Letters

Unfortunately, patient motion mimics mechanical pulsatile activ- ity. When faced with patient activ- ity, the oximeter may get confused as to what is motion and what is true pulsatile activity. Sensor de- sign is only partially capable of re- ducing motion artifact. Electrocar- diograph synchronization (C-Lock, Nellcor, Inc., Hayward, CA), an ad- vance in pulse oximetry technol- ogy, is effective in filtering out mo- tion artifact. The electrical activity of the heart is synchronized with the mechanical pulses seen at the oximeter sensor site. This allows the oximeter to accurately identify changes in the vascular bed that represent cardiac activity. Rather than suggest that manufacturers re- design their sensors, I would rec- ommend that clinicians apprise themselves of current advances in technology that address the motion artifact issue. Also, I would stress the importance of applying the sensor according to the manufac- turer’s directions to minimize mo- tion problems.

Pulse oximeters are exception- ally simple monitors to use. How- ever, this ease of use can lull the

the environment would have clari- fied my intent.

The technical problem of mo- tion artifact is appreciated in the lit- erature. I agree that sensor design is only partially capable of reduc- ing motion artifact. Other ways to improve the problem would be im- mobilization of the extremity or se- dation, neither of which is ideal with neonates. Electrocardiograph synchronization was not addressed in the literature I reviewed; thank you for providing the updated in- formation.

Thank you for your critique and clarification of these areas in my article.

Diane Comer, RNC) MSN Faculty Tennessee State University School

Staff Nurse Neonatal Intensive-Care Unit, and Instructor Basic Life Support (BLS) and

Nursing Service Department Vanderbilt University Medical

Nashville, TN

of Nursing

Pediatric BLS

Center

change was selecting an AIDS unit as one of three units for our sopho- more clinical course. Because of the high mortality rate of young adults on this unit, the faculty tried to select more psychologically ma- ture students for that clinical as- signment. For that reason, we were not able to draw conclusions in be- tween-group comparisons. How- ever, correlations suggest that hav- ing been assigned to numerous HIV-seropositive patients may in- crease students’ satisfaction with nursing these patients.

In closing, I thank you for pub- lishing three excellent articles about nursing care of women and infants with HIV infection/AIDS. I also commend you for writing edi- torials that challenge us to examine our attitudes and behaviors. Your editorials and recent changes in JOGNN make it even better. Thank you.

Katherine Wiley) EdD, RNC Loyola University Chicago, IL

Nutrition during lactation practitioner into a false sense of se- What a shock it was to see that the

person you chose to review Nutri- tion During Lactation (March/ April 1992 JOGNN) is an employee

caring for HIV-seropositive patients

curity if he or she does not fully understand the technology behind the device. For this reason, I felt compelled to clarify the discrep- ancies contained in Ms. Comer’s article.

In your March/April editorial, you reminded us of our duty to provide competent and empathetic care to

of Ross Laboratories, manufacturer of the most widely used artificial infant milks in the United States.

women and infantswith HIV infec- tion/AIDS. You also cited our 1987 study of nursing students, 36% of whom said they would refuse to

Thank you, at least, for identifying her affiliation. Readers would be hard put to understand the negativ- ity of the review if they believed it

D’ LetkoJ RN c’ Ms’ MBA Perinatal Nursing Consultant Alexandria, VA

The author replies. . . Thank you for clarifying the information about the presence of audible noise in the nursery interfering with pulse oximeter readings. As I reviewed that section, I realized the distinc- tion between audible noise and electrical current was not stated clearly. Perhaps the distinction of decreasing sensory stimulation in

treat seropositive patients if given the choice. In a follow-up student survey we conducted in 1991, only 14% said they would routinely re- fuse assignment to HIV-seroposi: tive patients.

Although we are disappointed with that percentage, we attribute the improvement in students’ atti- tude to several curriculum changes since 1987. The most notable

came from a neutral source. Admittedly, I am not neutral. I

am solidly in favor of breastfeed- ing, and I find Nutrition During Lactation a valuable book. I am grateful that a committee of experts has collected and commented upon the available literature for my use. And if their conclusion is that not enough good research has been conducted, that clinical rec-

September/October 1992 J O G N N 351