Showing papers in "American Journal of Nursing in 1973"

Ethics and Euthanasia

Abstract: It is harder morally to justify letting somebody die a slow and ugly death, dehumanized, than it is to justify helping him to escape from such misery. This is the case at least in any code of ethics which is humanistic or personalistic, i.e., in any code of ethics which has a value system that puts humanness and personal integrity above biological life and function. It makes no difference whether such an ethics system is grounded in a theistic or a naturalistic philosophy. We may believe that God wills human happiness or that man’s happiness is, as Protagoras thought, a self-validating standard of the good and the right. But what counts ethically is whether human needs come first—not whether the ultimate sanction is transcendental or secular.

Transient ischemic attacks.

Abstract: TIAs can now stand on their own as an important, and, at times, unique aspect of symptomatic cerebrovascular disease, distinct enough to warrant a textbook in its own right. With new information on a worrisome and serious natural history, growing knowledge of risk factors and their management, sophisticated neuroimaging techniques, and a broadening armamentarium of therapeutic approaches, the clinician is now faced with multiple levels of decision making. Does one admit the patient with a recent TIA to the hospital? What are the optimal imaging and diagnostic strategies? What antiplatelet agent to use? What is the role for surgery and interventional techniques? How do I optimally control associated risk factors?

Getting around with emphysema.

Abstract: A major problem for patients with advanced emphysema is their great difficulty in getting around physically because of extreme oxygen shortage. Sociability may be restricted, too, because their respiratory disability interferes with talking, laughing, and crying. In this analysis of the process patients used to cope with problems of physical mobility and sociability, the data are from interviews with 22

Caring for the aged: touching is talking.

Abstract: \"But no light falls on the hooded brain, On the shuttered heart\"(1). .... These lines about an old woman sitting in the sun describe my reaction the day I began group work with six aged patients, all diagnosed as having chronic brain syndrome. This diagnosis was the one criterion for membership in the group. I had requested to work with six patients, three men and three women. They were all confined to a locked unit in an \"L\" facility, a light mental facility. The youngest member was 64, the eldest 86, and the mean age was 78. The group was to be closed, but I planned to add individuals as members were transferred or died. Initially, my goals were to increase stimuli for these patients to see if their levels of response or coherence could be changed even slightly, to reality test consistently, and to use food as an adjunct to therapy. My last objective fell by the wayside after the first meeting when I discovered that these patients received five meals daily. On the only day when I could meet with them, they were scheduled to eat immediately after the session. So my third objective was out. During our first meeting, I wondered where to begin, since I wanted to use a constant theme with these people i the hope that it would provide some structure. I went around the circle and shook hands, holding each person's hand tightly and trying to maintain close, intense eye contact. I came to the last frail little lady. She was babbling, her eyes were closed, and I suddenly doubted my ability to offer much of anything to these people with \"shuttered hearts.\" But then a shutter moved in this tiny woman. As I held her hand with its tissue-paper skin, she pulled my head down to her a d kissed me tenderly on the cheek. At that moment I substituted \"touch therapy\" for \"food therapy.\" This was the best example of \"touch hunger\" I had seen in a long while. I was influenced by Ruth McCor-kle's thesis that \"the nurse must be aware that touching a patient can convey a message to him .... If the communication is to be effective, the nurse must perceive the nurse's touch as a concern for caring for him(2).\" The location for group meetings with the regressed elderly should be chosen carefully. Any extraneous noise interferes with their hearing and comprehension. Their attention spans are short so other distractions must be avoided when the group leader is working inMS. BURNSIDE is coordinator for nursing education, Ethel Percy Andrus Gerontology Center, University of California, Los Angeles. She was graduated from Ancker Hospital School of Nursing, St. Paul, Minn., and received her B.F.A. degree from the University of Denver, Colo., and an M.S. degree and a post-master's certificate in psychiatric nursing from the University of California, San Francisco. Ms. Burnside received support from NIMH contract 52-2403-8026 while writing this paper. She is grateful to Natalie Donahue, R.N., and W. Lee Towns, administrator, and the staff for their support and assistance.

