.'rote this article from
research carried out in a general hospital
in one of Canada's westem prm'inces.
The I J nur.
es she spoke !'.'ith ran[<ed in
age from 11 to 52 and had been nursing
for one to 20 years. Set'eral general dut\'
nurses (from ps \'chia try , pediatric.ç and
surgery), m'o nursing instructors and a
public health nurse participated in the
stud\'
All photos courtesy of Vancouver General Ho'pital
1
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SECOND IDIT10H
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Health
Assessl11.ent
Clinical
implications of
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Need we say more?
IVIDSBV
TIMES MIRROR
THE C. V. MOSBY COMPANY. L TO
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TORONTO. ONTARIO
M48 3E5
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Irelnancy
Bonnie H orIley
Hypertensive disorders in pregnancy
remain one of the three leading
causes of maternal mortality. The
disease appears in five to ten per
cent of all pregnancies, and is
responsible for a death rate of more
than one per cent. * The traditional
I term 'toxemia' ís becoming
inappropriate in that research has
revealed there is no toxin involved,
but the word is still used frequently
both clinically and in research
literature because no more
appropriate name has been found.
The role of the nurse in both
recognizing and monitoring the
development of the hypertensive
disorders in pregnant women is an
important one. Thus, it is necessary
to have a good understanding of the
basic pathophysiology, medical
management, and nursing care of
these disorders.
This learning package is intended
to provide you with such an
understanding, and it operates in a
very simple fashion. The information
content is presented in stages in
small sections after which pertinent
questions are asked to emphasize
the most important points. The
answers are provided at the end,
followed by a short post test which
will check your understanding of the
material.
'Canadian statistics report 22 maternal deaths from
complications in pregnancy in 1976; 6 of these were from
toxemia.
The Can-.llen NUrH
.JUlr/Augu8t 1171 43
CYCLE 1: Introduction
Up to 10 per cent of all pregnant women demonstrate hypertension; of these
women, two thirds have chronic hypertension, while the remaining one third
develops a form of hypertension, or toxemia, which is peculiar to pregnancy,
appearing late in gestation and subsiding after delivery. There are several methods
of classifying the hypertensive disorders; one is as follows.
.1. Preeclampsia
a) mild
b) severe
2. Eclampsia
.Chronic hypertension
Frequently the disorder is considered to be a continuum of mild preeclampsia
to severe preeclampsia to eclampsia; approximately 5 per cent of all the patients
with preeclampsia actually progress to eclampsia.
CYCLE 2: Changes in Hypertensive Disorders of Pregnancy
"Toxemia" is often called "the disease of theories" because it seems that everyone
who has ever worked with "toxic" women has put forth a suggestion as to its
cause. These ideas range from too little protein in the diet to incorrect alignment of
the woman's bed with the north pole! However, the exact cause is still unknown.
Toxemia is characterized by vasospasm and intravascular coagulopathy.
"Recent scientific studies have shown that these generalized changes in the
vascular system result in a number of alterations in the uteroplacental bed that may
compromise the integrity of the placenta and the fetus. "I Another study notes that
women who develop toxemia are apparently more sensitive to the pressor
hormones than other women. 2
The cause of the vasospasm is still not completely understood; the results can
be depicted as follows:
Vasospasms
Hypertension
!
t
, Renal perfusion
&
, Glomerular filtration
/\
/'
Damaged blood Hemoconcentration
vessel walls
Tissue damage
Utero-placental
blood flow
Proteinuria
Edema
( , - short arrow, means decreased)
The classical triad of manifestations of preclampsia is HYPERTENSION,
PROTEINURIA and EDEMA, and may be put into a simple formula.
"TOXEMIA" = HYPERTENSION + PROTEINURIA + EDEMA
In the hypertensive
disorders there IS
widespread
which provokes
This also leads to
decreased glomerular
and
.... JuIy/AugU8t 1971
The Cen.dl.n Nur..
Now that you have mastered the basic physiology you should find the rest relatIvely
simple. But don't forget the formula!
CYCLE 3: Predisposing Factors
"Toxemia" usually occurs suddenly sometime after 24 weeks gestation. It is seen
most frequently in primagravidas (especially the very young or those over 30),
diabetics, chronic hypertensives, and in women who have co-existing conditions in
pregnancy such as hydramnios, multiple fetuses or hydatidaform mole. As for
other factors, authorities are in disagreement on the importance of protein
deficiency in the diet. However, it is important to note that the incidence of this
condition is much higher in the lower socioeconomic groups who are more likely to
have a nutritionally deficient diet and less prenatal care. Research has found a
tendency for this condition to be familial.
One group of researchers has discovered that a high proportion of pregnant
women who demonstrate a rise in diastolic blood pressure of at least 20 mmHg
when turned from a lateral to supine position subsequently develop preeclampsia. 3
This has been known as the "rollover test" and may be employed as a screening
test during antenatal visits.
CYCLE 4: Mild Preeclampsia. Manifestations and Treatment
The early signs of mild preeclampsia are often so subtle that a woman may be
unaware there is anything wrong. The most dependable sign is a rise in blood
pressure: an increase of 30 mm or more systolic or 15 mm diastolic over the
patient's baseline values is significant. Excessive weight gain - more than 1 kg
per week - is another early sign. Proteinuria at this point may be absent or
minimal. By the time the patient develops signs that she herself can detect, the
disorder is usually advanced.
In this early stage, patients are often advised by their physicians to rest in bed
most of the day as this promotes diuresis by increasing venous return; a mild
sedative may be prescribed. Historically, sodium has been restricted, but more
recently authorities recommend a normal sodium intake. 4 The woman is instructed
to weigh herself each morning before breakfast, and visits to her physician may be
increased to twice a week. Many practitioners even hospitalize the patient; in
hospital urine testing for protein is started, and the woman is encouraged to
participate in her own care, doing such things as recording her daily weight, testing
urine, and selecting her diet.
CYCLE 5: Severe Preeclampsia
In severe preeclampsia, each of the three manifestations becomes more severe.
The blood pressure continues to rise and may reach 160/100. Edema increases
and facial and ankle swelling may be noticed. Proteinuria, which indicates the
extent of glomerular damage and the possible presence of small renal
hemorrhages, may reach 10 grams per litre of urine.
What are the predisposing
factors in toxemia?
What clinical
manifestations are
presented in mild
preeclampsia? (give
values where applicable)
1. Hypertension:
2. Edema:
3. Proteinuria:
What would you be
advising a patient with mild
preeclampsia?
1.
2.
3
The C8nedlen Nur..
Julyl Augue11171 45
Signs of increasing Central Nervous System irritability will appear: headaches,
dizziness, nervousness, visual disturbances, nausea and vomiting, and
exaggeration of reflexes (hyperreflexia). The vasospasm also contributes to the
visual disturbances by affecting the retina causing edema, hemorrhage and even
detachment. Of special note is the fact that epigast!'ic or right upper quadrant pain
(thought to be caused by stretching of the hepatic capsule) is a sign that
convulsions are imminent.
How do the 3 major
manifestations present
now? (give values where
applicable)
1. Hypertension:
2 Edema:
3. Proteinuria:
KEEP GOING! YOU'RE GETTING THERE.
CYCLE 6: Management of Severe Preeclampsia
The objectives of management at this stage are:
.prevention of convulsions
.delivery of a viable child
.delivery with a minimum of trauma for mother and child
.prevention of residual hypertension
The patient is now in hospital and placed on bed rest with encouragement to
spend as much time as possible lying on her left side. (Research has shown this
position increases uterine blood flow.)S Phenobarb has been used as sedation in
the past but this is now believed to have an adverse effect on the fetus. 6
A standard nursing care plan will include the following potential problems:
What are five sIgns of CNS
irritability?
What may signal a
convulsion?
PROBLEM
EXPECTED OUTCOME
1. Deteriorating condition due to
increasing vasospasm.
1. BP will decrease.
2. Weight will decrease.
3. Urinary output will increase
4. No signs of increasing CNS
irritability .
2. Apprehension due to lack of
knowledge re her condition and the
fetus' .
1. Will indicate understanding of why
procedures are done.
2. Can answer simple questions re
treatment.
3. Will discuss her anxiety about the
baby.
3. Skin breakdown due to edema.
1. No skin breakdown.
4. Boredom due to prolonged
hospitalization and inactivity.
1. Actively participates in hobbies and
diversional activities
NURSING ACTIONS
1. Monitor BP. PR. q4h or as ordered
2. Weight daily a.c.
3. Accurate intake and output.
4. Observe q4h for signs and
symptoms of Increasing CNS
irritability, i.e. anxiety, headaches,
nausea, visual disturbances,
epigastric pain.
1. Explain all procedures and nursing
measures carefully.
2. Employ empathic reflective
communication techniques.
3. Be on alert for verbal cues.
4. Ensure husband is included in
explanations so he can help support
wife.
1. Ripple mattress or sheepskin.
2. Genlle skin care to pressure areas
q4h.
1. Determine patient's interests and
involve appropriate services, i.e.
library. occupational therapy.
2. Encourage family and friends to
visit in moderation, and involve client
in sedentary occupation.
3. Visit frequenlly for short penods,
i.e. 5 minutes per 1-2 hours.
48 July/Augu8t 1979
The Cen-.llen Nur..
CYCLE 7: Magnesium Sulfate
If the preeclamptic patient does not respond to bedrest, antihypertensive and
anti-convulsive therapy is begun. Magnesium sulfate is the drug of choice here,
acting to block neuromuscular transmission. It is given intravenously as
intramuscular administration tends to be very painful. The nurse must be aware
that magnesium sulfate is a potent drug and can cause CNS depression. The
patient must be monitored closely and observed for decreased rate of respiration,
absence of patellar reflex, drowsiness, lethargy, slurring of speech, and anxiety. It
is imperative that respirations remain at mo
e than 12 a minute, and since this drug
is excreted entirely by the kidneys it is crucial that the urine output be monitored -
otherwise, the level of magnesium sulfate in the blood may rise to toxic levels. The
antidote for this is Calcium Gluconate and should be readily available at all times in
the event of sudden CNS depression. Serum magnesium should be checked
frequently; values of 4 to 6 mgm/1 00 cc are enough to prevent convulsions in the
mother without causing CNS depression in the neonate.
PRECAUTIONS FOR WOMEN RECEIVING MAGNESIUM SULFATE
1 . Continuous nursing care
2. Intravenous must be running
3. Foley catheter connected to drainage
4. Give drug only if
a. Patellar Reflex present
b. Urine output more than 20 ml/hr.
c. Respirations more than 12/min.
5. Calcium Gluconate is at the bedside
There's a lot in this cycle. isn't there? MagnesIUm Sulfate is an important drug and
deserves a great deal of attention.
CYCLE 8: Treatment Continued
Hydralazine (Apresoline) is used as an antihypertensive agent. Because of the
hemoconcentration present in toxemia, it is important that an adequate fluid intake
be maintained. As the drug takes effect and vasospasm decreases, there should
be a resulting increase in the patient's urinary output. Thiazide diuretics are not
recommended to increase diuresis as there is evidence that such drugs reduce
uteroplacental perfusion. 7
If severe preeclampsia does not improve after a few days of treatment,
termination of the pregnancy is advised. A premature baby has a better chance of
survival in an efficient and well-equipped neonatal intensive care unit than in the
uterus at this stage of the mother's illness. An oxytocin induction of labor is
attempted but if this is not successful, a Caesarean section will be performed.
Magnesium sulfate is frequently administered prophylactically throughout
labor, as this is the time when convulsions are most likely to occur. In addition, the
mother should be carefully observed for signs of abruptio placenta.
Even after a safe delivery, nursing care of the hypertensive patient should not
slacken. During the first 24 hours postpartum close observation is necessary as
eclampsia may develop. Normally, the hypertension may persist for a short time
following delivery, but by six weeks postpartum the patient should be
normotensive. The baby may be small due to the premature birth or intrauterine
growth retardation.
What are some of the
patient's potential
problems at this time?
1.
2.
3.
4.
What is the action of
Magnesium Sulfate?
______. What are the
indications of CNS
depression?
What nursing precautions
should always be
followed?
1.
2.
3.
4.
5.
What antihypertensive
agent is frequently
employed?
. As vasospasm
decreases, what should
happen to the urinary
output?
ConvulSions are
likely to occur during_
and
the first
hours postpartum.
The Cenedlen NUrM
July/Aulluell117i 41
CYCLE 9: Nursing Care Plan
If magnesium sulfate and other drugs were required in the control of severe
preeclampsia. the nursing care plan would require somE! adjustments It would
include the following:
POTENTIAL PROBLEM
EXPECTED OUTCOME
NURSING ACTIONS
1. Coma & convulsions due to
CNS irritability.
1 No coma or convulsions
1. Private room.
2. Restrict visitors.
3. Complete bedrest, side rails up.
4. Talk quietly.
5. Plan care so patient is disturbed as little as
possible.
6. Keep noise to a minimum.
7. Draw drapes, keep room lighting dim.
B. Take BP, PR, q2h (or as ordered)
9. Observe carefully for signs and symptoms
of increasing CNS irritability or impending
convulsions, e.g. nausea, hyperreflexia,
headache, dizziness, visual disturbances,
epigastric pain.
10. Administer drugs as ordered.
11. Monitor or administer magnesium sulfate
as ordered.
12. Have 'toxemia tray' in room with
emergency equipment: calcium gluconate,
needles, syringes, airway.
13. Rolled face cloth or padded tongue
depressor at bedside.
14. Oxygen and suction equipment
available.
2. Oliguria due to renal shutdown.
1. Urine output will be greater than
720 ml per 24 hours.
1. Encourage rest in lefllateral position.
2. Monitor renal function
a) hourly output
b) dip-stick test for proteinuria.
3. Report urine output if it drops below 30
ml/hr.
3. Undetected labor due to heavy
sedation
1. Signs of progressing labor
would be detected early.
1. Check for uterine tightenlngs q2h.
2. Observe for show q2h.
3. Observe for restlessness.
4. Fetal distress due to decreased
uteroplacental blood flow
1. Fetal heart rate will remain
stable.
1.CheckFHq1h.
2. Monitor the patient (as ordered).
3. Support during fetal monitoring.
4. Save 24 hour urine for estriol. if ordereu.
-
What are the patient's
potential problems at this
time?
1
2.
3
4
DON'T QUIT NOW! This is the end of preeclampsia so there isn't much more to go. Just
a bit on eclampsia and chronic hypertension...
41 July/Augu8t 1979
The Cen.".n NUrH
Eclampsia means a "flash - a shining forth" - a name which denotes sudden
onset. In eclampsia, all the manifestations of severe preeclampsia are intensified
It is characterized by convulsions and coma, and may result in death for both the
mother and the fetus.
Treatment is directed at controlling convulsions, stabilizing blood pressure
and maintaining renal function. Symptoms can usually be controlled in 4-6 hours
using magnesium sulfate and anti-convulsants such as Valium and Dilantin, but
care must be taken to keep CNS stimulation to a minimum. The nursing care is the
same as for the severe preeclamptic with the addition of protection of the patient
against injury during convulsions. When eclampsia occurs during labor,
contractions usuaJly increase in force and frequency, thus hastening delivery.
With most patients, the prognosis is favorable in that diuresis is usually rapid
after delivery. In some cases, however, pulmonary edema, cardiac failure or
aspiration pneumonia may result in death.
CYCLE 10: Eclampsia
What event differentiates
severe preeclampsia from
eclampsia?
. What drug is
most frequently employed in
the management of
eclampsia?
Hypertension is often referred to as the "silent killer". Many hypertensive women
are unaware of their problem until it is detected at a prenatal visit. Hypertensive
disease in pregnancy occurs most frequently in women who are older, multigravid
or obese.
About 25 per cent of these patients develop superimposed preeclampsia. This
is likely to appear earlier than ordinary preeclampsia and in a more severe form.
For all women with chronic hypertension there is a major risk of fetal growth
retardation.
CYCLE 11: Chronic Hypertension
Descnbe a "typical"
hypertensive gravid
patient.
What is a frequent fetal
complication with this
condition?
O.K., you've finally reached the end! Check your answers and then how about trymg
the post test to determine how much you've learned?
ANSWERS
CYCLE 2
Vasospasm, hypertension, filtration, edema
CYCLE 3
Primagravida, diabetics, chronic hypertensives, hydramnios,
multiple fetuses, hydatidiform mole,
lower socioeconomic status
CYCLE 4
1. Hypertension: systolic 30 mm Hg, diastolic 15 mm Hg above base
2. Edema: weight gain of more than 1 kg per week
3. Proteinuria: absent or minimal
1 . Weigh herself each morning before breakfast
2. Spend most of the day in bed
3. Keep each appointment with her doctor
CYCLE 5
1. Hypertension: as high as 160/100
2. Edema: becomes visible in the face and ankles
3. Proteinuria: as high as 10 g/Iitre
Headache, dizziness, nausea, visual disturbances, hyperreflexia
Pain in epigastrum or right upper quadrant
CYCLE 6
Apprehension, skin breakdown, deteriorating condition, boredom
CYCLE 7
Blocks neuromuscular transmission
Anxiety, drowsiness, lethargy, slurnng of speech, depressed respiration.
1. I.V. running
2. Catheter connected
3. Give drug only if a) patellar reflex present
b) respirations are above 12/minute
c) urine output is greater than 20 cc/hr.
4. Calcium gluconate at bedside
5. Continuous nursing care
CYCLE 8
Hydralazine (Apresoline), increases, labor, 24 hours
CYCLE 9
1. Development of coma and convulsions
2. Oliguria
3. Undetected labor
4. Fetal distress
CYCLE 10
Convulsions
magnesium sulfate
CYCLE 11
older, multigravida, obese
Intrauterine growth retardation
The Cen-.llan Nur..
July/Augu8l1971 49
POST TEST
In the 15 multiple choice questions select the best or most
complete answer.
Sally Kemp, 30 weeks pregnant, h,as just been told by the
obstetrician that she has mild preeclampsia. As the
office nurse, you remember that
1. Preeclampsia is more likely to occur in
1. young primigravidas
2. diabetiC's
3. placenta previa
4. low socioeconomic groups
a.1
b.2,4
c.1,2,3
d.1,2,4
2. Sally might complain about
a.nausea
b. tight rings
c.backache
d. constipation
3. You stress to Sally that increased rest is very
important, because it
a. minimizes the work of the heart
b. aids diuresis
c. decreases the likelihood of infection
d. would make her feel better
Sally's condition does not improve, so she Is
hospitalized.
4. The changes within the kidney which lead to
proteinuria include
1 . increased tubular reabsorption of sodium
2. small hemorrhages within the kidneys
3. concentration of intravascular contents
4. changes within the glomerulus
a.1,2
b.2,4
c.1,3,4
d.1,2,3,4
5. As Sally's edema increases, her urinary output will
probably
a. decrease
b. remain constant
c. increase slightly
d. increase substantially
6. A moderate or high protein diet is ordered for Sally
because
a. these patients tend to have smaller babies and extra
protein increases the baby's birth weight
b. babies born to these mothers tend to be premature and
extra protein increases their chances of survival
c. extra protein helps decrease the sodium content of the diet
d. the mother is losing albumin and amino acids from her
body
Sally's diagnosis Is now severe preeclampsia.
7. Signs of severe preeclampsia might Include
1 . blurred vision
2. irritability
3. diuresis
4. pyrexia
a.1,2
b.3,4
c.1,2,3
d.1,2,3,4
8. The primary action of magnesium sulfate Is to
a. prevent and control convulsions
b. decrease blood pressure
c. depress the central nervous system
d. alter the urinary output
9. Magnesium sulfate Is eliminated by
a.liver
b.skin
c. gastrointestinal tract
d. kidneys
10. The antidote for magnesium sulfate Is calcium
a. carbonate
b. gluconate
c. citrate
d. chloride
11. Signs of toxicity from magnesium sulfate Include
1. depressed patellar jerks
2. patient's complaints of anxiety
3. decreased respirations
4. patient's complaint of epigastric pain
a.1
b.2,3
c.1,2,3
d.1,2,3,4
12. When giving nursing care to Sally, It Is important to
1. turn her from side to side q1 h
2. allow her as much rest as possible
3. keep accurate intake and output records
4. answer her questions honestly and simply
a.1,2
b.3,4
c.2,3,4
d.1,2,3,4
13.ln order to facilitate emergency treatment, the nurse
would expect the "toxemia" tray to contain
1. an airway
2. padded tongue blades or rolled facecloth
3. needles, syringes
4. suction catheters
a.1
b.2,3
c.1,2,3
d.1,2,3,4
14. The main event which differentiates preeclampsia
from eclampsia Is
a. proteinuria
b. epigastric pain
c. convulsions
d. hypertension
50 JUIr/Augual1979
The C8nedlen Nur..
POST TEST ANSWERS
15. After an eclamptic patient has delivered, she must be
closely watched for the first
a. 24 hours
b. 48 hours
c. week postpartum
d. month postpartum
1 (d) 2(b) 3(b) 4(b) 5(a) 6(d) 7(a) 8(a) 9(d) 10(b) 11 (c) 12(c)
13(d) 14(c) 15(a)
References
1 Tichy, Anne M. Placental Function and its role in
toxemia, by on and D. Chong. MCN Amer. J. Matern. Child
Nurs. 4:2, Mar-Apr 1979, p. 84.
2 Pritchard, Williams. Obstetrics. 15th ed. New York,
Appleton-Century-Crofts, 1976, p. 553.
3 Ziegel, Ema, Obstetrical Nursing, by... and M.
Cranley. 7th ed., New York, Macmillan, 1978, p. 657.
4 Pritchard,op. cit. p. 56.
5 Ziegel,op. cit.. p. 657.
6 Pritchard.op. cit., p. 566.
7 Pritchard,op. cit., p. 565.
Bibliography
1 Alfonso, D. Complications arising during pregnancy by
... and D. Danforth. (In Clark. Ann L. Childbearing: a nursing
perspective, by... and Dyanne D. Alfonso, Philadelphia, FA
Davis and Co., 1976)
2 Butts, P. Magnesium sulfate in the treatment of
toxemia. Amer. J. Nurs. 77:8:1294-1298, Aug. 1977.
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3 Jensen, Margaret.Maternity Care: The nurse and the
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4 Miller, Mary Ann. The childbearing family: a nursing
perspective, by n. and Dorothy A. Brooten. Boston, Little,
Brown & Co., c1977.
5 Sonstegard, Lois. Pregnancy induced hypertension:
prenatal nursing concerns. MCN American J. Matern. Child
Nurs. 4:2:90-95, Mar-Apr, 1979.
Bonnie Hartley is a graduate of Kingston General Hospital
and Queen's University, Kingston, Ontario. She obtained her
M.Sc.N. degree from the University of Weste", Ontario.
Bonnie has taught obstetrics for a number of years and is
currently a co-ordinator of continuing education at Ryerson
Polytechnicallnstitute in Toronto. She has written three other
articles for The Canadian Nurse, most recently an
instructional package on Cortisone (CNJ, February 1978).
The author wishes to express appreciation to colleagues
E. Collins, G. Donner, and S. Spiegel for their assistance.
-;--,
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The Cenedl.n NUr..
July/AulIUå 1171 51
Nursing negligence in the
administration of medication...
Could it happen to you?
YOU AND THE LAW
Corinne Sl..lar
Medication errors - the wrong drug, the wrong dosage or
concentration. the wrong route or method of administration, the
wrong patient or wrong time of administration - CAN happen.
What's more. whenever a nurse makes an error in administering
medication to a patient. this action constitutes a potential legal
hazard.
Although to date there have been few Canadian cases
arising out of charges of negligence against nurses involved in
the administration of medication, the possibility ofIegalliability
does exist. As the presiding judge in one of these cases (BuRden
v. Harbour View Hospital) pointed out:
"Persons who are in charRe of dangerous things under which
category, I think. drugs are included, are Il1lder a duty to handle
them with such care that harm will not arise to those who
depend upon their sl..ill." I
/
.
i\
and harm befalls the patient, both the hospital and the nurse
may be held liable for her negligence. The hospital's liability
would be founded upon the doctrine of "respondeat superior"
("Iet the master answer") for hospitals are responsible in law
for the negligence of their employees in the performance of their
duties.
The cases that follow illustrate errors in the administration
of medication that have resulted in Court actions: consideration
of them will serve as a reminder that the possibility of such
incidents with their tragic consequences is ever-present. (Many
of the cases are American because. as has been pointed out.
there are few reported Canadian cases in this area of nursing
negligence .)
The wrong medication
In BURden
'. Harbour View Hospital,2the patient
as being
treated for a dislocated thumb. The physician asked nurse A for
Those who administer drugs must, therefore, handle and
novocaine. Nurse A asked nurse B to obtain the novocaine.
administer them with the greatest of care and attention. To Nurse B handed a bottle to nurse A who handed it to the
avoid errors and in order to ensure that the right patient physician. The physician drew the medication into the syringe
receives the correct drug in the correct dosage by the correct and injected it into the patient's thumb. Unfortunately, the
route as ordered by the physician, adherence to the basic bottle contained adrenalin (as labelled) and the patient died
nursing principles of medication administration is necessary. shortly thereafter. Neither nurse checked the label: if either
Checking the label three times and confirming the identity of the had, she would ha ve seen that the wrong drug had been
patient verbally or by examining the hospitall.D. band, are not procured. The physician did not read the label either.
supertluous procedures. The harmful effects of medication The Court held that both nurses were liable for their
errors upon patients can develop rapidly and disastrously if the \ respective failures to take care in supplying a dangerous drug.
procedures designed to ensure accuracy and due care are The hospital was liable under the doctrine of respondeat
neglected. superior, for the nurses were acting during the course of their
A nurse's conduct may be found by a Court to amount to employment. Mr. Justice Doull found the physician not
negligence if the course of that conduct falls below the standard negligent in failing to examine the label. He reached this
of care to be expected in the circumstances. ie. that of the conclusion because the order for the medication was a routine
reasonable prudent nurse ofIike training and experience. matter and as there was nothing in all the circumstances to put
Nurses are expected to have a working knowledge ofthe"'---- the physician on inquiry thereby necessitating further
medications which they administer. their side effects and- observation on his part, he was entitled to rely on the
contraindications, regular dosages and routes of administration.- competence of experienced nurses in carrying out his order.
Nurses are expected to be able to competently administer Thejudge said that if it is the duty of several persons to
medications and to reasonably foresee that harm will result to a guard against danger. one who fails to take precautions cannot
patient where there is negligence in the administration of escape by saying that another should have been careful enough
medications. to have caught his error. 3 He went on to state that such damage
Nurses are expected to utilize their professional was foreseeable: a trained nurse would know that novocaine is
knowledge, skill and judgment in administering medication. In to be hypodermically administered. Thus it was impossible for a
fact, physicians can rely on the nurse's competence in carrying nurse to be unaware that if adrenalin instead of novocaine were
out their order. It is incumbent upon the nurse to question the used, the danger of death would be great. It was the duty of
prescribing physician where she has any question or doubt or these nurses to check the label to see that the proper drug had
where there appears to be some error in the order. Failure to do been obtained.
so might expose the patient to an unreasonable risk of harm. As The physician was absolved ofresponsibility because he
well, such an omission might further result in the liability of the routinely would not have checked the label and the court said he
hospital or the physician or both. could rely on a trained and experienced nurse to obtain the
To voice one's concern and to clarify the order would seem bottle as requested.
to be the choice of the reasonable and prudent nurse. Failure to As a nurse, you mayor may not agree with the decision
communicate has been considered by the Courts to have been absolving the physician but, on the facts of the case. these
unreasonable and negligent in the circumstances. nurses clearly departed from standard. routine nursing practice
Where there has been an error or other mishap in the when they failed to check the label on the bottle.'
administration of medication as a result of the actions of a nurse
.
52 July/Augu8t tll7i
The Cenedlen Nur..
Creighton 5 describes two other cases:
In the first. a hospital and nurse in the U.S. were held liable for
injuries suffered by the patient when the nurse inserted drops of
hydrochloric acid in the patient's nose instead of nose drops.
In the second, a student nurse failed to read the warning on
the ampoule that the drug therein contained was for I.V. use
only. She injected the drug I.M. into the patient's buttocks. The
patient suffered damage to his leg.
Wrong dosage or concentration
In a 1940 Canadian case. a nurse administered silver nitrate
drops to the eyes of a new-born baby. She did not check the
strength of the solution she was administering; the
concentration was too high and the baby suffered severe
damage to one eye while losing the sight of the other. The
hospital was held responsible for the negligence of the nurse. 6
In another case.-the efforts of a well-intentioned nurse
resulted in the death of a three-month-old child admitted to
hospital with a congenital heart condition. Special arrangements
were made at the time of admission that the child's mother
would administer the child's daily dose of Lanoxin.@The nurses
were to give it only if the physician wrote a specific order. That
day, he had written "give 3.0 cc Lanoxin today for one dose
only. ..
The pediatric unit was very busy that day and the assistant
director of nursing. while on her rounds. decided to assist.
Noting that this drug had not been given, she proceeded to
prepare it. The nurse was unfamiliar with the pediatric elixir of
Lanoxin and from her knowledge of injectible Lanoxin.
he
thought that the dosage was high for a child. There was some
discussion with the registered nurse on duty and with a
consultant on the case. At no time was the prescribing physician
called. The nurse gave the injection. The dosage given was
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about five times the strength of the pediatric elixir. The child
died.
The parents recovered damages from the nurse and
physician. Thejudgment read. in part. as follows:
"As laudable as her intentions are conceded to have been on
the occasion in question, her unfamiliarity with the drug was a
contributing factor in the child's death. In this regard. we are of
the opinion that she was negligent in attempting to administer a
drug with which .
he was notfamiliar....Not only was Mrs.
Evans unfamiliar with the medicine in question but she also
l'iolated what has been shown to be a rule generally practiced
by the members of the nursing profession in the community
and, which rule we might add, strikes us as being most
reasonable and prudent, namely, the practice of calling the
prescribing physician when in doubt about an order for
medication."
Wrong route or method
Dramamine@ hypodennically was ordered for an obese patient.
The nurse charted its having been so given. The patient.
however. suffered severe necrosis of tissue in the area of the
injection site and required further surgery and hospitalization.
In awarding damages against the hospital. the Court 7 held that
on the evidence the injection. though charted as I.M., could not
have been thus given. The only conclusion consistent with the
injuries was that the Dramamine had been given s.c.
(subcutaneously). Only a subcutaneous injection of
Dramamine, which is highly irritating to tissues, could have
caused such damage.
The Court found the nurse negligent because:
I. She should have known that Qramamine, a well-known
drug. if given by injection must be given I.M. because of its
irritating qualities; and
2. The nurse should ha ve foreseen that a longer needle
would be required to achieve deep muscle penetration for an
I.M. injection to a patient of this girth.
Injuries resulting from administration
In giving I.M. injections. nurses are taught to carefully
detennine the site to avoid hitting the sciatic nerve. There are
reported cases where the patient recovered damages for injuries
sustained when the sciatic nerve was struck during injection. R In
an American case of this nature, the damages awarded were
$17.000. The patient was left with a limp that severely hampered
his ability to carryon his business.
The necessity for showing that the proper procedure was
followed is demonstrated in the decision of Cavan l'. Wilcox. ß In
that case. the physician ordered an injection of BicillinQl) which
the nurse gave in the deltoid muscle. The antibiotic entered the
circumflex artery and as a result the patient developed gangrene
in part of his hand. The Supreme Court of Canada absolved the
nurse of responsibility for this damage.
The Court found that the evidence indicated that she had
followed accepted nursing procedures and had pulled back on
the plunger prior to injecting the Bicillin to ensure that a blood
vessel had not been penetrated. Because no blood entered the
barrel. the injection was properly given.
The Court also found that the nurse was not negligent in her
failure to foresee such damage because of the proximity of this
artery. Such knowledge was established as not being part of
nurses' training and therefore was not part of that body of
knowledge to be possessed by the reasonable prudent nurse.
There have been some reports of cases where injury
resulted from the breaking of the needle during injection. In a
case where liability was found 10, a five-and-a-half-year-old child
was injured when the needle broke in his ann during a
vaccination. The child was upset and jerked his arm upon
feeling the prick of the needle. The Court found that the
physician had not met the required standard of care because he
failed to ensure that the ann was sufficiently immobilized. The
TIle Cllned18n NUrN
physician knew the child was upset and nervous and should not
have proceeded with the vaccination.
However, in Vezina v. D.II, the doctor was not found to
have been negligent. Here, the needle broke during the
administration of a spinal anesthetic prior to surgery. The Court
found that the physician had taken all reasonable precautions to
prevent such an accident. While the needle was of a fragile type,
there was no evidence that it had been twisted, bent, or
otherwise misused prior to breaking. Having done all he
reasonably was expected to have done, the physician's conduct
did not fall below the standard of car
required.
Mistaken identity
Nurses must be certain that the patient receiving the medication
or treatment is the person for whom it is ordered.
In an American case, a nurse and intern proceeded to
administer a blood transfusion over the protests of the patient.
The nurse had remarked that the blood had been donated by her
daughter; the patient insisted she had no daughter. In fact, the
blood had been ordered for another female patient on the same
floor. The patient recovered damages for the injuries she
sustained as a result of the blood incompatibility. Such an
example clearly underscores the responsibility to confinn the
patient's identity. Further, it illustrates the necessity of heeding
the patient. The patient's protestations in the foregoing example
should have put the nurse and physician on inquiry. A simple
investigation likely would have clarified the situation and the
hann would have been avoided. Nurses should listen to the
communications of their patients.
From these case illustrations, it is easy to see that errors
occurring in the administration of medication can result in legal
liability to the nurse and her employer, the hospital. The nurse's
adherence to the basic nursing principles of drug administration
and handling will serve to safeguard the health and well-being of
the patient. It may also serve to protect the nurse and the
hospital from either the commencing of a lawsuit or a finding of
liability.
Safety, generally, is the concern of hospitals and the
individuals connected with these hospitals. Safety in the
administration of medications, because of their inherently
dangerous nature, should be of paramount concern.
References
I [1947] 2 D.L.R. 338 (N .S.S.c.). p.340.
2 Ibid.
3 Ibid.
4 R. v. Giardine (1939) 71 c.c.c. 295 where the facts were
similar to Budgen (supra).
5 Creighton, Helen. Law every nurse should know. 3d ed.
Toronto, Saunders, 1975. p.128.
6 Barkerv. Lockhart (1940), 3 D.L.R. 427 (NBCA).
7 Barnes v. St. Francis Hospital and School of Nursing,
Inc. 507P. 2d. 288(1973 Kan.)
8 Huberv. Barnaby General Hospital. [1973]D.R.S. 653
(B.C.S.C.) as reported by Picard E. in Liability of doctors and
hospitals, p.37!.
9 Cavan v. Wilcox [1975] S.C.R. 663.
10 Cardin v. City of Montreal et al., [1961] S.C.R. 655.
II [1961] Que. S.c. 245.
'9\
"You and the law" is a regular
column that appears each month
in The Canadian Nurse and
L'irifirmière canadienne. Author
Corinne L. Sklar is a nurse and
recent graduate of the University
ofT oronlO Faculty of Law and is
currently arricling with a T oronlO
law firm.
'\.
..
The soft touch
for tender tissue.
-
100
JL
CKS*
Pre-Moistened Pads
For hemonhoi ds, feminine
hygiene, piles and personal
itching problems.
Culi., -"il'. AIm.,,,,
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.A8gIStered trademark of Parke DaVIS & Corroa
Parke. D8vIs & Company LId. registered I
P'I
,
Relieve postpartum and postsurgical
itching and burning with Tucks.
PARKE-DAVIS
54 July/Auguet 111711
TIle Cen-.ll.n Nur..
-
news
(continued from page 15)
Nurses speak out on
legal issues in health
Nurses, doctors, hospital
administrators, lawyers and
theologians from all across
Canada gathered in Ottawa
early in May for the Second
National Conference on
Health and the Law.
Approximately 200
registrants attended the
three-day session presented
by the Canadian Hospital
Association in co-sponsorship
with five other agencies
including CNA.
Speakers at the
conference addressed
themselves to several of the
legal problems that concern
health care workers:
. consent to treatment
(including spouses, children,
the mentally ill or retarded
patient, and prisoners)
. communicable diseases,
immunization
. human organ and blood
donations
. death and dying
. cessation of treatment,
euthanasia and patient
suicide.
Papers dealing with each
subject area were presented
by various authorities. These
formal proceedings were
followed by open forum
discussions which allowed
participants to voice their
specific legal concerns.
Nurses who addressed the
audience included Peggy
Searle, assistant director
health care services, Stony
Mountain Institution,
Manitoba who spoke on the
nurse's view of a prisoner's
consent to treatment;
Huguette Labelle, assistant
deputy minister, Corporate
Policy, Indian and Northern
Affairs who spoke on a
spouse's consent to
treatment; Lorine Besel,
director of nursing, Royal
Victoria Hospital, Montreal
who spoke of consent to
treatment by the mentally iIIj
retarded; Marllyn VanBibber,
Stanton Yellowknife Hospital,
Yellowknife, N.W.T. who
spoke about communicable
diseases among people living
in the Arctic; and Lesley-
Degner, associate professor,
school of nursing, University
of Manitoba who presented a
preliminary report from a
study she is currently
completing on nurses' views
concerning cessation of
treatment and euthanasia.
Several nurses spoke up
about their concerns as health
care workers who have to deal
with the practical application
of the law on a day-to-day
basis.
The director of nursing
from one hospital in Regina
asked about her legal
responsibility if called upon to
assign staff to care for a
patient with a highly
infectious disease. Under
these circumstances can
hospital employees refuse to
treat a patient?
In response to this
question Dr. Phll Stuart.
assistant professor of medical
microbiology and assistant
professor of medicine at the
University of Toronto
commented that health care
workers have a moral and
ethical responsibility to care
for all patients. He suggested
workers who have already had
contact with the infectious
patient during diagnosis be
assigned continuing care.
Lome Rozovsky, barrister
and solicitor from Halifax said
hospitals have a responsibility
to their patients to live up to
current standards in health
care. "You must warn your
employees of the inherent
dangers," he said, "and
provide them with all possible
protection to minimize their
danger of contracting the
disease. If you assign an
employee to a patient and he
or she refuses to comply then
you must decide if this means
they are in breech of their job
contract. From there you can
fire them or advise them to
quit. "
Dr. David Roy, director of
the center for bioethics at the
Clinical Research Institute of
Montreal said it is important
for us to "say that a doctor is
allowed, without incurring
penalty, to detennine death
through brain death. There are
people in Canada who have to
risk criminal incrimination
every day that they have to go
through the decision-making
process. "
A nurse from
Saskatchewan spoke as a
health professional who is at
the bedside giving care eight
hours a day. "The people who
are working directly with
patients who experience brain
death need some support. I
need input to help me cope
with this situation. I'm making
an appeal for someone to
come up with something now
to help us cope."
Closeup on the
Victorian Order of
Nurses for Canada
How does a venerable institution such as the VON, now going into its
eighth decade of existence, adapt to societal changes that
have taken place since its founding? National director Ada McEwan, in
her report to the 81 st annual meeting in Ottawa last Spring, outlined
some of the innovative steps being taken by various branches to meet
the changing health care needs of the diverse population served by VON
nurses.
. Last year, for example, one branch established a foot care service
for the elderly in that community. A podiatrist provided a short orientation
for the two nurses on staff and, in the first month of operation, more than
70 requests for the service were received.
. Approximately one third of all branches now provide health
counseling services in senior citizen complexes in an effort to help these
individuals remain healthy and independent as long as possible.
. One branch has developed a specialized visiting program for
patients with chronic respiratory problems; the same branch also
provides a homemaker/home help program and occupational health
service.
. Another branch has opened an adult day care center offering an
exercise program, craft activities, games and films to selected clients.
. Two branches offer daily visiting for at least the first five days after
early (soon after delivery) discharge of healthy mothers and newborns.
. Eight branches participate in a meals-on-wheels program in their
community.
. Four branches offer homemaker/home help service to temporarily
replace family members caring for relatives in their homes as an
alternative to institutional care.
Some other interesting statistics on the VON included by the
national director in her report:
. All but two of the 75 branches continue to have as their main
mission the provision of generalized visiting nursing service.
. In 1978, a total of 1,503,121 visits were made to 87,924 patients.
. Visits in 1978 were up slightly (six per cent) over the preceeding
year.
. Almost three-quarters (74 per cent) of the 1978 VON visits across
Canada were paid for by government sources - ranging from 100 per
cent in Manitoba to 21 per cent in Nova Scotia.
TIle Cen-.llan NUrN
July/Auguet 11171 55
Currents in cardiology attract record crowd
!vlore than 400 nurses and 100 physicians attended the 6th
annual Cardiology '79 conference sponsored by Humber
College in Toronto May 26 and 27. A total of 350 nurses also
participated in the two-day pre-conference ECG workshops:
the Dean of Humber's Faculty of Health Sciences. Lucille
Peszat. was enthusiastic about the attendance saying she felt it
was a sign of nurses' increasing interest in continuing
education. and their desire to meet with other nurses and share
experiences.
Rosemary Coombs. assistant director of Nursing Service at
the Ottawa Civic Hospital. excited her audience with a
presentation on the Civic's cardiac patient teaching program.
including a portion of the slide and sound show actually shown
to patients. Coombs outlined the development and evaluation of
the project. and spoke briefly of some of the problems that had
been encountered. On the whole. she said. it was felt the project
was a success: patients were showing a better understanding of
their illness.
SPHYGMOMANOMETERS
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Other sessions included presentation!> by Drs. H. Marriott
of Flonda and Leo Schamroth of Johannesburg. South Africa.
who spoke on arrhythmias and radiological pointers for the
nurse. respectively. These two presentations served as an
appetizer for more comprehensive workshops held by the
doctors in the afternoon. but were very informative. Other
afternoon options were:
. a workshop on basic 12 lead ECG interpretation given by
Marina Heidman. coordinator of the coronary care nursing
program at Humber College.
. a talk by Louis Wilson, R.N.. of the Lyndhurst Hospital in
Toronto on pulmonary function as related to cardiovascular
disease.
. a discussion of cardiac cellular physiology led by Anita
MacDowell. R.N.. coordinator of staff development at
Scarborough General Hospital.
Also included in the conference materials was a paper on a
patient teaching program in Sarnia. Ontario, written by
Margaret Zagrodney.
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The CaneclI.n Nur..
input
The Canadian Nurse invites your
letters. All correspondence is subjed
to editing and muat be signed,
although the author's name 1NIy' be
withheld on request.
More mystique unfortunate that it is the I must take strong university graduates who have
As a graduate of a schools of nursing themselves exception to the view still so much to learn about
three-year basic degree which tend to perpetuate this expressed blaming Miss practical nursing skills.
program,l read Jeanne Marie by implying that certain Nightingale for the woes of As Jeanne Marie Hurd
Hurd's article "Nursing and technical skills are not reaIly modem nursing. At indicates in "Nursing and the
the degree mystique" (April) important to learn. Nightingale School, St. degree mystique" (Apr. 1979)
with great interest. This schism seems to Thomas's Hospital. we were the nursing profession may
When I was in third year I extend to all areas of nursing. subject to discipline, but a weIl be in time of transition
found that I was stiIl afraid of It seems that good Ward Sister was looked with its future involving a
handling a simple I. V ., even treatment-oriented nurses up to by everyone from higher percentage of degreed
after two semesters of don't understand preventive consultant to ward maid, and nurses in our ranks.
medical-surgical teaching and health care, and vice versa. almost revered by the patient. Let us hope that part of
practice. It took working as a There is a subtle 'putdown' of As students our observations this change will include a
nurse's aide over Christmas each other's role and function. were listened to regularly, and renewed commitment to the
break to convince me that I Is this split indicative of an our training led us graduaIly ethics of our profession and
could. identity crisis in nursing? upwards in responsibility. respect for all our many
This may sound like a Perhaps our profession is Miss Nightingale members who adhere to them.
very simple and - yes, going through its adolescence: effectively removed Sara Otherwise we will lose the
technical- thing to be it is my hope that a firm and Gamp and the gin bottle, and benefit of very valuable skills
concerned about, but the united identity will emerge but made nursing respectable. and talents that exist among
point is I felt that as a third in the interim it is imperative Her ideal was to educate and the majority of nurses from
year nursing student I should that we all, whether degree or train young ladies to care for different educational
have been more comfortable diploma graduates, remember the sick - a skiIl never backgrounds.
with technical things than I that our basic function is to completely learned by sitting Thank you for expressing
actually was. I could provide assistance to the in a classroom. To blame her so well the thoughts of so
appreciate Hurd's statement health care consumer. Ifwe now for the worst of mode rn many of us with or without
that "it is still a truism that the can do this, we wiIl weather developments is to do her degrees.
diploma nurse...often has a the crisis. memory a grave injustice. -Norma-Jane Miller, R.N.,
decided advantage over the -Muriel Sherring, Wabasca, -Elisabeth Harding, SRN, Community Mental Health
degree nurse immediately Alberta. SCM, NipiRon, Onto Worker, Revelstoke, B.C.
following graduation in terms Jeanne Marie Hurd's . ..As a non-degreed
of performance ability and excellent article (April) has nurse, I am very grateful that Articles such as "Nursing
resulting ego strength." received wide approval among within the ranks of our and the degree mystique"
One of the biggest many nurses here. Nurses profession we have academics reflect the growing quality and
complaints of my nursing must co-operate and promote and degreed nurses who are wealth of ideas that The
class was about the lack of avenues of continued able to theorize about nursing Canadian Nurse has to offer
actual practice time. Of education for all. practice. At the same time, as today.
course, if we were concerned Regardless of the one who has worked in senior Thanks again.
enough we could gain preparation base, knowledge nursing administration -Heather Malone, R.N.,
additional experience during and skills become outdated positions, I am profoundly Vancow'erGeneral Hospital.
summer break periods. In too quickly to develop any grateful for the significant Vancouver, B.C.
short, we felt that more elitist group based on a contribution that hundreds of
practice was important. While once-earned degree rather non-degreed nurses and Clarification
the performing of technical than achievement and current licensed practical nurses
skiIls may be seen as a simple competence. continue to make to the Despite the fact that I feel
task, until these skills are The personal goal of quality of patient care. there is some substance to the
weIl-mastered they tend to continuing education is too I agree that a high level of concerns implicit in the
seem incomprehensible and often blocked by a feudal education for nurses is to be article: "N ursing
rather frightening. system of oppression of those desired, but education is also Nineteen-Eighty-F1oor" that
It is interesting too to who choose avenues other found in places other than appeared in The Canadian
note that many diploma than university to maintain universities or even colleges. Nurse, (March 1979) I would
nurses refer to university . like to take this opportunity to
graduates as "Oh, them... .. competence. Current Some of my most respected state that I am not the author
information is more readily colleagues have obtained
with a tone of condescension acquired through other within the hospital who has chosen to use the pen
which may be attributed to the avenues since curriculum environment a level of name Lawrence Nightingown.
new degree graduate's lack of revision at the university level education which makes them -Lawrence H. Jones, BScN
technical expertise. (but was is a slow process. invaluable to their patients, RN, Assistant Administrator
that all?).This appears to be -Marlene Kucey, Assistant their co-workers, their Nursing Services, Trail
evidence of the Administrator. Frank Eliason supervisors and perhaps Regional Hospital, Trail, B.C.
"professional-technical split" Centre, Saskatoon, Sask. above all, those new
Hurd refers to. It is
The Cllned18n NUrN
JuI)'/Auguet 1171 57
Conlents.-Lener 1064-2-C7, Feb. 14, I97S.-Visit to
library United Kinsdom.-Visits to Scandinavian countries.
here's how 16. D
/ilg
. D
nis
Humanison.les hõpitaux,
par.. .et Xavier Leroy. Publié pour I'J nstitut Sardoz
d'études en matière de santé et d'économie sociale.
Paris, Maloine, 1978. 238p.
17. Doy/
, Timothy C. The impact of health system
changes on the nalion's requirements for registered
Every nurse has practical ideas gathered from Publications recently received in the Canadian nurses in I98S. by... George E. Cooper and Ronald
G. Anderson. Hyattsville, Md., U.S. Dept. of
his or her experience on how to make life a Nurses Association Library are available on loan - Health, Education and Welfare, Bureau of Heallh
little easier for nurses and for patients. Here's with the exce.ption of items marked R - to CNA Manpower, Division ofNursins, 1978. 71p. (U.S.
How is a column for you and your ide{ls. If members, schools of nursins, and other institutions. DHEW Pub. no. HRA 78-9)
you have an original and practical suggestion Items marked R include reference and archive 18. Entry into nursing practice. Proceedinss of the
material that does not go out on loan. Theses. also R, national conference, Feb. 13-141978, Kansas City,
that you think might help other nurses to are on Reserve and go ou( on Interlibrary Loan only. Mo. Kansas City, Mo., American Nurses'
improve any aspect of patient care, why not Requests for loans, maximum 3 at a tim
. Association, 1978. 163p.
share it with other nurses? We'll send you should be made on a standard Interlibrary Loan form 19. Gabri
/, Rog
r Medical data interpretation for
$10. for any suggestion published. Let's hear or by letter giving author, title and item number in MRCP, by.. .and Cynthia M. Gabriel. Toronto,
from you. Write: The Canadian Nurse, 50 The this list. Butterwonhs, 1978. 192p.
Driveway. Ottawa, Ontario, K2P I E2. If you wish to purchase a book. contact your 20. "God bless you, my dear Miss Nightingale"
local bookstore or the publisher. Letters from Emmy Carolina Rappe to Florence
NOTE: Readers are reminded tbat they should check Nightingale 1867-1870. Edited by Benil Johansson.
Separate egg and add... ftrst wltb tbe Ubnlry or their JII'Ovinclal DUnes Stockholm. Sweden, Almquist and Wiksell
ueoclaUon, university or coJleJe, to determlM International, 1977. S7p.
We found a 'recipe' that works wonders whether they may obtain the publkatlon(s) they 21. Hospital R
s
arch and Educational Trust
on babies admitted with severe diaper require from tbls øoun:e. Being a nursing aide. 2d ed. Chicago, cl978. 442p.
rash. Place the baby on his stomach and BooIu and Documents 22. How to read financial statements: a practical
expose the buttocks, leaving his J. Ab/
son, J. OUlput variables and proposed approach to sound decision-makins for Canadian
investors. Montreal, Canadian Securities Institute,
undershirt on or nightgown rolled up and tables. by.. BN Chinnappa, E. Praught and J.D. cl977.4Op.
a receiving blanket across his thighs. Richardson. Ottawa, Dept. of Health and Welfare 2J. I nr
rnarional Labour Office Yearbook of
Survey, 1978. 146p.
Apply unbeaten egg white and dry with 2. - . Variables de production et pro jet de labour statistics, 1977. Geneva International Labour
oxygen at least three times a day. The tableaux, par... BN Chinnappa. E. Praught et I.D. Organisation, cl977. 909p
egg white provides the skin with prolein Richardson Ottawa Ministère de la Sante nationale 24. Lachanc
. R.A. Preparing your income tax
et du Bien-ètre social, Enquète santé, 1978. ISOp. returns Canada and the provinces. by... and G.D.
necessary for healing. The area should 3. Alb
rta Association of R
gisr
r
d Nurs
s The Eriks. 1979 edition for 1978 tax returns. Don Mills,
remain exposed. clean and dry at all quiet evolution: expanding roles for registered Ont. CCH Canadian Ltd, 1979..328p.
times. nurses inAlbena. Edmonton, 1978. Iv. (unpaged) 2S. Laun
r, D
borah J. Modem personnel forms,
-Judy Win"-, R..V., Brookfield, 4 Alternative birthins facilities. Columbus, Ohio, prepared by... Boston. Warren, Gorham and
Ross Laboratories, 1978. 8Sp. Lamont, cl976. (various pagings)
Bona
'ista Bay. Nfld. S. Am
rican Nurs
s Association Guidelines for 26. L
wis, Clara M. Nutritional considerations for
review of nursing care at the local level: emphasis the elderly. Philadelphia, Davis, c 1978. 49p.
Hand
Ice Packs given to professional standards review organizations
Have"you ever needed to apply ice packs and the use of outcome criteria in the review of
nursins care. Kansas City, Mo.. American Nurses
to reduce swelling and found that none Association. 1978. 12Sp.
were available? Well.. found that a 6. Am
rican Nurs
s' Association ANA manual of To Canadian Nurse
disposable, non-sterile glove filled with style. 3d ed. Kansas City. Mo., 1978. 77p. Readers
ice and tied tightly at the cuff serves the 7. An exploration ofthe limitations of
contraception. Proceedinss of a conference. Ontario
purpose. Wrap the glove in a towel or Science Centre. November I97S. Toronto, Onho
padding in case of leakage - if the cuff is Phannaceutical, 1975. 64p.
tied tightly, there shouldn't be any 8. Anduson. Elizab
rh T. The development and There are a few English and
problem. implementation of a curriculum model for some French CPS, 12th and 13th
community nurse practitioners. Hyattsville, Md.,
-Charlene Martineau, St. Bruno, U.S. Dept. of Health, Education and Welfare. Public editions, (for reference only)
Quebec. Health Service. Division ofNursins, 1977. I 26p. available to Students on a 1st
(U.S. DHEW Publication no. (HRA) 77-24). come 1st served basis, at $6.00.
Help for Handicapped 9. Bampton. B
rsy A. The female reproductive
system. rev. ed. Springfield, Va. Reproduced by
An invention for the handicapped patient National Technical Information service, 1977. S8p. The Compendium of
allows him to feed himself finger foods. 10. B
lzile. B
rrrand Inflation, indexalion et
The arm from wrist to elbow rests inside conflits sociaux, par...etJean Boivin. Gilles Pharmaceuticals and Specialties
a box constructed ofIight metal and Laflamme et Jean Sexton. Québec. Presses de is a valuable reference used by
!'Universite Laval. I97S. 228p.
padded with washable material. which II. Chisholm. David M. Par-Q validation repon: all health professionals.
rocks easily on acuned metal base. The the evaluation of a self-administered pre-exercise
patient cannot lift his arm unaided, but screenins questionnaire for adults. by. net aI. Send your orders to CPS (Nurse),
Ottawa. Health and Welfare Canada, 1978. 14Op.
he can raise food to his mouth. 12. Collishaw. N
il E. Physical aclivity in Canada, 175 College Street, Toronto,
-Jean Smith, R.N.. Regina, Sas"-. July 1978. by... John R. McWhinnie and Anila Ontario M5T IP8, include
Salmon. Ottawa, Lons Ranse Planning Branch, cheque or money order for $6.00
Dept. of Health and Welfare, 1978. lOOp.
Pruning Pills 13. Th
Commonw
alrh F oundarion - a fine offer, should you prefer
It was a patient who told me about the Commonwealth Caribbean directory of aid agencies: the 14th edition CPS '79. Price
most effective way to cut a hard, charities. trusts, foundations and official bodies $28.50.
unscored pill- use pruning shears. offerins assistance in Commonwealth countries in
the Caribbean region, edited by Norman Tell, and
Using the shears insures that the cut will Ronald Macfarlane. London, 1978. 128p.
be perfectly smooth and straight. Make 14. C ons
il canadi
n d
I'
nfana
r d
la
sure that the shears are clean and if you j
un
ss
. C omiri d' itud
sur /'
nfant
n rant qu
want to be more sanitary about the job, citoy
n. Rapport. Interdit aux mineurs: la place de
!'enfant dans la sociéte canadienne. Ottawa, Conseil
place the pill between two layers of canadien de I'enfance et de lajeunesse, 1978. 19Sp.
tissues while cutting. IS. Crichton, J. U. WHO Travel Fellowship
-Joan E. Travers, R.N., Victoria, B.C. repon. Vancouver, 1975. 3 pts. in I.
51 July/Auguet 1171
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The Cen-.llan Nur..
27. Mans
II. Jacqui
An inventory of innovative
work arrangements in Ontario, by..: Ron Wilkinson
and Alan Musgrave. Toronto, Onlario Ministry of
Labour, Research Branch, 1978. Illp.
28. Nash, Patricia M. Student selection and
retention in nursing schools. Hyattsville. Md. U.S.
Dept. of Health, Educalion, and Welfare. Public
Health Service. Division of Nursing. 1977.7.5p.
(U.S. DHEW Publication no. (HRA) 78-.5).
29. N ational L
agu
for Nursing Generating
effective teaching. New York, cl978. 81p. (NLN
Pub. no. 16-1749)
30. National R
s
arch Council. Committ
on a
Study of National N udsfor Biom
dical and
B
ha.'ioraJ R
s
arch Pusonn
J Personnel needs and
training for biomedical and behavioral research. The
1978 repon of the... Washinglon, National Academy
of Sciences, 1978. 368p.
31. Now that we've burned our boats...the repon
of the People's Commission on Unemployment
Newfoundland and Labrador. St. John's,
Newfoundland and Labrador Federalion of Labour,
1978. 117p.
32. Organisation mondia/
d
la Santi Critères
d'évaluation des objectifs éducalionnels dans la
formation des personnels de santé. Rappon d'un
groupe d'étude de rOMS. Genève, 1977. 48p.
33. Qu
vauvilli
rs. J. Connaissances de base,
soins courants. Protection de la mère et de renfant
par.... L. Perlemuter et. P. Conrad-Burat. Paris,
Masson. 1977. 148p.
34. St. Jos
ph's Hospital Foundation. Palliati>'
car
workshop. Hamilton, Ontario, March J J, 1978
Press kit. Iv. (various pagings)
3.5. Sod
r..trom, L
The Canadian health system.
London, Croom Helm, c1978. 271p.
36. Sutton. Lor
tt
V. A repon of a World Health
Organization travel fellowship to observe home
health services in the United States. Ottawa,
Victorian Order of Nurses for Canada, t978. .5Op.
37. Univ
rsity of Toronto. Offiu ofR
s
arch
A dminislration Patterns of research, edited by T.C.
Clark. Toronto, 1976-1978. 2v.
38. Wamer,AnneR. Credentialingofhealth
manpower and the public interest. Repon of
conference held January 30-31, 1978 Stouffers's
National Center Hotel, Arlington. Va. New York,
National Health Council, 1978. 69p.
39. World Health Organization Steroid
contraception and the risk of neoplasia. Repon of a
WHO Scientific GroUD. Geneva. 1978. .54p. Ots
Technical repon series no. 619)
Pamphlets
40. Ag
nu canadi
nn
d
dév
/oppl!ment
international Programme en bref de la direclion des
ONG pour 1977-1978. Ottawa. 1978. 41p.
41. American Hospital Association Educational
programs in the health field. Chicago, 1977. 3.5p.
42. American Hospital Association. Assembly of
Ambulatory and Hom
Car
S
rvius A prospectus
for a national home care policy prepared by... et aI.
Chicago, c1978. .5p.
43. Am
rican National Standards Institut
American national standard for writing abstracts.
New York, 1971. 12p.
44. - . American national standard for
bibliographic references. New York, 1977. 92p.
4.5. - . American national standard for the
preparation of scientific papers for written or oral
presentation. New York, 1972. 16p.
46. - . American national standard guidelines for
format and production of scientific and lechnical
repons. New York. 1974. 16p.
47. American Nurses' Association Code for nurses
with interprellve statements. Kansas City, Mo.,
1978.2Op.
48. American Nurses' Association Guidelines for
continuing education in developmental disabilities.
Kansas City. Mo., 1978. 27p.
49. -. Commission on Nursing S
rvices Policy
statement on nursing resources. Kansas City, Mo.,
1978.I.5p.
.50. Boyd. Edmond The government health Care
program in Cali, Columbia. Washington, Pan
American Health Organization, 1974. 9p.
.51. - . Health Services in Cuba. np. 197.5? 19p.
.52. Boyd. Edmond The Mexican institute of social
security OMSS). Washington, Pan American Health
Organization, 1974? lOp.
.53. British Columbia Operating Room Nurses'
Group Operating room standards; palienl outcomes,
nursing process and managemenl responsibilities. A
working document. Vancouver, 1978. 24p.
.54. Bruu, David L. Effects oftrace concentrations
of anesthetic gases on behavioral peñormance of
operating room personnel, by.. .and Mary Jane
Bach. Cincinnati, Ohio, U.S. Dept. of Health
Education and Welfare, Public Health Service,
Centre for Disease Control, National Institute for
Occupational Safety and Health, Division of
Biomedical and Behavioral Science, 1976. 32p.
(U.S. DHEW Pub. no. (NIOSH) 76-169)
.5.5. Canadian 1 ntemational D
v
/opm
nt Ag
ncy
NGO program summary, 1977-78. Ottawa, 1978.
41p.
.56. Canadian R
d Cross Soci
ty Annual repon,
1977. Toronto. 38p.
.57. L
Cons
iI intuprof
ssionn
1 du Qulb
c
L'avenir du professionnalisme au Québec; la
réponse des 38 corporations profession nelles,
membres du CIQ. Montréal. 1978. 23p.
.58. Dupuis, R. Travelers to the tropics-guidelines
for physicians, by... J. Keystone. J. Losos and A.
Meltzer. Ottawa, International Developmenl
Research Centre, 1978. 36p. (IDRC Pub. no. 106e)
.59. Friend, Judy Basic review for abdominal
examination during labour, by.. .and Peggy-Anne
Field. Edmonton, University of Albena, Faculty of
Nursing, 1977. t4p.
60. G t. Britain. Joint Board of Clinical Nursing
Studies Notes on the outline curricula. London,
1978. 16p.
61. Hunt, T.E. Geriatric medicine and gerontology
in the United States, Great Britain, Sweden and the
Netherlands. Saskatchewan, 197.5. 26p.
62. Hypoficondite
t infécondit
en Afrique
Résumé du rappon d'un se:minaire international sur
les facteurs d'hypofécondite et infécondite en
Afrique, tenu au centre des conférences de
rUniversité d'lbadan, au Nigeria, du 26 au 30
novembre 1973. Ottawa, Centre de recherches pour
Ie développement international, c1977. 31p.
63. Manitoba Association ofR
gister
d N urs
s
Educational leave and productivity. Position paper.
Winnipeg, 1979. l.5p.
64. Mc Whinnie , John R. L'évolution des années
potentielles de vie perdues (APVP) Canada et
provinces 1969-1976, par...et James C. Cudmore.
Otlawa. Planification à long terme (sante:) Ministère
de la Sante: nationale et du Bien-être social, 1978.
39p.
6.5. - . Trends in potential years of life lost
(PYLL); selected causes. Canada and provinces
1969-1976, by...andJames S. Cudmore. Ottawa,
Long Range Heallh Planning Branch. Dept. of
Health and Welfare, 1978. 39p.
66. Manitoba Association ofR
gist
red N urs
s
Occupational health nursing handbook. Winnipeg,
1978.2Ip.
67. National Health Council Distribution of health
personnel, an annotated bibliography, compiled by
Ellen Sax and Barbara Unterman. New York, 1976.
33p.
68. National Leagu
for Nursing Developing a
master's program in nursing. New York. cl978. 37p.
(NLN Pub. no. 1.5-1747)
69. National Leagu
for Nursing Responsibilities
and liabilities of board members in health care
agencies. New York. 1978. 26p. (NLN Pub. no.
21-1740)
70. - . Council of Diploma Programs Roles,
rights and responsibilities: the educational
administrator's 3 Rs. New York, 1978. 41p. (NLN
Pub. no. 16-1712)
71. -. Council of Home Health Agenci
s and
Community Health Servius Community health
administration in a cost-containmenl era. Papers
presented at the annual meeting Mar. 1-3, 1978,
Washington, D.C. New York, 1978. 18p. (N LN Pub.
no. 21-1743)
72. -. Effective boardmanship: hiring and
evaluating tl1e agency administrator. Three of the
papers in the collection were presented at the annual
meeting. Mar. 1-3, 1978. Washington, D.C. New
York, N.Y.. 1978. 2.5p. (NLN Pub. no. 21-1742)
73. -. Extended hours for /J.ome health services
Papers presented at the annual meeting Mar. 1-3.
1978. Washington. D.C. New York, cl978. 18p.
(NLN Pub. no. 21-1746)
74. - . A home health agency's approach to
marketins. Paper presented at the annual meetins,
Mar. 1-3, 1978. Washinston,D.C. New York, 1978.
7p. (NLN Pub. no. 21-1744)
7.5. Nursins administration: a selected annotated
bibliography of current periodical literature in
nursins administration and management, prepared
by graduate sludents in nursing administration at the
University of Texas School of Nursing at San
Antonio. New York. National League for Nursihg,
1978. 21p. (League Exchange no. 120) (N LN Pub.
no. 20- 174.5)
76. Ogg, Elizab
th Changins views of
homosexuaJity. New York. Public Affairs
Committee, c 1978. 28p. (Public Affairs pamphlet no.
.563)
77. OntarioCouncilofH
alth The planning
function of district health councils. Toronto, 1977.
3.5p.
78. On.ario C ouneil ofH
al.h Medical record
keeping. Toronto, 1978. J8p.
79. On.ario Nurs
s' Associa.ion Statement of
beliefs and long term goals with proposed time-table
for phasing in these goals. Toronlo, Ontano Nurses'
Association, 1979. 18p.
80. Organisa.ion mondia/
d
la San.i Promotion
et developpement de la médecine traditionnelle.
Rappon d'une réunion de rOMS. Genève, 1978.
43p. (Sa série de rappons techniques no 622)
81. Palm
r, S. Public accountability and peer
review in health care delivery in the United Slates
and United Kingdom, by...and D.G. Gill. Bethesda.
Md., U.S. Dept. of Health, Education, and Welfare
Public Health Service, National Institutes of
Health.... 1977. 31p. (U.S. DHEW Pub. no. (NIH)
77-1429)
82. R
gis'
r
d Nurs
s Associa'ion ofOn/ario
Submission to the Royal Commission oflnQuiry into
the Confidentiality of Health Records in Ontario.
Toronto, 1978. 12p.
83. Saska'ch
wan Pnchia.ric Nurs
s Associa.ion
Handbook. Regina, 1978. 3Op.
84. S
minar on uliliza.ion of au;ciliari
s and
community I
ad
rs in h
allh programs in rural
ar
as. Maracay, Vl'n
zu
/a, 18-27 NO\'
mlHr. 1974
Final repon. Washington, Pan American Health
Organization, Pan American Sanitary Bureau,
Regional Office of the World Health Organization,
1978.2Ip.
8.5. Smi.h.E.S.O. Venereal disease programs in
Great Britain. West Germany. Denmark and Sweden
with implications for Canada. Edmonton, 197.5. 17p.
86. Von Schilling. Karin Studies of child
development. Hamilton, 1974. 16p.
87 . World H
al.h Organiza'ion The promotion and
development of traditional medicine. Repon of a
WHO meeting. Geneva, 1978. 41p. (Its Technical
repon series no. 622)
GovernlMnt Documents
British Columbia
88. Brilish Columbia. Commission of Inquiry
Concl'rning .hl' Educalion and Training ofPrac'ical
Nurs
s and R
/a.
d Hospilal Pusonn
1 Repon.
Vancouver. 1977. 16p.
Canada
89. Commission d
lafonclionpubliqu
Canada.
Offic
dl' la promolion d
laf
mm
Brochures.
Ottawa, 1978. 3v. Sommaire: - 1. us conges de
maternité dans la fonction publiQue fédérale, 1977.
- 2. La garde des enfants: renseignements a
I'intention des fonctionnaires, 1978. -3.Le travail å
temps paniel dans la fonction publiQue fédérale.
90. Dl'pl. of N alional D
f
nu . Canada
Em
rgl'ncy M
asurl'S Organizalion Canadian
Emergency Measures College Arnprior, Ontario.
Ottawa, Dept. of National Defence, 1978? 8p.
91. Emploi
llmmigra/ion Canada. Analys
I
dév
/op
ml'nl-prof
ssions
I carriirl's Carrières
dans les services de santé. Ottawa,
The C8n-.l\en NUrN
Looking for more control over
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Choice of assignments, flexible
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Medical Personnel Pool is an
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Approvisionnements et Services, 1978. 24p.
92. Employm
n' and Immigra/ion Canada.
Occupa/ional and carur analysis and d
,'
/opm
n/
Careers in health services. Ottawa. Supply and
ServicesCanada. 1978. 24p.
93. H
al.h and W
lfar
Canada tntroduction to
medical services. Ottawa, 1978?v. (unpaged)
94. HnJllh and W
lfar
Canada. Hospi.al
Insuranc
and Diagnoslic S
rvic
s Repon, 1976.
Ottawa. 1976-77. l.5p.
9.5. - . F ami/}' Planning Di.ision Communication
in family plannins: a self-teaching manual. Ottawa,
1978. 16p.
96. - . H
allh C onsullanls Dir
clOral
. H
allh
Programs Branch Review of the literature on home
care. Ottawa. 1977. 93p.
97. -. M
dical Sl'rvius Branch Repon. 1976.
Ottawa.'v.
98. Labour Canada Canada and the international
labour code. Ottawa. Supply and Services Canada,
1978. 83p.
99. Labour Canada. Employm
n/ R
/alions
Branch I ndustrial relations research in Canada.
1976-77. Ottawa, Minister of Supply and Services
Canada. 1969-1978. 317p.
100. LaM's. S.a/ul
s, I'lc. Canadian Centre for
Occupational Health and Safety Act, S.c. 1978. Bill
C-3.5. Ottawa. Queens Printer, 1978. lOp.
101. Lois, SlCJluU.
Ic. Centre canadien d'hygiène
et de sécurité au travail. S.R. 1978. Bill C-3.5.
Ottawa, Imprimeur de la Reine. 1978. lOp.
102. M inislir
d
la D
f
nu naliona/
.
Organisation d
s mesur
s d' urg
ncl' du Canada
Collège canadien des mesures d'urgence, Arnprior,
Ontario. Ottawa, 1978? 8p.
103. PublicS
,,'icI'Canada. Offic
of Equal
Oppor/uni.il's/or Wom
n Pamphlets. Ottawa. 1978.
3v. Contents: -I.Maternity leave in the federal
public service, 1977. - 2 Child care information for
public servants. 1978. -3.Pan-time work in the
federal public service.
104. San/i
IBi
n-llr
social Canada Profit des
services médicaux. Ottawa, 1978? Iv. (non paginé)
10.5. - . Division d
la planificalion familia/
La
communication dans la planification familiale; guide
autodidactiQue. Ottawa, 1978. 16p.
106. S
cr
lary of Slall'. Educalian Suppor. Branch
Julyl Aug.... 11711 III
e.
An International Nursing Service
You'll find us lIsted in the u,hlte pages.
Guide 10 government of Canada programs of
financial aid for Canadian post-secondary students
Ottawa. Minister of Supply and Services, c 1978.
16p.
107. Sla/lSlics Canada Consumer price index;
revision based on 1974 expenditures; concepts and
procedures. Ottawa. 1978. 91p. (Catalogue no.
62-.546)
IOS. -. Universities: enrolment and degrees.
1977. Ottawa, 1979. 72p. (Catalogue no. 81-2(4)
109. Stalisliqu
Canada L'indice des prix à la
consommation; revision fondée sur les dépenses de
1974; concepts et procédes. Ottawa. 1978. 91p.
(Catalogue no 62-546)
110. Travail Canada Le Canada etle code
international du lravai!. Onawa, Ministre des
Approvisionnements et Services Canada. 1978. 92p.
III. Travail Canada. Dir
c/ion d
s rl'la/ions
n
maliir
d'
mploi La recherche sur les relations
indusl/ielles aU Canada- 1976/77. Ottawa, Minislre
des Approvisionnemenls et Services Canada.
1969-1978. 317p.
Ontario
112. LaMs. s/alu/
s, I'lc. An act respect ins the
occupational health and occupational safety of
workers. Bill 70. Toronto, Queen's Printer, 1978.
4Op.
Q
bK
113. \1inis/ir
d
s AJ]airl's socialu. Cons
iI d
s
Affair
s socia/
s
/ d
lafamill
laQu
,tion de la
promotion des initiatives volontaires dan, Ie
domaine des affaires sociales au Québec. Quebec.
1978. 27p.
Saskatchewan
114. D
p/. ofH
allh Proposal for a national health
disciplines education accreditation council. Regina,
1976. .5p.
United States or America
11.5. D
pl. ofH
al/h. Educa/ion. and W
lfar
.
Division of Nursing A directory of expanded role
programs for registered nurses. 1979. Hyattsville.
Md.. U.S. Dept. of Health, Education and Welfare.
1979. Iv. (DHEW Pub. no. (HRA) 79-10) R
eo July/Auguet 111711
The C.nedl.n NUrM
116. - . Public H
alth S
rvia. C
ntu for Dis
as
Control Sexually transmitted disease (SID)
statistical letter. Atlanta, 1978. .56p.
117. D
pt. of Health, Education and Welfar
A
directory of preceptorship programs in the health
professions. New York, National HealthCouncil,
1977. 7.5p. (U.S. DHEW Pub. no. (HRA) 77-62)
118. - . Offia of Prof
ssional Standards Review
Professional standards review organizations, a
selected bibliography. Rockville, Md.. 197.5. 101p.
119. V
/eransAdministration. D
pt. ofM
dicin
and Surgery Program guide, nursing service. 2d ed.
Little Rock, Ark.. VA Hospital, 1972. Iv. (various
pagins)
Scarborough Depanment of Health. Toronto,
Faculty ofNursins, University of Toronto, 1979.
174p. R
122. Greniu. Raymond Etude évaluative d'un
programme d'enseignement préopératoire de groupe
offen àdeux moments différents. Montréal, 1977.
174p. Mémoire -(M.N.) - Montréal. R
123. Linehan, Marc
lIa P. Absenteeism and job
satisfaction among nursing staff in a 100 bed
hospilal. Halifax. Registered Nurses Association of
Nova Scotia, 1978. 64p. Thesis (M.N.) -Dalhousie. R
124. Park
r. Nora I. A competency approach to
the development of credit examinations for assessing
point of entry of diploma graduates into a
baccalaureate nursins programme. Toronto. 1978.9p.R
12.5. R
gistered Nurses' Association of Ontario
Repon of the workins pany on approaches to
facilitate Ihe fit of new two year graduates. Toronto,
1978. .5lp. R
126. Toumish
y, Laura Hope Punishing the
Studies In CNA Repository Collection
120. Cam
ron, Cynthia Challenge in implementing
a conceptual framework. Strategies to favour or
avoid political perspective. Toronto. 1978. l.5p. R
121. Cunningham. Rosella Child abuse program
The University of Michigan Hospitals
sponsors H.1 working visas for
Canadian RNs
-.;;:
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'-
BEDSIDE NURSINCi
We feel that a nurse's time should be spent with patients: not carrying
messages. transporting patients, or searching for supplies and equipment
That is why each decentralized nursing unit is assigned a Unit Management
Supervisor to see that non-nursing tasks are camed out by non-nursing
personnel. This leaves our nurses free to devote their time and energy to the
important task of patient care.
We thmk It makes sense If you agree. we would like to tell you more about
the career opportunities at U of M Hospitals in Ann Arbor Please call collect
(313) 763-3010, or mail coupon below for additionalmformatlon to:
Nurse Employment Office
University of Michigan Hospitals
3280 HFPB, Box 46
M Ann Arbor, Michigan '48109
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Name
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pregnant innocents: single pregnancy in St. John's.
Newfoundland. St. John's. 1978. l48p. Thesis
(M.Sc.)-Memorial R
127. Trimmer, B
lIy Lou Impacts of early learning
in a bicultural situation. Ann Arbor, Mich., 1973.
IIp.R
128. Unil'ersité Laval. Écol
d
s Sci
nas
irifirmi
r
s Les sciences infirmières etles sciences
de la santé. Mémoire de l'École des sciences
infirmières, Université Laval. Québec, Qui. 1968.
112p. R
A udlo VIsual Aids
129. Binh control: methods and principles. Garden
Grove,Ca.. Trainex, 1978. I pam. I filmstrip, I
audiocaselte.
no. Canadian Nurses' Associa/ion. Biennial
Com'en/ion. Toron/o, June 25-28.1978 Proceedings
and papers. Toronto. Audio Archives of Canada,
1978.9 audiocassettes. Contents.-I.A Challenge to
the professional. Donna Wicks, Jocelyn Morin. The
emergins conflict of professional and consumer
rights. Bernadette Walsh.-2.The everyday realities
of ethical concerns. David Roy .-3.Ethical issues in
professional development. Abbyan Lynch, Margaret
SCOII Wright. Margaret Neylan.-4. Ethics of nursins
research. Laurier Lapierre. Moyra Allen, Huguette
Labelle, Marie-France Thibaudeau, Beverlee
Psychiatric Nursing
Post Graduate Program For
Registered Nurses
This 16 week full-time program combines
clinical experience with studies in comparative
theories of Personality Development,
PredisposinslPrecipitating Factors, Crisis
Theories..Nursing Process, Therapeutic
Modalities such as Counselling and Group
work, Outreach programs, Community
psychiatry and Professional Development.
Fall program begins September 4, 1979.
Winter program begins February 4. 1980.
For funher information contact:
Department He.d
Diploma Nursing
Health Scienc:es Di\'ision
Durham CoUege
P.O. Box J85
Oshawa. Ontario
LlH7L7
Cox.-.5.The professional association meels the
challenge. Marguerite Schumacher. Sheila
Belton.-ti.The frontiers of science and humanity.
Roy Bonisteel.-7.Canada health survey. T.
Stephens.-8.Current conflict and a look toward the
future. M. Josephine Flaheny .-9.President's
address. Joan Gilchrist.
131. Decisions. decisions. decisions. Garden
Grove. Ca. Trainex. 1978. I pam., I filmstrip, I
audiocassette
132. Labe"
. HlIgue/l
Health: the major link for
community development activities. Paper delivered
to the 2nd International Congress of the World
Federation of Public Health Associations and Ihe
69th annual conference of the Canadian Public
Health Association.. .on May.23rd, 1978. Halifax,
1978. I audiocassette. 60 min.
133. Leadership in nursing. Garden Grove, Ca.
Trainex. 1978. I pam., I filmstrip, I audiocassette.
134. Mental heallh series. Garden Grove. Ca. I
pam.. J filmstrip. I audiocassette.
13.5. The nurse. ethic!!. and the law. Garden Grove.
Ca. Trainex, 1978. I pam.. I filmslrip, I
audiocassette.
136. The nursing audit. GardenGrove, Ca.
Trainex, 1978. I pam.. I filmstrip, I audiocassette.
13 7. The nursing history. Garden Grove, Ca.,
Trainex. 1978. I pam.. I filmstrip. I audiocassette.
138. Pharmacology. Garden Grove, Ca. Trainex,
1978. I pam., I filmstrip. I audiocassette.
The Can-.llan Nur..
Jul)'/Auguet 11711 11
Classified
Advertisements
Alberta
ReaI*red Nunn required for acute
are general
hospital, expandina from 75 beds to 300 b1õds.
Clinical areas include: medicine, surgery, obstetncs,
paediatrics, psychiatry, activation and rehabilita-
tion, operatins room, emergency and intensive and
coronary care unit. Must be eligible for Albena
registration. Personnel policies and salary in accor-
dance with AARN contract. Apply to: Personnel
Administration, Fon McMurray Regional Hospital,
7 - Hospital Street, Fort McMurray, Albena, 1'9H
IP2.
Big Country Heallh Unit requires a DIrector to
commence work as soon as
ssible. Applicant must
be a Registered Nurse wtth some experience in
Public Health. This is a supervisory position and
applicant needs to be knowledgeable in the manage-
ment field. Salary nego .able based on qualifications
and experience. Please .pply in writina to: Director,
Big Country Health Unit, Box 279. Hanna, Albena,
TOJ tPO.
ReaI*red Nunn required fo.r .pan-time
d
II-
time employment. Must be ehglble for registration
with AARN. Salary and benefits as per U.N.A.
contract. Residence available. Apply in writins to:
Director of Nursins, Wainwright Hospital Complex,
Wainwright, Albena, TOB 4PO, or phone (403)
842-3324.
British Columbia
Head None - Pedletrks required for progressive
general hospital in Fraser Valley. Eligibility for
Registration in B-c. required. Advanced preparation
in administrative nursing techniques, including ward
management and principles of supervision or its
equivalenl. Apply in writing to: Director of Nursins,
Matsqui-Sumas-Abbotsford General Hospital, Ab-
botsford, British Columbia, V2S 3PI.
SUIft Nunes required for the following areas:
Psychiatry and Medical. Eligibility for registration in
B.C. required. Formal trainins and/or experience
preferred. Apply in writing to: Direclor of Nursing,
Matsqui-Sumas-Abbotsford General Hospital, Ab-
botsford, British Columbia, V2S 3PI.
E1Iperienced General Duty Gnduale Nurses required
for small hospital located N.E. Vancouver Island.
Maternity experience preferred. Personnel policies
according to RNABC contract. Residence accom-
modation available $30 monthly. Apply in writins to;
Director ofNursins. St. George's Hospital. Box 223.
Alen Bay, British Columbia, VON IAO.
Genenl Duty (B.C. registered) nurses required for
expansion to 422 acute care accredited hospital
located 6 miles from downtown Vancouver and
within easy access to various recreational facililies.
Excellent orientation and on-goins inservice prog-
ramme. Salary: $1.305.00--$1,542,00 monthly. Clini-
cal areas include coronary care, intensive care.
emergency. operating room, P.A.R.R.. medical/sur-
gical, pediatrics, obstetrics. onhopedics and activa-
tion units. Head Nurse position also required for our
critical care unit, effective immediately. Candidates
must have had at least two year's related experience
and should have a demonstrable record of manage-
rial skill Apply to: Co-ordinator-Nursing. Dept. of
Employee Resources. Burnaby General Hospital.
3935 Kincaid Street, Burnaby. British Columbia.
VSG 2X6.
E1Iperienced Nunes (eligible for B.C. Registration)
required for full-time positions in our modem
300-bed Extended Care Hospital located just thiny
minutes from downtown Vancouver. Salary and
benefits according to RNABC contract. Applicants
may telephone 525-091 I to arrange for an interview.
or write giving full paniculars to; Personnel Direc-
tor, Queen's Park Hospital. 315 McBride Blvd..
New Westminster. British Columbia, V3L 5E8.
British Columbi J
Assistant Director or Nunll1J! - Applicants are
invited for the position of Assistant Director of
Nursing. for a ;225-bed Acute General Hospilal.
Saint Mdry's Hospital is fully accredited and olTers
Medical. Surgical. Pediatric and Sub-special ser-
vices. Qualifications: At least B.Sc.N. with de-
monstrated leadership ability. Minimum of S years
progressive nursins experience with at least 2 of
these years in a Nur.ins Administrative position.
Address all enquiries in writing together with
complete resume 10; Director of Nursing, Saint
Mary's Hospital, 220 Royal Avenue, New
Westminster. British Columbia. V3L IH6.
Experienced Nunes (B.C. Regislered) required for a
newly expanded 463-bed acute, teaching. regional
referral hospital located in the Fraser Valley. 20
minutes by freeway from Vancouver. and within
easy access of various recreational facilities. Excel-
lent orientation and continuing education program-
mes. Salary-I979 rates-$130S.00--$1542.00 per
month. Clinical areas include: Operating Room, Re-
covery Room, tntensive Care. Coronary Care,
Neonatal Intensive Care, Hemodialysis, Acute
Medicine. Surgery, Pediatrics. Rehabilitation and
Emergency. Apply to: Employment Manager. Royal
Columbian Hospital, 330 E. Columbia St., New
Westminster, British Columbia, V3L 3W7.
Head Nurse - r.eoDatal Intensive Care Unit. The
Prince George Regional Hospital. a 340-bed acute
care and !2-bed extended care hospital. requires a
Head Nurse for the Newborn and Neonatallnten-
sive Care Unit. Requirements: Demonstrable lead-
ership and administrative skills. Clinical preparation
and previous experience in care of the critically ill
neonate and eligibility for registration with the
RNABC. Salary Range: $1500.00 - $1772.00 per
month. Interested applicants are inviled to submit
applications to the: Director of Personnel Services,
Prince George Regional Hospital. 2000 - 15th
Avenue, Prince George. British Columbia. V2M
IS2.
Regløtered Nunn required immediately for perma-
nent full time positions at IO-bed hospital in B.C.
Salary at 1978 RNABC rate plus nonhern living
allowance. Recognition of advanced or primary care
education. One year experience preferred. Apply:
Director of Nursing, Stewan General Hospital, Box
8, Stewan, British Columbia, VOT IWO. Telephone:
(604) 636-2221 Collect.
General Duty Nurses reqUIred for an acute general
hospital in the tnterior of B.C. Apply in writing to:
R. L. Keiver. Assistanl Administrator. Personnel,
Trail Regional Hospital. Trail. British Columbia,
VIR 4MI.
The Cancer Control Agency of British Columbia has
openings for experienced oneolo8} nurses in am-
bulatory eare and inpatient units. Positions olTe r
opponunities for teaching and research responsibil-
ity as well as patient care based on a primary nursing
concept. Interested applicants should write or
phone: Sue Rothwell. Director of Nursing. C.C.A.
B.C., 2656 Heather Street, Vancouver, British
Columbia, VSZ 3JJ (604) 873-6212.
St. Paul's Hospital inviles applications from B.C.
Regløtered N..... for full and pan time positions in
all areas of the hospital. St. Paul's is an acute referral
teachins hospital located in downtown Vancouver.
1979 R.N. rates $1305.00 - $1542.00. Generous
fringe benefits. Apply to: St. Paul's HOSpital,
Personnel Depanment, 1081 Burrard Street. Van-
couver, British Columbia, V6Z IY6.
Manitoba
Experienced Reaistered NuIWS required for a fully
accredited 200-bed Health Complex located in
Nonhern Manitoba. Must be eligible for registration
in Manitoba. Salary dependent on experience and
education. For funher information contact: Mrs.
Mona Seguin, Personnel Director, The Pas Health
Complex Inc., P.O. Box 240. The Pas, Manitoba,
R9A I K4.
Northwest Territories
The Stanton Yellowknife Hospital, a 72-bed accre-
dited, acute care hospital requires registered nurses to
work in medical, surgical, pedlatnc, obstetrical or
operating room areas. Excellent orientation and
in service education. Some furnished accommoda-
tion available. Apply: Assistant Adminislrator-
Nursins. Stanton Yellowknife Hospital, Box 10,
Yellowknife, N.W.T., XIA 2NI.
Ontario
RN, GRAD or RNA, 5'6" or over and strong,
without dependents, non smoker, for 175 lb.
handicapped. retired executive with stroke. Able to
transfer patient to wheelchair. Live in 1/2 yr. in
Toronlo and 1/2 yr. in Miami. Wages: $200.00 to
$250.00 wkly. NET plus $80.00 wkly. bonus on most
weeks in Miami. Write: M.D.C., 3532 Eglinton
Avenue Wesl. Toronto, Ontario, M6M IV6.
Saskatchewan
R.N.'s and R.P.N.'s (eligible for Saskatchewan
registration) required for 340 fully accrediled ex-
tended care hospital. For fun her information.
contact: Personnel Depanment. Souris Valley Ex-
tended Care Hospital. Box 2001. Weyburn. Sas-
katchewan S4H 2L7.
United States
CaUrornia - Sometimes you have to go a long way
to find home. But. The White Memorial Medical
Center in Los Angeles. California. makes it all
wonhwhile. The While is a 377-bed acute care
teaching medical center with an open invitalion to
dedicated RN's. We'li challenge your mind and offer
you the opportunity to develop and continue your
professional growth. We will pay your one-way
transponalion, offer free meals for one month and all
lodging for three months in our nurses residence and
provide your work vIsa. Call collect or write: Ken
Hoover. Assistant Personnel Director. 1720 Brook-
lyn Avenue. Los Angeles. California 90033 (213)
268-5000. ext 1680.
Nurse. - RN. - Immediate Openings in
California-Florida-Texas-Mississippi - if you are
experienced or a recent Graduate Nurse we can offer
you positions with excellent salaries of up to $1300
per month plus all benefits. Not only are there no
fees to you whatsoever for placins you, but we also
provide complete Visa and Licensure assistance at
also no cost to you. Write immediately for our
application even if there are other areas of the U.S.
that you are interested in. We will call you upon
receipt of your application in order to artanse for
hospital interviews. You can call us collect if you are
an RN who is licensed by examination in Canada or
a recent graduate from any Canadian School of
Nursing. Windsor Nurse Placement Service. P.O.
Box 1133, Great Neck, New York, 11023. (516-
487-2818).
"Our 20th Year of World Wide Service"
112 July/Auguet 11711
The Can-.llan Nur..
United States
United States
Replltered Nunes - CI.UfomIa - Rapidly growillj
inland port city in the heart of California's Big
Valley. 260-bed, fully accredited teaching hospital.
Ideal location within 2-3 hours by car of San
Francisco, Yosemite, Lake Tahoe, Monterey Penin-
sula and historic Mother Lode. Four-season climate
with snow-free winlers. Contact: Laurel Murphy,
Director of Nursillj, P.O. Box 1020, Stockton,
California, 9.5201, (209) 982-t800, Ext. 6016. Amr-
maIlve actlon/equlll opportunity employer.
R.N.'. - Our Florida Hospitals need you. We will
provide the work visa, help you locate a position.
find housing. arrange your relocation. No fees. Call
or write: MedIcal Rec:rulters of Amerlc:a, 1211 N.
Westshore Blvd., Suite 20.5, Tampa, Florida 33607
(813) 872-0202.
F10rlda NursIng Opportualt1eø - MRA is recruitillj
Reaistered Nurses and recent Graduates for hospital
positions in cities such as Tampa, St. Petersburg,
and Sarasota on Ihe West Coast; Miami, Ft.
Lauderdale and West Palm Beach on the East Coast.
If you are considering a move to sunny Florida,
contact our Nurse Recruiter for assistance in
selecting the right hospital and eity for you. We will
provide complete Work Visa and State Licensure
information and offer relocation hints. There is no
placement fee to you. Write or call Medklll
Recruiters of America, Inc. (For West Coast) 1211 N
Westshore Blvd., Suile 20.5, Tampa, FI. 33607 (813)
872-0202; (For East Coast) 800 N.W. 62nd St., Suite
.510, Ft. Lauderdale, F1. 33309 (30.5) 772-3680.
ReJløtered and L1celUed Pradlcal Nuneø needed in
Georgia of the U.S.A. Salary negotiable. Applicants
please reply to: Personnel Office, Shirley's Conva-
lescent Center, P.O. Box 96, Dahlonega, Georgia,
30.533.
RN's - Boise, ldabo - How would you like a
rewardillj career in an environment which offers you
immediate access to uncongested recreation areas
with rivers, lakes and mountains? Do you enjoy
tennis, golf, racketball, campillj, hiking, skiins and
horseback ridins? Sound excitins? It is. And there
are many opportunities for satisfying work at one of
Idaho's largest and most progressive medical
complexes. St. Alphonsus, located in Boise, is a
229-bed facility offering you positions in
orthopedics, ophthalmology, dialysis, mental health,
neurosurgery and trauma medicine. Excellent
salary, generous benefits and job security. Starting
salary adjusted for experience; benefits include
travel assistance, shift rotation, and free parkillj.
Write or call collect: Employment Supervisor,
Personnel Office, St. Alphonsus Hospital, 10.5.5
North Curtis Road. Boise, tdaho 83704. (20111
376-3613. EOE.
Nursinll OpportunIties In New Orleans, Loulslana-
MRA IS recruitins Registered Nurses and recenl
Graduates for several general and teaching hospitals
in the exciting New Orleans area. Openinss in many
speciallies and most Canadian Registered Nurses
can Qualify for licensure endorsement in Louisiana.
Contact our Nurse Recruiter for tuition assistance
plans. We will provide complete Work Visa and
State Licensure information. There is no placement
fee to you. Write or call Medlclll Rec:rulters of
America, Inc., 800 N.W. 62nd St., Suite .510, Ft.
Lauderdale, F1. 33309. (30.5) 772-3680.
Nursing Opportunity - Mississippi Baptist Medical
Center, a major 6()(}.bed hospital, has immediate
positions available for experienced RNs and recent
nursing school graduates in a variety of specialities
and medical/surgical areas. Competitive salaries,
liberal benefits. Visa, licensure and relocation
assistance provided. Located in Mississippi's capital
city of Jackson (population 300,(00), MBMC is the
state's largest and most modem privately operated
hospital. For further information write: Mrs.
Johnnye Weber, Nurse Recruiter, 122.5 North State
Street. Jackson. Mississippi 39201; or call collect
601/968-.513.5.
r" Before accePti",L any
position in the .S.A.
PLEAS
CALL US
COLLECT
w. Can Offer You:
A) Selection of hospitals Ihroughout
the USA
B) Extensive information regarding
HospitaJ-- Area. Cost of living. etc_
C) Complete licensure and Visa Service
Our Services to you are at
absolutely no fee to you.
WINDSOR NURSE
PLACEMENT SERVICE
P.o. Box 1133 Great Neck. N.Y. 11023
(516) 487-2818
Our 20th Year of World Wide Service ....,j
Grande Prairie General Hospital
Assistant Director of Nursing
(Acute Care)
Position required for a 230 bed hospital complex wilh
planning and construction underway for a 4
7 bed
complex to open Spnng 1983. located in a city of
20.000.
Upwdrd mobility within the organization possible.
Nursmg and Management experience required.
Experience in critical care nu.-sing an asset. Bachelors
or Masters degree in Nursmg and/or administration
deSIrable _
Sdlary: $20.000 - $23.000 annually.
Apply to.
Mrs. D. O'Brien
Director of Patient Service
t0409 -98th Str
t
Grande Pralri., Alberta
T8V 2E8
Or phone: (4011
32-7711 (Ext. 241
UNITED STATES
OPPORTUNITIES
FOR REGISTERED NURSES
A V AILABLE NOW
IN
ARIZONA
CALIFORNIA
TEXAS
WE PLAC E AND HELP YOU WITH:
STATE BOARD REGISTRATION
YOUR WORK VISA
TEMPORARY HOUSING - ETC.
A CANADIAN COUNSELLING SERVICE
PhoM: (416)449-5883 OR WRITE TO:
RECRUITING REGISTERED NURSES INC.
t200 LA WRENCE A VENUE EAST, SUITE JOI,
DON MILLS, ONTARIO M3A ICI
FLORIDA
OHIO
NO FEE IS CHARGED
TO APPLICANTS.
R.N.'. U.S.A. - Dunhill with 2.50 offices has
excitins career opportunities for both recent grads
and experienced R.N:s. Locations North, SOulh,
East and West. AU fees are paid by the employer.
Send your resume to: SOl Empire Buildillj, Edmon-
ton, Alberta, T.5J IV9.
NursIng P08ltlons AvaIlable: At a replacement facility
due to completion in early 1980. Diversified services
in a small community selling 6 miles from Ihe
Atlantic Ocean where water sports are available all
year round. University is within 30 miles where you
can further your education in nursing. Contact: Mrs.
B.J. Donnally, Director of Nursing, J.A. Dosher
Memorial Hospital, Southport. North Carolina
28461. (919) 4.57-6664 Belween the hours of 8:00-
4:30 p.m. Monday thru Friday.
Dallas, Houston, Corpus Cbrlstl, etc, etc, elC. The
eyes of Texas beckon RN's and new grads to
practice their profession in one of the most
prosperous areas of the U.S. We represent all size
hospitals in virtually every Texas and Southwest
U.S. City. Excellent salaries and paid relocation
expenses are just two of many super benefits
offered. We will visit many Canadian cities soon to
interview and hire. So we may know of your
interest, won't you contact us today? Call or write:
Ms. Kennedy, P.O. Box .5844, Arlinston, Texas
76011. (214) 647-0077.
Come to Texu - Baptist Hospital of Southeast
Texas is a 400-bed growth oriented organization
look ins for a few good R.N.'s. We feel that we can
offer you the chalIense and opportunity to develop
and continue your professional growth. We are
located in Beaumont, a city of 1.50,000 with a small
town atmosphere- but the convenience of the large
city. We're 30 minutes from the Gulf of Mexico and
surrounded by beautiful trees and inland lakes.
Baptist Hospital has a progress salary plan plus a
liberal fringe package. We will provide your immig-
ration paperwork cost plus airfare to relocate. For
additional information, contact: Personnel Ad-
ministration, Baptist Hospital of Southeast Texas,
Inc., P.O. Drawer 1.591, Beaumont, Texas 77704. AD
amrmaIlve adloa employer.
Nuneø - RN. - A choice of locations with
emphasis on the Sunbelt. You must be licensed by
examination in Canada. We prepare Visa forms and
provide assistance with licensure at no cost to you.
Write for a free job market survey. Marilyn Blaker,
Medn, .580.5 Richmond, Houston, Texas 770.57. AU
fees employer paid.
Excitement: Come and join us for year around
excitement on the border, by the sea, an unbeatable
combination. Enjoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed, acute care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opportunities. We have immediate openinss in all
areas. Excellent salary and frillje benefits. We invite
you to share the challense ahead. Assistance with
travel expenses. Write or call coiled: Joe R. Lacher,
RN, Direclor of Nurses, Valley Community Hospi-
tal, P.O. Box 469.5. Brownsville. Texas 78.521; I
(.512) 831-9611.
Miscellaneous
Cherokee LodI", Lake Rosseau, near Port Sandßeld.
A small friendly lodge, catering to adults who want a
Quiet relaxing holiday. Open May 24 to Thanksgiv-
ing. Good deepwater swimmins, boatins and walk-
ing. Golfing, dancing, ridins a short drive away.
Rates and folders on request. Write or phone: The
Turleys. (70.5) 76.5-3601, R.R. 2, Port Carling,
Ontario. POB IJO.
Elec:trolysls - Successful Electroly,,, Practice for
Sale. 6 months specialized included. Write or phone:
Margot Rivard, 1396 St. Catherine Street West,
Suite 221, Montreal, Quebec. HJG IP9. Telephone:
(.514) 861-19.52.
The Cened.... Nu....
OPPORTUNITIES
Associate Director
of Nursing Services
The Victoria General Hospital, an 800 bed adult
teaching hospital associated with Dalhousie
University, provides tertiary care in all clinical
specialties except pediatrics and obstetrics.
Located in Halifax with a wide range of
educational. cultural, and recreational
opportunities. The Hospital operates its own school
of nursing and seven other Allied Health Schools.
Responsibilities:
Works under the general direction of the Director of
Nursing Services. One ofthe prime responsibilities
will be for the personnel management aspects of this
department of approximately 1200 employees.
QualifICations:
Education:
Baccalaureate degree in nursing required. Masters
degree preferred.
Experience:
Minimum of three years experience in a senior
nurse-manager position.
Special Knowledge and Abilities:
A ware of current concepts of nursing service.
education and research. principles of administration
and personnel development.
Professional Opportunity:
The close liaison with Dalhousie School of Nursing
provides a ready opportunity to pursue professional
interests.
Salary and Benefits:
1978 salary to $24.237. - currently under review.
Full Civil Service Benefits.
Competition is open to both men and women.
Please quote Competition Number 78-455.
Enquiries should be addressed to:
Chairman of the Search Committee for Associate
Director of Nursing Senices
c/o Executive Director
Victoria General Hospital
1278 Tower Road
Halifax, Nova Scotia
83H 2Y9
Julyl AUfluat 1171 83
ð
invites applications for the position of
Canadian Nurses Association
Executi ve Director
The Executive Director is the chief executive
officer of the Association. Applicants must have
experience in nursing in Canada and be a member of
a professional nurses association. Demonstrated
senior administrative capabilities and ability to
maintain relationships with governments, allied
professionals. international organizations and the
public are essential. Successful candidate must be
able to work in both official languages.
Masters' degree required. doctoral degree
preferred. Salary negotiable.
Applications should be forwarded in confidence,
with complete resume of experience and
qualifications, before 21 September 1979 to:
Director of Professional Senices
Canadian Nurses Association
50 The Driveway
Ottawa, Ontario
K2P tE2
I
rrv 41_
Unit Supervisor
Alberta Social Services and Community Health, Eric Cormack
Centre. requires an individual for the direction ofa specific 24
bed unit, on a shift rotational basis and be responsible to assist in
the perfonnance of general supervisory and administrative
duties. Duties include providing direction to unit personnel
regarding resident care and programming, assisting staff in the
initiation and development of specific programs, to provide for
growth and development of each resident.
Qualifications: Graduation from recognized School of Nursing
(R.N.. R.P.N., M.D.N.). Eligible for registration in A.A.R.N. or
other appropriate professional organization. Considerable
related nursing experience, some of which should be in a
supervisory capacity. Experience in the field of mental
retardation would be an asset.
Salary $15,372 - $18,840
Competition #9177-4
This competition will remain open until a suitable candidate has
been selected.
Apply to:
Alberta Government Employment Office
Sth Floor, :\Ielton Building
10310 Jasper A venue
Edmonton, Alberta
TSJ 2W4
14 July/Auguat 1171
The Cen-.ll.n Nu....
Wish
ere
4;1 .(
.
, . ....
I.
--
...
_I
,_r. ,'. ....,. ,
- l' ç-....... .
.
. .
t'- .),"- (
.,-
"
"."
-.
.
...in Canada's
Health Service
Medical SelVices 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
selVices to Canada's Indian and Eskimo peoples, If you
have the qualifications and can carry more than the
nonnalload of responsibility. .. why not find out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to federal public
selVants.
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-selVice training and some
financial support for educational leave.
For further infonnation on any. or all. of these career
opportunities. please contact the Medical SelVices
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 Provo I
I . * Heallh and Welfare Sanle et Bien-ëtre social I
Canada Canada
,--------,
Manager of Nursing -
Operating Room
&
Manager of Nursing -
Recovery Room -Intensive Care Unit
Required for
Saskatoon City Hospital
Under the direction of the Director of Nursing, the Manager of
Nursing -Operating Room is accountable for the total operation
of a 6 theater operating room in a 376 bed. fully accredited acute
care Hospital.
Under the direction of the Director of Nursing. the Manager of
Nursing - Recovery Room -Intensive Care Unit. is
accountable for the total operation of a combined. II bed
Recovery Room and 4 bed Intensive Care Unit.
Qualifications
Registered Nurse with a Baccalaureate Degree or a course in
Post Basic Administration.
Minimum of 2 years related experience.
Proven managerial ability certainly an asset.
Salary
Commensurate with qualifications and experience.
Please send resume of qualifications and experience to:
Personnel Services Administrator
Saskatoon City Hospital
Queen Street & 7th A venue
Saskatoon, Saskatchewan
S7K OM7
Advertising Rates
For All Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
Rates for display advertisements on request.
Closing date for copy and cancellation is 8 weeks prior
to 1st day of publication month.
The Canadian Nurses Association does not review the
personnel policies of the hospitals and agencies
advertising in the Journal. For authentic information,
prospective applicants should apply to the Registered
Nurses' Association of the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2PIE2
.
TheCa__
"""/AUfluet 1171 III
Southern California Nursing:
Three Who Made The Change
" It was a big step to move from Southwestern Ontario to an
entirely new job and surroundings in California, but everyone on the
staff at St. Francis made me feel very welcome. They're all so warm
and friendly - I really feel like an integral part of their team.
"St. Francis is more than I ever expected, but for me Labor and
Delivery is the most exciting. Along with my helpful coworkers, the
advanced monitoring equipment. and delivery room techniques,l've
found my unit a great place to advance my knowledge.
"I am proud to be a part of St. Francis Medical Center. It's a
great place to work... come and see for yourself."
Shirley Allin, RN
..,
"
, .
"
" It was an experience moving from Ontario, Canada to the Los
Angeles area, but the entire. staff of St Francis Medical Center made
me feel welcome and right at home.
St. Francis is a very good medical center. I work on Definitive
Observation which is both challenging and a good place to advance
your knowledge. "
Mary Jane Grant, RN
" I came to St. Francis from Calgary Alberta Canada. The atmos-
phere at St. Francis is warm and personal and the people never
hesitate to make me feel at home.
"St Francis provides many channels for growth The staff is
always available for help.
"The knowledge and experience I am gaining through living and
working in a different country are limitless. I have met many new
people and seen many new places thanks to St Francis."
Colleen McPhail. RN
,
\ "''I
...................................
= St. Francis Medical Center is located just outside of Los Angeles, in the city of Lynwood. Facilities . .
embrace a complete range of medical-surgical services, including open-heart surgery, intensive and
. coronary care, definitive observation, acute and renal dialysis, neurostroke, inpatient psychiatry, in/out .
. patient rehabilitation, intensive newborn care, diagnostic and therapeutic radiology including cobalt and .
. ultrasound, and a 24-hour Emergency Department. The 524-bed hospital has a nursing staff of .
approximately 700.
. Make the change to a hospital that lets you be what you want to be Write us for more information or .
. call Brent Nielsen, RN, Nurse Recruiter, collect at (213) 603-6083. .
. 0 Please send me a brochure about St Francis Medical Center. .
= Name St. Francis =
Address ,.c: Medical C nt
· City State Z. e er .
. Ip 3630 E. Imperial Highway .
. Phone ( - ) RN 0 Student 0 . Lynwood, California 90262 .
. Area of interest An equal opportUnity employer .
CN-8-19
...................................
ee July/Auguel1878
The Cen.dl.. Nur..
Ryerson Poly technical Institute
Nursing Department
Presently Offers a General
Post- Diploma
Intensive Care Program
Running Twice Consecutively From
September - December &
January - April
A IS-week course, beginning in Sept. '79 & Jan. '80
aimed at producing general staff nurses qualified to
work in medical, surgical or general intensive care
areas.
Emphasis is placed on pathotherapeutics and as-
sessment skills and an integrated clinical experience.
Clinical experience offers ample opportunity for
immediate application of new knowledge and testing
of hypotheses.
For further information. contact Admissions Office,
Ryerson Poly technical Institute, 50 Gould Street,
Toronto. M5B IE8. or telephone Nursing Depart-
ment. (416) 595-5191.
Registered Nurses
1200 hed ho"pital adjacent to U ni.. er"ity of
Alherta campu" offers employment in
medicine. "urgery. pediatric", ohstetrics.
p"ychiatr
. rehahilitation and e'dended care
including:
. 1 nten"ive care
. Coronary ohsenation unit
. Cardiovascular surgery
. Hums and plastic"
. Neonatal intensi\ e Care
. Rcnal dialy"is
. Neuro-"urgery
Planned Orientation and In-Service Education Programs.
PostGraduate Clinical Courses In Cardiovascular-
Intensive Care Nursing and Operating Room Nursing
-\ppl
to:
Kt'cruitmt'nt Oftkt'r - '\ursin
l nÏ\t'rsit
of \Iberta Hospital
X
II- I12th Stret't
Edmonton, -\Iberta
T6<; 287
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
Cily
Prov./State Postal Code /Zip
Please complete appropriate category
o I hold active membership in provincial nurses' assoc.
reg. no./perm. cert./lic. no.
o I am a personal subscriber
Mail to: The Canadian Nurse, 50 The Driveway, Ottawa.
Ontario K2P fE2
[l]@]
University of
Alberta Hospital
Edmonton. Alberta
o
Assistant Director (Clinical
Nursing)
required for a 227 bed general acute and
extended care hospital, situated
approximately 30 miles from Vancouver in
a community of approximately 30,000
people.
This position is a leadership opponunity for
a highly motivated, innovative nurse to
concentrate primarily in the promotion of
quality patient care.
Liaison with a multi-disciplinary team in
development of patient programs is
necessary .
The applicant requires successful clinical
nursing experience at a leadership level and
must be eligible for registration in British
Columbia. Preference will be given to
candidate with a Bachelor of
Nursing Degree.
Apply:
Personnel Officer
Peach Arch District Hospital
15521 RusseU Avenue
White Rock, B.C.
V4B 2R4
(,"
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Public Health Nurses
The Cened.... NuI'M
Julyl AUflUelll71 87
( OPPORTUNITY Al tærra
Psychiatric N urses/
Registered Nurses
Offers R.N. 's
An UNUSUAL OPPORTUNITY.
The Alberta Hospital, Ponoka. an
active treatment psychiatric
hospital. located 104 kilometres
south of Edmonton. has positions
available for nurses.
A.M.I. Will FURNISH Onl Wly AIRLINE TICKET to Tlla.
Ind $500 Inlllil LIVING EXPENSES on I Loan Basi..
Aftlr Onl Yar'. Slrvlcl, TIll. Loan Will ÞI Canclilld
MI American Medlcallnlernalionallnc.
. HAS 50 HOSPITALS THROUGHOUT THE U.S.
Qualifications:
Must be a graduate from an
approved school of nursing. Related
experience would be an asset.
Registration in the appropriate
nursing association.
. lIow A.M.I. II "'endlngR.II. 'lID. HDlplllllln TIIiI.
Immlll'lIl tlplnlnp. 51'1" Rlngl 511.100 ID 516.500 plr Vllr.
. You can enjoy nursIOg In General Medicine. Surgery. ICC.
CCU. Pedlltllcs and ObstelllCS
. A M.I. provides an excellent ollenlatlOn program
In-service IralOlng
Salary: $13,608- $15.996
r------------"
I
.
. U.S. Nurse Recruiter I
I P.O. Box 17778, Los Anlleles, C
lif. 90017 .
I . Wllhoul obligation. please send me more .
Inlormallon and an Application Form I
I NAME
I AOOR ESS =======
=== I
I ClTY_ --- ST.___ZIP___I
TELEPHONE 1_ _I. _ _ _ _ _ _ __
I LlCENSES:___________1
. SPECIALTY:_ _ ____ _ __-I
YEAR GIIAOUATEO:_ _ _ STATE: _ _ __
'-------------
Competition #9176-8
This competion will remain open
until a suitable candidate has been
selected.
Apply to:
Personnel Director
Alberta Hospital
Box 1000
Ponoka, Alberta
TOC 2HO
High Risk Obstetrics and Neonatal
Intensive Care Nurses
McMaster University Medical Centre is a
progressive teaching hospital with a
multi-disciplinary team approach to patient care.
Major specialties include Obstetrical Intensive Care
and Neonatal Intensive Care units. When openings
occur in these areas for Registered Nurses. we
require experienced Staff. Inquiries are welcomed
at any time from mature. responsible individuals
who wish to work in a stimulating environment on a
12 hour shift system. Preliminary interviews can be
arranged for out oftown nurses eligible for Ontario
registration if written requests are accompanied by
detailed resumes. Occasional openings also occur in
other areas. and, all applications will be given
careful consideration.
The City of Toronto , Department of Public Health.
requires Public Health Nurses fluent in two
languages. and qualified for a generalized program.
1978 Salary Range $17.338 - $19,494 per annum
with attractive fringe benefits.
Apply in writing. giving full resume of qualifications
and experience to the:
Director of Public Health Nursing
Department of Public Health
8th Floor, East Tower, City Hall
Toronto, Ontario M5H 2N2
Please apply to:
Ms. Nora Prosser
Personnel Interviewer
Chedoke-McMaster Hospital
McMaster University Medical Centre Division
1200 Main Street West
Hamilton, Ontario
LSS 4J9
All positions are open to women and men
applicants.
ee July/Auguelll71
The Cllnedl.n Nu....
@
Foothills Hospital
Calgary, Alberta
The Department of Nursing and the
Department of Pediatrics, Neonatology,
are offering a five month clinical and
academic programme for Graduate
Nurses:
Advanced Course in Neonatal Nursing
Applications are being accepted for clas-
ses enrolling each March and September.
Participation in the programme is limited
to eight.
For furtber Inform.tlon please write to:
Mr. 8. Wright
Coonlln.tor of Educ.tlonlll Services
Foothills Hospltlll
1403-29 St. N.W.
Clllg.ry, Albert.
T2N 2T9
Registered Nurses
Grande Prairie General Hospital i,
presently accepting applica(ion
for
full-time, part-time, and casual nurses.
Present vacancies Me in Fmergency/OPD.
Maternity/Surgery. and Fenldle Medical.
Anticipated vacancie, in other units.
Apply to:
I\1rs. A. Janie
!'IIursin
Office
10409 - 98th Street
Grande Prairie, AIt
rta
T8\' 2EII
Or call: (01031 532-7711 (Ext. 2-1'
McMaster Universit)
Educational Program
For Nurses In
Primary Care
McMdMer Univer_ity School ofNurs-
ing in conjunction with the School of
Medicine. otTers d progrdm for regis.
tered nur'es employed in primary
care ,ettings who are willing to
assume a redefined role in the primary
hedlth care dclivery team.
Requirements (urrent Canadian Re-
gistralion. Sponsor
hip from a medi-
cal co-prdctitioner. At least one year
of work experience. preferably in
primdry care.
For further information write to:
Mona Callin. Director
Educational Program for Nurses
in primar) Care
"'acuity of Health Sciences
McMaster llniversity
Hamilton, Ontario I liS 4J9
Shaughnessy Hospital
Vancouver, British Columbia
Shaughnessy Hospital is a community teaching
hospital centrally located in the City of
Vancouver, B. c., having approximately 1100
beds and a staff of 1500 employees.
Currenl expansion on the Shaughnessy site
will include by 1980, a Children and Maternity
Hospitals which will total approximately 300
additional beds. Plans for the future also
include a 150 bed extended care unit.
In its growing role as an active community
teaching facility Shaughnessy Hospital
requires energetic nursing staff who are
committed to the delivery of high quality
health care.
For further information regarding current
Nursing vacancies please contact:
JoaJUIe Stagll.no
Employee Rel8tlons Depllrtment
SlulUghnessy H08plt.1
4500 o.k Street
V.nrouver, B. C.
Telephone: (604) 876-6767,1oc1I1271
Patient and Nursing
Services Consultant
Metro-Edmonton Hospital District No. 106 is
seeking a Patient and Nursing Services
Consultant with several years of experience in
nursing administration at a senior level.
The duties will involve assuming a mi\Îor role
in formulating the direction of clinical and
general patient services programming, facility
development. staffing and organizational
structure. In addition to being a consultant and
clinical advisor, the successful candidate will
become an integral member ofthe
Administrative and Planning team for a new
general hospital facility in Edmonton.
This is a senior position.
The salary is negotiable.
Please respond 10:
Executive Director
Metro-Edmonton Hospital District No. 106
8th Floor, 10009- 108 Street
Edmonton, Alberta
T5J IK8
International Grenfell
1\ssociation
nqUires immediatel)
Assistant Director of
ursing
for dccredited 1M-bed general ho'pital in SI
Anthony. Newfoundland
DUlle"i 10 mclude asslsling the Director of
Nursing with the pldnning. orgamzin(t.
direcllng dnd evaluating of the nUf..mg ,erVlce..
of Curti' Memorial Hospital.
Accommodation provided at rea'\onable ratc"'.
[ravel borne by the d!.soclation on minimum of
one year lliicrvicc. Group life health in"iurance
and penlliolon plðn otTered. Other fringe bcncfih.
.t\ppllcdnt\ mu'l be eligible for registration
with ^ "ocidtion of RC(ti"iICred N urse
of
Newfoundland. Post-ha..ic preparation.
bdccaldureatc degree in nur
ing or OIhcr
dC"ilfdhlc combination of experience and Iraining.
Sdlar)' an dccordance wilh Nfld. gO\lernmenl..,cale.
Apply to:
Mr. Scoll Smith
rsonnel Dirrdor
International Grenfell Association
St. Anthony. Nnd.
AO" 4S0
Assistant Director of Nursing
Applicants are invited for the position of
Assistant Direclor of Nursing. for a 225 bed
AcuteGeneral Hospital. Samt Mary's Hospital
is fully accredited and offers Medical. Surgical.
Pediatric and Sub-
pecial services.
Qualifications:
At least B.Sc.N. with demonstrated leadership
ability. Minimum of 5 years progressive nursing
experience with at least 2 of these years in a
Nursing Administrative position.
Address all enquiries in writing together with
complete resume to:
Director of Nursing
Saint Mary's Hospital
220 Royal A venue
New Westminster, British Columbia
V3L IH6
Registered Nurses
300 bed Accredited general hospital in
Vancouver requires full time R.N.s for
medical areas and 4 bed I.C.U. Candidates
should be eligible for registration with the
RNABC. Recent nursing experience
preferred. ICU candidates must have
previous ICU experience.
Starting salary $1305 - $1542 (RNABC
contract).
Please apply in writing to:
Employee Relations Department
Mount Saint Joseph Hospital
3080 Prince Edward Street
Vancouver, B.C.
V5T 3N4
R.N.'s
Registered nurses needed dt St. Theresa. Fon
Vermilion. Albena. We are looking for nurses
who are willing to be challenged with a wide
variety of nursing care settings in rural Albena.
Three full-time positions are open immediately
and another 3 positions after mid-June.
Nonhem allowance and subsidized single staff
housing are provided.
Please submit dpplicdtlOnS 10:
\fr. M. Ods
Bal: 400
Hil:h Level, Alberta
TOH tNO
The Cenedlan Nur..
July' Auguet 1171 It
Assignments in Abu Dhabi (Middle East).
If you're enjoying your nursing career but feel in
some way that you're not completely fulfilled, join
us in Abu Dhabi (United Arab Emirates) for a uni-
que challenge...you'll profit in more ways than onel
You'll experience a new cult1.lre, New people. New
sights. New sounds. And you'll gain a greater
degree of personal growth by caring for a wider
range of medical problems and interfacing with
people of different nationalities.
Whittaker is offering Registered Nurses with 3
years' post-registration experience a once-in-a-
lifetime challenge -the challenge of helping patients
who really need your help, and seeing direct results
from your knowledge and skills.
But there's more. There's free furnished housing.
An excellent salary of $16,500 (U,S. Dollars). Free
medical and life insurance, plus many other
benefits.
Fulfill your nursing career. If you're the kind of per-
son who can contribute your expertise and profit
the most from this kind of assignment, please sub-
mit your resume to:
Ellen Herman
Whittaker Corporation
Life Sciences Group
10880 Wilshire Blvd.,
Suite 604, Dept. 400
Los Angeles, CA 90024
Who says nursing
has to be duD?
l\
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Ufe Sciences Group
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70 July/Auguel1979
The Cenedlen Nur..
Public Health Nursing Supervisor
Public Health Nursing Supervisor required by or
hefore mid-August by district health unit.
Qualifications preferred include Certificate of
Competence from College of Nurses of Ontario;
Degree in Public Health Nursing and including
supervisory and administrati ve ability. proficiency
in oral and written communications. and at least
five years recent experience in public health
nursmg.
Salary scale maximum (1979) $20.054.; excellent
benefits; 35 hour week; transportation may be
supplied by the employer if required.
Written applications are requested to:
Personnel Officer
Kingston. Frontenac and Lennox and
Addington Health Unit
22] Portsmouth A venue
Kingston, Ontario
K7M ]VS
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Regi\tered Nurse in search of a change and a challenge-
look into nursing opportunities at Vancouver General Hospital. B.c.'s
major medical centre on Cdnddd's unconventional West Coast. Stdffing
expansion has resulted in many new nursing positions at all levels.
including:
General Duty ($1305. - 1542.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions availdble which could provide the opportunity
you've been looking for.
For thuse with dn interest in specializdtion. chdllenges await in many
drea
,",uch a,:
Neonatolog)' Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Burn Unit
Inservice Education
Coronary Care Unit
Hyperalimentation
Program
Renal Dialysis & Transplantation
Paediatrics
If you are d Nurse considering a move please submIt resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
855 West 12th Avenue
Vancouver. H.C. V5Z IM9
Index to
Ad vertisers
July/A u gust 1979
The Badge Maker
Canadian Dairy Foods Service Bureau
The Canadian Nurse' s Cap Reg' d
Canadian Pharmaceutical Association
Career Dress (A Division of
White Sister Uniform Inc.)
The Clinic Shoemakers
Dow Chemical of Canada Limited
Equity Medical Supply Company
J. B. Lippincott Company of Canada Limited
Medical Personnel Pool
TheC.V. Mosby Company Limited
Mostly Whites Limited
Parke. Davis & Company Limited
Posey Company
R ecruiting Registered Nurses Inc.
W. B. Saunders Company Canada Limited
Uniformity
-
16
32.33
52
57
Cover 2
4
25
55
17
59
40,41
Cover 4
53
58
50
8
Cover 3
Ad
'ertisillg M{lflager
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa. Ontario K2P I E2
Telephone: (613) 237-2133
Ad
'ertisillg Represelltatives
Jean Malboeuf
601. Côte Vertu
St-Laurent. Québec H4L IX8
Téléphone: (5 1 4}748-fi56 I
Gordon Tiffin
190 Main Street
U nionville. Ontario UR 2G9
Telephone: (416) 297-2030
Richard P. Wilson
219 East Lancaster A venue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
Member of Canadian
Circulations Audit Board Inc.
I3æE]
Welcome To
w
UNIF' R
"
ITV
.
Uniformity is simply a uniform store. But by no means is it a simple uniform
store. Uniformity is the very first "classy" uniform store, equipped to cater to
your budget. If you are a nurse, lab technician, doctor, dentist, medical
assistant, or lion tamer, then please come by and look us over. We can be
whatever you want us to be, from conservative to avant garde.
Square One
Mississauga, Ontario
275-6470
Bramalea City Centre
Brampton, Ontario
453-8300
Oshawa Centre
Shops Up Top
579-1123
Sunnybrook Plaza
Bayview&Eglinton
485-1888
Orillia Square
Orillia, Ontario
(705) 325-9394
545 Sherbourne St.
Sherbourne North of Wellesley
968-1808
Upper Canada Place
460 Brant St.
Burlington, Ontario
o
To assist us with our grand opening, just bring this ad and present it at the store nearest to you for a 10%
discount on regular priced merchandise.
Come see us.
WE'RE NEW! WE'RE DIFFERENT!
WE'RE UNIFORMITY!
IN THE OTTAWA AREA -
PROFESSIONALS KNOW THAT ONLY "MOSTLY WHITES L TD"
PROVIDES EVERYTHING THEY NEED:
STORE NO.1
STORE NO.2
UNIFORMS - HOSIERY - LINGERIE
DUTY SHOES - NAME BADGES
CAPS
And We Only Carry Canada's Finest Names:
WHITE SISTER
MLLE. GLAMOUR
WHITE CROSS
DESIGNER'S CHOICE
UNIFORMS REGISTERED
TWO LOCATIONS TO SERVE YOU
BELL MEWS PLAZA 1355 BANK STREET
BELLS CORNERS, NEPEAN (COR BANK & RIVERSIDE)
(EVENING SHOPPING) OTTAWA
820-1308
523-8988
DROP IN AND SEE US IF YOU CAN,
OR DROP US A LINE IF YOU CAN'T!
@
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thrd trot_me
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10539
- -
. A guide to clinical lab
procedures
. A family-oriented clinic for
CF patients
. A new role for the office nurse?
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CPISSET
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The
Can
Nune
SEPTEMBER 1979
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Style No 43859 - Pant suit
Sizes 5-15
'""Cares
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100% textur:ed polyester warp knit
Wtllt. Robin
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Style No 43820 - Dress
SIZes" 5-15
"Caresse Linen
1-00% textured polyester warp knit
White, Robm
-
White
Sister
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,-
-
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The
Canadian
Nune
September 1979
2!
a..
lU
Q>
The official journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75. NumberS
--
Here show 8 One breath at a time Cheryl Ann Sams 20
Input 9 CLINICAL LABORATORY PROCEDURES: /979 Update 25
You and the law 14 The nurse practitioner:
an idea whose time has come \1aureen McTal'ish 41
Calendar 18 An experiment in innovative staffing A lI.son J. S,"art 45
Library update 50 FRANI\.LY SPEAKING
A challenge in office nursing Betty Kowalchuk 48
I
... ..-
,..
The Canadian :V urse welcomes
suggestions for articles or unsolicited
manuscripts. Authors may submit
finished articles or a summary of the
proposed content. Manuscripts
should be typed double-spaced. Send
original and camon. All articles must
be submitted for the exclusive use of
The Canadian Nurse. A biographical
stalement and return address should
accompany all manuscripts.
\..
Cover photo - Behind the
mask. someone who cares.
This month CNJ salutes the
newest ofCNA 's affiliated
member associations - the
National Conference of
Operating Room Nurses. Our
cover photo courtesy of
Department of Medical
Communications. Ottawa
General Hospital. Ottawa.
The views expressed in the articles
are those of the authors and do not
necessanly represent the policies of
the Canadian Nurses Association
ISSN 0008-4581
Canadian Nurses Association.
50 The Driveway, Ottawa. Canada,
K2P IE!.
Indexed in International Nursing
Index. Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index. Hospital Abstracts,
Index Medicus, Canadian Periodical
Index. The Canadian Nurse is
available in microform from Xerox
University Microfilms, Ann Amor,
Michigan 48106.
Subscription Rates: Canadd: one
year. $10.00: two years, $18.00.
Foreign: one year, $I:!.OO; two
years, $:!:!.OO. Single copies: $1.50
each. Make cheques or money
orders payable to the Canadian
Nurses Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number, in a
provincial/territorial nurses
association where applicable. Not
responsible for journals lost in mail
due to errors in address.
CJCanadian Nurses Association,1979.
c54merica's
number 1 shoe
for Yðung women
in white!
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....
"-
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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
The Cenedl.. Nur..
September 1171 I
perspective
.. Let no man imagine he has no with nurses who need to hospital? How does she deteriorate before our eyes,
influence. .. elevate their standard of care. peIform as a patient then we shall have to live with
Henry George More often than not, we didn't advocate? the consequences of
do a thing about it. First, she must recognize diminished respect in the
Last April a letter appeared in A few months ago I that the patient is in a very community; if we want to
the Sault Ste. MarieStur accompanied a close friend to vulnerable position and that maintain pride in our chosen
written by a woman who the emergency ward of a her first responsibility is to work, we must take an active
complained about the care her downtown Toronto hospital to him, to see that he gets the role in renewing that pride.
small child had received in a collect the belongings of his best possible care. Directly or
hospital in that city. She brother who had died of a drug indirectly, this must be done. -Jane Bock, assistant editor
mentioned that all the nurses overdose. I knew one of the I nstead of witnessing an
on the pediatric ward seemed nurses at the desk; she smiled incident of poor care or unsafe
"tired and frustrated" and and asked how I'd been and practice and then discussing it
that the unit was "run more when we asked about the informally with other nurses
like ajailthan a hospital". She clothes she replied casually, at lunch or coffee, that nurse
complained generally about "Oh, he was a DOA - we must take positive action. It
the lack of professionalism never strip the DOA's when may be as simple as
among the nursing staff and they come in, we just send the approaching the nurse at fault
finished by saying, "It is up to bodies to the coroner." I and offering to teach her the EDITOR
nurses tOu.do something could see my friend reeling proper way, or directing her to ANNE BESHARAH
about it. " from the reference to his dead help, or it may require ASSISTANT EDITORS
Not long after, we at CNJ 21-year-old brother as a consultation with her head SHARON ANDREWS
received a somewhat similar 'DOA', but the E.R. nur
e nurse or supervisor. JANE BOCK
letter from a nurse who didn't. For days afterward I "Oh, I can't do that," SANDRA LEFORT
complained about the poor thought that I should go back one nurse replied to this
nursing care her mother had and tell her how callous she suggestion after describing a PRODUCTION ASSISTANT
received in hospital. She had seemed, and how she had harrowing evening working GIT A FEillMAN
documented incidents succeeded in upsetting a with an inexperienced nurse
reflecting both an appalling bereaved relative, but I didn't. she worried was not CIRCULATION MAfljAGER
lack of professional ethic
Everyone knows that administering medications PIERREITE HOlTE
(nurses discussing their Emergency nurses get correctly; "She wouldn't ADVERTISING MANAGER
hangovers in patients' rooms) hardened after awhile, don't listen and I'd feel like I was GERRY KAVANAUGH
and an ominous lack of they? tattling. " CNA EXECUTIVE DIRECTOR
professional knowledge The fact is that we can "If a nurse feels she can't HELEN K. MUSSALLEM
(accounts of near errors in make no excuses for even go to her head nurse,"
medication administration). these minor flaws in suggested Allison J. Stuart, EDITORIAL ADVISORS
This nurse too thought that if professional demeanor. The administrative assistant to the MATHlillE BAZINET,
we printed her account nature of the average hospital associate executive director- chairman, Health Sciences
perhaps "nurses would do patient is that of the nursing at Mount Sinai Department, Canadore College,
something about it". 'uninformed consumer'; he Hospital in Toronto, "she Nonh Bay, Ontario.
DOROTHY MILLER. public
The fact that nurses can knows absolutely nothing should go to her co-ordinator, relations officer, Registered
- and must - "do something about the bulk of hospital or the in service education Nurses Association of Nova
about it" is undeniable; but routines, terminology and instructor, or even to the Scotia.
writing letters is not the procedures. He relies on us director of nursing." The JERRY MILLER. direclOrof
answer. for everything. And ifwe're administration in most communication services,
When nurses refuse to reading letters from parents hospitals is "humanistically Registered Nurses Association
acknowledge that incidents of who feel their child was oriented" and nursing of British Columbia.
incompetence and 'jailed' in hospital, or from administration is receptive to JEAN PASSMORE,editor,
below-standard nursing care nurses who feel care given to anyone's problem, SRNA news bulletin, Registered
exist, they are like the ostrich their relatives was inadequate, particularly a problem related Nurses Association of
Saskatchewan.
burying his head in the sand: isn't it time we got worried to patient care. PETER SMITH, director of
we know about it, but we about it?The patients are The message is clear: talk publications, National Gallery
don't want to see it, and certainly worried and to somebody, DO something of Canada.
maybe if we don't talk about frightened. - not just within the halls and FWRITA
it, it will all go away. What to do? It is all very rooms of hospitals but VlALLE-SOUBRANNE,
Certainly, the number of well to talk about the nurse's wherever your practice takes consultant, professional
nurses who are actually role as patient advocate, but you. inspection division. Order of
incompetent is a very small what does this actually mean Ifwe nurses are content Nurses of Quebec.
minority but we have all, at for the average hospital staff to stand by and watch our
one time or another, worked nurse, in or out of the professional standards
about
How many of these facts
about butte
margarine and fat
do your
patients know?
act .lust 6% of the
. recommended daily
caloric intake is contributed
by butter.
Many health professionals mistakenly
believe that butter is a major contributor
to the over-consumption of fat by Canadians
which is considerably higher than the 35%
of total caloric intake recommended by
Health & Welfare Canada. In point of fact,
Canadians eat more margarine than butter
as well as many other fat-containing foods
such as meat, fish, poultry, eggs, cereal
products, salad oil and cooking oil.
act . The correlation be-
. tween the consump-
tion of hydrogenated ve , etable
oils and the incidence 0 colon
and breast cancers has been
widely publicized.
Results of a research study conducted by a
team of scientists headed by Dr. Mark Keeney
of the University of Maryland, and published
in the summer of 1978, produced compelling
evidence of a possible link between the con-
sumption of hydrogenated vegetable oils and
the incidence of colon and breast cancers.
'C aet . Hydrogenation
. changes the molecu-
lar structure of vegetable oils.
Hydrogenation is the process which solidifies
liquid vegetable oils into margarine, making
it "spreadable", and giving it longer shelf
life in the store. This process changes the
chemical composition of the vegetable oils
and it also "saturates" fats which, were
originally unsaturated.
aet . Cholesterol is an
. essential substance,
naturally present in the human
system... and is a problem only
to patients with specific lipid
profiles.
Such unsatisfactory conditions cannot be
significantly chan
d by dietary manipulation.
act . Butter has exactly
. the same number
of calories as margarine.
Weight-conscious patients, in the belief that
they are cutting calories, often give up the
good taste of butter for a less palatable
spread. . . an unnecessary sacrifice.
act . Canadians, on a per
. capita basis, consume
just half an ounce of butter per day.
This is just a fraction of the amount generally
believed by many health professionals to be
the per capita consumption of butter by
Canadians.
When you look at the facts,
you can see the good
in butter.
DAIRY BUREAU OF CANADA
'C aet . Approximately 2 to
. 3% of butter is linoleic
acid - the ingredient which many
scientists believe to be the
moderating, beneficial factor in
the diet-heart relationship.
The ideal level of linoleic acid in fats
intended for human consumption is not yet
agreed upon.
aet . Data exists which
. show a definite
correlation, in certain cultures,
between the high level of animal
fat consumption and the low
incidence of CHD.
The Masai and Innuit cultures indicate just
such a correlation. Interestingly, so, too,
does the Irish whose butter consumption,
though markedly greater than their Irish-
American counterparts, have a much lower
incidence of CHD.
SOURCES:
"
Mary C Emg. Robert ). Munn and Mark KeenllY OJetary
fat and cancer trends - a critique Federation Proceedmgs
372215-2220. 1978
Mann. C.V. and Spoerry. A StudIes of a surfacta..r and
cholesteremia in the MasaJ.Amer.] Gin Nutr.27 464.1974
Gershon Hepner. RIchard Fned. Sachea. Sr.]eor Lydia
Fusetli. and Robert Monn Hypocholesterok nic dfect of
yogurt and mùk o\m ). Gin. Nutr.. 32,19.24. 1979.
Déllry Farmers of Canada
Dairy Facts and Figures at a Glance 1978
. Seplember 111711
here's how
Every nurse has practical ideas gathered from
his or her experience on how to make life a
little easier for nurses and for patients. Here's
How is a column for you and your ideas. If
you have an original and practical suggestion
that you think might help other nurses to
improve any aspect of patient care. why not
share it with other nurses? Well send you
$10. for any suggestion published. Let's hear
from you. Write: The Canadian Nurse, 50 The
Driveway, Ottawa, Ontario, K2P IE2.
Ovol Drops
relieve
infant colic.
'"
,
r
'PAABI
ccpp
The c.on-.llen Nur..
Beautiful walls
Our ho
pital walls are often bare and
drab - to brighten them we di
play
chool children's art or photograph.. of
interesting people - royalty.
pioneers, civic leaders, etc. But the best
idea so far was to invite local artists to
display their oil paintings. with or
without price tags. The response has
been very good. to the benefit of artists.
patients. staff and visitors.
Ours is a rehabilitation center and
we have a recreational director
responsible for the work involved but
volunteers very often help.
-Jean Smith, R.N., Regina. Sask.
.,
1
.
L
Oval ffiP3
9ÆTfmI:ow.
r fS.i
Icohc
eH::JRnEk
Shhh. Ovol Drops. Also.v....bl.mtabl..formfor.dul..
Ovol Drops contain simethicone,
an effective, gentle antiflatulent
that goes to work fast to relieve
the pain, bloating and discomfort
of infant colic. Gentle pepper-
mint flavoured Ovol Drops.
So mother and baby can get
a little rest.
(ij)HqRnER
Easy breast feeding
With the advantages of breast feeding
becoming widely known (and its
popularity increasing) the postpartum
and nursery nurse needs to know how to
help the new mother with that often
bewildering first feeding. Even when the
mother has prepared her breasts and
nipples during pregnancy. the newborn
may have difficulty grasping the nipple.
So the baby howls, his mother ten
es up,
and nursing becomes frustrating if not
impossible.
This simple trick has helped many
obstetrical patients - myself included!
