Utah Nurse

Utah Nurse: The Official Publication of the Utah Nurses Association. Utah Nurse has been published quarterly since 1946 for the Utah Nurses Association, a constituent member of the American Nurses Association. Sent to RNs and LPNs throughout Utah, Utah Nurse provides a forum for members to express their opinions and become aware of healthcare issues in the state of Utah.

K RATE STAGE f. ID City, Utah No. 1882 Utah l\lurse Official Publication of Utah Nurses' Association u1-..1 · ~-, (' .... ~ -' · , - • "K[vif'f SA~ I Winter, 1972-73 Vol. 23 ,_,.,, No. 4 u· Vol. 23 No UT Executive It's the real thing. Coke. Table Editorial .. Appreciatio Impact - Operant Cc belie P Extending I Practic• From - lo' Tell Your F About And from ' The Pinto I General Pri Evalua• RN Evaluat " Necessity by Rul " From Stud Maternal C UNA Econo Payroll Dear UNA· UNA-ANA The Nurse Up with A Conver Where to ! Communica Utah Nurst American I Dates _ lnternation1 Old Time 1 The Utah I UNA Past " Care of ti Registr " Discharge Registr BOTILED BY THE COCA-COLA BOTILING COMPANY OF SALT LAKE American Blue Crass Coca Cola Cottonwoo• Geraldine'• Health Set Holy Cross Hyland Ph Mutual of Payson Cit Quality P• Robinson ' s University Valley We Wasatch ' EDITORIAL •• •• Utah l\lurse lol. 23 No. 4 Winter 1972-73 OFFICIAL PUBLICATION of the UTAH NURSES' ASSOCIATION 1058 E. 9th South Salt Lake City, Utah Phone [phone] ecutive Editor . . . CORALLENE McKEAN 1058 East 9th South Salt Lake City, Utah 84105 Assistant ANNETIA J. BILGER 11 "A" Street Apt. 36 Salt Lake City, Utah 84102 fable of Contents page ~orial ---------------------------------------------------·--· 3 -;iireciation --------------------------------------------------3 ~cl - by Wenona Gillette, R.N . _ 4, 5, 6, 7 "'4'ont Conditioning a s Applied to a Diabetic Patient - by Thellis Soderberg, R. N. - 8 ~nd ing the Scope of Nursing Practice ···-·-···-··-···----------- 9, 10, 11 , 12 - Iowa Nurses' Association -------------- 13 Your Professional Colleagues About UNA --·-·········---·········-··-·-····- 14, 15 from The W inner, His Thanks ------------- 15 Pinto Building Fund -··············-··-···-------- 16 ral Principles and Steps In The EYaluating Process ----·---------···---·------ 17, 18 EYaluation ---·-----------·--------·-------usity is the Mother of Invention" by Ruby Fa rncis, P. H.N . ···---------··-· -om Student to Registered Nurse" ------·--·-----··-. mal Child Conference Group Workshop ........ Econom ic and Ge neral We lfare Committee Payroll Deduction Form ············-----------UNA-ANA Member ----------------·· ·ANA Member ····-····-··---------------·-·Nurse and the Law ·········-·····--·····-·-·····-·· with Act ion - Down with Rhetor ic Convention Pre-Registration Form ____________ ..__ to Stay Dur ing Convention Time -------------vnication from the Department of Health .. Nurse Congratulates ·····-·-··-···------·-··'can Nurses' Association Convention Dates -·-·····-················-··-·····-·······-----···tionol Nursing Index -··-·-······-·-··-···. ftmt Therapy ···--·-·-·--··-······-····--··-- ······-·-·· Utah Nurse Welcomes ..................... --··-··-··--Past President Dies - Amel ia Miller ----of the Child With Neurogen ic Bladder" logistration Form ············--······-·-·--··-·arge Planning - " Follow-Up" Workshop Registration Form -------------·----------------- 19 20 20 20 21 22 23 24 26 27 28 28 28 28 29 29 29 30 31 ~vertisers can Fork Hosp ital ............................................ 6 Cro11 and Blue Shield --············-······-···········- 32 Cola ---················ ·······-················-··-·········- 2 woad Hospita l ····-········--·····--···-··-·····-·- 28 E Services Corporation ------------------ ··-------Cross Hospital ---·-·····-··-································· Pharmacy -··············-········-···-···-······--·- ...... I of Omaha ···········-···················----------City Hosp ital ·····-·-···············-·-···-·-··-----~ Press --------------··-··--·························· uon's ------------·---------------------------· ity of Utah Medical Center ·······-················· West Hospital -·-···········--······-··········-······Villa Convalesce nt ·················-··-········-- TER 1972-73 11 18 13 12 13 15 16 5 9 8 The statement " R emember, today is the first day of the rest of your life" is truly applicable to the registered nurse in 1973. Diversified doors of opportunities to practice the art and science of nursing are opening wide. Each opportunity, whether new or old, has responsibilities for which the professiona l nurse will be held accountable. No registered nurse can afford to venture into the years ahead of professional nursing naively or b lindly. Each one is expected to re-assess, re-evaluate and expand present skills and knowledge to effectively perform at the highest level of his/her potential. During the last thirty years, the rapid advance in biomedical knowledge has proved to be a challenge not only to nursing bu t also to medicine. These biomedical advances and the changes in the health care delivery system appear to have threatened some health professionals rather than merely challenging them. However, to hide within one's self and feel threatened is not only self destructive but is also very detrimental to the total profession. The public will no longer tolerate or stand by while some members of both the medical and nursing profession p lay the "n urse-doctor" game. The consumer wants quality health care now! For several years, a number of professional nurses have functioned at the consumer's front line. These experienced consumers and others are now seeking and expecting the nurse to function as their primary care agent, assessing, defining and administering to their immediate health care problems and when necessary, referring them to the proper resources. With these challenges facing the profession of nursing, every UNA member must ask, "Am I up-to-date in my knowledge? Am I providing my patients the safest quality care possible? Am I practicing to my highest potential?" The key factor is not where the nurse practices but rather how qualified and relevant is the practice in relation to the latest available information. As the New Year begins, have you accepted the challenge? Are you certified? Have you applied for certification? If not, is it because you or your professional co-workers do not en- dorse the present certification p gram? If that be the case, 197 3 is t time to accept this challenge. T sub-committee on the refinement the certification program is at wo1 The committee members are anxio to hear your ideas. Some UNA me1 hers have already taken the time identify their concerns. Any oth interested persons should do li.k wise. Please send your recommend tion to UNA Headquarters, in ca; of Mrs. Urla Jean Maxfield. When the present certification pn gram was adopted, some members nc at the convention business sess;or stated that because of the site selecte1 for the convention and the hours a which the session was scheduled, the were neither privileged to hear th1 questions and answers, nor to vote fo: or against certification. If you or any one of your profes sional co-workers feels that you wen denied this privilege, remember, tlH 1973 convention is in Salt Lake Cit) at the Tri-Arc Travel Motor Lodge, Wednesday, May 18, 1973 at 7:00 p.m., the work done by the Refinement Committee relative to certification will be presented for general discussion. Mark your calendar now - BE SURE YOU have your UNA-ANA membership card so that YOU can have a VOICE in making decisions which will influence the "REST OF YOUR LIFE." Corallene McKean, R. N. Executive Director --4-pprecialion All human beings have failings, all human beings have needs and temptations and stresses. Men and women who live together through long years get to know one another's failings; but they also come to know what is worthy of respect and admiration in those they live with and in themselves. If at the end one can say, " This man used to the limit the powers that God granted him; he was worthy of love and respect and of the sacrifices of many p eople, made in order that he migh't achieve what he deem ed to be his task," then that life has been lived well and there are no regrets. Eleanor Roosevelt PAGE 3 IMPACT Picture if you will for a moment a quiet, clear, green pool in a remote woodland. Fed by deep springs and its outlet draining through subterranean rocks, the water surface is o smooth it mirrors the sky in perfect duplicate. Suddenly a large stone is tossed into the middle of the pool and the reflected picture is shattered. An ever widening circle of waves, greatest at the point of impact, travels outward till smaller waves repeatedly advance and retreat against the sandy shores. I suggest that this is a substantially accurate description of the impact that the birth of a baby with a cleft lip and/or cleft palate has, and I would like to explore with you the substance of the waves produced. John and Mary B. were impatiently awaiting the arrival of their second child. Would it be another girl with blond curly hair and sparkling blue eyes like two year old Sally, or would it be a boy resembling John, 26, six feet tall, with brown curly hair? Mary, 24, had an uneventful pregnancy, felt well and especially happy, and continued working till just one month before the baby was expected. Mary and John arranged with the doctor for John to remain with Mary during labor and delivery, as he did when Sally was born; and both again attended pre-natal classes as a refresher course. Mary's mother arrived, the crib was made up, infant clothes neatly arranged in dresser drawers and Mary's suitcase packed. Everything was ready. There was, then, happy excitement when Mary felt contractions early that e v e n i n g . Later when John and Mary left for the hospital Grandma checked sleeping Sally and went to bed for intermittent sleep. Mary's labor progressed normally, without undue distress and rather rapidly, and at 2:30 A.M. she was taken to the delivery room. She and John were both disappointed that her doctor was out of town and Mary was a little worried about having the doctor on call whom she had never met. However, the nurse assured them everything would be just fine. Requiring minimal medication, Mary was alert, cooperative and anticipating the exciting moment of birth. The next few moments were busy ones. Then the time arrived. The doctor said, "Are there any harelips in your family?" "What a ridiculous sense of humor," thought Mary as she PAGE 4 IM by Wenona Gillette, R.N. heard John say, "No." Almost at once a wild fear from somewhere deep inside her arose toward the surface and time seemed suspended. The room was completely silent, no one spoke, it seemed no one breathed for an eternity. Then the doctor's voice, "Well, you've got a bad one here." The fear, like some all-powerful super-creature seemed to paralyze her body till she thought she could not breathe, could not think. Activity, voices were all a blur. Sometime later Mary was in her room and John said something about the doctor promising to call her regular doctor as soon as he returned. Finally exhaustion and sleep overtook Mary. John went to the nursery and asked to see the baby again. Maybe that first glimpse in the delivery room wasn't truly real. The nurse seemed hesitant, embarrassed, pitying. John's more searching gaze at the infant told him his first look was indeed real. The tiny girl had a gaping hole in the middle of her face, her mouth and nose were all mixed up, the nose itself seemed pushed to one side and when she cried he could see the roof of her mouth had a wide split in it. He felt an ache in the pit of his stomach and fearing he was going to be sick, he turned and hurried outside. Fumbling for the car keys he found the slip of paper on which the doctor had written, "State Crippled Children's Service," and a city 200 miles distant. As he drove home thoughts struck him in relentless bombardment. \!\That caused such a gruesome thing? Why should his baby be this way. \!\That had he - or Mary - done wrong? What was it the doctor said? "Are there any hare-lips in your family?" John swerved to the shoulder of the road, braked to a stop and stumbled out to retch repeatedly from an ache in his stomach but even more in his head. For now he knew he had caused this unbelievable thing. He was an orphan whose unknown background must surely hold the awful truth. Eventually, drained and weak, he returned to the car and decided when he returned home to find the seldom used Family Medical Book somewhere among his discarded school texts. Perhaps it would tell him how and why. It was still dark when Mary awakened as a nurse checked her. And then she remembered, remembered hazily a grotesque little face. Was that her baby? Suddenly wide awake she wam ed to see her now - this instant. T nurse suggested she go back to leti and see it in the morning. "Did tf baby really have a hare-lip?" T~ nurse tried to soothe her, "Don't yo1 worry, they do wonderful things nm everything will be fine. Try to , back to sleep." But Mary was worne and everything was not fine. Em thing was horrible and she wanted t see her baby girl - someone did it was a girl, didn't they - and s~ wanted to see her right now! Tt nurse sighed and said she'd bring tt baby in for a moment. While Mary waited she rubbed h cold, damp hands together. Then 11 recalled reading something in a ma~· azine several months before about babies being born with several thin, wrong with them. Maybe if her bab1' head wasn't right on the outside l wasn't right on the inside either. \, one had mentioned that, but ma1b they couldn't tell yet. \!