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.

Ill~]~l~fl1 l l~1 1 ~1 ~~~[~~~i~ll~i]il~[ l5l utah I\IU rse - Official Pu lication of 1974 .)\/urse Of Jhe 1Jear Virginia Gole See Page 5 Winter 7 4-75 Vol. 25 No.2 Ed ito ria I .............................................................. . Utah Nurse WINTER, 74-75 Vol. 25 No. 2 OFFICIAL PUBLICATION of the UTAH NURSES' ASSOCIATION 1058 East 9th South Salt Lake City, Utah 84105 Phone [phone] Executive Editor . . JACK E. McLELLAN , B.A. Associate Editor .............•.•...•• CORALLENE McKEAN, R.N. Assistant Editor ..................•.. ANNETTA J. BILGER, R.N., M.S. ••••••...•.•.•••.......•.••..•..........•• Table of Contents Editorial . . . . . . . . . . . . . . . . . . . . 3 Unite for Action . . . . . . . . . . 4 thru 8 100% Membership Club . . . . . . . 4 Nurse of the Year . . . . . . . . . . . . 5 District No. 2-News . . . . . . . . . . 7 From the Executive Director . . . . 9 Congratulations . . . . . . . . . . . . . . 9 Remotivation-An Aspect of Geriatric Care . . . . . . . . . . 10-11 Nursing at Utah State Train ing School . . . . . . . . . . . . 11 Nurses UnderstaffingLegal Liability . . . . . . . . . . . . . 12 Expanding Role of Neo-Natal Nursing . . . . 13-14-15 Ad~ertisers American Cancer Society . . . . . . Coca-Cola . . . . . . . . . . . . . . . . . . Cottonwood Hospital . . . . . . . . . . Hillhaven, Inc................ Holy Cross Hospital . . . . . . . . . . LOS Hospital . . . . . . . . . . . . . . . . Medical Personnel Pool . . . . . . . The Navy Nurse Corps . . . . . . . . The Quality Press . . . . . . . . . . . . University Hospital . . . . . . . . . . Utah State Training School . . . . Valley West . . . . . . . . . . . . . . . . . WINTER 1974-75 In the 1800's slavery, by statute, was abolished. In spite of the law many of the freed slaves chose to remain in the indentured role. Today it appears that one could draw an analogy between those slaves who preferred to remain in their servile role and the many individual registered nurses who seemingly prefer to remain in the subservient, abject obedient role rather than to move with the nursing profession into profession al responsibility and account· ability. The key to the analogy is that both the indentured slaves and the nurse chose this course of action, desiring to remain in the status quo role, themselves. The 1800 slaves exercised and the 1974 registered nurses are exercising their freedom of choice. It reminds one of the old saying "no one can belittle you without your consent." A controlled, insecure, b elittled individual does not permi t himjher self the opportunity for growth, development and subsequent independent maturity. The "controlee" remains in an immature dependent state. from the falsely secure, dependent role into the "come of age" independent role presents many challenging but complex opportunities to those who are sensitive to changing conditions and who courageously adjust to change. Change is inevitable. Change accompanies progress. Progress may be interrupted but it cannot be stopped. Even though everyone knows that change is inevitable there are always those who resist change until literally forced to grudgingly accept it. Characteristically they are the immature dependent persons who feel most comfortable in a "status quo" situation. Apparently, to protect their own ego, these resisters who eventually become the grudging accepters, very often identify themselves as the originators of the change i~ea. However society is forcing the profession of nursing to "come of age." The profession has reached a point in which revised thinking and innovative practices are the "mode of the day." Evolution is a phenomenon of the health care industry as a whole and nursing in particular. To venture All registered nurses, the independent and the dependent need to recognize that nursing is in a state of "crisis." The Chinese symbol for "crisis" is made up of two ideographs - one denoting "danger" and the other "opportunity." Whether the present nursing profession "crisis" ends in desolation or progress depends upon the energy, wisdom, courage and united effort of the innovative, independent, risk taking, future oriented, registered nurses. Corallene McKean Associate Editor Happiness is ••• NURSING AT THE COTTONWOOD LOS HOSPITAL • A 154-bed progressive, dynamic acute hospital 13 2 3 14 12 6 8 9 10 16 11 12 • A suburban seHing 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 3 AI\IA President's Message - Unite for Action Rosamond C. Gabrielson, R.N., M.A., President, American Nurses' Association Message to Utah Nurse& a t annual convention May 9, 1974 in Salt L ake City, Utah. I bring you greetings from the Board of Directors and the staff of the Amen c:m Nurses Association. It is a pleasure to be with you at your annual convention. You h ave chosen a most appropriate theme for your activities. During the n ext three days your realization of the importan ce of unifying nurses to act upon issu es confronting the entire h ealth care sysrern will b e reinforced. I might add that this theme will be stressed at ANA's convention in San Francisco on June 9-H. Programs focu sing upon special interests and common goals will address those concerns which have the grea test significance for nurses. I extend to you an invitation to join u s in San Francisco next month to p arti ci pate with your colleagues in r esolving the issues facing nursing and the health delivery system. When I think of uniting l:or action, I am reminded of the many times in history when var ious groups tPok up a cause and fought for certain rights. The signing of the Declaration of Ind ependen ce is a prime example of the impact of a group of individuals who joined force s to improve the system of government. Through actions and the written word, the fifty-six signers of the Declaration <;> f1 Independence identified inequities· in the m anner in which the colonies were ruled and struck upon a course of action to establish independence. It is appropri ate to draw an anal- ogy between those who fought for political independence in colonial times and those of us who are fighting for professional identity and professional autonomy in modern times. It would be beneficial if n u rses could h ave as effective an impact on the future of the h ealth care system as the colonists of 1776 h ad on the political system of England. There are certain factors affecting the h ealth care system today which warrant the same kind of unified respon se on the part of the nursing profession. PAGE 4 T h e health care system is undergoing d ynamic alteration as the result of m any socioeconomic, psychological and educational factors exerting pressure on all of the h ealth professions. Nurses, as the largest group of individually licensed health practition ers in h ealth care, could be critically affected by changes in the riclivery of h ealth care services. Before nurses can h ave a significant impact upon the situation, we must understand the trends which h ave affected and will continue to affect the delivery of health car e. Growth in Population Shortly after World War II, a popula tion explosion occurred . This unexpected growth has resulted in grea tly increased demand for more h ealth facilities and h ealth p ersonnel. Moreover, changes in the popula tion curve have accentua ted the problem. A disproportionate p ercentage of people are under 20 years of age and over 65 years of age. 1 These two age groups are the very ones tha t require inten sified health care attention. States such as Florida, T exas, Arizona, California and H awaii, for example, are faced with providing not only more hospitals, but extended care facilities and retirement homes for their over 65 popula tions. 