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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 


... 


\ 


\ 


- 
- 


-4 


\ 



 


, 


" 


. 


JIIVl Ij"ttu 
^
 V 111 ' 1<\' I' 
IflH11J 
I J.jI
iJ-Hl' 
Cf{}" J 


, 


\ \V 



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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 
care practices, establ1shed nursing education programs, and demanded legiSlation that w d insure 
qualiW in the nursing profession. Tcxiay's nurses are creating new trad.1tions in primary alth 
care, hæpital adrmniStration, medical legiSlation, community health care, and many exp nding 
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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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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 


., 




 


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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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.. 
, 


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. 



 


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... 
.(
 -
 
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,. -- 'n- .
 


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 


, 


ò 
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C 
 
, 
.... <t 
.. . I 
....
 ...7" 
.. 1 
.. ... 


(,> 
r 
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I 


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 


..... 


t 


,- 


'I 


'I 


- 


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" , 

 
 
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',- 


"\ 
. 


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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. 
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he pr. blem 
· f immunizati · n 
in anad · 


Sandra LeFort 


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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 



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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. 



- 


. 


" 


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. 


\, 



 
) 



 



 
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..... 


- 


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 


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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 
j 
I 



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 


-JA 


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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. 


\ 
\ 


- 
- 
I 


.. 


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 


\ 


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


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


-- 


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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,
 . 


. 


-=- 


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 . 


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'\ Drain & Shipley 
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i Two leading experts in the field provide clear, accurate coverage 
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Topics include the physiology of anesthesia, the effects of 
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Basic Nursing: 
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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. 


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All prices differ oUls,de U.S and subject to change 


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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. 


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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. 


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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. 


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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. 





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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 
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 


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!Ie Jenuery 111711 


,..- ""'II 


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patient 
needs 
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All of our employees are carefully 
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Each is fully insured (including 
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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 
ere 


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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 ;
 I 
I . 
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I ' 
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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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l 
FOR BABV'S SIC,II 


keeps a family's 
smooth skin smooth 


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5111 



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....Zincofa)( 


 FO
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. 


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 
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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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 


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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 


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TO DAY'S NURSING PROFESSIONAL 


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Human Sexuality for Health 
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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- 
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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., 
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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. 


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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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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- 
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By Karen Creason Sorensen, RN. BS, MN, Formerly Lecturer in 
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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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By Claire Brackman Keane, RN, BS, MEd. About 720 pp., 125 ill 
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This book will help you implement rehabilitative steps in both 
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By Ruth Stryker, RN, MA, Asst. Prof.. Long Term Care Administra- 
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By Mary W. Falconer, RN, MA; H. Robert Patterson, PharmD, MS; 
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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. 



 


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10 Febru.ry 1179 


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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.. 


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TEXTBOOK OF ANATOMY AND PHYSIOLOGY 
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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 


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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 
everyday practice. By Sylvia Jasmin. R.N., M.S. and Louise 
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 
care (leeds of their clients. Four major sections compare the advantages 
and disadvantages of using groups . . _ provide helpful guidelines for 
developing and structuring successful groups. . . analyze leadership roles 
and interaction of members. . . and explore therapeutic effectiveness. By 
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 
the advantages of this system. its workings, and its effects on patients and 
caregivers. The authors describe the evolution of methods for organizing 
patient care. . . deal with the nature and scope of primary nursing. . . and 
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 
presents concise. adaptable guidelines essential for sound emergency 
care. It uses a decimal referencing system forsimplepolicyand procedure 
retrieval - to stress management, treatments and responsibilities of 
various situations. Each policy includes a " key point" column which alerts 
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 
general courses in community health. this up-to-date text provides a 
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 
Methodology. The new edition of this successful text offers a 
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 
cohesive introduction to nursing fundamentals - organized around the 
many important roles of the nurse. Well-wntten and easy to understand, 
this text: 
. offers an overview of the nursing process, physical assessment 
and such nursing roles as communicator, planner, protector, 
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<' . \ 
\' 
.. 
" , 
...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. 


. 
. , 
, . 
. 
. 
, . 


. -= 
 
... 

 -"-.t 



 ... 
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 
_ J 
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.,;.!/ 


"MILL/ARE" 



 


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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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decimetre 
1 
1õõ metre 
centimetre 
1 
1õõõ metre 
millimetre 



 


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. 


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 


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p.
 
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025 X 10 23 :i 
J.w- m8rbl
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F.....u.ry 1 '71 21 


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grains of sand 


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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
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- 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. 


, 


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. 



 


. 

 

 



 



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. 


.. 



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. 



 


... 


-- 
, 


.. 


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. 



 


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Pel's 


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'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 
f

::

________________________________________________________________________________________ __
'?- - 
J. B. LIPPINCOTT COMPANY OF CANADA LTD. D Send and bill me later. 
75 Horner Ave., Toronto, Ontario M8Z 4X7 (PI t d h dl o h ) 
us pos age an an 109 c arges. 
D Payment enclosed. 
(Postages and handling charges paid.) 


LIPPINCOTT'S NO-RISK GUARANTEE 


D Nurses' Drug Reference, Paper, $14.00. 
D Nurses' Drug Reference, Cloth, $26.50. 
D Health Care of Women, $16.75. 
D Leadership for Change, $6.00. 
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 
Emergency Personnel, $23.75. 
D Lippincott's State Board Examination Review for 
Nurses, $13.00. 


Name 


Address 


City 


Provo 


Postal Code 


------------------------------------------------------ - ------------------------------------------------------ 


Prices are subject to change without notice. 
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. 


