Utah wheelchair soccer league offers an escape

---

Utah wheelchair soccer league offers an escape

League lets kids take control of specially adapted chairs to play soccer for an hour or two.

By Dana Ferguson

The Salt Lake Tribune

Published: May 29, 2012 10:40AM
Updated: May 29, 2012 11:33PM

Steve Griffin/The Salt Lake Tribune Youth soccer players line up their wheelchairs as they practice soccer at the Sorenson Multicultural Center in Salt Lake City on Wednesday, May 23, 2012.

Sounds of zooming and clicking filled the air as 10 soccer players in their power wheelchairs sped across the basketball court, moving a soccer ball toward the goal.

The kids spun and whacked the ball with custom racks attached to the front of their chairs as they tried to score on their opponents at the opposite side of the gym.

A taunt from goalie Gidget Winward, 12, echoed across the gym as the opposing team approached her goal.

“Bring it over,” Winward said, leaning forward in her chair. “Bring it.”

The 13-inch ball made its way to her side of the court, propelled forward by a power play from the opposing team, but Gidget quickly deflected the shot with the rack on her chair. A huge grin dawned. Gidget, along with the nine other players who came to Sorenson Multicultural Center to practice and scrimmage the night of May 23, make up the Salt Lake City youth wheelchair soccer league.

With greater hand-eye coordination than most, the players steer their chairs using handheld control sticks, which can propel them up and down the court.

The league, established by Shriners Hospitals for Children, Salt Lake County and Ability Found, offers the opportunity for children ages 7 to 18 to hop out of their everyday chairs and into specially adapted soccer chairs to play for an hour or two.

Shriners refurbished chairs donated by the county, and Ability Life donated funding to help add baskets to the front of each chair.

Program coordinator Ken Kozole said getting the funding to refurbish all the chairs proved challenging and that some of the chairs still do not have official baskets. Instead, some push soccer balls forward with white plastic boxes.

“It’s a minor miracle that we have 10 chairs up and running,” Kozole said.

Official equipment aside, Adriana Ibarra, mother of 14-year-old player Hugo, said the program has created an escape for her son. After fully losing his ability to walk a year ago from muscular dystrophy, Hugo found a way to do something he loves again.

“He gets tired of sitting in the same position all day,” Ibarra said. “So this helps distract his from his reality, from his problem.”

Hugo, one of the league’s best players, said he looks forward to the game each week.

“It’s a sport that I can play and enjoy,” Hugo said.

Nik Winward, Gidget’s 14-year-old brother, said he, too, enjoys the game each week. The only part he felt less than thrilled about was spending time with his sister.

“She pushes my buttons all the time. These buttons,” Nik said, pointing down at the control buttons on his chair. Leisha Roberts, mother to Drew, 14, and Noah, 12, said her sons enjoy the opportunity to improve their skills.

“It’s the only sport they can do themselves,” Roberts said. “It really gives them their independence.”

Ibarra said when Hugo went into his power chair full time, he lost some of his friends because they did not understand what he was going through.

For Ibarra, the diagnosis came with intense emotional repercussions as well.

“The world came down on top of me,” she said.

Changing their family’s lifestyle has been challenging, but the wheelchair-soccer league helps bring some normalcy.

Despite her language barrier (Ibarra speaks primarily Spanish), she has found community with the other parents in the soccer league.

“Every day is hard, everything we face, and there is no how-to book for this,” Ibarra said.

After an hour and a half of speeding around, spinning and socializing for players, and after their parents have gathered to support their children and one another, the game ends.

Game chairs get pushed into a supply closet in the gym. There they charge until the next week’s game.

Outside, the players roll to their vehicles, where many are lifted into their seats or roll up ramps to their designated spots.

They leave looking forward to next week’s game.

dferguson@sltrib.com

—

Youth Wheelchair Soccer League

The league practices and scrimmages Wednesdays at 7 p.m. at the Sorenson Multicultural Center, 855 W. California Ave., Salt Lake City. For information, call program coordinator Ken Kozole, 435-640-1325.