100o/o Membership Club UNA is pleased to let you know another group has been added to ou r club. Supportive Care Unit 2D at the McKay-Dee Hospital. Carol Ann Imhoff is t heir Cl inical Coordin ator. CONGRATULATIONS! Dislocation of Population Patterns During the last thirty years internal migration h as increased to an almost unbelievable degree. The reloca tion of m any Americans in the larger cities of the North, as well as th e exodus of many from deteriorating inner cities, and the arrival of Puerto Ric:ms in the New York area, Mex ican mig r~m t laborers in the Soutln.., est and Cuban r efugees in Miami ha v ;~ made thf orderly planning for h ealth services almost impossible. 2 Consequently, there is a maldistribution of health care facilities and p ersonnel through this country. As a result of the inequities in the present system, millions of Americans do not h ave access to needed h ealth care services. Sta tistics show that between 4-7 million persons in n eed of long-term care are living outside of institutions. Millions of American children h ave n ever seen a d entist; ten percent of the adult popuhtion suffers from undiagnosed hypertension; and an estim ated 60,000 persons suffering from cancer will die n eedlessly this year becau se th e di sease was not diagnosed early enough to be treated. 8 Inflation To further comp licate the situa tion, the cost of h ealth care services continu es to spiral. Since 1950, h ealth care expenditures h ave in creased by almost 600 perce n~. In fiscal 1972 American s spent $834 million on person al health care. This amoun t was over twice what was sp ent in fi scal year 1965. Yet 52 p ercent of the increase from fiscal 1%5-1972 went to keep up with inflation ra ther than to provide additional services.4 As a result of the unexpected population growth, the di sloca tion of popula tion patterns and the in flationary cost of services, critics of the health car e system h ave m ade two ob servations: 1) On a national basis, the present provision of h ealth services is fragmented, uncoordina ted and incomplete, and 2) High costs of essential h ealth care services stand in the way of effective delivery of health care to large numbers of p eople in this country. Those who are quick to find solutions to present h ealth care problems UTA H NU RSE offer limited plans for geographic and career mobility of health care workers or propose various programs of extended health care coverage. The shortcoming of more proposals is the failure to take into account the nature of public demands. Social Revolution The attitude of the American public toward health care services has been affected by two phenomena. In the past few years this country has experienced a "social revolution." 6 Civil rights, human rights, basic needs and their satisfaction, autonomy, self-identity and self-respect have received increased attention as subjects requiring re-examination. This climate of opinion is being reflected in the current concern among individuals that health be conceived not only as freedom from disease, but as a positive state of physical and mental well-being and that health care be recognized as a basic right of all people. Secondly, larger incomes and better education are now enjoyed by a much wider segment of the population. These individuals display an increased awareness of medical developments and the importance of preventing sickness through periodic examinations and early treatment. There is greater concern about the continuity of care and the possibility of assuring that there will be services and trained personnel available to provide assistance during a period of illness or stress. Increasingly atten tion is being paid to the plight of the mentally ill. There is growing concern about the mentally retarded, alcoholics, drug addicts, unmarried mothers and juvenile and adult delinquents. These groups are now recognized as individuals in need of health-related services, n ew methods of care, treatment and prevention will be needed. Virginia Cole - Nurse Of The Year The Utah Nurse is proud to honor Virginia Cole, recipient of the UNA 1974 NURSE OF THE YEAR AWARD. Not only 1s Mrs. Cole an active member of her professional association ANA-UNA, having served on the Public Relations Committee in 1959, Board Member in 1960-1964, and UNA President in 1965, but she also represents the profession of nursing in other community organizations; Women's Legislative Council, Utah In 1971 Virginia received the Beaty Award for the outstanding contribution to the field of Public Health. She has served the people of Utah as an outstanding and dedicated nurse in the Division of Health and continues her dedicated service in h er present position as Director for th ~ Nursing Bureau at the Utah State D ivision of Health. • significant role in the development of health manpower resources to meet the needs of the public. One of the most important opportunities for change in the current system of health care involves altering the practice of nurses and physicians so tha t nurses assume considerably greater responsibility for delivering primary health care services. Quoting from the report of the Secretary of Health, Education and Welfare on extending the scope of nursing practice: "As health care becomes increasingly valued in our society, nurses will be expected to take more responsibility for the delivery of primary health and nursing care, for coordinating preventive services, for initiating or participating in diagnostic screening and for referring patients who require differential medical diagnosis and medical therapies." There is growing concern about the health of employed workers and the relationship between poor health and unemployment: The American Nurses' Association maintains that the greatest barrier to this expanding role is the traditional view of nursing which places nurses in a totally dependent role, accountable to the physician at all times. In short, there is growing concern that health care services be more comprehensive. More Americans than ever before are seeking preventive, health maintenance, diagnostic treatment, restorative and protective services at reasonable costs. Nurses, as the largest professional group within the health occupations, must play a For too many years people have regarded "health care" and "medical care" as synonymous concepts. The fact is that all individuals require more than medical therapy. Comprehensive care implies provision for services which deal With the patient's psycho-social problems as well as his physical illness. WINTER 1974-75 Lung Association, Salt Lake Detention Home, and the Public Health Association. The nursing profession l c'an play a vital role in this type of h ealth care