The large rubber nipples designed for the
premature infant can be held in place
over the mother's nipple like a shield
(taking care to keep the outside nipple
sterile). The infant sucks breast milk
through the rubber nipple while his
mother holds it in place. The frantic and
hungry newborn will relax and so will his
mother, facilitating her letdown reflex.
Engorgement will be relieved and the
sucking action will draw out mothers
own nipples. The rubber nipple can soon
be removed, leaving the baby to continue
to nurse at the breast.
-M. Jordan, Halifax. Nova Scotia.
OVOI@80mg
Tablets
OVOI@40mg
Tablets
Ovol@
Drops
Antiflatulent Simethicone
INDICATIONS
OVOl is indicated to relieve bloating,
flatulence and olher symptoms
caused by gas retention including
aerophagia and infant colic.
CONTRAINDICATIONS
None reported.
PRECAUTIONS
Protect OVOl DROPS from freezing
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOl80 mg TABLETS
Simethicone 80 mg
OVOl 40 mg TABLETS
Simethicone 40 mg
Adults: One chewable tablet between
meals as required.
OVOl DROPS
Simethicone (in a peppermint
flavoured base) 40 mg/ml
Infants: One-quarter to one-half ml as
required_ May be added to formula or
given directly from dropper.
A HORnER
..,. Montreal. Cø.-.ada
input
\n impatient adH)Cate
Corinne Sklar's ..)' 011
alld the law" columns are
both thought-provoking and
informative. I commend CNJ
for this
eries.
I found her June column,
however. like a "who done it".
mystery: I knew before very
many lines the position the
author would take - i.e. the
typical position of those who
write about nursing from a
legal point of view. U sing as
my reference point the
experiences of
patient-consumers. concerned
nurses and patient
representatives. I would like
to make the following points:
. It is no longer a matter of
introducing a role. The
question now before us is
whether nursing or some other
discipline will fill the role (e.g.
the United States).
. The Society of Patient
Representatives (American
Hospital Association and
Canada) have shown in
evaluation of their programs
that a Patient Representative
system works and to the
benefit of all concerned.
(Most problems are resolved
at first level and thus a
breakdown in
Patient-Professional
communication is avoided.)
. This position could be
reasonable if patients and
nurses functioned in isolation.
What of the other members of
the Health Care Team? I have
received many letters from
patients. patient
representatives and nurses
citing incidents of violation.
ignoring and denying ofrights
of patients - which involve
the care of the patient as
delivered by all professionals
in the total health care system.
Having recently attended
an annual provincial nurses
association meeting,
remembering what nurses are
expressing to each other about
continuing conflict between
nursing peers, their
The c.on-.llen Nur..
co-workers and employers
and recognizing the limited
number of nurses who speak
up with the facts. I am faced
with two questions:
b it reasonable to expect
all nun,es to be their patients'
advocate when in essence
they are still struggling with
the difficulties of being their
own (nurses) advocate?
Where does this leave the
helpless desperate health
consumers and those nun..es
who voice concern" on their
behalf?
Patient Advocate, a
luxury or necessity?
Are you kidding?
-Arlee D. M(Gee. R.N.,
B.N., Resollrce Persoll-
Patiellts' RiRhts, New
Brullswic/.. Associatioll of
Re[;:istered Nllrses,
Frederictoll. N.B,
Unsafe at any speed
As a nurse who has
"been there" I would like to
comment on the June
"Perspective" .
I commend the nurses
involved who in my mind
acted appropriately.
professionally and most of all
safely.
How many of us have
been asked to "cope",
sometimes ordered to "cope" I
with an unsafe workload? Is
"coping" good enough when
we continually hear terms like
"quality care" and "medical.
nursing legal implications"?
I wholeheartedly agree
with Dr. Jo Flaherty. I do
believe registered nurses are
accountable for their behavior
and I find it appalling that
three I.C.U. nurses were
disciplined for recognizing an
unsafe situation and
responding in a sensible
manner.
I wonder what the
outcome would have been that
night, Feb. 27, 1976 at Mount
Sinai Hospital had a
catastrophe occurred? Would
the nurses involved have been
disciplined or even sued for
not recogni7ing an unsafe
workload?
Let"s face it. right now, in
1979. nurses are in a "Catch
22" situation.
-Mary C. Watsoll. R.N.,
Stell'art, B.C.
Looking back
As a writer and
researcher of insignia, I found
the March 1978 cover
illustrating school pins most
informative. An organization
which looks after the
wellbeing of its members and
looks to the traditions of the
past for inspiration is indeed
unique these days.
I was able to identify
several pins in my collection
Sep1ember 111711 II
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.
and may include them in a
future article.
-EirallHarris, Molltreal.
Quebec.
Information sharing
I am about to begin a
study into "Humall Semalitv:
The Effect of LOlIg-T erm
H ospitali::atioll of Premature
Babies Oil the Sexllal
Relatiollship of the Parellts
dllrill[;: that Time" and would
dppreciate correspondence
from health care professionals
whose field is related to this
area.
-L.D. ClOURh, R.N.,
B.S.N..20I, 3309 DUllbarSt.,
Vt/1lcoll\'er. B.C.. V6S 2B9.
Students & Graduates
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Each chapter begins with learning objectives which can be
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By Maureen E. Groêr. R.N. and Maureen E. Shekleton. R.N.
March. 1979 534 pages, 423 illustrations. Price, $1925.
HEALTH ASSESSMENT
Written by nurses for nurses. this well-illustrated guide
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. examine nu!ntlonal assessment sleep-activity patterns
and the use of climcallaboratory skills
By Lois Malasanos. R.N. Ph.D.; Violet Barkauskas.
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A New Book
NURSING CARE OF INFANTS
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Using a systems approach. this new book provides a
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. lab data and pharmacology information.
. emphasIs on and gUidelines for communicating with children
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. an appendix of normal values and assessment tools
By Lucille F. Whaley. R.N., M.S. and Donna L. Wong. R.N.,
MN.. P.N.P.: with 5 contributors March, 1979. 1,734 pages. 746
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Timely discussions explore such key topics as genetics.
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784 pages 684 illustrations. Price. $24.00.
CHILD HEALTH MAINTENANCE:
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CHILD HEALTH
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This concise text serves as both a student-oriented learnrng
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or ".....r zatlon é'nd ..Iboratory procedures.
· a nr hdptcr -- M----"l1ent tools and case audit gUldes-
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· Part I is organized according to specific nursrng diagnoses -
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COMMUNITY HEALTH CARE
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Help your students stay informed of the exciting new
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development by stressrng three basic concepts. the health-
Illness continuum. humankmd as an open system that always
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and development of the individual family. and community.
Student-oriented features Include.
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· up-to-date diScussions - both m concept and content.
· fascinatrng case studies to develop the thinkmg process and
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· the insights of noted contributors.
By Margot Joan Fromer B.S., M.A.; with 7
contributors January. 1979 484 pages, 110 illustrations Price.
$1800
IVIOSBV
TIMES MIRRDR
THE C. V. MOSBY COMPANY. L TO.
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TORONTO, ONTARIO
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Pnces subject to change A90735
14 Seplember 1871
The Centldl.n Nur..
YOU AND THE LAW
Where does the nurse's responsibility begin
and end in caring for a patient's belongings? Corinne Sklar
Case stud)
Fifty-five-year-old Mr. Evans is admined to your floor in late March
with a diagnosis of pulmonary emphysema. 0,: admission he wears,
in addition to his ordinary st1'f!et clothing, a heavy hooded winter
jacket, ski boots and an expensive new watch. Some friends who
come to visit bring him a new bathrobe and a pair of slippers. His
doughier decides that it would be safer to take his watch home; since
tire weather is turning milder, she also removes hisjacket and ski
boots and substitutes a lighter raincoat and d1'f!sS shoesforthem. As
Mr. Evans' nurse you mayor may not be aware of all these
changes. Should you be? What is the legal position ofthe
hospital and the nursing staff in the care of the patient's
belongings? Is it the nurse's responsibility to catalogue each
item of the patient's clothing an"d personal belongings on
admission and thereafter to police each itém?The responsibility
of a hospital and its staff may seem self-ev1dent when the
patient is unconscious or on his way to the O.R. but, typ!cally,
the patient is conscious, eventually ambulatory and shanng
ward accommodation with others. Each patient is admitted ånd
discharged as his condition dictates. The frequency of patie'1\
moves either into, within or out of the hospital may vary fro'JI
week to week, from day to day, from shift to shift. The "
increased flexibility of visiting hours adds to the number of
individuals who have access to patients and their belongings. Is
it the responsibility of the nurse to ensure that the nature and
quantity of the patient's belongings upon admission remains
unchanged throughout the period of hospitalization? Must
hospital permission be granted each time the nature and/or
quantity of the patient's belongings changes?
Statutes and regulations governing public hospitals
generally do not specify the care to be accorded the patient's
belongings: the aim and purpose of such legislation is to regulate;:
hospitals and those delivering care therein to promote and
safeguard the health, safety and well-being ofthose seeking care
and treatment within.
Hospitals are responsible for the treatment, care,
supervision and maintenance ofthe patient. Implied within this
undertaking is the responsibility to exercise care with respect to
the patient's belongings. The hospital carries out its duties
toward the patient either directly thro
h the hospital
corporation, for example by hiring of staff, or through the
services of its employees, servants and agents. It is responsible
in law for the negligence of its employees, servants or agents
acting within the scope of their employment (doctrine of
"respondeat superior" or "let the master answer"). The
failure of nurses to exercise due care in the care oj patient's
belongings might result in personal liability and/or liability to
the hospital-.employer.
There are two aspects of this problem to consider:
· belongings delivered to the staffby the patient or his
representative ' .
. belongings remaining in the patient's possession.
Let us consider the ramifications of each.
Staff "control" of patient possessions
. patient 1\ gives the admitting nurse his wallet containing
credit cards and $90.00, his new watch and his keys, all for
safekeeping until his wife arrives. .
. patient B is going to the O.R. for neurosurgery; she
Ives
the nurse her gold earrings, her watch, her engagement nng, her
glasses and her dentures.
. Timmy's mother asks the nurse to put away his
battery-operated game until he has fully recovered from the
effects of the anesthetic; since it is his prized possession, he'll
want it immediately on waking.
In each of the foregoing situations, when the nurse takes
the patient's belongings for safekeeping, the legal relationship
of bailment has occurred: temporarily, the owner has delivered
up possession of his property to the custody and control of
another. The person delivering up the goods is called the
"bailor" while the person with whom the goods are deposited is
called the "bailee". The bailment which occurs in the hospital
setting is a "gratuitous" bailment, that is, a bailment for which
there is no compensation payable to the bailee. The goods ofthe
bailor are to be returned to him either upon his request or in
accordance with his instructions at the time the bailment was
created.
However, in law there are several other categories of
bailment. A familiar bailment situation is that which occurs
when you. as bailor, deliver your car to a parking lot attendant;
the bailee gives you a ticket and then drives away to park your
car. A bailment has been created. On your return, you hand
over your parking ticket and pay your fee; the bailee delivers
your car to you and the bailment is terminated.
. In any bailment, the duty of the bailee is to take due care of
the bailor's property while under his care and control. The
bailee is answerable for any loss or damage to the property o(
the bailor while the property is in the hands of the bailee if such
, loss or damage results from his neglect or default.
If the bailee can show that such loss or damage did not
occur as a result of his default or neglect then no liability will
result. The onus lies with the bailee because he has the
knowledge of what has happened while the goods were in his
possession. '.
Where the bailment is gratuitous, usually gross neglIgence
on the part of the bailee must be proved although in the view of
Fleming, the modem approach to such cases would tequire
proof of negligence and not gross negligence on the part of the
bailee.
The standard of care required in the case of bailment is the
usual standard required in tort (civil) cases, that is, the common
law standard of the reasonable prudent perso
. This standard is
adjusted to consider the individual-circumstances oLthe case.
Note that this is not the usual higher standard required ofthe
professional. i.e. the standard of the reasonable prudent nurse.
Few such cases involving hospitals and their staff exist in
Canadian law. The ones that do are not recent and, in their
results, tend to absolve the hospital and staff ofresponsibility.
. In a 1905 case , lerÛno v Toronto General Hospital
Trustees,. the plaintiff alleged that $160.00 had been taken from
him while he was a patient in the hospital. His claim failed. The
court found that the evidence of the defendants contradicted the
evidence of the plaintiff and indicated that no money was taken
from him. During his seven-day hospitalization, the plaintiff
never once referred to this money nor asked for it.
. In a 1921 case,2 the jury's decision in favor of the plaintiff
was overturned by the appellate court thereby absolving the
hospital ofIiability. The plaintiff claimed that the $461.00 he had
with him when he was admitted to the hospital with severe
inj uries as a result of an accident was lost as a result of the
hospital's failure to safeguard his money. .
The majority of the court held that there was no findmg that
anyone connected with the hospital had taken charge of the
plaintiff's money, clothes or purse.
The Canedlan NUrH
However, in dissent, Magee J .A. said: 3
It was said that the plaintiff was treated gratuitously at the
hospital; but the trustees receÜ'e large grants of public money
for the purposes of the hospital, which must include taf...ing due
care of patients brought in, perhaps unconscious or suffering,
and unable to taf...e charge of their own property. The hospital
trustees cannot of course be held responsible for thefts when
prop
r care has been taf...en: but even if they are only gratuitous
bailees. remonable care should be taken of the patients'
property; and, if the stor)' of the plaintiff, whom the jury seemed
to ha\'e belie\'ed. were true, there mustha\'e been e\'en gross
negligence in a system which did not pro\'ide for due care or in
the carrying out of the S\'stem.
. In a 1952 case, 4 the patient sued for loss of a ring valued at
$1,400. I ntroduced into evidence was a document signed by
the patient's wife on his behalf stating that the ring was left at
the patient's own risk. However, the case turned on its specific
facts rather than the words of the document.
The evidence was that the patient wore his ring until one
evening when, feeling dizzy and increa
ingly ill, he gave the ring
to the nurse. The ring was returned to him the next morning and
he wore it all that day until evening wherl he was given an
injection and fell asleep. At that time. the ring was on his finger:
when he awoke, the ring was gone.
The court found that no bailment was violated because
none had been established. The hospital did not receive the ring
for safekeeping. The trial judge found that the patient was in a
ward with seven other patienrs and there were a number of
possibilities as to what had become of the ring. In fact, the
patient had clearly stated that in his view, the safest place for
the ring was on his finger. There was no reason for the staff to
again remove the ring for safekeeping. Based on these facts, the
plaintiffs case was dismissed.
- Where the patient delivers up possession of his valuables to
the hospital staff, reasonable care must be exercised to
safeguard the patient's property in order to fulfill the legal
requirements ofthe bailment created.
Belongings remaining in the patients' possession
The King case supra is an example of a court decision where it
was found that the patient had retained possession of the
valuable in questionfWlTere the patient retains possession of his
belongings, bailmenhs not create(l1However, this does not
mean that there is no respon
ibilirYon the part of the hospital.
.....Thellospital remains responsible whére there is evidence
to support a finding that the property was taken charge of by a
nurse or other hospital employee. {n giving care to patients,
nurses periodically handle the patient's belongings placing them
in drawers or lockers provided by the hospital. While doing so,
the nurse must ex'=rcise reaspnable care. As stated earlier, the
standard of care to which the nurse is held is that of the
reasonable and prudent person..-
A standard item which patients retain and for which due
care by nurses should be exercised is dentures. Dentures should
be placed in a transpare_nt container. The container should be
clearly and coñspìcuously labelled to avoid loss, damage or
misuse. Carelessly placing dentures in tissue or a towel could
result in their loss or damage for which the staff and hospital
might be found liable.
Patients are admitted to hospital with their belongings. It is
best to encouràge them to retain a minimum of personal effects
in their possession while hospitalized. Families should be
encouraged to assume custody of valuables and sums of money
on admission so that such items do not remain on the ward.
Prior to surgery or where the patient asks that the staff lock
up valuables, the usual nursing procedures should be followed.
The items placed in custody should be clearly listed on the
envelope and the list should be dated and signed by the patient
and the nurse. On return of items to the patient, the patient
should acknowledge in writing receipt of his valuables; it would
be prudent to check off the list of items and date of their return
in the presence of the patient.
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11 September 1171
The C.n-.ll.n Nur..
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In transferring patients within the hospital, staff should
exercise due care in ensuring that all of the patient's personal
effects accompany him. Where the patient is unconscious or
unable to assume any responsibility for his personal belongings.
the staff should make every effort to see that any valuables are
protected.
While hospitals are not insurers of the belongings of
patients. they are responsible for loss or damage when caused
by tfieir negligence. The care that is required is that which
would be ordinarily taken in similar circumstances. The want of
such care by the hospital staff in the performance of their duties
may result in a finding of liability.
* References
I (l905).50.W.R. p.76 (CoCt).
2 Gumina ". Toronto General Hospital Trustees. (1921), 19
O. W.N. p.547 (CA.)
3 Ibid., p.548.
4 King v. The Sisters of St. Joseph of the Diocese of
Hamilton, [1952]O.W.N. p.345.
*References not verified in CNA Library
.... .....
"You and the law" is a regular
column that appears each month
in The Canadian Nurse and
L'infirmière canadienne. Author
Corinne L. Sklar is a nurse and
recent graduate of the University
ofT oronto Faculty of Law.
... *7
,.."",
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Gold plaled, hold. your cap
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plain Caducaus 13.115/ pro
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Jewelry qualll,. In "MYy gOld
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No 501
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18 Seplember 1171
The c.n-.llen Nurse
calendar
September
Annual General Meeting of the
Corporation of Nurses of the
Montreal District. To be held
at the Sheraton Mont-Royal
Hotel, Montreal, Que., at
19:30 hours on Sept. 26, 1979.
Contact:C.N.M.D., 666 West
Sherbrooke St., Room 1004,
Montreal, Que., H3A /E7.
Ontario Assembly of
Emergency Care 2nd Annual
Meeting to be held at the
Skyline Hotel. Toronto on
Sept. 23-26,1979. Contact:
R.H.L. Galliver, M.D., Dept.
of Emergency Medicine, St.
Joseph's Hospital, 30 The
Queensway, Toronto,
M6R IB5.
October
Annual Meeting of the Nurse's
Association of the American
College of Obstetricians and
Gynecologists (District V) to be
held October 17-20, 1979 at
the Skyline Hotel, Ottawa.
(Conjoint meeting with
ACOG). Theme: Women
as health care consumers, a
change and a challenge.
Contact: Donna Barrett, 1/71
Ambleside Dr., Apt. 2107,
Ottawa, Ontario, K2B 8E/.
Dynamics of Critical Care
1979. A two-day seminar on
metabolic emergencies and
neurological emergencies to
be held Oct. 1-2, 1979 at the
Holiday Inn, Downtown
Toronto. Contact: Toronto
fJ,,(ftDl efJ."
+
1t
ChapterAACN, P.O. Box 37,
Postal Station "Z", Toronto,
Ontario, M5N 2Z3.
Nurse Practitioners
Association of Ontario Fall
Meeting to be held at the
Ramada Inn, Airport Rd., on
Oct. 13, 1979. Guest speaker:
Dr. Josephine Flaherty.
Contact: NPAO, Ruth
Nodn'edt, 29 - 1055
ShawnmarrRd., Mississauga,
Ont., L5H 3V2.
Call for papers for the 1980
Conference of the Association
for the Care of Children in
Hospitals to be held in Dallas,
Texas. Proposals for papers
are welcome until Oct. I. 1979
in the following areas:
adolescent care, ambulatory
care. child life. environment.
infant care, parents and
families. professional
development, research. Mail
proposals to: /980 ACCH
Conference Office, Children's
Medical Center, /935 Amelia,
Dallas, Texas, 75235.
November
CNA National Forum on
Nursing Education. To be held
Nov.13-15,1979attheSkyline
Hotel, Ottawa. Theme: The
nature of nursing education.
Focus: Degree or diploma?
Open to all registered nurses
to a maximum of 300.
Contact: The Canadian
Nurses Association, 50 The
Driveway, Ottawa, Ont.,
K2P /E2.
THE
LAST
THING HE
NEEDS
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When a patient can't
move around, gas can be
a problem, and a painful
one at that. So for pa-
tients who are immobile Ù --- -.
following surgery or for I Oval '
post-cholecystectomy
patients, give them extra I
strength OVOL 80 mg, the i
chewable antiflatulent '
tablets that work fast to I
51........
relieve trapped gas and
bloating.
80
ForGas
Centre
IesGaz
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8HQBJ}.fR
rPAAil
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Pro u{ t monoftraph available on request.
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Your patient may enjoy
being pregnant. But she
certainly doesn't enjoy the
constipation that often
goes with it! She'll thank
you for recommending a
laxative that works slowly,
gently and effectively.
That's the Metamucil way.
.
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I = -=
= .I
. --=- E
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OVOI@80mg
Tablets
OVOI@40mg
Tablets
Ovol@
Drops
Antlflatulent Simethicone
INDICATIONS
OVOl IS indicated to relieve bloating.
flatulence and other symptoms
caused by gas retention including
aerophagia and infant colic.
CONTRAINDICATIONS
None reported.
PRECAUTIONS
Protect OVOl DROPS from freezing.
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOl80 mg TABLETS
Simethicone 80 mg
OVOl4O mg TABLETS
Simethicone 40 mg
Adults: One chewable tablel between
meals as required.
OVOl DROPS
Simethicone (in a peppermint
flavoured base) 40 mg/ml
Infants: OnE
-quarter to one-half ml as
required. May be added 10 formula or
given directly from dropper.
e HQB
R
The c.n-.ll.n Nur..
Metamucil is madp
from (gluten-free) grain,
providing fiber that
produces soft, fully formed
stools to promote regular
bowel function.
Available as a powder (low In
sodlUm) and a lemon-lime flavourpd
Instant MIX (low In calories).
Why not gIve your patients our
helpful booklet about constipation?
Seplember 1.71 1.
MetaJnbcll@
The laxative most recommen
cians.
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20 Seplember 1878
The c.n-.llen Nur..
CF children need lots of pills,
Or they become very ill.
Little children, a little child,
Deserves to live longer than a little while.
Diseases, pain and sorrow,
Let's hope for a cure tomorrow.
Kevin D. was 15 when he wrote this
verse. When he was three, after
recurrent bouts of damaging respiratory
infection, his parents took him to a
doctor who diagnosed cystic fibrosis.
Kevin has lived since then "one breath
at a time", constantly struggling to keep
his lungs free of tenacious
life-threatening mucus.
Over the years, Kevin has been a
frequent visitor to the Hospital for Sick
Children in Toronto where he has been
treated as both an inpatient and clinic
patient. The HSC clinic, one of25 such
clinics in Canada, follows a total of 530
CF patients, including between 20 and 30
newly diagnosed patients annually. The
program that the nursing staff on the
chest ward in this hospital has developed
to meet the special needs ofCF children
and their families is a multi-disciplinary
approach that stresses independence and
self-reliance.
The disease
CF is an inherited generalized disorder
which affects the exocrine glands of the
body. Non-mucus producing glands
affected are the sweat glands which
produce secretions abnollTlally high in
sodium chloride. The mucus-producing
glands altered in CF are found in the
lungs, pancreas, liver, nasal sinuses and
urogenital tract. In CF the mucus
produced by these glands is abnollTlally
thick and sticky and collects in the
organs.causing them to expand or
hypertrophy. Some glands may be more
affected than others; some patients with
CF may be more seriously ill than others.
The lung is the organ most
profoundly affected by cystic fibrosis.
The cilia do not function properly
making it very difficult for the patient to
cough up the excess mucus. This
condition creates a very good breeding
ground for bacteria, usually staph aureus
or psëudomonas. The CF child easily
develops lung infections which lead to
areas of inflammation and
bronchiectasis. The damaged areas
become scarred and fibrotic, which
decreases gaseous exchange and
gradually compromises pulmonary
function. CF patients develop barrel
chests, clubbed fingers, and they tend to
exhibit use of accessory muscles in
respiration.
,
e
ea
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.
t
t
A family teaching program for
children with cystic fibrosis.
Cheryl Ann Sams
The nasal sinuses too become
obstructed with mucus and are prone to
the development of nasal polyps.
The pancreas is involved in about 85
per cent of cystics. The p'ancreas
produces trypsin, lipase, and amylase
but in CF the ducts which transport these
enzymes become blocked with mucus
and do not pellTlit the flow into the
intestine to aid in digestion offood. The
pancreas as a result becomes atrophied
and fibrotic, and the CF patient has great
difficulty in digesting fat and proteins.
Fat-soluble vitamins are not absorbed
well- the patients become thin and
malnourished.
Similarly, in the liver the biliary
ducts can become blocked and the
secretion of bile salts, which are a factor
in fat and protein digestion, is prevented.
In addition, the liver is unable to store
the fat soluble vitamins A, E, D, and K.
This blockage can lead to tissue
destruction and cirrhosis.
Unless they are severely affected by
the disease most CF patients have some
changes at puberty. Females have a
. greater incidence of cervical polyps, and
some have lowered fertility, but
generally they can reproduce normally.
There are now six CF mothers in the
clinic at the Hospital for Sick Children,
and they all have had nOllTlal children;
the children, however, are all carriers of
the disease. Of male CF patients, 99 per
cent are sterile because they are born
with incomplete vas deferens, seminal
vesicles and epididymis.
Cystic fibrosis usually affects
Caucasian children, but the underlying
cause of the disease's many
complic'itions is not known.
Occasionally there will be a CF child
born to a family of another race, but this
is not common. One out of every 3500
births is a CF child; the disease is -
inherited as a Mendelian recessive trait,
and both the parents of a CF child must
carry the CF gene. The carrier rate in the
general population is I :20 but in spite of
the tremendous amount of research
being done in this area, it is still not
possible to identify carriers of the
disease. Ifboth parents are carriers,
there is a 1:4 chance of their producing a
CF child. At the present time there is no
way to predict in pregnancy whether or
not the child will be afflicted.
Diagnosis
In some instances CF can still be difficult
to diagnose. In very early childhood the
disease can mimic other conditions-
celiac disease, for example, or bronchitis
and asthma. Newborns will sometimes
present with meconium ileus and rectal
prolapse. The child's skin may have a
salty taste or he may have recurrent
respiratory infections, fail to thrive, or
have large foul-smelling floating stools
(steatorrhea). Initial screening forCF is
usually a sweat chloride test which is
considered to be abnormal above 60
mEq/litre. The amount offat being
excreted in the stool can be measured
and duodenal contents tested for the
presence of pancreatic enzymes.
Radiological examination for changes in
the lungs is yet another indicator.
The age at which CF is diagnosed
varies: newborns with meconium ileus
are usually diagnosed immediately, but
some newly-diagnosed patients may be
in adolescence.
Manifestations
The main complications ofCF result
from the respiratory problems. Repeated
infections cause lung damage, the
bronchial obstruction leads to puJmonary
hypertension and eventually cor
pulmonale. If the heart cannot cope with
this extra workload, it may go into
right-sided failure. Patients with
advanced disease can present with
pneumothorax involving a varying
percentage of the lung.
But there are other manifestations of
CF as well:
· Patients can exhibit hemoptysis
which occurs when the bronchial arteries
going through the parts of the lung
affected by bronchiectasis become
distended and rupture.
· When biliary cirrhosis occurs,
patients may develop esophageal vances
and portal hypertension.
. Diabetes can develop in the
adolescent and young adult which is
usually controlled by insulin. The cause
of this is not known.
The C.n-.ll.n NUrH
September 11179 21
Treatment
The management of cystic fibrosis
focuses primarily on the prevention of
chest infections. ForCF patients to keep
their lungs clear they must follow a
rigorous daily treatment regime which
includes inhalations and physiotherapy.
The inhalations contain an antibiotic. a
bronchodilator, and tluid which helps to
liquefy the mucoid secretions. making
them easier to cough up. These
inhalations take about twenty minutes to
administer three times a day which is
followed by vigorous chest physio, aided
by a mechanical compressor. The patient
must concentrate on the individual lobes
of his lungs, spending about ten minutes
on each.
The CF patients at HSC are on high
saturated fat, high protein and high
calorie diets. They also take Vitamin E.
multivitamins, Vitamin K. saffioweroil,
and vitamin B with C fortis as
supplements to their meals. Patients with
pancreatic involvement must also take
cotazymes (pancreatic enzymes), which
usually amount to 7 to 10 capsules to be
swallowed per meal.
I n addition to these medications
every CF patient is on antibiotic therapy
prophylactically, and if he develops an
infection he starts on another.
Commonly used antibiotics are
cephalexin monohydrate (Ketlexl!Þ or
Ceporexl!Þ), clindamycin, ampicillin,
trimethoprim -s ul famethoxasole
(Septral!Þ, Bactrim
). If the infection
becomes serious the child is admitted to
hospital and given ticarcillin and
tobramycin intravenously.
Living with CF
The impact of cystic fibrosis is
tremendous: how a patient and his family
adjusts to the diagnosis physically and
emotionally has a profound effect on the
course and outcome of the disease.
CF still has an uncertain prognosis.
Patients are now living longer than ever
before and may reach their twenties and
thirties, due to antibiotics and
physiotherapy. Older patients are
pushing back the frontiers: the oldest
patient at the HSC clinic is 39.
Many factors affect the prognosis in
CF: it is important first of all that a child
be diagnosed early before permanent
damage is done. If there is good
compliance with the treatment plan,
there is a good chance of preventing any
permanent lung damage - many of the
complications ofCF are in fact
preventable to an extent.
It is important for the CF patient to
have a good understanding of his disease
and a positive attitude; otherwise coping
",
J
I
with the time-consuming daily routine
will be extremely difficult.
\1any CF children feel isolated and
'different'. as the disease affects every
part of their lives. Treatments interfere
with after-school play and often children
cannot fully participate in strenuous
physical activities. Many are
self-conscious about taking all their pills
in front of their classmates at lunch time.
They may frequently be absent from
school and can fall behind in their
schoolwork: teachers often
misunderstand the implications ofCF.
Because of the treatments and expense,
some CF children have never been away
from home or on a vacation.
Because CF is an inherited disease.
parents are also affected: they have to
deal with feelings of guilt and
responsibility, and anxiety over the
health of their child. A studyt of 30
adolescents and young adults showed
that communication was reduced or
non-existent in over two-thirds of the CF
families. The divorce and separation rate
too is above average in number because
of the stress involved.
The fact that the CF child requires a
great deal of attention may create a
dependence that is difficult to break and
parental- particularly maternal-
overprotection may intensify this. It is
difficult for the young CF adult to begin
functioning completely on his own.
Siblings may feel neglected by their
parents, jealous and perhaps guilty that
they are healthy. Parents may not have
any energy or time left over for
unaffected children.
The stud y 2 also showed that CF
children often feel inferior to their peers:
most had a poor body image. Typically
the adolescents are thin and have a
frequent harsh cough, and lack the
pubertal changes that make them
attractive to the opposite sex. The need
to conform is \'ery strong among
adolescents and the difference of their
lives is very obvious and painful.
Rebellion is often a part of personal
growth and many CF teens focus their
anger on their treatments. They stop
doing their physio and refuse to take
their pills in front offriends. Some will
not tell their friends that they have CF or
they will not tell them the whole story.
This is also a time when physical activity
lessens, particularly in girls, and there is
a greater danger of chest infection.
Maintaining the treatments in the face of
this rebellion places an even greater
strain on the parents: they know that
failure to follow the regime will impair
the adolescent's health. but in any case,
emotional relationships will be affected.
Education
In orderto helpCF patients and their
families overcome the physical problems
and to develop a positive attitude and
healthy self-image. the nursing staff on
the CF chest ward at the Hospital for
Sick Children developed a special patient
teaching program. The focus of the
program was to foster independence and
self-reliance through increased
knowledge of cystic fibrosis and its
treatment.
The age of patients admitted ranged
from 2 years to the early thirties, and
most are admitted for treatment of chest
infections. staying two to three weeks:
all are included in the teaching program.
HSC Cystic Fibrosis Clinic
Patients, by age
under 5 yr - 13%
5 - 10 yr - 22%
10 - 14 yr - 25%
15 - 19 yr - 23%
over20 yr - 17%
Total - 530
Teaching plan
There are many staff members involved
in the teaching program: a geneticist,
nutritionist. physician. public health
nurse and social worker as well as staff
nurses on the ward. The teaching team
leader organizes the individual plans and
ensures that each patient and his family
are taught according to the plan that is
drawn up for them.
At the time of a child's admission,
the nursing staff decides which nurse will
do the patient's assessment and plan the
teaching using a basic plan and fitting it
to the child's particular needs. If
possible, we try to assign a nurse who
has already established some rapport
with the child.
22 September 1171
The Canedl.n Nur..
To help us in our assessment we ask
the patient and his parents to fill out a
questionnaire which is intended to reveal
knowledge of the disease, who
participates in treatments at home and
preparation of medication, and how the
disease has affected activities. In
addition, we try to determine how well
the family is functioning, how
independent the child is, what attitudes
exist about CF and generally what kind
of support the family may need. We base
the teaching program on all this
information.
CASE STUDY: Ann
Ann is a I3-year-old girl who was
admitted for investigation of repeated
respiratory infections, which had
previously been diagnosed as
complications of asthma. Her sweat
chlorides on admission were 96 and 88
mEq/1 and her chest x-ray showed
over-inflation and patches of atelectasis.
A stool specimen for fecal fat showed
that she was excreting more than the
normal amount of fat, and her pancreatIc
stimulation test showed she was not
secreting sufficient enzymes. Ann's
diagnosis was cystic fibrosis.
As part of our routine, we asked
Ann to fill out a knowledge assessment
questionnaire to see what she had picked
up from otherCF patients on the ward
and to determine what her
misconceptions were. In analyzing the
results we found that Ann had only a
superticial knowledge of anatomy and
physiology.
We made appointments for the
parents to attend teaching sessions;
while they were relieved to have a firm
diagnosis of Ann's condition after all
these years, they were very upset about
the implications ofCF. Gradually all
three were able to deal with their feelings
and they were receptive to our teaching
as we reviewed our plan with them, and
helped to define their goals. We planned
both separate and combined sessions for
Ann and her parents.
Learning
Diane was a nurse who had built up a
good relationship with Ann and who did
most of the teaching. She discussed with
Ann the causes ofCF, which parts of her
body were affected, and she explained
any specific complications that Ann was
experiencing. Tools used included
posters and a realistic lung model. For
younger children we have a play kit
which includes medical equipment such
as I.V. tubing and auger suction, and a
picture explanatory storybook. Many
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children like to hook up the tubing to
dolls and put masks on them.
As Ann was older we asked her to
draw a picture of herselfla belling the
affected parts of the body. We hoped
through this to get some idea of her
subjecti ve image of self, and we then
reviewed the material with her parents.
The next session covered
medications; we feel that as soon as a
child is able to understand, he should
know what medications he is taking and
why. Diane taught Ann about her
medication, including the indications and
the possible side-effects she could
experience, using in part a slide-tape
presentation. She demonstrated pouring
the medication, and then allowed Ann to
do this. After Ann was supervised
several times and showed she was
capable, she routinely prepared and
administered them herself.
I n another session the
physiotherapist from the clinic discussed
the rationale of the physio routine and
then encouraged Ann and her parents to
handle the equipment. Once they had
been taught, the parents gave Ann her
treatments, and then Ann gave them
herself. Once again, as Ann proved
herself to be capable, she was
responsible for her own treatment.
The nutritionist assessed Ann's diet
taking into account calories and Ann's
personal preferences. She then
formulated a diet for Ann to be on at
home which was compatible with the
family's normal diet and budget
allowance. She was able to provide some
recipes for use at home.
The geneticist discussed the
implications ofCF with Ann's parents.
For older patients, genetic counseling
and birth control information can be
given, as well as sperm counts for male
patients who wish to know about their
fertility.
Fortunately, Ann's father had a drug
plan through his employer; these group
plans normally cover drugs, the
mechanical air compressor and the
physio tilt board necessary for postural
drainage. However, in the absence of
such a plan, we can arrange for payment
through an Ontario Crippled Children
grant.
Review day
After all the team members had gone
through the planned program with Ann
and her parents. we arranged a review
day to discuss and evaluate progress.
The doctor discussed first cystic fibrosis
and its prognosis, and the
physiotherapist reviewed the
all-important therapy with the family to
make sure they felt confident. The
nutritionist also reviewed her aspect of
the management; the public health nurse
described follow-up care and identified
helpful agencies. The nurse from the
ward reviewed once again Ann's
medication, and watched the family
prepare the medications for her. The
social worker had seen the family earlier
and encouraged them on review day to
talk about their feelings, and she offered
her continuing assistance; the geneticist
reviewed his counseling regarding
genetic implications. Finally, a nurse
from the CF clinic introduced the family
to the clinic.
Review day is held for all
newly-diagnosed cystics and for those
patients too who are found to need
re-teaching.
Evaluation
We evaluated the effectiveness of our
teaching before Ann was discharged by
re-administering the questionnaire and
checking the differences in her responses
from the time of admission and by giving
her a short test. We observed Ann and
her family doing physio and preparing
medications one final time.
We stressed the importance of
flexibility in planning a treatment
schedule that would fit into the family's
lifestyle. Ann was particularly concerned
about doing her treatments at school, but
Diane discussed this with her as well as
the issue of telling her friends and taking
her pills in their presence.
In spite of the apparent
organization. there are many factors
which interfere with implementation of
the teaching plan. Patients who have just
been diagnosed need time to adjust
before they can learn anything; if they
are anxious or depressed, fear death or
worry about their status, their
concentration is impaired. If parents
The Canadian NUrH
Sept....t>er 11171 23
have not told a child about his disease.
information from hospital staff could be
upsetting and even unwelcome. On the
other hand. some patients cope by
denying their illness entirely and of
course they resist any teaching. Those
who were diagnosed years ago may not
be aware of advances in treatment and
think they need no more teaching.
We try many different approaches in
attempting to break down these barriers.
For example. if a patient seems
uncomfortable on the ward. the nurse
may arrange a session in a more informal
atmosphere. Some patients are
extremely resistant to organization and
may respond better to a casual
on-the-spot teaching approach. during
the physio routine for example. Parents
who are defensive and reluctant to have
a child taught may need to work with a
social worker first to explore their
feelings about having a child with CF_
The teaching focuses on the family
when the patient is very young. but ifthe
newly-diagnosed cystic is an adolescent.
then education is directed at him.
In every case the effectiveness of
the teaching depends on the confïdence
the patient and family has in the staff.
Ann and her family adjusted well as they
were a close and supportive family who
were able to cope well with the
diagnosis.
However. many CF families are not
so easily ma
aged: examples of some
more difficult cases follow.
Case reports
. Mike was a 15-year-old boy whose
condition had been diagnosed at birth
and who was admitted for treatment of a
chest infection. His beha vior on the ward
in previous admissions had been a
problem and an assessment now
revealed that his knowledge ofCF was
poor. He refused to cooperate for blood
samples. was generally rebellious and
appeared to have absorbed nothing from
the program. Shortly afterwards he went
to another ward for minor surgery but
requested that he return to the chest
service. Reassessment showed he had a
greatly increased understanding of his
condition: we find that many rebellious
patients store up the information we give
them and use it when they can cope with
it.
. Twenty-year-old David's condition
had been diagnosed when he was 2. and
he was admitted for treatment of
hemoptysis. During the teaching we
realized he knew nothing of the genetic
implications ofCF, nor that he was
possibly sterile. He requested a sperm
count and learned that he was in fact
e
-,
,l"
aspermatic. By the time he was
discharged he had been able to discuss
his feelings about this and he appeared to
have adjusted.
. Alan, a 14-year-old boy who had
been diagnosed CF at birth. came in with
a chest infection. We learned that he did
his treatments only sporadically and
appeared to know little about CF. He
was very shocked and upset when a
fellow patient died - he said he hadn't
known anyone could die from CF. When
he was discharged he knew much more.
possibly because of the extra motivation
to learn.
The bottom line
The teaching program at HSC has
facilitated discussion of the patient's and
parent's individual problems with the
result that they generally benefit from
the sharing of these experiences. The
program has also provided an
opportunity for them to work out guilt
feelings and anger.
We have found patients who have
CF to be very special people: they have
to overcome apparently insurmountable
odds. Our teaching program comes from
the basic belief that with support.
encouragement and affection.
information and a focus on the positive
aspects of/ife. a person with CF can live
well. even if it is only one breath at a
time. ..,
References
*1 Lefebvre. A. Problems ofcystic
fibrosis patients in adapting to
adolescence and adulthood. Toronto,
University ofToron
o. 1974.
Dissertation submitted in partial
fulfillment of the requi rements for the
Diploma in Child Psychiatry.
2 Steinhauer. P.O. Psychological
aspects of chronic illness, by ... et al.
Pediatr. Clin. North Amer. 21 :4:825-840.
Nov. 1974.
.
Bibliography
I Anderson. Charlotte M. Cystic
fibrosis o.(the pancreas: manual 0.(
diagnosis and treatment, by ... and M.C.
Goodchild. Oxford, Blackwell Scientific
Publications. 1976.
2 Burnette. B.A. Family adjustment
to cystic fibrosis. A mer.J.N urs.
75: II: 1986-1989. Nov. 1975.
3 McCollum. AT. Coping with
prolonged health impairment in your
child. Boston. Little. Brown, 1975.
4 Fakkem. La Verne. How to help
the child with cystic fibrosis.
Amer.J.Nurs. 59:9:1269-1271. Sep. 1959.
5 Leonard. C.O. Genetic counseling:
a consumers' view. by... et al. New Eng.
J. Med. 287:433-439. Aug. 31. 1972.
,/
*U nable to verify references in CN A
Library
Cheryl Samsis a graduate of the Toronto
General Hospital School o.(Nursing and
has worked in pediatrics at Scarborough
Centenary Hospital and the Hospitalfor
Sick Children in Toronto where she is
now the teaching team leader on the
n'stic fibrosis unit.
Tom Burns is the award-winning
photographer who took the photos 0.(
Cheryl Sams and Diane Hardisn on the
CF ward at HSC. Mr. Burns is a cystic
himse((and isfollowed through the HSC
cystic fibrosis clinic.
Why c
dressings
several times a day
when once a week is plenty1
This is an Op-site dressing for non-infected ulcers.
When it goes on, it stays on... for a whole week.
Because Op-site is an adhesive, transparent dressing
that breathes and sweats with the skin. So you can keep
your eye on the entire healing process without the
interruptions of frequent dressing changes.
Op-site is easy on the patient too. It's neat, not bulky.
Patients can take regular baths or showers without
discomfort because Op-site is water-proof. Op-site is
also bacteria-proof, protecting the ulcer from
contamination.
Because once a week is plenty, Op-site means fewer
dressing changes. And that's less work and more time
for you.
--------------------
I Op - S ite(íi For f';lrther informa!ion a!x?ut I I
I Op-slte ulcer dressmg, fill m
the ultimate wound dressing and mail this coupon. I
I I
I
I
I I
I Address I
I I
I City Prov._Code I
I Mail to' [8] '---'" Smith f, Nephew Inc. 2100. 52nd Avenue I
. :5...: Medical Division l..ðchine.Oué..Canada I
I ". .-' HBT2Y5
--------------------
Your guide
to
Clinical Laboratory
Procedures
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a:
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t-
In laboratory medicine, approaches and techniques are changing more
rapidly than in any other branch of medicine. The automation of
procedures has resulted in a drastic decrease of cost per test, shorter
time requirements, increased availability of different kinds oftests, and
improved accuracy and especially the precision of the results. The
unprecedented explosion in the volume of laboratory tests, which has
inevitably followed, changed the whole approach to medicine and has
greatly increased its dependence on the laboratory. The impressive
improvements in diagnostic accuracy and speed are undeniable but
something in the human approach to the patient has been lost - he is
frequently subjected to tests that will not alter medical management, tests
ordered to confirm results of other tests, and sometimes to a battery of
tests that are ordered simply as a matter of policy.
It is important, therefore, that the whole medical team, including the
nurses, have a better understanding ofthe significance of specific
laboratory data for the welfare of the patient. The following condensed
information is presented to contribute toward this goal.
This is the sixth time that clinical laboratory procedures have
appeared in chart form in The Canadian Nurse since the original
compilation in 1949. Each time, the information has been updated; again
this time, a number of changes, additions and deletions have been made.
A complete conversion of the values to SI units was deemed impractical
at this time - the system has not been officially implemented in Canada
yet and most laboratories do not use it. It is also recognized that th
"normal values" differ from laboratory to laboratory due to
methodological differences. This problem will not be remedied until
national reference methods are developed and accepted.
This summary deals with Hematology, Blood Banking, Biochemistry,
Function Tests and Microbiology in that order. Obviously, microbiology
cannot be reviewed from the point of view of normal values, since the
discipline deals with identification of organisms not present in health
ratherthan with quantitative measurements of the deviation from normal.
The brevity ofthe chapter on microbiology is a reflection of its unique
character, not of its clinical importance.
2tI September 1171
The C.n-.ll.n Nur..
ABO - the main blood group system
Ac. - acid
A.C.D. - anticoagulant used in preserving blood
I a cid-citrate-dextrose)
ACTIi - adrenocorticotrophic hormone
A.F.B. - acid-fast bacillus; a characteristic
staining quality of the tubercle bacillus
Alk. - alkaline
B.S. - blood sugar
BSP - bromsulphalein; a liver function test
B.T. - bleeding time
BUN - blood urea nitrogen
C. - centigrade
Ca - calcium
CI- chlorine
C.P.K. -the enzyme creatine phosphokinase
Cr - chromium
C.S.F. - cerebrospinal fluid
Cu - copper
C.VJ. - cell volume index
dl- deciliter
Diff. - differential; used with reference to a
smear of blood or C.S.F. to determine the types
and percentages of white blood cells present
ECG or EKG - electrocardiogram
EDTA - an anticoagulant, frequently used in
blood samples for hematology
EEG - electroencephalogram
Eos. - eosinophil; a variety of white blood cell
E.S.R. - erythrocyte sedimentation rate
F. - Fahrenheit
F.B.S. - fasting blood sugar
Fe - iron
FSH - follicle stimulating hormone ofthe
pituitary gland
g. - gram
G.A. - gastric analysis
GC - gonococcus, causative organism of
gonorrhea
GI- gastrointestinal
H & E - hematoxylin and eosin stain; used in the
preparation of pathological material for
examination
Abbreviations and symbols
17HC -17-hydroxycorticoids
HCG - human chorionic gonadotrophic hormone,
present in pregnancy Ipregnancytest) and
malignant tumors of the testes
Hg - mercury
Hgb. - hemoglobin
5HIAA - 5-hydroxyindoleacetic acid
Ht. - hematocrit
ICDH - isocitric dehydrogenase, a tissue enzyme
Ig - the blood immunoglobulins, such as IgA, IgG,
IgM, etc.
IU - international unit
I.V. - intravenous
K- potassium
17KS -17-ketosteroids; urinary hormones from
the adrenal cortex and testes
L. or I. -liter
LDH -lactic dehydrogenase, a tissue enzyme
L.E. -lupus erythematosus
Lymph. -lymphocyte, a type of white blood cell
MCH - mean corpuscular hemoglobin
MCHC - mean corpuscular hemoglobin ..
concentration
MCV - mean corpuscular volume
mEq.ll. - milliequivalent per liter
mg. - milligram; see Weights
mi. - milliter, 1/1000 part of a liter
mOsm - milliosmole, 1/1000 part of an
osmotically active unit per liter
Myelo - myelocyte, the forerunner ofthe
granular leukocyte
N - nitrogen
Na - sodium
Neut. - neutrophil. a variety of white blood cell
NPN - nonprotein nitrogen
O
xygen
Osm - one osmotically active unit Imolecule or
ion) per liter
P.A. - pernicious anemia
Pap stain - Papanicolaou stain for cancer cells
PBI- protein-bound iodine, and estimation used
in connection with thyroid function
pCO.-partial pressure of carbon dioxide
pH - a symbol used to express acidity and
alkalinity
PI.Ct. - blood platelet count
pO ,-partial pressure of oxygen
P.S.P. - phenolsulphonaphthalein test, a method
for assessing function
R.A. - rheumatoid arthritis
R.B.C. - red blood cell count
Retic - reticulocyte, a young R.B.C.
RD - rheumatoid factor, present in blood in
rheumatoid arthritis and occasionally in lupus
erythematosus, etc.
Rh - Rhesus, the Rh factor of blood
risa - radio-iodinated serum albumin, a material
for measuring plasma volume
SGOT - serum glutamic-oxalacetic
transaminase
SGPT - serum glutamic-pyruvic transaminase
S.G. - specific gravity
T ,,-an in vitro test for thyroid function IT 3 resin
uptake)
T.--a test for thyroxine, the thyroid hormone
T.PJ. - Treponema pallidum immobilization, a
specific test of serum for syphilis
TSH - thyroid stimulating hormone ofthe
pituitary gland
U. - Uflit, a comparative weight measure
U.A. - urine analysis
Ur.Ac. - uric acid
VDRL - flocculation test for syphilis
VMA - vanilmandelic acid, a test for adrenal
medulla function
W.B.C. -white blood cell count
Weights - 1 kg kilog. 10 3 g.
1 g gram
1 mg millig. 10- 3 g.
1 ILg microg. 10-1\ g.
1 ng nanog. 10- 9 g.
1 pg picog. 10- 1 . g.
W.R. - Wassermann reaction
An Acknowledgment: Clinical laboratory procedures
first appeared in The Canadian Nurse in 1949; the
author of the original summary was Dr. E.M. Watson.
The author of the last revision, which appeared in
1974, was Dr. A.H. Neufeld. We are indebted this time
to the following for their special expertise:
Blood bank:
Janis Bormanis, M.D., F.R.C.P.fc), clinical
hematologist at the Ottawa Civic Hospital;
Hematology:
Frances A. Shepherd, M.D., F.R.C.P.fc), the Director of
Medical Services at the National Blood Transfusion
Service in Toronto.
Biochemistry:
Ivo Hynie, M.D., Ph. D., F.R.C.P.fc), Director of the
Bureau for Medical Biochemistry at the Laboratory
Centre for Disease Control in Ottawa;
The C.nMII.. Nur..
September 1171 'rT
Tests identified by proper names
The use of a scientist's name for laboratory tests
fortunately is on the way out, along with outmoded
tests. However, some persist and those most
commonly used follow:
Bence-Jones protein -the abnormal protein
found in the urine of about 50 per cent of patients
with myeloma
Bodansky unit-the amount of phosphatase
required to liberate 1 mg of phosphorus; test result
for alkaline or acid phosphatases (see also Sigma)
Coombs - a test used in pregnant women and
newborn infants relative to Rh sensitization; also
used in hemolytic anemias
Duke - a method for determining the bleeding
time of a patient
Kahn - a test for syphilis
King-Armstrong unit - an amount of
phosphatase required to liberate 1 mg of phenol;
test result for alkaline or acid phosphatases
Lange's Colloidal Gold - a test on C.S.F. as an
aid in diagnosis
Mosenthal- a two-hour specific gravity volume
test for evaluating kidney function
Papanicolaou - a technique for identifying
cancer cells
PauJ-Bunnell- a serological test for infectious
mononucleosis
Rumple-Leede - not a laboratory test, but a
method to determine capillary fragility by inflating
a blood pressure cuff and counting the petechiae
in a circumscribed area of skin
Schilling - a radioisotope test for pernicious
anemia and malabsorption
Sigma - the amount of phosphatase required to
liberate 1 mg of phosphorus; test result for
alkaline or acid phosphatases (see also Bodanskyl
Wassermann - the original test for syphilis
Westergren - a technique for performing the
R.B.C. sedimentation rate
Widal- a serological test for typhoid and
paratyphoid fevers
Wintrobe - a special tube for determining red
cell volume and sedimentation rate
Ziehl-Neelsen - a stain for acid-fast bacteria,
usually for tubercle bacilli
Clinical Microbiology
Clinical microbiology is a specialty that includes
bacteriology, mycology, parasitology and virology
It is most essential that sterile techniques be
followed for all specimen collection, containers
used and transport to the laboratory; the slightest
contaminant may well invalidate the result
Parasitology: With increasing travel and
temporary residence abroad, just about all human
parasitic infections are being seen in Canada. In
general. specimens, especially stools, must be
delivered to the laboratory in as fresh a state as
possible.
Examples of medically important parasites
are as follows:
Protozoa - amoebic dysentery, malaria
Platyhelminths -tapeworm. schistosomiasis
Nemathelminths - round worms. pinworms
Arthropods - scabies, body lice
Bacteriology: In the laboratory most specimens
are cultured on various types of media. depending
on the suspected organisms. The organisms are
subsequently identified and subjected to various
tests, such as antibiotic sensitivity, etc.
It is important that. whenever possible.
specimens be procured prior to use of antiseptics
or antibiotics.
Virology: The presence of virus is established
either serologically or by isolation. Virus
laboratories are highly specialized centers.
Therefore. in most instances, specimens are
referred to them for isolation and identification.
Usually, special specimen containers are supplied.
Mycology: These organisms (fungi) can
frequently be identified by microscopic
examination. When it is necessary to culture them,
they require up to several weeks for growth and
identification.
Hematological Values
Hematological analyses are performed on blood collected in anticoagulant, the usual
amount of blood required being 3-7 mi. The anticoagulants used are EDTA for routine
hematological analyses and sodium citrate for most tests of coagulation. Other tests may
be done on serum.
Many of the routine tests in hematology are now done on automated electronic particle
counting machines. The determinations listed are by no means a complete representation
of all tests done in a hematological laboratory. They do however represent the more
common tests that are requested. Normal values listed are generally accepted values but
there may be individual variations at different institutions. These variations however are
usually minor but of particular relevance to tests of coagulation. The column of clinical
significance is very much abridged and only gives some important considerations.
Determination Normal Values Clinical Significance
Autohemolysis 0.2-2.0% without glucose differential test for certain
hemolytic anemias (spherocytic)
Bleeding time
Duke 1-4 min prolonged when platelets reduced
Ivy 1-7 min in number or defective in
Template 1-9 1/2 min function
Blood film normal morphology of essential in diagnosis of most
(smear) RBC's, WBC's platelets hematologic conditions
Blood volume 60-90 ml/kg increased in polycythemia vera;
(Isotopic decreased in dehydration, shock,
determination) hemorrhage
Carbon monoxide minute amounts carbon monoxide poisoning or
hemoglobin intoxication (car exhaust, smoking)
Clot retraction 50-100% at 2 hrs a test of platelet function
Clotting time below 15 min (Lee White prolonged in hemophilia, also with
method) heparin administration
Coagulation Factor VI/I (50.200 percent) classical hemophilia
facto rs
Factor IX (60-140 percent) Christmas disease
other Factors other coagulopathies,
hereditary or acquired
Differential Total WBC 4,800-10,800
White Cell Count Mature neutrophils increased in many bacterial
40-75%; 2,OOO-7,500/cu mm infections
Lymphocytes increased in some viral
20-45%; 1,500-4000 infections; decreased in
lymphocytic leukemias
Monocytes
2-10"41; 200-800
Eosinophils increased in allergic
1-6% ; 40-400 conditions
Basophils
0-1%; 1-100
In children lymphs and
monos can be higher
Erythrocyte Male: 0-9 mm/hr increased in infectious and
Sedimentation Female:0-20 mm/hr inflammatory diseases
Rate (Westergren)
Fibrinogen 150-400 mg/l00 ml decreased with severe liver disease,
(D.I.C.) disseminated intravascular coagulation
The Cen-.llen Nur..
September 11171 211
Determination Normal Values Clinical Significance
Fibrinogen Split negative reaction at 1/4 increased in fibrinolysis, liver
Products dilution (latex fixation) disease,D.I.C.
Folate 3- 20 \lgll folate deficiency
Folate in R.B.C. 160-640 \lgll as above
G-6-PD (glucose- Usually a normal screening test low values in G6PD
6-phosphate deficiency associated with
dehydrogenase) quantitative values: hemolysis
120-240 mU/10 9 R.B.C.
Hematocrit Male: 40-54% decreased in the anemias;
Female: 37-47% increased in polycythemia and
hem oconcentration
Hemoglobin Adult male:
14-17.5 gl100 ml decreased in the anemias;
Adult female: increased in polycythemia and
12-15.5 gl100 ml hemoconcentration
Children: (3-6 years) (shock, burns, myocardial infarction)
12-14g/100ml
Hemoglobin HgA - about 95% hemoglobinopathies
electrophoresis HgA - < 3.5% (sickle cell anemia,
HgP -<2% (50 - 90% in the thalassemias, etc.l
newborn)
HgS sickle cell disease
HgC HgC disease
Iron See Biochemistry
Iron binding
capacity See Biochemistry
l. E. Preparation none positive in lupus
erythematosus
Mean corpuscular 27-32Wg increased in macrocytic
hemoglobin anaemia (i.e. pernicious
anemia; low in hypochromic anemia
i.e., iron deficiency)
Mean corpuscular 33-38% same as above
hemoglobin
concentration
Mean corpuscular 80-100 cu \1m same as above
volume
Mono Spot negative screening test for infectious
mononucleosis
Partial thrombo- 25-37 sec prolonged in hemophilia and
plastin time (PTT) other coagulopathies, used in
control of heparin therapy
Paul-Bunnell negative differential test for
(heterophil infectious mononucleosis
antibodies)
Plasma hemoglobin 0-3 mgll00 ml increased in hemolytic anemia
(primarily intravascular)
30 Sept....t>er 1171
The C.nedlen Nu...
Determination Normal Values Clinical Significance
Plasma volume 40-50 mllkg decreased in hemoconcentration;
(Isotopic increased in some with hypertension,
determination) and some other clincial
conditions
Platelet function normal response to useful to detect poor platelet
test (aggregation) ADP, Collagen, function, hereditary or drugs
Epinephrine
Platelets 150,OOO-450,OOO/cu mm decreased in thrombocytopenic
purpura and other clinical conditions;
increased in some inflammations
Prothrombin time 11-15sec mainly used in control of oral
anticoagulant therapy;
prolonged in liver disease
Red blood cell 25.35 mllkg in males decreased in blood loss;
volume ( 51 Cr) 20-30 mllkg in females increased in polycythemia vera
Red cell fragility increased if hemolysis useful in diagnosing hemolysis
(osmotic fragility occurs in over 0.5 percent due to spherocytosis (Le.
test) NaC1 hereditary spherocytosis)
Red cell survival Half-life: 25-35 days decreased in hemolytic
test (with 51 Cr) anemias; a test for life
span of the red blood cell
Reticulocytes 0.5-1.5% of all red an indication of marrow capability,
blood cells decreased in aplastic and other
anemias; increased as response to
blood loss or hemolysis
Schilling test 10"41 and over test for absorption of B 12;
(radio cobalt (urinary excretion) can diagnose malabsorption or
Vitamin B12) pernicious anemia
Sedimentation See Erythrocyte
rate Sedimentation Rate
Vitamin B12 150-600 pglml decreased in pernicious anemias,
malabsorption, malnutrition;
increased in chronic leukemia,
infectious hepatitis, liver cirrhosis
Blood Bank Results
Determination
Blood Bank Results
Clinical Significance
ABD Group
Antigen on
Red Cells
Group 0
Group A
Group B
Group AB
Antibody in
Serum
anti-A & anti-B 45%
anti-B 40%
anti-A 10%
neither 4%
determined on every donor and
potential blood transfusion
recipient
anti-A and anti-B cause rapid
destruction of transfused red
cells that carry the correspondìng
antigen which may cause mild
hemolytic disease of the newborn,
or may cause fatal blood transfusion
reaction
The C8nlldlen Nur..
September 11171 31
Determination Blood Bank Results Clinical Significance
Rh (Rhesus, D) Group Red Cells
Rh (0) positive 85% - determined on every donor and
Rh (0) negative 15% potential blood transfusion
candidate
- anti-Rh (0) may be found in the
blood of an Rh-negative person
following transfusion of Rh-
positive blood Dr pregnancy
with an Rh-positive fetus
- may cause severe hemolytic
disease of the newborn
- causes destruction of transfused
Rh-positive red cells
Other Rh (Rhesus) Red cells
blood factors Dr C 70"10 - not routinely determined
antigens E 30% - these antigens may stimulate
c 80% antibodies
e 98% - once present, they, like anti-Rh (0),
cause the destruction of transfused
red cells carrying that antigen
- these antibodies are produced
less frequently than anti-D
Antibody screen: Positive: the patient's serum contains - the crossmatch with some donors
search for antibodies antibodies to antigens on red cells will be incompatible
in a potential selected to detect most clinically - test is usually done before the
recipient's serum significant antibodies crossmatch to allow the lab
(other than anti-A Dr to identify the antibody to find
anti-B) compatible blood
Negative: no antibodies to antigens - expect the crossmatch to be
on the screening cells were detected compatible
- less possibility of danger if
uncross-matched blood is required
in an emergency situation
Crossmatch WHENEVER POSSIBLE, DONOR IS
(Compatibility test) THE SAME ABO AND Rh GROUP AS
THE PATIENT
Incompatible: the patient's serum - if antibodies are detected in
contains antibodies to antigens tests at 37 D C, indicates that
on the donor's red cells the red cells would be destroyed
if transfused
- in general, the more incompatible
in vitro, the more rapid the
red cell destruction in vivo
Compatible: antibodies against - no antibodies detected
antigens on the donors red cells in the crossmatch, does not
not detected always guarantee n"Drmal survival
of red cells
- antibodies against antigens not
on the donor cells will not be
detected
- very low levels of antibodies may
not be detected by the routine
crossmatch technique and may
rise at a later date to produce
delayed destruction of red cells.
- antigens present on donor cells
and absent on recipient cells
will not be detected, and may
result in antibody production
at a later date
- does not prevent febrile and
allergic transfusion reactions
32 September 11171
The Cen-.llen NUrH
Determination Blood Bank Results Clinical Significance
Direct Coombs' test EDTA BLOOD SAMPLE PREFERRED - caused by antibodies to antigen binding
or Direct anti- Positive: patient's red cells on own red cells or on transfused
globulin test have detectable globulin (antibody red cells or antigen-antibody complexes
or complement! on their surface adhering to red cells
- may indicate an immune basis for
red cell destruction in vivo
Negative: patient's red cells do - any red cell destruction if
not have detectable globulin on present is unlikely to be of
their surfaces immune origin
Cold autoagglutinins WARM (37 0 C) CLOTTED SAMPLE - may occur as an isolated disorder
Auto-antibodies Positive: indicates a cold autoagglutinin or may be associated with
active mainly in the is present infections such as Mycoplasma
cold pneumonia and infectious mono-
Whenever a positive result is nucleosis or Iymphoreticular
obtained the specificity, titre, disorders
and thermal amplitude (highest - if temperature of patient's
temperature of antibody reactivity) body or extremities reaches the
should be determined temp. of antibody reactivity, the
antibodies will cause destruction
of red cells in vivo
Negative: no significant cold - any red cell destruction, if present,
auto-agglutinins were detected is not likely being caused by cold
autoagglutinins
Biochemistry, Blood, Plasma or Serum Values
Most biochemistry tests are routinely carried out on serum. However, some tests require
special collection techniques and are performed on plasma or whole blood. New
micromethods are not available in all hospitals and the required volume of the specimen
has to be verified with the laboratory.
Determination Normal Range Note Clinical Significance
Acetoacetate 0.3 - 3.0 mg/dl increased in diabetic ketoacidosis, after
plus acetone prolonged fast, etc.
Aldolase 1.3 - 8.0 mU/ml increased in many conditions including
hepatitis, muscular dystrophy, and
myocardial infarction
Aldosterone 48
29 pg/ml supine, high sodium diet high supine value in primary aldosteronism
Ammonia nitrogen 15 - 110 Jlg/dl in heparinized blood, must
be delivered on ice increased in severe liver disease, GI bleeding,
immediately some inborn errors of metabolism
normal range dependent on
methodology, check with your
laboratory
Amylase 40 - 160 U/dl increased in acute pancreatitis, parotitis,
abdominal trauma
Ascorbic acid 0.4 - 1.5 mg/dl decreased in nutritional deficiency
Bicarbonate 22. 30 mEq/1 abnormal in acid-base balance disturbances,
GI and renal diseases
Bilirubin up to 0.3 mg/dl increased in obstructive jaundice
Direct
The Cen-.llen NUrH
September 11171 33
Determination Normal Range Note Clinical Significance
Bilirubin up to 1.2 mg/dl increased in jaundice
Total
Calcitonin not measurable high in medullary carcinoma of thyroid
Calcium 8 - 10.5 mg/dl increased in hyper-parathyroid ism, some
4 - 5.25 mEq/1 forms of cancer and other conditions
decreased in hypo-parathyroid ism, rickets,
renal disease, intestinal malabsorption
Ceruloplasmin 27 - 60 mg/dl range dependent on methodology decreased in Wilson's disease
Chloride 95. 105 mEq/1 abnormal in electrolyte imbalance due to
GI, renal or metabolic problems
Cholesterol 45 - 65 mg/dl higher in female high levels correlated with decreased risk of
HDl increased on exercise ischemic heart disease
Cholesterol 150 - 250 mg/dl lower in children increased in primary or secondary
total hypercholesterolemia
high level indicates increased risk of
ischemic heart disease
Cholinesterase 0.5 - 1.3 pH units decreased in liver disease
(Pseudo Decreased or qualitatively abnormal
cholinesterase) in some healthy people - high risk
in anesthesia
Copper 70 . 1401Jg/dl decreased in Wilson's disease
Cortisol 5 - 25 1Jg/dl diurnal variation: increased, no diurnal variation in
a.m. higher than p.m. Cushing's syndrome or disease
Creatine female - CPK isoenzymes useful to determine increased in muscle, myocardium or CNS
Phosphokinase 5-35IU/1 the tissue of origin disease
(CPK) male-
5-55IU/1
Creatinine 0.6 - 1.4 mg/dl increased in renal disease
Gastrin o - 20 'JIg/dl may be increased with duodenal ulcer
Glucose 60 - 110 mg/dl less than 160 after meal increased in diabetes. Decreased in different
(fasting) types of hypoglycemia
Growth hormone less than 5 ng/ml fasting, no stimulation. increased in acromegaly. low value
(HGH) significant only after stimulation
Immunoglobulins
IgG 500 - 1650 mg/dl decreased in immune deficiencies.
IgA 60 - 340 mg/dl for children consult detailed Increased in infectious, autoimmune
IgM 40 - 160 mg/dl age tables diseases, liver diseases, myeloma, etc.
IgD 1 - 6 mg/dl
Insulin 4 - 26J1U/ml usually with glucose tolerance
(fasting) High in insulin resistant diabetes, insulinoma
Iron 60 - 160 \Jg/dl higher in males than females increased in hemolytic anemias,
hemochromatosis. Decreased in iron
deficiency anemia
Iron binding 250 - 410 Jlg/dl increased in iron deficiency anemia,
capacity pregnancy. Decreased in hemochromatosis,
hemolytic anemia
34 September 11171
The Cen-.ll.n NUrH
Determination Normal Range Note Clinical Significance
-
lactate 0.6 - 2.0 mEq/1 oxalate blood, deliver on ice
immediately. increased in lactic acidosis
Higher in venous than in
arterial blood
lactic 60 - 160 U/ml lDH isoenzymes can identify Increased in myocardial infarction,
dehydrogenase source of increased lDH pulmonary infarction, liver disease, etc.
(lDHI
lipase up to 2.0 U/ml I ncreased in acute pancreatitis
lipids 450 - 1000 mg/dl increased in some hyperlipidemias. lipid
fractions (cholesterol, triglyceridesl more
useful for diagnosis
lipoproteins normal electrophoretic increasingly replaced by cholesterol, the electrophoretic pattern diagnostic for
pattern of chylomicrons, H D l cholesterol and tri-glycerides five types of hyperlipoproteinemia
pre-beta, beta and alpha
Magnesium 1.3 - 2.1 mEq/1 decreased in some forms of renal disease,
after insulin administration, rarely in
tetanus; increased in renal failure, metabolic
acidosis
5'-N ucleotidase 0.3 - 3.0 units
increased in some liver diseases
Osmolality 280 - 295 mOsm/kg abnormal in hypo- and hyper-osmolar states
p C0 2 35 - 45 mm Hg arterial blood, deliver on ice increased in respiratory acidosis
pH 7.31 - 7.45 arterial blood, deliver on ice low in acidemia, high in alkalemia
p 0 2 75 - 100 mm Hg arterial blood, breathing normal air. low in respiratory or heart failure.
May be 500+ mm Hg if patient Important for monitoring patients on
breathing oxygen respirator
Phosphatase male- increased in cancer of prostate, in
acid up to 0.63 sigma U/lnl non-hemolyzed hemolyzed serum
female - fresh or frozen serum
up to 0.56 sigma U/ml
Phosphatase 3 - 13 King-Armstrong higher in children and adolescents increased in biliary obstruction,liver disease
alkaline U/dl bone disease
13 - 40 lUll
Phosphorus adult - increased in renal failure
inorganic 2.5 - 4.5 mg/dl low in hyperparathyroidism
children -
up to 6.5 mg/dl
Potassium 3.5.5.0 mEq/1 serum must not be hemolyzed increased in renal failure, ketoacidosis,
Addison's disease. Decreased in recovery
phase from diabetic coma, in alkalosis
Prolactin 2 - 15 ng/ml high in galactorrhea due to hypothalamic
lesion
Protein fractions albumin low in albuminuria,liver disease.
albumin 3.5 - 5.0 g/dl Globulin fractions increased in infections,
globulin total 2.3 - 3.5 g/dl some forms of cancer, etc.
globulin a 1 0.1 - 0.4
a2 0.4 - 1.1
ß 0.6 - 1.2
y 0.5 - 1.5
The C.n-.llen NUrH
September 11171 35
Determination Normal Range Note Clinical Significance
Protein total 6.0 - 8.4 g/dl increased in dehydration, myeloma.
Decreased in renal diseases,liver disease,
malnutrition, protein-loosing enteropathy
Renin 1.1.! 0.8 ng/ml/hr supine, normal diet important in differential diagnosis of
10.0.:t. 3.7 ng/ml/hr upright, low sodium diet hypertension
plus diuretics
Sodium 135 - 145 mEq/1 increasl!1 in hyperosmolar coma, some
forms of dehydration. Decreased in
diarrhea, vomiting, tube drainage, diabetic
keto-acidosis, Addison's disease
T 3 resin 25 - 40% normal varies considerably increased in hyperthyroidism, nephrotic
uptake from laboratory to laboratory syndrome
Decreased in hypothyroidism,
oral contraceptives.
5.5 - 12.5 g/dl normal range varies from increased in hyperthyroidism, after oral
T4 laboratory to laboratory contraceptives. Decreased in
hypothyroidism and in states with low TBG
e.g., protein loosing enteropathy, nephrotic
syndrome.
SGOT 10 - 50 U/ml increased in diseases of liver, muscles, and
(glutamic - myocardial necrosis
oxalacetic
transaminase)
SGPT 10 - 40 U/ml in liver disease increased more than SGDT
(glutamic -
pyruvic
transaminase)
TBG 10 - 25119T 4/dl important to clarify discrepancy between
!thyroid binding clinical thyroid status, T 4, and T 3 resin
globulin) uptake
Testosterone adult male - low value in some forms of male sterility
300 - 11 00 ng/dl
adult female -
25 - 90 ng/dl
T riglycerides 50 - 150 mg/dl increased in type I, lib, III, IV and V
hyperlipoproteinemia, diabetes, nephrotic
syndrome, hypothyroidism
TSH 0.5 - 3.5 \lU/ml test not sensitive enough to usually high in hypothyroidism
distinguish reliably abnormally
low value from lower limit of
normal range
Urea Nitrogen 8 - 25 mg/dl decreased in serious liver disease. Increased
(BUN) in renal failure, dehydration, circulatory
failure
Uric acid 2.5 - 8.0 mg/dl male higher than female, increased in gout,leukemia, renal failure
significant racial differences glycogen storage disease type I,
lesch-Nyhan disease
36 September 11171
The C.n-.llen NUrH
Urine Values
Determination Normal Value Specimen Note Clinical Significance
Required .
Acetone plus negative random diabetic ketoacidosis
acetoacetate
(Ketone bOdies)
Aldosterone 5-201lg/24 hr 24 hr special di
t, hyperaldosteronism
keep specimen
cold
Amylase 40-240 Somogyi random pancreatitis,
U/hr parotitis, pancreatic trauma
Calcium 50-250 mg/24 hr 24 hr hyperparathyroidism, hypercalciuria with
kidney stones
Catecholamines:
Epinephrine up to 20119/24 hr check with the
Norepinephrine up to 1001lg/24 hr . 24 hr laboratory for
Metanephrines up to 1.3 mg/24 hr preservative; increased in pheochromocytoma
Vanillyl- 1.8-9 mg/24 hr avoid interfering
mandelic acid medication
(VMA)
Chlorides 100-250 mEq/1 random or important in studies of fluid and
24 hr electrolyte balance
Copper less than 24 hr high in Wilson's disease
1001lg/24 hr
Coproporphyrins 50-250 \19/24 hr 24 hr collect with increased in some types of
5 9 of sodium porphyria
carbonate
Cortisol 20-7511g/24 hr 24 hr keep specimen investigation of adrenal cortex
cold
Creatine less than 24 hr higher in children, increased in some muscle diseases
100 mg/24 hr in pregnancy
Creatinine 15-25 mg/ 24 hr constant under most conditions.
24 hr/Kg of Quantitative measurements in urine
body weight frequently expressed per mg of
creatinine
Follicle men-
Stimulating 5-25 IU/24 hr
Hormone (FSH) women - 24 hr important in the investigation of
midcycle endocrine disturbances
15.60 IU/24 hr
Follicular and luteal
5-25 IU/24 hr
17-0H male- range lower for
corticoids 8.25 mg/24 hr 24 hr some modern investigation of adrenal cortex
female - methodologies,
5-18 mg/24 hr check with your
laboratory; for
children consult
age tables
5-hydroxy indole-
acetic acid . 2-9 mg/24 hr 24 hr collect with increased in carcinoid
(Serotonin) 10 ml HCI tumors
The C8nlldlen NUrH
September 11171 37
Determination Normal Value Specimen Note Clinical Significance
Required
17-ketD- age male female for smaller investigation of adrenal and
steroids (mg/24 hr) children consult testicular functions
10 1-4 1-4 24 hr detailed tables
30 8-26 4.14
70 2-10 1-7
lead less than 24 hr investigation of chronic
120,.g/24 hr lead exposure
Osmolality 50-1200 mOsm/kg 24 hr investigation of concentrating
ability of the kidneys
Phosphorus 500-1500 mg/24 hr 24 hr influenced by diet together with serum phosphate
important in Ca and P metabolism
investigation
Porphobilinogen less than 24 hr important in investigation of
2 mg/24 hr random porphyrias
Qualitative test
negative
Potassium 25-100 mEQ/24 hr 24 hr varies with dietary important in investigation of
intake renal function, of adrenal cortex,
of water, electrolyte, and acid-base
balance
Pregnanediol female -
3-10 mg/24 hr 24 hr increased in investigation of ovarian function,
male- pregnancy and adrenal tumors
0-1.5 mg/24 hr
Protein less than increased in nephritis
150 mg/24 hr 24 hr and nephrosis
Sod ium 27-287 mEQ124 hr 24 hr same as potassium
Titrable 20-40 mEQ/24 hr renal and acid-base investigation
acidity
Urea 6-17 g/24 hr 24 hr some metabolic investigations
Nitrogen
Uric acid 0.4-1.0 mg/24 hr 24 hr useful in investigation of renal stones,
metabolic disturbances
Urobilinogen 0.2.3.3 mg/24 hr 24 hr preserve with increased in liver diseases and
Qualitative: sodium carbonate hemolytic jaundice
positive 1:20 random under petroleum
eth er
Cerebrospinal Fluid Values
Test Normal Value Note Clinical Significance
Appearance clear and colorless cloudy in meningitis, bloody
or yellow in CNS bleeding
Bacteriological negative frequently diagnostic in CNS infections
examination
Cell count 0-5 mononuclear number and type of cells variable with
cells per mm 3 the type of infection
35 September 11171
The Cen-.llen NUrH
Test Normal Value Note Clinical Significance
Chlorides 115-130 mEq/1 20 mEq/1 higher than serum increased in uremia, decreased in
tuberculous meningitis
Colloidal gold 0000000000 - abnormal in meningitis, syphilis
test 0001222111
Glucose 40-85 mgldl 20 mgldlless than serum. Always decreased in bacterial and tuberculous
compare with serum value meningitis, abnormal value significant
only if compared with blood concentration
Pressu re 70-180 mm of H2O not a true laboratory test increased in meningitis, brain edema,
5-15 mm Hg hemorrhage, etc. decreased in
dehydration, spinal renal block
Protein:
albumin about 50% of total increased in meningitis, spinal cord tumor,
IgG 5-15% of total etc.
total 15-45 mgldl
Functional Tests
The normal range is not only influenced by the variations between laboratory methodo-
logies, but also by modifications of the tests themselves as they are performed in different
establishments. The "normal value" below may provide useful information but should
be verified locally. Only the more common tests are listed. (Not alphabetically listed.)
. .
Test Principle Normal Value Clinical Significance
.
Metabolic al)d . ..
Endocril)e
a.c.-p.c. blood capacity of endocrine a.c. less than 110 mgldl useful in diagnosis and management of
glucose pancreas to react to p.c. less than 160 mgldl diabetes mellitus
glucose load
Oral Glucose 3 hr GTT . the sum of 0,1,2,3 hrs diagnosis of diabetes mellitus. Useless
Tolerance test same as above blood glucose concentration less if diagnosis can be established by a.c.-p.c.
(GTT). Usually than 500 mgldl blood glucose
1.75 of glucoselkg 5 hr GTT - blood glucose back
of body weight to normal after 2 hrs, does not in reactive hypoglycemia drop of blood
drop below 55 mgldl thereafter glucose below 55 mgldl is accompanied by
clinical symptoms
48 hr fast secretion of insulin no symptoms of hypoglycemia, in hyperinsulinism (e.g. insulinoma) test
(after Dver- should virtually stop glucose stays above 60 mg/dl, has to be terminated due to symptomatic
night fast, with decreasing insulin drops hypoglycemia and persistent high plasma
monitor insulin, blood sugar insulin level
blood glucose .
and clinical .
symptoms
every 2 hr)
Lv. insulin evaluation of the blood glucose drops to profound drop in hypopituitarism,
sensitivity functional capacity 45-60 mgldl after 1 hr Addison's disease and some other
(0.25 U/kg) of anti-insulin conditions. Note: be ready to administer
systems Lv. glucose immediately if needed
Lv. tolbutamide tolbutamide induces plasma insulin level increased by prolonged hypoglycemia and elevated
test release of patient's less than 50 uUlmllafter 30 min. plasma insulin in hyperinsulinism. Note:
(I g Lv.), own insulin Blood glucose more than 70% have Lv. glucose ready before starting
measure blood of fasting value after 1 hr the test
glucose, plasma
insulin every
10min.
The Cenedlen NUrH
September 1171 31
Test Principle Normal Value Clinical Significance
radioactive measure of the rate 5-45%, depends on geographical decreased in hypothyroidism, thyroiditis.
iodine uptake of thyroid hormone area and diet Increased in hyperthyroidism. Correlation
synthesis with clinical findings essential for
correct interpretation
T 3 suppression T
will suppress T 4 drops to subnormal level or suppression absent if thyroid not regulated
test T H with resulting to 50% of initial level by pituitary gland, e.g., thyroid adenoma
(100 Jig daily for drop in T 4 production
10 days)
ACTH stimulation ACTH stimulates urinary 17-DH steroids increased evaluation of endocrine adrenal cortex
test synthesis of 3-4 times functional reserve
glucocorticDids
Metapyrone test inhibition of cortisol urinary 17-0 H steroids doubled evaluation of pituitary - adrenal cortex
synthesis leads to functional response. Contraindicated
increased ACTH if ACTH stimulation is negative
secretion and to
increased production
of cortisol precursors
Dexamethazone dexamethazone will urinary 17-0H steroids decreased to useful especially in differential diagnosis
suppression suppress normal ACTH about one-third of pre-suppression of Cushing's syndrome
test secretion amount
Renal
diurnal normal kidneys react night volume smaller than day Sp. gravity almost constant (near 1.010)
variation promptly to osmotic volume. Sp. gravity variable in some chronic renal diseases.
changes due to normal during daytime by at least
activity and diet 9 points (e.g. 1.005-1.015)
cycle
Concentration testing maximum impaired in chronic pyelonephritis and
and dilution ability to concentrate other renal diseases
test or dilute urine after over 1.025 less than 1.003
water deprivation or
water load
Creatinine measures glomerular 90.130 ml/min most sensitive simple test for decreased
Clearance filtration glomerular function
Renal plasma PAH excreted both useful in differential diagnosis of
flow by glomular filtration 500-700 ml/min renal diseases
and tubular secretion
Tubular e.g., excretion of 77 mg/min of PAH useful in differential diagnosis of
functions PAH or reabsorption 380 mg/min of glucose renal diseases
of glucose
Reabsorption the relative amount of decreased, e.g., in hyperparathyroidism
of phosphorus phosphorus
reabsorbed from over 80%
glomerular filtrate
Gastrointestinal
D-Xylose xylose is absorbed more than 5 g excreted in urine urine excretion diminished in malabsorption
absorption test by normal intestine in 5 hrs (first establish normal renal function)
(25 g p.o) and partially serum level over 25 mg/dl
excreted by urine after 1 hr
Vitamin A absorption of fat. vitamin A level in serum doubled useful in investigation of malabsorption
absorption test soluble material in 3 hr syndrome
(200,000 units
in oil)
40 September 11171
The C.n-.llen NUrH
Test Principle Normal Value Clinical Significance
Schilling
test See Hematology
Gastric juice:
volume fasting 30-70 ml/hr useful in differential diagnosis of
nocturnal 600-700 ml stomach diseases
24 hr 2-31
Acidity: pH 1.5-2.0
acid output basal male 1-4 mEq/1 useful in differential diagnosis of
female 0.5-3 mEq/1 stomach diseases
Acid output after stimulation male 15-30 mEq/hr
maximum by histamine s.c., female 10-22 mEq/hr
preceded by Phenergan
or Histalog
Fecal fat more than 93% of less than 7g/day of fat in stool investigation of malabsorption
(3 days fat should be absorbed
50 g/day died
Bromsulphalein in healthy subject less than 7% retention after 45 m in liver function test
Lv. excreted almost
entirely by liver
Secretin Lv. secretin over 1.8 ml/kg of body wtlhr decreased in diseases of exocrine
test increases volume and bicarbonate concentration pancreas
of pancreatic juice over 80 mEq/1
Pulmonary
FEV 1 forced expiratory depends on age, height and weight decreased in restrictive lung diseases
volume in 1 second 3.71 for middle-aged average man
average man
MMEF mean maximal about 3_5 I/sec for middle-aged decreased in restrictive lung diseases
25- 75% expiratory flow man and obstructive airway disease
over the middle
half of FEV
Blood gases
pH 7.31 - 7.45 high pH - alkalemia
PC02 pH and pC02measured ---------------------------- - __Lo_
p_"!.::.!!
'l.'!'La_ --
r-r-- - _ _ _ ____.
"respiratory component 0 acid-base
directly, all other values 35-45 mm Hg balance. Increased in respiratory acidosis,
(including buffer base decreased in respiratory alkalosis. In
and actual bicarbonate metabolic acid-base disturbances the pC02
not listed here) arecalcul- change is secondary to changes in bicarbonate
ated from the two above (decreased in metabolic acidosis, increased
in alkalosis).
standard theoretical value "metabolic component" of acid-base
bicarbonate of bicarbonate con- balance. Increased in metabolic alkalosis,
( HC0 3) centration if blood 22-28 mEq/1 decreased in metabolic acidosis. Secondary
was equilibrated changes of standard bicarbonate in chronic
at pC02 = 40 mm Hg respiratory acid-base disturbances follow
the same direction as the pC02 abnormality
base excess calculated value,
indicates deviation -3 - +3mEq/l a measure of "metabolic component"
of buffer base above
from normal
p 0 2 See Chemistry
Sweat test various methods of Na+ below 80 mEq/1 concentrations of Na and Cl increase in
inducing sweating Cl- below 60 mEq/1 cystic fibrosis
followed by electrolyte
determination in sweat
The Can-.llen Nurae
September 1171 41
The history of the nurse practitioner moument as an acknowledged force in
this countQ' can be traced to the end of the last decade. (Its histoQ as an
accepted but largel
' unrecognized feature of the Canadian health care scene
goes back much further than that - to the days when nurses like Jeanne
Mance set up her cottage hospital in what was to become Montreal and the
Gre
' Nuns began \'isiting the sick in homes in the Quebec City area some
300
'ears ago.)
Thenurse
practitioner:
an idea whose
time has come
Maureen McTavish
In the 1960's expectations concerning the possibility of formalizing the
role of the nurse practitioner ran high. Many members but b
' no means all
of the nursing profession felt that nursing wàs read
' to accept a more
independent and autonomous function in the health care hierarchy. And the
issue is still a controversial one today.
Author Maureen McTa\'ish has giwn some thought to the issues that
surround the question and come up "ith some ideas on how nursing can
regain the impetus it once had in this direction.
NURSING
..... .M..
.HE
\5
NUR.SE
IÐ
"Primary health care is essential health
care made universally accessible to
indi\'iduals and families in the
community bv means acceptable to
them, through their full participation and
at a cost that the community and country
can afford. It forms an integral part hoth
of the country's health system of which it
is the nucleus and of the o\'erall social
and economic de\'elopment of the
community.'"
This is the definition that delegates to the
International Conference on Primary
Care, meeting in AlmaAta, Russia in
September 1978, decided upon. Reading
it, you may wonder just how relevant
such a statement is when applied to
developed countries like Canada. After
all, we can afford a very high standard of
health in this country and we have an
abundance of physicians in urban areas
at the moment. So why settle for
something as esoteric as "primary health
care" when we can go to the hospital or
the doctor's office?
But take another look. Our views on
i1Iness and health are changing. We are
beginning to see that we have created a
health care system that is staggeringly
expensive but is, nonetheless, incapable
of expanding fast enough to meet the
burgeoning health care needs of the
community that supports it. Prevention
is beginning to be recognized as the onJy
workable approach to this dilemma. As
our approach changes, as it must in the
light of this reality, what are the
alternati ves?
One of them of course is the division
of responsibilities for meeting primary
health care needs along new lines -
acceptance by the public and by the
health professions of a more autonomous
role for nursing in new practice patterns
and settings. One group of nurses with a
special interest in achieving greater
independence in their practice is the
group known as "nurse practitioners".
\.
\JIJJ.'_'^
""".. .
42 Sepllllllber 1871
The Can-.llen Nurae
What's happening?
In Canada. the idea of an expanded role
for nurses seems to be losing ground.
Despite the hue and cry from both inside
and out of the health professions about
the inefficiency of the health delivery
system and the need for more services
for more people. the nurse practitioner
continues to be underutilized. Is it
because we in Canada believe that there
is no place for such a health
professional? If so. perhaps we should
examine the question more closely. The
increasing need for community health
services. more emphasis on preventive
measures. more patient teaching, more
responsibility for health in the hands of
individuals - if we believe that these are
part of the direction that health care
should be headed towards, then are
nurses preparing for it?
It is these needs that the nurse in
primary health care or the nurse
practitioner seems to be gearing herself
to meet. In the early 70's, the Burlington
Experience 2 demonstrated the safety and
efficiency of the nurse practitioner in
providing primary health care. But not
much has been done since.
The issue is an extremely complex
one. involving both practical and
theoretical considerations. Abstract or
"theoretical" obstacles to utilization of
the nurse practitioner include:
. conflicting philosophies as to what a
nurse practitioner ought to be and ought
to do:
. lack ofreal definition as to the role
of the nurse practitioner;
. discord within the nursing
profession itself as to whether this is the
route nursing should follow;
. professional territoriality; and
. the whole complex process of
change itself.
Along with these abstract
considerations. there are also some very
practical reasons why the nurse
practitioner has continued to be
underutilized. These barriers include:
. the method of remuneration;
. the licensing of nurse practitioners;
. level of preparation; and
. lack of awareness and acceptance
on the part of physicians, administrators
and consumers about what the role of the
NP is or should be.
The outlook is not totally bleak,
however. The social climate today
supports efforts to break free of
longstanding stereotypes to a degree not
experienced by any other generation. It
is a time that is encouraging a
re-examination of traditional roles. that
invites flexible and innovative planning
and action. 3
Nursing's choice
Two questions require a decision by the
nursing profession as a whole:
. Is this the way for nursing to go in
the future?
. Is this to be the goal for all nursing
education and the pattern for all nursing
practice: or. are these practitioners to
remain a select and small group within
the profession?
If there is to be any truly informed
judgment as to whether the nurse
practitioner role is an appropriate one,
then nursing research must provide
answers. For too long. members of other
disciplines have charted nursing's future
course. 5 Through research. nurses must
examine the validity of the practitioner
role for nursing and at the same time,
take into account society's need for
increased quality and quantity of care
and consider nursing's share in the
responsibility for ensuring that these
needs are met.
This is not to say that nursing
research has completely ignored the
nurse's role in primary health care. The
Burlington studies are a prime example
of research carried out by members of a
variety of health disciplines including
nursing. But when the Boudreau report 6
was released in 1972. one of the principle
recommendations it contained was to the
effect that numerous studies across the
country would be necessary to properly
investigate the question. So far, the
nurses' role in primary health care has
been the subject offormal study in onJy
two provinces - Newfoundland and
Ontario.
Another research project. this one in
Quebec, was begun three years ago by
McGill University School of Nursing in
Montreal. A community health clinic.
staffed by nurse practitioners with
physicians acting on a referral basis onJy,
was set up in a middle class suburb. The
project is an experiment to see if
focusing on nursing care and preventive
health. with particular attention to the
family, is a distinct service that nurse
practitioners can bring to the
community. Even this project. however.
is in jeopardy. It has not received
additional funding from the federal
government for the coming year and so
will be closing its doors sometime this
summer. It is particularly unfortunate
because the clinic will have been in
operation for just under three years-
not really long enough to evaluate its
effect on the health of the community it
serves.
Defining the role
Perhaps one of the major problems. so
far. is that the role of the nurse
practitioner has been inadequately
defined. It is up to nursing to define the
role of the nurse practitioner more
exactly, by developing specific lists of
functions with specific objectives for
each function. In my opinion. this is the
first step in gaining acceptance by both
consumers and physicians. These groups
must know what they can expect from
the nurse practitioner. In addition. the
legalities involved in expanding the
nursing role must be fully appreciated.
One of the best existing models that
demonstrates the kind of work that must
be done to define the role of the nurse
practitioner is found in Clinically Trained
Nurse programs (CTNs). established at
several Canadian universities to educate
nurses working in isolated outposts in
the early 1970's.
The medical and nursing educators
associated with the CTN programs
became increasingly aware that the role
of this new professional in the health
field had no clear definition. They
decided that without specific criteria the
competencies of the CTN graduates
were very difficult to evaluate.
Consequently, the educators responsible
for the CfN programs decided to define
the role of the competent clinically
trained nurse in a clear. rigorous and
thorough way. For example. for each
erN skill that was described. certain
criteria had to be met:
. the skill. when performed, could be
observed by another nurse. physician.
etc.
. the description had to specify when
and where the clinically trained nurse
could be expected to adequately perform
the skill.
The Can-.llen Nurae
September 1871 43
Deciding on "hat's important
I n developing a program such as the
CTN program, a research committee had
first of all to decide on the objectives of
the program - what were necessary
skills?The literature 7 . b . 9 indicates that if
three out offour experts agree on the
desirability of an objective, then the
objective can be considered as having
content validity. Because the role of this
health professional was a contentious
issue however. further criteria were
developed. A validating panel was set up
composed of nurses, physicians. content
specialists (eg. obstetricians for
obstetrics) and university faculty. The
only skills that were considered
absolutely necessary for aCTN were
those that were labelled as "necessary"
by 75 per cent of each group on the
panel. "'The objectives also state very
clearly how independent the (TN may
be in her practice. They indicate if she is
to treat the patient by herself;
. to consult with a physician
(including the time constraints)
. to refer to a physician (including the
time constraints)
. to evacuate the patient (including
the time constraints and treatment dunng
evacuation).
This bank of objectives is part of the
research being sponsored by Medical
Services Branch of Health and Welfare
Canada.
Interestingly. several research
programs have been conducted at the
University of Alberta's CTN program
which indicate that nurses without the
CTN program do not possess necessary
specified skills even when they are
trained at the baccalaureate level. have
had e"perience in northern nursing
stations. or have had midwifery
training. II
The CTN program is just one model
for a nurse practitioner. Other specific
models need to be developed for each
kind of nurse practitioner. While the
CTN program is geared to nurses who
will be in isolated areas with minimal
access to a physician. nurse practitioners
in other settings will function very
differently. e.g. as co-practitioners in a
doctor's office, a'i health professionals
attached to a public health unit, perhaps
in some cases as a physician's assistant.
These different roles require definitions
that specify exactly what functions and
responsibilitit;'> these practitioners have.
Once these functions are
established. the content ofthe
curriculum for nurse practitioners needs
to be analyzed in order to establish
whether the training is appropriate to
their level of functioning. .2 For example.
the programs may need more of a
practice orientation than an academic
orientation. Other programs may need to
modify their approach to make students
more responsible for their own learning. 13
Increased responsibilit)
for patient assessment
It is obvious that there is a need for all
nurses to assume more responsibility for
total patient assessment. Beginning
practitioners need more skill in complete
health and nursing history taking and in
behavioral and physical assessment
skills than they have learned in
traditional programs. 14 Needs which
have been identified are: I
. a faculty which is more prepared in
the current clinical practice of
professional nursing;
. a clearer statement of the scope of
the complete behavioral and physical
assessment process as it applies to
nursing;
. a plan for the inclusion of all or
portions of that process into the
curriculum in order to prepare graduates
who can practice nursing at the level
currently accepted as professional.
Progress in this area has already
been made. University schools of
nursing have incorporated the teaching
of additional assessment skills into their
baccalaureate programs and many are
revising their curriculums in order to
reflect a broadened concept of nursing.
Diploma schools of nursing have
enlarged the scope of their curricula so
that graduates will be able to move out of
their traditional roles and into the
community. However. some schools
seem to have done this to a greater
degree than others and collaborative
effort needs to be made to standardize
programs across the country and arrive
at standards which are uniform to all
nursing graduates.
The problem ofreahty shock is still
with us. As yet there is still little effort
being put into building a support system
which could facilitate the students'
transition to the work setting. In many
cases the biases. priorities and role
images of the educators are academic or
disciplined-focused rather than
utilization-focused. 16 It is the
responsibility of nursing educators to
build the role of the educator as a link to
the delivery system. 17
Greater utilization
Once the role of the nurse practitioner is
clearly defined. the functions specifically
stated. the activities objectively
evaluated, the educational preparation
analyzed. then and only then can some of
the practical barriers and resistance to
the utilization of the nurse practitioner
be removed. How will this happen? Only
through nursing research of varied
approaches and in various locations that
demonstrate the vital and desirable
contribution that nurse practitioners can
make to primary health care. Adequate
funding will only be obtained when
nursing can approach governments,
health departments. community health
centers and general practitioners with
precise facts and data validating both the
economic rewards and the quality of care
gained by utilization of the nurse
practitioner.
Of course. in order to conduct such
research projects. funding is necessary.
Therefore. the interest and impetus that
was behind the nurse practitioner
concept in the early 1970's will have to
be revived. This means not only exerting
political pressure on governmental
structures but also gaining public
support. This may be difficult to do
because nursing has never done a very
good job of "selling itself' to the
consumer. Somehow. the idea that our
services are a commodity to be bought
by the public has been repugnant to the
profession as a whole. But this is in fact
the situation that nursing - among other
health professions - is finding itself in.
Ifwe feel that nurses in primary care
have a vital and desirable service to offer
then we must also convince the
community of this. if we are to be
allowed to provide this service.
Polish the image
I feel that nursing has in recent years
alienated itselffrom the general public
partially through putting increasing
emphasis on remuneration and financial
benefits. This is not to say that adequate
financial rewards for nursing services are
less than important. But the problem it
seems to me is that the public is still
unaware of exactly what nursing does for
them. what it has to offer. They have to
know why we're worth more. The
nursing profession must direct itself to
becoming more tuned into the public and
tuning the public into them - its
members must increase contact through
public education and the media in order
to gain acceptance and support for the
expanded role of the nurse.
Licensing and accreditation
including removal of some of the legal
restrictions on nurse practitioners can
only be commenced once the functions
and expectations of the role are more
clearly defined. How can someone be
licensed for something if it isn't clear
what that "something" is.
44 SepI","ber 1879
The Can-.llen Nurae
Research and more research
The resol ution of these problems -
financing and licensing - will be the
greatest contributors to acceptance of
nurse practitioners and thus to their
utilization. But research must come first.
Although not all barriers contributing to
the underutilization can be laid directly
at nursing's door, it seems to be that
nursing itself has been the biggest
obstacle in gaining utilization of the
nurse practitioner. If the issue of the
u nderutilization of these health
professionals is ever to be resolved, then
nursing must pull itself out of its lethargy
and apply the problem-solving process,
beginning with research. It is time to
collect sufficient data on a number of
unresolved issues. for instance:
. the name to be used to refer to
nurses working in each expanded role in
the primary care setting (nurse
practitioner or otherwise);
. the conflicting philosophies and
discord within the profession itself as to
what a nurse practitioner is, does, or
should be;
. professional territoriality and its
influences on expansion of roles;
. the traditional image of the nurse
and its contribution to resistance to
change;
. the effective identification and
utilization of the process of change itself;
. licensure of the nurse practitioner
and examination of the legal aspects of
expanded role nursing with the view of
protecting individuals engaged in this
form of practice;
. minimum education requirements
for primary care nursing, mechanisms to
ensure the quality of the educational
programs and mechanisms to ensure the
quality of graduates ofthese programs;
. funding and guidelines for the social
and economic welfare of nurses working
in expanded roles;
. lack of awareness on the part of
physicians, administrators and
consumers.
It has been too easy in the past to
blame the physician, the consumer, the
government or the system when, in fact,
responsibility for resolution of these
problems rests squarely on "nursing
shoulders"! The nurse practitioner is an
idea whose time has come. And with it, I
believe our time has come, as nurses, to
not only improve the quality of health
care in Canada but to open up a
challenging and rewarding field for our
profession. Let's not miss our
opportunity! 'iii
References
I Primary Health Care. Ajoint
report by the director general of the
World Health Organization and the
executive director of the United Nations
Children's Fund. WHO, Geneva, 1978.
p.2.
2 Sackett, D.L. The Burlington
randomized trial of the nurse
practitioner: health outcomes of
patients. Annals of Int. Med. 80:137-142,
1974.
3 Musgrave, Corrine. The nurse with
something extra may soon be phased out
in Ontario. T orontoGlobe and Mail.
Sept.2, 1976.
4 Lewis, Edith P. Editorial: nurse
practitioner the way to go?
Nurs.outlook. 23:3:147, Mar. 1975.
5 Ibid.
6 Canada. Dept. of National Health
and Welfare. Committee on Nurse
Practitioners. Report. 1972.
7 Bloom, B.S. Handbook on
formative and summative evaluation of
student learning, by... et al. Toronto,
McGraw-Hili, 1971.
8 Hayes, Patricia. Competency
criteria for nurse-midwifery, a
methodological study. Edmonton, 1974.
Thesis (M.H.S.A.). 1973.
9 Hazlett, C. B. Evaluation on
formative and summative evaluation of
student learning. by... et al. Toronto,
Canad.Med.Ass.J. 108:1282-1287,
passim, May 19, 1973.
10 Hazlett, op. cit. p.703.
II Ibid., p.708.
12 Herzog, Eric L. The
underutilization of nurse practitioners in
ambulatory care. Nurse Pract. 2:1:26-29,
Sep/Oct. 1976.
13 Manthey, Marie. Primary nursing,
by... et al.Nurs. Forum. 9:1:64-83,
1970.
14
15
16
17
Ibid.
Ibid.
Herzog, op. cit. p.28.
Ibid., p.28.
Maureen McTavish (B .N., University of
Calgary) is presently working as a staff
nurse in obstetrics at the Prince Rupert
Regional Hospital in British Columbia.
She states, "From the beginning of my
nursing education I have been drawn to
the concept of the nurse practitioner. In
my final year at the University of
Calgary in 1977, I had an opportunity to
research and write a rather extensive
paper entitled The underutilization of th{
nurse practitioner. I found it to be a very
complex issue."
The present article, The nurse
practitioner: an idea whose time has
come, is a condensed
'ersion of the
longer paper.
-
-
),
\J
NURSING
1M E
\S
NURsE
f OUT 1
Th. Cen-.llen Nur..
;.
f1
Within a nursing department the is'iue of
staffing evokes universal interest, but
from different points of view. The
nursing administrator focuses on
adequate coverage to provide
cost-effective quality patient care while
meeting contractual obligations. The
staffnurse's focus is on the time
schedule which best allows for her
private as well as nursing life:
specifically. the number of weekends off,
split days off, evening and night shifts,
etc. We decided to work at creating a
time schedule that would reflect
everybody's needs.
The trial was conducted on the
newly-created 34-bed inpatient
Rehabilitation Unit which was staffed by
12 R.N. 's and 5 R.N .A. 's. Our
experience with rehabilitation nursing in
an acute care setting was limited, and we
recognized that we could not
automatically assume that what worked
for other inpatient units would work here
as well. We had to be creative and
flexible in responding to this nursing
unit's particular needs. Our timing was
good: the unit had been functioning for
only eight months which Was long
enough for the initial settling in to have
taken place, but recent enough that the
staff was comfortahle in trying out new
ideas.
Objectives
Before creating a new staffing pattern we
discussed the specific goals we hoped to
achieve. These needs, as expressed
during our initial planning sessions,
included the following:
. to concentrate coverage at those
times of the day when the most nursing
intervention was required;
SepI_1871 45
In these times of result-oriented
planning, a group of nurses at
Mount Sinai Hospital in Toronto
discovered that the process of
working out a problem can
sometimes be as useful as the
solution itself. Here is what these
nurses learned when they
experimented with a new method
of stamn
.
. to provide learning opportunities for
increasing nursing knowledge of the
rehabilitation process;
. to increase involvement of those
working evening shifts in day activities.
and to provide a smooth transition from
day to evening coverage; and
. to meet the staffs requests for fewer
shift changes, more weekends off duty,
extended shifts - and extended time off.
To meet all these very worthwhile
objectives was a definite challenge to our
ingenuity. After much discussion we
decided to utilize both eight and twelve
hour shifts in the one staff rotation. This
would provide us with the flexibility
needed to achieve the diverse goals we
had set for ourselves. (See figure one)
Planning
The use of the twelve hour shift is
well-documented but we planned to use
it in a slightly different way. Our twelve
hour shift would be predominately an
evening shift. This would allow for
increased contact between day and
evening staff, a greater number of staff
during two of the three mealtimes,
increased numbers available for
afternoon educational and rehabilitation
therapy sessions, and increased time for
nursing conferences.
We also used longer periods of shift
work than was normal practice in our
hospital. The nursing staff were to be on
twelve hour day and evening shifts for
blocks offour weeks. This measure was
meant to meet the staffs request for
fewer shift changes. However, the
concept was in violation of our collective
agreement with the Ontario Nurses
Association, which did not allow for
more than two weeks of shift work
..
without a period of days. The staff
petitioned their association for
permission to use this new approach and
permission was granted.
The proposal in its final form was
presented to the Registered Nurses
whose response was, on the whole,
favorable. It fulfilled many of their
requests and they understood that the
new schedule could provide for more
effective patient care and staff
education. It was agreed that the new
schedule would be tested for a
three-month period and then be
evaluated by all concerned.
Working it out
The transition to the new schedule and
adaptation to the extended shift was
rapid. probably due to the staffs
enthusiasm for change. However, as
time passed it became apparent that the
new schedule was not meeting the goals
we had projected for it. We attempted to
examine the problems as they arose and
resolve them as best we could.
One of the major problems - and
one that was not specific to this unit -
was that the registered nursing assistants
could not, according to their union
contract, work the extended shift. This
meant that there were in fact two parallel
systems working at the same time: the
traditional eight hour shifts and
corresponding reporting times, and the
twelve hour shifts and their reporting
times. Consequently. the nurses felt they
were spending much of their time
receiving or giving reports. The rhythm
of neither the eight nor the twelve hour
shift established itself satisfactorily.
A problem that is always difficult to
overcome when instituting change is that
The Can-.llen Nur..
FIGURE ONE
4-WEEK TIME SCHEDULE
(schedule rotates downward)
Dates
Su MTu WTh F Sa Su MTu WTh F Sa Su M Tu WTh F Sa Su MTu WTh F Sa
R.N. n n n x x n n n n n n n x x x n n n x n n n n n n @x x
R.N. d x @)d d d x x d d x x d d d d d d n x x x x d d d d d
R.N. d x x E E E x x x x x E E E e x x E E E x x x x x E E E
R.N. x d d@) x d d d d x d d d x x x d d d d d d x d d d d x
R.N. x E E E x x e E E E x x x x x E E E x x e E E E x x x x
R.N. s d d n n x x x x d d d d d d x d d d d x x d
x d d
R.N. E E e x x x x x E E E x x E E E e x x x x x E x x E
R.N. e e x x d d d d x d d d d x x d d@) x d d d d x x d n n
R.N. x x x x E E E e x x E E E x x x x x E E E e x x E E E x
R.N. x D D D x x D D D e x x x x x D D D x x D D D e x x x x
R.N. x x D D D d x x x x x D N N n x x D D D x x x x x D D D
R.N. D x x d D D x x x x x D D D D x x d D D x x x x x D D D
4S September 1179
Name
Permanent night shift
12 R.N.'s
Code: N 12 hour night (1930-0745)
n 8 hour night (2330-0745)
D 12 hour day (0730-1945)
d 8 hour day .(0730-1545)
E 12 hour evening (1130-2345)
e 8 hour evening (1530-2345)
s statutory holiday
o possible position for statutory holiday
x day off
of tradition: expectations develop as a
result of what has been experienced in
the past. In this situation. the
expectations of both patients and staff
had to be considered. A patient on a
Rehabilitation U nit has usually had an
extensive period in hospital prior to his
arrival and has developed expectations
as to how his day will progress. He has
come to know that patients always have
their baths first thing in the morning,
followed by having their beds made.
Nurses seem to know that too,
regardless of what their common sense
may tell them! The discomfort that is
caused by not meeting these
expectations, by nót following the
traditional pattern, is intensified by the
expectations of those around us.
Accordingly, it was difficult to change
times for baths and other routine aspects
of patient care to correspond with the
periods of increased staff.
The new staffing pattern also posed
difficulties for Þoth the internal staffing
of the unit and the external staffing of the
hospital in toto. If a nurse working the
twelve hour evening shift is going to be
absent, how can you replace her when
this shift is not being used anywhere
else? If you have a shortage in the
morning which can be alleviated by the
twelve hour evening shift's arrival, do
you choose to overstafffor the rest of the
shift, or ask a nurse to change nursing
units in the middle of the day? These
questions were never satisfactorily
resol ved, and our goal of making
effective use of human resources was not
met.
I n practise, the nurses did not find
they were using the afternoon overlap
effectively. They became involved with
their patients and found it difficult to
extricate themselves for conferences,
rehabilitation therapy sessions and the
like. This is not a new problem in
nursing, but it remains a thorny one all
the same!
Looking back
The three month trial was completed and
the schedule was re-assessed. It was the
feeling of both the unit nursing staff and
nursing management that the schedule
had not achieved the specified goals. As
neither group was satisfied with the
results it was an easy matter to revert to
the traditional eight hour shifts and from
that position to determine how the
Rehabilitation Unit's goals could be
better met.
Although the exercise had proved to
be a failure in a general sense, there were
certain benefits derived from the
attempt. The unit staff were pleased that
the nursing administration had
responded to their concerns and had
been willing to try innovative ways to
meet their needs. The staff also felt very
much involved in the change process and
at no time were there complaints that
"N ursing Office" had arbitrarily
inflicted the new system on them. It also
reinforced for us, as managers, the idea
that what seems to work on paper does
not necessarily work in practice! Our
experience and even our mistakes helped
us to accept the fact that failures can
oCCUI whenever new approaches are
tried out, but the admission offailure
need not be negative. Our efforts may
also be of use and encouragement to
others who are interested in trying
innovative staffing methods to solve the
diverse and difficult problems with
which we are constantly being
confronted. 'iii
The author wishes to express her
appreciation to Mrs. M. Kerr, Head
Nurse. Mount Sinai Hospital, who was
instrumental in the development of this
project. Mrs. E.M. Rice,
associate executive director-nursing.
also provided valuable advice.
AUison J. Stuart. R.N., B.S c.N., D.H.A .
was the surgical coordinator at Mount
Sinai Hospital, Toronto, when she wrote
this article. She is currently the executive
assistant to the associate executive
director - nursing at the same hospital.
Tilkian & Conover
Understanding
Heart Sounds and
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The
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Watson
Medical-Surgical
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Frankly speaking
A Challenge
in Office Nursing
Betty Kowalchuk
If there is any group of nurses in the profession who appears to the public as a 'handmaiden to
the doctor', it has to be the office nurse. Her peers look upon her as having a 'cushy' job, with
little responsibility, and her medical employers do not tend to encourage her initiative. Betty
Kowalchuk believes the office nurse is as interested in quality patient care as any other nurse.
and she sees a new and expanded role for her: the nurse co-ordinator.
-, r
- I
..
,t
,. \
Kowalchuk:
(getling angf}'JLook, you don't just tell
me that my daughter is a diabetic and
then act vague. There's urine testing,
diets, more blood sugars and so forth.
I'm a nurse. I do know a little bit. What
comes next?!
-
-
-
... - rl
'2
"
J:
Ö
"
>
"
-;
o
'"'
"
1:
"
8
o
l
c..
.
-
r-
Pause
,
Receptionist:
Just a minute. please.
J
1
I,
FÙ'e minutes later.
Doctor:
Yes, Mrs Kowalchuk, Sheila's blood
sugar is 265, she's definitely diabetic.
She's only 17, so she should start on
insulin right away.
Kowalchuk:
What about a trial diet? She's not a small
child.
My 17-year-old daughter had had a number of unusual
symptoms over the past few weeks: constant thirst,
numerous trips to the bathroom, and others. I decided to
!o.end her to our family doctor to have a routine blood sugar
test done. The day after her visit, I called the physician's
office a"king for the results, and this is what ensued:
Doctor:
How long has she had her full growth?
Kowalchuk:
About two years.
Doctor:
Okay, I thmk we can try diet for awhile.
(Pau.çe) I hate 10 admit this, but I looked
up her record for January (Sheila had
had cy.uitis then) and there was a trace of
sugar in the urine. I'm afraid I over-
looked it because I wasn't looking for
sugar, just a sign of infection. I'm sorry
about that; as soon as I saw the white cell
count I didn't look further or think it
necessary 10 see her personally.
Kowalchuk:
I'm calling about Sheila's blood sugar.
Receptionist:
Just a moment. please.
Sneral minutes ofhemg On Hold later
Yes her blood sugar was high. Dr. .....-
says that Sheila is definitely diabetic and
will nt'ed treatment.
Another slight pause and then. as if talking to himself
LONG Sf LENCE
Kowalchuk:
Well, what comes next?
I really should interview every patient;
the chance of overlooking anything
would be much less.
Receptionist:
Well, I guess he'll want 10 see her.
The point of repeating that whole telephone conversation is
not to blame my family physician: he is far from stupid but he
is just too busy to remember everything, all the time. The
point is that I feel there is a place in family medical care, in
doctors' offices or clinics or whatever, for a new type of
The Cen-.llen Nurae
September 1171 41
nurse - the nurse co-ordinator. I see an urgent need for
specially trained RN's in these areas, nurses who would
coordinate a patient's problem from start to finish, keeping
track of his progress from family doctor to specialist or lab
and back again, and following up after treatment or surgery.
Aside from speeding up matters, the obvious advantage to
this type of service would be the alleviation of patient
anxiety.
Every nurse has a few horror stories to tell about patient
mismanagement - missed diagnoses, treks from specialist
to specialist, and the long anxious waits for lab results.
I sat down to supper one evening in the hospital
cafeteria with an ICU nurse who described her own trial and
error experience in trying to discover the cause of constant
rectal bleeding. She could not understand how her problem
could be so easily dismissed time after time, with no
suggestion (If follow-up. She said she finally gave up, and
tried to live with the problem for a few months until the
problem got still worse, and she went to another doctor and
then another surgeon. Finally the diagnosis of a rectal fistula
was made and the recommendation of immediate surgery,
but by then she was so confused and upset that she refused.
She would decide in her own time, she said. Now, I'm sure
this nurse wouldn"t have chosen to ignore a serious health
problem for months: it was only that nobody showed any
interest.
My own harrowing experience of ten months duration
began with a complaint of severe pain in one toe of my foot
and ended by my finally getting a diagnosis of periostitis and
having the toe partially amputated. Along the way, I was
passed from specialist to specialist, received
recommendations to try chiropractic, acupuncture,
biofeedback, and once even the suggestion that perhaps a
psychiatrist could help.
I see here in all these personal experiences, in all the
stories I hear, a real need for a special kind of nurse who can
step in and coordinate the communication between doctor
and patient; someone who can prevent the traumatic and
frustrating medical merry-go-round ride that so many people
find themselves on.
What would the nurse coordinator do? First of all, let
me point out that she should in no way be confused with the
nurse practitioner, who has often to diagnose and treat on
her own. The nurse coordinator would function strictly as a
liaison, taking the responsibility of directing pertinent
information to the doctor, and of explaining same to the
patient. This person would have to be interested,
sympathetic, knowledgeable, efficient and responsible.
Working in a family pmctice office, for a pediatrician, or in a
clinic, her job would be to follow up on those patients who
have not been immediately diagnosed. She can relieve a
patient's anxiety by keeping him up-to-date on his test
results, and making sure he keeps his appointments with
specialists, labomtory and radiological facilities. Patients
who have had treatment also require some sort of follow-up.
A phone call just to say "How are you, how are things
coming along?" can be the stage at which possible future
problems are recognized, as well as giving the patient that
much needed 'somebody cares' feeling.
Is this a 'pie-in-the-sky' idea? Am I naive in thinking
that medical practitioners could be sold on the idea of
expanding the role of the office nurse? There are some
advantages for the physician such as improved coordination
of patient care, and generally a better grip on the
responsibility of a heavy patient load, but is that enough?
Will the busy family doctor who hardly knows which end is
up after a long day admit he needs help? Not a half-trained
receptionist, but a nurse who is interested in communication
and patient care?
When I told my family doctor that I had eventually had
to have surgery he simply said, "Well. it doesn't matter how
the problem was diagnosed; as long as it was eventually
straightened out, that's all that matters." I don't agree. I
think something can be done to eliminate the frustration,
confusion and omissions that occur, and I think nurses are
the key. The office nurse should be more than a typist and
telephone answering service. I think she can be a person of
extreme value.
Is this a real solution? Is there anyone in a position to do
anything about it? Is the nurse coordinator a practicable
idea? Nursing education tries to focus on the practical
application of nursing skills but I don't think there is a course
anywhere on Office Nursing. Perhaps it's time there was. ..
Betty Kowalchuk is a graduate of the Brantford General
Hospital. and has a diploma from the Margaret Hague
Maternity Hospital. N.J. She was head nurse in the Case
Room at Toronto East General Hospital prior to hadng her
own family; she works now at TEGH as a general duty relief
nurse.
110 September 1879
The Can-.llan Nur..
library update
NOTE: Readers are reminded that they should check
first ..ith the library of their provincial nurses
association, university or coUege, to determine
whether they may obtain the puhlkatlon(s) they
require from this source.
Publications recently received in the Canadian
Nurses Association Library are available on loan -
with the exec pI ion of items marked R - to CNA
members, schools of nursing. and other institulions.
r;
-
Items marked R include reference and archive
material that does not go out on loan. Theses, also R,
are on Reserve and I!O out on Interlibrary Loan only.
Requests for loans, maximum 3 at a time,
should be made on a standard I nterlibrary Loan form
or by letter giving aulhor. title and item number in
this list.
If you wish to purchase a book, contact your
local bookstore or the publisher.
ït
either a case of acute laryngitis
or an obscene caU.."
deq
S!giOBe
It's more than good-tasting, it's good medicine.
Antibacterial, antifungal lozenges
\GlI G/axo Laboratories
v A GLAXO CANADA LIMITED COMPANY
.U1"'t"!:.'I
"\lt"'ut UH', "ko( '-"to "\1\1
,D
Product monograph available on request.
Books and Doc:umenu
I. American Nurses' Association. Council of
Nurse Researchers. Information package. Kansas
City, Mo. 1978. 9 parts in Iv. Contents. - I. ANA
By-laws to June 1978. - 2. Human righls guidelines
for nurses in clinical and other research. -3. The
ANA and research in nursing, reprint from Nursing
Researchers. - 4. Nursing Administration
Quarterly v.2 no.4, summer 1978. - S. Research in
nursing. - 6. Preparntion of nurses for participation
in research. - 7. Priorities for research in nursing.
- 8. List of Executive Committee. - 9. Members of
Commission on nursing research.
2. Anderson, Peggy Nurse. N.Y.. SI. Martin's
Press, cl978. 311p.
3. Association des Hôpitaux de la Province de
Québec. La révision de la loi sur les services de
santé et les services sociaux (L.Q. 1971, c.48) et
sujets connexes. Montréal, 1978. 82p.
4. Baldwin. Linda Mobile intensive care; a
problem-oriented approach, by...and Ruth Pierce.
Toronto, Mosby, 1978. 329p.
S. Bazowski. Peter Report on VancouverGenernl
Hospilal. Vancouver, 1978. Iv. looseleaf
6. Bergerson, Belly S. Pharmacology in nursing,
by...andAndresGolh. 14th cd. St. Louis, Mosby,
1979. 779p.
7. Berry, Edna Cornelia Introduction to opernting
room technique, by...and Mary Louise Kohn. Sth
ed. Toronto, McGraw-Hili, cl978. SS8p.
8. Brown, Jack Harold Upton The health care
dilemma; problems of technology in health care
delivery. New York, Human Sciences Press, cl978.
183p.
9. Butnarescu. Glenda Fregia Perinatal nursing.
Toronto, Wiley, 1978. 296p.
10. Cancer nursing; medical. Edited by Robert
Tiffany. Boston. Faber and Faber, c1978. I9Op.
I I. Childbearing: a nursing perspective. by Ann L.
Clark and Dyanne D. Alfonso. 2d cd. Philadelphia.
Davis, cl979. IOS2p.
12. Chinn. Peggy L. 1941- Child health
maintenance; concepts in family-centered care. 2d
cd. Toronto, Mosby, 1979. 934p.
13. -. Child health maintenance; a guide 10 clinical
assessment. by...andCynlhiaJ. Leitch. 2ded.
Toronto, Mosby, 1979. IS7p.
14. Comment lire les états financiers; un guide
pratique pour les investisseurs. Montréal, L'institut
canadien des valeurs mobilières, cl977. 43p.
IS. Commonwealth Nurses Federation.
Background papers. Meeting of Commonwealth
National Nurses Association, Imperial Hotel,
Tokyo, 29 May 1977, London. Iv. (various pagings)
16. Comprehensive pediatric nursing, by Gladys
M. Scipien...et aI. 2d ed. Toronto, McGraw-Hili,
c1979. l092p.
17. Distributive nursing prnctice: a syslems
approach to community health. Edited by Joanne E.
Hall and Barbara R. Weaver. Toronto. Lippincott.
c 1977. S36p.
18. Elder. Jean Transactional analysis in health
care. Don Mills, Ont., Addison- Wesley, c 1978.
17Sp.
/9. Emergency first aid: safelY oriented. 1st
Canadian cd. Ottawa, St. John Ambulance, The
Priory of Canada of Ihe Mosl Venernble Order ofthe
Hospital of St. John of Jerusalem, cl977. 136p.
20. Freeman, HowardEdgar. 1929- ed. Handbook
of medical sociology, by...et aJ. 3d cd. Englewood
Cliffs, N.J., Prentice-Hall, cl979. S16p.
21. Future directions in health care: a new public
policy. Edited by Rick J. Carlson and Robert
Cunningham. Cambridge, Mass.. Lippincott. cl978.
239p.
22. Gout: a clinical comprehensive. Research
Triangle Pack, North Carolina, Burroughs
Wellcome, cl971. 91p.
23. Groer, Maureen E. Basic pathophysiology; a
conceptual approach, by.. .and Maureen E.
Shekleton. Toronto, Mosby, 1979. S24p.
24. Holloway, Nancy Meyer. 1947- Nursing the
critically ill adult. Don Mills, Ontario,
Addison-Wesley, cl979. S98p.
The c.n-.llen Nur.e
Seplember 1171 51
Keep up with the
NEW and the NOW
in Nursing
Update your clinical skills with these new books
1 New! OPERATING ROOM TECHNIQUES FOR THE
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operating room nurses, this book is designed to present overviews of
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L. c. Crooks, R.N. Little, Brown. 459 Pages. Illustrated. 1979.
Paper, 115.00. Cloth, $21.00.
2 New! PERSPECTIVES ON ADOLESCENT HEALTH CARE.
Here at last is a text that not only presents the major ideas and issues
on this subject; it provides many clinical examples and offers valid
suggestions that can be put to use in a variety of clinical settings.
By R. T. Mercer, R.N., Ph.D. Lippincott. 420 Pages. 1979. $15.50.
3 New! NURSES' HANDBOOK OF FLUID BALANCE, 3rd
Edition. It presents basic knowledge of body fluid balance distur-
bances, with emphases on practical applicah"on. By N. M. Metheny,
B.S.N., M.S.N., Ph.D.; & W. D. Snively, Jr., M.D., F.A.C.P.
Lippincott. 406 Pages. 1979. 115.00.
4 New! MANUAL OF PEDIATRIC NURSING CAREPLANS.
This handy spiralbound manual will help nurses in all areas of prac-
tice to provide total care for the sick child as a member of the
family. The Hospital of Sick Children. Little, Brown. 347 Pages.
Illustrated. 1979. $15.00.
5 New! PHARMACOLOGY AND DRUG THERAPY IN
NURSING, 2nd Edition. In addition to the inclusion of several new
chapters, every chapter in the first edition has been extensively
revised; some have been expanded into complete sections! By
M.J. Rodman, B.S., Ph.D.; & D. W. Smith, R.N., M.A., Ed.D.
Lippincott. 1085 Pages. 1979. 126.00.
6 New! GERONTOLOGICAL NURSING. This practical new
book provides a comprehensive review of the medical, surgical, and
psychiatric problems associated with aging, accompanied by related
nursing interventions. By C. K. Eliopoulos, R.N., B.S., M.S.
Harper & Row. 384 Pages. 1979. 115.00.
7 New! PRIMARY CARE ASSESSMENT AND MANAGE-
MENT SKILLS FOR NURSES: A Self-Assessment Manual. This
unique manual provides a self-evaluation in physical assessment,
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Lippincott. Abt. 500 Pages. 1979. Abt. $20.00.
8 New! HIGH-RISK PARENTING: Nursing Assessment and
Strategies for the Family at Risk. High-Risk Parenting has a two-
fold purpose: to identify family difficulties resulting from situa-
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strategies for preventing and reducing these family problems. By
S. Ii. Johnson, R_N., M.N. With 24 Contributors.
Lippincott. 424 Pages. 1979. $17.75.
9 New! CARDIAC REHABILITATION: A Comprehensive
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out-patient follow-up through life-long health maintenance. By
P. M. Comoss, R.N., C.C.R.N.; E. A. S. Burke, R.N., C.C.R.N.; &
S. H. Swails, R.N. Lippincott. Abt. 250 Pages. 1979. Abt.116.00.
10 New! A GUIDE TO PHYSICAL EXAMINATION, 2nd
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much expanded and updated content mark the new edition of
this outstanding guide to physical assessment for health practi-
tioners. By B. Bates, M.D. Lippincott. 440 Pages. Illustrated.
1979. $27.00.
11 MATHEMATICS FOR HEALTH PRACTITIONERS:
Basic Concepts and Clinical Applications. Through a simple ap-
proach to conversion called "the equation method", this important
new text helps dispel the "math anxiety" that most students experi-
ence when having to deal with numbers. By L. Verner, Ph.D.
Lippincott. 165 Pa.\:es. 1978. $7.50.
12 New! TEXTBOOK OF HUMAN SEXUALITY FOR NURSES.
From its opening chapter to its closing pages of questions and
answers, this text effectively incorporates human sexuality into
nursing practice at a level that can be understood by both practicing
and student nurses. By R. C. Kolodny, M.D., et al. Little, Brown.
450 Pages. Illustrated. 1979. Paper, $15.00. Cloth, $21.00.
13 New! NURSING MANAGEMENT FOR PATIENT CARE,
2nd Edition. Important new features include reports on recent
theories of management, a deeper explanation of the nurse mana-
ger's relationship with staff members, and discussions of the expan-
ding role of the nurse manager. By M. Beyers, R.N., Ph.D.; & C.
Phillips, R.N., M.S. Little, Brown. 292 Pages. llIustrated. 1979.
Paper, $10.75. Cloth, $15.50.
14 New! COMMUNICATION FOR HEALTH PROFESSIONALS.
This timely book identifies and describes problem situations
stemming from communication breakdowns that commonly affect
health care personnel. By V. M. Smith, Ph.D.; & T. A. Bass, M.A.
Lippincott. 238 Pages. 1979. $7.50.
15 THE LIPPINCOTT MANUAL OF NURSING PRACTICE,
2nd Edition. This monumental second edition of a modern classic
incorporates massive revision and updating to offer the latest and
most accurate information available. By L. S. Brunner, R.N., B.S.,
M.S.N.; & D. S. Suddarth, R.N., B.S.N.E., M.S.N. With 9 Contri-
butors. Lippincott. 1888 Pages. Illustrated. 1978. $29.95.
16 New! CLINICAL GERIATRICS, 2nd Edition. New chapters
in the Second Edition include discussions of the aging kidney, the
lung, the female reproductive tract, and the oral cavity; also sexual
functioning and noninvasive diagnostic technology. By 1. Rossman,
M.D., Ph.D. With 43 Contributors. Lippincott. 704 Pages.
mustrated. 1979. 145.00.
17 NURSES' DRUG REFERENCE. Finally, a fingertip guide to
drugs organized with the nurse's needs in mind. More than 500
drugs, listed alphabetically, are described in a consistent, easy-to-
consult format that includes the drug's action and use, dosage and
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and legal status. Edited by S. M. Brooks, M.S. Little, Brown. 625
Pages. 1978. $14.50.
LIPPINCOTT'S NO-RISK GUARANTEE
Books are shipped to you On Approval; if you are not entirely
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112 September 1171
The c.n-.llen Nur..
2
. Kinsbourne, Maral Children's learning and
attention problems, by...and PaulaJ. Caplan.
Boston, Little, Brown, c1979. 300p.
26. Kneisl. Carol Ren, 1938- Mental health
concepts in medical-surgical nursing; a workbook,
by...and Sue Ann Ames. 2d ed. Toronto. Mosby.
1979. 163p.
27. Kozier, Barbara Blackwood Fundamentals of
nursing; concepls and procedures, by...andGlenora
Lea Erb. Don Mills, Ont., Addison-Wesley, 1979.
98Op.
28. Kubler-Ross. Elisabeth To live until we say
good-bye. Englewood Cliffs. N.J.. Prentice-Hall,
c1978. 16Op.
29. McGraw-Hili handbook of clinical nursing.
Edited by Margaret E. Armstrong ...et al. Toronto,
McGraw-Hili, c1979. 1474p.
30. McGrory, Arlene A well model approach 10
care of the dying client. Toronto, McGraw-Hili,
c1978. 18Op.
31. Moir, Donald D.. Pain relief in labour; a
handbook for midwives. 3d ed. New York. Churchill
Livingstone, 1978. 122p.
32. Morris, Dwight A. Health care administration;
a guide to information sources. by...and Lynne
Darby Morris. Michigan.Gale Research. c1978.
264p. R
33. Nursing care in eye, ear, nose and throat
disorders, by William H. Saunders et...al. 4th ed.
Toronto, Mosby, 1979.
2Op.
34. O'Brien, Mary T. Total care ofthe stroke
patient. by...and PhyllisJ. Pallett. Boston. Little,
Brown.cI978.379p.
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Health, 1978. 83p.
36. Phipps, WilmaJ. ed. Medical-surgical nursina:
concepts and clinical practice, by...et al. Toronto,
Mosby. 1979. 1634p.
37. Polit, DeniseF. Nursing research: principles
and methods. by...and Bemadelle P. Hungler.
Toronlo, Lippincott, cl978. 663p.
38. RegisteredNurses Association of British
Columbia. Labour Relations Division. Staff
representatives manual. Vancouver, 1978. Iv.
(loose-leaf)
39. Secourisme: orienté vers la sécurité - urgence
-1. éd. canadienne. Ottawa, L'ambulance St-Jean,
cl977. 14Op.
40. Sorensen, Karen Creason Basic nursing: a
psychophysiologic approach. by.. .and Joan
Luckmann. Toronto, Saunders, 1979. 13llp.
41. Stevens, BarbaraJ. Nursing theory: analysis,
application, evaluation. Boston, Little, Brown,
c1979.28Op.
42. Tilkian, Sarko M. Clinical implications of
laboratory tests, by ...and Mary H. Conover. 2d ed.
St. Louis, Mosby, 1979. 319p.
43. Tubesing, Donald A. Wholistic health; a
whole-person approach to primary health care. New
York. Human Sciences Press, c1979. 232p.
44. Wilson, Holly Skodol Psychiatric nursing,
by...andCarol Ren Kneisl. Don Mills,
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Pamphlets
46. Alberta Association of Registered Nurses.
Recommended role. Qualifications and terms and
conditions of employment for the occupational
health nurse in Alberta. Edmonton, 1979. 14p.
47. Association of Universities and Colleges of
Canada and Association of Canadian Community
Colleges. Health Sciences Accreditation Task
Force. Report ofthe joint working groups on
co-ordination of accreditation of health science
educational programs. Otlawa. Health and Welfare
Canada, 1976, Bp.
48. Canadian Nurses Association Submission to
the Commission on Inquiry into Redundancies and
Lay-offs in Canada's Labour Force. Otlawa, 1978.
IIp.
49. National League for Nursing Nursing
administration present and future. New York, 1978.
29p. (NLN Pub. no. 20-1739)
O. Registered Nurses Association of British
Columbia Statement on the province of British
Columbia lonalerm care program. Vancouver, 1978.
lOp.
51. Styles, Margretta M. Proposal for a study of
credentialing in nursing. submitted to the American
Nurses Association, Nov. I, IQ7
. Revised Dec. 7.
197
, Delroil, Mich., Wayne State University,
College ofN ursing, Center for Health Research,
197
. 31p.
Government Documents
Canada
2. Santi et Bien-2tre social Canada Direction
génerale du perfectionnement des programmes.
Direction des services médicaux. Recueil de
données sur la santé. Ottawa. 1978. 76p.
53. Secrhariat d' Érat. Direction ginirale de /' aide
à I'iducation Guide des programmes d'aide
financière du gouvemement du Canada destinés aux
étudiants canadiens de niveau postsecondaire.
Ottawa, Ministre des Approvisionnements et
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4. Statistics Canada Methodology of the
Canadian labour force survey 1976. Ottawa, 1977.
139p.
5. -. Health Division Utilization of health care
services in Canada; Irends in utilization of newborn
and obstetric services: implications for future
demand. Ottawa. HeallhDivision, Statistics
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54 Seplember 1171
The Cen-.llen Nur..
British Columbia
Classified
Advertisements
Alberta
University of Alberta Hospital and Faculty of
Nursing, U niversily of Alberta, requires a clinically
current nurse 10 develop and inslruct in a program to
prepare nea-natal nurse c1inicans. The primary
appointment will be al University of Alberta
Hospital and will involve clinical and classroom
inslruction at the post baccalaureale level. The
individual must therefore be eligible for appoinlment
to the Faculty of Nursing. Qualifications: Master's
Degree preferred; candidates with baccalaureate
degree and relevant combination of experience and
other education will be considered. Musl be eligible
for A.A.R.N. Registration. The University of
Alberta is an Equal Opportunily Employer. Salary
determined on basis of qualifications and experi-
ence. Apply to: Dr. A.E. Zelmer. Dean. Faculty of
Nursing. The University of Alberta, 3rd Floor -
Clinical Sciences Bldg.. Edmonton, Alberta, T6G
2G3.
ltepstered Nunes required for part-time and full-
time employment Must be eligible for registralion
with AARN. Salary and benefits as per U.N.A.
contracl. Residence available. Apply in writing to:
Direclor of Nursing. Wainwrighl Hospital Complex,
Wainwright, Alberta, TOB 4PO, or phone (403)
842-3324.
British Columbia
Experienced General Duty Graduete Nurses required
for small hospital located N.E. Vancouver tsland.
Maternily experience preferred. Personnel policies
according 10 RNABC contract. Residence accom-
modation available S30 monthly. Apply in writing to:
Director of Nursing. St. George's Hospital. Box 223,
Alert Bay, British Columbia, VON IAO.
Registered and Graduate Nurses required for new
41-bed acute care hospital, 200 miles north of
Vancouver, 60 miles from Kamloops. Limited
furnished accommodation available. Apply: Director
of Nursing. Ashcroft & Districl General Hospilal,
Ashcroft. British Columbia, VOK IAO.
Generat Duty (B.C. registered) nunes required for
expansion to 422 acute care accredited hospital
located 6 miles from downtown Vancouver and
within easy access to various recreational facilities.
Excellent orientation and on-going in service prog-
ramme. Salary: SI,305,OO-SI,542,OO monthly. Clini-
cal areas include coronary care. intensive care,
emergency, operating room, P.A.R.R., medical/sur-
gical. pediatrics, obsletrics, orthopedics and activa-
lion units. Head Nurse posilion also required for our
critical care unit, effective immediately. Candidates
must have had at least two year's related experience
and should have a demonstrable record of manage-
rial skill. Apply to: Co-ordinator-Nursing. Dept. of
Employee Resources, Burnaby General Hospital,
3935 Kincaid Streel, Burnaby, British Columbia,
VSG 2X6.
Shift Supervisor wilh previous experience required
for a 1000bed fully accredited hospital. Must be
eligible for B.C. registralion. N.U.A. course prefer-
red. Apply to: Director of Personnel, Fort St. John
General Hospital, Fort St. John, British Columbia,
VIJ IY3.
Generel Duty Nurse for modern 35-bed hospital
localed in soulhern B.C. 's Boundary Area with
excellenl recreation facilities. Salary and personnel
policies in accordance with RNABC. Comfortable
Nurse's home. Apply: Direclor of Nursing, Bound-
ary Hospital, Grand Forks, Brilish Columbia, VOH
IHO.