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slip waist belt adjustment allows you to 
fit the waist belt to the patient quickly 
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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 


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Royal Australian Nursing 
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Applications are invited from interested nurses 
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The projec.t will cover areas such as 
professional role definition throughout the 
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Research qualifications and experience 
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314 St. Kilda Road 
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Our active 1100 bed teaching hospital has 
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For further information apply to: 


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Shaughnessy Hospital 
4500 Oak Street 
Vancouver, B.C. 
V6H 3NI 
(604) 876-6767 



- ,it. -ute 
 
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." 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, 
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For further information and details about our com- 
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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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The Cen-.ll.n Nu... 


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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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A different appearance- 
A common need 
Both may benefit from Slow-
 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 
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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 


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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 .... 
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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 
patterns-you'll love my carefree lool"i! ßest of all 
I'll bring you the same fit and comfort you've 
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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 


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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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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. 


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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. 


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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. 



. 



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I Merch liTe 


The Cen-.ll.n Nur.. 


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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 simpler, more comfortable care for 
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. llerch 1171 


The Cen-.llen Nur.. 


news 


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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 


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Parent-child 
nursing 
NYCHOlOOAL ASPECTS 


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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 


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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 
Roberts, R N, M N 1978. 22B pp Price, 
$10.75. 


COMMUNITY HEALTH/ 
GERIATRICS 


New Volume I CURRENT PERSPECTIVES 
IN GERONTOLOGICAL NURSING. Questions 
on gerontology? Students Will find accurate 
answers In this ðuthorltatlve volume USing a 
multidisciplinary approach, ,t surveys all 
dimensions of thiS field - phYSIologICal, 
cultural, psychological, pharmacological and 
more Thought -provoking chapters on aging In 
Black, Chicano, Amencan Indian and Anglo 
cultures are excellent for stimulating class 
discussIons Edited by Adina M Reinhardt, Ph D 
and Mildred D QUinn, R N, M S ; With 19 
contnbutors March, 1979 Approx 304 pp, 1 
III us About $14.50 (C), $10.75 (P). 
A New Book NUTRITION IN THE 
COMMUNITY: The Art of Delivering Services. 
By Reva T Frankel M S Ed D. R D and Arllta 
Yanochlk Owen, MAR D September 1978 
412 PP. 49 illus Price, $15.10. 


IVIOSBV 


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12 llerch 11179 


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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 
(Health Services) 
Degree Program 
(Spring-Summer term 
starting April 1979) 
Applications are now accepted for the program 
combining independent study wilh tutorials on 
weekends in Toronto, as well as for the 
compelency based, external degree internship 
option offered for students at a distance. 
Credits toward advanced standing are given 
for managenal experience and prior education 
including B.Sc.N., R.N. and H.O.M. Cenifi- 
cate. 
The School is a member of the Association of 
University Programs in Health Administration 
and is supponed by the Kellogg Foundation 
grant. 
For information and application forms, please 
write to: 
Canadian School of Management 
S-415, OISE Building 
151 Bloor St., West 
Toronto,Onbno M5SIV5 


110 


...,j 



Todays nursing professionals 
turn to Saunders. 


Drain & Shipley 
-The Recovery Room 
Two leading experts in the field provide clear. accurate coverage 
of the recovery room in this valuable new, one-ot-a-kmd book 
Topics include the physiology of anesthesia, the effects 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, Major, Army Nurse Corps, RN. CRNA. BSN, Unlv 
of Arizona. Tucson, AZ; and Susan B. Shipley, RN, MSN. Nurse 
Researcher. Nursing Research Service. Walter Reed Army Medical 
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Order "f3186-X. 
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 concepts for the practitioner. Twenty eight contnbutlng 
experts provide special coverage of important topics such as 
biomechanics; nutrition; bowel, bladder. and catheter care; vital 
signs; respiratory care; the therapeutic nurse-patient relation- 
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 overvièw and study guide preceed- 
ing each chapter. and a two-color format for easy reading. 
By Karen Creason Sorensen, RN. BS. MN Formerly Lecturer in 
Nursing. Univ of Washington, Instructor of Nursing. Highlme 
College; Nurse Clinical Specialisl. Univ Hospital and Firland Sani- 
torium, Seattle. WA; and Joan Luckmann, RN, BS. MA. Formerly 
Instruclor of Nursing. Univ of Washington. Highline College. Seattle, 
Oakland Cily COllege and Providence Hospital COllege of Nursing. 
Oakland. CA About 1285 pp.. 435 ill Ready soon About $2000 
Order #8498-X. 


Dienhart 
-Basic Human Anatomy and Physiology 
3rd Edition 
The ideal way to refresh your knowledge of anatomy and 
physiology, this new edition has been carefully revised with 
special attention to the chapter on the nervous system You'll 
find expanded coverage of cytology and histology, and expanded 
glossary, and outstanding new illustrations. 
By Charlotte M. Dienhart, PhD. Asst. Prof. of Anatomy and Assoc. 
Prof of Allied Health Professions. School of Medicine Emory Univ.. 
Atlanta. GA About 350 pp., 170 ill (16 color Plates) Soft cover 
Ready soon Order #3082
. 


