Technology Enhancing Care In ACCU

Photo:Staff nurseCarol AcerneseR.N., checkson a patientin ACCUafter an alarmwas soundedby the new HPmonitoringsystem.

The Acute Coronary Care Unit (ACCU) recentlyacquired a state-of-the-art monitoring system fromHewlett Packard. The comprehensive monitoringdimensions of this system clearly demonstrate howtechnological advancements are being applied inhealth care today.

The Hewlett Packard system comprises two distinctbut interrelated components -- the bedside/ centralmonitor and the arrhythmia detection system. Thebedside monitor is equipped to detect and generatealarms for abnormal conditions on heart rate, respira-tory rate, invasive/non-invasive blood pressure,central venous pressure and pulmonary artery pres-sure. Numerical values and waveforms are continu-ously displayed at the bedside and on central deskterminals for evaluation by nurses.

Data management is an additional function of thebedside monitor and is defined as the collection,summarization, and presentation of data. Twenty-four hours worth of values are stored and can bearranged for viewing on each monitored parameter inthe form of numerical tables or graphic trends. This(please turn to page 7)

High Touch:Alternative Methodsof Health Care"High tech - high touch" - a phraseused to describe contemporary nursingpractice that we have all heard at least100 times. "High tech" needs littleexplanation, but what does "high touch"really mean?

Sue O'Neill and I attended aninservice program on therapeutictouch offered by Jean Daly, R.N., atLehigh Valley Hospital Center. Atthe time, I was engrossed in develop-ing the technical skills needed to carefor the critically-ill patient. I recog-nized the need to address the patientas a whole and attend to mental,emotional and spiritual needs. I wasnot sure I was ready for this! We inhealth care have our feet so deeplyplanted in the science of medicationthat it is difficult to take a step in anew direction.

Jean Daly is a local resident who hasdeveloped a private practice in theart of therapeutic touch and otherrelated skills. Therapeutic touch is amethod of providing comfort andcare to a person, utilizing the "layingon of hands." Many articles havebeen written on the effects of touchon patients, but seldom do we get towitness these effects firsthand. Wewatched in amazement as Jeanpassed her hands around the body ofa volunteer (Sue O'Neill), not actual-ly touching her, but just "sensing"her. The concentration was intense.(please turn to page 2)

o The Allentown. Hospital

A HealihEast Hospital

17th & Chew StreetsAllentown, PA 18102

Fall 1987

High Tech from page 1

The room was silent. Jean said thatshe "felt" a tremendous amount oftension over Sue's eyes and forehead.Sue admitted to having had severesinus headaches lately. In an out-ward motion, Jean pushed the air infront of Sue's sinuses away, and Sueclaimed relief.

I was amazed. Sue was stunned. Weleft the lecture with a great feeling ofexcitement and a strong desire toknow more.

Jean's primary focus of care isdirected to cancer patients and thosewith intractable pain. According toJean, the key is wholistic health care-treatment of the body, the mind andthe spirit.

Jean studied at the Association forResearch and Enlightement of theEdgar Casey Foundation in VirginiaBeach. The emphasis of the programis on "universal energy that is alwaysorderly, harmonious and in perfecttune." Jean believes in channelingthis energy in a positive way, toachieve wholeness in health.

•It has been a long and difficultstruggle for Jean to come to termswith her own feelings and doubtsonly to battle with the doubts ofothers. The proof is in the well-beingof the clients she cares for.

The service Jean Daly provides is sobasic and essential, a need that we inthe acute care setting find easy tooverlook. The nursing professionmaintains a philosophy advocatingthe treatment of the whole patient.Many of our care plans address theneed to comfort and reassure. Whattechniques do we employ to providefor these needs? Jean Daly hasdeveloped some tangible techniquesand is anxious to share them withher colleagues.

