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Providing More Relevant Maternity Services
facts and opinion Providing More Relevant Maternity Services LORRAINE W A L K E R , R N , EdD Maternity nursing has been redefined several times as patient needs have been more broadly identified. Changing social factors and consumer demands warrunt still another look at the way needs o f maternity patients are interpreted. Relevant social changes which need to be considered include: client dissatisfaction with a fragmented and depersonalizing system of health care, movement away from rigid and traditional definitions of nzasculinity and femininity, and lack of preparation for, and confusion about, parenthood. Each of these changes are examined and recommendations are made as to how nurses may better deal with them. Many of us recall the practice of “obstetrical nursing.’’ The obstetrical nurse was largely confined to the physician’s office or the hospital and her role centered on assisting with medical aspects of pregnancy, labor, and the postpartum period. “Obstetrical nursing” was eventually replaced by “maternity nursing,” when the focus shifted from the physiologic aspects of childbearing to the person, the woman, as she underwent the process of reproduction. The second concept put more emphasis on the social and psychologic aspects of childbearing, but this too was soon considered too narrow in scope. Childbearing, while a uniquely female experience, had great repercusions for all members of the family -the father, the toddler who suddenly was no longer the baby, the school age child who no longer had anyone with the time to listen to his problems. Consequently, there was another shift, this time from “maternity nursing’’ to “family-centered maternity care.” The nurse moved outside the confines of the highly compartmental areas of the nursery and the postpartum unit to decentralized nurseries and/or rooming-in patient units. Under this concept the mother and father began child care in the hospital. T h e father was permitted to be present during labor, and occasionally at delivery. Paternal involvement and the “natural childbirth movement” fostered an increase
34
in childbirth education classes aimed at preparing both parents for the labor process. Today maternity nursing again needs reconceptualization. I shall not propose any more new names for the field-that would only add confusion. Instead I would like to focus on the task of making maternity services more relevant to the needs, ideas, and interests of maternity patients. There seem to be new needs emerging due to a wide range of underlying social factors. Three of these factors which I will focus on are 1) client’s dissatisfaction with a fragmented and depersonalizing system of health care, 2 ) movement away from rigid, traditional definitions of femininity and masculinity, and 3 ) lack of preparation for, and confusion about, parenthood. Fragmented Health Care
Whether a woman is a clinic or private patient, it is increasingly rare for her to have continuity in the personnel who provide maternity services. The once sacred relationship between physician and patient has been disrupted by group practice. Nursing personnel in the hospital changes every eight hours, and each department within the maternity unit usually has a self-contained staff. A wide range of voices answer the phone at the doctor’s office, and it is difficult for the patient to tell if she is talking to a nurse, a receptionist, or
some miscellaneous person. Prenatal classes are frequently taught by still others. From the patient’s perspective, during the postpartum period, the obstetrician seems to relinquish all responsibility for the neonate and the pediatrician may seem equally unconcerned about the mother’s postpartum needs. Compartmentalization of personnel has served to make the package of health services fragmented and impersonal. It may be unclear how the patient moves from one service to another; there may be gaps in the service which no one obviously deals with, or there may be genuine conflicts in the policies and practices of the various services. Consequently, the patient, who is sometimes least able, is the one who must attempt to coordinate all these services. It is no wonder that many young people seriously consider and/or choose home delivery and avoid prenatal care. To health professionals, client rejection of maternity services is frightening not only because it endangers the mother and child, but because it indicates that we have failed to carry out our professional charge. This raises some important questions which would appropriately be dealt with by an organization such as NAACOG: -How can maternity services be better coordinated? -How can nurses be better utilized to reduce the fragmentation of maternity care? -What gaps exist in present services which nurses might well fill? Discussing these questions and looking for answers is a big step toward providing more relevant maternity services. Redefinitions of Sex Roles
Let’s turn next to the new thinking
“The rejection of exaggerated definitions of masculinity and femininity really has less to do with the liberation of a aex than with human liberation.”
