Noteworthy references

Noteworthy references

Noteworthy referen "Present status of the inferior vena cava umbrella filterI'' Mobin-Uddin, K, MD; Trinkle, JK, MD; Bryant, LR, MD: Sur- "Combined ...

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Noteworthy referen

"Present status of the inferior vena cava umbrella filterI'' Mobin-Uddin, K, MD; Trinkle, JK, MD; Bryant, LR, MD: Sur-

"Combined tenaculum and speculum," McDonald, B, MD: J Obstet & Gyn 38:928929 (December) 1971.

gery 70:914-919 (December) 1971. "Tenespec" is the name of an instrument The intracaval umbrella filter is used to in-

designed to incorporate the features of a

terrupt the inferior vena cava in order to

vaginal

prevent pulmonary embolism, particularly

source.

speculum,

tenaculum and

light

in patients for whom surgical ligation or

The handle constructed of stainless steel

plication of the IVC would have carried a

contains batteries and serves as a holder

higher mortality risk. Results are reported

for the blade. The speculum blades con-

400 patients treated in several medical

structed of a molded plastic come in vari-

for

centers since January 1970. Most investigators were satisfied with the simplicity of the procedure and with the results achieved.

A few problems with the filter were encountered and

modifications are being

ous sizes 'and are disposable. The ends of the speculum blades are fashioned into teeth which engage the cervix when pressure i s applied to a spring in the handle.

made in the design and in the instructions

The '7enespec" allows the physician a

for insertion in order to overcome these

free hand enabling him to do biopsies or

probI ems.

cautery o f the cervix.

Sarah A. Kllgore, RN Cincinnati, Ohio

Helen Wolk, RN East Paierson, NI I

d+ to 162

March 197.2

159

"An analysis and evalua+ion of mediated inservice education programs in the Iowa hospitals," Condon, Sister, MB, RSM, PhD: Health Sciences, Biomedical p 2809-8. This study was able to show the impact inservice education has on patient care in the state of Iowa. Many programs were undertaken to correct deficiencies of nurses in Iowa. Among them was a program by the Iowa Hospital Association that assisted hospitals in developing inservice education programs. In order to evaluate the results of the workshops, a study was performed with the following major findings:

1. The IHA was the most frequently mentioned agency providing inservice education to inservice directors.

2. Improvement in patient care was noted in the majority of hospitals participating in workshops.

These unusual diets have gained popuiarity in this country, especially among adolescents, as a form of protest against the establishment, or war, or man's inhumanity to man. Despite the sincerity of the motives of the young, adherents of the Zen diets are in great danger of incurring serious nutritional deficiencies, kidney dysfunction and possibly death. This extreme example of the trend toward natural and organic foods has prompted the American Medical Association's Council on Foods and Nutrition to issue the following comment on the Zen Diets: "When a diet has been shown to cause irreversible damage to health and ultimately lead to death, it should be roundly condemned as a threat to human health." Although some of the Zen Macrobiotic philosophies undoubtedly satisfy the emotional, spirtual and physical experiences for their followers, the rigid dietary restrictions are to be condemned as a health hazard.

3. The value of inservice programs i s recognized and financially supported by a high percentage of hospital administrators.

Muriel Hanewinckel, RN

4. Availability of media resources is di-

"Surgical speeiali.ies affect scheduling," Stewart, JT: J Am Hosp Assoc 45:132-

rectly proportional to the size of the hospital.

5. Productivity of employees has been increased in most participating hospitals.

Sarah A. Kilgore, RN Cincinnati, Ohio

"Zen macrobiotic diets," Council on Foods and Nutrition: JAMA 218:397 (October) 1971. The Zen Macrobiotic Diet, originated by Georges Ohsawa, adheres to the concept that a proper balance of Yen and Yang (dietary foods) can lead to a spiritual awakening or rebirth, and a healthy and happy life. The prescribed diets, 10 in number, are composed of natural and organic foods. They are predominantly vegetarian, with emphasis placed on whole grain cereals and restriction of all fluids.

Denver, Colo

136 (September) 1971. At Presbyterian Hospital in Dallas, a formula was devised t o determine how many hours per day or days per week the operating rooms would be in use, and to regulate the average surgical census. Prior to the study, admissions were a first come, first serve basis with 750 procedures done a month. With the new policy of admission that considers each specialty separately the surgical procedures each month has increased to 900. Needless to say, the rate in surgical procedures is greatly affected by the efdelays in ficiency of the surgical team starting and the complexity of surgical procedures within each specialty should also Helen Wolk, RN be included. East Paterson, NI

-

d+ to-

162

i65

AORN Journal

"To degree or not to degree," Miller, JW: J Am Assoc Nurs Anesthetists 455-460 (December) 1971. Emphasis on degrees has reached such magnitude in American society that some "professional groups" are requiring educational levels far beyond what is actually needed to practice competently in a given field. This "cult of credentialism" prevails particularly in the health fields. In nursing, employment differences between the baccalaureate nurse, the registered nurse and the technical nurse are hard to find. Consequently, the baccalaureate nurses are having to turn to education and administration to justify their extended training. This removes them from direct patient care.