If you wish to learn more abouttherapeutic touch, Jean Daly offers

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Guest EditorialThe nursing profession isbecoming increasingly morecompetent in handling com-plex and multifaceted situa-tions. We continue to developskills in the technical aspects ofclinical nursing. Althoughthese clinical skills are essen-tial to achieving physicalrestoration, the emotionalcomponent of the patient --the humanness of the patient --is equally important to thenursing process.

Patients and their families enter a dynamic environment, a world ofsights, smells and sounds that may be unfamiliar, frightening,depressing, embarrassing, rigid, and beyond their control. As thenurse considers therapeutic intervention with hospitalized patients,sensitivity to the complex facets of hospitalization, and an appreciationof the patient's viewpoint are paramount. The psychological supportoffered by the nurse influences the patient's perception of the illnessand the illness experience. This support also encourages patients todevelop their own abilities to understand situations, to regain a senseof control, and to actively participate in their own recovery.

Psychological support encompasses a wide range of goal-directedbehaviors - active listening, conveying acceptance, presencing,building trust, mobilizing hope, providing emotional and informationalsupport to the patients and their families, and facilitating the patient'ssense of personhood and dignity .

There is increasing pressure for nurses to be clinically responsible,technically competent, patient, nurturing, and supportive. Nursesneed to learn to care for themselves while caring for their patientsand to accept their own strengths and limits. Time should be allottedfor nurses to share their own feelings and concerns about their patients.This shared work experience would serve to decrease the sense ofisolation, to increase collaboration, to develop the professional andpersonal self-esteem of the nurses, and to support nurses in theprovision of higher quality patient care.

The challenge then to nursing is to continue to maintain empatheticprofessionalism, thus ensuring that the emotional care of the patientreceives as much emphasis as the technical care.

Patsy Lehr, R.N.Nursing Education

an inservice to health care providersand is planning an all-day workshop.We recommend you watch for her inthe future.

Debra Butz, R.N.Operating Room/Recovery Room

Susan O'Neill, R.N.Intensive Care Unit

Continuing EducationLPN Pharmacology/NAPNES Certification

In all areas of health care there is aneed for both practitioners andeducators to continue to developtheir professional knowledge andskills throughout their careers. Thisis especially magnified in nursingdue to the rapidity with whichknowledge is increasing as well asthe rate at which the technologicmethods for applying this know-ledge are advancing. The roles ofregistered and licensed practicalnurses are continually expandingand evolving. Continuing educationis one way to keep pace with theexpanding knowledge base andevolving roles.

The National Association forPractical Nurse Education andService (NAPNES) has provided, inthe area of pharmacology, a certifi-cation in the administration of medi-cations. All licensed practical nurses(LPNs) who participate in anapproved pharmacology course areeligible to sit for this certificationexam. Those who pass the exam

with a score of 70% or greater qualifyfor NAPNES certification.

This certification is nationally recog-nized as the acceptable requirementfor the administration of medicationsin any hospital. Successful comple-tion of the test is a hard-earnedhonor deserving of special recog-nition.

The Allentown Hospital had a veryrare honor bestowed recently whenthe Nursing Department was noti-fied that all of the applicants whotook the recently offered pharma-cology course had successfullypassed.

In addition, three nurses who chal-lenged the exam as well as two morewho took the course at Lehigh Coun-ty Community College also success-fully passed the exam.

These nurses worked hard for thishonor and deserve special recogni-tion for their efforts.

ONGRATULATIONS!

Peg Crissey, 4TSandra Hebda, PediatricsDaune Kunkel, 6TMary Kunkel, 5TJan Lawrence, 3TLisa Marsilio, 6TLinda Miller, PediatricsLinda Lichtenwalner, PediatricsMarilyn Malanitch, 5TFran McArdle, 6TDeb Nenow, Newborn NurseryColleen O'Boyle, 4TFred Oberacker, 4TJoann Pastula, 4TLinda Pfeifly,

Newborn NurseryMarilyn Ruddell, 5TLuann Shuman, PediatricsMaryann Taylor,

Newborn NurseryLinda Trella, PsychiatryDiane Tust, Pediatrics

Carol Mickey Midei, R.N.Nursing Education

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Clinical RoundsPersonal Computers in Nursing Administration

Nurse staffing is one of the most challenging and complex problems encountered by nursing administrators andhead nurses in the day-to-day management of their patient care units. The quality of patient care on a daily basisis directly influenced by the staffing of nurses. Although it is difficult to quantify patient needs, nurse staffingsystems have been developed to assume this role.