\Then Mary saw her daughter '~ felt helpless anger that this coul happen to her, to hers. Why and ho beat their rhythm also. She knew th drugs sometimes affected unbm babies. But she had taken noth1r. except vitamins the doctor had p1 scribed. Oh, there was the time ,1 had that bad headache and had tale four aspirins during the day. Cou that have caused this? The flood tears seem to help and as they 11 sided she felt an over-powering sur, of love, compassion and tremendo1 protectiveness toward the infant. Then panic gripped her. H, could the baby eat? She looked at t.e nurse, "But I'd planned to nurse h - how - how . . . " The nurse intt rupted, "Well, of course you can nurse it. I don' t know, we'll hare find some way. I think there's soi sort of special nipple you can get. B1 don't worry, they do wonderful thin, now." And so the first wave broke at the point of impact. Before going on let's list some the elements of this first ware. lk cause of the nature of the defect volved, with its distressing sight, cl t lip, especially when it is bilateral. t more immediately traumatic than number of more serious defects. the infa repair. for fostt of time. should goes hor until th old and Deep,\! Helples The 1 ly views inadequ take the helpless produci in failu esteem. as an e is able not onl but alsc Emergir As sc con troll love an mother! tremes. Disbelief, Denial, Disappointment Sometimes disbelief, denial and d appointment are so gTeat that paren are unwilling or unable to care r UTAH NU~lf WINTU ·I M PAC T (contin ued) she want- the infant or even to look at it before tant. The ~pair. Some parents have arranged to sleep or foster homes for varying lengths "Did the [ time. A few doctors feel the lip ip?" The 1ould be repaired before the baby on't you :oes home while others prefer to wait iing now, ntil the baby is two or three months ry to go Id and weighs at least ten pounds. as worried ne. Every- leep, Wondering Hurt, Anger, wanted to ielpless Resentment ne did ay The mother in particular frequentand he l'iews the event as proof of her own now! The adequacy as a mother. This may bring the ke the form of deep hurt, anger and lpless resentment. Her dream of rubbed her uducing a perfect baby has ended . Then she failure and consequent loss of selfin a mageem. Since she thinks of the baby [ore about an extension of herself, when she veral things able to consider rehabilitation it is f her baby'~ t only as restitution for the child e outside it t also for herself. either. ·o but ma7bc nerging Love and Compassion \s soon as the initial feelings are aughter she trolled they are submerged under this could e and compassion. This, for some 'hy and how ~hers, progresses to pathologic exie knew that mes. Unable to tolerate any negated unborn ken nothing tor had prcthe time she nd had taken day. Could he flood of as they subwering surge tremcndou ie infant. her. H<rn looked at the l to nurse he1 e nurse inte1r e you can't we'll ha\C to there's sonw u can get. But nderful thin~ tive comments about the affected chi ld, she devotes all of her time, love and attention to him to the exclusion of siblings and husband. The mother may hide her anxiety and deny conditions needing professional intervention thus preventing rehabilitation and growing emotional independence of the child. Cause Sought Invariably parents seek the cause, either in fami ly history or their own behavior both of which may produce overwhelming guilt. Or they may resort to fantasies such as superstitions rooted in childhood; blaming medical procedures (x-ray, blood transfusions); blaming the doctor; blaming their own deprieved childhood; blaming the husband b ecause of his lack of interest or attention during the pre-natal period; guilt feelings resu lting from a parent's thoughts related to unwanted pregnancy or a wish for abortion; and fears that other people might suspect the mother had attempted abortion. Depending upon their background, the parents may seek information from books, relatives, co-workers, medical personnel or anyone they can recall having a similar experience. Medical Staff Involved The doctor and the nurse are also a part of this initial impact. In the example cited could you see o~ sense the doctor's unpreparedness, his emotional reaction, perhaps his frustration, his feelings of helpfulness, failure, maybe even anger? After all, he had been called out of bed in the middle of the night to attend another doctor's patient. It was a small remote community (not all babies born with defects are delivered in large medical centers). The young nurse on duty worked part-time relief. It was her first experience with the birth of a cleft lip and cleft palate baby. I know, and you know, the situation was far from ideal, but we also know it is realistic. Immediate Knowledge Admitting whatever degree of crudeness, harshness, even professional inadequacy you may wish to assign to the doctor's handling of the immediate situation, at least the parents were told immediately. But what of the mother who is sedated, who returns to her room asleep, the husband who waits in the fathers' lounge? continued next page e broke at th 's list some of first wa\ e. n f the clef cc t in sing sight. cle~t is bilater,il, 1 umatic th.Ill ,\ u defects. appointment , denial and di ·cat that pall'llt ble to r~ll l' for UTAH NUR E * AN EQUAL OPPORTUNITY EMPLOYER CALL COLLECT . . . [phone], EXT. 301 llR 1972-73 UNIVERSITY OF UTAH MEDICAL CENTER SALT LAKE CITY, UTAH 84112 PAGE 5 IMPACT (continued) Perhaps the father is alerted by the doctor fairly soon, but sometimes as much as 24 hours pass before the mother learns the true situation. Can we feel her questions, her fears, her fantasies? Have nurses ever avoided such a mother, been busily brief in their contacts with her, carefully refrained from eye contact, answered questions vaguely, evasively? Unchecked fears are usually much worse than reality. A cute Grief Because of Great Loss and Resulting Mourning It is true that the parents' ability to handle their grief depends upon their individual personalities, their previous experiences, the extent of the defect and the child's response to parental care, but much more importantly, it DEPENDS UPON THE ACCEPTANCE AND EMOTIONAL SUPPORT PARE TTS RECEIVE FROM THE PEOPLE WHO ARE IMPORTANT TO THEM. And one of the most important people from the beginning of impact is the nurse. Hers is a position of tremendous responsibility because the extent and quality of her help may be an important factor in shaping the parent-child relationship and the child's eventual development to his greatest potential. The nurse, then, must understand all these things if she hopes to support adequately. What positive elements may be involved in therapeutic intervention? 1. Early, full communication: a. She should be kind, diplomatic, honest. Her sincere belief that the affected infant is an individual of great worth should be unmistakably evident. b. In simple terms she should explain the nature of the defect, problems to be faced, expected procedures, rehabilitation and the resources available. In general it is agreed this is the doctor's responsibility initially. c. The nurse repeats, reinforces, enlarges, gives concrete hope. 2. The nurse should offer practical advice regarding feeding, etc. (This requires clinical expertise.) a. A calm, concerned, unhurried, caring attitude that promotes belief in the parents' ability to cope is essential. b. It is important to explain, ~lem­ onstrate and supervise the r ePAGE 6 tum demonstration of feeding and caring for the child. c. She should encourage questions and listen to parents. d. It is helpful to arrange communication with other parents having cleft lip and cleft palate children who were successfully treated. e. Anticipatory giudance must also be given. Follow-up care is extremely important and may involve public health, office, hospital and specialist nurses. f. An understanding of the mourning process is essential. Encourage the mother to get extra physical rest in order to have an opportunity to review her thoughts and feelings. Encourage the parents' plans for active care (immediate) and assist them in planning for the future (rehabilitation) . 3. The nurse should feel understanding toward the doctor. It is important that the doctor and nurse work as a team so she should give the support and assistance needed. We have explored the largest wave at the epicenter of the shock. What of those waves in the widening circle? Grandma heard the key in the door and John's entering footsteps. "What's the news?" she whispered so not to awaken Sally. "We've another little girl but she has a problem - a big problem." After a brief explanation and assurance that Mary was all right, John said he had to get some sleep before time for work. However, Grandma noticed he spent several minutes at the bookcase and the light under his door remained on. She knew that, because she was shaking so hard, sleep was impossible. Surely the squeaky bed would arouse Sally. Finally she tip-toed into the kitchen, closed the doors carefully and dialed Grandpa. His sleepy voice became alert when she told him he had a new grand-daughter. He listened intently to her explanation, asked what could be done for the baby then predictably queried, "How can we help?" \!\Then she put the receiver down she felt better. Sorrow when shared is divided. The shaking had almost stopped and although no tears came she still felt as though a great weight pressed down upon the whole family. John said he would take her to see Mary during the evening visiting hours. She was eager ye t worried about going. "What do I say? What can I say? How do I comfort Mary? I've never been in this sort of po)!· tion before. Can I keep from cryin~: I must control myself. I must be strong to be helpful. But can I dl that? Or will I fail as a mother?" Unexpectedly the new mother helped Grandma as she entered th1 hospital room that evening. "Hello Mom, have you seen Judy yet? :\o; You must see her. Have the 11u1 it show her to you first. " Grandma noticed that the bab1 was not in the row of infants lined up close to the window crowded wit~ admiring parents and grand-parent, The nurse rolled her crib from a rear corner to a space at the far enc of the window. Sleeping on her side her head was a healthy pink am somehow the queer-looking nose ano mouth were smaller and less gruesom1 than she'd imagined. Much later when Grandma thought about that first visit three thing, stood out vividly. Her daughter said. 'Tm so glad it's something that can be fixed, aren't you?" And she agreed while hoping fervently that it coul1 indeed be fixed. Then Mary asked if she knew of any such defect in th1 family and she answered too quickh and probably defensively with an emphatic, "No, there isn't." It w. then John had burst out, "It's me. W elcome to AMERICAN FORK HOSPITAL E xpert nursing care C oncern for patients A ware of individual needs R ehabilitate to patient's potential E ndorses continuing education for staff Irene B. Evans, R.N. Director of Nursing AMERICAN FORK HOSPITAL 350 East Third North American Fork, Utah 84003 IM my mo And sh in his suring was J about edge an a COm the bal about John to the vice of for exp he spo help. Iprograr and th within a nurS4 cleft p hospita with ~ know a for litt And come. ~ Judy p the pl< how to She ur1 much, wonde1 all. TI he ga1 asked t as ofte: the ho tain sh very h• Mary's teach manua it in ti liked 1 gentle, to h er Ano parent .Judy. home recoil two y queer She 01 and ir arrival tender began and de perien In 1 Mary'~ York, Angel< ther ir W INTEI t of posim crying? must be can I do th er?" mother tered the g. "Hello yet? No? the uur:>e the baby ants lined wded with nd-parents. ib from a he far end n her side, pink and g nose and ss gruesome ma thought ree things ghter said, g that can she agreed at it could ary asked efect in the too quickly y with an 't." It was t, "It's me, e ts I needs tient's ing ff R.N. ing FORK North Utah I J\I P J\ C T (continued) ny mother probably had three eyes." \nd she remembered the bitter hurt n his voice and the apologetic reas'1ring voice of Mary. The third thing ·as Mary's increasing uneasiness bout the nurses' experience, knowl1'ge and abilities to help. There was complete stalmate about nursing he baby and no definite suggestions bout feeding her at home. John's phone call that afternoon o the State Crippled Children's Ser'ce offered the first concrete hope ir expert advice. The man to whom ~ spoke said they could and would ~Ip. He said there was an efficient rogram of assistance for their baby nd that finances could be arranged ithin the family budget. Best of all, nurse familiar with cleft lip and eft palate babies would be at the 01pital the next morning to talk 'th Mary and John. She would mow all about how to feed and care 1r little Judy. And Miss Jones, the nurse, did me. She showed Mary how to hold dy partly upright, to gently squeeze e plastic bottle and demonstrated ow to cross-cut the soft, soft nipple. e urged frequent bubbling and so uch, much more John and Mary ndered if they could remember it . Their fears were allayed when gave them a phone number and led them to call her whenever and often as they had questions. Since hospital nurses had been so cern she could not nurse Judy, Mary rv hesitantly asked Miss Jones. To ary's delight Miss Jones offered to ch her how to express her milk nually and explained how to use in the bottles. BJit the thing Mary ~best about Miss Jones was the tie, loving way she held Judy close her as though she truly cared. \nother big concern for the young rents was how Sally would react to dy. She knew a baby was coming ne with Mommie, but would she :oil from the peculiar face? If the ~ year old thought Judy's face eer or unusual she gave no sign. only appeared excited, pleased intensely interested in the new ral. She helped Daddy hold Judy ierly on the couch and when Judy san to cry announced emphatically, 3doubtless from extensive doll ex11ence, "Baby wanta bottle?" In the meantime Grandpa called n's older married sister in New :i, her bachelor brother in Los ~Jes and her newly married broin Houston. Thus is was that an UTAH NURSE TER 1972-73 unusually comforting and helpful letter soon arrived from New York and a shorter, brotherly note from Houston. There was a long phone conversation with the bachelor brother who asked about financial arrangements and said he would put a o one - not check in the mail. even Grandpa - knew that the Houston newlyweds had just learned they could expect a child, nor that there was a terrified and tearful wife and a young husband's frantic call to the doctor. And even though the doctor was very reassuring, there was the fear which would not disappear for eight long months. Grandpa was amazed to learn, in the course of business activity, that his boss' uncle had a hairlip, his barber's muchtache covered a repaired lip and even his secretary's sister had both a cleft lip and a cleft palate. Two days after Mary and Judy came home a neighbor with her four year old daughter and ten year old son brought a gift to Judy. At first Mary felt like hiding the baby or making excuses for not showing her. Then she decided, "No, I won't hide her. I think she's sweet. They must think she's sweet too." The neighbor exclaimed over-enthusiastically about the baby's scant blond hair, her size and her blue eyes (she'd heard the baby had been born "with something wrong") . The ten year old boy gazed at the baby silently a few seconds, then averted his eyes toward the window and shuffled his feet uncomfortably. The little girl also stared at Judy seriously, then as if deaf to her mother's chatter, asked Mary, "'Vhat's wrong with her nose?" Quickly the neighbor interjected, "Why, everybody's nose is different. Look, mine is bigger than yours." But the child still looked expectantly at Mary who replied, "It didn't grow right, but when she's a little bigger the doctor will fix it for her. " The girl considered this a moment, then queried, "Why didn't God make it right?" And Mary looked at Judy and said, "I don' t know." There were other gifts too. The landlord, a dentist, brought some books from his library which he said might provide helpful information. A woman called. A stranger to Mary and John, she had been contacted by Sally's pediatrician because her sixteen year old son, born with a similar defect, was now successfully rehabilitated. She was enthusiastic about the Crippled Children's Service program and gave the parents much encouragement. A middle-aged nurse's aide from a nearby nursing home offered to baby-sit on her afternoon off. And John came home one evening with a generous check - the combined donations from his co-workers. The waves of the pool continue toward the farthest perimeters with crests the family may but dimly sense: acceptance or rejection by future playmates, school, a teenage girl's eternal interest in make-up, dating, a career, marriage and what of her children? How long will it be till the pool is again a perfect mirror? If we accept the premise that individuals important to the parents can influence them to a great degree, then nurses must be sensitive to and have