---

© 2012 The Salt Lake Tribune

Utah wheelchair soccer league offers an escape

By Dana Ferguson

The Salt Lake Tribune

--> --> --> -->

Love it! CNA BLOG

---

These guys (still) like to spike

Men in the tourney’s oldest age division keep competing because they can.

By Jack wang

The Salt Lake Tribune

Published: May 30, 2012 08:01AM
Updated: May 30, 2012 08:01AM

Trent Nelson | The Salt Lake Tribune MAC Magic’s Jake Barkdoll spikes the ball over Rustys’ Gordon Peak on Tuesday in the 73-and-over men’s division of the USA Volleyball Open National Championships taking place at the Calvin L. Rampton Salt Palace Convention Center in Salt Lake City.

They can be found in the back corner of a large ballroom at the Calvin L. Rampton Salt Palace Convention Center, playing with rebuilt shoulders and on creaking knees. Some are bald, others sport shocks of pure-white hair.

And if you’re 73, they call you “kid.”

Meet the guys who are competing in the 73-and-over men’s division at the USA Volleyball Open National Championships, which has descended on Salt Lake City this week with 443 teams in all age groups, professional and amateurs. The tournament began over the weekend and runs through Saturday.

Those competing in the tourney’s oldest age division can’t move with the lateral quickness of their younger counterparts. And age has taken a toll on their vertical lift. Six weeks ago, a member of one of the 73-and-over teams suffered a heart attack. But he still made it to Utah.

“Anything you can think of that’s associated with age, we’ve had,” said Jake Barkdoll, the 78-year old player/coach of the Mid-Atlantic Club from Maryland. With piercing blue eyes and a 6-foot-3 frame, he still looks like an athlete.

“It’s amazing that they don’t have more problems,” said Barkdoll’s wife, Linda Suydam. “This team has been a very healthy team.”

So why do they still play? Because they can.

“It feels good to hit the ball,” said Barkdoll, who founded the Mid-Atlantic Club in 1992. Also known as the MAC Magic, the team has secured an astounding collection of hardware: 45 gold medals, 20 silvers and 18 bronzes over the past two decades.

MAC Magic won its 83rd medal Tuesday in a victory against Midwest (Michigan). In seven matches at this tournament, the team dropped only three sets.

Based in Maryland, Mid-Atlantic’s players hail from all over the country, gathering to compete annually at the National Championships and the Huntsman World Senior Games in Cedar City.

Every other year, the group also teams up for the National Senior Olympics. Spread out from Florida to Ohio, the players do not have time to practice together. Still, they play on their own to keep their game up, usually lacing up twice a week.

The team members’ backgrounds are as varied as their locations.

Barkdoll is a former engineer who also worked as an associate commissioner for the FDA. He currently lives in New Mexico, where he — like his teammates — enjoys retirement and plays volleyball regularly, often with men decades younger.

Bob Quackenbush is a former West Point cadet and military man who uses the gym at the Pentagon. From high school teachers to business owners, their past lives run the proverbial gamut.

What unites them is volleyball, simple and pure. Younger teams at the Salt Palace dared to wear tie-dye shorts or shirts with names like “Iron Man” and “Kal-El” across the back. The Magic, meanwhile, opted for an understated combination of red shirts and blue shorts. Most tuck in the shirts.

National success helped the team branch out from the Maryland area, and they began recruiting for quick reflexes and good instincts. At their age, though, knowledge of the game becomes infinitely more precious.

“Players who have played for a long time, they just have grooves in their head,” Barkdoll said. “They know where the ball’s going to be.”

Steady servers also help, and the Magic have one in Mike Maguire. Down one set to Rusty’s (Oregon) in the semifinals, Maguire opened the second set with a commanding serve, helping his team seize a 9-0 lead.

The key is knowing when to hit hard and when to hit softly.