In 1985, The Allentown Hospital Ad Hoc Patient Classification Committee, whose members were registered nurses,recommended the purchase of the Medicus Nursing Productivity and Quality System, and Automated Nurse StaffingOffice System (ANSOS). These two systems operate on the IBM personal computer and are now in place in theNursing Administration Office. Two hundred hospitals have the Medicus System and over 400 hospitals are usingANSOS. What do they do?

Medicus

Each morning at 9:30, nurses on allinpatient units use the Medicus tool to classify theneeds of their patients. Using a scantron sheet(preprinted computer data sheet), the nurse mostresponsible for the patient's care selects from a setof 37 pre-established indicators which apply to thepatient. The needs of the patient will influencethe indicators selected and will affect how thepatient "types out."

The data sheets are fed into a mark sensereader attached to the personal computer andprocessed. From these sheets, data and reportsare generated. The patient falls into one of fivecategories or patient types. The patient typedetermines the number of hours recommendedfor nurse staffing needs of a unit on a given day.The data yields objective measures of the nursingworkload and provides information regardingpatient volume and mix.

Automated Nurse StaffingOffice System

ANSOS allows creation of computerized sched-ules through "intelligent" scheduling and exact trackingof hands-on nursing care. The system tracks sick time,vacation, overtime and holiday hours. Through manage-ment reporting capabilities, ANSOS prepares staffingrosters and summaries; automates preparation of specialreports; tracks turnover, position control, license renewal;and prepares timecards for submission to Payroll. Theinformation is updated continuously from the dailystaffing sheets which are completed every 24 hours oneach nursing unit.

The two computerized systems are electronically interfaced and work together beautifully. It is now possible to trackhands-on nursing hours and correlate with patients' conditions and dependence on nursing staff. In the past, therewas only census to rely on, and census is certainly only part of the puzzle.

Through various reports, head nurses have an objective and validated system to assist them in evaluating workloadlevels and trends, to assess required staffing, and to utilize solid data for staffing justifications. Since DiagnosticRelated Groups (DRGs), the importance of cost to provide care has become a paramount concern. By utilizing state-of-the-art systems, the Nursing Department at The Allentown Hospital is better able to achieve enhancedmanagement control and support quality nursing programs.

Marion Edwards, R.N.Nursing Administration

Clinical RoundsA Nursing Challenge of a Very Different Kind

He arrives and is placed on a venti-lator and cardiac monitor, and allother necessary equipment is read-ied. A meticulous assessment ofbody systems is begun. But, the ac-tual reason this person is here willremain a mystery for hours. Thereare no family members available todiscuss the history of this event andno previous psychiatric history.-----------------------------------------------------------,

The phone rings and it is the admit-ting office: "His name is John Doe, 25years old of Ward Service Medicine. Hisdiagnosis: multiple drug overdose.Which bed do you want him in?"

Another overdose (O.D.)! There aretwo other O.D.s in the Intensive CareUnit already. Where should he beplaced? The decision is made to puthim in a bed near the desk in order toprovide close observation. Hope-fully, he will not be too noisy.

Waiting for a call from the EmerencyCenter, you find yourself wonderingwhy there is an increase in the O.D.patients over the past few weeks.Could it really be that old adageabout the full moon? It's not close to

a holiday, so you can't blame it onthat.

