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Circle No. d on Reader Inquiry Card

A J O B W E L L D O N E Thank you for publishing the well- written and thoughtful article, "Urina- ry Incontinence Among Nursing Home Patients: Issues in Research," by Marjorie Ramphal (Sept.-Oct. 1987). Dr. Ramphal provided a suc- cinct review of the factors contributing to urinary continence and inconti- nence and an equally succinct over- view and critique of studies done on incontinence of institutionalized pa- tients. Her discussion of interventions and outcomes reflects her ability to ad- dress an issue, relate data to a clinical situation, make a judgment, and rec- ommend further action and study.

I hope that the appearance of this ar- ticle means that Dr. Ramphal has a re- search project underway concerning nursing interventions and outcomes for diminishing urinary incontinence and for maintaining continence. This very complex and difficult clinical is- sue needs the considerable clinical and research expertise she conveyed. MARILYN J. HOWE, RN, MSN, FAAN

Assistant Researcher Center for Health Systems

Research and Analysis University of Wisconsin

Madison, WI

SAY " C H E E S E " Thank you for the article, "The Cam- era as a Nursing Tool," in the May/ June 1987 issue of Geriatric Nursing.

I have been working as a senior ser- vices coordinator for the past 10 years and have photographed some beauti- ful faces. It can be wonderful therapy!

Why not start a section showing one "ward winning" photograph for each issue? I'd be glad to submit a few right away.

Keep up the good work. L I N D A L A I S U R E

Venice, CA Editor's note: At this time, we cannot devote an entire section to photo- graphs, but we wouM be happy to con- sider photographs submitted for use in GN, depending on the space available and the subject matter.

A D I G N I F I E D A N D P E A C E F U L R E L E A S E On July 21, 1987, my father celebrated his 95th birthday in fairly good health--getting around with the aid of a walker. In general, he was quite inde- pendent, even going up and down stairs by himself.

On Sunday, August 9, I arrived home at approximately 11:40 pm after working the 3:00 to 11:00 PM shift. As I drove into the driveway, I noticed the lights on in my father's bedroom. This was unusual, because after he watched the news and had his snack, he was in bed by 8:00 PM.

When I got into the house, I read my sister's note and went upstairs to find out why my father was still up. "Hi, I'm home, what's wrong?" He said that he was taking a couple of Tylenol because his knee was aching--he suf- fered from osteoarthritis of the left knee, thus the reason for the walker. I said, "Okay, if you need me, call," and I went to get ready for bed.

Once in bed, I could still hear him making some fuss, so I went to his bed- room door. The light was out and he seemed to have dropped off to sleep. Even after returning to bed though, I still felt uneasy because he once again was stirring.

At about 1:30 AM, I went back to his room and asked him if anything was wrong. He now was sitting up in bed with the light on and said "I don't feel well." I asked, "How do you really feel? .... I feel like I'm going to die," he replied. "Father, maybe you are."

I checked his pulse, which was quite irregular. With that I woke my sister and told her I thought father was dy- ing. She went to his room while I called the doctor and told him about my fa- ther's condition. He said I could send him to the hospital, but I thought it better to wait a while. The doctor agreed, but said to call if I needed him.

I then called my brothers and sis- ters--there are seven of us--and my nephdw, Dennis, who idolized his grandfather and often sought his ad- vice. I also called our pastor.

14 Geriatric Nursing January/February 1988

; p r i n g e r p u b l i s h i n g c o

adequate Care of the Elderly. A Health Care Perspec- tive on Abuse and Neglect. T. Fulmer. and T. O'Malley. Presents guidelines for handling vital aspects of care such as understanding and assessment of elder abuse, case management and support pro- grams. 192pp / 1987 / $21.95 A Nurse's Guide to Caring for Elders. M. F. Carroll and L. J. Brue. Topics inc lude phys ica l changes, as~;essment of aging, nutri- tion, and psychosocial aspects of care. 240pp / 1987 / $20.95 soft

Exercise Activities for the Elderly. K. Flatten, B. Wilhite, and E. Reyes-Wafson. A handy resource for those working directly with in- stitutionalized and home-bound elders. Illus. 240pp / 1987 / $19.95