With the "professional nurse" removed from bedside nursing, there has been an acceleration in the number of licensed practical nurses being trained and employed. If current trends continue, this will undoubtedly cause increased economic and service competition for the registered nurse.

meaning and reasons for degrees should not be abused, "else the real social purposes that degrees serve will be jeopardized."

Sister Vincenf, RN Indianapolis, Indiana

"The relevant 'who' of problem solving," Standeven, M, RN, MA: Nursing Forum 10:166-75, 1971. Commonly described methods of problem solving usually indicate action steps to be taken but leave out who should be involved at each step. Indication of the relevant "who" for each step of the problem solving method can serve to remind the problemsolver that there may be many other contributors who can help in definition and implementation of the problem. Overcoming resistance to change is a critical issue in the solution of problems. Resistance is l e u when those who are involved in a problem or affected by the solution have a say in bringing about the solution. This emphasizes the relevant "who" in problem-solving

.

Instead of providing new opportunities for nurses to extend their profession in allied health services, entirely new categories of workers have been formed within the health profession, ie, the physician's assistant. The competency of the nurse has not necessarily been improved by the holding of a degree. Nor has her professional image been enhanced among her colleagues in the health field. The degrees should be an assurance that the holder possesses a certain body of knowledge or skills in a particular field of study or practice. Professional competence i s a sound base for gaining distinction. The

A model of the problem-solving method, indicating who needs to be involved and what needs to be done, i s presented by the author. An example of its relevance to nursing i s also included. The model emphasizes action as a result

of convergence of interest in reference to a problem. Collection of data to identify and define the problem i s done by those who have the right to initiate and those with the obligation to respond. Fulfillment d goals, execution of plan and evaluation of results are vital components of the model.

Barbara J. Gruendemann, RN Encino, Calif

d+ to 7 7 0

March 1972

165

"Total hip replacement first year's experience," Stauffer, RN, MD; Johnston, RC, MD: Archives of Surgery 103:668-671 (December) 1971. Although all clinical data i s not yet complete, some definite clinical impressions have been made. Most patients with unilateral or bilateral procedures are able to discard their crutches within a matter of two to four months. Motion range is increased but the most gratifying aspekt has been pain relief. There are still some concerns such as the rate of wear, the local and systemic effects of debris, and the long term effects of implantation of polymethylmethacrylate. Only time and further continued study will show whether these excellent results can be maintained over a period of years.

Sarah A. Kflgore, RN Cincinnati, Ohio

"Soft tissue affections of the hand and wrist," Phalen, GS, MD: Hosp Med 7:47-59 (December) 1971, Through diagrams and photographs, a review of some of the most common disorders affecting the soft tissue of the hand are discussed. Tendinitis and tenosynovitis being the most common. Trigger finger, the most common form of tenosynovitis, occurs when the synovial covering of the tendon sheath becomes thickened by either inflammation or repeated trauma. The thickening prevents the gliding motion of the tendon within its sheath. Treatment consists of splinting the area involved for a week for two if a spontaneous recovery does not occur. If this treatment fails, it may be necessary to inject a corticosteroid into the tendon sheath. Only 30% of the patients need surgical intervention. The most common and debilitating form of nerve entrapment i s the carpal tunnel syndrome. The median nerve i s compressed in the carpal tunnel caused by a nonspecific

170

tenosynevitis. If rest and injection of steroids do not produce relief, surgical intervention Helen Wolk, RN may be necessary. East Paferson, NJ

"The subcutaneous injeefion," Pitel, A, RN, PhD: AJN 71:76-79 (Jan) 1971. The author notes historical events and discoveries which led to the present-day use of the subcutaneous injection. Also noted are conflicting instructions in the procedure which are present even today. Review of the literature and knowledge of skin histology and physiology led Dr. Pitel to put forth dictum of the subcutaneous injection: 1. Inject the medications deeply into subcutaneous tissue neither stretching nor grasp ing the skin to make a skin fold. 2. If a 1/," needle is used, inject the needle into the skin at a 90 degree angle to the skin surface; if a longer needle i s used, inject at a 45 degree angle. 3. Remove needle rapidly, apply firm pressure, and massage over the injected area. 4. Devise a rotation scheme for repeated injections, selecting areas in the upper arms and anterior and lateral aspects of the thighs and lower ventral abdominal wall. Cited as a topic for further study is the question of routine skin preparation before injection. Experimenters have suggested that washing the skin can enhance skin bacterial growth rather than retard pathogenic invasion. Normal skin lipids, the fatty acids present in sebaceous secretions, have antiseptic properties. The removal of these lipids, in certain instances, has caused a higher number of bacteria to be recovered in experimental groups. Nevertheless, the author suggests the use of aseptic skin preparation technic until further research indicates otherwise.

Barbara Gruendemann, RN Encino, Calif

AORN Journal