As you ponder, the EmergencyCenter calls with the patient's report."This is 25 year old John Doe who over-dosed on Valium, Dalmane and Tylenol.He arrived unresponsive and remains so.Extremities are flaccid. His arterialblood gas was poor, respirations wereshallow. He was subsequently intubatedand is being manually ventilated. You'llneed a ventilator. His stomach waslavaged and charcoal instilled via anEwald tube. He now has a nasogastrictube in place to low wall suction. Alladmitting lab tests, serum and urinetoxicology, and chest x-rays were done.Oh -- he's on a 302 involuntary commit-ment. When can we bring him up?"

Hoffman's Forte: When They Can't Eat Cakeand TPN May Be The Prescribed Treatment

Chronic starvation is an outcome ofmany illnesses. Its treatment may betotal parental nutrition. In someinstances, the ill person or his or herfamily is able to assume responsi-bility for the total parental nutrition(TPN) regimen at home. For this tooccur, the patient needs to acquire apotpourri of special knowledge,skills and attitudes.

Most providers have insufficientexperience with home TPN to sup-port the patient through the processof learning to live with it. One ex-cellent resource is the nutritionalsupport nurse at Lehigh ValleyHospital Center.

A few weeks ago, the 6T staff and Ihad an opportunity to contactMarian Hoffman, R.N., the HospitalCenter's nutritional support nurseavailable to The Allentown Hospital.Marian holds a BSN degree fromCollege Misericordia, a master'sdegree in education from Villanova

University and six years of experi-ence in nutritional support nursing.She brings her rich background tothe bedside, where she appearsarmed with a Hickman catheterdangling from a rubber torso, slides,booklets, and a vivacious, self-assured personality. She helps tomonitor nutritional status whileteaching the patient and his or herfamily the intricacies of Hickmancatheter care, TPN administration,operation of an electronic infusionpump, and safety. Marian blendshumor and optimism with facts andmuch practice. She draws on theexpertise of the nutritional supportteam as necessary.

Gradually, she encourages the pa-tient to assume full responsibility."It's the most rewarding aspect of thework," says Marian. "There is nothinglike seeing the families managing athome and having them tell you that theybelieve they can do it." Marian saysthe trust patient and/or families(please turn to page 7)

As you make the bed you debateabout putting a waist posey belt onthe bed, then remember it is Hospitalpolicy, even though he is unrespon-sive. Better safe than sorry, so youlock the belt in place. You wonder ifthis is his first suicide attempt. Whatmade him want to either end his lifeor use this extreme gesture to cry outfor help?

Next, a patient care plan is develop-ed. The short terms goals are quicklywritten based on the admissionassessment: stabilize and monitorhemodynamic state, prevent compli-cations, and transfer to Psychiatry.But dealing with this patient's psy-chological needs is also a goal.

The challenge facing the ICU nurse isdealing with the patient's psycho-logical needs, which are so uniqueand vital. Sometimes the experienceis rewarding. Sometimes it is frus-trating and impossible. Often it isquite challenging: usually the pa-tient is vulnerable, angry, scared, andwants to go home.

The typical experience involves arequest for two privileges -- a cigar-ette and a phone call. Trying to ex-plain the smoking policy of theHospital is of no avail. Many timesthe patient is given permission to goto the smoking room with an escort.In order to make a telephone call, itagain entails disconnecting themonitor and all other equipment,taking the patient to the desk(please turn to page 7)

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RecognizingNew Vice PresidentBonnie Smith, R.N.,was recently promoted from herposition as director of OutpatientServices to vice president. We wantto take this opportunity to recognizeBonnie's accomplishment andapplaud a nurse's success.

Ann Andres, R.N., Labor and Delivery, andJane Ballman, R.N., Dialysis Center,

completed the master's degree program inHuman Resource Administration from theUniversity of Scranton.

Victoria Geiger, R.N. and Karen Schleicher, R.N.,both Labor and Delivery nurses, passed thecertification examination for inpatientobstetrical nursing given by the Nurses'Association of the American College ofObstetricians and Gynecologists (NAACOG).

