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ROYAL SOCIETY
419
During the whole treatment physical therapy must be in constant use. Patients need not be confined to bed for more than a few days after rib-resection, but at no time must observation or attention to detail be relaxed. Treatment must be active the whole time under the direct care of the surgeon.
-
THE NURSE AND THE SISTER THE duties of the nurse, we are often reminded, have there is no clear answer to the never been analysed : " question " what is a nurse If the principle of the twoyear basic course in nursing, followed by a course for a senior. qualification, is accepted it also becomes necessary to distinguish between the duties of the nurse and the duties of the sister. Some help in this is afforded by a recent analysis from America. Dr. J. J. Golubdirector of the Hospital for Joint Diseases, New York City, plans to train what he calls "practical nurses " in a course lasting only a year, and to use such girls when trained to supplement registered nurses-the equivalent of our sisters-on the wards. The registered nurse, he says, " must continue to occupy the position of leadership in the profession. She may do bedside nursing.... She may be a hospital floor supervisor, or the head nurse of a nursing unit
of a hospital, supervising the work of several other she may be director of a department of nursing or of a hospital’s school of nursing ; she may become a teacher of nursing ; she may undertake special studies with the object of specialising in public health, anaesthesia, industrial nursing, medical social service, or hospital administration." or a
wing
nurses ;
There are many nursing procedures, however, which need not be performed by a registered nurse, and he goes on to analyse 150 nursing practices which he assesses as suitable only for the registered nurse, or else as capable of being done by the practical nurse. All which fall under the heading of " control and supervision " are assigned to the registered nurse ; they include supervision of all nursing services and ward staff, charting, preparation of ’patients for surgery, postoperative care and care of patients during recovery from anzesthesia, preparation of emergency trays, care of poison cupboard and medicines, supervision of linen and supplies, the serving of special diets, isolation technique, and reports and unusual occurrences. on accidents Under the heading of administration, however, only 2 out of 15 duties are assigned to the registered nurse : these are the writing of reports on staff shifts, and the task of reporting a patient’s condition to the doctor. The practical nurse is given the jobs of receiving new patients, disposing of their clothes and valuables, looking after them at the time of discharge, -preparing accounting reports on ward charges, answering telephone calls, taking messages, answering patients’ signals, receiving
visitors, delivering mail, arranging flowers, requisitioning supplies, drugs, and linen, and filling in routine slips for the examination of specimens. The practical nurse also undertakes the entire 24 duties listed under the headings of housekeeping and transport, which include regulation of heat and light for patients, supervising porters and ward maids, the lifting, turning, and carrying of patients, and the transfer of patients to the theatre and back. All the duties of assisting the physician-with dressings, transfusions, bladder irrigations, and other ward operations-fall to the registered nurse, the practical nurse only being required to furnish equipment and supplies. The section of most interest is that headed " care’of the patient " : here, out of 64 procedures, 46 fall to the practical nurse and only 18 to the registered nurse. Those reserved for the registered nurse include preparation of fracture, traction, and cradle beds ; nasal and rectal feeding ; preparation of instrument trays ; hot packs ; cupping ; the dressing of bedsores ; eye, ear, and nose irrigations ; the care of drips ; and the giving of medicines and injections. The practical nurse, however, 1.
Hospitals, Chicago, January, 1947.