LaFleur & Starr 
- Unit aerking in Health Care Facilities 
This important new book provides a complete learning resource 
from terminology of anatomy and physiology and communicati ng 
with personnel to transcrition and making orders. It combines 
theory and practice in a step-by-step explanation of duties. 
Behavioral objectives. reproductions of actual forms, review 
sections and tear-out work sheets are included. 
By Myrna LaFleur, RN. BEd. Instructor. Unit Clerk Program, Maricopa 
Technical Communily College, Phoenix. AZ; and Winifred K. Starr, 
RN. MEd. Director. Unil Clerk Program, Maricopa Technical 
Community College. Phoenix. AZ. About 765 pp., 1 50 ill Ready soon 
Order #5594-7. 


Tllkian & 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. Asst Clinical Prof. of Medicine 
(Cardiology). UCLA School of Medicine. Assoc DireclorofCardiology. 
Holy Cross Hospital and Valley Presbyterian Hospital, San Fernando 
Valley. CA. and Mary Bourdreau Conover, Arrythmia Workshops, West 
Hills Hospilal and West Park Hospital, Conoga Park. CA; and Faculty. 
National Critical Care Inslitule. Orange. CA. Package. Order #8878-0. 
Book only. About 145 pp. lIIustd Soft cover. Ready soon. 
Order #8889-1. 


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. Aboul 720 pp.. 125 III 
Ready soon Order #5313-8. 


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14 Merch 11171 


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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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. 


f' , 
.. 


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. 


\ 


, 


.. 


I, 


_,II 


/ 
 '-
 


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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&. 


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. 



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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. 


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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 
 
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Please send me the following book(s) 'on approval:' 
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o Health Care of Women, $16.75. 
o Manual of Neurologic Nursing, $9.25. 
D General Systems Theory ApVlied to 
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Practice, $29.95. 
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34 M.rch 1979 


The Cen-.ll.n Nur.. 


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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: 


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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. 


- 


---- 



 


::;-i:r-...... 


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 


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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. 
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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. 

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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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'(-. 

 
"$
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. 



 . 


 
- 


.. 


J:. 


,. 


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f. 
! 


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 


" 


. 
t} r. ,. .;{ 
- 1'\
' 

 
 
. · t' 
,- ,- 


- 


,. 


.... 


...... 


" 


!!!' 


-' 


...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 
!>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 
I 
I 
I 


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 


, 



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.. 
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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- 
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CORICIDIN (antihistamine, 
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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 , 
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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 
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Mail to: 
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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 
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Name: 


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Address' 


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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 
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CONTINUE YOUR STUDIES WHILE YOU WORK, 
WITH THESE OPPORTUNITIES FOR 


SENIOR 
HEAL TH SERVICE EXECUTIVES: 


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ea services 
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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] 
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 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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No 521 BLUE. No. 523 GREY AU 15
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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 
(5) All excess ointment should be removed e
ch time 
dressing IS changed T 
(6) Use of the Ointment should be terminated when sufficient 
debndement of necrotiC tissue has taken place. 
Overdose: Action of the enzyme may be stopped. should 
this be desired. by the appllcalton of Burow S solution U S P 
(pH 3 6-4 4) to the leSIon 
How Supplied: Available In 25 gram Jar of sterile Ointment 
Product monograph available on request. Store at room 
temperature 


-Reg T M of Knoll Pharmaceutical Co 


ø 
Pentagone 
LABORA -IR S lTO 
V....Gr.....1 eu.to.c 



clears the way 
for healing 
dermal ulcers 
and burns 


Experts describe the 
unique ability of Santyl 


In dermal ulcers: "Among the proteolytic enzymes,only 
collagenase is able to digest the helical structure of un- 
denatured collagen fibres. These fibres are involved in 
the retention of necrotic wound debris." 
(Varma, Bugatch & German, Surgery. Feb. 1973) 


In burns: "In a typical patient, after five days of treatment 
with collagenase ointment, second-degree burns of 
the lower extremities were completely healed and re- 
epithelization from the cutaneous layers of deep second- 
degree burns had started on the hands. After fifteen days 
of collagenase treatment, third-degree burn areas were 
completely cleared of eschar." 
- W. E. Zimmefmann, Mod. Med. (U.S.A.), Apr. 1970 


Santyl clears the way for healing: 
"By clearing the ulcer base of necrotic, pyogenic material, 
healthy granulations are able to appear and subsequent 
epithelization ofthe ulcer can occur. I think the significant 
aspect of topical collagenase is its ability to rapidly debride 
the ulcer base so that in the meantime other causative 
factors can be determined, compensated and treated." 
(M. Murray Nierman. "Cutis", Oct. 1976) 


e 


Pentagone 


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Fully illustrated in colour, this brochure describes more 
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(Helga Vetra, Derrick Whittaker. Geriatrics, Aug 1975) 


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M........ 
I PMAC) I PAAB I 



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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Communicable diseases, immunization 
Human organs and blood donations 
Death and dyinl! 


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City 


For further information \ 
SECOND NATIONAL CONFERENCE 
ON HEALTH AND THE LAW 
Canadian Hospital Association, 
410 LaurierAvenue West, I 
Ottawa, Ontario KIR 7f6 
Telephone: (613) 238-8005 


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(continued on page 48) 


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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 
in the same ratio as will be found in the examination. 
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 


, 
\ 
. 
.. 
'- 
J 

 
".. .... 
,.... 

 
po. 
, - 


"t . 

. 


...... 


, 
, 



 



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: 


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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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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 
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effectively. That's the 
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and may be preferred for r r . 
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tion in geriatric and ........ 
cardiac patients. 
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Metalnuåf 


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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. 


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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. 


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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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52 April 1979 


Th. C.nedlen Nur.. 