Bonnie is a diploma graduate ofLutheran Hospital, Md. She laterobtained her bachelor's degree inHealth Administration from St.Joseph's College, Maine and is cur-rentlyenrolled in the University ofScranton's master's program inHuman Resource Administration.She will complete her master's degreerequirements in December 1987.

Jack Schwab, R.N.,currently one of our evening supervisors,has been appointed head nurse of theTransitional Care Unit (TCu), scheduled toopen in February 1988. More information onJackand the new unit will appear in thewinter edition of Nursing Voice.She began her work experience as a

pediatric nurse at Lutheran Hospital,Md. and later worked at GreaterBaltimore Medical Center. She wasalso a public health nurse for theBaltimore Department of Health.

After leaving Baltimore, Bonnie lived• in Cuba for two years while her hus-

band was in the service. She says thiswas an interesting time since she hadthe opportunity to visit other islandsin the Carribean.

poison education programs and tookthese programs into the schools.Under Bonnie's leadership, TheAllentown Hospital poison centergrew from serving our Hospital toserving 20 participating hospitals.

Services, and grants management.Bonnie was also involved in thedevelopment of the AmbulatoryCare Professional Association ofEastern Pennsylvania, which becamean official organization in September1987 with Bonnie as the firstpresident.

Bonnie has been at The AllentownHospital for the past nine years.Starting at the Hospital as a volunteerworking with Russell Puschak, M.D.,Pediatrics chairman, she wrote agrant proposal for a poison controlcenter. During this time, Bonnie wasalso involved in volunteer service formany community organizations someof which include Meals on Wheels,Lehigh County Medical Society, andthe Miller Memorial Blood Center.

In 1982, Bonnie was appointed direc-tor of Outpatient Services. This posi-tion encompassed administrativeresponsibility for the AmbulatorySurgical Unit, Hemophilia Center,the Clinics, Emergency Center andthe Lehigh Valley Poison Center. InJuly 1985, the Gastrointestinal Labor-atory and the dental facility wereadded to her responsibilities.

All of this leaves little spare time forBonnie, but in her leisure time shedoes enjoy horseback riding andskiing. Bonnie resides in Allentownwith her husband and daughter, andhas a son attending college. Inaddition, she adds that her familyalso includes two cats and twohorses.Until the poison control grant was

approved, The Allentown Hospitaldid not have a formal poison controlprogram. In September 1978, Bonniebecame coordinator for the LehighValley Poison Center. She developed

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With Bonnie's promotion to vicepresident, she assumed responsibil-ity for all the outpatient services justmentioned plus Pastoral Care,WomanCare, Physical Therapy

We congratulate you, Bonnie.

Kily Fenstermaker,R.N.Nursing Administration

ACCU from page 1

enables the nurse and physician toeasily observe the effect of inter-ventions on the critically- ill patientover a specific period of time.

Another function of data manage-ment is in performing physiologiccalculations of hemodynamic, oxy-genation, ventilation, and renal data.These derived values such as system-ic vascular resistance, cardiac index,and left cardiac work provide a moreaccurate indication of undesirableoutcomes and can warn of majordysfunction and allow for earlierintervention.

The second component is thearrhythmia detection system. This isdesigned to alert the nursing staff tochanges in cardiac rhythm. The com-puter accomplishes this by continu-ously analyzing the patient's rhythmto identify abnormalities. Once de-tected, audible/visible alarms aregenerated with a recording of theevent. The alarms are graded andprioritized according to severity. Forinstance, ventricular fibrillation is ared alarm signifying that a life-

threatening condition exists. Amissed beat is a yellow alarmsignifying a serious but not life-threatening condition. The accuracyin this system's performance isgreatly enhanced when given appro-priate feedback by the nursing staff.

The alarm events are stored chrono-logically and arranged by categories.They can be displayed by bar graphsto evaluate trends, illustrating a de-crease or increase in frequency ofevents. They can be compared toother data to identify relationshipspreviously unsuspected.