can
undertake
bathing
and
bedmaking,
the
serving
of
food, the feeding of infants and preparation of their food, the giving of bedpans and simple enemas, temperature-taking, poulticing, the care of the head, and routine treatment for scabies and the exanthems. Dr. Golub also suggests that the practical nurse could assist in other hospital departments, such as the nurseries for newborn infants, the special-diet kitchen, the occupational therapy department, and the theatre. His analysis does not of course apply fully to British hospitals, because the nursing techniques differ a little. But in general the picture is the same ; and it is enlightening to be told that of 150 common nursing practices 97, or 65%, do not need the attention of a highly qualified sister, but can be safely undertaken by girls with a much
simpler practical training. PSYCHO-ANALYSIS ILLUSTRATED NOT only the general public but many doctors are curious to know what goes on in the psycho-analyst’s consulting-room ; for here is a branch of medicine which cannot be demonstrated to a class of eager students, or even to the solitary clinical assistant. Dr. Berg1 has therefore done many of us a service by ringing up the curtain on those secret sessions and telling us exactly what one patient said and-which is more to the pointwhat he replied, or didn’t reply. He does it cheerfully and competently, cleverly postponing his revelations, and presenting his tale with the skill-of the natural storyteller. What the reader thinks about psycho-analysis at the end of it will no doubt depend on the bent of--or bends in-his own personality. In the case discussed, analysis was successful ; and the situations revealed were of the kind which Freud has taught us to expect. Yet even Dr. Berg finds analysis puzzling at times. In theory, a man should benefit from an honest attempt at self-knowledge, from peeling off his layers as Peer Gynt peeled the onion ; in practice, some do but some don’t. Even if current interpretations of mental mechanisms are accepted fully, it is clear that an understanding of them will not, in itself, put the mind at ease. As Dr. Berg says, " insight alone is rarely sufficient to bring about more than very slight amelioration, and sometimes with the fullest insight amelioration of symptoms is the slightest." He attaches much importance to the emotional release which . in: this successful case accompanied the growth of insight ; and the reader is tempted to wonder whether the emotional release without the insight might not be equally effective ; or at least whether the same favourable result could somehow be achieved with less trouble and expense. ROYAL SOCIETY IN the list of 24 new Fellows of the Royal Society we are glad to see the names of several members of the medical profession and several others closely concerned in its work. Surgery is represented by Mr. Geoffrey Jefferson, F.R.C.S., professor of neurosurgery at Manchester, whose election will give much pleasure to his fellow clinicians. There are two biochemists (Prof. E. J. Conway, lB’I.B’., of Dublin, and Prof. H. A. Krebs, M.D., of Leeds), a member of the staff of the Imperial Cancer Research Fund (Dr. James Craigie), a physiologist (Dr. W. S. Feldberg, of Cambridge), and a geneticist (Prof. C. H. Waddington, SC.D., of Edinburgh). Among the three women now elected we are particularly happy to find Miss Muriel Robertson, D.sc., head of the department of protozoology at the Lister Institute. ‘
Tun Minister of Labour and National Service has nominated Mr. G. P. BABNETT, one of H.M. deputy chief inspectors of factories, to be chief inspector in succession to Mr. H. E. Chasteney, whose death was announced in our issue of March 8. 1. Deep Analysis. By Charles Berg, M.D. Lond., D.P.M., physician to the British Hospital for Functional Mental and Nervous Disorders. London: Allen and Unwin. Pp. 261. 12s. 6d.
During the whole treatment physical therapy must be in constant use. Patients need not be confined to bed for more than a few days after rib-resection, but at no time must observation or attention to detail be relaxed. Treatment must be active the whole time under the direct care of the surgeon.
-
THE NURSE AND THE SISTER THE duties of the nurse, we are often reminded, have there is no clear answer to the never been analysed : " question " what is a nurse If the principle of the twoyear basic course in nursing, followed by a course for a senior. qualification, is accepted it also becomes necessary to distinguish between the duties of the nurse and the duties of the sister. Some help in this is afforded by a recent analysis from America. Dr. J. J. Golubdirector of the Hospital for Joint Diseases, New York City, plans to train what he calls "practical nurses " in a course lasting only a year, and to use such girls when trained to supplement registered nurses-the equivalent of our sisters-on the wards. The registered nurse, he says, " must continue to occupy the position of leadership in the profession. She may do bedside nursing.... She may be a hospital floor supervisor, or the head nurse of a nursing unit
of a hospital, supervising the work of several other she may be director of a department of nursing or of a hospital’s school of nursing ; she may become a teacher of nursing ; she may undertake special studies with the object of specialising in public health, anaesthesia, industrial nursing, medical social service, or hospital administration." or a
wing
nurses ;
There are many nursing procedures, however, which need not be performed by a registered nurse, and he goes on to analyse 150 nursing practices which he assesses as suitable only for the registered nurse, or else as capable of being done by the practical nurse. All which fall under the heading of " control and supervision " are assigned to the registered nurse ; they include supervision of all nursing services and ward staff, charting, preparation of ’patients for surgery, postoperative care and care of patients during recovery from anzesthesia, preparation of emergency trays, care of poison cupboard and medicines, supervision of linen and supplies, the serving of special diets, isolation technique, and reports and unusual occurrences. on accidents Under the heading of administration, however, only 2 out of 15 duties are assigned to the registered nurse : these are the writing of reports on staff shifts, and the task of reporting a patient’s condition to the doctor. The practical nurse is given the jobs of receiving new patients, disposing of their clothes and valuables, looking after them at the time of discharge, -preparing accounting reports on ward charges, answering telephone calls, taking messages, answering patients’ signals, receiving
visitors, delivering mail, arranging flowers, requisitioning supplies, drugs, and linen, and filling in routine slips for the examination of specimens. The practical nurse also undertakes the entire 24 duties listed under the headings of housekeeping and transport, which include regulation of heat and light for patients, supervising porters and ward maids, the lifting, turning, and carrying of patients, and the transfer of patients to the theatre and back. All the duties of assisting the physician-with dressings, transfusions, bladder irrigations, and other ward operations-fall to the registered nurse, the practical nurse only being required to furnish equipment and supplies. The section of most interest is that headed " care’of the patient " : here, out of 64 procedures, 46 fall to the practical nurse and only 18 to the registered nurse. Those reserved for the registered nurse include preparation of fracture, traction, and cradle beds ; nasal and rectal feeding ; preparation of instrument trays ; hot packs ; cupping ; the dressing of bedsores ; eye, ear, and nose irrigations ; the care of drips ; and the giving of medicines and injections. The practical nurse, however, 1.