Generel Duty Rexiltered Nurse, preferably with one
year experience, including Obstelrics. Salary, be-
nefits as per RNABC contraCI. Starts August 27.
Small hospital in scenic West Kootenays - skiing,
fishing. golfing, boating, hiking, swimming. Apply:
Siocan Community Hospital, Box 129, New Denver,
British Columbia, VOO ISO.
British Columbia
Carlboo Collexe invites applications for Instructors
with clinical experience in medical-surgical, and
psychiatric nursing. Master's degree is preferred,
but will consider B.S.N. with at least 2 year's
teaching experience. Salary range is SI5,801 to
S28,131 per annum, presenlly under review. Place-
menl will be based on qualifications and experience.
There are presenlly two positions available, com-
mencing as soon as possible. Please submit resume,
complele with letters of reference, prior to Sep-
tember 20. 1979 to: Personnel & tndustrial Relations
Manager. Cariboo College, Box 3010, Kamloops,
British Columbia. V2C 5N3.
Experienc:ed Nurses (eligible for B.C. Registration)
required for full-time posilions in our modern
300-bed Extended Care Hospital located jusl thirty
minutes from downtown Vancouver. Salary and
benefits according to RNABC conlract. Applicanls
may telephone 525-0911 to arrange for an interview.
or write giving full particulars to: Personnel Direc-
tor, Queen's Park Hospital. 315 McBride Blvd.,
New Westminsler. British Columbia, V3L 5E8.
Experienced Nunes (B.C. Regislered) required for a
newly expanded 463-bed acute, teaching. regional
referral hospital localed in the Fraser Valley. 20
minutes by freeway from Vancouver. and within
easy access of various recreational facilities. Excel-
lent orientation and continuing education program-
mes. Salary-1979 rales-$1305.00-$1542.00 per
month. Clinical areas include: Operating Room, Re-
covery Room. Intensive Care, Coronary Care,
Neonatal Intensive Care. Hemodialysis, Acute
Medicine, Surgery, Pediatrics, Rehabilitation and
Emergency. Apply to: Employment Manager, Royal
Columbian Hospital. 330 E_ Columbia St., New
Westminster, British Columbia, V3L 3W7.
Applications are invited for the-position of Director
of Nunlng wltb admlnlslretIve qualifications. Applic-
ants must have Iheir B.C. registration and should
have post graduate degree in nursing administration
wilh several years of practical experience al the
supervisory level. This position will encompass the
administration of a 7 bed hospital on Vancouver
Island. It will necessitate the supervision of the
nursing and support staff, purchasing and financial
reconciliation at month end. An invaluable oppor-
tunity to gain experience in all facets of hospital
administration. The hospital is situated in a rapidly
expanding area of Northern Vancouver Island. This
position is available immedialely. Salary negotiable.
Please reply in writing to: Mrs. K. L. Watson,
Chairman, Port Alice Hospital Board, Box 100, Port
Alice, British Columbia, VON 2NO.
RexJslered Nurses required immediately for a 340-
bed accredited hospital in the Central Interior of
B.C. Registered Nurses interested in nursing posi-
tions at the Prince George Regional Hospital are
invited 10 make inquiries to: Direclor of Personnel
Services, Prince George Regional Hospital, 2000-
15th Avenue, Prince George, British Columbia.
V2M IS2.
Reailtered N...... required immediately for perma-
nent full time positions at to-bed hospital in B.C.
Salary at 1978 RNABC rate plus northern living
aIlowance. Recognition of advanced or primary care
education. One year experience preferred. Apply:
Director of Nursing, Stewart General Hospital, Box
8, Stewart, British Columbia. VOT IWO. Telephone:
(604) 636-2221 Collect.
Two geoerel duty a...... for 21-bed acute care
hospital on Vancouver Island's beautiful Pacific
Coast near Pacific Rim National Marine Park.
Friendly atmosphere. Salaries in accordance with
RNABC agreements. Apply: Direclor of Nursing,
Tofino General Hospital, Box 190, Tofino, Brilish
Columbia, VOR 2Z0. (604) 725-3212.
St. Paul's Hospital invites applications from B.C.
ReJlltered NUIWI for full and part time posilions in
all areas of the hospital. St. Paul's is an acute referral
teaching hospital located in downtown Vancouver.
1979 R.N. rates SI305.00 - SI542.00. Generous
fringe benefits. Apply to: St. Paul's Hospital,
Personnel Department, 1081 Burrard Street, Van-
couver. British Columbia, V6Z. IY6.
Manitoba
Experienced Jte&lstered Nunes required for a fuIly
accredited 200-bed Health Complex located in
Northern Manitoba. Must be eligible for registration
in Manitoba. Salary dependent on experience and
education. For further information contact: Mrs.
Mona Seguin, Personnel Director, The Pas Heallh
Complex Inc., P.O. Box 240. The Pas, Manitoba.
R9A I K4.
Northwest Territories
The Stanton Yellowknife Hospital. a 72-bed accre-
diled. acule care hospital requires regiSlered nurses to
work in medical. surgical, pedtalric, obstetrical or
operating room areas. Excellent orientation and
inservice education. Some furnished accommoda-
tion available. Apply: Assistant Administrator-
Nursing, Stanton Yellowknife Hospital, Box 10,
Yellowknife, N.W.T., XIA 2NI.
Ontario
Neurosurgkal stan' nune. Ontario registration, re-
quired for rull time position in I,OOO-bed teaching
hospilal affiliated with the University of Toronto.
Includes neurosurgical intensive care area and spinal
cord if1.iury unit. Preference given to applicants wilh
recenl related experience. Salary and benefils
according to ONA contract. Applicants may send
resumes to: Sunnybrook Medical Cenlre, Personnel
Department, 2075 Bayview Avenue, Toronto, On-
tario, M4N 3M5 or phone (416) 486-3612.
RN. GRAD or RNA. 5'6" or over and strong,
without dependents, non smoker, for t75 lb.
handicapped, retired execulive with stroke. Able to
transfer patient to wheelchair. Live in 1/2 yr. in
Toronto and 1/2 yr. in Miami. Wages: $200.00 to
S250.00 wkly. NET plus $80.00 wkly. bonus on mosl
weeks in Miami. Write: M.D.C.. 3532 EgJinlon
Avenue West, Toronto, Ontario, M6M IV6.
Saskatchewan
R.N.'s and R.P.N.'s (eligible for Saskalchewan
registration) required for 340 fully accredited ex-
tended care hospital. For further information,
contact: Personnel Department, Souris Valley Ex-
tended Care Hospital, Box 2001. Weyburn, Sas-
katchewan S4H 2L7.
Two Rexiltered NUIWI required by 27-bed hospital
localed 90 miles East of Regina, Saskatchewan on
Highway No. 48. Salary as per S.H.A.-S.U.N.
1978-1979 contract agreement. Please send resume
to: Mrs. Loretta Ferch, Director of Nursing, Kipling
Memorial Union Hospital, Box 420, Kipling, Sas-
katchewan SOCJ 2S0 or phone: 736-2553, Extension
2.
United States
CellfomJa - Sometimes you have to go a long way
to find home. But, The White Memorial Medical
Center in Los Angeles, California, makes it all
worthwhile. The White is a 377-bed acute care
teaching medical center with an open invitation 10
dedicaled RN's. We'll challenge your mind and offer
you the opportunity to develop and continue your
professional growlh. We will pay your one-way
transportation. offer free meals for one month and all
lodging for three months in our nurses residence and
provide your work visa. Call collect or write: Ken
Hoover, Assistant Personnel Director, 1720 Brook-
lyn Avenue, Los Angeles, California 90033 (213)
268-5000, ext. 1680.
The c.nedlen Nur..
Seplember 1171 55
United States
United States
Rqlslered Nunes: Several openings for e!'perienced
nurses (including tCU/CCU) in a full servIce I 50-bed
hospital. Fifteen minutes to the beach & 2 hours to
the mountains of Southern Calif. Located on the
southern rim of the L.A. basin. Bay Harbor Hospital
is rated for outstanding patient care and innovative
nursing programs. We will provide the necessary
assistance for a working visa. Write: Sally Madden.
Nurse Recruiter. Bay Hamor Hospital, 1437 W.
Lomita Boulevard. Harbor City, California, 90710.
California - Rqbtered Nunes and Ne.. Graduates.
St. Vincent Medical Center is a 386-bed. modern
facility with positions in the following areas:
Med/Surg, Oncology, Nephrology. ICU, CCU,
Cardiology. Cardiac Surgical unit, Renal Dialysis,
Otology, Operating Room. We provide training for
all areas. temporary housing and assistance with visa
and licensure. To obtain further information write
to: Mary J. Wylde, 2131 West Third Street. Los
Anseles. California 90057 or call collect to (213)
484-7221.
Reptered Nunes - Callfornla - Rapidly growing
inland port city in the heart of California's Big
Valley. 260-bed, fully accredited teaching hospilal.
Ideal location within 2-3 hours by car of San
Francisco, Yosemite, Lake Tahoe, Monterey Penin-
sula and historic Mother Lode. Four-season climate
with snow-free winters. Conlact: Laurel Murphy,
Director of Nursins. P.O. Box 1020, Stockton,
California, 95201, (209) 982-1800. Ext. 6016. Amr-
maUve adloD/equai opportwalty employer.
Florida NunlDa Opportunities - MRA is recruitins
Reaistered Nurses and recent Graduates for hospital
positions in cities such as Tampa, St. Petersburg,
and Sarasota on the West Coast: Miami, Ft.
Lauderdale and West Palm Beach on the East Coast.
If you are considerins a move to sunny Florida,
contact our Nurse Recruiter for assistance in
selectins the right hospital and city for-you. We will
provide complete Work Visa and State Licensure
infonnation and offer relocation hints. There is no
placement fee to you. Write or call MrdkaI
ltecrultrnof America, Inc:. (For West Coast) t211 N.
Westshore Blvd., Suite 20S, Tampa, FI. 33607 (813)
87H)202; (For East Coast) 8OON.W. 62nd St., Suite
StO, Ft. Lauderdale, Fl. 33309 (3OS) 772-3680.
Nunln, Opportunities In New Orleans, Loul8ll1.Da-
MRA tS recruitina Registered Nurses and recent
Graduates for several general and teaching hospitals
in the exciting New Orleans area. Openinss in many
specialties and most Canadian Registered Nurses
can qualify for licensure endorsement in Louisiana.
Contact our Nurse Recruiter for tuition assistance
plans. We will provide complete Work Vis'! and
State Licensure infonnation. There is no placement
fee to you. Write or call Medical Rrc:ru1len of
America, lac., 800 N.W. 62nd St., Suite 510. Ft.
Lauderdale, FI. 33309. (305) 772-3680.
Nar.1 - RNs - Immediate Openings in
Califomia-Florida-Texas-Mississippi - if you are
experienced or II. recent Graduate Nurse we can offer
you positions with excellent salaries of up to $1300
per month plus all benefits. Not only are there no
fees to you whatsoever for placìna you, but we also
provide complete Visa and Licensure assislance at
also no cost to , ou. Write immediately for our
application even i there are other areas of the U.S.
tbat you are interested in. We will call you upon
receipt of your application in order to arrange for
hospital interviews. Y 011 can call us collect if you are
an RN who is licensed by examination in Canada or
II. recent graduate from any Canadian School of
Nursins. Windsor Nurse Placement Service, P.O.
Box 1133, Great Neck, New York, 11023. (516 -
487-2818).
"Our 20th Year of World Wide Service"
Dallas, Houston, Corpus Christl, etc, elc, elc. The
eyes of Texas beckon RN's and new grads to
practice their profession in one of the most
prosperous areas of the U.S. We represent all size
hospitals in virtually every Texas and Southwest
U.S. City. Excellent salaries and paid relocation
expenses are just two of many super benefits
offered. We will visit many Canadian cities soon to
interview and hire. So we may know of your
interest, won't you contact us today? Call or write:
Ms. Kennedy, P.O. Box 5844, Arlington, Texas
76011. (214) 647-0077.
Before accePti'l.l any ""II
position in the .S.A.
PLEASE CALL US
COLLECT
We Can Otter You:
A) Selection of hospitals throughout
the U S.A
B) Extensive information regarding
Hospita
Area. Cost of Living. elc
C) Complete Licensure and Visa Service
Our Services to you are at
absolutely no tee to you.
WINDSOR NURSE
PLACEMENT SERVICE
P.o. Box 1133 Great Neck. N.v.11023
(516) 487-2818
"'- Our 20th Year 01 World Wide Service
United States
Nursing Opportunity - Mississippi Baptist Medical
Center, a mllior 600-bed hospital. has immediate
positions available for experienced RNs and recent
nursing school graduates in a variety of specialities
and medical/surgical areas. Competitive salaries,
liberal benefits. Visa, licensure and relocation
assistance provided. Located in Mississippi's capital
city of Jackson (population 300,(00), MBMC is the
state's largesl and most modern privately operated
hospital. For further information write: Mrs.
Johnnye Weber, Nurse Recruiter, 1225 North State
Street. Jackson. Mississippi 39201; or call collect
601/968-5135.
/" ""\
Offers ReNe's
Ë
A
An UNUSUAL OPPORTUNITY.
AVI
A.M.I. Will FURNISH Onl Wly AIRLINE TICKET to Tlxas
Ind $500 Inlt"l LIVING EXPENSES on a loan Basis.
Attlr Onl Vllr'. Service. TIll. loin Will ÞI Canclllid
"'MI American Medicallnternalionallnc.
. !lAS5O HOSPITALS THROUGHOUT THE U.s.
r . lIow A...I. II RlavlUng 11.11.'11. HOIplllilin TIIII. I
IlIImldllt. Op.nl.....I.llry Rlngl $11.000 to $16,500 plr Yur.1
. You can enJOY nurSing In General Medicine. Surgery. ICC.
CCU. Pedialrics and Obstetllcs
. A M 1_ provllles an excellent ollentallon program
in-service Irainlng_
r------------"
I
,
, U.S. Nurse Recruiter ,
, P.O. Boll 1777e, los AnSeles, Calif. 90017 ,
I . Without oDllgatlon please send me more ,
Intormatlon and an Application Form I
IIIAME_________ ___
I ADDRESS___________I
, ClTY_ ___ ST.___lIP___1
TELEPHONE 1_ _) _ __ _ _ _ _ __
I LlCENSES:___________,
, SPECIALTY:_ _ ______ -_-I
YEAR GRADUATED: _ _ _ STATE: _ __
"'------------
R.N.'s U.S.A. - Dunhtll with 250 offices has
excitins career opportunities for both recent grads
and experienced R.N.'s. Locations North, South,
East and West. All fees are paid by the employer.
Send your resume to: 801 Empire Building, Edmon-
ton, Alberta. TSJ IV9.
Nurses - RNs - A choice of locations with
emphasis on the Sunbelt. You must be licensed by
examination in Canada. We prepare Visa fonns and
provide assistance with licensure at no cost to you.
Write for a free job market survey Or call collect
(713) 789-1550. Marilyn Blaker, Medu, 5805
Richmond. Houston, Texas 77057. All fees employer
paid.
Come 10 TUII5 - Baptist Hospital of Southeast
Texas is a 400-bed growth oriented organization
looking for a few good R.N.'s. We feel that we can
offer you the challenge and opportunity to develop
and continue your professional growth. We are
located in Beaumont, a city of 150,000 with a small
town atmosphere but the convenience of the large
city. We're 30 minutes from the Gulf of Mexico and
surrounded by beautiful trees and inland lakes.
Baptist Hospital has a progress salary plan plus a
liberal frinse packaae. We will provide your immig-
ration paperwork cost plus aiñare to relocate. For
additional infonnation, contact: Personnel Ad-
ministration, Baptist Hospital of Soulheast Tellas,
Inc., P.O. Drawer 1591, Beaumont, Texas 77704. An
amrmatlw adloa aaployer_
Ellc:ltemrnt: Come and join us for year around
excitement on the border, by the sea, an unbeatable
combination. Eqjoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new J17-bed, acute care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opportunities. We have immediate openings in all
areas. Excellent salary and fringe benefits. We invite
you to share the challenge ahead Assistance with
travel expenses. Write Or call collect: Joe R. Lacher,
RN, Director of Nurses, Valley Community Hospi-
tal. P.O. Box 4695, Brownsville. Texas 78521; I
(512) 831-9611.
Project HOPE is in the process of recruitmg Nune
Educ:alOn in the following specialities and countries:
Midwife and O.R. Nurses in Egypt, ICU and O.R.
Nurses in Morocco, Family Nurse Practitioners in
Jamaica, and Ph.D. Nurse Educators in Brazil.
Excellent benefits, travel paid and salary negotiable.
Send resume to: Joan Harmon, Project HOPE,
Millwood, Virginia 22646, U.S.A. Equal Opportun-
it y Employer.
Australia
Faculty POIItIo.. - Available in under-graduate
instruction in: Medical-Surgical Nursing and Com-
munity Health Nursins. Dynamic program con-
ducted in coqjunction with a University Hospital.
Salary - commensurate with qualifications and
experience. Senior Lecturer AS2I,I80-$24,687.
Lecturer A$15,786-$20,736. Preference: Masters
Degree, Teachins and Clinical Experience. The
Senior I..eclurer will be responsible for course
co-ordination and curriculum development. An
extensive teachins background is essential. The
Institute has allowance schemes covering re-Iocation
expenses, immediate superannuation, insurance
cover and assistance with accommodation. Closins
date for applications: 3 weeks after publication of
this advertisement. Appointees are expected to take
up duties in November, 1979. Curriculum vitae and
transcripts of tertiary work to: Miss Lydia Hebes-
treit, R.N. Head, Department of Nursing, Preston
Institute of Technology, Plenty Road, Bundoora,
3083 (Melbourne) Australia.
Miscellaneous
Electrolysis - Successful Electrolysis Practice for
Sale. 6 months specialized included. Write or phone:
Margot Rivard, .1396 St. Catherine Streel West,
Suite 221, Montreal. Quebec, HJG IP9. Telephone:
(514) 861-1952.
51 Seplember 111711
The Can-.llen Nur..
RN's and GRADS
Looking for the perfect position?
If you describe it in a letter, we'll let you
know when we see it. or one that comes
close.
Possibly it is in one of our client
hospitals, like St. Mary's in Nevada, The
Medical Center in Texas. Piedmont in
Georgia. or in a hospital in anyone of a
dozen different states and provinces.
Our client hospitals pay us to help you
look. and that's a nice arrangement for
you and for us.
Wood, Watson Professional Search
Suite 207, 1962 Y onge Street
Toronto, Ontario M4S IZ4
(416) 482-2238
Special Scholarships
The International Association for
Enterostomal Therapy wishes to
announce the fonnation of new
scholarships to be awarded to registered
nurses interested in working in this
specialty field and in improving quality
care for the Ostomy patient.
Presently, there are twelve E. T. training
programs in the U.S. Scholarships are to
be awarded to applicants who have met
the requirements for admission to an E.
T. program.
Application deadline is December I,
1979.
For further information write:
International Association for
Enterostomal Therapy, Inc.
Central Office
2506 Gross Point Road
Evanston, Illinois 60201
50th Anniversary
Celebration
Seton General Hospital in Jasper
National Park invites all ex nursing
staff to attend their 50th
Anniversary Celebrations May 5th
to lith. 1980 Inclusive.
A Gala Banquet and Ball atJasper
Park Lodge. May 10th.
Come and renew old acquaintances
and make some new ones!
F or further infonnation contact:
Mrs. Donna Lane, R.N.
Box 1063
Jasper, Alberta
TOE IEO
Head Nurse
Head Nurse for 24-bed coronary and
post-coronary care unit, in a 650-bed
fully accredited hospital. North
Vancouver. B.C.
Candidates will have Baccalaureate in
Nursing or Advanced Preparation in
Administration. Clinical expertise in
coronary care. Previous Head Nurse
experience preferred. At least 4-5 years
successful graduate experience.
Salary :
As perR.N.A.B.C. Agreement-
$1500.00-$1772.00 per month.
Please send resume to:
Lions Gate Hospital
Personnel Department
230 East 13th Street
North Vancouver, British Columbia
V7L 2L7
Department of NursinJl:,
Grace Materni\) Hospital. Halif....
seeks
Head Nurse
For
Special Neonatal Care (Tnit
ChallcnglnKJobopponumty In nconatèl.l nur,mgml-anadd-"
large...t obstclncal hO!ior11al (SOOO deh \<'cnC'-'/ycar; 1000
admi......ons to Special "oeonalal Care l!mt/).cdr, M
or
ob"lrlncal and neonatalleachm, ho'\pltal (or Dalh('lU<;;lc
LJmvcr...ty èl.nd the central oMlclneal rcfcrral UnIl for Nova
Scolla. Pnncc Edward bland and pam, ofNcw Brun'iiwlck
Rcspon'iilblc 10 Ihe Chnlcal Co-ordmalor for organlzallon and
admlnlSlrallon or clmlcal nu....mgcare glvcn loaculcl)' III and
convalc'iiclng ncwtx>rn mfanh E!l.ccllcnl opponuml)' 10 perfect
pre!>cnt programmcs and 10 dcvclop ncw programme!!. .umed al
Impro\-'lng and cXlendmg thc scope or neonalal nursm, Salary
aC(:ordmg 10 Nova Scolla Nu
es' Umon Coniraci PO"1
avallablc Immedlalely
Thc candldale!> musl havc S )"cars' c'pencncc m nconalal
nur
m, and musl be eh,lbk for regl'loiraiion Iß Nova Scolla
Manaaemcnt expenencc dnd skill!>. broad knowledge or
pennalal hcalth concepl!> and graduallon rrom a po!>1 diploma
nconalal nunlnlcou
c dC!>lrablc Apply m wnlmg 10
Miss \tar..ret. FURuson. R.......
DU"<<Ior or .....unlnl
Grace \talunil, Hosphal
H.llru. No". Scot.a
Km ."'J
OpenlßI!> are also 8v.;ulablc for Icncral dUly nur'iiCS m 1M
nconalal Unit
Fishermen's Memorial Hospital
reqUIres
One (1) (O.R., 0.8.S.,
O.P.D.) Supervisor
PG in OR rëquired: Past
Administrative Experience & OBS
experience desirable
Please address all inquiries to:
Director of Nursing
Fishermen's Memorial Hospital
Lunenburg, Nova Scotia
BOJ 2CO
McMaster University
Educational Program
For Nurses In
Primary Care
McMaster University School ofNurs-
ing in conjunction with the School of
Medicine. ofFers a program for regis-
tered nurses employed in primary
care settings who are willing to
assume a redefined role in the primdry
hedlth care delivery team.
Requirements Current Canadian Re-
gistration. Sponsorship from a medi-
cal co-practitioner. At least one year
of work experience. preferahly in
pn mary care.
For further information write to:
'\'Inna Callin. Director
Educational Program for "Iurses
in Primar} Care
Faculty of Health Sciences
lc
laster llniversity
Hamilton. Ontario L8S 4J9
Nursing Co-ordinator
Applications for the position of
Medical-Surgical Co-ordinator are
being accepted for mid-September
by this 300 bed fully accredited
hospital.
Experience in supervision with a
Bachelor of Nursing Degree
preferred.
Temporary accommodation
available.
Please reply sending a complete
resume to:
Director of Personnel
Stratford General Hospital
Stratford. Ontario
N5A 2Y6
Foothills Hospital, Calgary,
AI berta
Advanced N eurological-
Neurosurgical Nursing for
Graduate Nurses
A five month clinical and academic
program offered by The Department of
Nursing Service and The Division of
Neurosurgery (Department of Surgery)
Beginning: March, September
Limited to 8 participants
Applications now being accepted
For further information, please write to:
Co-ordinator of In-service Education
Foothills Hospital
1403 29 St. N. W. Calgary, Alberta
T2N 2T9
The C.nedlen Nur..
Bermuda Hospitals Board
R.N.'s- Victoria, B.C.
Applications dre invited for the position of
Operating Room Supervisor in our 3!O bed
general hospital. which is accredited ",ith the
Canadian Council on Hospital Accreditation.
On the West Coast you can enjoy a
unique Canadian climdte and a
challenging nursing career at a
progressive 422-bed acute care hospital.
The appointee would be responsible for the
mandgement and supervision of a busy Operat-
ing Room and Recovery Room suite. undertak-
ing some 6000 operations per year.
An active Operating Room and a referral
Intensive-Care Nursery are seeking
experienced nurses to join their team.
Applicams should be Registered Nurses. who
have a minimum of five years Operatins Room
experience. two years of which were in a
management role. Bachelor's degree desirable.
Demonstrated ability in management of per-
sonnel and coordination of medical staff
activities required. Experience and ability in
budget preparation and cost control systems
would bean advantage
Applications are also invited from nurses
with an interest in Cardio/Pulmonary,
Urology, and General Medical/Surgical
nursing. Extended shift schedules
available.
Applicants must be H.C. registered or
eligible for registration in H.C.
tmerested applicants should apply in confi-
dence. submiuing resume and statement of
desired salary to:
Apply in writing indicating experience
and area of interest to:
Director of Nursing
King Edward" II Memorial Hospital
P.O. Box 1023
Hamilton 5, Bumuda
\t. J. Duncan (Ms.)
Personnel
nager
Victoria General Hospital
841 Fairfield Road
Victoria, British Columbia
V8\ 386
EXPERIENCED RN'S &
NEW GRADS
HTHE PERFECT OPPORTL
ITY"
Saint Anthony Hospital, located in Columbus, Ohio.
This 400-bed acute care facility offers excellent opportunities
for furthering your nursing career.
No Contracts to Sign
Rotating Shifts
Air Fare Paid
One Month Free Accommodations
Plus Exciting Challenges
Saint Anthony, a medical-surgical institution, has a complete
range of services. including:
. Open Heart Surgery
. Intensive and Coronary Care
. Definitive Observation Unit
. Renal Dialysis
· Diagnostic and Therapeutic Radiology
· 24 Hour Emergency Department
Don't wait, call or write immediatel
.
Make the change to an institution that lets you be what you
want to be. For further information, call our Nurse Recruiter,
Norma Shore, Collect.
EXCLt:SIVE (' ANADIAN REPRESE
T A TlVES
RECRUITL
G REGISTERED NURSES INC.
.
'111111
IIIIII
U'..I.
1200 Lawrence Avenue East
Suite 301, Don Mills
Ontario M3A ICI
Telephone: (416) 449-5883
.
September 1171 57
University of Saskatchewan
,"
11
"'
.s...
Dean of Nursing
._ "
.,
-
.;-
.
( In'
Applications dnd nominations are invited
for the position of Dean of Nursing with
the appointment to be made effective
July I, 1980.
The College of Nursing currently has a
complement of 28 full-time faculty
including the Dean and an Assistant
Dean. 1978/79 enrollment in the
four-year baccalaureate program was 350
full-time students.
Applicants must have appropriate
academic and professional qualifications
and the necessary leadership and
management skills to direct effectively
this important segment of the
University's Health Sciences program.
Nominations and applications with
complete resumes will be accepted until
15 December. 1979 and should be
addressed to:
Dr. R.W. Begg, President
Unhersit) of Saskatchewan
Saskatoon, Sask. S7N OWO
,-.
r
I
I
I
I
I
I
. --'--"j
-,..
,-
I;)
58 September 1171
The c.n-.ll8n Nur..
Registered Nurses
The Perfect Opportunity
Could Be
Right Around The Corner
How can you be certain that the opportunity you see to-day is the
best one for you?
The truth is, you can't. without the guidance of job-market
professionals who know the nursing business as well as the
placement business. That's why. before you sign on Ihat dotted
line to-day, you should check wilh Recruiting Registered Nurses
Inc. We're the Canadian Medical Placement Specialists
throughout the United States.
We know where the bests jobs are. how much they pay, and
where you'll fit in. R.R.N. can give you more than just ajob-
we can help you build a satisfying career.
R.R.N. has immediate positions available in:
California- Texas-Florida-Ohio
Don't wait!!!! Call or write immediately for further infonnation.
Recruiting Registered Nurses Inc.
1200 Lawrence Avenue East, Suite 301
Don Mills tM3A lCI) Ontario
Telephone: (416) 449-S883
"No Fee To Applicants"
REGISTER NOW
ð
CNA NATIONAL FORUM
ON NURSING EDUCATION
13, 14, 15 November 1979
SKYLINE HOTEL - OTT A W A
Theme: The nature of nursing education
Focus: What is basic nursing education? Diploma or
degree?
. Nursing model and the Curriculum
. Nursing specialization
. Accreditation
OPEN TO ALL REGISTERED NURSES
- MAXIMUM OF 300...
CNA Members - $100
Non-Members-$175
Complete program details and registration form in
June issue or write The Canadian Nurses Association,
50 The Driveway, Ottawa, Onto K2P lE2. Tel. (613)
237-2133.
I
OPPORTUNITY .J._
Assistant Director of Nursing
Rosehaven is an accredited extended care facility
accommodating approximately 300 geriatric residents and is
located 60 miles southeasl of Edmonton in the city of
Camrose. Reporting to the Director of Nursing, the
successful applicant will be responsible for assisting in
policy fonnation, planning, organizing, implementing and
evaluating all aspects of resident care. This position will
become vacant during June.
Qualifications:
Nurse applicant must be eligible for registration in Alberta.
B.Sc. in Nursing preferred. They should have progressive
nursing experience in which leadership and other
administrative skills have been demonstrated.
Salary up to $20.604.
Competition #9186-6
This competition will remain open until a suitable candidate
has been selected.
Apply to:
o\lberta Government Employment Office
Sth floor. Melton Building
10310 Jasper Avenue
Edmonton, Alberta
TSJ 2W 4
...4
Ad vertising Rates
For All Classified Advertising
$15.00 for 6 lines orIess
$2.50 for each additional line
Rates for display advertisements on request.
Closing date for copy and cancellation is 8 weeks prior
to 1st day of publication month.
The Canadian Nurses Association does not review the
personnel policies ofthe hospitals and agencies
advertising in the Journal. For authentic infonnation,
prospective applicants should apply to the Registered
Nurses' Association of the Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
KlPIE2
.
The c.nedlan Nur..
Nursing Opportunities in Vancouver
Vancou\'er General Hospital
If you arc: a Regis(ered Nurse in search of a change and a challenge -
look into nursing opponunities at Vancouver General Hospital. B.C:s
nuijor medical centre on Canada's unconventional West Coast. Staffing
expansion has resulted in many new nursing positions at all levels,
including:
General Duty ($1305. - 1542.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the opponunity
you've been looking for.
For those with an interest in specialization. challenges await in many
areas such as:
Neonatology Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Burn L'nit
Paediatrics
Inservice Education
Coronary Care Unit
H} peralimentation
Program
Renal Dialysis & Transplantation
If you are a Nurse considering a move please submit resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver Genenl Hospillll
8SS West 12th Avenue
Vanc:ouver, B.C. VSZ 1\19
DALHOl'SIE l"'IIVERSIT\
HALIFAX.
. s.
C.....ADA
Ær
Director of the School of
ursing
Applications are invited for the position of Director of the School
of Nursing. Dalhousie University. The appointment should be
taken up by July 1st, 1980.
The School of Nursing is pan of the Faculty of Health
Professions. which also includes the Schools of Pharmdcy.
Physiotherapy. Physical Education. and Humdn
Communication Disorders. Olher Faculties within the
University relating to health care are Dentistr) and Medicine.
There are four programmes within the School of Nursing: namely
the Basic B.N. degree. the Post-R.N. degree. a regional M.N
degree. and the Diploma in Outpost and Public Health Nursing.
The Director of the School of Nursmg IS normally appointed for a
five-year term and is responsible to the Dean of the Faculty of
Health Professions for the leadership and administration of the
School. It is expected that the candidate would have a doctoral
degree. and show eVidence of suitable clinical. nursing
education. and/or adminislrative experience. The incumbent
would panicipate in some teaching and research. and maintain a
liaison with the university community and related orgamzations
outside the university. This posilion ofTers an exciting challenge
in admimstration. programme development and research.
Application. curriculum vitae and names and addresses of three
referees should be fOIWarded to:
Robert s. Tonks, Ph.D.
Dean
Faculty of Hellllh Professions
SIr Charles Tupper Medklll Bulldlne
DIIIbousle Unlvenlty
HaUfax. Nova Scotia CaD8d& B3H 4H7
September 111711 511
OPPORTUNITIES
Associate Director
of Nursing Services
The Victoria General Hospital. an 800 bed adult
teaching hospital associated with Dalhousie
University. provides tertiary care in all clinical
specialties except pediatrics and obstetrics.
Located in Halifax with a wide range of
educational. cultural, and recreational
opportunities. The Hospital operates its own school
of nursing and seven other Allied Health Schools.
Responsibilities:
Works under the general direction of the Director of
Nursing Services. One of the prime responsibilities
will be for the personnel management aspects of this
department of approximately 1200 employees.
Qualifications:
Education:
Baccalaureate degree in nursing required. Masters
degree preferred.
E'\:perience:
Minimum of three years experience in a senior
nurse-manager position.
Special Knowledge and Abilities:
A ware of current concepts of nursing service,
education and research. principles of administration
and personnel development.
Professional Opportunit}:
The close liaison with Dalhousie School ofN ursing
provides a ready opportunity to pursue professional
interests.
Salary and Benefits:
1978 salary to $24.237. - currently under review.
Full Civil Service Benefits.
Competition is open to both men and women.
Please quote Competition Number 78-455.
Enquiries should be addressed to:
Chairman of the Search Committee for Associate
Director of Nursing Services
c/o Executive Director
Victoria General Hospital
1278 Tower Road
Halifax, Nova Scotia
B3H 2Y9
eo September 1171
The C.medlan Nur..
Required Immediately for our Osler
Campus:
Project Director - Occupational
Health Nursing
Program -to assume responsibility for coordination and
development of a modulized part-time post-diploma certificate
program in Occupational Health Nursing.
Recent experience in O.H. Nursing, Master degree and previous
curriculum and teaching experience preferred.
Refer to No. 79-057-F. This is a sessional appointment.
Both These Positions require a candidate who has the ability to
function in a creative self-directed manner in the developmental
aspects of these programs.
Salaries are based on the current academic schedule.
Direct resume to:
Humber
O
Faculty Relations OtrlCer
Box 1900, Rexdale, Onto
M9W SL7
.
';r:.;Jj-
.
;W%
Chisasibi Hospital
Fort Georges' James Bay
-
Chisasibi Hospital, Fort George, James Bay, (located
70 miles west of LG2) requires the services of:
Registered Nurses
Requirements:
. Registered nurse with practice rights
. Standing member ofO.I.I.Q.
. Experience in isolated post - an asset
. Immediately available
Salary
. Collective agreement with M.A.S., plus isolation
premIUm
Marcel Bonenfant
Northern Quebec Module
2100 Guy Street, Suite 204
Montreal, Quebec, H3H 3M8
Tel: (514) 933-2724
I
ÆB
I
I
OPPORTU\JITY
Nurses
Applications are invited for positions at Alberta
Hospital, Edmonton, a 650 bed active treatment
psychiatric hospital, located 4 km. outside of
Edmonton.
Successful candidates must be graduates from a
recognized School of Nursing and eligible for
registration in their professional association; willing to
work shifts. Vacancies exist in Admissions, Forensic,
Rehabilitation, and Geriatric Services.
Note: Transportation is available to and from
Edmonton. Accommodation is available in the Staff
Residence.
Salary $1,229- $1,445 per month (Starting salary
based on experience and education)
Competition #9184-9
This competition wiII remain open until suitable
candidates have been selected.
Qualified persons are invited to phone, write or submit
applications to:
Personnel Administrator
Alberta Hospital, Edmonton
Box 307
Edmonton, Alberta
T5J 2J7
Telephone: (403) 973-2213
...
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Mail to: The Canadian Nurse, 50 The Driveway, Ottawa,
Ontario K2P I E2
The Cenedlen Nur..
OurTradition is Excellence
O'Connor Hospital
San Jose, California
We repre
ent d 300-bed acute care facility that has teaching
affiliations with major universities and other communit}
colleges.
O'Connor Hospital is located in the beautiful southern San
Fmnci
co Bay area. A community rich in parks, beaches,
cultuml and educational recreational activities, new shopping
centres, many exciting restaumnts and offers a very fine and
diversified mode of living plu
clo
e by aredS of interest such as
mountains and de
ert resorts and "excitmg" Lake Tahoe.
Experienced RN'
can find challenging opportumties in the
following
pecialties:
. I.CU.
. c.eu.
. Med-Surg
Plus mdny other departments.
As a key member of our nursing team, some of the extensive
benefih you will receive are:
. aclive on-going in
ervice program
. medical and health in
urance
. retirement and dental plan and many other excellent
benefits.
J-or further detail
contact our Canadian Representative
Miss Shore
Nurse Recruiter
Recruiting Registered Nurses
1200 Lawrence Ave.. E.. Suite 301
Don Mills. Ontario
13A lCI
(416) 449-5883
Registered
urses
I
()O heJ ho"pital aJjacent to Uni\er"it) of
Alhena campu" offer" emplo\ ment in
medicine, !I urge ry , pediatrics.
orthopaedics, obstetrics, psychiatry,
rehabilitation and extended care including:
· Intelhi\ e care
· Coronar) ohsenation unit
· CarJiova"cular "urger)
· Hum.... anJ pla....tic"
· Neonatal intclhi\ e care
· Renal Jial) ....i"
. Neuro-...urger)
Planned Orientation and In-Service Education Programs.
PostGraduate Clinical Courses in Cardiovascular-
Intensive Care Nursing and Operating Room Nursing.
\ ppl
tll:
Recruitment Ol1icer - 'ur
in
l ni\ersit
of -\Iherta Ho
pital
H
O- I 12th Street
Fdmontlln. Alberta
T6<; 2B7
[
September 111711 111
OPPORTUNITY 41-.
Nurses/Psychiatric Nurses
The ClaresholmCare Centre. a 320-bed residential and
rehabilitation facility for psychosocially handicapped adults,
invites applications from R.N.'s and R.P.N.'s for staff
positions. Successful applicants will assist charge nurses in
the operation of their units and participate in planning and
implementing progmms for the rehabilitation and reactivation
of long-tenn residents. Qualifications: Graduation from an
approved school of nursing (R.N. or R.P.N.); must be eligible
for registration with the appropriate professional Alberta
Association. NOTE: Reasonable
ingle accommodation
available: rotating shift work involved. Salary Range: $13,608
- $15.996 per annum (currently under review).
Competition Number: 9184-L-I
Closing Date: Open
For Application Fonn Contact:
Personnel Administration Office
Government of Alberta
Room 401. Professional Building
740 - 4 A venue South
Lethbridge. Alberta
TlJ ON9
Telephone: 329-5420
[l]@
University of
Alberta Hospital
Edmonton, Alberta
o
112 September 111711
The Cenedlan Nur..
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.
4i
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can go a long way
, . . to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either- because
there are ecfucational 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:
........,
I Medical Services Bnmch I
Department of National Health and Welfare
Ottawa, Ontario K1A OL3
I Name I
I Address I
I City Proll. I
I .. Heallh and W.lla.... Santé el Bien-lire social I
Canada Canada
........
Index to
Advertisers
September 1979
Abbott Laboratories
Ayerst Laboratories
Canadian Dairy Foods Service Bureau
The Canadian Nurse' s Cap Reg' d
The Clinic Shoemakers
Cover 3
53
6. 7
9
4
Encyclopaedia Britannica Publications Limited 17
Equity Medical Supply Company 16
Glaxo Laboratories
Frank W. Horner Limited
J.B. Lippincott Company of Canada Limited
Medical Personnel Pool
50
8.18,19
51
19
TheC.V. Mosby Company Limited 10, II. 12, \3
Nordic Laboratories Inc. 52
Parke, Davis & Company Limited 15
W.B. Saunders Company 47
Schering Canada I nc. Cover 4
G .D. Searle & Company Canada Limited 19
Smith & Nephew Inc. 24
Studio Clavet Inc. 16
White Sister Uniform Inc. Cover 2
Advertising Manager
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa. Ontario K2P I E2
Telephone: (613) 237-2133
Advertising Representatives
Jean Malboeuf
60 I. Côte Vertu
St-Laurent, Québec H4L IX8
Téléphone: (514)748-6561
Gordon Tiffin
190 Main Street
U nionville. Ontario UR 2G9
Telephone: (416) 297-2030
Richard P. Wilson
219 East Lancaster A venue
Ardmore. Penna. 19003
Telephone: (215)649-1497
Member of Canadian
Circulations Audit Board Inc.
Im:J
EMBER
[ 0 )
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There is only one Butterf
*
ABBOTT
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I
"When friends or patients ask your
advice concerninQ relief of cold
symptoms conside( the advan-
tages offered ,by the CORICIDIN
family of cold products, The
various CORIClDIN*preparations
are formulated to r:1tovide effec-
tive relief of speciflc groups
"-
of symptoms that genèrally
accorrfpany <:'oOIds: Regular
CORICIDIN (antihistÖmine,
analgesic, caffeine bom- .,.
pound) is intended for use
at the first sign of a cold
where congestion is not a
problem or when decon-
gestants are contraindi-
cated. CORICIDIN 'D
is
formulated for use when
nasal or sinus congestion is
pronounced..
For your younger patients CORICIDIN
is available as CORICIDIN Pediatric MEDILETS* and
CORICIDIN 'D' MEDILETS, both chewable tablets, and
pleasant tasting COR
IDIN Pediatric Drops for infants or
very young children.
'-
---
j
{
'Free Booklet Offer
We've attempted to answer many questions about colds,
their cciJ..ses, effects a
d relief in an informative booklet
entitled ''How to Nurse p Cold". It's yours, free of charge, if
you'll simplyfiU in and mail the coupon on this page.
I Mail to:
Schering Canada Inc.
I 3535 Trans Canada
Pointe Claire, Quebec
H9R 1B4
Please send me my free
copy of your booklet "How to Nurse a Cold".
Additional copies only available upon written
request.
Name:
( P lease print)
Address:
City:
Postal Code:
. Reg. T.M
Provo
r;
f .+ :;:"-
Bu. En nom ]
thrd troe"'me
cl... clll...
t I053
_ ..'Ie
an. ·
Nune
. Special feature: CHILDBIRTH
TODAY
. Femoral allograft - a nursing
challenge
. Patient simulation as a
teaching technique
. Nine-page Fall book review
roundup
OCTOBER 1979
.
. I
BICLIOTHEQUE
SCIENCES INFIRMIERES
OCT 2S 1 ' (9 :
D
FA ...
_ L
desi
ers
A ·
LIMITED C olce
EDITION
A Division of
White Sister Uniform Inc.
ER'S CHOICE PRESENTI
N FOR THE WOMAN OF TO
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Style No. 43468 - Pant suit
Sizes' 3-15
Royale "Caresse"
100% polyester warp knit
White, Blue
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Sizes: 8-18
Royale "Caresse"
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The
Canadian
Nurse
October 1979
The official Journal of the Canadian
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number 9
Input 6 Childbinh today Special Feature 17
Calendar 8 Countdown on O. B. nurses Peggv-Anne Field 18
- You and the law 10 Nurse-midwifery: are we
missing the boat? JulianneN. Powis 21
News 12 Post graduate maternity
nursing program Rosie Steele 24
Special supplement: Nova ScOlia's Reproductive
A look at books 42 Care Program Joyce MacDonald 27
Research 55 The LeBoyer Method:
What does it mean now? MarvGrossman 28
Library update 58 Here and there: a look
at nursing in France Mary Grossman 31
Nursing grand rounds: Helen A lemany.
Femoral Allograft Patrick Ferguson.
Jean Grice.
AllisonJ. Stuart 32
Time out! Betsv LaSor 36
Sharing the experience Valerie Willetts-Schroeder 39
...
I
The stor) begins... Contented
is the only word for the
newborn featured on this
month's cover. Within
minutes of delivery. his tiny
hand reaches for and finds his
father's finger. Cover photo of
a Le Boyer birth in Zurich.
Switzerland by Colleen
Stainton. associate professor
of nursing. University of
Calgary.
The Canadian Nurse welcomes
suggestions for anicles or unsolicited
manuscripts. Authors may submit
finished anicles or a summary of the
proposed content. Manuscripts
should be typed double-spaced. Send
original and carbon. All anicles must
be submitted for the exclusive use of
The Canadian NUrse. A biographical
stalement and return address should
accompany all manuscripts.
The views expressed in the anicles
are those of the alJlhors and do not
necessanly represent the policies of
lhe Canadian Nurses Association
ISSN 0008-4581
Canadian Nurses Association.
50 The Dnveway. Ottawa. Canada,
K2PIE2.
Indexed in International Nursing
Index. Cumulative Index to Nursing
Literature. Abstracts of Hospital
Management Studies. Hospital
Literature Index. Hospital Abstracts,
Index Medicus, Canadian Periodical
Index. The Canadian Nurse is
available in microform from Xerox
University Microfilms, Ann Arbor.
Michigan 48106.
Subscription Rates: Canada: one
year. $10.00; two years. $18.00.
Foreign: one year. $12.00; two
years. $22.00. Single copies: $1.50
each. Make cheques or money
orders payable to the Canadian
Nurses Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new, along with
registration number. in a
provincial/territorial nurses
association where applicable. Not
tesponsible for journals lost in mail
due to errors in address.
eCanadian Nurses Association,1979.
-
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Number one...and still groYling!
THE
CLINIC
SHO.:
M
ÏI\,\lJh.Ji,@
CHOOSE FROM MORE THAN 30 PATTERNS. . . SOME STYLES ALSO AVAILABLE IN COLORS. .. SOME STYLES 3%-12 AAAA-EE
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-10, 7912 Bonhomme Ave. . St. Louis, Mo. 63105
Th. Cen-.lIW1 Nur..
OcIober 111711 Ii
perspective
Guest editorial intensive care level regimes to If nurses are to keep pace a graduate of the Ottawa Civic
what is a natural process is with rapid change in health Hospital School of Nursing
Contradictions: a 400 gram senseless and wasteful. care delivery, we must and received her B.Sc. in
infant exists attached to life Consumer groups seem to acknowledge the need for Nursing from the University
support systems - a 1000 agree, rebelling against what major change in our attitudes of Ottawa (summa cum
gram fetus is aborted; a they see as unnecessary and our knowledge. laude). A Public Health Nurse
newborn infant is welcomed medical intrusion, and in some -M. Colleen Stainton, with the Victorian Order of
into a family after years of cases parents go so far as to Associate Professor, The Nurses for the past four years,
infertility - a child is battered opt for home deliveries. University of Calgary, and she has also worked as a staff
and abused: a mother who has (In Canada home 1979 World Health Fellow. nurse at the Montreal General
attempted to smother her deliveries are still of Hospital (Cardiac Surgery and
Down's syndrome child is questionable safety as we do General Surgical Intensive
referred for ps ychotherapy, not have the necessary Care Unit) and at the Toronto
only weeks after she was community support system.. herein General Hospital (Respiratory
offered an abortion. that exist in Britain or Failure Intensive Care Unit).
How can one provide an Denmark.)
educational program to assist The issue at hand is
the professional nurse to deal clearly not home vs. hospital .
with these complex delivery, or what kind of EDITOR
phenomena in obstetrical delivery method to use - the As the International Year of ANNE BESHARAH
the Child draws to a close,
nursing? real issue is how can nurses nursing leaders across the ASSISTANT EDITORS
Parent-child nursing has dssist in providing the patient JUDITH BANNING
changed markedly in just the with a childbirth experience country are becoming JANE BOCK
past decade: increased that is both natural and safe? increasingly vocal about what
What knowledge and skills do they see as a weak link in the PRODUCTION ASSISTANT
technology has added new chain of health care - the GITADEAN
dimensions to nursing care in we need in this age of
the perinatal period, but while advancing technology to care that mothers and their CIRCULA nON MANAGER
the neonatal death rates have provide good maternal health unborn children receive in the PIERRETTE HOTTE
fallen, one must guard against care? The answer is that we months between conception ADVERTISING MANAGER
believing in a cause and effect must use the technology as it and birth. at the hour of birth GERRY KAVANAUGH
relationship. Something is still was intended, to help us care and in the weeks immediately
missing: what about the child in new ways. after. In this issue, some of CNA EXECl TIVE DIRECTOR
these nurses discuss the HELEN K. MUSSALLEM
who survives a premature As a professional group, problems that they see in
birth through life support nurses must be able to predict maternal/child nursing today EDITORIAL ADVISORS
measures in the intensive care and plan for new trends in MATHILDE BAZINET,
nursery only to return to health care, and to respond in and speculate on the direction chairman. Health Sciences
hospital. dead, abused by a constructive way to that the profession might take Department. Canadore College,
forgotten parents who found questions from the health care to improve this care. North Bay, Ontario.
him a stranger in their home? consumer. To do this, nurses OOROTH'MILLER.public
relations officer, Registered
Nurses are concerned in maternal/child health care Nurses Association of Nova
that technology is not serving must have the intellectual ...
Scotia.
them well in practice, and not skills and the practical JERRY MILLER, director of
supporting the parents and knowledge to visualize as well communicmion services,
children. During a recent tour as solve technical problems. .. Registered Nurses Association
I made of Europe and Undergraduate programs at - of British Columbia.
Scandinavia. I found that the best grdnt only a degree in JEAN PASSMORE,editor,
concerns of nurses involved in learning; the real skills and SRNA news bulletin, Registered
maternity care are universal: knowledge required for Nurses Association of
competent leadership and Saskatchewan.
midwives, and even \ PETER SMITH, director of
physicians, say that once mature clinical judgement publications, National Gallery
valued clinical skills are being come with graduate level of Canada.
lost. How can one teach preparation - and this could FLORITA
clinical judgement when a include midwifery. While New developments...CNJ VIALLE-SOUBRANNE,
monitor is thought to give the in-service and continuing readers will have noted from consultant. professional
best information? Those in education are helpful. we need changes in the journal inspection division. Order of
favor of advancing technology more people who have masthead new developments Nurses of Quebec.
say that every labor requires preparation at the master's on the production side of the
all possible technical aids to and doctorate level in the magazine. With this October
ensure safety, but surely the service setting. issue, we welcome assistant
general application of editor Judith Banning. Judy is
II October 1171
The Can-.ll.n Nur..
input
The Canadian Nurse invites your
letters. AU correspondence is
subject to editing and must be
signed, although the author's
name may be withheld on request.
Feet of clay? scope may be reached sooner International research (which involves simply
The "You and the law" than originally planned. project completing a questionnaire) to
column on patient advocacy The objectives of our Recently I have contact me at the address
(June) was most interesting. association are: undertaken several listed below. We are very
As a person with a . to promote and to epidemiological and excited about this project,
master's degree in medical provide continuing education serological investigations of both because of its
sociology, I would have as defined by the needs of the Crohn's disease, orregional international flavor and
agreed that nurses have a members; enteritis; along with many because of the significant
growing awareness of their . to promote awareness of other researchers we have involvement of the nursing
responsibility in safeguarding professional accountability in failed to identify the cause of profession in epidemiological
patients' rights. However. as Critical Care Nursing; the condition. but we have research.
a person who recently spent . to improve the quality of noted an increase in incidence Many thanks.
10 days as a patient in B.c. 's patient care through the in recent years and believe -Dr. John Francis Mayberry
largest hospital, I know that promotion of nursing research that infection may playa role Department of
patients' rights are still an in Critical Care; in the etiology. If this is true. Gastroenterology
unknown concept to some of . to compile a resource file it may be possible that nurses University Hospital of Wales
the average staff nurses for reference and assistance in may have an increased Heath Park
dealing with patients on a meeting the objectives of the exposure to such an agent. Cardiff, CF44XW
day-in. day-out basis. Associ ati on. We are attempting an GreatBritain.
While your magazine Membership fees are $12 international study to assess
serves as a very positive force per year. whether the condition occurs Did you know...
for nursing in Canada, I am Anyone wishing further more commonly among For those who are allergic to
afraid you are too often guilty information is urged to nurses than in the general insect venom help is on the
of the" ivory tower" contact us: population by comparing the way. A commercial
syndrome. Most of your Niagara Association of frequency with which Crohn's whole-body insect extract for
authors appear to be leaders in Critical Care Nurses, Box 61, disease occurs before and treating patients with serious
your profession. Perhaps you Weiland. Ontario, L3B 5N9. after nursing education with allergic reactions to venomous
should stop and ask the -Candace M. Paris, the rate for ulcerative colitis. bites and stings has been
"average" staff nurse and the Secretary N.A.C.C.N. We would be grateful if experimentally tested and
"average" patient about the you would ask any Canadian found successful in the U.S.
state of patients' rights and Working with nurses who have either The extract will be useful
patients' care. antihypertensives Crohn's disease or ulcerative against bumblebee. yellow
I would suggest that in We enjoyed the recent colitis and who are interested jacket. honey bee and wasp
some situations in Canada, article "Hypertension: in participating in this study stings among others. OW
patients have no bill ofrights Antihypertensives and how
and are treated as less than they work" by Pam Haslam, Working with antihypertensives
first class citizens. but note that no mention is
-Jeri Bass, Brentwood Bay, made of any of the numerous Reference - Compendium of Pharmaceuticals and Specialties - 13th
B.C. combination drugs now on the Edition, 1978.
market.
A new addition From our experience as After certain drugs have been titrated to an individual patient, it is
The Catalogue of special nurses in the Lloydminster possible to use one preparation that is a combination of several drugs.
interest groups (June, 1979) is Hospital. and in the Some Antihypertensive Combination Drugs are:
a valuable and long overdue Saskatchewan Heart
compilation of professional Foundation Blood Pressure Aldactazide lt - (spironolactone + hydrochlorothiazide) - two
groups for Registered Nurses Screening Program. we have diuretics, one of which is potassium-sparing.
in Canada. compiled a list of some of the Aldoril1!> - (methyldopa + hydrochlorothiazide) - sympatholytic +
diuretic.
I would like to apprise more common Combipres" - (clonidine + chlorthalidone) - sympatholytic +
you of our group -the antihypertensive combination diuretic.
Niagara Association of drugs used in our area (See Diupres'" - (chlorothiazide + reserpine) - diuretic + sympatholytic.
Critical Care Nurses - which box). Dyazide
- (triamterene + hydrochlorothiazide) -two diuretics, one
was formally inaugurated May We hope all nurses of which is potassium-sparing.
IS, 1979. Our first meeting working with hypertensive Hydropres P) - (hydrochlorothiazide + reserpine) - diuretic +
was enthusiastically received patients will find it useful. sympatholytic.
by the local nursing -Leanne Sauer, R.N., Hygroton-Reserpine
- (chlorthalidone + reserpine) - diuretic +
community and our B.Sc.N and Vi\'ian Knisley, sympatholytic.
membership. which now R.N., Nurse Rautractyl-4 or _2<'Ð - (rauwolfia + bendroflumethiazide)-
sympatholytic + diuretic.
numbers 88, is growing C oordi na tors-Lloydm ins te r, Ser-Ap-Es,lj) - (reserpine, hydralazine HCL + hydrochlorothiazide)-
quickly. It appears that our Blood Pressure Screening sympatholytic, vasodilator + diuretic.
goal of becoming provincial in Program, Lloydminster, Sask. Supres
- (methyldopa + chlorothiazide) - sympatholytic + diuretic.
Ie. risall
cuts the cost of decubitus care
by controlling
infection fast
Debrisan sucks bacteria and tox.
ins out of decubitüs ulcers. The
ulcer is quickly cleansed, healthy
granulation appears, and healing
can begin.
These (wet, exudative ulcers)
averaged two days to clear the
superficial infection and five days
from the onset of therapy to ap-
pearance of good granulation
tissue in the ulcer base."1
""
\
\
Day 0 Infected, heavily Day 2 Exudate diminished. Day 14 Clear, healthy
exudating decubitus ulcer on Erythema and edema granulation base; grafted
left hip. reduced. successfully.
.... ..
... ..
/1
by relieving
pain and
ooour fast
-.. :a.,.-' .....
Day 0 Infected exudating Day 4 Clear, healthy
decubitus ulcer on knee. granulation base.
Day 14 Ulcer healing after
Debrlsan discontinued.
, All patients in whom rest pain was
present at the start of treatment
noticed almost immediate relief of
the rest pain when Debrisan was
applied to the wound."2
, Debrisan was commenced and the
following day, the smell had disap-
red "3 '
pea .
Day 0 Undermined sacral Day 7 Surgically debrided Dåy 28 Appearance on
decubitus ulcer infected with before Debrisan therapy and healing.
Pseudomonas and E.coll. after 7 days, infection
controlled.
by saving valuable nursing time
Only one Debrisan chenge a day.
is needed. Debrisan therapy can "'
be stopped as soon as all signs of
infection have gone and the ulcer
is clean and granulated.
, Debrisan appears to be, in my
opinion, just what we as nurses
are seeklng."4
..
,
.T-. H e.udlltion Is"" ....,.
After removing crust or
necrotic tissue, pour a thick
(4 mm) layer of Debrisan on
the ulcer.
Cover with a dressing.
When the beads are
saturated (12 to 24 hours
later) rinse and wipe them
away. Apply a fresh layer of
Debrisan.
Debrisan e cleans
decubitus ulcers fast.
.
Pharmacia (Canada) Ltd.
U Dorval, Québec
Rel_
1. Um LT, Michudll M. Bergen JJ. Angiology 29:11, Sept 1978
2. Bewick M, Anderson A, tlin TrIIIls J 15:4, 1978
3. Soul J. Bri. J Clln Pract, 32:8, June 1978
4. DiM.scIo 5 RN. DecubItus C.. A N_ Appro8Ch:
A Nursing Rnponslbllily, on "".1 .....mI8CIII (C....., lid. e Reg T M
8 October 111711
calendar
October
Third Annual Nursing Lecture
Series sponsored by the
University of Manitoba and
the VON, Winnipeg Branch.
Theme: Middle management
in nursing: perceptions of
health care providers. Guest
lecturer: Rebecca Bergman,
Tel Aviv University, Israel.
To be held on Oct. II. 1979 at
2000 hours in the auditorium
of the Winnipeg Art Gallery,
Winnipeg, Manitoba.
Nursing Symposium at
Toronto General Hospital,
Toronto, Ontario on
Oct.24-25, 1979. As a
celebration of the 150th
anniversary of the hospital,
the symposium will provide an
historical review and update
of contemporary nursing
practice. Contact: Audrey
Abbey, Assistant director of
nursing, Staff development, 4
Elizabeth Wing, Toronto
General Hospital, /01 College
St., Toronto, Ontario.
M5G I L7.
,...
.,
.
...
I.," ,
.'''
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, .
,
". !
-
, ,
,
The C.n8dlen Nur..
Third Nurse Educator
Conference - Excellence in
Education. To be held Oct.
14-17, 1979. Program will
focus on curriculum and
program development,
evaluation, faculty and
clinical work. Contact: Ruby
Browne, Nurse Educator, 12
Lakeside Park, Wakefield,
MA 01880.
Scientific Meeting of the
Inter-urban Stroke Academic
Association to be held in
Ottawa on Oct. 19-20,1979.
The program is of interest to
those working with stroke
patients. Contact: Dr. B.E.
Krysztofiak, Royal Ottawa
Hospital, 1/45 CarlingAve.,
Ottawa, Ont., KIZ 7K4.
Cardiopulmonary Care 1979:
A Practical Guide for the
Family Physician and Critical
Care Nurse. To be held Oct.
18-20, 1979 at the Royal
Columbian Hospital, New
Westminister, B.c. Contact:
Dr. R.C. MacPherson,
Director of Medical
Education, Royal Columbian
Hospital, New Westminister,
B.C., V3L JW7.
þ- "',
o/;:
èØ'leP".
\)
.# 8
'11'
THE
LAST
THING HE
NEEDS
IS GAS.
r,
\\
(\
November
Canadian Association of
Gerontology 8th Scientific and
Educational Meeting to be held
on Nov. 1-4, 1979 at the Hotel
Nova Scotian, Halifax, N .S.
Contact: Dr. M.K. Laurence,
Dept. of Family Medicine.
5599 Fenwick St.. Halifax.
N.S., B3H IR2.
Radical head and neck
surgery: a multidisciplinary
approach. To be held at
Mount Sinai Hospital in
Toronto on Nov. 2, 1979.
Contact:A.M. Zulis,
Assistant Director, Nursing
Education, Mount Sinai
Hospital, 600 University A
'e.,
Toronto, Ontario, M5G IX5.
CNA National Forum on
Nursing Education. To be held
Nov.13-15, 1979 at the Skyline
Hotel, Ottawa. Theme: The
nature of nursing education.
Focus: Degree or diploma?
Open to all registered nurses
to a maximum of 300.
Contact: The Canadian
Nurses Association, 50 The
Driveway, Ottawa, Ont.,
K2P IE2.
Order of Nurses of Quebec
Annual Meeting to be held on
Nov. 7-9, 1979 in Montreal.
Contact:ONQ. 4200 ouest.
boul. Dorchester, Montréal,
Québec, H3Z IV4.
Canadian Intravenous Nurses
Association 4th Annual
Convention. To be held at the
Inn on the Park Hotel,
Toronto on Nov. 20-21,1979.
Contact: CINA, 4433
SheppardAve. East, Suite
200, Agincourt, Ontario,
MIS IV3.
Special Scholarship
The International Association
for Enterostomal Therapy has
announced the fOllTlation of
new scholarships to be
awarded to registered nurses
interested in working in this
specialty field and in
improving quality care for the
ostomy patient.
Application deadline is
December I, 1979. Contact:
International Associationfor
Enterostomal Therapy,Inc..
Central Office, 2506 Gross
Point Rd., Evanston, Illinois,
60201. 'V
When a patient can't
move around, gas can be
a problem, and a painful
one at that. So for pa-
tients who are immobile
..n_ _.
following surgery or for I 0 ''' 01 '
post-cholecystectomy .'
patients, give them extra ,80
strength OVaL 80mg, the ForGas
chewable antiflatulent __
Cootre
tablets that work fast to IesGaz 8 HORnER
relieve trapped gas and lQIfER M",t..a' C. ,,,.,,,
bloating. Pro uct mono!,:raph available on requeat.
,
.
.
..
IPiAil
, ,
,
Why change dressings
several times a day
when once a week is plenty?
This is an Op-site dressing for non-infected ulcers.
When it goes on, it stays on... for a whole week.
Because Op-site is an adhesive, transparent dressing
that breathes and sweats with the skin. So you can keep
your eye on the entire healing process without the
interruptions of frequent dressing changes.
Op-site is easy on the patient too. It's neat, not bulky.
Patients can take regular baths or showers without
discomfort because Op-site is water-proof. Op-site is
also bacteria-proof, protecting the ulcer from
contamination.
Because once a week is plenty, Op-site means fewer
dressing changes. And that's less work and more time
for you.
--------------------
I 0 S . t !ô" .. I
P _ I e For f';Jrther Informa!lon alx?ut I
I Op-slte ulcer dressing. fill In
the ultimate wound dressing and mail this coupon. I
I I
I Name I
I I
I Address I
I I
I City Provo_Code I
I Mail to' [8] '---'. Sm,th f, Nephew Inc. 2100,52ndAvenue I
. : Slll: M
dicl!ll Division lachine. Qué.. ClInlldlil I
I .'. _.: H8T2Y5
--------
-----------
10 October 111711
The C.n.dI8t'l Nur..
.,
YOU AND THE LAW
--.......
J ....
r
Hands that care: are they safe?
Corinne Sklar
Du you wash your hands between çare delivery to individual
patients? Usually? Always? Are you sure that you always
adhere to the principles of aseptic technique?
Strict adherence to the fundamentals of aseptic technique
and the broader principles of control of infection is an important
requirement for aU those who work in hospitals. This applies
not only to those who deliver health care directly to patients but
also to everyone who works in a hospital: when infections or
cross-infections result from the failure of the hospital staff to
properly safeguard the patient, that hospital may be found
legally resp
nsible. Infections which are spread by hospital
personnel or other health professionals are termed nosocoJ11ial;
the prevention of such infections is of concern to both hospitals
and people who work in them.
Hospitals are responsible for maintaining a safe
environment for their patients. including an environment which
does not result in further illness to the patient. This
responsibility extends also to providing a safe environment for
its staff. Thus. our public hospitals statutes provide. either
directly or by regulation. that hospital employees must undergo
periodic health review. have regular chest x-rays. and. in
certain circumstances. submit stools for culture. The reasons
for the foregoing are self-evident: if members of hospital staff
are ill or carriers of infection, they run the risk of
communicating disease to others, whether employees or
patients in that hospital.
The hospital also bears the responsibility of instructing its
employees with respect to proper technique to avoid
cross-infection - the proper method of hand-washing ,.of care
in mopping floors to avoid clouds of dust. of careful handling of
waste products. etc. Such instruction is necessary so that !>taff
can avoid harm to themselves as well as others.
Hospitalliabilit)
In an American case. an inexperienced orderly contracted
hepatitis when his skin was accidentally punctured by some
needles in the garbage bag he was delivering for disposal. The
Court found that the hospital was bound to provide a safe place
for its employees to work: a hospital. as an employer. has a duty
to warn inexperienced employees of any dangers connected
with their employment and this duty involves teaching the
employees how to avoid such dangers. tIn such a case. the
employees should be gi ven infonnation on the use of protecti ve
clothing and gloves and any other pertinent data to ensure the
safe handling of such waste.
In another American case reported by Creighton,2 the
death of a baby from miliary tuberculosis resulted in a finding of
liability against the hospital. The nurse who cared for the baby
in the nursery had a cough and was actually suffering from
tuberçulosis. The nurse's supervisors faded to report her
condition; the hospital was held to have been negligent in
having pennitted that nurse to work.
In a 1934 case (the only reported Canadian case in the area
of infection control). the hospital was absolved of legal
responsibility. 3 I n that case. a child was admitted to the hospital
suffering from diphtheria. Smallpox was in the Vancouver area
at the time and. subsequently. seven children were admitted to
the same floor. all suffering from smallpox. The same nurses
attended to all of the patients. When her mother complained.
the little girl with diphtheria was transferred to another floor
where there were no smallpox patients. This patient was later
discharged. cured of diphtheria but nine days later she was ill
with smallpox and was ultimately disfigured.
The claim against the hospital did not allege negligence
against the hospital employees. Instead, the complaint was
based on the failure of the hospital to segregate its patients so as
to avoid cross-infection. Because of expert testimony that the
hospital had adhered to the accepted and widespread general
practice prevailing at the time. the hospital was absolved of
responsibility.
Standard of care
The events referred to above took place in 1934. If they had
taken place in 1979. the result would probably have been
different: if a Court today finds the generally prevailing
standard of care wanting, then that Court may impose a higher
standard of care and find liability. It is important to remember
that cases are decided on their own facts and on the evidence
presented to the Court: if there had been allegations that the
hospital staff had been guilty of negligent breaches of sterile
technique. this factor. even in 1934. might also have made a
difference in the outcome. In commenting on this case, Lord
Nathan said: 4
But, now that it is recoRnised that a hospital authority is liable
for the neRliRence oflhe nursinx staffin such respects. it is as
well to point out that. in circumstances such as those under
consideration, the stronger the e1'idence that an infallible
technique has been adopted to amid the possibility of
cross-infection. the more compelling is the inference that, if
cross-infection does occur, it must have been caused by a
breach of that technique on the part of the hospital staff A
patient miRht therefore succeed in an action on the Rrolmd that
such a breach amounted to neRlixence for which the hospital
authority was ,'icariously liable: an{J an inability to point to the
specific member of the stajfresponsible and to the exact
occasion of the breach would not necessarily be fatal to the
action.
The CuI-.llen NUrH
Instruction in the proper technique to avoid infection and
cross-infectIon is part and parcel of a nurse's education from the
earliest days. Failure to adhere to these basic principles can
result in hann to patients and may result in liability to the nurse
and her employer. the hospital.
In the 1963 case of He/man v. Sacred Heart Hospital,S the
patient successfulIy sued the hospital for injuries resulting from
a staphylococcus infection contracted in the hospital. The
evidence was that the nurse caring for the plaintiff touched him
after caring for his room-mate who was suffering from a
purulent discharging boil. The lack of sterile technique in caring
for these patients was held to have led to the plaintiffs injuries.
Failure to pay due care and attention also resulted in
liability in another American case. 6 A nurse brought a new
mother a baby to nurse. This baby was suffering from impetigo
but was not this mother's child. Later the mother's own
newborn developed impetigo and suffered complications. The
negligence of the nurse was found to have been the cause of the
child's infection.
Protecting yourself and the patient
Nurses are a m
or factor in infections or cross-infections
through their adherence to (or breach of) the principles of
aseptic technique. Nurses have a duty to adhere to these basic
nursing principles so that infections that may be prevented by
ordinary and reasonable care are duly controlled. In doing so
they safeguard not only the health and welI-being of their
patients, but also their own health and that of their co-workers.
Handwashing between patients is time-consuming when you're
busy - a simple task too easily overlooked. However. the time
taken to fulfilI this basic responsibility is time welI spent: it
serves to protect the health interest of both the patient and the
nurse and the nurse protects the interest of both herself and the
hospital against legal responsibility.
Infection control is the responsibility of both hospitals and
their employees :nufses have a major role to play in the control
of infection. Failure to fulfilI this responsibility may result in an
alIegation of negligence being brought against the hospital and
its nurses.
References
I *Wall..er \'. Graham el al. 343 So.2d 1171 (La 1917). (In
Hosp. Infection Control, Nov. 1978. p.174.)
2 Creighton. Helen. Law nerv nurse should know. 3d ed.
Toronto. Saunders. 1975. p.I34.
3 *J'lIncou\'erGeneral Hospital v. McDaniel et al. [1934] 4
D.L.R. 593 <P.c.).
4 *Nathan. Medical negligence. London, Butterworths &
Co. Ltd.. 1957. p.IO:.!.
5 *381 P2d605 (Wash. 1963)
6 *KircllOffl'. St. Joseph 's Hospilal 260NW 509 (Minn.
1935)
* Unable to verify in CNA Library
- ...
"You and the law" IS a regular column
that appears each month in The
Canadian Nurse and L'injìrmière
canadienne. Author Corinne L. Sklar is a
ream graduate of the Unh'ersity of
Toronto Faculty of Law. Prior to
emering law school, she obtained her
B .Sc.N. and M.S. degrees in nursing
from the University of Toronto and
University of Michigan.
""7
-
Oct_1171 11
CD
'.
'\
C'
C'
"i..
Ð
C' o
.'1 C'
.
.Q: 0'1
.
9t. lII
Open to bolh
men and women
NURSES FOR
COMMUNITY
HEALTH
219-193-034 - 056-057-058
Salary:
$15,999 - $18,867
Plus various allowances
Ref. No.: 79-NHW-MS-Q-24 (143)
HEAL TH AND WELFARE CANADA
MEDICAL SERVICES
SANMAUR, INOUCDJOUAC, WINNEWAY, P.Q.
Duties
These positions offer challenging nursing opportunities to
work with native people in the provISiOn of treatment and
preventive health servIces.
Qualifications
Acceptable nurses reglstrallOn on a Provonce or Terrltorv of
Canada: traoning In public health nursing or B.Sc.N. plus
experience. Candidates wIthout these qualifications mav be
consIdered for apPointment at a lower level.
Language Requirements
For certaon positions, knowledge of English IS essential. for
others, knowledge of French is essential While for olhers.
knowledge of English and French IS essential.
Umlongual persons may apply for bilingual positions but
they must ondlcate their willingness to become bilongual.
The Public Service Commission will assess the likely aptltud o
of candidates to become bllongual. Language Iraonong will be
provided at public expense.
"Additional jOb onformatlon IS available by writing to the
address below"
"Toute onformatlon relative à ce concours est dlsponlble en
françals et peut être obtenue en êCrlvant à l'adresse.sUl-
vante" .
How to apply
Send appllcallon form andlor resumê to:
Vvon Levreault, Regional Personnel Advisor
Department of National Health and Welfare
515, Ste-Catherine Street West, 2nd Floor
Montreal, Quebec
H38 184 tel. no.: (5141 283-6360
Please quote the applicable reference number at all times
12 October 111711
The C.n.dl.n NUrH
news
Thirteen nurses receive awards valued at
more than $30,000
Scholarships, totaling $30,500, have been granted to 13 Canadian
nurses by the Canadian Nurses ....oundation.
The Canadian Nurses ....oundation, which was established in
1962 by the Canadian Nurses Association, receives funds and
administers fellowships for the preparation of nurses for
leadership positions. A total of 202 scholarships have been
awarded Wlder the program since it was set up in 1962. CN....
funding is voluntary and dependent on gifts, donations and
bequests from individuals and or2anizations.
This year, four nurses received scholarships for study at the
doctoral level:
. Susan French of
Burlington, Ontario will
continue her doctoral studies
in adult education at the
Ontario Institute for Studies in
Education. She plans to return
to her teaching po.st at the
Faculty of the School of
Nursing, McMaster
University. French has also
been named winner of the Dr.
Katherine E. MacLaggan
Fellowship.
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(Add Appropriate P.O. Box 3480 Regina, Sa.k., 54P 3J8
Provo Tax) P.O. Box 35313 Stn. E., Vancouver, V6M 4G5
. Peggy Anne Field of
Edmonton, Alberta will
receive $4.500 to continue her
doctoral studies in education
at the University of Alberta,
to pursue her interests in
research and maternity
nursing.
. Kathleen Rowat of
Montreal, Quebec has been
awarded a $4,500 scholarship,
for a second year, to complete
her doctoral studies at the
University of Illinois, Medical
Center. Her interests include
the nursing of individuals and
their families and the areas of
chronic illness and pain.
Rowat intends to return to the
McGill University School of
Nursing upon the completion
of her degree.
. Joy Winkler of Winnipeg,
Manitoba will also receive
$4,500 to continue her
doctoral studies at Wayne
State University College of
Nursing, Detroit, Michigan.
Her principle area of study
will be primary health care
research. Winkler plans to
return to the University of
Manitoba, School of Nursing.
Nine nurses received
scholarships valued at $3.000
each for study at the masters'
level:
. Karen Chalmers of
Winnipeg. Manitoba, who was
also the winner of the Eleanor
Jean Martin Nursing Award,
will complete her Master's
degree in community health
nursing at McGill University.
Her interests include research
and primary health care. This
is the second year she has
been a CNF scholar.
. Ellen Hodnett of Toronto,
Ontario will begin studies
leading to the degree of
Master of Science in Nur"ing
at the University of Toronto.
She plans to return to teaching
in the field of parent-child
nursmg.
. Eileen Hourigan of
Edmonton, Alberta will study
for a Master's degree in
Nursing at the University of
Alberta. She hopes to utilize
her education as a clinical
nurse specialist in the field of
pediatric oncology.
. Cheryl Jackson of
Montreal. Quebec will begin
study for a Master of Science
(Applied) in Nursing at McGill
University. Following
graduation, she hopes to
continue her work in teaching
young families and to extend
her clinical experience in
neonatal nursing.
. Marcelle Langlois of
Chelsea, Quebec plans to
study for a Master of Science
degree in medical-surgical
nursing at the University of
Montreal. She will specialize
in the areas of chronic illness
and gerontology. Langlois
plans to return to a teaching
position with the School of
Nursing, University of
Ottawa.
. Joan Leech of Toronto,
Ontario will complete her
studies for a Master of
Science degree in Nursing at
the University of Toronto.
Her main interest is the area
of adult cardiovascular
nursing and she plans to
continue her work in this field
upon completion of her
studies.
. Joyce Rainville of
Montreal, Quebec has won a
CNF scholarship for a second
year. She will complete her
studies toward a Master of
Science degree (Applied) at
McGill University, focusing
on family health and
psychiatric nursing. Following
completion of her studies, she
hopes to work with families in
a community health setting.
. Linda Reiche of Toronto.
Ontario has also won a CNF
scholarship for a second year.
She will complete her
Master's studies at the
University of Toronto, in
advanced community health
nursing. Reiche plans to
continue in the field of
community health, preferdbly
among the native people of
Canada.
. Lynn Scruby of
Winnipeg, Manitoba has been
named winner Qf the Helen
McArthur Canadian Red
Cross Fellowship for
Graduate Study. She will
complete a Master's degree in
community health care
systems at the University of
Minnesota with this $3,500
award. Scruby plans to
continue working in a
community-based agency
offering the opportunity for
clinical practice, consultation
and teaching.
;:z>
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CNA 's Tas/... Group on Nursing Practice Standards has met
twice since it was set up early this Summer. Pictured during one
of their meetings are members: (standing) Myrtle Tregunna,
da\' care coordinator, St. Vincent's Hospital, Vanco/H'er;
Karen Mills. associate director, City of Edmonton Local Board
of Health; Jessica Ryan, head nurse, Chaleur General Hospital,
Bathurst. N.B.: Louise Lévesque, director ofCNA projects;
(seated) Evel}n Adam, associate professor of nursing,
U ni,'ersity of Montreal; Louise Lemieux-Charles. director.
Nursing Proce.çs Project, Registered Nurses Association of
Ontario: Pat Wallace, director, CNA Nursing Practice
Standards Project.
"Continuing concern by the
nursing profession to take
steps towards developing
sound evaluative measures of
nursing care as well as societal
expectations is having an
impact on the direction the
nursing profession is taking."
says Pat Wallace. She is
Project Director for the CNA
Definition of Nursing Practice
and Development of Nursing
Practice Standards.
Teamed with Pat Wallace
is Louise Levesque. Director
ofCNA Projects. She says
that a vital factor is the
concern of the provincial and
federal governments in
relation to value received for
the health care dollar. and the
role of consumers of health
care services in relation to
"assurance" of quality care.
"The development of
standards for nursing practice
is a prerequisite in assessing
nursing care because they
provide a baseline for the
determination of quality
measurement," says
Levesque.
Levesque emphasizes
that CNA does not intend to
duplicate work already done
at the provincial level. It will
build on existing knowledge to
complement the efforts of all.
Both Levesque and Wallace
have already been in contact
with provincial/territorial
associations as well as other
organizations concerned with
standards of nursing practice.
Wallace says the
objectives are two-fold: to
develop a definition of nursing
practice and to develop
standards that are applicable
to all fields of nursing
practice. She says they will be
concrete. achievable and
understandable to nurses. to
other health professionals and
to consumers.
Looking ahead, project
plans include an Advisory
Panel to provide expert
guidance and critical analysis
and a Reaction Panel to
comment on all drdfts. Ways
of obtaining feedback from
many health related groups
and from CN A' s general
membership will be
determined - the aim is to
involve as many individual.,
and groups as possible
without making the project
structure too cumbersome.
Wallace says completion
date for the project is June
1980: "It will be the end and
the beginning - phase II may
focus on validation of
standards and the effect on
quality of care."
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14 Oct_II178
Th. Cenadlan NUrH
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in increasing their income by becoming owners of a studio.
Sfudio Clavet Inc. has qualified professionals who are ready
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If you have approximately 7 years nursing experience and
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Nurses review health needs
of B.C. Corrections inmates
The five nUTses who made up
a Task Committee on Health
Care Facilities within the B.c.
Corrections System have
completed their review of
relevant federal and provincial
studies and come up with a
comprehensive series of
recommendations intended to
ensure that all correctional
institutions in the province
meet certain prescribed
minimum standards.
Chief among the
recommendations is the
suggestion that "within the
Corrections Branch there be a
nurse employed as Director of
Nursing Operations for the
province who would be
responsible directly to the
Commissioner of
Corrections." The Director of
Nursing Operations, the
report recommends. should
have a degree in nursing and
an expressed commitment to
research and the development
of programs directed towards
health promotion and disease
prevention.
The Task Committee Was
established in June 1978 after
passage at that year's RNABC
annual meeting of a resolution
directing the provincial
nurses' association to "seek
infonnation about the
facilities and administrative
system under which registered
nurses are expected to carry
out their duties within the
corrections system. ,.
The committee c
nsisted
of Chainnan Phillis Latowski
of Richmond, B.c.. Linda
Bishop of Pitt Meadows. Iris
Passey of Burnaby, Olive
Simpson of New Westminster
and Areta Stewart of Surrey.
Their report was adopted
by RNABC directors early
last Summer and has since
been forwarded to. among
others: the province's
Attorney-General,
Corrections Brdnch officials,
B.c. Health Minister Bob
McClelland, members of the
provincial legislature.
Registered Psychiatric Nurses
Association of B.c., the B.c.
Medical Association, the B.c.
Association of Social Workers
and the B.C. Branch of the
Canadian Bar Association.
Task Committee
members also recommended
establishment of a Forensic
Health Advisory Committee
to the Corrections Branch
consisting of representatives
from nursing, dentistry. social
work, phannacy, the clergy
and a consumer group.
A total of 32 concerns
were described by the task
committee as requiring
"prompt consideration" by
the proposed Forensic Health
Committee. These included
recommendations that:
. nursing needs of inmates
be met by employing
registered nurses and
registered psychiatric nurses
. the role and functions of
forensic nurses be clearly
defined and that nurses not be
used for purposes of security
. all nurses have current
industrial first aid certificates
. opportunity and funding
for orientation. inservice and
continuing education
programs for nurses be made
available
. policy and procedure
manuals with respect to health
care be made available and
that those policies and
procedures pertaining to
nursing care be fonnulated by
nurses
. nurses participate in
planning health care facilities.
NP AO Executive
The Nurse Practitioners
Association of Ontario has
announced the names of their
1979-80 executive following
their annual meeting held in
Toronto this past spring.
One hundred and ten
nurse practitioners attended
the 6th annual conference
during which they participated
in seminars and discussed
current trends. clinical
problems and techniques of
patient management in
primary health care.
The new president is
Susan Mackenzie-Miller. who
is employee health nurse at
the Toronto Western
Hospital. She replaces past
president Susan Finnie. who
practices at the Flemingdon
Health Centre in Don Mills. '"
uniformity
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tC9
"
Does Canada face a shortage of qualified O.B.
nurses?
The case for the nurse - midwife.
Mothers and babies are safer now in the Atlantic
provinces.
A Canadian nurse visits a LeBoyer clinic.
Countdown on 0.8. nurses
. -
..
I ,-_
"
Is there a crisis developing in
maternity nursing? After three
years of research into
maternal/newborn care in
northern Alberta hospitals, this
author says "Yes, there is."
I ,
\
.
Obstetrical care - including prenatal,
labor and delivery and postnatal care -
is, of course. a function of both
physicians and nurses. It is also an area
which is demanding more and more from
the people who work in it - more
knowledge, more skills. more
preparation and more experience. High
risk mothers today are detected early,
critically ill newborns are cared for in
neoflatal intensive care units, all
reducing the maternal/newborn death
rate. As well. new concepts offamily
centred maternity care and early bonding
are recognized as important elements to
the psychological development of the
family.
With this increasing knowledge
base, we have to wonder whether nurses
in Canada are being prepared to
adequately care for mothers and
newborns. Do they get the clinical
experience they need while they are
students? It would seem that they do not.
Right now, obstetrical nurses receive
extra preparation in their specialty
through on-the-job training, by taking
advantage of the very few courses
available in maternity nursing or by
going to another country to take
midwifery courses. Surely this is a far
from satisfactory situation.
-..
- -.....,
,,--
. .. '
-.-
-
-
-
-
f-
---I
n Ie Field
At the University of Alberta, a
revised program in advanced obstetrical
nursing was funded by the provincial
department of Advanced Education and
\1anpower in 1976. As a condition of the
grant, a study of obstetrical nursing
practice in Alberta was undertaken and,
in all. three studies were completed. The
first study examined the employment
patterns of nurses in 70 hospitals in
northern Alberta; the second validated
the skills and behaviors necessary for
registered nurses working with mothers
and newborns and whether new
graduates had these skills: the last study
surveyed current educational programs
and examined both content and clinical
practice.
STUDY NO.1
The first study looked at the employment
patterns of nurses working in northern
Alberta hospitals. Forty-nine ofthe 70
hospitals surveyed responded to a
questionnaire sent to them. The hospitals
were grouped according to bed sizes:
1-24; 25-49; 50-99; 100-299; and over 300
beds - and all of them reported at least
20 deliveries in 1976. *
The survey examined three areas:
. the qualifications of nurses
presently giving maternal/newborn care;
. the preferred qualifications of
nurses working in this area;
"The actual range of deliveries was between 20 and
o\'er4,OOO.
.
..
þ
. orientation period (the period of
time before a new employee is put in
charge of patient care on evenings and
nights. )
Findings
In terms of educational preparation. one
third of all nurses employed in
maternal/newborn nursing had
midwifery or advanced obstetrical
preparation while one quarter of the
nurses employed in labor and delivery
had similar advanced preparation. In all,
131 nurse-midwives were identified as
working but of these only 19 were
prepared in Canada.
Employers stated a strong
preference for nurses with advanced
obstetrical preparation and there was a
consensus that new graduates would not
be employed in labor and delivery
nursing unless no other applicant was
a vailable. Hospitals with 500 or more
deliveries per year indicated that lateral
transfers were possible after nurses had
worked for a year or more in postpartum
or newborn nursing.
Orientation periods for new
employees varied widely depending on
the size of the hospital. For hospitals
under 100 beds, orientation ranged from
14-30 days. while new graduates might
not be in charge for one to six months in
hospitals over 300 beds.
Th. C.n-.ll.n NUrH
OcIøber Iln 11
TUDY NO.2
Pan one
One question asked in this second study
was. "What skills and behaviors are
necessary and desirable for nurses
working in obstetrics?"I n all. a total of
99Lbehaviors.. were identified from
three sources:
I) a search of the literature on roles and
functions of maternal/newborn nursing
2) a perusal of nursing standards in the
field
3) the responses of experienced nurses
currently working in obstetrics.
A questionnaire was sent to nurses
involved in direct patient care for
validation of the identified behaviors. To
be considered a necessary or desirable
behavior. 70 per cent of the respondents
had to agree.
Findings
Antepartum care
Relatively few skills were va'idated as
necessary for hospital nurses in this area.
Since many smaller hospitals refer
patients with complications to
metropol it an centers, the number of
units in northern Alberta admitting
prenatal mothers is relatively small.
Also, because prenatal teaching is
generally given by community health
nurses. involvement of hospital nurses
with mothers in the prenatal period is
limited.
Labor and delil'ery
Almost one third of the behaviors
validated in labor and delivery care were
general nursing skills related to
assessment on admission, assessment of
the progress of labor. management of the
second stage and immediate care of the
newborn. In general. the skills validated
as necessary fell short of published
recommended standards for care.
Postpartum care
There was a split in the behaviors
necessary for the staff nurse and those
considered necessary for the head nurse.
For example, behaviors related to
physical care of the mother were
necessary for the ..taff nurse while those
relating to psychological support,
teaching and counseling were necessary
for the head nurse but only desirable for
the staff nurse. I n general. behaviors and
skills requiringjudgment were
considered desirable for the staff nurse
but necessary for the head nurse.
..555 behaviors were wlidaled as necessary 323
validaled as desIrable.
To nurse the mother with
postpartum complications, skills and
behaviors related to physiological
conditions (such as diabetes and
thrombophlebitis) were considered
necessary while those related to
psycho-social factors (such as grieving
and family planning) were considered
desirable.
Newborn ca re
Most behaviors related to physical
newborn care were considered necessary
for the staff nurse. Skills in guidance and
counseling of the parents were
considered desirable. Physical
assessment of the newborn was a
desirable skill for staff nurses but
necessary for head nurses.
Only nine skills related to the care of
the newborn including suctioning, giving
oxygen by mask. gavage feeding and
incubator care were validated as
necessary for all nurses working in the
nursery. However. hospitals with over
300 beds and 250 deliveries a year
validated a wider range of skills as being
necessary in the care of the ill newborn.
U nl'lliidated skills
Some of the identified skills were not
validated by 70 per cent of the
respondents. The unvalidated skills
seemed to fall into four groups:
. !>kills which are occasionally carried
out by nurses but which nonnally fall in
the medical domain, ego emergency
delivery
. skills no longer in common use, ego
rectal examination
. skills and behaviors associated with
new techniques or tenninology. ego use
of partograms to record progress of
labor
. use of specialized equipment or
procedures.
Pan two
Another question considered in this
study was "which skills and behaviors
are required by nurses on employment
and which are acquirable on the job?"
Generally. behaviors identified as
necessary were those that were
considered to be a "requirement on
employment". Desirable skills. ego
psycho-social skills were thought to be
acquirable on the job. However. there
was a question concerning who would
help the new graduate acquire these
skills.
The study found that the smallest
hospitals needed the most highly skilled
practitioners. However, these hospitals
had short orientation periods. a lack of
in-service facilities and relatively few
obstetrical patients. They were not in a
position to provide the experience that
would allow the graduate to acquire
skills on-the-job.
Pan three
This part of the study looked at the
question. "Are new graduates
perfonning the validated skills and
behaviors satisfactorily or
unsatisfactorily?" A new graduate could
be from a hospital or college diploma
program or from a basic baccalaureate
program.
Findings
Antepartum
In general. skills in antepartum care were
perfonned satisfactorily by new
graduates except in the case of physical
care skills associated with antepartum
complications. New graduates were not
seen as perfonning these satisfactorily.
Labor and delil'ery
In labor and delivery care. hospital
graduates were satisfactory on eight out
of twenty-one grouped behaviors.
However. they were unable to time
contractions. assess the progress of
labor. assess the need for medications or
manage the second stage oflabor.
College and baccalaureate graduates
were seen to be even less successful in
their ability to give care. Since the
behaviors validated as necessary did not
even meet minimal standards set by the
American Nurses A..sociation (1973) and
the Nurses Association of the American
College of Obstetricians and
Gynecologists (1975), these findings
have serious implication.. for nursing
care.
Postpartum
In postpartum nursing care, behaviors
validated as necessary by all ho..pitals
were generally satisfactorily performed
by new graduates. Postpartum
complications where the mothers
required more extensive care were
limited to the large hospitals and
necessary skills were not always
performed satisfactorily by new
graduates.
Newborn
The behaviors and skills necessary in
caring for the nonnal neonate were
perfonned satisfactorily by new
graduates. On the other hand, the nine
behaviors validated as necessary for the
care of the ill newborn were
unsatisfactorily perfonned. No new
graduates were prepared to work in
centers where more complex care of the
sick newborn was carried out.
20 OcIøber 111711
The C.nedlen NUrH
STUDY NO.3
The last study was a survey of current
nursing education programs (both
diploma and baccalaureate) in Alberta
and examined the content and clinical
practice obtained by students in the area
of maternal/newborn nursing.
Findings
Ten schools responded to the survey. All
of them seemed to provide the student
with an adequate knowledge base for
maternal/newborn care. But clinical
practice varied greatly among the
schools, particularly practice in labor
and delivery. The range of experience in
this area spanned from 16 to 170 hours.
Three of the four hospital programs
offered an optional or a required senior
experience in labor and delivery care as
did two of the college programs.
The majority of instructors indicated
that they felt the experience (ifless than
40 hours) was inadequate. They stated
they saw no way of increasing it within
the current curriculum. Two instructors
(from a school offering students 16 hours
experience) stated that the graduates had
the skill to function as beginning
practitioners. I t is of interest to note that
these instructors had only two years
work experience between graduating and
beginning to teach.
Only two schools offered experience
with the sick newborn. one offering
seven hours. the second providing
approximately 75 hours of experience.
Generally the focus was on the well
newborn in both theory and practice.
Implications for nursing
It appears that graduates from nursing
education programs in Alberta have
minimal competence in the care of the
postpartum mother and well newborn.
Most do not have even minimal
competence in caring for the mother and
newborn who develop complications (a
problem generally restricted to large
metropolitan centers) nor are they
competent to care for the woman in
labor. Not surprisingly. the hospitals
with the least facilities for training nurses
on the job required the best prepared
nurses.
Most hospitals indicated that they
are reluctant to hire new graduate
to
work in labor and delivery nursing
thereby inferring that only experienced
nurses should work in rural hospitals.
But if a nurse graduates without basic
skills she is unlikely to have them five
years later unless she has been persistent
in her efforts to learn more about the
care of the mother in labor. I n the
meantime. the metropolitan hospitals
suggest it takes three to six months to
"orientate" the new graduate. In effect,
she must learn labor and delivery nursing
after she becomes a graduate.
What to do?
In my view,
t is time that educators and
nursing service personnel decide the
purpose of obstetrical nursing in the
basic curriculum. Does Canada need a
second level program as is common in
other countries? Such programs have
provided much of the skilled nursing care
Canadian hospitals have utilized in the
past. For example. there is evidence that
leadership in maternal/newborn care has
been provided by nurses who have
received advanced preparation in
countries other than Canada. Generally
this preparation has been midwifery and
the majority of nurses have been
recruited from the United Kingdom,
Australia, New Zealand. India, Ireland
and the Phillipines. Because overall
immigration in Canada has decreased
over the last few years. we do not have
this source so readily available.
How do we prepare nurses for
neonatal intensive care and intermediate
care units? In many cases. it has been
on-the-job training. But is this good
enough? Can hospitals afford to divert
monies allocated for patient care to
provide several months on-the::job
training? Can an adequate pool of nurses
be prepared in this way? As an
alternative, should clinical certificate
courses be offered and if so. by whom?
Are continuing education programs
available?
It is my contention that if we do not
find answers to these questions and find
them quickly there will be a crisis in
maternal/child nursing within the next
five years. The development of nursing
'itandards will identify minimum
competencies needed for registered
nurses, but this is only the beginning.
Nurse educators need to look at their
accountability in terms of behaviors and
skills of their graduates: they need to sit
down with their peers in nursing service
to decide what the real needs are. Then
they must make a realistic plan that
identifies content and competencies at
the basic level and the type of
educational program needed on a
continuing education level. The agencies
that should offer su
h continuing
education programs must also be
identified.
Good obstetrical care must be a
priority in today's health system. The
level of care given in the prenatal period.
during labor and delivery and
immediately after birth can vastly
influence the health status of both the
mother and child. The nurse's role in the
delivery of this care in both the hospital
and the community is of tremendous
importance. It is ourresponsibility to
provide the best care possible. OW
Bibliography
I American Nurses Association.
Standards. Maternal-child health
nursing practice. Kansas City, Mo, 1973.
2 Andrews, Heather A. Educational
needs of registered nurses: a report
commi.uioned by the Alberta
Association o.fR egis tered Nurses. Ad
Hoc Committee to Study Ways of
Promoting Post-Basic Degree Program
Studies in Alberta. Edmonton, Alberta
Association of Registered Nurses. 1978.
3 Canada. Health and Welfare
Canada. Recommended standards for
maternity and newborn care. Rev. ed.
Ottawa, I nfonnation Canada, 1975.
4 *Field, Peggy-Anne. A follow-up
.wrvey ofgraduatesfrom the advanced
practical obstetrics course. January 1972
to March 1977 (inclush'e). Edmonton,
University of Alberta. Faculty of
Nursing, 1978.
5 Supplement to a I'lliidation of skills
and behaviors that are nece_uary and
required for maternal-newborn nursing
and their successful performance by new
graduates. Edmonton. University of
Alberta, Faculty of Nursing. 1979.
6 "Trends in obstetrical nursing
employment. Northern Alberta. 1976.
Edmonton, University of Alberta,
Faculty of Nursing. 1977.
7 I nterprofessional Task Force on
Health Care of Women and Children.
Joint position statement on the
de,'elopment o.tJamily-centered
maternity/newborn care in hospitals.
Chicago. 1978.
8 Modelforutili;:ation ofNAACOG
standards. Washington. Nurses
Association of the American College of
Obstetricians and Gynecologists. 1977.
9 Obstetric, gynecolo}?ic and
neonatal nursing functions and
standards. Chicago. Nurses Association
of the American College Obstetricians
and Gynecologists. 1974.
10 Neonatal intensÏ\-e care.
Supplement. Chicago, Nurses
Association of the American College of
Obstetricians and Gynecologists, 1978.
*Unable to verify in CNA Library
Peggy-Anne Field is an associate
professor in thl' Faculty o.fNursing at
the Uni,-ersitv of Alberta in Edmonton.
She has bee'; el;lplo.ved at the U of A
since 1964 and has responsibility for the
A d\'anced Practical Obstetrics Program.
S he has also taught maternal/ newborn
nursing and nursin}? education.
Field obtained her education at
Addellbroo/..e's Hospital. Cambridge,
England. recei,'ed a B.N. degree from
McGill UnÏ\'ersitv and an M.N. from the
Uni,-ersity of Washington. Currently,
she is on educationallew'e to "'ork on a
Ph.D.
The C.n-.llen NUrH
OcIøber Iln 21
Nurse -Midwifery
are we missing tHe
At 2336 hours on May3. 1978Annie
Schmo/ze was born into the quiet
atmosphere of the Booth Maternity
Centre, Philadelphia. P A, U.S.A. Her
parents. Jeanne and Ken, had both
acti\'ely participated in the modified
"LeBoyer" birth and as nurse-midwife,1
had attended at the deli\'ery of the baby.
Throughout the labor Ken had been
beside his wife pro\'iding support and
encouragement during the contractions
while Jeanne concentrated on her
pushing and breathing until their
daughter was born. Still covered with
amniotic fluid and \'ernix, Annie was
placed directly on her mother's stomach
where she wriggled warmly against
Jeanne's skin and gazed wide-eyed and
bewildered at the excitement around her.
Annie's birth was the culmination of
months of prenatal preparation for Ken
and Jeanne.
Their first child, Kris, a bright-eyed
little bov, was born in the conventional
surroundings of a hospital. Jeanne "'as
gÏ\'en antenatal. intrapartal and
postnatal care by a physician. For their
second child, howe\'er, they elected to
participate in the birth experience to a
greater extent and so they chose Booth
Maternity Centre. They are just one of
many couples who annually seek ollt the
kind of care and birth etperience offered
at the Booth, a centre runjointly by
obstetricians and nurse-midwi\'es.
The Canadian scene
Similar birthing experiences are being
carried out in a variety of settings in the
United States* but. in Canada, the
options are more limited. By far the
largest number of births in Canada occur
in hospital with its clinical routine and
subsequent feeling of alienation for many
parents. Because of growing consumer
awareness. some parents are choosing to
have their babies at home. Since very
fe\\- physicians wiIl attend at a home
birth. some of these couples are cared for
by unqualified birth attendants who have
no legal. medical or emergency backup:
others use qualified attendants who.
because of existing medical and legal
regulations. are practising outside the
law and who also have no emergency
backup. Because of Canadian
Julianne Powis
demographic considerations, some births
also take place in remote nursing stations
with qualified nurse-midwives and
outpost nurses practising within the
jurisdiction of Medical Services. Health
and Welfare Canada. Most of these
alternatives provide various forms of
perinatal care.
Dissatisfaction and concern
Evidence from public health agencies.
hospitals. the media and my own
personal observations suggests that
many Canadian parents are unhapp}
with their limited involvement in the
birth process. This growing
dissatisfaction cannot and should not be
ignored. Childbirth is a natural process.
not a pathological condition: why should
barriers exist that prevent a woman from
sharing this life experience with her
partner. friends or children? More and
more, mothers and fathers want a
choice: they want a safe, satisfying birth
experience that can be shared with those
closest to them. Research suggests that
total participation in the birth can have a
significant bearing on the future stability
of the family unit. Do we as health
professionals have the right to withhold
this choice from parents?
Unfortunately. the alternatives to
hospital delivery now being chosen by
parents can be dangerous and needlessly
jeopardize the lives of both mother and
baby. Health care professionals are
justifiably concerned. In May 1978 the
British Columbia Medical Journal
observed: "It was noted in the annual
....,J
.Su: Cart)'. E/ain
. A/t
rnativ
birth c
nt
rs. bv ...
and Alison Rice. Canad.Nurs. 73://:3/-34. No>.
/977.
.
.
boat?
report of the Maternal Welfare
Committee of the Health Planning
Council ofVancow'er, B.C., that
out-of-hospital delÏ\'eries are becoming
premlent. During 1965-1975, 2,253
registered home births were noted - the
non-registered numbers may be
significant. The report also indicated its
continued condemnation of the practice
of home deli\'ery - based on inadequate
emergency facilities for the home, and
the number of women eventually
admitted to hospital from abandoned
home deli\'ery with pre\'entable,
life-threatening conditions."
The World Health Organization
places equal importance upon the
medical and psychological aspects of
health care. Consequently we must
accept that the safety of mother and baby
is paramount in both areas.
Canadian families seeking
out-of-hospital delivery sites or care
offered by lay attendants, compromise
their medical safety to achieve the
psychological satisfaction which is
important to their integrity. If the
outcome of their decision is a healthy
mother and baby. then their goal has
been achieved. Ifcomplications arise.
then what are the long term ramifications
both medically and psychologicaIly?
The \alue oftechnolog)
In the majority of pregnancies.
complications wiIl not arise but not all
pregnancies turn out weIl. Advanced
medical technology and emergency
facilities must be readily available for
those who need it. Tremendous
advances have been made to improve
maternal/infant mortality and morbidity
and it would be a serious error to
discredit the judgments of physicians
expert in detecting pathology and in
instituting appropriate interventions.
However. future parents may well have
justifiable complaints about physician
insensitivity. the lack of encouragement
to be involved in decisions for care. the
over-use of technology and the
dehumanizing aspects of hospital
routines.
There is no guarantee that a
pregnancy. birth or post delivery will be
without risk of unforeseen
complications. Regardless of how
normal progress may appear. we must be
alert for any significant changes in the
.,tatus of both mother and child and have
22 OcIøber 111711
The C.nedlen NUrH
,
the expertise and technology available.
For the pregnant woman who is
considered to be high-risk. technological
intervention is a necessity for the healthy
outcome of the pregnancy. But
technology must be adapted to the
individual, and the mother and family
must be given support to decrease the
adverse ps ychological effe'Ct of its use.
For the mother who is low-risk.
individualized care is still the key. Think
about the rigid and coldly mechanical
routines that often take place on
obstetrical units? Could these not be
substituted or modified for more
individualized measures or even deleted
completely? Each family's needs are
unique; we must learn to accept that fact
and to recognize its significance in the
care that we offer the expectant family.
both father and mother.
Providing alternatives
Considering the concerns of Canadian
families, it is my contention that
maternal/child nurses must evaluate how
they can better meet parent's needs.
Ideally. nursing involvement should
begin early in the pregnancy - to
provide information about nutrition, to
answer questions and allay fears. to help
them grow with their changing life-cycle
and to support their preparation for
parenting. Involvement should not stop
at the delivery but extend into the early
weeks and months that follow.
In addition. activities or routines
that "force" parents to consider unsafe
birth experiences cannot be condoned.
As an alternative. there is a need for a
safe setting where parents can achieve
their goals of involvement and
satisfaction in the birth experience.
For the low-risk pregnancy, the
obvious answer lies in legally
recognizing. educating and employing
nurse-midwives in Canada's health care
system. Safe and satisfying antenatal.
intrapartum and postpartum care. with
complementary parent education classes
is. in my view, the mandate of this
professional. The nurse-midwife is an
expert in the normal aspects of the
child-bearing cycle and is educated to
recognize any abnormality.
Canadian Nurses Association
Statement on the Nurse-Midwife
:'
Position
At the present time, the delivery of health services to Canadian women during the span of
their reproductive life is fragmented, uncoordinated, and sometimes, inadequate. In
addition, there exists a growing demand for more extensive counselling and educational
programs in this area.
CNA recommends recognition of the nurse-midwife as the health professional best
equipped to meet the growing need for counselling services and for greater continuity of
care within this area of the health system.
Function
The nurse-midwife provides a family-oriented service which offers comprehensive care to
the mother and child during the entire maternity cycle.
The nurse-midwife is prepared, through her education and experience, to give the
supervision, care and advice that women require during pregnancy, labor, delivery and
following birth.
This care includes: supervision of uncomplicated pregnancies, conduct of normal
deliveries, institution of preventive measures, detection of abnormal conditions in mother
and child, procurement of medical assistance when necessary, execution of emergency
measures in the absence of medical help, and care of the healthy newborn.
The nurse-midwife provides counselling, not only for the individual woman. but also
for the family and members of the community. This assistance includes advice on
common gynecological problems, family planning and child care, as well as pre-natal
education and preparation for parenthood.
Preparation
National standards regulating educational programs and practice should be developed
joinlly by nurses, physicians and nurse-midwives and implemented by nursing regulatory
bodies.
Nurse-midwifery programs should be provided in institutions of nursing education.
These programs should be offered at two levels: post basic (diploma or baccalaureate)
and master's degree.
Qualification
A nurse-midwife is a person who is eligible for registration as a nurse in a province of
Canada, has successfully completed a prescribed course of study in nurse-midwifery in a
recognized educational program and has acquired the requisite qualification to be
certified to practice nurse-midwifery.
Practice and remuneration
The nurse-midwife functions as a member of the health care team. The amount of
physician participation and supervision depends on the degree of deviation of the
maternity cycle from the normal. The scope of activities and responsibilities varies
according to the setting.
Remuneration should be on the basis of a salary which is adequate, competitive, and
reflects responsibility, experience, educational qualifications and seniority.
CNA supports the establishment of a national organization for nurse-midwives and
agrees with the principle of formal liaison between this organization and CNA.
February 1974
Reviewed August 1976
Reviewed June 1978
Satisfactory collegial relationships
have been established in the United
States where the nurse-midwife carries
out antenatal and postnatal care in
collaboration with an attending physician
in a private office, clinic or community
health setting. For such joint practices.
in-hospital birthing rooms that have a
home-like atmosphere appear to be the
appropriate setting for nurse-midwife
attended births. All emergency facilities
are readily available though not
intrusive. Intrapartal care is again given
in collaboration with physicians.
On-going continuity of care is best
provided in a congenial atmosphere
where everyone works together for the
benefit of a safe outcome for mother and
child. The nurse-midwife must be able to
function interdependently with the
family's physician. obstetrician and all
members of the maternal/child health
care team. Throughout the world. we
find nurse-midwives practising in all
manner of settings. But for the system of
health care in Canada. it would appear
that the nurse-midwife/physician
practice and in-hospital birthing rooms
would be the most practical and
acceptable.
The economic issues related to
health care need to be evaluated
carefully before any long lasting changes
are implemented. The system will not
The C.nedlen NUrH
OcIober 117V 23
improve if nurse-midwives are just
another add-on to the alread y crowded
forum of health care workers. The
economic implications of initiating
improved nurse-midwifery programs in
Canada and the updating of foreign
trained nurse-midwives must be
analyzed. In addition, a basic standard
for nurse-midwifery education and
practice must be fonnally established.
Presently, there are three
nurse-midwifery education programs in
Canada:
. the Advanced Practical Obstetrics
Program at the University of Alberta in
Edmonton:
. the Outpost Nurse Practitioner
program at Dalhousie University in
Halifax, N.S.:
. the Outpost and Nurse-Midwifery
Program at Memorial University in St.
John's, Nfld.
Graduates of these programs
generally work in remote areas of
Canada. or in a foreign country. Some
return to hospital or public health
agencies to work in their respective
maternal/child care areas. Others leave
maternal/child health because of
restrictions on nursing practice in this
area.
Conclusion
There are no immediate answers to the
dilemma that parents in Canada face
today in seeking a more satisfying birth
experience. Nor are there immediate
answers for the numbers of
nurse-midwives who face an unknown
future in their professional lives. But
perhaps there is hope: on the national
level. the Canadian Nurses Association
is currently meeting with the Society of
Obstetricians and Gyneeologists to
discuss the role of the nurse in obstetrics
in Canada. Provincially, the Registered
Nurses Association of British Columbia
has established a task committee**
studying the future of nurse-midwifery in
that province and ha.. met with the B.C.
Medical Association. Both of these are
steps in the right direction.
It is my belief that in Canada there is
room for the satisfaction achieved by
parents such as Jeanne and Ken. It is
also my view that there is a very great
need for the skills of the nurse-midwife
who is a qualified health care
professional and an important member of
the maternal/child health care team. OW
.ORNABC Nurse-Midwifery TaskCommillee Report
is now QI'ai/able from:
RNABC
2130 West 12th A"e.
V ancou"er. British Columbia
V6K 2N3
Allention: Margarl!l Lonergan.
WILL B.C. BE THE FIRST?
The Summer issue of the RNASC NEWS brought word to British Columbia nurses of action
taken by directors of their professional association to formally approve the Report of the
Task Committee on the Future of Nurse Midwifery in B.C., submitted to them after 10
months' work by committee members Julianne Powis. Elaine Carty and Norma Foster.
The RNABC NEWS story notes: "Although the role of the nurse-midwife practitioner has
been supported by the Canadian Nurses Association for more than four years, RNABC could
become the first provincial body to attempt to foster the introduction of midwifery in its
jurisdiction. Other associations across Canada will be watching to see how this proposed
new role for registered nurses will be accepted by the medical profession and the health care
consumer."
The report recommends that:
e the practice of nurse-midwifery be legally defined as "part of the ordinary calling of
nursing" within the B.C. Medical Act and that RNABC join with the B.C. Medical Association
in issuing a joint statement on nurse-midwifery.
e practicing nurse-midwives meet RNABC-approved standards of practice and that their
functions follow those oullined in the association's 1978 position statement.
e development of the role of the nurse-midwife begin with registered nurses who are
already midwifery program graduates and that RNABC encourage the introduction of
refresher courses for them.
e that practicing nurse-midwives be salaried, paid by their employers or by B.C. Medical
Services Commission, instead of working on a fee-for-service basis. Once the new role is
implemented. it should be studied in depth to assess its acceptance. validity and cost
effectiveness within the health care system.
Approximately 100 "qualified nurse-midwives" identified themselves to the association
last Spring when the RNABC NEWS carried a questionnaire requesting this information. All
but seven of these nurses expressed interest in a midwifery refresher course.
The RNABC NEWS concludes: "Clearly, midwives are interested in practising in British
Columbia. RNABC supports the concept, physicians accept the possibility, and the public
seems ready for alternative delivery systems. From all appearances, nurse midwifery IS an
idea whose time has finally come to Canada."
Acknowledgement: Special tlllln/..s go to
Jeanne, Ken and Annie Schmol;:e,
Philadelphia; nurse-midwives and
physicians at Booth Maternity Centre,
Philadelphia; Vic/..i Walton, The Birth
Place, Seattle, WashinglOn; andGary
Dodd, Nanaimo. B.C.
.-
.
Julianne N. Powis(R.N., Sault Ste.
Marie, Ontario; C.N .M.) is a graduate
of the Ad\'Gnced Practical Obstetrics
Program. UnÙ'ersity of Alberta. She
received cert{fìcation as a member of the
American College of'Vurse Midwil'es
after completing a refresher program at
Booth Maternity Centre in Philadelphia.
A ctil'ely illl'oll'ed in the Western Nurse
Midwives Association of Canada and a
member ofNAACOG, RNAO and
RNABC, Powi.'. is the chairman of the
Registered Nurses Association ojBritish
C olumhia' s T as/.. Committee on
Nurse-Midll'ifery.
Powis has had ohstetrical
etperience in a number ofllOspitals in
Canada and M ll1'yland, U.S.A. and has
wor/..ed as a nurse-midw{fe in the
Canadian north. Currently she is a labor
and delil'ery room nurse at Vancolll'er
General Hospital, Vancoul'er, B.C.
Phmos by Juhanne Powi
and Ken Schmolze
24 OcIøber 1878
The C.nedlen NUrH
Post graduate maternity nursing program:
meeting the need in the Atlantic region
Inservice programs are usually
established to meet a need
within the hospital in which
they originate. The post
diploma maternity nLrsing
program at the Grace
Maternity Hospital in Halifax,
however, was set up to meet a
much broader need - that of
hospitals not just in Nova Scotia
but throughout the Atlantic
region.
The need for such a program was
identified by analysis of enquiries from
nurses and hospital administrators
throughout the region directed to the
Grace Hospital. Confirmation came in
the form of response to a questionnaire
sent out in 1972 to 24 hospitals - 18 in
Nova Scotia. five in New Brunswick and
one in Newfoundland.
Once the need for a cour"e of thi...
nature wa., established. the provincial
government was approached for
approval and funding and. in the Spring
of 1973. an eight-week course in
maternity nurSIng was launched
Course development
The main objective of the new program
was to meet the needs of hospitals in
Nova Scotia specifically and the Atlantic
region in general by providing nurse
working in these institutions with
specialized training and nursing care
beyond the diploma level. The course
was developed by assessing the changes
in equipment. procedures. diagnostic
tests, new programs, etc., occurring at
the Grace Maternity Hospital five years
prior to implemention of the course, and
for the five-year period following
implementation. The cUlTiculum was
designed to include concurrent
theoretical and clinical teaching and
supervised experience covering all
phases of maternity nursing care.
Rosie Steele
Content was developed bearing in mind
that the basic knowledge of this nursing
specialty had already been attained.
The curriculum was flexible in that
the nurses indicated the necessary
learning they required in order to fulfill
job positions more efficiently and
knowledgeably in their particular nursing
area. All aspects of maternity nursing
were covered, with a concentration of
classes in the first two weeks and clinical
rotations in the remaining six weeks.
Enrolment
To be eligible for the course, nurses
must be registered in their provincial
association. have at least one year of
experience in maternity nursing or
equivalent and intend to continue in thi"
field. The nurse"s receive certificates
te'itifying to their successful completion
of the course and their ability to fulfill its
objectives. The course meets criteria .,et
out by the Registered Nurses
Association of Nova Scotia for an
Approved Recognition Program:
graduates are eligible for Continuing
Education Units. Originally, the program
was eight week., in length and was
offered in the Spring and Fall of each
year, with a limit of'iix students per
course. From October 1973 to November
1917, 34 nurses graduated from "even
courses. In the Fall of 1977, the course
was extended to twelve weeks
specifically to include more neonatal
intensive care nursing. To date, a total of
63 nurses have graduated from the
program.
Lectures
Planned, structured classes are arranged
to cover a review and gradually progress
to in-depth theory covering all aspects of
the maternity cycle and the newborn ana
neonatal period. Lecture topics include:
. anatomy and physiology review
. embryology
. infertility and endocrinology
. premature labor
. high risk obstetrics
. bleeding in pregnancy
. anaesthesia and analgesia in labor
. genetics
. diabetes in pregnancy
. hypoglycemia in neonate
. toxemia in pregnancy and
hypertensive diseases of pregnancy
. fetal monitoring
. Rh disease
. gestational assessment of newborn
. maternal aspects of Rh disease
. temperature control
. neonatal a'ipects ofRh di...ease
. R.D.S. and other respiratory
diseases of neonate
. fetal malnutrition
. physiology and nursin care In
puerperium
. resu
citation of newborn
. shock in newborn
. drug addicted mothers and their
newborn
. complications oflabor
CAPE BRETON
Summerside' 'North Sydney
NEW BRUNSWICK PEl. 'Sydney
.Charlottetown Inverness
T atamaglluche
Moncton' 'Amherst 'New Glasgow
'Truro
'Windsor NOVA SCOTIA
Kentville' Berwick
A
napolis 'Halifax
Digby . Bridgewater .Sponsored Candidates
Yarmouth' 'Shelburne
The Cen-.llen NUrH
Octoberll11 25
ITEM
Returned to
work on a
maternity unit.
Implemented
acquired knowledge
imo daily
schedule.
Used available
equipment to
better advantage.
Given opponunity
to teach new
techniques.
Suggested changes
in unit.
Changes favorably
accepted by
nursing staff.
Changes favorably
accepted by
medical staff.
Provided with a
salary increment
after course.
Eight weeks WdS
sufficiem for
fulfillment of
course objective...
Table one
Report of the Followup Questionnaire
to Course Graduates, October 1973 - May 1977
(N = 26)
YES
85.0%
NO
PARTIALLY
15.0%
NO
RESPO"VSE
TOTAL.
100%
73.0%
11.5%
4.0%
11.5%
100%
96.0%
77.0% 15.0%
88.0% 8.0%
73.0% 4.0%
65.0% 4.0%
8.0%** 9:!.0%
31.0% 61.0%
4.0%
100%
8.0%
100%
4.0%
100%
23.0%
1 ()()%
4.0%
27.0%
100%
100%
11.0%
100%
"Twenty-seven questionnaires were returned, one of which wa'i incomplete.
**Following completion of the course, these two candidates became head nurses. Thus. the salary increment was related to the change in StdtuS
rather than to succe..sful completion of the course.
Conferences
N ur.,es are gi ven assigned reading and
study periods. Daily clinical confe-ence'i
are held: conferences are al..o held with
the ..ocial worker. nutritionist and
physiothempist which enable the nurses
to identify the role and need for these
resources in their own hospital and/or
community
Teaching practice
Planned teaching experience with the
public health prenatal classes is
provided. Each nurse prepares and
presenl'i one class and participates in
teaching prenatal exercises.
Nurses also attend cla..ses at the
Prenatal Clinic at the Grace Maternity
Hospital and incorporate patient
teaching on the following topics. into
their clinical experience: baby bath.
breast feeding, family planning, diabetic
teaching cla..ses etc.
Clinical experience
Under the guidance of a senior resident
or instructor the nurses are taught
history-taking. abdominal palpation.
vaginal examination. pregnancy
assessment. laboratory tests. etc. on a
1:2 ratio (ie. one resident to two
students). This experience covers a
one-week period at the beginning of the
clinical rotation to the prenatal clinic.
Supervised clinical pmctice is provided
in all areas of the hospital including the
antepartum unit.
Special classes
Provision is made for the nurses to
attend any addresses. conferences or
lectures being held in the Halifax area
which are of interest and pertinent to
maternity nursing. A four-hour seminar
on communications and handling critical
incidents is given. Nurses attend general
inservice presentations at theGrace
Maternity Hospital as well as high risk.
neonatal and chart round... Field trips to
the Neonatal Intensive Care Unit at the
Izaak Walton Killam Hospital for
Children. the Planned Parenthood
Association and the local university
library are also arranged.
Evaluation
In an attempt to evaluate the
effectiveness of the post graduate
maternity nursing courses offered at the
Grace Maternity Hospital between
October 1973 and May 1977, two
follow-up questionnaires were developed
in June 1976. One questionnaire was sent
to the directors of nursing service who
had sent nurses to take the course; the
second was sent to the graduates from
the course.
21 OcIøber Iln
For the most part. the directors of
nursing felt the course had fulfilled their
objectives in sending the candidates;
they were very positive and supportive
of continuation of the course. They also
had suggestions to make for
improvements in the content of
physiology. fetal monitoring. and for
assisting candidate
to better utilize
facilities in "home" hospitals as
compared to the facilities available at the
Grace Hospital. Directors felt the course
should be lengthened but noted that
allowing a candidate to attend for a
longer period might present staffing
problems.
Most course graduates met course
as well as individual objectives (see table
one): they were better able to utilize
available equipment and were
encouraged to teach and implement
changes in their units. They reported
also that changes had occurred In all
areas of maternity care from prenatal
teaching, nursing care of complicated
pregnancies. in the areas oflabor.
delivery. postpartum, newborn care and
the introduction of newer diagnostic
tests and equipment. since the
completion of the program (see table
two ).
The strength of the course appeared
to be the confidence achieved to fulfill
the role of the nur
e as a teacher and the
importance of teaching throughout the
whole maternity cycle. Its weakness lay
in the need for more theory in all given
situations and the need for more neonatal
content.
A two-week update program for
graduates of the initial eight-week course
was offered last Winter to provide these
nurses with the neonatal nursing content
now offered in the l2-week course. The
first of a series of two-day workshops for
graduates of the program was held in
March 1978.
The value of the program offered at
Grace Maternity Hospital is best realized
from the changes implemented by
graduates in their chosen field of
maternal and child health care. These
changes must be recognized as
contributing factors in the steady decline
of maternal and newborn morbidity rates
that has taken place in recent years in the
province of Nova Scotia. OW
r,
-
The C.n-.llen NUrH
Table two
Graduates' Suggested Changes for Improving Quality of Care
Which Have Been Implemented
High Risk Pregnancy Improved assessment/care
Labor
Improved assessment/care
Vaginal examinations
Felal Monitoring
Fathers in the delivery room
Scrub nurse now circulates
Nursery
Improved assessment/care
Changes in rigid nursery rules
6.85%
20.55%
15.07%
23.29%
Improved assessment/care
Family centered care
Bonding
Breast feeding
Rooming-in
Family planning
Continuity of care between hospital and home
Postpartum
Teaching/Counseling I mproved teaching (general)
Improved inservice
Diagnostic Tests
Kleihauer
Dextrostix
8.22%
5.48%
9.59%
Emergency can for nursery
Fetal monitor
Doptone
Ictometer
Phototherapy light
Tool chest for neonatal transpon
Equipment
9.59%
General improvement in techniques
I.V. therdpy
Change in visiting policies
Cooperation with physicians, public health nurses and
other re
ource personnel
Changes in most things
Other
No Drdmatic Change
Total
(N = 26)
1.37%
I 0ü'Æ
Rosie Steele, the author of this article,
has been an instructor with the Post
Diploma Maternity Nuning Program for
the past six Years. A graduate of
Aberdeen Hospital in New Glasgow.
N.S., she completed the post graduate
course in obstetrics at the Royal Victoria
Hospital in Montreal. Rosie has worked
as a staff nurse, acting head nurse,
clinical instructor in labor and delirery.
and clinical instructor in postpartum
(nursing students). With the exception of
two years spent iI/ gynecology, all of her
nursing experience has been in the area
ofob.
tetrics .
· A complete report on the Maternity
Nursing Program can be obtained by
writing to the Nursing Education
Department. Grace Maternity HospiJal,
Halifax, N.S. B3H IW3. The cost of$3.00
covers handling and postage.
Acknowledgement: The Maternity
Nursing Program owes its continued
etistence to the support andful/ding
prodded by the Nova Scotia Departmeflt
of Health; to the administration. medical
ami nursing staff of the Grace Maternity
Hospital who recogni
e its ,'alue; to the
Nora Scotia Reproducti,'e Care
Program whose risiting nur,
es recognize
areas of cOl/cerl/ to I/urses and promote
the course as a step further to their own
exchange program; to the directors of
nursing who COll1il/ue to sel/d
candidates; and to the graduates who
continue to request ongoing education
and updating following the course.
Those who plan and implement this
program acf...nowledge this support and
are gratefitl for it.
-
.
I
r...
Closeup on Nova Scotia's
REPRODUCTIVE CARE PROGRAM
A 24-hour-a-day obstetrical service that offers advice on how to manage the high risk
maternity patient? A toll free number to call for help in solving problems you encounter with
the neonate? These are just some of the ideas that have been incorporated into a program
for improving reproductive care in the province of Nova Scotia.
The program is the brainchild of the Nova Scotia Medical Society and Dalhousie
University personnel. and is supported by the provincial Department of Health. It got
underway in 1974 and seeks to promote the highest possible standards of reproductive care
for all women in the province. to ensure that both mothers and babies benefit from advances
in care as soon as they become available and to provide all women and neonates. no matter
where they are living in the province. with the same uniformly high standard of care.
The program offers a variety of services. including visiting perinatal nurses who will,
on request, survey nursery and case room facilities in a hospital and submit
recommendations to the nursing service in that hospital; a project co-ordinator who will also
help hospitals establish a family-centered maternity care program; a nurse exchange
program which provides for replacement by a nurse from the central unit when a nurse from
a community hospital wants to attend the central unit; prenatal and risk identification
forms for use by physicians; on-site perinatal mortality and morbidity chart reviews with
reports and recommendations by obstetrical and neonatal perinatologists; procedure
manuals, reporting forms. and educational opportunities. The program is also closely
associated (allied) with a post diploma maternity nursing program and a neonatal intensive
care course for nurses.
Results - in the form of vaslly improved perinatal mortality statistics - are encouraging.
Since 1965 perinatal mortality has fallen from 21.2to 10.2 per 1000; full size stillbirths and
neonatal deaths have been reduced by one-half; and underweight neonatal deaths by 60 per
cent. The chance of a neonate dying in a small or medium size hospital was previously twice
that in the central region; now these smaller hospitals, with adequate referral. are essentially "-
able to equal results of the central hospital.
Nurses and doctors throughout Nova Scotia have participated enthusiastically In the
program. and made it work. If you would like to learn more. please contact:
Joyce MacDonald, R.N.
Project Co-ordinator
Reproductive Care Program
The Medical Society of Nova Scotia
5821 University Avenue
Halifax, N.S. B3H 1W3.
U
:I
I
õ
0..
DO
"-
7-
"'"
o
Õ
.c
0..
A few years ago, when Dr. LeBoyer's book Birth it, I' nee appea . I I urses and doctors
chose sides according to their reactions to this revolutionary idea: that birth is essenf My a painful
experience for the baby. Since then, delivery practises have been modified and we must all
acknowledge Dr. LeBoyer's contribution. Mary Grossman was on hand for a LeBoyer delivery at a
clinic in France and gives us an update on this once controversial method.
##
"'''-0
a.
,
,,-)
The LeBoyer Method:
What does it mean now?
Frederic LeBoyer is the French
obstetrician who introduced the
"radical" approach to childbirth during
the early '70's that rocked health
traditionalists in both Europe and North
America.
He dimmed bright operating room
lights. requested silence during delivery
and placed the infant upon the mother's
tummy even before the umbilical cord
was severed. Neither did he believe in
swinging baby by the feet in order to
achieve a shrieking but breathing infant.
He believed that voices. the first touch,
first breath. are all initially painful to the
infant. Consequently. he encouraged the
baby to "set his own adaptive pace" and
suggested soothing the transition from
the secure world of the womb to the
world of harsh and uncertain reality. by
allowing the infant to finally relax in the
familiar environment of a wann bath. *
Many of the above approaches to
childbirth have been familiar to us for a
number of years now. Where LeMaze
concentrated on helping women to cope
with the pain of labor, LeBoyer focused
*Fredénck LcBoyer. POllr lint' Na;f\ancl' wm Violf'IICI'.
Edltlon!'\ du Seuil. J 976.
Mary Grossman
on the painful experience of the infant as
it goes through the birth process. "It is
painful for the child to be born." says
LeBoyer. "No one has ever given
consideration to this. My books are not
about the pain of giving birth. but about
the pain of being born:'
His was a basic idea that had
evolved through years of observation'
and experience but LeBoyer's theories
on childbirth have always remained
suspect from the standpoint of medical
safety. scientific validity and technical
originality. **
As nurses we have a responsibility
to potentiate the health and welfare of
both mother and child - and part of that
responsibility requires a sound
knowledge base. Realizing that we can
easily have input in changing various
childbirth practices, I felt that I
personally needed more information on
LeBoyer and his ideas. As a result. I
arranged to observe a "LeBoyer birth"
at a clinic situated just outside Paris
called 'The Maternity Clinic of Lilas"
where the obstetrician's concepts are
..MO"iit recently the AS"iioclation of Obstetricians and
Gynaecologists of the Province of Quebec pre..ented a
pO'ioition paper agam..t LeBoyer".,. practices. August 2. 1978.
regularly put into use in conjunction with
a number of other childbirth theories. A
small hospital. only 1.051 births were
registered there for the year 1977.
Interestingly, Nelly Boudoul. a midwife
at the clinic said that the majority of the
women patients were nonconformists in
French society. They are often students
and professors, and usually politically
progressive, involved in various
community projects or the arts.
The LeBoyer technique
The delivery I saw involved an
overweight preeclamptic young woman
of23. primagravida. whose pregnancy
had been complicated by hypertension
and edema that had manifested during
her final trimester. She was admitted to
the clinic ten days prior to delivery and
placed on bedrest. Her status. as well as
that of her unborn infant. was considered
as being "at risk". The decision was
finally made to induce labor. and a
doctor, midwife, and nurse were in
constant attendance. I n the event of any
complications. the O.R. was alerted to
prepare for a possible emergency
Cesarean Section.
The C8n8dlen NUrH
Oct_ 1171 21
When I arrived, the mother had
entered into the second stage of labor:
she \\-as resting comfortably, her head
supported by a pillow. Everyone was
dressed in street clothes, except for the
midwife who wore a protective plastic
overcoat. The intrauterine pressure and
fetal heart beat were being monitored
electrically -this was interesting, given
the general association of LeBoyer's
name with a 'natural" childbirth. that is.
no technical device.
The father was present helping to
guide his wife with the LeMaze breathing
and massaging her stomach. back and
forehead. The nurse had sho\\-ed him
how to interpret the monitoring screen so
he was able to follow the duration and
severity of his wife's contractions.
When the infant's head was
detected. the nurse lowered the window
shades so that the room was not really
dark (as is often thought to be the case
with a LeBoyer type birth) but the bright
sunlight was cut off. The room was still
bathed in natural light that did not
compromise one's ability to make
accurate and ongoing clinical
assessments of the progress ofIabor. As
the baby's head became even more
visible with contractions, the nurse
requested silence. The mother's legs
were then placed in stirrups. Following
an episiotomy the infant girl was brought
into our world while the mother
observed via a strategically placed
mirror. Immediately the infant was
placed prone on the mother's tummy and
she was instructed to run her hand in an
upward motion along baby's back. to
help bring up any secretions from the
baby's lungs.
The midwife showed the father how
to wipe the secretions from the child's
mouth and the nurse closely observed
that neither the parents nor child were
having any difficulties. Within seconds
the baby spontaneously began to
breathe. The doctor and midwife quickly
did their primary clinical assessment of
the baby's heart beat. color,
respirations, muscle tone and reflex
response.
The nurse then wrapped the baby in
wanned blankets and continued her
observations. Approximately twenty
minutes after the delivery, a warm bath
was prepared and again under the careful
supervision of the staff the father slowly
placed the baby in the water. The baby
did not cry: her facial expression
changed from a grimace to calm. First
one leg extended, then the other and then
the anns unfolded. She lay suspended in
the water with her eyes open. The nurse
checked the temperature of the water
with her elbow, and after giving the little
girl a few minutes "to relax" she
instructed the father to gently place her
into another wanned blanket. While the
mother delivered the placenta the nurse
instilled drops into the infant's eyes, and
then returned her to her mother and put
her to the breast. Within minutes, the
baby was sucking.
Controversy
For all the public attention to LeBoyer's
"technique" his primary contribution to
delivery practice has less, I think, to do
with methodology than with a general
humanization of the childbirth process.
It involves in particular a sensitivity
toward the infant never seen before in
the delivery room. However, in a
profession that has measured its
capability by purely objective means of
measurement and assessment,
LeBoyer's ideas have been translated
into pure methodology and subjected to
intense 'objective' scrutinization. Of
course, it is right that any new approach
to health and prevention in the health
sciences be carefully assessed. It is
equally important that the essence of a
new idea or a new approach to practice
not be obfuscated in the course of its
examination. By defining LeBoyer in
tenns of a scientific method, medicine
has perhaps unwittingly misrepresented
what he actually advocates.
LeBoyer himself claims that 'There
is no LeBoyer method. There is only a
way of considering the newborn that is
essential. ,. LeBoyer's own refusal to be
categorized. along with an almost poetic
manner of self-expression and a flair for
the dramatic have resulted in a number
of varied" Le Boyer" interpretations that
have little or nothing to do with
LeBoyer's own ideas, but which
nevertheless have been attributed to
him. For example, the presence and
participation of families and friends at a
delivery has often been associated with
LeBoyer when in fact this was
independently initiated by the Lilas
clinic which felt the move was a natural
development of LeBoyer's emphasis on
humane awareness.
On the other hand, many
obstetricians criticize LeBoyer's
egotistical approach in the delivery room
and make particular reference to his
criticism of the father's presence at the
childbirth. In an interview with LeBoyer
he said, "I do not want to say that the
father should not attend the birth. But
the way many people have approached
this is something else. Everyone is
saying, 'and me'?: the father, the
mother, their friends, the doctor. All
want to participate. All want to be a star.
And all I am saying is not to forget the
baby. The baby is the only star. His
needs are the most important at the
moment of his birth." An exhausted
mother who must cope with an endless
stream of visitors is not capable of
fulfilling her first responsibility -
meeting the emotional and physical
needs of the infant.
More criticism has centered around
the cutting of the umbilicus. It is a polIcy
at Lilas to encourage fathers to cut the
umbilicus as a means, symbolic or
otherwise, of including the father in what
traditionally has always been a
mother-child domain. This is not part of
the LeBoyer approach for the simple
reason that he feels too many needs
cannot be met at once and lead to the
detriment of the inarticulate and
vulnerable baby. Moreover, LeBoyer
speaks on an ethical, not psychological
level. "At Lilas, they talk only in tenns
of psychology, of binding, of the relation
between the mother and child, the
helplessness of the infant." As far as the
timing for the cutting of the umbilicus-
despite the flowery tenns described in
his books - the separation of the baby
from the mother occurs when the cord's
pulsations cease which is not unlike
conventional obstetrical theory.
In an effort to fulfill LeBoyer's
concern for the acute sensations the
infant initially experiences, many of his
closest followers have entered a debate
on the pros and cons of administering
prophylactic eyedrops. To date a
concensus has not been reached.
Following the delivery the midwife
told me it was "not necessary to give the
drops". Interestingly, the nurse a few
minutes later did administer drops saying
that she felt the prevention was worth
the minimal affront to the child.
An assessment
The ambiguous publicity over LeBoyer
and his ideas has ultimately raised fears
about security. There are questions
about the possibility of closely
monitoring the mother and child in a
Le Boyer delivery, the danger of his
approach should an emergency arise, the
implications of a "darkened room" in
clinical assessment and the dangers of a
wann tub bath.
The birth which I witnessed was
testimony to the anticipatory care and
the precautions taken to assure safety no
matter what course the delivery would
follow. Despite the medical
complications, the underlying priority
was to anticipate the infant's feelings and
sensations once the delivery had
occurred. LeBoyerdoes not advocate
any approach that compromises security
for either mother or child. "What I am
saying has nothing to do with security,
but with the feelings of the newborn, and
how we may offset the pain that is
necessarily associated with his birth."
Nevertheless, a humanistic
approach has often played second fiddle
to the all consuming attention to
technology. The post partum bath so
important to LeBoyer is a case in point.
Skeptics worry about the chances of
respiratory complications or illness
resulting from bathing so soon after
30 Oct_ 1171
Th. Cen-.ll.n Nur..
delivery. It is also argued that the bath
which LeBoyer feels simulates baby's
fonner environment, thereby easing
his/her transition from one environment
into another, actually interl'eres with the
natural childbirth process. But for
LeBoyer, the wann bath is essential to
assuage the infant's inarticulate fears at
being shoved into a world he has never
known. He feels this has been proven
through observing the contracted, tense
body of the infant relax visibly in the
water medium. To LeBoyer, given that
all clinical assessments are normal, a
bath given whether twenty minutes after
delivery or twenty-four hours later,
requires little extra effort on our part and
may mean a great deal to a frightened
baby.
What LeBoyer is actually trying to
say is not so different from the basic
tenet of the nursing profession - caring
for patients through anticipation and
meeting of emotional and physical needs
in any individual. As Nelly Douboul, a
midwife at the Lilas Clinic states, "What
is important is that M. LeBoyer
considered the baby not as a child of the
mother, or an object of the doctor, but as
a person with its own sensibilities, not
something that cries, but a person who is
expressing himself."