The Hewlett Packard monitoringsystem has greatly aided patientmanagement by nursing personnel inthe ACCU. The knowledge derivedfrom this system, correlated withastute nursing assessment, has assist-ed in defining and executing anappropriate individualized plan ofcare for each patient.

Carol Acernese, R.N.Acute Cororuzry Care Unit

Brenda Salatino, R.N.Nursing Education

TPN from page S

have in her is a bonus. "It's just greatand it keeps me going."

A nurse's nurse, she also assists herpeers in caring for patients' nutrition-al needs. Slide projector in hand, sheis seen hustling off to the Hickmancatheter inservice programs. Pencilin hand, she works on nursing poli-cies and procedures for safe, effectivenutritional support. Notes in hand,she reaches out to the community,speaking to a variety of profession-als at colleges or community centers.

Like all roles, Marian's has a uniqueset of challenges. There are manydemands on her position. Her inabil-ity to control the time necessary tocare for patients makes it difficult to

meet deadlines. "I'm often stretchedthin and sometimes buried beneath aheap of work."

There are role ambiguities whichmay confuse patient teaching."Patients learn best if they can deve-lop trust and confidence in oneinstructor. Although all disciplinesteach the same principles, individualstyles may contribute to patient con-fusion," Marian says.

Despite the frustrations, we cancount on the services of the nutrition-al support nurse for ourselves andour patients into the future. Whenasked what is on the horizon, Marianreplied, "There are so many things toaccomplish, Ican't imagine a better

NURSING CHALLENGEfrom pageS

telephone, and being understandingas one phone call stretches to three.Both of these privileges become time-consuming, especially with anassignment of other critically-illpatients.

In conclusion, 0.0. patients repre-sent varied ICU nursing challenges.They can be noisy, uncooperative,manipulative, and almost unbear-able. Sometimes, they have criticalphysical needs which may requiredialysis, respiratory assistance orinvasive monitoring. Sometimes apatient does not survive. Othertimes patients come up from theEmergency Center alert and sittingup on the stretcher. They may regretwhat they have done or may havebeen seeking atttention. Not allO.D.s can be grouped together. Eachone is unique and needs to be caredfor as an individual.

The leU nurse, assigned to monitoroverdose patients, is always remind-ed of the need to care for a patientnot only physically, but also psycho-logically, emotionally, and socially.In an environment in which nursinghas become very technical andmonitor-oriented, it often presents achallenge of a very different kind.

Michele Geiger, R.N.Intensive Care Unit

position. It gives me a chance to combinethe two best aspects of nursing - patientcareand teaching. The longer Ido it, thebetter I like it."

Marian Hoffman can be consulted toteach, or help teach patients, with anorder for home TPN through aphysician's consult to the nutritionalsupport team. She is available fornursing consultation on beepernumber 1163.

Carole Moretz, R.N.6T

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Flossie's Forget-Me-Nots

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Dear San,

[ toU you: ['ti wriu aDout tIi.eprogress on tIi.e'East 'UVlg. Lhao« staned to see some waUs cominqdoum, anti there are pCenty if 60;cessitting around anti Iots if people ta!King aDout TTWVing.

'Ihe stories those aU waUs couid u{[f 'Mien [ wa£k.into oU 'Wara jI . tliat s wfim 'Eaucationa£ 'Devefopment anti tIi.e:Jfeart Station fiatf6een . I uionder fww we squeezed 20 iron 6etfs in tfiere. '!Tu sitfe rails were aetaclia6Ce . remember a£[ tIi.e times we pinched' our fingers?:Jfow about: aragging a£[ those portaDCescreens around patients' 6etfs for privacy?