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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. 


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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 
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Please PrInt. 
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ZIP I 
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State 


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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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POSEY SOFT BElT 
Comfortably prevents patients from slid- 
ing In wheelchairs or geriatric chairs. Soh 
polyurethane cushion Is so soft your pa- 
tient will hardly know It's there. Wash- 
able. Sm., med., Ig. 
No. 4125 


, 
, 


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POSEY FOOTGUARD 
Helps prevent footdrop or rotatIon while 
allowing foot movement Rigid plastic 
shell with soft liner supports the foot and 
keeps the weight of bedding off of the 
foot "T' Bar stabihzes foot. 
No. 6412 


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POSEY PATIENT RESTRAINER 
Get the added plus of shoulder loops and 
straps. Comfortable. vest criss-crosses In 
front or rear and waist belt lies to bed 
spring frame. Excellent In wheelchairs too. 
Sm.. med., Ig. 
No. 3111 



",1
 


Health 
Dimensions Ltd. 
2222 S. Sheridan Way 
Mississauga, Ontario 
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.. 



'.. \ 


.s 

 


4 
, 


".1 ;:z I 
, JJ! I 
"'l..- 
 
 
- 
.-...r4i
i r 
-.

 


. 
.
 
III 


\t-\ 
'\ 
\ 


"'
 
..
 
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 
,........ 


Aprl1187i 111 


m 


'. 
'\ 
C'
 

 


 i:'
 

 
"i... 
"'''$ 
;(:- 
C' o
 


 i:'
 

O'. o
 

 .o
 


. 

 

$ 


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
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natural fabric, and to 
release soil easily when 
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White. 31 R 002 302 A. $25 
2-pc. pant set has button- 
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Pull-on pants. Mint Green, 
White. 31 R 002 393 B. $30 
.Reg'd Can. T.M. 


II 
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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 



 


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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 
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MAY 1979 


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Sizes: 3-15 
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100% textured Dacron" polyest 
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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 


;( 


, I 
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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. 
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Fundamentals 
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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. 


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PHARMACOLOGY IN NURSING 


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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: 


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on 'lastromt"'stmal 
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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. 



 
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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 -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 


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Basic 
pathophysiology 
A CONCEPTUAl AP 


Groer and Shakl 


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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 



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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- 
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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 
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of life-threatening disorders manifested by abnormal sounds. 
Clear and concise. it's the first package of its kind available to 
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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 
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Because pediatric nursing has come a long way, so has Marlow. 
The fifth edition of this highly respected work maintains a 
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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. 
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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- 
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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. 


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enter Order # and Author: CN 5/79 I 
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in England: 1 Sf. Anne's Rd.. Eastbourne. East Sussex BN21 3UN 
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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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10 ...,111711 


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 



 


.. \ 
, 


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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. 


[tI(Q)ææIHJ(Q)IJ]])
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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 
_ effectively. Thafs 
. . the Metamucil 
! _ _ -=:::-. way. 
I::::: I "-1' 
I 



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...I 


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. 
L
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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; 
00 

 


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I 
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7 "r] ì r1 vi J 

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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
 


.... 



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.. 


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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. 


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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. 


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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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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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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. 


, 


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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 



 

 


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. 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
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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. 
\.. 



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 
...I 
> 
o 
::i 
c( 
(/) 


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 
W 
:J: 
Q. 
o 
Z 
- 
:æ 
c( 
to- 
W 
o 
c( 


TYLENOL GÞ 
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!') 


- 


II 


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 


en 

 
W 
N 
::i 
5 
. 


Drugs 
VALlUM
, LlBRIUMI!'). SERAXI!'). 
ATARAXI!') 


Therapeutic uses 
used to allay moderate anxiety states 
and relieve muscle tension associated 
with psychomotor agitation 


c( 

 
I- 

 
o 
z 
- 


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 


en 

 
W 
N 
::i 


Drugs 


PHENERGAN(!!), STELAZINEI!'), 
STEMETIL I!') 


o 
z 
c( 


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 
 


en 
I- 
Z 
c( 
en 
en 
w 

 
Q. 
W 
c 
i= 
z 
c( 
o 
::i 
> 
o 
æ 
I- 


Drugs 
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 


en 
w 
z 
i 


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 


,
,. 



 



 


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.... 
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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NURSES 'ENLlGH". Po..r1ul bum lor a.amln.tlon 01 
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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 
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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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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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Technical training 
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PHARMACEUTIQUES LT
E 
PHARMACEUTICALS LTD 


2775 Bovet st., Laval, Quebec 
Tel: (514) 331-9220 
Telex: 05-27208 


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. 


TIlE A Y\A PEGO\ \ PEELI'G 



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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 
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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. 



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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' , 


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. 



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ix?ut I I 
I Op-slte ulcer dressing, fdlln 
I the ultimate wound dressing and mail this coupon, I 
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. : S
II' Mediclill Division Lachine. Qu
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--------------------
 



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 
the Care of Children in Hospital. 



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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. 


- 
/-, 



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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. 


.. 


J 


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. 


II 


II 


. 


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J 


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. 


, 



 


\ 


... 


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. 


. 



 
. ' 1 
...... .. - 
--=-- 
...... 


.... 



 


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1:: 


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. 



TIM CeMdIM..... 


......1
 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. 


-.. 


- 


... - 


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. 


- 
..... 


"'-- 


"'" 


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. 


",; 


,.. 



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. 


., 


----..\ 
L-- ... 