delivery. For nursi ng's unique contr ibution to health care is firmlv based in its ability to combine kn~wledge from the n a tural and social sciences to provide maintenance of human e, individualistic concern for person al needs of people receiving care. Professional lde••tity If the nursing profession is to uni te behind a central cause or theme it should be to promote the primary rol,: of nurses in the delivery of comprehensive health care. For I firmly believe tha t the effective utilization of nurses is the key to provision ot quality health care services at reasonable cost to the consumer. And it is through the professional association that we may respond collectively to those legal and ethical issues which impede the fullest utilization of nurses at the national, state and local levels. Unite for Action "United for Action" - the perfect 1974 slogan for the nursing organii::ttion. Our cause is professional identity and professional autonomy. Our course of action is multi-faceted: I. It is important that we take advantage of every opportunity to offer input into legislative proposals affec ting the delivery of health care. 1974 is a crucial year for the nursing profession. Twelve major health care programs expire on June 30, 1974 unless they are extended. In addition , Congress is expected to enact a plan for national health insurance thi s PAGE 5 year. Legislative action on these measures could greatly affect the future utiliza tion of nurses in the health care system. 2. It is crucial that we voice our position on current issues pertaining to the legal regulation of nursing practice. Any definition of practice should be stated in terms broad enough to permit flexibility in the utilization of personnel within the bounds of safety and to permit changes in practice consistent with trends. Where nursing practice acts limit the functioning of nurses, we should work for their modification. In addition, all nurses must be made aware of the fact that proposals such as the extension of institutional licensure would invest responsibility for legal regulation of competency, utilization of personnel, s«;_tting of performance standards and determination of new personnel categories with an agency which is also responsible for fiscal operations of the health care institution. Moreover, continued competence is the responsibility of the individual practitioner. Nurses should be made aware of the ramifications of legislation which would require evidence of continuing education as a condition for licensure renewal. !S. It is vital that we develop and implement appropriate quality controls which will hold individual practitioners accountable for their nursing performance. Society bears witness to the fact that if a group of practitioners fails to establish their own controls and safeguards, the rules and regulations of others may be imposed upon them. If nurses are professionals and nursing is a mature profession, nurses must control their own practice. At the national level, the American Nurses' Association is working with other health-related organizations in an effort to promote the more effective utilization of nurses. Various structural units of the Association maintain communication with over fifty health-related groups. The joint efforts of ANA and these groups have a number of position statements, resolutions and research papers on the state of the health care system. Only nurses h ave the expertise to identify appropriate guidelines and standards for nursing practice. Only nurses are competent to evaluate nursing care and nursing performance. In 1973, two important liaison groups were formally established, the Federation of Specialty Nursing Organizations and ANA and the Interorganization Committee for Implementation. 4. It is urgent that we organize the nursing profession to participate in determining their employment conditions. I£ we do not actively organize our profession and formally represent as many nurses as possible others will do it for us. Unions are already moving to organize employees of nonprofit hospitals, including registered nurses. The health care field is the third largest in numbers of employees in the United States, and the largest unorganized industry, a tempting target. The Federation of Spe-cialty Nursing Organizations and ANA was established in an effort to work toward more coordination in awas of mutual interest such as accreditation, certification, licensure and continuing education. A nursing group qualifies for membership in the Federation if it is a national organization of registered nurses with a body of knowledge and skill in a defined area of clinical practice. Presently, fourteen organizations are represented in the Federation and ":r LATTER-DAY SAINTS HOSPITAL utSing I 1.• ' GIVING •TEACHING•LOVING• REACHING EQUAL OPPORTUNITY EMPLOYER Many opportunities tor nurses in accredited 570 bed teaching and research hospital . All subspecialties. including 5 ICUs, are available as well as OR, ER and some openings in primary nursing. ProgrfliSive nursing service employs unit dose. bedside clinical records and problem orieted charting. CONTACT : Gail Wakefield, Nursing Recruiter 325 8th Avenue, Salt Lake City, Utah 84143 1801) 322-5761, Ext. 2402 PAGE 6 UTAH NURSE five additional organizations audi t Federation meetings. The Interorganization Committee for Implementation is composed of three of the nation's leading nursing organizations - the N ational League for Nursing, the American Nurses' Association and the American Association of Colleges of Nursing. Last year the committee issued a joint statement calling for more extensive and efficient use of nurses in the country's health care system. Since that time the three organizations have worked to identify explicit goals to enlarge nursing's contribution to the health care of people and have worked to develop programs to achieve these goals. Not only is ANA working to unite the efforts of health-related groups, we are attempting to develop tools and programs which will guide the performance of all nurses in the delivery of quality nursing services. We are depending on the state and district nurses associations to implement these measures in their respective states. As members of the Utah State Nurses Association there are a number of ways you can unite for action: unite to improve the quality of nursing care; unite to assure the public of individual and collective accountability of qualified professional nurses; and unite to increase the accessibility of health care services. Organize State Nurses Earlier this year ANA launched a campaign to organize the nation's 200,000 active nurses for the purpose of collective bargaining. The Association has committed substantial financial resources to support the 52 constituent nurses associations to bring about collective bargaining in each health care facility. When I speak of collective bargaining, I am referring not only to organized efforts to improve salaries, fringe ben efits and working conditions of nurses, but to organized efforts to improve the quality of nursing care provided the public. Approximately one-third of ANA's membership is already covered by a contract negotiated by their respective state nurses associations. Through