an understanding of these sources of influence. In other words, the nurse should see the whole disturbed pool, not just the point of impact. It has been said that each person is the result of all he has ever been, ever known, ever felt, ever dreamed. The nurse faces the challenge and must accept the responsibility of therapeutically shaping the forces which affect the parents of such children in her care. BIBLIOGRAPHY Atkinson, Helen C. "Care of the Child with Cleft Lip and Palate," American journal of Nursing, Vo. 67, o. 9, Sept. 1967, pp. 1889-1892. Barker, R. G. and Wright, H. F. "Midwest and Its Children," The Psychological Eco- logy of an American Town; Evanston, Ill., Roe, Pedterson and Co., I 955. Forbes, Nancy Penman, "The Nurse and Genetic Counseling," Nursing Clinics of North America, Dec. 1966, pp. 679-688. Freud, S. "Mourning and Melacholia," Collected Papers, Vol. 4, London: Hogarth Press, 1934, p. 152. Golub, Sharon. "Genetic Counseling: Heading off Birth Tragedies," R . N., 69: 38-47, ov. 1969. Harvin, J. S. and Gruber, Haskell. "Team Approach to Cleft Lip and Palate," U.S. Air Force Medical Service, 17: 22-24, Jan. 1966. Jaeger, Margaret A. Child Deve lopment and Nursing Care, New York: McMillan Co., 1962, pp. 188-193. Kallus, Jane et. al, "The Child with Cleft Lip and Palate," American journal of Nursing, Vol. 65, April 1965, pp. 120-127. Keilher, Helen. "Expanding Knowledge in the Field of Genetics; Its Meaning for the Nursing Profession," Bulletin of Mass. Nursing Association, Fall-Winter I 968. Lindemann , E. "Symptomatology and Management of Acute Grief," American Journal of Psychiatry, Vol. 101 :141, 1944-45. Sofnit, A. J., and Stark, Mary H. "Mourning and the Birth of a Defective Child," Psychoanalytic Study of the Child, lnternationalal Universities Press, ew York: Vol. 16, 1961, pp. 523-537. Tisza, Veronica B., et. al. "The Parent's Reaction to the Birth and Early Care of Children with Cleft Palate," Pediatrics, 30: 86-90, July 1962. Tisza, Veronica B. "Management of the Parents of the Chronically Ill Child," American Journal of OrthoPsychiatry, Vol. 32: 55, 1962. PAGE 7 Operant Conditioning as applied to a Diabetic Patient By Thellis Soderberg, R.N. An article in a recent American Journal of Nursing on Operant Conditioning, as applied to hospital patients to change undesirable behavior was of great interest to me. A TwoWay Radio broadcast on Behavior Modification as applied in both home and hospital situations was most interesting and showed some gratifying results. The application of this approach to a diabetic patient in a home situation was considered. This appeared to be a bit difficult on first consideration because the patient was an elderly Spanish lady who could speak or understand very little English and the visiting nurses could speak or understand very little Spanish. Mrs. Consuelo Torres, age 73, lived alone in a small apartment. She prepared all her own meals made up of typical Spanish foods, rich in starches and carbohydrates. She was running a 4 plus sugar, almost consistently. The urine was tested four times a day; 7:00 a.m., 11:00 a.m., 4:00 p.m., and 9:00 p.m. The Agency nutritionist had visited with the patient and a daughter, in an attempt to improve the patient's understanding of the importance of staying on an 1800 calorie a day diabetic diet. The daughter agreed to buy the food the nutritionist suggested for the diet, and to instruct the patient in the preparation of it, if necessary. The life-long eating habits of this charming little Spanish lady were not to be so easily changed. She continued to e~t whatever she wished ancl to disregard the daughter's advice and help. The visiting nurse 's attitude toward this disregard of the prescribed diet was one of showing disapproval of the high sugar content of the urine as indicated by the tests. Trying to commu nicate to her in limited Spanish that this was very bad for her eyes, her feet, and her general health, always stressing the negative in word, voice, and gesture. This failed to bring about any change. The daughter said, "Mama is too old to change h~r ways now." A staff conference was held with the Educational Supervisor, Miss Ada Burt, and other staff nurses who had similar patient problems. The Op~r­ ant Conditioning approach was discussed, and it was found this approach uses social approval to help patients drop their sick behavior. Nearly all elderly patients need social reinforcement even more urgently than most of us. This could consist of sincere compliments on their appearance, their accomplishments, or their attitude about their illness, and the courage with which they face the changes. Everyone needs to be understood and appreciated, and these positive reinforcements can be used to encourage more social interaction when behavior is desirable. When behavior becomes undesirable then a very minimal social interaction takes place, in other words, a withdrawing of positive reinforcement. It has been found that the use of negative reinforcement is less effective than positive. By not scolding or acknowledging the undesirable behavior, and instead, showing immediate and genuine approval for desirable behavior, a patient learns to modify the behavior for the reward of the positive reinforcement or approval. In order to apply the Operant Conditioning plan we found we must reverse the methods we were using. This WASATCH VILLA CONVALESCENT NURSING HOME 2200 EAST 33rd SOUTH SALT LAKE CITY, UTAH 4 86-2096 RESTORAT I V E CARE F OR THE CONVALESCIN G a nd CHRON I CAL LY I LL MRS. HARRIET PETERSEN, R.N. A DMINl,STRATOR was done by not commenting on th1 undesirable behavior and by making a record or chart or some visual meam to show the patient the desirable changes and to praise each effort to improve. It was felt important to hm all the staff and family members in· volved aware of this reversal of meth· od as an enatic pattern of positi1e reinforcement could cause the patient to revert back to undesirable actions. Consistency seemed important. All the nurses going into the home to give care were informed that when they tested the urine specimens that the patient should be involved. That she be shown how the tests were dorn and that she watch the entire procedure. She was to watch the bubblin~ in the test tube and the changin~ colors and to compare this to the color chart. W'henever the color changed to orange, or 4 plus, no show of disapproval was to be used nothing but a quick test and put it aside. Each of the four tests wa; 10 be made quickly if four plus. ~o social inter-action was to take place. But when a test tube began to turn. beautiful blue, or even a light green. than an exaggerated show of appro1al by words, looks, and gestures, that were at the command of the nur . were to be used, and a prolongec period of social inter-action was to be used. urses were urged to takt time to learn some Spanish wonh and phrases to help in communicatin, this feeling of good will. We all knOI that a smile, a pat on a shoulder, an an affectionate attitude are unde stood in any language, and this 11a1 found to be so with Mrs. Torres. Mrs. Torres showed a decided in terest in watching the testing proceG ure and really became involved in th1 results. The daughter said that ,1 got up very early to "get ready" fo the nurses and that she really looke forward to our visits after we begar to involve her more and to prolon, the period of social inter-action whe the results were good. A gTaphic record was kept at th1 beginning of this planned progra1 of operant conditioning, during 'f tember, 1969. This showed a definir reduction in the sugar level, with onh occasional flare-ups of 4 plus. "'11t we figured the mean sugar for Juni which was 3.5, with the mean 1u~Jr for September, which was 2.3, thi seemed proof of a dramatic chan~ which we feel was due to our po1it11 reinforcement program From Ext• Extend To a the na roles f< functio over, n fession: and els and p i to the edge, c for hea of pro nurses, profess: The Commi elem en mary,; to indi tion, tl now ge bility, is exer nurses allied res pons ide th not n01 tice in 1 the Cc each o. means In Prin One tunities system• the pra so that greater primaP term P paper A son's fir of illne that lea be don1 and (b) tinuatic health, sympto1 In p1 of nurs< respons manage such as requisit: diagnos routine flow of ments. J Connell From H. f. W. - ting on the by making isual means e desirable :h effort to tant to have aembers insal of methof positive the patient lble actions. rtant. :o the home that when cimens that olved. That cs were done entire proe bubbling e changing this to the the color 4 plus, no to be u eel, and put it tests wa~ t_o r plus. , 'o take place. n to turn a light green, of approval stures, that f the nur e prolonged tion was to ged to take anish words municating Ve all know 1otllder, and are undernd this was Torres. decided inting proced· ·oh-eel in the id that -,he t reach., for eally lookc:cl er we began l to prolong -action when ~ kept at the eel program during Sepcl a definite: -el, with on I plus. "·hen ar for June inean sugar vas 2.3, thi rntic changl', our po iti\e UTAH NURSE Extending the Scope of Nursing Practice ~xtended Role For Nurses To attempt a definite statement on he nature and scope of extended oles for nurses would go beyond the unction of the Committee and, morei1·er, may not even be possible. Proessional nursing, as suggested here .nd elsewhere, is in a period of rapid .nd progressive change in response D the growth of biomedical knowlrlge, changes in patterns of demand or health services, and the evolution professim_ia_l relationships among urses, physioans, and other health rofessions. The following infonnation is the .ommittee's attempt to delineate lements of nursing practice in pri1ary, acute, and long-term care and oindicate, for purposes of illustraon, those elements for which nurses ~v generally have primary responsibty, t~ose for which responsibility exemsed by either physicians or urses or by a member of one of the lied health professions, and those .1ponsibilities that generally fall outde the practice of nurses who are ~l ?ow utilized or prepared to prac(em extez:ided roles as envisioned by e Committee. The groupings in ch of these categories are by no ans all-inclusive. Primary Care ~n.e of the most important oppormues for change in the current >Lem of .health care ir1volves altering e pracuce of nurses and physicians that nurses assume considerably '.ater responsibility for delivering :imary health care services. The m Primary Care as used in this per has two dimensions: (a) a per's first contact in any given episode illness with the h ealth care system t leads to a decision of what must done to help resolve his problem; d(b) the responsibility for the conuation of care, i.e., maintenance of Ith, evaluation and management of 1ptoms, and appropriate referr a ls. In present practice the utilization nurses varies extensively. Some are ponsible for institutional areas of nagement and communication h.a~ .inventory and supply, making ut 1t10ns for laboratory and other gnostic and treatment services ltine charting and managing th~ 1· of charts, and making appointnts. A study reported by Yankauer, nnelly, and Feldman (Pediatrics TER 1972-73 45: No. 3, Part II, March 1970) reveals that in pediatric practices nurses engage primarily in technical and clerical .t~s~s alon~ _with such patient care activities as givmg minor medical ~dvi~e and i.nformation and interpretmg mstruct10ns. In contrast, nurses in public health agencies have traditionally functioned r:l~tively independently, but with physlClan collaboration, in patients' homes, in remote, isolated rural and g~e~to area~, and more recently in chmcs, hospitals, and community care centers where they have: assessed problems of individuals and families· t~eated min?r illne.sses; ref~rred pa~ tiei: ts for differential medical diagnosis; arranged for referrals to social service agencies and organizations· given advice and counsel to promot~ health and prevent illness; supervised health regimens of normal pregnant w?men and of children; and worked with health-related community action programs. Such functions, however, have not been institutionalized by common agreement of nurses and physicians or by medical and nursing educators. As he~lth care b.ecomes increasingly valued m our society, nurses will be expected to take more responsibility for ~e delivery of primary health and ~ursmg care, for coordinating preventive_ sen:ices,. for initiating or participatmg m. diagno~tic screening, and f~r refei:rmg patients who require differential medical dia<mosis and 0 medical therapies. Primary Care Functions for Which Many Nurses Are Now Generally Responsible: • Case finding and medical referr~l. These activities usually are carried out by nurses who function in. pati:nts' homes, in community chmcs, m schools, and in industrial settings. Identification of ills, actual and impending, is expected of all nurses. Case finding and social agency referral. Generally this function is carried out in patients' homes, in ~ommunity clinics, in schools, and in mdustry, although hospital nurses increasingly assess social and economic circumstances of patients and seek to prevent problems and complications that are related to social and economic factors. e Valuable .service to the commumty A ppeciates your evaluations Listens to the patients L istens to the people f mploys qualified personnel Your concerns are our responsibilites Works towards improved patient servtces Endorses continuing education for personnel Specialized patient care Total h.e alth team commLtment HOSPITAL 4160 West 3400 South Serves: Granger, Hunter, Magna and Kearns continued next page PAGE 9 Extending l\lurses' Hole Primary Care Functions for Which Nurses and Physicians Share Responsibility • Health surveillance of pregnant and pospartum women, well babies and children, patients discharged from therapeutic regimens, homebound invalids, and persons in rest and nursing homes. • Identification of the need for, and assisting in the planning and implementation of, changes in living arrangements affecting the health of individuals. • Evaluation of deviations from "normal" in patients who present themselves for treatment. • Assessment of the responses of patients to illness and of their compliance with and response to prescribed treatment. • Performance of selected diagnostic and therapeutic procedures, e.g., laboratory tests, wound care. • Prescription of modifications needed by patients coping with illness or maintaining health, such as in diet, exercise, relief from pain, and adaptation to handicaps or impairments. • Making referrals to appropriate agencies. Primary Care Functions for Which Many Nurses Are Now Prepared and Others Could Be Prepared: • Routine assessment of the health status of individuals and families. • Institution of care during normal pregnancies and normal deliveries, provision of family planning services, and supervision of health care of normal children. • Management of care for selected patients within protocols mutually agreed upon by nursing and medical personnel, including prescribing and providing care and making referrals as appropriate. • Screening patients having problems requiring differential medical diagnosis and medical therapy. The recommendation resulting from such screening activities is based on data gathered and evaluated jointly by physicians