In fact, the only real departure from
traditional delivery practice may merely
be the final acknowledgemem of the
baby's sensitive needs. right from the
moment of its birth. Le Boyer hopes that
he will be remembered for having
brought back "some of the art" to a
profession that has increasingly prided
itself on technological competence. I
would venture to say too that M.
LeBoyer has brought some nursing
concepts to medical practice (with the
focus in this instance on the newborn
infant). In doing so, his sensitivity for the
infant, understood in its proper context,
may succeed in buffering the pain and
trauma the newborn must surely
expenence. People who question the
originality of LeBoyer's technique
(whether it was his idea first or not to put
the baby on mother's stomach), or who
exaggerate the question of safety in his
attention to the feelings of the newborn
baby, are perhaps missing the point. His,
quite simply, is a common sense
approach to what we already know about
how a baby feels, senses and reacts.
What is not known is appreciated
through a simple process of
identification. LeBoyer's "philosophy"
is not motivated by any long term
psychological cause and effect
considerations. If anytning, it deals with
the present; it is a humane reaction to a
set of circumstances - the process of
childbirth. How one approaches the
human drama on a technical level is less
significant to understanding LeBoyer's
message than understanding how one
should care for the principals involved:
thz mother and then especially the
newborn child. Henri Fontana, a
Parisian psychologist interested in the
significance of birth had this to say:
"People should realize that some affront
in life is necessary. But what counts is
our attempts to deal with traumatic or
violent acts. This. I think. is what
LeBoyer is doing." OW
Bibliography
*1 Cheynier, J.M. Que sa naisscl1lce
soit unfhe. Editions de laCourtille,
1978.
2 LeBoyer Frédérick. Pour une
naissance sans \'iolence. Paris, Seuil,
1976.
3 Whitner. Willamay. The influence
of bathing on the newborn infant's body
temperature, by ... and Margaret
Thompson.Nurs.Res. 19:1:30-36,
Jan./Feb. 1970.
4 Cronenwett, Linda. Father's
responses to childbirth, by... and Lucy
Newmark. Nurs.Res. 23:3:210-217,
May/Jun. 1974.
*Not verified in CNA Library
Mary Grossman,B.
c.N., is a recent
Rraduate of McGill UnÏ1'ersity, and has
worked in the small J nuit community of
hdoolik, and ill the surgical intellsil'e
care unit ofa huspital in France. Since
returtlinR to Montreal she has worked at
the Montreal Children's Hospital and
has beRl1n srudies toward her master's
degree this fall.
-
, "
"
Here and there
A decade ago, university
students and workers in
France took to the streets to
protest the traditional
intransigence and
hierarchical character of the
nation's political. industrial
and academic institutions.
One of the direct
consequences of this
turbulence was to bring the
state of the nursing
profession under scrutiny
and since then there have
been dynamic changes as
the profession struggles to
live up to increasing societal
and medical expectations.
There have been reforms at
the scholastic level: a high
school leaving certificate
(baccalaureate) is now a
minimum prerequisite for
acceptance in a nursing
program, for example, and
the number of nurses, after
a period of declining
enrollment, has increased
from 345,000 in 1974 to
425,000 in 1977, but serious
problems still beset the
profession.
Traditional concepts
Throughout France there is
a strong national sense of
tradition which has served
to provide the foundation of
the country's social order;
nowhere is this attachment
to traditional values more
closely adhered to than
within the nursing
profession. Nurses in France
have always emphasized
nursing qualities-
considerateness,
punctuality, the ability to
effectuate doctors' orders-
as opposed to nursing
presence. Consequently,
subservience to authority is
still valued as a measure of
vocational service. Added to
this is an observable
tendency to perceive the
world of health and illness
strictly within a medical
framework - thereby
reinforcing the traditional
subservience of the nurse to
the doctor. Recently,
however, a combination of
events, including the
International Women's
Movement and increased
emphasis on higher
education, has lead to
general disillusionment
among the younger
a look at nursing in France
graduates and there are doctors but within the patient in detail-their here." A patient reinforced
indications that these profession itself, from those history, diagnosis, these observations:
concepts are changing. who are in positions of treatment and present "Neither the nurse nor the
influence. Nurses are not status - as well as being doctor ever seem to have
The new nursing order expected to have a capable of devising a daily time. But I think really that
professional opinion. Not to nursing assessment. She they are just uncomfortable
With few exceptions the think. Just to do." encourages her staff to have having to confront my
organization ofthe nurses is a dir.ect line of fears."
hierarchical, with the head An assistant head nurse on communication with the
nurse and her assistant the total care service doctors, while continuing to The question of whether the
delegating work on the basis mentioned above keep her informed. This profession is able to meet
of task assignment. Nursing commented: "Unfortunately minimizes the risk of an the needs and growing
Service means the our form of nursing incomplete or misinformed demands of its own
implementation of doctors' organization has usually patient report and is also an members might also be
orders. To that end, task worked to crush one's important step in the raised. Widespread feelings
assignment is the realization self-bsteem and finally Our establishment of a new of job dissatisfaction and
of that service. One nursing concern about the working relationship, low self esteem that I
student in her final year of profession itself. Each nurse underlining the contribution encountered among those
nursing told me that had a particular task to and capabilities of both who worked with me would
throughout her 20 - month perform and the key to all professions to patient seem in themselves to
apprenticeship in various knowledge of the patients assessment and care. indicate a lack of
hospitals she had and their management was professional appreciation
experienced nursing only as held guardedly by the head The future of nursing for one of the primary tenets
a series of tasks. Now, quite nurse and her assistant." While general consensus in social psychological
unexpectedly, she found exists between the concepts in growth and
herself on a ward, where a An example of this was the government and the development - the need of
"total patient care" (very way in which information profession on the need to all individuals to find an
unusual by French nursing was communicated: no broaden the academic opportunity for self
standards) approach had formal nursing report curricula in preparation for realization.
recently been introduced. existed that included all an expanded role in the field
"At first it was really difficult members of oncoming and of health and prevention, Nursing by task assignment
to know how to approach off-going teams. Instead, the the subjects of primary within a strictly hierarchical
nursing here without head nurse would emphasis are biology, and authoritative order does
wanting someone to tell me communicate pertinent anthropology, and not allow for much self
what to do next." administrative information, sociology; psychology (as expression. At best, it is
The changes at the e.g. who was going for an opposed to the study simply mechanized work that calls
scholastic level introduced operation, consultation, or of psychiatric illness) does into question the
during the seventies also testing. Only critically ill not appear to hold a similar responsibility ofthe
introduced new ideas that patients would be interest. It was my personal profession not only to its
are inevitably at odds with mentioned on the basis of experience that social patient population but to
the technique-oriented tt>eir medical status. A psychological concepts as those who provide the care
approach still practiced in nursing kardex generally applied to nursing practice and service - the nurses
most hospitals. Not recorded diagnosis, tests remain at an intuitive stage themselves.
surprisingly young and operations and any at best - which in part may
graduates are not only at unusual clinical be attributed to the widely Conclusion
conceptual loggerheads developments. A social and skeptical attitude towards
with the old nursing psychological assessment psychology taken by many All change requires time. It
vanguard but they threaten was not routinely assessed. French people. is not realistic to expect that
the hierarchical On rounds, the doctors also the 'old' nursing order will
infrastructure that has addressed themselves to the A professor at a school of yield gracefully to the
hitherto served as the head nurse rather than to nursing in Paris expressed present exigencies of the
traditional base for their the particular staff nurse her belief that the present profession but for nurses in
authority. who was responsible for the scholastic program does not France this is nevertheless a
care and assessment of a do enough to help nurses period of expectation and
Their older colleagues, given patient. understand the emotional hope. Slowly, through the
having consolidated their needs of patients: "Basically school system and through
authority through the I talked to a nurse who there is a real fear of the initiative of determined
nursing hierarchy, are initiated the total care communicating and creative graduates,
generally disinterested in approach on her service; meaningfully with patients. practice will come to be
any exchange or sharing of she is a recent graduate of That is why they go and see equally based on a
information that might the Nursing School for the patient only when there theoretical and practical
threaten their own positions "Superior Training" (a is a specific nursing approach; there will be
and traditional beliefs. One university nursing degree intervention to do." Another more assessment and less
nurse who actually began still does not exist) and is teacher put it more bluntly: routine. French nurses have
her studies as a medical attempting to upgrade the "Because of the close begun at last to carve out a
student, and then switched role of nurses on her service working relationship ofthe new identity which will, it is
to nursing had this to say: by making each one nu rse to the patient the to be hoped, more closely
"What has been most responsible for the total care patient may very well need approximate the needs of
difficult to accept is the lack of her assigned patients. It to discuss what his illness their patients and
of respect with which a behooves every nurse on means to him and the themselves.
nurse is held, not only by the her staffto know about each nurses could do a lot more Mary Grossman
32 Oct_111711
Th. Can-.ll.n Nur..
JOHN GRAN*, a 26-year-old native
of Haiti. had immigrated to Canada with
his family to further his studies in
preparation for medical school in Spain.
InJanuary 1977 he had undergone
currettage and grafting of a lesion in the
right femur. A diagnosis of giant ceIl
tumor was made at that time. He was
weIl until the Spring of 1978 when he
developed weakness and pain in the right
leg. In July. John heard his bone
"crack" and he was unable to bear
weight on his right leg.
Investigations confirmed the
diagnosis of a pathological fracture at the
site of the bone graft. probably due to a
recurrence of the tumor. The fracture
was stabilized with a spica cast while
alternative treatments were considered.
The options were both limited and
drastic: mid-thigh amputation or femoral
aIlograft. The latter was an experimental
procedure and depended on the
availability of a suitable donor and the
knowledgeable cooperation of an
appropriate patient.
John's case was assessed carefuIly
and the proposed treatment was femoral
aIlograft. The purpose of the surgery was
to remove the tumor by performing an en
bloc excision of the lower third of the
femur with replacement by an allograft
from a fresh cadaver. To supplement the
aIlograft a segment of the patient's own
fibula about 15 centimetres in length
(autograft) was to be placed in an
adjacent position and fixed to the
aIlograft. The circulation of the fibular
autograft was to be maintained by means
of a microvascular anastomosis carried
out between a small vessel left attached
to the fibula and a blood vessel at the
new femur site.
The fibula autograft had two
functions: to act as a living internal splint
and to be a viable bone graft that would
hasten union of the allograft to the
femur. At this stage plans were not made
to re-anastomose blood vessel.. to the
allograft since this might promote an
early rejection prohlem.
ON THE ORTHOPEDIC UNIT
Helen Alemany, head nurse: John first
came to our orthopedic unit on July 21.
1978. Priorto his arrivaI.John's spica
cast was removed and the fracture
stabilized with a Steinmann pin through
the proximal end of the tibia attached to
twelve pounds of traction.
Nursing
grand
rounds:
FEMORAL
ALLOGRAFT
HelenAlemany, Patrie/.. FerRuson
Jeaf! Grice, Alli.wn J. Stuart
I nitially the nursing staff
encountered a number of problems in
their attempts to provide physical and
emotional support to John. We soon
learned that he was an extremely
independent person; he identified
himself as a "do-er", an achiever. one
who was always in control. and now he
was faced with immohility, dependency
and loss of control. This theme of control
appeared again and again throughout his
hospital ization.
At first we all found it difficult to
communicate with John. He was an
anxious. talkative. young man who
tended to intellectualize a great deal.
This was a source of concern for us and
early in his hospitalization we asked our
social worker to see him. We also
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discussed approaches to his care at one
of our regular conferences with a staff
psychiatrist. There was no doubt that
John was in a very anxiety-provoking
situation and was faced with some very
real worries -How long would he IlllI'e
to waitfor surRery? Would it be
successful? What would happen to his
leg?
At first. he was unable to voice his
fears, However, as}1e hecame better
acquainted with the staff. he began to
talk more openly. His ability to cope was
of utmost concern to him. We allowed
him as much control over his daily care
as possible and reinforced the fact that
we thought he wa'i coping well.
The C8n-.llen Nur..
OcIoÞer 11171 33
GRAFTS
All grafts may be defined as: "skin or other living substance inserted into a similar substance
to supply an absence or defect by attachment and growth into an integral part of the ongmal
substance".'
An autograft is a graft obtained from the recipient's own body. Because it is obtained from
the same body. there is no attempt at rejection by the body.
An allograft is one obtained from a member of the same species. The recipient builds up
antibodies to the graft. which it perceives as a foreign substance. and attempts to reject it. If
Immunosuppressants are not used. then the graft usually does not survive. However. in bone
allografts although an immunological reaction does take place. the graft is usually not
rejected. Studies have indicated that this may be due to the very slow absorption of bone by
the recipient. ·
GIANT CEll TUMORS (osteoclastoma)
Giant cell tumors are aggressive. fast-growing tumors most commonly found in young
adults between the ages of 20 and 40. The tumor forms after the bone is fully grown and thus
is not found in adolescents who are still growing. The site of the tumor is usually in the region
of the former epiphysis of the long bones: the lower end of the femur; the upper end of the
tibia; and the lower end of the radius. Metastasis to the lung and other parts of the body is
common. Pathological fractures through the tumor site may also occur.
The patient usually does not have any symptoms until the tumor is well established. Then he
or she may complain of localized pain or swelling. and limitation of movement of the nearest
joint.
Diagnosis is done by radiographic examination. followed by biopsy of the affected tissue.
Traditional treatment is to currette the neoplastic tissue and to fill the area with bone chips
from the patient's own iliac crest. If the growth of the tumor is particularly rapid and invasive or
shows involvement of adjacent soft tissue. then amputation of the limb must be considered.
The site of the tumor may also be irradiated.
The importance he placed on his
dbility to handle any situation was
reflected in his refusal ofanalge'iia. Even
though it was apparent to us that he was
having pain, he refused any medication
offered. One night when a nurse found
him in tears, he explained that to "admit
to pain" was unacceptable in his culture
because it indicated weakness and an
inability to cope. When he was assured
that taking analgesia did not have that
meaning to us and that it would not alter
our perception of him. he began to
accept medication with no apparent guilt
feelings.
Consistency on the part of the
nursing staff was an important element in
John's care. At first he was quite
demanding and would repeat his
demands each time a new nurse was
assigned to care for him. Whenever
possible these demands were noted and
complied with but some requests (such
as having the traction removed while he
showered) obviou'ily could not be met.
We felt that the underlying cause of
John's demanding attitude wa'i anxiety
so we gave him constant explanations of
what could and could not be done and we
also encouraged the medical staff to
reinforce our approach. After repeatedly
hearing the same responses to his
questions and demands, his anxiety level
dropped and he was able to really hear
and understand what we were saying.
Gradually John settled into his daily
routine. Skin care. turning. positioning,
leg exercises, deep breathing and
coughing were all familiar to him. A
Spanish speaking volunteer visited him
regularly and brought him Spanish books
to read. John waited and we waited with
him.
Another area of concern for us was
how John felt knowing that his surgery
depended on someone else's death. He
was a very religious man and this was the
key to his acceptance of the situation. He
felt that the transplant would mean that
the other person had not died in vain and
that he would, in fact, live on through
John. John had decided that he too
would donate his body to science and in
this way. the chain would be
perpetuated.
Thirty-six days after his admis'iion
to the unit, the day of John's surgery
arrived at last. It was a real high for him
and we shared in his excitement.
PREPARA TIONS IN THE OR
Jean Grice, R.N.: As operating room
coordinator, I first became aware of John
Gran when Dr. Gross, surgeon-in-chief
approached me with a set of x-rays
asking if we had a prosthetic implant
suitable for a patient requiring a massive
femoral transplant. I was to know Mr.
Gran better during the ensuing weeks.
Dr. Gross and I discussed the
problems that we might anticipate during
surgery. The major concern was the
length of the surgery, an estimated
sixteen hours. Other concerns included:
. type of anesthetic;
. prevention of pressure sores;
. temperature control;
. prevention of infection:
. availability of a donor; and
. availability of nursing staff.
Type ofane.HheÚa
I n consultation with the department of
anesthesia, it was agreed that Mr. Gran
would be given an epidural anesthetic
initially in order to reduce the length of
time he would spend under a general
anesthetic. This worked out well. The
patient was able to spend five hours
under epidural anesthetic before
becoming restless and only then was he
given a general anesthetic for the
remaining eleven hours.
Pressure sores and
temperature contrul
The plan during surgery also involved
the use of an alternating pressure
mattress to alleviate pressure on bony
prominances; however, this conflicted
with the need for a hypothermic blanket
for temperature control. The anesthetist
agreed to the use of cellulose blankets
around the patient's upper torso.
34 Oct_ 11171
The C8nedlen NUrH
Since the time of Mr. Gran's
surgery, however. it has been found that
temperature control is of paramount
importance and a hypothermic blanket is
used for all similar cases. Pressure areas
are still a concern and an hourly regime
of massage is used. The head position is
altered hourly. A four-inch thick foam
mattress is used with cut-out rings for
any dependent areas.
Infection
The infection control problem was
alleviated by the use of a laminar flow
system. This type of air flow system
utilizes highly filtered air directed
vertically from a filter bank in the ceiling.
down towards the operating area. The
volume of air makes only a single transit
over a given area and contaminants are
flushed away as they are released. This
system provides an "ultra clean"
environment that is necessary in many
orthopedic conditions and transplant
procedures. 3 Even with this system the
need for traffic control is very important.
The surgical team for this operation was
double that of a regular procedure. This
means that as many as twelve people
were in the operating room at anyone
time. Everyone on the team had to keep
in mind their role in controlling
infections and that "an infection problem
is often a people problem" .
A milahility of nUrSillR staff
The availability of nursing staff was also
a problem since this kind of procedure
must be done on an emergency basis.
Plans were developed for four nurses to
be available for the first eight hours with
another four taking over for the latter
half of the case. The exceptional length
of this procedure was due to the fact that
the site of the tumor (right femur) and the
microvascular graft (right fibula) were
both from the same leg. This did not
allow room for two surgical teams to
work simultaneously. Because this
surgery is now penormed more
frequently at our hospital. a
"microvascular" team is being
developed with ,>taff on 24-hour call.
A vailability of a donor
A suitable donor was received in the
operating room on August 26. This
patient had died approximately four
hours previously. In the case of a bone
allograft with microvascular anastomosis
of an autograft, rejection is not a
problem. The autograft encourages new
bone growth and also provides a living
internal splint.
THE SURGERY
A team of surgeons removed the femur
from the donor and prepared it for
transplant to John Gran. Concurrently,
Mr. Gran was receiving an epidural
anesthetic in an adjacent OR suite. He
was monitored with arterial and central
venous pressure lines and cardiac
telemetry. He was then placed in the
supine position and his leg was prepped
and draped. (A tourniquet was not used.)
An anterior incision in the right thigh was
made: rectus femoris and vastus lateralis
muscles were separated. Care was taken
to identify and retract proximally the
neurovascular bundle into vastus
lateralis at the upper end of the incision.
The incision was extended to the capsule
of the knee joint laterally around the
patella to the tibial tuberosity. The
patella was retracted, maintaining the
insertion of the patellar tendon. The
lower half of the femur was stripped, and
ligaments were cut so that they remained
attached to the tibia. The femur was then
dissected out, a step-cut osteotomy
being done through the middle third.
The donor allograft was fixed with a
12-hole blade plate. Collateral ligaments
were fixed with staples to the donor
femur. The cruciate ligaments of the
knee were not repaired. The fibula graft
was then screwed to the medial aspect of
the femoral graft. A branch of the
peroneal artery was left attached to the
fibular graft and was anastomosed to a
branch of the femoral artery in the vastus
lateralis using 10/0 nylon. The wound
was closed in layers and four hemovacs
were left in position. A plaster of paris
cast was applied from the groin to the
toes. By then, sixteen hours had passed.
Mr. Gran spent the first twenty-four
hours postoperatively in the intensive
care unit. His vital signs were monitored
closely as were blood loss, circulation
and movement of the toes. Relief of pain
was a major problem. At first, he
complained of generalized body
discomforts due to the long surgical
procedure and intravenous Pantopon llÞ
was used for pain control. But as the pain
increased and localized at the sites of
surgery, Pantopon was ineffective and
Marcaine@, a local anesthetic agent. was
administered by means of an epidural
catheter. Later in the evening however
he became quite agitated complaining of
great pain and he wanted the cast cut.
Pantopon in combination with diazepam
was given and provided enough relief so
that he was able to rest. By this time. the
initial oozing through the cast had
stopped and hemovac drainage was
minimal. Vital signs were within normal
limits and he was ready to be transferred
back to the nursing unit.
BACK ON THE WARD
Helen Alemany, head nurse: When John
returned to the unit, we were glad to see
how well he had come through the long
surgical procedure. For the next 4H hours
however he continued to be in pain. At
first he was very uncooperative but the
staff found that he responded well to
nursing measures such as frequent
turning. repositioning and massage done
in a wann, empathetic manner. These
along with the judicious use of analgesics
alleviated the pain.
As before, John was very attention
seeking even resenting the time nurses
spent in caring for other patients in the
same room. The nurses were patient with
him. tried to be consistent in their
responses to him and set limits on his
behavior.
We all recognized that this was an
anxious time for John because the
outcome of the surgery was still
uncertain. X-rays and bone scans of the
right femur were done on the 5th postop
day, and then on a biweekly basis. The
results were encouraging and 12 days
after his surgery, John was allowed up
for the first time. Because ambulation
had to be very gradual, he could not bear
Th. C8n8dlen Nur..
OcIober 1871 35
weight on the affected leg and was taught
how to use crutches. The following week
the cast was removed and a sand splint
was placed under the leg. The splint
could be removed for knee mobilization
exercises and then re-applied and held in
place with tensor bandages. This kept
the leg supported between exercise
periods. Gentle knee bending exercises
were also initiated. John was very
enthusiastic about his increased mobility
and it was difficult to keep his activity in
check. The need to proceed slowly with
knee mobilization was reinforced and
emphasis was placed on leg
strengthening exercises.
Our social worker continued to visit
John regularly as did the Spanish
speaking volunteer. Members of a local
church group visited each Sunday and
they provided him with a great deal of
support. His faith seemed to have canied
him through a very difficult period.
REHABILITA TION
Patrick Ferguson, slaffnurse: John came
to our rehabilitation unit for the final
phase of his treatment on October 11,46
days after having undergone surgery. He
was apprehensive about the move to a
new area but when he was recei ved on
the unit by our head nurse, who is fluent
in Spanish. he seemed to feel more at
home. The common interest in the
language provided an "acceptable"
reason (in John's eyes) for her to spend
some time with him every day.
The nursing role in this phase of his
treatment was to offer physical therapy
to strengthen the muscles in the affected
limb and increase knee mobility, and to
assist him in adjusting psychologically to
his physical limitations. At this time. he
was still using crutches and was unable
to bear weight on the right leg.
John approached his exercise
regimen earnestly and seriously. His
independence and need to control the
environment was very much in evidence
in his experimental approach to pain
control. Sometimes he would take an
analgesic prior to therapy, sometimes
after and sometimes not at all. In the
same manner he adjusted his exercise
regime from day to day in an attempt to
increase the mobility of his leg and to
strengthen the musculature.
Although John spent more than 120
days in the hospital he never lost sight of
his long term goals. He worked hard to
get stronger and spoke often about what
he would do when he left the hospital
saying that he was looking forward to
starting his medical studies the following
September. John talked freely about his
surgery and its impact on him physically.
but he kept his feelings and emotions
very much to himself.
During his stay on our rehabilitation
unit John spoke about his family. his
church and his plans for the future.
Because his family was in another part of
Canada his main contact with them was
by phone. John spent a great deal of time
reading the Bible and frequentl}
attended services on Sunday mornings.
In addition many church members
visited him in hospital. which was a great
boost to him since his family was unable
to do so.
Probably the greatest difficulty John
encountered during this period was
waiting for a brace. John needed the
added support of an ischial,
weight-bearing. long leg brace that had to
be custom made and fitted before he
could be discharged but the cost was
more than he could afford. Although he
had been living in Ontario his health
insurance was maintained by his family
in another province and as a result the
paperwork required to obtain funds was
extensive and progress seemed slow.
John's impatience grew since the only
thing keeping him in hospital was the
need for the brace. Happily a private
donation made the purchase of the brace
possible, but when the brace was
delivered it did not fit correctly and John
faced another seige of waiting. It took a
great deal of reassurance and
reinforcement about the need for the
brace to convince John to wait for the
brace again before discharge.
At last, 120 days after his ani val.
John was discharged from hospital with a
well-fitting brace.
A united approach
I n summary. caring for John required a
full range of nursing skills in all areas -
orthopedics. operating room and
rehabilitation. Powers of observation.
assessment skills. communication and
technical nursing functions were all put
to use with this challenging patient. It is
apparent to all of us who took part in his
care that no area of nursing supercede"
another but all mesh together to form a
unified and all-encompassing approach
to the nursing management of the
complex patient. '"
Ackno\\ledgement: The authors wish to
express their apprecllltion to Dr. AI/an
E. Gross, surReon-in-chief. Mount Sinai
Hospital. Toronto. Ontario for his
assistance.
References
I Taber's cyclopedic medical
dictionary, 10th ed. by C. W. Taber
(editor). Philadelphia. F.A. Davis. 1968.
2 Gross. Allan E. The
immunogenecity of allograft knee joint
transplants. I n Clinical orthopedics and
related research by... etal. 132:155-162.
May 1978.
3 Brigden. Raymond J. Operating
theatre technique. Edinburgh, Churchill.
Livingstone, 3d ed. 1974. p.20-2I.
*The name of the patient is fictitious.
Helen Aleman) (R.N.. B.S eN.) is head
nurse at Mount Sinai Hospital, Toronto,
Ontario; Patrick Ferguson (R.N .. B.A.) is
a staffnurse at Mount Sinai Hospital,
Toronto; Jean Grice (R.N.J is operating
room co-ordinator at Mount Sinai
Hospital. Toronto; and Allison J. Stuart
(R.N.. B.Sc.N., D.HA.) is
administrati,'e assistant. Mount Sinai
Hospital. Toronto.
31 OcIOber 11171
The C8nedlen Nur..
The use of Simulation in Teaching
Psychiatric Nursing
Betsy LllSor
,
.
A student's rIrst experience in psychiatry can be terrifying: "Who are the patients and who are the staff? What do I say if
someone talks to me?" There is a method which the nursing educator can use to help prepare the student for that first
encounter on a psychiatric rotation.
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The implications of large numbers of
students practising in the clinical setting
are being seriously questioned by some
who believe the constant intrusions into
patients' primte lives may be difficultfor
them to accept. Students o..fnutrition,
rehabilitation therapy, nursing,
pharmacy and medicine all im'ade the
patient's environment at some point. To
help these students de
'elop needed
assessment skills, patients are o..ften
required to repeat their histories oJÞer
and m'er, and relief comes only when a
patient is .. too sick" to be assigned a
student.
But the need to educare the student,
especially the student nurse, to perform
safely and competently is imperative,
and educators are obliged to lookfor
high-quality alternate learning
experiences.
Teaching techniques
The simulated hospital ward with the
"Chase family" as practice patients has
been used in nursing education as one
alternative, and learning packages and
audiovisual programs have enriched this
particular technique. However, none of
these techniques provides the real
experience of interacting with another
human being; asking personal questions,
touching and penorming physical tasks
produce anxieties when the neophyte
nurse comes face to face with a person
who is genuinely ill. Developing a basic
foundation of skill in human interaction
is crucial to the development of more
complex skills later on.
Medical education took the initiative
in finding an alternative method - the
'practice patient'; Barrows in the early
1960's developed the use of the
simulated patient. In simulation a person
has been carefully taught how to mimic
or present an accurate replica of a
specific disorder. To all observers, the
"patient" could actually be suffering
from an illness as shown by various
symptoms and responses to examination
and questioning. 1
Th. Cen-.ll.n NUrH
October 1179 37
Initially. actors. because they know
how to perfC'rm well. were used as
patients. but gradually it was found that
many people in a community could take
on the duties of simulation - retired
people. housewives, students - anyone
who has a little extra time.
I nitially too, the primary use of the
simulated patient was to examine student
knowledge. This method can be usedjust
as well for students to practise a
beginning skill, and nowhere is this of
more value than in teaching nursing
students who are beginning a psychiatric
experience.
It must be noted at the outset that
this teaching method with its use of
people enacting patients is potentially
expensive; the basic ideas are of value
however. and nursing instructors may
use their initiative and imagination to
alter the method to suit their individual
needs.
Psychiatric nursing
The initial experience in the psychiatric
setting often provokes anxiety among
both faculty and students. Instructors
find it difficult to structure a student's
first experience. and students are
unaccustomed to the apparently
unstructured nature of the psychiatric
ward - no one wears uniforms. patients
are up and walking around. and few
technical skills need to be performed.
Students want to move into this nev,
experience comfortably and to develop
new skills. but for the instructor this is a
problem: responses in student-patient
interaction are unpredictable. The prime
task of the psychiatric nurse is to interact
therapeutica:Jy. which is accompli!>hed
in part by being able to interview well.
How does the instructor control a
student's initial contact with the
psychiatric patient? How can she ensure
that the student learns from the
experience?
All beginning interviewers benefit
from practice time that allows the learner
to develop different approaches. Ideally,
the student should be able to step out at
the moment she feels overwhelmed.
explore what has happened, and then
perhaps try again with a different
approach. When the intensity of the
moment is lessened. the learner is
usually able to learn more, ask questions
freely. and to become aware of
alternative approaches.
In this respect, a simulated patient,
representing a given emotional
disturbance by using typical verbal and
behavioral responses, could give the
student the experience of practising her
therapeutic use of self and
communication skills. 2 The major
emphasis is on an initial encounter with a
patient.
The method
Since it is not feasible for one "patient"
to repeat an interview for each of 24
students. and since the emphasis on the
experience is practice and not evaluation
of performance. it was decided that one
patient could be shared by several
students at the same time. A student
could step aside when she felt
overwhelmed and turn the interview
over to another.
The method on the whole is
comprised of a combination of two
techniques regularly used in
psychotherapy: role-playing, and
video-tape (VTR) playback. We used the
technique as follows.
Three students. one faculty member
and a "patient" sit in a studio with the
remaining class in another room
connected by closed-circuit television.
The students and instructor sit in one
comer of the room, the patient in
another.
One of the student volunteers begins
the interview by approaching the patient
in the manner she would use on the
ward, and the interview progresses until
the student feels uncomfortable or
senses that things are going wrong, at
which point she calls 'Time out!" The
patients have been instructed to freeze at
this signal. and to act as though they do
not hear the ensuing discussion.
The student returns to her group and
discusses what is happening. When a
new idea is developed, the next student
approaches the patient; she is free to
continue from where the first student left
off or to start afresh.
During the discussion the students
frequently turn to the instructor for help,
which is the ideal time to encourage them
to use problem-solving to work through
uncomfortable situations. Suggestions
may be made too about the ways
interviews can be conducted. how to
make initial contact, and how to
terminate an interview comfortably and
therapeutically. A firm emphasis is
placed on returning to lecture notes and
reading, but the student is encouraged to
avoid any actual intervention approaches
at this stage. The major goal is to
practice interviewing skills, the
therapeutic use of self, and basic social
skills in the context of an initial meeting
with a psychiatric patient.
The entire interview is taped and
viewed simultaneously by the rest of the
class in another room; at the end of the
practice session, everyone, including the
"patient". goes into the other room and
views a reply of the video-tape on a
cassette machine which can stop and
restart at any point.
Reviewing the situation for a second
time reinforces the learning process and
allows for questions and discussion from
class or faculty. The tape is played until
someone asks for it to be stopped. and
some areas can be skipped entirely if
there is no value in a second viewing. At
the end of the playback the patient is
asked to share how he or she felt
responding to certain of the students'
approaches; often the patients give
invaluable insights.
Sample situations
The following example is an account of
one simulation experience. The patient
was programmed to be hyperactive. or
"manic". The student timidly
approached the patient. pulled her chair
close and sat on the edge of the seat. She
introduced herself but before she could
finish the patient yelled. "Finally you got
here." gave her a pad of paper and pencil
and said. "Here. take a letter." The
student continued to follow orders until.
contrary to the usual practice. the
instructor called. "time out". When the
student rejoined the group she was asked
if she knew why she had given all control
to the patient so quickly and completely.
She responded that she hadn't known
what else to do and thought this was a
good way to begin rapport. The students
were at once horrified and very anxious
about continuing the experience and
spoke of their concerns in the discussion.
A major fear of students in working with
psychiatric patients is that they will be
manipulated. and here they were face to
face with an obviously powerl"ul
manipulator. Once they had recognized
this concern the group explored the
different approaches they might use with
the instructor's help.
With several alternative!>
established the next student approached
the patient a little less timidly but with
stubborn determination to avoid any
controlling behavior the patient might
try. A battle of wits began. The patient
tried to interview the student and
rambled from subject to subject while
constantly moving about the room. The
student in turn used silence as a control
and the patient became more and more
active until the student finally called
"Time out".
The concept of manipulation was
again discussed along with the goal of the
interview. The need to understand
nursing process in each clinical rotation
(which includes a detailed assessment)
tends to make students overly anxious
about data collection; the goal to
establish some contact with the patient
subsequently became mixed up with the
goal to gather information. The students
asked what could be done with a patient
who defied contact thus making it
impossible to meet either goal. This
question was posed to the group. They
were asked what they recalled about
contact with this type of patient from
previous lecture material on manic
behavior. Transfer of learning frem the
31 October 11711
The Cenedlen Nur..
classroom to the clinical area was
reinforced in this way and the theory
gave them some structure to their
problem-solving exercise.
The next student, armed with new
knowledge, made her entrance. She
introduced herself and said she would
spend a few minutes with the patient and
then return to see her later. The patient
attempted to engage her in some sort of
conversation but the srudent's responses
were smiles or simple yes or no answers.
At "Time out" she fled from the patient
without any termination explanation; she
said she had felt extremely
uncomfortable and could not think of a
way to leave gracefully.
The group adjourned to the rest of
the class to be met with applause. The
viewers become engrossed in the
experience and frequently yell out
suggestions and encouragement to the
T.V. during the simulation. They had
identified greatly with the manipulation
and control theme and little playback
was actually needed to stimulate a
discussion.
The patient's discussion revealed
her alarm at how easily the student had
followed her orders and that she had then
felt compelled to test her limits. She had
enjoyed the way the third student had
introduced herselfbut had felt nervous
about her reluctance to talk and she felt
very much disliked.
The discussion became somewhat
intense but the group was generally able
to empathize with both the patient's
behavior and the students' attempts to
interview her.
Because the first patient was so
radically different from any the students
had ever had. the next was chosen with a
view to easing their anxiety. Depressed
patients are not unusual in other clinical
settings although the verbalization of
worthlessness is generally more evident
in psychiatry. The students could easily
make contact and get information as the
patient was eager to talk. but the major
concern here was what to do with the
information.
One might que<;tion why a 'manic'
patient, who needs reduced stimulation
and who is generally not assigned to
beginning students, would be chosen; the
reason is that often these patients, in
their active role on the ward, are the first
to approach the new students and engage
them in a conversation. The
overwhelming impact of that encounter
often makes the students retreat and feel
quite inadequate. Since the goal is
interviewing, not intervention, it is felt
that all situations warrant exposure and
practice. Manipulation and control are
major themes during the first few weeks
and this is an excellent patient situation
in which to begin a discussion about
initial involvement with patients on a
psychiatric ward.
Students are frequently reminded
that the simulation is a learning
experience and that they are not being
evaluated on interviewing skills.
Students who have had the experience
claim that they gained much more from
being involved. Some students have said
they were sorry they did not volunteer as
they felt their skills were as good as
those who risked interviewing before the
class. Occasionally a student has felt
humiliated and has commented several
weeks later that the instructor must have
thought she was inept; it is wise to be
aware of this possibility and to give
encouragement to those students who
take the risk and thereby assist in
everyone's learning experience.
Developing the learning situation
The details of setting up an interview
practice lab can present difficulties. It
takes time to program "patients" and to
check them out to see if they are
adequately prepared. and it is costly to
hire someone to simulate a patient.
There are five rotations in our academic
year and each lab uses two patients.
Faculty members share the load of
preparing patients but our budget does
not allow us to pay them. We have used
volunteer staff nurses; because of their
wealth of clinical experience, they
require less preparation time. However,
the free time they have available is
limited and many more patients need to
be programmed.
Our students unanimously agree
that the practice situation is of enormous
value for them before they actually begin
their clinical experience. Faculty time
and energy, therefore, is directed
towards this important teaching method
in clinical practice.
Value to students
The use of simulated patients for
teaching health care skills can have a
variety of applications: this paper has
shown one example, in teaching
psychiatric nursing. The major value
seems to be in the students' ability to
retreat from a difficult situation and to
explore what the difficulty was, rather
than struggling through to an
unsatisfying conclusion and then
realizing what the alternatives were.
Patient simulation can provide a
range of pathological behaviors to which
a student can respond and practice initial
contact with a patient and the
subsequent development of an interview.
One added value to this learning
experience is to encourage the student to
draw on the theory she has learned about
particular behavioral responses.
The use of audiovisual equipment
too is an invaluable aid that allows a
large class to participate in the practice
on two patients. Immediate playback
gives the students further reinforcement
oflearning in a new and perhaps anxious
situation. The self-esteem of the student
is enhanced when fewer initial blunders
occur in the early part of any learning
experience, and the implications of
students practicing on genuine patients
are diminished. '"
Acknowledgement: The author would like
to gh'e credit for the stimulus for
developing this teaching technique to
Leslie Degner of the V nh.ersity of
Manitoba School of Nursing who
presented a video tape on this method in
1973 at 0 Canadian Universities Schools
of Nursing (CAUSN) meeting in
Winnipeg.
References
* I Barrows. Howard. The
programmed patient: a technique for
appraising student pelformance in
clinical pathology, by... and Stephen
Abrahamson.J.Med.Educ. 39:803, Aug.
1964.
2 Curtis, Joy. An instructional
simulation system offering practice in
assessment of patient needs, by... and
Marilyn Rothert.J.Nurs.Educ. 11:23-28.
Jan. 1972.
Bibliography
I Lincoln, Ruth. Using simulated
patients to teach assessment. by... et al.
Nurs.outloo/... 26:5:316-320, May 1978.
2 Wallston, Kenneth A. A
role-playing simulation approach toward
studying nurses' decisions to listen to
patients, by ... and Barbara S. Wallston.
Nurs.Res. 24:1:16-22, Jan./Feb. 1975.
*Unable to verify inCNA Library
Betsy LaSorRN.. M.N., has varied
experience wor/...ing in both surgical and
psychiatric nursing in the U.S. and
Europe. After coming to Canada she
taught at the Unil'ersity of British
Columbia for eight years. LaSor
co-edited the book Issues in Canadian
Nursing.
We all know there is more to nursing than what we read in textbooks, but how does a student nurse learn what it is to truly
care? One student's experience with a dying man helped her to understand not just the special needs of the terminally ill
patient, but the special things a nurse can and must do to help.
Sharing the experience
Valerie Willetts-Schroeder
"Death has become the pro\'ince of
specialists - medical, pastoral and
commercial. It is no lonRer the shared
experience ofmanv. "t
In recent years the dying patient in
hospital has been the object of a great
deal of discussion: critics claim that we
have removed the naturalness from
dying and left the dying patient alone
with fear and alienation. By taking him
out of his personal environment, awa}
from the people and things that have
special meaning for him, by placing him
in a barren but noisy atmosphere
surrounded by people who are paid to
'care' for him, we have, in effect. robbed
him. Medicine. in its dedication to the
saving and maintaining of life. leaves
little room for dying. It seems to some as
though aseptic technique has been
absorbed into the very approach of
hospitals. and more emphasis is placed
on the perl"ormance of routines than on
those aspects of caring that differentiate
human compassion from mechanical
performance. It is no surprise to us then
to be told that we fail to deal
satisfactorily with the dying patient: it
should be recognized too that. when we
shy away from caring for the dying. we
miss out on an important experience and
in so doing. we fail ourselves.
I believe that the nurses who are
with a patient the most during the
terminal phase of life must accept the
responsibility of meeting his particular
needs. We must be "prepared to care".
When I was a student. I had a brief but
memorable experience which made me
realize the importance of my role not
onJy as a nurse who knew the technical
things to do. but as a caring. sharing,
persun.
Mr. Schwegler*. aged 71 years. was
admitted to hospital with a diagnosis of
terminal cancer. He had had cancer of
the bladder seven years before for which
he was treated with a cystectomy and
ileal conduit. However, the disease had
metastasized to his lungs. Mr. Schwegler
was a Dutch Canadian farmer who spoke
and understood onJy a little English. And
he was dying.
. nam
is fictitious
When I met Mr. Schwegler he
seemed to be in a stage of depression and
partial acceptance of his prognosis. He
shared his feelings with me one day after
morning care. I was straightening up his
unit while he rested. the curtains still
pulled around the bed; with his eyes half
open he watched me working and said he
felt he no longer had any interest in
anything. that all he did was sleep and
still feel tired. He recalled that he had
been a farmer and had worked long hours
with plenty of energy, but - "no more".
I asked him about his farm and family.
He had a large family. he replied. and I
answered. "You must be lonely." He
burst into tears and sobbed that he and
his wife had been married for 39 years
and that he missed her. his children and
home. One of his sons had died, he said,
but he hoped to meet him again in
heaven. He spoke of his religious faith.
I sat down with Mr. Schwegler and
took his hand firmly in mine. While he
was crying he would frequently increase
the pressure of his grip which made me
feel he was trying to express his suffering
while telling me too that he found my
presence reassuring.
As he talked he became calmer and
began to quote from the Scriptures. He
spoke often in Dutch, and even though I
did not know exactly what he was
saying. I felt that he was taking some
comfort from his faith. He asked for the
large-print book of verses he kept at hi<;
bedside; the print in the Bible was too
small for him to read. I cleaned his
glasses and gave him the book and
helped him to hold it as he read for
awhile. Feeling that he was much
calmer, I left him to pray in peace.
A question offaith
I had heard some of my classmates
mention that they found shared prayer a
comfort. so I sought out a classmate who
spoke Dutch with the idea that. through
their common language. she might
enhance the experience of sharing with
my patient. But she offered to find me
scriptures in English instead. At coffee. I
approached another Dutch-speaking
classmate. but she said she would prefer
not to meet Mr. Schwegler - she hated
to see anyone cry. especially an older
person. I talked then to the RN in charge
and she told me that Mr. Schwegler's
family visited him every day. and that
they often prayed together. I went back
to his room and found him sleeping with
his book still in hand. and his glasses
askew. I took them quietly away. but left
them nearny. within his reach.
I recalled from my readings of
\1 urray 2 the guidelines for emotional
support of the dying patient: relieffrom
loneliness. the need for dignity. diverse
everyday activities and, finally, the need
for some hope to achieve an intellectual
acceptance of the reality of impending
death.
I realized that, ifl were going to help
my patient meet at least some of these
needs. I would have to become more
personally involved. As part of this
objective. I encouraged him to take some
initiative in his care: I got him to sit up
and bathe his chest and arms. and shave
himself. He appeared delighted when I
applied aftershave and cologne, inhaling
deeply and exclaiming "For me?!" I
placed a basin on the floor and allowed
him to soak his feet which he seemed to
enjoy immensely. wriggling his toes and
closing his eyes. I gave him analgesics a<;
soon as he said he had pain: I checked
him frequently for fecal incontinence and
changed him immediately when required
to keep him comfortable: I spoke in short
simple meaningful sentences.
enunciating clearly to ensure his
comprehension; I gave morning care
with rest periods as he needed them. and
I kept his bed area orderly and neat with
a minimum of confusion and noise.
At the end of my tour of duty I went
to say goodbye to my patient. He clasped
my hand firmly and held it for a moment;
I felt he was saying more thanjust thank
you -I felt grateful too. and glad I was
able to help.
Inner strength
"The individual who has learned to
accept his life for what it was and who
accepts the inevitability of death can
meet death with less fear. "3
I think I actually saw this happen
with Mr. Schwegler: he became
physically more relaxed and emotionally
composed as he spoke of his anticipation
of heaven. I felt a sense of awe when I
realized the power and depth of his
conviction.
Several years ago, the minister who
conducted my father-in-Iaw's funeral
service gave us a message that had
considerable impact on my views about
death. He pointed out that when we
grieve we are mourning our loss. We
have forgotten the basic Christian
principle that the dead person has moved
on to another, better life and that if we
can we should be glad. We cry and
become upset because we are in an
atmosphere which is conducive to the
expression of feeling without negative
social sanction.
But very little of our socialIzation
prepares us for the shock or the finality
of death. We are in an age of negotiators,
of controllers and decision makers. We
realize as never before that when we die,
we are powerless in the face of forces
over which we have no control- there
is no bargaining for a better contract.
Similarly, in life we are geared to
postpone the unpleasant for as long as
possible, and in dealing with death we
tend to put off the personal and spiritual
development required to meet and
accept death with peace.
Becoming involved wIth patients on
a personal level exacts a toll. "Ifthe
nursing staff were to become genuinely
involved with the needs of each dying
patient, and with the responses of the
grieving family, much more emotional
support of the staff would be necessary
than now exists."4
My own experience with Mr.
Schwegler was both exhausting and
rewarding. I had perceived that he wa
a
lonely person who needed to express his
sorrow and his pain. He didn't want
answers or solutions from me,just
company. I was deeply affected by his
distress and by the realization that he
needed me. We as nurses must reach into
ourselves to find the faith and strength
we need to help people deal with death.
But our resources are not inexhaustible:
they must be replenished. I n order to
care for others we must first care for
ourselves: we need reinforcement,
feedback, and some sort ofreturn for our
emotional investment.
My experience helped me to realize
that I am able to care for a person in the
true sense of that word -I was able to
fulfill some of his needs on one particular
day. My feeling of exhaustion made me
aware too that caring involves a kind of
budgeting of inner resources,just as one
would do with time or money. I f I find I
am unable to meet someone's needs then
I must find someone else who can, or
help the person to help himself.
The world is both beautiful and
harsh: the key to a satisfying existence is
to do our best within our personal limits
and to accept, when we must. the reality
that there is a great deal we cannot
change. '"
References
I Murray, Malinda.Fundamental.
of
nursing. Englewood Cliffs, N.J.,
Prentice-Hall, 1976. p.491.
2 Op. cit., pages 487 - 501.
3 Op. cit., p.201.
4 Op. cit., p.494.
Bibliography
I Brunner, Lillian Scholtis.
Lippincott Manual of Nursing Practice.
by __. and Doris Smith Suddarth.
Toronto, Lippincott, 1978.
2 Kübler-Ross, Elisabeth. On death
and dying. New York, Macmillan, 1970.
Valerie Willetts-Schroeder graduated
from the nursing program at Red Deer
College in Alberta this year. She i.
loo/..ing forward to practising nursing in
the city olVancolII'er. B.C
,
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To meet the
expanding responsibilities
of clinical nursing...
1 New! OPERATING ROOM TECHNIQUES
FOR THE SURGICAL TEAM. A comprehensive
reference for practicing operating room nurses, this book is
designed to present overviews of the major surgical pro-
cedures, including relevant anatomy, indications for each
procedure, and the related nursing obligations. Based on
operating room practice and the tenets of surgical nursing,
this book provides a broad frame of reference from which
each nurse can glean information according to her unique
needs. Edited by Lois C. Crooks, R.N. Little, Brown. 459
Pages. Illustrated. 1979. Paper, $15.00. Cloth, $21.00.
2 New! MANUAL OF PEDIATRIC NURSING
CAREPLANS. This handy spiralbound manual will help
nurses in all areas of practice to provide total care for the
sick child as a member of the family. Throughout, the
manual emphasizes the parents' important role in the treat-
ment program and offers specific guidelines for their
involvement. The Hospital for Sick Children, Toronto.
Little, Brown. 347 Pages. Illustrated. 1979. $15.00.
3 New! PHARMACOLOGY AND DRUG THER-
APY IN NURSING, 2nd Edition. The new 2nd edi-
tion has been so exhaustively revised that it is virtually a
new textbook, yet it retains the lucid and readable style,
and the comprehensive coverage, that put the first edition
in a class by itself and made it "the book to beat" in nurs-
ing pharmacology. By M. J. Rodman, B.S., Ph.D.; and D.
W. Smith, R.N., M.A., Ed.D. Lippincott. 1085 Pages.
1979. $26.00.
4 New! PRIMARY CARE ASSESSMENT AND
MANAGEMENT SKILLS FOR NURSES: A Self-
Assessment Manual. This unique manual provides a
self-evaluation in physical assessment, medical management
of diseases, health counseling, and coordination of commu-
nity resources for health promotion. By M. F. Stromborg,
R.N., Ed.D., N.P.; & P. M. Stromborg, M.D. Lippincott.
Abt. 500 Pages. 1979. Abt. $20.00.
5 New! A GU I DE TO PHYSICAL EXAM INA-
TION,2nd Edition. This guide serves as an excellent
working reference in patient care for specific techniques of
interviewing and examination; for assessment of health
status; and for differentiation among abnormal findings.
By B. Bates, M.D. Lippincott. 440 Pages. Illustrated.
1979. $27.00.
6 New! NURSING MANAGEMENT FOR
PATIENT CAREr 2nd Edition. Focusing on patient
care, the authors analyze such behavioral aspects of nursing
management as staff motivation and development, and the
evaluation of staff performance. By M. Beyers, R.N., M.S.;
and C. Phillips, R.N., M.S. Little, Brown. 292 Pages.
Illustrated. 1979. Paper, $10.75. Cloth, $15.50.
7 THE LIPPINCOTT MANUAL OF NURSING
PRACTICE, 2nd Edition. This monumental second
edition of a modern classic incorporates massive revision
and updating to offer the latest and most accurate informa-
tion available. By L. S. Brunner, R.N., B.S., M.S.N.; & D.
S. Suddarth, R.N., B.S.N.E., M.S.N. With 9 Contributors.
Lippincott. 1888 PaKes. Illustrated. 1978. $29.95.
8 New! CLINICAL GERIATRICS, 2nd Edition.
New chapters in the second edition include discussions of
the aging kidney, the lung, the female reproductive tract,
and the oral cavity; also sexual functioning and noninvasive
diagnostic technology. By I. Rossman, M.D., Ph.D. With
43 Contributors. Lippincott. 704 Pages. Illustrated.
1979. $45.00.
9 NURSES' DRUG REFERENCE. Finally, a
fingertip guide to drugs organized with the nurse's needs in
mind. More than 500 drugs, listed alphabetically, are
described in a consistent, easy-to-consult format that in-
cludes the drug's action and use, dosage and administration,
cautions, adverse reactions, composition and supply and
legal status. Edited by S. M. Brooks, M.S. Little, Brown.
625 Pages. 1978. $14.50.
Lippincott
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--------------------.
42 October 1171
The Cenedlen NUrH
r,
tf\,e
1
Emergency nursing, edited by Jeanie
Barry. Toronto, McGraw-Hili
Ryerson. 1978.
Approximate price: $/9.95
To date little has been written about
emergency department nurses and their
particular knowledge needs. The text
under review attempts to remedy this by
providing information on the skills.
background and judgment nurses need to
provide care to critically ill and injured
patients.
Emergency nursing is divided into
three sections. The first. entitled the
Biological Basis of Emergency Nursing,
consists of chapters on the anatomy and
physiology of the nervous.
cardiovascular, respiratory and renal
systems. Two chapters deal with
associated diagnostic tests. namely
12-lead electrocardiography and blood
gas analysis. In each chapter many facts
are presented but they are rarely
integrated. As a result supplementary
texts would be necessary for those
nurses who desire a good understanding
of biological function. For the less
well-informed nurse, the information as
presented could prove confusing.
Section Two overviews the
Psychosocial Basis of Emergency
Nursing. Included are brief chapters that
summarize current information about
communication, anxiety and the grief
process. The authors have related these
concepts to the emergency setting which
is useful.
The final section of the book
consists of chapters on the various
urgent and emergent problems seen in an
active emergency department; there are
chapters on such diverse topics as
orthopedic injuries, emergency care of
driving accidents and respiratory distress
in children. The pathophysiology,
.
I
I I
described. "The Patient's Bill of Rights"
and the general duties of a hospital
ombudsman give a view of rights in
hospital.
Another emphasis is practicality.
Advice is given on what to take when
admitted to hospital and how to
recognize hospital personnel by their
uniforms. Ranges in fees for various
operations are listed. There is one
section devoted to helping children
through surgery.
Topics are concisely presented in
understandable lay language. This book
is of v alue to those facing surgery.
Health care workers and students would
benefit from its review of concerns from
the consumer's viewpoint.
Re,'iewed by Cynthia Dobbs, Assistant
professor "Laurentian U ni,'enity School
of Nursing , Sudbury, Ontario.
med-surg
--
o
assessment and management of each
problem is presented.
My concern with this section is the
lack of organization of the otherwise
helpful content. Few topics are dealt
with completely in any chapter; instead
the reader is referred to tables and
content contained elsewhere in the book.
For example, to benefit from all the
content about cardiovascular problems,
the reader must consult no less than six
different chapters.
The book is enriched by the large
number of excellent diagrams and tables
and by the references and bibliography
that are found at the end of each chapter.
Emergency nursing contains much
valuable information. It will be a useful
resource to any nurse interested in the
initial assessment and management of
patients who seek care in an emergency
department, but to obtain maximum
henefit from the text one would require
time and patience.
Re,'iewed hy Ek:abeth Rideout,
assistant professor, educational
program for nur.
es in primary care,
McMaster U lli,'ersity, F acultv ofH ealth
Sciences, Hamilton, Ontario.
The patient.s guide to surgery by
Lawrence Galton, New York.
Avon, 1977.
Approximate price $2.50
This book describes over 150
operations for the surgical consumer. as
well as psychological preparations for
surgery, choosing a surgeon, and usual
fees.
An emphasis on patient rights is
apparent throughout. The prospective
patient is encouraged to ask questions
that seem important to him. How to
check a surgeon's qualifications and
recognize male chauvinism are
The Cen-.ll.n "UrN
October 1171 43
ursing and the criticall
ill patient
by Nancy Meyer Holloway. 585
pages. Menlo Park. California,
Addison-Wesley Publishing
Company. 1979.
Critical care nursing is concerned
with individuals undergoing
life-threatening physiologic crises. This
book describes a conceptual framework
ba
ed on patient needs, to as
ist the
nurse in providing goal-directed.
meaningful care to critically-ill patients.
The material presented has been tested
by nurses in clinical practice. The
authenticity of material with emphasis on
the "why" or rationale for nursing
actions. as well as specific examples on
"how-to" carry out patient assessments
and nursing interventions, makes this a
valuable reference text for all nurses and
students in critical care settings.
Content of the book is organized
according to patient needs for fluids.
aeration. nutrition, communication and
'itimulation. Each chapter begins with a
list of behavioral objectives the learner
should achieve upon application of
content in clinical prdctice. Patient
assessment based on knowledge of
relevant anatomy and physiology is
emphasized. Specific nursing
interventions are discussed and criteria
for evaluation of the patient's progres
are provided. Application to clinical
practice is facilitated by the relevance of
the material. the specific directions
provided and the use of the components
of the nursing process to organize
content. The final chapter deals with
application of the framework in clinical
practice and provides examples of
nursing care plans.
This comprehensive text on critical
care nursing is a valuable reference book
and one I would choose for my personal
nursing library. The integration of
content within a nursing framework
makes it unique in the literature of a
speciality area traditionally based on the
medical model.
Rel'Ïel<."ed bv Joan Royal, R.N., B.Sc.N.,
.W.Se.N., Assistant professor.
.WeMllster Unil"ersity School of Nursing,
and Clinical Nurse Specialist, St.
Joseph's Hospital, Hamilton, Ontario.
Cardimascular nursing: pre\ention,
intenention and rehabilitation by
Jeanne 1\1. Holland. 218 pages.
Boston. Little, Brown and Co..
1977.
The main emphasis ofthis book is
on developing the nurse's knowledge so
that
he/he is better able to aid in patient
rehabilitation.
The author presents an overview of
the cardiovascular field. beginning with a
review of phy
iology. She then discu
ses
patient assessment before delving into
the two major manifestations of heart
disease - valvular defects and
myocardial infarction. The author
explains treatment regimes thoroughly
so that nurses can understand the
rationale behind them and explain them
to her patients. She also takes a look at
the complications which can follow
myocardial infarction and at ways to
prevent them.
The problem of angina pectoris is
described: methods of treatment are
included. Exercise and drugs are
emphasized and examples are given of
how to be specific in teaching.
A sample teaching guide for patients
with myocardial infarction is included.
Emphasis is placed on documentation
and evaluation of the teaching in order to
assess the level the learner has reached.
This book. as described by the
author. is intended to update and refresh
the knowledge of the nurse who has been
absent from active participation. as well
as being dn aid in continuing education. I
believe that it will also be useful as a
reference for student nurses who
undertake a course in this specialty.
The one great fault is not in the
content but in the physical presentation
as the printing is very small. Many idea!>
are developed on one page with little
diversion in the way of pictures or tables
etc. This is a drawback to reading the
text in its entirety. but the book remains
useful as a reference.
Re,'iewed by Lorna Rankin. instructor.
General Hmpital School of Nursing, St.
John's, Ne>>foundland.
AAC
Organization and
Management of Critical-care
Facilites, by Diane C. Adler and
Norma J. Shoemaker . Toronto.
Mosby, 1979.
Approximate price: $/6.75.
Having personally been involved in
the evolution of two critical care areas in
the past few years. I found this book to
be of tremendous support.
The book has illustrated the changes
in critical care nursing over the decades
with emphasis on today's organization
and management. The author has
covered a lot of ground in a very concise
fashion. and has made the information
applicable to any level of hospital
organization. The illustrations, from
floor plans to nursing management,
manage to reveal all the important points
to consider when putting a new unit
together.
I feel the author has allowed this
book to be useful to any level of nursing.
paramedical or other health care
personnel. The data is of use for
a) implementation. b)understanding. and
c)knowledge of what is a notably high
cost center in any institution. It
illustrates a tremendous effort to support
a sensitive yet often intimidating area in
the health care system.
Through all the documentation. one
main thought predominates in chapter
conclusions: over the years procedures
have improved technically. philosophies
have broadened. and care has become
more sophisticated asc.C.U.'s evolve.
But with all these changes. the needs of
the patient must be met through
communication, and not just by one
person but by the whole health care
team.
The book emphasizes today's
methods. at whatever level ofC.C.U.
management, based on the total team
concept. The communication system is
seen to be growing as "an ever widening
circle" .
Rniewed bv Margaret Zanin, R.N..
Head nurse, EA/CU, The Wellesley
Hospital, Toron/o.
Dealing with death and dying. 2d ed.
Nursing Skill book Series, Series
Editor Patricia S. Chaney. 189
pages.lntermed Communications.
Jenkintown. Pa.
Approximate price $7.95
The purpose of the book is stated in
the forward: "this book single mindedly
tackles the practical problems of
thanatology, how to deal directly with
the feelings and fears of the patient. the
family. yourself and other staff
members. ,. This has been achieved
through the selection of published
articles by well-qualified authors and the
inclusion of Skillchecks at the end of
each section.
The book is introduced by a letter on
death from Elizabeth Kubler Ross. Her
message to health professionals is that.
as they live every day fully. they are then
able to become involved with the dying
and to become comfortable in caring for
them.
The book is so organized that there
are sections dealing with the patient,
with the family and with yourself and the
staff. The last section. "Some personal
views" . is of particular note. The article,
.. Surviving: four patients talk". gives
added insight into the feelings of persons
who are facing death.
This book has something for
everyone. There are articles of particular
interest such as, "Children's special
needs" by Robert E. Kavanaugh. or
doing the Skillcheck.
It is one that every health
professional who is dealing with death
and dying should have. Many will have
read the various articles in other
44 October 11711
Th. Cen-.ll.n Nur..
publications but there is considerable
merit in having a book that brings these
together. This gives a more complete
picture of the topic. Personally, I found
new insight into the caring of the dying
and would recommend this book for the
health professional's own library.
Re
'iewed by Ina Watson, Associate
Professor, College of Nursing,
University of Saskatchewan, Saskatoon,
Saskatchewan.
pharmacology
Giving cardiovascular drugs safely,
(Nursing Skillbook Series) edited by
J. Robinson. Horsham Pa.,
Intermed Communications, 1977.
The authors had three purposes for
this textbook: to demonstrate that nurses
in any field will encounter clients with
cardiovascular disease; to emphasize
what the nurse specifically needs to
know about cardiovascular drugs; to
emphasize the need for client education
about cardiovascular drugs.
The book succeeds in meeting its
purposes. The chapters are constructed
such that a client situation, within the
community introduces the drugs
involved in that chapter. Information
about the drugs is presented in clear,
concise language. Reinforcement is
provided by charts regarding drug
administration, drug interactions, span
of action, and sample client-teaching
aids.
One of the book's most noteworthy
points is its emphasis on client
education. The publisher gives explicit
permission to recopy each aid for
distribution to clients. The aids are
phrased in clearly understood lay terms.
While they pertain mainly to drugs, there
are also aids pertaining to diet therapy
which may be prescribed.
The other noteworthy point is the
emphasis on the nurse's knowledge
needs. The aforementioned charts
provide quick, easy reference material.
The chapters clearly explain what the
drugs are doing, and what the nurse
should look for specifically to judge the
drugs' effects. There is a large element of
self-directed learning present.
Skill checks at the end of each section
require use of the material presented in
the section to answer questions about
client care situations.
Interesting points about the drugs
are brought up, such as the role of
magnesium in relation to digitalis
therapy; and facts about body system
functions, ego liver and kidney, which
will affect the drug's metabolism and
excretion.
Nurses, particularly those working
in a pharmacy and in the community, will
find the emphasis on client teaching of
great assistance. Nurses in all settings
will find the information on drug actions
and side-effects very useful.
Reviewed by Phyllis Durnford, Clinical
Coordinator, Algonquin College Nursing
Program, Pembroke Centre, Pembroke,
Ontario.
Nurses drug reference by Joseph A.
Albanese. 692 pages. Toronto,
McGraw-Hili, 1979.
The purpose of this book. dS the
author states, is "to fulfill therapeutic
nursing objectives of the current
professional nursing model, the nurse
must be knowledgeable in all aspects of
pharmacology and therapeutics."
The text is divided into four parts.
Part One contains drug indexes which
cross reference the drugs by generic
name. brand name and pharmacological
classifications.
Part Two contains comprehensive
drug monographs, containing such things
as classifications, p:tarmacologic action,
therapeutic uses, dose ranges, patient
instructions, contraindications, adverse
effects, clinical nursing implications and
management of overdose. This particular
format, with headings in red and specific
information in black, al\ows one to locate
information quickly and easily.
Information contained in the
monographs is accurate and complete.
Especially helpful for student nurses are
the drug interactions, clinical nursing
implications and patient instructions.
Part Three is a reference section
containing units of measure of the metric
and apothecary systems, but also of
value are lists of drugs that induce
certain adverse reactions such as
agranulocytosis, thrombocytopenia and
several others. A reference of laboratory
values is also included.
Part Four contains an appendix of
nursing and drug related information,
much of which applies to the U.S.
The material in this book is well
written and presented. The drug
monographs which form the bulk of the
book make it a valuable reference, which
I am certain will be appreciated by
nurses in clinical practice, students and
instructors.
Re
'iewed by Marlaine Finnegan, R.N.,
B.Sc., M.Ed., Ottawa, Ontario.
pediatrics
Comprehensive pediatric nursing
(second edition) by Gladys M.
Scipien, et al. New York,
McGraw-HilI. 1979.
Those familiar with the first edition
of this text will note the addition of four
new chapters, as well as significant
revisions and updating in the remainder
of the text; it remains an excellent
reference text for educators, students
and practitioners engaged in providing
quality nursing care for children and
their families.
The text provides a wide scope of
pediatric nursing content and an
overview of specific bio-psycho-social
knowledges, theories and concepts
related to normal growth and
development. These provide the baseline
for nursing assessment and rationale for
intervention. The text further discusses
current health care issues in pediatrics,
briefly exploring trends in today's health
care delivery and the potential for
nursmg.
The third part of the text focuses on
the nurse's role in assisting children and
their families to deal effectively with
illness and hospitalization. and the last
section of the text discusses specific
childhood pathology, providing
significant information on medical
diagnosis, treatment and associated
nursing management.
The authors of the text meet their
objective of high-level pediatric practice
through sharing of the expertise of
multiple authors: recent research in
pediatrics is incorporated into the text
and presented with critical objectivity.
Reviewed by PilviOolup, Lecturer,
School of Nursing, McMaster
University, H ami/ton, Ontario.
Th. C...dlen Nurs.
October 1171 45
Pediatric primary care second
edition by Catherine De Angelis. 651
pages. Boston. Little, Brown and
Co.. 1979.
The first edition of this
comprehensive text was published in
1975 under the title Basic Pediatrics for
the Primary Health Care PrOl'ider. Both
editions purport to" ...impart to
members of the pediatric primary health
team specific. pertinent knowledge that
has been carefully selected from the
broad field of pediatrics:'
The original text was expressly
written for the "non-physician care
provider", particularly the pediatric
nurse practitioner and the physician's
assistant. This text probably met a felt
need among nurses who were
establishing new roles where an
expanded "medical" knowledge base
was mandatory.
In the second edition, the author
(a nurse turned physician) has added
relatively little that will enhance
pediatric nursing practice. Revisions and
additions clearly reflect the decision to
include physicians in the target audience.
Offour new contributing authors one is a
nurse and three are physicians.
Improvements in the new edition include
a more comprehensive discussion of the
assessment of the child and the
management of common childhood
diseases and behavioral problems. End
of chapter bibliographies have been
greatly expanded but, although it would
have enhanced the text significantly. no
nursing literature is cited.
The book is well organized and
clearly presented in four parts titled I
Data Base. II Health Management, III
Common Signs. Symptoms and
Diseases. and IV Problems of Behavior.
The few illustrations and photographs
contribute to the text but more would
have been helpful. particularly in the
section describing physical assessment.
Several distracting charts and forms are
interspersed throughout the text that
could have been grouped in an appendix
for easy reference.
Unfortunately, the book lacks a
family-centered holistic approach to the
care of children and fails to stress health
promotion and maintenance aspects of
pediatric care. The book's "how-to"
approach is simply unequal to the task of
dealing with the extremely complex
challenge of providing primary pediatric
health care.
I n summary. this text offers no new
insights or creative intervention
techniques that would significantly
contribute to nursing education or
practice.
Rniewed by Patricia McKeel'er, R.N.,
M.N., lecturer, Faculty of Nursing.
Unh'ersity of Toronto.
Who speaks for the children: The
plight of the battered child by Peter
Silverman. Don Mills. Ontario.
Musson Book Company, 1978.
Approximate price: $8.95
1979 is the International Year of the
Child, and this thought-provoking book
leads the reader to take a hard look at the
care of abused children in Canada. The
writer is ajournalist who covered an
inquest into the death of a child. and
subsequently interviewed a wide range
of people concerned with the child
welfare system.
His stated goal is to "present a
layman's view of the weaknesses and
strengths of the system, and the
problems faced by dedicated men and
women who try to make it work against
great odds, public indifference and
government apathy". It is not an
academic paper. and some professionals
might be critical of the relative lack of
documentation of sources and research
cited.
However. the writer looks at many
aspects of the situation. and gives an
understanding portrait of those who
work in child welfare. At the same time
he clearly points out the failings of the
system, the lack of resources. the
ambiguity of laws and the ill-defined
roles of various agencies. It becomes
very clear that our society, while
expressing Concern about child welfare,
is unwilling to commit the money and
resources needed to solve the prohlems.
This book is of interest to any who
work with children or families; it does
not give solutions but provides a clear
background for a debate of the issues.
Nurses. along with other professionals,
need to look at the rights of children. and
how these can be protected.
Rel'iewed by Helell Eifert. associate
prl
ressor, School ofNunillg. The
U ni\'ersitv of British C olumhia,
VaIlCOU\'er, B.C.
Your bab} & child: from birth to age
five by Penelope Leach. 512 pages.
Toronto, Random House of Canada.
1978.
Appro'âmate price: $19.95
The author's research has
convinced her that the "whole baby
business" is becoming unnecessarily
serious and forbidding. and that parents
now worry too much about their ability
to cope and subsequently feel guilty
about their inexperience and
shortcomings. Leach's book is
addressed primarily to parents and to
others who care for infants and children
on a regular basis. Its aim is to help these
people find "positive courses of action"
that will be heneficial to the child. and in
turn give joy and reward to those
responsible for the child's care.
The book is organized into stages.
beginning with birth and ending with age
five. For each stage the author discusses
developmental tasks. thought processes
and the range of emotions. This is a large
book and much of it is devoted to helping
parents find solutions that work for
them. For instance. when she discusses
sleeping habits and patterns from six
months to one year, she makes five
sensible and plausible suggestions in the
event that bedtime may be upsetting for
the baby. This is not, however. a book of
rules: it suggests rather that parents
listen to the child and to their own
feelings. and emphasizes the importance
of flexibility and thoughtfulness in child
reanng.
The text i!> current and reflects
contemporary concepts of feeding
practices, toilet training and other
aspects of child care. The hook is richly
illustrated with photographs. dra
ings.
graphs and charts: the color illustrations
in particular bring it to life. A special
feature is the Encyclopedia/Index which
is more than a reference index.
containing technical information not
dealt with in the main text.
Your Baby & Child was originally
puhlished in Britain, but the book has
been very successfully adapted for North
American readers.
Obviously the book is meant for
parents to use and enjoy. In addition.
this sensitive. well-researched text
would be a useful reference for
community health nurses, pediatric
nurses and student nurses.
Rel'iewed by Eli';,aheth Stewart-He,Bel,
former puhlic health lIurse and nursing
educator, Ottawa, Ollt.
Pediatric history taking and physical
diagnosis for nurses. 2d ed. by Mary
M. Alexander and Marie Scott
Brown. Toronto, McGraw-Hill.
1979.
Approximate price: $/2.45
The second edition of this excellent
book is much more comprehensive and
complete than the first edition. It
contains a wealth of information
necessary for nurse practitioners
working with children. One of the
purposes of the second edition is to
improve nurses' skills in the recognition
of age-specific differences in the
comprehensive assessment of children;
the authors have accomplished this
purpose admirably.
Many points referred to in the first
edition are expanded upon and
developed more fully in the second
edition. For example, the pelvic exam is
now included in the section on
Looking for fresh, new ideas
in nursing texts?
Here they are:
New 4 th Edition! C
MPREHENSIVE CARDIAC CARE:
A Test for Nurses. Physicians. and Other Health
Practitioners. 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. Proven effective In the
classroom. this volume Is the leading text In Its field. The
new edition will give your students the Infonnatlon they
need on all aspects of cardiac care - anatomy and
physiology: coronary artery diseases: assessment of patient:
complications: electrocardiography: and pacemakers.
Emphasis throughout the book Is on prevention and early
rehabilitation. New material covers risk factors In coronary
artery disease: and current pacemaker therapy. March. 1979.
406 pages. 699 illustrations. Price. 813.25.
A New Book! MOSBY'S MANUAL OF EMERGENCY CARE:
Practices and Procedures. By Janet M. Barber. R.N.. M.S.N.
and Susan A Budassl. R.N.. M.S.N.. M.I.C.N. This hea'-1ly
Illustrated new book offers your students a quick reference
to assessment skills and specific techniques for life support
and stabilization of the critically 111 or Injured. Arranged In a
handy outlined format. discussions stress signs and
symptoms. Interrelationships of pathological phenomena.
and critical criteria and decision-making. August. 1979.
Approx. 704 pages. 493 illustrations. About 821.75-
A New Book! STRESS AND SURVIVAL: The Emotional
Realities of Life-Threatening IllneBB. Edl ted by Charles A.
Garfield; with 51 contributors. A most comprehensive
preSentation. this text anaJyzes stress and survlvaJ
for heaJth care workers deaJlng with patients
and families facing life-threatening Illness.
Noted contributors Identify the
seq uence of major emotionaJ events
encountered by the professlonaJ
and Ihe patient from diagnosis
through cure or death. OptlmaJ
means of giving emotionaJ
support are closely examined to
show students the ways In which
they can be InstrumentaJln
promoting quaJlty of life. longevity
and. at times. survivaJ. March. 197'
406 pages. 9 illustrations. Price. 81 ,
A New Book! CARDIOPULMONARY RESUSCITATION:
Procedures for Basic and Advanced Life Support. By
Patricia Diane Ellis. R.N.. M.N. and Diane M. Billings. R.N.,
M.S. This new book Is designed for anyone responsible for
administering life support measures In situations of
cardiopulmonary arrest. Initial chapters cover anatomy and
physiology of the respiratory and cardiovascular systems.
The authors then describe procedures for assessment of
cardiopulmonary emergencies. basic life support. and
advanced life support (Including restoration of ventilation.
restoration of circulation. and parenteral therapy). The flnaJ
chapters describe the organization of an emergency medlcaJ
system and provide hlstoricaJ. legal. ethical. and
psychological perspectives. December. 1979. Approx. 272
pages. 161 illustrations. About 810.75-.
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Practices and Procedures. By Linda Feiwell Abels. RN..
M.N. Offer your students clear. concise Instructions on basic
cIitical care techniques \\1th this useful new text.
Emphasizing systems assessment. It details rationales and
procedures necessary for maintenance of body homeostasis.
Practical. comprehensive tables and useful appendices are
Included - and margin Indicators highlight significant
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illustrations. PIice. 816.75.
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A New Book! MEDICAL-SURGICAL NURSING: Concepts
and Cliolcal Practice. Edited by Wilma J. Phipps. RN.. B.S..
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Woods. RN.. M.N.. Ph.D.; with 46 contIibutors. Using both a
systems and a conceptual approach. this Innovative text
reflecls the myriad changes In contemporary
medical/surgical nursing. The first two parts discuss such
general aspects as soclo-cuJtural perspectives. the nursing
process. stress and adaptation. and POMR Part III analyzes
specific medical/surgical problems. Students will
partlcularlv value unique chapters on ecology and health.
health care delivery systems. and an epidemiologic approach
to health care. March. 1979. 1.648 pages.731IUustrations.
PIice.830.oo.
A New Book! BASIC PATHOPHYSIOLOGY: A Conceptual
Approach. By Maureen E. Groer. RN.. Ph.D. and Maureen
E. Sheklelon. RN.. B.S.N.. M.S.N. This conceptual approach
I resents the basic biology of disease from the perspective of
teratlons of normal physlolo
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ganlsm as an open system In continuous Interaction with
the environment. Diseases are presented In terms of models
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symptoms. Helpful behavioral objectives begin each chapter.
March. 1979.534 pages. 423 lUustrations. PIice. 819.25.
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48 October 111711
The Cenedlen Nur..
examination of the female genitalia
including suggestions for peIforming a
pelvic exam for the first time on a young
adolescent. The musculoskeletal chapter
also contains some new material relating
to current information in the field of
sports medicine as it relates to the
school-age child.
This book is unique in that it is
written by nurses for nurses, and
manages to discuss areas traditionally
considered to be in the "medical"
domain (history taking, physical exam,
screening tests) while maintaining a
nursing perspective throughout. It is a
must for those nurses interested in
peIfecting their skills in comprehensive
assessment of children.
Reviewed by D. Joan EaRle, associate
professor, Faculty of Health Sciences,
McMaster UnÏl'ersity, Hamiltoll,
Olltario.
community health
Communitv health care and the
nursing process by Margot Joan
Fromer. 440 pages. St. Louis,
Mosby, 1979.
Approximate price: $/8.00
Community health care and the
nursing process provides an overview of
community health care in general. and
community nursing in particular. The
health care system, its history,
institutions, agents, ethics and methods
are explored in the first half of the book.
Next, the health-illness continuum,
mankind as an open system, and the
effects of stress on the individual, the
family and the community are
developed. The nursing process and
nursing audit and two particular areas of
health care - school and occupational
health nursing - complete the content.
Fromer's book brings together a
number of health care concepts and
concerns which are perhaps more fully
developed in other books. Aside from a
brief reference to Keynes. Marx and
Friedman in connection with economics
and poverty there is little new material;
the three pages on mental illness add
little to our knowledge of a major health
problem. As usual. the most serious
drawback for Canad ian teachers and
students is that the health care system
described is American.
On the credit side, the book is broad
in scope, each chapter is followed by an
extensive bibliography and some good
models are discussed and illustrated. The
format permits one to study systems,
methods, family and nursing practice in a
logical order.
Community health care and the
nursing process will assist teachers to
give an overview of community health at
a basic level. but the American content
and high cost may make it undesirable as
a required text. A Canadian text on this
subject is badly needed.
Rniewed by Alice Caplin. associate
profeHor of nursillR, U nÏl'ersity of
Saskatchewall, Sa.
katooll, Sask.
Care of the mentally retarded by
Marian Willard Blackwell, Boston,
Little. Brown and Co., 1979.
This excellent text written by
Marian Blackwell, RN. MS. who is a
former staff nurse in a center for the
mentally retarded in Massachusetts, and
consultant to a government commission
on retardation, is a comprehensive look
at literally all facets of nursing care of the
men tall y retarded.
She begins with a brief discussion of
the basic concepts and philosophies of
care in this special field. followed by an
excellent discussion of the
pathophysiology of causes of
retardation. genetic and external. Her
research is current and covers a wide
range of disorders from PKU to herpe.\
proRenitalis to malnutrition. Having thus
laid out a groundwork of medical
knowledge, Blackwell proceeds to
discuss the nurse's role in care of the
neonate, and in meeting the needs of the
family of a retarded child: she details as
well the care of institutionalized
individuals. The nurse's role in the
community is emphasized in the
presentation of such progrdms as genetic
counseling, birth control counseling to
prevent teenage pregnancies.
maintenance of retarded persons'
personal rights. public education and
research. Blackwell's book will appeal to
all nurses, regardless of the degree of
their actual involvement with the
retarded: her information is both
practical and theoretical. and is
presented in a highly readable fashion.
Re\'iewed by Jalle Bocl-... R.N., B.A.,
assistallt editor, CNJ.
psychiatry
\
Comprehensive psychiatric nursing
by Judith Haber et aI., Toronto,
McGraw-Hili, 1978.
Approximate price: $2/.55
I consider this text to be a good one
and a valuable contribution to nursing
literature because of its eas y read ing
style, its emphasis on the family and it..
behavioral approach to therapy.
The purpose of the text is clear, but
a more in-depth explanation of the
espoused "comprehensive approach"
would be helpful. The authors should
also define more clearly the level of the
"basic nursing student" for whom they
are producing this text. They should also
limit the scope of the text to either
students, practitioners or educators but
not to all three groups.
The chapter headings are well
outlined and the objectives stated at the
beginning of each chapter are relevant
and useful. The behavior approach to
pathology is good. Examples of
completed nursing care plans at the end
of each chapter and behavior
descriptions would have been very
useful.
I feel that the text is slightly long for
a basic text but it is easy to read and
would be suitable for a second year
diploma or associate degree program. It
is well-presented, interesting and current
in perspective.
This text would be useful for a
school program because of its behavioral
approach in terms of objectives and
description of pathology. The format for
content proceeds from simple to
complex and normal to abnormal. The
concepts of prevention are mentioned
but are not integrated consistently
throughout each chapter.
Re\'iewed by Adam Ro/.., instructor,
ADN ProRram, Northeast Wisconsin
Technical/ nstitllte. Green Bay
Wisconsin.
The Cen.cllen Nur..
OcIober 111711 411
Principles and practice of psychiatric
nursin
by Wiscarz et al. Toronto.
Mosby. 1979.
Approximate price: $20.50
Rather than presenting psychiatric
nursing as a practice to be based on the
traditional model of disease. the author.,
have used the nursing process
consistently in each of the chapters as
the conceptual model for implementing
psychiatric nursing practice. Current
literature and recent research findings
are quoted IiberaIly throughout the book
The first section of the book focuses
on principles of psychiatri . nursing
practice applied to various common
behaviors to patients in a variety of
settings. The second section focuses on
the practice of psychiatric nursing and
current treatment modalities.
It is the first section which is most
impressive due to the material"s
organization. chapter consistency and
emphasis on nursing care.
Certainly. some of the behaviors
upon which the chapters are based are
not new. However, in the chapter on
a:1xiety nursing intervention is discussed
in relation to levels of anxiety and
relaxation interventions are included.
Greatest originality is demonstrated in
chapters on disruptions in relatedness
and prohlems in expressions of anger. In
the former. the concept of loneliness and
the inability to develop mature
interpersonal relationships is analyzed
throughout the life cycle. Psychological
and sociological stressors leading to
loneliness and resulting behavioraIly as
withdrawal. suspicion. manipulation and
dependency are discussed. As in all of
the chapters in this section long and
short term goals are stated and
appropriate nursing intervention
emphasized: this is the first psychiatric
nursing textbook to put any empha.,is on
anger and to discuss the various
behaviors which represent the
expression of anger. and the appropriate
interventions.
The second .,ection of the book
focuses on the practice of psychiatric
nursing. Chapters on Group therap).
Family therapy. Behavior Modification
and Community Health Nursing are
current and comparable to any Tecent
text. The chapter on death and dying
extends to include the nurse's own
reactions and the family of the dying
person. The chapter on psychiatric
evaluation. crisis therapy and adolescent
psychiatric nursing excel in their depth.
use of examples and demonstration of
the nursing process.
The text is outstanding in its
extensive chapter on counseling the
victim ofrape.
Because of the emphasis on nursing
this textbook is of value to all nurses
concerned with quality nursing care. The
educator might wish for greater depth in
theory and those who are not scholars
less quotes and more simplicity of
language. But all will be able to
implement better nursing care plans and
give better nursing care through the use
of this book.
Rniewed by Pac Heherc. teacher,
Fanshawe Colle1!e, St. Thomas,
Ontario.
Mental health concepts in
medical-surgical nursing: a
workbook 2d ed. by Carol Ren
Kneisl and Sue Ann Ames. Toronto.
1\10sby. 1979.
Approximate price: $/0.25
The effects of physical illness on the
psychological and interpersonal needs of
individuals and their families has long
been recognized by nurses practicing in
general hospital settings.
The authors intend this workbook to
enhance the visibility of interpersonal
needs of adult patients having medical or
surgical problems and they have
achieved their purpose by skiIlful
integration of the psychosocial and
physical components of nursmg care. In
this edition. as in the first. content is
organized in three subject areas: the
patient experiencing anxiety. the patient
with alterations in body image, and the
patient with psychophysiological
dysfunction. Individual patient case
studies comprise each part: these
presentations add validity to the
workbook as they emphasize how people
cope during periods of illness. and how
nurses can assist patients to adapt and
solve problems.
A brief. but concise theoretical
framework precedes each section which
provides an information base for the
reader to study the individual case
histories. Each patient study has a series
of multiple-choice and subjective
questions which can be done as
self-directed testing, in smaIl group
discussion. or as teacher-directed tests.
\10st of the questions test the reader's
ability to apply principles and explain
rationale. Some options in the
multiple-choice questions do not require
the reader to discriminate. as the
incorrect answers are obvious, but this
does not hinder the overall effectiveness
This is an excellent book for all
nurses involved in planning and giving
direct patient care.
Re\'iewed by Rae Malcolm. Instructor,
Royal Jubilee Hospital, School of
'Vursing, Victoria. B.C.
education
Current perspectives in nursing:
social issues and trends by Michael
H. Miller and BeverlyC. Flynn.
Toronto.c.V. Mosby. 1977.
Approximate price $/ / .05
Many weIl-knov'n nursing leaders
have contributed to this book edited by
MiIler and Flynn. Consequently, the
issues are well researched. very
contemporary and presented in a
scholarly fashion. Each chapter is
replete with additional selected
references for the reader to pursue.
Chapter I discusses the ethical
aspects of group level decisions and
reminds the reader that in the past.
nurses have been educated to consider
the individual patient. Today. in our
health context and respect for rights. we
are urged to focus on "maximization of
benefits for whole groups of patients" .
Frank and Carolyn Williams carryon in
their second chapter regarding social and
moral concerns. discussing principles
relative to human experimentation.
Much background information is
provided regarding statements from
professional groups concerning this
ethical issue. The 1966 Declaration of
Helsinki is also noted.
Part II, on research issues, contains
Flynn's conceptual framework for
evaluating community health nursing
practice. Operational definitions and
statistical tabulations suggest that this
may not be for the average reader.
Aydelotte's subsequent chapter on the
need for well-conducted research in
nursing not only makes this plea in order
for nursing to achieve its purpose. but
corroborates the need for many of us to
increase our knowledge base. even to
comprehend Flynn's previous concept as
well as Aydelotte's message.
Other significant issues fiIl the
remaining chapters of the book. issues
such a.., sexuality. death and dying,
consumerism. preparation. role. function
and legal aspects for the nurse
practitioner. and myths of the nurse
educator are explored. Joyce Passos
describes and criticizes this latter issue.
and notes that these "myths...relate in
50 OcIober 111711
The Cen.cllen Nur..
some way to the definition of nursing as
an intellectual discipline.....
For those interested in the American
Nurses Association, special interest
groups are outlined via an historical
perspective. Who joins and why, based
upon representation, should prove
controversial reading as Miller and Flynn
contend that this organization "should
become more popular with the staff
nurses it needs to attract. "
This book, although an American
publication, written by nursing leaders
primarily from the U.S.A., clearly cites
the need for more re
earch in the social
issues presented. It is scholarly reading,
perhaps not for all readers. However, for
those nurses who wish to acquire a better
understanding of the areas of nursing in
which most changes are occurring, it is
recommended reading.
Reviewed by Dol/yGoldenberg,
chairman, Nursing Education, St. Clair
College of Applied Arts and Technology,
Windsor, Ontario.
Clinical nursing techniques fourth
edition by Norma Dison, St. Louis.
Moshy. 1979.
Approximate price: $/5.75
Clinical nursinR techniques is a
comprehen
ive manual. The author's
stated purpose of providing
"explanatory information and
meaningful illustration!'. to facilitate
learning. reviewing and modification of
techniques used in the practice of
nursing" has been well mer. Baseline
information is provided which the nur
e
may then augment with the practices.
policies and specific equipment of her
agency. The text is clearly written and
provides tables organized into technique.
prohlems and solution or rationale. for
quick reference.
This fourth edition contain.. 703
illustrations which offer step-by-step
instruction
on such hasics as
hed-making, toothhrushing. gloving.
crutch-waking. etc. The author
progresses through the spectrum of
clinical practice to more involved
techniques such as use of respirators or
heparin lock
: detailed u!'.e of mechanical
equipment ..uch as hydraulic lifts is well
depicted. This manual would he of
valuahle as..i
tance to students,
heginning practitioners or nurse..
returning to practice, and as a ready
reference for those who develop and
revise dgency procedure manuab.
However. it is technique.\ that are the
focu
and readers are advised to look
elsewhere for detailed phy
iological
explanations.
The text is organized into n
chapters which are inconsistently titled
o that those headed by patient needs.
such as "Ventilation" or "Elimination"
are interspersed among nursing
functions. such as "Application of
Topical Medications". "Irrigations",
etc. In addition, the index at the back
doe.. not always lend itself to easy access
of material: for example. heparin locks
are not listed as such but may be found
under Intravenous Fluid Therapy-
heparin.
The 15-page section on C. P. R..
while basically sound, does not conform
exactly to the standard., for one-man
rescue as laid down by the American
Heart Association and endorsed by the
Canadian Heart Foundation.
Redewed hy Penni Man.mur, R.N..
B.N.,/mtructor, St({t(Development, St.
Michael's Hospital, Toronto, Olltario.
Fundamentals of Nursing by
Luverne Wolff. Marlene H. Weitzel
and ElinorV. Fuerst. 6th ed.. New
York, J. B. Lippincott Company,
1979
This text has been almost
completely revised to meet the needs of
today's students and practitioners. The
content. although hasic. is appropriate at
many leveb along the health-illne..s
continuum.
The hook is divided into five
sections containing variou.. numhers of
chapters. The chapters in turn contain
behavioral ohjectives and a glossary of
terms which can serve as an excellent
source offeedhack for the student
wishing to master a
pecific section.
The discussion of the law and
nursing Acts are. in many instances,
particular to the United States. and
Canadian nur.,e educators will have to
keep thi.. in mind if they wish to use thi..
text.
The authors have quite
uccessfully
used General Sy
tems Theory as the
basis for the de
cription of the nursing
process and for the discussion of
homeostasis. stre
s and adaptation.
The new chapter
on Growth and
Development and Behavior Modification
are well presented and should be helpful
adjuncts to the beginning student.
Thi<; updated and revised edition of
Fundamentals of Nursing is simply
written and few words are wasted
de..pite the volume.
The authors have developed a
workbook to accompany this or any
other hasic texthook. rhe correct
answers given for the questions posed
are derived from scientific principles.
Many of the que..tion
refer to specific
patient situations thereby providing for
the application of knowledge.
Both the text and workhook would
be an as!'.et to classroom teaching and
learning.
Rn'iewed hy Elizaheth Holder, R.N.,
B.Sc.N.. M.Sc.N., instructor, Humher
C ol/eRe of Applied A rts and T echnoloRY,
Rexdale, Ontario.
general
Nutrition; proteins, carbohydrates
and lipids, Nutrition; weight control
and Nutrition; vitamins and minerals
- sodium and potassium, by Clara
H. Lewis. Philadelphia, Davis,
1978.
The author gives a brief description
in the introduction to each unit, in which
the various aspects of the particular
nutrient are identified: then a set of
objectives is outlined which the student
will meet when the unit is completed.
Objectives are clearly and concisely
stated.
The programmed unit which follows
is well structured and in some cases has
good tables and diagrams including
review questions. The effects of
nutrients on the body and how these are
affected in disease are also discussed.
The role of diet in decreasing risk factors
for specific conditions has also been
included.
The post-test at the end of each unit
is a good learning tool for the student: it
helps to recapture the important points
that should be learned and remembered.
The diagrams and charts given in the
section on Sodium and Potassium are
excellent in that they assist the individual
to learn the causes of deficiency and the
role of the particular mineral in the body.
It also clearly states the effects of
deficiency on the human body.
The section on weight control deals
with the physiological aspects of energy
balance. the caloric needs of the
individual and the caloric content of
foods. This section is of particular help
to nurses who will be involved at some
time or other in helping patients who
In tune with
today's nursing
practice
J. B. LlPPllIoCOTT CO
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------------------------------------
1 New! PERSPECTIVES ON ADOLESCENT
HEALTH CARE. Here at last is a text that not only
presents the major ideas and issues on this subject; it pro-
vides many clinical examples and offers valid suggestions
that can be put to use in a variety of clinical settings. By
R. T. Mercer, R.N., Ph.D. Lippincott. 420 Pages. 1979.
$ 15.50.
2 New! NURSES' HANDBOOK OF FLUID
BALANCE,3rd Edition. Here is a handbook on
the basics and practical application of knowledge of body
fluid disturbances, designed for nurses and all members of
the allied health sciences. The purpose of the book is to
present the fundamental physiology involved in body fluid
disturbances, employing a systematic yet simple approach
to classification and diagnosis. By N. M. Metheny, B.S.N.,
M.S.N., Ph.D.; and W. D. Snively, Jr., M.D., F.A.C.P.
Lippincott. 406 Pages. 1979. $15.00.
3 New! GERONTOLOGICAL NURSING. This
practical new book provides a comprehensive review of the
medical, surgical, and psychiatric problems associated with
aging, accompanied by related nursing interventions. Com-
mon diseases of each body system and their unique features
in the aged are discussed in detail. By C. K. Eliopoulos,
R.N., B.S., M.S. Harper & Row. 384 Pages. 1979. $15.00.
4 New! HIGH-RISK PARENTING: Nursing
Assessment and Strategies for the Family at Risk.
HIGH-RISK PARENTING is not intended for anyone
particular clinical specialty but draws upon infonnation
from many specialties (maternal-child, medical-surgical,
community health, mental health, etc.) and is intended for
nurses in any setting who work with families at risk. By
S. H.Johnson, R.N., M.N. With 24 Contributors.
Lippincott. 424 Pages. 1979. $17.75.
Lippincott
...
5 New! CARDIAC REHABILITATION: A
Comprehensive I'Jursing Approach. The purpose of
this book is to provide a comprehensive yet practical refer-
ence for a little-known but fast-developing field of nursing.
By P. M. Comoss, R.N., C.C.R.N.; et al. Lippincott. Abt.
250 Pages. 1979. Abt. Sl6.00.
6 MATHEMATICS FOR HEALTH PRACTI-
IONERS: Basic Concepts and Clinical Applica-
tions. ThrouKh a simple approach to conversion called
"the equation method", this important new text helps dis-
pel the "math anxiety" that most students experience when
having to deal with numbers. By L. Verner, Ph.D.
Lippincott. 165 Pages. 1978. $ 7.5 O.
7 New! TEXTBOOK OF HUMAN SEXUALITY
FOR NURSES. From its opening chapter to its closing
pages of questions and answers, this text effectively incor-
porates human sexuality into nursing practice at a level that
can be understood by both practicing and student nurses.
By R. C. Kolodny, M.D.; et al. Little, Brown. 450 Pages.
Illustrated. 1979. Paper, $15.00. Cloth, $21.00.
8 New! COMMUNICATION FOR HEALTH
PROFESSIONALS. This timely book identifies and
describes problem situations stemming from communica-
tion breakdowns that commonly affect health care person-
nel. The two major objectives are to provide an overall
understanding of the process of communication and its
complexities in various contexts and to provide instruction-
al techniques to enable the reader to develop greater
communicative proficiency within those contexts. By
V. M. Smith, Ph.D.; & T. A. Bass, M.A. Lippincott. 238
Pages. 1979. $ 7 .50.
Name
Address
Provo
52 October 1171
The Cenadlen Nur..
may be undernourished or
overnourished or who have problems
controlling their weight. It explains by
simple diagrams the effect of energy
production and energy release by the
body.
I feel these books serve as a useful
tool to the student; they aid in
understanding and applying knowledge
about nutrition. They allow the student
to carryon independent study in
nutrition and assist them in
understanding the important role
nutrition plays in the maintenance of
optimal health for the individual. They
also help the student to understand the
role of deficiencies in the body and their
effects on the individual.
Re
'iewed by Doris Spain, Orillia,
Ontario.
Assertive skills for nurses by Carolyn
Chambers Clark, Wakefield, Mass.
Contemporary Publishing, Inc.,
1978. Approximate price: $8.95.
Carolyn Chambers Clark has
developed a rather unique workbook to
meet the needs of a variety of nurses. It
focuses on assertive skills in the work
setting, rather than on therapy for
persons who have severe anxiety,
aggressive or psychiatric problems.
The book may be used for individual
or group study. It is suggested for use as
self-study, as a basis for a workshop for
nurses, or introduced as a component in
a nursing curriculum.
The book is organized into seven
modules. Each module contains a
prelearning evaluation, a focus for
learning, an infonnation section, learning
activities and experiences, problems to
solve or study, a postlearning evaluation,
and an evaluation of the module. The
modules are sequenced; the knowledge
gained from one module provides a basis
for learning from subsequent modules.
The introduction emphasizes the
importance of practicing assertive skills
and obtaining feedback; whether the
book is used by individuals or groups. It
is felt by the author that assertive
behavior is learned behavior.
The focus of the seven modules are:
understanding and use oftenninology,
factors that hinder and necessitate
assertiveness in nursing, assessment of
one's level of assertiveness, suggested
strategies to use to practice assertive
behavior, assessment of job skills and
goals, giving and taking criticism and
help, and ways to control anxiety, fear,
and anger.
Although the use of assertive skills
has only recently been emphasized for
nurses, much of the content is not new.
The requisite skills suggested for
assertiveness exemplify skills in the
areas of helping relationships and
leadership. The development of
increased self-awareness, and
mobilization of individual potential
through goal-setting are emphasized.
The focus on practice provides
much opportunity for introspection. The
author suggests helpful ways of changing
communication patterns and developing
a more assertive approach with
physicians, supervisors, co-workers and
clients.
In conclusion, I would recommend
this book for nurses in service or an
educational setting. It is most relevant to
those persons who are interested in
either developing or facilitating the
development of "Assertive Skills for
Nurses" .
Reviewed by Janet Moore, Assistant
Professor, Faculty of Nursing,
University of Calgary , Calgary, Alberta.
Expanding horizons for nurses edited
by Bonnie Bullough and Vern
Bullough, 360 pages, New York,
Springer Publishing Company, 1977.
Approximate price: $/0.50
This is the third volume in the
series, "Issues in Nursing", by the
Bulloughs. It deals with the
opportunities opening up for nurses as
professionals and with the problems
related to the expanding nursing role.
The selection of articles is relevant
and most are very readable. They bring
together a number of interesting
viewpoints on the is!.ues being
considered. In addition. most of the
articles have good reference lists. All of
the sections have well-chosen articles.
The two sections that are especially
interesting are Clinical Controversies,
which deals with sexuality, abortion,
insanity and euthanasia and, Women's
Liberation and Nursing. which brings
both historical and sociological
perspectives to the consideration of
nurs ing and women's role in society.
This book would be a useful addition
to any nurse's reference library,
particularly if she did not have access to
an extensive source of journals.
Re\'iewed by Myrtle E. Crm..ford.
Professor ofNursillg, College of
Nursing, U Ilil'ersity (
f SasÅlItchewlIIl,
SasÅatoon, SasÅatchewull.
Family living and sex education: a
guide for parents and youth leaders,
2d ed, by Dr. S.R. Laycock,
Toronto, Mil Mac Publications Ltd.,
1976.
This edition of Laycock's guide
contains a most unusual foreward which
in actuality is a detailed summary and
review of the text. It contains an
encapsulation of the sociology of the
present day Canadian family. Crowe, the
author of the foreward, outlines
explicitly the existing characteristics of
today's family profiles that must be
considered by educators to meet the
specific needs in Family Life.
Laycock's approach to family life
education follows a life cycle and
predominates in the sociological aspects
of sexuality despite the fact that he states
sexuality is a total need of man. Hence
the reviewer's reaction is that Erick
Fromm's text The art oflm'ing should be
an adjunct to Laycock's text.
The general informative and
controversial topics of sexuality are dealt
with in a respectful and sound way. The
development of an individual's
responsibility and sound values are
encouraged. The role of parents as the
prime educators offamily life is clearly
identified as is the fact that the family life
educator's role is determined by the
parents and the public as well as public
opinion. Laycock's guide has listed
many references and resources to
facilitate the reader's accessibility to
data. Hence physicians and nurses
involved in family health, as well as
health educators would find the guide a
valuable resource book.
Rel'Ïewed hy Margaret T. OlJiak,
B.Sc.N. Ed., M.Ed., Assistant
Professor, Unh'ersity of Ottawa, School
ofNuning.
Childbearing: A Nursing Perspective,
2nd edition, by Ann L Clark and
Dyanne D. Alfonso. 1052 pages.
Toronto, McGraw-Hili Ryerson,
1979.
Approximate price: $26.95
The authors' stated purpose is to
"assist teachers in their endeavours to
educate the nex t generation of nurses"
and from this point of view the book is
successful. This detailed volume is an
excellent tool for the teacher rather than
a basic textbook for the student.
The book is actually a collection of
work by 24 authors, each with expertise
in a particular field. The result is a
scholarly work which has been
well-researched and is comprehensive.
I n some areas, genetics for example, the
content is very complex and may prove
difficult to the reader who does not have
prior knowledge. However, the book is
well endowed with photographs, charts,
tables and diagrams which are used to
effectively interpret, support and
substantiate the text.
This is a reference text that will be
useful to teachers of obstetrical nursing,
for educators who are developing
nursing curricula, and for libraries.
Rel'iewed hy Eli
aheth Stewart-Hessel,
former public health nurse and nursing
educator, Ottawa, Onto
/"
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Top of the line from
Saunders
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Watson
Medical-Surgical Nursing and
Related Physiology
2nd Edition
Thoroughly revised, this newedilion includeslhe
latest information on topiCS rangIng from patient.s
rights, response to illness and physical assess-
ment-to immunologic respOnse. shock and
much more The chapters on cardiovascular
disease and the nervous system have been ex-
tensively revised. An excellent choice for those
preferring a smaller medical-surgiCal text.
8y Jeannelle E. Walson, RN. MScN, Prof. Emeritus
Faculty of Nursing, Univ of Toronto. Can 1043 pp
161 ill. 523.95. Just Ready Order 119136-8.
Methods in Critical-Care
The MCN Manual by the American
Association of Critical-Care Nurses
In response to an increasing demand for informa-
tion, the American AssocIatIon of Cntical-Care
Nurses manual provides guidelines for the per-
formance of over 100 advanced procedures at
the heart of critical care nursing today. Using a
step-by-step format, the book gives an overview
and defines the purpose, special equipment,
actions and rationales, precautions and related
care for each of Ihe methods covered. Use of Ihe
Swan-Ganz catheter, inlra-aortic balloon pump
management. pacemaker management. peri-
toneal dialysis and total parenteral nutrition are
only a few of the topics you'll find covered in this
unique manual. Bibliographic references
are provided.
8y The American Asst":. of Critical-Care Nurses;
Editor-in-Chief. Sally Millar, RN CCRN, Head
Nurse, Respiratory/Surgical Intensive Care Unit.
Massachusetts General Hospital: Leslie K. Sampson,
RN, CCRN, Patienl Care Coordinator. Intensive
Care Unit, Emergency Unit. and Recovery Room,
Albert Einstein Medical Center, Northern Div., Phila ;
Sisler Maurila Soukup, RSM. RN, MSN Critical
Care Clinical Nursing Specialist, St. Luke.s Hospital.
Cedar Rapids. IA: and Sylvan Lee Weinberg. MD,
Clinical Prof. of Medicine and Co-Director. Group in
Cardiology, Wright State Univ. School of MedIcine,
OH. About 400 pp. Soft cover. Ready soon.
Order 111006-4.
Bamard. Clancy & Krantz
Human Sexuality for Health
Professionals
This multi-disciphnary approach to the field
stresses the need for sex education and sexual
counseling and the importance of knowledge on
the part of all health professionals, wllh emphasis
on the nurse. Many nursing programs offer
courses on the subject now Contributions include
material from 28 leading authorities including
physicians, professional counselors, clergy.
psychologists, and nurses.
By Martha Underwood Barnard. RN MN. Faculty-
Nurse Clinician. School of Nursing 8arbara J.
Clancy, RN MSN Assoc. Prof., School of Nursing
and Kermil E. KranIz. MD. Prof. and Chairman.
Obstetrics and Gynecology and Dean of Clinical
Affairs all of Univ. of Kansas Medical Center Kansas
CIty. 301 pp lIIustd Soft cover 511 95 April 1978
Order 111544-9.
Expiration Date Interbank =
Full Name AU
I l
PosItion and Affiliation If Applicable Home Phone Number l
Home Address
AU
CIty State ZIP
SIgnature
..M&
"----
..... ....
.
"",.
Falconer et 01
Current Drug Handbook 1978-1980
Over 1500 drugs are included In thIs easy 10 use
soft cover reference-grouped by usage and fUlly
indexed by both proprietary and generic names.
The book fotlows a format that lets you grasp
pertinent facts at a glance, such as name, source,
synonyms and preparations, dosage and admin-
istration; uses, both primary and secondary;
aClion and fate: side effectsandcontralndications
8y Mary W. Falconer, RN 8A MA Formerly
Instructor of Pharmacology O'Connor Hospital
School of Nursing, San Jose. CA. H. Robert
Pallerson, 8S MS, PharmD Prof of 8,010gy and
MicrObIOlogy. San Jose State Univ . Edward A.
Guslalson. 8S. PharmD. PharmacIst Valley MedIcal
Center. San Jose, and Eleanor Sheridan. RN 8SN.
MSN, Asst Prof., College of Nursing. Arizona State
Univ Tempe AZ.312pp Soft cover 5960
March 1978 OrderIl3568-7.
Miller & Keane
Encyclopedia and Dictionary of
Medicine. Nursing and Allied Health
2nd Edition
ConSiderably updated, the ever popular Mlller-
Keane is now more complete, more meticulously
revIsed, and easier to use than any other diction-
ary available in the field. Wriffen on a health care
team model. the book is patienl oriented rather
than "disease oriented:. It addresses the palient
in lerms of pSyChe and soma, goes beyond the
definition to emphasize specific points, and in-
cludes Important sCIentific principles and plenty
of valuable illustrations Send for your copy today.
8y the Late Benjamin F. Miller, MD, and Claire B.
Keane,RN 8S,MEd 1148pp.139ill.(16color
plates) March 1978. Flexible-binding. thumb-
Indexed. 521 00 Order 116357-5. Hardbound not
thumb-Indexed 517 95 Order 116358-3
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To order tItles on 3D-day approval,
enter order ;t and author
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Klaus & Fanaroff
Care of the High-Risk Neonate
2nd Edition
Patterned after the highly successful first edItIon
this new rigorOUSly revised and up-<lated second
edition further bridges the gap between the
physIologic prinCIples and clinical management
in neonatology. Popular features, such as critical
comments on conlroversial points. case material
and queslion-answer exercises that apply infor-
mation from each chapter have been retained
8y Marshall H. Klaus. MD Prof of PedIatrics and
Avroy A. Fanaroff, M8(RAND). MRCPE Assoc
Prof of PedIatrics. bothoftheCaseWestern Reserve
Unov School Of MedIcIne 437 pp lIIustd 52340
July 1979 Order 115478-9.
Gillies & Alyn
Saunders Tests for Self-Evaluation of
Nursing Competence
3rd Edition
FollowIng the same patterns as nursIng licensure
exams this book serves as a perfect means for
you to refresh your knowledge of clinical nursing
maffers. It IS divided Into four speCialty areas.
Maternity and GyneCologic, Pediatric, Medical-
Surgical, and Psychiatric and Mental Health
Nursing. Ten new sections have been added to
this edition. including amniocentesis hyper-
bilirubrinema, and failure to thrive Don t start
reviewing for your exams without Gillies & Alyn.
Order now '
8yDeeAnnGitlies,RN.8S MA MAT.EdD DIvIsional
Nursing Director, Surgical Nursing Cook County
Hospital. Chicago. and Irene Barret! Alyn. RN A8.
MSN PhD Prof of NursIng College of NursIng Unov
of illinoIs Chicago 496 pp 51435 April 1978
Order #4132-6.
---------
=
..,
I
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All Prices dIffer 01
U Sand subJec"" change I
CN 10/79
AU
W.B. Saunders Company
____.J
P.O. Box 207. Philadelphia. Pa. 19105 _ _ _
in Canada: 1 Goldthorne Ave. Toronlo. Ontario M8Z 5T9
in England: 1 St. Anne's Rd_, Eastbourne. East Sussex BN21 3UN England
in Australia: 9 Waltham Street. Artarmon. N.S.W. 2064
54 October 1171
Slow-'" foIk&
(ferrous sulfate-folic acid)
hematinic with folic acid
Indications
Prophylaxis of iron and folic aCid
deficiencies and treatment of
megaloblastic anemia, during pregnancy,
puerperium and lactation.
Warnings
Keep out of reach of children
Contraindications
Hemochromalosls, hemOsiderosIs and
hemolytic anemia
Adverse Reactions
The following adverse reactions have
occasionally been reported Nausea,
diarrhea, constipation, vomiting,
dizziness, abdominal pain, skin rash and
headache
Precautions
The use of folic acid in the treatment of
pernicious (Addisonian) anemia, in which
Vitamin 812 is deficient, may return the
peripheral blood picture to normal while
neurological manifestations remain
progressive
Oral kon preparations may aggravate
eXisting peptic ulcer, regional enteritis
and ulcerative colitis
Iron, when given with tetracyclines, binds
in equimolecular ration thus lowering the
absorption of tetracyclines.
Dosage
Prophylaxis.
One tablet daily throughout
pregnancy, peurperium and lactation.
To be swallowed whole at any time of
the day regardless of mealtimes.
Treatment of megaloblastic anemia:
During pregnancy, puerperium and
lactation; and in multiple pregnancy'
two tablets, In a single dose, should
be swallowed dally
Supplied
Each off-white film-coated Slow-Fe tablet
contains 160 mg ferrous sulfate (50 mg
elemental iron) and 400 mcg folic acid In
a specially formulated slow-release base
Packaged In push-through packs
containing 30 tablets per sheet and
available In units of 30 and 120.
Full information available on request
References
1 Nutrttlon Canada National Survey A report
by NutritIon Canada to Ihe Deparlment 01
National Health and Wellare. Ottawa.
Information Canada. 1973 Reproduced by
permission of Informal Ion Canada
2 R R StreIff, MD. Folate Deficiency and Oral
ContraceptIves. Jama. Oct 5, 1970,
Vol 214 No 1
CIBA
DORVAL aUEBEC
H9S 1B1
See advertisement on cover 4
C-6026R
The Cenadlen Nur..
Womanpower and health care by
MarleneGrissum and Carol
Spengler. Boston, Little, Brown,
1976.
This book is about nurses. Nurses
make up the vast majority of the health
care workers of our country, but how
much power do we have in determining
the way the industry is run or about what
kind of service is given?The discrepancy
between our numbers and our power is
very great and the reason for it is the
subject of this book.
Grissum and Spengler consider the
implications of the fact that most nurses
are women. I was not surprised by much
of it but was endlessly pleased at the
clear-sighted way in which they reveal
the relationship of the difficulties in the
woman's role with the difficulties in the
nurse's role. They begin at the beginning
with how little girls are brought up. This
is not a very exciting part if the reader
has already considered socialization and
the limitations of sex detennined roles.
Still I think this basic feminist
background is essential to what follows
in the book.
What follows are discussions about
such things as the role nurses have, its
limits, the similarities between
"ward-keeping" (nursing) and
housekeeping, power, collective
bargaining, change and so on. These are
the real situations that nurses face and
Grissum and Spengler have done well in
showing how our socialization as females
prevents us from dealing with these
problems effectively.
My favorite chapter, partly because
I was so pleasantly surprised to see it
there. was the chapter on self-love. In
what other nursing book has there ever
been a chapter entitled "How do I love
me?" As I read it I kept thinking, "Ves,
this is it. This is really our problem."
The book itself has a few problems.
It reads in several places as though the
distinction between nursing and
doctoring is always clear or should be.
Well, it is not and sometimes I found this
a little puzzling. The style changes
throughout the book because each
author wrote particular chapters. I was
quite disappointed to see in my favorite
chapter that the word "he" was used to
talk in a general way about the
importance of self-esteem. The whole
book is about nurses as women. This use
of masculine words to refer to a
theoretical person seems to me to be a
lack of application of the ideas of the
book within the book. It is just one more
thing which stifles the self-esteem of
women.
Many times while reading I wanted
to talk over the ideas with other people in
nursing. As this desire recurred I grew to
view the book as a basis for discussion. I
feel it would be excellent for such a
purpose within many nursing curricula. I
think it would be useful for all ages and
all levels within nursing. Although it is an
American publication, it deals main1y
with social attitudes which largely we
have in common with the States, rather
than legal matters. This is a stimulating
book for any nurse. It compiles the
pieces of the problem that have been
straggling out here and there in the
magazines of the last several years. I
recommend it.
Reviewed by Nora Briant while in the
post-basic B.N. program at the
University of New Brunswick in
Fredericton (/977).
Path to biculturalism by Marlene
Kramer and Claudia Schmalenberg,
Wakefield, Mass., Contemporary
Publishing, 1977.
Approximate price: $/0.95
The authors refer to biculturalism as
two subcultures. the practice of nursing
as a student and the practice of nursing
as we see it in employing agencies.
The reader analyzes his/her OWn
conceptions and feelings through
exercises and tests. The book is set up
under five program sections, progressing
from early phases ofreality shock to the
final steps in resolving the conflicts.
The phases of reality shock a new
graduate experiences are identified. The
authors analyze and diagnose these
phases from a diary written by a new
graduate throughout her first year of
employment. They include feelings of
rejection, isolation and finally the
recovery phase.
The dynamics of moving from a
student nurse to the working world are
examined. Self-concept and self-esteem
are threatened. This section enables a
new graduate to examine his/her
conceptions as a nurse and compare
them with those of the employing
organization. The differences in
feedback systems, in terms of "how am I
doing", between being at school and at
work are worked through in Program III.
These differences are related to value
systems, role expectations and reward
systems.
Nurse educators would find the
section relating to the variance in the
criteria for evaluation between the
school and the agency helpful in
preparing the new graduate for coping
and adapting successfully to the working
situations.
The final program works through six
principles to assist the new graduates to
resolve their conflicts constructively and
hold to their ideals of the nursing
profession.
-Reviewed b\' Keit/w DGI'ev, Orillia,
Ontario. 'V . -
The Cen-.llen Nur..
October 1171 55
research
A reminder - CNA urges all Canadian nurses
to forward copies of their theses. dissertations
or studies to the Canadian Nurses Association
for inclusion in the Repository Collection of
Nursing Studies.
e Staff"mg
Analysis of the Use of a Computer Generated
Staff'mg Schedule on a Nursing l:nit in a
General Hospital. Halifax. N.S., 1978. Thesis
(M.N.) Dalhousie University by Ruth H.
McKenve.
This is a descriptive case study which
examines the development and
implementation of a computerized scheduling
program written to produce schedules for the
nursing staff on a unit in a general hospital.
The schedules were used for a twelve-week
period and were evaluated by comparing the
data collected prior to the test period with
data collected at the end of the test period.
There was an increase in nursing staff
satisfaction with the rotations; administrative
activities related to staffing and time spent on
these activities showed no change.
e H) pertension
The Effects of Selected Factors on the Older
Adult's Management of Treatment for
Hypertension. Toronto. Onto 1978. Thesis
<M.Sc.N.). University of Toronto by
M.Gayle BurnsBierre.
The purpose ofthe study WaS to identify the
effect of personal. environmental and lifestyle
factors on the cider adult's management of
prescribed treatment for hypertension. The
selected factors were knowledge of the
disease and of the treatment regimen.
demands of the regimen, inlerest in health and
social support.
Forty-seven hypertensive adult.,. 60-74
years old. were interviewed at home using a
structured schedule. Over three-quarters of
the sample took their medication regularly.
one halffollowed their diet and lifestyle
recommendations and almost one half had
controlled their blood pressure to the de
ired
level. Age. sex. and length of time since
diagnosis were not related to adherence but
living alone had a negative effect.
Knowledge of hypertension was nol
related to adherence; however. knowledge of
the regimen had a positive influence when
subjects did not have difficulty managing
treatment. Two or more lifestyle
prescriptions, medication side effects that
interfered with daily life and having specified
demands of the disease or treatment were
negatively associated with adherence.
Two-thirds of the sample perceived social
support from health professionals; over
one-quarter from no one.
The health needs of the sample were: an
accurate knowledge of treatment. a strategy
to deal with medication side effects and
lifestyle behavior changes and the opportunity
to discuss their perceptions of health and
treatment.
e Pediatrics
A Stud) of the Effects of Clinicalln\estigations
Conducted in the Homes of Children with
Metabolic Disorders. Toronto. Ont. 1978.
Thesis (M.Sc.N.). University of Toronto by
Eleanor Grace Pasko
The purpo
es of Ihis study were a) to
determine whether children with metabolic
disorders who had regular clinical
investigations conducted in their homes
would manifest fewer or less severe
psychological effects than children who had
similar tests in the hospital; and b) to describe
the impact of such investigations on the
family.
This study compared two groups of
children between four and 18 years of age with
20 subjects in the home group and 20 subjects
in the hospital group.
The study concluded that for these
children, hospitalization affected both the
child and his family adversely. It was a costly
and disruptive experience and prevented the
child from continuing his normal schooling
and peer relations. The type of clinical
investigations conducted can be safely and
accurately done at home when nursing
assistance is provided. Parents expressed a
preference for the testing to be done at home,
thereby allowing the child to maintain nonnal
family and peer relations. The cost to the
family and to the health care system is very
much reduced when investigations are
conducted at home.
"When I was thirteen, I really wanted
to be a nurse. Today I remembered why:'
/
I
"Patient contact. That's
what nursing meant to me
all along. And that's what I get
as an Upjohn HealthCare
Services sM nurse.
rf
A
.
__'i)
,-
.......... .
"I'm the kind of person
who needs that special one-
on-one relationship with a pa-
tient. I also need some control
over my work schedule, for my
family's sake. And I thrive on
variety... it keeps me growi ng.
"Working with Upjohn
has turned out to be a different
kind of nursing than I'd
ever known. But it's the kind
I always had in mind."
HÞv\b402-C@19""9 Hf"i!llrhCarr
rvlce., Up,ohn lid
r
Interested? Find out
what others say about Upjohn
HealthCare Services. Oppor-
tunities in home care, hospital
staffing and private duty. Of-
fices in 14 communities across
Canada. Write for our booklet
today.
-----------------------
[ mIL] UPK>>iN
E:D HEALTHCARE
___ SERVICES 1M :.-
r
Please send me your
free booklet "Nursing
Opportunities at
Upjohn HealthCare
Services."
"'ame
Address
Phone
Cltv
ProvinCE'
Postal Cod..
Mail to: Upjohn HealthCare Services
Dept.A
Suite 203
716 Gordon Baker Road
Willowdale, Ontano M2H 3B4
-----------------------
51 OcIober 1171
The Cenadlen Nur..
e Consumer rights
Attitudes of Registered Nurses Towards
Consumer Rights and Nursing Independence.
Vancouver, B.C., 1978. Thesis (M.N.),
University of British Columbia by Florence
Grace Green.
This study investigated the possibility that
registered nurses working directly with the
patient may hold attitudes towards consumer
rights and nursing independence which are
different from those in the literature and those
of nurse leaders and activities. A
questionnaire was sent by mail to a random
sample of registered nurses with a return of
392.
The attitudes expressed suggest that
nurses are motivated to accept the patient as a
participating member of the health care team
but they need support to assume the risks
associated with a self-image incorporating
professional autonomy and interdependence.
The mean of the total sample was
sufficiently high to encourage nurse leaders to
provide assertive leadership on: the issues of
consumer rights in health care, informed
access to information by the consumer, and
nursing automy.
e Genetic counseling
Factors Involved in a Mother's Decision to Seek
Antenatal Genetic Counseling and have an
Amniocentesis at an Advanced Maternal Age.
Toronto,Ont.,1978. Thesis (M.Sc.N.),
University of Toronto by Barbara Lynn
Davies.
The study sought to identify factors involved
in the decision of mothers of advanced
maternal age to seek antenatal genetic
counseling and to have or not have an
amniocentesis. The factors involved in
decision-making included benefits, barriers,
perceived susceptibility, perceived severity,
cues to action, motivation, abortion issue,
religion, social influences, gestation at
counseling. knowledge of genetic risk prior to
pregnancy and employment. Comparisons
were made between mothers who decided to
have an amniocentesis and those who did not,
mothers who were 35-39 and those over 40
years of age, and nulliparous and multiparous
mothers. The total sample was 74 and
included 66 mothers who decided to have an
amniocentesis and 8 who refused.
The study generated some implications
for nursing and health care practices,
education and research. It is recommended
that nurses in various clinical areas counsel
potential mothers of advanced maternal age to
increase awareness and understanding of
amniocentesis. Recommendations for future
research are made including finding teaching
methods most effective for amniocentesis
counseling and studying the large group of
mothers who do not seek counseling.
Ovol Drops
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Anliflatulent Simethicone
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OVOl is indicated to relieve bloating,
lIatulence and other symptoms
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CONTRAINDICATIONS
None reported.
PRECAUTIONS
Protect OVOl DROPS from freezing.
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOl80 mg TABLETS
Simethicone 80 mg
OVOl4O mg TABLETS
Simethicone 40 mg
Adults: One chewable tablet between
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OVOl DROPS
Simelhicone (in a peppermint
lIavoured base) 40 mg/ml
Infants: One-quarter to one-hall ml as
required. May be added to formula or
given directly from dropper.
Ð HQB1JgR
The Cln8dl.n NUrH
. Families
OcIober 1171 57
Spinal Cord InjUI): Earl
Impact on the
Patient's Si
niflcant Others. Vancouver. B.C..
1978. ThesisIM.Sc.N.) by Geraldine Angela
Hart.
This exploratory study was designed to gather
information about the needs and concerns of
significant others of patients with recent
spinal cord injuries. Seven respondenls were
asked about the impact of the patient's
injuries on their own lives and about their
feelings in relalion to the treatment they and
their patients were receiving from health care
personnel.
The findings of the study demonstrated
the presence of selected needs and concerns
in a small convenience sample of significant
others of spinal cord-injured patients. Further
research would be necessary to delermine
whether the findings are representative and
whether there is a relationship between
expressed needs and concerns and the sex of
pdtients and/or significant others.
. Spinal cord injul)
Experiences and Nursing fljeeds of Spinal
Cord-Injured Patients. Saskatoon,
Saskatchewan 1978, by RoseG. Kinash.
University of Saskatchewan.
This exploratory study was designed to
describe the experience and needs of spinal
cord-injured patients and to identify
implications for nursing during Ihe hospital
phase. The data were obtained through
structured interview
with eight persons who
had experienced spinal cord trauma and who
were at various stages in the adaptive process.
The sample consisted of two individ uals with
paraplegia, five with partial quadriplegia and
one with complete quadriplegia. Experiences
ofthese persons were described. physical and
psychological needs were identified and
implications for nursing were ascertained.
. Nursing Audit
The Development of a Nursing Audit Tool.
Toronto.Ont.. 1978. Thesis (M.Sc.N.).
University of Toronto by Doroth\' Margaret
Craig.
The purpose ofthis study was to develop an
audit in
trument. for use with discharged
public health nursing records. which v.as
relevant to the practice of public health
nursing in Ontario. The development ofthe
instrument was undertaken to promote
excellence in the provision of nursing care in
the community.
On the assumption that the care provided
was documented. the audit instrument was
able to discriminale between poor. deficient.
fair, good and excellent nursing care on the
discharged records. It was able to identify
strengths which could be maintained and
weaknesses which could lead to
recommendations regarding measures 10
improve the care provided.
I mplications for nursing practice and
nursing research were stated in the report and
recommendations were made to be included
in a guide for using the audit instrument.
. Nutrition
Factors Influencing the Construction of a
'1utrition Knowledge Test for the Elderly.
Calgary,Alta..1978. Thesis (M.S.) by Norma
E. Thurston.
This study examines several factors important
to the development ofa nutrition knowledge
test suitdble for a sub-population of
non-institutionalized elderly persons who
previously have demonstrated evidence of
preventive health practises.
A test blueprint was constructed, the
initial preliminary test developed and advice
and judgment solicited from specialists. A
second preliminary test and then a final test
called "Nutrition Information Survey" was
written.
The test has both measurement and
educational purposes. Several
recommendations for future practice with and
test administralion to the elderly are
di,cu'
ed.
. Perceptions of illness
The \ oung Adult's Reported Perceptions of the
Effect of Congenital Heart Disease on his Life
St}le. Toronto.Ont., 1978. ThesisIM.Sc.N.)
by Stella Burton Doucet.
The purpose of this study was 10 identify the
young adult's reported perceptions of the
effect of congenital heart disease on his
lifestyle. It was hoped that the knowledge
gained could contribute to improved care
aimed at the prevention of psychosocial
problems associated with the cardiac
condition.
Twenty-five young adults, aged 18-30
years, who were diagnosed with congenital
heart disea
e during childhood were
interviewed in their homes. The findings
showed thaI the respondents experienced a
variety of concerns and problems related to
their perceptions oftheir condition,
inlerpersonal relationships. activity, and
school experiences during childhood and
throughout their life process.
. Continuing education
An Asse
sment of Selected Continuing
Education Experiences for Professional
Growth and Competence of
urses.
Fredericton. N.B.. 1978. The
is(
1.Ed.).
University of New Brunswick bv A lice Russ
Wacintosh.
This study was undertaken a
a preliminary
effort to assess the continuing education
experiences for nurses in one New Brunswick
city in terms of the programs available and the
quality of the programs. Deficient areas
identified would provide future focus for
study and improvement.
Questionnaires were administered to
nineteen potential sponsors of continuing
education experiences offered in 1977. From
the sponsors who responded (95 per cent)
there was no indicalion of an over-all plan to
provide learning experiences for nurses. The
programs reported were one-time offerings
mainly conducted in response to an informal
expression of need from nurses which was
also recognized by the employer or sponsor.
Conclusions in thi
study
uggest needed
action in the selected city regarding
continuing education through:
I. Identification of nur
es' real needs
2. Promotion of nurses' inlerest in continuing
education
3. Co-ordination of continuing education
progrdms
4. Planning for presenl and future need
.
. Education
A Follow-up Study of Graduates from the Four
\ ear B.Se. Program in Nursing, Unhersit} of
Alberta. Edmonton. Alta.. 1978 by
Peggy-Anne Field. (B.N., M.N.).
A follow-up study of graduates ofthe
four-year baccalaureate in nursing program.
U of A was conducted one year after
grdduation for the classes 1970-74 inclusive.
The method utilized was a mailed
Queslionnaire to graduates and employers.
Findings indicated that graduates had
problem-solving abilities and incentive to
carryon their own education in the work
situation. They suffered conflict between their
ideals and the reality of work. The majority
worked in first level positions in hospital or
community health agencies. There appeared
10 be a movement toward community health
when five-year trend
were examined. The
graduates participated in professional
activities.
Graduates had concerns about their
abilities 10 function as nurses in relation lo
clinical skills, administrative ability,
organization of work. setting priorilies for
patient care and leadership skills.
As a group. they rated highly in the areas
of communication skilb dnd interper<iOnal
relationships and rated adequale in nursing
assessment, intervention and evalualion.
The Effect of a Self-instructional Module on the
Le\el of Questions Posed b}
ursing
Instructors During Post-Clinical Conferences.
Vancouver, B.C., 1979. Thesis(M.A.),
University of British Columbia by Jenn!{er
L)'nnCraig.
The purpose of this study was to prepare and
evaluate the effectiveness of educational
materials for clinical nursing instructors in
order that they may improve their questioning
skills during post-clinical conferences.
The education of many clinical
instructors prepared them 10 nurse not to
teach but an instructor is e"pected to help
students integrate their experiences and relate
them to nursing theory. One of the many skills
required to do this is the posing of
thought-provoking questions.
A self-instructional learning module was
designed to teach nursing instructors how to
ask questions directed toward the higher
levels of cognitive processes. The design of
the study was a pre-test/post-test control
group with 14 nursing instructors from four
faculties of nursing as subjects. Six
instructors formed the experimental group
and eight the control group.
It was concluded that the
self-instructional module had been effective in
raising the level of questions asked. "V
51 OcIober 1878
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1""hly
The Cln-.llen NUrH
library update
Books and Documents
I. Ackroyd, Ted J. Health and medical economics;
a guide to information sources. Michigan, Gale
Research, c1977. 149p. R
2. Addison-Wesley's nursing examination review.
Sally L. Lagerquist, editor. Menlo Park. C
.,
Addison-Wesley Publishing Co. Health ScIences
Division, c1977. 454p.
3. Alexander. Mary Merkel Pediatric history taking
and physical diagnosis for nurses, by ...and Marie
Scott Brown. 2d ed. Toronto, McGraw-Hili, c1979.
529p.
4. Adreoli, Kathlt!t!nG. Comprehensive cardiac
care; a text for nurses, physicians and other health
practitioners, by...et aI. 4th ed. SI. Louis. Mosby.
1979. 398p.
5. Anthony, Catherine Parker Texlbook of
anatomy and physiology. 10th ed. St. Louis. Mosby,
1979. 731p.
6. Arje, Frances Burton Psychiatric-mental health
nursing; 1500 multiple choice questions and
referenced answers. Edited by.. .and Charlotte H.
Martin and Irene L. Sell. 3rded. Flushing, N.Y.,
Medical Examinalion. cI972. 186p. (Nursing
examination review book. no. 2)
7. Brunner. Lillian Sholtis Traité des soins
infirmiers en médecine-chirurgie, par Lillian Sholtis
Brunner et Doris Smith Suddarth. Montréal.
Editions du Renouveau Pédagogique. c1979. 1314p.
8. Campbell. Claire Nursing diagnosis and
intervention in nursing practice. Toronto, Wiley,
c1978. 1928p.
9. Cancer pathophysiology. etiology. and
management: selected readings. Edited by Louise C.
Kruse, ...et aI. Toronto, Mosby. 1979. 483p.
10. Carini. Esta Carini andOwen's neurological
dnd neurosurgical nursing. by.. .and Barbara Lang
Conway. 7th ed. SI. Louis. Mosby. 1978. MOp.
II. Current perspectives in nursing management.
v.I. Edited by Ann Ma:riner. Toronto. Mosby. 1979.
214p.
12. Current practice in gerontQlogical nursing, v.I.
Edited by Adina M. Reinhardt and Mildred D.
Quinn. Toronto. Mosby. 1979. 237p.
13. Desharnais. Anna Review of surgical nursing.
Toronto. McGraw-Hili, c1979. 228p.
14. Dison. Norma Greenler Clinical nursing
techniques. 4th ed. Toronto. Mosby. 1979. 491p.
15. Ercolano. Norma H. Review of medical
nursing. Toronto. McGraw-Hili, c1979. 285p.
16. Feinstein, Maurice B. Pharmacology; 1539
multiple choice questions and referenced answers.
Edited by...and Harriet Levine. 3rd ed. Flushing,
N.Y.. Medical Examination. c1974. l86p. (Nursing
examination review book. no.6)
17. Folta,JeannelleR. A sociological framework
for patient care. 2d ed. Edited by...and Edilh S.
Deck. Toronto. Wiley. c1979. 51Op.
18. Fream, William Charles Notes on surgical
nursing. 2ded. New York, Churchill Livingstone.
1978. 393p.
19. Gibberd. F. Nurses handbook of current drugs.
by...and RichardD. Tonkin. 3ded. London. William
Heinemann. c 1978. 138p.
20. Green. Judah Review of matern all child
nursing. Toronto, McGraw-Hili. c1979. 323p.
21. Hamilton. Persis Mary Basic maternity
nursing. 4th ed. Toronto. Mosby, 1979. 248p.
22. Haring, Ph vilis Review of mental health
nursing. Toronto. McGraw-Hili, c1979. 216p.
23. Harris. CeliaC. A primer of cardiac
arrhythmias; a self-instructional program. Toronto.
Mosby. 1979. 112p.
24. Hazards at work. national seminar. Toronto,
Canada. Nov. 16th-17th. 1977. Proceedings. A
transcript of" Hazards at work: law and the
workplace". Toronlo, Corpus, 1978. 105p.
25. Holmes, Marguerite C. Basic sciences: 1800
multiple choice questions and referenced answers.
Edited by...et aI. 3d ed. Flushing, N.Y.. Medical
Examination, cl973 188p. (Nursing examination
review book no. 4)
26. Hymovich, Debra P. Family health care.
Edited by.. .and Martha Underwood Barnard. 2d ed.
Toronto, McGraw-Hili, cl979. 2v.
27. Jasmin, Sylvia Behavioral concepts and the
nursing process, by...and Louise N. Trystad.
Toronto, Mosby, 1979. 193p.
28. Kaminsky. Daniel Microbiology; 1500 multiple
choice questions and referenced answers by... Alice
E. Hogan and Arlene L. Levey. 3rd ed. Flushing.
N.Y., Medical Examination, c1974. 157p. (Nursing
examination review book, no. 7)
29. Kübler-Ross, Elizabeth Questions and answers
on death and dying. Toronto, Collier Macmillan.
c1974. l77p.
30. Marriner. Ann The nursing process; a scientific
approach to nursing care. 2d ed. Toronto, Mosby,
1979. 276p.
31. Moore. Mary Lou Reahties In childbearing.
Toronto, Saunders, 1978. 772p.
32. Moroney, James Surgery for nurses. 14th ed.
Edinburgh Churchill Livingstone, 1978. 662p.
33. Nephrology nursing; perspectives of care, by
Francine P. Hekelman and Carol A. Ostendarp.
Toronto. McGraw-Hili, c1979. 326p.
34. Nordmark, Madelyn Titus Scientific
foundations of nursing. by. ..and Anne W.
Rohweder. 3d ed. Philadelphia, Lippincott, cl975,
1967. 426p.
35. The normally sick child. Edited by Jan van
Eys. Baltimore, University Park Press. c1979. 188p.
36. O'Brien. Marion The toddler center; a practical
guide to day care for one-and-two year olds. by...et
al. Baltimore. University Park Press. c1979. 337p.
37. Organisation mondiale de la santI? La
contraception par les stéroides et Ie risque de
néoplasmes. Rapport d'un Groupe scientifique de
I'OMS. Genève. 1978. 59p. (Série de rapports
techniques no 619)
38. L 'hypertension artérielle. Rapport d'un Comité
OMS d'experts. Genève. 1978. 62p. (Série de
rapports techniques, no 628)
39. La surveillance. moyen de prévenir et de
réduire les risques pour la santé associés aux
entérobactéries antibiorésistantes. Rapport d'une
réunion de I'OMS. Genève. 1978. 6Op. (Série de
rapports techniques no 624)
40. Prince. Jovce Minds. mothers and midwives:
the psychology.of childbirth. by.. .and Margaret E.
Adams. Edinburgh. Churchill Livingstone. 1978.
179p.
41. Professionallnstitute of the Public Sen'iCt! of
Canada Submission 10 the conciliation board in the
matter of the public service staff relations act and a
dispute...in respect of all employees of the nursing
group. Ottawa. 1978. Iv. (various pagings)
42. Taylor. Clarence E. Mathematics for nursing.
Boston. Little. Brown. c1978. 135p.
43. Trower. Chris Arbitration at a glance: a manual
on how to prepare and present a grievance to a
Board of Arbitralion. Toronto. Labour Research
Institute. cl974. 255p.
44. VanZwanenberg. Dinah Neurosurgical
nursing care. by...andC.B.T. Adams. Toronto,
Oxford University Press, 1979. 133p.
45. Whaley. Lucille F. Nursing care of infants and
children. by...andDonna L. Wong. Toronto,
Mosby. 1979. 1718p.
46. World Health Orllanization Arterial
Hypertension. Report of a WHO Expert Co
mittee.
Geneva. 1978. 58p. (Its Technical report senes. no.
(28).
47. World Health Organization Surveillance for
the prevention and control of health hazards due to
antibiotic-resistant enterobacteria. Report of a WHO
meeting. Geneva. 1978. 54p. (Its Technical report
series. no. 624)
48. Ziegel. Erna Obstetric nursing, by Erna Siegel
and Mecca S. Cranley. 7th ed. New York.
MacMillan. c1978. 911p.
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The Clnedlen Nur..
Classified
Advertisements
Alberta
The Drumheller Heallh V nit requires a Supervløor or
Nunes with experience and qualifications in Public
Health for supervision of a staff of eight district
nurses in preventive programs of community health
to a population of 28,000 in an area of 4000 square
miles. Main office is located in Drumheller, popula-
tion 6,000. 85 miles from Calgary. For information or
application forms please reply, giving curriculum
vitae to: Agnes E. O'Neil, M.D.. D.P.H., Medical
Officer of Health, Box 1180, Drumheller. Alberta,
TOJ OYO.