.\ 


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:'
I:U 


n._ 
."........... 
J-6w 
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 
1lE4t7Jf 
 


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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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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 
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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. 


-............... 
. To order on 3D-day approval, . 
. enter order '# and au thor: CN 6/79 . 
. I I L I I . 
. AU AU AU I 
o check enclo8ed- Saut\den pay. po.lage 
 
. We accept VIsa and Mastercharge. -=- I 
I D Visa # OJDD ODD ODD [[]] I 
I D Master Charge # moo DODD [ll] ODD I 
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Full Name 
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I I 
I Posillon and Affiliation (If Applicable) Home Phone Number 
I Home Address 
I CIty 
I 
. SIgnature 
All prices differ outsIde U S. and subject to change. 
I 
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. 


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A different appearance- 
A common need 
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 
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Bulk En nomDre 
third trOlOWtme 
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. Toxemia In pregnancy 
. Tetanus: treatment and cure 


. How the Immune system works 


. Where Is nursing headed? 


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A Division of 
White Sister Uniform In 


50n Flowing 5klrt Suits 
in our beautiful new 
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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. 



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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. 



 
, 
- I - 
'- .- I , 
V 
, , . , 
. - ..- , 
- ---.. - - 


Professional/administrative 
staff - (left to right) Claire 
McKeogh, Rose Imai, Gisèle 


. 
- - 
- 
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-
 
- 
4 
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. 


Testing service -seated (left to 
right) Lorraine Bourque, Gladys 
Jones, Eric Parrott, Lise 
Chevrette; standing Shirley-Ann 
I 


1\1 1 
'.. I I 
/ , '. i 
/11 

 
, 


--- 



 


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. 


- 

 , . . - 
.... . 
- 1 
- 
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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 



, 


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 


. 


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 
.................... 
Send on 3D-day approval: CN 8179 . 
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. 0 Sorensen & Luckmann: BASIC NURSING . 
. #8498-X $34.80 . 
...., Luckmann & Sorensen: 
· MEDICAL-SURGICAL NURSING · 
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 ,

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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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\ 


01 


...., 


, 


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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 


.. 


.:t t 


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, 


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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 
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 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 


J. B.lIPPINCOTT COMPANY OF CANADA lTD. 
Servmg the Health Professions in Canada Since 1897 


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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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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- 
. 


1 
I 


.. 
i--' . ..... 



 


\P 


f 


\.. 


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 
I' s;; 
l r 
" 
,\ 


.., .... ... 
.... 

 ---. 
... 

 

 / 
- 
... 
---- 
---- 
.. 


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 



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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 



 


, 



 
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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 



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IVIDSBV 


TIMES MIRROR 


THE C. V. MOSBY COMPANY. L TO 
86 NORTHLINE ROAD 
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 
/\ 


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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 
family, by... et al. St. Louis, Mosby, 1977. 
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. 



 

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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. 


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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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.. Julyl AIIfI.... 1171 


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 



 
o 
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obÇ;'i 

ÂP


 
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desired. Easy to install; does not bolt to 
bed. Includes anti-rotation blocks Fits any 
hospital bed 
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222 S. Sheridan Way 
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Canada L5J 2M4 
Phone: 416/823.9290 


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 
your nursing career? Medical Per- 
sonnel Pool can give it to you. 
Choice of assignments, flexible 
hours, staff development programs. 
But don't think you have to 
sacrifice for it. MPP offers exceUent 
insurance coverage, RN consulta- 
tion, and the freedom to choose 
your O\AIT) hours. 
Medical Personnel Pool is an 
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of qualified, experienced, supple- 


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 


-.;;: 
" 
t' 
... 
.. ....... 
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' 
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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 
OThe 
o
 
Y
;
 
----------------------------------------ëÑ879- 
Name 


I 
I 
I Addr... 
I 
I City 
I 
l______

_________

_________






!



______ 


Stet. 


Zip 


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 

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- l' ç-....... . 
.
. . 
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.,- 


" 


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-. 
. 


...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 


(," 


j
I'" , 
,I 01 


. ',I.. 


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? 


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W hittakell 
Ufe Sciences Group 


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-It 



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! 



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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. 



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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. 


'" 


, 


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'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 


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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. 


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BASIC PATHOPHYSIOLOGY: 
A Conceptual Approach 


The authors of this useful new text have organized the vast 
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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 
provides practical methods for obtaining a complete history and 
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By Lois Malasanos. R.N. Ph.D.; Violet Barkauskas. 
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NURSING CARE OF INFANTS 
AND CHILDREN 


Using a systems approach. this new book provides a 
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pregnancy. interferences with normal pregnancy. labor and its 
complications. the post-partum period. and both normal and 
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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. 
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784 pages 684 illustrations. Price. $24.00. 



CHILD HEALTH MAINTENANCE: 
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Sundeen, R.N.. M.S.: with 15 contributors. April, 1979.656 
pages, 24 illustrations Price. $20.50 


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By Margot Joan Fromer B.S., M.A.; with 7 
contributors January. 1979 484 pages, 110 illustrations Price. 
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TIMES MIRRDR 


THE C. V. MOSBY COMPANY. L TO. 
86 NORTHLINE ROAO 
TORONTO, ONTARIO 
M4B 3E5 
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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black:, blua or gr..n No 32 12.28 Neh. 


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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Iwlat ,..tura. No. 301 RN" 
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plain Caducaus 13.115/ pro 



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Jewelry qualll,. In "MYy gOld 
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t-!URSES EAA'UNOS. For pierced No 503 Nu,...'s Akie 
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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 
IS GAS. 