“It ie no wonder that many young people eeriouely consider and/or choose home delivery and avoid prenatal care.” about male and female roles. Although some may point to the woman’s liberation movement as the catalyst, the movement is probably a symptom rather than a cause of changing attitudes toward sex roles. In 1955 Levinson and Huffmanl reported on attitudes toward family life. T h e traditional approach to sex roles, as they saw it, placed masculinity and femininity at opposite ends of a continuum. Masculinity was associated with rigid standards of financial success and the central control in family life, femininity was the extreme opposite: submission to male authority and virtual dependence on the male for decision making and financial support. In my opinion, this is an insightful interpretation in that the emphasis is off masculinity and femininity per se, and on the rigid roles into which persons were cast simply by virtue of their sex. The rejection of exaggerated definitions of masculinity and femininity really has less to do with the liberation of a sex than with human liberation; with the freedom to develop to one’s personal satisfaction, unrestricted by personally meaningless standards. Emphasis on human liberation led many women to reconsider to what extent they are willing to have their lives dominated by the responsibilities of motherhood. For many men it has meant a new freedom to genuinely enjoy and nurture their children. These new ideas relate to maternity nursing. W e should examine current nursing practices to see which are out of step with the times. For example, infant care classes on the postpartum unit are typically offered in the daytime when most fathers are working. It is more common for the mother and father to have no outside help when the baby is brought home and, therefore, more beneficial for March/April 1974 JOGN Nursing
both parents to attend infant care classes. Another example: most preand postnatal parent classes focus on the mother as fulltime caretaker of the child. Thus we omit many topics which would help the mother who returns to work. For instance: -What are important considerations in selecting a baby sitter or day care center for an infant? -How may mothers deal with mixed feelings which arise when they must leave young children in child care facilities? -How may the father help the mother deal with the dual role of mother and working woman? -How can a mother work and continue to breastfeed? The maternal role in child care iadeed deserves further consideration. It is widely held-by parents and professionals alike-that the natural mother is the besr person to care for her young child. In popular myths about motherhood, there is a magical relationship between mother and child. The child senses the specialness of his mother’s touch, and the mother automatically knows what his needs are. T h e special relationship is considered innate, so no one can ever replace the natural mother’s care. While this myth might seem humorous and unscientific, it is a powerful cause of guilt in parents, especially mothers, who use child care services outside the home. Reports of the deleterious effects of lack of mothering or separation from the mother on the young child2v3 have lent a scientific basis to the belief in the need for mothers’ care. Such studies describe grossly abnormal motor, emotional, and mental development in children who experienced maternal separation or lacked maternal care.2.3 They offer powerful evi-
dence in favor of keeping mothers at home with young children. However, it is irrational to apply all the conclusions of studies of children who were institutionalized or experienced total separation from the mother, to normal children who spend only a portion of the day away from their parents4 T h e two situations are not comparable. In fact, Bruner has noted that it is the qzlality not the quantity of the contact that is essential for a child to form normal attachment to adult caretakers5 In addition, attachments to other caretakers such as day care personnel do not appear to interfere with the attachment to the mother. One final, comment on changing ideas about sex roles; maternity nurses who work with parents need to take stock of their own attitudes about masculinity and femininity. Those who hold traditional ideas about sex roles may unknowingly alienate parents who do not share their attitudes.
Help With the Parental Role T h e third factor that needs to be considered in offering relevant maternity services is the clients’ lack of preparation for, and confusion about, parenthood. There are several reasons why parents may be unsure of the best way to carry out the parental role. As children they may have been exposed to highly rigid or highly permissive patterns of childrearing which they do not wish to apply to their own children. Having rejected the model of their own parents, they must start anew to define parenthood in a way which is comfortable or meaningful for them. Finding a new pattern is not easy. Newstands and bookstores are full of publications by experts who are more than willing to tell parents the
3s
“Parents should be helped to express their feelings of frustration and guilt associated with parenthood in healthy and constructive ways.” best way to raise their children. Unfortunately, these experts do not necessarily agree, and their advice may not fit in with the life style, values, or personalities of the parents or children. Furthermore, the parents themselves may not agree on what parenthood is all about. As a result, there is an increased need among parents for professional guidance in carrying out their role. In my opinion, this guidance should begin at least in the first trimester of pregnancy and be available throughout childrearing. It should go beyond, but not preclude, simple information giving. It should help parents clarify their feelings and values that relate to parenthood and its problems. It should include the use of parent groups for tapping and testing methods of handling childrearing problems. Parents should be instructed in growth and development so they may better understand their children’s needs and behavior. Parents should be helped to express their feelings of frustration and guilt associated with parenthood in healthy and constructive ways. And they should be offered support and encouragement as they face the various crises involved in becoming and being a parent.