R.N.'s required by a 560 bed acute care hospital
located in downtown Edmonton. Positions available
in most clinical areas. Personnel policies and salary
is in accordance with the A.A. R.N. contract.
Applicants must be eligible for registration with the
A.A. R.N. Apply to: Nursing Employment Office,
Edmonton General Ho,pilal. 1II1I Jasper Avenue,
Edmonton. Alberta T5K 01.4.
Registered nunes required for 15-bed accredited
active treatment hospilal in a lakeland resort area,
130 miles northeast of Edmonton. Salary $1211 -
1454 per month. Apply: Director of Nursing, St.
Therese Hospital, Box 880. St. Paul, Alberta. TOA
3AO.
British Columbia
Experien<<d General Duty Graduate Nurses required
for small hospital located N.E. Vancouver Island.
Maternity experience preferred. Personnel policies
according to RNABC contract. Residence accom-
modation available $30 monthly. Apply in writing to:
Director of Nursing. St. George's Hospital. Box 223.
Alert Bay. British Columbia. YON IAO.
Shift Supervisor with previous experience required
for a 1000bed fully accredited hospital. Must be
eligible for B.C. registration. N.V.A. course prefer-
red. Apply to: Director of Personnel. Fort St. John
General Hospital. Fort St. John. British Columbia,
VIJ IY3.
O.R. and P.A.R. - Head Nurse required for an
accredited 1000bed acute hospital in a fast growing
progressive community in B.c. Experience or
ddvanced preparation required. Must be eligible for
B.c. registration. Salary - $1500 - $1112 per
month. Benefits in accordance with R.N.A.B.C.
contract. Apply to: Director of Personnel. Fort St.
JohnGeneral Hospital. Fort St. John. B.C. VIJ IY3;
Phone (604) 185-6611.
General Duty Registered Nurses required for 108 bed
accredited hospital. Previous experience desirable.
Staff residence available. Salary as per R.N.A.B.C.
Contract with northern allowance. For further
information please contact: Director of Nursing.
Io..itimat General Hospitdl. 899 Lahakas Boulevard
N.. Kitimat. B.c. VIIC IE1.
Public Health Nursing position available end of
Seplember with progressive community health
centre in the beautiful Queen Charlotle Islands_ Job
entails carrying out provincial public health prog-
rammes in Queen Charlotte City (population 1000)
and several remote logging camps. Could be 4/5 time
position. For further information contact: Co-
ordinator. Health and Human Resources, P.O. Box
619. Masset, British Columbia. VOT IMO.
British Columbia
Experienced Nurses (eligible for B.C. Registration)
required for full-time positions in our modem
300-bed Extended Care Hospital located just thirty
minutes from downtown Vancouver. Salary and
benefits according to RNABC contract. Applicants
may telephone 525-0911 to arrange for an interview.
or write giving full particulars to: Personnel Direc-
tor, Queen's Park Hospital, 315 McBride Blvd..
New Westminster, British Columbia. V3L 5E8_
Experienced Nurses (B.C. Registered) required for a
newly expanded 463-bed acute. teaching. regional
referral hospital located in the Fraser Valley. 20
minutes by freeway from Vancouver. and within
easy access of various recreational facilities. Excel-
lent orientation and continuing education program-
mes. Salary-1919 rates-$1305.00-$1542.00 per
month. Clinical areas include: Operating Room. Re-
covery Room. Intensive Care. Coronary Care.
Neonatal Intensive Care. Hemodialysis. Acute
Medicine. Surgery. Pediatrics. Rehabilitation and
Emergency. Apply to: Employment Manager. Royal
Columbian Hospital. 330 E. Columbia St.. New
Westminster. British Columbia. V3L 3W1.
Applications are invited for the pO'ltion of Director
or Nursing with administrative quallncatlons. Applic-
anls must have their B.C. registration and should
have post graduàte degree in nursing administration
with several years of practical experience at the
supervisory level. This position will encompass the
administration of a 1 bed hospital on Vancouver
Island. It will necessitate the supervision of the
nursing and support staff. purchasing and financial
reconciliation at month end. An invaluable oppor-
tunity to gain experience in all facets of hospital
administration The hospital is situated in a rapidly
expanding area of Northern Vancouver Island. This
position is aVdilable immediately. Salary negotiable.
Please reply in writing to: Mrs. ..... L. Watson.
Chairman. Port Alice Hospital Board. Box 100. Port
Alice, British Columbia. YON 2NO.
Regtstered Nurses required immediately for a 340-
bed accredited hospital in the Central I nterior of
B.C. Registered Nurses interested in nursing posi-
tions at the Prince George Regional Hospital are
invited to make inquiries to: Director of Personnel
Services. Prince George Regional Hospital. 2000-
15th Avenue, Pnnce George, British Columbia,
V2M IS2.
Registered Nunes required immediately for perma-
nent full time positions at IO-bed hospital in B.C.
Salary at 1978 RNABC rate plus northern living
allowance. Recognition of advanced or primary care
education. One year experience preferred. Apply:
Director of Nursing. Stewart General Hospital, Box
8. Stewart. British Columbia, VOT IWO. Telephone:
(604) 636-2221 Collect.
St. Paul's Hospital inviles applications from H.C.
Registered Nunes for full and part time positions in
all areas of the hospital. St. Paul's is an acute referral
teaching hospital located in downtown Vancouver.
1979 R.N. rates $1305.00 - $1542.00. Generous
fringe benefits. Apply to: St. Paul's Hospital.
Personnel Department, IOSI Burrard Street, Van-
couver, British Columbia, V6Z IY6.
British Columbia
Two general duty nurses for 21-bed acute care
hospital on Vancouver Island's beautiful Pacific
Coast near Pacific Rim National Marine Park.
Fnendly atmosphere. Salaries in accordance with
KNABC agreements. Apply: Director of Nursing,
Tofino General Hospital, Box 190, Tofino, British
Columbia, VOR :!ZO. (604) 725-3212.
Manitoba
Experlen<<d RegIstered Nunes required for a fully
accredited 200-bed Health Complex located in
Northern Manitoba. Must be eligible for registration
in Manitoba. Salary dependent on experience and
education. For further information contact: Mrs.
Mona Seguin. Personnel Director, The Pas Health
Complex Inc.. P.O. Box 240, The Pas. Manitoba,
R9A I K4.
Northwest Territories
The Slanton Yellowknife Hospital. a 72-bed accre-
dited, acute care hospital requires registered nurses to
work in medical, surgical, pediatric, obstetrical or
operating room areas. Excellent orientation and
inservice education. Some furnished accommoda-
tion available. Apply: Assistant Administrator-
Nursing, Stanton Yellowknife Hospital, Box 10,
Yellowknife, N.W.T..XIA 2NI.
Saskatchewan
Two Registered !\iurses required for an 8-bed aCute
care hospilal in rural Saskatchewan, 40 miles N.W.
of North Batlleford. Salary and personnel policies
according to S. V.N. contract. Contact: Director of
Nursing. Box 178. Edam, Saskatchewan, SOM OVO.
Two RN's required for a 32 bed. fully accrediled
general hospital. For further information contact:
Director of Nursing. St. Joseph's Hospital. Gravel-
bourg. Saskatchewan SOH IXO.
rwo Registered Nurses for general duty. required for
modem 22-bed hospital. Lestock. Sdskatchewan.
Location, 90 miles north of Regina. Apply in writing
to: Director of Nursing. St. Joseph's Vnion Hospi-
tal. Lestock. Saskatchewan SOA :!GO. Telephone:
274-2215.
R.N.'. and R.P.N.'s (eligible for Saskatchewan
registration) required for 340 fully accredited ex-
tended care hospit..1. For further information,
contact: Personnel Department. Souris Valley Ex-
tended Care Hospital. Box 2001. Weyburn. Sas-
katchewan S4H 21.7.
United States
R.N.'s U.S.A. - Dunhill with 250 offices has
exciting career opportunities for both recent grads
and experienced R.N.'s. Locations North, South.
Easl and West. All fees are paid by the employer.
Send your resume to: 801 Empire Building, Edmon-
ton, Alberta, T5J IV9.
The Cln-.llen NUrH
October 1171 .1
Vnited States
Ceuromle - Sometimes you have to go a long way
to find home. But. The White Memorial Medical
Center in Los Angeles. California. makes it all
worthwhile. The White is a 377-bed acute care
teaching medical center with an open invitation to
dedicated RN's. We'll challenge your mind and offer
you the opportunity 10 develop and continue your
professional growth. We will pay your one-way
transportation. offer free meals for one month and all
lodging for three months in our nurses residence and
provide your work visa. Call collect or write: "'en
Hoover. Assistant Personnel Director, Ino Brook-
lyn Avenue, Los Angeles, California 90033 (213)
268-S000. ext. 1680.
R.N. 's; Live in California near beautiful Monterey
Peninsula - Sunshine and beaches - Temperate
weather all year - Two hours from San Francisco.
Work in modem fully accredited 2 II-bed acute care
hospital. Position openings in IO-bed ICU-CCU and
26-bed Concentrated Care Unit. Med-Surg. OB and
OR. Flight to Salinas and two-week motel accom-
modations ifhired. Assistance available for immigra-
tion and registration. Excellent benefits! Information
available. Call collect 8:00 a.m. to 3:00 p.m.. Pacific
Daylight Savings Time. ask for Miss Harmon or
Mrs. Madison. Or write to: Salinas Valley Memorial
Hospital. 450 E. Romie Lane. Salinas. California
91901. Tel.: (408) 424-2251, ext. 232.
Nursing Opportunity - Mississippi Baptist Medical
Center, a m/lior 600-bed hospital. has immediate
posilions available for experienced RNs and recent
nursing school graduates in a variety of specialities
and medical}surgical areas. Competilive salaries,
liberal benefits. Visa, licensure and relocation
assistance provided. Located in Mississippi's capital
city of Jackson (population 300.000). MBMC is the
state's largest and most modem privately operated
hospital. For further information write: Mrs.
Johnnye Weber. Nurse Recruiter. 1225 North Stale
Street. Jackson. Mississippi 39201; or call collect
601/968-SIH.
Nun
s - RN. - tmmediate Openings in
California-Florida-Texas-Mississippi - if you are
experienced or a recent Graduate Nurse we can offer
you positions with excell
nt salaries of up to S 1300
per month plus all benefits. Not only are there no
fees to you whatsoever for placing you. but we also
provide complete Visa and Licensure assistance at
also no cost to you. Wrile immediately for our
application even if there are other areas of the U.S.
that you are interested in. We will call you upon
receipt of your application in order to arrange for
hospital interviews. You can call us collect if you are
an RN who is licensed by examination in Canada or
a recent graduate from any Canadian School of
Nursing. Windsor Nurse Placement Service, P.O
Box 1133, Great Neck. New York. 11023. (516 -
487-2818).
"Our 20th Year of World Wide Service"
Dallas, Houston. Corpus Christi, etc. etc. etc. The
eyes of Texas beckon RN's and new grads to
practice their profession in one of the most
prosperous areas of the U.S. We represent all size
hospitals in virtually every Texas and Southwest
U.S. City. Excellent salaries and paid relocation
expenses are just two of many supe.- benefits
offered. We will visit many Canadian cities soon to
interview and hire. So we may know of your
interest. won't you contact us today? Call or write:
Ms. Kennedy. P.O. Box S844. Arlington. Texas
7601 I. (2141647-0077.
Don't
left out in the cold: RN's enjoy the
semi-tropical weather of Weslaco. Texas located in
the hear! of the Rio Grande Valley. Close to South
Padre Island's sunny beaches and the Mexican
Border. Knapp Memorial Methodist Hospital cur-
rently has 100 beds and we would like you to help
staff an additional 80 beds - 10 in an ICU-CCU unit.
Also need nurses for Med/Surg. Nursery and OB.
Contact Debby or Connie. Personnel Office,
'" \IMH. 1330 E. Sixlh St.. Weslaco. TX. 78S96.
(SI2) 968-8S67, Ext. 286 or 162.
United States
Florida Nursl.. Opport....... - MRA is recruiling
ReJPstered Nunes and recent Graduates for hospital
positions in cities such as Tampa. St. Petenburg,
and Sarasota on the West Coast; Miami, Ft.
Lauderdale and West Palm Beach on the East Coast.
If you are considering a move to sunny Florida,
contacl our Nurse Recruiter for assistance in
selecting Ihe right hospital and city for you. We will
provide complete Work Visa and Stale Licensure
information and offer relocation hints. There is no
placement fee to you. Write or call Medical
RKruII
norAniertce,I_.(ForW
stCoast) 1211 N.
Westshore Blvd.. Suite 20S, Tampa, FI. 33607 (813)
872
202; (For East Cout) 800 N.W. 62nd St., Suile
SIO, Ft. Lauderdale, F1. 33309 (30S) 772-3680.
CD 0<>0" to b<
AJIV""
NURSES
Correctional Services. Caned.
Saskatoon Sas.katchewan
New 100 oea forenSIc psycm
lnc .ac:;lIIty nG Ie\. Jlhy
opened In Saskatoon and requires var.ous nurSing staft
STAFF NURSE
R N S.lary $14.456 $16326/YI and
$1.ooo/yr P F A
R P N S.lary $14312 $15973/yr
lunder rev.ew) and 11.ooo/YI P F A
Duties
Provide direct nurSing care to patients on a 24 110ur belS
aU.II'IC.tlons
Ehglblilty for registration as a Registered Nurse or Rpgls
tered Psychlatnc Nurse In a province or territory of Canada
E
penence In nu
lng care Knowledge of English 15 essen
hal
TEAM LEADER
Salary $15.117 $16.986/yr .nd
$1.ooo/yr P_F A
Duties
RE"SPOns.ble for f.rst hne SuDef'VISlon of approximately 7
nurses dunng day and even.ng shifts In a unll of 12 or 24
beds
aU.llflcatlom
Ehglbility for reglstraho,.. as ReQlstered Nurse In a prOVince
or terntory of Canada E xpenef\ce .n Psychlatnc Nurs.ng
and the ability to Implement rut n!) programme techO!
Ques Knowledge of Enghsh IS
ntlal
NURSING SUPERVISOR
Sal.rv $17.180 to $19.669/vr .nd
$1.ooo/yr P F A
DUlies
RE"Sponslble on a rotating shih basiS 'or the nurSIOg oper
atlon 0' the tOlal l105pltal
Qualdlc.llons
Ellglblhty fOf reglstretlon as a Registered Nurse In a prOVin-
ce or terntory of Canada Expenence'n Psychlatflc Nursing
and superviSing a nurSing service unit
United States
Come 10 Tn.. - Baptist Hospital of Southeast
Texas is a 400-bed growth oriented organization
looking for a few good R.N.'s. We feel that we can
offer you the challenae and opportunity to develop
and continue your professional growth. We are
located in Beaumont, a cily of ISO,OOO with a small
town atmosphere but the convenience of the large
city. We're 30 minutes from the Gulf of Mexico and
surrounded by beautiful Irees and inland lakes.
Baptist Hospilal has a progress salary plan plus a
liberal fring
package. We will provide your immig-
ration paperwork cost plus airfare to relocate. For
additional infonnation, contacl: Personnel Ad-
ministration, Baptist Hospital of Southeast Texas,
Inc., P.O. Drawer n91, Beaumont, Texas 77704. All
alftrmatln adiDa empklyer.
'.
"
"
CO-ORDINATOR OF NURSING IN-
SERVICE EDUCATION AND CLINICAL
NURSING
Sal.ry" $17180 to $19 669/yr and $1 ooo/yr P F A
Dutl.
PrOVides ongomg 10
erVlce education to aU levels of nurSIOg
staff
aUalllle.llons
Baccaleureate Degree or a Diploma 10 NursIOg from a recog
nlzed school of NursIOg Ehglblhty for registration as a Re
glstered Nurse In a province or terntory of Canada Acl t
able expeJlence and expertise In the chnlcal teaching of PSV
chlatflc and general nUfSIOg Proven abll.ty to plovlde PX
pert professional advise In psychlatflc nurSing Knowledge
of Enghsh IS essential
Chanen.
This new faclhty provides an opportunrty fOI you to par
tlClpate 10 the opening and development of a new psych.
.tflC facility the first of ItS type In Canada We requlle
nurses. Mth 8n expeflence 10 p'ychlatry who ale Interested
In ðC::eptlng responSibility and learnmg forensIc psych.atry
nLlnlng skills
Benefits
EKcelient penSion plan free Llnr'orms and shoes good sick
leave benefits, evenmg. OIght and INeekend premiums, 11 Sta
tutory Hohdays 3 weeks vacation to start plus other bene
fits too nWT'lerous to list Excellenl rnsef'Vlce .rarnrng pro
gram
Hours of Work Average 37 5 hours per 'M!ek
For further mformatlon call DIIKtor of NLlrslng at 1306.
6654166 Rpglonal Psycmatflc Centre Sashnon.
k
"A.ddltlonal Job rnformatlon IS available by Wfltrng to the
address below'
"Toute rnformatlon lela1lvl\a ce concours est dlspomble en
francaiS et peut étre oblenue en ecuvant a I'adresse SUI\, an
te"
(AnticIpatory Stall'"9)
How 10 .pply
Send 'lOur application form and/or résurT1@ 10
Keith Sincla.,. St.ffrnll Consult.nt
Public Service Comml_lon of Canada
500 286 Smith Street
Wlnnlpe;. M.mlob. R3C DK6
P/
.se quote th
.ppllc.ble 'efe'enc
numbe/.t all times
12 October 1878
The CIInedlen NUrH
Nurses
The Department of Social Services, Senior
Citizen's Home Care Branch, Regional Care
Centre, Battleford, requires several registered
nurses for the new Level 4 Special Care Vnit.
Applicants must be registered nurses with at
least one year of professional nursing .
experience. Registration as a general nurse in
Saskatchewan is essential.
Salary: $15,OOO-$t7,424 (Nurse 2)
Competition: 604112-9-788. Closing: As soon
as possible.
Forward your application fOnTIS and/or
resumes, quoting position. department and
competition, to:
Public Service Commission
1820 Albert Street
ReJÚI., Suhtcbe...n
S4P 3V7
Registered Nurses
Operating Rooms
Applications are invited from Registered
Nurses with previous experience and/or
PostGraduate in Operating Room
techniques. Staff membersare rotated
throughout all the various disciplines.
Salary ($1,305 to $1,542 per month).
Benefits as per the RNA BC Contract.
Registration essential.
Please send resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
8SS West 12th Avenue
Vancouver, B.C.
VSZ IM9
University of British Columbia
Health Sciences Centre-
Extended Care Unit
Requi res
General Duty Nurses
To work as a member of an interprofessional
team in a modem 300 bed extended care unit.
Must be able to work well with elderly and
handicapped patients in a long-term care
setting. Nurses must apply and be accepted as
eligible for licensure in British Columbia.
Financial consideration lIiven for
baccalaureate preparation in nursing.
Interested persons may telephone or wrtte to:
Hosplbl Employment Oll1cer
Hellhh ScIences Centre
Unlnrshy or BritIsh Columbi.
V.ncouver, B.C. V6T IW5
Telephone: 604- 228-6764
Positions are open to both female and male
applicants.
United States
Exdtement: Come and jom us for year around
excitement on the border, by the sea, an unbeatable
combination. Enjoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed. acule care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opportunities. We have immediate openings in all
areas. Excellent salary and fringe benefits. We invite
you to share the challenge ahead. Assistance wilh
travel expenses. Write or cllIl coDed: Joe R. Lacher,
RN, Director of Nurses, Valley Community Hospi-
tal, P.O. Box 4695, Brownsville, Texas 78521: I
(512) 831-9611.
Nurses - RNs - A choice of locations wilh
emphasis on the Sunbe1t. You must be licensed by
examination in Canada. We prepare Visa fOnTIS and
provide assislance with licensure at no cost to you.
Write for a free job market survey Or call collect
(713) 789-1550. Marilyn Blaker. Medex, 5805
Richmond. Houston. Texas 77057. All fees employer
paid.
Israel
Year in Israel for Registered Nurses - unique
opportunity for English-speaking nurses with ICV-
CCV, Operating Room Dialysis, or Neonatallnten-
sive Care experience. For a one-year commitment
program offers round-trip transportation, full salary
and benefits. one month's orientation and language
classes, and one month's paid vacation. Low cost
housing available for single applicants. Send cur-
riculum vitae to Mrs. Matjorie Korenblit. RN, Nurse
Recruitment Coordinator, Personnel Office. Shaare
Zedek Medical Center, P.O. Box 293. Jerusalem,
Israel.
Miscellaneous
Get the r.cls....bout ..omen and .ddictions. Three
graphic posters for display to give your clients
important infonTIation aboul women and alcohol,
minor tranquilizers and stress. Send for your free
posters today. Available in English or French.
Q.O.L. Resource Directions. 2466 Dundas St. W.,
#506. Toronto, Ontario M6P IW9.
Graduates of 1975 Diploma Nursing Class from St.
Clair College, Thames Campus, please contact
Adrienne Clinansmith. Box 2. Birtle. Manitoba ROM
OCO for reunion information.
Department or Nursing,
(;race Maternit
Hospital, Halir..
_eeh
Head Nurse
for
Special
eonatal Care Unit
ChaliengmgJob opportumly in nconi:l.tèl.l nur-...mg In Canada' ""
Iargc'l oh'lclnul hv..ptlal (
OOOdcll\.ene",/)'ea.... IUUO
adml....lon
10
peclaJ ",,",eonaldl (a...c l'ml/
ea"'l. MdJor
ob..leln..al and neonalaJleadunø ho!!opltal for Diilh,lu"le
l m\'er"lt
' and the cennal oÞ...tetn..al rcferral umt fo... No\.a
cotla. Pnnce Ed\olra...d hland dnd part!!. of New Ðrun..w...k
Re...pon
.ble to thc Chm..al Co-o...dmator for orøam.latlon and
.wmmlstrdtlon of climcal nu.....mø ..arc øiven to acutely III and
con\.ale.-.cmø newhorn mfanl.... E,cellen. opportumty to perfcct
prc
cnl programme... and to dc\.elop new progrdmme... "limed iit
impro\.'maand eJltcndmø the !!ocopeof ncondtdl nur...ml': Salary
acco...ding to Nova Scotia N u.....e.... Union C ontn.ct Po,t
a\'all..ble Immedlatel
fhr ('8ndldale
mu...t ha",e 3 yea...... expenencc 10 nconataJ
nur...mg and mu.... he ehl':ll1lc fo... regl
tration 10 Nova
Oll.iiI
Management e'prnencc and ...kl1l.... bl'"Oad knov.ledge of
pcnn",\dl hc",lth com:epl" dnd grilldualion from a po..\ diploma
neonataJ nur.-.ml! cou......C' de....raþlr ^ppl} 10 wnting to:
\b
5 M.rl.n1 h"'luwn. R. "".
DlrKlor of .....unlnR
GrlliCc \i.lcrnh,. Hospd8l
H..if... .....0". Scotia
B.\H I"J
Opcmng
arc al..o available for 8cneral dUly nur..e... In Ihe
neonataJ umt.
1 ,
J-.
RN's and GN's
Want to nurse in:
Reno, with St. Mary's Hospital?
Atlanta. with Piedmont Hospital?
Cleveland, with St. Alexis Hospital?
Or how about Apple Ri ver Valley
Memorial. in Wisconsin?
If you are considering a move south.
contact us. We probably represent al
least one hospital that has what you
need.
Wood, Watson Professional Search
Suite 207
1962 Y onge Street
Toronto. Ontario M4S IZ4
Supervisor of Community
Health Nursing
Vegreville Health Unit requires a
suitably qualified and experienced nurse
forthe above position.
Responsibilities include planning,
implementation. direction, co-ordination
and evaluation of the Community Health
Nursing Program. In the absence of the
Director, assumes the duties of same.
Salary range: $20.899 - $25,427.
Excellent fringe benefils.
Application in writing including
curriculum vitae should be addressed to:
Mrs. R. Cunningham
Director
VegreviUe Health Unit
Box 99
Vegreville, Alberta
TOB 4LO
This position will remain open until a
suitable candidate has been selected.
Nursing Co-ordinator
Applications for the position of
Medical-Surgical Co-ordinator are
being accepted for mid-September
by this 300 bed fully accredited
hospital.
Experience in supervision with a
Bachelor ofN ursing Degree
preferred.
Tempordry accommodation
available.
Please reply sending a complete
resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
N5A 2Y6
The C8n-.llen NUrH
McMaster University
Faculty of Health Sciences
Clinical Nurse Specialist -
Gerontology
Associate Dean of Health Sciences
(Nursing) and Director of School of
Nursing required for January I, 1980.
The appointee will be expected to
provide leadership for the further
development of Nursing within the
Faculty of Health Sciences and its
programmes in education, research and
clinical service.
Excellent opportunity for a Masters'
prepared Clinical Nurse Specialist with
experience in Gerontological Nursing.
The Clinical Nurse Specialist will
function as a Change Agent, Researcher,
and Educator promoting a high standard
of care.
Qualifications: Preferably a doctoral
degree with some administrative
experience in the University setting.
St. Boniface General Hospital is a 880
bed acute care hospital. The Extended
Care Unit 188 beds and Day Hospital
provide a progressive Geriatric
Rehabilitation Program.
Salary and appointment level
commensurate with qualifications and
eAperience.
Excellent salary and benefits.
Applications including curriculum vitae
and names of 3-4 referees should be sent
to:
Please send resume to:
Dr. J. F. Mustard
Dean
Facult
of Health Sciences
McMaster t:ninrsity
1200 Main Street West
Hamilton, Ontario
L8S oU9
Mrs. L. Rivers
St. Boniface General HospItal
409 Tache Avenue
WinnIpeg, Manitoba, Canada
R2H 2A6
EXPERIENCED RN'S &
NEW GRADS
"'THE PERFECT OPPORTl
ITY"
Saint o\nthon} Hospital, located in Columbus, Ohio.
This 400-bed acute care facility offers excellent opportunities
for furthering your nursing career.
No Contracts to Sign
Rotating Shifts
Air Fare Paid
One Month Free Accommodations
Plus Exciting Challenges
Saint Anthony. a medical-surgical institution. has a complele
range of services. including:
e Open Heart Surgery
e Intensive and Coronary Care
e Definitive Observation Unit
e Renal Dialysis
e Diagnostic and Therapeutic Radiology
e 24 Hour Emergency Department
Don't
ait, call or
rite immediatel}.
Make the change to an institution that lets you be what you
want to be. For further information. call our Nurse Recruiter,
:'Iiorma Shore, Collect.
EXCLlSIYE CANADIA/Ii REPRESE"iTATIYES
RECRl ITI
G REGISTERED "il'RSES J'IoC.
'.1111
IRIII
U'.IIL
1200 Lawrence Avenue East
Suite 301, Don Mills
Ontario M3A ICI
Telephone: (416) .w9-5883
.
OcIober 1171 13
r
""'"
,
U So HUP.SE
RECAUITMENT
AVI
Offers R.N. 's
An UNUSUAL OPPORTUNITY.
A.MJ. Will FURNISH One Wly AIRLINE TICKET 10 Te.as
end $SOO Inillel U
ING EXPENSES on eloan Basis.
After One Yeer's Service, This loan Will Þe Cancelled
MI American Medical Inlernational Inc.
. HAS 50 HOSPITALS THROUGHOUT THE U.S.
I . Now A.MJ.II R.crulIlng R.N.'I lor HOlpll.llln TIIiI. I
Ilmmediitl Oplnlngl. Slllry Rlngl 511.000 10 516.500 plr vllr.j
. You can enJoy nurSing on General Medlcone. Surgery. ICC.
CCU. Pedlatncs and Obstetncs
. A M I provides an excellent ollentatlon program.
on-servoce tralnong
r------------"
I -
I U.S. Nurse Recruiter _
I P.O. Box 17778, Los Angeles, Cillif. 90017 I
I . Wlthoul obligation. please send mé more _
I Inlormallon and an ApplicatIOn Form I
NAME
I AOOR ESS =========== I
I ClTY_ --- ST.___ ZIP___I
TELEPHONE (__1_ _ __ _ ____
I LlCENSES:____________
_ SPEClAlTY:________ ____
VEAR GRAOUATEO: _ _ _ STATE: _ _ __
'-____________rI
..---
; , .
I '
I
.
c
-
.
S4 October 1878
The Cln-.llen NUrH
Bermuda Hospitals Board
Applications are invited for the position of Assistant Director of
Nursing - Quality Assurance in our 320 bed hospital which is
accredited with the Canadian Council on Hospital Accreditation.
The successful applicant would be responsible to the Director of
Nursing for the development and direction of a new Department
of Quality Assurance. This department is being established as a
support service to the Department of Nursing in particular as
well as to other hospital departments, and will be responsible for
coordination of new employer orientation; continuing and
inservice education: quality control surveillance, including
infection control and nursing audit; and patient education. the
department will have a total staff of five persons.
Applicants should be registered nurses with several years of
nursing experience, preferably in both nursing education and
nursing management positons, Master's Degree in Nursing or
Nursing Education.
Interested applicants should apply in confidence submitting
resume and statement regarding desired salary.
Director of Nursing
King Edward VII Memorial Hospital
P.O. Box 1023
Hamilton 5, Bermuda
Senior Clinical Nurse
COJLJLEGE OF
NEW CAJLEDONIA
Nursing Instructors
Located in the geographic centre of
beautiful British Columbia. the College
of New Caledonia serves a region of
120,000 people. Applications are invited
for positions of full-time nursing faculty
at the College of New Caledonia with a
start date in January 1980.
Qualifications: Applicants must have a
baccalaureate degree and must be
registered or eligible for registration in
British Columbia. Preferably applicants
will have two years of nursing practice
and teaching experience. In particular.
medical-surgical nursing experience is
preferred.
Salary: $18.050.00 to $32.450.00 per
annum. Placement dependent upon
qualifications. Relocation assistance is
also available.
To apply. submit a curriculum vitae and
the names of three references to:
Ms. L. Winthrope
Personnel Officer
CoUege of New Caledonia
3330 - 22nd A venue
Prince George. B.C. V2N IPS
.,
I
rrv Æm
Nurses/Psychiatric Nurses
Graduates from approved Schools of Nursing with
eligibility for registration with the appropriate
Professional Association in Alberta are invited to
apply for Nurse I and Psychiatric Nurse I positions at
the Michener Centre in Red Deer. Alberta. Michener
Centre provides residential care and trdining for 1.700
developmentally handicapped residents. Nurses will
participate in life skills progrdmming for the residents
in addition to providing general duty nursing services
Red Deer is a progressive and growing community
with a present population of 40,000. It is situated
mid-way between Calgary and Edmonton in the heart
of Alberta's beautiful Parkland area. Lakes. parks, and
the Rocky Mountains are all in close proximity and
recreational opportunities abound.
Salary $14,748- $17,340
Competition #9176-10
This competition will remain open until a suitable
candidate has been seIc
ted.
Apply to:
Personnel Administrator
The Michener Centre
Box 5002
Red Deer, Alberta
T4N 5Y5
Telephone: (403) 343-5611
CoUq:e of NursinR
llniversit} of Saskatche"an
Community Health Nursing
Specialist
This position will be a joint dPpointment
between the College of Nursing.
UniversIty of Saskatchewan and the
Department of Heallh. City of
Saskatoon. The purpose is to promote
the development within the Depdrtment
of Health. City of Saskatoon. pmctice
facilities for students involved dt the
University of s..skatchewdn dnd to do so
in a way that protects the quality of
service to clients. families dnd the
community.
Qualifications:
e Masters degree with d major in
Community Health Nursing.
. Progres"veC.H. Nursing
experience in which leadership ability.
coordinating abIlity. teaching skills. dnd
competence as aCHN have been
dò:monstmted.
. Current registration in Saskatchewan
. Evidence of hedlth and emohonal
stability required for the demands of the
position.
Salary level in accordance with
university policy and the faculty mnk for
which the candidate is qlldlified.
'\pplicdtions including a detailed resume
dnd names of three referees should be
addressed to:
Hester J. k.ernen
Professor and Dean
Collq:e of NursinR
1 nÏ\ersit} of Saskatche" an
Saskatoon. Saskatche"an
S7N OWO
Required
Salary -GN-4-$I3579.00 to
$16506.00 annually.
Applicalions are invited for Senior
Clinical Nurse in normal newborn and
neonatal intensive care nursery.
Applicants must have post-basic
preparation in neo-natology and a
minimum of one year's recent clinical
experience in a normal newborn nursery
or two years' current clinical nursing
practice in a neonatal intensive care unit.
Applicants must possess leadership and
teaching ability to integrate patient care
and staff development.
Must be actively registered or eligible for
registration in New Brunswick.
Please forward application and resume
to:
Nurse Recruitment Officer
Dr. Everett Chalmers Hospital
P. O. Box 9000
Fredericton, N. B.
E3B 5N5
Telephone 452-5177
m
. J<<!b
.
ÐtSSaÖS...act1.oß.. .
the NUOIber 1
Killer of
Nursing
lIere at the Careers know bet"re making any commit
L'CrA
1edjGÙ Cen- nk'nL You'll also learn about
l\'aila-
ter ,,'e're ,'etY concerned with joh satisbction ahle housing. cost of Ih"ing. the California
. "
in
ursing" \'fe respect your professional lifcstyle. and any other questions you han'.
position en(
ugh to kno,,' that
:ou neL'd all \X'c arc always looh.ing for professionals
the facts before you come to I CIA. or any in Clinical !\:ursing and :'\iursing
lanagcmem
other place for that matter. who feel that nursing is a positi,'e experience.
Besides making a highly competitin' Simply forward the coupon to me and J'IJ
salary and useful benefits, you ,,'ill find indi tah.c it from there.
,-idual responsibility and personal in\'()h'e-
ment at I TClA. In addition. \'()l\ ,,'ill be using
. ,
e,'ery bit of nursing education you ha,'e
acquired and be doseh' suppoI1ed as a
memher of your patients' health care team.
end in the coupon and 'H.,'II prm'ide
you ,,-ith all the information you'll need to
.
A.nt hony \'feat herford, R:\'
:\'urse Recruitcr
I "CL\.
kdical Center
10911 \X'c\'l)urn A ,'en ue
Los Angeles, CA 9002-t
(21.)) R2::;-HI-t1
I ....
------------,
IJCLA I
; e ,,,11 me mor" abolll ['CIA I
Medical I Aòòn........ I
City
,.
r . .
tatl" I .
'-'=' IU; Zip
\n \l!ìrm.II;H" \<I;"n fmplo\l"r Tdl"phonl" (
. Hl"st timl" to call .
I
P
Tific dinical Jrl"a ." I
R:'Ij _I.\";\j Datl" of (.raòuatton
L C:'Iò1()""'9
------------
III OcIober 111711
The Canedlen Nur..
Our Tradition is Excellence
O'Connor Hospital
San Jose, California
We represent a 300-bed acute care facility that has teachmg
affiliations with major universities and other community
colleges.
O'Connor Hospital is located in the beautiful southern San
Francisco Bay area. A community rich in paßs. beaches,
cultural and educational recreational activities, new shopping
centres, many exciting restaurants and offers a very fine and
diversified mode ofliving plus close by areas of mterest su.:h as
mountains and desert resorts and "exciting" Lake Tahoe.
Experienced RN's can finð challenging opportunities in the
following specialties:
. I.C.U.
. c.C.U.
. Med-Surg
Plus many other department:..
As a key member of our nursing team, some of the extensive
benefits you wiJI receive are:
. active on-going in service program
. medical and health insurance
. retirement and dental plan and many other excellent
benefits.
For further details contact our Canadian Representative
Miss Shore
Nurse Recruiter
Recruiting Registered Nurses
1200 Lawrence Ave., E., Suite 361
Don Mills. Ontario M3A ICI
(416) 449-5883
Registered
urses
I
{)O hed ho...pital ad.ia
ent to Lni\er...it} of
.\Iherta camrlh olTer... emr1o} ment in
medicine, surgery, pediatrics,
orthopaedics, obstetrics, psychiatry,
rehabilitation and extended care including:
.Inten...i\ecare
. Coronary oh...cnation unit
. Cardiova...cular ...urger}
. Burn... and rla...tic...
. :"Jeonatal inten...ive care
. Renal dialy...i...
. Neuro-surgery
Planned Orientation and In-Service Education Programs.
Post Graduate Clinical Courses in Cdrdiovascular-
Intensive Care Nursing and Operating Room Nursing.
\ppl
to:
Recruitment Ol1ker - '\ur..inJ!:
l ni\er..it
of -\Iht'rta Ho'pital
M
O- 112th Street
Edmonton. .\Iht'rta
Tó<; 287
Registered Nurses
Neonatal Intensive Care Unit
Registered Nurses
Delivery Room Suite
Applications are invited for the above positions.
Experience in High Risk Maternal and Newborn
Care required.
Ontario Registration.
Excellent salary and benefits.
Contact:
Director of Nursing
Grace Hospital
339 Crawford Ave.
Windsor, Ontario
N9A 5C6
Tel. No. 255-2294
[1]@
University of
Alberta Hospital
fdmonton. Alberta
o
The Cen-.llen Nur..
Oct_lll1 17
Q: Nam.e 4 things
that depend upon
the sun for growth.
A: QJ
Oranges
Tomatoes
Peaches
3 out of 4 isn't bad, but let's concentrate on the one you
missed. N.M.E. stands for National Medical Enterprises,
a progressive multi-hospital network that offers you a
choice of 23 preferred locations to work and live in.
Our community hospitals vary in size from 50-310
beds, the facilities are modern, and equipped with the
latest in health care apparatus.
Now, let's talk choices. With winter already gearing up,
our generous relocation assistance can whisk you away
to the warm California or Florida beaches, Texas plains
or Washington pines. Adjust your lifestyle to any of our
locations, and if you decide to move within our N .M.E.
network, you keep your benefits and we assist in the
relocation. No way to lose.. .every way to gain. Now
that you've got all the answers, and are ready to grad-
uate on to N.M.E., call me collect: Shirley Cotten, RN,
at (213) 477-1941, or send the attached coupon for
immediate consideration
Shirley Cotten, RN, Manager-Nurse Recruitment
National Medical Enterprises, Inc.
11620 Wilshire Blvd.,
Los Angeles, CA 90025
--------------- ,
. Please send me
I more inform a- My specialty is_ I
tion about a I r RN L S t d t
I choice career in: am an u en I
o Northern Graduation Date
I California Name I
I 0 Sou
hern Address I
CalIforma
I 0 Florida City State Zip_ I
o Washington Telephone ( )
. 0 Texas CN 1079 .
..--------------..
BIDe
118 October 111""
The Cenedlen Nure.
Wish
yan were
here
. "I
\jl
'1 J., '" . ,
- ') i
Iv.
"
.. .in Canada's
Health Service
Medical Service.. Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand gro\\<s every day.
Take the North for example. Communit) Health
Nursing is the major role of the nurse in bringing health
'iervices to Canada's Indian and Eskimo peoples. If you
have the qualitìcations and can cafI) more than the
nonnalload of responsibilit) '" why not tìnd out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing\\< hich in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career. and it is possible to advance to
senior positions. In addition. there are educational
oPJ
Jrtunities such as in-service training and some
tìnancial support for educational leave.
For further infonnation on an). 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
IN
I
I Address I
I City Prov I
I I -*- Health and Welfare Sante el Bien-étre social I
OW' Canada Canada
,-....---,
Nursing Opportunities in Vancouver
Vancouver General Hospital
tf you are a Registered Nurse in search of a change and a challenge -
look into nursing opportunities at Vancouver General Hospital, B.c. 's
mllior medical centre on Canada's unconventional West Coast. Staffing
expansion has resulted in many new nursing positions at all levels,
including:
General Duty ($1305. - 1542.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the opportunily
you've been looking for.
For those with an interest in specialization. challenges await in many
areas such as:
Neonatology Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Burn Unit
Paediatrics
Inservice Education
Coronary Care Unit
Hyperalimentation
Program
Renal Dialysis & Transplantation
tf you are a Nurse considering a move please submit resume to:
Mrs. J. MecPhal1
Employee Relations
Vancouver General Hospitel
855 West 12th Avenue
Vancouver, B.C. VSZ IM9
Advertising Rates
For All Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
Rates for display advertisements on request.
Closing date for copy and cancellation is 8 weeks prior
to 1st day ofpuhlication 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 Drivewa}
Ottawa, Ontario
K2P tE2
"
Th. C.nedlen Nur..
0
11179 III
Index to
Advertisers
October 1979
Ayerst Laboratories
The Badge Maker
The Canadian
urse's Cap Reg'd
CIBA Phannaceuticals
The Clinic Shoemakers
Dept. ofNauonal Health and Welfare
Designer's Choice (A Division of
White SisterUnifonn Inc.
DowChemical of Canada Limited
Equity Medical Supply Company
Frank",. Horner Limited
J.B. Lippincott Company of Canada Limited
The C. V. Mosby Company Limited
Parke, Davis & Company Limited
Phannacia (Canada) Limited
Posey Company
W.B
aunders Company Canada Limited
chering Canada Inc.
Smith & Nephew Inc.
StudioClavet Inc.
U nifonnity
Upjohn Health Care Services
Wellcome Medical Division
(Burroughs Wellcome Limited)
59
I:!
14
54, Cover 4
4
II
Cover 2
16
40
8,56
41. 51
46,47
13
7
58
53
Cover 3
9
14
15
55
70
Adl'ertisitlR Representatil'es
Adl'ertising Manager
Jean Malboeuf
601. Côte Vertu
St-Laurent. Quebec H4L IX8
Téléphone: (514) 748-6561
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa. Ontario K:!P IE:!
Telephone: (613) 237-:! 133
Gordon Tiffin
190 Main Street
U nionville. Ontario UR :!G9
Telephone: (416) 297-2030
Richard P. Wilson
219 East Lancaster Avenue
Ardmore, Penna. 19003
Telephone: (215) 649-1497
\Iember of Canadian
Circulations Audit Board Inc.
1m:]
I
OPPORTUNITY Ærm
Clinical Nurse Specialist
Alberta Hospital. Ponoka, a 500 bed accredited active
treatment Psychiatric facility, is now seeking
applications from creative nurse specialists seeking a
challenging career opportunity.
Qualifications: Graduate of an approved School of
Nursing and eligible for registration in an Alberta
Association. Baccalaureate and Minimum of Master's
degree in Mental Health and/or Behavioral Sciences.
Considerable work experience, preferably in the
Mental Health Field.
Salary: $18,024 - $22,596
Competition #9212-5
This competition will remain open until a suitable
candidate has been 'ielected.
Apply to:
Personnel Uijrector
Alberta Hospital
Box 1000
Ponoka, Alberta
TOC 2HO
Registered Nurses
The Petfect Opportunit}
Could Be
Right Around The Corner
How can you be certain that the opportunity you see to-day is the
best one for you?
The truth is. you can't. without the guidance of job-market
professionals who know the nursing business as well as the
placement business. That's why. before you sign on that dotted
line to-day. you should check with Recruiting Registered Nurses
Inc. We're the Canadian Medical Placement Specialists
throughout the United States.
We know where the bests jobs are, how much they pay. and
where you' II fit in. R.R.N. can give you more than just ajob-
we can help you build a satisfying career.
R. R. N. has immediate positions available in:
California- Texas-Florida-Ohio
Don.t wait !!!! Call or write immediately for further information.
Recruiting Registered Nurses Inc.
1200 Lawrence A
enue East, Suite 301
Don Mills (M3A ICIIOntario
Telephone: (4161 449-5883
......0 Fee To Applicants"
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 b.lby 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.
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Available in 10 and 50 g tubes and 115 g and 450 gJars.
"'M
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Burroughs Wellcome Ltd.
laSalle. Qué.
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_ When friends or patients ask your
advice concerning relief of cold
symptoms consider the advan-
tages offered by the CORICIDIN
family of cold products. The
various CORIÇI DIN*preparations
are formulated to provide effec-
tive relief of specific groups
of symptoms that general
accompany colds. Regular
CORICIDIN (antihistamine,
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at the first sign of a cold
where congestion is not a
problem or when decon-
gestants are contraindi-
ated. CORICIDIN 'D' is
formulated for use when
nasal or sinus congestion is
pronounced.
For your younger patients CORICIDIN
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CORICIDIN 'D' MEDILETS, both chewable tablets, and
pleasant tasting CORICIDIN Pediatric Drops for infants or
very young children.
Free Booklet Offer
We've attempted to answer many questions about colds,
their causes, effects and relief in an informative booklet
entitled "How to Nurse a Cold". It's yours, free of charge, if
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Additional copies only available upon written
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Both may benefit from Siow-R' folic.
Prophylactic iron and folic acid supplementation recently, a number of physicians have queried the
during pregnancy is now an accepted practice effect of oral contraceptives on serum fola
levels
among Canadian physicians. It has also been in women. Dr. Streiff reports: "This complicatio"r1
established, through the publication in 1974 of (of oral contraceptive therapy), however, m Ë Y e
Nutrition Canada 1, that many Canadian women recognized more frequently in the future... Fate
may not be obtaining the necessary nutritional deficiency associated with oral administrati n of
requirements from their diets. For instance, 76.1 % contraceptives does not necessarily requir
of adult women (20-39) had inadequate or less than discontinuance of the drug regimen but f9 ic acid
adequate intake of iron and 67.9% were at high or therapy is definitely indicated."2 I
moderate risk of low serum folate levels. More
CIBA
Dorval, Quebec
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10539
. Canada's health assocIatIons
work together to prevent
handicap In newborns
. Montreal's Hereditary
Metabolic Disease Unit
. An outreach program for
Vancouver mothers
. Ten days of tomato
sandwiches? A healthier
lifestyle for the chronic
schizophrenic
I'J" .: fßJ i\JG LIBRARY
NOVEMBER 1979
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ONE OF TODAY'S MOST PRESTIGIOUS LABELS
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Sizes: 3-13
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White. Pink.
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White, Pink.
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The
Canadian
Nune
November 1979
The official journal of the CanadIan
Nurses Association published
in French and English
editions eleven times per year.
Volume 75, Number 10
Input 6 Healthiest babies possible Jennifer Warnyca,
Susan Ross.
Christine Bradley 18
News 7 A teenage pregnancy epidemic? Susan MacDonnell 22
You and the law 14 A regional program for the management T eTry Reade.
of hereditary metabolic disease Caroline Clow 24
Names 45 The single mother: can we help? Jo Billung-Meyer 26
Books 48 Coalition for the Prevention of Handicap M. Anne Besharah 29
Calendar 62 O.B. staff alert Sheila Cameron 30
Diagnosis: Down's Syndrome LindaJ. Nixon 33
Closeup on Fetal Alcohol Syndrome Jane Bock 35
The nurse in the community:
infant stimulation Judith Banning 36
Handicap: A parent's pen;pective Heather Rankin 38
Nut 'tion nd the chronic schizophrenic Jennifer Pyke 40
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""IIovember morning in the
marsh" might well be the title that
l6-year-old Meena Boyal of
Stratford, Ontario, had in mind
when she painted this month's
cover illustration. The painting is
from the archives of AU About Us,
a non-profit organization founded
seven yean; ago to promote
creativity in children.
--,
The Canadian Nurse welcomes
suggestions for articles or unsolicited
manuscripts. Authon; may submit
finished articles or a summary of the
proposed content. Manuscripts
should be lyped double-spaced. Send
original and camon. All articles must
be submitted for the exclusive use of
The Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
The views expressed in the articles
are those of the alJthors and do not
necessanly representlhe policies of
the Canadian Nun;esAssociation
ISSN 0008-4581
Canadian Nurses Association,
.sO The Driveway, Ottawa, Canada,
K2P IE2.
Indexed in International Nun;ing
Index, Cumulative Index to Nun;ing
Literature. Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medicus, Canadian Periodical
Index. The Canadian Nurse is
available in microform from Xerox
Univen;ity Microfilms, Ann Amor,
Michigan 48106.
Subscription Rates: Canada: one
year. $10.00; two years, $18.00.
Foreign: one year, $12.00; two
years, $22.00. Single copies: $1.50
each. Make cheques or money
orders payable to the Canadian
Nurses Association.
Change of Address; Notice should be
given in advance. Include previous
address as well as new, along with
registration number, in a
provincial/territorial nurses
association where applicable. Not
responsible for journals lost in mail
due to eITOn; in address.
Canadian Nun;es Association. 1979.
4 November 11179
The C.n-.llen Nur..
perspective
Guest Editorial sexuality that they hesitate to Nurses are in an excelIent
Shirley Wheatley ask for information and position to effect a change. In
direction from anyone, most many settings we are the
How many times, in the past of all their family physician. primary contact. In schools, \
year, has your caseload The teen years are a time clinics, hospitals, even
included a teenage for testing: teens test their socially, we can let teenagers
mother-to-be? Experts now parents' authority in many know we are available to
estimate that about two thirds areas and. even when the listen to their questions. Of
of North American teenage communication channels are course, this means making ;.-
women have had sexual open, there is often reluctance sure we understand our own
intercourse by the age of 19; to discuss sexuality and values and attitudes.
about 25 per cent of them wilI attendant values. At the same Fóllowing this, we must
be pregnant before the age of time, teens are subject to ensure that the necessary
20. considerable pressure from services are available in the
I n the province where I their peers and from the media community: clinics, About the author: Shirley
work. a 1917 study of 486 to look and act "sexy". Many information centers, hospitals Wheatley is president-elect of
teenagers attending birth teens are convinced that they and schools should have the /8,052-member Registered
control clinics indicated that are the only one in their crowd volunteer and professional Nurses Association of
approximately one third of not sexually involved. staff trained and available. Ontario. A graduate of the
this number were sexualIy Just as there is no single Their manner mU.51 invite and Nurse Practitioner program
active by their 15th birthday. cause, there is no single not intimidate the young at the University ofT oronto,
In that same year, one third of solution to this dilemma. The people who need their help. she was until recently
the 60,000 reported abortions question is not whether we As respected members of super\'isor of community
performed on Canadian believe that teenagers should the community. nurses are in workers with Family Planning
women were on teenagers. 30 or should not be sexualIy a position to lobby for these Services, Department of
per cent of whom were under active; the fact is that large services through their local Public Health inToronto./n
the age of 16. numbers of them are and they health units, school boards. this position, and as a
As nurses and as parents, don't ask permission first. local government - any part-time nurse practitioner at
we must ask ourselves: why is TelIing them about sex does mechanism available. In Don Mills Birth Control
this happening? not condone irresponsible Ontario, Family Planning will Clinic, she has worked to
The obvious answer is behavior; it simply shows that soon be a core or mandatory increase awareness of birth
that teenagers today use you respect their ability, given program in all health units. control and sexuality in young
contraception sporadicalIy or some guidance, to make ChalIenging local school people through seminars,
not at alI: more than 80 per decisions for themselves boards at the elementary and wor/...shops, etc.
cent of them use no effective based on adeq uate and secondary school level as to [/I September, Shirley
contraception at first reliable information. We must what is being taught, and how, opened a private practice of
intercourse and many do not let our teenagers know their is another strategy we can nursing from her home, .. Se
f
approach a clinic or doctor questions are valid and their pursue. Home and school Care Consultants". As an
until after they have judgements sound. associations are an excelIent independent nurse
experienced a pregnancy I believe kids have the medium for reaching parents. practitioner, she expects 10 be
scare, ifat alI. right to express their I nvite yourself and/or another seeing "indh'idual clients for
What do adolescents sexuality, at any age. and local expert to a meeting and health assessments. as well as
actually know about today, when teens are invite parents to discuss their teaching and working with
contraception? Outwardly maturing earlier and concerns with you. various groups on a contract
they appear very remaining economically Team work is a concept hasis. "
sophisticated and some of dependent longer, ifthey very familiar to nurses and in A graduate of Mack
them in fact have some basic choose to express themselves this case it can be applied in a Training Schoolfor Nurses,
knowledge of how their bodies through intercourse. perhaps community context. St. CatherinesGeneral
work. What they don't have is they are simply being less Determine who your alIies are Hospital, Shirley has worked
specific information about hypocritical than past in the community; work with in i'arious capacities at the
how and when they can generations. AII young people them to lobby for good sex H ospitalfor Sick Children in
become pregnant, where to experiment sexually and some education and services. Have Toronto, including head nurse
get reliable information and include intercourse. We must a strong and united front for in the Teen Clinic where, she
services that wilI prevent also support those who the inevitable opposition. says, "approximately 40 per
pregnancy, and the choose not to be involved. We have nothing to lose cent of our clients were
opportunity to dialogue with There must be a forum for and everything to gain from teenagers with problems in
peers and experts in their own dialogue for all young people, improving the future the area of sexuality,
community. As a society, we regardless of age or sex, emotional and sexual health of contraception, i'enereal
make them feel so guilty ahout where they can test their our young friends.
disease, pregnancy and
any expression of their opinions and values. abortion."
Th. C.nedlen Nur..
Novem.....'11711 5
for professional growth...
1 MANUAL OF PEDIATRIC
NURSING CAREPLANS
Deportment of Nursing, The Hospital for Sick Children,
Toronto.
The authors cover the entire spectrum of pediatric disorders
and present two sets of interrelated care plans: one based on
the hospitalized child's age; the other on his or her specific
disease. Throughout, the manual emphasizes the parents'
important role in the treatment program and offers specific
guidelines for their involvement.
little, Brown. 320 Pages. 1979. $13.00.
2 GERONTOLOGICAL NURSING
By Charlotte Kopelke Eliopoulos, R.N., B.S., M.S.
This practical new book provides a comprehensive review of the
medical, surgical, and psychiatric problems associated with aging,
accompanied by related nursing interventions. Specific coverage
is given to measures designed to promote good respiration,
elimination, and activity to compensate for age-related changes
interfering with these functions. Common diseases of each body
system and their unique features in the aged are discussed in
detail.
Harper & Row. 384 Pages. Illustrated. 1979. $15.00.
3 NURSES' DRUG REFERENCE
Edited by Stewart M. Brooks, M.S.
All nurses will welcome this fingertip guide to drugs, organized
specifically with their needs in mind. It lists alphabetically over
500 generic drugs and describes-in an easy-to-consult format-
each drug's action and use, dosage and administration, cautions,
adverse reactions, composition and supply, and legal status. A
glossary of drug classifications affords extensive cross-referencing
for quick referral to hard-to-find information. Impeccablyorga-
nized and absolutely reliable, NDR will serve as the standard ref-
erence for any health practitioner who dispenses drugs regularly.
little, Brown. 500 Pages. 1978. Paper, $14.25. Cloth, $27.00.
4 THE LIPPINCOTT MANUAL OF
NURSING PRACTICE, 2nd Edition
By Lillian Sholtis Brunner, R.N., B.S., M.S.N.jand Doris Smith
Suddarth, R.N.., B.S.N.E.,' M .S.N.
This monumental Second Edition of a modern classic-the most
comprehensive single-volume reference on nursing practice ever
published-incorporates massive revision and updating to offer
the latest and most accurate information available. What this
means is more detailed, substantive, and complete coverage
of every phase of medical/surgical, maternity, and pediatric
nursing!
lippincott. 1868 Pages. Illustrated. 1978. $29.95.
LIPPINCOTT'S NO-RISK GUARANTEE
Books are shipped to you On Approvalj if you are not entirely
satisfied you may return them within 15 days for full credit.
5 PERSPECTIVES ON ADOLESCENT
HEALTH CARE
By Ramona Thieme Mercer, R.N., Ph.D.
With 72 Contributors.
Counseling adolescents on their optimal growth and health
requires a wide range of specialized knowledge and skill. Here at
last is a text that not only presents the major ideas and issues
on this subject; it offers valid, practical suggestions that can be
put to use in a variety of clinical settings.
Ramona Thieme Mercer together with twelve contributing
authorities, develops several major themes in relation to specific
perspectives on adolescent health. These themes include the
special psychosocial needs of the adolescent, the interrelation-
ships of his or her family members, and the effects of larger
society on the adolescent's evolving adult identity.
lippincott. 420 Pages. May, 1979. $15.50.
6 OPERATING ROOM TECHNIQUES
FOR THE SURGICAL TEAM
Edited by Lois C. Crooks, R.N., B.S.Ed.
The first two chapters deal with aseptic technique and sterili-
zation and with the anesthetized patient. The emphasis is on the
underlying principles, as shown by the concentration on the four
sources of contamination in the chapter on aseptic technique.
The remaining ten chapters of OPERATING ROOM TECH-
NIQUES FOR THE SURGICAL TEAM are devoted to precise
descriptions of anatomy, disease entity, diagnostic measures,
surgical techniques, and nursing responsibilities for the most
frequently performed surgical procedures.
little, Brown. 459 Pages. Illustrated. 1979. $ 21.00.
Lippincott
J. B. LIPPINCOTT COMPANY OF CANADA lTD.
Serving the Health Professions in Canada Since 1897
:
:: .o :::::_
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Please send me for 15 days 'on approval':
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3
6
4
5
o Payment enclosed (postage & handling paid)
o Bill me (plus postage & handling)
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Prices subject to change without notice.
CN" 179
II November 1979
Th. Cenedlen Nur..
input
The Canadian Nurse invites your
letters. AU correspondence is
subject to editing and must be
signed, although the author's
name may be withheld on request.
A course to follow Look at programs at home Apathy syndrome
In the last paragraph of A As a nurse in Canada, I Although I agree in CNA MEMBERS AND
Challenge in Office Nursing was astonished by an article in principle with the opinion ASSOCIATION
(Frankly Speaking, Sept. '79) a recent Canadian Nurse expressed by Jessica Ryan in MEMBERS
is the statement "I don't think entitled "Not all patients need Frankly Speaking, June 1979,
there is a course anywhere in hospitals" (March 1979). I believe that the syndrome of CNA members and association
office nursing." J have just The author seems to have apathy is a result of fast-paced members are invited to submit
enrolled in a 30 hour course little faith in the Canadian living. The apathetic resolutions for presentation at
offered at the Sir Sandford system of community health individual, let alone the the Annual Meeting and
Fleming College in care. Granted, there may be apathetic nurse, is blasé about Convention, June 1980.
Peterborough, Ontario which room for change and/or his/her environment. Resolutions must be signed by a
is entitled 'The Medical Office improvement but the fact As a nursing educator J CNA member and forwarded to
Assistant' . remains that there are new feel partly responsible for the the Resolutions Committee, CNA
Topics covered include and exciting programs being lack of interest encountered in House by 31 March 1980.
first aid in medical developed to shift health care the young nurse.lfthe student
emergencies, assisting with into the community. For is not instructed sufficiently in Resolutions received after 31
examinations, special example, there is a current chapter and union affairs, how March 1980 cannot be presented
diagnostic tests, diets, and interest in encouraging the can we hope that he/she will to the annual meeting.
others. public to become more be interested as a professional
I am hoping there will be involved in their own health nurse? Most teachers are
more emphasis on care as well as the care of ill actively involved but how EDITOR
nurse-patient communication family members at home. The often do we bring the students ANNE BESHARAH
and follow-up care in the St. John Ambulance and the into our discussions? Perhaps ASSISTANT EDITORS
program, and I inte,
d to Canadian Red Cross have this could be one small step in JUDITH BANNING
emphasize this nee
in class traditionally offered courses diminishing apathy. JANE BOCK
discussion. .' I
in home nursing. In 19'77-1978, -Monique L. Levesque. PRODUCTION ASSISTANT
-Jane (Holden) Allison, materials for a multi-media RN., B.ScN., Bathurst, GIT A DEAN
Fraserville.Ontarió. home health care course were N.B.
developed for the two CIRCULATION MANAGER
Other side up agencies. The program is Comment on PIERRElTE HOlTE
The drawings on page 23 called "There's No Place Like September's Editorial ADVERTISING MANAGER
(July/August) are confusing to Home for Health Care" and Nursing today is a very GERRY KAVANAUGH
some of us...You tell us the has been designed to teach stressful, taxing situation and
patient is lying face down basic home health care I do not think the remedy is CNA EXECUTIVE DIRECTOR
(almost semi-prone) but the through the media of for "tattletales" in our HELEN K. MUSSALLEM
two little dots suggest eyes programmed learning booklets profession to upgrade it. We EDITORIAL ADVISORS
looking towards the ceiling. and 16 mm color film. would like to give the care we MATHIlDE BAZINET,
May I suggest that the ear At the present time a have been taught to give. chairman, Health Sciences
would be more helpful in research study is being carried The problem today lies Department, Canadore College,
placing the head in the correct out in a number of sites across more in the workloads and North Bay, Ontario.
position. Canada to determine the paper work expected of us DOROTHY MILLER, public
relations officer, Registered
Also, just a little increase relative effectiveness of than in negligent care! Nurses Association of Nova
in anatomical detail would various combinations of these -Linda Stevenson, R.N. Scotia.
help show which body parts media in modifying the JERRY MILLER, director of
are higher and which are knowledge, attitudes and communication services,
lower. skills of the lay public who The case of the missing arrow: Registered Nurses Association
These drawings, in short, partici pate. Author Bonnie Hartley of Bntish Columbia.
are not up to your usual high Although J agree that it is (Hypertensive Disorders in JEAN PASSMORE, editor,
standards. Otherwise, I hope important to consider what Pregnancy, July/August) SRNA news bulIetin, Registered
you keep up the good work; I other countries like Britain are draws the attention of readers Nurses Association of
Saskatchewan.
myself always look for doing in health care, I think to the fact that an arrow was PETER SMITH, director of
Corinne Sklar's column that we must carefully inadvertently omitted from publications, National Gallery
before anything else but all the examine the service and the diagram on page 43 of her of Canada.
articles are well worth educational programs that are article. This arrow should lead FLORITA
reading. currently operating in our own directly from the word VIALLE-SOUBRANNE,
-Anne Carney, BN, country, to make the home the "vasospasms" to the word consultant, professional
Nursing coordinator (Days). place for health care. "hypertension". .., inspection division. Order of
Montreal Neurological -Myrna I. Baker, B.Sc.N., Nurses of Quebec.
Hospital. Health Care Research Unit.
University ofT oronto.
v
Th. Cenedlen Nur..
news
Former CNJ editor,
educator dies in Florida
Virginia A. Lindabury. editor ofT he Canadian N Ilrse from
September 1965 to August 1975. died in Naples, Florida. on
September 14th after fighting an eight-month battle against
cancer.
Lindabury's association with The Canadian Nurse began in
1962 when she joined the staff of the then Montreal-based
publication as an English assistant editor under editor Margaret
E. Kerr. On Kerr's retirement in 1965 after 21 years as editor,
Lindabury became the sixth editor in the 6O-year history of the
publication.
V .A.L.. as she signed her editorials. Wd
a champion of the
rights of members of the profession to which she belonged. In
her farewell editorial in the August 1975 issue ofCNJ. she paid
tribute to "nurses who care...(who) can be found in hospitals,
clinics. and communities from coast to coast in Canada. Along
with their clinical expertise. these nurses still have time to show
love. compassion. and sympathy to patients and to relatives.
They make me proud to be a nurse. In our society, which often
seems too impersonal. so competitive. and, indeed, even cruel.
love and compassion for one's fellow human beings, are, in the
last analysis, all that really matters....'
A graduate of the Toronto General Hospital School of
Nursing, Lindabury obtained her diploma in nursing education
and her B.Sc.N. in Nursing from the University of Western
Ontario. Before her appointment to the position of assistant
director-nursing education at Brockville General Hospital in
southeastern Ontario. she was a surgical instructor at the
Wellesley Divi.,ion ofTGH and medical-surgical and pediatric
instructor at the Royal Victoria Hospital in Barrie.
After moving to Florida four years ago. Lindabury joined
the staff of the magazines Naples Guide and Naples Now. In
January 1977 she became managing editor of these publications.
A year later she resigned to resume her nursing career after
taking a refresher course that Summer. She worked as a nurse
clinician on the staff of Naples Community Hospital until
entering as a patient in January of this year. InJuly she returned
to Canada to visit friends and relati ves in Ottawa and Toronto
and to spend a month at the family cottage on Lake Erie.
November 1979 7
Some people need
to be cared for. Others
need a chance to care.
Upjohn HealthCare Services
brings them together.
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I n any community, there are people
who need health care at home. There are
also people who want worthwhile part-ti me
or full-time jobs.
We work to bri ng them together.
Upjohn HealthCare Services'" pro-
vides home health care workers throughout
Canada. We employ nurses, home health
aides, homemakers, nurse assistants and
companions.
Perhaps you know someone who
could use our service, or someone who
might be interested in this kindofjoboppor-
tunity. If you do, please pass this message
along. For additional information, com-
plete the coupon belovv, or call our local
office listed in your telephone directory.
r--------------------.
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R1j-.... HEALTHCARE
____ SERVICES. M
Please send me your free brochures (check oneor both):
o "Nursing and Home Care"
o "Nursing Opportunities at UPJohn HealthCare Services"
Name
Address
Phone
City
Postal Code
Province
Mail to: Upjohn HealthCare Services
Dept.B
716 Gordon Baker Road, Suite 203
Willowdale. Ontario M2H 3B4
HM 641O-C @ 1979 HealthCare Services Upjohn, Ltd.
L____________________
8 November 1979
The Canadian Nurse
news
End stage renal disease: 1979 and beyond resources may be redeployed Health services division
to offset negative effects of receives Kellogg grant
Renal specialists from across reconstruction, i.e. it is this problem.
the country met in Montreal, possible to remove areas of Karen Whitelaw, head The University of Alberta
September 14 and 15, for the stenosis and insert new nurse, Renal Dialysis Unit, division of health services
fourth annual national tubing. Ottawa Civic Hospital, administration is the recipient
symposium sponsored by the .. transplantation: with a emphasized that a major of a $371.800, five-year grant
Canadian Society of Dialysis first cadaveric alIograft, after nursing problem in this type of from the W.K. KelIogg
Perfusionists. Nurses, a short period of dialysis. unit is frustration due to lack Foundation of Battle Creek,
technicians, nephrologists. kidney transplantation failure of positi ve reinforcements. Michigan. The purpose of the
dieticians. social workers, rates are very low. New With the initial help of a grant is to facilitate the
industrial representatives, as immunosuppressant drugs and psychologist, group support development of two new
welI as individuals suffering more recently the sessions have been academic programs: the first a
from renal disease. discussed development of a fl uorescent established in their unit. for alI one-year program leading to a
the many aspects of dialysis activated celI sorter which levels of staff. By alIowing post-graduate Diploma in
and transplantation. alIows production of specific them to look at themselves Health Services
Dr. Eli Friedman. of the antibodies, point to further more objectively. the Administration; the second a
Downstate Medical Center. improvements in participants feel their ability Ph.D. program in Sociology
State University of New transplantation success rates to set realistic goals and (Health Care Planning and
York: was the keynote Dr. \. Shimizu. Director objectives for their patients as Evaluation) which wilI be
speaker. He emphasized the of Dialysis, St. Joseph's welI as for themselves has jointly administered by the
momentous changes that have Hospital. Hamilton. Ontario. improved tremendously. Department of Sociology and
occurred in the treatment of described a Spouse Relief The Canadian Society of the Division of Health
end stage renal disease in the Program which has been set Dialysis Perfusionists (CSPD) Services Administration.
past twenty years. In fact. up to assist families in coping offers qualified nurses and A considerable amount of
with the improved methods with home dialysis. This technicians a certification the KelIogg grant is
and availability of dialysis. program. funded by a Canada program which is recognized earmarked as felIowship funds
statistics in the U.S.A. now Works grant. prepares basic by the Canadian Society of for students enrolled in the
show a decrease in the dialysis technicians capable of Nephrologists. Membership in Ph.D. program. The
proportion of kidney assisting in the home in times the society is open to alI fellowships wilI vary in
tran'.plants done annualIy. offamily illness, when persons actively concerned amount, -depending on the
A panel of specialists important business or social with dialysis and training, experience and need
from each of the fields of engagements arise and for an transplantation and current of each student. but begin at a
treatment for renal failure optional two-week rest period information is disseminated baseline of approximately
discussed the situation here in annualIy. Sixty percent of the through a bi-monthly $7,000 per annum for a
Canada - now and in the spouses took advantage of the newsletter. When the society graduate of a master's degree
future. Problems and program. While the was founded in Halifax in program and are open to
refinements of treatments psycho-social problem.. of the 1968. the founding president students with a master's
were discussed in the areas of: spouses decreased about five and vice-president were both degree in Health Services
. acute hemodialysis use in percent. the most notable nurses concerned about Adrilinistration, or equivalent,
severe medical or surgical effect was in hospital back-up education and communication or in Sociology.
conditions has improved demands. The requirement of among those involved in this Did you know...
prognoses greatly, however hospital back-up due to specialized field.
the problem of malnutrition spouse-related problems Four years ago. the The Association of Registered
with this treatment mode dropped about 65 percent. society bnke away from its Nurses of Newfoundland has
rem.lins unsolved. A major issue at the American counterpart to been awarded a Certificate of
. continuous am hula tory seminar was administrati ve establish a Canadian Commendation by Saint
peritoneal dialvsis (C APD). It problems resulting from certification progmm. Since Francis Xavier University,
now seems that nutrition increased demands for service then, membership has Antigonish. Nova Scotia, for
nther than the threat of and a decreased amount of increased to 340. Fran its exemplary contribution to
peritonitis is the chronic money with which to work. Boutilier. head nurse, Renal the field of adult non-formal
problem due to the Representatives from the Dialysis Unit, Victoria education.
improvement of dialysis federal government. hospital General Hospital. Halifax, The university colIected
systems and procedures. administration. medicine, N .S. is currently the data on 3,040 associations,
. use of PTFE [(raih when nursing and technology president. For membership or societies. councils,
a suitable natural grafting site debated many facets of this newsletter information federations and clubs in the
is not available. These grafts issue. Quality does not have contact: Canadian Society of four Atlantic Provinces: the
have been found to be to suffer as financial restraints Dialysis Perfusionists, 1270 professional association was
relatively resistant to infection are applied. Often, by Sherbrooke St. W., Suite m-7, one of the 450 .,e1ected to
and amenable to reassessing priorities. Montreal. P.Q. H3G IH7. receive the award,
ENGRAVED NAME-PINS IN 4 SMART STYLES - SIX DIFFERENT COLOURS... :.:.-:;:'::
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Metamucil is made
from (gluten-free) grain,
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AvaIlable as a powder (low In \..
sodIUm) and a lemon-hme flavoured " .
Instant Mlx (low in calones), \
Why not gIve your patients our "
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Metalnucll@
The laxative most recommended by Physicians.
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ASI( A.OUT OUIII GENEROUS OUAN"", DISCOUNTS FOR
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USE A SEPARATE StoIEET OF PAPf.R IF NECESSARY
12 Novem.....,979
Th. C..nllCllen Nur..
news
Health professionals learn more The study also shows that be encouraged to use whole
about latest in infant nutrition the size of a baby is milk since a diet low in fat
determined by the amount of means greater consumption of
food and calories consumed other nutrients. This
The milk of mothers giving adequate levels of many of and not by whether the baby is imbalance of nutrients, among
birth to premature babies has these minerals to meet the breast or bottle fed nor the other things, could provide an
unique properties that may be requirements of premature time solids are introduced into unnecessary stress to the
advantageous to these rapidly babies during the early weeks its diet. kidneys of a young baby.
growing infants, according to oflife. Although not all the data The study also shows that
a Toronto pediatrician Zlotkin suggests that in from the study have been fully sodium (sah) intake of babies
currently doing research in the future, rather than feeding analysed, a few other is much lower than figures
this area. premature babies interesting facts about feeding reported in previous studies,
Dr. Stanley Zlotkin was intravenously, "it is practices have emerged. mostly due to eating salt-free
one of several authorities who conceivable that limited Dr. Yeung has found that commercial baby foods.
addressed more than 300 nutrients which are missing in many mothers are feeding . 'Intake, although low, is
public health nurses, the mother's milk of babies two per cent or adequate and meets the daily
pediatricians, dietitians, premature babies could be skimmed milk, resuhing in a recommended level." said Dr.
nutritionists and other health added to that milk. Using this lower than the recommended Yeung. 'V
professionals attending two type of regime, the infant intake off at in the diet. He
one-day symposia in would potentially benefit from suggests that mothers should
Vancouver an
in Edmonton not onJy the immunological
this Fall. factors present in fresh human
"The pre-term infant milk, but also the appropriate Closeup on
represents a special nutrients for optimal growth."
problem," Dr. Zlotkin says, a generation of non-smokers?
"since he has missed three to Too many calories
14 weeks of gestation in which I nfants whose energy intake in More than 20,000 pre-teens in the province of Alberta have
he is assured of an ideal their first year of life meets or good reason to think twice before taking up the nicotine habit.
nutritional milieu from the exceeds Canadian Dietary The kids, all of whom live within a 200-mile radius of Calgary,
mother. .. Standards recommendations, have been exposed to a special preventive program sponsored
Referring to research are being overfed, nutritionist by the department of social development and community
recently conducted by David Yeung told health health, division of tuberculosis control of Baker Memorial
Stephanie Atkinson at the professionals attending the Sanatorium and the Alberta Lung Association.
University of Toronto, symposia. Mona Zahara, nurse consultant for Baker Memorial, is
Zlotkin said that the Dr. Yeung, who is just "the ladywith the black lungs" who has been taking her
composition of breast milk completing a study involving half-hour program on the health hazards of smoking into grade
from mothers of pre-term 403 babies in the five classrooms throughout southern Alberta for the past five
babies, has been found to Montreal-Toronto area, years. Mona's 52-slide presentation features illustrations of the
have a significantly higher reported that infants in his respiratory system, pictures of the normal lung, "lungs in
level of nitrogen than the milk study "achieved normal danger", a cartoon of black lungs surrounded by items that
from mothers who gave birth growth while consuming contribute to air pollution, microscopic views of lung tIssue,
to full term babies. fewer calories than alveoli sacs, mucus glands and cilia and illustrations of the
"For a given volume of recommended by CDS9" His effects of bronchitis, emphysema, lung cancer and heart disease
milk, a premature infant findings, he says. support on the respiratory and circulatory systems.
would recei ve 20 per cent those of other recent The children are also informed about the advantages of not
more nitrogen than the full Canadian studies showing that smoking, ways to protect non-smokers and the long term risks
term infant if both were fed his the CDS recommended that smokers run.
own mother's milk." And energy intake is suitable for Mona says the program owes its start to the enthusiastic
since two-thirds of the babies up to one month, but support she received in the early stages from public health
nitrogen of a full term baby is excessive by 10 to 20 per cent nurses in her target area of rural Alberta. These nurses were
required in the last two for babies from three to II successful in obtaining permission from the local school
months of pregnancy, this months. districts to introduce the classes and also helped by contacting
difference is important. Further results from the teachers at the grade five level and drawing up schedules for
In addition to the protein study confirm findings that visits.
composition of the premature breast feeding is on the "Only time will tell," Mona says, "how successful the
infant's mother's milk, the upswing in Canada. "Not only program has been but I believe that if we want the adults of the
milk was analysed for a are more mothers breast future to take more responsibility for their health habits, then
number of important minerals. feeding, but the duration of we must help them by giving them the information they need
Results showed that breast feeding has increased," early in life. This information should continue throughout their
'premature milk' contains said Dr. Yeung. educational years."
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Th. C.nedlen Nur..
YOU AND THE LAW
Sinners or Saints?
The Legal Perspective
Corinne L. Sklar
The decision of the Board of Arbitration in the caseRe Mount
Sinai and Ontario Nurses Association I has resulted in much
discussion and comment within the health profession. The
decision, which was upheld on appeal to the Divisional Court,2
is of particular importance to the nursing profession, to
hospitals and to their administrators. The editor of this journal
discussed the issues confronting the profession as a result of
this decision in a succinct and thought-provoking editorial on
page four of the June issue. In her view, the issues which the
decision raises are' 'fundamental to the direction of future
growth and autonomy" within the nursing profession.
The case was brought before the three-member Board of
Arbitration on behalf of three nurses, employees of Toronto's
Mount Sinai Hospital. The nurses complained that the hospital
had disciplined them unjustly in suspending them for three tours
of duty without pay. The disciplinary action resulted from the
refusal of these nurses to accept on the I.e. U. and provide care
for a cardiac patient. This refusal was based on the nurses' view
that the admission of this patient to the I.e. U. would endanger
the patients already under their care on the unit. The patient
was brought to the 1.e.U. where his care. both medical and
nursing, was delivered by the team of physicians.
In a two to one decision, the Board upheld the disciplinary
action taken by the hospital against the nurses. In the view of
the majority:
"I) the grievors (the three nurses) were given a valid work
assignment;
2) the grievors refused to carry out that assignment;
3) thegrievors had, in all the circumstances, no justification
for believing that the hospital was not looking to them to
carry out the assignment; and
4) the grievors are unable to raise any of the known defences
to the "obey and grieve" rule.
Consequently, the employer has made out a prima facie
case of insubordination.' '3
The minority position was expressed by W. Walsh in a
strongly worded dissent.
The Board reached its decision after hearing all of the facts
and expert opinion in evidence, after hearing the legal
arguments and after applying the relevant legal principles.
Whether a case is heard by a court or a tribunal, the facts
presented in evidence are crucial to its disposition. So in this
case. the circumstances of this incident were highly relevant to
the outcome. It is important that the profession be aware of the ,
facts of the case on which the Board made its determination.
This column will focus primarily on the facts of the case
and on the majority decision. Next month's column will
examine the minority award in dissent and will discuss the legal
implications of the decision for the nursing profession.
.,
-.4.
L- ..
i\
The decision of the Board has relevance to nurses across
Canada; its effect may not be solely limited to Ontario. While
the decision of the Board will be material to similar cases in
Ontario, the decision will only be of "persuasive" force outside
Ontario. In the hierarchy oflegal decision, the determination of
a board or tribunal may be overturned or set aside by a superior
court on appeal. Thus, within each province, the decisions of
lower courts may be affirmed or overruled by superior courts.
Decisions of the higher courts within each province are binding
upon the lower courts only of that province. Decisions of the
Supreme Court of Canada , on the other hand, are binding on all
of the courts of this land in similar cases.
The Board's ruling, therefore. will affect similar cases
brought in Ontario. However, a different award might result if
the facts of the case were sufficiently different to distinguish it
from the Mount Sinai circumstances.
The facts
The following facts are taken from the reported decision:
. The nurses' shift began at 1930 hours and terminated at
0810 hours - a 12 hour and 40 minute tour of duty. There were
six nurses working on this shift - four were I.C. U. nurses and
two were relief nurses (non-Le.U. nurses). Ofthe latter, one
nurse had not had any experience in ventilating patients in the
previous two years nor at Mount Sinai Hospital, while the other
had no experience in ventilating patients.
. There were eight patients already being cared for in the
I.C.U. Five of these patients required ventilating.
. The nurses' evidence was that this was "the busiest night
they had ever experienced" .
. The cardiac patient, R, was brought to Emergency and
during investigation suffered respiratory arrest. R was intubated
and ventilated manually. The senior medical resident decided
that R 's admission to the I.c. U. was necessary and began to
prepare him for admission. He telephoned the unit in order to
advise the nursing staff of this admission so that the necessary
admission preparation would be commenced. The nurses
refused to accept the patient.
. Telephone conversations ensued between the nurses and
the physicians. The nurses informed the nursing supervisor that
they felt that they could not accept another patient. The
supervisor told the nurses on the unit that they' 'should cope"
with the problem and "to do the best that you can". The
supervisor later called the unit to report that Dr. H was coming
in. Again the nurses protested to her that they could not take
care ofthe patient R. The supervisor thereupon told them "to
try anyway" .
. The nurses did not provide nursing care to the patient R.
Dr. H was advised by one of the nurses that "no nurse felt
Th. Cenadlen Nur.e
capable of taking responsibility" for R. Care for the patient R
that night was delivered by the members of the medical team.
The principle issue before the Board was whether or not the
nurses' failure to provide the patient R with the nursing care he
was entitled to expect from the hospital"s nursing staff
amounted to insubordination. The affirmative finding of the
Board upheld the disciplinary action of the hospital.
The defence
The nurses argued that they had not been clearly instructed to
provide nursing care for the patient R and that they had
honestly but mistakenly believed that the physicians had
willingly agreed to deliver the required nursing care to the
patient because the nurses felt incapable of so undertaking in
the face of their heavy patient load. They further argued that
their refusal was justifiable in the exercise of their professional
judgment. Given their assessment of the condition of the
patients already under their care on the unit and their concern
that if they abandoned these patients, legal liability and
professional discipline might result, the nurses felt that this
refusal was justifiable.
The majoril} decision
In their consideration of the Mount Sinai case, the Board
applied the principles of arbitration. In their application of these
principl
", the Board also considered the extent to which the
principles of arbitration law could be applied to the hospital
employment setting.
"It is a principle of arbitrable jurisprudence that, in order
to succeed in a claim of insubordination, an employer must
establish that the employee has wilfully refused to carry out a
work instruction. The essence of the offence is that it represent"
a challenge to the authority of the employer to order and direct
the work-force. ".
The Board went on to consider the nature of the
instructions and the belief of the nurses that the physicians were
assuming care for the patient R as stated in their defence.
The Board considered this matter within the context of the
hospital setting and noted that the nature of the work performed
assumes that the employee is one who is self-directed and who,
because of the professional skill and knowledge possessed, does
not require dose and direct supervision. Such an employee
does exercise some independent judgment as to what is required
in the circumstances.
In addition, the Board clearly stated that in a labor
relations context (emphasis added), the medical staff have no
supervisory authority o\'er the nurses (emphasis added). The
employment relationship is between the hospital and the nurses
and the supervisory authority here arises out of that
relationship. "...it is the nursing office, in the person of the
nursing supervisor, which 'directs' the nurses in what they
do. "5 (Nurses should note that the discussion here relates to the.
employment context and NOT to the legal aspects of
physicians' orders to nurses with respect to a patient's medical
care, e.g., the ordering of medications. Different principles and
considerations apply to a nurse's refusal to carry out orders of
that nature given by the medical staff.) "An issue of I
insubordination can only arise where the nurses have failed to
respond to an instruction of the nursing supervisor to whom
they are accountable. "6
The majority ofthe Board concluded that the nurses had
been given instructions by their supervisor to accept and deliver
care to the patient R, even though the language used by the
supervisor was not that of command. Her approach to
supervision was tailored to recognize the professional nature of
the relationship between herself and the nurses. Further, the
nurses were familiar with her style of approach, having been
told in the past to "cope", "to try your best". Therefore, the
Board said that the nurses had no reasonable basis for assuming
that the supervisor's instructions were not to be taken
seriousl y . ..
November 1979 15
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Health Guide
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Second Edition (1979)
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The second -.lillon of the Health Guide lor Travallers to Werm Climetes.
published by the Cenedlan Public Heelth Associetion. IS deSIgned to ecquelnt
the IndIvIdual wIth the precaullons needed belore Irsvaillng to. and whIle In hot
climates It IS a valuable resource publication that can be used by doctors. nurses.
heslth educators snd other members 01 the health prolesslon who counsel
Intending travellers to the tropics Bnd 5ubtroþlcs
In addition 10 In'ormatlOn on proper clothing. how to avoid food. water and
Insect-borne diseases. there IS a chapter on vanous medical problems Including
stmgs and bltes_ Yellow-fever Vaccination Centres in Canada are listed and an
Index to countnes and regions IS provided at the baCk of the GUide which enables
the reader to easily Identify what Immunizations are needed for any part of the
world and which countries Or areas are malaria-tree or have malaria risks.
Caples 01 the Guide ere svelleble Irom Caned 'an Public Health Associstlon. 1335
Cerling. SUite 210. Onawa. Onleno. Csnsds KIZ SNS Tel.: (613) 725-3769 8S
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16 November 1979
The Cenadlen Nurs.
The Board also concluded that it was not reasonable in all
of the circumstances for the nurses to have inferred that the
physicians had willingly agreed to deliver nursing care to the
patient R because they agreed with the position the nurses had
taken. The Board said that in the face of the statements made by
the nurses during the course of the hearing that medical staff are
not competent to assess the need for nursing care and to provide
it, the nurses should have been concerned about the quality of
the nursing care the patient R would receive from the
physicians (emphasis added).
In considering the judgment made by the nurses that they
were unable to assume the responsibility of care for R without
jeopardizing the care of their own critically ill patients, the
majority of the Board concluded that the nurses did not possess
better and more accurate knowledge of the needs of the patients
than the medical staff. They based this conclusion on the
following:
I. The nurses had minimal knowledge of the needs of R, only
that he had been intubated and required ventilating.
2. The nurses had no general knowledge of the condition of the
other patients on the unit. Each was familiar with the condition
and needs of her own patients: knowledge about the other
patients was informal and not detailed.
3. There was no team leader designated within the group or
charge nurse to make a general assessment of the needs of the
patients and of the workload. None of the nurses conducted
such a systematic review so that the needs of the unit could be
assessed, evaluated and adjusted.
4. The physicians have more extensive training and are in a
better position to assess and make judgments of the critical
needs of patients.
5. The nurses did not seek the assistance of the intern who was
familiar with the condition of all of the patients on the unit. The
Board concluded that the medical staff was "in the best position
to assess the global needs of the patient and the capacity of the
I.C.U. to provide for those needs". 8
In considering the need in the work place for authority in
the decision-making process, the Board examined the "obey
and grieve" rule. The Board considered this rule in the context
of both the hospital setting and the professional nature of the
employees. The Board noted that the professional's exercise of
independent expertise. knowledge and judgment are important
factors to be considered in examining the question of whether or
not an instruction ought to have been carried out. The Board
carefully indicated that a hospital differs from an industrial
setting for. in addition to the interests of the employer and the
employee, there is a third interest, namely that of the patients.
Thus the needs not only ofthe patient R, but also those ofthe
patients on the unit had to be considered. The Board concluded
that the medical staff were in a better position here to assess the
needs of the patients. The nurses' judgment here failed to meet
the test of arbitral review in that the nurses formed the judgment
"rather hastily and on the basis of incomplete information" and
the judgment did not "properly distinguish" between the needs
of R and the other patients. 9
The "obey and grieve" rule permits employees to
challenge a management decision. Its operation recognizes the
interests of both the employer and the employee in the
circumstances. There are exceptions to the strict application of
this rule. However, care is taken not to unduly extend the limits
of the exceptions. Thus. an employee may refuse to carry out an
order where the task is unsafe or is reasonably believed to be
unsafe or where the order would result in the employee's
committing an illegal act. In such cases, refusal to comply
attracts no disciplinary action: the refusal is justifiable.
In this case, the Board upheld the unsafe limitation as
applying only to danger or hazard to the employee. "We do not
believe that the safety exception can be extended to protect
persons who are not parties to the collective agreement from
personal danger,"'U
Under the second exception, illegality, the Board
considered the nurses' argument concerning their exposure to
potential civil liability and professional discipline. The Board
stated that such legal liability of the nurses to the other patients
on the unit was uncertain. "It is essentially a question as to
whether or not the nurses conformed to the standard of care of
the reasonable nurse in the circumstances and, while it is not
our role to decide the question of the legal liability of the
grievors. one would expect a Court of law would, in assessing
this question. have regard to the circumstances. "\I
The Board characterized as dangerous the recognition of
the defence of illegality in this kind of case because of the
uncertainty with respect to legal liability . In their view, to
recognize the defence would interfere with the employer's
interest in having work assignments completed. The Board
recognized that this approach "puts employees at some risk".
However, in its view, the risk was not substantial.
. The employer as a hospital is under a statutory obligation
to provide care for patients admitted into the hospital.
Moreover. the employer may well be liable both originally and
vicariously for damage which results to patients while in the
institution. That circumstance requires that the employer be put
in a position in which it can effectively insist that certain
instructions be carried out. I f the employer were unable to so
insist and were to be in the position of having to defer to the
superior profess ional judgment of its employees it would be
placed in an intolerable legal position, one in which it could not
protect itselffrom legal liability ,"12
Having so determined. the Board di'imissed the nurses'
grievance.
The nurses appealed to the Divisional Court. That court
upheld the finding of the Board.
The legal implications of this decision will be the subject of
next month's column together with an examination of the
decision of the dissenting Board member. '"
* References
I (197M) 17 L.A.C. (2d) 24:!.
2 As yet unreported: reasons released Apr.18. 1979.
3 Supra, Note I. p.26!.
4 Ibid.. p.245.
5 Ibid.. p.246.
6 Ibid.
7 Ibid.. p.25!.
8 Ibid.
9 Ibid.. p.253.
10 Ibid., p.259.
II Ibid., p.260.
12 Ibid.. p.26!.
*U nable to verify in CNA Library
--
"You and the law" is a regular column
that appears each month in The
Canadian Nurse and L'infirmière
canadienne. Author Corinne L. Sklar is a
recent graduate of the UnÏ\'ersity of
Toronto Faculty of Law. Prior to
entering law school, she obtained her
B.Sc.N. and M.S. degrees in nursing
from the University of Toronto and
UnÏl'ersity of Michigan.
-
.
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18 November 1979
The Canadian Nurse
healthy child, a sure future
rHedlthiest
dbies Possible
The Vancouver Perinatal Health Project
Sandra is eight weeks pregnant with her
first baby. She appears pale and anxious.
and has started her pregnancy 20 pounds
(9.09 kg) underweight. Sandra and her
husband, Bill. have recently moved to
Vancouver from northern Briti
h
Columbia. This isolation from family and
friends has escalated their concerns
about becoming parents.
Manjit, an East Indian woman. who
speaks very little English. is pregnant for
the fourth time in three years. Her first
baby weighed 200U grams and ha
been
ill frequently. Her second pregnancy
ended in a miscarriage and her third
pregnancy resulted in another low
birthweight haby. 2400 grams. Three
months postpartum, she is now pregnant
........
-
.-
J
.
Jenfl({er Warnvca
Susan Ron
Christine Bradley
dgain. Manjit and her husband came to
Canada four years ago to join his parents
and his brother's family. As her husband
is a lahorer at the saw mill. it is difficult
for them to make ends meet.
What Sandra and Manjit have in
common is that they were both part of
the Vancouver Perinatal Health Project.
This two-year project which began in
November 197() was designed to identify
and respond to such problems a<; 10\.\
birthweight. perinatal mortality and
morbidity. In I 97(), approximately seven
percent of the babie<; born in Vancouver
weighed 2500 grams or less. This
occurred despite excellent phy
ician and
ho
pital resources. It compared poorly
,
'-
....
.
.. ...
o
to the low birthweight ratio of other
developed countries such as the four to
five per cent in Scandinavia and five per
cent in France.'
Obviously. it is not enough to rely
olely on medical and hospital care to
obtain the be<;t possible perinatal health.
Many aspects of health involve personal
respon<;ibility: poor maternal nutrition,
smoking and alcohol consumption are
known to have majoreffect<; on the
health of newborns. Exi...ting programs
did not deal with these problems fully.
Therefore the Project wa<; planned and
implemented with major priority given to
assuring maternal well-being during
pregnancy.
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The general purpose of the
Vancouver Perinatal Health Project wa'i
tv. o-fold:
. to demon'itrate that the combined
influence of specific and validated health
mea,ure,>. initiated early in pregndncy,
v.ould result in hedvier. healthier infants.
. to determine a method by v.hich a
more effective perinatal health system
could be provided for the community.
Tv. 0 programs were developed:
Parents. Choice, a comprehensive
perinatal health program for cla
s
attenders and Healthie
t Babies Possible.
an outreach nutrition program for the
hard-to-reach woman.
I. PARE:\TS' CHOICE
This program v.as designed to plOvide
comprehensive preventive sen ices
during pregnancy, childbirth and the
early postpartum period to the expectant
couple. I n addition to eight prenatal and
two postnatal cla'ises. it had several
unique feature.. which di'itinguished it
from regular prenatal cla....e...
. A multidi_sciplÙwry team approach
to perinatal care: The team consisted of
a dietitian-nutritionist. a communit}
health nurse. a research psychologi'it and
an office manager. The participating
ph} sicians and the ho
pital staff of 5t.
Paul"s Hospital. Vancouver were al..o
part of the team. Communication
betv.een team members wa.. a priorit}.
. Early re.ferraland systematic
llHeHment of clients: Client.. were
referred to the program on confirmation
of their pregnancy (six to 13 weeks
gestation). Evaluation started at the
initial interview and included asseS'iment
of their medical. nutritional. social and
emotional needs. The nutritional
a'isessment wa'> augmented by a
computer progrdm for diet anal}..i...
which was designed specifically for
prenatal evaluation u..ing current
Canadian Dietary Standard! and the
Higgins Method. ' for recommended
intake. One seven day. one five day and
one 24-hour diet and activity record was
analysed for each client and follow-up
counseling wa, given by the nutritionist
. Continuit'- of care: The community
health nurse. who taught the classes.
visited the client.. in the hospital and
made home visit, until six months
postpartum. This facilitated as..e'i,ment
of coping abilitie
during the transition to
parenthood. The team approach to
perinatal care served to enhance this
continuit} of care.
The Canadian Nurse
. Postpartum support :0. en-ices: As the
postpartum period is a critical one for
establishing new family relationship'"
and as it i!oo especially important that new
mothers and families have ready access
to health care resources. postpartum
services were developed by the project_
The,e included weel.Jy drop-in 'ie'isions.
brea..tfeeding support, lending library,
volunteer babysitting. cla'is reunions and
publication of a newsletter.
Sandra wa'i referred to Parent's
Choice by her phy..ician when her
pregnancy was confirmed. At an initial
interview with Jennifer. the Project
community health nurse (chn). Sandra
and her husband. Bill. were given
information about her pregnancy and the
effects of her lifestyle on the growing
fetu,> (11 ri'i!.. assessment).
During Sandra's fir
t trimester, the}
attended three prenatal clas..es along
\\ith several other couples, all of whom
were expecting their first baby during the
same month and \\ ho were delivering at
the same hospital. The..e clas
es were
taught by Jennifer with help from Sue.
the dietitian-nutritionist.
While in the fir,t trimester, Sandr;l
!..ept a se\-en day food record which wa,
analysed b} computer for nutritiondl
adequacy. She \\a.. then seen by Sue for
indi \- idual nutrition coun..eling.
Nutritional analysis wa'i repeated at 20
v.eeb and 34 wee!.., gestation. With
counseling and encour;lgement,
andra
made great imprO\ emems in the quality
and quantity of her food inta!..e. She
gained 45 pounds during her pregnancy
(a net gain of 25 pounds or 11.35 kg).
Sandra wa.. given information about
the effects of smoking on her baby and
..he h;ld an individual coun'ieling session
with the Health Department physician.
\-lotivated to have a healthy baby and
\\ ith the ,upport of the Project staff and
her hu..band, she managed to quit
,moking altogether by 20 \\ eeks
gestation.
Nov.mber 1979 19
In their first three prenatal classe..,
Sandra and Bill learned about the
anatomy and physiology of pregnancy.
fetal development. nutrition. lifestyle
and preparation for parenting. They
practiced exer"i,e'i, breathing
techniques and relaxation. The fourth
clas,. given at 20 weeks gestation.
focused mainly on preparation for
brea..tfeeding. The last four clas'es
occurred in the third trime,ter. They
covered labor. delivery, the newborn.
early postpartum and included a tour of
St. Paul".. Hospital.
After she had completed the cla..ses,
Sandra came regularly to the weekly
drop-in to practice her breathing and to
meet other Project mothers. It was here
that ,he made the decision to breastfeed
after seeing so many happy nursing
mothers. Here too. she had a chance to
talk over and allay her many fears
concerning childtlirth. She began her
lahor prepared and confident.
Michael was born after a ten hour
labor \\eighing 3600 grams. He WdS alert
and active and nursed vigorously on the
deliver} table. Breastfeeding and infant
care teaching. initiated hy the Project
team. wa.. continued by hospital staff.
They were very 'iupporti\-e of
tichael
rooming-in with Sandra, and Bill could
vi'iit both hi' wife and child whenever he
pleased. During Sandra'..
hO'ipitalization. Jennifer vi'iited to
di..cuss her labor and delivery and to
prmide continuity of care.
Home vi
its were made routinely at
one week, three months and six months
pO..tpdrtUm. At each visit. Jennifer
weighed, mea,ured and examined
\lichael and answered Sandra's many
que,tion... Data wa'i collected regarding
the baby', nutritional status and his
health. At three and si, months. \-lichael
wa' given the Denver Developmental
Screening Test.
Sandra and Bill came to two
postnatal classes which covered infant
development. infam feeding and
postpartum adjustment. Sandra
continued to attend the weekly drop-in.
Table one
BIRTHWEIGHTS
1975 1976 1977/78 1977/78
Comparison Project
N=445 N=472 N=358 N=156
Average (g) 3340.9 3289.3 3319.1 3440.3
% 2501 (g) 7.4 6.6 5.6 3.8
& under
% 3001 (g) 21.6 26.8 233 16.6
& under
20 November 1979
When she had difficulties with sore
nipples. the support and advice from the
other mothers and the Project staff
helped her overcome them. She
continued to breastfeed Michael for ten
months. One lasting benefit of the
Project was the babysitting cooperative
started by Sandra and some of her
classmates. The co-op allowed the
mothers time to develop their own
interests and the babies benefited
through interaction with other infants.
Results
Outcome measures such as birthweight
and infant health of the 156 Project
babies were assessed and compared to
information gathered about the infant'i of
a nonproject group. This comparison
group was formed from women who al,o
delivered their first baby at S1. Paul's
Hospital but who did not participate in
the Parent's Choice program. Prenatal
class attenders from within the
comparison group were also studied.
Maternal risks and the impact of
psychological prohlems on the prenatal
period were evaluated.
· Birth outcomes: The Project group
improved upon anticipated birth
outcomes by achieving a mean
birthweight of 3440 gram, and a low
hirthweight rate of 3.R per cent. Table
one shows the hlrthweight results for
primipara at S1. Paul's for the year, 1975
to 197K
I n addition. over 54 per cent of the
Project infants attained an optimal
birthweight of over 3400 grams as
opposed to onl y 42 per cent of the
comparison group infant.... However. the
bir1hweight of the Project infants wa, not
significantly greater than that of the
infant, of the prenatal class attenders.
· H ealth (
rthe infclf/t: There were
statisticall} significant differences
hetween the Project group and the
comparison group in the area of mfant
health. The PrQ;ect group had a higher
rate of breast feeding at discharge from
hospital. one week. three months and six
months postpartum. At three months.
the illness rate of the comparison group
infants was three times greater than that
of the Project group. As \-\-ell, the Project
infants weighed more at six months,
started solids later. and a greater
proportion received fluoride drops. This
improved infant health wa'i ,till apparent
when Project infants were compared
with the infants of the prenatal cia,..
attenders.
The Canadian Nurse
Table two
RISK FACTOR ASSESSMENT
Risk Factors
Diet - calories (less than 90% rec. amount)
protein (less than 90% rec. amount)
Weight gain (poor, irregular)
Underweight pregravid
Infection (vaginal, respiratory)
Under 18 years
Smoking
Significant alcohol (greater than 21 gm/day)
Significant drugs
Financial problems
Previous poor outcome (miscarriages and abortions)
Stress (marital, emotional, fatigue)
Percentage
45
10
35
40
70
1
24
8
25
30
35
75
· Maternal ris" manaKement: A
system of maternal risk factor
a...sessment wa, developed in the course
of the program'. Twenty-five risks
ranging from diet to stress were a...sessed
and totalled for each of the 156 women
once each tJimester. The average risk
score per trimester wa'i 4 and the average
ri..k score per pregnancy was 13. O\-er
one half of the women were considered
to be moderate or high risk (score of 10
or more). See Tahle two for Risk Factor
Assessment.
De..pite thi...large percentage of
women at risk. succe...sful birth
outcomes were achieved through
intensive nutrition and lifestyle
counseling. For example:
-The increase in diet for women at risk
averaged 426 calories and 26 grams of
protein. Caloric and protein intake were
significantly related to birthweight.
-The mean maternal weight gam for
pregnancy was ..
5.6 pounds (16.2 kg.)
with a net gain (when adjusted for
underweight) of 32.5 pounds (14.S kg.).
This higher net weight gain resulted in
modification of the impact of low
pregravid weight on hirthweight.
-As well. there was a decre.lse in the
numher of clients drinking alcohol from
76 per cent to 46 per cent and a decrea...e
in the numher of ...mokers from 27 per
cent to 15 per cent.
· Psychological aspect.L Very little
ha... heen written hnking psychological
aspects of pregnancy with physical
outcomes. In the Project group. it Was
found that higher levels of anxiety and
depression ,I'i measured by the
State-Trait Anxiety Inventory' and the
Depre-.sion Adjective Checklists 6 were
a,sociated with:
-less net weight gain of the mother
-less weight gain and lower birthweight
of the infant
-a higher pregnancy risk score
-a shorter length of ge,tation
-fewer \-\-eek-. of breast feeding
-longer stay in ho,pital (mother)
-less positive dttitude, towards lahor,
delivery and haby at one month and
three month...
II. HEI\L THiESr BABIES POSSIBLE
Healthiest Rabie... Po..sible (HRP) wa, an
outreach program to provide free
prenatal nutrition counseling to women
at risk. The program was dðigned to
complement existing prenatal classes by
predominantly reaching women who did
not attend clas...es and by encouraging
wider use of these and other health
service.... Counseling wa.. provided by
paraprofessional Nutrition Aides.
The Aides functioned as "informed
pee..... .. They were lay people with
community work experience who were
given a ...ix-week training program on
nutrition. pregnancy and counseling. The
bilingual Aides were all recent
immigrants to Canada but with good
English language skills; Native Indian
and low income Aides had experienced
living on Social A...sistance therehy
gaining an understanding of the services
dvailahle to low income families.
Service was aimed at two target
groups: cultural or language groups, e.g.
East Indian. Chinese. Greek. Italian and
Native Indian and women needing
special intervention. e.g. lo\-\- income,
teenagers. single women. nutritional
ris",". Counseling was available in five
language.. and wa.. open to hoth
primigravida and multigravida.
An exten,ive publicity progrdm and
information 'pread by word of mouth
re...ulted in many ...elf-referrals in addition
to referral... hy physicians, ...ocial workers
and puhlic health staff.
\Ianjit is representative of the
"omen seen by the HealthIest Bahies
Possible Aides during the Project She
"a" referred to H BP by a friend who was
also receiving counseling. I-.amlesh. the
Ea'it Indian Aide. visited her at home six
time.. during her pregnancy and twice in
the pO'itpartum period, counseling her in
their common language. Punjabi.
-'\s the primary aim of the counseling
"a" to promote a health} life'ityle.
e..pecially in the area of nutrition.
Manjit's diet wa.. as'iessed using the 24
hour diet recall. her weight record.
gener,tI ri..Io.. assessment and a detailed
discu..sion of her food habit... <\nalysis of
her protein intake wa, indicated because
orthe vegetarian diet. Gift certificates
for
liters of milk a "eek were gi\-en to
\larUit to supplement her diet.
In addition to prenatal nutrition
coun..eling, I-.amlesh advi'ied \larUit on
budgetmg and infant feeding. She
enrolled her in Engli..h cla....es for
immigrant women and acquainted her
with resource.. available in her
community.
After a fulltenn pregnancy. M,tnjit
gave birth to a healthy son. Gurdeep.
weighing 3350 gmms. Gurdeep wa..
hrea..tfed and had none of the feeding
problem.. and re..pimtory illnesses seen
in his sihling... Following the birth.
\Ianjit had a tubal ligation. the re..ult of a
decision she and her husband had made
after a famil} planning discus..ion with
!...amle..h. Nll\\ they were <lhle to face the
future" ithout the medical and financial
'itress of more children.
Result,
The Healthie..t Babies PO'i'iible program
reached 213 "omen and achieved a It'"
blrthweight ratio of 2.
per cent and a
mean hirthweight of 3357 grams. This
compared very fa\-orabl\- with figure.. for
the o\-erall Vancouver population (7.2
percent and 3300 gram, in 197ft). The
program also ..ucceeded in reaching the
"at ri,k" population Nearl}
three-quarter.. of the women were new
immigrants: of the Engli'ih-,pealo..ing
group. one quarter "ere single "omen.
10 per cent were teenager'i and nearly
half had il1l:ome.. of les, then $1 O.O()() per
annum.
Differences "ere ..een in the
birthINeights of the five ethnic groups
and these ,eemed to be related to
alterable ph
..ical characteri..tics rather
than intrinsic ethnic differences, For
example. theChmese women "ere the
mo..t underweight pregravid. the mo,t
undernouri..hed and gained the lea..t
during their pregnanc} - their infant'i
had the Im\ e'l mean "irth"eight (3113.3
gram,).
The C.nadl.n Nur..
Implications
fhe results of the Vancouver Perinatal
Health Pr(
iect reflect the advantages of
increa'iing the level of perinatal care.
. A verage perinatal care. as rellected
hy the birth statistics of the Vancouver
community. results in a large numher of
low hirthweight hahies.
. Regular prenatal class attendance
impro\-es birth outcomes hut the health
of the infant is not optimal.
. Parent'.. Choice Program
attendance demonstrated hoth improved
birth outcomes and improved infant
health. As "ell. positive changes in
health behavior. such as reduced
smoking and alcohol consumption,
improved nutritional ,tatus and
increa..ed nel "eight gain were observed.
The reduction of anxiety and depression
pO'itpartum. folio" ing slre"ful births.
indicated the critical importance of
continued 'iUpport in the early months
after childbirth.
Even the highest Ie\-el of care
cannot benefit the \-\<omen and familie.. it
does not reach. Women who do not
choose 10 participate in formal pelinatal
programs malo..e an outreach program an
essential.,elvice. The Project exhihited
Ihe effect of a fle\. ihle approach to this
population.
The Healthiest Babies Pos,ible
program showed that It "a'i po..sible to
identify and cOlInselthe non-attender'i
\-\< ith a high degree of succes, and that
thi, high ri,k group could achieve hirth
outcomes to equal or better tho,e of the
overall population.
Nurse\ cal/ w/..e aI/ aC';I'e role both
pn!fes.\Ï01/l1l1y al/d political'-" 10 1'II\ure
thatthi.
goal (!f the he\t po.\.\ihle
peril/awl health IS reached. Recently.
the follo"ing re'iolution wa' pa'iSed at
the sixty-..eventh annual meeting ofthe
Regi,tered Nur..e, A"ociation of Briti,h
Columhia: RFSOI VED. that the
R
-'\ BC urge the \lini'itry of Health 10
implement prO\incially the
recommendation, oUllined in the
Vancouver Perinatal Health Project:
Perinatal Health Care for the Cily. ""
November 1979 21
References
I Wynn. Margaret. Prnention o{
Ú",dicap of perinatal ori"in; an
introduction to French policy and
legÜlatiol/ by Margaret Wynn and
ArthurWynn. London. Foundation for
Education and Re'iearch in Childbearing.
1976.
2 Canada. Health and Welfare
Canada. Health Protection Branch.
Dietary S talldarc/fnr C allada. Ottawa.
Information Canada. 1975.
3 Higgins. Agnes. Nutritiol/ alld tire
outcome o{pregllancy. Paper pre
ented
at Canadian Public Health Association.
Annuall\1eeting. St. john's.
Ne"foundland.June 1
-21. 1974.
p.244-
56.
4 Bradley. C.F. Tire VallcouI'er
Peril/atal H ealtlr Project: a .wmmar"
report, byCF. Bradley.S. Ro
s.J.
\\'arnyca. Vancouver. Vancouver
Health Department. 197K
5 *Speilberger. C .0. ST AI mali/wi
.fÌlr tire state-trait ant:iel\' im'elltorv. by
CD. Speilherger et al. Palo Alto, Ca.
Con"ulting P,ychologi,ts Pre". 1970.
6 Lubin. B, L . Adjective checklist for
rnea'iurement of depression. Arch. G('I/
P'yclriat. 12, p.57-70. 1965.
*Unahle 10 \-erify references in CN "-
Library
Christine Bradle
, a psy( /wlogist. It'(IS
Re.
earch A.uociate with tire I ancolll'er
Peril/mal H ealtlr Project. Sire i,\ 1/01'.'
Project C oordillator o( Project Prepare.
tt'hich i.
,
tud\'ing maternal adaptatiol/ in
the pO.Hpartum period.
Susan Ross. a dietitial/-flutritiollÜ,t It'(U
coordinator v{the I/t11/couI'er Periflatal
Health Project alld presellll\' is Nutrition
COflHllttlltt with tire l'al/COIII'er Health
f)epartmellt.
Jennifer \\arn)cai
a graduate oft/Ie
School vfNursil/g. VI/iI'enit.\' (
{British
Columbia. She Illu heefl a childhirth
educator and commul/i,-,'lrealth nurse
\-illce graduatiofl. She t\'tU the project
IIune on the VaflCOUI'er Peril/a tal Health
ProjcClafld is 1IOIt'al/Une re.\earcher
It'ith Project Prepare.
..
.
22 November 1979
The Canadian Nurse
healtl-'
child, a sure future
A teenage
pregnancy
epid
!!1ic?
-
THE GROWING MENACE OF
TEENAGE PREGNANCIES!
PREGNANCY EXPLOSION
AMONG SINGLE TEENS!
EPIDEMIC OF TEENAGE
CHILDBEARING!
'"
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Headlines like these are becoming more
and more familiar. In fact. it seems that
hardly a week goes by without some
reference to the problem of teenage
pregnancy in our local newspapers or on
radio or television. But is this the real
problem? Do we actually have an
epidemic of childbearing among our
teenage women? Answers to these
questions are critical as any such
increases will inevitably be accompanied
by a host of medical problems associated
with teenage childbearing: low
birthweight babies, hirth complications
and increased rates of morbidity and
mortality for mother and child.
What about the teenage mother'i
who make up these statistics? What do
we know of them? Most often, these
young mothers are described by the
media as single. living alone and existing
on public financial aid. They are thought
to have poor nutritional habits: their
knowledge of child care is considered
inadequate and their ability to cope with
the
trains and demands of parenting is
judged to be severely limited. They are.
therefore, considered to be at high risk
for child abuse. I fthis portrait is
accurate, and if we are truly in the midst
ofa teenage pregnancy explosion. then
the need for more intensive health care
'iervices for this group is urgent.
A closer look at the 'itatistics on
teenage pregnancy and childbearing.
however. suggests that the situation is
more complex than the media depicts: in
some in'itance
the situation seems to be
improving, yet there have been change'i
which mu..t give U'i cau..e for serious
concern.
-.-
TlENAOI .1ItrH "ATE" CANADA. 'a,.lln
r-
r-
..... r-
r--
r-
- r-
.--
..
55
50
4S
4()
35
30
25
20
..
'0
1!iJ21 1931 1941 1951 19
1961 1966 '971 1916
",_.... ........lVO'bIo'ofÞOr1l'lsl* I OOO
'G<<I15 IlIre....
......
PutIkaIo'IoIc.ns...FIM:! SI-.nC...-d.I 111211971 p
sdV
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'dV
'.SI--.n..-clD....At9.,_S<<:toon ....1It>
o.".uI SI..-n (;...-d.I 19!11 1gee
The teenage birth rate
I s the rate of teenage childbearing
actually increasing? The teenage birth
rate is a measure of the number of births
per 1.000 females aged 15 to 19 years of
age. It is used to determine the likelihood
that a teenage woman will give birth and
is the best parameter to assess changes in
childbearing. as it takes into account
alterations in the total teenage
population.
Canadian statistics over the pa'it 55
years (See Figure one) reveal a definite
pattern throughout the entire country.
Having reached a high in 1961, the
teenage birth rate has actually been
declining since then. as evidenced
particularly in the 1976 rates. the last
year for which figures are available. A
smaller proportion of teenagers are
having babies today than at any time
since the 1940's. Clearly. we are not in
the midst of an epidemic of teenage
childbearing in Canada. I nstead. we
appear to have made considerahle
headway in halting what was a growing
problem.
The teenage birth ratio
How then can we account for the recent
attention given the whole area of teenage
childbearing? The answer appears to lie
in the kinds of statistics which have been
used to measure changes in childbearing.
The most common one quoted is what is
known as the teenage birth ratio. Thi'i
ratio i'i established by determining the
number of teenage hirths per I ()()O births
of the total population. rhis parameter i'i
useful in determining the impact of
teendge childhearing on service..
provided for the newborn since the
--
..-nt M" 0If
..-D ". "
"'"
AIC). \'lAM..... 0WI;1Il CAMADot. ,., I'''''
--.........
--......--..... "'.
..,-
----
...-
....
-.......
.......
..., ,.' '.. ....
_ 1'71 "7\
--. ...,.. d -..... I!l-I'''
- ....Rllllld........lOy-..-.JO'-
"'r"d_""1S-1'
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'OOO_""I!t-"
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health oftheo;e infants, e
pecially tho..e
born to extremely }oung \\omen, is
generally con
idered more precarious_
Cmil the earl} ..eventies. the trend
in Canada \\a.. clear-the teenage birth
ratio wa<; increao;ing. In 1929.
approximately five per cent of all
mothers giving birth \\ere teenagers.
Thio; figure increa..ed to approximately
I 1.5 per cent in 1971. Since we know that
the rate of teenage childbearing ha..
declined. it seems safe to conclude that
thio; increao;ed visibility of teenage
mothers mu
t be due in large part 10 the
greater decline in the birth rate of women
over the age of
O. A comparison of the
birth rates of the t\\O age groups io;
pre
ented in Figure two. The margin
between the birth rates of the two groups
ha.. narrowed ..ub
tantially over the
}edfO;.
The<;e figures. however. relate only
to childbearing among the teenage
population. What about the more general
problem ofteenage pregnancy? Is it
po
..ible that the decline in teenage
childbearing o;imply reflecto; the fact that
man} more of our pregnant teenagero; are
having abortion..?
Teena
e pre
nanQ rate
A measure of teenage pregnancies
(excluding mio;carriagesl. may be
estimated by totalling the abortion and
childbearing <;tatistics for teenager...
E\-en then. the rate of teenage pregnancy
is declining although the decrease when
abortions are included is quite small.
-\bortions do appear to be having a
considerahle effect on the decline in
childbearing among teenagers (<;ee
Figure three).
The Can.dlan Nur..
..... -
nI1lAOI"'GMAIIIC'tllJan:- CANADA UIO TMI. fIIIOWeCfS ""
, '" ,.
"'- .. '"
... w, ...
....... ",
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.-u...woc..
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'....
"-"'...--..,
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o ,:::,,: yT=
CMI""" 0 "-OI'--""'
'-"'-
,>!!..........,
&our.:. I_..F...
_'--_'*'12
nP 1'1'&.
The <;ituation in some province<; is
quite alarming. British Columbia. for
in<;tance. has a rate of abortion among ib
teenage population that almost equals its
childbearing rate. The conclusion is
obvious: abortion is being used a.. a
means of birth control.
The teena
e iIIe
itimac
rate
In view ofthe
e facts. can we infer that
no problem exists concerning
childbearing and pregnancy among our
teenage population in Canada? The
ano;wer to thi
is an emphatic no
We do
have a problem and one that is
continuing to grow in magnitude. I n the
o;tati..tic
relating to out-of-wedlock
childbearing among teenagers. the
percentage of teenage birth<; that are
out-of-wedlod. hao; been mcreao;ing at an
alanning rate over the pao;t :!O years (see
Figure four). Twenty years ago. the
respono;e to a premarital pregnancy was
most often marriage. If the mother did
not marry. adoption was generally the
alternati\-e. Toda}. teenage mother.. are
increasingly opting to remain single.
Alternatively. they seek abortion. What
increa..es the o;eriousness of the <;ituation
i<; the fact that more and more oftheo;e
young women are deciding to keep and
raio;e their children on their 0\\ n.
November 1979 23
.....-
"l1li Cl:1I'T Of' OUT-()II' ...DI...OCII. ..,... TO 'UII"'aon CAfIADA '''' I_
....
....
-c........, __ 0.-
o OudWlillolllllclla...s
o .....1Ow.dP...
Although no national figures are
available on this trend. some indication
of the numbers of single mothers Io..eeping
their babies can be obtained from
individual hospitals. All births in the
Halifax-Dartmouth area of Nova Scotia.
for instance. occur in a single maternity
hospital. In 197().ju<;t overlWperC'ent of
all babies born out-of-wedlock in this
ho..pital were kept by their mothers.
These percentages seem to be getting
higher. In o;ummary. the situation is this:
even though the actual rate of teenage
childbearing is decreao;ing. ofthoo;e who
do give birth. more and more are
remaining o;ingle and keeping their
infant
.
The implication
of the situation are
disturbing. !\Iany of these mothers are
only children themselves. yet they are
making the decision to keep their
children. This decio;ion io; a\\eo;ome.
con
idering their immaturity and the
tremendous responsihilitieo; that such a
choice entails.
What are the consequences ofthis
decision? Should our health care
o;erviceo; be giving special attention to
this grov.ing population of young
mothers ?The an
wer muo;t certainly be
}es. or;,
Susan \lacDonnell.B.A., M.A.. is the
Principallm'estiRator of a "Study (Jf
Unmarried Jlother.l." which is current".
hei/lR carried out hy the Nm'a Scotia
Department (
fSocial Ser..;ces, u'ith
fimdi/lR from Health aflll Welfare.
Canada.
24 November 1979
The Canadian Nurse
healthy child, a sure future
A Regional Program for the Management of
Hereditary Metabolic Disease
Terry Reade allllCaroline Clow
The authors describe a unique program designed for the treatment of patients with complex diseases due to inborn
errors of metabolism.
I nre.wiRation and treatmem of children
with inborn errors of metabolism is
relatirely nell' in the field o.{health care.
The Hereditary Metabolic Disease unit
at the Montreal Children's Hospital was
one of the first o.{its /..ind to be
established in North America and. since
/967.. has been caring for an increasing
numher of children with treatahle
Renetic disorders who require
speciali
ed care and clo.
e supen'ision.
Techniques, de\'eloped lInd e\'aluated in
the unit, depend on allied health
per.\Onnel im'o/i'ed in the care (
{
ambulatory patients. The re.mlt: an
imegrated prugram that prol'ides
optimum care to patienh at an
acceptahle le\'el o{cost-e.f{ecti\'ene.u. I
Our treatment center in Montredl is one
offour in a regionalized network of
Genetic Medicine formed in 1972 in the
province of Quebec under the provincial
Ministry of Social Affairs. In addition to
treatment of hereditary metabolic
disease, the Quebec Network of Genetic
Medicine provides genetic screening.
counseling. a prenatal diagnosis service
and ongoing research." I t is operated by
the four university medical schools in the
province: Laval. McGill. Montreal and
Sherbrooke. Each of the four regional
centers of the network has individual
areas of expertise and is free to design
programs to meet the needs of its
particular community.
At the McGill center. located at the
Montreal Children's HospitaL" patients
are referred either by a physician. the
hospital or they may have been detected
in the newborn '\creening program
(Figure one). Medical intervention
provided by the Unit minimizes the
effects of various metabolic diseases
resulting from the expression of mutant
genes.
Non-physician personnel. one of
whom is a registered nurse. perform
moo;t of the health supervision and
technical work in the management of the
patients. The approach is predominantly
aimed at ambulatory patients and many
of the procedures for monitoring disease
control are performed in the home. Two
staff members work full time
co-ordinating the daily care of70 patients
with a dozen different types of hereditary
metaholic disease; help is available from
other members ofttle health team in the
Biochemical and Medical Genetics
Figure one: Relationship bet"een senices of screening b
Quebec Net"ork of
Genetic '\ledicinc and other health pro\iders.
SCREE"III
G
'-.
THE
P
TIE
T
\
\
TREAT'1E
T
r
COl I'oSELING
j
Divi.,ions. Weekly team meetings are
held to review the progress of patients
and to discuss current m.edical problems.
Community and hospital resources are
used extensively and contact with
patients is maintained on a continuing
bao;is by mail and telephone. or through
home visits if indicated. Medical care not
directly relevant to the management of
the genetic disease is provided by the
family physician or pediatrician to whom
periodic reports are sent.
Treatment
Most physicians. whose opportunitieo; to
treat any single genetic disease over a
lifetime of practice are limited. welcome
the centralized treatment of genetic
disease where teams of experts share
their experience with several diseases.
Once the appropriate diagnosis has heen
made. the patient is officially entered
into the program. One of the full time
allied health personnel then becomes
involved, along with the geneticist. in
organizing and helping to carry out
diagnostic procedures. The test results
are collected and o;taff often attend
discussions with the various consultants
and the patient's parents. Subsequently.
2
þ
REFERRAl
h
\10 HOSPIT<\L
The Canadian Nurse
November 1979 25
a suitable home program is organized for
each patient who requires treatment, a
program which varies according to the
type of disease. The principles, however,
are simple and employ four basic
procedures. alone or in tandem.'
1. substrate restriction, when substrate
accumulation is the principle cause of the
phenotypic pathology
2. product replacement. when depletion
of a metabolite is the important event
3. coenzyme supplementation when
activity of the mutant enzyme can be
enhanced by large amounts of coenzyme
4. enzyme replacement.
A low intake of phenylalanine in
classical phenylketonuria /PKU) and of
branched-chain amino acids in maple
syrup urine disease (MSUDI illustrates
the principle of substrate restrictmn.
Patients with these diseases require a
permanent special diet: nutrient intake
must be balanced in order to limit the
intake of compounds potentially harmful
to them while supplying the nutrients
necessary to promote normal growth and
development. Dietary products, which
are made available for these patients
through the "Food Bank", make it
possible to treat rare hereditary
conditions with success.
Frequent blood monitoring is done
in the home by the nurse for the infants
with maple syrup urine disease -less
often for older patients if good control is
maintained. In children with
phenvlketonuria. blood samples are
taken by parents or the nurse. to monitor
the phenylalanine concentration and to
provide an index of biochemical control.
These samples are collected on filter
paper and mailed to the Net\\ork's
control laboratory in Quebec City. After
analysis the results are then phoned to
the unit.
Other patients. o;uch as those with
X-linked hypophosphatemic rickets.
require a different mode of treatment
which follol.\oo; the principal of product
replacement. Phosphorous. lost from the
bOdy in the urine becauo;e of an inborn
error of membrane trano;port in the
kidney. is replaced by oral
supplementation and with added vitamin
D. The patient takes these medications
periodicall} throughout the da} and
blood levels are monitored in bi-monthly
home visits. If the patient lives too far
from our center. blood sampling is
arranged at a hospital or clinic near their
home and the results are mailed to us.
The parents of children with various
types of genetic disorders are trained,
mostly by the health personnel. to
manage their child's condition. When
children are part of a home care program
the burden of care is placed mainly upon
the parent!> who have [0 cope seven days
a week, year after year. with special
diets or medication. Added to this heavy
burden is often an underlying feeling of
guilt and responsibility for their child's
genetic defect. Parents are encouraged to
telephone if help is needed but as their
understanding of the disease and its
treatment grows, most families become
more and more self-reliant. Regular
home visiting gives the nurse an
opportunity, through her observations
and communications, to assess the
parents' ability to manage theirchild's
medical regime.
We have found that families
welcome the mutual concern and
exchange of information: they are
reluctant to call a busy physician about
the little things that worry them. A
survey recently carried out by a third
party independent of the program
showed that most parents have
developed preference for involvement
with allied health professionalo; in the
care of their children.
The Food Bank
Our e\penence with dietary treatment.
and with the distribution of o;pecial diets
through the centers of the Quebec
Network. led to the development of a
National Food Distribution Center for
the Management of Hereditary
Metabolic Disorders in Canada. The
"Food Bank" has a networlo.. of
treatment centers right acroo;s Canada
and ensures regional availability of the
special diet products necessary in the
treatment of patients with hereditary
metabolic disease. It also provideo; a
system which permits collaborative
evaluation of treatment programs.
The development of the food bank
was an important step in the care of
patients requiring special diets: the
semi-synthetic milk substitutes and
special food items are absolutely
necessary for treatment of some inborn
errors of metabolism. In Quebec. the
regional genetic center repre.,entative
notifies the health center closest to the
patient. and the diet products are made
available at no cost to the patients
through the Quebec provincial
department of social affairs. The parents
place their order every month and pick
up the food when notified by the health
center in their district of ito; arrival.
Conclusion
The Hereditary "Ietabolic Disea.,e Unit
at the Montreal Children'o; Ho.,pital
provides a much-needed service in the
management of 'everal complex
metabolic diseases. With the help of the
home-vio;iting program and the food
bank. personnel are able to initiate and
carry out individualized treatment plans
to improve and maintain the well-being
of patients with hereditary metabolic
disease. 'iI
Hereditary Metabolic Diseases
treated by Home Care Program
phenylketonuria
hyperphenyla1aninemia
hereditary tyrosinemia
homocystinuria
cystinuria
cystinosis
Fanconi syndrome
vitamin 0 dependency
maple syrup urine disease
histodanemia
pseudohypoparathyroldism
hypophosphatemic bone disease
miscellaneous others
Terry Reade i.\ a Rrtlduate of the
H OJpitalfor Sick Childrell School c
f
Nursing ill Toronto. alld receil'ed her
B.A. from C vncordia V llil'enity in
01ltreal. .\peciali::.illR ill community
IIursÙIR. She i.
currently Ùn'oll'ed with
the Hereditary M etaholic Disease V nit
and is a re.
earch associate with the
Faclllty(
rMedicille. McGill Vnil'enity.
Caroline Clow, is co-director oIthe
etaholic Disease Vllit at the Montreal
C hildrell' s Hospital alld is aleclllrer ill
pediatrics at McGill Vllil'ersit.\".
.\cknowledgements: The authors It'ould
li/"e to expreu their appreciatiOll to Dr,
C .R. Serher, director of the de Belle
Lahortltory.f;,r Biochemical G elletin at
the M vlltreal Childrell' s H ospitalfor his
cOlltilluous adl'ice and enCOllrtlRemellt
a lid to the Milli.\lry ,,(Social A.f.fairs. VII
hell{l{rc
f the Quehec N etwor/" ofG elletic
edicille. which 11lI.
helped /IS appl,' vur
/"nowleciRe to patient.
with Renetic
disea.
e more e.trectil'ely.
References
I Clow. C L. :\tanagement of
hereditary metabolic di,ease. The role of
allied health personnel. by Cl . Clo\\ et
al. New EIIRIMed.
84:1292-1298.
Jun.lO. 1971.
2 Scriver, C. R. Genetics and
medicine: an evolving relationship. by
CR. Scriver et al. Sciellce
200:4344:946-95
. May 26. 1978.
3 Reade. Terry. Home care of
children with inborn errors of
metabolism. by Terry Reade and
Caroline Clo",. C Gllad.N une
66: 10:41-42. Ocr. 1970.
4 C low. C. L. On the application of
knowledge to the patient with genetic
diseao;e. by C L. Clo\\ et al.
Prog.Med.Gellet. 9:159-
IJ, 1973.
5 C ommiltee for I mprovement of
Hereditary Di.,ease Management.
Management of maple o;yrup urine
disease in Canada. C wllId.M ed.A S.\' I
115:10:1005-1010. Ion. Nov.20. 1976.
26 November 1979
The Cenedlan Nurse
health
child, a sure future
The single
mother:
can w-e help?
More often than not, regular prenatal classes fail to meet the special needs of the
young, unmarried expectant mother. What are their needs? How can nurses
learn to recognize and do something about them?
Jo Billung-Meyer
In spite of sex education in the schools,
more liberal access to birth control
information and methods, and in spite of
essentially legalized abortion, the single
teenage mother is a definite entity in
North America today. Observers
disagree on the reasons behind this
paradox. Why is it. for example. that
almost all (95 per cent) of teens st:eking
contraceptive advice at birth control
clinics have already experienced
unprotected intercourse?
What observers do agree on are the
substantial hazards - both mental and
physical - that surround and threaten
these young mothers and their offspring..
Dr. Sidney Segal. head of the division of
maternal. fetal and neonatal medicine at
the University of British Columbia. and
director of neonatology at Vancouver
General Hospital. observes: "the child
born to a mother 16 years of age or
younger is three times as likely to die
before it reaches its first birthday; or if
the baby survives. it is more likely to
have brain or nervous disorders."2 Segal
feels that some extra risks of pregnancy.
such as hypertension. anemia. toxemia,
or prolonged complicated labor. may
arise because young mothers actually
reject prenatal services and nutrition
advice.
Aside from the obvious physical
dangers is the fact that an ever increasing
number of these adolescent mothers
decide to keep their babies but discover
after a year or two they cannot cope and
then give the baby up for adoption. This
time lapse can result in irrevocable
psychological damage to the child. Of the
5002 illegitimate births recorded in B.C.
in 1977, only 865 babies were adopted
out: less than half of these placements
were made during the first month of the
baby's life.
Teenage mothers are seldom in a
favorable position when it comes to
providing the emotional and financial
support their baby needs. Many are
themselves the victims of inadequate
parenting and are currently undergoing
varying degrees of conflict with one or
both of their own parents. A large
majority are school dropouts, lacking
marketable job skills or experience. Not
surprisingly, the incidence of child abuse
and neglect is higher in the homes of
single teenage mothers than in the
general population. 3 Obviously. the
adolescent mother needs all the help she
can get in the crucia! months before her
baby is born. Why then. when childbirth
education is very much the accepted
thing these days, do single young
expectant women reject the conventional
support systems provided by society in
the form of prenatal education classes?
I think I found the answer in dealing
with the few single expectant mothers
who came to my prenatal classes for
couples: I became aware of the guilt,
fear. stress and often the sense of
tragedy that attend<; these young girls.
Many of them simply dropped out of the
classes because they felt like outcasts in
the atmosphere of togetherness and
mutual support of the couple-oriented
programs. Although they were very
frightened by the prospect of childbirth.
they tended to deny their fears: the deep
sense of guilt they repressed often made
them reluctant to disclose even their
identities. Some came from other cities.
hiding out during their pregnancies in the
back bedroom offriends, isolated,lonely
and very afraid.
The project
Observations such as these spurred
me on. a few years ago, to introduce a
pioneer program designed especially for
single expectant mothers: I was
convinced of the urgent need for this
specialized type of program. After
considerable study. planning, thought.
and personal financial investment. I
came up with a course which essentially
used the group dynamics approach to
promote peer support. A warm and
relaxed atmosphere was to be created in
which each girl would feel free to express
her feelings and thoughts. and where
mutual support could be both given and
recei ved.
My aim in conducting the classes
was to prepare the single mother
mentally and physically: to increase her
knowledge of pregnancy and childbirth.
to improve and maintain her health and
that of the infant through nutrition
counseling, and to build her self-esteem
so that she might face her new role with
greater strength and courage. A
social worker was available whose
counseling made each mother aware of
her options to either keep her child or
place the baby for adoption. Referrals
were also made to the home visiting
teacher employed by the Greater
Victoria School Board, and the girls
were encouraged to continue their
education to increase their ability to
provide adequately for the child. My
overall objective was to help these girb
turn their pregnancy from an utterly
devastating crisis into an experience
from which they might learn and grow.
Planning considerations
Any good prenatal course such as those
suggested in the Teacher's Guide of the
International Childbirth Education
Association ManuaP may be adapted for
single mothers if one keeps in mind their
special needs. Erikson" points out that
the failure of an adolescent to develop a
sense of identity leads to role confusion
and prevents the individual from
attaining the next step in development-
the ability to be intimate with others. "If
any of these stages go unresolved, they
can hinder the individual's development.
contentment. and satisfaction with life.
I n the pregnant adolescent. this will lead
to difficulty in forming relationships and
in parenting her infant."
It was apparent that the single
mother's greatest immediate needs were
to be accepted, 10 develop a positive
self-image. to belong to a supportive peer
group, and to have her fears replaced by
knowledge. It is important to relate to
each mother on an individual. caring
basis, as well as to strive 10 make the
course acceptable to all. In the words of
Steinman:
Staff members should expect
adolescents to become dependent in this
new situation of pregnancy. but
independence is the ultimate goal, for
independence is essential to parenting
capability. Meeting someone's personal
needs mOl'es her in the direction of
independence. Like a child. a patient
learns to trust the person who is
prm';ding for or nurturing her
(dependence). Later she will be able to
use this nurturance in establishing
independence for herself and her
off-spring. 6
A simplified psychoprophylactic
method such as the modified Lamaze can
readily be learned in an 8-week course.
Since most single mothers tend 10 be
tense due to their situation. more
reassurance and word-imagery is
required than usual to help them master
the breathing and relaxation techniques.
They can be motivated easily with the
explanation that the purpose of the
exercises is to make childbirth easier for
them.
Taking into consideration
adolescents' liking of television. many
films were utilized. and group
discussions were preferable to the
lecture method. It was not possible to
eliminate the lecture altogether but I
found the attentiveness and regular
attendance of the group remarkable and
encouragmg.
It was planned that exercises should
be taught in the first hour so that those
who planned to place their baby for
adoption could leave before the class on
parenting the new baby. A short
"bathroom and chat" break between the
two sessions allowed the girls to mingle
and talk privately. Iffunds pennit. a
nutrition break would be of great benefit.
Each class member was encouraged
to bring a partner they knew and trusted:
a friend (male or female). sister or
mother. Those without partners knew
they could call on me or one of the two
volunteers to help.
The Canad.an Nurse
The program
The first two classes were offered free to
all single mothers so they would attend
as early in their pregnancy as possible.
..
.,
\
-
"
"
and then they were to return in the last
trimester for the remaining six classes.
Because there is often a tendency not to
value anything that is free. a fee of ten
dollars was charged. This was waived in
the event of real financial hardship.
A suggested reading list of book..
available from the public library Was
handed out, but few of the girls in the
younger age group used it. To overcome
this, a personal letter was given to each
one. describing in detail on a 14 to 17
year comprehension level. the hospital
procedures they might encounter, the
onset and stages of labor. and how to
cope with each. To my surprise. every
girl commented that she had benefited
from this letter.
The psychological reactions to
pregnancy were presented in a skit in the
first class in which two unwed teenagers
discussed their own and their mothers'
reactions to the pregnancy; one girl had
an understanding and supportive mother,
the other had to defy her mother's "we'll
have you aborted" attitude. Both
expressed a whole range of emotions:
fear. guilt. loss of self-image and a sense
of isolation. Most participants identified
strongly with the emotions brought out in
this skit. and were relieved to realize
they were not alone with their fears.
Before the end of the first class each
participant was asked to write down all
that she had eaten and drunk in the last
24 hours. including quantities. These
were critically analyzed. and comments
were written on each one encouraging
the girls to meet their nutritional needs.
The slips were returned in Class II before
a discussion on nutrition. Emphasis was
put on balancing a limited budget. while
still providing the necessary nutrients.
Keen interest was shown in the physical
changes during pregnancy and in the
growth and development ofthe fetus.
The "do's and don'ts" of pregnancy ,
November 1979 27
including self-medication, drugs.
alcohol, smoking and how to overcome
minor discomforts were also discussed in
this class.
,.L i
'IJ
J1
I
>
"
.
Ai..
