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Consider starting your own business to help older adults maintain their health and functional abilities.

It is clear that the two institutions where nurses play a critical role--hospitals and nursing homes--are experiencing major problems. Patients in these institutions are not receiving the full benefits of the best health care America has to offer. Organized nursing has the opportunity and capacity to resolve these difficulties and in the process improve both patient care and the importance of our profession. The time is right for change. To date, nursing has not taken on this difficult leadership task. I believe we will remain dependent on other professions unless we take on significant responsibilities for resolving the problems facing these two institutions. The GMENAC report on health manpower suggests that out profession should not rely on others for public policy recommendations which will affect our future. Nursing has greater respect and national visibility than ever before. Within this decade, nursing has the potential ability to help resolve the crisis affecting these two institutions. The future of the nation's hospitals, nursing homes, those for whom we care, and of the nursing profession may depend upon how we respond to these two challenges in the years ahead.

W HAT IS IT LIKE to be a nurse in a space-age hospital? We at Memorial Hospital of Long Beach, California, believe we know. This is such a modern hospital that we think it may well be up to date 50 years from now! In 1960, we opened our new sixstory structure which cost $10,800,000 to build and equip. When we started planning for this new hospital, we had innovations in mind. We wanted a postsurgery nursing care unit, seven-foot beds which could be adjusted by pressing an electric switch, equipment made of new plastic materials, procedures to minimize staphylococcus infections, colorful uniforms, and new personnel who might be known as "patient representatives." Before we moved our entire staff and patients from Old Seaside Memorial Hospital to this new building, we planned for many changes. Many of our innovations not only make hospital life easier for the patient, but also permit him to do for himself things that in so many hospitals consume hours of nursing staff's time. This is a hospital in which patient comfort and efficiency not only are reconciled, but actually contribute to one another! Consequently, we are able to carry out our concept of nursing in a thorough, conscientious way. That concept is constant, patient-centered care. The postsurgery unit here is a refinement of the original recovery room. It provides services more complex than merely the caring for postoperative patients during recovery from general anesthesia. The postsurgery unit is divided into a postanesthesia section and an intensive surgical care section. The postanesthesia section functions on a 24-hour basis. The patient is delivered to this section from the operating room by the anesthesiologist, who reports to the nurse the condition of the patient and the clinical changes to be observed and reported. Postoperative orders are given. The nurse telephones a report to the Patient Information Desk when the patient is admitted, and hourly thereafter. She makes this re

Y OU all will, I hope, reach the mid-period of life, that age period or span of life which is or should be so significant. It is the time of life when you should be of the greatest value and service to society. It is that span of life which carries the chief burdens of the affairs of man. It is responsible for the support, direction, and education of the on-coming generation. Assuredly the quality of service, whether it be of the nursing profession or of any other vocation of man, should be at its height. Quality service depends on education, training, and ideals, on the one hand, and on a sound, vigorous, and harmoniously developed bodymachine-an energy-generating human motor of the first magnitude-on the other hand. All of you in the nursing profession are thoroughly imbued with, and accept without reservation, the proposition that education, training, and ideals are essential to quality nursing. In fact, it is a postulate with you and continually drives you on. Membership and participations in professional societies; subscriptions to and earnest studies of journals devoted to nursing and kindred subjects; attendance at institutes, summer schools, and universities; continual efforts to maintain an open and inquiring mind; all these show that you are wholly consigned to the principle that education, training, and ideals are essential requisites for quality nursing. But what about that other requisite, health, the energy-generating body motor of the first magnitude? Most of us fall down when it comes to this essential factor to quality service. Sufficient physical examinations and tabulations have been made for the age span of from 35 to 50 or 60 years, so that we have a fairly accurate picture of the health conditions of our people during this most significant time of life. Approximately, 98 per cent have defects and only 2 per cent are normal, free from body-mind blemishes. In this group, in addition to many defects of the special sense organs, of teeth, focal infections, of digestion and nutrition, under weight, overweight, of postural and other bone-joint-muscle structures, and of the nervous system-emotional instability, the ravages of the degenerative diseases-heart, blood pressure, arteries-apoplexy, and kidneysBright's disease, manifest themselves. Unfortunately, this group of diseases is not associated with disturbing symptoms until well advanced. They come on like the thief in the night, insidiously, and reach irreparable stages before we are aware of them. The early detection and arresting of the degenerative group of diseases can be done only through the efficient periodic health examination-the annual overhauling. Of the 1,304,109 deaths in the United States in 1932, Utah excepted, 300,000, or close to one-fourth, were due to the degenerative group of diseases. Eighty per cent of all life insurance rejections are due to this group. Cancer is a blight of which women must be intelligently aware. One woman in eight, after the age of 40, dies from this affliction. Diabetes is increasing its death toll in this age span especially among women. After all, it is surprising how very few disorders are responsible for our national mortality. Five groups of disorders claim more than a million of our 1,300,000 deaths. These are the degenerative group, the respiratory group