“Maternity nurses in diiTerent departments or agencies need to start talking with each other about what they are doing.” ten lead to more positive attitudes and more efficient utilization of each other’s services. In addition, maternity nurses from different areas need to look together at the overall pattern of health care in their community. An overview would help to identify gaps and lags in the services as well as conflicting policies and practices, such as having methods of prepared childbirth ‘taught in the community with which labor room nurses are unfamiliar. Only when gaps and lags and conflicts are identified, can nurses take steps to correct them. Another crucial task in effecting more relevant, less fragmented maternity services is gaining the freedom for nurses to move outside agency walls to provide health services in other settings when these are needed. This might mean childbirth educators going into the labor unit, office nurses visiting patients in the hospital, and hospital nurses making follow-up contacts with new parents. In m y estimation continuity of care will remain an unattainable goal until nurses have this flexibility. Gaining such freedom will be a long, hard struggle for it means changing policies of agencies and attitudes of physicians and also nurses. However, I feel that
the maternity nursing profession is like a sleeping tiger: almost overlooked when it is a t rest, but capable of instigating a lot of action when it gets moving. References 1. Levinson, D., and P. Huffman: “Tra-
ditional FamiIv Ideolocw and Its Relation to Persdnality.” TPersonality 23: 251-273, 195s Bowlby, John: Maternal Care and Mental Health. New York, Schocken Books, 1966 Spitz, Rene: “The Influence of the Mother-Child Relationship, and Its Disturbances,” in Mental Health and Infmt Development. London, Routledge & Kegan Paul, 1955, pp. 103-108 Wortis, Rochelle: “The Acce tance of the Concept of the Maternaf Role by Behavioral Scientists: Its Effects on Women.” Am J Orthopsychiatry 41: 733-746, October 1971 Bruner, Jerome: “Overview on Development and Day Care,” in Day Care: Resources for Decisions. Edited by Edith Grotberg. Washington, D.C., US. Government Printing Office, 1971, p. 96 This article is adapted from a speech presented at the meeting of the Texas Section of NAACOG in San Antonio, Texas, March 8, 1973. Address reprint requests to Dr. Lorraine Walker, 2017 Ashby Avenue, Austin, T X 78704
Expand Nursing Dialogue
You may ask how maternity nurses can begin to provide more relevant health services to mothers and families? First, maternity nurses in different departments or agencies need to start talking with each other about what they are doing. T h e suspicion and lack of understanding that can occur between personnel in different health agencies that offer similar or related services is amazing. Getting together to share information and experiences, including problems, can of36
Publishrd i.w 7 l z m y nursing jourizals, Doctor Walker’s nrticles prinzarily concern her major interest, methodologic issxes i72 nursing theory aT2d research. A.r~rongher research interests s6e also includes value inquiry in nursing, postpartum a d j ~ ~ s # ? e ~and t , the vzother-child relationship. T h e author holds a doctorate in Education and a n :US in h7ursing Edzication from lndiana University. She received her B S N from the University of Dayton and her diploma from Holy Crosc CentraE School of Nursing. Shc is a n Associate Professor with the University of T e x m School of Alzrsizg at Austin and fornwrly taught at the University of Hmwii m d Pfrrdue University. Doctor Walker is a nteniber of N A A C O G , the A N A , Signra Theta T a u , the Anierican Association for ihr Advancement of Scicrice, and the Philosophy of Education Society. March/April 1974 JOGN Nursing
New 2nd edition.. .
THE DIAGNOSTIC INTERVIEW by Ian Stevenson, M.D. Formerly titled MEDICAL HISTORY-TAKING, this new edition describes in a systematic manner what is known about the do’s and don’ts of medical history-taking. Part I discusses the important factors affecting the doctor-patient relationship and how this relationship influences the outcome of medical interviews. It also considers other general principlea of importance for the interview. Part I1 describes what information is to be obtained during the interview. In Part 111, the author considers the techniques to be employed. Numerous examples of actual interviews are given including examples of common errors that should be avoided. Throughout the book, the author emphasizes the importance of observing the patient’s non-verbal communications as well as his verbal statements. In the new second edition, more emphasis has been given to the influence of the interviewer-patient relationship in shaping the information given by the patient. Greater emphasis is also given to the current eituation of the patient as an influence on how he sees and describes his earlier life. The references have been completely updated. This book is not addressed solely to the psychiatrist, and is not loaded with specialized psychiatric jargon. Rather, it is written for the practitioners of all branches of medicine, at all levels, who wish to improve their skills in interviewing. “In this attractively produced and eminently readable little volume, Ian Stevenson . . . has applied himself to an important and largely untouched area of clinical medicine. Until the publication of this book there had been no work combining the organic-diagnostic requirements of medical history-taking with the insights into interviewing technics gained by modern psychiatry. Dr. Stevenson has synthesized the two with conspicuous success . . .”-Annals of Internul Medicine (reviewing the 1st edition) By IAN STEVENSON, M.D., Professor of Psychiatry and C h u i m n , Department of Neurology and Psychiatry, University o f Virginia School of Medicine, Charbttesuille. 290 Pages. 12 Illustrations. $6.00
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Medical Department Mail Order Department, 2350 Virginia Avenue, Hagerstown, Md. 21740 Please send me on approval : 0 Stevenson: THE DIAGNOSTIC INTERVIEW . . . . . . . . . . . . . . . . . $6.00 0 Check enclosed (SAVE! We pay postage and handling) Bill me
HARPER & ROW, Publishers, Inc.