Contact isolauo« anti resistant organisms weren't even wortfs in our voca6ufary in tfiose aays. 'We scru66et! witfi soap ana a stiff 6rusfiforfive minutes, anti then. aU our procedures witfi 6are liantfs. '1QI.66ergfoves were used only in tIi.e~ 9Ww, we cany Cate;cgfoves inour pockets afongwitfi our pens ana tape. [ao 6efieve I'm immunefor {ije!

Ofi, those trays if medications we carrietf· gCass cups in meta! holders on a ctifeteria size tray. It was fieavy, anti remember fiow weweren't a£f.owet! to set the tray tfown for any reason. JIlf{ if tIi.egCasses were wasfietf 6y tIi.emetficine nurse tifter wefi use anti tli.en arietf.If tli.egCasses weren't tirietf propeny, tfie pif£s wouU sticK-to tfie 60ttom, ana don. 'tforget tliat we fiatf only one lianti to use to administermedications ... tIi.eotli.er one was sti£[ fioUing tIi.e tray. If we dropped' tIi.e tray, a£[we couU tio was cry.

'Ihe :Jfea{tfi Office, on tfie tfiirti ffoor 6etween Sections C anti'lJ, was a 6usy place. ~mem6er fiow we stood. in line witfi menstrua{ crampsfor tfiat fiorri6Ce6rown {iquU medicine. Ldon. 't: remember tliat it ever fiatf a name . tfie 60ttCejust saitf "[or cramps ." 'We aUn't K-nowwfiicfi was worse, tIi.epain or tIi.e treatment.

On tIi.efourtfi floor were See tions 'E ana:J{, meaica{ wartfs witfi many poor patients. On Section :J{,some patients fiatf actuaf£y avet! tlurefor 10 to 15years. 'Ihere were no nursing homes then, only tfie County:Jfome, now ca/ld Ceaar6root PeopCe in the Lefiigfi 'Ila1Ceyreferret!to tliat as "Ihe Poor :Jfouse. - '!Tu nursing suiff aU tfie Caunaryfor these Wits, as each. tfay tli.ey wore tli.eir ·fiouse dress" just as tfieywouU haoe at home. 'l1iey sat in their cliairs a£[tiay fong anti surveyet! their domain.

Section 'E was a story in itself, witfi tIi.esCanting tift Jfoors, tIi.ecu6ides for tuberculosis patients doum. tIi.eside, isoCation 6uc~ts (gar6agepai£s}jor their aisfies, anti 6ig OiQVJentonKi witfi Ceatfierstraps, wfiicfi attacfiea tIi.e tonKi to tIi.epatient s 6ea. Section 'E was at one timean open roof. Pneumonia patients were pfacet! tfiere for fresfi air, wfiicfi was consUeret! a cure. '1Tr.isunit was 60tfi fun anti a fot if fiarawort

[ smile wfien [ tfiinK-if fww far we liave atfvanceti in K!;owCetfgeana ucfinofogy. 'Eacfi new piece if sophisticated equipment amazed usat wliat it tiU anti fww it improved patient care. 'But you K-now,San, tIi.ecommon factor in patient care, tli.en ana now, is tIi.efiumantoudi. jIs tIi.eprofession continues to adoance, tfiis part if patient care wi£[ remain uncliangea.

I'm. anxious to see wfiat tIi.enew 'East 'UVlg wi£[ 6rmg to us. ['{[ iorue again soon.

'Yourfrient!,1"fossie

Pat Stein, R.N.4T

NursingVoice

Nursing VoiceCommitteeMembers

I. ClaussS. CruzK. FenstermakerA. FerryM. GeigerK. KalinoskiK. KeirnC. MoretzS. Oravec

M.L. PatariD. PopovichM. RankinL. ReppertB. SalatinoP. SteinS.TetiM. UngradyS. Youtz

H. Seifert, EditorK. Puskar, Editorial Advisor

V. Barz, Creative AdvisorD. Yodis, Production Coordinator

B. Caserta and L. Miller, TypistsS. Domblaser, Photographer

C. BachertP.BlaserJ. BortzA. BrownD. Butz

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