and nurses. • Consultation and collaboration with physicians, other health professionals, and the public in planning and instituting health care programs. Assumption of these responsibilities requires that nurses so engaged have knowledge and requisite skills for: • Eliciting and recording a health history: • Making physical and phychosocial assessments, recognizing the range of "normal" and the manifestations of common abnormalities: • Assessing family relationships and home, school, and work environments: • Interpreting selected laboratory findings; • Making diagnoses, choosing, initiating, and modifying selected therapies; • Assessing community resources and needs for health care; • Providing emergency treatment as appropriate, such as in cardiac arrest, shock, or hemorrhage; and • Providing appropriate information to the patient and his family about a diagnosis or plan of therapy. In Acute Care The role of the nurse in acute care is in many ways more clearly defined than it is in other areas of health care. Acute care consists of those services that treat the acute phase of illness or disability and has as its purpose the restoration of normal life processes and functions. The nurse's role in acute care has, by tradition, been somewhat restrictive in many clinical settings, perhaps by virtue of the fact that the physician is recognized as the chief health care practitioner in these settings. It should be anticipated that nurses, and head nurses in particular, will become increasingly free of managerial functions. This will provide opportunity for nurses to assume added responsibility for the clinical management of patients. Acute Care Functions for Which Nurses Are Now Generally Responsible • Recognizing "cue complexes" or syndromes - such as pulmonary embolism, acute renal failure, insulin shock, and hemorrhage - and the making of clinical inferences. • Provisions of emergency treatment as appropriate, e.g., in cardiac arrest, shock, hemorrhage, convulsions, and poisoning. • Provision of appropriate infor. mation to the patient and his family about diagnosis or plan of therapy following physician-nurse appraisal. Acute Care Functions for Which Nurses and Physicians Share Responsibility Such responsibilities are now be· ing shared in some settings on the basis of mutually agreed upon protocols by physicians and nurses: • Carrying out selected diagno i and therapeutic procedures and in· terpreting information such as biochemical reports. • Translating research findings in· to practice, e.g., previous research conclusions concerning the causes of postcardiotomy delirium can be used to minimize sensory monotony and sleep deprivation in intensi\'e care units. Acute Care Functions for TVhich Many Nurses Are Now Pre/Jared and Others Could Be Prepared • Securing and recording a health and developmental history and mak· ing a critical evaluation of such rec· ords as an adjunct to planning and carrying out a health care regimen in collaboration with medical and othe. health professionals. • Performing basic physical am psychosocial assessments and translat ing the findings into appropriate nursing actions. • Discriminating between nonu and abnormal findings on physic and psychosocial assessments and re· porting findings when appropriate. • Making prospective decision, about treatment m collaboratio1 with physicians, e.g., prescribin, symptomatic treatment for coqza, pain, headache, nausea, etc. • Initiating actions, within a protocol developed by medical and nur• ing personnel, such as making " justments in medication, orderin, and interpreting certain laborator tests, and prescribing certain rehabili· tative and restorative measure. T11 examples of these actions are: I a coronary care nurse recognizes sin[} atrial arrest or block, discontinm' the maintenance dose of digitali d cording to standing orders, notifie1 the physician, and prepares to a1'i'1 with such measures as tranmno 1, pacing or isoproterenol drug therapi and (2) a nurse administers postw drainage, clapping, and vibrating , Exie a part patien proble emph) In Loi The affecte imper< roles o vi ding in Ion less th: pre par ciety h assume: contirn in all ; tive d portan Loni service. tomati. rehab ii all age care st should ment 1 staffs, 1 needs and th partici1 The term c the pra both p cationa and th( experie Man· to extc: now that scribed ticed in rarity, : them a charge sume h Long T Which. Generai • Gi, exercise ed by t • Te of his J ments o • Te. member plan fo1 ate inforis family f therapy ppraisal. Vhich now begs on the on protodiagnosis s and inh as bio- ·ndings ins research causes of n be used fOtony and ~ nsive care Extending l\lurses~ Role a part of the treatment cycle for patients with chronic pulmonary problems caused by bronchiectasis, emphysema, or fibrocystic disease. In long-Term Care The increasing numbers of people iffected by long-tenn illness make it mperative to reshape and extend the oles of physicians and nurses in proiding for their care. Nurses involved n long-term care often function at ess than the level for which they are lfepared and less effectively than soiety has a right to expect. As nurses ume broadened responsibility for :ontinuing care of the chronically ill n all age groups, we can expect posiil'e changes in this increasingly imIOrtant area of heal th care. Long-term care consists of those rvices designed to provide sympomatic treatment, maintenance, and TVhich habilitative services for patients of a red II age groups in a variety of health red are settings. Provision of this care g a health and niak- ~ould be the result of mutual agreeent between medical and nursing f such reca ffs, and should be based upon the nning and eeds and resources of th e patient regimen in n d the readiness of the family to l and other rticipate in the plan of care. The nurse's responsibility in longysical and nn care varies greatly according to nd translat1e practice setting, the viewpoints of appropria tc oth physicians and nurses, the edutional prepara•ion of the nurse, een normal nd the extent of her competence and on phy ical xperience. nts and rc~Iany experimental efforts relating propriate. o extended roles of the nurse are decisiom mv m progress. It is likely ollaboration at all of the activities deprescribing '.libed below are now being pracfor COl)ta, ed in a few settings. Their relative etc. Jfity, however, warrants pointing to em as areas in which nurses disithin a proarge or could be prepared to asal and nur-.me further responsibility. making adn, ordering m1g Term Care Functions for laborator 'hich Nurses Are Now ain rehabili11erally Responsible: asure . Two (l) • Giving treatments rehabilitative ognizes .,inoercises, and medications as prescribdiscontinu<: by the physician. digitafo ac• Teaching the patient, members ers, notifil'' his family, or both to give treatares to a.,.,i,t .nts or medications when indicated. trans' enou rug th era J>). • Teaching patients and family sters po.,tu1 al embers to carry out the medical vibrating a~ 2n for specia l diet, taking into conUTAH NURSE lNTER 1972-73 sideration cultural background, personal preferences, a n d financial status. • Observing and evaluating patients' physical and emotional condition and reaction to drugs or treatments. • Calling new signs or symptoms to the attention of the physician and arranging for medical attention when the patient's condition appears to warrant it. • Recommending a p p r o p r i a t e measures regarding physical and social factors in environment that affect patient care. • Instituting immediate life-saving I~~asures in the absence of a phys1oan. • Assisting the patient and family to identify resources which will be helpful in maintaining him in the best possible state of health. Long-Term Functions for Which Nurses and Physicians Share Responsibility: • Making necessary changes in a treatment plan in light of changes of the patient's physical or emotional tolerance and in accordance with an established treatment plan. • Giving families information and encouragement which mav help them to adopt attitudes and practices that promote health and reduce anxiety, tension, and fatigue. • Providing continuous health guidance for mentally ill patients and their fami lies until all practicable rehabilitation of patient and family has been achieved with a joint decision of therapists involved. • Making appropriate referral for continuity of care. Long-Term Care Functions for Which Many Nurses Are Now Prepared and Others Could Be Prepared: • Assessing physical status of patients at a more sophisticated level is now common in nursing practice. • Securing and maintaining a health history. • Within protocols mutually agreed upon by medical and nursing staff - make adjustments in medications; initiate requests for certain laboracontinued next page care • 1sourgame. put your valuable nursing skills into action with Assistant Commissioner of Nursing THE HEALTH SERVICES CORPORATION 2050 University Building Salt Lake City, Utah 8411 1 or the Director of Nursing at: Jn Idaho: CASSIA MEMORIAL HOSPITAL, Burley; FREMONT GENERAL HOSPITAL, St. Anthony; IDAHO FALLS L.D.S. HOSPITAL, Idaho Falls; In Utah: COTIONWOOD L.D.S. HOSPITAL, Murray; FILLMORE L.D.S. HOSPITAL, Fillmore; LATTER-DAY SAINTS HOSPITAL, Salt Lake City; LOGAN L.D.S. HOSPITAL, Logan; McKAY-DEE HOSPITAL CENTER, Ogden; PANGUITCH L.D.S. HOSPITAL, Panguitch; PRIMARY CHILDREN·s HOSPITAL, Salt Lake City; SANPETE L.D.S. HOSPITAL, Mt. Pleasant.; SEVIER VALLEY CHURCH HOSPITAL, Richfield; UTAH VALLEY L.D.S. HOSPITAL, Provo; In Wyoming: STAR VALLEY L.D.S. HOSPITAL, Afton. PAGE 11 Extending l\lurses' Role tory tests and interpret them; make judgments about the use of accepted pharmaceutical agents as standard treatments in diagnosed conditions; assume primary responsibility for determ,ining possible alternative for care settings (institution or home) and for initiating referral. • Conducting nurse clinics for continuing care of selected patients. • Conducting community clinks for case findings and screening for health problems. • Assessing community needs in long-term care and participating in the development of resources to meet them. • Assuming continuing responsibility for acquainting selected patients and families with implications of health status, treatment, and prognosis. • Assuming responsibility for the environment of the care setting as it affects the quality and effectiveness of care. LEGAL CONSIDERATIONS Implementation of extended roles for nurses requires careful evaluation. Reasonable conduct is used to refer to the standard of care that the law impose-; on individuals. The Handard for nurses and physicians is reasonable care under the circumstances. Reasonable care requires the exercise of that degree of skill and care that other individuals of comparable training and experience exercise under comparable circumstances. The standard of reasonable conduct for nurses does not shift even though the circumstances may differ from case to ~ase. The permissible scope of activity for nurses does increase as the education and training of nurses becomes more sophisticated and as they NOW! Nursing Practice Acts in the ma· jority of States have been construed by the State supreme courts. There· fore, there are few definitive judicial decisions as to what constitutes prescription by a licensed physician or what constitutes an act of diagnosis or a prescription of therapeutic or corrective measures within the meaning of the Medical or Nursing Practice Acts. The nurse's legal liability is not new. In fact, the fundamental legal doctrines of negligence and malpractice are applicable whether one is asserting the conduct of the nurse in carrying out a simple treatment or in executing a procedure as complex a1 attempting to defibrillate a heart. Delineation of the boundaries of nursing practice requires that nurm continue to examine the nature of nursing, the needs of society, and the part nurses play in the delivery of health services today and in the future. Once the profession has accepted a function as falling within the sphere of nursing, then each nurse who carries out that function mu t obtain the syst~matic instruction needed to acqmre the necessan knowledge and skill to support her practice. The nursing profession must turn to two legal sources - statutory law and common law - if the profession is to move with social needs and scientific change in extending the scope and sphere of nursing practice are assigned tasks that increase their skills through experiences. There is an ever widening area of independent nursing practice involving judgment, procedures, and techniques. This is due to natural evolution, commencing with the nurses' assumption of certain activities carried out under medical direction, and the subsequent relaxation or removal of that direction. Concomitant w i th increasingly complex nursing practice is the continual realignment of the functions of the professional nurse and physician. The boundaries of responsibility for nurses are not shifting more rapidly simply because of increased demands for health services. The functions of nurses are changing primarily because nurses have demonstrated their competence to perform a greater variety of functions and have been willing to discontinue performing less important functions that were once performed only by nurses. In this period of rapid transition, the identical procedure performed on a patient may be the practice of medicine when caITied out by a physician or the practice of professional nursing when carried out by a nurse. Nursing Practice Acts Nursing Practice Acts like Medical Practice Acts set forth educational and examination requirements, provide for registration of the professional, and describe the practice of the profession in broad general terms. There appears to be great difficulty in defining professional practice in general language with specific application in mind and yet still providing the necessary freedom for interpretation of the law required to cover new and innovative techniques and future conditions of such practice. Specific definitions restrict the permissible scope of practice to those functions specified and make change impossible in the absence of legislative action. Statutory Law. In every American jurisdiction, the statute governing th1 practice of nursing defines profe,. sional nursing in broad general tenm. It permits the profession to adrance into broader practice areas, pro1·ided it can demonstrate the ability to dm upon knowledge of physical, biolo¢· cal, and social sciences. Thus, al· though the general statutory definition permits an expanding role for the nurse, it allows the practice of a for Members of the Utah Nurses Assn.! Available through: The following Programs are: Officially Sponsored and Endorsed by Your Assn. D Income Protection - provides an emergency paycheck when illness or injury keeps you from working. D Hospital, Surgical and Medical Expense protection. D Special one-policy Life Insurance for the entire family (and any children in the future) never increases! PAG E 12 I at one low premium that MutuiJIC\. ef0mi1hi1~ 11lr CompdnlJ dwt pdlJS l ifr lnsur•nu Affili•tr: Unilrd of Om•h.t M VIVAl Of OMAHA l""WllA""Cl (0M Pl\l'lj'r "°"4l OHICl OMAHA. h UIA!.M WM. 8. TOOHEY AGENCY Salt Lake ......... 487-0781 2104 E. 33 South Provo ............ 374-9968 444 No. University Ogden . . . . . . . . . . . 