“When you see a nice floater, you get so busy staring at the label on the ball you forget to play it,” says Barkdoll, who was named Most Valuable Player for 73-and-over division.

There are moments when these older guys still look young. A good play might yield a butt pat or a tongue wag. A bad one might end with the ball being thrown hard into the floor.

Almost all of them are volleyball lifers, and the passion is still alive.

Celebrations, though, tend to be toned down. Gotta preserve those knees.

---

© 2012 The Salt Lake Tribune

These guys (still) like to spike

By Jack wang

The Salt Lake Tribune

--> --> --> -->

Students at Centerville Junior High prepare to perform ‘Hello, Dolly!’

---

Students at Centerville Junior High prepare to perform ‘Hello, Dolly!’

The big time • Eighth- and ninth-graders will be center stage at CenterPoint Legacy Theatre.

By Carol Lindsay

Special to The Tribune

Published: May 24, 2012 10:18AM
Updated: May 24, 2012 10:16AM

Paul Fraughton | Salt Lake Tribune The cast of Centerville Jr. High School's production of "Hello Dolly!" rehearse in the school's music room.

Chaos describes the scene in the dance room at Centerville Junior High School.

Music fills the room. About 70 kids bounce around. Some are singing, others laughing and still others are reading books and doing their homework.

They’ve learned their dances, they’ve learned their music, and they know where to stand. Well, mostly.

Eighth- and ninth-graders at Centerville Junior High have been working for months to learn the play “Hello, Dolly!,” and they’re gearing up to perform it tonight and through the weekend at CenterPoint Legacy Theatre.

All the practice sessions have been held at the Junior High in the dance room or cafeteria. The actual performances will he held at CenterPoint, but due to production schedules, students won’t rehearse there until the last second. Only their final rehearsals will be held on the stage where they will perform.

“We are so lucky that we get to use a great facility. The kids have a good idea what the stage and set are like, but until the last minute, they have never been on it, so we have to over-prepare. To use beginners in this way is scary. It’s a hard thing to be able to think on your feet in the movement and react how you need to, but they always do an excellent job” said drama teacher Ami Swallow.

Students have been practicing during their seventh period class. As the performance looms, they have been practicing every day after school for two hours. “We’ve practiced too many hours, yet not enough,” Swallow said.

The students in the play had tryouts in January. Savannah Moffat, 15 and in the ninth grade, won the role of Dolly. When she found out she was going to play the lead, she was so excited she knocked over a few chairs. Savannah would love to be a professional actress someday.

“I’m definitely nervous about my performance, but it’s more excitement. Learning the lines has been tough. I’m just exhausted every day. I’m tired all the time, but it’s worth it,” Moffat said.

Parents are supportive of the students in the play and have shared responsibility for props, costumes and the sets. They are also helping with sound and lighting.

In addition to the fun of learning new skills, practicing and performing, the cast members have enjoyed the opportunity to spend time with their friends and build new relationships.

Jessie Harrison, 15, performs as a waiter and in the ensemble.

“I love being with friends and being able to dance. I’ve been dancing for 10 years,” she said. “I’m not particularly nervous, just hoping it will run smoothly. The hardest thing has been time management trying to get everything to fit together.”

Swallow has been impressed by her students.

“It’s always great to see how much junior high kids can do. It’s always amazing to me,” Swallow said. “We always put on a wonderful show.”

closeup@sltrib.com

—

‘Hello, Dolly!’

Where • Centerpoint Legacy Theater, 525 N. 400 West, Centerville

When • Thursday, May 24 and Friday, May 25 at 7 p.m.; Saturday, May 26 at 2 p.m. and 7 p.m.

Cost • $6.50, available at Centerville Junior High School, 625 S. Main Street, Centerville

---

© 2012 The Salt Lake Tribune

Students at Centerville Junior High prepare to perform ‘Hello, Dolly!’