Class III covered the onset and
stages oflabor. and how to cope with
each pha..e. Hospital procedures from
admission through delivery were
thoroughly explained. and my "letter".
described earlier. was handed out. A
postscript was added for each girl who
was planning adoption. or those who
were still undecided, asking whether she
would like to talk to a classmate in the
same situation. Many were greatly
relieved to discover they were not alone
in this difficult decision; it is an
unfortunate fact that the young mothers
who were intending to keep their babies
looked down upon those who were not.
For this reason. it was important to offer
extra support and encouragement
privately.
The class on parenting brought out
many of the mothers' unrealistic
expectations about their future roles. and
about the baby. The change of roles. the
responsibilities and demands of
parenthood, and budgeting skills were
discussed. Also considered were the
emotional needs of both baby and
mother. and how to meet them.
I n another class. the importance of
birth control was demonstrated. It is a
fact that there is a type of "unwed
mother syndrome" 7 which starts with
out-of-wedlock pregnancy followed by
school drop-out. becoming a welfare
recipient. and then a repeat pregnancy
resulting in loss of self-esteem and
general failure to become a productive
individual.
Because of the documented high
incidence of child abuse and the
multitude of psycho-social and health
problems that face these adolescent
mothers, we decided to devote the last
class to subtle encouragement of the
young mothers to give their children for
adoption. We accomplished this in a
non-threatening manner by inviting to
this class single mothers whose babies
28 Novem..... 1878
were more than a year old to answer
questions. The discussions brought out
the realistic struggles and frustrations of
the unwed teenage parent in providing
for her child, and the resulting sacrifice
of time and money for her own interests
and education. A single mother who had
placed her baby for adoption described
how she had taken great care to decide
the type of family she wanted her child to
have, and how painful this decision had
been to make but that she realized her
baby now had the love and security she
could not have provided. Finally in the
presentation, an adoptive mother
expressed her deep appreciation for the
love and courage it took for someone to
give up a baby for her, and she told how
the new baby had enriched her and her
husband's lives. It was hoped that this
presentation would realistically show the
options open to each young mother,
while leaving her free to draw her own
conclusions and assess her own
motivations and capabilities. Especially
those who had been undecided about
adoption were able to look at the
situation from a new perspective.
Results
To promote these classes, a letter was
written to every general practitioner and
obstetrician listed in the Yellow Pages,
as well as the principals of all junior and
senior high schools in Victoria. Also
notified were agencies such as
Birthright, Adoption and Fostering
Services, alternative schools, the Birth
Control Clinic, etc.
The response has been excellent. In
the first set of classes, 12 girls enrolled,
18 in the second, and there are currently
16. The age ranged from 14 to 33, but 65
percent of the group Was in the 14 to 19
age bracket. All were single: the majority
had left school, but two of the women in
theirtwenties were university students.
The regular attendance,
participation in, and results of these
classes have been most gratifying. Most
of the mothers did remarkably well
during childbirth and were ahle to
remember and use the
psychoprophylactic methods they had
learned in class. Answering a
questionnaire, all fell they had gained
knowledge and confidence, and some
comfort in knowing they were not alone:
they felt good about the whole
experience.
Follow-up however has been
difficult because these girls are
constantly moving without leaving
forwarding addresses or telephone
numbers. Some have actually returned to
the classes to show their babies, and
some keep in touch with each other.
Almost all the young mothers who kept
their babies have expressed interest in a
reunion.
The CenMllen Nur..
Conclusions
It is important that groups be organized
to help pregnant adolescents acquire
knowledge, good parenting skills, a
renewed self-image, and to generally
meet their emotional and educational
needs so that the mothers can in turn
meet the needs of their infants. Child
care services should also be made
available so that these women may
continue their education and not fall prey
to the syndrome which in the past has
been responsible for some 80 per cent of
teenage mothers not completing high
school, and for the suicide rate which is
seven times that of adolescents without
children." Even when teenage mothers
eventually marry, two thirds of these
marriages end in divorce. 9
The alarming incidence of single
mothers and adolescent pregnancies
represents a serious social, economic
and health prohlem which is
compounded by the individual's
rejection of regular prenatal services. By
designing and presenting classes which
are tailored to meet the specific needs of
these young women and by presenting
them in an : tmosphere in which they feel
comfortable, it is possible not only to
counteract some of these risks, but even
to help each mother to use this life crisis
positively. '"
References
I * Battaglia , F.C. Obstetric and
pediatric complications of juvenile
pregnancy, by... et al. Pediatrics
32:902-910. 1963.
*Claman, A.D. Pregnancy in the
very young teenager, by... and H.M.
Bell. Amer.J.obstet .Gynecol.
90:350-354, 19M.
Clark, J.F. Adolescent obstetrics-
obstetric and sociologic implications.
Clin.Dbstet.Gynecol. 14: 1O:!6-IOJ6, Dec.
1972.
Coates, J. B. Obstetrics in the very
young adolescent.
Amer.J.Obstet.Gynecol. 14: 108:68-72,
Sept.!,1970
*Nietsche, P. Schwangerschaft,
geburt und wochenbett beijugendlichen,
by... amlJ Wienold,
Zentralbl.Gynaekol. 91 :348-353, 1969.
2 *VGH public forum looks at the
need.. of the child.R.C. Med. J. 22:1,
Jan., 1979.
3 *Gossage, J.D. Child abuse and
neglect.R.C. Med.J. 21:5, May 1979.
*N ye, F.I. S choul-age parenthood.
Exten. Bull. 667, Washington State
Univ.. Pullman, April 1976.
Tonkin, R. Mortality in childhood.
R.C. Med.J 21:5, May 1979.
4 *Bruneau, B. The childhearing
year- teacher's guide by... et al. Mar.
1977.
5 Erickson, E.H./dentity: youth and
crisis. New York, N.Y., WW. Norton,
1968.
6 Steinman, M. E. Reaching and
helping the adolescent who becomes
pregnant. MCN Amer.J. Matern. Child
Nurs. 41:1:35-37,Jan/Feb. 1979.
7 Tankson, E. The adolescent
parent: one approach to teaching child
care and giving support.JOGN Nun.
5:3:9-15, May/Jun. 1976.
8 Nye. F.I. School-age parenthood.
Exten. Bull. 667, Washington State
Univ., Pullman, Apr. 1976.
9 *Kennedy, Edward, Senator. 1975
Congressional Record,121:154.0ct. 21.
Additional bibliography
1 Ashdown-Sharp, Patricia. A guide
to pregnancy and parenthoodfor women
on their own. New York, N.Y., Random
House, 1977.
2 Colman, Arthur. Pregnancy: the
psychological experience. by... and
Libby Colman. New York, N.Y.,
Bantam, 1977.
3 *Edwards, M. The new parent
class. Seattle, Pennypress, 1978.
4 *Edwards, M. Teenage Parents.
Seanle, Pennypress, 1978.
5 *Kitzinger, S. An approach to
antenatal teaching. National Childbirth
Trust, NCTTA 2,1968.
6 *Kitzinger. S. Education and
counselling for childbirth. New York,
N. Y., Macmillan, 1977.
*References not verified by CNA
Library
Jo Billung-Meyer is a graduate of the
Massachusetts General Hospital School
of Nursing and has a post-graduate
teaching certificate. She has worked a.f a
head nurse in hospitals in Winnipeg and
Vancouver andfor the past six years has
been teaching prenatal classes at the
Victoria General Hospital. She
welcomes enquiries from other nurse.f
who want to e.ftahlish classe.f in their
community.
Acknowledgement: G ra t eful
acknowledgement i.f gil'en to the
following personsfor their assistance
and support: Dr. Janet Bavelast,
Psychology Dept., Unil'enityof
Victoria: Barbara Burke, Director of
Nursing. Victoria General Ho.fpital:
Mary Jane Maclachlin, Counselling
Psychologist, Unh'ersity
fVictoria:
Barbara Dane, Ron Polstein, and Jan
Wilson, social workers, Marilyr. Pazder
and Hennie Nyholf.
A healthy child, a .
fu
Closeup on
Coalition for th
Prevention of
nd-
a
Healthier mothers and babies is a goal that .
organizations in the health care field have
support. The Coalition for the Preventi'1r r .
of the Canadian InstItute of Chi! I Healtl embr r ces r
approach to the problem of mal n9 prenatal-penn t
understood and utilized
r: he first, nurse
tives of the C
ctors of CNf
II e Coall ''''1 '
,eir whol
hment of th
<>d to share
revIew, J and comma!
Information papers no
. Rh Isoimmunization
. Hospital Perinatal Co
. The Health Risks of T
. NutritIOn and Pregnan
. Teenage PregnanclÐ1
. Screening 01 Newborn.
. Low-birthweightlnlant
. Rubella.
Members of the Coalition. in a t
n to CNA. Includ
. Canadian Pediatric Society
. Canadian Hospital AssoC'latlJn
. Canadian Society of Obstetnl"ans & C
. Health and Welfare Canada
. Canadian Association for the Mentally R rded
. Canadian Rehabilitation Cot.ncll for the' -d
. Canal,tian Medical Association
. CanafjiaFl Public Health Association
. College Q amily Physicians
. L'As: J rJes médecins de la Ian.
· Féd ilL S médeOll1s omnipraticiens d J
The cti of the Coalition are.
1. to gi'(e recognition and support to the . . . ndicap It- oug 1
prograrrls health care and f<jucation . mportant natio. ority.
. to la ncn a public education campaign to educate not onl
the public, but also the
health ole. .nals in the importance of making belter prenatal-peri are available,
acce Ible, u stood and utilized.
to.. and coordinate national and provincial efforts (professional.
al and agency) on behalf of healthier mothers and infants.
. ct priorities, policies and allocation 01 resources lor maternal and newborn
services.
'y 5
Ih
..1tUþ
ulli-Iac .ed
are more aval .'
eve been involved in the program through
dlan Nurses Association 10 organizational m. .
ally endorsed the p se. organization and pr.
e then, CNA member associations across the co ve
6Upport. These provjl}Kia
ssociatlolS III contribute to
n's objectives thrOl. the efforts 01 individual nurses who
rtlse, experience anQpkllls in various whys. including
terature provided l;1y tr.e Coalition.
rogress focus on A,pict such as:
tees
0, Alcohol, Marij..n
nd Caffeme during Pre .ane
.
..
.
- ..
.
..
.
.
.'
1t
.
.
ecologists
.
.
,
.
.. ..
..
..
'"
.
..
...
.
.
...
4
30 November 1979
The Canadian Nurse
A new baby is born and soon after delivery doctors tell the new mother that her infant is mentally retarded How
should O.B. staff deal with this very different patient? Leave her alone? Not talk about it? The following article reveals
some of the new mother's feelings in such a situation. and gives helpful suggestions on how to deal with this patient and
her special child.
C.
STAFF
ALERT
Sheila C amerol/
When my infant was born with Down's
Syndrome. I was devastated. but even in
my traumatized state I was able to
recognize that some of the things the
nurses caring for me did were helpful.
others were not. Now, five years after
that initial experience I have had time to
consider all the feelings I experienced
then, to talk to others about their
experiences and to read up on the topic
of mental retardation. My ultimate goal
was to discover what the O.B. nurse
,hould knov. to be able to 'ihare this
traumatic experience.
To this end I surveyed ten mother'i
who had been informed within 72 hours
of delivery that their child had a
condition resulting in mental retardation.
I asked them to indicate which of their
hospital expeliences had been helpful.
which were not. and what they felt had
been missing.
All but one parent experienced a
need for privacy following discovery of
the baby's handicap: mothers seemed to
find being with the mothers of healthy
babies particularly distressing at thi"
time. Only two of the mothers had had
this need met however: one hu,band had
persisted for three days before obtaining
a private room for his wife. Another
mother was upset when more than once
she was given the wrong child at feeding
time. While mistakes like this should
always be prevented, it is especially
important to keep them from happening
to the parents of handicapped children.
I n general. feeding time wa'i a
particularly ditlïcult experience for most
families for many reasons. Mother'i
found long feeding time'i difficult.
.
especially a,> many of the infants did not
feed well. One parent who was
unsuccessfully attempting to breast feed
stated, "Staff always stayed for a few
minute'i trying to get him to nurse; when
he wouldn't they left for periods up to 45
minutes. At times I thought he'd drown
from my tears, at other times I became
so angry I wanted to drop him on the
tloor. .. When a baby was too sick to be
brought out for feedings, one parent
appreciated being allowed in the nursery
at feeding time. while another stated. "I
needed to be close to my baby, I was
never pennitted closer than the nursery
window. and she was alway'i at the far
'iide of the room, never brought close."
One young mother, when asked ifshe
wanted to feed her baby. had said "no",
but at the next feeding a nurse brought
the infant to her and stayed while she
fed him. She said she found this gentle
encouragement to handle her baby
hel pful.
All mothers expressed the need to
talk about their feelings. but only two felt
free to talk to the nursing staff. One
mother recalled that a well meaning
nurse had brought her a pencil and paper
to wlite down questions for the doctor.
"Ifonly ,>he had realized I just needed a
sympathetic listener to sit with me and
let me express my.fl'elil/gs." Night-time
was particularly difficult and falling
asleep and staying asleep presented
problems for all mothers. One mother
appreciated ha vi ng staff keep her
company in the night. The need for ex tra
time with husbands. friends or family
Wa'i expressed too by mo"t parenb. One
parent who was pennitted unrestricted
visiting hours said it wa" very comforting
for her to have her husband with her.
--
P.trents found it particularly helpful
when nurses !>pent time talking with
them ahout their infants as human
beings. Bonding can be extremel)
difficult for families with handicapped
youngsters. yet the lack of it increa'ies
mother's guilt and coping with the
apparent lack of love i'in't easy. Mother..
felt staff were most supportive when
they just dropped by to say how the
babies slept in the night, how much
feeding they had taken, or just how they
had been during the afternoon. They
noticed too how staff handled their
infants. "One nurse brought him
completely covered in the blanket and
never opened it as though there wa
something grotesque inside, while
another carefully uncovered him for me
and touched him and talked to him just
like she did with all the other babies".
"One nurse even used to sing to sooth
him." These simple caring actions
encouraged mothers greatly.
All parents surveyed had their
children in Infant Stimulation Programs
and found them helpful for both
themselves and their youngsters. (It is
interesting to note that not one had been
referred by a physician: five had been
referred by hospital staff nurses or public
health nurses. while the other five were
referred by friends and relatives.) All
parents felt it would have been helpful
for hospitals to refer them to Infant
Stimulation Programs. or A.
1.R.'s
(Association for the :\fentally Retarded),
so that they could learn more about their
child's handicap. and the support
services available.
Other thing., the parents said were
helpful. or which might have been
helpful, "ere genetic counseling
referrals. literature. pamphlets or books
about the particular problem. and
physicians or nurse'i "ho were informed
about the condition. :\lany parents found
staff to be poorly informed on the "hole
about the problem of retardation-
probably because retardation i'i really a
learning problem rather than a health
problem: while it may he caused by a
specific genetic or physiological
anomaly, usually retardation is not
responsive to any medical treatment. We
should not therefore be reticent in calling
in A.:\1.R. statfto help with information
about the learning disorder.
The Cenedlen Nurse
One group of parent!. not surveyed
were those who did not take their infant...
home. There are times even today when
parents. for various reasons, do not want
to take their children home. It is
imperative that"e try to be empathetic
with these people too. as this may be the
best decision for them. yet it i!> too easy
for us to be judgmental in such a
o.;ituation. The
e parent'i tend to vanish
entirely from the professional's vie",
and while they no longer require help for
their child they are left to cope alone
with the feelings they have after the
experience. I spoke with one father who
appeared to have unre'iolved feelings
about the situation. even after 20 years.
Referrab to mental health counseling
facilities for the.,e parents should be
considered too.
Of interest is the fact that in one
Infant Stimulation Program. in Wind
or,
after three and a half years of operation,
of 56 children and familie'i serviced only
one family had considered institutional
placement of their child. One might
conclude that with increased external
...upports mO'it families can learn to cope
o.;ucces
fully with a handicapped child.
Ho" specificallycanO.8. staff help
parenh most in tho
e few first dayo.; after
infant'i are horn?
First. it io.; necessary to develop a
better understanding of what exactly
the
e families are experiencing. then to
assess each family one encounters and
plan the appropriate nursing
interventions. Understanding of the
causes and effect... of mental retardation
can be gained from reading appropriate
information: there are several books
availahle on the
ubject and numerou'i
publications may be obtained from
a<;sociations for the mentally retarded
hee below). A "ell infonned nur<;e is in a
better po...ition to help her patient.
Reaction
The birth of a child with an identifiable
mental defect cause
very deep
emotional trauma. It is highly unlikely
that the ne" parents will have had much
contact in the pao.;t with retarded people
or their families. Probably they have had
only minimal intere
t in the "hole area
- an attitude reinforced by the North
American cu...tom of keeping retarded
people of all ages separate from the rest
of the population: they ta"e their
education in ...eparate o.;chools. their
recreation in segregated groups and
many live in special residential settings.
Though great strides have been made in
the U. S. folio" ing the Kennedy interest
in mental retardation and the Carter
interest in mental illness. there is still a
stigma in the minds of most people
attached to mental problems of any kind.
November 1979 31
Our own profession cares for many
people with mental di'iorders, but in
separate settings - mental hospitals,
special schoob, residential schools for
the retarded - so there is not that much
exposure even during a nurse's
professional life. While many new
programs are being developed, the
negative connotations of retardation will
persi'it until individuals, families and
communities come to accept the retarded
person without hesitation or reservation.
The parents of a retarded baby are
experiencing a loss. a kind of death.
Their hopes for a healthy normal child
have been shattered and they are
terrified. The nurse involved in their care
is dealing with a ...ituational crisis.
parents who are experiencing agrief
reaction. The nur'ie must recognize the
stages of grief and mourning and try to be
understanding of the dynamics involvfd
in this emotional experience.
There is however. a difference:
there has been no real death. there will
be no funeral. no formalized mourning.
Feelingo.; of guilt will be pre
ent: "Did
those antibiotics in the ...econd month
cause this?"' and anger: '1 feel like
dropping him on the tloor." The parent'i
will be fearful too of what lies ahead:
they are concerned for themselves and
forthe siblings ofthe ne" infant.
Adjustment
As preoccupation with the lost child
dimini<;hes. parent<; will be able to adjust
and develop feelings of love for the new
child. This acceptance will take o.;ome
time but it is important that they do
accept the child for until they do. they
will not be able to adequately love and
care for the baby.
Many factor.. intluence the parents'
eventual acceptance and there are many
que'ition'i for the nurse to consider when
trying to help. Wao.; the child planned for
and wanted bv both parents. or
unplanned and creating an
"inconvenience"? Is the guilt that the
parents are experiencing e.\cessive?
With whom do the parents have
meaningful relationships? lack of a
spouse orclo'ie family memhers "ill
place an added burden on a new parent.
32 November 1979
Parents will be affected too by previous
losses and grieving experiences. How
successfully have they been worked
through?This new experience may
revive unresolved past experiences.
Finally, the physical and psychological
health of mourners at the time of loss is
important in determining their capacity
to deal with it. It is obvious that a new
mother. who may be debilitated by her
nine months of pregnancy and the
experience of giving birth. is not in the
best physical or emotional state to deal
with loss successfully.
As is always the case with grief
reactions. not all individuals go through
every stage of the process: they may
fluctuate back and forth or skip some
stages. and all family members will
progress at their own individual pace. It
is also obvious that the whole of the
reaction will not be experienced in the
immediate postpartum period. but
assessment and intervention at this time.
with co-ordination with suitable external
support services. will assist the family
achieve a successful outcome.
How to get there
Assess all your data and make yourself
available to the family for discussion.
Listen and ohsen'e. Consider:
How do the parents perceive the event
and what behavior are they exhibiting?
What is the physical and emotional 'itate
of the parents?
Can they identify previous loss
experiences and discuss them?
Do they have any knowledge of mental
retardation - if so what do they know?
What culturdl influences are present. and
important, in the family's situation?
What kind of support is being given by
other family members. friends.
physicians?
Having collected your data,plall a
team conference where all nursing and
auxiliary personnel can share their
findings. Plan intervention carefully
considering that some staff may feel very
uncomfortable in the presence of the
family - help them express their feelings
and do not assign them to the patient
until they feel ready.
If you work in a care setting where
Primary Nursing is practiced you will
have someone to co-ordinate care - if
not, establish one person who i<; v.illing
to do this.
Principle
' ofinten'ellTion:
. Show acceptance of the parents and
their new child.
. 8e available to them to permit them
to express their feelings of grief-
denial. anger. guilt, pain and fear.
Recognize all the
e feelings as normal.
rhe Canadian Nurse
. Help them to gain an intellectual
understanding of their crisis - that their
sadness is because of the child they have
lost. as well as because of the anxieties
created by the handicapped infant. Seek
help from your Psychiatric or Social
Work Department if you feel
uncomfortable in this area.
. Help the family find the facts - ego
it isn't true that all Down's Syndrome
children are alike.
. Enquire whether there are concerns
about future children: genetic counseling
may be required.
. Identify support services available
in your community and help the family
make initial contact with a suitable
service such as an Infant Stimulation
Program or a local Association for
Retarded Persons. The initial contact
with
upport agencies i
often difficult
for parents.
. Be a good co-ordinator of services.
There will be no situations in which you
have all the required information but
know your resources and use them:
physicians and psychiatrists for physical
amI emotional concerns: local facilities
for retarded persons for appropriate local
programs: the social service department
for financial or cultural concerns;
priests, rdbbi or minister" for religious
considerations.
. Obtain literature for your nursing
unit. Publication lists can be obtained
from:
National Association.fÒr Retarded
Citi:.ens
2709 A\'elllle E. East
P.o. Box 6109
A rlill?toll , Texas 76011
Natiollal /nstitllTe Oil Melltal
Retardation
4700 Keele Street
Kinsmen Bllildill.!!
Dowll.H'iew.Olltario
M3J IP3
I oo!..ing hac!..
Reflecting on the life of my own famil}
over the past fi\e years, the first days.
weeks and month'i were indeed the mo<;t
difticult. As we worl..ed through our o\'. n
grief reaction' we learned about
ourselve<; and our child. We di'icovcred
ourselves starting to love him, and care
fin him. just as we do our other children.
He returns this love and i<; indeed a
human bcing and an individual in his o\'.n
right. He shows concern for all f
lmily
members as they do for him. Certainly he
is slow to learn. but when he finally
succeeds at ne" tasl..s. we all experience
great happiness. What we initially sa" a'i
a great tragedy in our lives has developed
into the most significant learning venture
which we shall probably cver
expericnce. ...
Sheila Cameron, R.N., B.A., M.A.. is
cllrrently assistant professor of nllrsin?
at the Uni\'ersity of Windsor. She has a
wide ,'ariety of clinical nllrsin?
experience in Britain, the U.S. and
Canada, and has become deeply
illl'o/i'ed in associations for the mental/v
retarded. She has been chairperson and
prO?rlml consllitant of the l1
fant
Edllcation program for the W illdsor
llSsociarion and u member of the Child
De\'elopment Sen'ices Committee in her
commlinity.
Bibliography
I Aguilera. DonnaC. Crisis
intervention, by DonnaC. Aguilera and
Janice M. Messick. 2d ed. Saint Louis.
Mosby. 1974.
2 Engel. George L. Grief and
grieving. A mer.J.N IIrs. 64:9:93-98, Sep.
1964.
3 Howell, S.E. Psychiatric aspects of
habilitation. Pediatr. Clin. North Am.
20:203-219. Feb. 1973.
4 I\.allop, F. Working with parents
through a devastating experience. The
birth of a mongoloid child.JUGN Nllrs.
2:3:36-4\, May/Jun. 1973.
5 Lindemann. E. Symptomatology &
management of acute grief. Amer. J.
Psychiarn'. 101: 141-148. 1944.
6 Menolascino. F.J. Parents of
mentally retarded. An operational
approach to diagnosis and management.
J. Amer. Acad. Child. Psychiat.
7:589-60:!. Oct. 1968.
7 Miller. L.G. Helping parents cope
with the retarded child. Northwest Med.
68:542-547, Jun. 1969.
8 -. Toward a gredter understanding
of the parents of the mcntally retarded
child.J.Pediat. 73:699-705. Nov. 1968.
9 Perske. Robert. New directions for
parents of persons 11'/10 are retarded, by
Robert Perske and Martha Pcrske.
Na<;hville. TN. Abingdon, 1973.
10 Stutz. Sara D. The nursing
challenges of 08: whcn the baby isn't
normal RN 34: II :40-43. Nov. 1971.
II *Wolfensbergcr. W. The principle
ofnormali::'lItioll in human serl'ices.
r oronto. National I nstitute on Mcntal
Retardation, 1972.
*Rcference not verified by CNA Library
The Canadian Nurse
November 1979 33
Diagnosis:
Down's
Syndrome
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Nine and one-half years ago in a large
Canadian hospital, a daughter was
born to a 24-year-old mother and her
husband of the same age. At a time
when "zero population growth" was
the catch phrase, this was the
daughter who would complete their
family of two. "Perfect," they said.
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34 November 1979
The Canadian Nurse
But it was not to be. The mother,
who was a Registered Nurse.
remembered giving a clinical
presentation on Down's Syndrome in her
third year of nursing school. After seeing
her new daughter. an alarming question
formed in her mind: could this infant be
Mongoloid? After discussing this with
her doctor. a consultation with a
pediatrician was arranged. The diagnosis
was clear, there was no doubt, the baby
was mongoloid.
With the baby present. the
pediatrician reviewed the signs of the
syndrome. The baby was hypotonic (less
active than normal). The occiput was
somewhat fiat and the head small. The
nose was small too and from a profile
was relatively tlat. Her eyes slanted
upward slightly (slanting palpebral folds)
and small folds of skin could be seen at
the inside corners (inner canthal folds).
The irises of her eyes were speckled with
light colored "Brushfield" spots. Her
ears were small and the helix folded over
slightly. Her mouth was small making
her tongue appear large. Her neck had
loose folds of skin and seemed short. Her
hands were small and bore no Simian
Crease - a single crease (instead of the
normal two) across the upper palms. Her
fifth fingers were short but there was no
c1inodactyly as is often apparent in
Down's Syndrome. There were two
creases on her fifth finger, not one as is
common in Down's Syndrome but she
had the traditional gap between her first
and second toes. As a tinal check. he
ordered x-rays of the baby's hip joints
and blood was taken for chromosomal
studies.
The infant bore the signs of trisomy
21 as do the great majority of children
with Down's Syndrome (D.S.).
Normally there are 46 chromosomes or
23 pairs in each normal cell. Each pair is
designated with a number from one to 22.
The twenty-third pair is the sex
chromosome pair. This child had 47
chromosomes with one extra
chromosome added to the number 21
chromosome - hence, tri-somy.
Over the next fev. weeks the child's
condition was further assessed and the
harsh medical facts were revealed to the
parents. I remember it well because I
was that baby's mother.
Facing reality
Knowledge of these facts helped us to
face reality. We were grateful that our
daughter's diagno'iis had been given to
us and that all of our questions had been
answered in a straight forward manner.
However. it was unfortunate that we had
not been presented with the whole story.
There is a positive side to statistics
that needs to be remforced in a situation
such as this. We were told that
approximately 30 to 40 per cent of D. S.
children have heart defects. but we were
never reminded that over 50 per cent do
not. We were toldD.S. children are
subject to respiratory illness and
gastroenteritis. No one said "Down's
Syndrome children vary in their
susceptibility to infection. Pneumonia
and gastroenteritis are much less
common in all children today and
antibiotics have greatly reduced the
number of deaths. D.S. children seem to
respond to treatment about as well as
normal children". I
About four per cent ofD.S. babies
are born with incomplete development of
the intestine they said. No one
emphdsized the 96 per cent who do not
suffer this way. No one said, "lfno
problem becomes obvious during the
first several months. there need be little
concern. "2 Acute leukemia occurs in one
percentofD.S. children, we were [Old.
No one eased our worry by mentioning
that the risk after the first two or three
years is low.
My medical text in Pediatrics
contained an atrocious picture ofaD.S.
child - the classical worst example. My
Obstetrics text, still in use in the
mid-sixties, gave the incredible advice
that a D.S. child should be removed from
his mother and placed in an institution
before an attachment fonned.
It is unfortunate that. armed as we
were with such facts that we had been
given or had been able to find on our
own. there was no one to share another
part of that reality with us, someone who
had actually experienced living
day-to-day with a retarded offspring and
who had coped.
I t is no wonder either that with the
gloom and doom statistics hanging over
the head of this newborn and with no
support agency at hand for parents. m}
husband and I spent several months in a
grieving distressed state. This type of
reaction is common to all parents ofD.S.
children: a timeless description of the
feelings of the people concerned can be
found in "The Child Who NeverGrew"
by Pearl S. Buck.
Gradually the intense grief reaction
began to fade. Our daughter. Jennie.
contrary to our impression of the medical
facts. began albeit slowly to grow and
thrive. Yes. she had respiratory and
gastrointestinal upsets and a minor heart
murmur. but we managed. To our delight
we found that Jennie Was capable of
learning many "normal" behaviors:
sitting. crawling. walking. speaking and
even reading. Finding the methods that
would help Jennie utilize her intellectual
potential. helping herto make strides.
despite developmental lags. took up
much of my time.
Today. Jennie is a relatively
healthy. happy. contributing member of
our family. She is particularly fond of her
younger brother. Mark. whom we
adopted two years ago and who is also a
D.S. trisomy 21 child.
If Jennie's birth were to take place
today. I hope that we could anticipate:
· Doctors and medical personnel who
would present us with the facts
realistically but not without hope.
. A model of acceptance from those
concerned. Even after these many years
I remember that our daughter was given
the gentlest handling and was wrapped in
the brightest pink blanket in the nursery
during those unforgetable hospital days.
I remember the baby being brought at a
time that must have been inconvenient
for the staff, so I could hold her and
weep. I remember the anxiety of the
Head Nurse when she told me that she
had prompted the pediatrician to give me
his diagnosis and still wondered whether
she had done the right thing. I remember
the nursing staff who lingered an extra
minute at my bed in case I should want to
talk. I remember kindness and caring.
. Contacts with the local Association
for the Mentall y Retarded and Down's
Syndrome parents who had coped,
willing to tell me about their experience
when I felt I wanted or needed this.
. The name or names of doctors in the
area particularly interested in working
with and understanding Down's
Syndrome children.
. Recent and timely reading material
for me to read when I craved knowledge
about our child's affliction: notable is
"The Child With Down's Syndrome
(Mongolism): Causes. Characteristics
and Acceptance" by David M. Smith.
. An Infant Intervention Worker or
Infant Stimulation Home Teacher such
as Mark has had. who could visit on a
regular basis while I adjusted to my
baby's condition. She could provide me
with a model of an accepting attitude by
handling this baby gently and, at the
same time. offer me emotional comfort
and support and knowledge in time of
crisis e.g. feeding problems. illness.
Perhaps this would help decrease my
infant's hospital stays and increase my
confidence in my ability to handle some
of her problems. She could help assess
my child's level of development and
teach me how to help her to master the
next developmental steps. (Mark's
Infant Stimulation Home Teacher had an
R.N. background in pediatric nursing.)
. I nfonnation sources about progress
in education for D.S. children. I am
particularly encouraged by the ideas from
the Model Preschool Center for
Handicapped Children - an
experimental. educational unit at the
University of Washington. This program
is a highly organized. sequenced.
diagnostic and prescriptive program
whose goal is to help each D.S. child
attain as nearly normal development as
possible through early and continuous
intervention.
Victon o\er D.S.
Altho
gh the birth of a D.S. infant. on
the average I :640 births. is inevitably a
shock to parents, it does not have to be a
totally negative experience for those who
choose to keep their children and accept
them as they are. Out of their stress can
come positive attitudes.
By \wrking through thi, grievou<;
situation. my husband and I feel that we
have gro\\-n closer: we know that we can
handle whateverlies ahead. In fact, our
attitude to all our children has changed.
We now focus on more positive
attitudes. i.e. what our children can do.
not what they can't. The remarkably
effortless development of an average
child has tal..en on new meaning.
"!though our D. S. children require extra
attention in time and patience. we have
learned that it is possible to maintain a
balance that lets our two "normal"'
}oung<;ters feel loved and secure.
Noone can take from us those
moments of victor} when. after long
hours ofworl.. on their part as well as
ours. Jennie and l\Iari.. accomplish a
specific goal. How well we rememberthe
da} Jennie attempted dinnertime grace at
a time when speech \\-as still difficult for
her. Our normal voung<;ters could
singsong it so ",ell. so easily: "God i..
Great. God is Good. Let us thank Him
for our food. Amen."
Jennie's version. abbreviated but
still a \ ictor}. brought a ne\\- meaning to
us. "God IS:' she said, "Amen:' ...
References
I Smith. Ddvid W. The child I\'ith
Du\\"n's !>yndrome (11IOn?olism), by
Da\id W. Smith and Ann C. Wilson.
Toronto. Saunders, 1973.
2 Ibid.
Bibliograph}
I Smith. David W. The child \\"ith
Du\\"n's .
yndrome (11I(mgoli.
m), by
Da'\ id W. Smith and Ann C. Wilson.
Toronto. Saunders, 1973.
2 "'Orientation manual on mental
retardation: Pt.l. Toronto. National
Institute
Iental Retardation.
3 Buck. Pearl S. The child \\"ho ne\'er
gre\\". Scranton. P:\. John Day. 1950.
xU nable to verify references in CN A
Library
Linda J. 'ii"on, a graduate of St.
BOl1{face S cllOOI ofN ursing, is the
mother offour children. including Jennie
and .\1arl... Since obtaining a cert
fìcate
in Early Childhuod Educatiunfor the
Mentally Retardedfrom Humber
College. Toronto, she has acted a.
a
\'oluflteer/teacher in a small community
nursery for handicapped children in
Oromocto, N.B. and in a school for
trainable mefltall\' retarded near
Alliston. Olltario. She and herfamily are
1I0\\" li\'illg in Lahr. Germany.
The Canadian Nurse
November 111711 35
Closeup on
Fetal Alcohol Syndrome
Jane Bock
The Fetal Alcohol Syndrome (FAS) is a term that has been used for the past dozen
years or so to apply to a collection of defects and deficiencies found in babies born
to chronic alcoholic women. Early researchers thought the syndrome was due in
part to the malnutrition that frequently coexists in alcoholics, but more recent
research has proven that there is likely no correlation. Further, and most alarming,
it now appears that FAS can appear in the babies of women who are only
moderate users of alcohol- the so-called "social drinkers".
Common abnormalities in the Fetal Alcohol Syndrome include pre- and
postnatal growth deficiency, microcephaly and a series of facial abnormalities such
as thin upper lips, midfacial hypoplasia and shortened palpebral fissures (eyelid
crease). 1
Although according to some studies, the complete FAS has never been seen
in any but chronic alcoholic mothers , 2 evidence shows increasingly that any mother
who drinks is at risk.
"There is a spectrum here," says Dr. Henry Muggah at the Ottawa Civic
Hospital, referring to the continuum of effects of alcohol ingestion in pregnancy;
"Less than 2 ounces of alcohol- that's one drink, one beer or a three-ounce glass
of wine - is probably okay, there's no evidence of harm, but 2 1/2 to 6 ounces?
Who knows?"
Who knows, indeed. Dr. Mary Jane AShley of the University of Toronto. quoted
in the Canadian Family Physician, says: "A safe limit of drinking hasn.t been
established," and she called "disturbing" the findings that even moderate drinkers
may have babies with signs of FAS. She advises that "drinking in pregnancy
should be considered hazardous until it's proven safe. The best advice when you
don't know is 'don't do it'. "3
The variability of the teratogenic effects of alcohol on the developing fetus is
probably due to varying exposure at various times during gestation, in conjunction
with the genetic background of the individual fetus.. It is assumed that the level of
alcohol that can be measured in the mother's serum is important, so 'binge
drinking' may be considered to be the worst for the unborn child. However,
according to Dr. Madeleine Maykut of Health and Welfare Canada, health
protection branch, who has recently published two articles on the subject, no one
knows what the minimum amount of absolute alcohol required to cause damage is.
"We cannot predict who will be affected," she said, adding that in some cases
women may be causing the fetus harm by drinking before they even know they are
pregnant. "Some say, 'weill don't drink during the week, just on the weekend', but
that may be too much. You might go out to dipner and have alcohol in your parfait
for dessert, and that might be too much. Nobody knows."
Dr Maykut said that both nurses and doctors should advise patients to give up
smoking and drinking for the entire pregnancy. "It won.t kill anyone to stop drinking
for nine months," she said.
The nurse's responsibility is clear, and applies not only to those who work in
doctors' offices or prenatal clinics, but to any nurse who comes in contact with
women of childbearing age: patients, friends, family.
. women should be encouraged to see their doctors early in pregnancy for
nutritional and I!festyle counseling.
. drinking and smoking should be discouraged, with adequate rational
explanations.
. the general public must be educated against the
"another-little-drink-won't-hurt-you" argument that is no longer justified.
Most prospective mothers don't have to think twice about making any sacrifice
for their unborn child; it is up to us to see that they get fair warning.
References
1 Hanson, J.W. Fetal Alcohol Syndrome. JAMA No. 14,235:1458-1460, Apr. 5,
1976.
2 Can.Fam. Physician. Discuss fetal alcohol effects in preconception
counselling: MD, Vol. 25:695, June 1979
3 Ibid.
4 Clarren, SK and Smith, D. The fetal alcohol syndrome. New Eng. J. Med.
298:1063-1067,1978.
Bibliography
1 Fielding, J.E. The pregnant drinker. Am.J.Pub.Health 68:835-836, 1978.
2 Morrison, A.B. and Maykut, M.O. Potential adverse effects of maternal
alcohol ingestion on the developing fetus. CMAJ 120:826-828, Apr.7, 1979.
The nurse in the community: infant stimulation
J
I
31 Novem.....111711
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Louise works closely with mother Armande and two-year-old Cory. Cory standing alone and
Increa'ted emphasis on reducing health costs through prevention and early problem intervention has meant that Infant
Stimulation programs are recehing greater government financial backing and, as a result, are becoming more widely
available. These programs are designed to enrich an infant's sensory experiences and promote the development of
cognitive, social, emotional, language and motor skills.
Is there a place for nurses within these programs? CNJ talked to Louise Mather, who was a community health
nurse with the Centretown Community Resource Centre in Ottawa and is now an Infant Development Worker with the
Infant Stimulation Programme at the Centre. We asked her about her contribution to the program.
Case Study
David, an infant boy, with Down's Syndrome was referred to
us by his pediatrician at the age of three weeks. On my
initial visit, I was greeted by both parents who seemed
rather hesitant and unsure of my purpose and their present
situation. Upon seeing David, I commented on how much he
resembled his Dad. His father uttered an exclamation of
surprise and said, "But he has Down's Syndrome, how can
he look like me?" After discussing the infant's Down's
Syndrome features, I reinforced that this was only part of
his genetic makeup and that there is often a strong family
resemblance.
Judith Bannin[?
CNj: HOI\' did )'OU as a nurse become interested in the field of
infant stimulation?
Louise: Before the program was set up. I worked as a
community health nurse with the Centre. making home visits:
counseling on birth control, diets and lifestyle: working in well
baby clinics: administering Denver Developmental Tests, etc. I
felt comfortable with babies and their families in their home
environments and really wanted to become part of this program.
As I have always felt that the developmentally handicapped
child had a very positive role to play within the family and the
community. thi.. was a way for me to promote this.
As I worked with David and his parents, their relationship
strengthened and David made many developmental gains.
He sat alone at nine months, was pulling to stand at eleven
months and surprised us all by walking when he was two
years.
By the time David was enrolled in a special preschool at
age two and one half years, the other children in the
neighbourhood considered him a welcome playmate and
there were many knocks On the door to see if David could
come out to play.
CNj: Tel/us something about the staff of the prowam, Louise.
Louise: Our staff includes three members. whose backgrounds
are physio/occupational therapy. nursing and ps ychology. The
physio/occupational therapist carries a case load of five to six
families and coordinates the program. The nurses each carry a
caseload of from 12 to 15 children who are visited at home.
usually on a weekly basis. We coordinate our program with
other services and utilize many community resources. i.e.
pediatricians, social workers. speech therapists. public health
nurses and nutritionists, to assist us in meeting these families'
needs in a comprehensive way.
CNj: What qualities do you consider necessary to wor
within
WI infant stimulation pro[?ram?
Louise: As a group we have been readily accepted by parents.
we have tried to be accessible, empathetic and neutral. We all
ha ve a genuinely positive attitude towards quality of life and the
potential of the developmentally handicapped child. However.
some very definite skills are required to be effective in this role:
. a 'iound knowledge of normal physical. emotional and
social development.
. counseling ability, i.e. kn0wing when a family is ready to
face reality, is frustrated. angry or disappointed. and an ability
to draw out these feelings. An ability to present a reality is a
great asset.
. problem identification: physical. emotional or social.
. teaching skills, i.e. the ability to teach families and children
as well as co-workers.
. organizational skills. which may be used to assist parents
to integrate the program into their daily routine as well as to
organize a demanding caseload.
. assessment skills. i.e. recognition of when a family needs
your help or is just not coping and requires more assistance or
other levels of service.
. knowledge of community resources and the ability to make
constructive referrals.
The c.n-.llan Nur..
Nov_t>erI.79 37
[ . . "-
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taking steps forward with support.
C
J: How do \'ou determine what to include in a hume
prox ram ?
I ouise: Every home that we enter is different and the goals we
set for each child and family vary accordingly. Sometimes it is
impos
ible to begin the obvious task ofintant stimulation
without fi
t dealing with other considerations. e.g. housing.
money management or nutrition. When problems in these area.;
exist we utilize resources within the community and make the
appropriate referrab.
Parents often have difficulty accepting their baby a'ijust a
baby and thinking of him as a "handicapped baby" can interfere
with healthy parent/child interaction. To facilitate this process.
we reinforce the idea as much as possible that thi, baby should
be treated a'i a "baby". So y"e act as role models and 'ihow the
parents that it is alright to do all of the normal things. By
talking. cuddling and playing with the baby, we are often able to
elicit responses from the child that the parent!. have never seen.
They are amazed. Sometimes on our next visit, these parents
y" ill tell us that they were able to initiate that response again.
thu'i providing encouragement for them.
Actual goal-setting is accomplished between the parents
and the y"orker. Initially. the worker may see groS'i motor
coordination as a priority but the family may feel that social
cognitive skills are more important. Since. in the end. it is the
family y"ho must carry out the home program, we would focu'i
on their major concern and later begin integrating the other
areas a
indicated.
We U'ie time-dated goals and do a'\sessment'i every six
months.
CNJ: H 0'" do you see the role of the neonatal nurse in the
huspital and the community?
Louise: Hospital'i have changed greatly. Today, with the
increa'iing number of children's hospitals, nurses seem much
more aware of children's needs.
We try to keep a fairly high profile and are in contact with
neonatal and toddler hospital units and public health agencies
regularly. Neonatal nurses are in a good position to assess both
the needs of the child and the familv on discharge. The
knowledge that infant 'itimulation is available has eased the
pre'i'iure on the ho'pital nurses greatly. Now they can talk to
parents, knowing that there is help and support in the
community.
Public health nurses give us many referrals now that they
are aware of our program. Recognition of developmental delays
frequently i'i not possible until six months of age and often it is
the public health nurse who is in contact with the child at this
time.
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Infant development involves the whole family.
C'-IJ: When ynu \1'urk so closely with families . /' m sure that
there are time.
when, despite the manv rewards. vuu m/ot feel
,'ery frustrated and drained of ideas.
Louise: Yes. we begin our relationship with some families in the
prenatal period. Although not much actual stimulation can be
done before six weeks postnatal. much counseling i'i often
required during this time, to optimize infant/parent bonding.
Then the actual stimulation begins, with the main goal being
integration of the progrdm into each family's daily lifestyle.
We've learned not to be afrdid of becoming involved with these
families as they seem to respond well to this total caring altitude
on our part. Naturally, we recognize that we must be careful not
to go too far.
These children may not aly"ays follow normal
developmental patterns. After working unsuccessfully for 'iix
months with one little girl to establish sitting. her mother and I
were running out of idea... So we decided to try standing and
walking. She accomplished these skills quickly and even now
sits for only very short periods.
Supportive co-workers are a necessity to give rea'isurance.
to act as sounding-boards and to give a different perspective.
Now that we are well into the program we've learned that when
we're dealing with a very low functioning child. for an extended
period of time. it is often useful to bring a new person into the
situation with fresh idea.. and approach. In this way we utilize
all of our skills and strengths.
Bihliography
I *Canning. Claire D. The g
fì of Martha. by Claire D.
Canning and Jo..eph P. Canning. Boston. Children's HO'ipital
Medical Center. 1975.
2 *Dmitriev. Valentine. Du":n' s sYlldrome performa nee
im'elltor\' manual. Seattle. University of Washington. 1976.
3 Hanson. Marci J. T eachillR your Down' s syndrome inflillt:
a xuide for parents. Baltimore.l'niversity Park Press. 1977.
4 *Horrobin. J . To Ri,'e WI edge: a guide for ne\1' parents oj
Down's syndrome (mungoloid) children, by J. Horrobin et al.
\1inneapolis. Colwell Press. 1974.
5 Pueschel. Siegfried M. Down's syndrome: gruwif/)? lInd
learnif/x, by Siegried M. Pueschel et al Kansas City, K... Sheed
Andrews and McMeel. 1978.
6 Smith. David W. The child ,,'ith Down's syndrome
(munxolism). by David W. Smith and Ann C. Wil.;on.
Philadelphia. Saunders, 1973.
*Unable to verify in CNA Library
38 November 1979
Handicap:
A parent'
perspective
Heather RlInJ..in
The Canedlan Nurse
I
'-
,
Seven years ago, I became the parent
of a physically handicapped child.
Since then, I have \iewed the
professionals and the facilities
available to these children from the
standpoint of a parent. This article is
based on my own personal
experiences and the observations of
other parents I have met in my role as
spina bifida co-ordinator at the
Ontario Crippled Children's Centre.
"Expectant parents 100J..fnrward to their
l
f.lsprinR a.l" someone 1\'1/0 will re.flect the
best they Ill/l'e in them, an extensiOfl of
themsell'es into the flext Refleratiofl." I
No parent is emotionally prepared for
the birth of a less-than-perfect child:
even those of us who pride ourselves on
being emotionally stable adults find great
difficulty in adjusting to the fact that our
newborn infant is not a healthy. beautiful
baby. At first we tend to disbelieve -
"the doctors have made a mistake - thi'i
cannot possibly happen to us - surely at
any moment we will awaken from this
terrifying nightmare'"
As the days and weeks pass. the
professionals come and go, we are forced
to acknowledge the sad truth: our ...on,
our Billy, has spina bifida. My husband
and I were as hewildered and ignorant as
any new parent<;. We asked all the usual
que...tions: "How did this happen'?",
"What went wrong?". "'What is the
future for our child?" and "Will thi...
happen again?"
Far too often the parents of a
handicapped child feel that they are
alone and that there is no one to share
their problems. The professionals are
busy and impersonal and they are
he'iitant to gi ve definite opinions. N ur .,es
cannot answer for the doctors and one
specialist cannot speak for another: it
seem'i impossible to get the team
together. This lack of information and
co-ordination makes the new parents
even less sure of their ability to handle
the complex problams that lie ahead. It is
at this time. immediately following birth.
that the family needs constructive
support. a sensitive person (nurse. social
worker or perhaps another parent) to
whom they can express their feelings of
guilt. anger, fear. hostility. fru'itration
and resentment.
As soon a'i Bill and I had somewhat
recovered from the inltial .,hock, we
were determined to find out all that we
could about spina bifida. We read
articles. explored available facilities and
learned the medical jargon
(myelomeningocele. h ydrocephal us,
shunt, C.S.F..I.V .P.. c.c.c..
peritoneal, trabeculation. reflux
contractures, stretchings. the list is
endless). In some re...pects. we were
more fortunate than many new parent'>
...ince we were already the parents of a
five-year-old daughter. Vikki.
Friends send cards and flowers. but
they hesitate to visit. Your family tells
you not to worry: '"Medical science can
do such wonderful things now". or they
keep repeating how "cute" the haby is.
An aunt of mine voiced the opinion, and
I have heard this since from other
.,ources, that Bill and I were "chosen" to
be the parent'i of a handicapped child
becau'ie we pO'isessed such quantities of
patience, love and compassion. Much
more disturbing is the idea that your
husband's parents may blame you while
your family insists that there was never
anything like this in your background.
They, too. are groping for answers.
Although we eventually became
relatively familiar with Billy's care in the
hospital. the first few weeks at home
were an exhausting and frw'trating
period of adjustment. Professionals warn
us not to over-react, but it is difficult to
remain calm when one is constantly on
the alert for danger symptoms - fever.
irritability, vomiting. drow'iiness. tense
or bulging fontanelles and increased head
circumference. We tend tQ forget that
our child can also sutler from a cold or an
upset stomach and any sign of illness
becomes a matter of m<uor signitícance.
The first emergency visit to the
hospital almost invariahly ta"es place at
night. The staff is indifferent and the wait
is endless. Sometimes we are sent home
with the instructions to "watch Billy
carefully" only to return the next
morning. On other occasions when he is
admitted for ob.,ervation and tests. days
pas... before any conclusive results are
made known to us.
I n the meantime. we try to keep up
some semblance offamily life. Vik"i
must be fed, cared for and made to feel
equally wanted and important: her
emotional and physical needs must be
met too. It is common for brothers and
sisters to experience feelings of anxiety
with each hospitalization of the
handicapped sibling and to feel
resentment and jealousy of the parents'
involvement - particularly that of the
mother - with the handicapped child.
.
..
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"
.. SihlinRs ,,'hose /ires may he
orerslllldowed by the demands of the
handicapped child need particular
understcmdinR (f !>eriOlH emotional
dÙ.1Iirbcmce is 10 he elI'oided."z
Since a handicapped child cannot
help but cause ten..ions within the family
life. parents are not always able to meet
the physical and emotional demands
made upon them. The disabled child
brings an added strain to a marriage. This
stres" not only relates to anxiety about
the child. but al"o affects the relationship
between the husband and wife. The
parents continue to require
understanding and support if the family
unit is to function in a way that is most
productive to the handicapped child as
well a.. other members of the family.
The parents of a handicapped child
must continually make adjustments. At
first I dreaded making new friend" -
people to whom I would have to explain
Billy'" condition. I wa" embarrassed
because he wore a hat ..0 that hi.. ..hunt
would not be noticeable. I cringed when
sales derks joked about his being lazy.
"When are you gOing to learn to walk
and help mommy'?" y"as the usual
comment. It i., still difficult for me to
visit friends with healthy new babies and
to share their joy without "ome
re..entment.
I know that our lifestyle has changed
since Billy wa" born: suppositories.
medication, brace." walkers. therapy.
doctors' appointments and. more
recentlv. intermittent catheterization are
all part of our live., now and. }-es. they
are time-consuming and often
exhausting. but we have become
accustomed to them as part of our
routine.
I do not believe that our social life
has become too restricted. but
preventing thi.. from happening ha..
required a conscious effort on our part.
Th. Cenedlen Nur..
Nov.mber 1979 311
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We still go on holidays each year as a
family. Everything take.. more planning
now: there is more luggage and
equipment but it is well worth the extra
effort. Recently. Billy acquired a
y"heelchair and we have had. perforce. to
become conscious of accessibility. Last
year. we were delighted to find that
Disney World was a place that we could
all enjoy: it was easy to manage with the
wheelchair and we were able to use the
ho"pital area off Main Street for Billy's
personal needs.
. 'The criticlII ear/y yellrs in the lijè
c
f the child ,,'ith spina h({ìda tend to be
duminated b\. a succession of medical
prohlem!>., hCJ.\pital admissions. surRical
operations and cumplications of them
all. A!> a re.mlt. it is ean to O\'er/oo/.. his
hcüic emotional, sucial and educatiunal
needs ,,'hich unh' differ from those uf any
other child in that they are more dUTìcult
tu sati
6' ."1 A child's adaptation to his
disability is a., greatly influenced by the
way in which his parents relate to him a..
it i" by the degree of his handicap. He
need.. to participate in peer relationships.
to develop "elf-control and social skill."
to experience the feelings of
participation and achievement and the
opportunity to make choices.
As parents. we recognize the need
for Billy to experience as much
independence as possible and are
prepared to take "prudent risks" - an
afternoon toboganning in the park. apple
picking in the Fall and other activities
which encourage his growth. However.
Bill and I continue to need professionals
and other parents of hdndicapped
children to assist us in establishing
realistic goals and to provide support
during the crises.'"
References
I Gitler. David and Vigliarolo.
Diane. The handicapped child and his
family. I nstitute of Rehabilitation
Medicine. New York University Medical
Centre, 400 East 34th Street. New York.
N.Y. 10016: July 1978. p.5.
2 Stark.G.D. Spina b({ìda prohlems
and manaRement. Edinburgh. Blackwell
Scientific Publications, 1977. p.139.
3 Ibid.. p.14 I.
About the author: Heather Rcm/";'I is
courdinator uft/le SpiflCl B(fìda Prowam
at the Ontariu Crippled Children's
Ce1l1re in Toronto. She is a memherof
the Ontario A dl'isory Council on the
Physically Handicapped and is the
mother of two children, Vil..l..i(aRe Il)
and Bill\' (age 7).
Ontario Crippled Children's Centre
Combined Spina Bifida Clinic
For the 325 children and their families
followed by the Combined Clinic, this
program offers a multidisciplinary team
approach to a long term problem that has a
great impact on the whole family.
Comprehensive care cuts down on the
number of visits to various specialists:
neurosurgeon, orthopedic surgeon,
general surgeon (bowel management). and
urologist. It also facilitates communication
and cooperation between all of the team
members, including nurses, physicians,
therapists, social worker. orthotist, x-ray
technician, volunteers and the coordinator.
Cases are generally reviewed at
intervals of from three to six months but
the child does not see every doctor at each
visit. Specialists amve for the clinics,
which are held on the first and third Friday
of each month, early in the afternoon.
Morning appointments allow time for the
therapists to assess each child and, during
this time, allied health services are
available to the families.
40 November 1979
The Canadian Nurse
Nutrition and the
Chronic
Schizophrenic
The current trend in psychiatric therapy is to minimize institutionalization
and deal with patients on an out-patient basis. Unfortunately, the patient
with chronic schizophrenia may not be able to handle the responsibility of
almost total self-care, resulting in a poor quality of life. A study done at the
Clarke Institute in Toronto reveals the implications of poor nutrition in
these patients, and proposes ways for nurses to help.
Jennifer Pyke
Schizophrenia is a psychotic disorder
characterized by the individual's
withdrawal from social interaction,
apathy and confusion of emotions. It
occurs usually in young adults but may
develop at any time in one's life; the
exact causes are not known. Current
treatment for schizophrenia includes the
use of tranquillizers. supportive
psychotherapy (either one-to-one or in
groups), vocational rehabilitation and
socialization activities. The period of
hospitalization for schizophrenics has
become progressively shorter. and
current psychiatric practice is to deal
with the chronic schizophrenic patient
on an out-patient basis. and to offer
therapy through mental health clinics
and hospital out-patient departments.
Schizophrenia remains a major
problem in health care 2 and still
represents the most frequently-made
admission diagnosis in psychiatric
institutions and the psychiatric units of
general hospitals.
It is unfortunate however that with
the trend to releasing patients from their
dependent status as in-patients to
self-care that community housing
facilities have failed to serve adequately
the large numbers of discharged
chronically-ill psychiatric patients.
Consequently. community mental health
workers - a large number of whom are
nurses - find themselves trying to cope
with chronic schizophrenics who are
living in poor conditions, attempting an
existence on welfare or small disability
pensions.
The irony of this from a treatment
standpoint is that the chronic
schizophrenic often exhibits the
secondary symptoms of the disorder,
namely apathy and a general lack of
motivation. which are not compatible
with almost total self-care. These
particular symptoms generally result in
poor self-care such as neglect of personal
hygiene, poor or absent dental care, and
an unsatisfactory diet.
The special importance of this latter
effect may be seen in a review of current
literature on schizophrenia. In a review
article, D.J. Kallen describes the
difficulty in separating social and
economic dysfunction from malnutrition 3
and one might theorize that the addition
of a disease such as schizophrenia would
intensify the problem. He notes that
apathy. listlessness and
unresponsiveness are symptoms of
malnutrition in adults; these same
symptoms are found, as previously
noted. as secondary signs of chronic
schizophrenia.
Numerous studies have been carried
out too on the relationship between folic
acid deficiency and certain mental
disorders. Kasowski and Kasowski in an
article devoted to folic acid deficiency.
note that many psychiatric disorders
including schizophrenia have been
associated with folic acid deficiency. but
that it is still unclear whether folate
deficiency is a cause or an effect of the
mental disorder" The population studied
in the article was chronically ill and so
there was a continued use of neuroleptic
drugs. Boullin observes that "adverse
drug reactions are more likely to occur in
the young, old, malnourished and
obese" and that "since little is known
about the effect of nutritional state and
age upon drug actions and interactions.
the physician should pay particular
attention to potential hazards in
susceptible elements of the
population. "5
Since poor dental care is a part of
general self-neglect and also somewhat
related to diet. the summary by Stahl on
the relationship between nutritional
deficiencies and dental disease is also
worth noting. "N utritional deficiencies
apparently do not initiate periodontal
disease. but may modify the severit.y and
extent of the lesion by altering the
resistance and repair potential of the
affected local tissues." 6
Pauling, Hoffer and Dohan have each
implicated eating habits in the
pathogenesis of schizophrenia 7 . H . 9 ; while
there is no firm evidence that poor eating
habits contribute to the development of
the disease there remains a probability
that these habits take their toll in the
subsequent deterioration of patients with
longstanding schizophrenia.
Tsuang and Woolson note that due to
improvements in treatment and public
health methods the life shortening effects
of mania and depression have been
alleviated. but remain unchanged in
schizophrenia. 10
The focus of this article is on the
importance of nutrition in the care and
treatment of the c'hronic schizophrenic.
and includes a study done at the Clarke
Institute of Psychiatry in Toronto which
provides some evidence to support the
hypothesis that unhospitalized patients
with this particular disorder are indeed
subject to deficient nutrition.
The Cenedl8n Nurse
November 1979 41
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The Clinic
The active treatment clinic at the Clarke
is designed to treat chronically iII
psychiatric patients, the majority of
whom are chronic schizophrenics. It is
denoted as an "active" treatment area
because the staffbelieves that in spite of
the presence of a chronic illness, each
individual can still achieve a relatively
high level of function within the
community and a better quality oflife.
With this in mind, all facets of a patient's
life are examined: vocational.
recreational. housing, family and other
social relationships, physical and
emotional health. Thus, nutrition
becomes one important aspect of the
total treatment plan.
Due to the large number of patients
(130) and relatively small numbers of
staff(one almost fulltime psychiatrist,
two almost fulltime residents. four very
part-time residents. three part-time
nurses, one part-time occupational
therapist and one part-time social
worker) and the active treatment
emphasis, the program is carried out in
groups when this is both feasible and
therapeutic.
The average patIent at the clinic is
young, male, white, and has been
hospitalized at least twice for functional
psychotic episodes. Allan, for example,
.
....
, / ...
, --
/ -...
-
./
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is 27 years old and was first diagnosed as
suffering from a process schizophrenia
when he was 22. At age 20 he dropped
out of university and has since
maintained a transient lifestyle, changing
rooming houses frequently and holding
unskilled jobs for only brief periods of
time. Often he lives entirely on
government a<;sistance. His life is
characterized by aimlessness and
apathy, and he finds little to maintain
interest or to give him pleasure.
In therapy, Allan's lifestyle has been
the major focus: hygiene, nutrition and
useful activities are discussed and
planned. Allan's nutrition is of particular
concern because he often "forgets" to
eat when he is preoccupied, and when he
does eat his diet is at a subsistence level.
He recorded his dietary intake for two
weeks as part of our study and for ten
days, tomato sandwiches were his major
meal of the day.
Group obsenations
Included in the groups at the clinic are
two social groups and one cooking
group: it was in these sessions that a
number of observations were made
about the nutritional status and
food-related habits of chronic
schizophrenics.
The social groups are the largest
with about 25 to 35 people in attendance
at anyone session. To enhance the social
atmosphere snack<; are made available:
coffee, tea, and cookies, which were
later supplemented with muffins, cheese,
carrot sticks and juice. We noted that:
. a significant number of the patients
drank several cups of tea or coffee during
the sessions, and often had more either
before or after in the hospital coffee
shop.
. the social act of passing and sharing
food is usually completely foregone
unless patients are reminded by staff
members. The patients often took their
food directly from the dietary
department wagon, and did not take the
plates to the tables provided for them.
. several patients have been observed
to literally gorge themselves on the food
presented. four or five muffins at a time,
with little concern or even awareness of
other group members. There was no
apparent recognition of the fact that
others might have to go without.
These observations made in the
social groups were significant in that
they revealed a connection between
certain symptoms of chronic
schizophrenia and behavior exhibited at
mealtimes. The excessive intake of
caffeine noted in many patients is of
special importance because, inasmuch as
caffeine intake is a common problem in
the general population, in the psychiatric
patient the symptoms of high caffeine
intake may be misinterpreted as
symptoms of psychiatric illness. Effects
such as "nervousness, irritability,
tremulousness, occasional muscle
twitching, insomnia (and) sensory
disturbances" may be noted, and it is
also reported that "caffeine seems to
counteract the sedative/hypnotic effect
of medications. "II
42 November 1979
Th. Canadian Nurse
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The fact that the patients often
neglect to pass food to other group
members or that they take as much food
as they want without thinking of others,
is a reflection of the schizophrenic's lack
of involvement with his environment,
and his total concern with selL
The cooking group was another
excellent time in which to observe the
schizophrenic's behavior concerning
food. and led to several conclusions
about the quality of the patients' diets at
home. The group has been conducted by
myself and a volunteer for about six
years, and has included approximately
eight patients who were to learn cooking
skills as well as to work as part of a group
and to improve food-related social skills
After six years of observations, we
concluded that not even the most basic
food preparation skills should be
assumed in the chronic schizophrenic.
unless seen. Cooking group observations
included the following:
. New members were found to be
unable to perform simple tasks such as
beating an egg. slicing a cucumber or
coring an apple. One young woman was
asked to make sandwiches: she was able
to butter the bread but she put the filling
on the dry side and presented the group
with a plateful of" inside-out"
sandwiches.
. Several people were noted to be
impatient waiting for the food to cook
and ate several slices of bread and sugar.
or bread and peanut butter, sitting down
less than fifteen minutes later to a meal.
...
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"'
. Social skills were noted to be
lacking during meals. dishes were often
not passed and left inaccessible to other
patients, condiments were just reached
for. and food was not routinely wiped
from the face and mouth.
As in the social groups, the
observations made in the cooking groups
may be seen to be the effects of chronic
schizophrenia. The apparent total
self-concern and lack of awareness of
others mark the schizophrenic's inability
to perform as a member of a group. The
failure to perform simple tasks too may
represent the patient's general apathy
and passi vity, or even that the
schizophrenic's perceptual processes
have been altered in some way: in other
words, were these tasks never really
learned or have the skills been lost as a
result ofthe schizophrenic process?
It was apparent to us from the
observations we made in the various
group sessions that the chronic
schizophrenic patient's behavior in
food-related areas such as food
preparation and mealtime social
conventions warranted further study.
Validation of observations made in
therapy was necessary to assess the
importance of nutrition in the overall
treatment plan of chronic
schizophrenics. Uppermo
t in our minds
were the thoughts that malnutrition
among these patients presented many of
the same symptoms as did
schizophrenia, and that certain of their
food habits, such as excessive intake of
caffeine, were actually interfering with
therapy. Also to be considered was the
fact that meals are both a social or group
activity, and a means of structuring one's
daily activities.
.
-
..
,
\
.
;
..
...
----
The project
A controlled study offood intake and
eating patterns of socially isolated
chronic schizophrenics was carried out
in the clinic in the summer of 1976 to test
the following hypotheses:
I. Chronic schizophrenics living alone
have demonstrably poorer nutrition than
a non-psychiatric group living in similar
socio-economic circumstance!>.
2. Chronic schizophrenics have an
excessive intake of calories.
3. Chronic schizophrenics have
disorganized eating patterns in
comparison to those of
non-schizophrenics.
The seven subjects all had a primary
diagnosis of chronic schizophrenia which
meant that they had each had at least two
functionally psychotic episodes requiring
hospitalization. The actual number of
hospitalizations for the group ranged
from two to 15 with the average being
five. The subjects were all well-known to
the therapist and were considered to be
reliable recorders and were stabilized on
neuroleptics at the time of the study.
Selection of the subjects was based
on the following criteria: age between 20
to 60 years: no other medical disorders:
no history of drug or alcohol abuse: not
to be on any special diet or vitamin
supplements: to be living alone dnd on
minimal income (that is, minimum wage.
welfare or other subsidy): to be cooking
for self or eating in restaurants.
The control group for the study
consisted of7 non-psychiatric patients
who were well-known to a local public
health nurse. and who also met all the
above criteria.
F or the study, both groups y" ere
asked to keep an inventory of all food
eaten in a two-week period. At the end of
this time. the infonnation was analyzed
and examined as to specific nutrients
calculated from standard food tables and
the Canadian Dietary Standards
(C.D.S.),t2
These records were completed by
four female and three male patients who
were between the ages of 24 and 49
years, who recorded a total of 86 days.
The control group consisted offour
females and three males bety,een the
ages of 20 and 58 years who kept records
for 94 days.
The results
Our infonnation revealed that:
. the psychiatric patients had an
overall "poor" diet when compared to
that of the control group
. more subjects than controls were
actually deficient in calories. Male
subjects averaged less than 1500 calorie..
per day
. there was a marked lack ofvariety
in the subjects' diet
. subjects tended to eat "empty
calorie" foods such as coffee.
carbonated drinks, doughnuts. or french
fried potatoes
. five of the subject'i lacked any kind
of meal pattern. whereas control'i
exhibited a pattern of three meals a day
taken at regular intervals
The Canadian Nurs.
. all subjects showed a diurnal pattern
offood intake. demonstrated by
beginning to eat later in the day and
stopping food intake earlier in the
evening than the control group.
No actual deficiencies of vitamin C.
niacin or thiamine were noted in either
group and no correlation could be found
in the subject group between the number
of psychotic episodes in a patient's
history and intake of nutrients.
Reviewing the findings of the !>tudy.
it would seem reasonable to 'itate that a
poor diet. particularly one deficient in
calories. could playa significant role in
the appeardnce of the secondary deficits
in chronic schizophrenia. namely apathy
and lack of motivation.
Implications
Looking at the general picture of
nutritional status. eating habits and
food-related behavior for chronic
schizophrenics who live alone in their
community leads to a better
understanding of the relationship
between poor !>ocial skills and nutrition
In the general population much of
our eating occurs in the context offamily
and social interaction: food is served at
parties as !>nacks or perhaps suppers:
coffee breaks and lunches are taken with
fellow workers: friends who visit are
offered food and drink: dinner is often
the central event of a social evening.
MEDIAN DML Y NUTRIENT DEF ICIENCIES 0: CHRONIC SZP VS CONTRQS
C. D. S. lor low activity
Deficiencies greater than
5 ubjects
fl M
12 M
13
'4 M
15 F
16
17 F
Controls
Ii F
'2 F
13 M
'4 F
'5 M
16 M
17 F
Protein Calcium Iron Vit A Rlblollavin Calories
9g-40g 500mg 16mg-lOmg 3700 i. u 1 (),-l. lmg 190:t-ZI50
59 loomg 2mg 500 i. u. O.lmg 500
-
.
-
.
-
. . . .
.
. .
. . . . .
-
I .
T
1
-
I . .
. Recommended lor females
November 1979 43
Thus. we can see that the behavior
surrounding food consumption is a
medium of social expression. and eating
is an act around which communication
and interaction takes place. For people
who are socially isolated. such
interaction is rare and for clinic-treated
psychiatric patients. may take place only
at group meetings in the clinic, or once a
year when their estranged families invite
them for Christmas dinner.
Social isolation therefore can be
seen to playa vital role in the poor
nutritional status of these people. and
unle!>s therapists become aware of
measures to improve patients'living
accommodations. diet. hygiene and
concommitant social skills. the plight of
the isolated chronic schizophrenic will
continue and worsen.
Treatment clinics can make u
e of
snacks offered in group meetings.
ensuring the food offered has some
nutritional value. Food can be used
therapeutically to promote and
strengthen social skills: '3 passing plates
of food for instance increases aWarene'iS
of other group members. and sharing
reinforces group cohesion. The use of
napkins and other social conventions
increases a patient's acceptability, and
personal hygiene. In addition. the
importance of meals as a means of
structuring the patient's day cannot be
overestimated.
In other psychiatric disorder... the
severe secondary symptoms that are
found in chronic schizophrenia do not
exist;U the 'manic' patient. for example.
returns to the degree of function he
possessed at his pre-morbid level.
Schizophrenics however tend to
deteriorate after each episode. leading to
increased apathy and lethargy. The
schizophrenic's life cycle may be seen to
be marked in part by chronically poor
nutrition which in turn may well play an
important part in the continuation ofthe
disease process. '"
Jennifer P) ke. R.N.. is a Rraduate of the
K itchener-W ater/oo School of N ursinR
if/ Ontario. She has wor"ed at the Clade
IflStitute of Psychiatry for the past twelve
years, and has been with the actÏ\'e
treatment clinic since its inception in
1972.
ACknoy,ledgement: This stud\' was
funded by the Research Fund
Committee. Clar"e IflStitute of
Psychiatry. The author wishes to
ac"nowledRe the assistunce and
upport
oj Dr. Mary V. Seeman.
44 November 1979
The Canadian Nurse
THERAPEUTIC DRUGS FOR CHRONIC SCHIZOPHRENICS
Phenothiazine drugs were introduced in the 1950's and several phenothiazine
derivatives are commonly used today. Some oral anti-psychotics are:
chlorpromazine (LargactiI OO ), trifluoperazine HCL (Stelazinel!!>) and
perphenazine (Trilafonl!!>). Injectable drugs are fluphenazine enanthate
(Moditenl!!>) and fluphenazine decoanate (Modecatel!!>).
The side effects listed below have not been noted in every phenothiazine,
but they have been reported in one or more and should be remembered when
these drugs are administered.
Adverse effects:
. Behavioral: oversedation,
impaired
psychomotor
function,
paradoxical effects
such as agitation,
excitement,
insomnia and toxic
confusional states.
. AutonomiC nervous
system: dry mouth, fainting,
stuffy nose,
photophobia, blurred
vision.
. Gastrointestinal: anorexia,
increased
appetite,
nausea,
vomiting,
constipation
and others
Dosage: when maximum
therapeutic response is
achieved, the dosage
should be gradually
reduced to a maintenance
level.
See CPS for further details.
References
I *Wing, J. K. The social context of
schizophrenia.Amer.J. Psvchiatry 135
(II): 1333-1339, 1978.
2 Canada. Statistics Canada. Mental
health statistics.
3 Kallen, OJ. Nutrition and society.
JAMA;/ 215:94-/00, /97/.
4 *Kasowski, M.A. and Kasowski,
W.J. International symposium reviews
folic acid and the nervous system.
Canad.Med.AssJ. 119(9):1134-1138,
1978.
5 Boullin, D.J. Nutrition and drug
actions and interactions. Primary Care
4(1): 173-181, 1977.
6 Stahl, S.S. Nutritional influences
on periodontal disease. World Rev. Nutr.
Diet. 13:277-297, 1971.
7 Pauling, L. Orthomolecular
psychiatry in Orthomolecular
psychiatry: treatment of schizophrenia
edited by David Hawkins and Linus
Pauling. San Francisco, Freeman, 1973,
pp.I-17.
8 *Hoffer, A, The chemical basis of
clinical psychiatry, edited by I.N.
Kugelmass. Springfield, 111., Charles C.
Thomas, 1960.
9 *Dohan, F.C. Relapsed
schizophrenics: more rapid improvement
on a milk and cereal free diet.
Br.J.Psychiatry 115-595, 1969.
10 Tsuang, M.T. Mortality in
patients with schizophrenia, mania,
depression and surgical conditions.
BrJ.Psychiatry 130:162-166, 1977.
II Greden, John F. Anxiety or
caffeinism: a diagno
tic dilemma.
Amer.J.Psychiatry 131( 10): 1089-1092,
1974.
12 Canada. Dept. of National Health
and Welfare. Nutrient \'alue of some
common (oods, 1971.
13 M'asnik, R., et al. "Coffee and": a
way to treat the untreatable.
Amer.J.Psychiatry 128:164-167, 1971.
14 Tsuang, MT. op. cit.
Yo UTe in
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Bibliography
I Reid, D. L. Food habits and
nutrient intakes of non-institutionalized
senior citizens, by D. L. Reid and J .E.
Miles. Canad. J. Public Health
68(2):154-158,1977.
*Unable to verify references in CNA
Librdry
The Canedlan Nurse
Nov.mber 1979 45
names & faces
Joan Gilchrist, Director of
McGill University School of
Nursing, was recently named
Flora Madeline Shaw
Professor of Nursing. The
Flora Madeline Shay, Chair in
Nursing. named after the first
Director of McGiIrs School of
Nursing, was established in
1957.
Professor Gilchrist,
Director of the School since
September 1972, is a grdduate
of the Wellesley Hospital,
School of Nursing. Toronto;
the University of Toronto
(Diploma in Clinical
Supervision); and McGill
University /B.N. and M.Sc.
Applied}.
A fOllTler president of the
Canadian Nurses Association
from 1976 to 1978, she was
awarded the Queen's Jubilee
\1edal in 1977 for her
contributions to Canadian
health care.
Joyce Ne,itt. founding director
of the School of Nursing at
Memorial University of
Newfoundland. has written a
history of the nursing
profession in Newfoundland.
Entitled White Caps and Black
Bands the book traces the
evolution of nursing from the
time of Maria Nugent (Sister
Joseph Nugent) who died in
1847 while nursing victims of
the typhus epidemic in SI.
John's. up to 1934 and the
re-organization of the
Graduate Nurses Assol.:iation
under Lucy BaITon. fhe text is
supported by old photographs
from the collections of Dr.
Nigel Rusted. the London
Hospital. the International
Grenfell Association and from
the private collections of those
connected with the medical
profession.
White Caps and Blac/..
Bands begdn as a sabbatical
year research project with the
. support of the Canada Council
and Memorial University.
"However I soon realized that
the research would take much
more than one year, so when I
returned to teaching at
Memorial I continued to work
on the book through holidays
and week-ends for four
years." Nevitt said.
Edna Rossiter of Vancouver,
is the fourteenth Canadian
nurse to receive the Florence
Nightingale Award from the
International Red Cros
.
A former RNABC
president (1957-60, Rossiter
retired from the pOMtion of
Director of Nursing,
Shaughnessy Hospital.
Vancouver in 1968. Since 1978
she has served as honordI)
secretary of the B.C.-Yukon
Division of the Red Cross.
Rossiter gradudted from
Victoria's Royal Jubilee
Hospital and rose to the rank
of major while serving with
the Royal Canadian Army
Medical Corps in Europe
during World War II.
Phyllis Jones has been
appointed dean of the Faculty
of Nursing , University of
Toronto for a five-year tellTl
beginning July l. 1979
succeeding fOllTler dean
Kathleen King. Jones is a
graduate of the U ofT having
received her B.Sc.N. in 1950
and her M.Sc. (health
administration) in 1969. Prior
to her appointment she wa'i a
professor in the nursing
faculty and has been
responsible for graduate
courses in community health
nursing and nursing
leadership, as well as the
development and teaching of
continuing education courses. "V
GREAT DEBATES
over controversies in the management of
HIGH RISK PATIENTS
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"Crystalloids Vs. Colloids"
"Nytroglycerin Vs. Nilroprusside"
"Central Venous Vs. Pulmonary
Artery Pressure"
"Tracheostomy Va. Endotracheal
Intubation"
"Programable Calculators Vs.
Computers"
"Pros and eons of Colloid
Osmotic Pressure"
"Pros and Cons of Steroids
in ARDS"
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MYER H. ROSENTHAL, M.D.
WILLIAM C. SHOEMAKER, M.D.
H. J. C. SWAN, M.D.. PH.D.
MAX HARRY WElL, M.D., PH.D.
@@
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DEPARTMENT OF
MEDICAL EDUCATION
January 11-13. 1980
CENTURY PLAZA HOTEL
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For ,ntormation
call (213) 855-5541
or write to
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This program offers a total 01
19 hours 01 Continuing Education
credit for physicians and nurses.
CHAIRPERSONS:
JOHN DE ANGELlS, M.D.
LAURA WORTHINGTON, RN., M.S.
@
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Nutrition
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Clinical
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L WL "AJØ
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THE NUIISE.1M_Y
Basic
pathophysiology
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48 November 1979
books
Emergency care, assessment and
intervention edited by Carmen
Germaine Warner. 2d ed. St. Louis,
Mosby, 1978.
Approximate price: $17.25
This book gives the reader a
comprehensive review of emergency
care with an emphasis on assessing the
client and making decisions regarding
necessary interventions. It would assist
the graduate nurse in developing her
The Canadian Nurse
assessment skills, in setting priorities
and in making decisions in various
emergency situations. The book gives
accurate and concise criteria for
assessing a wide variety of emergency
situations and provides guidelines for
intervention based on scientific
principles and recent medical research.
More specifically, chapters one and
two are definitely oriented to the
American health care system and are of
little operational use for Canadians.
However. they do provide Canadian
readers with insight into what is being
done in some areas of the United States
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hospital nursing staff
For full details and traming supplies, contact your Nordic representative or
write directly to us.
M
:
OJ Chomedey laval. P 0 H7S 2A4
in terms of emergency care. Some of the
information in these chapters
(communication systems and informed
consents) are elements necessary in any
emergency system and are therefore
more relevant and useful to members of
health care systems outside the United
States.
I n chapter four, "Emergency
Nursing." the functions of an emergency
nurse are stated in very conceptual
terms. I feel that this is of no benefit to a
basic undergraduate nursing student.
The functions of the emergency nurse
should be more clearly identified. For
example, which emergency nursing
functions are classified as independent or
interdependent, and which are
collaborative? Basic undergraduate
students probably would not know.
Chapters six through 33 provide the
reader with the facts necessary to a!>sess
a variety of emergency situations and
give specific guidelines for planning
intervention. I found no di<;crepancies or
omissions in the chapters and thought
they were very well presented. I was
particularly impressed with the writer's
ability to get the important facts and
information across in such limited space.
It is often difficult to determine what one
should have for a knowledge base in
emergency care.
I n summary. the book provides a
comprehensive re\'iew of knowledge and
skills necessary in assessing and
intervening in a variety of emergency
situations. In order to benefit from this
book, the nurse must have previous
experience and knowledge regarding the
topics covered. I would not recommend
this book as a text in an undergraduate
school of nursing. I would, however,
recommend it for all graduate nurses
working in critical care areas or as a text
for continuing education in emergency
care.
Rniell'ed by Debbie Sutherland. M.S.N.
Assistant Professor. Memorial
V ni\'ersity of N ell{OIifldland. School of
Nursing. St. John's. Nellfoundland.
BOOKS RECEIVED
Listin/< (
f a puhlication doe
not preclude in
subsequeflt rel'iew. Selection.
.for rel'iew will
be made accordinR to the iflterest.
of our
readers and a.\ space permits. A II rel'iew.\" are
prepared on illl'itatioll.
Readings in the sociolog) of nursing, edited
hy Robert Dingwall & Jean I\.klnto!>h. Nev.
York. Churchill Livingstone. 1978.
Clinical nursing techniques, hy Norma
Dison. 4th ed. Toronto. Moshy. 1979.
Melloni's illustrated medical dictionaQ, by
Ida Dox. Baltimore. WiIIi..m
& Wilkings.
c1979.
Criteria for the determination of death;
working paper:!3, by Law Reform
Commission of Canada. Canada. Mini
terof
Supply and Services. 1979.
Report of the Se,enty-Fïfth Ross Conference
on Pediatric Research. The ductus arteriosus.
Ohio. Ross LaNmuories, 1978.
llnderstanding the rape victim: a synthesis of
research findings. by Sedelle Katz. Toronto,
Wiley,cl979.
'\Iursing management for patient care, by
Matjorie Beyers & Carole Phillips. :!d ed.
Boston. Little. Brown, c1979.
Care of the mentally retarded. by Marian
Willard Blackwell. Boston. Little, Brown,
c1979.
Nursing care of infants and children. by
Lucille F. Whaley & bonna L. Wong.
Toronto, Mosby. 1979.
Humanizing hospital care. by Gemld P.
Turner & Joseph Mapa. Toronto,
McGraw-Hili, c1979.
Basic human anatomy and physiology, by
Charlotte M. Dienhal1. 3rd ed. Toronto.
Saunders, 1979.
Elementary medical biochemistry. by
J.M.I\1. Brown &G.G. Jaros. Durban,
Buttersworths, 1977.
Organisationat structure and the care of the
mentally retarded, by Norma V. Raynes,
Micheal Pratt & Shirley Roses. London.
Croom Helm, c1979.
'\Ieonatal pulmonary care, by Donald W.
Thibeault...et al. Don Mills, Ont.,
Addison- Wesley. c 1979.
Le nursing en ps}chiatrie: pour une vision
globale, par Judilh Haber...et al. Montreal.
HRW. c1978.
M} body. m} health: the concerned woman's
guide to gynecolog}, by Felicia Hance
Stewart...et a1. Toronto. A. Wiley Medical,
c1979.
Primary nursing: a model for indhidualized
care, by Gwen Marram & Margaret W.
Barrett. 2d ed. Toronto. Mosby. 1979.
Guide to nursing management of psychiatric
patients, by Sharon Dreyer. David Bailey &
Will Doucet. 2d ed. Toronto, Mosby, 1979.
Current practice in nursing care of the adult
issues and concepts. \ot. one, by Maureen
Shawn Kennedy &Gail Molnar Pfeifer.
Toronto. Mosby, 1979.
'Iatemal and child health nursing. by Joy
A. Ingalls & M. Constance Salerno. 4th ed.
Toronto, Mosby, 1979.
Bachelor of Administration
(Health Services)
Degree Program
Applications are now accepted for the program
combining independent study with tutorials on
weekends in Toronto, as well as for the
competency based, external degree internship
option offered for students at a distance.
Credits toward advanced standing are given
for practical managerial experience and prior
education including B.A., B.Sc., B.Sc.N.,
R.N., R.T.. H.O.M. Certificate and University
or College Courses.
The School is a member of Ihe Association of
University Programs in Health Administration
and is supported by the Kellogg Foundation
grant.
For information and application forms, please
write to:
Canadian School or Management
S-425. OISE BuDding
252 Bloor St., West
Toronto. ODtario M5S I V5
The c.nadlen Nurae
November 1979 49
Women's health and human wholeness, by
Loretta S. Bermosk & Sarah E. Porter. New
York, Appleton-Century-Crofts. 1979.
Hope for hypoglycemia, by Broda A.
Barnes. Fort Collins, Colorado, Broda A.
Barnes, 1979.
Self-assessment of current knowledge in
oncology nursing. by Rosemary Wang & Ann
Manchester Kelley. New York. Medical
Examination, c 1979.
The new nurse's work entry: a troubled
sponsorship, by Patricia Benner & Richard
Benner. New York, Tiresias Press. c1979.
Natural childbirth the Swiss way. by ESlher
Manlus. Englewood Cliffs, Prentice-Hall.
cl979.
The recovery room. by Cecil B. Drain &
Susan B. Shipley. Toronto, Saunders. 1979.
Practical notes on nursing procedures, by
Jessie D. Britten. 7th ed. New York,
Churchill Livingstone. 1979.
General surgical nursing. by Jane Emily
DeLoach. New York. Medical Examination,
1979.
Body structure and function, by Sondra Von
Arb. Mankato. Mn.. Minnesota Scholarly
Press, 1979.
Dept. of Emergency Medicine. Guidelines
manual: policies and procedures, by Jeffrey
MacDonald & Pal Kinder. Toronto. Mosby.
1979.
Self-assessment of current knowledge in
mental health nursing, by Doris J. Stoltzfus.
Garden City. N.Y., Medical Examination,1979.
Frogs into princes, by Richard Bandler &
John Grinder. Moab. Utah, Real People
Press, 1979.
Orthopedic nursing: a programmed
approach, by Nancy A. Brunner. 3rd ed.
Toronto, Mosby, 1979.
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W ÇLl!!/!A!!!'
fJ!l!lPljl!.!v D
1 DORCHESfER AVENUE TORONTO ONTARIO MBl 4WI
50 November 1979
Leadership in nursing, by Margaret M.
Moloney. Toronto, Mosby, 1979.
The cancer unit: an ethnography, by Carol
P. Hanley Germain. Wakefield, Ma., Nursing
Resources, 1979.
Obstetrical nursing. Continuous education
review, by Malo-Juvera, Dolores...et al. 2d
ed. Garden City, N.Y., Medical Examination,
1979.
Nurse practitioners: USA, by Harry A.
Sultz, Henry, Marie & A. Judith. Toronto,
Lexington Books, 1979.
Health guide for travellers to warm climates,
by Stanley S.K. Seah. 2d ed. Ottawa,
Canadian Public Health Association, 1979.
Maintaining cost effectiveness, by Elsie
Schmied ed. Wakefield, Mass., Nursing
Resources, 1979.
Ovol Drops
relieve
infant colic.
I
,.
'PAABI
ccpp
Th. c.n-.llen NUrH
Nurses' handbook ofOuid balance, by
Norma MilIiam Metheny & W.O. Snively. 3rd
ed. Toronto, Lippincott, c1979.
Introductory maternity nursing, by Doris C.
Bethea. 3rd ed. Toronto, Lippincott. c 1979.
Perspectives on adolescent health care, by
Ramona T. Mercer. Toronto, Lippincott,
1979.
Childbearing; physiology, experience, needs,
by Jayne DeClue Wiggins. Toronto, Mosby,
1979.
Work manual for introductory maternity
nursing, by Doris C. Bethea. 3rd ed. Toronto,
Lippincott, cl979.
A guide to physical examination, by Bamara
Bates. 2d ed. Toronto, Lippincott, 1979.
The patient with end stage renal disease, by
Larry E. Lancaster. Toronto, Mosby, 1979.
1
-
_;r""
15l1li
Ovol Drops contain simethicone,
an effective, gentle antiflatulent
that goes to work fast to relieve
the pain, bloating and discomfort
of infant colic. Gentle pepper-
mint flavoured Ovol Drops.
So mother and baby can get
a little rest.
Oval am
CAA.
-.-
ft I
ng I
. relief
. I of infant
colle
6HORr'Æ:R
Shhh. Ovol Drops. AlooB'B,IBblemtabletronnrorBdulu
eHQB
R
Maternal and child nutrition, edited by Jill
s. Slattery, Gayle Angus Pearson & Carolyn
Talley Torre. New York,
Appleton-Century-Crofts, 1979.
Current practice in critical care. Toronto,
Mosby, 1979.
Community decision making for social
welfare; federafism, city government and the
poor, by Robert S. Magill. New York, Human
Science Press, cl979.
Nurse's guide to drugs. Horsham, Pa.,
Intermed Communications, 1979.
Programmed mathematics of drugs and
solutions, by Weaver, Koehler. Toronto,
Lippincott, 1979.
Community development research, edited by
EdwardJ. Blakeley. New York, Human
Science Press, 1979.
Drugs and pharmacology for nurses, by S.J.
Hopkins. London, Churchill Livingstone,
1979.
The doctor and the law; a practical
handbook for the Canadian physician, by H.E.
Emson. Toronto, Macmillan of Canada,
cl979.
Coping with neurologic problems
proficiently. Horsham, Pa.,lntermed
Communications, 1978.
*THE LIBRARY'S ACCESSION LIST IS
A V AILABLE ON REQUEST WITH A
STAMPED, SELF -ADDRESSED
ENVEWPE. 'iI
OVOI@80mg
Tablets
OVOI@40mg
Tablets
Ovol@
Drqps
Antiflatulent Simethicone
INDICATIONS
OVOl is indicated 10 relieve bloating,
flatulence and other symploms
caused by gas retention Including
aerophagia and infant colic.
CONTRAINDICATIONS
None reported.
PRECAUTIONS
Prolect OVOl DROPS from freezing.
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOl80 mg TABLETS
Simethicone 80 mg
OVOl4O mg TABLETS
Simethicone 40 mg
Adults: One chewable lablel between
meals as required.
OVOl DROPS
Simelhicone (in a peppermint
flavoured base) 40 mg/ml
Infants: One-quarter to one-half ml as
required. May be added to formula or
given directly from dropper.
e HQB
R
What's New?
TEXTBOOK OF HUMAN SEXUALITY FOR NURSES
By Roben C. Kolodny, M.D.; William H. Masters, M.D.; Virginia
E.johnson;and Mae A. Biggs, R.N., M.S.
While nurses fully realize that sexual health is an important com-
ponent of the overall well-being of their patients, the effects of
health problems on sexuality are less apparent. To explain the
biologic and psychosocial impacts on sexuality of a variety of
medical and surgical conditions, the authors of TEXTBOOK OF
HUMAN SEXUALITY FOR NURSES draw on 25 years of
clinical experience and research from the Masters & Johnson
Institute. From its opening chapter, Sexuality as a Clinical
Science for Nurses, to its closing pages of questions and answers,
this text effectively incorporates human sexuality into nursing
practice at a level that can be understood by both practicing and
student nurses.
Little, Brown. 450 Pages. Illustrated. 1979. Paper, $15.00.
Cloth, $21.00.
GERONTOLOGICAL NURSING
By Charlotte Kopelke Eliopoulos, R.N., B.S., M.S.
This practical new book provides a comprehensive review of the
medical, surgical, and psychiatric problems associated with aging,
accompanied by related nursing interventions. Specific coverage
is given to measures designed to promote good respiration,
elimination, and activity to compensate for age-related changes
interfering with these functions. Common diseases of each body
system and their unique features in the aged are discussed in
detail.
Harper & Row. 384 Pages. Illustrated. 1979. $15.00.
A GUIDE TO PHYSICAL EXAMINATION,
2nd Edition
By Barbara Bates, M.D.
New chapters on interviewing and history-taking, and much
expanded and updated content mark the new edition of this
outstanding guide to physical assessment for health practi-
tioners. Detailed and concise, it's an excellent on-the-job
reference for interviewing and examination; for assessment of
health status; and for differential diagnosis among abnormal
findings. There are now more examples of abnormalities, more
information on the cardiac chapter, a new section on the
stuporous or comatose patient and revised chapter on the
pediatric examination.
Lippincott. Abt. 425 Pages. 1979. $25.00.
NURSES' HANDBOOK OF FLUID BALANCE,
3rd Edition
By Norman Milligan Metheny, B.S.N., M.S.N., Ph.D.; and W.O.
Snively,jr., M.D., F.A.C.P.
Almost totally rewritten and revised, with a wealth of new
material, this edition is twenty percent larger than the previous
one! It presents basic knowledge of body fluid balance distur-
bances, with emphasis on practical application. New material
and major revisions include: new knowledge of homeostasis;
a summary of the latest information on nutrition; an expanded
section on real-life case histories; greatly increased emphasis
On acid-base disturbances; and greater coverage of elemental
diets, tube feedings, diuretics, and adrenocortical steroids.
Lippincott. Abt. 400 Pages. 1979. Abt. $15.00.
NURSING MANAGEMENT FOR PATIENT CARE,
2nd Edition
By Marjorie Beyers, R.N., Ph.D.; and Carole Phillips, R.N.,
M.S.
In this second edition, the authors live up to the impeccable
reputation established by NURSING MANAGEMENT FOR
PATIENT CARE. Important new features include reports on
recent theories of management, a deeper explanation of the
nurse manager's relationship with staff members, an enlarged
chapter on the plan of care, and timely discussions of the
expanding role of the nurse manager, including her function in
health-care organizations other than hospitals and in disputes
with unionized employees.
Little, Brown. 292 Pages. Illustrated. 1979. $10.75.
COMMUNICATION FOR HEALTH PROFESSIONALS
By Voncile M. Smith, Ph.D.; and Thelma A. Bass, M.A.
This timely book identifies and describes problem situations
stemming from communication breakdowns that commonly
affect health care personnel. It relates the importance of
communication to the maintenance of public confidence in
health care institutions and personnel, and explains skills
necessary to communicate effectively with patients and clients,
co-professionals, supervisors, and subordinates.
Lippincott. Abt. 200 Pages. 1979. Abt. $8.50.
Lippincott
J. B. LIPPINCOTT COMPANY OF CANADA LTD.
Serving the Health Professions in Canada Since 1897
75 Horner Ave., Toronto, Ontario M8l4X7
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.
ffld
fu
;
-------
o KOLODNY: Textbook of Human Sexuality for Nurses,
Paper, $15.00.
o KOLODNY: Cloth, $21.00.
o ELIOPOULOS: Gerontological Nursing, $15.00.
o BATES: A Guide to Physical Examination, 2nd Ed., $25.00
o METHENY: Nurses' Handbook of Fluid Balance, 3rd Ed.,
$15.00.
o BEYERS: Nursing Management for Patient Care, 2nd Ed.,
Abt. $15.00.
o SMITH
Communication for Health Professionals,
Abt. $850.
o Payment enclosed (postage & handling paid)
o Bill me (plus postage & handling)
Name
Address
City
Postal Code
Provo
Prices subject to change without notice.
CNII/79
12 November 11711
Th. c.nMllan NUrH
Classified
Advertisements
Alberta
The Drumheller Health Unit requires a Supervbor of
Nw.. with experience and qualifications in Public
Health for supervision of a staff of eiøht district
nurses in preventive programs of community health
to a population of 28,000 in an area of 4000 square
miles. Main office is located in Drumheller, popula-
tion 6,000, 8S miles from Calgary. For information or
application forms please reply, giving curriculum
vitae to: Agnes E. O'Neil, M.D., D.P.H., Medical
Officer of Health, Box 1780, Drumheller, Alberta,
TOJ OYO.
Realltered Nunes required for full or part time work
for Medical and Surl!ical floors. To work rotating
shifts. Positions available immedialely. Apply to:
Mrs. S. Tiechreb, Director of Nursing, Pincher
Creek Municipal Hospital, P.O. Box 968. Pincher
Creek, Alberta, TOK IWO.
Rqlltered nw.. required for 7S-bed accredited
active treatment hospital in a lakeland resort area,
130 miles northeast of Edmonton, Salary 51217 -
14S4 per month. Apply: Director of Nursing, St.
Therese Hospital. Box 880, St. Paul, Alberta, TOA
3AO.
British Columbia
Experienced General Duty Graduate Nurses required
for small hospilal located N.E. Vancouver Island.
Maternity experience preferred. Personnel policies
according to RNABC contract. Residence accom-
modation available 530 monthly. Apply in writing to:
Director of Nursing, St. George's Hospital, Box 223,
Alert Bay, British Columbia, VON IAO.
O.R. and P.A.R. - Head Nurse required for an
accredited 1000bed acute hospital in a fasl growing
progressive community in B.e. Experience or
advanced preparation required. Must be eligible for
B.e. registration. Salary - 51S00 - 51772 per
month. Benefits in accordance with R.N.A.B.e.
contract. Apply 10: Director of Personnel, Fort St.
John General Hospital, Fort SI. John, B.e. VIJ IY3;
Phone (604) 78S-66 I I.
General Duty Nurse for modem 3S-bed hospital
localed in southern B.e. 's Boundary Area with
excellent recreation facilities. Salary and personnel
policies in accordance with RNABe. Comfortable
Nurse's home. Apply: Director of Nursing, Bound-
ary Hospital, Grand Forks, British Columbia. VOH
IHO.
General Duty RqI!ltered Nurses required for 108 bed
accredited hospital. Previous experience desirable.
Staff residence available. Salary as per R.N.A.B.e.
Contract with northern allowance. For further
information please contact: Director of Nursing,
Kitimat General Hospital, 899 Lahakas Boulevard
N.. Kitimat, B.e. V8C IE7.
Registered Nurses required immediately for a 340-
bed accredited hospital in the Central Interior of
B.e. Registered Nurses interested in nursing posi-
tions at the Prince George Regional Hospital are
invited to make inquiries to: Director of Personnel
Services, Prince George Regional Hospital, 2000-
ISth Avenue. Prince George, British Columbia,
V2M IS2.
British Columbia
Experienced Nurses (eligible for B.e. Registration)
required for full-time positions in our modem
300-bed Extended Care Hospital located jusl thirty
minutes from downtown Vancouver. Salary and
benefits according to RNABC contract. Applicants
may telephone S2S-0911 to arrange for an interview.
or write giving full particulars to: Personnel Direc-
tor. Queen's Park Hospital, 31S McBride Blvd.,
New Westminster, British Columbia, V3L SE8.
Experienced Nurses (B.e. Registered) required for a
newly expanded 463-bed acute, teaching, regional
referral hospilal located in the Fraser Valley. 20
minutes by freeway from Vancouver, and within
easy access of various recreational facilities. Excel-
lent orienlation and continuing education program-
mes. Salary-1979 rates-5130S.00--5IS42.00 per
month. Clinical areas include: Operating Room, Re-
covery Room, Intensive Care, Coronary Care,
Neonatal Intensive Care, Hemodialysis, Acute
Medicine, Surgery, Pediatrics, Rehabilitation and
Emergency. Apply to: Employment Manager, Royal
Columbian Hospital, 330 E. Co
umbia St., New
Westminster, British Columbia, V3L 3W7.
Head Nunc for t6-bed Psychiatric Unit in a
Northern B.e. hospital. Must be eligible for B.e.
registration with a minimum of two years experience
and proven administrative skills in a similar position.
Apply in writinlJ to the: Director of Nurses, Mills
Memorial HOSpital, 4720 Haugland Avenue, Ter-
race, British Columbia, V8G 2W7.
Experleac:ed maternIty, I.C.U./C.C.U., ud Operat-
In. Room General Duty nunes required for 100-bed
accredited hospital in Northern B.e. Must be
eligible for B.e. registration. Apply in writinJl to the:
Director of Nurses, Mills Memorial Hospital, 4720
Haugland Avenue, Terrace, British Columbia, V8G
2W7.
Manitoba
Public Health Nunc required immediately for com-
munity health centre at Lac du Bonnet, Manitoba.
Work on a team with other health disciplines.
Tourist area 70 miles from Winnipeg. Apply to:
Executive Director, Lac du Bonnet District Health
Cenlre. Box 1030, Lac du Bonnet, Maniloba, ROE
IAO.
Challenging Career Opportunity ror Registered Nurses In
Canada's North - A 100 bed acute care hospital in Nonhem
Mdnitoba which services Thompson oind several small
communities in the surrounding area has immediate vacan-
cies in Pediatrics. Medicine/Surgery. Obstetrics and Critical
Care. This opponunity will appeal to nurses who want to
increase their existing ski11s or develop new skills through our
comprehen!rr>ive inservice program. Many of our nurses have
become experienced in flight nursing. Candidates must be
eligible for provincial registration as d.ctive practicing
members. We offer an rxcellent range of benefits. including
frer dental plan. accident. health and group life insurance.
Salary rnnge is SI.078 - SI.340 per month dependent on
qualifications and experience plus a remoteness allowance.
Apply in writing or phone: Mr. R.l. Irvine. Director of
Personnel. Thompson General Hospital. Thompson. Man-
itoba. R8N OR8. Phone: (204) 671-2381
Experienced ReJlltered N...... required for a fully
accredited 200-bed Health Complex located in
Northern Manitoba. Must be eligible for registration
in Manitoba. Salary dependent on experience and
education. For further infonnation contact: Mrs.
Mona Seguin, Personnel Director, The Pas Health
Complex Inc., P.O. Box 240, The Pas, Manitoba,
R9A IK4.
Manitoba
Applications, including resume and name of referees
are invited for Faculty whh prore.loaal competence
In Community Health Nunln.. This full time position
will commence September t, 1979 or as soon as
possible. Candidates should have at least a Master's
Degree, as well as teaching experience and a
publication record. Salary and rank are negotiable
and commensurate with qualifications. Considera-
tion will be given to those with polential for teaching
effectiveness in the Canadian health care scenes.
Apply to: Professor June Bradley, Acting Director,
The School of Nursing, University of Manitoba, 21S
- 9S Curry Place, Winnipeg, Manitoba, RJf 2N2.
Northwest Territories
The Stanton Yellowknife Hospital, a 72-bed accre-
dited, acute care hospital requires registered nurses to
work in medical, surgical, pediatric, obstetrical or
operating room areas. Excellent orientation and
inservice education. Some furnished accommoda-
tion available. Apply: Assistanl Administrator-
NursinJl, Stanton Yellowknife Hospital, Box 10,
Yellowknife, N.W.T.,XIA 2NI.
Ontario
P.H.N. - Registered Nurse qualified in Public
Health Nursing with Degree or Diploma for
generalized public health nursing programme. Apply
in writing with resume to: Director of Nursing,
Haldimand-Norfolk Regional Health Unit, Box 247,
Simcoe, Ontario, N3Y 4LI.
Director of Nursing required for an accredited
18S-bed Active Treatment General Hospital in
Northern Ontario. Position: The Director will be
responsible for planning, organizing, directing and
evaluating the activities of the Nursing Departmenl:
must be aware of current concepts of Nursing
Service and have enthusiasm for initiating and
following-up new ideas, projects and programs.
Qualifications: Candidate must be currently regis-
tered in the Province of Ontario and possess a
Baccalaureate Degree in Nursing or have de-
monslrated competence and ability in a senior level
nurse management position. Salary is commensurate
with qualifications and experience. Please forward
applications to: Personnel Director, St. Mary's
General Hospital, 41 Pine Slreet North. Timmins.
Ontario. P4N 6K7.
RN, GRAD or RNA, Y6" or over and strong.
without dependents, non-smoker, for 18S lb. hand-
icapped retired executive with stroke. Able to
transfer patient to wheelchair. Live in 1/2 yr. in
Toronto and 1/2 yr. in Miami. WaJles: 5200.00 to
527S.00 wkly. NET plus 590.00 wkly. bonus on most
weeks in Miami. Write: M.D.e., 3S32 Eglinton
Avenue West, Toronto. Ontario. M6M IV6.
Saskatchewan
Two RN's required for a 32 bed, fully accredited
general hospital. For further infonnation contact:
Director of Nursing, St. Joseph's Hospital, Gravel-
bourg, Saskatchewan SOH IXO.
Rqlstered Nunes required immedialely for penna-
nent full time positions at a 30-bed accredited
hospital in Esterhazy, Sask. Must be eligible for
S.R.N.A. registration and willing to work rotating
three shifts. Apply to: Director of Nursing, St.
Anthony's Hospital, Box 280, Esterhazy, Sas-
katchewan, SOA OXO; or phone: (306) 74S-3973.
Saskatchewan
R.N.'s and R.P.N.'s (eligible for Saskatchewan
registration) required for 340 fully accredited ex-
tended care hospilal. For further infonnation.
contact: Personnel Department. Souris Valley Ex-
tended Care Hospital. Box 2001, Weyburn, Sas-
katchewan S4H :!L7.
United States
USA - Positions available in Texas, Arkansas and
Nevada, for Reat.tered Nu.... For information
please write to: Mrs. G. Nees, President, Pacific
International Employment Service Inc., 7110 Dye
Drive, Dallas, Texas, 7S248.
R.N.'. U.S.A. - Dunhill with 2SO offices has
exciting career opportunities for both recenl grads
and experienced R.N.'s. Locations North, South.
East and West. All fees are paid by Ihe employer.
Send your resume to: 801 Empire Building. Edmon-
ton, Alberta, TSJ IV9.
Maternal Child Health Super>lsor -tf you think the
time has come for you to select a new professional
environme:ll, then Ihe time has come for you to
seriously consider joining Kaiser-Permanente. a
dynamic JACH accredited teaching hospital. At
Kaiser. a superior benefit package is offered to all
fun time RN's. and because we believe in the
importance of continuing education. we offer 24
hour in-service training on all shifts. Our Maternal
Child Health Dept. is seeking a leader: a licenset1 RN
who has a strong background in Maternal Child
Health, and who is accomplished in the ability to
lead olhers. Send your resume for an earnesl review
of your qualifications in confidence to: Ann Marcus.
Dir. of Nurse Staffing. Kalser-Pennanente
edlcal
Center, 4867 Sunset Blvd.. Los Angeles, California
90027 (213) 667-6932.
The Cen-.llen Nure.
Offers R.N.'s
An UNUSUAL OPPORTUNITY,
A.M.I. Will FURNISH One Wly AIRLINE TICKET to Teus
Illd S500 Inltll' LIVING EXPENSES on a loin Basis.
Anlr Onl Y..r's Se",lcI, TIlls loan Will be Cancelled
MI American Medical International Inc.
. HAS 50 HOSPITALS THROUGHOUT THE U.S.
. lIow A...I. II ".wang ".11:1 lor HOl,llIlllo T..II.
Immel/al. D,lftlilfl. II'lry IIlng. 111.000 10 $16. SOD per Y....
. You can enloy nurSing in General MedIcIne. Surgery. ICC.
CCU. Pedlalncs and Obstetncs
. A M I provides an excellent onentatlon program.
m-seMce training
r------------..
I .
. U.S. Nurse Recruiter .
I P.O. Box 17778,los AnAeles. Calif. 90017 .
, . WIthout obhgaÞOn. please send me more I
InlormaÞon and an ApphcallOn Form ,
I !lAME
I AODII ESS -=======
=== I
I DTY_ --- ST.___ZIP___,
TELEPHONE (_ _1_ _ _ _ _ _ _ __
I UCENSES:___________.
. SPEDALTY:_ ____. __ ---I
YEAR GRADUATED. _ _ _ STATE _ _ __
,,____________rI
EXPERIENCED RN'S &
NEW GRADS
"THE PERFECT OPPORTU
ITY"
Saint Anthony Hospital, located in Columbus, Ohio.
This 400-bed acute care facility offers excellent opportunities
for furthering your nursing career.
No Contracts to Sign
Rotating Shifts
Air Fare Paid
One Month Free Accommodations
Plus Exciting Challenges
Saint Anthony, a medical-surgical institution. has a complete
range of services, including;
. Open Heart Surgery
. Intensive and Coronary Care
. Definitive Observation Unit
o Renal Dialysis
o Diagnostic and Therapeutic Radiology
. 24 Hour Emergency Department
Don't wait, caD or write immediately.
Make the change to an institution that lets you be what you
want 10 be. For further information. call our Nurse Recruiter,
orma Shore, CoDed.
EXCLUSIVE CANADIAN REPRESENTATIVES
RECRlTr....G REGISTERED Nl'RSES VIIC.
1.111-
II III
11_ II.
1200 Lawrence A venue Easf
Suite 301, Don Mills
Ontario M3A IC]
Telephone: 14]6) 449-5883
-
November 11171 53
United States
NunN - RNs - A choice of locations with
emphasis on the Sunbelt. You must be licensed by
examination in Canada. We prepare Visa fonns and
provide assistance with licensure at no cost to you.
Write for a free job market survey Or call collect
(713) 789-tSSO: Marilyn Blaker, Medex, SSOS
Richmond. Houston, Texas 770S7. All fees employer
paid.
California - Sometimes you have to go a long way
to find home. But, The White Memorial Medical
Center in Los Angeles. California. makes it all
worthwhile. The While is a 377-bed acute care
teaching medical cenler with an open invitation to
dedicated RN's. We'll challenge your mind and offer
you the opportunity 10 develop and continue your
professional growth. We will pay your one-way
transportation, offer free meals for one month and all
lodging for three months in our nurses residence and
provide your work visa. Call collect or write: Ken
Hoover, Assistant Personnel Director, 1720 Brook-
lyn Avenue, Los Angeles, California 90033 (213)
268-S000, ext. 1680.
t10rtda Nu...... Opportullltiel - MRA is recruiting
Registered Nurses and recent Graduates for hospital
posilions in cities such as Tampa, St. Petersbu
.
and Sarasota on the West Coast; Miami, Ft.
Lauderdale and West Palm Beach on the East Coast.
If you are considering a move to sunny Florida,
contact our Nurse Recruiter for assistance in
selectinl the riøht hospital and cilY for you. We will
provide complele Work Visa and Stale Licensure
information and offer relocation hints. There is no
placement fee to you. Wrile or call Medical
RKnaitenof "'-rica, lilt. (For West Coast) 1211 N.
West shore Blvd., Suite 20S, Tampa, FI. 33607 (813)
87H)202: (For East Coast) 800 N.W. 62nd St., Suite
SIO, Ft. Lauderdale, FI. 33309 (30S) 772-3680.
.
{
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,
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54 Novem.....'979
50th Anniversary
Celebration
Seton General Hospital in Jasper
National Park invites all ex nursing
staff to attend their 50th
Anniversary Celebrations May 5th
to lith, 1980 Inclusive.
A Gala Banquet and Ball at Jasper
Park Lodge, May 10th.
Come and renew old acquaintances
and make some new ones!
For further information contact:
Mrs. Donna Lane, R.N.
Box 1063
Jasper, Alberta
TOE lEO
I nternational Grenfell Association
invites applications for the positIOn of
Director of Nursing
for an accredited 160-bed general hospital in
SI. Anthony, Newfoundland.
Travel expense borne by Association on
minimum of one-year service. Fringe benefits.
Applicants should have administrative
experience and be eligible for registration in
the Province of Newfoundland. Preference
given to candidate with B.Sc. or masters in
nursing. Salary in accordance with provincial
government scale.
Apply to:
Mr. Scott SmIth
Personnel Director
International Grenfell AMoclatlon
St. Anthony, Newfoundland
AOK 4S0
McMaster University
Educational Program
For Nurses In
Primary Care
McMaster University School ofNurs-
ing in conjunction with the School of
Medicine. offers a program for regis-
tered nurses employed in primary
care settings who are willing to
assume a redefined role in the primary
health care delivery team.
RequIrements Current Canadtan Regist-
ration. Preceptorship from a medical
practitioner. At least one year of work
experience, preferably in primary care.
For further information write to:
Mona Callin, Director
Educational Program for Nurses
in Primary Care
Faculty of Health Sciences
McMaster University
Hamilton, Ontario L8S 4J9
Th. c.n-.llen Nur..
United States
RN'I - Bo6Ie, Idaho - How would you like a
ew
ng career in an environment which offers you
unmediate access to unconlested recreation areas
with. rivers, lakes and mountains? Do you eqjoy
tennis, aolf, rackelball, camping, hiking, sküng and
horseback riding? Sound exciting? It is. And there
are many opportunities for satisfyinl work at one of
Idaho's largest and most progressive medical
complexes. SI. Alphonsus, located in Boise is a
229-bed. facility offering you position's in
orthopedtcs, ophthalmology, dialysis, mental health,
neurosurgery and trauma medicine. Excellent
salary, ge!'erous benefits w:'d job security. Starting
salary adjusted for expenence; benefits include
tra
el assistance, shift rotation, and free parking.
Wnte or call collecl: Employment Supervisor,
Personnel Office, St. Alphonsus Hospital, 1055
North Curtis Road, Boise, Idaho 83704, (208)
376-3613. EOE.
]
NUrMI - RNI - Immediate Openinls in
Califomia-Florida-Texas-Mississippi - if you are
experienced or a recent Graduate Nurse we can offer
you positions with excellent salaries of up to $1300
per month plus all benefits. Not only are there no
fees to you whatsoever for placing you, but we also
provide complete Visa and Licensure assistance at
also. no. cost to . l ou. Write immediately for our
appllcalton even I Ihere are other areas of the U. S.
that you are interested in. We will call you upon
receipt
f you.r application in order to BlTange for
hOspltalmtervlews. You can call us collect if you are
an RN who is licensed by examination in Canada or
a recent araduate from any Canadian School of
Nursing. Windsor Nurse Placement Service, P.O.
Box 1133, Great Neck, New York, 11023. (516 -
487-2818).
"Our 20th Year of World Wide Service"
Dallas, Houoton, Corpus ChrIsti, etc, etc, elc. The
eyes of Texas beckon RN's and new grads to
practice their profession in one of Ihe most
prosperous areas of the U.S. We represenl all size
hospitals in virtually every Texas and Southwest
U.S. City. Excellent salaries and paid relocation
expenses are just Iwo of many super benefits
offered. We will visit many Canadian cities soon to
inlerview and hire. So we may know of your
interest. won't you contact us today? Call or write:
Ms. Kennedy, P.O. Box 5844, Arlington, Texas
76011. (214) 647-0077.
Come to Tnas - Baptist Hospital of Southeast
Texas is a 400-bed growth oriented organization
looking for a few good R.N. 's. We feel that we can
offer you the challenge and opportunity to develop
and continue your professional growth. We are
located in Beaumont, a city of tSO,OOO with a small
town atmosphere but the convenience of Ihe large
city. We're 30 minutes from the Gulf of Mexico and
surrounded by beautiful trees and inland lakes.
aptist f:lospital has a progress salary plan plus a
liberal fnnge package. We will provide your immig-
ration paperwork cost plus airfare to relocate. For
additional infonnation, contact: Personnel Ad-
ministration, Baptist Hospital of Southeast Texas,
Inc., P.O. Drawer 1591, Beaumont, Texas 77704. An
amrmlltlft mloa employer.
Exdtement: Come and join us for year around
excitement on the border, by the sea, an unbeatable
combination. Eqjoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed, acute care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opportunities. We have immediate openings in all
areas. Excellent salary and fringe benefits. We invite
you to share the challenge ahead. Assistance with
travel expenses. Write or calI collect: Joe R. Lacher,
RN, Direclor of Nurses, Valley Community Hospi-
tal, P.O. Box 469
, Brownsville. Texas 78521: I
(512!831-961I.
Don't be left out In the cold: RN's eqjoy the
semi-tropical weather of Weslaco, Texas localed in
the heart of the Rio Grande Valley. Close to South
Padre Island's sunny beaches and the Mexican
Border. Knapp Memorial Methodist Hospital cur-
rently has 100 beds and we would like you to help
staff an additional SO beds - 10 in an tCU..cCU unit.
Also need nurses for Med/Surg, Nursery and OB.
Contact Debby or Connie, Personnel Office,
KMMH, 1330 E. Sixth St.. Weslaco, TX. 78
96.
(512) 968-8567, Ext. 286 or 162.
Nursing Co-ordinator
Applications for the position of
Medical-Surgical Co-ordinator are
being accepted for mid-September
by this 300 bed fully accredited
hospital.
Experience in supervision with a
Bachelor ofN ursing Degree
preferred.
Temporary accommodation
available.
Please reply sending a complete
resume to:
Director of Personnel
Stratford General Hospital
Stratford, Ontario
NSA 2Y6
Clinical Nurse Specialist -
Pediatrics
This position represents a challenging
opportunity for a Maslers prepared nurse with
experience in general and critical pedialric
care.
The successful applicant will serve as a role
model and educator responsible for staff
development in two pediatric units which
provide quality family centered care in a
primary nursing environment.
Please send resume to:
Mrs. L. Rivers
Manpower Services
St. Boniface General Hospital
409 Tache Avenue
Winnipeg, Manltoblt
Canada
RZH ZA6
Assistant Director of
Nursing
required for N anaimo Regional General
Hospital, a 360-bed acute general
hospital. Duties to commence January
1st, 1980. Must have or be eligible for
B.C. registration. BSN and previous
experience preferred.
Please direct applications to
The Director of Nursing
Nanaimo Regional General Hospital
1200 DutTerin Crescent
Nanaimo, British Columbia
V9S 2B7
The Can-.llan Nur..
Head Nurse
Coronary Care ['nit
Vancouver General Hospital
Applications are being accepted for the above position. The Unit
consists of a 3 bed Intensive Care Unit. 10 acute care beds and 8
sub-acute care beds. The successful applicant will be involved in
the planning and development of an mterim Coronary Care Plan.
Apþlicants should have a minimum of2 years previous
experience in a related capacity and preferably hold a B.S.N.
Salary scale and benefits according to the RNABC Agreement.
Please submit applications to:
Mrs. J. MacPhail
Employee Relations Department
Vancouver General Hospital
855 West 12th Avenue
Vancouver, B.C.
VSZ 11\19
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Registered Nurse in search of a change and a challenge -
look into nursing opportunities at Vancouver General Hospital. B.c.'s
ml\Ïor medical centre on Canada's unconventional West Coast. Staffing
expansion has resulted in many new nursing positions at all levels.
including:
General Duty ($1305. - 1542.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the opportunity
you've been looking for.
For those with an interest in specialization. challenges await m many
areas such as:
Neonatology Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Surgery
Inservice Education
Coronary Care Unit
Hyperalimentation
Program
Renal Dialysis & Transplantation
Burn Unit
Paediatrics
If you are a Nurse considering a move please submit resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
855 West J2th Avenue
Vancouver, H.C. V5Z IM9
November 19711 55
...... - - - "",,000'
_ _ ....
.....- ....., "9 ,
" City of Regina \
I I
1'1
I CAREER OPPORTUNITIES I
I I
I I
I I
I City of Regina I
I reqUIres I
I I
I Director of Public Health I
I Nurses I
I A unique and challenging administrative position I
I in a City Health Department serving a population I
of 156,000. To assume responsibility for
I coordination and administration of the nursing I
division comprising a staff of 35 nurses who
I provide service in the community and schools. I
To assist in the developing of municipal public
I health nursing programs and administer and I
coordinate these programs with other health
I functions and agencies. I
I Prospective applicants should have a Master's I
Degree in Public Health Nursing supplemented
I by courses in public health administration, I
coupled with at least five years experience in
I public health nursing, including experience in a I
supervisory or administrative capacity. The
I incumbent must be eligible for registration with I
the Saskatchewan Registered Nurses
I Association. I
I Salary: $23,976. to $29,988. per annum (1979 I
I rate). I
I Applications, including resume and salary I
expected, may be forwarded to:
I The Personnel Department I
I City of Regina I
P.O. Box 1790
I Regina, Saskatchewan I
S4P 3C8
I I
I
I
, ,.... I
....--------.",
56 Novttmber 1979
Department or Nurslnll,
Grace Maternity Hospital. Halirax
seeks
Head Nurse
for
Special Neonatal Care Unit
Challcnamajob oppor1unil)' In neonatal nu...
inl in Canada.s
la"'le
" obstclnea) hO'ioplla11 ""000 dch...ene"'fycar. I
admi
slons 10 Special Neonatal Care Unit/ynl'"). MoUOT
oÒ..lclncal and nconalallCachlnø hospltaJ for Dalhouslc
LJni\lcI'"SII)'..nd the ccnl.-al obslclneal rcfCITal unit for NO\ia
SCDlla. Pnnce Edward Island and part.. orNe... Brunswick
Rco;.pom,lblc to the Climcal Co-ordinator for organl.latlon and
admtnlsuarron of climeaJ nu.....UJI care gi1icn '0 acutely .11 and
convalescing newborn Infants Excellent oppor1unity to perfect
present programmes and to dC\lclop new programme.. aimed at
Improving and extrndml the 'iCOpC ornconatal nurSmB Salary
accord'OB 10 Nova Scotia Nu......c....UnionContracl PO"I
available m\medlalely
The candldales musl have
years. e'penence In neonala)
nu.....mlj: and mU"1 be ehlj:lblc fo... rell'll"alron In Nova Scolla
Man..,emenl eJtpenence and skills. broad knowledøe of
pennalal health (:onceplo;. and Iradualion from a posl diploma
neonalaJ nursml Course desirable. Apply m wriling (0'
\fig \farK_rel Frrluson. R.N
Dirrctol' or
uni...
Grllte \falerntly Hospital
Halltn. No". Scot..
8JH 1\\3
Opcnmas arc a'!oo available for leneral dUly nurses In Ihe
neonalal uml
Foothills Hospital. Calgary,
AI berta
Advanced Neurological-
Neurosurgical Nursing for
Graduate Nurses
A five month clinical and academic
program offered by The Departmenl of
Nursing Service and The Division of
Neurosurgery (Department of Surgery)
Beginning: March, September
Limited 10 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 21'9
New Brunswick
Applications are invited for the following
position for the academic year beginning July
I, 1980 in a basic baccalaureate prOllram.
An experienced teacher in both the acute care
clinical setting and the classroom in
Medical-Surllical Nursinll to work with
senior students.
Applicants should be able to qualify for the
rank of Assistant or Associate Professor.
Doctoral degree preferred. Master's dellree
essential.
Salary is in accordance with qualifications and
experience.
Applications should be addressed 10:
Dean I. Leckie
Faculty or Nursinll
University or New Brunswick
P. O. Box 4400
Fredericton, N. B.
EJB SAJ
The c.nedlen Nur..
Director of Nursing
For
Kelowna General Hospital
Required For May, 1980
The 459 bed (171 Extended Care) hospital has
a wide ranII' of services and expects continued
IIrowth. This is a senior management position
reporting to the Executive Director.
Applications are invited from those with
appropriate experience and education.
EligibIlity for relllStration with the R.N .A.B.C.
essential.
Reply with complete resume to:
Mr. C.R. Elliott
Execuli ve Director
Kelowna General Hospital
Kelowna
British Columbia
VIYITZ
Administrative Supervisor
(Nursing)
Responsible for the complete operation of the
hospital on the evening shift with some
rotation to other shifts during the year.
Quallncatlons:
. Certificate of competence
. Head Nurse or supervisory experience
. B.Sc. Nursinll preferred
This is an administrative position in an active
217 bed general hospital located in a university
city. The position carries an attractive salary
scale.
Apply in writinll to:
Personnel Department
Guelph General Hospital
115 Delhi Street
Guelph, Ontario
NIE 4J4
Head
urse - Adolescent
Unit
Children's Hospital. Vancouver
A Head Nurse is required to assume a
leadership role in our existing 18 bed
Adolescent Unit and to plan for a 22 bed unit in
a new tertiary care leachinll pediatric facility
scheduled to open in Vancouver in mid-1981.
This is a challenging opportunity for an
experienced nurse (Baccalaureate preferred)
with proven administrative skills, a sound
knowledlle of medical and
urgical nursing and
a liking of adolescents.
I n the development of this growing
prollramme, the appointee will be a key figure
in the Adolescent Care Team and will have an
exciting opportunity to ,hape the future of
adolescent care in this province.
Interested candidate's possessing these
qualifications should forward their resumes to:
Miss Roselyn Smith
Director or Nuninll
Children's Hospital
250 West 59th Avenue
Vancouver, B.C.
I V5X IX2
Internalional Grenfell Association
invites applications for
Public Health Nurses and
Registered Nurses
Accommodation, fringe benefits and
group life insurance. Salary in
accordance with Newfoundland
Nurses Collective Agreement.
Travel paid for minimum of one year
service.
Apply:
Mr. Scott Smith
Personnel Director
International Grenfell Association
St. Anthony. Newfoundland
AOK 4S0
MANIT
BA
This position is open to both men and women
Apply in writing referring to Competition
Number CN636 immediately.
Assistant Director of
Nursing Education
The Department or Health and Community
Services. Institutional Services, Brandon
Mental Health Centre. requires a person to be
responsible to Director, Nursing Educalion for
planning, implementation, and assessment of a
Psychiatric Nursing Diploma program. Duties
include coordinating activities for both
classroom and clinical experience. and
committee work at middle management level.
Baccalaureate degree in nursinll with teaching
experience. Extensive backllround in
psychiatric nursinll. preferably with RN and
RPN licences.
Salary Range: SI8.4S3 - S2S.IS2 per annum.
Civil Service Commission
340 - 9th Street
Brandon, Manitoba
R7 A 6C2
Waterford Hospital
Career Opportunities For
Registered Nur"""
The Walcnord HO\þllal. a fully accredltcd 400
hcd P\)'chialnc Inshtution. affilialed with
\.temorid' Umversll)! School ofNlJr..lßgand
Medical School. has openinl!l for Rrgl'liiilcl"ed
Nurses :n all servicc!t. Including ncW.
c'pandcd. õ:(nd acute ca...e "iocrviccs
-\n oncmallon pTOsr.:rm is offered
Sdlary i.. on Ihe ..calc ofSI::!.
- 14. Ai
4i per
annum A p..ychialric Service J1:.lIowancc or
S 1.129 pCI" annum IS aVOIdable: ill addiflon 10
ba'ilc ..alar)'. Both
Iary and "UoW.ancc
pre'icntly under ...cvle....
The HosþltaJ is clo\c to aJl amenillcs
..hopping. lransponatlon dnd rCcreallon
faclhlies.
.t\ccommodallons a\<allablc In HO'Þpilal
Residence al nommal cosl.
Aþþhutions m wri11n1 should be addres<iied 10
Ihe under<ii1lned
Ptnonnel Dlrroctor
\\ alerford HospilaJ
\\.Ierford Bridl't RDaid
SI. John's. 'Iewfoundl.nd
AlE
J8
Telephone
umbu: (709) .168-6061. ext. .'41
Th. Cen-.llen Nure.
A Completely
\1odern Teaching Hospital
Requires
Registered Nurses
---=
....
----
- ..
...
- -äã ---
---
-...
This 500 bed general hospital is the major
teaching facility for the Medical School of
Memorial University of Newfoundland.
Services offered -
Critical Care. Medical. Surgical Coronary Care.
General Surgery. Urology. Gynecology.
Medicine. Nephrology. Clinical Teaching.
Neurosciences. Cardiology. Cardiovascular
Surgery. Orthopedics. Hemodialysis (kidney
transplants). Emergency and Out Patient
Services. active Rehabilitation Program (adult).
The Staff Development and Training Department
offers ongoing lectures and demonstrations in
addition to a 6 month diploma course (twice
yearly) in -Critical Care Nursing.
Neurosciences. Operating Room Nursing.
Located in St. John's. Newfoundland - the
oldest city in North America with a population of
120.000. offering cultural and recreation
activities in a friendly atmosphere.
Fishing. hunting. boating available
approximately 10-14 miles outside the city.
For information regarding salary and relocation
expenses and other conditions of employment
write or call -
\liss Doroth} Mills
Staffing Officer -
ursing
The General Hospital
Prince Philip DrÍ\e
St. John's, NOd.
AIB3V6
Telephone # (709) 737-6450
November 111711 57
CD
'.
'\
"..
.
.. "C' d!
III""
III
o
."l C'
.
.
o..,
. ,,
9"111
Open 10 both
men and women
SOLICITOR GENERAL
THE CORRECTIONAL SERVICE OF CANADA
VARIOUS LOCATIONS IN MANITOBA,
SASKATCHEWAN AND ALBERTA
REGISTERED NURSES
SALARY: $15,117 to $17.479 - Penological Allowance up
to $1,000 per annum, Educational Allowance if applicable
COMPETITION NO.: 79-PSC/SOL-OC.s028
DUTIES: Requores active co-operation with other members
of the health care team. Responsibilities Includes out-
patient and bedside nursing, emergency first aid and
counselling for Inmates. Nurses employed will be directly
and indirectly Involved In the development of mental and
physical health programs for the inmates. This is an excit-
ing opportunity for dynamic persons seeking satisfaction
and challenge In a progressive department.
Full time and part time posillons are available.
Benefits: Excellent pension plan. Good sick leave benefits
Evening, night and week-end premiums. 11 stalutory holi-
days. Minimum three weeks vacation. Continuing
education opportUnities. 8elocatlon expenses.
QUALIF ICA TlONS: Current registration as a registered
nurse m a province or territory of Canada. Knowledge of
English is essential.
For further mformatlon, please contact Phyllis Pelers,
Regional Nursing Officer at (3061665-4871, Saskatoon.
IPSC Clearance No. 529-1 B6-00 1 )
All applications must be received by:
December 31,1979
"Additional job mformation .s available by writing to the
aadress below'"
"Toute information relative à ce concours est disponible en
français et peut être obtenue en écrivant à I'adresse
suivante" .
How to Apply
Send application form and/or resumé to:
P. BRUNEAU, STAFFING OFFICER
PUBLIC SERVICE COMMISSION OF CANADA
1110 - 1867 HAMILTON STREET
REGINA, SASKATCHEWAN S4P 2C2
Please ruote applicable competition number at all times.
I
58 November 1979
Th. Cen-.llen Nurs.
Ministry of Health
Community Nurses
Competition 79:2061-38 $18,768 - $22,176
Applications are invited from qualified persons to fonn an
Eligibility List (valid for six months) of community nurses
from which vacancies occurring at various locations in British
Columbia will be filled.
Duties include provision of general public nursmg,
counselling and crisis intervention services in the area
concerned; liaison with health professionals and others
providing care, and encouragement of appropriate use of
available facilities.
Qualifications - University degree in nursing, including
public health training, or equivalent combination of education
and experience; preferably some general nursing experience.
including directly related duties; registered. or able to obtain
registration. in the Registered Nurses Association of British
Columbia; use own car, or government, on expenses.
Return applications immediately
Posttlons
are open to both
men and women.
Obtam applications from.
and return to. address below.
544 Michigan Street, Victoria, B.C., V8V 1S3
Assistant Head Nurse
Ophthomology
Vancouver General Hospital
Under direction of the Head Nurse is responsible for planning,
organizing. co-ordinating, teaching, supervising and participating
in all activities relating to the effective delivery of optimum
patient care or the ophthomology team (2-3 operating rooms).
Assists in the development and evaluations of each member of
the team.
Applicants must be registered m B.C. Minimum of two years
experience in operating rooms, with advanced nursing skills in
ophthomology. Demonstrated leadership potential and
interpersonal skills.
Please submit applications to:
Mrs. J. MacPhail
Employee Relations Department
Vancouver General Hospital
855 West 12th Avenue
Vancouver. B.C.
V5Z IM9
Registered Nurses
Neonatal Intensive Care Unit
Registered Nurses
Delivery Room Suite
Applications are invited for the above positions
Experience in High Risk Maternal and Newborn
Care required.
Ontario Registration.
Excellent salary and benefits.
Contact:
Director of Nursing
Grace Hospital
339 Crawford Ave.
Windsor. Ontario
N9A 5C6
Tel. No. 255-2294
Ad vertising Rates
For All Classified Advertising
$15.00 for 6 lines or less
$2.50 for each additional line
Rates for display advertisements on request.
Closing date for copy and cancellation is 8 weeks prior
to 1st day of publication month.
The Canadian Nurses Association does not review the
personnel policies of the hospitals and agencies
advertising in the Journal. For authentic information.
prospective applicants should apply to the Registered
Nurses' Association Qfthe Province in which they are
interested in working.
Address correspondence to:
The Canadian Nurse
50 The Driveway
Ottawa, Ontario
K2PIE2
The C.n-.llen Nur..
November 11711 51
Nurse Educator
.
Intensive Care Nursery
MISERICORDIA
Registered Nurses
HOSPITAL
Applications are invited for the above vacancy. The incumbent
will be..responsible for all nursing educational progrnms
pertaining to the Neonatal Intensive Care Unit. He-she will act
as a resource person in the provision of clinical knowledge and
expertise in relalion to the practice of nursing and the provision
of safe nursing care.
This SSS-bed active treatmenl tea..hi"JI hospital is inviting
applications from experienced registered nurses for the
foUowi"JI areas:
Medklne: Our medical units are all general medicine areas.
The vacancies we have are permanent, fulilime, rOlating shift
positions. Previous experience will be evaluated as applicable.
Qualifications are:
IntensIve Care: This is a l3-bed medical-surgical/coronary
unit, with an expansion in progress. The vacancies we have
are permanent. fulltime positions on a 12-hour shift rotation. A
minimum oftwo years general duty and/or I.c. U. experience
is essential_
. Grnduate of an approved school of nursing with current
registrntion in B.C.
. Baccalaureate Degree or equivalent post basic education.
. Demonstrnted highly successful work performance within
the specified clinical field.
. Demonstrnted skills in leadership and interpersonal
relations.
. Demonstrnted managerial ability.
Labor'" DeUvery: This unit consists of ten labor rooms and
four delivery suiles. The vacancies we have are permanent,
ful/time, rotati"JI shift positions. Previous obsletrical
experience and/or certified midwifery training is required.
Candidates must be eligible for active Alberta registration.
Salary and benefits as per RNABC contrnct ($1,500 - $1,772 per
month).
We do encourage applicalions on an on-going basis for all
other areas of nursing as wel/.
t nterested candidates are asked to reply by submitting a
comprehensive resume. inc1udi"JI date of availability. For
more information. please feel free 10 call (collect), (403)
484-8811 ex134\.
SylvIa Andre....
PrnonMI Olflcer
Mberlcordla HospItal
16940-87 A venue
Edmonton, Alberta
TSR 4HS
Please send resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
855 West 12th Avenue
Vancouver, B.C.
V5Z IM9
DIRECTOR OF EDUCATION
is required by
THE CANADIAN ASSOCIATION OF MEDICAL RADIATION TECHNOLOGISTS
RESPONSIBILITIES:
The primary function of this position is to research, identify, and develop the appropriate educational experience
directed towards both under-graduate and post-graduate levels; and to organize and ensure the appropriate
access by the membership to educational resources involving current, continuing, and developing programs at
these levels. The Director of Education as a senior member of the .associations administrative staff will be respon-
sible to the Executive Director. This position will be based at the associations head office in Ottawa. The position
will require extensive travel throughout Canada.
QUALIFICATIONS:
The applicant must have an interest in education relative to professIonal development; preferably should have
prior experience in adult education, and a technical background in medical radiation technology. or similar
experience within other health professions. A command of both the English and French languages would be
an asset.
OPPORTUNITY:
This challenging career is open to a self-motivating person with a demonstrated ability to function at an
administrative level, and whose major interest lies in the educational process.
SALARY:
Commensurate with experience and background to a maximum of $26,000 per annum plus benefits.
Applications must be submitted in writing including a curriculum vitae, a minimum of three references who can be
contacted if necessary and a brief expression of personal views on continuing education as related to Allied
Health Disciplines, to the Executive Director, C.A.M.R.T. Suite 410, 280 Metcalfe Street, Ottawa K2P lR7
Canada postmarked not later than December 15, 1979. All applications will be treated in confidence.
80 Nov.mber 1979
Registered Nurses
Nursing opportunities exist at
VancouverGeneral Hospital, H.C.'s
major medical centre. Recent
graduates and experienced
professionals are invited to explore
employment possibilities in a variety
of nursing departments.
Excellent benefits. including 4
weeks vacation. Salary range $1,305
- $1.542 per month.
Please send resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
855 West 12th Avenue
Vancouver, B.C.
V5Z IM9
Registered
urses
Th. CenltCllen Nurs.
Vernon Jubilee Hospital
Vernon, British Columbia
A 258-bed acute and extended care
hospital in Okanagan Valley invites
applications for the following
position:
Assistant Director of
Nursing
An excellent Career opportunity for
a qualified, innovative individual
involving senior responsibility for a
specific Nursing division.
The applicant must have the ability
to plan, implement, and assess new
projects and programmes. Must be
eligible for H.C. registration.
Preference to the applicant with
advanced educational, clinical, and
administrative preparation and
experience.
