Showing papers in "American Journal of Nursing in 1981"

Professional Nurturance: Preceptorships for Undergraduate Nursing Students

Abstract: Both nursing education and nursing service are concerned about the disillusionment and frustration of new graduates when they enter the work world. Kramer describes this phenomenon as "reality shock"(1). One way to prevent and ease the impact of reality shock is to expose nursing students to the "real world" of nursing while they are students. Preceptorships are one way to accomplish this goal. Kramer designed and tested an anticipatory socialization program to help students in their transition from student to graduate nurse(2). We have adapted Kramer's suggestions and used them as the foundation for our preceptorship program at Capital University School of Nursing. Although the idea of preceptorship is not new, it has been used most often with students in community health nursing or in the practitioner role. We use it in an acute care setting. At Capital University School of Nursing, the preceptorships were developed by the faculty as part of the final course in the curriculum. The intent of this course, entitled Professional Enrichment, is to help students build confidence, to increase their level of independent functioning and sense of accountability, and to help them deal effectively with professional-bureaucratic conflicts. A preceptorship is an individualized teaching/learning method. Each student is assigned to a particular preceptor for the entire three-

Percutaneous transluminal coronary angioplasty

Abstract: Percutaneous transluminal coronary angioplasty (PTCA) has recently gained acceptance and popularity in the United States as an alternative to coronary artery bypass surgery for selected patients who have coronary disease. The interventional radiologist, with the use of x-ray imaging and percutaneously introduced catheters, can now diagnose and treat vascular disease, often eliminating the need for and expense of major surgery(l). Percutaneous transluminal angioplasty (PTA) involves dilatation of the lumen of a stenotic artery using a special catheter directed under fluoroscopy to the site of the atheromatous lesion(2,3). In 1964, PTA was introduced by Dotter and Judkins as a technique to produce dilatation of atherosclerotic lesions in the femoral artery of patients who were not ideal candidates for

Nursing priorities for the 1980's: hospitals and nursing homes.

Abstract: It is clear that the two institutions where nurses play a critical role--hospitals and nursing homes--are experiencing major problems. Patients in these institutions are not receiving the full benefits of the best health care America has to offer. Organized nursing has the opportunity and capacity to resolve these difficulties and in the process improve both patient care and the importance of our profession. The time is right for change. To date, nursing has not taken on this difficult leadership task. I believe we will remain dependent on other professions unless we take on significant responsibilities for resolving the problems facing these two institutions. The GMENAC report on health manpower suggests that out profession should not rely on others for public policy recommendations which will affect our future. Nursing has greater respect and national visibility than ever before. Within this decade, nursing has the potential ability to help resolve the crisis affecting these two institutions. The future of the nation's hospitals, nursing homes, those for whom we care, and of the nursing profession may depend upon how we respond to these two challenges in the years ahead.

The Arab American In the Health Care System

Abstract: Immigrants who are not able to communicate readily with health care workers easily fall into the category of "unpopular patients." An immigrant's difficulty in speaking or understanding English is the obvious barrier, but differences in ideas, concepts, and beliefs may be more important and certainly pose more subtle and, therefore, more complex problems. One group of immigrants who have received minimal attention in the literature, but whose concepts are particularly different from those of most health care providers in this country are Arab Americans. For example, Arab Americans are likely to perceive health care providers as naive, lacking in expertise, unwilling to be accountable for decisions, narrow in perspective, yet concerned with areas deemed irrelevant to the Arab's complaint(s). Arabs are puzzled by health professionals' seeming lack of ability to make decisions and by the numerous explorations and tests needed for diagnosis, all of which is interpreted as a definite lack of expertise. While other clients and health professionals may consider a "careoriented" system preferable, ArabAmerican immigrants do not. They do not expect personal care from health professionals; they expect effective cure. They expect and receive personal care from other

Guidelines for Prevention Of Hospital Acquired Infections

Abstract: Hospital acquired, or nosocomial, infections affect nearly two million patients each year in the United States. Aside from the more than $1 billion dollars a year this figure reflects, nearly 3 percent of these patients die as a direct result of hospital acquired infection(l). The factors that interact to produce infection are complex, and there are no simple solutions to prevention or cure. It has been estimated, however, that, with certain precautions, nearly half of the nosocomial infections could be prevented(2). There are certain factors that predispose individual patients to infection over which we, as clinicians, have little or no control. These include the patient's age, the degree to which the patient is compromised by disease processes, the type and number of invasive procedures administered, the therapy received, and the length of hospitalization(3). Even healthy patients, however, are targets for nosocomial infection from exposure to hospital pathogens or from therapeutic or diagnostic invasive procedures. In general, most infection control measures are directed at: * Minimizing numbers and kinds of organisms transmitted to potential sites of infection in susceptible hosts. * Avoiding transmission of any organisms by sterilization or disinfection of supplies and equipment. * Boosting host defenses whenever possible. The major sites affected by nosocomial infections are the urinary tract, surgical wounds, the res-

The shortage of hospital nurses: a new perspective.

Abstract: There appears to be a critical shortage of hospital nurses in the United States, despite a 15-year national effort to bring the supply of nurses into balance with increased demand. Careful...