By Carol Lindsay

Special to The Tribune

--> --> --> -->

CNA Student Poetry (CNA BLOG)

By Leslee Jones


First Day of School 
May 14, 2012
First day of school
I'm nervous and timid
What do my classmate think?

They all appear younger
Timid and shy
We all just to look at the sky

Some are early
Some are late
Some probably won't even show up today.

Each trying to be cool
To impress with their dress
Each carrying their own distress

All seem young, lack experience
and trust-all just seem to be hoping for good luck

The classroom is filling
We are all willing
We'll see what happen to this
new group we are cheering.



School is Out
School is out
Let's all shout
Some will pass
Some won't last
Those who do
Will scoop up poo
and
Whose who don't
Well, just can't cope.
Friendships have come and gone
Teachers too
When work time arrive
I hope we will all thrive
LJR
May 25, 2012

Interesting debate

Kentucky weighs politics, medicine in death row inmate’s surgery

Kentucky • Should tens of thousands be spent on hip replacement for a man to be executed?

By BRETT BARROUQUERE

The Associated Press

Published: May 17, 2012 12:43PM
Updated: May 17, 2012 06:11PM

Louisville, Ky. • A condemned killer’s fight to receive surgery for agonizing hip pain pushed Kentucky officials into an uncomfortable debate over security, politics and even the possibility of inviting scorn from Fox News pundits.

Emails and memos obtained by The Associated Press show corrections officials struggling to reconcile their duty to provide medical care with the political ramifications of spending tens of thousands of dollars for surgery on a man they plan to execute. A key problem would turn out to be security issues that led several hospitals to balk at treating inmate Robert Foley.

“Hip replacement for an inmate who has exhausted all appeals and will soon be executed?” Kentucky State Penitentiary warden Phil Parker wrote in an email on Nov. 22, 2010. “I can see this making Fox News on a slow news day, maybe even on a busy news day. In fact, I bet (Fox News host Bill O’Reilly) would love to put this in his ‘Pinheads’ commentary. Just a thought to consider before it goes too much further.”

Prison officials also made contingency plans to call off the surgery if Gov. Steve Beshear set an execution date, and they considered whether to consult with him about the procedure.

“I think it is that important and all this may have political consequences,” Parker wrote a year before Beshear’s re-election. Ultimately, Beshear’s spokeswoman said he wasn’t contacted about it.

Foley, 55, was convicted of killing six people in eastern Kentucky in 1989 and 1991, making him the most prolific killer on the state’s death row. His status as an extremely dangerous prisoner was a key factor in the state’s difficulty finding a surgeon and hospital, according to the documents obtained through a public records request and a lawsuit filed by Foley.

Foley still hasn’t had the surgery, with Parker lamenting in an email they had no options after an exhaustive search.

State officials deny that politics played a role, and there’s no evidence in the documents that political considerations prevented the surgery.

A spokeswoman for the Kentucky Justice Cabinet — which oversees corrections and law enforcement — declined to comment because of the pending lawsuit.

Foley’s attorney, Jamesa Drake, said the state needs a way to care for condemned inmates, even those with complex needs. Foley, who has been on death row since 1993, is unable to get around without help because he’s at risk of a dangerous fall, Drake said.

“If you’re on death row, it’s just like anybody else,” Drake said. “If you need a new hip, you need a new hip. It hurts.”

The Department of Corrections acknowledged his degenerative hip in a response to the lawsuit, but also said he has been receiving adequate care. The federal lawsuit filed in March is pending.

Assistant Attorney General Brenn Combs wrote to Drake that the Department of Corrections couldn’t enter into a legal agreement about the hip surgery because it would impose requirements exceeding “our legal duty regarding inmate health care.”

“The Department is not interested in doing that and, like me, nobody else here can see a way that it would help inmate Foley,” Combs said in a Nov. 14 email.

It’s not unusual for inmates to receive treatment outside of prison, and Foley has twice left death row for other surgical procedures.

Foley first complained to prison officials about the persistent pain in his right hip in September 2010, saying his leg sometimes “gives out on him,” according to the lawsuit.