Caring for the aged: when words fail.

Abstract: Patients with an organic brain syndrome, I have found, are able to respond to nonverbal communication when they are no longer able to understand or communicate verbally. For instance, Mr. A., an 81-year-old man, tramps down the hospital corridor several times a day, dipping to the right on alternate steps like a farmer whose 16-hour chores have finally caused a painful knee. He takes those trips to inspect his imaginary fence. When he finds \"trouble,\" he grabs the corridor railing and tugs and pulls until he finally rights his \"fence,\" all the while threatening to kill the one who did the damage. If a nurse speaks to him about taking his medication, he appears not to hear her. Any effort to interfere physically with his fence mending elicits enraged resistance, reinforced by his striking out at the intruder. The effective approach is to wait until he comes toward the nurse as he \"inspects\" the rest of the fence. With outstretched hand, a warm smile, and eye contact, she can take his hand, observe his return smile, and lead him to the medication cart. There he willingly takes his medication in a spoonful of custard. This man has organic brain damage but nevertheless responds appropriately to nonverbal communication at a time in his life when he no longer understands or uses verbal language. This man's brain damage is caused by general deterioration or atrophy of the brain. However, arterial disease, a cerebral accident, or an intracranial tumor or lesion are the more specific causes of an organic brain syndrome. The characteristics of organic brain syndrome include disorientation for time, place, or person; impaired immediate recall; deficits in recent and remote memory; a weakening of intellectual functions; and defects in grasp and comprehension. Problems caused by this syndrome \". . . may be indicated by difficulty in retaining and reacting to questions or commands. They may also be indicated by faulty reaction to a situation or an interpersonal transaction, revealing that it is not understood\"((1 ). Such limitations necessarily call for some innovation in communicating. D. M. Mackay states that the \"etymological root of the term (communicatio) means sharing or distributing .. . [communication is] signalling,\" and these signals vary according to the needs of the patient(2). Mr. B., for example, talks continually at mealtime. As he sits at the table, he directs his farm hands in a decisive manner. He does not see anyone standing directly in front of him, not because he is blind, but because he sees only the activity he is imagining at the moment. When his tray is placed before him and he is informed it is there, he does not hear what is said or, at best, says, \"What's that?\" and runs his hands through the hot food. Placing a fork in his hand and urging him to eat also is not successful; he cannot make the MS. PRESTON is editor of the Kansas Nurse, the official publication of the Kansas State Nurses Association. Ms. Preston was graduated from Clara Maas Memorial Hospital School of Nursing, Newark, N.J. Ms. Preston's article was based on her course work at Washburn University of Topeka, Kansas.

Grieving and the loss of the newborn.

Abstract: Grieving and the Loss of the Newborn The death of an infant just prior to or following delivery is always difficult to accept. The surviving mother and family pose special problems for nurses in an obstetrical service where one expects the excitement and joy of birth, not grief and mourning. Yet caring for bereaved mothers is a part of nursing. Nurses can provide support and information which will allow these patients to both ventilate their grief and participate in decisions related to their care. Ways in which this can be done emerged in interviews with 25 women who lost babies in