organization and direct participation, these nurses have secured improved economic and practice conditions in their employment that, in a signed agreement, reflect their professional WINTER 1974-75 District No. 2 · News During August 1974, the UNA District #2 officers made positive strides toward informing district members about the critical issues currently facing professional nurses. The officers, with Helen Farr as president and Ruth Wheeler as program chairman, have sponsored a program explaining the Nurse Practice Act, as well as a session on "Professional Organizations-Unions." Both meetings were held twice to allow optimum attendance. St. Ben edict's Hospital nurses are excited about the ever closer reality of the n ew Benedictine Hospital. Public beds on the n ew facility will b e open October 8, 197 5. W eber County Hospital, Roy, reports that their n ew program on geriatric reality orientation and remotivation is proving itself an asset to geriatric therapy. Patients, personnel, and pa tients' families are all actively involved in this process of remotivation for the elderly. The Department of Nursing at Weber State College is bulging as the department reports the largest enrollment in its history. On the Ogden campus there are IIO freshman students, and 72 sophomores; the Logan school and Utah Technical College both have 24 freshmen and 24 sophomores. The total enrollment for the three campuses is 158 freshmen and 130 sophomores! status and provide a stable base for further improvement. effectively for the purpose of selfassessment, education, control and peer evaluation. When standards have been developed carefully and integrated with a program of education and consultation, the quality of patient care has risen constantly. If the individual standard is intellingently and carefully thought out in respect to its role in formulating the concept being expressed, it will provide guidelines for determining the best and safe.st means of providing high quality patient care. I urge you to circulate both the standards of nursing practice and nursing services and develop workshops or programs to interpret these standards and demonstrate methods of implementation. If we can bring into membership most of the nurses of this country and represent as many of them as legally possible within their employment settings, we can be sure nursing will speak for itself and will have an effective voice. To this end, I urge you to wage an aggressive campaign to organize all active registered nurses in Utah. Implement Quality Controls In 1973 Standards of Nursing Practice and Standards of Nursing Services were published. The purpose of the ANA Standards for Nursing Services is to delineate guidelines for the development of a nursing care system that is relevant to contemporary health care needs. These standards guide the actions of those nurses who are responsible for the organization and management of nursing services. The Standards of Nursing Practice were developed in order to provide tools by which to evaluate and improve upon the quality of nursing care. From a perceptive point of viewstandards are tools that can be used The McKay-Dee Hospital employees will mi ss Mrs. Ruth Brown, Psychiatric Clinical Director, who has accepted a teaching position this fall at Weber State College. A new Cardiac Arrest team has been formed at the McKay-Dee Hospital to answer Code 66 calls. Richard White, M.D., Cardio-pulmonary D epartment, and Bonnie Judkins, R.N, . M.S., Med-Surgery Clinical Director, have organized ,the team of five members for each shift of duty. They also are training the team members. Mary Ann Anderson, R.N. Education Coordinator Ex. 61 One way to implement the Standards of Nurisng Practice and to improve the quality of nursing care is to initiate a system of peer review. Peer review is the process by which registered nurses, actively practicing, appraise the quality of nursing care in a given situation in accordance with established standards of practice. The American Nurses' Association has developed guidelines for the establishment of peer review committees to help nursing groups identify peer review functions and determine policy. In every health care facility in PAGE 7 which nurses practice, there should be provisions for continuing peer r~ view as one means of maintaining standards of practice and upgrading n ursing care. Promote Continuing Education Activities The quality of health care d epends to a large degree on the knowledge, skills and attitudes of practicing nurses. With the emergence of new knowledge, technologies and continuing social change, a concerted. effort is necessary to assist nurses in I) maintaining their practice; 2) promoting and exercising leadership in effecting change in health care delivery systems; and 3) fulfilling individual aspirations. ANA supports the concept of volun tary continuing education for all nurses as one of the means by which nurses can maintain competence and meet the standards of practice developed by the profession. Continuing educa tion in nursing consists of planned learning and experience beyond a basic nursing educational program. Earlier this year, the American Nurses' Association developed standards for continuing education in nurs- ing and continuing education guidelines for state associations in order to develop the proper climate and mechanisms to facilitate continued learning by practitioners. If nurses are to be provided with worthwhile learning opportunities, continuing education activities must be carefully planned at the local, state and regional levels. I encourage you to work toward the development and promotion of voluntary continuing education activities in your state. Our course of action does not resemble the b attle waged by the colonists in 1776 in order to gain their independence. However, our basic objectives are the same: 1. Colonists wanted the right to voice their own concerns and interests. 2. Colonists wanted to establish and implement their own system of government. 3. Colonists wanted to have a say in shaping their social and economic conditions. 1. Nurses want to speak for nursing. 2. Nurses want to control nursing practice. 3. Nurses want to participate in d~ termining employment condition and Preparing for a Nursing Career? I ' You Have A Lot To GiveYou Receive A Lot In Return • SHARE SKILLS • INCREASE ABILITIES • RECEIVE STATE EMPLOYEE BENEFITS • HELP THE HANDICAPPED • GROW WITH AN EXCITING HUMAN SERVICES FIELD UTAH STATE TRAINING SCHOOL American Fork, Utah Contact: BERNICE ARCHIBALD Director of Nursing 756-6022 PAGE 8 improving nursing services and the health care system. Perhaps, it is wise if nurses would take to heart the words of Benjamin Franklin at the signing of the Declaration of Independence. He said, "We must all h ang together or assuredly we shall all h ang separately." If nurses fail to unite forces to promote nursi ng's role, in time many nursing duties and responsibilities may be consumed by other h ealth careerists and the role of the nurse in the delivery of health care will be totally suppressed. And this is why I said to each of you, let us unite for action. FOOTNOTES Esther Lucile Brown, Nursing Recon· sidered: A Study of Change, Part I (Philadelphia: J. B. Lippincott Company, 1970), p. 4. t 2 Ibid., p . 