Foley initially didn’t want the surgery and tried to fashion his own hip brace out of “flip flops and other everyday items.” Foley said the brace helped with the pain in an affidavit signed in February, but prison officials confiscated it.

After Foley agreed to the surgery, officials searched for a doctor to perform the $56,000 operation. At the time, Foley was under a death warrant signed by Beshear.

“If and when an order is received to execute Foley, I will contact (then-prison medical director Dr. Scott Haas) to try to stop all medical procedures related to his hip replacement,” Parker wrote.

No execution date was set, and a judge later halted lethal injections as the state weighs execution procedures. It’s not clear when executions could resume.

While looking for a hospital, corrections officials increased Foley’s pain medication and looked into the logistics of moving him.

But prison nurse Chanin Hiland wrote in a September 2010 email to Haas that orthopedists in Paducah, Madisonville and Murray had been contacted, and “none of them want any part of this.”

“The farther we have to go, the more security will have to be sent with him; although, it is obvious he will not be running anywhere soon,” Hiland wrote. Foley’s hepatitis C infection was a further risk factor.

In November of that year, Parker and Haas asked Corrections Commissioner LaDonna Thompson for advice on security. Parker also wrote Hass about his concerns about publicity and whether he could be safety housed outside the prison system.

The difficulty in finding a surgeon illustrates the “gray area” between the law’s requirement of treatment for inmates and a hospital’s ability to turn down those patients, said Rebecca Walker, an associate professor of social medicine at the University of North Carolina in Chapel Hill.

“Everyone would probably agree he ought to get his care somewhere. It’s a collective responsibility,” Walker said in a phone interview. “Who does it is the question.”

After finding a doctor to perform the surgery, Foley and corrections officials thought they had found a hospital when Frankfort Regional Medical Center initially agreed. Corrections officials and the hospital set the surgery for Feb. 28, 2011 and conducted preoperative testing.

During a meeting between corrections officials and hospital staff on Feb. 22, 2011, hospital CEO Chip Peal said he hadn’t been aware the surgery was scheduled for less than a week later. A memo by Parker summarized security measures and noted that Peal needed others’ approval.

Peal returned to the meeting after 30 minutes and said the surgery was off.

“CEO Peal stated that they never had a patient at the hospital that required security and that he felt this was too high a profile person to be the first,” Parker wrote.

At that point, corrections officials were left with few options.

“After over a year of exhaustive search for a surgeon and hospital, this was our last hope,” Parker wrote to Thompson and Deputy Commissioner Jim Erwin on Feb. 23, 2011. “I expect future legal action in this matter, however, we know of no other options at this time.”

---

© 2012 The Salt Lake Tribune

Kentucky weighs politics, medicine in death row inmate’s surgery

By BRETT BARROUQUERE

The Associated Press

--> --> --> -->

Does brain injury link NFL players, wounded warriors?

 

By Stephanie Smith, CNN

updated 3:00 PM EDT, Wed May 16, 2012

Veterans in the study had been exposed to IED blasts, but some had also sustained accident or sports-related concussion.

STORY HIGHLIGHTS

• Dementia-like disease in brain tissue of NFL players shows up in four veterans
• Study suggests thread links athletes and IED survivors exposed to traumatic brain injury
• Can exposure to even one blast result in brain damage that persists and progresses?

(CNN) -- The same dementia-like disease found in the brain tissue of several National Football League players has shown up in the brains of four U.S. veterans exposed to improvised explosive devices and other head trauma, according to new research.

The suggestion made by the research is that a common thread binds those exposed to traumatic brain injury, whether it occurs on the football field or in the war theater.

"We found the same changes (the same damage to the brain) in veterans just as we did in athletes," said Dr. Ann McKee, a study co-author and director of the Neuropathology Service for VA New England Healthcare System. "This is interesting and intriguing."