Apply, sending complete resume,
to:
Director of Personnel
Vernon Jubilee Hospital
Vernon, British Columbia
V IT 5L2
1200 hed ho"pitaJ adjacent to l' ni\ er'\itv of
Alherta campu" off
r" employment in -
medicine, surgery, pediatrics,
orthopaedics, obstetrics, psychiatry,
rehabilitation and extended care including:
. Inten"i\ccare
. Coronary oh"ervation unit
. Cardiova'\cular "urger
. Rurn" and plastic"
. 1\.eonatal inten"ive care
. Renal dialysi'\
. Neuro-surgery
Nursing Unit Coordinator
Required By The Thompson
General Hospital,
Thompson, Manitoba
The Thompson General is a fully accredited
100 bed acute care hospital located in a modem
community of 18,000 in North Central
Manitoba.
The successful applicant will be given the
responsibility of planning, organizing and
directing the aClivities of a 46 bed
Medical/Surgical Unit.
Applicants must be eligible for registration
with M.A.R.N. Preference will be given to
those wilh Administrative lrai'ning and/or
experience.
The salary range for this position is $17,600-
$22,200 per year. Other benefits include Group
Life. Pension Plan, free dental program,
income protection and remoteness allowance.
Those inlerested are asked to apply, in
confidence, giving details as to experience,
education and references to -
Mr. R.L. Irvine
Director of Prrsonnel
Thompson General Hospital
Thompson, Manitoba R8N OC8
Telephone (204) 677-2381
(Q]@
University of
Alberta Hospital
Edmonton. Alberta
Planned Orientation and In-Service Education Programs.
PostGraduate Clinical Courses in Cardiovascular-
Intensive Care Nursing and Operating Room Nursing.
\ppl
to:
RelTuitment Ollicer - "uro;in
l.nÏ\er!oit
of \Ibt'rta Ho!'>pital
x
o - 112th Street
Edmonton, '\Ibt'rta
rM; 287
o
Th. C.n.dlen Nur..
Supervisor
Intensive Care Nursery
Applications are being accepted for the above position. The
incumbent will be under the direction of the clinical director and
will provide leadership in the development and implementation
of current clinical practice for the unit as well as being
responsible for the nursing administration of the area.
Qualifications:
Registered Nurse (eligible for registration in B.C.).
Baccalaureate degree or equivalent post basic education.
Demonstrated highly successful work penormance within the
specified field. Demonstrated skills in leadership and
interpersonal relations.
Demonstrated managerial abilities.
Salary and benefits as per R.N.A.B.C. contract ($1,632 to $1,924
per month).
Please send resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
8SS West 12th Avenue
Vancouver, B.C.
VSZ IM9
Tomorrow's Challenge ..................
. Active Rehabililation (Neurological. Orthopedic and Arthritic)
. Restoralive Care
. Supportive Care
. Pediatrics (Rehabilitation)
. Domiciliary Care (D.V.A.)
Registered Nurses expand your career with Wascana Hospital, a 269 bed
Rehabilitation/Extensive Care I nstitution, the largesl of its kind in
Western Canada.
. Planned Orienlation
. On-going Staff Development Programs
. Rehabilitation Course olTered
. Attracti ve salary and fringe benefits
. Located in the heart of Regina surrounded by beautiful Wascana Park
. An abundance of cultural, recreational and social leisure time
activities
. University city.
For further information on nursing opportunities write to;
Nursing Recruitment OlrlCer
South Saskatchewan Hospital Centre
4101 Dr"dney Avenue
Regina, Saskatchewan
S4T lAS
-
Name
Address
City
P rovo
Postal Code
November 19711 111
...
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can go a long way
. . . to the Canadian North in fact!
Canada's Indian and Eskimo peoples in the North
need your help. Particularly if you are a Community
Health Nurse (with public health preparation) who
can carry more than the usual burden of responsi-
bility. Hospital Nurses are needed too... there are
never enough to go around.
And challenge isn't all you'll get either- because
there are educational opportunities such as in-
service training and some financial support for
educational studies.
For further information on Nursing opportunities in
Canada's Northern Health Service, please write to:
........,
I Medical Services Branch I
Department of National Health and Welfare
Ottawa. Ontario K1A Ol3
I Name I
I Address.. I
I City Provo I
I . . Health and Welt".t! Sanlé et Blen-ftre social I
Canada Canada
,........
12 NGvember 111711
calendar
November
A Day on Diabetes. A
workshop sponsored by the
Waterloo-Wellington Chapter
of the Professional Health
Workers Section ofC.D.A. on
November 12, 1979 at the
Kitchener-Waterloo Hospital
Auditorium. Contact: Dawn
Best. Waterloo-Wellington
Chapter, P.H.W.S. of
C.DA., c/o Diabetic
Education Center,
Kitchener-Waterloo Hospital,
835 King Street W.,
Kitchener, Ontario,
N2G IG3.
Cardiac and PuJmonary
Emergencies, a two day
critical care symposium for
nurses, will be held November
14-15, 1979 at Laurel Point
Inn, Victoria. B.C. Contact:
Doug Connell, Parkside
Emergency Physicians, 928
Pandora Al'e., Victoria, B.C..
V8V 3P3.
Canadian Intravenous Nurses
Association 4th AnnuaJ
Convention to be held on N ov .
20-21, 1979 in Toronto.
Contact: C1NA, 4433
Sheppard Ave. Ea.ft, Suite
200, Agincourt, Ont.,
MIS IV3.
December
An Occupational Health
Nurses Workshop to discuss
the role oftheO.H. Nurse in a
company safety and loss
control program, will be held
December 6-7, 1979. Fee: $85.
Contact: Total Loss Control
Training Institute, P.o. Box
/085, Station B, Rexdale,
Ontario, M9V 2B3.
The Canadian Public Health
Association invites submission
of Abstracts for their 71st
Annual Conference to be held
in Ottawa, Ontario, June
23-26, 1980. The theme of the
Conference is "Public Health
in the 1980's - Opportunity
or Demise?" Deadline for
abstracts: December 31. 1979.
Contact: Dr. John Hastings,
Chairman, Scientific Program
Committee, /335 Carling
Ave., Suite 2/0, Ottawa,
Ontario, KIZ 8N8.
F our professional nursing
associations and five
university faculty/schools of
nursing in the Maritimes will
The Can-.llan Nur..
co-sponsor a conference,
Research Basis for Nursing in
the Eighties on October 22-24,
1980 at the Hotel Nova
Scotian in Halifax, N .S. A call
for papers will be in the fall of
1979 and there wilI be open
registration. The four
associations are: NBARN
RNANS, ANPEI, and '
ARNN. The faculty/schools
of nursing are Memorial
University of Newfoundland,
Dalhousie University, St.
Francis Xavier University,
University of New Brunswick
and Université de Moncton.
The American Thoracic
Society/Canadian Thoracic
Society AnnuaJ Meeting
Committee invites submission
of Papers on all Scientific
Aspects of Respiratory
Disease for presentation at the
1980 Joint Annual Meeting in
Washington, D.C., May
18-21,1980. Abstracts must be
submitted before December
31, 1979. Contact: Whitney W.
Addington, Chairman
ATS/CTS Annual Meeting
Committee, American
Thoracic Society, /740
Broadway, Ne
York, N.Y.
/OO19.
1980
Ontario Crippled
Children's Center 7th AnnuaJ
Conference -
Multi-Disciplinary Approach
to Management: Overview of
Pediatric Rehabilitation. To be
held January 21 - 25, 1980.
Course fee: $100. Contact:
Ann Campbell, Coordinator,
The Education Department,
Ontario Crippled Children's
Center, 350 Rumsev Road
Toronto, Ontario, M4G IR8.
Canadian Orthopedic Nurses
Association 3rd AnnuaJ
Conference to be held
February 19 - 22, 1980 at the
Sheraton Center, Toronto,
Ontario. Contact: Conference
Publicity Committee,
Canadian Orthopedic Nurses
Association, 43 Wellesley
St. E., Toronto, Ontario,
The Third Annual Symposium
on Patient Education
organized by The Johns
Hopkins University School of
Hygiene and Public Health,
will be held March 26-30,
1980. Contact: ll'Gn Barofsky,
Hampton House 654, The
Johns Hopkins University,
School of Hygiene and Public
Health, Baltimore, Maryland.
Index to
Advertisers
November 1979
Abbott Laboratories
Ayerst Laboratories
The Canadian Nurse's Cap Reg'd
Canadian Public Health Association
Canadian School. of Management
Career Dress (A Division of
White Sister Uniform Inc.)
Cedars-Sinai Medical Center
Equity Medical Supply Company
Glaxo Laboratories
Frank W. Homer Limited
J. B. Lippincott Company of Canada Limited
Medical Personnel Pool
TheC.V. Mosby Company Limited
Nordic Laboratories Inc.
Parke, Davis & Company Limited
Pharmacia (Canada) Limited
W. B. Saunders Company
Schering Canada Inc.
G.D. Searle & Company Canada Limited
Upjohn Health Care Services
Cover 3
13
15
15
49
Cover 2
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II
49
50
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46,47
48
to
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Cover 4
II
7
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When friends or patients ask your
advice co
ceming relief of cold
symptoms consider the advan-
tages offered by the CORICIDIN
family of cold products. The
various CORICI DIN*preparations
are formulated to provide effec-
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CORICIDIN (antihistamine.
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at the first sign of a cold
where congestion is not a
problem or when decon-
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formulated for use when
nasal or sinus congestion is
pronounced.
For your younger patients CORICIDIN
is available as CORICIDIN Pediatric MEDILETS* and
CORICIDIN 'D' MEDILETS, both chewable tablets, and
pleasant tasting CORICIDIN Pediatric Drops for infants or
very young children.
Free Booklet Offer '
We'Ve attempted to answer many questions about colds,
their causes. Effects and relief in an informative booklet
entitled "How to Nurse a Cold". It's yours, free of charge, if
you'll simply fill in and mail the coupon on this page.
,
Mail to:
Schering Canada Inc.
3535 Trans Canada
Pointe Claire. Quebec
H9R1B4
Please send me my free
copy of your booklet "How to Nurse a Cold"
Additional copies only available upon written
request.
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Address:
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. Looking toward the future:
CNJ salutes the children
. Informing, supporting,
reassuring the hospitalized child
. Babies at the window: neonatal
Jaundice and phototherapy
. Necrotizing enterocolitis:
theories and
nursing management
· Dangerl Children at play
,
-
The
an- -
Nune
DECEMBER 1979
"---
1
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tr6 NT">!
.
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...L U:.I'I 'I:",;:)
DEC lél"''1"
J::
.'.rlf,I'r1IERES
NURSING LIBRARY
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SlVI
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l\i3H
'1J
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A Division of
White Sister Uniform I
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In our beautiful ne
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The
Canadian
Nurse
December 1979
The official journal of the Canadian
Nurses Associallon published
in French and English
editions eleven times per year.
Volume 75, Number II
Commentary 5 Speaking out: A national
child health policy? Joan Dawson 24
Input 6 Helping preschool children
learn to be safe Helen Eifert 26
Here's How 8 Preparation of toddlers
and preschool children
for hospital procedures Judith A. Ritchie 30
Research 9 Hospital books for children Elizabeth Crocker 33
News 12 WPW Syndrome: A case study Coleen Manning 34
You and the law 16 What a little care can do Nicole Cave 38
Vancouver. here we come' Babies with necrotizing
CNA's 1980 Convention 22 enterocolitis: what to watch for Beverle\ Hastings McBride 41
Calendar 51 Neonalal jaundice Faye Johnson.
and phototherapy Frances Tufts 45
Books 53 Caring for the child with cancer:
the nurse practitioner Barbara J. Price 48
Annual Index 55
.
.
..
.,.
-.. -
...
I
"Come sing a song of joy" in
hospital halls and wherever
our fellow human beings are in
need of cheer. The three
nurses on the cover of our
December issue are caroling
in the halls ofQueensway
Carleton Hospital in the
Ottawa-Carleton region.
Cover photo by John Evans
Photography Limited.
The Canadian Nurse welcomes
suggestions for anicles or unsolicited
manuscripts. Authors may submit
finished anicles or a summary of the
proposed content. Manuscripts
should be typed double-spaced. Send
original and carbon. All anicles must
be submitted for the exclusive use of
The Canadian Nurse. A biographical
statement and return address should
accompany all manuscripts.
The views expressed in the anicles
are those of the authors and do not
necessarily represent the policies of
the Canadian Nurses Association.
ISSN 0008-4581
Canadian Nurses Association.
so The Driveway, Onawa. Canada.
K2P IE!.
Indexed in International Nursing
Index. Cumulative Index to Nursing
Literature, Abstracts of Hospital
Management Studies, Hospital
Literature Index, Hospital Abstracts,
Index Medicus, Canadian Periodical
Index. The Canadian Nurse is
available in microform from Xerox
University Microfilms, Ann Arbor.
Michigan 48106.
Subscription Rates: Canada: one
year, $10.00; two years. $18.00.
Foreign: one year, $12.00; two
years, $22.00. Single copies: $1.50
each. Make cheques or money
orders payable to the Canadian
Nurses Association.
Change of Address: Notice should be
given in advance. Include previous
address as well as new. along with
registration number, in a
provincial/territorial nurses
association where applicable. Not
responsible for journals lost in mail
due to errors in address.
CJCanadian Nurses Association,1979.
rite season's
best wisltes to !Iou
and !lollr entire stall wlto give
patience and IInderstanding
all !lear 'rollnd.
Your Clinic Shoemaker
Th. Cenedlen Nurs.
Commentary on IYC
Hold my hand, help me cross
the bridKe,
to a briKhterfuture.
As 1979 dre\'. to a close, CNJ
o;taff\'.ho have endea...ored
during the year to keep the
ca...e for children con..tantly in
the minds and thoughts of
nurses, wondered just what
effect this special "year of the
child" would have on the
health oftomorrow's adult..,
To find out, we asked
some prominent Canadians
\'. hose work is primarily
concerned with protecting the
righto; of children "to grow up
in an atmosphere of affection
and mOlal security... to have
adequate nutrition and
medical care", what they saw
as the main accomplishments
of 1'\ C
..
:\far) Wilson.R,V. MA.
Callac/ialllYC Commiuioller
ami Coorc/illator, M allitoba
/} C Steerillg Committee:
"Although Canadians are
blessed with a high standard
of living - with universal
health care and a broad range
of health and social services
- we nevertheless still have
children who are poor,
undernourished, ahused.
neglected. diseased.
undereducated. unsupervised
and uncared-for. To meet the
basic common needs of these
children we need well defined.
integrated action programs.
Priorities within the health
care system. a" I see them.
are:
. the reduction of infant
mortality through primary
health care measures reaching
under-served groups
. ensuring access of all
children and their families to
clean. "afe water o;upplieo; and
adequate sanitation
· ensuring the survival and
sound development of
children during their most
vulnerable period - from
birth to six years
· reduction and eventual
elimination of malnutrition.
adolescent obesity and
exceso;ive consumption of
inappropriate foods
· adequate immunization
against preventable disease
. improved and exp.mded
programs for children with
special need....
In addition. \'.e muo;t
concern ourselveo; with the
need to reduce:
- accidental deatho;
-detrimental efTecto; of
alcohol. smoking. drug ahuse
-emotional illness.
loneliness. adolescent
suicides. and
- teen pregnancies."
John \1. Elder..WD.
presic/ellt, C all ac/ia II Pl'C/iatric
Soden':
"During lYe. the Canadian
Pediatric Society has
concentrated on its goal of
increa"ing the number of
Canadian infants who are
breast fed up to the age of six
month" or longer. Our task
force. organized with the
cooperation of the federal
government and the LaLeche
League. included
nutritionists. ohstetricians and
puhlic health nllr...es.
Activities included production
of 50.000 Breao;t Feeding
Resource .....its. editorialo; and
articles in Canadian
publications. promotional
buttons at our annual meeting
and aso;io;tance in the
production of a color film for
the lay puhlic on hreao;t
feeding:'
Beatrice 1\1. Williams.
Rt\i. H ealtl! Regioll
Ac/milli.
trator.
Ro.
etoll"ll-Biggar-Jo.. imlersley.
Sas/..atcl!ewall..IÍJrmer IYC
Commis
it"'er:
"I see 1979 as a heginning:
each year in the eighties. more
and more attention will be
focused on the child and
gradually changes will occur
in lifestyles and attitude".
resulting in more
consideration being given to
raising healthier. more
wholesome children.
Parent". professionals
and the community can do
much more to improve the
quality of life for children. The
decision to have children
"hould carry with it a serious
commitment: children should
be given the opportunity to be
born healthy and to thrive in
an em ironment filled with
lo"e and ...ecurity "0 thell they
develop to their optimum level
and foo;ter a healthy concept
ofthem...elves.
Professionals can predict
"at risk infants" and strive to
identify health problem... "0
that intenention 01 remedial
action can take place earlier.
Parents need to be better
informed and kno\'.leligeahle
in the techniques of child
rearing. They must be
supported in their effort... to
provide a learning. loving
environment for their
youngsters. Parents are
human and they cannot
always cope with the demands
placed on them. We need to
offer an instant ...upport
...ystem to parento;. whether
t hey are family, friends or
co-workers.
Shirle
Post.RN. B.Sc.
N.f-c/.. J1HA. execl/tit'e
c/Ùector. Callac/iall II/.\"(itllte
(?rCl!i!d H mltl!:
"For the institute, every year
is the year of the child. In 1979
we welcomed the preparation
by the Canadian Commi'iSion
for IYC of the background
paper. "The Child and
Health". setting out a national
agenda for action. The
commission makes it
ahundantly clear that o;ociety
is not adequately meeting the
health and o;ocial needs of
many Canadian children-
needs such as
. better prenatal and
perinatal care
. improvement of the
immunization ...tatus of our
children
. "humanization" of our
service" to mother... and
children
. reduction of the number
of accidents to children, and
. better health education
for students.
These are concerns that the
Canadian Institute of Child
Health had also identified as
priorities for its program".
I personally feel that IYC
has helped Canadians to focus
their attention on the children
who are often forgotten in our
society and has made them
aware that many of our
children are Ilot OK -that
many of our health and social
policies and programs need to
be reviewed and updated.
D8c:.mber 1979 5
In 19
O it i... e...sential that
thi... momentum be maintained
dnd that we find ways to wOlk
cooperatively toward... thi...
end. It i... clear from the
problem... that ha"e been
identified related to health and
social iso;ues that the ...olutions
\'. ill require the effort... of
per...ono; in many dio;ciplineo;.
national organizations. all
levelo; of government and the
general public. I would like to
see nursing play an influential
role in determining the
direction that health care for
mother... and children will tdke
in the 19
(rs."
TheCanadian
Commi"sion puts it thi... way:
"Let u... hope that the
experience of ...haring a year
with children will send all of
uo; into 19
Oand beyond.
encouraged and rene\'.ed."
EDITOR
ANNE BESHARAH
ASSIST ANT EDITORS
JUDITH nANNING
JANE BOCK
PRODlICTION ASSIST ANT
GITA DEAN
CIRCULATION MANAGER
PIERRETTE HOlTE
ADVERTISING MANAGER
GERRY KAVANAUGH
CNA EXECUTIVE DIRECTOR
HELEN K. MUSSALLEM
EDITORIAL ADVISORS
MATHILDE BAZINET.
chairman. Health Sciences
Department, Canadore College.
North Bay. Ontario.
DOROTHY MILLER.public
relations officer, Registered
Nurses Association of Nova
Scotia.
JERRY MILLER, director of
communication sen'ices,
Registered Nurses Association
of British Columbia.
JEAN PASSMORE,editor,
SRNA news bulletin. Registered
Nurses Association of
Saskalchewan.
PETER SMITH,directorof
publications. National GaUery
of Canada.
FLORIT A
VIALLE-SOUBRANNE,
consultant. professional
inspection division. Order of
Nurses of Quebec.
6 Dec:ember 1979
The Cenedlen Nur..
input
A living tribute
Nurses in Canada were
saddened to learn of the death
of Virginia Lindabury, fonner
editor of The Canadian Nurse.
I n her capacity as editor,
Virginia had an important
influence on nursing and
nurses in Canada: she
encouraged a sense of unity
within the profession but at
the same time solicited
diverse opinions on issues that
were controversial.
She believed that
"...change is an inevitable
part of the evolvement of an
association and that a decision
to reassess goals is a sign of
progress, not regression...
Rigidity of purpose and fear of
losing face by questioning
goals, functions and even
motives, can lead only to
eventual extinction."
She wrote hard-hitting
editorials that challenged
readers to do something either
individually or collectively
about such crucial issues as
discrimination, pensions,
strikes and collective
bargaining, lobbying, a
revised income tax act, etc.,
but her sense of humor was
always present.
Her tributes to other
Canadian nurses were
sensitive and thoughtful and
provided the professional with
a sense of history in very
personal terms.
Virginia Lindabury was a
staunch supporter of the
Canadian Nurses Foundation,
not only making personal
contributions but also
promoting and soliciting
support for CNF from nurses
in Canada. As president of the
Students & Graduates
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Address
Name ..,...................................................
(block letters)
City
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Postal Code .......
Your graduation school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CNF I believe it is appropriate
to suggest that those who
share Virginia's belief in the
future of nursing make a
donation to CNF in her
memory.
-Louise Tod, president,
Canadian Nurses
Foundation.
Reunion anyone?
As a graduate of the
Hamilton Memorial Hospital,
North Sydney, N .S., I ask,
"Who would like to plan a
Reunion, to take place in
1980?" This question is
directed to all graduates of
Hamilton Memorial and St.
Elizabeth Hospitals.
A second question,
"Who is interested in
becoming involved in
re-activating our alumnae
association, and helping to
make it once again, a viable
operation?' '
Please write: "'-ay
Flemming, 61 King Street,
North Sydney, N.S. or:
-Stella Doyle T ompÁi ns, 37
Colonial A\'enue,
Stephe1l\'ille, Nfld., A2N IY9.
Too tired to care?
How much does a
sympathetic smile, a soothing
backrub. a heating pad or a
drink of ice water cost? And
how much do any of these
"comfort measures" mean to
you when you're feeling
lousy? Enough to make you
think "I'm feeling better",
right?
But what has happened to
this kind of empathetic caring
in our hospitals? I've been
working in these institutions
for close to 12 years now and
it seems to me we've been
letting ourselves become too
mechanical.
I know that there is more
pressure on nursing staff,
especially full time staff, these
days...more patients, less
money means more stress.
However. we mustn't allow
ourselves to become so
regimented that we're cold.
After all we are dealing
with people, human beings
like you and me! We can't
operate them like puppets on a
string and expect them to
confonn passively to our daily
routine because we're short
on time.
If there's one thing I've
learned through working with
people, it's that you get a lot
further a lot faster if you make
requests as though you were
asking a favor. Say, please
and give them time to
accomplish it.
Imagine yourselffeeling
perfectly rotten on day one
post-op. Your nurse comes
bombing in after breakfast to
tell you the doctor wants you
to get up: she starts rushing
around to collect your slippers
and housecoat...
Contrast this with the
nurse who has the heart to tell
you earlier, ie. as she is
helping to pass breakfast trays
or linen or even as she is
helping you with your bath,
that she knows you're
uncomfortable but exercise is
an important part of recovery
to prevent post-op
complications and the doctor
really would like you to try
getting up. She then proceeds
to ask if you would like to take
a go at it now or after she has
done a couple of other
patients.
I'll bet you'd prefer the
second approach that gives
you time to contemplate the
situation. I'd even be willing
to bet that you'd find yourself
saying something like,
"Which would suit you better,
nurse?"
It works I ike a chann:
take your most difficult
patient, show him a little
human compassion, give him
some T. L.c. and I'll
guarantee that the next day or
the day after, your patient will
no longer be so difficult.
I can hear your cry: "But
we don't have time for such
Th. Canadian Nur..
D8c:.mber 1979 7
carrying on!" I don't believe
it! :\Iost of", hat I'm saying
does not require any
additional time . It's mostly
the attitude with which you
approach what you are doing.
How much time does it take to
gently rouse a "troke patient
before you turn him over? Or
to warm up the back rub by
rubbing your hands bri"kly
before applying it'? Even the
most confused patient
appreciates this.I'm sure.
If you are among those
who already approach nursing
in a compassionate humani"tic
manner then I salute you.
Keep up the good work! If. on
the other hand. you are not.
then I suggest you take a good
long 10010.. at yourself. Ponder
".
"
,
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, ,
,
,,' 0'
"
-
,
, , .' "/
,
awhile on that familiar
quotation: "00 unto others as
you would have them do unto
you'" If you have difficulty
treating your patients with
respect and understanding, try
to imagine that your charge is
your spouse. child or parent.
Maybe then your attitude will
change.
The ultimate reward in
nursing should not be the
almighty dollar but rather a
complimentary statement
from a patient such as: ul\ly,
you have such a gentle touch"
or'" hope ifl'm ever ill again
that you're my nurse" or even
a simple sincere. "Thank
you".
We are professionals and
in nursing being professional
$e;"è;<Pl eP'"
i.
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=
THE
LAST
THING HE
NEEDS
IS GAS.
r,
\\
includes caring and I mean
REALLY caring about our
patient" and showing it. Let's
not get so involved in our busy
schedules that we forget this.
-Shirle\' Christo, Bramalea,
Ontario.
Three against one
The message in your
September "Perspective"
could have been effectively
delivered without mentioning
the city.
As a subscriber to the
Sault Ste. Marie Daily Star I
read the letter referred to.
I also read three other
letters to the editor in the
same paper. praising the
nurses and the nursing care
given in that hospital.
Since it was deemed
necessary to mention the city
in your article, why not
mention that one negative
letter drew three positive
responses?
Maureen Tral[(er, R!\ . Elliot
La/..e.Olltario.
Did
ou know...
From Nurses' Drug Akl1: digoxin
toxicity may result when the
digitalized patient is exposed to a
wide vdriety' of other medication.
For example, when quinidine is
given to patients on digoxin,
serum digoxin levels can rapidly
increase - such patients should
be monitored carefully for signs of
toxicity. Nurses should always
remember there is a complex
interplay among drugs that can
result in a sequence of drug
reactions.
((
When a patient can't
move around, gas can be
a problem, and a painful
one at that. So for pa-
tients who are immobile.._ _
following surgery or for I
Ovol "
post-cholecystectomy II
patients, give them extra II"
strength OVOL 80 mg, the
chewable antiflatulent
tablets that work fast to
relieve trapped gas and
bloating.
(Ø)H.ORf]SR
IPAAil
,
.
.
.
80
FaGas
CmIre
IesGaz
la_
Pre u( t monograph available on request.
I December 1979
Decubitus Ulcers
An audio-visual
presentation available
on loan, free of charge
This presentation describes treat-
ment and dressing techniques for both
simple cutaneous and deep decubitus
ulcers, using BenOxyl 20% (benzoyl
peroxide) Lotion.
The taped narrative, by W.E. Pace,
M.D., M.Sc., F.R.C.P.(C) and Heather
Hanson, R.N., runs for approximately
30 minutes and is supported by a series
of before-and-after illustrative colour
slides.
To complement the slide-tape pre-
sentation a folder illustrating the dress-
ing techniques is available in quantity.
For any of the above material
including a complete script, pleas
write to:
Scientific Services Dept.
Stiefel Laboratories
(Canada) Ltd.
6635 Henri-Bourassa Blvd. W.
Montreal, Quebec H4R tEt.
OVOr
80mg
Tablets
OVOr
40mg
Tablets
OVOr
Drops
I
Antiflatulent Simethicone
INDICATIONS
OVOl is indicated to relieve bloating
flatulence and other symptoms '
caused by gas retention Including
aerophagia and infant colic.
CONTRAINDICATIONS
None reported.
PRECAUTIONS
Protect OVOl DROPS from freezing.
ADVERSE REACTIONS
None reported.
DOSAGE AND ADMINISTRATION
OVOl80 mg TABLETS
Simethicone 80 mg
OVOl40 mg TABLETS
Simethicone 40 mg
Adults: One chewable tablet between
meals as required.
OVOl DROPS
Simethicone (in a peppermint
flavoured base) 40 mg/ml
Infants: One-quarter to one half ml as
required. May be added to formula or
given directly from dropper.
A HORnER
'W' Montreal Canada
Th. Canedlan Nur..
here's how
E.very nurse has practical ideas gathered from
his or her experience on how to make life a
little easier for nurses and for patienls. Here's
How is a column for you and your ideas. If
you have an original and practical suggestion
that you think might help other nurses to
improve any aspect of patient care, why not
share it with other nurses? We'll send you
$10. for any suggestion published. Let's hear
fro.m you. Write: The Canadian Nurse, 50 The
Dnveway. Ottawa. Ontario, K2P lE2.
A New Patient Information System
When our hospital's Operational Audit
data was analyzed. it appeared we had a
wea
ness in .the .area of patient teaching,
particularly m dIscharge preparation. It
was decided then that the Department of
Nursing should organize a patient
information system.
Production of handouts was begun
at the request of nursing units, and we
started out by devising information
handouts relating to specific diagnostic
tests, such as the upperG.l. series. We
wanted to be able to recycle the
handouts and so we arranged for them to
be printed on sturdy yellow paper
protected by a see-through plastic cover.
As the demand for information
ncreased. we expanded our scope to
mclude dIscharge information. The
ake-home sheets (not to be returned)
mcluded such topics as drug infonnation
instructions following vascular surgery ,
and breastfeeding. Information sheets
were also sent to local doctors' offices to
provide information for people coming in
to the hospital for tests.
The system has met with great
success for several reasons: the material
is consistent and all patients get the same
information: the information can easily
be changed should a procedure be
altered: the written material can be
shared with family members by patients:
sheets may be written up in several
languages.
The only disadvantage we have
thought
f to date is that staff may rely
too heavIly on the handouts and omit
giving personal explanations, so we
stress that the information system is
meant to be used as a patient teaching
tool by the nurse and is no substitute for
her actual explanation.
In three years we have come up with
37 handouts which are all now in active
circulation, and we look forward to
producing still more as they are needed.
-Margaret J. Henricks, Chairperson,
Patient Teaching Committee, Ottawa
Ch'ic Hospital, Ottawa.
Haute Couture for Wheelchair Patients
Try as you might, it's hard not to feel
frustrated when you have to keep
changing the clothes of a chair-ridden
patient who is incontinent of urine.
Wo.rse. if nursing staff is too busy, a
patIent can end up sitting in wet clothes
or incontinent pads for too long because
the change to dry clothes is arduous and
time-cons
ming. However. a simply
altered pair of pants or dress can
eliminate this problem, save on laundry,
and allow the convalescent or
chronically ill patient to be dry, dreo;sed
and warm.
The trousers are modified as in the
diagram: the center back seam IS opened
(and raw edges hemmed) with the legs
cut round the back just below the
derriere so the patient's bottom can be
exposed for easy changing of pads or
flannelette diaper when he is raised a few
nches up ofT the chair. When the change
IS complete and the patient settled back
in the chair, the pant flaps are tucked in
around him and the back closed with
Velcro tapes or cotton ties. (Pins are
uncomfortable and dangerous.)
For lady patients who prefer a dress
to pants, a skirt may be modified in
similar fashion - open down the back
seam to the knees where it may be
snapped or sewed closed to keep the
patient's legs warm.
It may not be Yves St. Laurent, but
your patients will be happy and
comfortable, and that's reward enough!
-Jean Smith, R.N., Regina, Sa.
k.
Water Bags
Especially helpful for the prevention and
treatment of decubitus ulcers in
bedridden patients are 'water bags' made
from the plastic bags used in hospitals
and restaurants to dispense milk.
Measuring 22 inches by 28 inches, they
may be rinsed out and refilled with
enough wann water to float the patient's
body orlimb off the bed. The water bags
are small enough not to hamper regular
turning or treatment of bedsores with
heat lamp and medication.
-Jean Dodd, R.N.,
Walkerville-Windsor, Ontario.
research
A rrminder-CNA urges all Canadian nurses
to forward copies of their theses, dissenations
or studies to the Canadian Nurses Association
for inclusion in the Repository Collection of
Nursing Studies.
. Gerontol
)
The ne.elopment of a Geriatric ASSt'ssment
Instrument for Long Term Carr Facilities.
Vancouver. B.C., 1979. Thesis (M.Sc.N.)
University of British Columbia by Jane
Buchan.
The purpose of this slUdy was to design a
reliable and valid a'isessment instrument that
would provide a multi-dimensional profile of
the elderly resident of a long term care
facility. The instrument consisted of 31
unweighted items measuring functioning in
five essential areas - cognitive. phY'iical,
emotional. social and instrumental. Ratings
were based on the observations of long term
care staff who were in close contact with 76
elderly residents of one extended care unit.
The inslrument showed a high degree of
internal consistency with the Ihree major
components identified a'i: cognitive behavior,
independence in daily living and physical
functioning. Both reliability and validity of the
in'itrument were demonstrated. Although only
a preliminary form of analysis, the instrument
showed that a high level of mental
functioning. combined with a low level of
independence in daily living, was predictive of
death within three to nine monlhs in the
sample population. Implications of results and
suggestings for funher research and potential
uses of the assessment instrument are
discussed.
. Post natal concerns
A Comparison of Mother's Concerns
Regarding the Care-taking Tasks of Newborns
with Congenital Heart Disease Beforr and After
As.'ìUming their Care. Toronto, Ont.. 1978.
Thesis (M.Sc.N.), Univer'iity of Toronto by
Janel May Pinelli.
-
This exploratory study sought to identify,
during the newborn's hospitalization,
mother's concern'i regarding the care-taking
tasks of their infants with congenital hean
disease and to determine one month
subsequent to discharge whether the mother's
concerns had changed. The sample consisted
of ten mothers of infants who were up to two
months of age at the time of the first interview
which was conducted in hospital. A second
interview wa'i conducted in the homes of the
subjects one month subsequent to discharge.
The content of the responses to the interview
questions was analyzed and presented under
the major headings of selected characteristics
of the sample, developmental tasks of
parenthood and selected maternal attributes.
Implications and recommendations are
presented in light of the small non-random
sample.
Th. C.nedl.n NUrH
. Child abuse
Child Abuse P
ram: Scarborough
Department of Health. Toronto, Ont.. 1979 by
RosellaCunninf?ham. (B.Sc.N., M.P.H.),
University of Toronto.
The study was done a) to assist in defining the
parameters forthe classification offamilies to
be placed on an existing High Risk Regisler
and b) to more clearly describe the role and
responsibilities of the public health nurse in
relation to child abuse. The current child
abuse program in the Scarborough Health
Dept. was examined by exploring the nurses'
perceptions of the application of the nursing
process to families where there had been or
might be child abuse. Specifically, the value
Ovol Drops
relieve
infant colic.
'PAABI
ccpp
Decem..... 1878 8
and use of the Scarborough High Risk
Regi'iter were documented.
Findings indicated that the nurses'
perceptions of child abuse factors were
congruent with Ihose reponed in the
literature. They demonstrated a knowledge of
child abuse, Ihe imponance of nursing
lV'Ice
and emphasized prevention throughout all
phases of the nursing process. The 31 familie'i
who responded to the questionnaire rated the
public health nursing service as "valuable" or
"very valuable".
The High Risk Register was perceived by
Ihe nurses to be a method of measuring the
scope of child abuse in the area and of
emphasizing the needs offamilies where there
was or might be child abuse. Suggestion'i were
made to increase its value and use, as well as
to improve the child abuse program.
Ovol Drops contain simethicone,
an effective, gentle antiflatulent
that goes to work fast to relieve
the pain, bloating and discomfort
of infant colic. Gentle pepper-
mint flavoured Ovol Drops.
So mother and baby can get
a little rest.
(6)HÇ>RnER
Shhh. Ovol Drops.
....-.:
.
L
Oval [)ffi)
s..GBro;
fs r
actJllf
.
. relief
of ,nfant
col _
I
&oo:R
AI!!IO available In tablet form (01'" adults
11
IJ I .
-J::
} I, .
I (
, h
The kidnapping
was solved
because the bab
left prints at the
scene of the crime.
You could only describe it as a hellish nightmare.
A three-day-ald infant had been snatched from his nursery crib, in the maternity
section of a small Southwestern hospital.
Mercifully, for his parents, the events of the drama unfolded rapidly. Within forty-
eight hours the child had been found, unharmed. His kidnapper was in custody.
But what of the lifelong uncertainty these parents might have been forced to
endure? The gnawing suspicion that maybe-just maybe-the child returned to them
was not truly their own.
A Hollister product, the Disposable FootPrinter, spared this family-and hun-
dreds like them-from needless worry and fear. FootPrinter provides hospitals with
a permanent record of individuality. Perhaps the
only record. tv\any experts believe footprints are
often the single best means of establishing identity.
And, indeed, in the case described here, posi-
tive identification was obtained only after law-
enforcement officials compared the baby's foot-
prints with a set made at the time of birth, using
the Hollister FootPrinter system.
Of course, for Hollister, footprinting is only
one of many ways we're leaving our mark on
the health-care community.
Hollister products touch millions of people.
Nearly one mi II ion ostomates, for example, lead
more meaningful lives due to Hollister technology.
And we're still seeking answers. Because
someday, that infant we helped reunite with his
family may need our assistance once again.
We plan to be ready for him.
.....
.
. ",
.
# Hollister
r
12 December 1979
news
Ji'"
... ' .
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.... .
, J
The Canadian Nurae
, ..
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.... -;'
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....
Canada was among 64 member countries participating in the
largest-el'er biennial meetin!? o.f the Council ofN ational
RepresematÏl'es of the Imernational Council of Nurses in
Nairobi, Kenya. in September. Canadian nurses were
represented by the presidem o.fthe Canadian Nurses
Association, Helen Taylor, (left) and CNA executil'e director,
HelenK. Muuallem.
Nurses from 64 countries
attend ICN meeting in Africa
Salary and conditions of
employment for nurses in all
of the 89 member countries of
the International Council of
Nurses (ICN) will be the chief
concern of that organization
over the next two years. The
decision to give priority to
efforts to improve the social
and economic status of nurses
around the world was made by
the Council of National
Representatives of the ICN
during its recent meeting in
Nairobi, Africa.
Another priority agreed
on by Council members,
according to CNA president
Helen Taylor who represented
Canadian nurses at the
meeting, is the need to
develop a greater awareness
among members of the
significance of nursing
research in efforts to improve
practice and meet the health
and welfare needs of the
people. TheCNA, which
through the Canadian
International Development
Association (CIDAt provided
financial assistance to some
memher countries which
would not otherwise have
been able to attend the Africa
meeting, will, according to
president Taylor, "be sharing
our expertise" with nurses in
less developed countries to
assist them in finding ways of
using their power and
influence to accomplish
socio-economic goals for
nurses and nursing.
A total of 89 countries
now belong to the ICN ; the
decision to admit Cyprus as
the 89th member country was
taken by the CNR in Nairobi.
A "Workshop on Primary
Care", sponsored by the
World Health Organization
(WHO), was held in
conjunction with the ICN
meeting and also attended by
the representati ves of the
Canadian Nurses Association.
The 17th Quadrennial
Congress of the ICN, a year
and a half from now, will be
held in Los Angeles from June
28 toJuly 3,1981. The last
ICN Congress in Tokyo,
Japan, in June 1977, attracted
more than 12,000 nurses from
alI around the world.
ARNN Remembers Past - Looks to the Future
"Nursing education programs
must be part of the general
educational field: there must
be provision for continuing
education and equal emphasis
must be placed on theory and
practice in nursing
education." said Dr. Virginia
Henderson, research
associate emeritus, Yale
University, at the 25th
anniversary annual meeting of
the Association of Registered
Nurses of Newfoundland.
Dr. Henderson was
keynote speaker at the
meeting which took place
October I to 3 in Corner
Brook: the meeting theme
was: "A past to remember-
a future to shape". She said
that administration should
attempt to free everyone in
the system to function as
effectively as they can. In the
future she feels health care
systems and administration
will be on a regional basis and
therefore will be more
government controlled. This,
says Dr. Henderson, will be
for the better as the public will
have more input into the
operation. More consumers
will be placed on hospital
boards and they will be able to
present more effective
criticism.
"Every nurse must be a
practitioner...it is the job of
the nurse to get inside the skin
of the person she is helping
and do for him what he would
do for himself if he had the
health, will, and the
knowledge." said Dr.
Henderson.
"It would be a sound idea
to use the prototype of the
midwife in envisioning the
nurse of the future, as the
nurse may well be responsible
for primary care and the
doctor utilized as a
consultant. This presents the
concern that the physician will
then lose personal contact
with his patient. "
Marguerite E.
Schumacher, dean, Faculty of
Nursing, The University of
Calgary told the meeting that
nursing and educating systems
are responsible for developing
in today's nurse the
characteristics of
accountability, the ability to
enquire systematically and a
dedication to the ideal of a
master craftsmanship.
Schumacher feels that in
preparing nurses for the
future, a baccalaureate degree
will be necessary. "We are
slow to accept the fact that
nursing includes discipline of
the mind and the ability to
question the researchable-
to survive as a profession we
must change."
Alice Furlong, former
ARNN assistant executive
secretary, in her paper
entitled, "Erosion of the
nurse's role", said she
questions whether it is need or
lack of insight into our role
that is making nurses delegate
duties. Furlong feels that we
must question and realize
what we do: the responsibility
for action must be assumed by
nursing itself as we must
preserve what is appropriately
ours and we must be
perceived as capable and
competent by others.
Other highlights
The Minister of Health for
Newfoundland, the
Honorable H. Wallace House
said that a "Future to Shape"
in nursing must be the
collective responsibility of the
government and the ARNN.
Dr. Shirley Stinson, CNA
president-elect told the
meeting that the business of
organized nursing is
important, that it would be
very naive for nurses to think
as long as they are doing the
best they can, everything will
be alright. She stressed the
importance of education and
being aware of changes that
are taking place in nursing.
Dr. Stinson said that
interdependence of nursing
groups in Canada is necessary
and good, as the CNA
requires constructive input
from all factions of nursing to
enable it to base decisions on
nursing informatively and
wisely.
ARNN president,
Margaret MacLean said that
nurses must have
cohesiveness and work
together. "We must express
our opinions to our
association and not undermine
Th. Caned Ian NUrH
D8c:ember 1179 13
It
function by voicing these
opinion
to other health
personnel or as'iuciations."
:\lacLean predicts. "a
glorious future for nursing if
\\-e increase our knowledge in
nUl'
ing and use our influence
with the <\RNN to improve
the health care of clients, the
tatus of nursing and the
individual nurse."'
Resolutions approved by
<\RNN members included
xeparation of a brief to Mr.
Justice Emmett Hall on the
implications of the pre
ent
system of health care. the
pre!o.ent delivery svstem and
nurse utilization: an approach
to the govemmentto resolve
the matter of funding for
nurses to further their
education at a baccalaureate
level. and continuing
exploration with Memorial
U ni versity of Newfoundland
School of Nursing as to the
po
sibility of establishing a
:\lasters of Nursing program.
It was also resolved that the
association actively consider
the implications of adoption of
the longtenn goal of
placement of basic nursing
education at the baccalaureate
level in the general
educational 'itream.
I
Women as health care consumers, a change and a challenge
Women as health care
consumers are challenging the
svstem. demanding more
control: as dissatisfied
consumers the power that
they wield can cause the
health care system to change.
Mary Vachon. RN. MA. PhD.
keynote speaker at the
District V NAACOG
Conference. suggested in her
address that nur!o.es often feel
threatened by other women
who appear to be usurping
their power and,
consequently. they are
uncomfortable and not always
empathetic when dealing with
women in the health care
system.
Vachon, who is a
Research Scientist. Clarke
I nstitute of Psychiatry and
Assistant Professor,
Department of Psychiatry.
University of Toronto,
advised nurses in her audience
that they could best face the
future by thinking more about
themselves - first as women
and secondly as nurses. By
reading about the history of
women and of nursing, nurses
will more readily understand
their own reactions. as well as
the reactions of women
consumers to health care and
their place in it. she noted.
"As women. we must
begin to like our'ielves more
and try to understand and
support each other. As
nurses, we must begin to
assume control over our own
lives, we must try to
hare
control in the health care
environment with the
consumer. ..
Examining the many
changes and directions in
obstetrical and gynecological
nursing stimulated much
dialogue among the 400 nurses
from Canada and the United
States who attended the
District V annual conference
of the American College of
Obstetricians and
Gynecologists in Ottawa,
October 17 to 21. The nurses
are among more than 20,000
nurses within NAACOG. The
organization this year
published ajoint statement
with the American College of
Obstetricians and
Gynecologists on the role and
educational development of
the Ob'itetric-Gynecologic
Nurse Practitioner and. in
1980, certification
examinations will be available
for Inpatient Obstetric
Nursing Certification and
Obs/Gyn Nurse Practitioner
Certification.
These examinations will
he written in Toronto and
many centers in the U.S. on
April 18. 1980. with
application'i required by
February 8. 1980. Eligibility is
dependent upon experience
and employer documentation
of perfonnance. F urt her
infonnation is available from
NAACOG Certification
Corporation. One East
Wacker Dr.. No. 2700,
Chicago. Illinois. 60601. In
1981, a certification
examination will be offered
for the neonatal intensive care
nurse.
A sabbatical year
in international development
(-....\
:aJ
\.......7
The LD.R.C. offers ten awards for training, personal study or
im'estigation in international development to Canadian pro-
fessionals in 1980-81.
Candidate.
- may already be working in international development
or wish to become acquainted with the field through a
sabbatical year.
- must be at least 35 years old. Canadian citizens or
landed immigrants with 3 years residence and have 10
years professional experience.
Programme
- to be developed by the candidate. May be any form of
trai ning work/study or personal investigation
provided:
a) the programme has direct relevance to the prob-
lems of developing countries.
b) it provides increased professional competence as
well as a greater familiarity with developing coun-
try problems.
Field or dlM:lpllne
- Unrestricted
INITRNA1l0NAL
DEVELOPMENT
RESEARCH CENTRE
CANADA
Length ot award
Minimum 6 months - maximum one year
Value
Stipend up to $23,000, field travel and research costs
up to $4,000, plus international travel costs and train-
ing fees
Application.
- Available from:
Professional Development Award - Canada
International Development Research Centre
P.O. Box 8500
Ottawa, Canada
K1G 3H9
Deadline tor application.
- February 15, 1980
Award. announced
- May 15, 1980
The International Development Research Centre is a corpor-
ation established by an Act of the Canadian Parliament, May
13th, 1970.
t
12
1- The soft touch
lor tender tissues.
.
100
TUCKS*
Pre-Moistened Pads
For hemorrhoids, feminine
hygiene, piles and personal
Itching problems.
e."i J.' ttil,.Astril,"1
N 443646
...... mark 01 Parke DaviS & CornPd(1)
& Company LId . regIstered uSE!!"
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I
PARKE-DAVIS
Occupational health nurses
attend alcoholism conference
Four occupational health
nurses shared their
experiences in the largely
uncharted field of establishing
employee alcohol and drug
abuse programs with close to
100 of their colleagues during
Input '79 in Ottawa last
September.
The nurses, Norma
Hooper of Halifax. Kay
Lawther of V ancouver,
Genevieve Tartre-Lemieux of
Montreal and Neilia
MacKeigan of Halifax, work
for a variety of employers: a
food chain, department store,
communications company and
the federal Department of
National Defence.
All four were
instrumental in setting up
early intervention drug and
alcohol abuse programs within
the framework of their
employee assistance plans in
their place of employment.
Steps in each case included:
. approval or activation of
an existing company policy
recognizing addiction as a
health problem
. selling management and
unions on the advantages of
· the program to both the
employer and employee
. education and
sensitization of supervisors
and employees in
identification and detection
skills
. establishment of a system
of counseling, community
referrals, treatment and
followup.
Although approaches
differ, according to the
setting, the four nurses agreed
that the crucial elements in
establishing a successful early
intervention program are:
credibility, confidentiality and
continuity.
Close to 400
representatives of industry,
business, government and the
health and social services
fields attended the three-day
3rd Biennial Canadian
Conference on Occupational
Alcoholism and Drug Abuse
in Ottawa. The event was
billed as the "largest, most
knowledgeable gathering of
Employee Assistance
Program specialists in
Canada." This year's
conference was unique in
tenns of both size and
Canadian participation:
registration was nearly double
that of previous years and, for
the first time, was almost
exclusively Canadian.
Estimates place the
number of employees who
might be assisted by primary
prevention and early
intervention programs at
approximately 25 per cent of
the total number of workers in
any occupation or work
setting.
r- ::".
\I" .
I... ..:_
Infection control practitioners,
people in the middle-
p," .
More than 200 doctors and
nurses attended the second
national infection control
symposium held in Toronto
October 17 to 20, for the
Canadian Hospital Infection
Control Association
(CHICA). The symposium
was preceded by three days of
workshops and seminars
comprising an introductory
course in infection control.
The event attracted some 350
registrants.
One of the highlights of
the symposium for nurses was
a debate in which the rights
and responsibilities of a
ft\6'
;: .'
.l2.
.
,
hospital infection control
committee were discussed by
Drs. Dennis Maki of the
University of Wisconsin, and
Irving Koven of Toronto. The
doctors noted that the
infection control nurse often
felt like the "person in the
middle" having to work
between the hospital
committee and the
"sometimes unfriendly
preserve of the surgical unit".
Dr. Koven stressed that
communication was a skill of
great importance, that doctors
needed to know what is going
on in their hospitals. regarding
control of infection, and that
doctoJ;. "ho have prohlems
"ith infection need to kno"
"what they're doing wrong".
Dr. l\1al-..i added that the
general goal of the infection
control nur
e and committee
"as "not to assign blame. but
to improve peIformance".
Nursing sessions
included presentations on the
control of burn infections by
Cheryl Leeder RN of London
Ont.. infection control in the
u...e ofiV devices hy Sharon
Swain RN of Ajax-Pickering.
and workshops on employee
health programs and the
professional training of the
infection control practitioner.
Of interest to nurses involved
in dialysis was a workshop on
the prevention of infections in
both hemo and peritoneal
dialysis patients; also offered
"as a seminar on infection
control in the long term care
institution.
Dr. Alistair Clayton of
the Laboratory Centre for
Disease Control, Health and
Welfare Canada, outlined a
new federal government
program for infection control;
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LISTER BANDAOE SCISSORS
ManufaCtured 01 f nul a..._ A
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No 898. 3
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Th. Canadien Nur..
among the priorities such a..
organizing response to
ho
pital epidemics and
monitoring the prevalence of
infectious diseases is the goal
of a Canadian training
program for nurses interested
in practicing infection control.
ursing home nurses
work to improve care
The way to stop complaint..
about nursing homes.
according to Ontario's
\1inister of Health, Denni
Timbrell. is to do a better job
of explaining to people what
they can and should expect
from them in the way of care
before they need this
information. Timbrell was
addres
ing 306 participants.
including about
O nurses. at
the
Oth annual convention of
the Ontario Nursing Home
Association in Ottawa in
October.
The health minister cited
improved public perception of
nursing homes as one of the
major benefits of
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biKk. blue or green No 32 12 21 NCh
accreditation. Twelve nursing
homes out of a total of 330 in
the province have now
achieved a
creditation. The
association has set a target of
100 accreditated home.. by
September. 1980.
Two years ago a nursing
committee was formed within
the association to allow nurses
from across the province to
meet for support. exchange of
ideas and most important, to
eMablish improved standards
of nursing care in the nursing
home milieu. These nur
e
have now prepared a standard
charting system to be used in
nursing homes throughout the
province. The svstem is
specifically designed to
facilitate implementation of
the nursing process, reduce
duplication of charting and
individualize resident care.
Concern about
medication management and
the indiscriminate use of
laxatives has resulted in a
recommendation from the
nursing group urging the
fonnation of a PharmaceutIcal
Therapeutic Committee in
every nursing home. This
Nu"aEa CAP TACS
Oold pla.e(J. 1'10lClI your cap
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PUII'1 bullon tor Ip'ln
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D8c:ember 11171 15
committee would ensure
provision of an emergency
drug kit. review re!'idents'
medications. maintain
individual phannaceutical
profiles. monitor drug
reactions and interactions and
provide drug information and
inservice education. A
research project to examine
the use of laxatives is
currently in its initial stages.
Through their committee.
the "nursing home nurses"
have gained credibility: as
well as sitting on the
Standards Committee of the
Ontario College of Nurses,
they frequently lobby on
issues concerning the role of
the registered nurse. the
registered nursing assistant
and the health care aide in
Ontario Nursing Homes.
More infonnation is
available from Emilia Rizzuto,
chainnan. Nursing
Committee. Ontario Nursing
Home Association. 6075
Yonge St., Willowdale.
Ontario. M
M 3W2.
;s, .N....ELL.D PINS.
O B..
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,
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Jewelry Qullity In hNwy gold
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NURSES EARRINGS. For plerce<J No SOJ Nu...... Aki.
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Excephonaliliurninahon.
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.........................................oo........................................................ ..................oo...................oo.. ........ .....
16 December 1979
Th. Cenedlen Nur..
YOU AND THE LAW
Sinners or
Saints?
The Legal
Perspective
Part Two
Corinne Sklar
Background
Last month, aut/lOr Corinne Sklar redewed the facts
surrounding the case Re Mount Sinai Hospital and the Ontario
Nurses Association' and the reasons of the majority of members
of the Board of A rbitration for their decision, a decision upheld
Findings
The board upheld the disciplinary action taken by the hospital in
suspending the three nurses involved for three days without pay
on a finding of insubordination. The insubordination resulted
from the nurses' refusal to accept on the I.CU. and deliver
nursing care to a cardiac patient, R: the nurses' refusal was
based on their judgment that to accept this patient would
endanger the patients already under their care. There were eight
patients already in I.CU. that night, and five were being
ventilated. The I.CU. was being staffed by six nurses: four
regular I.CU. nurses, two relief nurses. Of the latter, one had
no experience at all in ventilating patients and one had no
experience in ventilating in the previous two years and no such
experience at Mount Sinai. Contrary to agreed hospital policy,
no team leader or charge nurse was appointed by the nurses that
night. Care (medical and nursing) to the new patient R was
delivered un the I.C U. by four physicians and a respiratory
technician.
The majority of the board found that the nurses had refused
to carry out a valid work assignment and that the evidence did
not support their defences to the "obey and grieve" rule. Thus,
the defences of justification and illegality could not be applied in
support of the conduct of the nurses.
The dissent
W. Walsh did not agree with the findings and the award of the
majority of the board: in his view there was no insubordination
because "there was no order or direction given to all or any of
the I.CU. nurses to provide nursing care for patient R". 3
Further, even if a direction had been given, in his view, "this is
one of those circumstances where the 'obey and grieve' rule
does not properly apply" .4The dissenting board member would
have upheld the grievance of the nurses against the discipline by
the hospital.
The evidence of the hospital staff(physicians and nurses)
and the expert testimony of Dean M. Josephine Flaherty were
emphasized in the dissenting opinion. I n reaching his
conclusion, Walsh focused on the following:
I. the function of an I.c. U. nurse with respect to ventilators
2. the role and conduct of nursing administration
3. the professional responsibility ofthe registered nurse.
.,
---.......
J ....
by the Divisional Court of the Supreme Court of Ontario on
appeal by ON A. q his month. she looks at the reasons of the
dissenting member of the three-person board and considers the
implications of the majority decisionfor nursing.
1. Ventilators and the responsibility of the I.C.U. nurse
The evidence of the physicians and the nursing supervisor
clearly established the operative hospital policy that "ventilated
patients cannot be left unobsen'ed or unattended". 5The critical
nature of the I.CU. was also noted: "Every patient in LCU. is
critical. The condition of each patient varies from minute to
minute".6 "In the LCU. one anticipates the patients are
critically ill and need intensive nursing care and the patients'
condition can change hourly" .'The function of the I.C U.
nurse in respect to the ventilator was described from the
evidence of the intern. Her duty to observe the machine. to
ensure its operation, and to suction p.r.n., at her discretion, to
clear the lines of secretions and condensation so that the
patient's effective breathing is maintained were described.
"Basically, a ventilator assists a patient to breathe. Without
such assistance it would be fatal". This evidence also touched
upon the variation in the degree of nursing attention required fOI
different patients:
"Critically ill patients with lots of monitoring equipment,
in-dwelling tubing. those on ventilators. require a
considerable amount of nursing attention. Some require
almostfull-time nursing attention. Others. in practice may
require less. There is a great mriability in needs. medically
and nursing."M
The dissent noted that on the night in question five out of
eight patients were on ventilators and quoted testimony that thi
proportion was higher than "normal". Further, it was noted
that a tour of duty is meant to provide lunch and coffee breaks.
On this shift, the nurses were so busy that such breaks in fact
were not taken. The foregoing evidence was heavily
emphasized by the dissent in considering the conduct of the
nursing administration (through the nursing supervisor) and the
exercise in general of professional judgment by the registered
nurse.
2. Nursing administration
Walsh concurred in the finding of the majority that the absence
of a team leader contributed to the misunderstanding and
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18 December 1978
Th. Canadien Nurs.
It
difficulties that occurred on that night regarding the new
admission. However, in his view, the hospital supervisory staff
were aware of this omission. and did nothing to rectify it. The
dissent noted that the supervisor on that night took report from
each nurse individually. Yet. a practice consistent with the
hospital policy requiring the designation on specialty units of a
team leader would result normally in the supervisor receiving
report from that team leader only. On the evidence, the practice
on LC U. for some time was the practice followed on the night
in question: each nurse individually reponed to the supervisor:
no one nurse was designated to report comprehensively for the
unit. I n the view of the dissent. the supervisor was therefore
aware that no team leader had been designated and nothing was
done to correct this practice. 'This culpable omission on the
part of management could well have lulled the nurses into
believing that there was no serious requirement to take
seriously the hospital policy of having a team leader selected for
each shift."9
Further, given the nurses' stated unwilhngness to accept
responsibility for another critically ill ventilator patient becau<;e
of their already heavy workload and the supervisor's knowledge
that there was no team leader who would examine. plan and
reorganize the workload in order to meet this contingency. the
dissent found that neither the supervisor nor the physicians did
anything to assess the situation and develop a new plan of
action. The nursing administration did nothing in the face of the
LCU. staffs obvious desire for assistance and remedial action.
The dissent here re-emphasized the constant care required by
the five ventilated patients and the critical nature of the LCU.
where "drastic and fatal changes" can occur suddenly.
The dissent looked with disfavor on the position taken by
the majority that as professionals the nurses did not require a
clear order to accept the new patient and that "knowing" the
supervisor's style of supervision. they should have known that
.'cope", "do your best" was consonant with a direct order:
"With respect, I submit that ifregistered nurses are
expected as professionals to recognize that a request to
'cope' is intended as an explicit directive, then surely they
should be treated as professionals when they earnestly urge
in their professional judgment that they receh'e help for the
proper treatment of patients that busy night, and when their
professional judgment is outraged hy a request that they
somehow prm'ide nursing aid to another critical patient at a
time when, in their judgment, this will further endanger the
critically ill patients already entrusted to their care. The
hospital cannot hm'e it both ways - that nurses apply their
professionalism to translate 'cope' into 'obey', but that the
same nurses disregard their professionalism when in their
professional judgment their own patients st{fJer by being
abandoned, whilst they attended to a new, seriously ill
patient." 10
Even if such words constitute a direct order, in the
circumstances. in the view of the dissent. such an order was
improper and the nurses were justified in refusing to comply.
The justification was based on the exercise of the nurses'
professional judgment based on the requirements of the LCU.
for complete alertness and the individual attention required by
the five out of eight critically ill patients.
3. The obligation of the pfofessional nurse
Dean M. Josephine Flaherty gave expert evidence at the
hearing and it was her testimony with respect to the role of the
nurse and the exercise of her professional judgment that
provided the basis for the dissenting award. Testimony of an
expert witness is given as evidence of the professional standard
to which those professionals are held. The expert does not
proffer a judgment on the conduct of those particular
professionals in those particular circumstances but. instead,
testifies as to the standard expected of the reasonable
practitioner in general and similar circumstances. The relevant
evidence of Dean Flaherty is best presented in her own words
as they appeared in the dissenting award. II
On the position of the registered nurse:
"As professionals they are accountable for their heha\'iour
rather than accountable to someone in a hierarchy and as
persons who are accountable for their professional
beha\'Îour. Thev must ma!..e judgments about the
appropriateness of their nursing actions and if at any time
they belie\'e that an order is questionable those nurses are
obliged by the ethical code gm'erning nursing and by the
contents of and the regulations under The Health Disciplines
Act of Ontario to refuse to carry out questionahle orders
until they satisf\' themsel1'es that the carrving out of the
orders would not be in conflict with their professional ethics
and with their commitment to excellence in the practice of
their profession."
On comparing the professional responsibility of a
registered nurse and a physician:
"It is d
f.fìcult to distinguish between the two because I think
that the memhers of both professions are professionals II'ho
are accountable for their behm'iour, who possess !..noll'ledge
and s!..ills relemnt to the practice of their profession, II'ho
are committed to master craftsmanship to the practice of
their profession, who are guided by a code of ethics which
demands of them that they act with integrity and that to mv
mind means doing what )'ou belie,'e to be right no matter
what the cause (no matter how difficult it is for you as an
indi,'idual in a situation; e.g., if I practice in a way which I
belie,'e is the right lI'ay for me as practitioner el'en though
someone may critici;:e me for gh'ing nursing care in the style
that I belie\'e is the proper style, then I beline I am acting
lI'ith integrity and I am prepared to be accountable for that
before anybody). "
On the obligation of the nurse wh
n ordered or requested to
care for another patient when in her professional judgment to do
so would place the patient already under her care at risk:
"In my ,'iew under those circumstances a nurse is obliged to
communicate to his or her immediate super\'Ïsor or anyone
else to whom he or she reports that in the nurse's ,'iew he or
she is unable to care for the new patient safely and
competently. "reporting of this did not result in the nurse
being gÏl'en assistance, then in my l'Ïew that nurse lI'ould
hm'e to ma!..e a projéssionaljudgment about II'hether he or
she would attempt to gÏl'e some care, partial care to all of
the patients or only to the patients for II'hom the nurse lI'as
responsible originally. That judgment 1I'0uld im'ol,'e
consideration by that nurse ahout whether action or lack of
action on hi.
or her part would result in danger or threat to
the safety and/or we{táre of the patient inl'Ol1'ed. "
On the distinction between a nurse's professional
responsibility and her duty to her employer:
"It is difficult to separate the responsibilitv to an emplover
from her responsibility as a prqfessional because I belie,'e
that my first responsibility to my employer is for me to
behm'e as a competent professional nurse if my emplover
has hired me as a professional nurse ."
On the nurse's response to "do the best you can" by a
supervisor:
"She must ma!..e a professiona/judgment ahout what action
he or she would ta!..e or not ta!..e and be accountable for that
judgment.' ,
ORE OF SAUNDERS' FINESt
LeMaitre & Finnegan
THE PATIENT IN SURGERY
4th Edition
This excellent revision provides an
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the student, graduate nurse, and O.R.
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NURSING SKILLS FOR AWED
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Th. C.nedlen Nur..
In commenting on this evidence, the di
.,ent noted that a
professional nurse is expected to exercise an independent
professional judgment for which she is accountable. The
employer of a professional nurse expects her to exercise her
professional judgment and responsibility in fulfilling her
professional duties. The dissent further concluded that nursing
administration is responsible for tho'ie delivering nursing care:
nursing administration hires, fires, disciplines and directs the
professional nurses employed by the hospital.
The evidence of the assistant director of nursing
established that on accepting report on a patient. the nurse
accepts professional responsibility for that patient. Once report
is accepted, the potential for civil liability regarding the care of
that patient commences.
Based on the foregoing, the dissent concluded that there
had been no direct order to accept the patient R on the Unit and
therefore there was no insubordination. Even if there had been
a direct order. in the view of the dissent. given the facts and all
of the circumstances the nurses were justified in refusing to
follow the directive in the exercise of their profe'isional
judgment.
The dissent concluded with the following cogent
ob'iervations:
"...Holt' dues sllch a predicament ari.\e, as uccurred during
the earl\' morning oj F ehruary 27, 1976, in the intef/sil'e care
unit at Muunt Sinai? Huw do thuse in authority alluw a
situatiun to arise where er:perienced I.C.U. nunes, caring
for I'e
v sic/,. patients l'ame.
tly conclude they require help for
patients alread\' under their care and cannot attend to still
WI additional critically ill patient witllOutJitrther
endangering those already in their care. Surely. if this
i1l1ulerahly wretched circum.Hance is the result uf some
failure ofmana
ement, then the people at the hottom of the
ladder, the hard-wor!..ing profeHionalnunes should not he
made the scapegoat.\...
...Ifthe situation that developed is the direct or indirect
cu
sequence oj the wt-hack infundsfor health care in
Ontario, then the Gm'emment would be well ad\'i.
ed to loo!..
at their Iwndiwor!.. a.
manife.
t in the pain that has heen
\'isited on nurses, doctors and administrative people at
Mount Sinai that night and in e\'ents since then, not to speak
of the I/Q;:.ard.
to which a numher of patients might hm'e
heen unnecessarily er:posed...
., .The demise of none of the patient.
was hastened in any
way by the e\'enH. But who !..nows what might Illl\'e occurred
if the nunes had weakened in their resol\'e and had acted
against their olt'n training and professionllijudgment during
the difficult and painful night and earl\' morning ofF ehruary
26and27.1976."
Divisional Court decision
On appeal. the board majority decision was upheld: The
Divisional Court agreed that the subjective opinion of the
nurses was not validly formed. The reasons of the board in
finding that the judgments were based on incomplete
information and that the physicians' informed judgment was
more complete satisfied the Court that the board had properly
addressed itselfto the questions hefore it.
The nurse as an employee
The issue raised in this case is the thorny issue of control. The
view of nursing is that the profession is independent and as 'iuch
its inherent elements include the exercise of professional
judgment and accountability for judgment. The decision here
appears to limit the action a nurse can take in the exercise of her
professional responsibility. The decision clearly gives the
hospital-employer the right to insist that nurses carry out
employment directives which in their professional view are not
acceptable in the circumstances. The majority decision places
nurses in the position of "obeying" first and "grieving" later
with the legal justification for refusal limited to illegality and
personal jeopardy of the employee. The effort here was to
balance the needs and re'iponsibility of the hO'ipital against the
needs and responsibility of the professional nurse: the hospital's
needs prevailed.
The pivotal interest here should be the interest of the
patients to whom the hospital and the nurses owe a legal duty.
Several writers have commented that a ruling adverse to the
hospital would have set a precedent with wide-ranging
ramifications: nur'ies would then have held vast power over
their employers.
The responsibility of the hospital
The award clearly fixes legal responsibility upon the
hO'ipital-employer and provides nurses with the approach to be
followed in similar circumstances. In law, hospitals are reqUIred
to hire competent staff in sufficient numbers to deliver care to
the patients within. Ontario Regulation 729 underThe Puhlic
Hospitals Aa tl deals with hospital management. S.16(1} of that
regulation states that a hospital shall have on duty at all times
sufficient nursing staff to give such nursing care to every patient
in the hospital as is required for the patient's care and
treatment. subject to the limitations in subsection 2. S.16(2)
states the minimum registered nurse requirement on the evening
and night tours. However, this nurse-patient ratio would not be
relevant to a
pecialty unit with the nursing needs of an I.C.U.
A hospital is therefore legally responsible to provide care to the
patients admitted and to provide competent nursing staff to
deliver such care. The hospital can be found both originally and
vicariously liable for harm befalling patients while in the
hospital. In general. hospitals are vicariously liable for the
conduct of their employees during the course of their
employment. Thus, if the damage suffered by a patient is found
to have been caused by the negligence of a nurse. the hospital
may be found vicariou'ily liable for this damage ir. the
circum'itances.ln any case. all of the facts and circumstances
surrounding the event are important to the determination of the
case. The result of this award should be considered in light of
the facts and circumstances involved in the situation.
The issue of the potential civil liability of the nurses was
viewed differently hy the majority and the dissent. The dissent
considered this a highly relevant factor justifying the exercise of
professional discretion of the nurses in the manner complained
of by the hospital. I n this view. the facts supported the
conclusion drawn by the nurses, ie. that it would be unsafe to
accept patient R under the current working conditions. The
majority found that no answer to potential civil liability could be
given with certainty. However, the board confirmed that in any
question of civil liability the question always asked is whether
or not the nurses conformed to the standard of care of the
reasonable nurse in the circumstances (emphasis added). A
court of law always considers the circumstances in which the
events transpired. As the majority stated, the fact that the
nurses had been instructed by the employer to rearrange their
workload so as to attend to the interests of the new patient,
would be highly relevant.
Nursing responsibility
The fact of the employer's order alone is not sufficient to fix the
hospital with sole responsibility, however. Nurses have a duty
to warn an employer with respect to unsafe conditions in a
hospital. 1.1 Whether the hazard concerns equipment, hospital
property or conditions leading to unsafe care. the duty remains.
Once informed, the hospital knows or ought to have known that
the dangerous situation exists. The onus is then on the hospital
to take appropriate remedial action.
Nurses also have the duty to maintain the standard of
nursing care reasonable in the circumstances. I n response to the
order to accept a new patient. having informed nursing
administration of the difficulty. nurses may not ignore
professional standards. For example. nursing procedures and
techniques in the administration of medications must still be
Th. Cenadlen Nura.
D8c:ember 111711 21
\
fÙllowed. One cannot .,ay. "I didn't check the medication lahel
becau'e I \'.as so busy \'. ith the extm patient(s)". The standard
of care to \'.hich a nur'ie would be held in circumstance'i such a.,
raised bv this ca.,e \'.ould be that of d rea.,onable nurse of hke
training and e'l.perience in
imilar CÎrcumsw1Ices (emphasis
added).
The aWdrd of the board empha.,ized the failure to appoint a
team leader and the resultant mabilit} to make a global
assessment ofthe needs and capacity of the unit. If there i'i such
a hospital requirement, it should be fulfilled. Such a de.,ignation
i., sensible in terms of organization and management of unit .
nur.,ing cale in ordinary circumstances. Where necess<lry. the
team leader should report the circumstances and problem facing
the unit to the appropridte ,>upeJ"\isor. Having done '>0. the
reque'it for a\.,istance and the respon,ibility for remedial dction
and/or direction falls upon nursing administration. The
.,upervisor then hds the responsibility for decision, discussion,
reas\essment of the needs of the unit etc. Both the nurse and the
,upervisor will tonn a profe."ional judgment ba,ed on the
relevant facts.
I n my vie\'.. the award did not proper!} dlstingui.,h between
critical needs invoh,ing nursing care and critical needs involving
medical care. Of course there i'i an area of overlap: it is one
thing to as-.e'is the medical needs of the Pdtient on a unit.
another to asseS'> the capacity of the unit to deliver the nursing
care to meet tho'ie medical needs. A nursing assessment is
necessary to consider the capacity of the unit to deliver nursing
Cdre to fulfill the needs. both medical and nursing. of the
patients. A medical reas,>essment of critical needs might alter
the prevailing orders for care. For example. on rea'isessment,
two patients might have had ventilator care discontinued. The
capacity of the unit to deliver nursing care would then have
been materially altered: two nurses \'.ould have been freed from
con\tant observation of those patients.
However. there was no medical reasseS'imenl. Even if
there had been, there likely would not ha....e been the change in
order contemplated above. That the unit did require additional
staff was evidenced by the fact that on the next shift, the
complement of the unit was increased to eight I.C. U. nurses
and a charge nurse.
Had there been a team leader that night who had made the
global dssessment. it is unlikel} that the physicians' judgment
would have been preferred. The reliance on the "more
extensively trained" professionaJ"sjudgment occurred in the
absence of the global assessment.
With regard to professional disciplinary action being taken
by the professional body (here the College of Nurses of
Ontario), it is important for nurses to remember that they must
report to the employer an inability to accept specific
responsibility where special training is necessary or the nurse
feels incompetent to function without supervision. Failure to so
report is defined as professional incompetence. After this. the
responsibility for direction and supervision falls again to the
employer through the instrumentality of nursing administration.
The award in this case has left many nurses feeling angry.
reduced to a profession of complainers and "buckpassers". The
decision doès squarely place legal responsibility upon the
hospital-employer. The employer's ann with respect to nurses.
is nursing administration. The decision also mdicates the route
by which nurses can protect themselves in similar
circumstances. The decision has not removed the independent
exercise of professional judgment by the nursing profession.
It bears repeating that nurses have a duty and responsibility
to question physicians' orders that in their view are incorrect.
e.g. wrong dosage ordered. The focus in this decision is an
order by the employer not an order by the physician in regard to
patient care. The award clearly indicates that orders directing
the nursing workforce in the performance of their obligation to
the employer arise from nursing administration (the hospital)
not the medical stafT.
This a\'.ard is only hinding in Ontario: it i, of per.,uil'iÎve
force in other jurisdictions. Sub.,equent ca.,es may \'.ell alter
thi'i result. The result, as always. is contingent on the facts and
circum'itances of the ca.,e at hand. Here. the re'iult demand'i
that nurses conduct themselves professionall} yet it does little
to resolve the dilemma facing the professiondl nurse: obey first.
grieve later. The professIon must apply the le\Son to he taken
from the award and govern itself accordingly.
References
I (1978) I7 L.A.C.
4:! (Onl.).
:! As yet unreported; reasons released April IS. 1979.
3 Note I. supra p.:!M.
4 Ibid.. p.
68.
5 Ibid.. p.:!63.
6 Ibid.. p.:!6:! (evidence of Dr. L).
7 Ibid.. p.:!63 (evidence of A'isi..tant DIrector of Nursing R)
8 Ibid.. p.:!6:!.
9 Ibid., p.:!63.
10 Ibid.. p.265.
II Ibid.. p.:!65-:!66.
12 R.S.O. 1970c.378 a,> amended R.R.O. 1970 Reg. 729.
s.16.
13 Sklar. C. L. Hospital hazards and the nur\e. Canael.
Nurse 74:7: 16-18. JulylAugu'it 1978.
"You and the la\\" is a reglliar coillmn that IIppelln ellch month in The
Canadian N IIrse and L' in/irmière canadienne. A IIthor Corinne L. Sklar
is a recem gradllate of the Um"'enit\ ofT oronto F aClllt\" 01 LlIw. Pri(}r
to enterin/? law .\Chool. .çhe obtained her BScf'; and il,IS de/?rees in
n/lrsin!? from the Unil'ersit\. of Toronto and Uni\ enit\' (
f Michigan.
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IT'S TIME TO TALK CNA CONVENTION 22-25 JUNE 1980
IT'S VANCOUVER - BOOK NOW! YOU'LL NEED SHELTER TOO
CNA s annual meetIng and conventIon sIte IS the elegant Hyatt
Regency Hotel In downlown Vancouver. "offers superb
accommodatIon and IS connected to a 6O-store shopping complex All
the rooms on any lloor are SImIlar and Include a Indge and electnc
blanket Upper lIoors offer breathtakIng VIewS and you'll reach Ihem on
Polans glass elevators - 341100rs up. open to the mountaIns and the
cIty sparkle below SpecIal CNA convent,on rate IS $44 sIngle - $58
double - that s lar below the usual guest rate at thIs super deluxe hotel
There are several excellent restaurants offenng dInIng and atmosphere
at low pnces that will surpnse you. And there's a pool so bnng your
bathing su11 and lIve In luxury al modest CNA ConventIon Hyatt rates.
Other excellenl holels are near Ihe Hyatt
CNA has a specIal rale at Holiday Inn Centre, Harbours/de: $38 single
- $42 double, thIS hotel only It overlooks the harbor, close to the lerry
pIer - a 50 cent sea bus and transler bus wIll take you to one 01 the
many stunning sealood reslauranls In North Vancouver, the .'Seven
Seas" There IS a pool and sauna - all beds are double sIze in single or
twIn accommooatlon.
less than a block Irom the Hyatt.s the dIstinguIshed Hotel
Vancouver, long a landmark In Vancouver and a lavonte wIth many
convention goers Rates are $44-$64 single, $59-$79 double on a
Ilrsl-corne basIs.
Just lour blocks trom our conventIon sIte is the Century Plaza - It'S
an apartment-type hotel wllh 30 tloors 01 overSIzed sUItes, perfect II you
want to make up a CNA convention group, perhaps lour colleagues and
Inends. Full kitchen, dInIng room ensulte II you really want to budget and
whIp up your own gourmet treats. Each sUIte has a balcony wIth vIews
that wIll keep your camera cllck.ng And, there s a JumpIng .d,sco" ,I
you re In the mood. Rates $34 sIngle $40 tWIn and $46tnple (SpeCial
CNA convention rate)
The Hotel Grosvenor IS well known 10 B C travellers Slightly
continental In appearance It has a reputation lor clean and restful
accommooallon close to downtown
hopplng and restaurants Ra(es
appr $32 standard, sIngle or double and $34 deluxe wIth a 10 per cent
discount " you show your 10 IndicatIng that you re a CNA conventIon
delegate Irs only a short walk lrom the Hyatt
IMPORTANT - MAKE YOUR
ROOM RESERVATIONS NOW
Because It offers so much Vancouver IS a popular convention center. II s
Important to Plan Ahead - Make Your Resenlat,ons Now and In all
cases mentIon that you're attending the CNA conventIon. (The Century
Plaza and the Grosvenor wIll want a Ilrsl night depoSIt) Resenlat/on
cards lor Ihe Hyatt and Holiday Inn are avaolable lrom CNA. 50 The
Dnveway, Ottawa, OntariO, K2P 1 E2 or you can wrote direct 10 the hctels
listed in the accompany'ng box.
Looking ahead - we'll be tellong you more about B.G. tours,
shoppIng, sightseeing and dInIng In luture Issues 01 CNJ. Watch lor
Convantlon RegIstration Card In The January 'ssue Along Wllh An
Outline Of What May Be The Most Exciting CNA Convention
Program Yel.
CNA CONVENTION ACCOMMODATION
Hyatt Regency Hotel
655 Burrard St.
Vancouver, B.C.
V6C 2R7
(604-687-6543)
CNA Convention Site...
Century Plaza
1015 Burrard 51.
Vancouver, B.C.
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Travelodge toll free)
Hotel Vancouver
Burrard St.
Vancouver, B.C.
V6C 1 P9
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Holiday Inn Centre,
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1133 West Hastings St.
Vancouver, B.C.
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840 Howe 51.
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/
NeJv from Lippincott
New! The first book of its kind. . .
Pearls for Nursing Practice
A Choice Collection of Tips, Hints, Improvisations and Bright Ideas That Make Nursing Easier and Patients Happier
By Arlene Odom Nichols, R.N.) B.S.N., M.S.N.)'and Joy Day, R.N., B.S.N.
Here is a thoroughly delightful book, written and edited by cannulating high pressure arterio-venous fistulae); tips
a group of concerned, dedicated nurses who have gone from specialists; tips from generalists; and tips from the
quietly about the business of caring for sick people and allied health professions, particularly on diet, physical
noting little tricks. (actually innovative solutions) that therapy, and speech and hearing.
seemed to make things work better. Their discoveries or An ideal gift, a practical problem-solver, a joy for all nurses
"pearls" are shared with you in an organized fashion, everywhere, Pearls for Nursing Practice will above all faci-
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Numerous illustrations accompany the text. ease and benefit to patient and nurse alike.
Throu
hout its two hundred and fifty pages, Pearls for Lippincott. 250 Pages.
Nursing Practice will give you old tips (the easiest way to Illustrated. September, 1979. $10.50.
put on a pillow case, or give a back rub); new tips (like
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A definitive treatment of normal aging in its many dimen-
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management of specific high risk pathophysiologic problem
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· A Quick Review of the most common problems
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· Bibliographies contain items that will deepen the clini-
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· The Index is designed to help the clinician move from
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Lippincott. 570 Pages. September, 1979. $22.50.
Nursing Management
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By Margo McCaffery, R.N., M.S.
Nursing intervention for pain relief is the focal point of the
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Lippincott. 340 Pages. September, 1979. $19.00.
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12/
\
24 December 1979
The Cenedlen Nur..
,
f
Speaking out:
r
"
'-
À national
child health
policy?
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Does Canada, as the Task Force on the Child as Citizen proposed in its report two years ago, need a national child
health policy? Joan Dawson, a public health nurse, believes it does. She suggests that nurses !thould be helping now to
"shore up the preventive components of the health system" I and make it truly child-centered.
Joan DLHI'Sot/
"Since the early years are.m crucial to
the healthy de\'elopment (
fthe child,
children should enjoy a compulsory
continuous rexular proRram l
fhealth
maill1enance and promotion throuxhout
these years. Such a program shoulcl
include: well chilcl care; immuni;:ation;
comprehensi\'e early
creeninx for
de\'elopmental problems: nutrition and
dental health; and day care. The.
e
programs should then be fÒllo wed up bv
school health and physical {ì1lle.u
programs which, particularlv as children
grow older, encouraxe their indi\'idual
re.
ponsihilitvfÒr health anelfitness.. .the
riXht of the child to helilth care is
meaningle.fs unle.u unÍl'ersal health
programs are {lI'ailahle and unless the
child hm access to those proxrlllflS. It is
not enough to leave program initiatives to
selected clinics or parts of the public
health service or to focus only on certain
regions."2 (emphasÜ added)
The more I read about and work in the
public health field. the more I am
convinced that the pre')ent system of
health promotion, disease prevention
and early intervention is in desperate
need ofre-organization and leaden,hip. I
am supported in this observation by
member') of the Task Force who
commented that: "Despite recent
developments in health policy. acce
s 10
health care and the appropriateness of
health services are issues which remain
in limho - neither adequately resolved
nor energetically addressed."3
The 1977 review of public health
services in Ontario,
prepared by the
Canadian Public Health Association,
cites further proof. lis authors paint a
depressing picture of:
. muddled thinking: "11 is apparent
that the fundamental issue is a lack of an
agreed-upon goal or role for the public
health system in Ontario.":;
. erratic service:" ...there is a lack of
common definition across the province
as to what constitutes a program."6
. administrative confusion:
.. ...management issues at the local level
are identified a., critical at this point in
time and there are a number of concerns
relating to the effectiveness of local
boards of health...a highly controversial
issue is the proper role of the Medical
Officer of Health."7
A health-oriented policy
Nurses involved in health maintenance
and promotion programs must realize
both their opportunity and responsibility
to become dominant in the
decision-making of the future. This will
only he acheived by becoming more
knowledgeable. active and sophisticated
politically. Not only is their existence as
a viable profession at
take. but the
program., which they have carried out in
the past with great benefit to the
community are injeopdrdy. for they are
controlled by politicians whose
knowledge of public health issues is
frequently questionable. Public health
nurses must demand legislation that will
both clarify their function and protect the
public's right to receive their services.
Two years ago. for example. in
Ontario's Peel County, the local lay
board of health was able, quite legally. to
eliminate the area's public immunization
program in the name of economy!
That same year. a report from the
Ontario Council of Health observed that:
"A very wide range of immunization
levels between the 44 Ontario Public
Health U nits has been demon.,trated in a
survey by Dr. Shirley Johnson. The
variations range from one public health
unit with less than 60 per cent
D.T.P.polio to two with greater than 90
per cent; one public health unit with less
than 30 per cent measles to one with
greater than 80 per cent. The reasons for
these variations have not been studied. "M
The Canadian Medical Association
Journal. in a recent editorial. addressed
this issue: "(fchildren are not fully
immunized because they do not have
routine health care. then the private
approach 10 immunization is not likely to
succeed. If older school children are to
receive the recommended boosters.
school health programs should be given
the responsibility and provided with the
necessary personnel and funds. Serious
attention should also be given to
enactment of compulsory immunization
laws associated with school
attendance.'" A national immunization
policy. with public health nurses legally
responsible for its administration, would
.,eem to be a vidble solution to this
problem. The mechanism for this policy
- in the form of a national
recommended immunization schedule
issued by the National Committee on
Immunizing Agents in October, 1978 and
subsequenlly endon-ed by the Canadian
Pediatric Society - already exist. (see
The Canadian N urse.January 1979).
Th. Cenedlan Nurae
D8c:ember 1971 25
The present Ontario Public Health
Act specifies many duties for the public
health inspector in terms of maintaining
standards of water, food and sanitation.
Their legal protection in performance of
these duties is explicit. ,n I can find no
such specific protection for public health
nurses; their duties are as nebulous as
"the promotion of the public health and
the prevention or treatment of disease:'"
It is interesting that the public health
nurse is to be "subject to the direction
and control of the M.D.H. ".2. Where is
the Director of Nursing?
\\ ell child care
Unless nurses demand clear legislation
regarding public health nursinl? activities
and responsibilities, many invaluable
programs will be abandoned, and others
will be taken over by potentially less
competent disciplines.
. The pro1'Ísion of pre-natal classes
by the local health department should be
mandatory. with minimum qualifications
required for the teacher; requirements
including a degree or diploma in public
health nursing, a course in adult
education and at least six months
obstetric experience. A maximum
pupil/teacher ratio should be specified.
probably I :20. Funding must be clarified.
· The frequency and nature l
f
postpartum
'isits must be reassessed in
response to the current move towards
early hospital discharge and home
deliveries. Public health nurses should
have the legal responsibility to offer a
home visit to every newly delivered
mother. In the case of discharge before the
third day postpartum. the nurse should be
required by law to visit within twenty-four
hours of discharge to record vital signs.
fundal height, lochia and breast condition
of the mother and the weight. feeding
status and condition of the skin. eyes and
umbilicus of the infant.
· Mass screening of school children
for vision and hearing problems should
be mandatory, with the public health
nurse responsible for all final checks and
follow-up. The age group chosen could
be left to the discretion of the local
authority. but should be required at least
twice in a child's school career. This
type of program is justified by the
numbers of defects identified in areas
where well run programs are presently
available.
· Pre-school medicals with a full
immunization history should also be
compulsory with the local authority
responsible for providing a physician for
those children with no family doctor and
the public health nurse being responsible
for organizing and staffing any clinics
necessary to ensure such medical
examinations.
\
\
· H il?h school health prol?ram.
are
inadequate at present since health and
physical education are now optional
credits in Ontario. An alarming number of
student.. do not choose these courses and
as a result many young people receive no
health instruction at all from the age of
approximately 14 years. All students not
taking this credit should be required to
enroll in formal instruction programs
which include first aid, communicable
diseases, nutrition and parenting skill"
given by the public health nurse.
The author of an article on health
care cosh in the Financial Post noted:
"An effective strategy must increase the
emphasis on health promotion.
concentrating where it will do the most
good. First. health education in ,chools
must be upgraded. In most provinces.
instruction for young people is
superficial and inadequate. Elementary
first aid may not even be included.
Children 'ihould have the primary skills
to be responsible for their own health,
rather than becoming passive adult
consumers of sickness-treatment
services. This means a major upgrading
of health education at elementary and
secondary levels, with the necessary
facilities and teaching support to put the
message across. ".3
Listen to the members of the Task
Force on Children as Citizens again:
"What we need are programs to
implement a vigorous preventive focus.
They should have a universal or
potentially universal population base;
they should use a mix of professions:
they should recognize families and
children at risk: they should suppon the
family. Such programs are entirely
feasible. Their development and
implementation require no grand
re-ordering of society... What is required
is the political will 10 act on our
much-vaunted principles of social
justice. "14
Political will to act means lobbying.
It means you as a nurse writing to your
member of federal parliament. member
of provincial legislature. local council.
boards of health and even newspapers. It
means attending meetings and speaking
up. Ifthis is distasteful to you. consider
the alternative of having decisions made
for you by other disciplines.
W. Harding LeRiche. professor of
epidemiology in the Faculty of Medicine
of the University of Toronto has written:
.. ...in running a health service politics
are as important as medical science.
Politics and the political system is the
way through which ideas in medicine and
medical science can either be put into
practice or can be wrecked. "I
Ontario
nurses should be particularly alen as
revision of the present Public Health Act
is 10 be debated in the newly opened
provincial parliament.
In this Year of the Child, I can think
of no finer accomplishment for nursing
than to successfully lot-by for legislation
that will ensure that our services meet
the needs of every child in our country. I
urge you to examine the policies within
your own pr0vince. We will only reach
our goal when politicians everywhere. at
every level. recognize the value of
preventive medicine and legislate
policies and functions that will ensure
that the public continue to receive the
benefit of our diverse nursing skills '"
References
I Canadian Council on Children and
Youth. Task Force on the child as a
citizen. Report. A dmittance restricted.
the child as a citi;:.en ill Canada. Ottawa.
Canadian Council on Children and
Youth, 1978. p.60
:! Ibid.. p.7:!
3 Ibid., p.50.
4 Ontario public health; .wme
current issues. Toronto. Mini'itry of
Health, 1977.
5 Ibid., p.3.
6 Ibid.. p.5.
7 Ibid.. p.I3-14.
8 Ontario Council of Health. Task
Force on Immunization. Immuni:;:.ation.
Toronto. 1977. p.9.
9 Gold, Ronald. Immunization in
Canada: 1979. (editorial)
Canad.MedA.u.J. 1:!1:6:698. Sep.:!:!,
1979.
10 *Ontario. Laws and 'itatutes.
Public Health Act. Rev. Statutes ofOnt..
ch 377. office consolidation.4:!. Oct.
1975. p.:!6.
II Ibid..35 (6). p.:!:!.
12 Ibid.,35 (7), p.22.
\3 *Bennett.James E. Perspective.
health care services. pt.6. by James E.
Bennett and Jacques Krasny. Financial
Post May 7, 1977.
14 Canadian Council on Children and
Youth.op.cit., p.73.
15 LeRiche, W. Harding. Seventy
years of public health in Canada.
(editorial) C anad.J.Public Health.
70:3: 162. May/Jun. 1979.
*Unable to verify in CNA Library
Joan Dawson, a I?raduate ofG u\" s
Hospital in London. England and l
{the
public health nursinl? diploma program
at the U nh'ersi1\' ofT oronto, is also a
certified midwife. The mOlher of two
teenage children, she is presently on
staffwith the Etobicol..eCommunity
Health Department.
21 December 19711
The Cenedlen Nur..
Four-year-old Jamie: "When I
grow up,l'm going to get a
police motorcycle. Sometimes
you have to get a helmet, for a
motorcycle you have to get a
helmet. ..
Mother: 'That's right."
Jamie: "Then you won't fall
down. ..
This anecdote, although humorous,
indicates one of the factors involved in
child safety - children really do not
understand how to be safe; they do not
think logically about the cause and effect
of events in their small lives. They need
help.
By the time children begin school
their behavior varies widely from one
child to another, as does the willingness
of their parents to let them do things on
their own. The common goal of parents
is to raise children who are safe and free
from injury, and this involves the gradual
transfer of responsibility from parent to
child. After the first year of life.
accidents are the major cause of death
and injury among children.
Nurses work with families who are
raising children and so they find that
teaching accident prevention is an
accepted part of their role. They care
also for the victims of accidents in
hospitals and clinics. It is important
therefore to understand some of the
theories about childhood accidents, and
to be aware of the nursing implications in
working with young families.
Let us watch some first-grade
children as they stream out the doors of
their school into the sunshine and head
home. How much have they learned
about safety before they started school?
Jean lives across from the school:
her grandmother meets her at the
classroom door and takes her hand to
walk her home. James is also met by his
mother; he lives half a mile away across
two main roads. David waits for his sister
who is in Grade three to walk the two
blocks to his home. Grant's father is
parked iñ a car across the street waiting
for him; Grant dashes out of the school
gate and runs across the street without
Help in 9
presc
ool
c
ildrel)
learl)
to
be
safe
Helen Eifert
"There is no such thing as an accident.
What we call by that name is the result
of some cause which we do not see."
-Voltaire
looking. Linda has to walk six blocks
home alone; her mother is at home with a
new baby. Linda is very shy, and waits
around quietly looking for someone else
going her way and then tags behind.
Dennis is fiercely independent and has
insisted to his mother that he can go back
and forth alone: she lets him but at first
followed behind him out of sight to see
that he was alright. Peter hops on his
bicycle and rides home through the
traffic.
Research
Most accident research is based on study
of accident victims. often comparing
them with a matched control group of
persons who are accident-free.
Epidemiologists have looked at
accidents by time of day, location. social
class, age of child involved and so on
Thus we learn that boys have more
accidents than girls. white children more
than orientals. children with siblings
more than only children. The child
accident victim is often described as
daring, overconfident. competitive and
extroverted. 1.2'
'
There is some
suggestion that children with repeated
accidents more often come from
disturbed family situations. Children
who have repeated accidents seem to
differfrom those who have a single
accident. and some researchers suggest
that accident repeaters also have higher
rates of other illnesses.
.
.fi
The accident victims we see in the
Emergency department or doctor's
office are only a small proportion of the
children who fall. run into roadways.
climb up to get mother's pills and so on.
Children are frequently in unsafe
situations or they behave in potentially
injurious ways but in many cases no
injury results. One study suggested a
possible formula: accidents occur when
an individual with poor decision-making
. ability takes high risks in an unsafe
environment. 7 Small children are only
beginning to learn to assess risks and to
make decisions about what to do in a
variety of situations. and much of their
safety depends on supervision by others
and general environmental safety.
Helping parents to raise children safely is
a challenging and difficult task. and it
involves the assessment of a variety of
human and environmental factors.
The child
To learn to behave safely in a variety of
everyday situations, a child must
recognize the abilities and limits of his
own body. and he must learn the rules.
knowledge and skills which will help him
to assess the hazard in any situation. As
he learns, there must be a gradual shift of
responsibility for his behavior from
others to himself.
A child learns about his body and its
capabilities through the activities of
everyday life. Often home and
neighborhood allow a child to learn to
run, climb, avoid obstacles, learn what is
edible and what is not. identify how
traffic moves and so on. However, some
children live in severely restricted
environments. in high rise apartments.
The Cenedlen Nur.e
D8c:ember 1971 27
\
for example. and have limited
opportunity for exploring. Some helve
familie'i "ho !.upervi!.e everything very
c1osel} .
uch a... the traditional oriental
family:'other familie... push children to
do things before they actually have
adequate phv
ical capability. In any
ca'ie. by the early ...chool } ears most
children have ...ome sense of them
elves
- their speed. strength and
coordination, their acuity of vision and
hearing. Thinking of safety, one might
que'ition how accurate is this perception
of self in relation to actual abilities'? b
the child likely to avoid new situation!..
or to rush into anything'? Can he
accurately judge his ability to accompli"h
a particular ta!.k'?
Cognitive development provides
some
tructure for the kind offormal
teaching which "ill be effective with
various ages of children. In infancy,
...afety is totall} dependent on the action
of others, though a., the activity level of
the child increases. so may the possiblity
of accident occurrence. Thus it is the
parent who has to assess the
environment for haLards and adapt to the
child's increasing motor abilities in
turning. climbing, cra"ling. By age two
most children can learn
imple
prohibitions if they are expressed clearly
and consistently. With developing
language skill. three- and four-year-olds
are more amenable to explanation but
their understanding may be limited, as
was the case with Jamie who thought a
helmet would prevent him from falling
off his motorcycle.
The thinking and logic of
four-year-olds often reflech a magical
notion of reality: they may believe that if
they cross the road at a crosswalk, they
cannot be hit. One four-year-old said. "If
you don't do up your seatbelt. you'll
crash."
By age six. children think more
logically but the tendency persists to
think in extremes, and they have
difficulty making judgments that involve
shades of difference. For instance a
Grade one child after listening to a
policewoman discuss what to do when
approached on the street by a stranger
concluded "all strangers are sick."
A study in Germany observed some
differences in safety practices in the
various age groups.' F our- to
five-year-olds didn't look when crossing
the street near school, they just crossed;
six- to seven-year-olds looked once and
then ran across without looking further;
eight- to nine-year-olds walked across
but continued to watch as they crossed
the street.
Obviously it is important in teaching
child safety to have some awareness of
developmental levels and children's
understanding of the information
pre
ented to them.
It i'i important too to consider the
individual differences in children. Many
researcher!. have !.hown that newborn
infant
differ in many behavioral
characteristic.,. including general activity
level. responsiveness, adaptability to
change and there is thought to be some
degree of persistence in these
characteristics as a child develops. '"
There can be little question that the child
who crawls, climbs and wal"s early and
displays vigor is expo'ied to a greater
degree of hazard than the quiet child who
sits and plays at length with an
eggbeater. There !.eem!. to be
considerable variability too in how close
a child stays to his parent; !.ome remain
close while others run off at the first
opportunity. Watch a group of
preschooler!. or kindergarten children in
a playground; the differences both in
approach to activities and in
coordination and motor ability are great.
Some stand at the side and watch; others
try thing
cautiously; still others rush
into things without any real idea of their
capabilities. Thus the child's need for
supervision and teaching must be
tailored to his individual characteristics.
Three families
Families greet their newborn infant with
some preconceptions about what the
child will be like. Many have definite
views on how a boy or girl behaves and
they may ascribe the personality
characteristics of themselves or other
family members. The experience of the
child in the family is an outcome of a
complex interaction of his own
characteristics, his environment and the
parents' well-being. preconceptions.
beliefs and expectation.... Observations
of parents and pre...chooler... reveal the
existence of many different style., of
childbearing with varying degrees of
predictahility and consistency in the
child's experiences.
Sarah, for in!.tance,
eemed more
like a skillful playschool teacher than a
mother. She had three children, ages
two, four and six, who lived with her in a
fairly small hou
e. She had quit her job
as a physiotherapist to stay home with
her children. Sarah read books about
children, and especially liked those
showing creative activities and games.
Her style of mothering involved quiet.
unobtrusive watching as the children
played, and as their interest waned she
would smoothly suggest another activity
bring in material., and then work nearby.
As she expressed it, "if you don't keep
some order, it gets out of hand." She
took the children regularly to a
playground and joined them in running,
swinging from a bar and climbing. and
she helped each child in turn to do things
within his physical capability. She was
quite conscious of hazards and always
knew where the children were. When the
six-year-old found a broken bottle she
helped him pick up the pieces: "The only
safe place is the garbage. " These
children experienced a varied interesting
environment, were challenged to use
their bodies and yet they had consistent
supervision and received help as needed.
Their family life was pleasant and
predictable.
By contrast, Karen, another mother
of three younger children, whose ages
ranged from five months to three years,
was quite unpredictable in her relations
with the children. especially the
three-year-old. Karen had experienced
prolonged periods of depression after
each pregnancy and even with the help of
a loving and concerned husband, had a
great deal of difficulty coping with daily
activities. Within a single observation
period of 90 minutes she was first warm
and affectionate and then suddenly
angry, hitting the eldest child for no
obvious misbehavior half an hour later.
She talked unceasingly to the children,
often in a series of admonitions; for
example, when the three-year-old was
holding a piece of gum: "where is
it...pick it up...Iook under the bed and
pick it up and put it in the toilet... where
is it...don't leave it there and let it get
stuck in the rug... what will Daddy say if
the gum gets stuck in the rug... were you
in Mommy's room...1 thought the door
was locked. During this monologue,
Karen was feeding the baby and had her
back to the child she spoke to; she never
looked around or enforced any of her
statements. The childjust sat picking up
and dropping the gum.
28 December 1979
The Cenedlen Nurse
These children had had a serie, of
minor injuries during the ,ix months
period of observation. On one vio;it
Karen reponed: "Yesterday all three of
them hdd accidents: Patty caught her
finger in a door, Barb ferr down the ,tairs
and Andrew fell off the che'tertield."
Mother fell down the basement o;tairs
while carr}ing the two-year-old and a
basket of laundry at the same time-
fortunately. neither wa, "eriou,1 y hurt.
The family li\ed in a o;mall townhou,e
and the children rdrely got out becau'ie of
the problems involved in organizing
outings with three small children. Thus
theo;e children experienced a fairly
restricted environment with erratic
unpredictable attention and ,upervi,ion
from their mother.
Barbara. the third mother, had two
children. the second of whom wao; an
exceptionally lively three-}ear-old, who
had had many near accidenh. Their
interaction in the park ao; Daniel swing,
consists of a ,eries of admonitions from
the mother, followed by challenges from
her child:
Mother: "Be careful. you'll fall and hun
your,elf. ..
Daniel: "Me can do it."
Mother: "Not too high."
Daniel: "Me can go high by myself."
Mother: "Yes. I know, but be careful."
(Daniel Jumps l
ff)
Mother: "How many times do I have to
tell YOll not to jump otJtillthe o;wing
stop,." (later) "Don't go into the yard
till I get there, the gate to the pool isn't
locked."
Daniel: "Mom, you dJdn'tlock it. you're
supposed to lock it."
Note here that the child pays little
attention to mother's almost non-stop
admonitions. but at the same time he
holds her responsible for not locking the
gate: the idea is that if he is hurt, it will
be his mother's fault. The situation
seems to involve a somewhat anxiouo;
mother paired with a very lively child,
and ,orne incongruence between her
view of what he can do and his actual
abilities. One sometimes ,ees almo,t the
oppo,ite behavior, where the parent
actually challenges the child to do daring
things. and gives implicit approval-
"his dad was really wild when he was a
boy. climbing over the rooftops and
everything, and Gary i,justlike him."
Some significant variables in
understanding how a child learns safety
behavior in the family include the
paren!', well-being. and the dissonance
between the child's behavior and
parental expectations or desire,.
Accident rates have been ,hown to be
related to family functioning, and such
things as disturbed family relation,hips.
lack of supportive interper,onal
relations. and distress about living
conditio no; can have an adverse effect
Thus, in understanding the child's
experience one must look at how the
whole family functions and the specific
interaction between the child and those
around him.
Emironment
The home environment is full of hazards
to the small child: community health
nur,es have long provided guidance to
parents on how to accident-proof the
home. Interestingly. one study"showed
that children who repeatedly ingested
poisons did !JOt come from more
hazardous homes than a control group,
and in fact were more often under direct
parental supervi,ion at the time of
ingestion than children with a single
episode of poison ingestion. The authors
suggested that the children ingested the
poison a, a challenge to their mothers.
and that the event was purposeful. not
accidental.
Of course. it is difficult to identify
and eliminate all hazards in a home as
seen in the experience of a mother whose
II-month-old child leaned over the toilet
to reach the water and toppled in head
first She was fortunately seen and
rescued immediately. Another study5
suggests that infant injuries represent
"true accidents" in contrast to accidents
among older children: family functioning
wa, found to be correlated with accident
occurrence in three to ten-year-olds but
not in infants. due perhaps to the
difficulty of calculating accurately an
accident rate in infants in a short time
span.
Environmental hazards around the
home and neighborhood may be beyond
the control of individuals. Social class is
clearly related to hazard in that the Door
are more likely to live in
semi-industrialized. crowded
neighborhoods and near major
thoroughfares. Nelson Foote wrote of
the' 'differential distribution of safety in
society. as a concomitant of wealth and
poveny" ." Parents and health workers
have a two-fold task: to help children to
learn to behave safely in a complex
environment, and through community
action to try to eliminate the more
obvious hazards.
Epidemiological studies of accident
occurrence help in identifying vulnerable
age groups, as well as times and places
which are associated with increased
accident rates. A study of traffic
accidenb involving children showed
higher rates in Spring and Fall, peak time
of day to be between three and ,ix p.m..
and higher rates in semi-industrialized
congested areas. The higher frequencies
occurred in three-year-olds, (who often
ran between cars in mid-block) and
five-year-olds (who frequently crossed at
interc;ections). "The type of accidental
injury changes as children grow older:
o;mall children experience more falls,
suffocation. poisoning and bums while
older children are more often involved in
collisions, or struck by flying or thrown
objects. and suffer injuries from handling
sharp objects. !These studies help in
identifying the hazards which are most
imponant at various ages.
Nursing approaches
Observations of 15 families with small
children concerning the development of
health behavior showed that incidents
related to safety and accident prevention
constituted a quaner of all health-related
interactions. The proportion was
greatest among two- to four-year-olds.
Thus it is apparent that a good deal of the
interaction between a small child and his
parents relates to safety. and it would
seem important to know more about
what learning is occurring and how
parents can be helped to function
effectively.
In the family which is functioning
well parents often express a need for
some guidance in understanding the
child's developmental level and
capabilities. Sarah, the mother of three
described earlier was particularly
interested in resource materials and
books which outlined suitable activities
for various ages. Parents are interested
too in comparing notes with other
parents and so family drop-in centers and
playgroups often serve to get parents
together. Some community health nurses
use the child health clinic as a place for
mothers' groups. For many parents. the
chief need is for information and for
The Cen.dlen Nuree
D8c:.mber 1878 211
\
reinforcement that they are doing a good
job. (One reference on behavioral
indi"iduality \\-hich is quite helpful is
Your Child is a Person by Chess and
Thomas.)12Thus. one goal of nursing can
be to help the parents learn about their
children, to appraise them realistically
and to develop appropriate goals and
expectations.
When family functioning is
disturbed the nursing role is much more
complex: in many cases poor safety
practices and accidents are pan of an
individual family's functioning. Research
has shown that families are at higher risk
for childhood injuries when factors such
as marital discord, physical or mental
illness. extreme poveny, inadequate
housing or alcoholism are present. There
are no simple answers for problems such
as these and teaching about safety may
very well be ignored or considered
irrelevant. Two activities might possibly
be helpful:
. help the family to build up a suppon
network offriends or relatives who will
help out at stressful times. This is not an
easy task as many unhappy people with
low self esteem resist attempts to involve
them with others; for some. drop-in
centers and mothers' groups provide a
welcome opponunity to meet others and
get out of the home. Community health
nurses generally know neighborhood
resources and activities, and can help
neighbors get together to share
babysitting and so on.
. work with other social agencies in
providing needed suppon services.
Karen, described earlier, was helped
greatly by the provision of homemaking
s rvices. along with psychiatric care for
herself. hon term family suppon
service. 'ten take the pressure off for a
time and he p he family to resolve basic
difficulties. Unfonunately, when Karen
initially sought help she was described
by a nurse as lazy and unwilling to look
after her own responsibilities. However.
her underlying mental strength was
indicated by her persistence in getting
the help she needed. Social service
agencies today are generally committed
to the goal of strengthening family life.
and nurses can work cooperatively with
social workers in identifying needs and
strengths.
On a wider scale, nurses need to
look at the community and the social and
political forces which are a part of family
functioning and childhood safety. One
must be continually vigilant in awareness
of environmental hazards. and
knowledge of who or what agency can
take action. There are a variety of
government and voluntary agencies
conce "l1ed with safety. but each
individual has an ongoing responsibility
to see that standards are enforced. and
that new hazards are identified. What
constitutes a hazard? One example is a
child-proof medicine bottle which a
six-year-old opened easily. Another is a
defective crossing light near a school-
corrected quickly by a phone call to City
Hall. but not before several children
narrowly escaped being struck by a car.
Are you aware of safety standards for
infant cribs and do you use these when
talking to expectant parents? Nurses
need to be totally involved in the
community in which they work: focusing
solely on an individual patient ignores
the social and political realities which
may in fact contribute to their illness and
disability. Safety is but one facet of a
complex interplay of individual behavior
and environmental and social factors.
Conclusion
While it ha'i been suggested that
self-injury may actually be an expression
of the value of self-preservation and a
testing of how much others value the
victim, " most research suggest'i at least
that the obvious non-random incidence
of accidents implies a strong need for
health professionals to focus on the
characteristics of both families and
individuals related to accidents. To do
this. the nurse must have an awareness
of child development. an understanding
of family function and interaction, and be
an active panicipant in the community. 'W
References
I "'Manheimer. Dean 1.50.000
child-years of accidental injuries, by
Dean I. Manheimer et al. Public Health
Rep. 81:6:519-533.Jun. 1966.
2 "'-.Personality characteristics of
the child accident repeater. by Dean I.
Manheimer and Glen D. Mellinger. Child
Del't. 38:491-513.1967.
ê
'"
t..I
."
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c
3 "Read, John H. Pedestrian tra/fic
accidents inl'Oll'inR children in the City
ofVancoul'er, Callada by John H. Read
et a!. Vancouver. B.C.. University of
British Columbia Faculty of Medicine
Child Health Programme. 1960.
4 Husband, Peter. Families of
children with repeated accidents. by
Peter Husband and Pat E. Hinton.
Arch.Dis.Child. 47:396-400, Jun, 1972.
5 Plionis, Elizabeth Moore. Family
functioning and child accident
occurrence. Amer.] .Ort/wpsychwtn'
47:2:250-263, Apr. 1977.
6 "Sobel, Raymond. Repetitive
poisoning in children: a psychosocial
study, by Raymond Sobel and James A
Margolis. Pediatrics 641-651, Apr. 1965.
7 "Suchman, Edv.ard A. Currem
research in childhood accidents, by
Ed\\-ard A. Suchman and Alfred L.
Scherzer. New" ork, Association for the
Aid of Crippled Children. /960.
8 .....urokawa. Minako. Childhood
accidents as a measure of social
integration. Call.Rel'.SocioIA nthro.
3:67-83, 1966.
9 "Limbourg, :\-1arie. Anicle cited in
Psychological Abstracts no.2269, Jan.
1978, from Zeitsch,ijt fur Experimentelle
Ulld AIlRewandte PS\'chologie
23:4:666-677, 1976.
10 Thomas. Alexander. B ehal'ioral
individualit\' in early childhood. by
<\lexanderThomas et a!. New York.
New York University Pre'is. 1963.
II "Foote, Nelson N. Sociological
factors in childhood accidents.(/n
Haddon, William. Accident research:
methods and approaches, by William
Haddon et a!. Nev. York. Harper. Ro\\-.
1964.) p.448-458.
12 Chess. Stella. Your child is a
person: a pS\'c/lOlogical approach to
paremhood wit/wilt guilt. by Stella
Chess et al. New" ark, Penguin. 1976.
'"
'"
."
"
"'Unable to verify in CNA Library
Helen Elfert.RN, BN, MA, is associate
prl?fessor in the School ofNursillg at the
Unil'ersity of British Columhia. She is a
graduate of the Hospital for Sid..
Children in Toronto, and obtained her
degrees at McGillalld Nell l"ork
U nil'ersities, respectil'ely. M rs. EUert
has a I'arie(\' l?f clinical experience in
pediatric mining bOTh as a staff and
head nurse, and is hene(f the mother of
a six-vear-old.
Da a used in this article K'as collected by
the author with the anistance of May
Yoshida. Marguerite Warner, and
'\larie-France Thibeaudeaufor a project
entitled The Del'elopment of Health
Behlll'iour in Children. which was
conducted under the guidance of Dr.
Mo
ra Allen. (National Health Rnearch
and Dpl'elopment Program Grant
no.605-/237-44).
30 D8c:.....t>er 111711
The Cenedlen Nurse
Ð.
Preparation
of toddlers
and
preschool
children
for hospital
proceaures
Judith A. Ritchie
What can we do to make a young child
emotionally "ready" for hospital or
health care experiences, and how do we do
it? Books, films and lectures can pro\ide
facts and ideas hut, to be really successful
preparing children, the indhidual nurse,
teacher, child-life worker or physician
must approach the child and his family
with a sensitive and open mind, obsenin
the child's play, drawings, \erbal and
non- verbal communications for signs of
confusion and upset.
What follows are some general
guidelines for the preparation of children
of any age and specific suggestions based
on developmental considerations for the
preparation of toddlers and preschoolers.
'C. -:IP"
GENERAL PRINCIPLES
Children of all ages need preparation for
any event: this process may be brief and
immediate, or detailed and spaced over a
period of time, but even the very young
child need
some warning of what i'i
.., going to happen to him.
This preparation mU'it be geared to
individual need
and level of
development: there is no one recipe for
succe
s. The level of development will
indicate how the child may perceive and
interpret procedures. and determines
both the content and method of
preparation. Previous experience does
not necessarily mean a child will be able
to cope without help. Indeed. the
experience of past illnesses or repeat
procedures may have a cumulative effect
and overwhelm the child.
I
..,
, --
,
'1
.. / I
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'- I
-
Prepamtion should always be brief.
accurate and simple: extra details can be
gIven according to need at any time. The
amount of information given will depend
on the child's age and the time available,
and the child's individual ability to
assimilate the information.
Always remember, whatever you
say either increases or decreases stress
in the child.
Who should do the preparing?
Everyone has an imponant role to play
in preparing a child and when each
person involved in a child's care fultïlb
his role. the child will feel like a human
being who is important and about whom
people care. The primary role in
preparation is taken by the parents.
/J
'"
"
01)
nurses and child-life wor
er'\. Next in
line are phy
ician
. physic.!1 and
occupational therapi
ts ,md technici,m,:
the'e people tend to operate in the ;;;
'þospital on a sort of" in-om" basis and
are les
li"ely to have opportunity to
learn the complexities of a child's È
particular information needs.
Prepamtion must always begin
"where the child i
" instead of at the ð
point an adult may con
ider the logical
starting place. To do thi" you must learn
how the child explains events that have
already occurred. and what expectation'i
the child ha'i about \\ hat''i going to
happen next. Assessments must be
based on a sound knowledge of child
development and ofchildren's usual
conceptions of and reaction
to illness
and hospitalization.
A basic guide to question.. to be
addressed in preparation is simply what
wi1l happen and what sensation.. win be
experienced? In other words. what will
the chird feel. see. hear, taste and ..mell?'
:\Iso to be considered is the
outcome. The child mU'it have the cycle
completed for him: for example. a child
going to the operating room needs to
know that he will wake up in the
Recovery Room and then return to hi..
room.
The detail given in any ofthe..e
areas may increase with the child"s
maturity and as he indicate.. a need for
more infonnation.
Resources you can use include:
. people who use both verbal and
non-verbal means of communication to
explain events and to comfort
. books and drawings which
graphically or verbally portray events
and objects
. modeb of organs. the human body.
or the hospital
. therapeutic play with specially
adapted dolls. puppets. or ho
pital
equipment.
THE TODDLER
Developmental cOllsideralions: The
toddler's perceptions of and reactions to
illness and hospitalization are most
ffected by the (]eyelopmental factors of
autonomy and separation-individuãtion.
The primary concern of the toddler is
separation from familiar caretakers:
lesser concern
are loss of contrõf.
inobffity or Integrity.
The toddler's lack of ability to
express himself verbally means he is
open to being overwhelmed by the
sights. sounds and sensations of
procedures in hospital. Generally. we
can expect fearful responses to-,my -
proce dure- involv ing lou d noises õ;:
unfamiliar or unpleasant sensafions such
as pam, body intru-sìon. pre
sure. hot or
The Cenedlen Nur.e
.
D8c:.mber 111711 31
cold, and restraint. especially \\-hen he is Therefore. even smaller dolls with such
in the back-lying position. The toddTer equipment may not be helpful in As soon as a procedure is
ma} express fear either by screaming instruction. completed, the toddler should be
frantically or with rigid control and wary
he basic principle in preparation of released from restraint and permitted to
\ igilance. the toddler IS to make him aware that we assume the upright pO'iition unless that is
-
re trying to tell him sometl.liI)g, --=- contraindicated. The toddler always
Approaches: Prepare the child's parent" 'meihing we hope he will learn and reacts as if he feels very vulnerable in the
and, ifat all possible, permit one of them remember. back-lying position.
to accompany the child for the
procedure. Be certain to determine what
previous information the parents have
and what preparation of the child they
have already done. Parents need
information too. not onl} about what will
happen, but also what they can do to
as
i'it their child. With specific
instruction about the nature of their role,
most parents can (Olerate being actively
present while their child undergoes
treatment or procedure.
The person \\- ho is preparing the
child must use 'iimQI
factual statements
about \\-hat is happening, employing
familiar. non-threatening words such as
"fix" and "measure" mther than "take
out" or "take"_
The use of play can help the child
under'itand what is beyond his verbal
capability: the young child approaches
the world in terms of action and masters
it through play. We can make use of the
child's approach by letting him see and
handle equipment such as
1eThoscopes,
thermometers ,md suitably-equipped
dolls may be used sO the child can act out
what is happening (0 him. While the
toddler may not understand the meaning
of dressings. s(Omas, casts. etc., on dolls
used for preparation, they do seem to
identify with them once the procedure
ha'i been carried out. For example, an 18
month old with an esophageal lye bum
did not seem to understand efforts at
preparation for insertion of a
gastrostomy tube and string guide for
dilations. However. following the
procedure she literally "latched-on" (0 a
doll with a "gastrostomy tube". string
and a hole in the mouth in which to act
out dilations.
The timing of preparation for the
(Oddler should be just prior (0 the e \ ent
- but the child must always receive
some warnmg.
\
\\
Cautions: It is essential to be aware of a
child's l"Cactions and to determine from
these how much information he should
be given: we must watch for cues that he
is feeling overwhelmed or confused.
The toddler is beginning the stage of
fantasy development and this results in a
difficulty in distinguishing between
fantasy and reality. This may cause him
to react with fear when faced with
life-sized dolls or puppets which are
"equipped" with realistic scars, casts,
etc.: his cognitive abilities are not
developed enough so he can easily
transfer information to himself.
Helping the child to cope: Maintaining
contact with the child, whether it is
visual. auditor) or- if possible -
tactile. during the procedure \\-ill give
him a feeling of security. By holding the
child we can give as much body contact
as possible: constant soothing talk will
make him feelles'i alone and frightened.
Toddlers usually cope with stress in
their own individual and con
istent
ways. Some react by screaming
throughout a procedure, others by rigid
control or withdrawal.
...
,
t
.....
"
s
".
- .
,-
M,
...
r
#
. .
. Jason, aged two years, always
stayed in rigid control during an\'
e,((l1ninations. renipunclUres, x-rays or
other procedures. He held the nurse' s
hand. I
.atc"ed care.f;llly. perspired and
softl\' said "ooooh" ifhe were hurr.
When it all became too muchfor him, he
turned his head away and stared silently
at the wall.
. Barbara, aged eighteen months,
screamed and required constant
restraintfor her frequent abdominal
dressing changes. The nurse del'eloped a
rilUalfor each dressing change: Barbara
was placed on her bacl.. with the nurse's
arm under and around her and holding
her hand. and Barbara'sfm'orite blanl..et
was placed OI'er her face. This resulted
in immediate cessation ofBarbara's
struggle. and while the nurse tall..ed to
her, Barbara remained still throughout
the procedure. It seems that afm'orite
blanl..et corning the face shuts out the
threatening em'ironment and, at the
same time, is afamiliar source of
comfort and safety.
'It/>
When it's over: "Preparation" must
continue even after the procedure is
completed: playing the experience out
and acting out feelings with books. dolls
and puppets help the child to come to
terms with the experience. By age two
years, the child practises repetition of
events in an attempt to master the
feelings surrounding them. Jason was
hospitalized for a complete medical
investigation; following his discharge,
his mother noted he had developed a new
game - he repeatedly used any pointed
object (0 jab the paw of his fa vorite teddy
bear, cried "00000" and picked up the
bear (0 comfort it! When the nurse made
a home visit and presented a play-kit to
Jason. he immediately selected the
syringe and needles and proceeded to
inject one of his dolls more than
twenty-fïve times.
Older toddlers and young three-year
olds use more symbolic play to help with
mastery. For example. Michelle, aged
3 I/
had been critically ill for a long
period following surgery. She reacted
favorably (0 puppets. play and stories
about getting better and going home.
THE PRESCHOOLER
Developmental considerations: The
egocentric nature of the preschool child
and his incomplete concept of body and
self at this stage of his development
results in concerns of body integrity and
fear of intrusion when he is ill or
hospitalized. Separation is of less
Concern than in the toddler, but remains
an important area. The child's ability to
fantasize combined with his normal
egocentricity may result too in general
misconceptions about what is being done
- he may view treatments and
p rocedu res as punishment- and in
feelmgs of guilt about being ill.
- Forexample, Keith, aged four, said
of the hospital. "This is a bad place for
boys and girls to be," and later
continued, "/11 never go on a 'mobile'
(snowmobile) again. I promise." Kent,
also four, was very upset during a
difficult venipuncture. When the intern
teasingly said, "Maybe you haven't got
any blood:' Kent replied, crying, "You
took too much yesterday! You took it all
yesterday!"
32 December 111711
The Cenedlen Nur"
J;).
However, the same child might tolerate
this infonnation if it is given through
fantasy by applying the child's story to
Use ofp/ay: Just as the toddler does, the puppets or dolls. Lisa, aged five, could
pre-school child may use play before and tolerate no direct explanation about her
after a orocedure in an att empt to condition, treatments or investigations.
understand the event and tõñïãstèr -----n owe ver, she listened avidly and clearly
- kehngs about it: such play seems to be identified with a situation in which the
most therapeutic when not directed by same infonnation was given as if it were
the adult. It is not important that the about hertoy donkey, Eeyore.: 1
child gives an irúection or places a
dressing correctly. Almost any
procedure can be implemented on a
stuffed toy, doll or puppet: puppets have
been made with scars and removable
parts, etc. to aid the preschooler and
school-aged child's understanding of
surgery or condition or treatments. Even
young children have enough manual
âëX 1en ty to carry out procedures such dS
injections, suture removal. dressmg
changes, cast applications and removals,
The older toddler's and
preschooler's increa'icd ability to
express himself verbally facilitates our
determination of his concerns, and
permits more detail in preparation and
explanation. However. a child's
vocabulary may be such that he_might
misinterpret similar sounding words or
be unnecessanly fnghtened when
unfamilIar or thr eatening-soun ding
words are used.
Approaches to preparation: As for the
toddler. parents of the preschool child
'ihould be helped to prepare their child
for procedures. They normally explain
events to their child and are therefore
most familiar with the child's vocabulary
and signs of confu,ion or distress.
Beginning by determining what the
child already knows and thinks. we can
clarify and extend his understanding
through verbal explanations, books, and,
for the older preschooler, body outlines.
The child tends to tolerate and assimilate
information if it is given in smallcfoses-
over time. We mustbe syste mat ic about
what information will be given and
certain that various personnel do not
give different information. There is
research evidence that preparation at the
time of the stressful event (stress-point
preparation>. opportunity to rehearse the
event in play, and support given during
the event, are the most effective means
of reducing the child's degree of upset
and increasing cooperation. 2
Both preschool and older children
seem to respond favorably to preparation
which consists of a "sketchy", but brief
and accurate overview of what is
expected. followed by more detailed
explanations at the time of each event.
Explanations may be aided by books
'iuch as Curious GeorRe Goes to
Hospital by H. Rey, Mister ROKers Talks
About by Fred Rogers andGoinK to the
Hospital by B. Clark. Other useful aids
are simple pictures such as body outlines
which show very simple diagrams of the
inside of the body and models of body
parts, or hospital equipment.
Cautions: The individual attempting to
prepare the child for procedures must be
alert to signals indicating "information
overload". To continue explanations in
spite of cues that the child is becoming
frightened and overwhelmed only serves
to heIghten anxiety and may in fact be
\/orse than completely omitting -
preparation. Preschool chIldren give
ver.... clear signs of increasing anxiety
sucn as long periods of silence. wide
eyes and fixed facial expression,
constant fidgeting or attempting to move
away from the area. playing with toys
unrelated to the topic under discussion,
changing the subject of conversation and
sudden disruptions. such as the need to
void or an outburst of hyperactivity.
GÞ
..
ff
ø'\
,\
.
removal of chest tubes on dolls or
puppets. It is wise. for safety reasons, to
conduct such play sessions with
individual supervision and in a quiet
place. I have made very crude
adaptations of dolls to demonstrate
ostomy stoma, amputations,
gastrostomy tube and halo-femoral
traction and cast, and children seem to
identify readily with such dolls.
Similarly, hospital models do not need to
be elaborate to pennir the child to play
out going to various hospital areas such
as from own room, to operating room, to
recovery room and back to own room. A
wise precaution in adapting dolls or
making model hospitals is to avoid
including too much equipment as the
preschool child may find it
overwhelming and anxiety-producing.
Some children may actually find a
direct explanation of what is wrong or
what is going to happen too threatening.
In short
Nurses who regularly deal with children
who are faced with hospitalization seem
to be increasingly aware of the need to
explain their actions to the child. We
-must also be aware of the needs of the ill
child's siblings and can use any of the
above approaches to clarify their
misconceptions or alleviate their fears. If
siblings cannot come to the hospital,
parents may be willing to take home
models or adapted dolls which would
help prepare the siblings for the ill child's
homecoming.
In conclusion, successful
preparation depends on the use of our
imagination to creatively display
informatIon, our knowledge of the
child's developmental characteristics
and our sensitivity to the child's
.
responses. At the same time, we must
J: exercise caution about the extent and
enthusiasm of the preparation so as not
to overwhelm the child. We have a
multitude of resources, both material and
human, that we can and must use to
spare the hospitalized child an episode of
needless fear and anxiety. 'W
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.c
c..
Judith A. Ritchie,RN, BN, MN. PhD, is
currently an associate professor in the
Rraduate program of the School of
NursinK at Dalhousie Uni\'ersity in
Hal
"ax, N.S. She has had pediatric
nursing experience as a staff nurse.
clinical specialist and uni
'ersity teacher.
A pastCNF scholar, Ritchie is currently
a member of the CNA committee on
nursing research. and of the redew
boardfor nursing papers.
References
1 Johnson, J .E. Altering children's
distress behavior during orthopedic cast
removal, by J .E. Johnson et al.
Nurs.Res. 24:6:404-410, Nov.{Dec.
1975.
2 Visintainer, M.A. Psychological
preparation for surgery pediatric
patients: the effects on children's and
parents' stress responses and
adjustment, by M.A. Visintainer and
J.A. Wolfer. Pediatrics 56:2:187-202,
Aug. 1975.
3 Ritchie, J. Fantasy in
communicating concerns about body
integrity. Matern. Child Nurs. J.
1:117-126, Summer 1972.
Th. Cenedlen Nurs.
D8c:ember 1979 33
Hospital b
Q!s
" for children
Flizabeth Crocker is the dirl'c{or (
fthe Child Life Department. Thl' l.\Clac Walton A.i/lam Hospital for Children in Hal(fcn:. Nm a S 'o{ia.
An annotated h
t of books for children to
give them an idea of what a ho
pital
eJ\.perience is all about.
Clark. Bettina. Pop-up going to tire
\c hospilal, Westminster :\ld.. Random \.-1
/". House. 1971.
Children enjoy this "tory about Andy's
tonsillectomy. The illustrations are
bright and. in many cases. movable.
Andy packs his own suitcase. is not
allowed to eat before his operation. h,ts
blood taken from his finger. sees people
dres
ed in green. breathe.. "special dir"
in the operating room to make him fall
a"leep. wakes up in the recovery room.
and has a sore throat. Pre
chool to
Grade 3.
*Falk, Ann Mari, The ambulance. Burke
Publishing Co. Ltd.. 1966.
Five-year-old Tom has appendicitis and
an ambulance tales him to the hospital
for an emergency operation. Tom reacts
realistically to getting an injection. his
parents leaving. oral medications. and
walking for the first time after his
appendectomy. Good illustrations and
large, easy-to-read print male this an
e'l(cellent book. Preschool to Grade 4.
GydaJ. M., When Oily wenlto hmpital, b)
... and T. Danielson. Hodder and
Stroughton, 1975. (Also a,ailable as
Quand Olh.ier "8 a I'hôpital, distributed
in Canada b) Editions Heritages)
This is one of a series of books that deals
accurately and compassionately with
crises that may happen to small children.
Oily has to go to hospital because he is
sick While he does not have to have an
operation. he learns about them and
X-rays from other children. Included in
the narrative are points such as Oily
being upset wt en his parent" leave and
being very "clingy" on return home. The
accompanying illustrations offer further
insight into both the activities and
emotional aspects of hospitalization.
Primary to Grade 6.
\
*Haas. Barbara Schu}ler. The hospital
book, Baltimore. The John Street Press,
1970.
This i
e
..entially a coloring book with
the black and white illu
trations and
clear text providing a balanced and
general vie" of ho\pitalization. The
following are found in the 48 pages:
admission procedures. ho
pital food.
bed
. call bells. injection
. finger stick.
temperature, and blood pre.,
ure:
otoscope. X-ray machine. oxygen tent,
intravenou
fluid therapy: traction for
broken bone.. and wheelchair,,: play and
school program
: simple diagrams of
major organs dnd bone". Pre
choolto
Grade 4.
Jes'iel. Camilla, Paul in Hmpllal. by '"
and Hugh JolI}. New York. Methuen
Children.s books, 1972.
Paul fall.. from a tree. hi.. finger becomes
badly infected and he has to go to the
ho
pital. There he meets many other
children and, through the text and
excellent photograph
. the reader learns
about a wide variety of hospital
taff.
equipment and procedures. Although
some of the word
and pictures are
specifIc to British hospitals. this is
nonetheless an excellent portrayal of
ho
pitalization. Primary to Grade 6.
Rey, H.A. and M. Curious George go.s to
the hospital, Boston, Houghton :\1ifflin
Comp: ny, 1966.
Because Sl. man} children are already
familiar with this mischievou\ monkey,
this book i
both entertaining and
comforting to young children ... "If
Curious George can go to the hos pital. I
guess it's o.k.!" George 'iwallows a piece
of jIgsaw puzzle which results in a visit to
the hospital. a barium
wallow in X-ray
and finally an operation. Even though he
takes along his favonte ball for comfort,
George cnes when his visitor leaves and
lets out a scream even before he gets his
preoperative needle! Illustrations show
details of a clinic waiting area. the
operating room. children's ward and
playroom. Preschool to Grade 3.
Stein. Sara bonnett..-t hospital story. New
York. Walker and Company, 1974.
This book is one of a serie
of" open
family books" for children and pdrents
to read together. Photographs drld large
print conve} the story to children while
'imall t} pe in the margin focu'ie.. on
guidelines for parents in helping a child
cope with hospital experiences. Jill. the
principal character, has her tonsils out.
Preschool to Grade 3.
*Weber, Alfon... Elizabeth gets well,
Scranton, Pa., Thomas Y. CrowelI. 1970.
The illustration., in this book are superb
and convey a great deal about hO'ipitals
and children'
feeling
. The stor y is
well-told and accurate - it follows
Elizabeth who ha
to have her ,lppendix
out. Reference is made to
uch things a'
the preoperative injection (and resulting
drymouth). the operating room. IV
fluids. thir
t. stitche
and blood tests.
Through other patient
. Elizabeth and
the reader learn about ca't'i and X-rays
Primary to Grade 4.
X. Welzenbach, I.F. Wendy Well and Billy
, )Jetter say" h.!/Io hospilal". Visitthe
hospilal see through machine. Meet tire
hospital sandman and.4sk a "mill-yun"
hospital questIOns by... and N. Cline.
Chicago, Med-Educator, 1970.
In this series offour books, Wendy Well
and Billy Belter walk across black and
white photographs of hospital scene" and
comment on how they perceive things.
Technical terms and quipment are
de
cribed in both factual and child-like
terms. As well as covering a wealth of
information about hospitals and various
procedures, these books provide insight
into how children might see or
understand things. Preschool to Grade 6
Wolde, Gunilla. Thomas goes to the
doctor, Boston. Houghton Mifflin
Company. 1972. (Also available as Titoll
chez Ie docteur. distributed in Canada by
Granger Frères).
Thomas visits his doctor (a woman) for a
check-up. Thi" is sÞ'Jwn to include
undressing, weight and height.
examination of throat and ears. use of a
stethoscope and an injection. Thomas
visibly dislike" the injection but gets
support from his mother and the doctor
Later pages show him at home giving his
teddy needles. Preschool.
* A I'ai/able in paperbac/...
34 D8c:ember 1979
Th. Cenedlen Nur.e
'.
"
Syndrome:
.
.-
, ,
,
,
'" "
.
,
I ,. '
Co/een Manning
". -""*
Ginger was seven years old when she was admitted to our Intensive Care Unit for the ninth and final time. Over the
past five years this precocious little girl had been afflicted with stubborn attacks of paroxysmaJ ventricular
tachycardia, the result ofa congenital cardiac condition, Wolff-Parkinson-White syndrome.
Ginger is one of the lucky ones. Her story has a happy ending.
CASE STUDY
Ginger, age seven, was admitted to our
unit with an episode of tachycardia. As
this was her ninth admission in five years
for the same problem, she was familiar
with our routine and her condition. She
told us that her admission was due to a
"tachycardia", reminded us that she
"took Digoxin" and "didn't like
needles" .
WPW syndrome was suspected and
with every subsequent admission. an
EKG and rhythm strips from her cardiac
monitor were taken to confinn that the
underlying cause of her tachycardia was
WPW syndrome and not Digitalis
intoxication or some other cardiac
dysfunction. Ginger liked the "Happy
Face" pediatric monitor electrodes that
we applied "to watch her heart beat";
even when she was feeling well, she
tolerated her monitor connection,
wandering about as far as the cable
would allow her. EKG suction
electrodes had become known as
cherries and we explained that this
machine was actually" taking a picture
of her heart beat".
Ginger's episodes of tachycardia
occurred most often when she was
active, but occasionally developed when
she was sleeping. Her tachycardia
resulted in a cardiac rate of 230 to 250
beats per minute. At these times, Ginger
complained of subjective feelings of
palpitation. Initially. in order to
tenninate the tachycardia, vagal
manoeuvres such as carotid sinus and
orbital pressure were applied with no
success. This technique failed on all of
her admissions.
Digitalis treatment and subsequent
digitalization had been helpful initially in
correcting attacks oftachycardias and
deterring further episodes. On several
occasions Ginger required rapid
digitalization, but minimal elevation of
Ginger's Digoxin level above the
therapeutic range resulted in evidence of
sinus arrests and nodal and ventricular
ectopic beats on her cardiac monitor.
Minimal success was seen with various
medication regimes which were initiated
over her many admissions. Ginger's
tachycardia was persistent.
Consequently, electrical
cardioversion was the only treatment
which met with any success. Digitalized
patients may not tolerate cardioversion,
due to Digoxin's action on excitability of
and conduction through heart tissue.
The Cenedlen Nurs.
D8c:.mber 1979 35
A V Node
NORMAL CONDUCTION SYSTEM
The normal electrical impulse of the heart begins in the
sinus node. From this node, the impulse spreads through
the atria. The P wave of the electrocardiogram (EKG)
results from this activation. The impulse is then delayed at
the atrioventricular node. allowing the atria to contract. The
PR interval of the EKG represents the time for the impulse
to reach the ventricles. After passing through the His
bundle. the impulse travels to the bundle branches and
PUr\(inje network to individual ventricular muscle cells,
resulting in ventricular contraction. The QRS complex of
the EKG represents this ventricular stimulation. Recovery
of the muscle cells is represented by the T wave.
Bundle of His
Bundle Branches
Ventricles
R
T
I
I r
I I
,"" PR jQ
"" .12-.20 I
, I
, sec. I
I
I
I
S.......,
QRS '.......
.07-.12 sec. ........
\
Such treatment results in a high
incidence of arrhythmias post
cardioversion. So, Ginger's maintenance
Digoxin dosage wa
discontinued and a
waiting period was established to allo"
the Digoxin level in her body to fall to a
safe level. Although Digoxin acts quickly
upon administration, the plasma half-life
is about thirty-six hours when renal
function is normal.