5. a "The President Is Planning A Major Move In Health Care," Nev1 York Titnel, January 20, 1974. " "Health Insurance: Action Stalled At Committee Level," August 4, 1975. & Brown, pp. 8-10. e Extending the ScoPe of Nursing Prac· tice, A Report of the HEW Secretary's Com· mittee to Study Extended Roles for Nurses, November 1971, p. 9. Is this your opportunity to get back into nursing? You were an RN or an LPN and a good one. But the demands of home and family took you from your profession. You miss it. Yet you still don't have the freedom to return to full-time duty. Medical Personnel Pool, nationwide leader in professional nursing services, may be just what you need. We can arrange for your valuable skills to serve - your way. In the time you have available, on the schedule that best fits your other obJtgations. If your professional standards are as high as ours. we need you. And, perhaps, you need us. Shall we talk it over? MEDICAL PERSONNEL POOL • Surety Financial Center 1935 South Main St. Suite 418 Salt Lake City, Utah 84115 487-7491 . UTAH NURSE From the Executive Director Jack E. McLellan ) 1 1 I thought this brief article might be the best way to introduce myself to you, and to take the first step toward establishing a line of communication. As we become better acquainted, you'll find that I rather emphatically stress the need for concise, meaningful communication at all levels of your organization. I'm presently going throug~ the usual process every person startmg a new position goes through - becoming acquainted with the organization and its policies, m~eting wi.th board officers and committee chaupersons, and asking many questions. Hopefully, the orientation period won't take too long. Having worked for the Utah Group Health Plan for a number of years, I'm not a newcomer to the health care field. I gained a vast appreciation for the responsibilities, problems, and satisfactions found within the various medical areas - particularly nursing. UGHP contains a variety of positions and duties, some controversial, within the nursing units. I spent many stimulating hours talking with nurses and exploring programs, problems and philosophies. My duties at UGHP included budgeting and supervision; personal functions such as recruitment, salary administration, job descriptions, and personnel evaluation; and public relations effort with the media, government agencies, political offices, and community organizations. I was involved in developing training programs, including preparing and conducting educational programs of all kinds, obtaining consultants, and coordinating films and speakers. One of my main interests was in working with supervisors to determine needs for upward mobility, job enrichment, and motivation of personnel. Another responsibility I had while at UGHP included developing a comWINTER 1974-75 plete information, communication and publication system for staff and plan members. I designed, wrote, edited and printed newsletters, brochures, and visual aid materials, and performed photographic servi~es, including audio-visual presentatiOns. I hope much of the experience gai~ed at UGHP will add to my effectiveness with the Utah Nurses' Association. As a part-time instructor at Westminster College, I became acutely aware of the need for effective communication. I had the privilege of teaching a Group Communications Workshop which stressed communication skills, enrichment factors, and problem. solving tec_hniques. ~he communicatiOn area 1s much hke the weather - everybody complains but nobody does anything about it. Although we can't do much about the weather we can - and will - do something about communication. You ca~ be looking forward to more on this subject, including short but concentrated workshops. Nurses at Westminster College should know my wife, Eva, who is the Faculty Secretary at the college. We have two girls - Verlene, age 14 and Charlyn, age 9. We are definitely an outdoor-oriented family, spending most of our free time in the mountains and desert canyon country. We backpack, cross-country ski, and bicycle. I have been active in m~un­ taineering, river running, spelun~mg, and activities related to the environmental movement. Photography is a major interest for me and my parttime business. I am a qualified professional photographer and photographic consultant. My education includes a B.A. from the University of Congratulations to: Duane Walker Mr. Walker became the Director of Nursing Service at the University of Utah Medical Center on February 1, 1975. He took over the position that was held by Minnie Walton. Minnie Walton Mrs. Walton now is the Assistant Administrator of Patient Care Services and Associate Dean of the University of Utah College of Nursing. We extend congratulations and well wishes to both Duane and Minnie in their new positions. .•••••••••••••••.•••.•..................... THE NAVY NURSE CORPS Contact : Lt. Marilyn Jean Anderson at 415-273-7791 (collect) if you are a graduate of :1 3 or 4 year Nursing program and are 20 to 34 years of age. Discover if you are eligible to start the adventure of Navy Nursing! $9595 to $12,669 starting. Colorado, with specialized training i~ personnel administration at the Umversity of Wisconsin. I fliP presently working toward a M.B.A. at the Umversity of Utah with emphasis on organizational development and human behavior in organizations. The objectives of UNA are extremely worthwhile. They are ones that I know I can sincerely and confidently work toward. I am most impressed with the association leadership. You have a strong, knowledgeable Board of Directors and active groups that provide effective leadership. A continuation of this effort and resulting achievements, depends upon everyon e-members, districts, the board and myself - establishing and achieving both short and long range goals. Together, we can accomplish our two major objectives: (1) maint~in high standards of nursmg practice, promote the professional and educational advancement of nurses, and promote the overall welfare of nurses, and (2) ensure that all p:ople in t_his state receive the best possible nursmg care available. I hope to meet most of you at the aDil.ual convention in May, if not sooner. If the preliminary information I have reviewed can be used as an indication, the convention promises to be a good one. Informatio_n on. t~e convention will be forthcommg Withm the next few weeks. Please remember that I am as close as your telephone or a quick letter. Your ideas and suggestions will help me to work most effectively for you. It's good to be here, working for you and with you. Jack E. McLellan Executive Director PAGE9 Remotivation: An Aspect Of Geriatric Care Of all the men and women who have reached the age of 65 since the dawn of mankind, 25% are alive today. In 1900, life expectancy at birth was 47.3 years; in 1939, it was 69.7 years, an astounding increase of more than 22 years in four decades. Today's figures are even higher; clearly the trend is for an everlonger life. The aged population is expected to more than double in the 40 years between 1960 and the year 2000. Due to this increasing life-span, one of the most critical problems