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 
tQ'"Ø 


8HQBJ}.fR 


rPAAil 
lfE!!J 


Pro u{ t monoftraph available on request. 



]
r 


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. 
. 
 u" 
I = -=
 

= .I 

 . --=- E 
..J 


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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Choice of assignments, flexible 
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But don't think you have to 
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Medical Personnel Pool is an 
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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. 


, 


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ea 
a 
e 


. 


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. 



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Your guide 
to 
Clinical Laboratory 
Procedures 


t- 
ð 
a: 
L5 
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. 


- 
- 



 


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\J 


NURSING 


1M E 
\S 


NURsE 
f OUT 1 



Th. Cen-.llen Nur.. 


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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. 



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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 

 
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" 
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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. 


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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 
SURGICAL TEAM. A comprehensive reference for practicing 
operating room nurses, this book is designed to present overviews of 
the major surgical procedures, including relevant anatomy, indica- 
tions for each procedure, and the related nursing obligations. By 
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, 
medical management of diseases, health counseling, and coordina- 
tion of community resources for health promotion. By M. Frank- 
Stromborg, R.N., Ed.D., N.P.; & P. M. Stromborg, M.D. 
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- 
tions that place a child or a parent at risk; and to suggest nursing 
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 
Nursing Approach. It covers the realm of cardiac rehabilitation 
in its enh"rety-from hospital admission to hospital stay, and from 
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 
Edition. 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. 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 
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'S NO-RISK GUARANTEE 
Books are shipped to you On Approval; if you are not entirely 
satisfied you may return them within 15 days for full credit. 


--------------------- 


J. B. LIPPINCOTT COMPANY OF CANADA LTD. 
75 Homer Ave., Toronto, Ontario M8Z 4X7 
o Bill me (Plus postage and handling) 
o Payment enclosed (Postage and handling paid) 
Please send me on 15-day approval the book(s) whose 
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Provo 



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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3
. OSlrea, Enrique M. The careofthe drug 
dependent pregnant woman and her infant, by...et 
al. Lansina. Mich., Michiaan Department of Public 
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, 
Addison-Wesley. c1979. 8
5p. 
4
. Women in stress; a nursing perspective. Edited 
by Diane K. Kjervik and Ida M. Martinson. New 
York. Appleton-Century-Crofts, cl979. 342p. 


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 
Services, c1978. 16p. 

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 
Canada. 1978. 88p. 



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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

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Dean of Nursing 


._ " 
., 


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.;- 


. 


( 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 


,-. 
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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 



 . 

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.

;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 


... 


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 


D I hold active membership in provincial nurses' assoc. 


reg. no./perm. cert./Iic. no. 


D I am a personal subscriber 


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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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 
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"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. 
'- 


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'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 


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Bu. En nom ] 
thrd troe"'me 
cl... clll... 
t I053 
 


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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 ... 


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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 



 
Style No 3436 - Dress 
Sizes: 8-18 
Royale "Caresse" 
100% polyester warp knit 
White, Blue 



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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.," , 
.'''
 I " 
, . 


, 

 
". ! 
- 


, , 


, 


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. 


MARY DOE R. N. 
SUPERVISOR 


NAME PINSI 


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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. 



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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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on rei uvenescence, acne, and other rei ated ski n probl em s. 


It is the only internationally recognized peeling and is 
presently being markefed throughouf Europe. In France, in 1965, 
this product won the Gold Cup from Le Comité du Bon Goût 
Françai s. 


France Clovet, R.N. (Hôtel Dieu - Chicoufimi, affiliafe of 
Laval Universify) has the exclusive rights for thi s formula in 
Canada. Sfudio Clavet Inc., "ho has been serving Canadians 
for years in Montreal, is currently recruiting nurses inferested 
in increasing their income by becoming owners of a studio. 


Sfudio Clavet Inc. has qualified professionals who are ready 
to train you to become specialisfs in this field. 


If you have approximately 7 years nursing experience and 
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We are a member of the Belter Business Bureau. 


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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. '" 




 
 
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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. 


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


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- 


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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. 




- 


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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. 


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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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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 


J. B. LlPPINCOTI' COMPANY Of CANADA LTD. 
Serving the Health Professions in Canada Since 1897 
75 Homer Ave., Toronto, Ontario M8Z 4X7 
Books are shipped On Approval; if you are not entirely satisfied 
you may return them within 15 days for full credit. 
Current nursing catalogue available free upon request
 
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OMPANi"OF CANAD 
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Please send the following for 15 days 'on approval'; 
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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-. 


STRESS 

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A New Book! MOSBY'S MANUAL OF CRITICAL CARE: 
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 
mateIial throughout the book. May. 1979.440 pages. 267 
illustrations. PIice. 816.75. 


COMPRI!HI!NSIVI! 
CARDIAC CARE 


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A New Book! MEDICAL-SURGICAL NURSING: Concepts 
and Cliolcal Practice. Edited by Wilma J. Phipps. RN.. B.S.. 
AM.. Ph.D.: Barbara C. Long. RN.. M.S.N.: Nancy Fugate 
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
 - regarding the human 
ganlsm as an open system In continuous Interaction with 
the environment. Diseases are presented In terms of models 
of major concepts. rather than as a compilation of signs and 
symptoms. Helpful behavioral objectives begin each chapter. 
March. 1979.534 pages. 423 lUustrations. PIice. 819.25. 