Name
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Address
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March/April 1974 IOGN Nursing
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in childbirth education classes aimed at preparing both parents for the labor process. Today maternity nursing again needs reconceptualization. I shall not propose any more new names for the field-that would only add confusion. Instead I would like to focus on the task of making maternity services more relevant to the needs, ideas, and interests of maternity patients. There seem to be new needs emerging due to a wide range of underlying social factors. Three of these factors which I will focus on are 1) client’s dissatisfaction with a fragmented and depersonalizing system of health care, 2 ) movement away from rigid, traditional definitions of femininity and masculinity, and 3 ) lack of preparation for, and confusion about, parenthood. Fragmented Health Care
Whether a woman is a clinic or private patient, it is increasingly rare for her to have continuity in the personnel who provide maternity services. The once sacred relationship between physician and patient has been disrupted by group practice. Nursing personnel in the hospital changes every eight hours, and each department within the maternity unit usually has a self-contained staff. A wide range of voices answer the phone at the doctor’s office, and it is difficult for the patient to tell if she is talking to a nurse, a receptionist, or
some miscellaneous person. Prenatal classes are frequently taught by still others. From the patient’s perspective, during the postpartum period, the obstetrician seems to relinquish all responsibility for the neonate and the pediatrician may seem equally unconcerned about the mother’s postpartum needs. Compartmentalization of personnel has served to make the package of health services fragmented and impersonal. It may be unclear how the patient moves from one service to another; there may be gaps in the service which no one obviously deals with, or there may be genuine conflicts in the policies and practices of the various services. Consequently, the patient, who is sometimes least able, is the one who must attempt to coordinate all these services. It is no wonder that many young people seriously consider and/or choose home delivery and avoid prenatal care. To health professionals, client rejection of maternity services is frightening not only because it endangers the mother and child, but because it indicates that we have failed to carry out our professional charge. This raises some important questions which would appropriately be dealt with by an organization such as NAACOG: -How can maternity services be better coordinated? -How can nurses be better utilized to reduce the fragmentation of maternity care? -What gaps exist in present services which nurses might well fill? Discussing these questions and looking for answers is a big step toward providing more relevant maternity services. Redefinitions of Sex Roles
Let’s turn next to the new thinking
“The rejection of exaggerated definitions of masculinity and femininity really has less to do with the liberation of a aex than with human liberation.”
“It ie no wonder that many young people eeriouely consider and/or choose home delivery and avoid prenatal care.” about male and female roles. Although some may point to the woman’s liberation movement as the catalyst, the movement is probably a symptom rather than a cause of changing attitudes toward sex roles. In 1955 Levinson and Huffmanl reported on attitudes toward family life. T h e traditional approach to sex roles, as they saw it, placed masculinity and femininity at opposite ends of a continuum. Masculinity was associated with rigid standards of financial success and the central control in family life, femininity was the extreme opposite: submission to male authority and virtual dependence on the male for decision making and financial support. In my opinion, this is an insightful interpretation in that the emphasis is off masculinity and femininity per se, and on the rigid roles into which persons were cast simply by virtue of their sex. The rejection of exaggerated definitions of masculinity and femininity really has less to do with the liberation of a sex than with human liberation; with the freedom to develop to one’s personal satisfaction, unrestricted by personally meaningless standards. Emphasis on human liberation led many women to reconsider to what extent they are willing to have their lives dominated by the responsibilities of motherhood. For many men it has meant a new freedom to genuinely enjoy and nurture their children. These new ideas relate to maternity nursing. W e should examine current nursing practices to see which are out of step with the times. For example, infant care classes on the postpartum unit are typically offered in the daytime when most fathers are working. It is more common for the mother and father to have no outside help when the baby is brought home and, therefore, more beneficial for March/April 1974 JOGN Nursing