facing nursing today is the large number of insti tutionalized geriatric patients and their complex, diverse emotional and physical care needs. One aspect of geriatric care is that of remotivation of the aged citizens housed in a variety of health care facilities throughout the United States. Motivation as defined by Abraham Maslow revolves around the concept that man is a "wanting" animal who rarely reaches a state of complete satisfaction; and if he does, it is only for a brief period of time. "As one desire is satisfied, another pops up to take its place. When this is satisfied, still another comes into the foreground. . . It is characteristic of the human being throughout his whole life that h e is practically always desiring something." A concept perceived by this writer is the idea that many geriatric persons who are institutionalized lose their "wanting" aJ;lility or in essence their motivation.' ·A deeper understanding of this concept reveals that the aged person does not quit wanting b ecause his n eeds are satisfied, but rather, has learn ed to not "want" because of the needs expressed are so often ignored. An example of this idea is the loss of reality experienced by many patients. According to James C. Folsome, M.D., reality indeed does change for geriatric citzens as families are no longer able to integrate the grandparents into their home. Consequently, a person who has elevated himself to a place of high self esteem loses his importance in face of the entire family's needs. This loss - often exhibited by the geriatric family member being placed in a nursing home of senior citizens' housing unit - may very well result in confusion and disorientation of the person. Programs such as Social SePAGE 10 curity and Medicare have been established to help older people meet their basic biologic needs for food, shelter, and health in the retirement years. As a result, extended care facilities seem to have replaced extended families, with confusion still being maintained as a typical behavior. This manifest behavior according to Doctor Folsome, often causes the elderly individual to be labeled. It has b een this nurse's experience that the labels come in a variety of syllables, i.e., senile, chronic brain syndrome, and other non-specific terms. The dilemma of learning to not "want", which according to Maslow is the absence of motivation, could also be termed learned helplessness. Studies conducted in 1973 by Seligman, Maier, and Oversnier have validated the learned h elplessness theory on the human species. Could the reader now take a moment to relate loss of reality and placement in the family, institutionalization with subsequent learned helplessness, which too often is conveniently labeled by medicine and nursing as senility, and then consider the affect, conversation, and physical appearance of the last geriatric patient seen by the reader in an institutional setting? It would seem to this nurse that meeting the physical problems of survival of the geriatric person is only a part of the challenge. A geriatric nurse also must seriously consider the psychosocial difficulties the aged person faces in adjusting to this new and often uncontrollable era of his life. Somehow this writer cannot resist comparing the words, concern, love, involvement, and nurturing with the words, senility, chronic brain syndrome, old age, and oppression. Could it be, perhaps unconsciously, that nurses are better able to label than love the aged? Some psychiatrists have PRINTING TYPOGRAPHY LITHOGRAPHY RULING The Quality Press 52 EXCHANGE PLACE SALT LAKE CITY related that people see a future image of themselves when they see the homeless, friendless, and insecure. Could this be true of mental confusion, grey hair and painful joints as well? It would seem that the social structure of this country has built a system of decreased importance of the elderly and an everpresent emphasis on the young. This type of culture might indicate that labeling of the institutionalized geriatric patient is easier than the utilization of Abraham Maslow's theory of human motivation. Learned helplessness in geriatric p erson alities can be combated by remotivation or the stimulation of "wanting" in these people. The idea of recognizing and removing sensory deprivation from the environment of those in any institution certainly is not a new one. But methods of application of the theory in relationship to care of the geriatric patient has just recently begun to be verified and utilized. Most recently this utilization has been in the form of reality orientation sessions and remotivation groups for inhouse patients. The emphasis of such group meetings is the altera tion of sensory deprivation as it exists in the lives of many in institutions. Sensory deprivation can be described as the elimination, reduction, or stereotyping of stimuli from vision, hearing and touch. It has been noted that confusion, oppression, mental insufficiency, and vivid imaginations are symptomatic of the elderly; but are practitioners also cognizant of the idea that these symptoms may be due to the " ... lack of constant meaningful, contact from the outside world." (Moody, 1970, 2353) ? In an institutional environment, the geriatric patient is often exposed to monotonous sensory input and relationships tha t are less meaningful than those he has previously known. The underlying goal of such groups is to motivate the patients; more specifically to stir up interest and desire which lead to mental and physical motion. Harriet Fish states: "Just providing things to do isn't enough. People must somehow be drawn out of themselves and into an activity which will provide the pleasure and satisfaction of accomplishment." It is essential to note that the basis of the reality orientation approach to a group is the philosophy that each individual should make the maximum UTAH NURSE use of his assets: no one should be considered senile, but rather as a person with specific abilities and function levels. Recent literature has indicated that reality orientation is most appropriate for patients who are confused or disoriented from any cause (Phillips, 1973). "Reality orientation attacks these processes by continually stimulating the patient through the repetition of basic motifs such as the patient's name, where he is, the day of the week, the month, the year, what meal comes next, and so on." An additional underlying aspect of group functioning is the ego-building attitude of active friendliness. The ramifications of this attitude are easily understood in that it simply makes the patient feel unworthwhile because someone bothers to care about him as an individual. In line with this is the touch therapy which should be used at each session. Paul T. Furlong, Ph.D., states that most geriatric patients are touch starved; and because they are not touched by other people spontaneously and with sincerity, they subconsciously feel a lack of self worth. In a long-term hospitalization setting, this writer feels that the basic physiological needs of the patients are met by means of the functioning of the institution. And as has been mentioned, perhaps security or safety needs as defined by Maslow are met since an extended care facility can also