ALSO OF INTEREST: 
A New Book! DEPARTMENT OF EMERGENCY MEDICINE 
GUIDELINE MANUAL: Policies and Procedures. By Jfjfrey 
R. Macdonald M.D. and Pat Kinder. RN. June. 1979.344 
pages. lllUustrations. PIice. 828.75. 


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The C. V. Mosby Company. Ltd. 
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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
IPA:IIY OF CANADA LTD. Books are shipped On Approval; if you are not entirely satisfied 
Serving the Health Professions in Canada Since 1897 you may return them within 15 days for full credit. 
75 Homer Ave., Toronto, Ontario M8Z 4X7 P 
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I Prices subject to change without notice. 

 CNlO/79 I 
------------------------------------
 


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 
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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 = 
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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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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. 


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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. 


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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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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 



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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 
,. 
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tatl" I . 
'-'=' IU; Zip 
\n \l!ìrm.II;H" \<I;"n fmplo\l"r Tdl"phonl" ( 
. Hl"st timl" to call . 
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Tific dinical Jrl"a ." I 
R:'Ij _I.\";\j Datl" of (.raòuatton 
 
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------------ 



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 
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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. 


o 


I 


. " 
'- '" 

 
. ... 
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., .... 
( 

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keeps a family's 
smooth skin smooth 


, Zinêofa
' 
\.... FOR BABV'S Slt 11i 


 ". -- Zincofax 
Q sy'S sI<'f'I 

 FOIt SA 


,
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Contains Anhydrous Lanolin and 15% Zinc Oxide. 
Available in 10 and 50 g tubes and 115 g and 450 gJars. 



 "'M
" 



 I Wellcome Medical Divisiol 
Burroughs Wellcome Ltd. 
laSalle. Qué. 



- 


..
 


" 


..(; 


<II 


. 


_ 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, 
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- 
ated. 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 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. 
o 


111 1 1111 11 
Hor,
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! I I I I 11/ /1 



 

 


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II 


Mail to: 
Schering Canada Inc. 
3535 Trans Canada 
Pointe Claire. Quebec 
H9R lB4 
Please send me my free 
copy of your booklet "How to Nurse a Cold". 
Additional copies only available upon written 
request. 
Name: 


[Please pnnt) 


Address: 


City: 
Postal Code: 
. Reg TM 


Provo 


I PA.1J
 1 



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A different appearance- 
A common need 
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 



. + Z'_ 
 
Bulk En nombrw 
third tro...eme 
cia.. clasM 


tS(
02

6gi
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Th lJldv QF IHr
hA f"'\'KI5St.:T lIn 
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"'''''....1..''''.:...:> I. u-J ...JERES 
Nune NOV 231-"" 


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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Style No. 43741 
- Skirt Suit 
Sizes: 3-13 
Royale Stripe Sensations 
100% textured woven 
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White. Pink. 


I 


Style No. 43780 
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Sizes: 3-1 3 
Royale Stripe ensatio 
100% Textured woven 
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White, Pink. 


.. 



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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' 

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....' 
n 


""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 




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Please send me for 15 days 'on approval': 


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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 
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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. 


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Please send me your free brochures (check oneor both): 
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o "Nursing Opportunities at UPJohn HealthCare Services" 


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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, 



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Metamucil can help. Why 
not recommend a laxative 
that works slowly, gently 
and effectively. That's the 
Metamucil way. 
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November 111711 11 


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 " 
helpful booklet about constipation? \. 
Metalnucll@ 


The laxative most recommended by Physicians. 


- ,-I 



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GOld plated, holds ,"our up 
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compartment. tor 
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In .rrong p)..Uc ca.. 
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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. 


., 




 



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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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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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Avroy A. Fanarofl, MB(RAND). MRCPE. Assoc. Prof 
of PedIatrics. both of Case Western Reserve Univ 
SChool of MedIcine. Cleveland. OH. 437 pp. lIIustd 
52340 July 1979 Orner fl5478-9. 


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Two leading experts provide clear. accurate 
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anesthesia. the effects of various anesthetic 
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and factors that affect recoverv from anesthesia 
in particular patients 
By Cecil B. Dram, RN. CRNA BSN. Major. Army 
Nurse Corps. Univ of Arizona. Tucson: and Susan B. 
ShIpley, RN. MSN. Major Army Nurse Corps; Nurse 
Researcher. Walter Reed Army Medical Center. 
Washington. DC 608 PD 167ill 52035 March 1979. 
Order fl3186-X. 


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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 


........ 
- 
.- 


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. 



 


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 


, 


'- 


.... 


. 


.. ... 


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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. 


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 1961 1966 '971 1916 


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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 



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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.. 


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 '-"'- 
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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 


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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 


Li 1ldo J. N ixo1l 
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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. 


tÞ 


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PhotoCilobe and Mall. Toronto 



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 
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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. 




. 


.. 


.... 


. 



 


" 


.. 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 
, 
J , 


-- 
,. 
'- 
k 
'" . 
t 
- 


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, 


. 


.... 



 
, / ... 
, -- 
/ -... 

 - 
./ 
, 
.Þ " 


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 


. 


-- 


'J 


, 


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. 


... 


::J 


.I 


. 


. 
, 


"' 


. 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. 


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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 


TOPICS: 
"Invasive Vs. Non-Invasive 
Monitoring" 
"IMV Vs. Assist Control 
Ventilation" 
"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" 


PARTIAL LIST 
OF FACUL TV 
JOHN B. DOWNS. M.D. 
JAMES FORRESTER, M.D. 
WILLIAM GANZ. M.D.. C.SC. 
RONALD L KATZ. M.D. 
GERALD S. MOSS. M.D. 
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. 