both parents to attend infant care classes. Another example: most preand postnatal parent classes focus on the mother as fulltime caretaker of the child. Thus we omit many topics which would help the mother who returns to work. For instance: -What are important considerations in selecting a baby sitter or day care center for an infant? -How may mothers deal with mixed feelings which arise when they must leave young children in child care facilities? -How may the father help the mother deal with the dual role of mother and working woman? -How can a mother work and continue to breastfeed? The maternal role in child care iadeed deserves further consideration. It is widely held-by parents and professionals alike-that the natural mother is the besr person to care for her young child. In popular myths about motherhood, there is a magical relationship between mother and child. The child senses the specialness of his mother’s touch, and the mother automatically knows what his needs are. T h e special relationship is considered innate, so no one can ever replace the natural mother’s care. While this myth might seem humorous and unscientific, it is a powerful cause of guilt in parents, especially mothers, who use child care services outside the home. Reports of the deleterious effects of lack of mothering or separation from the mother on the young child2v3 have lent a scientific basis to the belief in the need for mothers’ care. Such studies describe grossly abnormal motor, emotional, and mental development in children who experienced maternal separation or lacked maternal care.2.3 They offer powerful evi-
dence in favor of keeping mothers at home with young children. However, it is irrational to apply all the conclusions of studies of children who were institutionalized or experienced total separation from the mother, to normal children who spend only a portion of the day away from their parents4 T h e two situations are not comparable. In fact, Bruner has noted that it is the qzlality not the quantity of the contact that is essential for a child to form normal attachment to adult caretakers5 In addition, attachments to other caretakers such as day care personnel do not appear to interfere with the attachment to the mother. One final, comment on changing ideas about sex roles; maternity nurses who work with parents need to take stock of their own attitudes about masculinity and femininity. Those who hold traditional ideas about sex roles may unknowingly alienate parents who do not share their attitudes.
Help With the Parental Role T h e third factor that needs to be considered in offering relevant maternity services is the clients’ lack of preparation for, and confusion about, parenthood. There are several reasons why parents may be unsure of the best way to carry out the parental role. As children they may have been exposed to highly rigid or highly permissive patterns of childrearing which they do not wish to apply to their own children. Having rejected the model of their own parents, they must start anew to define parenthood in a way which is comfortable or meaningful for them. Finding a new pattern is not easy. Newstands and bookstores are full of publications by experts who are more than willing to tell parents the
3s
“Parents should be helped to express their feelings of frustration and guilt associated with parenthood in healthy and constructive ways.” best way to raise their children. Unfortunately, these experts do not necessarily agree, and their advice may not fit in with the life style, values, or personalities of the parents or children. Furthermore, the parents themselves may not agree on what parenthood is all about. As a result, there is an increased need among parents for professional guidance in carrying out their role. In my opinion, this guidance should begin at least in the first trimester of pregnancy and be available throughout childrearing. It should go beyond, but not preclude, simple information giving. It should help parents clarify their feelings and values that relate to parenthood and its problems. It should include the use of parent groups for tapping and testing methods of handling childrearing problems. Parents should be instructed in growth and development so they may better understand their children’s needs and behavior. Parents should be helped to express their feelings of frustration and guilt associated with parenthood in healthy and constructive ways. And they should be offered support and encouragement as they face the various crises involved in becoming and being a parent.