394-4950 2938 Washington UTAH NURSE Exie skill o necess; ing SCi The statut( stance: tion. I a nurs nized l fession would acts to The r nurse not ac scope hibito1 result. a legal role of tual co mg pr establi~ tivity, statute courts and ac. Com sentiall practiti creasirn Throuil the co{i exam in ute. At are the tice in by statl res pons examin1 the ex1 goals oJ sion d( ci ion p tice for the stat nursing Survey c of ANA Since responsi practice the iter Which or Coulc ther Re: and dis1 of the J and Sta States a turns w ments o dicated WINTER · in the man construed urts. Theretive judicial stitutes prephysician or diagnosis or eutic or corthe meaning ing Practice bility is not mental legal and malpracether one is the nurse in oundaries of s that nurses he nature of iety, and the e delivery of d in the futhas accepted within the each nurse unction must instruction he necessary support her Extending l\lurses' Role skill only when it is supported by the necessary knowledge of the underlying science. The interpretation of language in a statute will depend upon the circumstances at the time of the interpretation. If it were customary practice for a nurse to perform certain acts, recognized by the medical and nursing professions, it is doubtful that the court would rule the performance of such acts to be in violation of the statute. The reverse would be true. If the nurse is performing acts which are not accepted as within the normal ;cope of nursing activity, a prohibitory interpretation would likely •esult. On the other hand, if before a legal interpretation is required, the role of the nurse is expanded by mutual consent of the medical and nursng professions, and has become an -~t~blished part of the pattern of ac'.ll'lty, there is less likelihood the tatute would be interpreted by the ourts to prohibit such established md accepted acts. n must turn statutory law he profession 1 needs and tending the sing practice. ry American overning the fines profeseneral terms. to advance eas, provided ility to draw ical, biologi. Thus, alutory definiing role for ractice of a ENCY 487-0781 h 374-9968 ty 394-4950 UTAH NURSE Common Law. Common law is esmtially judge-made law. The nurse ractitioner is held today to an inreasingly high level of responsibility. "hrough decisions handed down by e courts, the nursing profession can ·amine standards derived from statte. At times, common law decisions re t~1e first to interpret nursing prace m areas not specifically defined statutory law. It then becomes the 1ponsibility of the profession 1-o ,amine these decisions in terms of e expectations of society and the als of the profession. If the profeson decides that a particular de1ion points the way to nursing prace for the future, it may mean that statute regulating the practice of mmg should be reconsidered. rvey of State Constituent ANA and State Boards of Nursing Since each of the states has legal ponsibility for control of nursing 1etice within its borders several of items listed as "Functions for bich the Turse Is Now Prepared Could Be Prepared to Assume Furr Responsibilities" were excerpted ~ distributed to state constituents the American Nurses' Association d State Boards of Nursing in 53 tes and territories. Although rems were not complete, the comnts of the several respondents inJted that there are no legal barNTER 1972-73 HYLAND PHARMACY 3291 Highland Drive 485-9281 or 466-0787 11 The Store With Prescriptionafity11 his family with implications of di; nosis, prognosis, and progress wh1 mutually agreed upon by medical a1 nursing staffs. The majority of the responden stated that functions relating to tl physical and environmental care 1 the patient including respirat01 needs, nutritional needs, and mea ures relating to security are all ord nary ~ursing activities. Liability h;; been imposed for a nurse's failure t provide for patient safety, such as aF plying restraints or providing sid r~ils', or fai!ure to evaluate a pa uent s capaoty for safeguarding him self. . In conclusion, nursing will con tmue to change, and it is anticipated that both nursing and law will evalu· ate these changes and make any nee· essary adaptations to meet society's changing needs. DOUG ROTH Reg istered Pharmacist riers related to the functions presented and that these are expected activities although specific authority is lacking. Some of the respondents indicated that assessment of patients carried out by nurses is generally referred to as "nursing diagnosis" or "nursing assessment." It was indicated that the barriers are more traditional than legal. Comments indicated that in some advanced health care settings, a health history is a common nursing practice. Also, if the nurse does not initiate laboratory tests essential to establish life-saving measures, e.g., blood and urine samples in diabetic acidosis, this could be construed as negligence. It is of importance that liability has been imposed when injuries have resulted by negligent omissions in life-saving situations. Here again, the standard of care is the reasonable conduct test discussed earlier, and no greater risk of liability exists merely because emergency circumstances prevail. There was general consensus that there are no legal barriers to nurses assuming the responsibility for acquainting the selective patient and From - Iowa Nurses' Association The "Legislature has authorized the creation of a study committee to study the Licensure and certification of all the professional groups and will probably take a look at the various practice acts for these professional groups. Have You Seen The New 96-Bed M odern PAYSON CITY HOSPITAL Enjoy a Home-town Spirit w ith PROGRESSIVE PROFESSIONAL NURSING BEYERLY DIXON Director of N ursin g Phone: Payson 465-2535 PAGE 13 Tell Your Professional Colleagues About UNA The primary objectives of the Utah Nurses' Association, the official spokesman for registered nurses, are: 1- Meeting the health care needs of the people of Utah. 2- Improving the nursing care of the people of Utah. 3- Preventing the development of health care problems. These objectives are being met by: 1- 2- a- Family Care Practitioners b- Coronary and Intensive Care Nurses c- Emergency Nurse Practitioners d- Pediatric Nurse Practitioners Improving nursing care by: a- Assisting communities in the evaluation of their nursing service and education . b- Encouraging and supporting the development of upward mobility (career ladder) within nursing education. c- Periodically surveying the nurse man power of the state. (Latest survey copies available at Headquarters: Detailed study is $3 .00 and summary copy is 75¢ .) d- Developing and implementing in collaboration with the Board of Higher Education the Master Plan for Nursing Education. (Copies are available at UNA Headquarters for 25¢ per copy.) 3- Collaborating with the other health disciplines in evaluating Utah's total health care delivery system. 4- Supporting the Utah Nurses ' Association and Utah Medical Association 's Joint Practice Committee whose goals are developed . Copies available at UNA Headquarters for 25¢ per copy. 5- Encouraging and providing opportunities for nurse practitioner experts to work together to establish specific Standards of Practice , which are Standards of Patient Care. Geriatric Standards published and available at Headquarters for 50¢ per copy. 6- Adopting and implementing the certification program . Applications are available at UNA Headquarters - no charge. 7- PAGE 14 Encouraging and assisting in the development of educational opportunities for registered nurses to expand their knowledge to become: D e: Assisting and cooperating in the development of a Nurse-Evaluation Program - Peer review. 8- Cooperating with the Utah Professional Review Organization . 9- Reviewing in collaboration with Utah Medical Association and Utah Hospital Association , all proposed Health Legislation to determine if the patient's total health care needs are being considered. to n e' bel UTAH NURSE WINTE 10 - Responding to a community's or an individual's nursing care concerns. 11 - Officially representing professional nursing on various state and local councils concerned with health care : 1- State Comprehensive Health Planning : a- Greater Salt Lake Health Planning. Tooele Comprehensive area-wide b- Box Elder, Cache, Rich area-wide Comprehensive Health Planning . c- Weber Basin area-wide Comprehensive Health Planning. 2- State Health Data Systems Advisory Council 3- State Medicaid Advisory Council 4- Community Services Council 5- Community Nursing Service Board of Directors 6- Higher Board of Education's Advisory Planning Committee for Health Care. 7- Utah Professional Review Advisory Council 8- Women's Legislative Council 9- State Emergency Services Advisory Council 10 - University of Utah College of Nursing Continuing Education Advisory Council. 11 - Department of Registration Board of Nursing . 12 - Utah Heart Association Nursing Education Committee 13 - American Cancer Society - 14 - Utah Council on Aging Utah Division If you have any questions or desire more information, please feel free to call: Mrs. Corallene McKean, R.N. Executive Director Utah Nurses' Association 1058 East 9th South Salt Lake City, Utah 84105 Telephone [phone] -THE COVER- And From The Winner, His Thanks! Dear PRINTING TYPOGRAPHY LITHOGRAPHY urses Association: Just a note to thank you for our new car. \!\Te are just beginning to realize that it's really ours. We are very happy with it and could never express how much winning the car means to us. It's still hard to believe. We keep expecting it to tum into a pumpkin. Thank you again so very much, Bob, Valeice, and Bobby Goudge RULING Quality Press 52 EXCHANGE PLACE SALT LAKE CITY 363-5751 UTAH NURSE WINTER 1972-73 PAGE 15 Ge In The Pinto Building Fund Congratulations to District No. 4 ! They are the $100.00 Winner! l NOTE : Bob Goudge (See Cover and Page 15) THE PINTO WINNER IS THE SON OF UNA MEMBER JANET GOUDGE, Dist. 4 District Membership Total Collections Per Nurse DISTRICT 1 725 $6,858.00 9.4 DISTRICT 2 258 1,493.00 5.8 DISTRICT 3 194 1,145.00 5.9 DISTRICT 4 63 894.00 14.2 DISTRICT 5 22 53.00 2.4 DISTRICT 6 38 344 .00 9.0 "Take if from Cal. ••" YOU CARE -WE CARE MASTECTOMY PROSTHESIS So natural even SHE can forget! YES, WE CARE ABOUT YOUR PATIENTS. THEY ARE OUR CUSTOMERS Robinson 's professionally trained people stay abreast of modern sur'g-ica l procedures in order to supply the finest in easy-to-use appliances and accessories that can make the difference in speedy recovery and a happy psychological adjustme nt following the most difficult surgery. Trained Male and Female Fitters Complete Privacy Recommend ROBINSON'S for a breast prothesis that removes all anxiety and embarrassment. Closely resembles the human breast. Stimulates breast movement in normal or rigorou s activity. Choice of four: • • • • 1 Tru-Life by Camp Economical sponge type Weighted sponge type New silicone forms We are anxious to serve. HEADQUARTERS FOR COLOSTOMY AND ILEOSTOMY appliances and accessories. Trained, understanding people at ROBINSON'S will assist patients in choosing accessories for hand Ii ng postoperative problems involving skin breakdown,. odor, etc. Most nurses pref er these appliances for ease of application, odor resistance and patient comfort. Complete instructions with each appliance . CALL 521-0535 ~ ~ohinson's lf!. Cl,-- 409 EAST 4TH SOUTH Hours: 9 to 6 Monday through and including Saturday. Free storeside parking. PAGE 16 UTAH NURSE "Ev an en• ies an• tain c structi goal i velopn and a to eng One c and s1 ing a One o superv lectual includ1 cal ju the SU own ef ative r process visor's The tion re tion. ": will re where staff rn these p all eval can be living. made c of pre events t to mak1 Evah steps, a continu types o complet objectiv or prog ied anc what ex achievec intellec intimate measure The purpose nursing of nurs identify staff th ' Pau High e r E lin Com WINTER General Principles and Steps In the Evaluating Process by Charlotte R. Waterstradt "Evaluation is both a means and an end. As a means it includes studies and procedures designed to maintain or improve the quality of in1truction or of learning . . . As a 5oal it means the individual's de;elopment of the attitude, knowledge, md abilities which will enable him ·o engage in the evaluation process." 1 ~ne could then say that evaluation ind supervision, which infers teach.ng and learning, are interrelated. ~ne of the objectives or goals of all upervisors is to stimulate the intelectual gTowth of personnel. This ncludes developing and using criti:al judgment. On the other hand, he supervisor must determine her wn effectiveness by the use of evalutive methods, hence the evaluation rocess becomes a part of the superisor's philosophy. E pie pafor The general principles of evaluaon remain the same in every situaon. To simplify understanding, I ill refer generally to the situation here a supervisor is evaluating a ~[£ nurse. I am not inferring tha t 1ese principles are not the basis of II evaluations, on the contrary they m be incorporated in all aspects of ring. Specific references will be ade occasionally to the evaluation procedures, programs, and/ or ents to help illustrate points I wish nmake. Evaluation involves a series of ps, all interrelated, and frequent ntinuous appraisals by different pes of measurement devices. The mplete process is based upon the jectives or purposes of a procedure program and the results are studrl and examined to determine to Mt extent the objectives have been hiered. It is essentially a dynamic tellectual process, although it is timately connected with specific ,asurement tools. The nursing supervisor's major 1rpose is to provide better quality r>ing care. To evaluate the quality nursing care, the supervisor must :ntify or spell out clearly with her ff the characteristics or qualities ing. TAH NURSE ·Paul L. Dressel, et al., Evaluation in her Education, Boston, Houghton MiffCompany, 1961, pp. 24-25. l~TER 1972-73 that make up quality nursing care. Too, she must look at the quality of preparation of the individual staff members giving nursing care. It may be necessary for her to individually help them develop their skills and techniques as well as patient teaching techniques so that they function effectively in giving the kind of nursing care characterized as quality nursing care. Before evaluating an individual, you must know the criteria to be used in the evaluation process. What are the objectives or desired outcome? w·hat are the standards of care upon which you will base the evaluation? The supervisor might identify such characteristics or qualities as interpersonal relations with the staff, the patients, and the visitors, nursing knowledge and skills, professional attitude, and many others. Each characteristic or quality must then be more specifically described by statements of nursing behavior which serve as a guide for rating the quality of care given by each nurse. Careful inquiry and investigation should be made to determine and define or describe these general characteristics or qualities and to set up the descriptive behavioral statements. A comparison is then made between the criterion (descriptive behavioral statement) and the actual behavior. Observation is always an interpretation, therefore, one must realistically recognize its many limitations. Continuous anecdotal records, based upon what is typical for this individual, in terms of the goals, allows for a certain amount of