Two of the military cases, and a group of mice studied concurrently by researchers, suggest that a single IED exposure could instigate the cluster of abnormal protein in the brain that characterizes the disease, called chronic traumatic encephalopathy.

CTE derives some of its notoriety from cases like that of Dave Duerson, a former Chicago Bear who shot himself in the chest in 2011 and was found to have dense clusters of tau protein permeating his brain and spinal cord.

Tau is released by neurons when the brain is rocked inside the skull and, when unleashed, tends to lodge in parts of the brain responsible for memory, judgment and mood.

The same group of researchers at the Boston University School of Medicine who examined Duerson's brain excised thin slivers of brain tissue from four U.S. veterans who died suddenly. Those were compared to tissue taken from two other groups: three amateur football players and a professional wrestler with a history of concussion; and a control group of four young people who died suddenly with no history of concussion.

What tends to confuse these cases is the inability to isolate the effects of an IED blast. Veterans included in the study had been exposed to IED blasts between one and six years before their deaths, but some had also sustained accident or sports-related concussions.

Questions are then raised about whether the blast itself or the history of concussion -- or both -- contributes to CTE.

"It's a little like trying to figure out the plot of a film by looking at the last frame," said Dr. Lee Goldstein, associate professor at Boston University School of Medicine and Boston University College of Engineering. "You have an idea about how the ending occurred, but you don't know the plot line that got you there."

That's where the mouse study comes in.

"What the mouse study does is ask a very specific question lingering in the field, which is, can exposure to even a single blast result in brain damage that persists and possibly progresses?" Goldstein said.

To answer that question, researchers exposed a group of mice to blast winds -- some up to 330 miles per hour -- that mimic what might occur in the wake of an IED blast and compared them to a group of mice the same age, living in the same conditions, that were not exposed to blasts.

The effect of the blast is described by researchers as a "bobblehead effect," the brain rocking back and forth inside the skull, similar to what happens during a concussion, and in some people it leads to brain damage.

Two weeks after exposure to the blast, brain tissue in mice showed evidence of tau protein.

"We were expecting the effect after multiple exposures," Goldstein said. "We were not anticipating this."

"They have definitively shown that blasts and shaking of the head gives you the same pathology seen in sports concussions," said Dr. Jack Tsao, a Navy commander, neurologist and director of traumatic brain injury programs for the U.S. Navy Bureau of Medicine and Surgery.  "The mouse model then gives you a potential for investigating the cause of what's happening.

"It's an important first step in raising further awareness of this issue," Tsao added.

Some military cases were notable for overlapping of symptoms reported by football players later diagnosed with CTE -- including headaches, irritability, difficulty sleeping and depression -- and for a diagnosis of post-traumatic stress disorder before death.

The research also raises questions about a potential subgroup of veterans returning from the war with a diagnosis of traumatic brain injury.

"It's safe to say right now that we're not sure what the overlaps are," said McKee, a professor at Boston University School of Medicine.  "Most people feel there is an overlap, and some cases of PTSD will be accounted for by CTE, but not all."

"The authors speculate that there may be a link," Tsao said. "It is very interesting to think this is going on and certainly well worth looking into, but ... there is no direct evidence yet based on what we've seen."

Study authors acknowledge limitations of their cases series -- published online Wednesday in the journal Science Translational Medicine -- including a small study size and obvious anatomical differences between mice and humans, but they believe they have enough information based on the study to move toward developing therapies to address CTE.

"That is the burning question that needs to be addressed now," Goldstein said.

Why Nurses Need More Sleep

By Jennifer Larson, contributor
May 9, 2012 - It’s mid-afternoon, and your energy is waning. You’re sleepy and a little cranky, so you pour yourself another cup of coffee to propel you through the rest of your shift. How many cups have you already had? You’re trying not to think about that.
It’s a scene repeated daily in hospitals, clinics and offices all over the United States. Many of us function on less sleep than we really need, so we adopt survival mechanisms to help us.
In fact, a report in the April 27 issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report noted that about one-third of the U.S. workforce gets six or fewer hours of sleep per night. That’s at least one hour less than the National Sleep Foundation’s recommended amount of nightly sleep, which is seven to nine hours.