serve as the extended family for the patient. Only a limited number of the aged and chronically ill are ever going to get well and go home once again to function independently in society. Becau se of this, it is believed essential by this writer that facilities which care for such patients should feel keenly the responsibility of giving the patient a quality of life that is due him. The need to be needed is common to all human beings; the elderly must have opportunities to give of themselves and, therefore, be needed. They also deserve times of learning about the everchanging world that exists outside of the hospital complex; a time for making decisions; for living; for talking and being listened to by someone. Remotivation and new sensory input are effective means of meeting such complex needs. Loneliness is the world's greatest problem according to Doctor GlasWINTER 1974-75 ser, and it is this nurse's premise that Geriatric Remotivation Groups based upon the principles outlined in this paper make effective strides against combating this pandemic disease. INDEPENDENCE You lost Your independence You said, the day we Stopped you making your own pot Of tea. (Burnside, 1973) REFERENCES Fiah, Harriet U. Activities Program for senior citizens. New York: Parker Publishing Company, 1971. Folsom, J.G. Reality orientation for the elderly mental patient. Geriatric Psychiatry; Spring, 1968, 291-llOS. Furlong, P.T. Clinical Psychologist, Ogden, Utah, June, 1973. Maslow, A.H. Motivation and Personality . New York: Harper and Row, 1970. Moody, Linda, Baron, Virginia, and Monk, Grace. Moving the past into the present. American journal of Nursing, 1970, 70 (II) , 2353-2356. Newton, . Kathleen, 8c Anderson, Helen C. Geriatric Nursing. St. Louis: C.V. Mosby Company, 1966. Phillips, D.F. Reality Orientation. Hospitals, July I, 1973, 46-9; 101. Reilly, Sue. Dr. Glasser without failure. Human Behavior, May, 1973, 17-23. Seligman, M.E. Fall into helplessness, Psychology Today, June, 1973, 43-8. Tuck, Barbara R . The geriatric nurse, pioneer of a new specialty. R.N., August, 1972. 35-8. M ary Ann Anderson, R .N., B.S. Coordinator of Educational Services Weber County Hospital Roy, Utah Nursing at lJtah State Training School The philosophy of the Utah State Training School nursing is based upon the dignity and worth of the individual. The nursing staff believes that each mental retardate has the basic right to receive effective nursing care which is a personal service based on his needs as they relate to him as an individual and to his clinical disease or conditioa. The nursing staff has the knowledge and the understanding that the mentally retarded differ in degree and not in kind from other human beings. The practice of nursing is an application of both human compassion and technical skills. The objective is to provide education, training, habitation and quality health care for the mentally retarded in this institution. With this objective in mind and with the changing role of the health care specialist, the nurse not only brings her special technical skills into use but also her initiative to plan programs which involve the total care of the child. Do you like teaching? Here, ongoing inservice training programs provide the opportunity to share your knowledge by teaching nursing aides and participating in continuing education classes for the Licensed Practical Nurses! The Utah State Training School is affiliated with the University of Utah Medical Center. Thereby their current knowledge, facilities and staff are available for the residents. Teaching and research, directed by the medical director, a well qualified pediatric neurologist, and special chomosonal studies by a geneticist, provide the nurse with an exciting, challenging opportunity for learning some of the causes and prevention of mental retardation in. this very progressive field. Nurses at the school are versatile and are assigned duties which allow them to use their skills through clinical consultation and teaching services. Nurses plan and assist at the many specialty clinics held either monthly or bi-monthly. These include psychiatric, orthopedic, EarN ose and Throat, neurology, surgery, gynecology, dermatology, cardiology and gastroenterology. These clinics are held by prominent physicians, specialists in their respective fields. Each Utah State Training School nurse brings to a nursing assignment, her skills, understanding, empathy and a sincere desire to serve the handicapped child as a total person. The nursing staff comprises a key link in the necessary chain of adequate human services. Each nurse fills herjhis role well and is an excellent example of human compassion and well applied professional skills. Betty G. Spencer Information Specialist PAGE 11 Nurses Understaffing · Legal Liability THE CHARGE NURSE WHO SIMPLY ACCEPTS UNDERSTAFFING AS A FACT-OF LIFE FAILS TO UNDERSTAND HER PERSONAL PROFESSIONAL RESPONSIBILITY IN THIS MATTER. Indeed, she may unwittingly involve herself in a situation endangering the health and safety of patients by her failure to do something effective about the lack of adequate nursing sta'ff on her Unit. One of these days she may find herself on the receiving end of a blockbuster lawsuit, along with others in her Unit. From a legal point of view, it would be n egligent for her to make the gracious assumption that her awareness of the subpar staffing situation is shared by Nursing Service Administration and by the general administration of her hospital. Those responsible for administration have a right to assume that this charge nurse will bring to their attention any deficiencies in nursing service which might affect the quality of patient care in her Unit. The Courts are very impersonal in their reaction to evidence of understaffing. The legal message to nurses is clear. When an understaffing situation presents itself in a critical care area or in any other area where nurs- ua 1 ~ ing service is rendered, the nurse responsible for the Unit or patient care area should make certain that the Nursing Service Administration is made clearly aware of the problem and administrative officers must rectify such a situation without delay. YOU SHOULD GET THE MESSAGE THROUGH TO NURSING ADMINISTRATION LOUD AND CLEAR WHEN UNDERSTAFFING IS YOUR PROBLEM. Maybe you are just plain tired of trying to get the message across. Maybe you are thoroughly exasperated because nobody among the nursing brass in your hospital seems to give one tinkers damn about understaffing on your Unit. Our answer: Keep trying to make the communications system work. Put your understaffing observations in writing. Retain a copy of your notes or memoranda for your own information and legal protection. Some will say that you are being overly legalistic about the problem. Yet it is a legal problem in terms of the health and safety of patients in your Unit. Then there is the additional matter of protecting yourself as a professional in the event that the long arm of justice points in your di· house that is never dark ••• a door that is never closed" HOLY CROSS HOSPITAL join us in providing quality patient care 1045 East First South Salt Lake City 801 .. 