objectivity to enter into the process. Objectivity in evaluation can only be accomplished when the goa ls or purposes and evaluation criteria are clearly defined. No one can make critical judgments without facts. One must know what is going on presently, what has occured, and what can be expected. More frequently than not, jumping to conclusions after observing some particular incident may lead to an erroneous evaluation. Several things may affect the process such as time, place, and personalities. Circumstances and people are continually changing, hence evaluations must also change. The important thing is to view the individual nurse fairly and correctly in the context of the situation which includes the past, present and future. Assumptions and hypotheses concerning the situation must be made from evidence found. Selecting points which are specifically applicable to the problem requires a systematic examination of all facts. The relevant data is then separated from the mass. The supervisor's original opinions may change radically when she discovers the reasons why the staff nurse did something or did not do something. Actual knowledge of the individual's abilities, skills, interests, personality, background, and nursing experience will also aid in appraising the incident. These are but a few of the reasons for constant revision of all evaluations and why they should be considered individually and be made repeatedly over a period of time. When evaluating, the supervisor must not forget that each situation will possibly affect the one and each action of the nurse and its result may affect subsequent actions and results. The complex combination of facts and judgment with probable alterations insists upon accurate and permanent records. Comparison and analysis of anecdotal records, rating scores, and/or interviews ·will show the supervisor the prog ress the nurse has made, her areas of weakness which need further attention, and the effect and results of her own supervisory methods. The evaluator moves from assumptions, to pertinent facts, to hypotheses, and finally to judgments. I believe that it has been amply emphasized that this complete process is based on the primary objectives or purposes formulated and discussed with the staff member before the evaluation was begun. I would like to add here that these objectives and purposes may also have to be revised periodically or circumstances and/or expectations change. Methods of evaluation that a supervisor might use would include: observation recorded in anecdotal notes, check lists, rating scales, verbal interviews, and actual behavior and productivity. None of these methods are infallible and all should be used with caution. It is there, desirable to continued next page PAGE 17 Principles in Evaluation use several methods to provide complete and representative data upon which to base a judgment. The final synthesizing of the facts into a worthy decision can not . be considered final. Any evaluat10n should and must be continually appraised and adjusted accordingly. Whether the supervisor is evaluating a person, event, process, or procedure, the principles remain the sa:ne: know the purpose of the evaluat1?.n; base the evaluation on clearly defmed objectives; identify the components of the objectives, and further identify each component by rele_va~t behavioral statements; make penod1c assessment of behavior, and then make a judgment; then start again. Evaluation is a constant process of reexamination which brings new aspects of the situation into focus. Is this judgment valid and reliable? Evaluation is a weighing and choosing among alternatives; errors in judgment can be made in any phase of the process. There is no infallible criterion whether a person is or will become a "good" nurse. The supervisor is dealing with probabilities, not with certainties. As I have said, a comparison of facts, obtained through the use of several measurement tools, will provide some reliability if the supervisor is flexible and objective. Personality characteristics of the supervisor also affect the evaluation process. The examiner must have insight into her abilities and her limitations, while conscientiously questioning and examining the actual data. She should plan evaluations and later examine them in retrospect. She must analyze her own motives, thoughts, and actions and be willing to admit when she is wrong. Her whole attitude and philosophy should be based on professional thinking, which is obviously evaluative thinking. The word "evaluation" as I have used it, far transcends the customary meaning of the word. It means more than constructive criticism or the technology of testing, it is a process of thinking. Nevertheless, one does need a tool to use and in addition, the staff nurse should be aware of areas upon which the supervisor has Free Yourself I• practice nursing at holy cross hospital. Freedom is nothing else but a chance to do better. Camus For freedom in nursing practice contact D UANE 0 . WALKER, R .N . tlll'H:CTO" 01" ,..URS I NG SUtl/1Clt5 HOLY CROSS HOSPITAL 1045 East First Sout h Salt Lake City . Utah 84 102 Telephone: (801 ) 328 -9 171 AN EQUAL QPPQRTUNITY EMPLQVER based her evaluation. Hence, I have prepared a tool which has proved sue· cessful. This evaluation tool was designed to be simple and yet all encompa · ing. The points were not printed on the original form and the total score was meant only to be a guide for fur· ther evaluation and teaching. After the form has been filled out by the head nurse, the tool is turned over to the supervisor who interpreted and scored it. Needless to say, this fonn should not be used alone, other means of evaluation should be used in conjunction with it. Neverthele s, it has proved a valuable tool to begin ' evaluating nurses based on standards set by the American urse Associa· ti on. Recognizing the general principle of evaluation and using this tool, anecdotal records, and systematic ex· amination of all facts, the supen•isor and/or head nurse should be able to objectively counsel the staff nurse with the hope of improving patient care by stimulating the growth and development of her personnel. The staff nurse, in addition, must be involved, for without joint appraisal b) the participants, identification of the areas that need to be strengthened and finally, the realization of the necessity for improvement iu time areas, an evaluation is just another form to file. It is hoped that this paper will help the supervisor and the nurse to set high goa ls and to recognize the necessity of thoughtful evaluation,. In turn, this will lead to imprmed skills and better patient care. General Principles and Steps In The Evaluation Process Bibliography American Nurses' Association, Fune· tions, Standards and Qualifications for Practice. July 1959. Cooper, Russell M. The Two Ends of the Log Minneapolis Uni\'ersity of Minnesota Press, 1959 pp 317. Dressel, Paul et al. Evaluation in High er Education Boston, Hough· ton Mifflin Company l 961 pp 479. Rines, Alice R. "Evaluation and Learning the Practice of Nursing". Doctor of Education Project Re· port. New oYrk, Teachers College, Columbia University 1959. Tate, Barbara L. "Evaluating the Nurse's Clinical Performance" Nurs· ing Outlook IO: 35-37, Jan. 62. Know Basi1 Abili Knov Basic Skills Su pr Ther ca Proc re< Ob SE Leade Orga Teac Com Res~ fol Judg Crea lnterp Patie Co-v. Phys Ad mi Profe! Parti< Purs1 Parti< Acee A war Appe; Groo Spee HygiE Re Ii at Full 1 Part Cont Willir W I NTE PAGE 18 UTAH NURSE -- i - ce, I have roved sues designed encompassprinted on total score ·de for furing. After out by the ed over to reted and this form ne, other d be used evertheless, ol to begin standards se Associa- l principles this tool, ~~;:~~i:~; [ be able to taff nurse ng patient p owth and nnel. The ust be inppraisal by tion of the rengthened on of the t rn these st another paper will e nurse to cognize the valuation~. imprO\cd care. eps Rl\I EVALUATION Fair Good Basic Scientific facts and principles and ability to apply them to pt. care. 1 Ability to recognize signs and symptoms and take appropriate action. 2 2 3 2 3 3 4 3 4 2 3 Know legal limitations in the practice of nursing . ~ UTAH NURSE 2 Basic leadership and teaching skills plus communication skills. Very Good Skills (manual dexterity) Supportive : Physical hygiene, safety measures, nutrition , positioning etc. Therapeutic: Administration of meds , emergency care of shock, cardiac arrests, catherization, irrigations. 2 3 4 5 Procedural: Management of IV therapy, interpretation of signs and symptoms, accurate recording of l&O nurses notes, diagnostic procedures. 2 3 4 5 Observational: Physical and emotional changes of patients - 2 3 4 5 2 2 3 3 3 4 4 4 vs expectation vs fact leadership Abilities Organization Teaching - organizes time and duties - uses time well - aware of budgetary needs 2 patient and co-workers Communication - general communication abilities with people Responsibility - willing to accept responsibility to patient, hospital and unit -accurate follow through - dependable 2 3 4 5 Judgmental - 2 3 4 2 5 3 3 4 3 3 3 5 4 4 4 5 4 4 3 3 5 Creativity - capable of sound evaluation and judgment imagination - initiative Interpersonal Relations (inspires confidence and able to get along and communicate with . . .) Patients 2 Co-workers 2 2 2 Physician Administration 4 1rofessionalism Participates in her professional organization Pursues independent study (workshop - 2 2 2 professional reading) Participate in inservice program (minimum 2 times a month) progressive and cooperative Aware of responsibility to job and employer - Two Ends University 9 pp 317. luation 111 on, Hough961 pp 479. ation and f Nursing". Project Reers College. 1959. uating the ance" Nursan . 62. Below Fair Knowledge Accepts change, is flexible - tion, Funcalif ica ti on W ARD . . . .. . . . . ... R.N. No ..... .. . . ... . Guide interest 3 3 3 2 2 5 4 4 ~ppearance Grooming 2 Speech 2 2 Hygiene Reliability (longevity) Full Time (note if not punctual) 5 Part time (note if not punctual) 3 Continuous length of employment (consider sick leave) Willingness to fill in - rotate - 1 yr. 1 3 yrs. 3 10 yrs. 5 6 extra shifts Total Score WINTER 1972-73 5 yrs. 32-45 yrs. 2 3 46-62 63-81 4 82-99 5 100-119 not Acceptable PAGE 19 by Ruby Francis, P.H.N. Weber County Health Dept . "Necessity is the Mother of Invention", was especially applicable in the following situation. As a public health nurse, I felt responsible in finding some means to provide my patient a drink of water. Mrs. T. is a 45 year old patient with multiple sclerosis, who at the present time weighs about 75 pounds and is about 5'7" tall. When admitted as a public health patient in 1960, she was confined to a wheel chair, but continued to try to keep her home in order, attend to four children, plus a two month old baby. She has through the years continued to lose the use of all extremities, until at the present time has only limited control in turning her head a few degrees and speaking in spastic syllables. All of the children are married but two boys ages 17 and 12. Mr. T. is a very ambitious man, but to maintain his home and family necessitates his being away from home each day. With the two boys going to school, Mrs. T. is left alone during these hours without fluids. During one home visit I was very perplexed as to a way that I might fulfill her needs while she was alone. Thoughts ran through my mind as to what could be done and thinking of a water container such as little animals use, I decided that these same mechanics could be developed for a drinking apparatus for Mrs. T. operated in providing material to make a drinking apparatus. The equipment used was a flask, rubber stopper with a hole in which a glass tube fitted with curved rubber tubing IO inches long. Mr. T. made a support which was clamped to the head of the bed. (See figure No. 1) This support had a large hole drilled to hold the flask. By positioning the support and placing the curved tube near Mrs. T's mouth, she is able to draw the water out. Only when she draws on the tube does the water come out. Because she can control the fluid intake, this apparatus is very beneficial for other fluids. (See figure No. 2) With this idea in mind, I consulted the laboratory personnel, who co- A Report of the Nurse Career Pattern Study The first comprehensive report of a research project to document the characteristics of nursing students and the progress of their professional ca· reers as nurses has been published by the Division of ursing. This Divis· ion is a part of the Bureau of Health Manpower Education at HEW's ational Institutes of Health. Information is presented on the personal, financial, and social char· acteristics of entering students; their choice of a nursing career and a specific nursing school; their career plans; and, in the instances of with· drawals, the reasons and conditions that prompted them. Figure No. 2 The results were tremendous! Not only for helping to supply the much needed fluids necesary for Mrs. T's physical condition, but it gave her self esteem. Here was one thing she was able to do for herself! She could have a drink of water whenever she wished and didn't need to bother anyone. This spark of being a little self sufficient for even a drink of water had a valuable positive effect on this patient. I am submitting this little information and pictures of the apparatus with the hope that it might be put into use for someone else who may be in like circumstances. Maternal Child Conference Croup Workshop "Well Child Assessment" The Ma tern al Child Conference Group in conjunction with the State Health Department and the Continuing Health Education Division of the University of Utah College of Nur:.ing will be presenting three work· shops, on "Well Child Assessment". I-Week of June 25 to be held in Ogden, Utah 2-Week of July 9 to be held in Cedar City, Utah. 3-Week of July 29 to be held in Price, Utah. A notice with an application for pre-registration will be sent out by the Continuing Health Education Division. Should you not receive a notice and are interested in attending, write to Darlene Peay, Unim· sity of Utah College of Nursing, 25 North Medical Drive, Salt Lake City, PAGE 20 I UTAH NURSE . UN, ti It is on sale by the Superintendent of Documents, Government Printing Office, Washington, D.C. 20402 at the small price of just $1.00 per copy. Satisfying this physical need has also appeared to have calmed some of her spasticity. At each visit she takes a sip of water and with a small breathy laugh lets me know how much she appreciates being able to get a drink. Figure No. 1 "From Student lo Registered Nurse" -- --- WINTER 1t to rse~~ UNA Economic and General Welfare Committee has prepared the following Payroll Deduction Form for UNA members. areer report of a ment the dents and ssional cablished by his Divisof Health EW's Na- PAYROLL DEDUCTION FORM DO YOU DESIRE payroll deduction for your dues? The Utah Labor Code and Regulations 34-32-1 provides as follows: "Whenever an employee of any person , firm, school district, private or municipal corporation, within the State of Utah executes and delivers to his employer an instrument in writing whereby such employer is directed to deduct a sum at the rate not exceeding 3% per month from his wages and to pay the same to a labor organization or union or any other organization of employees as assignee, it shall be the duty of such employer to make such deduction and to pay the same monthly or as designated by employee to such assignee and to continue to do so until otherwise directed by the employee through an instrument in writing". d on the cial charents; their and a speeir career s of withconditions rintendent t Printing 402 at the r copy. PAYROLL DEDUCTION FORM UTAH NURSES1 ASSOCIATION 1058 EAST 9TH SOUTH SALT LAKE CITY, UTAH 84105 onference the State e Continuion of the of Nursree workssment". TO (employer) ................................................... . you are hereby authorized and instructed to withhold from my earnings the sum of $. . . . . . . . . . . . . . . . per month for . . . . . . . . months and to transmit the same directly to the Utah Nurses Association at the above address in payment of my professional dues. e held in Very truly yours, e held in e held in NAME .. . ... ... . .. .... .. .... ... ... .... .. ........... . cation for t out by Education receive a in attendy, Univerursing, 25 Lake City, ADDRESS .................. ... ....... .... . ........ .... . SOCIAL SECURITY# .. ..... . .. ... ..... .. ..... . .. .. .......... . .. .. . LICENSE# ............................................. . ~TER 1972-73 PAGE 21 Dear UNA-ANA Member: The membership goal for 1973 is 2,200. The association needs your help. - - - Please post this graphic picture in the specific area where you practice. - - -Tell your professional co-workers about the . . association. - - - Encourage them to have a voice in their professional future. - - - UNA-ANA is anxious to hear your and their ideas. Remember, the value of the association increases with use and exchange of ideas. Members are the decision makers. Sincerely, Membership Committee Please Post! * * * H Registered l\lurse Prescription see opposite page PAGE 22 UTAH NURS! WINTER i; Registered Nurse i; UNA-ANA Member Free Rider * UNA * ANA For relief of back strain Recruit a non-member Stat! For relief of professional aphasia - Join UNA-ANA Stat! Utah Nurse 's Association American Nurse 's Association Headquarters: 1058 East 9th So. Salt Lake City, Utah 84105 UTAH NURSE MER 1972-73 PAGE 2~ The l\lurse and the Law From The Regan Report on Nursing Law c Post-Surgical Nursing and the Law RESTRAINTS USED IN THE CARE OF POST-SURGICAL PATIENTS in hospital Recovery Rooms often figure in injuries to such patients. Ironically, the restraints which are ordered and applied to avoid certain types of accidents, can cause serious injury if the restrained patient is not properly monitored by nursing service. As part of her professional experience, a nurse in a special care unit, such as a Recovery Room , is expected to know how to use restraint equipment in a manner designed to adequately protect the disturbed patient. Delay by a nurse in using the restraint required may be tantamount to negligent-by-omission . All of this adds up to a timely legal warning . A nurse should know when and how to use restraints properly both with and without prior medical orders, depending upon circumstances, in the care of the post-surgical patient. HERE'S A RECENT CASE IN POINT: A six-year old patient had undergone eye surgery. When a Recovery Room nurse noticed the child trying to reach for the bandages on both eyes, she applied restraining boards to both arms of the child . The child 's mother, who was at her side during this period , claimed that the child groaned and complained of the pressure in and on her arms and that the arms were checked infrequently. When the restraints were removed about 18 hours after they were applied, there was damage to the child 's left arm which required treatment by an orthopedic surgeon . This lawsuit followed . The court remarked : "The jury could have considered the hospital nurses to be negligent in failing to prevent the child from struggling against the boards, particularly in review of the child 's age and condition and the fact that the hospital had notice of the possibility of injury." It was established that a greater standard of care should be exercised in the treatment of the very young or the very old. IN THE CASE REFERRED TO ABOVE, NO ONE CRITICIZED the nurse's decision in putting restraining boards on this child 's arms. To the contrary, it was apparent that what she did was right and in accordance with nursing practice . However, in using restraints, it is important that the restraints be commensurate with the patient's strength and be sufficient to protect the patient and others. The negligence in this case related to the degree of nursing surveillance over the restrained patient. THE ADMINISTRATION OF MEDICATIONS POST-OPERATIVELY at a time when the patient is gradually regaining full consciousness presents another type of situation in which accidents frequently occur resulting in litigation against hospitals and their Recovery Room nursing personnel. Consider the following case, for example: Lisa Bernardi , 7 years of age , was a patient in an acute care hospital, having undergone surgery for the drainage of an abscessed appendix. The attending physician had written a post-operative order that she was to be given an injection of tetracycline every twelve hours . During the evening of the first day following surgery, a nurse injected the dosage of tetracycline in Liza's right gluteal region . It was later alleged that the nurse negligently injected the , tetracycline into or adjacent to the sciatric nerve, cau sing Lisa to have a complete "foot-drop" and to lose permanently the normal use of her right foot. The Colorado Supreme Court ruled in favor of this injured patient and against the hospital as the employer of the nurse. The court said : " We have concluded that the rule of Respondent Superior applies here. The hospital is responsible for the acts of th is nurse." It is of the essence that nurses working in such a Unit be particularly well skilled in the care and nursing service required by the seriously ill patients temporarily confined therein. With all due regard for the necessity of some interchange of nursing personnel between Units in a particular hospital , areas such as the post-operative Recovery Room , should be recognized as requiring special nursing skills and specific orientation. Nursing Liability for Faulty Equipment "HOW LONG HAVE YOU BEEN LOOKING AT A BROKEN WHEELCHAIR? OR AT THAT AUTOCLAVE WITH A DEFECTIVE HEAT INDICATOR?" Perhaps you are a supervisor who is aware of the budgetary limitations for replacement of patient care equipment and you feel it is an exercise in futil ity to bring such problems to the attention of the Director of Nursing Services . Or perhaps you are a charge nurse who has been told that " nothing can be done about it until the end of the fiscal year" so many times that you have just given up trying to convince somebody that such potential sources of accidents will inevitably result in someone being seriously hurt. Or, finally, you may be an R.N . or L.P.N. or nurses' aide who feels that responsibility for observing such defective equipment is simply none of your business. Therefore , you choose to remain silent when you discover broken and defective equipment of this type. If you fall into any of these categories of nursing personnel , you are mistaken in your attitude. You are apparently unaware that you share a responsibility with your hospital employer in this constant need to be observant of possible sources of accidents to patients, to your fellow employees , to visitors or others in the hospital. You may be unaware that your contract of employment with your hospital requires that you communicate your observations regarding such faulty equipment to those in authority above you . You may r.ot realize that your failure to do so constitutes a breach of contract which could not only involve you directly in liability but could be a sufficient cause for your discharge from employment. AS AN EMPLOYEE OF A HOSPITAL, A NURSING HOME OR A MEDICAL GROUP, you share responsibility for maintaining conditions of safety. People using the facilities of such health care institutions , have a right to assume everybody involved in the rendering of care, is conscientiously alert to the potential sources of accidents which could result in injuries. It would be an indictment of your professional status for you to exhibit a NON-COMM ITAL and disinterested attitude towards the discovery of faulty equipment PAGE 24 which you know or should have reason to know is to be used al some point in time in the care of patients for whom you share certain professional responsibility. Hospitals , nursing homes and other health care facilities try assiduously to maintain highest levels of safety in the dispensation of health care. To maintain such levels and to keep incidents and accidents to an irreducible minimum requires the cooperative effort of everyone . HOW DO YOU PROTECT YOURSELF, YOUR EMPLOYER AND THE PATIENTS YOU SERVE RELATIVE TO DEFECTIVE EQUIPMENT? The answer to this question requires an understanding of the liability of your employer for the care and safety of patients and others who use the facilities . The legal standard of care req uired of your institution is, generally speaking, REASONABLE CARE UNDER THE CIRCUMSTANCES OF EACH CASE. In this regard, accidents and incidents which are determined to have been unforeseen and unpredictable are generally regarded as being beyond the scope of hospital liability. For liability to be present, it must be shown among other things that the hospital knew or should have known that the equipment in question was defective. The failure of anyone employed by a hospital to take timely notice of defective equipment and the failure of such employee to communicate the observed defect to those in a position to do something about ii, would result in liability for the hospital as employer and for the individual careless employee. It follows , therefore, that everyone involved in nursing care should protect herself, her employer and the patients to whom she is rendering service by promptly reporting faulty equipment and defective material as soon as she observes such defects. The failure of nursing service and of administration to respond to such observed potential dangerous situations in the past is not sufficient cause for a nurse to neglect her own responsibility of dutifully reporting any evidence of defective equipment. UTAH NURSE S) WINTER > right and in a memory is forever ng restraints, with the pat1t and others. nursing sur- Have you been looking for a bra that? )PERATIVELY :onsciousness i ts frequently 1eir Recovery for example : ute care hosm abscessed :>ost-o pe rative 1cycline every ,wing surgery, : right gluteal r injected the .using Lisa to ly the normal ed in favor of 1ployer of the e rule of Reinsible for the )fking in such ursing service 1fined therein. ange of nursareas such as ~ n ized as re- • • • • • • • • n. to be used at 1ou share cernes and other hest levels of in such levels l minimum re- PLOYER AND :;TIVE EOUIPderstanding of if patients and care required NABLE CARE n this regard , 1ave been unbeing beyond ~nt , it must be 1r should have 1e. The failure :::e of defective nmunicate the thing about it, lr and for the that everyone employer and nptly reporting she observes administration tuations in the t her own re~fective equip- UTAH NURSE Eliminates strap strain Shapes and firms sagging bustline Won't ride up Minimizes the large heavy bustline Retrains breast tissue to increase cup size Creates cleavage Best bra available for prosthesis Custom fitted over 17 5 sizes 151 6 So. 1500 E. Salt Lake City, Utah 84105 486-8053 or Geral d ine Bu rton M a ri e S. Ech ols 52 1-8943 485-8697 Shows available for groups also career opportunities m R 1972-73 PAGE 25 UP WITH ACTION DOWN WITH RHETORIC PRE-REGISTER BY MAY 11 , 1973 Utah Nurses' Association Convention •... May 16, 17, 18, 1973 I TO BE HELD AT THE TRI-ARC TRAVEL LODGE MOTEL AND CONVENTION CENTER MAY 16, WEDNESDAY .......................... .4:30 to 10:00 p.m. PRESENTATION OF CERTIFICATION REFINEMENT CRITERIA MAY 17, THURSDAY . ........................ 8:00 a.m. to 4:00 p.m. BANQUET ............... . ............ 7:00 p.m. MAY 18, FRIDAY ............. . .......... . .... 8:00 a.m. to 6:30 p.m. REGISTRATION INFORMATION 1 - NO PRE-REGI STRATIONS ACCEPTED AFTER FRIDAY, MAY 11 , 1973. 2 - NO MONEY WILL BE REFUNDED AFTER MONDAY, MAY 14, 1973. SAVE$$$$$$ - PRE-REGISTER PRE-REGISTRATIO N REGISTRATION AT SITE $ 7.00 -- Wednesday $14.00 $20.00 $20.00 $ 4.25 $ 9.50 $10.00 $10.00 $ 3.25 $ 8.50 -- Thursday -- Friday per person for lunch (Thursday and Friday) per person for banquet (Guest tickets $8.50 ea.) -- Wednesday -- Thursday -- Friday per person for lunch (Thursday and Friday) per person for banquet (Guest tickets $9 .50 ea.) $42.00 .. TOTAL AMOUNT FOR PRE-REGISTRATION FOR THE THREE DAYS, AND INCLUDES LUNCHEONS AND ONE BANQUET TICKET. PRE-REGISTER - Save You and Us time at Convention TEAR- O FF F OR SAVE $$$$ - PRE-REGISTER PRE - REGI S TR ATI O N Utah Nurses' Association Convention .... May 16, 17, 18, 1973 0 D D D D MAY 16, Wednesday ..... .. . ..... $ 7.00 MAY 17, Thursday ............. .. $10.00 MAY 18, Friday . . . . . . . . . . . . . . . . . $10.00 LUNCHES D D MAY 17, Thursday .... . ...... . $3.25 MAY 18 Friday . . . . . . . . . . . . . . . $3.25 MAY 17, Thursday Banquet ......... $ 8.50 GUEST Banquet tickets each .... $8.50 .... Indicate number of tickets . ... . Total $ ..... .. . TOTAL AMOUNT ENCLOSED$ ............ MY CHECK NUMBER .......... . .c. 1. ~r-t.b 1=.+-h . . .!-:Iv..... ... ................ ?.~ .~ :-. '-' ·'· ~.J Name ./. q ':+; ';> · · ;>. 0 Address PAGE 26 . . . ........ .... ..... . ... ..... . Business telephone number -t ~ • .I ~ · · ~ · .~t ·. ~.-?-. · . .. · . . . . . Street .,s. {-.. <:2..-.. City I • ~ •• •••• •• x'-!-. ~ <;>$. ... ... , .. Zip UTAH NURSE WINTER Where to stay during Convention Time... Proximity of various motels to the convention center allows for a greater flexibility in choice. The prices are listed below to familiarize yourselves with the accommodations. The convention will be held at the Tri Arc Travel Lodge. iJORIC ~ 1973 Tri Arc Travel Lodge 161 West 6th South Area code 801 - 521-7373 TER Single occupancy Double occupancy Double occupancy Double occupancy I bed $17.00 per I bed 19.00 per 22.00 per 2 beds 3 persons 24.00 per (Extra bed brought in room) 2 queen size beds $26.00 per Four persons per room night night night night night Roadway Inn (Directly across from the Tri Arc) 154 West 6th South Area code 801 - 521-2930 3. bed bed Single occupancy Double occupancy Four persons per room 17.50 per night 20.50 per night 28.50 per night Coveys Little America (One block east of Tri Arc) 500 South Main Area Code 801 - 363-6781 rriday) $9.50 ea .) 