- Email: [email protected]
Cover to Cover
&#‘!!
TO
T H E
Cover to Cover
I
just wanted to let you know how much I enjoyed your premier issue. In fact, I read it cover to cover one Saturday morning with a cup of coffee. I rarely have the opportunity to read a journal completely, but when I started Lifelines I found that I could not put it down. All of your articles were timely, interesting, and pertinent to my practice. Thank you so much for a great journal-Keep up the good job!!
EDITOR
family planning care they so desperately need. If pregnant, they will not seek prenatal care for fear of repercussions, placing themselves and their infants at risk. Can we ethically discriminate between reporting the teen who is having a sexual relationship with a 31-year-old man, while ignoring the
Donna Eannuzzo, RNC, BSN My co-workers and I think your new magazine is great-we’re looking forward to future issues-is there any chance this will become a monthly publication? Keep up the great work!
Penny Bright, RN, BSN St. M a r y Women’s Wellness Clinic Galesburg, IL From the Editor: Lifelines publishes six times a year, during the evennumbered months, alternating with the Journal of Obstetric, Gynecologic, and Neonatal Nzirsing (JOGN N J.-Ed.
Protecting Our Teens n the commentary, “Saving Our Children from Children,” by Patsy Kennedy (April, 1997), Ms. Kennedy suggests that we “report it” when a young minor, who has become pregnant “by a much older male,” comes under our care. I agree with Ms. Kennedy that we need to take steps to curb the escalating trend toward increased teen pregnancies; however, I don’t think that the threat of reporting them or their sexual partners to the authorities is the ideal solution. Fear of discovery and the potential legal ramifications will scare teens away from seeking the
10
Lifelines
15-year-old whose sexual partner is 18? In many states, this would also be considered statutory rape-yet it could be the high school sophomore whose boyfriend is a high school senior. Reporting him to the authorities would label him as a sex offender-a record that will follow him around for life. We need to continue to educate teens about responsible sexual behavior, encourage contraception each and every time they have sex, and continue to fight to protect their right to receive confidential reproductive health care without fear of repercussion. Also, congratulations on such an excellent publication!
Kathryn Munson, RNC, WHNP AWHONN Midstate Section ChairlDistrict I 1
From the Author: The differences between state laws regarding age of sexual consent and state laws regarding consent for medical treatment (often lower for the latter) create a dilemma for those of us who care for minors in family planning clinics. Nurses need to consider why most states originally lowered the age of consent for medical treatmen-so that underage girls and boys who might be victims of incest, or sexual or physical abuse, could seek health care and protection. Those same laws currently assist health care professionals who provide badly needed contraceptive services for teenagers. Lifelines’ readers are, for the most part, health care professionals and parents who. already teach their children the consequences of committing crimes such as speeding, driving under the influence of alcohol, theft, and violent acts, such as murder and rape. But we need to go further to clarify the issue of rape and age of sexual consent with our young men and women. And perhaps, as nurses, parents, teachers, and members of society, we should rethink current teen dating relationships and provide the protection that the youngest of our girls so desperately need.
Patsy Kennedy, RNC, WHNP
Working with Epidurals In response to “Flirting with Disaster” (February, 1997), the sensationalism conveyed in this article was better suited to a tabloid TV show than a professional organization’s publication. I found the content and flavor of Jack Stem’s piece demeaning to labor and delivery RNs and self-serving the interests of CRNAs (job security). AS long as state Nurse Practice Acts allow nurses to participate in advanced epidural pain management, it’s not in the best interests of the AWHONN members providing
this type of care currently sanctioned by her state board to be presented opinion published as fact. Introducing the positions of the ASA, ANA, or ACOG professional organizations would have brought balance to a complex, evolving issue, and lent support rather than publishing evidence of subjecti\e risk to memhers currently working through this clearly unresolved practice concern.