When Words Fail

Abstract: Patients with an organic brain syndrome, I have found, are able to respond to nonverbal communication when they are no longer able to understand or communicate verbally. For instance, Mr. A., an 81-year-old man, tramps down the hospital corridor several times a day, dipping to the right on alternate steps like a farmer whose 16-hour chores have finally caused a painful knee. He takes those trips to inspect his imaginary fence. When he finds "trouble," he grabs the corridor railing and tugs and pulls until he finally rights his "fence," all the while threatening to kill the one who did the damage. If a nurse speaks to him about taking his medication, he appears not to hear her. Any effort to interfere physically with his fence mending elicits enraged resistance, reinforced by his striking out at the intruder. The effective approach is to wait until he comes toward the nurse as he "inspects" the rest of the fence. With outstretched hand, a warm smile, and eye contact, she can take his hand, observe his return smile, and lead him to the medication cart. There he willingly takes his medication in a spoonful of custard. This man has organic brain damage but nevertheless responds appropriately to nonverbal communication at a time in his life when he no longer understands or uses verbal language. This man's brain damage is caused by general deterioration or atrophy of the brain. However, arterial disease, a cerebral accident, or an intracranial tumor or lesion are the more specific causes of an organic brain syndrome. The characteristics of organic brain syndrome include disorientation for time, place, or person; impaired immediate recall; deficits in recent and remote memory; a weakening of intellectual functions; and defects in grasp and comprehension. Problems caused by this syndrome ". . . may be indicated by difficulty in retaining and reacting to questions or commands. They may also be indicated by faulty reaction to a situation or an interpersonal transaction, revealing that it is not understood"((1 ). Such limitations necessarily call for some innovation in communicating. D. M. Mackay states that the "etymological root of the term (communicatio) means sharing or distributing .. . [communication is] signalling," and these signals vary according to the needs of the patient(2). Mr. B., for example, talks continually at mealtime. As he sits at the table, he directs his farm hands in a decisive manner. He does not see anyone standing directly in front of him, not because he is blind, but because he sees only the activity he is imagining at the moment. When his tray is placed before him and he is informed it is there, he does not hear what is said or, at best, says, "What's that?" and runs his hands through the hot food. Placing a fork in his hand and urging him to eat also is not successful; he cannot make the MS. PRESTON is editor of the Kansas Nurse, the official publication of the Kansas State Nurses Association. Ms. Preston was graduated from Clara Maas Memorial Hospital School of Nursing, Newark, N.J. Ms. Preston's article was based on her course work at Washburn University of Topeka, Kansas.

Touching Is Talking

Abstract: "But no light falls on the hooded brain, On the shuttered heart"(1). .... These lines about an old woman sitting in the sun describe my reaction the day I began group work with six aged patients, all diagnosed as having chronic brain syndrome. This diagnosis was the one criterion for membership in the group. I had requested to work with six patients, three men and three women. They were all confined to a locked unit in an "L" facility, a light mental facility. The youngest member was 64, the eldest 86, and the mean age was 78. The group was to be closed, but I planned to add individuals as members were transferred or died. Initially, my goals were to increase stimuli for these patients to see if their levels of response or coherence could be changed even slightly, to reality test consistently, and to use food as an adjunct to therapy. My last objective fell by the wayside after the first meeting when I discovered that these patients received five meals daily. On the only day when I could meet with them, they were scheduled to eat immediately after the session. So my third objective was out. During our first meeting, I wondered where to begin, since I wanted to use a constant theme with these people i the hope that it would provide some structure. I went around the circle and shook hands, holding each person's hand tightly and trying to maintain close, intense eye contact. I came to the last frail little lady. She was babbling, her eyes were closed, and I suddenly doubted my ability to offer much of anything to these people with "shuttered hearts." But then a shutter moved in this tiny woman. As I held her hand with its tissue-paper skin, she pulled my head down to her a d kissed me tenderly on the cheek. At that moment I substituted "touch therapy" for "food therapy." This was the best example of "touch hunger" I had seen in a long while. I was influenced by Ruth McCor-kle's thesis that "the nurse must be aware that touching a patient can convey a message to him .... If the communication is to be effective, the nurse must perceive the nurse's touch as a concern for caring for him(2)." The location for group meetings with the regressed elderly should be chosen carefully. Any extraneous noise interferes with their hearing and comprehension. Their attention spans are short so other distractions must be avoided when the group leader is working inMS. BURNSIDE is coordinator for nursing education, Ethel Percy Andrus Gerontology Center, University of California, Los Angeles. She was graduated from Ancker Hospital School of Nursing, St. Paul, Minn., and received her B.F.A. degree from the University of Denver, Colo., and an M.S. degree and a post-master's certificate in psychiatric nursing from the University of California, San Francisco. Ms. Burnside received support from NIMH contract 52-2403-8026 while writing this paper. She is grateful to Natalie Donahue, R.N., and W. Lee Towns, administrator, and the staff for their support and assistance.

