Valuable personally and professionally

LETTERS ABOUT INCONTINENCE CARE The issue on urinary continence (Nov.y Dec.) is the most complete and professionally excelIent presentation I have ever seen . Thanks for this wealth of really useful information. I want copies for the other RNs on our SO-bed skilled nursing unit, which is part of a rehabilitation hospital in a complex containing a large retirement res idence. Our patients reflect the statistic established by our medical director that about 70 percent of the well elderly first go to a doctor because of urinary problems. Carol . Brink's "Assessing the Problem" (page 241) is most comprehensive. I would add only that I've found it imperative to observe female post-elimination cleansing, especially when the woman's medical record shows repeated bladder infections due to Eschericia coli or Proteus. This observation can be made on the first day that you can spend time with the patient during toileting. Invariably the wiping is back to front. . This is best corrected at the time it is happening, when you can help the woman with this less easily talked about intimate problem, which exists because of ignorance, pain, or joint limitation. If this is done with a regard to privacy and with-some reinforcement from yourself or other stafT members, the habit can bc changed. If bladder infection recurs or if the patient is forgetful and a family member is supervising, I explain the front-to-back technique to the spouse or family member, who is grateful that talk about toileting is being facilitated, and invariably interested. Several daughters and other relatives have found resolution of their own problems. No one works more intimately with patients or is more able to help them achieve continence than the nurse. Another helpful urinary device for men-when you have decreased fluid intake and tried late night toileting and still see a 2 A.M . to 6 A.M. incontinence-is a baggie. Stuff it with crumpled paper towels, 102 Geriatric Nursing March/April 1981

deflate the air, and attach it to the penis snugly with a one-inch-wide piece of material or binding, with jockey shorts over top. This device protects skin, prevents wet beds, permits rolling and turning better than an external collecting device, and it is much cheaper for home or hospital use. I take issue with the implication on page 263 in "Urethral Catheterization" that 700 m!. is the permissible upper limit in expanding bladder capacity. Through experience I believe this is too high for elderly patients. As the authors point out, overstretching diminishes blood flow and thereby lowers tissue resistance to infection. Such a high level also would .sec m contraindicated by the agc variable, because of decreased cell reproduction and elasticity. Our engagement in life depends in large measure on our involvement with choices-and GN has given all of us much ammunition to work on more and better choices for the aging person. ANNE JULIE WHITE, R.N ., Pa.

DELIGHTED READER Congratulations! Geriatric Nursing is a tremendous contribution to the field of aging and thc elderly. Lam delighted with the two issues I have received, September/October and Novcmbery Decernber. If the first two issues May/June and July/August are available I would appreciate receiving them. SR. ROBERTA BRUNNER, R.N., Fla.

GNS PURPOSES AND POTENTIAL Thanks to Geriatric Nursing, an additional medium by which to promote nursing of the aged. From reading this journal, its purposes seem to be: (I) To recognize attitudes toward the aging process and the aged client which influence nursing and health care, (2) to identify health care needs of aging adults, (3) to discuss how the aging process influences the health care of

the aged, (4) to identify issues which affect gerontological nursing practice, (5) to identify and report how psychosocial factors impinge on the health care and health of aging adults, (6) to recognize that geriatric nursing takes into account .assessment and health promotion throughout the life span, and (7) to provide data for research in geriatric and gerontological nursing. I foresee that outgrowths bf Geriatric Nursing will be a higher level of nurse/patient education, role models in geriatric/gerontological nursing, a need for more frequent publication of your journal, more positive nursing and multidisciplinary stafT attitudes, multidisciplinary submission of articles to GN and ego integrity for the journal stafT. Keep up the excellent work. MARY R. WATSON. R.N .• Fla.

VALUABLE PERSONALLY AND PROFESSIONALLY . I value Geriatric Nursing. I'm a retired health education and community organization worker, a Fellow of the Health Education Section of the American Public Health Association, and member of thc National Association of Social Workers. Now in the geriatric category myself, I find the journal of personal as well as professional value. KATHERINE Z. W. WHIPPLE. N .J.

Speaking as one whose only knowledge of aging comes from personal experience but who has been in publishing long enough to know a winner when he sees one, I think Geriatric Nursing is tops. GLENN F. ROBINSON, N.M.

MAINTAIN GN's SLIM LINE Thanks for a journal that conveys a philosophy of aging that expresses a profound love and respect for persons living their autumn years. I hope you will maintain the journal's slim line-as a conscientious Continued on page 150