Kathleen Besson, RN,BSN Gastonra, N C From the Author: I f pointing out the reality that nonanesthesia RNs are not trained or licensed to practice anesthesia is demeaning and self-serving, so be it. I am all for nursing practice advancements, but not beyond capabilities. A general surgeon doesn’t seem to think it’s demeaning to not perform open heart surgery. It’s really not up to the ASA o r ACOG to determine whether it’s appropriate for nonanesthesia personnel to perform fuiictioiis that place the RN or, more importantly, the patient, at risk. Physicians d o
is hypotension. Waiting to treat
not determine safe nursing practice, nurses do. There is more involved in the management of labor epidurals than the proper technique of reinjecting the catheter. Bowing to the pressures within the medical establishment doesn’t facilitate safe nursing practice. The reality is the pregnant patient is at a significantly higher risk for life-threatening complications than the nonpregnant patient when epidural local anesthetics arc used to manage labor pain. The training for safe and effective inanagement of labor epidurals takes place in a school of nurse anesthesia, not a school of nursing, midwifery, o r during a n in-service put on by the department of anesthesia. A nurse reinjecting a labor epidural will be held to the same standard as that of a CRNA. With regard whether standards exist regarding the monitoring of vital signs of a woman receiving an epidural for labor pain management (Letters to the Editor, April, 1997), the single most detrimental side effect to the fetus during epidural analgesia
hypotension until the baby or mother becomes symptomatic is unacceptable, as is picking an arbitrary number for the systolic blood pressure t u reach before management occurs. The guidelines for monitoring blood pressure given within the article are practical and appropriate. If they are interpreted as implying a standard that doesn’t exist, perhaps it’s time that one be established. Jack Stem, RN, CRNA
Write: ”Letters to the Editor,” AWHONN Lifelines, 700 14th St., N.W., Suite 600, Washington, DC 20005-2006; or E-mail us a t Lif elines@AW H 0 N N.org.
- - ~ ___ I MBNR Platinum Plus. ,-__________-__
THENEWSTANDARD ___________ k 5.9% ISN’T GOLD. I
_I__^L
~
. . the only card you’ll ever need. I
___-___I______-____.__...-._____-----.
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b No Annual Fee Fixed Introductory Annual Percentage Rate
(APR) for cash advance checks and balance transfers?
Prioricy Customer service-24 hours a day Credit: line increase decisions in 15 minutes or less $1 million Travel Accident Insurance* Free Year-End Summary of Charges MBNA Platinum PLUSRegistry-card and document registry, emergency cash and airline tickets, and more b Exclusive MBNA Platinum Plus fraud and privacy protection b Free express delivery for card replacement b Supplemental lost checked luggage protectionup to $3,000
b b b b b
C R E D I TL I N E
U P TO
$100,000 Please mention priority code QUGZ when calling.
Call 1-800-523-7666 to Request Yours Today!
August 1997
Lifelines
11
TO
T H E
Cover to Cover
I
just wanted to let you know how much I enjoyed your premier issue. In fact, I read it cover to cover one Saturday morning with a cup of coffee. I rarely have the opportunity to read a journal completely, but when I started Lifelines I found that I could not put it down. All of your articles were timely, interesting, and pertinent to my practice. Thank you so much for a great journal-Keep up the good job!!
EDITOR
family planning care they so desperately need. If pregnant, they will not seek prenatal care for fear of repercussions, placing themselves and their infants at risk. Can we ethically discriminate between reporting the teen who is having a sexual relationship with a 31-year-old man, while ignoring the
Donna Eannuzzo, RNC, BSN My co-workers and I think your new magazine is great-we’re looking forward to future issues-is there any chance this will become a monthly publication? Keep up the great work!
Penny Bright, RN, BSN St. M a r y Women’s Wellness Clinic Galesburg, IL From the Editor: Lifelines publishes six times a year, during the evennumbered months, alternating with the Journal of Obstetric, Gynecologic, and Neonatal Nzirsing (JOGN N J.-Ed.
Protecting Our Teens n the commentary, “Saving Our Children from Children,” by Patsy Kennedy (April, 1997), Ms. Kennedy suggests that we “report it” when a young minor, who has become pregnant “by a much older male,” comes under our care. I agree with Ms. Kennedy that we need to take steps to curb the escalating trend toward increased teen pregnancies; however, I don’t think that the threat of reporting them or their sexual partners to the authorities is the ideal solution. Fear of discovery and the potential legal ramifications will scare teens away from seeking the
10
Lifelines
15-year-old whose sexual partner is 18? In many states, this would also be considered statutory rape-yet it could be the high school sophomore whose boyfriend is a high school senior. Reporting him to the authorities would label him as a sex offender-a record that will follow him around for life. We need to continue to educate teens about responsible sexual behavior, encourage contraception each and every time they have sex, and continue to fight to protect their right to receive confidential reproductive health care without fear of repercussion. Also, congratulations on such an excellent publication!