Family reaction to a severe burn.

Abstract: Not only the patient but his family, too, are psychologically traumatized by the impact of a severe burn. Family members, like patients, bring with them established ways of dealing with crisis situations. Frequently, their established ways of dealing with crises are inadequate and cause the entire family to act in strange or inappropriate ways. These reactions can seriously affect the hospital adjustment and subsequent rehabilitation of the patient. Well-meaning attempts to help the family may only accentuate the problems if these attempts are made without understanding the reasons for the family's actions. Therefore, part of the team approach on the University of Michigan Burn Unit is the early psychosocial evaluation of the patient's family by the social worker. This information is shared with the other team members as a

Job-related back injuries in a hospital.

Abstract: During 1970, the approximately 3,500 employees of the Wilmington Medical Center in Delaware reported 623 job-related injuries. As the table of injury classifications indicates, 85 were job-related lifting injuries to the back, a category that includes cervical, thoracic, and lumbar insults. In most industries, low back disability is the top reason for compensation payments; in money paid for sickness benefits, it ranks second only to upper respiratory infections(1,2). At the Wilmington Medical Center, nursing employs approximately 1,520 people, more than 43 percent of all employees.. These 43 percent of employees in the nursing service accounted for 57 (67 percent) of the lifting injuries. Housekeeping was the only other department that contributed a significant number, 11, (nearly 13 percent). Thus, nursing and housekeeping accounted for almost 80 percent of all job-related back injuries. The remaining 20 percent was spread evenly throughout all other departments.

Should continuing education be mandatory

Abstract: My arguments against requiring continuing education for renewal of a license are based on my philosophical beliefs and on important practical considerations. If learning resources are not readily available, compulsory requirements will create hostility, engender feelings of guilt, and create further division in an already divided profession. Only the nurse practitioner can determine his own learning needs, for these are specific for the responsibilities he has in the position he holds, his past experience, and his educational background.

Do nursing educators practice what is preached

Abstract: DR. KOHNKE is an assistant professor, Division of Nurse Education, New York University, New York. Her experience in nursing has been equally divided between education and service and she is one of three nurses who operate a group nursing practice in Stuyvesant Town-Peter Cooper Village, New York City. She is a graduateof Mound Park Hospital School of Nursing, St. Petersburg, Fla. and holds two master's degrees, one in counseling and guidance from the University of Florida and one in nursing from Teachers College, Columbia University, New York, N.Y., where she also received her Ed.D. A year later the American Nurses' Association published a position paper on nursing education (2). This paper defined the minimum preparation for beginning professional nursing practice and for beginning technical nursing practice. Many distinguished nursing educators, such as Lulu Wolf Hassenplug, Dorothy E. Johnson, Ruth V. Matheney, and Fay Carol Reed have written about the differences in educational preparation and practice for the nursing technician and the professional nurse (3-6). Martha Rogers in 1965 and Marjorie Ramphal in 1968 were particularly clear in delineating these differences (7,8). The years passed and the controversy continued to rage. Although educators said there were differences in the graduates of various types of programs, little difference was seen in their utilization in the service agencies. And, no great strides were being made to accommodate differences in practice. Therefore, in late 1971, I determined to investigate whether educators were producing, in fact, two different products. The study was completed in early Spring 1972 (9). It examined what the literature stated was the knowledge base, responsibility, and role in the curricular preparation of the nurse technician and the professional nurse. The nurse technician was defined as a graduate of an associate degree program and the professional nurse was defined as a graduate of a baccalaureate program. Lists were developed, stating what the literature review of each type of curriculum revealed. Interview guides were then developed, and 22 deans, 11 from each of the two types of programs, were interviewed. The interview was intended