In preparation for the electrical
cardioversion. Ginger fasted and was
anaesthetized in the unit. The
cardioversion necessitated an
intravenous which was upsetting to
Ginger. She would watch her monitor
closely after her cardioversion. as the
nurses promised her that the LV. would
be removed once her pulse remained
slow.
Frequently. several attempts at
cardioversion were required to convert
her tachycardia as it became increasingly
resistant to this treatment. Finally. her
episodes of tachycardia became more
frequent to the point where monthly
hospital admission was required.
Ginger's treatment was now at a
standstill: in fact. she wao; regressing.
Her pediatrician persisted in attempts to
obtain further te..ting in a center capable
of doing His bundle recordings. Such
testing is"highly
pecialized and at that
time was not available in Canada.
A local fund-rdising drive, organized
to deferGinger's treatment costs, met
with tremendous community support
enabling Ginger to be referred to an
American center which was experienced
in mapping cardiac impulse conduction.
Through the use of intra cardiac electrode
catheter recordings. an accessory path
was found in the right anterior
atrioventricular groove. At the time of
surgery, the Kent bundle was located
superficially in the epicardial layer. and
was divided by right atriotomy. Ginger
was discharged on the eighth
post-operative day in stable condition.
WolfT-Parkinson-White (WPW) is a type
of congenital cardiac anomaly known as
pre-excitement syndrome. Pre-excitation
exists ",hen all or some portion of the
ventricular muscle is activated earlier
than would be anticipated ifthe impulse
reached the ventricles by way of the
normal conduction system. I Conduction
fibers in the atrium operate as accessory
pathways for impulse transmission
causing premature activation of the
ventricles. The incidence of the
syndrome is thought to be O.lto 3.1 per
1000 population 2
PathophysioloRY
rhe classic fonn of pre-excitement
associated with WPW syndrome
involves an accessory pathway
commonly called the Kent bundle. An
impulse emanating from the sinus node
not only follows the normal conduction
system pathway but also stimulates the
Kent bundle which conducts the impulse
directly from the atrium to the ventricle
(Figure one). The resulting
electrocardiogram (EKG) shows a short
PR interval (less than 0.10 seconds) and a
wide QRS complex with a delta wave.
The shortened PR interval is due to the
early stimulation of the ventricle by the
Kent bundle. The impulse once in the
ventricle is passed slowly from muscle to
muscle. This produces slurring at the
beginning of the upstroke of the R wave
and fonns a delta wave (Figure two). The
accessory pathway opens and closes
spontaneously, resulting, at times. in a
normal EKG.
Figure one: ACCESSORY PA THW A Y IN WPW
Atrial Activation
Accessory Kent Bundle
3S D.c....ber 1979
The Cen.dlen Nurs.
...
PR Interval
less than .11 sec.
QRS
Complex
wider than .12 sec.
RETROGRADE ACTIVATION OF
ACCESSORY PATHWAY
Premature
Atrial Contraction
I AV Node
T
Sinus Node
Accessory
\
His Bundle
I
\
FUSION OF IMPULSES
RE-ENTRY CIRCUIT ESTABLISHED
PRODUCING RECIì'ROCA TING
TACHYCARDIA
Accessory
Pathway
\;(,'.
nth.....
..LOP
" """" ..,
L
Paroxysmal supraventricular
tachycardias occur in 40 to 80 per cent of
patiems with WPW syndrome.:' Usually
this tachycardia is precipitated by a
premature beat. In sinus rhythm, the
impulse usually follows the normal and
accessory pathways. This results in
ventricular fusion of the impulse. At the
time ofa premature beat, the normal and
accessory pathways may be at different
stages of recovery. Usually. the
accessory pathway requires a longer
recovery time than the atrioventricular
node. Therefore. the premature beat may
be blocked at the Kent bundle but be
conducted via the normal conduction
system to the vemricles. This impulse. as
it spreads through the ventricles. finds
the distal end of the accessory pathway
excitable and so is propagated back
through the Kent bundle to the atrium
(Figure three). Consequently. the atria
may be stimulated a second time by the
same impulse. The resulting circuit
initiates an episode of tachycardia.
Treatment
. Medical Therapy: Pharmacological
therapy of supraventricular tachycardias
associated with WPW is aimed at
reducing the number of premature beats
and changing refractory periods of the
A V node and accessory pathways.
Digitalis is the drug of choice. It's
depressive action focuses mainly on the
normal conduction system. prolonging or
completely blocking A V node and His
bundle conduction. Since large dosages
are often required in treatment of WPW.
signs of toxicity must be anticipated. In
children the most reliable signs of
digitalis toxicity are manifestations of
cardiac arrhythmias especially
paroxysmal atrial tachycardia with A V
block. The gastrointestinal signs of
nausea. vomiting and diarrhea are rdre.
Children's dosages are
5 to 50 per cent
that of an adult. 0.04 to 0.06 mgm/kg
daily for children from 2 to 10 years.
Digitalization is advised for a year after
the tachyarrhythmia has been corrected
to prevent a recurrence.
Proprdnolol ((nderaP') or another
amiarrhythmic drug is frequently
required in addition to Digitalis. They
prove effective by prolonging the
refractory period of the A V node and
therefore reducing the difference in
refractory periods in the two pathways.
Propranolol reduces heart rate,
myocardial irritability and force of
contraction. It is contraindicated in the
presence of bronchial asthma. allergic
rhinitis. sinus bradycardia. cardiogenic
shock and cardiac failure. In WPW
syndrome. the most common adverse
cardiac effect is bradycardia. especially
if digitalis intoxication is present.
Some ofthe newer agents successful
in treatment oftachydysrhythmias are
not available in Canada. · When medical
treatment fails. more drastic mea'iures
must be utilized.
· Cardiol'er.rion: Electric shock
causes momentary depolarization of the
majority of heart fibers, thereby
terminating the tachycardia and allowing
the sinus node to be re-established as
pacemaker.
. Surgical Treatment: Surgical
imerruption of the accessory pathway is
considered when a disabling tachycardia
is unresponsive to medical therapy.
Accessory pathways are identified by
multiple intracardiac electrode catheter
recordings.
Complications
In children and infants, congestive heart
failure (CHF) almost always follows
paroxysmal tachycardia. In older
children the signs and symptoms ofCHF
are almost identical to those experienced
by adults. i.e. fatigue, exercise
intolerance. anorexia, abdominal pain,
cough. breathles'iness at rest. elevation
of systemic and venous pressure,
orthopnea. basal rales. edema of
extremities. cardiomegaly and a gallop
cardiac rhythm. HoweverCHF is much
more difficult to recognize in infants.
Edema in these infants is almost
undetectable clinically. Signs may
include tachypnea, feeding difficulties,
poor weight gain. excessive perspiration.
irritability, weak cry. dyspnea with
costal and sub-costal retractions,
pneumonitis with or without
pneumothorax. hepatomegaly and
cardiomegaly.
The Cen.dlen Nur..
D8c:.mber 11179 37
ursing Care
While in our unit. Ginger presented
several unique nursing problems for us.
'\s coronary pediatric admissions ",ere
rare. we were faced", ith a challenge.
0\ er a fi ve- year span, Gi nger had
numerous admissions and became
endeared to the staff. Her familiarity
with the unit routine reduced her level of
stress greatly on admission, Even
examinations by various personnel did
not seem to disturb her overtly. She was
very independent. a characteristic
encouraged by her parents who wanted
her to participate in the normal activities
of her age group and tried not to let her
cardiac condition interfere with this.
During Ginger's admissions, the
maintenance of bed rest proved to be the
greatest nursing challenge. Since we
recognized that immobilization is
probably the most difficult aspect of a
child's illness.:; the importance of
providing age appropriate play material
was ob\ious. Ginger's favorite toys and
dra",ing needs were obtained. Her
frequent drawings of home and family
demonstrated her desire to be out of
hospital. Ginger also played out her
feelings by handling hospital equipment
and by playing nurse. A realistic doll that
had to suffer through the confines of
bedrest and the torture of an intravenou
helped Ginger to adapt to her
environment.
Fortunately forGinger and the
nurses, Ginger's mother. although also
caring for an infant at home, was able to
spend a great deal of time at the unit and
was deeply involved with Ginger's care.
Nutrition proved to be another
problem area for the nurses and Ginger.
During hospitalization. Ginger's appetite
was generally poor. Of course. trial
medications frequently caused anorexia
and naU'iea. Small. frequent feedings
were attempted with little succes'i.
However. because ofGinger's likeable
nature and unfortunate situation. the
nurses frequently succumbed to reque!>t'i
for cookies and pop. In retrospect. the
limiting of treat,> and sweet'i to after
meals might have produced better
results.
Being the only child in a very active
Intensive Care Unit produced bedtime
problems forGinger and the staff. The
nurses were easily manipulated into
agreeing to reading one more story,
playing one more game, drawing one
more picture or having one more snack.
We all felt sorry for her in her
predicament. When it was recognized
that we were all the victims of
manipulation, a bedtime routine for
Ginger was established. This evening
regime consisted of a telephone call
home. several read-aloud stories. a
snack. h'i care and a soothing massage.
The establishment of this regime usually
produced success. When the regime was
not followed, however, Ginger would
often be awake much longer than the
adults in the unit.
It seems obvious now. that our
approach toGinger's care could have
been more consistent had we held team
conferences. Even Ginger's mother was
a source of information and advice that
we did not utilize fully.
Epilogue
Surgery has brought about a dramatic
change in events for Ginger. who it
seemed would be condemned to a life of
frequent hospitalization. Now. two years
after surgery. she has remained
tachycardia free. with an EKG that
shows normal sinus rhythm.'"
References
I Gallagher. JohnJ.
Wolff-Parkinson-White syndrome. The
problem. evaluation. and surgical
correction, by John J. Gallagher et al.
Circulation 51 :5:768. :\lay 1975.
2 -. The Wolff-Parkin!>on-White
syndrome and the pre-excitation
dysrhythmias, by JohnJ. Gallagher et al.
Med.Clin.North Am. 60: I: IOJ. Jan.
1976.
3 Ibid.
4 "Peretz. Dwight. Newer agents for
the treatment of cardiac dysrhythmias.
by Dwight Peretz and Michael Walker.
B.C.Med.J. 21:2:60. Feb. 1979.
5 Marlow. Dorothy R. TntbooJ.. of
pediatric /luning. 4th ed. Toronto.
Saunders. 1973. p.630.
Bibliography
I Arnsdorf. !\.forton F.
Electrophysiologic properties of
antidysrhythmic drugs as a rational ba
is
for therapy. M ed.Clin.N ouh Am.
60:2:213-232. Mar. 1976.
2 Chung. Edward K.
Tachyarrhythmias related to
Wolff-Parkinson- White syndrome. Heart
Lung 6:2:262-268. Mar./Apr. 1977.
3 Gallagher. JohnJ.
Wolff-Parkinson-White syndrome. The
problem. evaluation, and surgical
correction, by John J. Gallagher et al.
Circulation 51:5:767-785, May 1975.
4. -. The Wolff-Parkinson- White
syndrome and the pre-excitation
dysrhythmias.
fedical and surgical
management. by John J. Gallagher et al.
Med.Clin.NorthAm. 60: I: 101-123. Jan.
1976.
5 Gillette, Paul C. The mechanisms
of supraventricular tachycardia in
children. Circulation 54: I: 133-139. Jul.
1976.
6 l\fantaka
. Michael E. Natural
history of Wolf f-Parkins on-White
syndrome discovered in infancy. by
Michael E. Mantakas et al.
Amer.J.Cardiol. 41:6:1097-1103. May
22, 1978.
7 Marlow, Dorothy R. T e-abook of
pediatric nursinl(. 4th ed. Toronto,
Saunders. 1973.
8 "Peretz. Dwight. Newer agent'i for
the treatment of cardiac dysrhythmias.
by Dwight Peretz and Michael Walker.
B.C. .Wed.J. 21:2:51'<-61, Feb. 1979.
9 Sung, Ruey J. Clinical and
electrophy
iologic observations in
patients with concealed accessory
atrioventricular bypass tract'i. by Ruey
J. Sunget a/. Amer.J.Cardiol.
.to:6:839-R47. Dec. 1977.
"Unable to verify in CN A Library
Coleen 'Ianning is a Rraduate of the
Faculty ofN ursinI(, U 1Ii1'ersity of
Toronto. After graduatioll, she 1\'0rJ..ed
a.v a swff nurse ill the ICU /CCU at Trail
Regiollal Hospital. For the past two
\'ears she has held the positioll of
Education Coordinator at this hospital.
Ackno"ledgment: To Ginger' s parents,
Dr. Paul GelpJ..e and the ICU nursinl(
staff "'ho agreed to and assisted in
sharinl(Ginl(er's story and to Mrs.
Audrey Turller for her time at the
t\'pewriter.
38 D8c:ember 1979
The Cenedlen Nurse
What a
I-
can 10
I
,
r
Nico/eCave
....
,..
.
,
,') .
'"
J
-
-
Photo byNFB PhotothequeONI-
How can a nurse establish a trusting and helping relationship with a child who cries and screams at
the sight of anyone in a uniform? How does a nurse communicate feelings of caring and
understanding to such a child? The task is not easy. Author Nicole Cave, as a second year nursing
student, successfully cared for such a child and says the secret lies in patience, perseverence,
knowledge, good organization and individualized care.
During my four week period in
pediatrics, I cared for a little girl whom I
will call Heidi. She had been admitted to
hospital for treatment of congenital
dislocated hips that consisted of
operative bilateral hip manipulation and
then the use of Buck's extension traction
on both legs. Because of the traction she
was confined to bed, lying prone or
supine for most of the day. Her only
"outing" was to the play area. Heidi had
experienced several other
hospitalizations for the same problem
and had undergone surgery in the past.
I first met Heidi on my touring and
orientation day to the hospital. two
weeks after she had been admitted.
Although Heidi was four years old and
her growth and development had
progressed normally. she appeared tiny
and delicate. She weighed I3. 7 kg (which
was five times her birthweight of 2450
grams).t and she wa
99 cm tall. Her
blue eyes were very expressive and her
face was cute and round. but her color
was pale due to a low hemoglobin level.
Her short brown hair was the main
attraction - she had a little ponytail
sitting on the top of her head that fell
over like a fountain.
A difficult patient
During the first week that I looked after
Heidi. I noticed many things about her
behavior that were disturbing. For
example. she hardly ever smiled and
kept her thumb in her mouth most of the
time. Many children in hospital are
happy to have someone come and talk to
them, but not Heidi. Whenever someone
approached her. she cried out, put her
head down on the mattress, turned her
head away or simply refused to talk. If
people were outside her room. during
rounds for instance. Heidi's facial
muscles tensed up and she became very
restless. If they entered the room Heidi
would cry out and scream to me. "I
don't want them to come and see me; tell
them to go away." She calmed down
only when they left. It was obviouo; that
her attitude towards those caring for her
and to hertreatment was very negative
and unfortunately. she had been labelled
as "a difficult patient" by the staff.
Giving Heidi the necessary nursing
care was not easy since she seemed to
express all her fears. anger and
frustrations during that process. A
typical morning began with breakfast
foIlowed by a number of nursing
procedures: bath care which
necessitated unwrapping the traction
bandages. giving skin care to her legs
with alcohol (the smeIl of which she
disliked intensely), rewrapping the
traction bandages. checking the dressing
for oozing and checking for pedal pulses.
During each of these procedures. Heidi
either cried or screamed and her body
tensed up from head to toe.
"What are you going to do to meT'.
she would ask in a very annoyed and yet
frightened voice.
The most upsetting period for Heidi
and for me started after bath care when
her medications were given. She hated
the taste of her drugs - ferrous sulfate.
penicillin VK, codeine and ASA '.In
addition to the terrible taste. Heidi kne\\.
that the administration of her
medications signaIled the imminent
arrival of the physiotherapist who would
put her through a series of painful
exercises. As soon as I brought her
drugs. Heidi would commence to throw
tantrums and cry. so much so that she
coughed. gagged and sometimes
vomited. At other times. she cried on
and off for an hour. repeating through
her tears. ''( don't want her to come;
she's going to hurt me:'
When the physiotherapist did arrive,
Heidi cried and screamed: when I went
over to hold her. she pinched my arms.
The analgesic given to her prior to physio
did not seem to make much difference
since she was convinced that the
exercises would hurt no matter what
anybody said Or did. In the initial period
after surgery. Heidi did experience a lot
of pain but later on. the pain seemed to
be anticipatory rather than actual. For
example, Heidi started her crying and
screaming "ouch" even before the
physiotherapist touched her legs.
Behavior problems
Whenever Heidi felt threatened. anxious
or frustrated, she regressed to sucking
her thumb and roIling her miniature
ponytail between her fingers. I n order to
shift attention away from the treatment
to be administered, she complained of a
sore stomach. On two different
occasions the physiotherapist stopped
the exercises because of Heidi's stomach
complaints. But after assessing that this
was a strategy used by her patient to
postpone or bypass the threat of pain.
The CBnedlen Nurs.
the physiotherapist continued the leg
movements despite Heidi's protestations
- not a comfortable situation for either
of them.
Heidi also tried the strategy of
abdominal aches with me prior to
receiving her medications. Another
coping mechanism she used was anger:
she often threw tantrums. screamed.
cried. pinched.. .One day when her
mother was visiting at medication time
she yelled in a very angry tone of voice:
'The nurse is hurting me. Can't you stop
h .,..
er.
All of Heidi's reactions to the threat
of pain were normal and understandable.
She could not comprehend how her
mother could stand by and let other
people hurt her even if it was "for her
own good"". The preschooler's most
effective natural protection against
threat is activity.1 an avenue not open to
Heidi. Her regressive behavior and
agressive manner were well justified
considellng that Heidi was confined to
bed. immobilized in traction and thus
unable to actively protect herself from a
perceived threat. Her external release to
thi
situation was to cry. yell. pinch etc.
In this way she could release her
frustrations instead of internalizing
them. 3
\\ hat to do
It is obvious from this description of
Heidi that she was a frightened little girl
who trusted no one on staff: she was
indeed a chaIlenge for those of us looking
after her. In planning my care for Heidi,l
decided to use several approaches to
alter her behavior. with the goal of
making her hospitalization experience
easier on her and on the staff.
Establishing trust
First I observed Heidi and her mother
together. When I did. I realized that
Heidi was actuaIly a very affectionate
little girl and so I decided to emulate the
approach her mother used in order to get
closer to Heidi. to establish a familiar
one-to-one contact and to gain her trust.
I realized that I had been afraid to get too
close to her because of the strong
resistance she had offered initiaIly. Once
I overcame this fear, I approached Heidi
D8c:.mber 1979 311
more openly and allowed her to do things
which I had noticed she liked doing with
her mom such as letting her comb my
hair, rub my face. hug me, kiss me or
hold my hand, play imaginary games and
look at family pictures together. As a
preschooler, Heidi needed the kind of
security and stability that a familiar
nurse could provide during her mother's
absence.' I became someone Heidi
could identify with. had some control
over and whom she trusted.
Having met my goal that Heidi
would begin to trust me. I started
introducing other people into our sphere.
in a non-threatening fashion. For
example, I pointed out pretty colors of
uniforms and asked Heidi's opinion
about them. I emphasized that my
teacher and classmates loved little
children and how much they would like
her to talk to them sometimes: I adopted
a positive attitude toward everybody
involved in the hospital setting who
came in contact witn her directly or
indirectly. I hoped this would help Heidi
realize that they meant no physical harm
to her.
EventuaIly. Heidi let many people
approach her. She no longer cried when
someone came into the room and in fact
was able to talk to them in a relaxed and
happy manner. She still felt a little tense
around doctors but she no longer cried at
the sight of them. She even let them take
a picture of her legs one day and she put
on a big smile for the photographer.
Decreasing anxiety
Knowing of the association Heidi made
between receiving her pain medication
and the subsequent physio, my nursing
instructor and I discussed the possibility
of taking her off medication prior to her
exercises. Since the codeine did not
seem to make any difference to her
perception of pain, we thought this
would be a way to avoid upsetting her
morning. After talking to the physician.
we tried it. Our first attempt
unfortunately was not successful
because the pain was stiIl too severe for
Heidi to endure without medication. This
was 15 days postop.
Our second attempt one week later.
proved much more successful. The pain
had now decreased enough to take her
off the medication and the result was that
Heidi could not wait for bath care to be
over so that we could play games
together. She was now able to delay the
thought of her painful exercises until the
physiotherapist actuaIly came, instead of
becoming upset an hour beforehand.
40 D8c:.mber 1979
To further reduce periods of upset, J
decided to evaluate her need for the
other medications she was receiving. I
discussed the possibility of discontinuing
her penicillin VK with the team leader
since Heidi no longer had a sore throat; I
also suggested that another hemoglobin
test be done because it had been three
weeks since the last level was taken. The
new results were within normal limits
and one morning, Heidi greeted me with
a big smile and said, in a very happy
voice, that she no longer had to swallow
any pills.
Participation in care
I encouraged Heidi to participate in her
care as much as possible. For example,
while I unwrapped the bandages I had
her help me by cutting the tape or by
holding on to the Ace@ bandages while I
applied the tape. I had her check her hip
dressings and tell me whether they were
clean or dirty. She took great pleasure in
the initiative I had allowed her to take on
and she soon became a little expert at
telling me how to do my job. By being
allowed to take part in her own care,
Heidi could identify with the hospital
environment in a positive way.s
Characteristic of her age and stage
of development, Heidi was very much
concerned with her body and its
intactness. 6 Because I was aware ofher
fears in this area, I made a point of telling
her exactly what J was going to do-
where I would touch her and why. As far
as skin care was concerned, we had a
compromise: I would apply the alcohol
to her legs as quickly as possible while
she held her nose to block out the odor.
This worked out fine for both of us.
Play therapy
In order to shorten the waiting period
before physio, I used various distraction
techniques such as singing and playing
cards with her. After awhile, Heidi no
longer asked to go to the playroom
before physio; in fact, there were times
when I could have taken her but she
refused. She insisted on staying in her
room until the physiotherapist came.
Again, allowing her to make decisions
about how she would spend her time was
very important in order to meet her need
for independence that is evident in the
preschooler .1
After discussing play therapy in
greater detail during one of our ward
conferences, J introduced a play doll to
Heidi which looked very much like her.
The doll had Buck's traction as did
Heidi; they both had a hip dressing and
Th. C8nedlen Nurs.
both had their own crutches. The doll
also had her own kit including alcohol
(which was really water), dressmg
material, tape, etc. The doll even had a
ponytail just like Heidi's.
Heidi's first reaction to the doll was
that it was very funny. But she soon
named it after herself and spent a lot of
time playing with it, practising her
nursing skills over and over until her kit
ran out of supplies. The purpose of the
doll was to allow Heidi to practise all the
procedures that Heidi herselffeared so
much on her own body. In this way, she
could transfer some of her feelings to the
doll and let her frustrations out. thus
helping her adapt to her treatment. H
When Heidi had noticeably adjusted
more to the hospital environment, the
doll became just an ordinary doll which
Heidi shared with her roommates.
Changes
It was encouraging for me and the rest of
the staff to see the change in Heidi's
behavior. In part. the change was due to
her decreased degree of pain. and to the
physiotherdpist who had shown Heidi
much affection and patience. In time,
Heidi was able to return the affection
since she had grown to like the
physiotherapist very much. As well,
Heidi became more mobile, and had
developed self-confidence in using her
crutches. She loved showing off her
crutch walking and now called staff over
to give them a demonstration of how well
she did her range of motion exercises.
The staff were thrilled with her progress
and she was praised highly for her
efforts.
Heidi had changed from a shy,
withdrawn, distant, whiny and
frightened little girl to an open. cheerful.
cooperative, pleasant and affectionate
child. Everybody came to like Heidi
because of her friendliness.
Conclusion
The change in Heidi's behavior did not
occur overnight but over the period of a
month. The goals set for Heidi and the
interventions used varied as did her
needs over this period of time. In dealing
with Heidi, flexibility as well as patience,
caring, gentleness and understanding
were essential to helping her adjust to
her situation. These qualiti::s as well as a
sound knowledge of growth and
development enabled me to foster
Heidi's trust first in myself and then in
others and eventually to help her master
her many fears.'"
A uthor. Nicole Cave, wrote" What a little
care can do" in the summer of 1978
shortly after her pediatric rotation. At
that time. she was in her second year of a
B.Sc.N. program at McGill University in
Montreal. She states, "I hm'e enjoyed
caring for children very much and as a
mother of two children / was able to
blend some of my own experiences with
the tremendous amount of knowledge
learned while dealinR with other
children."
Cave has since graduated from the
B.Sc.N. program and is now working in
the Montreal General Hospital in the
area of genera I surgery. She plans to go
into community health nursing in the
future.
ACknowledgement: Thanks goes to Susan
Zuijwijk,jì-Jrmer clinical instructor,
McGill Unh'ersity School ofNursinf?,for
her support and assistance in the
preparation of this article.
References
1 Comprehensh'e pediatric nursing,
edited by Gladys M. Scipien et al. New
York. McGrdw-Hill, 1975. p.14I.
2 Ibid., p.38:!.
3 Freud. Anna. The ego and the
mechanism of defence. New York.
International Universities Press, Inc.,
1966. p.56.
4 Chadwick, BarbaraJ. Maintaining
the hospitalized child's home ties. by...
et a\. Amer.J.Nurs. 78:8: 1360-1362, Aug.
1978.
5 Kintzel, KayC.Ad}'anced
concepts in clinical nursing.
Philadelphia, Lippincott, 1971. p.51.
6 Beland. Irene L. Clinical Nursing,
by... and Joyce Y. Passos. New York,
Macmillan, 1975. p.390.
7 Erikson, E.H./dentity: youth and
crisis. New York. Norton, 1968. p.116.
*8 Erickson, Florence. Play
interviews for four year old hospitalized
children. Monographs of the Society for
Research in Child Development,/nc.,
23:3, Serial no.69, 1958.
*U nable to verify references in CNA
Library
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Th. Cenedlen Nurs.
D8c:.mber 1979 41
Babies with
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what to watch for
Although necrotizing enterocolitis. an
ohscure disease affecting the neonate. can
he traced back to U!91. it was not until the
mid-60's that it "as recognized and
diagnosed with much greater frequenc
.
Wh
its sudden and recent
ackno"ledgment and classification? One
e'\planation is that new technolog
in
neonatal intensive care units along "ith
laboratoQ ad\ances and ne"
de\elopments in h
peralimentation ha\e
combined to saw many small infants" ho
a numher of
ears ago would ha\e died. -\
ph
sician obsenes: "l\Ia
he it is part of
the price "e pa
for increasing sunhal of
10" birth "eight infants. '"
Reports on the incidence of
EC
indicate that three to eight per cent" of all
babies admitted to neonatal units de\elop
the disease and that of the infant deaths in
neonatal units. two to the per cent.! can he
attributed to necrotizing enterocolitis.
Howe\er. statistics differ from one
neonatal unit to another. from one city to
another and from one countr) to the
next. 4
Who get.. NEC?
The very small preterm infant, in
particular those who have suffered
asphyxia or hypoxia at birth or
perinatally, are at greater risk for N EC
But babies of higher birth weight have
been affected also. especially those who
are small for gestational age (SGA), and
those born with hyaline membrane
disease or cyanotic heart disease. Babies
who have suffered birth trauma or
registered low Apgar scores are also at
risk.
What causes :\IEC?
The etiology ofNEC appears [0 be
related to hypoxia or asphyxia. When the
infant suffers an oxygen deficiency.
blood is shunted away from the
mesenteric, renal and peripheral beds in
order to satisfy the emergency needs of
the brain. heart, liver and other organs.
This shunting of blood severely
compromises the integrity of the bowel.
Vascular insufficiency in the mesenteric
area leads to bowel ischemia and a loss
Ben'rley Ha.\lil/gs McBride
I\.
Photograph ofx-rav
shOl
'ing pneumatosis
of protective mucosa followed by
proteolytic autodigestion. This. in turn,
predisposes the neonate to sepsis. a
condition further complicated by the
poor immunological responses of the
infant, especially the preterm infant.
Bacterial invasion of the mucosa
and submucosa by gas-forming
organisms such as E. Coli. Klebsiella
and Pseudomona.. can occur. The final
stage may be penoration of the howel
with resultant peritonitis.
On gross examination. the bowel
will appear dilated with a brown or
blue-grey hue. Microscopically. the
bowel mucosa will appear edematous
and hemorrhagic with necrosis extending
through tht: submucosa and muscle
layers. Villi and crypts will be absent, a
sign which may be missed if examination
is done during an acute inflammatory
response. There may be thrombi
formation in the mesenteric capillaries.
arteries and veins. A positive sign of
necrotizing enterocolitis is the presence
of air in the bowel wall (pneumatosis)
due to the activity of gas-forming bacilli.
Because of the recent recognition of
NEC as a common problem in neonates.
a number of possible causes for the
disease have been postulated but so far
no single factor has been identified.
Health care teams working with
neonates are cautioned to provide
treatment and care in light of current
research knowledge: "Those wor\..ing in
intensive care units must remain vigilant
in case N EC represents a new iatrogenic
disorder caused by some change in
clinical practice." 5
Current theories
One of the most popular theories about
NEC concerns infant feeding. 6 The idea
is that when high risk infants are fed with
a high volume of milk formula and
hyperosmolarelemental feeds, an
increase in gastrointestinal secretions
occurs making the formula isotonic. This
causes the mucosaoftheGllumen to
become i'ichemic.
Many neonatal care units are
experimenting with breast milk feeds
(preferably fresh rather than frozen) but
the only research to support the
"breast-milk-only" theory has been
conducted on rats. The studies show that
fresh rat brea'it milk containing
leukocytes protected newborn rats from
experimental bacterial necrotizing
enterocolitis. Frozen or thawed rat milk
lacked these protective leukocytes and
proved to be effective only when
leukocytes were added. Researchers
acknowledge that human studies must be
done before these results can be applied
to man. 7
Another hypothesis suggests that
the polyvinyl-chloride in plastic feeding
tubes may produce a toxic disorder
affecting the vascular tone of the bowel. H
While both these theories may have
validity. N EC has also been found in
infants who have only been fed
intravenously. and who have never been
fed by mouth.
Other findings associated with NEC
include the following:
. NEC has been noticed with greater
frequency in infants with an umbilical
artery catheter line which may cause an
obstruction of blood flow to the
mesentery.9 But whether the catheter per
42 D8c:.mber 1979
The Cenedl.n Nur..
I
\.
se is the inciting factor or is incidental in
distressed. hypoxic infants is not
known;1O
. There ha
been an a
sociation made
between N EC and the hypervi
cosity
that results from polycythemia.
Researchers have noted that a o;]udging
ofred blood cell
occurs with decreao;ed
intestinal proficiency;\(
. Research also show
a relationship
between infanh with N EC and
coagulation abnormalities, especially in
those infant
with hypoxia. 12
Dia
nosis
Nurses. because of their :!4-hour contact
with the high risk infant, are in a good
position to detect the early
igns and
symptoms of necrotizing enterocoliti
in
the infant. Early diagnosis and treatment
may shorten the course of the disea
e
and improve the survival rate. t . 1
NEC usually occurs four to ten days
after the birth of the baby but can appear
as early as four hours or as late as thirty
days after birth. Some cases have even
occurred after one month of age. The
first insidious sign" ofNEC may include:
. apnea
. temperature instability
..
. vomiting
. lethargy
. increase in abdominal girth.
Thi
la
t sign whether sudden or gradual
is an indication of abdominal dio;tention
caused by the production of air in the
bowel.
With all infant
fed by na"o-gastric
tube, gastric aspiration should be done
every four hour
. A return of half or
more of the previous feed indicateo;
dige
tion difficulties and the presence of
bile in the aspirant is highly indicative of
NEe. Ifbile is present. feeding
should
be stopped amI the infant observed for
other "ign
or symptoms ofN FC.
Feedings should be restarted only when
the dangerofNEC has been ruled out.
Stools should be tested for reducing
sugars (produced when the absorptive
capacity ofIhe bowel is diminished) with
Clinitest ) tablets and for occult blood
(pre
ent as a re
ult of insult to the
intestine or colon) with Hemate
t )
tablets. A study done at McMaster
University in Hamilton. Ontario reports
that gastrointestinal bleeding occurred
as an earl y indication of necrotizing
enterocolitis in 86 percent of the infants
in the study. H
Blood serum values should be
monitored for thrombocytopenia, other
clotting abnonnalities and progressive
metabolic acido
is. For infanh with
suspected NEC, a "septic workup"
should be done. At Children's Ho
pital
of Eastern Ontario in Ottawa. this
consists of swabs of the ear. throat.
umbilicus and groin. blood cultures and a
lumbar puncture.
A conclusive diagnosis can be made
by x-ray which will show generalized
bowel distention with pneumatosis - the
hallmark of NEe. The disease may
involve short segments of the small
intestine, and if allowed to progress. will
spread further in theGI tract, eventually
involving the stomach and the large
intestine.
The aim and purpose of the care of
I. these infants is the early detection and
treatment ofNEC in order to prevent a
more serious situation and the trdgic
consequences of penoration and
peritonitis.
Treatment and nursing care
TJeatment of necrotizing enterocolitis
generally consists of supportive medical
care. To date. the role of o;urgery in the
treatment ofNEC is controversial and
has not been agreed upon. I;; When the
disease i
sllspected or diagnosed.
complete rest of the intestine and bowel
is imperative. Oral feedings are stopped
and a na
o-ga
tric tube is inserted and
attached to straight drainage to keep the
stomach empty of ga.,tric contents.
Because these babies are in
electrolyte imbdlance. they are started
on intravenous hyperalimentation
consisting of an amino acid solution and
a fat emulsion. The alimentation which
aids in restoring and maintaining
electrolyte balance is individuall)
ordered for each infant on a daily basis.
Serum electrolytes must be checked
frequently and alimentation constituents
altered as necessary. In addition. vitamin
BI2'" and folic acid are administered 1M
since these nutrients are unstable in
hypemlimentation solution.
Accurate intake and output records
must be kept and losses or gains
rectified. An accurate record of urine
and stoollos" and amount of blood
withdrawn is extremely important. The
loss of even .4 cc of blood from a toOO
gram infant is. in relation to size. a large
one. Because of the frequency of blood
tests. a complete blood count and
differential count of these infants 'ihould
be monitored. NEC babies show a
tendency for anemia and any
unnecessary blood loss will simply
aggravate an already hazardous
condition. A hemoglobin of I:! grdms or
less may be an indication for a
transfusion of packed cells. Other blood
leveb that require monitoring are blood
gas measurements, calcium and glucose.
The Cenedlen Nure.
D8c:ember 111711 43
SOME NORMAL BLOOD TEST VALUES
Route
"Blood values in babies with NEC can be either increased or decreased
depending on electrolyte Imbalance"
Result
35 mg/dl
3.1-25.5 mg/dl
133-146 mEq/1
4.6-6.7 mEq/1
100-117 mEq/1
6-11 mg/dl
0-1 day 6 mg/dl
1-2 day 8 mg/dl
3-5 day 12 mg/dl
Values taken from:
Avery, Gordon B. Neonatology. Toronto, Lippincott. 1975.
Pierog. Sophie H. Medical Care of the Sick Newborn, by. . and Angelo Ferrara.
2d ed., SI. Louis, Mosby, 1976.
Test
Glucose
BUN
Sodium
Potassium
Chloride
Calcium
Total Bilirubin
Venous or arterial
Venous or arterial
Venous or arterial
Venous or arterial
Venous or arterial
Venous or arterial
Capillary
Blood Gases
pH
p.CO.
p.O.
Base Excess
NAHCO.
Arterial
Arterial
Arterial
Arterial
Arterial
7.35-7.45
35-45 mm/Hg
50-70 mm/Hg
- 4 mEq/1
19-24 mEq/1
(See hCH). !\ntihiotic
uch a
Gentamycin 1!\1 and Ampicillin IV may
he admini.,tered. Experiments have al
o
heen done with or,.1 kanamycin .16
Since necrotizing enterocoliti., will
aggravate any tendency towards apneic
or bmdycardiac spells. these infants
should be put on apnea and/or ECG
monitors if they are availahle. If
monitors are unavailahle. these infant.,
must be watched extremely carefully for
respiratory or cardiac difficulties.
Continue to check for occult blood and
reducing sugars and monitor blood
glucose levels during each shift by the
use ofDextro!'otix. Abdominal girth
readings should he taken frequently for
companson purposes.
If the haby i., receiving lipids (fatty
emulsion.,) in the alimentation. a
lipidstick* te
t should he done daily and
the pla...ma checked for cloudine.,s.
Cloudines!'o indicating an excess of fatty
sub!'otance
in the blood is a sign that
lipid... should not be given until the
cloudine...!'o disappears.
Vital 'jigns should be taken
frequently according to the !'oeverity of
the disea...e: temperature readings are
taken by axilla to prevent any further
insult to the colon.
After the crisis
When oral feedings are ordered resumed.
(when pneumotosis is no longer visible
on x-ray) NEC infants should be fed
fresh breast milk if available. If
unavailable. several other feeds can be
used !'ouch a., full or half strength Isomil"'.
a soy protein i
olate formula. or
Pregestamil"'. a therapeutic formula for
infants with malabsorption di
orders.
1\
*L ipidsticks are obtained by taking
approximately .03 cc of blood in a
microcapillary tube. Block Ihe end of the tube
containing the blood and re...t the tube upright.
After one half hour, the plasma will have
sepamted from the blood con...tituent.... Take a
reading of the pla...ma.
There are no hard and fast rules for
feeding- each child is fed according to
his or her need and condition.
At our ho'>pital. mothers are
encouraged to pump their brea!'ots to
provide fresh breast milk for their baby.
A room with an electric brea.,t pump is
provided forthe use of nursing mothers.
Breast milk is then refrigerated for up to
3 days and if not used. may then be
frozen.
In addition to the obviou!'o nutritional
advantages for the infant. the mother
also benefits from providing breast milk
for her bdby. Because the child is
critically ill. the mother may feel helpless
because she ha!'o no control over the
situation. Mothers have stated that by
supplying hreaM milk, they feel they are
doing something for their baby and an
important bond between the mother and
infant is formed.
Nurses working in neonatal units are
extremely busy and concerned ahout the
critically ill condition of their patients.
Nurses can tend to forget or not make
time for one of the most important
con.,idemtions - the parents. If
admi!'osion takes place afterthe infant's
birth it is more likely to be the father
alone who ha,> initial contact with the
NICU nursing staff. Parents not only
ha ve to cope with the reality of their
baby's illne!'o!'o hut mU!'ot also see their
baby isolated in what one ofthe parent!'.
called "a hotbox".
I n more severe illness. the infant
may be on a respirator neces!'oitating
tubes in the infant's mouth leading from
a large and noisy machine: add to that
apnea and ECG monitors with their bell...
and whistles and I. V. pumps that click
and buzz. A nurse needs only to recall
the first time she was oriented to an
intensive care unit to begin to under.,tand
the terror of these parents. Recently a
most poignant letter describing the
feelings of parents was sent to the
neonatal unit at our hospital by the
mother of one of the 'babies'. It
describes their feelings dUlIng their
daughter's stay:
Personal(,'1 found it I'e/").' hard to go into
the hospital el'ery da,.... to see Sheena,
until I was ahle to chanRe and.féed her:
then it meant something.lnfact we hoth
hated it, hut felt that we I\'ould he looÁed
dOl\'n on ({we did not go. You are tryinR
hard to Áeep yourself emotionally
together and gO;"1( in with all the
equipment IlOoÁed onto her, just upset liS
all the more.
With all the bustle in the unit. many
parent., feel that they are in the way.
Nurses must remember that no matter
how inconvenient the parent's presence
may be. it is their right to be there, No
matter how .,ick the infant, the parents
should be encouraged to stroke. touch
and talk to their child. Many parents
01 ust be shown how to enter the isolette:
their terror of this situation and all that
surrounds it. and their fear of hurting
their tiny, ill infant is too great for them
to manage on their own. Compassion.
empathy and patience are emotions a
nurse must po...sess if she or he is to work
effectively in thi... type of unit.
Because the cause ofNEC has not
yet been firmly established dnd
treatment is still the product of research.
it i... difficult to provide direct answers to
parent's questions. Relapses are
frequent and a parent may leave the
infant one day progressing well and
feeding beautifully, only to return the
next day to find the infant back on
straight drainage and intravenous
feedings. Growth and maturation is a
long and tedious process in the healthy
premature baby; in a preemie with NEC',
it is longer and is a most tense time in the
lives of parents. Some infants have
remained in hospital for as long as six
months. Parental support must never let
up at any time. This support c<ln come
from the medical staff, from a social
worker or perhaps from a team of
44 December 1979 The Cenedlen Nure.
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volunteer parents of former infant
patients who are willing and interested to
offer support when needed.
Treatment is not always successful
and in some cases, these babies die. In a
number of neonatal units. therapy groups
for grieving parents have been formed-
coordinated by a nurse or a social service
liaison worker from the unit. Emotions,
feelings of guilt and other concerns can
be sensitively and carefully dealt with
during these sessions.
Follo\\ up care
Before the baby is discharged from the
hospital. it is very important for the
parents to establish contact with their
own pediatrician or physician so that he
or she is aware of the baby's condition.
Liaison 'ihould also be set up from the
ho!>pitalto the pediatrician by a letter
containing details of the infant's illne!>!>
and cour!>e of treatment.
In addition, hahies who have had
N EC accompanied by complicating
factors !>uch a'i:
. a history of respimtory distress
necessitating a\si'ited ventilation
. a history of cerebml anoxia or
convulsions
. a hirth weight of le...s than 1500
grams
are seen in a follow up clinic at the
Children's Hospital in Ottawa. dt three
and six months and at yearly interval<.
until at least two years of age. Followup
care is most important with the!>e infants
to detect any resultant prohlems: as well.
careful notation of followup results is
e'isential to aid in the further research of
NEe.
When the haby come., to the clinic.
the neonatalogist takes a complete
history and performs a physical and
-neurological examination including an
asse\sment of the correct gestational
age. A Bayley developmental
aSSeS'iment of the child is conducted by
memhers of the psychology department
and results are 'ihared at an
.
interdisciplinary conference following
the clinic. Reports are sent to tl'le child's
physician along with any
recommendations for further treatment.
Summar)
Parents continue to be apprehensive
about their baby's wellness for a long
time after taking the infant home from
the hospital. Sheena's mother
summarizes the feelings of many parents
whose babies have necrotizing
enterocolitis:
I am also aware that quite a lot of babies
do not ma/..e it. I t is something a parent
Ih'es with til/ the day thev actually and
phvsical/y are ,fitting in the car taÁing the
baby home. E,'en then YO/lli,'e with the
crib deaths etc. Because you go thro/lgh
the neonate part you are I/ot at ease till
at least ;<oix months q{ter the bahv is
home.
Because of the ohscurit} 'iurrounding
necrotizing enterocolitis, nurse'i who U'ie
their skills of observation. atlentivene'is,
care and concern will continue to be
important memhers of the re!>earch team.
This must be kept in mind at all time!>
when nursing these infants. OW
Ackno\\ ledgment: The au thor wishes to
tllll1lÁ Sue Stephenson. B.N., clinical
inst/"llctorand BrocÁ MarM/lrl"l/y, M.D.,
neol/atoloRist. C hi/dren' s Hospital of
Eastern Ontario, Ottawa. for their
as.l"istal/ce and encoul"ll[.?ement in the
writing of this article.
References
I Book, L.S. Comparison offa'it-
and slow-feeding rate schedules to the
development of necrotizing enterocolitis.
by... et aLJ.Pediatr. 89;3:46
-466. Sep.
1976.
2 EditoriaLJ.Pediatr.90:458-46I,
Mar. 1977.
3 Behrman, Richard.
N eonawl-perinatal medicine: disease of
the fews and infant. 2d ed. S1. Louis.
Mosby. 1977. p.6to-614.
4 Report. Lancet. 1:459-460. Feb.26,
1977.
5 Ibid.
6 Book. op.cit. p.463.
7 Report. PedResearch. 2:906-909.
Jan.-Dec. 1977.
8 Rogers. A.F. Intestinal
perforation. exchange transfusion. and
P.V.c.. by... and R.M. Dunn. Lancet
2: 1246. Dec.6, 1969.
9 Philip, AlistairG. Neonatologv-a
practical guide. Flushing, N.Y.. Medical
Examination Publishing Co. Inc.. 1977.
p.185.
to Avery.Gordon B.Neonatology:
pathophysiology and management of the
newborn. Toronto. Lippincott, 1975.
p.M5.
II Tudehope, 0.1. The haematology
of neonatal necrotizing enterocolitis, by
... andV.Y. Yu.Aust.Paediatr.J.
13:3:193-199. Sep. 1977.
12 Ibid.
13 Ibid.
14 Ibid.
15 Philip, op.cit. p.185.
16 Egan, E.A. A prospective
controlled trial of oral Kanamycin in the
prevention of neonatal necrotizing
enterocolitis. by... et aLJ.Pediatr.
89:3:467-470, Sep. 1976.
Be\'erley Hastings McBride graduated
from the Montreal General Hospiwl
School ofNursinR and ubtained a
diploma in teaching and administration
from the Detroit Women's Hospital. She
has had a ,'uriety of clinical e"(perience,
doing Reneml duty nursing and teaching
obstetric nursing. She wor/..edfor mal/Y
vears in Montreal as afamily planning
coursel/or. and at the time (
fwriting this
article ,\.he It'as a staffmember i/1 the
neonatal i/1tel/si,'e care unit at the
Childrel/'s Hospital of Eastern Ol/tario.
\1cBride is currently afill/-time stlldent
swdyinR C cl1Iadian History at Carleton
V ni,'ersity in Ottawa.
-
-
\ .,
The Cenedlen Nur..
D8c:....ber 1979 45
,
tI
"
tI
.
I
-
and phototherapy
Frances Tufts
Faye Johnson
Babies at the
indow: we've known for more than 20 years that sunlight helps
dissipate jaundice in newborns, but how does it work? What is jaundice?
The authors discuss phototherap} in light of cunent medical research and
outline specific nursin
measures for care of the jaundiced newborn.
u
\
i
",-'-
....
.....
It.
f
.u
.
""
.,;'
I
Exchange transfu\ion\ have. for the la'\t
30 years. heen the routine treatment for
<;evere hyperbiliruhinemia or neonatal
jdundice. In the early 1951rs. an English
nur<;ing sister made the <;erendipitous
ohservation that bahie<; on the sunnv side
of the nursery had less of a prohlem \\ ith
jaundice. The phenomenon wa<;
imestigated by Dr. Cremer, whose
conclusions were puhli'ihed in 1958. and
further by Dr. lucev in 1968 who
demonstmted the effectiveness of
phototherapy in the hyperbilirubinemia
of premature infants. I Since that time,
the increasingly widespread use of
phototherapy had reduced markedly the
need for exchange tran<;fu.,ions.
.
...-.
...
-...
-
-
-.
"!
Bilirubin metabolism
Prior to a discu<;sion of phototherap}'. It
is helpful to review hilirubin metaholi<;m
and normal neonatal jaundice and it'>
potential consequences.
Biliruhin i., the end product ofthe
cataholism of heme (hematin), the major
source of which is circulating
hemoglohin. The normal life expectancy
of an infant's erythrocyte is 90 days
while that of an adult's red blood cell is
120 days. This !>horter life\pan raises the
production of bilirubin in the infant to
leveb two to three times greater than in
an adult on a per kilogram body weight
basis. !.In addition, the ne\\ horn has a
limited ahility to clear the bilirubin from
his system due to an immature liver.
The bilirubin thus produced is called
unconjugated or indirect. Before pd'ising
through the liver it is carried in the
plasma bound to a large albumin
molecule. and is highly lipid soluble. The
pare[lcl1ymal cells of the liver have the
apacity to efficiently select
unconjugated bilirubin and render It
water soluble or conjugated, for
excretion in the bile.
The unconjugated bilirubin which is
bound to albumin cannot leave the
vascular space: any unconjugated
bilirubin which is unbound is free to
leave the bloodstream and permeate
tissues. Because it is fat soluble. the
unconjugated bilirubin has a high affinity
forfauy tissue. particularly brain. 3
Jaundice. or the yellowish discoloration
of the skin becomes apparent at serum
bilirubin levels of ahout 5 mg/lOO'mls.
46 December 1979
The Cenedlen Nur.e
Among the factors which predispose
to the development of jaundice are
prematurity. dehydration (often as a
result of poor feeding or po.,t maturity)
and sepsis. The amount of bilirubin
which can be carried by the albumin,
another critical factor in development of
jaundice. is dependent on three factors:
I. the amount of albumin
2. the affinity of the albumin for bilirubin
or binding capacity of albumin
3. the presence of other substances
which compete with the bilirubin for
sites on albumm. I
Nur'ies should note that. among
orientals. a certain percentage of babies
lack the enzyme G6PD
(gl ucose-6-phos phate dehydrogenase)
essential for metabolism of bilirubin by
the liver and are thus more prone to
development of neonatal jaundice. '
Consequences of neonatal jaundice
The severity of consequences for the
normal newborn depend on the maturity
and weight of the baby, the level of the
serum bilirubin. the time of onset of
jaundice and its duration. Jaundice
appearing during the first 24 hours is
usually considered to be a sign of an
underlying pathological process. The
"physiologic" jaundice most often seen
in the normal newborn nursery usually
appears between two and three days;
jaundice which develops after five days
should alert the nurse to the possibility of
sepsis.
Of grave concern is the development
of kernicterus. So long as it remains
bound to albumin. the unconjugated
bilirubin is confined to the vascular bed
but unbound unconjugated bilirubin can
cross into the basal ganglia of the brain.
where it is thought to interfere with the
cells' oxygen uptake and utilization. The
resultant kernicterus is characterized
first by CNS depression. lethargy and
diminished Moro and sucking reflexes
and is followed by a period of excitation
and seizures.
I nfants who survive the neonatal
period usually have serious CN .S.
sequellae in the form of severely
impaired intellectual and motor
function. 6 Even low levels of serum
bilirubin. well within the "physiologic"
range (< 15 mg/lOO mls) may cause
kernicterus in particularly vulnerable
infants.
. Babies with Rh incompatibility are
more at risk; the increased hematin,
produced as a result of excessive
hemolysis. competes with the bilirubin
for sites on albumin.
. The preterm infant is especially
vulnerable due to the immaturity of liver
enzymes. and a decreased
albumin-bmding capacity - the result of
acidosis. The hypoglycemia, common in
pre term infants. results in an increase in
circulating free fatty acids which
compete for sites on albumin. These
problems are often compounded by
hypoalbuminemia. -
. The cold-stressed baby is more at
risk as a result of circulating
non-esterified fatty acids, byproducts of
chemical thermogenesis, which compete
for binding sites.
. Certain drugs given to either baby or
mother during later pregnancy, compete
with bilirubin for albumin. Such
medications include ASA. sulfonamides.
oxacillin and parenteral drugs containing
.,odium benzoate."
. Infants with complications due to
asphyxia. sepsis and meningitis are also
at risk due to their generalized weakened
condition.
Phototherap)
The routine use of phototherapy in the
management of rising or high bilirubin
levels is increasing. Advantages include
the following considerations:
I. It is convenient and easy to use.
requiring no special skills in
administration.
2. It is relatively inexpensive as it uses
economical fluorescent lights.
3. Its administration makes no great
demand on the time of the nurses and
physicians involved.
4. It is a safe, non-invasive and effective
means oflowering serum bilirubin.
One ,>tudy concluded that this form
of treatment is equally effective in
infants of all races. regardless of skin
pigmentation. "' Likewise. gestational
age and birth weight do not appear to
have any influence on infam response to
therapy; the degree of illness or health of
an infant has no effect on the outcome of
treatment.
The actual process whereby
phototherapy lowers serum bilirubin
levels is not known for certain; it is
thought that a photodegradation process
at the skin surface renders the bilirubin
water soluble and thus able to be
excreted in the urine and stool. II
Three types of light are most
commonly used m phototherapy: the
daylight fluore.,cent tubes. the standard
blue light and special "superblue"lights.
The daylight fluore'icent allows for
greatest observation of the infant. but the
rate of absorption of effective rays is the
lowest of the three. The .,tandard
blue lights are more effective; however.
they make accurate observation of
baby's color more difticult and could
re'iult in undetected cyanosis. The
superblue lights. although mo..t effective
in reducing bilirubin levels. have the
rather distressing di'iadvantage of
causing headaches. nausea and even
vomiting in nursing staff caring for the
infant.. under the'ie lights. With adequate
.,hielding to protect nur.,ing staff. these
lights can be used effectively and an
additional incande'icentlight 'iource
improves visibility of the baby's color. I!
A difference of opinion exists
regarding the most effective use of
phototherapy, either through continuous
exposure or intermittent use.
Investigators at the University of Pad ova
in Italy have concluded recently that
continuous exposure to the lights is most
effective. I.!
Nursing implications
No long term adverse effects of
phototherapy have been documented.
The nursing implications of caring for the
infant undergoing phototherapy are
directed mainly toward the immediate
undesirable effects of exposure to the
lights.
Support and teaching of parents of
the jaundiced infant too is of primary
importance. In most instances the infant
is separated from the mother except for
feedings which tends to disrupt the
important acquaintance process of the
first fey, days of life. Nursing action.. to
facilitate maximum parental involvement
with the infant during this time is
important; ,>ome hospitals allow
phototherapy to be given in the mother's
room. In any case, teaching parents
ahout the transient untoward effects of
phototherapy i
essential.
Some doctors request that mother
interrupt breastfeeding to hasten the
drop in serum bilirubin levels. This may
be upsetting for the mother: the nurse
must support her. allowing free
expression of her feelings of frustration.
The nurse must take the initiative too in
teaching the mother how 10 maintain
lactation either through manual
expression of breast milk or through use
of a breast pump.
The Cenedlen Nur..
One of the side effects of
phototherapy is an increased metabolic
rate which necessitates an increa.,ed
caloric intake. The nurse should prepare
for more frequent feedings and keep
accurate records of amounts fed to
infants. Babies may fail to gain weight
during the course of treatment and
mothers need to be told that following
treatment the amount baby eats may
decrease for a short time, but that he will
gain weight.
Insensible fluid loss increases due to
dilatation of capillaries at the skin
surface and means the baby's fluid
requirements are increased. Water can
be given bet\\-een feedings to prevent
dehydration: the nurse must be aware of
the signs of dehydration and intervene
appropriately should they occur.
Loose, green watery stools. the
result of the rapid breakdown of bilirubin
by phototherapy. are a common
occurrence. and another source of water
loss. Mothers and fathers need an
explanation of this and reassurance that
stools will return to normal following
cessation of therapy.
Temperature problems range from
hyperthermia m the infant in a heated
isolette'. to hypothermia in the baby
exposed in an open cot. The baby's unit
should-not be placed against a cold
outside wall. Temperatures should be
checked q2h during the course of
phototherapy: axillary temperatures are
best as they not only reflect a change in-
skin temperature beforé a change in body
core temperature, but they are also less
traumatic to a rectum already irritated by
frequent loose stools. When a thermistor
probe is used. it should be covered by
opaque tape which ensures that the
probe reflects accurately the baby's skin
temperature and not heat produced by
the lights.
Eye shields are an e!\sential aspect
of caring for the baby undergoing
phototherapy. Data on the possible
effect of high intensity light on the eyes
of human infants are lacking but
evidence from animal studies indicates a
potential for retinal damage. For this,
reason. it is imperative that the eyes of
an infant undergoing phototherapy be
protected by opaque eye shields (see
photo). Care must be taken to ensure
that the infant's eyes are closed under
the patches to avoid any corneal
abrasions and the eyes must be inspected
regularly (q4h) for signs of conjunctivitis.
The nurse must also see that the
eyeshield does not slip down over the
nose. blocking air passages.
Since the photodegradation reactIon
takes place in the skin. it is important
that the max imum amount of skin
surface is exposed to the light. Baby girls
.,hould remain undiapered: baby boys
may be covered by a bikini diaper which
allows maximal skin exposure while
ensuring protection of the environment
and any close neighbors during voiding!
No evidence yet exists to support the
belief that sterility results in boys
ex posed to phototherapy.
Once phototherapy has begun. the
skin becomes less jaundiced and can no
longer be u
ed as a guide for estimating
bilirubin levels. The nurse must be aware
of lab results of serum bilirubin levels
and report these to the physician.
The "bronze baby syndrome"
wherein the skin turns a grey-brown
color is an uncommon but very
distressing adverse effect. Parents need
reassurance that this is harmless and will
disappear within two or three months
after cessation of treatment.
A plexiglass shield will protect the
infant from ultraviolet rays which would
otherwise produce an erythematous
reaction in the skin and incidentally
prevents injury from accidental
explosion of any of the bulbs.
As with all electrical equipment. the
nurse must take care to ensure proper
grounding. and that worn or frayed cords
are repaired or replaced. U
..
Treatment of choice
The use of phototherapy in the
munagememof hyperbilirubinemia has
reduëQdthe need fo
exchange .
,transftlsions so that it remains the
tréåtment of choice often for only severe
hyperbilirubinemia, especially when duë
to pathologic processes. Phototherapy
affords the nursery nurse an opportunity
to apply her knowledge and skills of
observation to provide a high standard of
nursing care to both the jaundiced infant
and his family. A knowledge of bilirubin
metaþolism,jaundice and the role played
by phototherapy is essential: the
implementation of these nursing
guidelines will. it is hoped. be rewarded
in practice. 4.
References
I Seligman. Jerry. Recent and
changing concepts of hyperbilirubinemia
and it., management in the newborn.
Pediatr. Clin. North Am. 24:3:509-527.
Aug. 1977. p.518.
D8c:ember 1979 47
2 Harris. Thomas R. Major risks to
the neonate. (In Clark, Ann L.
Childbearing: a nursing perspective, by
Ann L. Clark and Dyanne Affonso.
Philadelphia. F.A. Davis, 1976.) p.693.
3 Korones, Sheldon. High ris"
newborn infants: the basis for intensh'e
nursing care. 2d ed. Toronto, Mosby,
1976, p.193.
4 Harris, op.cit. p. 692.
5 Schaffer. Alexander J. Diseases of
the newborn, by Alexander J. Schaffer
and Mary E. Avery. 3d ed. Philadelphia,
Saunders. 1971. pA98.
6 Korones, op.cit. p.198.
7 Harris. op.cit. p.692.
8 Ibid.
9 Lucey, J.F. The unsolved problem
of kernicterus in the susceptible low
birth weight infant. Pediatrics
49:5:646-647. May 1972. p.646.
10 Tan. 1\.. L. Phototherapy in the
management of neonatal jaundice.
Nurs.J.Singapore. 16:1:22-23, May
1976.
II Avery, Gordon B. .Veonatalogy:
pathophysiology and management of the
newborn. Philadelphia, Lippincott. 1975.
p.355.
12 Seligman. op.cit. p.524.
13 Rubaltelli, F.F. Effectiveness of
various phototherapy regimes on
bilirubin decrement, by F.F. Rubaltelli et
al. Pediatrics 61 :6:838-841, Jun. 1978.
14 Gartner, Lawrence. Jaundice and
liver disease, by Lawrence Gartner and
Lee Kwang-Sun. (In Behrman, Richard
E. Neonatal-perinatal medicine-
disease of the fetus and infant. 2d ed.
Toronto. Mosby, 1977.) pA12.
F.am:es Tufts, RN, BN. is a graduate of
the Ñ ;ghtingale School of Nursing in
.;70ronto, and obtained her Bachelor of
Nursing from McGill Vnh'ersity,
Montreal. Until recently she was
teaching obstetrical nursing in stl{ff
education at the Ottawa Cil'ic Hospital,
and now resides in Don Mills, Ontario
where she awaits the birth of herfirst
child.
Faye Johnson, RN. graduaredfrom the
Victoria General Hospital School of
Nursing in H al
fax, N.S., and has a wide
"ar
e,-\' of clinical experience in hoth
pediatric and obstetric nursing. S<f1e is
currently employed in maternal-child
nursing at the Ottawa Ci,'ic Hospital.
Acknowledgement: The authors wish to
than" Dr. M.H. Hardie, neonatalogist,
Ottawa Civic Hospital and Dr. William
James, pediatrician in Ottawa,for their
assistance with thi.5 article.
41 Deçember 1979
The Cen.dlen Nur..
Caring
or the Child
with Cancer:
Advances in the field of pediatric
oncology over the past few decades
have resulted in a higher survival rate
for many forms of childhood cancer,
notably Wilm's tumor, acute
lymphocytic leukemia, histiocytosis
X, rhabdomyosarcoma and
Hodgkin's disease, for which there is
now a very real chance of cure for a
significant portion of patients. The
child with a malignancy is no longer
managed by one physician: care
involves a judicious blend of surgery,
radiotherapy, chemotherapy and
possibly immunotherapy. A number
of health care professionals may come
together to form a multidisciplinary
team of specialists in infection
control, nutrition, psychosocial
intervention and pharmacy. In the
past, children diagnosed with cancer
were hospitalized for several months
resulting in family disunity and
financial stress; it was to prevent this
that people in this province joined
together to petition the government
for outpatient facilities like the ones
now available through the Southern
Alberta Pediatric Oncology Program.
Barbara J. Price
.
the nurse
practitioner
--I
..
.
.
r
"
-
-
-
...
"\
... '
..
The Cenedlen Nur..
D8c:ember 1979 49
The Clinic
Our "total care" pediatric oncolog}
outpatient clinic was established in
Calgary in 1975. The setup was based on
the following concepts:
. Cancer is long term illness with
intermittent acute episodes rather than
an acute process that brings immediate
death.
. We should direct our goals toward
creating an environment of
independence. happiness and self worth
for the patient and family.
. The patient and family have the
right to know the disease, prognosis and
plan of treatment, and they should be
included in the decision-making process.
. Care of the patient with cancer
encompasses an explicit body of
knowledge.
The full time staff nucleus comprises
of a director (hematologist-oncologist),
two nurse practitioners and a secretary;
because of the specialized nature of the
field, it was felt the extended role for the
nurse would be a definite asset. Some
basic guidelines were established but the
position was left flexible enough so that
the nurse could assess and administer to
the needs of an individual child and
family.
The qualifications and skills that
such a nurse would bring are unique: she
must have a minimum of five years
appropriate clinical experience with
above average knowledge and skills
related to the area of oncology nursing;
she must be capable of working in an
interdisciplinary environment and have
excellent communication and
interpersonal skills: strong leadership
ability is essential; she must demonstrate
an interest in continuing education and
must be willing to participate in
educational programs. In addition, she
must be willing to participate in the
development of both nursing and medical
oncology research protocols.
To illustrate how a nurse functions
in this role, I will describe the process
that a child and family go through from
initial consultation and commencement
of treatment as an inpatient, through
continuing treatment and support in the
outpatient clinic. Home visits may be
necessary in the terminal stages.
Inpatient
It is very difficult to tell parents that their
child has cancer. The nurse
practitioner's initial contact with a family
occurs when a conference is scheduled
following confirmation of diagnosis. The
director, a resident on the inpatient UOlt,
a nurse from the inpatient unit and the
nurse practitioner meet together with the
parents. They are told the diagnosis,
prognosis, the plan of therapy, side
effects of therapy and about the support
systems and resources availahle to them.
We attempt to establish an atmospl]ere
of honesty, cohesiveness and warmth
between the medical-nursing staff and
the family at the outset. A unified
medical-nursing staff is essential to the
provision of consistent support and care
to the family.
Rounds are made daily by the
hematologist-oncologist and the nurse
practitioner while the child is a patient in
hospital. During this period, the nurse
practitioner will try to establish a healthy
relationship with the child and parents. It
is a time to answer questions, encourage
the expression offears, dispel myths and
develop trust. Frequently parents of
these children are not even aware that
children can get cancer, but in fact,
malignant disease is second only to
trauma as a killer of children over the age
of one year.
During the child's period of
hospitalization, the nurse practitioner
spends many hours with the parents
teaching them in detail the concepts of
cancer treatment. They become
acquainted with basic hematology, what
chemotherapy is and how it works, and
the importance of nutrition. They are
taught to observe for signs and
symptoms of infection and/or toxicity
from chemotherapy, and a summary of
the treatment protocol is given to them
Team-efforts are coordinated by the
nurse practitioner to provide financial
and emotional support systems
immediately, reducing the risk of a
family crisis. The family can review
information and ask questions at any
time during the period of adjustment.
Parents use a binder to collect all of
the information given them including the
protocol and flow sheets. If they are
from outlying areas where other
physicians may be carrying on follow-up
care, this detailed information may prove
invaluable. They are responsible for
maintaining their child's flow sheets,
which chronicle surgery, chemotherapy,
radiotherapy, transfusions, antibiotics,
blood work and any scans, x-rays or
cultures that may have been done;
through this they become cognizant of all
facets of their child's disease and its
treatment.
At the clinic, we believe that
parents' continued control of the basic
care of their child is of the utmost
importance so that their lives can be
reasonably normal once their child is
discharged. They can do this with great
skill but only if they have been well
informed and understand what is
involved in treating neoplastic disease.
We also believe that the parents should
assume some of the responsihility in
teaching their child about his disease and
its treatment. The need for compliance
from the parents and the child is
imperative to the child's well-being and
his eventual acceptance of the treatment.
A few days prior to discharge. the
parents and possibly the child, are taken
to the outpatient clinic, which is located
immediately adjacent to the Foothills
hospital to meet the clinic staff and learn
the routine. Their first clinic visit is then
less anxiety-provoking.
Outpatient
The outpatient program encompasses
assessment, treatment, reactivation, mid
and/or long term care, terminal care,
outreach and follow-up education and
research: the nurse practitioner's role
has evolved so that she actively
participates in all these functions.
The child is first seen in the clinic
lab: almost all the children have
complete blood counts done, including a
differential and platelet count. They also
have their height, weight and vital signs
recorded and each child is seen for
complete physical assessment by a
physician or the nurse practitioner. The
nurse practitioner has become skilled in
examination technique through
physician supervision and knowledge
acquired through a post-graduate
program in pediatric oncology. It is of
particular importance during the physical
assessment to examine carefully for
clinical signs of infection, toxicity of
treatment and any sign of tumor
recurrence or spread.
The physical examination should be
carried out in a relaxed but organized
manner. Children need to be either
played with or talked to at first, in order
to gain their confidence; the approach
should be gentle but firm. Children may
be held on their parent's lap during the
examination - the examiner will
encounter far less resistance with this
method!This is an opportune time too
for the nurse practitioner to assess how
the parents are coping at home: they may
have the support of close relatives or
friends, adequate spiritual well-being and
financial stability but if they lack in any
area, psychosocial intervention may be
necessary. The nurse practitioner must
be alert for signs of increased stress and
make suitable resources available to
them.
Based on subsequent evaluation the
child's physical assessment and lab
results, appropriate action will be taken:
cultures may be obtained, x-rays taken,
liver and renal function studies done,
50 D8c:ember 1979
The C.nedlen Nur..
antibiotics ordered or medication for
pain relief ordered. If a bone marrow
aspirate and biopsy. or diagnostic lumbar
puncture is indicated, the nurse
practitioner will carry out these
procedures following the physical
examination. Chemotherapy may follow.
and it is her responsibility to prepare the
calculated dose of drug. administer
antiemetics. initiate the I. V. and
supervise the administration of
chemotherapy. Obviously, it is
imperative that she be well versed in the
action. preparation. administration and
side effects of all chemotherapeutic
agents.
Well-informed parents playa
distinctive support role during this time
by holding the child's hand. explaining
the procedure. and by providing gentle
physical restraint when necessary; the
presence of the parent many times has a
calming effect on the child. Under any
circumstances. with or without parents.
the nurse practitioner must offer simple
explanations regarding procedures to the
children which aids in their willingness to
cooperate.
While the children are receiving
their chemotherapy. they may make use
of the play room or the teen room.
V olunteer mothers do a wonderful job of
supervising these areas, providing an
atmosphere of pleasant acti vity. These
areas, which were developed because
the nurse practitioner recognized the
need for them. are equipped with toddler
toys, puzzles. crafts, coloring books.
T.V. and television games.
The number of times a child is seen
in the clinic varies from several times a
week to once a month, while he is on
"active treatment". The children who
are seen in the clinic for "follow-up"
care after completing therapy have
survived the "active treatment" phase
(which may be as long as three years)e
and no clinical evidence of disease can
be found. Assessment will continue at
least once a year for a total of fifteen to
twenty years.
Clinic visits are I escheduled and
specific blood studies and/or x-rays are
booked at the end of each clinic day. It is
the responsibility of the nurse
practitioner to ensure that all follow-up
studies are carried out. subsequent
results brought to the attention of the
physicians. and are then filed
appropriately. A conference is held
following each clinic, at which time each
child seen that day is reviewed. This
provides a mechanism whereby all staff
members become aware of the physical
assessment and treatment. and any
unusual events that have occurred in a
child's life.
Home visits
There comes a time during the treatment
course when a decision must be reached
regarding the continuation of therapy.
Certainly, it would seem inhumane to
carryon aggressively if a tumor is out of
control and every method known to have
an impact on that particular disease has
been used. Although the family is always
kept informed of the child's progress
during therapy. the implications of
placing a child on "terminal care"
require that another conference be
scheduled for the
hematologist-oncologist. nurse
practitioner and the parents. It is a time
to discuss with the family the feasibility
of stopping therapy. At this point. we
have established a close bond with the
family and can speak frankly and openly
with them. Once the decision is reached
to stop all therapy. we suggest that they
care for their child at home while the
nurse practitioner continues with
assessment and support by doing home
visits.
The frequency of home visits is
determined by the ability of the family to
manage, and the condition of the child.
Ensuring comfort is of prime importance
at this time and the nurse practitioner has
many sources of professional help at her
disposal. The Home Care Program can
be called upon if procedures such as
enemas are required. According to her
judgment in appraising pain, the
physician will order suitable analgesia.
The parents and nurse practitioner
usually find that the family's home
environment is a much more comfortable
place to discuss fears and expectations
about death. Many parents express a
desire to keep their child home until he
dies and we inform them of the
procedures to folio", if and when death
occurs at home.
I must emphasize here how
important it is for the nurse practitioner
to seek support from her peers. This is an
emotionally draining time and to remain
effective. she should seek out those with
whom she can easily relate. Fortunately.
in our clinic, all staff members are very
much aware of this situation and offer
the needed support.
A follow-up home visit is carried
out several months after the death of a
child. Generally. the family has attended
clinic a multitude oftimes over several
years and has developed friendships.
Often at this time they need reassurance
that the decision regarding their child's
treatment was the correct one, and that
they cared for their child in the best
possible way.
At the center
The nurse practitioner in a pediatric
oncology clinic has a special opportunity
to perform a vital coordinating role; she
is on call 24 hours a day during the week
to respond to the needs of her patients
and their families, and she is the first
professional to be aware of problems as
they arise and to have the opportunity to
take action. It is her responsibility to
keep her knowledge of cancer and its
treatment at optimum levels by attending
lectures given by allied health
professional,>. preparing lectures herself
and participating in conferences.
attending appropriate rounds regularly
and by taking advantage of spare time to
read current literature.
The role of the nurse practitioner
affords a tremendous challenge to the
nurse willing to actively participate in the
care of the child with cancer. Her skills
and knowledge and personal vitality
ensure that comprehensive quality health
care is delivered to these children and
their families.
Barbara J. Price, R.N.. is a graduate of
the St. Michael's School of Nursing in
Lethbridge. Alberta. She has worked in
various clinical settings at the Foothills
Hospital and completed a post
graduate program in pediatric oncology.
When this article was written she was a
nurse practitioner with the Southern
Alberta Pediatric Oncology program,
and she has recently taken a position at
the Foothills Hospital as an instructor.
She hopes that other nurses might be
encouraged through opportunities to
perform in an extended role to de\'elop
better health care standards for their
communities.
..; ...
\
.f
The Cenedlen Nure.
D8c:ember 111711 51
calendar
Notice o{upcoming nuning
e.'ents, to be included in
Calendar, should be forwarded
to CNJ at least two months prior
to the desired publication date.
1980 Canadian Orthopedic !\urses Hotel, Toronto, Ontario. 3()and 31. 1980. Contact:
AS'iociation 3rd Annual Contact: Vir[.?inia Garc/hOlue, Marilyn Me\'er. Mineral
Ontario Crippled Children's Conference to be held C om'ener, Puhlicity Sf'rin,;.. Hospital. Box 1050,
Center 7th Annual Conference February 19-22. 1980 at the Committee, 5lW The East Bm!ff. Alherta TOL OCO.
- l\tulti-I)isciplinar
Sheraton Center, Toronto. Mall. Apt. 404, IslinglOn,
Approach to Management: Ontalio. Contact: COI!{erence Ontario. M9B 4A 7. The Second World Conference
O\eniew of Pediatric Puhlicit\' Committee. American College of of Operating Room Nurses will
Rehabilitation. To be held Canac/ian Orthopedic Nurses Nurse-Midwives, 25th Annual be held in Lausanne,
January 21-25. 19HO Coup;e A.Hociation.43 Wellesle\' St. Meeting will he held May Switzerland on August 12-15,
fee: $100. Contact: Ann E.. Torol/fo, Ol/fario. 10-15. 19HO in Minneapolis. 1980. Contact: AORN
Camphell. Coorc/inator. The The Journal of Nursing Minnesota. Contact: J1eeting Serl'ice
Ec/ucation Department, Administration's Third American College (
,. Department, to170E.
Ontario Cripplec/ Children's National Conference will be Nune-Mic/lI'il'e.\'.801-1012 Missi.Hippi AI'e., Dem'er.
Cellter. 350 RUl1ue\' Roac/. C %rado 80231 .
held March 30-ApnI2. in New 14th St. N. W .. Washin[.?toll.
TOrollto, Ontario. M4G IR8. York with a theme of Nursing DoC. 20005.
Administration in the 19HO'
Third World Conference on
The Gerontological Nursing -Meeting the Challenge\. The annual National Teaching Medical Informatics, To be
AS'iociation of Ontario 1980 Contact:Jo-Anne Latino. The Institute of the American held in Tokyo, Japan on Sept.
Conference will he held Jou,."al (
"NursiIlR As.'iociation of Critical Care 29-0ct. 4, 1980. The
February 12, at the Royal Ac/mini.\fration.lnc.. 12 Nurses will be held May 20-23, conference is concerned with
'\ ork Hotel. C ontdct: La/...esic/e Par/..., Wa/...e.fìelc/. in Atlanta, Georgia. Contact: the application of computer
Christine Souter, MA 018RO. AACN, P.o. BorC-19528, technology to all fields of
GerontoloRical NursillR In'ille CA 927/3 (7/4) medicine. A session on
A ssociatioll, c/o 65 The Operating Room !'Jurses of 752-8191. Informatics in Nursing is
Haw/...sheac/ Crescent. Greater Toronto are Banff \1ineral Springs Hospital planned. Contact: Or[.?anbllR
Scarborou[.?h.Ol/fario, presenting the sixth National Reunion to celebrate their 50th Committee, Medillfo 80
MIW 2Z4(416)46/-825I, Conference to be held Aplil28 anniversary, will be held May To/...yo. P.o. Bor40, HOIIRO.
Local 226. - May I, 19HO, at the Skyline To/... \'0, Japan.
CA
1980 DEPARTURES
EGYPT/KENYA ENCOUNTER - 16 Days
Monthly departures throughout 1980
from U.S. $2250.00 all inclusive from Toronto
SENEGAL - A WEST AFRICAN
WilDLIFE SAFARI - 15 Days
January 12/80, February 9/80, March 8/80
from U.S. $1830.00 all inclusive from Toronto
ONLY 71/2 HOURS FROM TORONTO AND
50% OF THE AIRFARE TO EAST AFRICA
KENYA lUXURY SAFARI - 16 Days
Monthly departures throughout 1980
from U.S. $2200.00 all inclusive from Toronto
KENYA/SEYCHEllESfTANZANIA -
NATURAL HISTORY, WilDLIFE AND
CONSERVATION SAFARI - 22 Days
January 14/80, February 18/80 plus monthly
departures throughout 1980
from U.S. $2990.00 all inclusive from r-oronto
7th ANNUAL SUMMER EDUCATIONAL
SAFARI - 25 Days
Egypt & Kenya - July 28 to Aug. 21/80
from U.S. $3150.00 all inclusive from Toronto
SPECIAL MEETINGS AND GUEST LECTURERS
INCLUDED. OPEN TO PERSONS FROM ALL
WALKS OF LIFE
Brochures on these and other African Safaris
available from:
. . EAST AFRICAN TRAVEL CONSULTANTS INC.
"'t.: 1'.\ 33 Bloor Street East, Suite 206
.. Toronto, Ontario M4W 3H1 (416) 967-0067
r pj;;to';"a;d'b
h;;;tc;:- - - --,
I NAME I
I ADDRESS I
I I
I TELEPHONE I
I SERVING CANADIANS YEAR ROUND I
L... _ _ _
E
R
T.:... _ _ _.J
F.A. DAVIS COMPANY
INTER-OFFICE MEMO
TO Canadian Nurse Educators
Re: Saperstein & Frazier:
INTRODUCTION TO
NURSING PRACTICE.
FR
ITID.UT
(r\WU)iIng WxI IiU1I
u.p-d.arað
rb .
By Arlene B. Saperstein, MN, RN, Assistant Professor, Division of Nursing Studies, Curry College, Milton, Massachusetts; and
Margaret A Frazier. MS, RN, Director, Learning Resources Laboratory, Boston University, Boston, Massachusetts; with 43 other
contributors.
(A new. fundamental nursing text that up-dates the basIcs).
1. Does this book cover concepts adequately for a Baccalaureate program?
Yes. Appropriate concepts are selected and thoroughly discussed. Concepts relating to the client, health and illness, and
the health care system are covered extensively. Concepts are applied to the practice of nursing and many examples,
covering a variety of clinical settings, are interwoven throughout.
Strengths of the book's conceptual approach:
1. Emphasizes a wellness approach to heal.th care and nursing rather than being disease-oriented.
2. Discusses the latest concepts, e.g., material on homeodynamics and stress, crisis, group process, client as consumer,
legal aspects of nursing.
3 Provides detailed, in-depth coverage that is organized and presented in such a way as not to confuse the student
4. Follows through on concepts and integrates them throughout the text.
5. Explains psychosocial aspects as well as physical aspects and emphasizes their interaction.
6. Presents the client as an active participant in his health care. rather than a passive recipient of care.
7. Presents the nurse as a person with the necessary knowledge and skills to assess the client"s health care needs,
coordinate health care efforts and resources, and plan and provide health care measures to meet the client"s needs,
including providing client education and acting as client advocate.
8. Helps the student to better understand herself as a person and as a nurse, and to make optimum use of her potential.
2 Does this book adequately cover the skills and nursing procedures for a Baccalaureate program?
Yes. A unit on the nursing procedure presents a step-by-step process of obtaining data, formulating a nursing diagnosis and
care plan. implementing the plan of care, and evaluating nursing care. Not merely a check list of what to do, this unit
explains how and why.
The next unit discusses. in-depth, specific clinical skills and procedures. The student is introduced to: the procedure,
when and why it is used, the necessary equipment. the preparation of the client. the skills utilized, and what and how
to monitor during and after the procedure.
Strengths of the book's approach to this material:
1. Consistently focuses on helping the client. not merely being able to perform procedures.
2. Chapters Include glossaries as a helpful reference for students.
3 Includes the latest procedures and equipment.
4. Excellent tables present step-by-step descriptions of the procedures, the scientific principles/rationale upon which they
are based, and specific suggestions and nursing considerations.
3. Does the book attempt to cover physical assessment/physical examination? If so, how well is it done? Should this be
included in a fundamentals text?
Yes. Separate chapters on physical examination of the adult and assessment of the child allow more extensive discussions
of theories, scientific principles, implicatIons, and special considerations, along with the step-by-step specifies of a physical
examination. Nurses are performing more and more physical assessments and a fundamentals book including such material
is most appropriate for a Baccalaureate program.
4. Does the book adequately cover human sexuality, legal aspects, communication skills and interviewing techniques,
preventive health care, psychosocial aspects, and group process?
Yes. Two of the strong features of the book are the thorough treatment ofthese topics in individual chapters and the application
of the material throughout the book.
JMK:cd
-Al1Mi1i.on ÑWtbimo EwtrOTO'lb:
Write to our textbook marketing department in Philadelphia.
Pennsylvania. on your school s letterhead. to receive copies
for adoption consideration. Be sure to include the title of
the course you will be teaching, enrollment, and the name of
the text you currently require for the course.
:::J F. A. DAVIS COMPANY
Ñ, 1915 ARCH STREET
':: PHILADELPHIA, PENNSYLVANIA 1
.
DIstributed in Canada by
McAJnsh II C. . lid We c 'm Branch
IS:- 5 Yonge :"ue ,t 730 W st Broadwa
Toronto Ontallo M4S 1 L6 Vancouver BC V 1r
books
Admittance restricted: The Child as a
Citizen in Canada. Repon:
published by the Canadian Council
on Children and Youth. 1978. 172
pages.
Approximate price: $8.95.
This repon is about children, about
the attitudes. policies and practices that
affect the quality of life for children in
Canada: the title itselfsignifie!> that
current practices in providing for the
need.. of children have grave limitations.
The Task Force which authored the
repon is a group of practicing
professionals from the fields of health.
education. child welfare, child protection
and la\\. and they present their
examination and opinions of a variety of
issues. Generally. they repon on the
status of children in Canada. looking at
four area.. of concern: health care.
protection, economic suppon and
education. The purpose of the repon is
to give a holistic approach to the needs of
children and to spark a debate from
which changes might evolve. as well as
to provide a !>ource book from which
communitie.. can identify their own areas
of concern.
The repon is a valuable source
book, and one chapter in panicular.
'The Child's Need for Health Care" is
of relevance to nurses. especially those
working in community programs.
Rniewed b\" Karin ,'on Schilling, RN,
MScN. Associate Professor, School of
NursinR. McMaster Uni\'ersity,
Hamilton. Ontario.
Canadian Standards Association
C.S.A.'s Committee on Sterilization has
recently published two handbooks on
standards for sterilization which might
be helpful for nurses working in C.S.R.,
O.R.. or small surgical clinics or offices.
The books include guidelines for
packaging materials, sterility testing.
record-keeping, and various sterilization
methods. The books are Effecthe
Sterilization in Hospitals b) the Eth)lene
Oxide Process ($8.50) and Effective
Sterilization in Hospitals by the Steam
Process ($7.50). For infOimatior. On
ordering, contact the Standards
administrator. Health Care Technology
Program. C.S.A.. 178 Rexdale Blvd.,
Rexdale, Ontario. M9W IR3.
Th. Cenedlen Nur..
Care of Children in Health Care
Setting A Re
ource and Self
E\aluationGuide i..sued by the
Canadian 1 n
titute of Child Health.
This text !>ets out to do e"actly
a.. de!>cribed - act as a re
ource and
..elf-evaluation guide. Becau
e it
doe
not get sidetracked. 1 feel it ...
one of the beM planned and most
down-to-eanh tool.. available to
pediatric unit.. in general ho!>pital..
\\ hich are trying to survive and. at
the <;ame time. offer high qualitv
care to children \\ ithin a setting that
i
e
entially geared to adult... I nits
appendices. the text offers
guideline!> 10 a polic} manual. a \ ital
tool in any depanment. Also
D8c:ember 1979 53
included i.. a li..t of procedure.. that
<;hould be ..et out. a teaching 1001 on
CPR. and a ..erie.. of Profile Sheeh
\\ hich are very well done. The text
offer.. too d collection of lists:
available boob. organization<;
\\hich deal with children. and
information about film rental from
theCiCH.
-\11 in all thi<; boo"- !>eem<; to be a
busy head nurse's dream. and
anyone !>taning out a<; a ne\\ head
nurse or
etting up a new unit
hould
cenainly appreciate it.
Rt','iewed hy J eHica Ryan. head nurse.
Chaleur General Hospital, and
11Ie11lher-at-larRefor nur
inR practice.
CNA Board (
rDirect(}rs.
"When I was thirteen, I really wanted
to be a nurse. Today I remembered why:'
/
( .
"Patient contact. That's
what nursing meant to me
all along. And that's what I get
as an Upjohn HealthCare
Services SM nurse.
f'+
j .-
, ..
,.....,
.
t-
........
''I'm the kind of person
who needs that special one-
on-one relationship with a pa-
tient. I also need some control
over my work schedule, for my
family's sake. And I thrive on
variety...it keeps me growing.
"Working with Upjohn
has turned out to be a different
kind of nursing than I'd
ever known. But it's the kind
I always had in mind."
HMb402.C@; 1979 HeolthCore Stotv,c", UPlohn.l.d
r
Interested? Find out
what others say about Upjohn
HealthCare Services. Oppor-
tunities in home care, hospital
staffing and private duty. Of-
fices in 14 communities across
Canada. Write for our booklet
today.
-----------------------
[A]
K)HN
E:D HEALTHCARE
-.- SERVICES SOl ,
" -
I.
Please send me your
free booklet "Nursing
Opportunities at
Upjohn HealthCare
Services."
"'ome
Addreso:.
Phone
City Provmce Postal Code
Mail to: Upjohn HealthCare Services
Dept.A
Suite 203
716 Gordon Baker Road
Willowdale, Ontario M2H 3B4
-----------------------
54 D8c:ember 1979
F
o
OSe.
) 'f
Fe.. \.
'I Obb'f
p
'f
c,O
'
POSEY
MODESTY APRON
\,
Help your patients cover up with the
Posey Modesty Apron. Attractive, colorful
prints In nylon jersey material. Waist strap
helps keep them sitting comfortably In
chair. Each apron has a handy pocket.
No. 4550
)
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POSEY HEEL PROTECTORS
All the features of higher priced heel pro-
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Difficult to remove but comfortable to
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No. 3614
Health
Dimensions Ltd.
2222 S. Sheridan Way
Mississauga, Ontario
Canada LSJ 2M4
Tél.: 416/823-9290
"'4
Th. Cenedlen Nur..
BOOKS RECEIVED
Listing of a publication does not preclude its
subsequent review. Selections/or re
'iew will
be made according to the interests of ollr
readers and as space permits. A /I rel'iew sa re
prepared on im'itation.
Teaching and learning strategies for
physically handicapped students, by Mary
Lynne and Calhoun & Margaret F. Hawisher.
Baltimore, University Park Press, c1979.
Recreation programming for
developmentally disabled persons, edited by
Paul Wehman, Baltimore, University Park
Press, cl979.
Gastroenterology in clinical nursing, by
Barbara A. Given & SandraJ. Simmons. 3rd
ed. Toronto, Mosby, 1979.
Basic drug calculations, by Meta Brown.
Toronto, Mosby, 1979.
Handbook for infectious disease
management, by Come lis A, Kolff & Ramon
C. Sanchez. Don Mills, Ont.,
Addison-Wesley, c1979.
Compliance and excellence, edited by W.T.
Singleton. Baltimore, University Park Press,
c1979.
Vocal resonance; its source and command,
by M. Barbereux-Parry. North Quincy,
Mass., The Christopher Publishing House,
c1979.
Instructional guide to the nature and
managementofstress, byG. Maureen
Chaisson. Tucson, Arizona, University of
Arizona Health Sciences Center, c 1978. (54
color slides, I audio cassette, I instructional
guide booklet, I duplication master copy of
the post-test)
Childbirth education: a nursing perspective,
by Jeannette L Sasmor. Toronto, Wiley
Medical Publication, c1979.
Review of hemodialysis for nurses and
dialysis personnel, by e.F. Gutch & Martha
H. Stoner. 3rd ed. Toronto, Mosby, 1979.
Mosby's manual of emergency care;
practices and procedures, by Janet M. Barber
& Susan A. Budassi. Toronto, Mosby, 1979.
Bacteriology and immunity for nurses. by
Ronald Hare & E. Mary Cooke. 5th ed. New
York,Churchill Livingstone, 1979.
Notes on gynaecological nursing, by William
C. Fream. New York, Churchill Livingstone,
1979.
Combatting cardiovascular diseases
skiUfuUy. Hosham, Pa., Intermed
Communications, c1978.
The human heart; a guide to heart disease,
by Brendan Phibbs. 4th ed. Toronto, Mosby,
1979.
Free yourselffrom pain, by Dr. David E.
Bresler & Richard Trubo. New York, Simon
& Schuster, c1979.
Infant and toddler learning episodes, by
John H. Meier & PaulaJ. Malone. Baltimore,
University Park Press, c1979.
Learning episodes for older preschoolers, by
John H. Meier & Paula J. Malone. Baltimore,
University Park Press, c1979.
The &Cute abdomen for the man on the spot,
by J.e. Angell. 3rd ed. London, Pitman
Medical, cl978.
Psychological aspects of myocardial
infarction and coronary care, edited by W.
Doyle Gentry & Redford B. Williams. 2d ed.
Toronto, Mosby, 1979.
A vision fulfilled; the story of the child ren' s
hospital of Winnipeg 1909-1973, by Harry
Medovy. Winnipeg, Man.. Peguis Pub., 1979.
Writing scientific papers in English; an
ELSE-Ciba Foundation guide for authors, by
Maeve O'Connor & F. Peter Woodford.
London, Pitman Medical, cI977.
Child abuse and family-centered care, by
Rosella Cunningham. Toronto. University of
Toronto. c1979.
Geriatric care for nurses, by F.
Barrowclough & e. Pinel. London. William
Heinemann, c1979.
Sanctit" of life or quality of life in the context
of ethics, medicine and law. Ottawa. Supply
and Services. 1979.
The nursing process a humanistic approach,
by Elaine Lynne La Monica. Don Mills.
Ontario. c1979.
Pediatric cancer therapy, edited by Carl
Pochedly. Baltimore, University Park Press,
c19",9.
ECG arrhythmia interpretation: a
programmed text for health care personnel, by
Harold A. Braun & Gerald A. Diettert.
Reston, Virginia. Reston Pub. c1979.
New directions in patient compliance, edited
by Stuart J. Cohen. Toronto. Lexington
Books. c1979.
One in ten; the single parent in Canada,
edited by Benjamin Schlesinger. Toronto,
University of Toronto, c 1979.
The pocket medical encyclopedia and first
aid guide, byDr. James Bevan. New York.
Simon & Schuster. 1979.
Classroom evaluation strategies, by
Elizabeth C. King. Toronto, Mosby, 1979.
Care of the high-risk neonate, by Marshall
H. Klaus & Avroy A. Fanaroff. 2d ed.
Toronto. Saunders, 1979.
.THE LIBRARY'S ACCESSION LIST IS
AVAILABLE ON REQUEST WITH A
STAMPED, SELF -ADDRESSED
ENVEWPE.
Overseas Opportunities
NlIRS[S
CLISa has openings for public health
nu"es and nursing instructors in Africa
and Papuà ;'I;ew Guinea. Applicants must
hà
e Canadian qualifications and be pre-
pared to "ork with limiled supplies and
eljuipment. TraHI is an important COm-
ponent of communih health care "ork.
"hile nurse instructors are usuall\
a((àched to nursing colleges.
Qualifications: Degree and or Public
Health .r-; ursing experience is essential.
Contract: 2
ears.
."'alar}': I 0" b\ Canadlàn standards but
sufficient for an adequate lifcst
Ie.
Couples will be considered if there are
positions for both partne".
For more information. "rite.
ClISO Health-DI Program
151 Slater Street
O((a"a. On!. KIP 5H5
Th. Cenadlan Nur..
D8c:ember 111711 113
Classified
Advertisements
Alberta
urw Coordinator For l.nhersity-
d Genelíc
Coun
Ulng Programme. Duties include data collec-
tion and pedigree drawing, followup Questionnaires
or ,isits. inservice and undergraduate teaching.
public education. and bibliographic searches. Suita-
ble candidate with Master's degree will also be
appointeð to Faculty of Nursing at the level of
instructor or assistant professor. Send curriculum
vitae and 3 references to: Director. Northern Alberta
Programme for Prevention oflnherited Diseases. 4th
Floor. Clinical Sciences Bldg.. Edmonton, Alberta,
HG Xi3.
British Columbia
Experienced LeneraJ Duty Graduate
urses required
for small hospital located N .E. Vancouver Island.
Maternity experience preferred. Personnel policies
according to RNABC contract. Residence accom-
modation available 530 monthly. Apply in writing to:
Director of Nursing. St. George's Hospital, Box 223,
Alert Bay. British Columbia. YON IAO.
General Duty Nurse for modem 35-bed hospilaJ
located in southern B.C's Boundary Area with
excellent recreation facilities. Salary and personnel
policies in accordance with RNABC Comfortable
Nurse's home. Apply: Director of Nursing. Bound-
ary Hospital, Grand Forks. British Columbia. VOH
IHO.
General Duty Registered
urse, required for 108 bed
accredited hospital. Previous experience desirable.
Staff residence available. Salary as per R.N.A.B.C
Contract with northern allowance. For further
information please contact: Director of Nursing.
Io.itimat General Hospital. 899 lahakas Boulevard
N.. Kitimat. B.C V8C IE7.
Experienced
urses (B.C Registered) required for a
newly expanded 463-bed acute. teaching. regional
referral hospital located in Ihe Fraser Valley, 20
minutes by free"'ay from Vancouver. and within
easy access of various recreational facilities. Excel.
lent orientation and continuing education program-
mes. Salary-1979 rates-51305.()0-51542.00 per
month. Clinical areas include: Operating Room. Re-
covery Room. Intensive Care. Coronary Care.
Neonatal Intensive Care. Hemodialysis. Acute
Medicine. Surgery. Pediatrics. Rehabilitation and
Emergency. Apply to: Employment Manager. Royal
Columbian Hospital. 330 E. Columbia St.. New
Westminster. British Columbia. V3l 3W7.
Experienced Nurses (eligible for B.C Registration!
required for full-time positions in our modem
300-bed Extended Care Hospital located just thirty
minutes from downtown Vancouver Salary and
benefits according to RNABC contraCI. Applicants
may telephone 525-0911 to arrange for an interview.
or write giving full particulars to: Personnel Direc-
tor. Queen's Park Hospilal. 315 McBride Blvd..
New Westminster. British Columbia. V3l5E8.
Registered Nurses required for both acute and
extended care in a 125-bed hospital in the South
Okanagan. Experience in obstelrics and medical-
surgical preferred. RNABC contract in effect. Apply
stating Qualifications and experience to: Nursing
Administrator. South Okanagan General Hospital.
Box 7f1J. Oliver. British Columbia. VOH \TO. Phone:
498-3474.
Hud 'l/une for male medical/surgical ward required
for early 1980. Experience as a Head Nurse. N.U.A.
and university preparation desirable. Also. general
duty nurses for all services in 156-bed accredited
a
ute care hospi
1 are required. Apply in writing to:
Director of Nursmg. West Coast General Hospital,
3841 8th Avenue. Pon Alberni, British Columbia.
V9Y 4S I.
British Columbia
(;eneral Duty RN's or Greduete 'l/urses for 54-bed
Extended Care Unit located six miles from Dawson
Creek. Residence accommodation available. Salary
and personnel policies according to RNABC Apply:
Director of Nursing. PouCe Coupe Community
Hospilal. Box 98. Pouce Coupe. British Columbia or
call collect (6041786-5791.
Regis1ered Nurses required immediately for a 340-
bed accredited hospital in the Central Interior of
B.C Registered Nurses interested in nursing posi-
tions at the Prince George Regional Hospital are
invited to make inquiries to: Director of Personnel
Services, Prince George Regional Hospital. 2()()() -
15th Avenue. Prince George. British Columbia,
V2M IS2.
Registered Nurses required for penn,ment fulltime
position at a 147-bed fully accredited regional acute
Care hospital in B.C Salary at 1979 RNABC rate
plus non hem living allowance. One year experience
preferred. Apply: Director of Nursing. Prince
Rupert Regional Hospital. \305 Summit Avenue,
Prince Rupert. British Columbia. VSJ 2A6. Tele-
phone (collecf) (604) 624-2171 local 227.
ExPerienced maternity, I.C.l,fC.C.U.. end
rat-
Ing Room General Duty aunes required for IOJ-bed
accredited hospital in NOrlhern B.C Must be
eligible for B.C. registration. Apply in writing to the:
Director of Nurses. Mills Memorial Hospital. 4720
Haugland Avenue. Terrace. British Columbia, VIIG
2W7.
Head Nurse for 16-bed Psychiatric Unit in a
Northern B.C hospital. Mu" be eligible for B.C.
registration with a minimum of two years experience
and proven administralive skills in a similar position.
Apply in writing to the: Director of Nurses. Mills
Memorial Hospilal, 4720 Haugland Avenue, Ter-
race, British Columbia. VIIG 2W7.
Registered Nurses - Full-time and casual relief
positions are available at the University of British
Columbia, Health Sciences Centre. Extended Care
Unit. The 12 hour shift. the problem oriented record
charting system. and emphasis on maintaining a
normal and reality based clinical environment, and
an mterprofessional approach to management are
some of the features offered by the Extended Care
Unit. Interested applicants may enquire by calling
228-6764 or 228-2648. Positions are open to both
male and female applicanls.
Manitoba
Challengine Carftr Opportunit) fGr Rrgistered 'Junes in
C'nutda'
'orth - A JlX) bed aCUle Care hO!.Pll..tJ In !\,ol1hern
Manitoba ",hlch services Thompson and "eve.-al small
communities in the "ufToundmg area has immediate \lacan-
cie!. in Pediatric
. Medicine/Surgery. Obstetrics and Cntìcal
Care. This opponunit}l will appe4flto nurses who want 10
increase their e'\lstìng skdl\ or de\.clop new skills through our
comprehensive ìnsen ice program. Many of our nUl'"Ses have
become e
perienced in flight nursing. Candidates must be
eligible for pro\.incial registration as acti\.e practicing
membel'"S. We offer an excellent range of benefits. in.::luding
free dental plan. accident. health and group life Insurance.
Sala'). range is SI.078 - SI.J
O per month depeooen' on
qualifications and experience plus a remoteness allowance.
Apply in "",riting or phone: Mr R L Irvine. Director of
Pel'"Sonnei. Thompson General Hospital. Thompson. 'tan-
itoba. R
f',OR8. Phone: t2(4) 677-2Jgl
Northwest Territories
The Stanton Yellowknife Hospital. a 72-beå accre-
dited. acute care hospital requires registered nurses to
work in medical, surgical, pediatric. obstetrical or
operating room areas. Excellent orientation and
inservice education. Some furnished accommoda-
tion available. Apply: Assislant Adminislrator.
Nursing. Stanton Yellowknife Hospital, Box 10,
YeUowknife, N.W.T., XIA 2NI.
Saskatchewan
Registered !\iurse required for l3-bed acute care
hospital in Southweslern Saskatchewan. Salary as
per current S.H.A.-S.U.N. Agreement. Please send
resume to: Mrs. G.P. W,lliamson, Secretary-
Treasurer. Kincaid Union Hospital. Kincaid, Sas-
katchewan. SOH 2J0. Telephone - Office (306)
264-3227 or Residence (306) 264-3349.
R.1Ii. 's and R.P.N.'s (eligible for Saskatchewan
regIStration) required for 340 fully accredited ex-
tended care hospital. For further information.
contaCI: Personnel Department. Souris Valley Ex-
lended Care Hospital. Box 2001. Weyburn. Sas-
katchewan S4H 2l7.
Vnited States
R.N.', l;.S.A. - Dunhill with 250 offices has
exciting career opportunities for both recenl grads
and experienced R.N. 's. locations Nonh. South.
East and West_ All fees are paid by the employer.
Send your resume to: 801 Empire Building, Edmon-
ton. Albena. T5J IV9.
Nunes - RNs - A choice of locations with
emphasis on the Sunbelt. You must be licensed by
examination in Canada. We prepare Visa fonns and
provide assistance wilh licensure at nO cost to you.
Write for a free job market survey Or call collect
(713) 789-1550. Marilyn Blaker, Medex, 5805
Richmond. Houston. Texas 77057. All fees employer
paid.
California - Somelimes you have to go a long way
to find home. But. The White 'femorial Medical
Center in los Angeles. California. makes it all
worthwhile. The White is a 377-bed acute care
teaching medical Center with an open invitation to
dedicated RN's. We'll challenge your mind and offer
you the opponunit) to develop and continue your
professional growth. We "ill pay your one-way
trnnsportation, offer free meals for one month and all
lodging for three months in Our nurSes residence and
provide your work visa. Call collect or write: Ken
Hoover. Assistant Personnel Direclor. 1720 Brook.
Iyn Avenue, Los Angeles, California 90033 (213)
268-5000. ext. 1680.
t10rlda Nunlq Opportuallies - MRA is recruiting
Registered Nurses and recent Graduates for hospital
positions in cities such as Tampa, St. Petersburg.
and Sarasota on the West Coast; Miami, Ft.
Lauderdale and West Palm Beach on the East Coast.
If you are considering a move to sunny Florida.
contact our Nurse Recruiter for assistance in
selecting the right hospital and city for you. We will
provide complete Work Visa and State licensure
mformation and offer relocation hints. There is no
placement fee to you. Write or call MedkaJ
R<<rulten or "-rial, IDC. (For West Coast) 121 IN.
Westshore Blvd., Suite 205, Tampa. Fl. 33607 (813)
872
202: (For East Coast) 800 N.W. 62nd St., Suite
510. Ft. lauderdale, Fl. 33309 (3051772-3680.
Nurse. - RN. - Immediate Openings in
California-Florida-TeJlas-Mississippi - if you are
experienced or a recent Graduate Nurse we can offer
you positions with excellent salaries of up to 51300
per month plus all benefits. Not only are there no
fees to you whatsoever for placing you, but we also
provide complete Visa and licensure assistance at
also no cost to you. Write immediately for our
application eVen if there are other areas of the U.S.
that you are interested in. We will call you upon
receipt of your application in order to arrange for
hospital interviews. You can call us collect if you are
an RN who is licensed by examination in Canada or
a recent graduate from any Canadian School of
Nursing. Windsor Nurse Placement Service, P.O.
Box 1133. Great Neck, New York, 11023. (516-
487-2818).
"Our 20th Year of World Wide Service"
14 D8c:....ber 1979
Th. Cenedlen Nur..
Offers R.N.'s
An UNUSUAL OPPORTUNITY.
A.M.I. Will fURNISH One Way AIRLINE TICKET to Texas
Ind $500 In It III LIVING EXPENSES on I Loan Basis.
After Onl Vllr's Service, This Loan Will be Cancelild
MI American Medicallnternationallnr..
. HAS 50 HOSPITALS THROUGHOUT THE U.S.
. lIow A.M.!.ls R'CI\IlIlng II.N:llo. Hospllals In Tells
Immldlalo Oplnlngl. Salary Range $11.900 10 $16.500 per Yoa..
. You can enjoy nu,sino in General Medicine. Surgery. ICC.
CCU. Ped,alllcs and Obstetllcs
. A M I provIdes an excellent Ollentation program.
in.servlce t.ammg
r-------------.
I
,
, U.S. Nurse Recruiter ,
_ P.O. Box 17778, Los Anllel4's. Calif. 90017 ,
I . Wllhout ob"gallon. please send me more. ,
Inlormation and an ApplicatIon Form I
- IIAME ____________
_ AOORESS____ ___ ____
_ CITY. ___ ST.___ ZIP___I
TELEPHONE(_ _I. _____ _ __
I L1CENSES.___________,
_ SPECIAlTY: _
___ _. _ _ _ _-I
YEARGRAOUA'EO:___ STATE _ __
..____________rI
United States
Dallas, Houston, Corpus Christi, elc, elc. etc. The
eyes of Texas beckon RN's and new grads to
practice their profession in one of the most
prosperous areas of the U.S. We represent all size
hospitals in virtually every Texas and Southwest
U.S. City Excellent salaries and paid relocation
expenses are just two of many super benefits
offered. We will visit many Canadian cities soon to
interview and hire. So we may know of your
interest, won', you contact us today? Call or write:
Ms. Kennedy, P.O. Box 5844, Arlington. Texas
76011. (214) 647-0077.
Waterford Hospital
Career Opportunities For
Registered Nurses
.
Okanagan College
Coordinator of
Nursing Education
Duties:
Responsible to the Dean of Instruction
for the day-to-day operation of all
nursing programs including a Diploma
Nursing program (28 months), a Practical
Nursing program (10 months), Long
Term Care Aide (14 weeks), refresher
courses, seminars and workshops.
Post-basic courses are planned.
Additional responsibilities in health
education may be developed in the
future. Some teaching is required.
Qualifications:
M.Sc.N. desirable or equivalent:
experience in nursing education and
administration; teaching experience;
varied clinical experience; demonstrated
leadership qualities. The successful
candidate must be a B.C. registered
nurse or eligible to become one.
Salary: In the $30,OOO/annum range
Benefits: A comprehensive package
is provided.
Duties to commence in the summer of 1980.
Applications and furtherinformation:
The Dean or Instruction
School or Health Education
Okanagan College
1000 K.L.O. Road
Kelowna, B.C.,
VIY 3V3.
Closing Date: 29 February 19RO
EXPERIENCED RN'S &
NEW GRADS .
I ..
"THE PERFECT OPPORTUNITY" t
Saint Anthony Hospital, located in Columbus, Ohio. , I
This 400-bed acute care facility offers excellent opportunities j
for furthering your nursing career. ,
No Contracts 10 Sign I
Rotating Shirts
Air Fare Paid
One Month Free Accommodations I
Plus Exciting Challenges
Saint Anthony, a medical-surgical institution, has a complete f
range of services, including:
. Open Heart Surgery
. Intensive and Coronary Care
. Definitive Observation Unit
. Renal Dialysis
. Diagnostic and Therapeutic Radiology
. 24 Hour Emergency Department .
Don't wait, call or write immediately. 111111-
Make the change to an institution that lets you be what you I 1III I
want to be. For further information, call our Nurse Recruiter,
Norma Shore, CoDed. '-"1'1
EXCLUSIVE CANADIAN REPRESENT A TlVES
RECRUITING REGISTERED NIJRSF's INC.
1200 Lawrence A venue East
Suite 30 I, Don Mills
Ontario M3A ICI ... .. ,- -
Telephone: (416) 449-58113
The Watcrford Hospital. a fully accredited 400
Þcd P..yd1latnc In..lliulion. affiliated with
Memond) llm\lcr..il)' C;;chool ofNur..lOS; and
'1cdical School. ha'\ openln':!\; for Rf'gl
tcred
Nur..c'\:n ",II 'Iiiocrviccs. including new.
c"<pandcd. c\nd acute care ..crvice..
An or;cnl.-\llon program i.. offered
Salary 1'1; on the ..calc ofSI2.0
- 14.5S5 per
anm,m A P'Iiioychialric Service A.llow
nce of
SI.l29rer annum i.. available ili addltioll to
ba..ic
alary. Roth ..alary and "illo"-ancr
pre..cntly under review
The Ho"pltall.. clo
e to aU amemlle,:
shopping. transportation and reCf'Canon
facilitle
Accommodations 3'Vadahle In Hospital
Re..idence at nommal co
r
APf1licarlOn
'" wnrmg should tie addre",..ed to
the undcr
lgncd:
Pt-nonnrl ()irKtor
"..'rrford H
plr.1
W.luford Brtdlft: Roed
St. John'
. Nrwfoundl.nd
AlE 4J8
TekpholW Numbt-r: (109) :\68-6%1, rxt. 341
Th. Cen.dlan Nur..
D8c:.mber 111711 65
United States
USA - Position
available in Texas, Arkansas and
Nevada. for ReglRend Nunes. For informalion
plea
e write to: Mrs. G. Nees. President, Pacific
International Employment Service Inc., 7110 Dye
Drive, Dallas. Texas, 75248.
Before accepting any
position in the U.S.A.
PLEASE CALL US
COLLECT
We Can Offer You:
A) Selection of hospitals throughout
the USA.
B) ExtenSive Information regarding
Hospita
Area. Cost of living. etc.
CJ Complete licensure and VIsa ServIce
Our Services to you are at
absolutely no fee to you.
WINDSOR NURSE
PLACEMENT SERVICE
P.o. Box 1133 Great Neck. N.Y. 11023
(516) 487-2818
..... Our 20th Year of World Wide Service ...,j
New Brunswick
Application
dre invited for the following
po_ition for the academic year beginmng July
I. I9ROin a ba_ic haccalaureate program.
An expenenced teacher in both the acute care
clinical setting and the classroom in
Medical-Surgical Nursing to work with
senior students.
Applicants should be able to qualify for the
rank of A"istant or A"ociate Profe"or.
Doctoral degree preferred. Ma"er's degree
e"ential.
Salary .s In accordance with qualifications and
experience.
Applications should be addressed to:
Dean I. L<<kie
Facuhy of "Iursing
University of 'lie.. Bruns..ick
P. O. Box 4400
Fredericton. N. B.
E3B SAJ
Cape Breton Hospital/Braemore
Home Complex
Community Mental Health Nurses
The Cape Breton Hospital(Braemore
Home Complex has vacancies for 2
Community Mental Health Nurses.
These positions report directly to the
Coordinator of Community Mental
Health Nursing.
The successful candidates will be
responsible for direct nursing care for
clients reporting on an out-patient
basis. including counselling service;
and consultation on psychiatric nursing
care. A Bachelor of Science in Nursing
required; previous psychiatric
experience is essential.
Interested applicants please reply to:
Director or Personnel
M. V. Fortune-Stone
P.O. Box SIS Sydney, Nova Scotia
BIP6H4
Come to Tou - Bapt.st Hospital of Southeast
Texas is a 400-bed growth orienled organization
looking for a few good R.N.'s. We feel that we can
offer you the challenge and opponunity to develop
and continue your professional growth. We are
located in Beaumont, a city of 150,000 with a small
town atmosphere but the convenience of the large
city. We're 30 minutes from the Gulf of Mexico and
surrounded by beautiful trees and inland lakes.
Baplist Hospilal has a progress salary plan plus a
liberal fringe package. We will provide your immig-
ration paperwork cost plus airfare to relocate. For
addilional information, contact: Personnel Ad-
ministration. Baplist Hospital of Southeast Texas.
tnc.. P.O. Drawer 1591, Beaumont. Texas 77704. An
amrmatlve IICtlon employer.
,,"xcitement: Come and join us for year around
excitement on the border. by the sea. an unbeatable
combination. Enjoy the sandy beaches of So. Padre
Island or the unique cultures of Old Mexico. Our
new 117-bed. acute care hospital offers the experi-
enced nurse and the newly graduated nurse an array
of opponunities. We have immediate openings in all
areas. Excellent \alary and fringe benefits. We invite
you to share the challenge ahead. Assistance with
travel expen,e,. Write or call roUeCI: Joe R. Lacher,
RN. Director of Nurses, Valley Community Hospi-
tal. P.O. Box 4695, Brownsville, Texas 78521; t
(512' 831-9611.
[
Æn
Team Leaders
The Eric Cormack Centre. Edmonton, which provides residential accommodation
and developmental opportunities for 92 dependent multi-handicapped children
and young adults. has a number of full-time, part-time and short-tenn Team
Leader positions available. These persons will supervise and direct a team in
providing for the health maintenance needs of residents living on a 24 bed unit.
Emphasis is placed on developmental nursing programs and the Team Leader will
participate in and assist staff in establishment and initiation of varied resident
development programs, as well as supervising and co-ordinating ongoing
programs. Varied shift assignments are available.
Qualifications: Graduation from a recognized school of nursing and current
eligibility for registration in the appropriate professional organization. A strong
desire to develop health maintenance and developmental nursing skills would be
essential. Some exposure and expenence in the field of mental retardation. as well
as some supervisory experience would be an asset.
Salary $14,748- $17.340
Competition #9176-11
This competition will remain open until a suitable candidate has been selected
Unit Supervisor
Alberta Social Service
and Community Health. Eric Connack Centre, has an
opening for a Unit Supervisor who is responsible for the direction of a specific 24
bed unit, on a shift rotational basis and be responsible to assist in the penonnance
of general supervisory and administrative duties. Duties include providing
direction to unit personnel regarding resident care and programming. assisting
staff in the initiation and development of specific programs, to providç for growth
and development of each resident.
Qualifications: Graduation from a recognized School of Nursing (R.N.. R.P.N..
M .D.N.). Eligible for registration in A.A.R.N. or other appropriate professional
organization. Considerable related nursing experience. some of which should be
in a supervisory capacity. Experience ih the field of Mental Retardation would be
an asset.
Salary $15,372 -$18.840
Competition #9177-4
This competition will remain open until a suitable candidate has been selected
Apply to:
Alberta Government Employment Office
5th Floor, Melton Building
10310 Jasper A venue
Edmonton, Alberta
T5J 2W 4
61 December 1979
Th. Cen.dlen Nur..
Head Nurse
Head Nurse for the Paediatric Unit
of 50 beds in a 400 bed acute care
regional referral hospitaL Must
have NUA course; preferably a
nursing degree and with 3-5 years
experience with demonstrated
administrative skills and clinical
expertise. RNABC rate $1,500.00
to $1,772.00 per month plus
education differential.
Apply to:
Personnel Director
Royal Inland Hospital
311 Columbia Street
Kamloops, British Columbia
V2C 2TI
Intensive Care Nurses
300 bed Accredited general
hospital in Vancouver requires
full-time R.N.s for 4 bed I.C. U.
Candidates should be eligible for
registration with the RNABC.
Previous LC.U. experience
required.
Please apply in writing to:
Employee Relations Department
Mount Saint Joseph Hospital
3080 Prince Edward Street
Vancouver, B.C. VST 3N4
-
IBIiI
Head Nurse
Applications are invited for the
position of Head Nurse in our 35
bed medical unit.
Qualifications should include
progressive experience in a
medical unit. Baccalaureate
Degree preferred.
Apply in confidence send full
resume to:
Director of Personnel
Public General Hospital
106 Emma St.
Chatham, Ontario
N7L lA8
Supervisor - Operating Room
Required to assume a leadership role in
an expanding Operating Room Suite
presently under construction with date
of completion September 1980.
The applicant must have demonstrated
leadership and administrative skills,
post-graduate education in O.R.
nursing and past experience as a Head
Nurse or Supervisor.
Must be eligible for B.C. registration.
Position becomes available January 1980.
Prince George Regional Hospital is a
340 bed acute Regional Referral
Hospital located in Central B.C.
Qualified applicants are invited to
submit their resumes to:
Assistant Executive Director,
Patient Services
Prince George Regional Hospital
2000 - 15th A venue Prince George. B.C.
V2M IS2
University of British Columbia
M.Sc.
(Health Services Planning)
Programme
A programme is offered which is specifically
designed for persons with experience in
health and/or social services. Applicants
must be graduates in one ofthe health. social
or life sciences. or Commerce.
Candidates without experience in health care
are eligible, but preference will be given to
praclising health professionals or managers.
II is anticipated that graduates will find
appointments at relatively senior planning
levels of Canadian or international health
selVices or in health care research.
Students laking the research option are
eligible to apply for Nalional Health Grant
Fellowships and Student Fellowships.
For details. write to:
Course Director (Health Services
Planning)
Dept. of Health Care & Epidemiology
University of British Columbia
2075 Wesbrook Mall
Vancouver, B.C. V6T lW5
Nursing Supervisor
Required for a surgical area in a
233 bed Accredited General
Hospital. The successful applicant
will have experience in Nursing
Administration and possess a
B.Sc.N. Degree.
Equivalent combination of
education and experience will be
considered Excellent benefits and
salary range.
Apply To:
Assistant Executive Director of
Nursing Services
St. Joseph's Hospital
290 N. Russell Street
Sarnia, Ontario
N7T 6S3
Head Nurse - Adolescent
Unit
Children's Hospital. Vancouver
A Head Nurse is required to assume a
leadership role in our eXISting 18 bed
Adolescent U nit and to plan for a 22 bed unit in
a new tertiary care teaching pediatric facility
scheduled to open in Vancouver in mid-1981.
This is a challenging opportunity for an
experienced nurse (Baccalaureate preferred)
with proven administrative skills. a ,ound
knowledge of medical and ,urgical nursing lind
a liking of adolescents.
I n the development of Ihis growing
programme. the appointee w:.JI be a key figure
in the Adolescent Care Team and will have an
exciting opportunity to ,hape the future of
adole,cent care in this province.
Interested candidate's possessing these
qualifications should forward their resumes to:
Miss Roselyn Smith
Director or Nursing
Children's Hospital
250 West 59th Avenue
Vancouver, B.C.
V5X lX2
C,lpe Breton Ho'pilal/
Braemole Home Complex
Co-Ordinator-Communit
\Jental Hio-alth :'Iiursing
fhe (dpe !lrelon Ho,pit.lllRraemore Home
Complex m,i(e, .lppliGllionv for the po"lion
01 Co-ordin"tor of ( t'mmonil' \Ientdl He,llth
ur'\mg
I he ,ucce"ful ,Ipphc,tn' ".11 he re'pon,ihle
for the overo.111 admini,trdtlon In l:ummunnv
menldl hedlth nur,ing ",nice' dV "ell ,1\
pro\ rdinE direct nUf'.m!! care on J.n
out-pJ.tlent h...,,,
\ !I.lChelorof Sc.ence in Nor,ing.' required;
\I.."er' Le,el preferred. Succe"fol dpplic,tnt
mll'. po"e,
pre\tiou, P,\dll.ltnc Nur,ing
expenem:e: <tdminl\trdtl\ e experience
",ould he ..m .t',eL .
Sdlð.ry commen,urate "' Ith qUdllfic,t.tlon' .md
expenence:excellenl henefil program ,l\ail,lhle.
Plea,e forv..nd enquirie, to:
Director of Personnel '\1. '\. Fortune-Slone
Cape Breton Ho'pital P.O. IIox !i15
SJdneJ.:'oo>aScotia IItPt.H..
Registered Nurses
Full and part-time vacancies in a
new expanding hospital with
progressive programmes in long
tenn care. rehabilitation and
geriatrics.
Must be eligible for Ontario
registration.
Write to:
Assistant Director of Nursing
West Park Hospital
82 Buttonwood Avenue
Toronto, Ontario
\'16M 2JS
Th. Cen-.llen Nur..
D8c:ember 1971 17
R.N. 's
AMERICA
We have over three hundred openings throughout
the U.S.A.
If you are interested in working in:
florida. Virginia, Maine, New York, New Jersey,
.:\Ussouri, California, !\Iass., or an} other areas
we can offer you the opportunity to broaden your
professional experience in either teaching or
community hospitals. Your preference in specialty
areas will be considered.
. Complete licensure and visa service
· Hospital brochures. areas. benefits. housing.
etc. will be provided to you
Please send your resume to:
International Nurses Registry, Ltd.
1003 Park Blvd.
Massapequa Park, Ne\t York 11762
(516) 798-1300
We place you in a position that fits your
requirements. not just a spot.
I
CJPPORTUIJITY .dl.m
Nurses
Applications are invited for positions at Alberta Hospital,
Edmonton, a 650 bed active treatment psychiatric hospital,
located 4 km. outside of Edmonton.
Successful candidates must be graduates from a recognized
School of Nursing and eligible for registration in their
professional association; willing to work shifts. Vacancies exist
in Admissions, Forensic, Rehabilitation, and Geriatric Services
'\Iote: Transportation is available to and from Edmonton.
Accommodation is available in the Staff Residence.
Salary $I,:!:!9 - $1,445 per month (Starting salary based on
experience and education)
Competition #9184-9
This competition will remain open until a suitable candidate has
been selected.
Qualified persons are invited to phone, write or submit
applications to:
Personnel Administrator
<\-Iberta Hospital, Edmonton
Box 307, Edmonton. Alberta
TSJ 2J7
Telephone: (403) 973-2213
You'll step into "tomorrow's" nursing when you enter our internationally famous teaching, research and acute care
facility. Progressive, interested in your ideas: nursing at Stanford can be all YOIl want it to be. YOU have a major say in
your career advancement. You have time for patient care: to explore new techniques: to research new procedures.
The Stanford Nurse never stops learning.
Enjoy the advantages of a university medical environment. Talk with us. Chances are you'll like the looks of tomorrow.
We offer an outstanding salary and benefit package, today! And under our innovative benefit program, we will even pay
you for your time off! For more information, please send your resume and salary requirements to: Nurse Recruiter,
Stanford University Hospital, Stanford, CA 94305. or call COLLECT: (415) 497-7330. An equal opportunity affirmative
action emplover male/female
--Tomorruw.. is just 38 mites trom
San Francisco ...----------------
-------
,.._.._'.1 I would like to know
more about Nursing Opportunities
S1<mliJrc:ll i1Ì\ -crsit)' ., Stanto'd.
'I $'. :\ ledical Center
Name
f11'mmIT
11111 1 1 .'I'tJ"t
. 'U'tI ..
1111111 , Jt
. 11l111I J "
.
i flTî ,'III!" I ,
_.
f
fll
.
G)
III
I ,"'; T"(
a. _
-
Address
.#
City
State
Phone
Graduate 01 AA
Dip
Area ollnteresl
4
I
Zip
BS_
Yr
C'CN/1279")
88 December 1979
Th. Cenedlen Nur..
Nursing Opportunities in Vancouver
Vancouver General Hospital
If you are a Registered Nurse in search of a change and a challenge -
look into nursing opportunities at Vancouver General Hospital, B.c.'s
m
or medical centre on Canada's unconventional West Coast. Staffing
expansion has resulted in many new nursing positions at all levels,
including:
General Duty ($1305. - 1542.00 per mo.)
Nurse Clinician
Nurse Educator
Supervisor
Recent graduates and experienced professionals alike will find a wide
variety of positions available which could provide the opportunity
you've been looking for.
For Ihose with an interest in specIalIzation. challenges await in many
areas such as:
Neonatology Nursing
Intensive Care
(General & Neurosurgical)
Cardio- Thoracic Sur
ery
lnserv."e Education
Coronary Care Unit Burn Unit
Hyperalimentatiou Paediatrics
Program
Renal Dialysis & Transplantation
If you are a Nurse considering a move please submit resume to:
Mrs. J. MacPhail
Employee Relations
Vancouver General Hospital
855 West 12th Avenue
Vancouver, B.C. V5Z IM9
Wrnø Your TICleøt TO
SOuUlem CalUOrnla
How many times have you had an opportunity to
tell your side of the employment story. . to write
your own ticket as it were with a prospective
employer? As an AN you certainly have formed
certain ideas about what you are looking for in a
job and what you expect from a Nursing Adminis-
tration Dept Well, SMHMC wants to hear from
you.
As a 399-bed teaching hospital we think we have a
lot to offer with our special care areas and our
upbeat, modern approach to the health care field.
But that's just our side. What's yours? Call us collect
or drop the coupon in the mail so we can get
together and exchange ideas. You'll find us flexible
and great listeners. Also, ask about our transporta-
tion reimbursement and temporary housing.
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Q!\> Santa Monica'HoSJ'üal I
Mecßtal C,nter, r! I --,
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Name I
urrlIlIllII1IflrrI
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An Equal O
nity EmploveZ
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Mental Health Nurse
Applications are invited for the position of Mental Health Nurse
with the Digby-Annapolis Mental Health Clinic. The incumbent
will be an active member of a multi-disciplinary team providing
services to the community. Participation in active clinical
programmes including individual, group. marital and family
therapy. Other duties include organizing and co-ordinating
activities with other community agencies. act as consultant to
hospital nursing staff and public health nurses.
Qualifications:
Minimum of 2 years experience in psychiatric or mental health
nursing. Current registration as a registered nurse in the Province
of Nova Scotia. Masters Degree in nursing preferred.
Baccalaureate degree in nursing with additional preparation in
psychiatric or mental health nursing or equivalent acceptable.
Please submit qualifications and resume to:
John Hinton
Department Head
Digby-Annapolis Mental Health Clinic
P.O. Box 249
Digby, Nova Scotia
BOV JAO
Nurses needed for Springdale
Hospital and Valle)' Vista Senior
Citizens Home
Nur.e, dre needed forGeneml OUI} tNur,e I)
dllhi, 30 Þed dccredited dcute care ho'pit,tl
and 76 Þed ,enior citizen, compln.
Opportunitie\ are .tvdildÞle for climcdl
de,elopment m d .... ide ,Ired including
Oþ,letric,. P"edi,uric,. Surger}. C drdiac
C,tre.Genemll\ledlcme .md Fmergem:} in
our dcute care centre.
Our Senior Citizen, Complex hd' Þeen
operating: for jU\t 1"0 \e
lr' clnd \\c are no",
developing,' ne.... pl,m \0 meel the need, of
<;emorCitizen,. Nu"ing w,lI pld' d m,ljor role
m the de,elopment dnd in,tilUlinn of the program.
Support ,erHce, mclude I dÞor..rnn. "( -Ra\ .
PhY\lolhempy. Occupdllondll hempy. Soci,tl
Senice' dnd Home Care Progmm.
We hdve an acttve In-ServICe Progrdm w,th
opportunitie' to d\lend ....ork,hop, dnd
,emind" 'pon,ored Þ) ..\ "Ocidl;on, and
other in,titulion,.
'ecessa
Qualification"
-\cl"e reg"trd(ion or mtenm certificate
with the A "ocidtion of Regi,tered Nu"e,
of Newfoundldnd.
1 Good Phy,ical dnd l\Ientdl Health.
3. Genuine intere,t in people.
4. Potentialle.lde"hip .tÞili(y.
Sdldry $1!.041! - S14.1
1!4 (presenll) under review)
Apply in wnting to:
\1.. D. Stlljtg. R.:'<j.
Director or :'<jursing
Green Ba} Health Care Centre P.O. Box 280
Springdale. l'iewfoundland
AOJ ITO
The Cen-.llen Nur..
D8c:ember 1979 119
Registered Nurses
Come to work in scenic Comer Brook!
Registered nurses are needed for this 350 bed Regional General
Hospital. with detached 60 bed Special Care Unil, serving the
Wesl Coast of Newfoundland.
The hospital offers good fringe benefits such as four weeks
annual vacation and eight statutory holidays plus binhday
holiday. In addition there is a hospital pension plan and a group
insurance plan for all pennanent employees.
Accommodation and assistance with transponation is available.
Negotiated Salary Scale:
I January, 1979 - $12,771.00 - 15,429.00
I January, 1980 - $13,410.00 - 16,199.00
(Contract not yet signed)
Service Credits recognized.
Interested applicants apply to:
Mrs. Shirley M. Dunphy
Director of Personnel
Western Memorial Regional Hospital
P.O. Box 2005
Corner Brook, Newfoundland
A2H 6J7
Registered Nurses
I
oo hed hlhpital adjacent to University of
.-\Iherta campll" offer" employment in
medicine, surgery, pediatrics,
orthopaedics, obstetrics. psychiatry.
rehabilitation and extended care including:
. I ntensive care
. Coronaq ohservation unit
. Cardiovascular surgery
. Burns and plastics
. Neonatal intensive care
. Renal dialysis
. Neuro-surgery
Planned Orientation and In-Service Education Programs.
PostGraduate Clinical Courses in Cardiovascular-
Intensive Care Nursing and Operating Room Nursing
-\ppl.\ to:
Recruitment Officer - 'ur'iinJ:
l'nÍ\ersit
of -\Iberta HO'ipital
H440 - 112th Street
Edmonton. Alberta
TM; !B7
Nurses
The Department of Health. Saskatchewan
Hospital, North Bauleford. requires
psychiatric and general duty nurses to work in
their accredited psychiatric treatment facility
located on the banks of the North
Saskatchewan River, some ninety miles
northwest of Saskatoon, in the heart of
Saskatchewan's recreational area.
Applicants will be nurse graduates eligible for
registration in the Province of Saskatchewan.
Salary: ($14,568-$16,848(Nurse 1)
Starting salary commensurate with
experience and training
Competition: 604111-9-782 Closing: As soon
as possible
For further information and application forms
please contact: The Personnel Office,
Saskatchewan Hospital, P.O. Box 39. North
Bauleford Saskatchewan, S9A 2X8, or
telephone area code 306445-9411.
Forward your application forms and/or resumes
to the Saskatchewan Public Service Commission,
1820 Albert Street, Regina, S4P 3V7, quoting
position, department and competition number.
(U]@
University of
Alberta Hospital
Edmonton. Alberta
o
70 D8c:ember 1979
Th. Canedlan NUrH
Wish
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.. .in Canada's
Health Service
Medical Services Branch
of the Department of
National Health and Welfare employs some 900
nurses and the demand gro\\ s every day.
Take the North for exanlple. 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 \:arry more than the
nonnalload of responsibility. .. why not find out more?
Hospital Nurses are needed too in some areas and
again the North has a continuing demand.
Then there is Occupational Health Nursing which in-
cludes counselling and some treatment to federal public
servants.
You could work in one or all of these areas in the
course of your career. and it is possible to advance to
senior positions. In addition, there are educational
opportunities such as in-service training and some
financial support for educational leave.
For further infonnation on an). or all. of these career
opportunities. please contact the Medical Services
office nearest you or write to:
I
I
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Medical Services Branch I
Department of National Health and Welfare
Ottawa. Ontario K1A OL3
I
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Name
Address
City
Prov
..
Health and Welfare
Canada
Sante et Bien-être socIal
Canada
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Index to
Advertisers
December 1979
Ames & Company Limited
The Badge Maker
The Canadian Nurse's Cap Reg'd
Career Dress (A Division of
White Sister LJniform Inc.)
The Clinic Shoemakers
CUSO Health-DI Program
F.A. Davis Company
East African Travel Consultants Inc.
Equity Medical Supply Company
Hollister Limited
Frank W. Homer Limited
I ntemational Development Research Centre
J. B. Lippincott Company of Canada Limited
Parke, Davis & Company Limited
Pharmacia (Canada) Limited
Posey Company
W. B.
aunders Company Canada Limited
ScheringCanada Inc.
Stiefel Laboratories (Canada) Limited
Upjohn Health Care Services
17
21
6
Cover 2
4
54
52
51
15
10, II
7,8.9
13
23
14
Cover 3
54
19
Cover 4
8
53
Advertising Representatives
Ad
'ertising Manager
Jean Malboeuf
601, Côte Vertu
St-Laurent. Quebec H4L IX8
Téléphone: (514) 748-6561
Gerry Kavanaugh
The Canadian Nurse
50 The Driveway
Ottawa, Ontario K2P I E2
Telephone: (613) 237-2133
Gordon Tiffin
190 Main Street
Unionville, Ontario L3R 2G9
Telephone: (416) 297-2030
Richard P. Wilson
219 East Lancaster Avenue
Ardmore. Penna. 19003
Telephone: (215) 649-1497
,"ember of Canadian
Circulations Audit Board Inc.
mE
.
-e.rlsa
cuts the cost of decubitus care
o
by controlling
infection fast
Debrisan sucks bacteria and tox.
ins out of decubitus ulcers. The
ulcer is quickly cleansed, healthy
granulation appears, and healing
can begin.
" These (wet, exudative ulcers)
averaged two days to clear t 0
superficial infection and five days
from the onset of therapy to ap-
pearance of good granulation
tissue in the ulcer base."1
-....
\
Day 0 Inlected, heavily Day 2 Exudate diminished. Day 14 Clear, healthy
exudatlng decubitus ulcer on Erythema and edema granulation base; grafted
left hip. reducec:l. successfully.
'".,..
.'
&-,,1"
'"14
by relieving
pain and
Odôur fast
-... a.,.,.
Day 0 Infected exudatlng Day 4 Clear, healthy
decubitus ulcer on knee. granulation base.
Day 14 Ulcer healing after
Debrisan discontinued.
" All patients in whom rest pain was
present at the start of treatment
noticed almost immediate relief of
the rest pain when Debrisan was
applied to the wound."2
" Debrisan was commenced and the
followina day, the smell had disap-
peared.''3 .
Day 0 Undermined sacral Day 7 Surgically debrided
decubitus ulcer inlected with belore Debrisan therapy and
Pseudomonas and E.col/. after 7 days, Infection
controlled.
by saving valuabl- nursing time
Only one Debrisan change a day.
is needed. Debrisan therapy can "
be stopped as soon as all signs of
infection have gone and the ulcer
is clean and granulated.
" Debrisan appears to be, in my
opinion, just what we as nurses
are seeking."4
Day 28 Appearance on
healing.
....
1
.
)
.T_, If e.utI8t1on Is...., hefty.
After removing crust or
necrotic tissue, pour a thick
(4 mm) layer of Debrisan on
the ulcer.
Cover with a dressing.
When the beads are
saturated (12 to 24 hours
later) rinse and wipe them
away. Apply a fresh layer 0'
Debrisan.
Debrisari cleans
decubitus ulcers fast.
.
Pharmacia (Canada) Ltd.
\I Dorval, Québec
Ret_s
,. lIm LT. Mlchud8 M, Øerll8n JJ, Angiology 29:8, Sept 197.
2. Bewick M. Ande..- A, tlln TriIIls J 15.4. 1918
3. Soul J. Brit J Clln Pract. 32"1. Ju...197.
4. DlMssclo S RN. c.c:ubltus c... A N_ ApprOllc:flc
A Nural/lg Rnponsollillty, on file st ....11'RIICÑI (CsNld8lltct
· Reg. T.M.
7
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......
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HOv. I",
! ITQ NUpr EA ' , I ' , , I ,
, I , I I'U COL
11/ II
,.
When friends or patients ask your
advice concerning r.elief of cold
symptoms consider the advan-
tages offered by th$ CORICIDIN
family of cold .products. The
various CORIClDIN*preparations
are formulated to provide effec-
tive reliek>f spé.cific groups
of symptoms that generally
accompany colds. Regular
CORICIDIN (antihistamine,
analgesic, caffeine com- ..,.
pound) is intended for use
at the first sign of a cold
where congestion is not a
problem or when decon-
gestants are contraindi-
cated. CORrCIDIN 'D' is
formulated for use when
nasal or sinus congestion is
pronounced.
For your younger patients CORICIDIN
's available as COR/CiDIN Pediatric MEDILETS* and
ORICIDIN 'D' MEDILETS, both chewable tablets. and
leasant tasting CORICIDIN Pediatric Drops for infants or
v- young children.
Fr= - Booklet Offer
We" - attempted to answer many questions about colds.
their causes, effects and relief in an informative booklet
entitled "How to Nurse a Cold". It's yours, free of charge, jf
y 'II si ply fill in and mail the Coupon on this page.
I
..
Mail to:
Schering Canada Inc.
3535 Trans Canada
Pointe Claire. Quebec
H9R 1B4
Please send me my free
copy of your booklet "How to Nurse a Cold".
Additional copies only available upon written
request.
Name:
( Pl ease pnnt)
Address:
City:
Postal Code:
. Reg. T.M
Prov.
La B.ibUo;thè.que
Universit
d'Ottawa
EcMance
OCT 28 19&
OC1 OCT 2 1
8
MAR 1 2 1983
tI\
R - 9 '983
MAR 1 7 1983._
MAR 1 5 1983
t\ -1 \9
\
The L.ibJz.aJty
University of Ottawa
Date Due
f
I
$.,
U d'/ of Ottawa
lfiir l ' I, III " l :" l ll I " If 1 ' 1/1 11 '.11
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