“Maternity nurses in diiTerent departments or agencies need to start talking with each other about what they are doing.” ten lead to more positive attitudes and more efficient utilization of each other’s services. In addition, maternity nurses from different areas need to look together at the overall pattern of health care in their community. An overview would help to identify gaps and lags in the services as well as conflicting policies and practices, such as having methods of prepared childbirth ‘taught in the community with which labor room nurses are unfamiliar. Only when gaps and lags and conflicts are identified, can nurses take steps to correct them. Another crucial task in effecting more relevant, less fragmented maternity services is gaining the freedom for nurses to move outside agency walls to provide health services in other settings when these are needed. This might mean childbirth educators going into the labor unit, office nurses visiting patients in the hospital, and hospital nurses making follow-up contacts with new parents. In m y estimation continuity of care will remain an unattainable goal until nurses have this flexibility. Gaining such freedom will be a long, hard struggle for it means changing policies of agencies and attitudes of physicians and also nurses. However, I feel that
the maternity nursing profession is like a sleeping tiger: almost overlooked when it is a t rest, but capable of instigating a lot of action when it gets moving. References 1. Levinson, D., and P. Huffman: “Tra-
ditional FamiIv Ideolocw and Its Relation to Persdnality.” TPersonality 23: 251-273, 195s Bowlby, John: Maternal Care and Mental Health. New York, Schocken Books, 1966 Spitz, Rene: “The Influence of the Mother-Child Relationship, and Its Disturbances,” in Mental Health and Infmt Development. London, Routledge & Kegan Paul, 1955, pp. 103-108 Wortis, Rochelle: “The Acce tance of the Concept of the Maternaf Role by Behavioral Scientists: Its Effects on Women.” Am J Orthopsychiatry 41: 733-746, October 1971 Bruner, Jerome: “Overview on Development and Day Care,” in Day Care: Resources for Decisions. Edited by Edith Grotberg. Washington, D.C., US. Government Printing Office, 1971, p. 96 This article is adapted from a speech presented at the meeting of the Texas Section of NAACOG in San Antonio, Texas, March 8, 1973. Address reprint requests to Dr. Lorraine Walker, 2017 Ashby Avenue, Austin, T X 78704
Expand Nursing Dialogue
You may ask how maternity nurses can begin to provide more relevant health services to mothers and families? First, maternity nurses in different departments or agencies need to start talking with each other about what they are doing. T h e suspicion and lack of understanding that can occur between personnel in different health agencies that offer similar or related services is amazing. Getting together to share information and experiences, including problems, can of36
Publishrd i.w 7 l z m y nursing jourizals, Doctor Walker’s nrticles prinzarily concern her major interest, methodologic issxes i72 nursing theory aT2d research. A.r~rongher research interests s6e also includes value inquiry in nursing, postpartum a d j ~ ~ s # ? e ~and t , the vzother-child relationship. T h e author holds a doctorate in Education and a n :US in h7ursing Edzication from lndiana University. She received her B S N from the University of Dayton and her diploma from Holy Crosc CentraE School of Nursing. Shc is a n Associate Professor with the University of T e x m School of Alzrsizg at Austin and fornwrly taught at the University of Hmwii m d Pfrrdue University. Doctor Walker is a nteniber of N A A C O G , the A N A , Signra Theta T a u , the Anierican Association for ihr Advancement of Scicrice, and the Philosophy of Education Society. March/April 1974 JOGN Nursing
New 2nd edition.. .
THE DIAGNOSTIC INTERVIEW by Ian Stevenson, M.D. Formerly titled MEDICAL HISTORY-TAKING, this new edition describes in a systematic manner what is known about the do’s and don’ts of medical history-taking. Part I discusses the important factors affecting the doctor-patient relationship and how this relationship influences the outcome of medical interviews. It also considers other general principlea of importance for the interview. Part I1 describes what information is to be obtained during the interview. In Part 111, the author considers the techniques to be employed. Numerous examples of actual interviews are given including examples of common errors that should be avoided. Throughout the book, the author emphasizes the importance of observing the patient’s non-verbal communications as well as his verbal statements. In the new second edition, more emphasis has been given to the influence of the interviewer-patient relationship in shaping the information given by the patient. Greater emphasis is also given to the current eituation of the patient as an influence on how he sees and describes his earlier life. The references have been completely updated. This book is not addressed solely to the psychiatrist, and is not loaded with specialized psychiatric jargon. Rather, it is written for the practitioners of all branches of medicine, at all levels, who wish to improve their skills in interviewing. “In this attractively produced and eminently readable little volume, Ian Stevenson . . . has applied himself to an important and largely untouched area of clinical medicine. Until the publication of this book there had been no work combining the organic-diagnostic requirements of medical history-taking with the insights into interviewing technics gained by modern psychiatry. Dr. Stevenson has synthesized the two with conspicuous success . . .”-Annals of Internul Medicine (reviewing the 1st edition) By IAN STEVENSON, M.D., Professor of Psychiatry and C h u i m n , Department of Neurology and Psychiatry, University o f Virginia School of Medicine, Charbttesuille. 290 Pages. 12 Illustrations. $6.00
I
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Medical Department Mail Order Department, 2350 Virginia Avenue, Hagerstown, Md. 21740 Please send me on approval : 0 Stevenson: THE DIAGNOSTIC INTERVIEW . . . . . . . . . . . . . . . . . $6.00 0 Check enclosed (SAVE! We pay postage and handling) Bill me
HARPER & ROW, Publishers, Inc.
Name
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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I 1 I I I
March/April 1974 IOGN Nursing