328..9171 Ext. 636 rection in terms of liability. When an accident occurs, resulting from someone's negligence, those involved in the happening of the accident tend to be self-protective. Your verbal communications with Nursing Service Administration, however poignant and persistent, may be difficult for others to recall. Dated copies of communications transmitted in a professional manner, following the failure of verbal notices regarding understaffing, will prove to be one of the strongest points in your defense. Such written evidence will demonstrate your awareness of a potentially dangerous problem. Further it will show the steps you took to put Nursing Service Administration on notice of the problem. IN UNION THERE IS STRENGTH - AND WE DON'T NECESSARILY MEAN L-A-B-0-R UNION. Your Unit is probably not the only one understaffed in your hospital. Hospitals, Health Centers and Skilled Nursing Facilities have become terribly cost conscious. Is it any wonder. Perhaps such cost consciousness is long overdue. In any case, the word in some hospitals is "never use an R .N . when an L.P.N. could do the job and NEVER use a nurse where an Aide or Orderly will suffice." In the light of this kind of attitude, is it any wonder that you are understaffed - at least by traditional standards of practice. This kind of cost·cutting crusade has to be sparked by a strong mandate from administration if it is to achieve its purpose. Sometimes the mandate is misunderstood by those charged with its implementation. It is inconceivable that the administration of any health care facility would order costcutting that would endanger the well being of patients. Nevertheless, the emphasis may be placed on the economics of the situation and not on preserving existing high standards of patient care. When this is the case, some enterprising department heads will cut corners and will justify understaffing on this basis. To forestall this economic blitz, every hospital should have a Nursing Practice Committee composed exclusively of nurses. It should be constituted for the purpose of establishing quality standards of nursing care. The Nursing Practice Committee should establish policy for the appropriate deployment of nurses in order to maintain adequate staffing patterns and avoid the pitfalls of understaffing. -From the R eagan Report PAGE 12 UTAH NURSE Expanding Role of l\leo-l\latal Nursing and its Legal Aspects By Patricia C. Isaacs, R.N. Neonatal nursing is the care of the newborn infant who is considered high-risk, regardless of gestational age or birth weight and whose existence or hope for survival dep ends upon special medical care, equipment and physical facilities. The special care is made possible by a health team comprised basically of the physician and the nurse, also other medical and paramedical personnel required to maintain a Newborn Intensive Care Unit (N BICU) . There must be good interac tion between the nurse-physician team. It is this team that provides the excellent medical and nursing care to the critically ill newborn. Mutual confidence and respect between the nurses and the physicians enhance the quality of care the babies r eceive. Without h armony, unders tanding and respect, there could be no productive interaction b etween nurses and physicians and the quality of care given would n ot mee t the high standards required for these infants. What exactly is the role of the neonatal nurse and h er responsibilities? She gives expert nursing care to the high-risk n ewborn and/ or the critically ill infant. She must con stantly monitor the condition of each baby and report to the unit physician any subtle changes or indication of a problem. She must be able to initia te emergency procedures when indicated, such as bag and mask resuscitation. She provides not only ph ysical care for the baby but also social stimula tion continuously. The nurse provides information and invaluable support to the parents who are coping with an overwhelming situation. She must tolerate emotional stress and strain which may become very intense in the nursery. She should possess a knowledge of various laboratory tests, such as blood gases and bilirubins. WINTER 1974-75 She h as continuous teaching responsibilities. The nurse is with the baby more than any other member of the team. Should the role of the nurse stop in the nursery with observation , actual nursing care, communication, teaching or should her knowledge and skills continue to expand not only in the nursery but also outside of the nursery? ' 1\'ho is more qualified than the nurse to assist the physici an in the assessment and the care of the highrisk infant in the delivery room and in transporting the infant from the referring hospital to the NBICU. She m ay transport the ill infant with or without a physician depending upon the condition and the judgment of the referring physician and the neon atologist at the receiving cen ter. It is unrealistic to provide a physician on all transports. Each call is considered a consultation and therefore, should be a t this time, a decision making process and should be coordin ated by the n eonatologist as to the kind of transporting team required and the method of tran sporting, i.e.; fixed wing aircraft, helicopter, or ambulance. the physician with all procedures that the baby requires before and during the transport. Educational programs must be started to teach the nurse or nurses who qualify andj or have the capabilities to provide those specific services and then only under certain conditions may she do this. She must be educated and supervised in doing these procedures in our nurseries, not left to do her first intubation at a referring hospital with just the knowledge but no ac tual b efore hand practice or skill in doing such a procedure. She must be covered legally so that there will be no suits for malpractice liability. We will go into the legal aspects later. LUCILLE BALL IS ONE WOMAN WHO TAKES THE ADVICE SHE GIVES Transport experi ence is not just getting the baby safely and quickly from the referring hospital but it is transporting the baby with essentially the same kind of care given in the intensive care nursery. The nurse must be able to m ake keen observations and to exercise judgment as to the n eeds of the infant and then follow the guidelines se t for her. The nurse who transports should be able to initi a te many different kinds of procedures such as starting peripheral intravenous fluids, intuba ting, umbilical vessel catheterization and aspiration of pneumothoracesis. She must be able to give emergency drugs intravenously, i.e.: 50% dex trose, sodium bicarbonate, calcium glucone and epieph ::rine. She must communicate constan tly wi th her own hospital and n eonatologist about her observations and judgment when it is nurse transport. She must h ave the infant's condition as stable as possible before leaving the referral hospital. If it is a nurse-physician transport, then the nurse must be able to assist Each year, every woman should have a Pap test. It's the best way to find out if you're free of cervical cancer. The test is painless, and takes few minutes. It can .only save you suffering, It can save your life. Please have a Pap test. Soon, Very soon.': a American Cancer Society * 1 'AUS UAC£ CONTR lBUTW BY THE PUBLI$HE. PAGE 13