Recreation Activities for the Elderly. In this guide are simple crafts that utilize easily ob- tainable, inexpensive materials and recommended hobbies for home- bound and institutionalized elders. Illustrated 240pp / 1987 / $19.95 2 Vol. set, $35.50 N-1

Springer Publishing Co. / 11~36 Broadway, New York, NY 1001 Y

Circle No. I 1 on Reader Inquiry Card

LETTERS

Soon after, I began wiping my fa- ther's head with a cool cloth because he began to perspire. His pulse rate was about 40 to 44 - -ve ry erratic. By 2:30 AM everyone had arrived. As each spoke to him, he opened his eyes and recognized and spoke to each of them. There were bits of idle conversation and, when the subject o f p l u m b i n g u his t rade- -came up, my father made some witty remarks.

The pastor then told him that he was going to say a few prayers. My father understood and answered to the prayers in a clear, audible voice with the rest of us.

As the family gathered around his bed, I knelt by his side, gently squeez- ing his hand. I said to him, "Father, everyone is here now; everything is go- ing to be o k a y . . , so it's okay to die and go home to mother. She's waiting for you."

Though the night outside was gloomy and wet, inside was far differ-

li./eal eria f rie Uurse

ent. At 4:50 AM, a man was allowed to die in dignity, in the house he h imse l f built, in his own bed, with his family gathered around him.

He died as he lived: peacefully and with dignity.

E. TERESA H A R N E Y , RN, BSN Paxton, MA

A P O I N T O F C L A R I F I C A T I O N In "Nursing Home Reform Bills and Hearings Focus on Staff Preparation and Improved Survey Methods" (News Watch, Sept.-Oct. 1987), it was stated that the bill, H R 2270, would re- quire nurses aides to have state certi- fied training and that unlicensed aides must either have completed or be en- rolled in a state approved program.

I would like to point out that aides are never licensed. The article should have referred to them as "uncertified" not "unlicensed." Certification mere- ly indicates that someone has met the requirements of a particular program. Licensure implies much more, includ- ing the right to practice according to standards set by a licensing board. And i f the practice is not carried out accord- ing to standards, licenses can be with- drawn.

Interchanging licensed and certified in this instance is not only incorrect, it

Methodist Hospital, long e s t ab l i shed as a r e n o w n e d research , teaching and referral center with many technological "firsts" to its name, offers an enthusiastic and experienced clinical geriatric nurse the opportunity to join our new Geriatric Medicine Program. You will play an integral role in our newly remodeled Geriatric Assessment Clinic, a referral center that targets the major problems of older patients. We offer you the flexibility to design the position to your interests and abilities, while participating in an inter- disciplinary approach. You will also use your specialized geriatric training as an RN to obtain histories, perform exams, and counsel patients. Experience in acute or long-term care required; expertise in geriatric issues, and a Master's degree or nurse practitioner, are preferred. As Indiana's leading health care facility with 1120 beds, we will provide you with an excellent salary and benefit package that includes relocation assistance, on-going educational opportunities and exceptional challenge. Please call Patricia B. Brown, RN, Employ- ment Representative collect at 317/929-3547, or forward resume with salary requirements to: Methodist Hospital of Indiana, Employment Office - PB, 1701 N. Senate Blvd., P.O. Box 1367, Indianapolis, IN 46206. An Equal Opportunity Employer.

M e t h o d i s t Hospi

16 Geriatric Nursing

Circle No. 12 o n R e a d e r Inquiry Card

January/February 1988

further erodes the standing of health care providers who pass licensure ex- aminations and continue to maintain standards ofpractice.

L A U R I E J. B R O B E R G , RN, BSN Yarmouth, ME

Editor's note: Thank you for picking up on our using the terms licensure attd certification interchangeably. You are correct; they are not the same.

I only wish licensed nurses under- stood that difference when they encour- age and allow aides to carry out nurs- ing care.

CORRECTIONS: In "Irving Kleinman: Music Man" (Nov.-Dec. 1987), sentence 5, paragmgh 10,p. 346 should read, "And he says after victory in World War II . . . . "Sentence 3, paragraph I I, p. 347 should read, "Now that the Grey Pan- thers are the American agency for FIAPA . . . . "

Our Nov.-Dec. cover is a photo of the Philadelphia Electric Company not the Four Seasons Hotel as was stated on p. 287.