THIS paper considers especially the nursing care of patients with carcinoma who are being treated with radium. The nursing care of patients affected with the conditions designated as malignancies is presenting an increasing problem to nurse educators, for this care involves not only the application of all of the technics employed in medical and surgical nursing but the more subtle technics of mental hygiene and social service as well. The psychological aspect of the nursing care of malignancies is an important factor, inasmuch as treatment and nursing care do not always eventuate in restored health; further, the disease is such a long drawn-out, wasting, and agonizing one that the morale of the patient is often difficult to sustain. It is certain then that the nurse who has contact with these patients needs a definite mental hygiene technic. She should be a person of cheerful temperament, interested in humanity, and emotionally well balanced. She must be able to inspire confidence in her patients to such a degree that they believe their condition curable and that they, themselves, are on the road to health and economic independence. There is difference of opinion as to whether a patient should be made aware of his malignancy. In certain hospitals it has been found psychologically more desirable not to acquaint the patient with his diagnosis, but rather to tell him that he has a new growth, and that many new growths, such as warts, hemangiomas, et cetera, are now being treated by radium and the fact that he is receiving radium treatment is no indication that he has a malignancy. This practice, which might be criticized as verging on deceit, has served to allay the shock which inevitably follows the reception of the news that one has a cancer and gives the patient a set of mind to cobperate in the treatment. Exquisite nursing care is indicated throughout the entire illness. It is particularly important to note, however, that when the patient is bedridden or when it is found necessary that he be in bed for a course of radium treatment, an essential part of the nursing care is careful attention to all bony prominences, especially the back, which areas seem oversensitive, due, no doubt, to the generally debilitated condition of the patient. The diet should be high-caloric and of the type that is best suited to the area treated with radium. For example, in rectal cases a non-residual diet is indicated whereas

HE drama of nursing lies seldom in the operating room, as is usually supposed, but more often at the bedside, in the home, or in the clinic. True drama begins when two human beings come face to face, one of them helpless to solve his physical, or perhaps, his mental problem, forced to give up all reserve and to bare his very soul, it may be, for the consideration and the expected help of the other. Someone said that all nurses have been attracted to their work by an instinct for drama which makes

OXYGEN is the most vital substance required for life. Man can live only a few minutes without it. If he does survive an episode of oxygen want, he may suffer from permanent residual damage, frequently involving the brain and sometimes involving the heart. With the increased use of oxygen therapy in treating patients with various clinical conditions in recent years, many hospitals have established oxygen therapy departments; and descriptions of oxygen therapy procedures can be found in the medical literature (1,2,3,4).

NURSES in the Army as well as those in other federal services and in civilian life will be interested in the following statements and facts about organized medicine and organized nursing as demonstrated at an Army hospital. Similar examples could, of course, be found in other Army or Navy hospitals and in institutions under other auspices, but interest is focused just now upon this one hospital because of the exhaustive cost study which was made there by non-military investigators. There has been much comment recently in newspapers, medical journals, and other publications on the findings and recommendations of the Committee on the Costs of Medical Care, under the chairmanship of Dr. Ray Lyman Wilbur. Criticism and approval have been focused principally on the recommendations that medical -service should be furnished

IT IS impossible to discuss tuberculosis nursing in all its phases in a brief space, therefore I have merely tried to emphasize the salient features met with in the daily care of the average case of pulmonary tuberculosis. Nurses trained in a general hospital, and unfamiliar with the care of the tuberculous, will find that a little practical knowledge in the field of psychology is of the greatest value when caring for such cases. The patient is often misunderstood, and the nurse has real difficulty in appreciating his viewpoint, unless she grasps his mental attitude. In the first place the nurse must take into consideration the fact that the patient has been through a period of severe mental suffering after being informed of his condition, the outcome of which has been irritability, depression, a very self-centered state of mind, and a feeling that he has been cut right off from life, therefore he is very much in need of cheerful encouragement. The nurse must interest herself in the patient's welfare; gain his confidence; and try to help him overcome his habit of letting his mind dwell continually on his symptoms, by arousing his interest in his surroundings, and outside affairs. Ability to do this constitutes a real triumph for the nurse, for when his mind is occupied, his spirits will improve, and that is a great step forward in his progress toward health. While it may be advisable at times to restrict visitors, as soon as possible a few refreshing contacts from the outside world should be permitted. The patient usually derives much benefit as well as pleasure from such visits, finding them both helpful and stimulating.

surgery and his family are likely to approach the experience with unusual tension and anxiety. The heart itself is a symbol of life and any interference with its function stirs the imagination. There is the additional awe and anxiety which accompanies the use of complex apparatus, especially when the person must rely on that apparatus for the continuation of the vital functions of blood flow, maintenance of body temperature, and adequate oxygen supply. Some of this anxiety is lessened, when the child and his family come to the cardiac unit in the hospital before the surgery is performed and see and talk about the equipment that will be used. Doctors and nurses talk with the child and his parents. They are shown the water seal drainage bottles and chest tubes, the oxygen equipment, the flexible electric rectal thermometer, the Levin tube, the intravenous equipment, the electrodyne, the polygraph machine, and the suction machines for the water seal drainage bottles and the Levin tube.