Ethical Issues in Nursing

In this attempt at developing standards for the nurse practitioners, the authors have developed general guidelines relativeto common patient problems noted during their experiences as nurse practitioners and educators in an ambulatory adult care setting in a major medical center. Protocol is defined as “an organized method of analyzing and dealing with a disease process or symptom complex.” A major argument against the use of protocolscenters around the “predetermined mode of operation” for care of patients with specific complaints. Opponents believe the mode of operation “stifles the clinical judgment” of nurse practitioners, but the authors contend that establishment of protocols demands creativity and innovative thinking from the practitioner who designs and uses them. They further state that use of protocols leads to better patient care by eliminating the possibility of oversight in collecting data and implementing the proper plan of care. Sample worksheets are providedto be used for patients with common acute, self-limiting problems and chronic diseases as well as for determination of health maintenance programs. The worksheets are completed during the patient interview, and all aspects of the patient’s main complaint are exploredthrough a list of predetermined questions. The design of the worksheet provides direction in collecting relevant data. Following the worksheet examples, a rationale relates symptoms to the chief complaint and justifies the recommended plan of care. This book is of value to the nurse practitioner interested in formalizing a standard nursing process for patient care. However, OR nurses will not find this book useful because information in the plan section relates to ordering specific laboratory tests, therapeutic medications, and patient education, which are performed by surgical residents and students in the hospital setting. Jacqueline L Muir, RN Arlington, Va

Ethical Issues in Nursing.Schoolof Nursing, Catholic University of America, Washington, DC, and Department of Nursing Services, Catholic Hospital Association, 1438 S Grand Blvd, St Louis, Mo 63104, 1976, 99 pp, $6. Today, nurses at all levels are faced with ethi-

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cal issues that cannot be ignored. They must look at the age-old mysteries of sickness, suffering, life, and death in light of expanding scientific knowledge and new technologies. Nursing instituteshave been held in Boston, Chicago, Houston, and San Francisco to deal with some of these issues. Papers from the institutes provide the material in this book. The nurse who holds to Judeo-Christian values may well be concerned about when life-sustaining means are ordinary or extraordinary. What is the difference between active and passive euthanasia? How are living wills and the Christian affirmation of life alike and different? What have new scientific studies shown regarding the beginning of life and how may these studies change thinking on abortion? Some of the principles of ethics and ethical decision making may not be entirely new to some readers but the idea of Christian Ethical Perspective Committees for health care facilities is an interesting and new one. Wheelocks paper, “Nursing and Pastoral Care,” and Capp’s presentation, “Nursing as Ministry,” will help show how we as nurses reveal our ethical principles to patients, their families, and our coworkers by our words and actions. Sister Kane, RHSJ, RN, MEd Cornwall. Ontario

A Source Book of Nursing Research, 2nd ed. Downs, Florence S, Newman, Margaret A. F A Davis Co, 1915 Arch St, Philadelphia, Pa 19103, 1977, 200 pp, $7.95 paperback. Realizing the importance of nursing research in the development and evaluation of effective methods of patient care, Downs and Newman have collected a wide range of studies to provide teachers and students in nursing research programs with suitable material to critique. In this second edition, the articles are divided into two groups: those evaluating nursing intervention and those studying indices of health. Subjects are studied in social, institutional, and laboratory settings, using a wide range of methodologies-questionnaires, clinical observations, and laboratory tests of physiological changes related to controlled variables. Size and composition of population samples also differ greatly from study to study.

AORN Journal, April 1978, V o l 2 7 , No 5