Coping with a leg amputation

Abstract: Amputation of any body part carries with it a change in body image, but perhaps one of the most serious alterations in body image comes with loss of a leg. For not only will the individual's physical appearance be altered, but depending upon the level of the amputation, his mobility may also be seriously compromised. Most amputations of the leg are secondary to a disease process-for example, diabetes or arteriosclerotic heart disease(1). Therefore, many of these patients are over the age of 50 and may also have a chronic disease. Because of recent advances in vascular microsurgery techniques, many patients who, in the past, would have needed an above-theknee amputation, are now receiving below-the-knee amputations. Regardless of the underlying cause or level of the amputation, the person who has undergone one will go through four phases as he or she adjusts to the loss: impact, retreat, acknowledgment, and reconstruction(2). In each phase, the client will require both physical care and emotional support as he attempts to adjust to his altered body image. reactions are manifested, however, will depend upon several factors. One is the reason for the amputation. For example, the impact of an amputation due to trauma is often much greater than that of a diseaserelated amputation. Many people who have an amputation because of vascular disease have had their leg problem for a long time, have realized that it was not improving, and have either figured out for themselves or been told by their physician that they might eventually require an amputation. Thus, they may have worked through much of the impact phase before the surgery. In contrast is the person who loses a leg in an automobile accident; for him, the amputation is sudden, and the impact is usually

When the Diagnosis Is Raynaud's

Abstract: First, there is blanching as the result of a sudden vasospasm. Then cyanosis occurs, as hemoglobin releases oxygen to the tissues. Finally, the color changes to bright red as reactive hyperemia occurs. During these color changes the involved body parts-usually the fingers-are at first cold and numb; this is quickly followed by throbbing pain, tingling, and swelling. This sequence of events is Raynaud's phenomenon. The phenomenon may be secondary to various systemic disorders or, if no underlying cause is found, primary. When primary the disorder is called Raynaud's disease(1). In general, people with Raynaud's disease or phenomenon must learn to live with it. Attacks are intermittent and are usually triggered by cold, but can be triggered by emotional stress. Thus, people who have this peripheral vascular disorder must make adaptations in their lives that involve avoiding cold and cold things and reducing emotional stress. Health care providers can offer many practical suggestions to clients who are attempting to adjust to this, at best, inconvenient and, at worst, debilitating problem. The fact that there is both a Raynaud's disease and a Raynaud's phenomenon can lead to confusion, particularly since the two terms are often used interchangeably. Technically Raynaud's phenomenon is the broader term, with Raynaud's disease being its major cause. Other causes of Raynaud's phenomenon include the occlusive arterial diseases and the collagen diseases, notably scleroderma. Raynaud's phenomenon also occurs as a result of occupations that tend to traumatize the hands, for example, using a jackhammer and even typing or piano playing.(1). It is not always easy to differentiate between the disease and phenomenon, but, in general, Raynaud's disease occurs primarily in women, while the phenomenon is seen in both sexes. The onset of the disease can occur at any time between ages 18 and 40, but it usually begins in the teens or early twenties. The phenomenon tends to occur later, usually after age 30. In the isease the symptoms are usually bilateral and symmetrical, while in the phenomenon they may be unilateral and asymmetrical. When a person develops symptons-particularly after age 30-he may need to be followed for several years in order to determine whether the symptoms are primary or secondary. This is because signs of an underlying disorder may appear years later. For example, Raynaud's disease has preceded the diagnosis of scleroderma by 12 years(1).

The unspoken needs of families during high-risk pregnancies.

Abstract: I have had four high-risk pregnancies. Out of those four pregnancies, I only have one child. I have spent 17 months in and out of bed trying to have babies and have had seven hospital admissions. ,After I became a nurse and began working with high-risk obstetrical patients, I realized the problems my husband and I faced were not unique. I talked with other high-risk pregnant women and their husbands and heard the same fears and anxieties that we had expressed. Pregnancy is considered a "normal" event. But, for high-risk obstetrical patients, especially for women who have to spend much of their pregnancy bedridden and constantly burdened with the fear of losing the baby, pregnancy is not normal. These families are left out of the health care system. As nurses we need to recognize their special needs, and we are in a position to fill that gap. Some of the women I worked with expressed problems throughout pregnancy. Some had had many high-risk pregnancies; other had only one. They all felt a lack of empathy from almost every health professional they came in contact with. They all said, "No one understands what it's like." Problem pregnancies are not a happy occasion. They are filled with fears, tensions, and special needs. Both personally and professionally, I believe that these fami-

Touching is for everyone.

Abstract: touching the aged client. The five words had to be selected by each student; none were suggested. The questionnaire was given to the students before their experiences in the maternity and gerontologic clinical areas. A second questionnaire was given to the students afterward. The second questionnaire contained the same four questions, but in the past tense. Both questionnaires were given to 75 female students; 69 returned the first questionnaire, and 52 returned the second. The stu-

Temperature measurements in children.

Abstract: perature. Far too many nurses and physicians still base their interventions on these two assumptions. Are they valid? Are there variables that would affect these assumptions? A number of studies have been done on infants and newborns comparing the accuracy and safety of various temperature-taking sites. These studies indicate that in this age group rectal perforation and peritonitis are very real dangers when the rectal route is used(1-4). Very few studies, however, have examined temperature-taking sites in older children. While the physical dangers of rectal temperatures remain of primary importance, psychosocial considerations become added factors as children grow older. Toddlers and preschoolers object strenuously to removing their clothing and having intrusive procedures done. It is also difficult for parents to take rectal temperatures on wriggly babies, angry toddlers, and modest preschoolers. In spite of all these drawbacks, the rectal site continues to be preferred because it is thought to be most accurate.