1 bed 1 bed (extra bed) 2 beds Single occupancy Double occupancy Three persons to a room Four persons to a room REGISTER 1973 $20.00 22.00 24.00 26.00 per per per per night night night night Motel No. 6 176 West 6th South Area code 80 I - 521-3280 $3.25 (This motel is located across the street and one block west of the Tri Arc. They accept reservations two and three months in advance. The capacity for the motel is 55 singles - 55 doubles. So first come, first served. Make your reservations in February.) $3.25 Single occupancy Double occupancy Double occupancy Three - four persons $ ....... . I 1 2 2 bed bed beds beds $ 7.00 per night plus tax 8.16 per night plus tax 9.33 per night plus tax 10.49 per night plus tax The Convention Committee can not be responsible for quality of facility or services. The room price infonnation is given so as to allow you to make your own choice. UTAH NURSE I TER 1972-73 PAGE 27 Communication from the Department of Health, Education, and Welfare Public Health Service Regarding Drug Rehabilitation for Nurses. Utah Nurses Association: I am writing to inform you of a newly developed treatment program designed specifically for registered nurses who are drug users. This program is located at the National Institute of Mental Health Clinical Research Center in Lexington, Kentucky, the federal narcotics hospital. The purpose of the program is twofold: (1) to provide a facility capable to meeting the unique needs of addicted nurses, and (2) to conduct clinical investigation of this problem in order to advance understanding of its genesis and effective treatment. In brief, the mechanics of the program are as follows: Eligibility is limited to registered nurses who use drugs and desire treatment. Such individuals should call me at [phone], extension 2353. I will arrange for their admission to the program. Nurses will reside in Ascension House, Rehabilitation Services for Women, on a unit reserved for them. Withdrawal from addicting drugs will be carried out when necessary. Complete medical services will be available. There will be daily group therapy and a self-governing milieu administered by the nurses themselves. Plans are being made to develop a continuing education program, possibly in connection with the University of Kentucky, to allow for a useful and productive professional experience during the treatment period . Only voluntary self-referred patients will be accepted. Individuals will determine the length of their stay themselves and no prior commitment to a specific time in treatment need be made. There will be no fee for treatment and transportation to the Center as well as transportation home will be paid for by the Center. We believe this program will be attractive for a number of reasons. Nurses will have the opportunity to have group therapy exclusively with other nurses in similar circumstances, under the guidance of a staff who are experienced in the problems of drug use. In addition, their identities and the fact of their treatment for drug use will be completely confidential. (This confidentiality is guaranteed by Act of Congress.) Thus , a period of treatment in a Center distant from their homes will provide a resource for self-help which will not jeopardize their professional careers. Utah Nurse Congratulates The Following Members on Their New Appointments: MAR ILYN PARK, Advisory Coun· cil, of the Comprehensive Health Planning Mental Health Representative. COR ALLENE McKEAN, Vice Chairman of Comprehensive Health Planning Advisory and will become the Chairman, June I, I 97 3. American Nurses' Association Com· mittees: SISTER CARO LITA, Membership Committee. DUANE WALKER, Careers Com· mittee. I would greatly appreciate your disseminating this information to nurses in your jurisdiction . Please contact me for any additional information which may be of help to you. Yours sincerely, David G. Levine, M.D. Staff Psychiatrist HAPPINESS IS . .. NURSING AT THE COTTONWOOD LOS HOSPITAL • A 154-bed progressive, dynamic acute hospital • A suburban setting located at 5770 South Third East - Murray, Utah • A friendly place to work Rewarding and challenging Opportunities in Medical, Surgical and Obstetrical Nursing including Specialty Units • You'll love belonging to the- HOSPITAL with a PAGE 28 Many ni Monopc Once tn They co Our tam Without He trave To de/iv He was With OU/ Our me< And oftWhen vii He cam£ Devote t But neve Ame rican Nurses' Association Conve ntion will be held in San Francisco, Califo rni a June 9 to June 14, 1974. Painting: Prescrib• Some to But we c International Nursing Index Problem: In musta Which m But knoc Sharing my responsibility for this program will be Phyll is Preston , R.N., Head Nurse, Ascension House, and Sally Lipscomb, R.N., Psychiatric Nurse, Ascension House. At present we must restrict this program to female registered nurses. Depending upon the response, we may expand our efforts to accommodate male nurses as well. Further off in the future are similar programs for other health professionals such as physicians and pharmacists. The USE Has pre And du1 It was o INTER NATIONAL URSING I DEX, the complete index to current Ii terature on nursing, is published by The American Journal of Nursing Company in cooperation with the ational Library of Medicine. Utilizing the NLM's computerized facilitie and a skilled team of indexes, International Nursing Index provides ref· erences on every nursing subject to approximately 200 nursing periodicab published in the United States and abroad and to over 2,300 non-nursing periodicals indexed in Index Medicm. Published quarterly, International Nursing Index cumulates with each new issue for the calendar year. The fourth issue each year is durabh bound in cloth and includes all references for the year PLUS lists o[ books on nursing published in the United States and other countriei during the year, lists of national and international nursing associations' publications, and lists of all doctoral dissertations prepared by nurses. Subscriptions to International Nurs· ing I ndex for the current calendar year are $25.00, which includes three q uarterly issu es and the hard corer an nual cu mulation, sent postpaid to any address in the world. UTAH NURSE For a tini A Smith It loosen• And c/ea Of green It was ou To purify Or to ma1 When stn We staye. Hot ginge Relaxed < To cleans Required Epsom S1 It never f< Syrup of Would als T'was ger And curec When sic (Our ham£ I'd rather Than take Watkins L To sore jo It assuage And post WINTER ratulates nbers on 1tments: ~isory Counbive Health Representa- 0/J :Ame :J/ierap'J The use of medicine, with complexities, Has prevailed down through the centuries And during the horse and buggy days, It was dispensed in dubious ways. \fany nostrums by themselves, .AN, Vice \fonopolized the drugstore shelves. asive Heal th Jnce tried, you may be sure, will become 1hey could either kill or cure. 973. iation Com- Jur family doctor had to plug Vithout access to a wonder drug. Je traveled tar, mostly alone, ·o deliver babies in the home. Membership ~ areers Com- 'e was our friend, kind and good, ith our home-cure remedies he understood lur meager means and few facilities, ~ d oft-times praised our rare abilities. Lydia Pinkham appeased the wife Flashing through the change of life. Her disposition became less snappy, Which made her husband very happy. For tight congestion in the chest, Mustard plasters proved the best. A camphored oil rub then ensued With a wee sip of brandy, for good attitude. To bring a tester to a head, We applied a poultice of milk and bread. Sometimes Denver Mud was tried Until the sore was purified. With Watkins Powder we 'd brush our teeth, Upper, lower and underneath. Although accomplished with vigorous zeal, It lacked the enticement of sex appeal. If we punctured a toot with a rusty nail, We'd soak it hot in a water pail, Add Epsom Sa/ls to purge the wound, Otherwise, our precious lives were doomed. hen vital emergencies arose e came to our bedside to diagnose , ssociawill be ancisco , to June evote his time to explain and advise, Jt never to blame or to criticize. 1intings on barns o'er dale and hills, escribed Doctor Pierce's liver pills . 'me folks relied on the phony strategem, ut we didn 't have the gall to try them. ng Index ob/ems arose that required heat, mustard water we 'd soak our feet. ~ich made the digits scarlet red, t knocked a cold out of the head. U R S I NG ndex to cur- a tingling tickle in the throat, g, is publish- Smith Brothers' blob was the antidote. rnal of Nur - oosened our stuffed up noses, ti on with the d cleared the air of halitosis. icine. U tiliz- green sage tea we were quite sardonic, ized facili tie as our -bitter, spring-time tonic dexes, Jnter- purify the blood and make it rich , provides ref- to make us gag, I don't know which . g subject to g periodicah ~n stricken with the menses pain d States and stayed secluded from the rain, non-nursing ginger tea, served a la carte, dex Iedicus. axed and soothed the aching part. International es wi th each cleanse the tract from putrefaction, ar year. The quired strong and instant action. is durabh om Salts would step you quick; ludes all ref- ever failed to do the trick. LUS lists of up of Figs , in measured potion, ished in the uld also set the wheels in motion . 1er countrie~ as gentle, mild, and sweet to take, national and icured many a stubborn tummy ache. associat i on~· f all doctora l y nurses. ational ursrent calen dar "n cl udes three e hard CO\ er t postp aid to d. UTAH NURSE en sick and green around the gills, ' home was void of shots and pills). ather inter my bones in soil ill take a dose of Caster Oil. ijns Liniment was an aid joints, or shoulder blade. waged the pain of rheumatism, dpostponed old age tossilism. 5Dre ~YER 1972-73 For laceration , or abrasion, Carbolic Salve served as medication. With magic power it brought relief, And subdued the howl of painful grief. Hall's Remedy gave a tangy zip To canker of the mouth or lip, And if it failed to heal the sore, A rinse of Potash was the cure . Hospi tal at Bremerton, ·w ashington where she worked as a coronary care n urse from September 1970 until July 1972. Before that she was stationed at the Naval Hospital in Philadelphia for o ne and a half years. During that time, she worked in the intensive care u nit and the operating room. She graduated from the University of Portland in 1969 and joined the avy Nurse Corps in December 1967 under the Navy Nurse Corps Candidate Program. D uring her senior year the Navy paid all her tuition and school expenses p lus she received a monthly salary. In December 1968 she was commissioned as an ensign in the N urse Corps. Utah wi ll miss LT. SANDRA A. KIR KPATRICK, who leaves the Navy R ecruiting after spending three years as this command's Nurse Recruiter. She will be stationed at the Long Beach, California city's aval Hospital. D uring her tour she received the avy Commendation Medal for her outstanding performance of duty. GOOD LUCK TO YOU SA DRA, in your new position. Sulphur and mo/asses, sweet and thick, Had soothing value when we were sick With quinsy, or a hacking cough; A few measured doses would check it off. During the time we had the mumps We bloomed out like tat-faced chumps. To hold the stubborn disease in check, A pouch of Asafetida adorned the neck. After each contagious disease was spent, We 'd sally forth from imprisonment While doors were sealed on every side to fumigate with formaldehyde. Such home-cure remedies, with some to spare, Were administered with tender, loving care. Indeed, we've come a great, long way Since we hitched Old Dobbin to the shay. The above verses by Leah S. Merrill, 440 East Third South Street, Apt. No . 17, Sall Lake City, Utah 84111 are dedicated to Utah 's Senior Citizens. THE UTAH NURSE WELCOMES: LT. MARGARET A. LEINEWEBER, who reported to the San Francisco lavy Recruiting District on August 30 as the relief of LT. SANDRA A. KIRKPATRICK, the command's urse Corps recruiter. Lt. Leineweber has come from the Naval Utah Nurses' Association Past President Dies Amelia 1iller, former resident of Ogden, Utah, died in Portland, Oregon on June 16, 1972. Miss Miller was the Director of the School of nursing and Nursing Service at the Thomas D. Dee l\Iemorial Hospital Ogden, Utah, in 1936. She was very active in the professional nursing organizations and the Business and Professional '"' oman's Club during her professional life. She was president of the Utah State urses Association and a member of the Board of Iurse Examiners while employed at Ogden, Utah. PAGE 29 Maternal Child - Community Nursing Conference Groups A Nursing Workshop "CJ\RE OF THE CHILD WITH NEUROGENIC BLADDER" FEBRUARY 21 , 1973 WEDNESDAY - ' 4:00 p.m. SHARP to 8:30 p.m. REGISTRATION BEGINS AT 3:30 p.m. TO BE HELD IN THE SCHOOL ROOM AT SHRINERS HOSPITAL Fairfax Avenue at Virgin ia Street REGISTRATION FEE (Includes a box supper) SNAU and UNA MEMBERS .......... . ........ $ 4.00 USMA MEMBERS . . .......... . ...... . ..... . . $ 4.00 NON - MEMBERS ... . . ... .... . . . . . ... . ... . . . $ 8.00 ome a The program will cover the embryology, physiology, physical and emotional care aspects of neurogenic bowel and bladder problems. Special care procedures including Crede, Management training routines , and th e lleal Loop surgery will be discussed . nto the md Reh MEMBERSHIP CARDS WILL BE REQUIRED TEAR-OFF PRE-REGISTRATION Maternal Child - Community Nursing Conference Groups Workshop "CJ\RE OF THE CHILD WITH NEUROGENIC BLADDER" 0 0 0 " UNA and SNA UMEMBERS ............... $ 4.00 USMA MEMBERS ........... . ........ . .. $ 4.00 NON - MEMBERS ........ . ...... . ....... $ 8.00 MEMBERSHIP CARDS WILL BE REQUIRED NAME: .... . ... . ........... . ........ . ....................... .. .. . ......... . ........ . NAME ADDRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sfreet City RETURN PRE-REGISTRATION FORM TO : AD DRE Zi p UNA HEADQUARTERS 1058 East 9th South Salt Lake City, Utah 84105 DEADLINE FOR PRE-REGISTRATION IS FEBRUARY 14, 1973 PAGE 30 UTAH NURSE WINTER 1 UNA Community Nursing Service and Holy Cross Hospital Presents "DISCHARGE PLANNING - FOLLOW-UP" Workshop FEBRUARY 12, 1973 30 p.m. MONDAY 4:30 to 9:00 p.m . REGISTRATION BEGINS AT 4:00 p.m. TO BE HELD AT MOREAU HALL, 1002 EAST SOUTH TEMPLE REGISTRATION FEE (Includes a box supper) REGISTERED NURSES ............. $ 4.00 STUDENT NURSES . . . . . . . . . . . . . . . . $ 2.00 ome and learn about referral services available. If we can't give you the exact office, we will help you get '.o the system . Guest speaker will be Dr. Robert D. Baer, Physiatrist, Head of Department of Physical Medicine owel and ·d Rehabilitation . leal Loop CREDITATION POINTS - 2 points per contact hour for area of expertise 1 point per contact hour per other TEAR OFF - PRE-REGISTRATION Community Nursing Service and Holy Cross Hospital R"" GE PLANNING - FOLLOW-UP" W "DISC kshop FEBRUARY 12, 1973 0 REGISTERED NURSE . . . . . . . . . . . $ 4.00 0 STUDENT NURSE .............. $ 2.00 FEE MUST BE ENCLOSED WITH REGISTRATION PRE-REGISTRATION SAVES YOU TIME - ~ME SEND IN TODAY ........ . )DRESS .. .. . . . ............................ ..... ............ . Street Zip REl City L t\J PRE-REGISTRATION FORM TO UNA HEADOUAP- _ S 1058 East 9th South DEADLINE FOR PRE-REGISTRATION IS FEBRUARY 7, 1973 MEMBERS AND NON-MEMBERS ARE WELCOME! UTAH NURSE YER 1972-73 PAGE 31 A DDRE~CORRECTIONREQUfilTED ~~~~~~~~~~~~~~~~ Return Postage Guaranteed Utah Nurses' Ass'n. 1058 East 9\h South Salt Lake City, Utah 84105 BU LK RATE U. S. POSTAGE PA ID EL !ZA3ETH r!O 19-r~ :O'J1H l..STH :;AST ~ALT LAKE Cl1Y, 1AH ij 22 J,~Q) There she was. With bright wotchful eyes that said "I con help." A crisp, yet gracious bustle of activity The assurance of skill and reassurance born of genuine concern. A kind and comforting word. A sincere smile. A Nurse. BLUE CROSS - BLUE SHIELD . Constant attention to the wel) -being of the patient . .. the mark of a professional nurse in administering care ... the function of Blue Cross and Blue Shield in pro· viding for the economics of that care. Salt Lake City, Utah PermitNo.1882