Hospitals, Chicago, January, 1947.
can
undertake
bathing
and
bedmaking,
the
serving
of
food, the feeding of infants and preparation of their food, the giving of bedpans and simple enemas, temperature-taking, poulticing, the care of the head, and routine treatment for scabies and the exanthems. Dr. Golub also suggests that the practical nurse could assist in other hospital departments, such as the nurseries for newborn infants, the special-diet kitchen, the occupational therapy department, and the theatre. His analysis does not of course apply fully to British hospitals, because the nursing techniques differ a little. But in general the picture is the same ; and it is enlightening to be told that of 150 common nursing practices 97, or 65%, do not need the attention of a highly qualified sister, but can be safely undertaken by girls with a much
simpler practical training. PSYCHO-ANALYSIS ILLUSTRATED NOT only the general public but many doctors are curious to know what goes on in the psycho-analyst’s consulting-room ; for here is a branch of medicine which cannot be demonstrated to a class of eager students, or even to the solitary clinical assistant. Dr. Berg1 has therefore done many of us a service by ringing up the curtain on those secret sessions and telling us exactly what one patient said and-which is more to the pointwhat he replied, or didn’t reply. He does it cheerfully and competently, cleverly postponing his revelations, and presenting his tale with the skill-of the natural storyteller. What the reader thinks about psycho-analysis at the end of it will no doubt depend on the bent of--or bends in-his own personality. In the case discussed, analysis was successful ; and the situations revealed were of the kind which Freud has taught us to expect. Yet even Dr. Berg finds analysis puzzling at times. In theory, a man should benefit from an honest attempt at self-knowledge, from peeling off his layers as Peer Gynt peeled the onion ; in practice, some do but some don’t. Even if current interpretations of mental mechanisms are accepted fully, it is clear that an understanding of them will not, in itself, put the mind at ease. As Dr. Berg says, " insight alone is rarely sufficient to bring about more than very slight amelioration, and sometimes with the fullest insight amelioration of symptoms is the slightest." He attaches much importance to the emotional release which . in: this successful case accompanied the growth of insight ; and the reader is tempted to wonder whether the emotional release without the insight might not be equally effective ; or at least whether the same favourable result could somehow be achieved with less trouble and expense. ROYAL SOCIETY IN the list of 24 new Fellows of the Royal Society we are glad to see the names of several members of the medical profession and several others closely concerned in its work. Surgery is represented by Mr. Geoffrey Jefferson, F.R.C.S., professor of neurosurgery at Manchester, whose election will give much pleasure to his fellow clinicians. There are two biochemists (Prof. E. J. Conway, lB’I.B’., of Dublin, and Prof. H. A. Krebs, M.D., of Leeds), a member of the staff of the Imperial Cancer Research Fund (Dr. James Craigie), a physiologist (Dr. W. S. Feldberg, of Cambridge), and a geneticist (Prof. C. H. Waddington, SC.D., of Edinburgh). Among the three women now elected we are particularly happy to find Miss Muriel Robertson, D.sc., head of the department of protozoology at the Lister Institute. ‘
Tun Minister of Labour and National Service has nominated Mr. G. P. BABNETT, one of H.M. deputy chief inspectors of factories, to be chief inspector in succession to Mr. H. E. Chasteney, whose death was announced in our issue of March 8. 1. Deep Analysis. By Charles Berg, M.D. Lond., D.P.M., physician to the British Hospital for Functional Mental and Nervous Disorders. London: Allen and Unwin. Pp. 261. 12s. 6d.