@@ 
CEDARS-SINAI 
MEDICAL CENTER 
DEPARTMENT OF 
MEDICAL EDUCATION 
January 11-13. 1980 
CENTURY PLAZA HOTEL 
Los Angeles. California 


For ,ntormation 
call (213) 855-5541 
or write to 
Room 2049 
Cedars-Sinai MedIcal Center 
Box 48150 
Los Angeles. Ca. 90048 


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 
. nd diet therap 


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implications of 
laboratory tests 


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Basic 
pathophysiology 
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community 
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Fundamentals 
of nursing 
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Need we say more? 


IVIOSBV 


TIMES MIRROR 


THE C. V. MOSBY COMPANY, lTD. 
B6 NORTHlINE ROAD 
TORONTO. ONTARIO 
M4B 3E5 


A90892 



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 


The first and last word 
in all-purpose 
elastic mesh bandage. 


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Quality and Choice 
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Widest possible choice ot 
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(3m, sm, 25m, and sOm). 


Highly Economical Prices 
Retelast pricing isn't just 
competitive, it's flexible, 
and can ea<;ily be tailored to 
the needs of every hospital. 


Technical training 
. Training and group demonstrations by our representatives 
. Full-colour demonstration folders and posters 
. Audio-visual projector available for training progra-nmes 
. Continuous research and development in cooperation with 
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. 


<'Mother can't talk too much, 
her throat's bothering her." 


deqyggio:. 
It's more than good-tasting, it's good medicine. 
Antibacterial, antifungal lozenges 
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.
 
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ng I 

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. 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. 



 
. 


{ 
I 
I 
I 


..... 


, 


- . 



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 


---= 
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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 


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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 


45 
II 
49 
50 
5,51 
44 
46,47 
48 
to 
9 
17 


Cover 4 


II 
7 


Advertising Representatives 


Adverfising Manager 


Jean Malboeuf 
601. Côte Vertu 
St-Laurent, Québec H4L lX8 
Téléphone: (514) 748-6561 


Gerry Kavanaugh 
The Canadian Nurse 
'\0 The Driveway 
Ottawa, Ontario K2P I E2 
Telephone: (613) 237-2133 


Gordon Tiffin 
190 Main Street 
Unionville. 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. 


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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 


, 



 


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The 
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Nune 


DECEMBER 1979 



 


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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 


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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 


". 



 


" 


,
 
., to t ,'.'
 
,j. 
", \,' , 
, , 


, 

 
,,' 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.

 

\) 
 

 = 

 


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. 


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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- 
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So mother and baby can get 
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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 


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The Canadian Nurae 


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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 



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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'
;: .' 


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. 


, 


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; 


nCaS-fAYLO" / 
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SINOlE-HEAD TYPE. AaaþoYe 
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LISTER BANDAOE SCISSORS 
ManufaCtured 01 f nul a..._ A 
must tor every nUrN 
No 898. 3
 
No 699.""" 
No 700,5\'1 
No 702,7.... 


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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NURS
S 4 COLOUR PEN lor rKorèhnq I.mpar.,u.... 
blood pr...u.... Me One-hand operation ..Iects 
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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 



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committee would ensure 
provision of an emergency 
drug kit. review re!'idents' 
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available from Emilia Rizzuto, 
chainnan. Nursing 
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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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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.' , 



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20 December 1979 


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 
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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 
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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 
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less than a block Irom the Hyatt.s the dIstinguIshed Hotel 
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convention goers Rates are $44-$64 single, $59-$79 double on a 
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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 
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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 
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The Hotel Grosvenor IS well known 10 B C travellers Slightly 
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hopplng and restaurants Ra(es 
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Looking ahead - we'll be tellong you more about B.G. tours, 
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\ 



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 
." 
;; 
'" 
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 
- 
'- 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 


Ë 
" 
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" 
" 
. 
 

 
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8 
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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- 


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I 


, 



 


r 


Nico/eCave 


.... 


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, 


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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 


- 
-- 
- 


"..... 



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 


. 


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.,;' 


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 
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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 


)
 
") 


"- 

(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 


,c- 


J 



 


POSEY COMFORT VEST 
Difficult to remove but comfortable to 
wear For use in bed or wheelchairs. Non- 
slip waist belt adjustmenl allows you to 
fit the waist belt to Ihe 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 



"'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. 


--------------------
.
--.
þ-
.
- 
Q!\> Santa Monica'HoSJ'üal I 
Mecßtal C,nter, r! I --, 
1. _
I., 
.
, CA 10404 
( ....,..:..... bL 2537 
Name I 
urrlIlIllII1IflrrI
 
:
IH!Hl:T1!lllllilI1ll.n I )1 L 

 
 ., 

 
'l.:=- 
gH " 
An Equal O
nity EmploveZ
l.f ...... -<CN-12 


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


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 
ere 


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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 
I 
I 


........, 
Medical Services Branch I 
Department of National Health and Welfare 
Ottawa. Ontario K1A OL3 
I 
I 
I 
I 


Name 


Address 


City 


Prov 


.. 


Health and Welfare 
Canada 


Sante et Bien-être socIal 
Canada 


---- 


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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HOv. I", 
! ITQ NUpr EA ' , I ' , , I , 
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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 


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$., 


U d'/ of Ottawa 
lfiir l ' I, III " l :" l ll I " If 1 ' 1/1 11 '.11 
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