Kathryn Munson, RNC, WHNP AWHONN Midstate Section ChairlDistrict I 1
From the Author: The differences between state laws regarding age of sexual consent and state laws regarding consent for medical treatment (often lower for the latter) create a dilemma for those of us who care for minors in family planning clinics. Nurses need to consider why most states originally lowered the age of consent for medical treatmen-so that underage girls and boys who might be victims of incest, or sexual or physical abuse, could seek health care and protection. Those same laws currently assist health care professionals who provide badly needed contraceptive services for teenagers. Lifelines’ readers are, for the most part, health care professionals and parents who. already teach their children the consequences of committing crimes such as speeding, driving under the influence of alcohol, theft, and violent acts, such as murder and rape. But we need to go further to clarify the issue of rape and age of sexual consent with our young men and women. And perhaps, as nurses, parents, teachers, and members of society, we should rethink current teen dating relationships and provide the protection that the youngest of our girls so desperately need.
Patsy Kennedy, RNC, WHNP
Working with Epidurals In response to “Flirting with Disaster” (February, 1997), the sensationalism conveyed in this article was better suited to a tabloid TV show than a professional organization’s publication. I found the content and flavor of Jack Stem’s piece demeaning to labor and delivery RNs and self-serving the interests of CRNAs (job security). AS long as state Nurse Practice Acts allow nurses to participate in advanced epidural pain management, it’s not in the best interests of the AWHONN members providing
this type of care currently sanctioned by her state board to be presented opinion published as fact. Introducing the positions of the ASA, ANA, or ACOG professional organizations would have brought balance to a complex, evolving issue, and lent support rather than publishing evidence of subjecti\e risk to memhers currently working through this clearly unresolved practice concern.
Kathleen Besson, RN,BSN Gastonra, N C From the Author: I f pointing out the reality that nonanesthesia RNs are not trained or licensed to practice anesthesia is demeaning and self-serving, so be it. I am all for nursing practice advancements, but not beyond capabilities. A general surgeon doesn’t seem to think it’s demeaning to not perform open heart surgery. It’s really not up to the ASA o r ACOG to determine whether it’s appropriate for nonanesthesia personnel to perform fuiictioiis that place the RN or, more importantly, the patient, at risk. Physicians d o
is hypotension. Waiting to treat
not determine safe nursing practice, nurses do. There is more involved in the management of labor epidurals than the proper technique of reinjecting the catheter. Bowing to the pressures within the medical establishment doesn’t facilitate safe nursing practice. The reality is the pregnant patient is at a significantly higher risk for life-threatening complications than the nonpregnant patient when epidural local anesthetics arc used to manage labor pain. The training for safe and effective inanagement of labor epidurals takes place in a school of nurse anesthesia, not a school of nursing, midwifery, o r during a n in-service put on by the department of anesthesia. A nurse reinjecting a labor epidural will be held to the same standard as that of a CRNA. With regard whether standards exist regarding the monitoring of vital signs of a woman receiving an epidural for labor pain management (Letters to the Editor, April, 1997), the single most detrimental side effect to the fetus during epidural analgesia
hypotension until the baby or mother becomes symptomatic is unacceptable, as is picking an arbitrary number for the systolic blood pressure t u reach before management occurs. The guidelines for monitoring blood pressure given within the article are practical and appropriate. If they are interpreted as implying a standard that doesn’t exist, perhaps it’s time that one be established. Jack Stem, RN, CRNA
Write: ”Letters to the Editor,” AWHONN Lifelines, 700 14th St., N.W., Suite 600, Washington, DC 20005-2006; or E-mail us a t Lif elines@AW H 0 N N.org.
- - ~ ___ I MBNR Platinum Plus. ,-__________-__
THENEWSTANDARD ___________ k 5.9% ISN’T GOLD. I
_I__^L
~
. . the only card you’ll ever need. I
___-___I______-____.__...-._____-----.
_l______l___l____
b No Annual Fee Fixed Introductory Annual Percentage Rate
(APR) for cash advance checks and balance transfers?
Prioricy Customer service-24 hours a day Credit: line increase decisions in 15 minutes or less $1 million Travel Accident Insurance* Free Year-End Summary of Charges MBNA Platinum PLUSRegistry-card and document registry, emergency cash and airline tickets, and more b Exclusive MBNA Platinum Plus fraud and privacy protection b Free express delivery for card replacement b Supplemental lost checked luggage protectionup to $3,000
b b b b b
C R E D I TL I N E
U P TO
$100,000 Please mention priority code QUGZ when calling.
Call 1-800-523-7666 to Request Yours Today!
August 1997
Lifelines
11