“We have this idea that we can be a 24-hour society and function well,” said Arlene L. Johnson, Ph.D., RN, a nursing researcher at George Mason University, who has studied sleep and performance in nurses.
“But it’s not true.”
Common signs of inadequate sleep include mood swings and irritability, an increased inability to concentrate, memory problems, weight gain, and of course, feeling drowsy or tired during the day.
“Getting by” on less sleep than you really need isn’t the ideal way to function. For one thing, it could have serious consequences for your patients. You may not be alert enough to deliver the top-notch care that your patients expect from you--or that you expect from yourself. You might even make a mistake.
Chronic sleep restriction affects your critical thinking skills, noted sleep expert Michael Decker, Ph.D., RN, the Byrdine F. Lewis Chair in Nursing and associate professor in nursing, neuroscience and respiratory therapy at Georgia State University.
“As a person suffers reduced sleep, their reflexes become slower and their decision-making skills become reduced,” said Decker, one of only a handful of registered nurses certified by the American Board of Sleep Medicine.
Three studies that provide additional evidence:

• A 2006 study in the American Journal of Critical Care titled “Effects of Critical Care Nurses’ Work Hours on Vigilance and Patient Safety” examined logbooks completed by 502 critical care nurses. Those nurses routinely worked longer shifts than they were supposed to, and that tended to decrease their vigilance and increased the likelihood of making errors. According to the authors, these findings supported recommendations from the Institute of Medicine recommendations to limit nurses’ work hours to 12 consecutive hours during a 24-hour period and reduce or minimize the use of 12-hour shifts.
• A 2003 study in the journal Sleep found that sleep loss and drug use can have similar effects on people. The authors of “Ethanol and Sleep Loss” wrote that sleep loss “was more potent than ethanol in its sedative effects but comparable in effects of psychomotor performance.”
• A 2011 study by Penn State College of Medicine researchers found that a surgeon’s brain has to work harder to learn new tasks when she is sleep-deprived, which could have ramifications if unexpected events occur during surgery. The study was published in the American Journal of Surgery.

But it’s not just your patients who are affected by your lack of sleep. You suffer, too. According to the American Academy of Sleep Medicine, good sleepers have a better quality of life and suffer less depression than people who don’t get enough sleep.
Additionally, people who don’t get enough sleep have a greater tendency toward developing conditions like obesity, high blood pressure, diabetes and metabolic syndrome.
“Most nurses are carers or givers, and we tend to ignore our own body,” Johnson said. “Our body is telling us what we need, and we tend to ignore that, and we try to move forward.”
But, she cautioned, if we want to live longer, healthier lives, we have got to put a higher premium on sleep. “It’s imperative that you take care of yourself now, and one way to take care of yourself is to get a good night’s rest,” she said.
How can you improve both the amount of sleep you’re getting and the quality? For those not working the night shift, experts suggest developing a nightly routine. Try to get to bed a little earlier, and give yourself some time to “wind down” before going to bed, and disconnect yourself from all your electronic devices. And if you need to employ some accessories to help you shut out the world, definitely go that route.
“Whatever it takes,” Johnson said. “If it takes eye covers, if it takes ear plugs, if it takes getting darkening shades for your room.”
Those steps can also be helpful for nurses who work the night shift and need to block out the daylight and the daytime noises when they’re trying to sleep. It is definitely harder to get enough sleep when you’re a night-shift worker, Decker said.
“They need to protect their sleep in the daytime,” he said. “The rest of the world doesn’t know that you’re a night-shift nurse, so the phone still rings in the daytime, people still show up at the door.”
Plus, you are working against your body’s own circadian rhythms, particularly if your job requires you to work rotating shifts. “It’s very difficult to train your body to stay awake at night, and then two weeks later, expect your body to stay awake in the daytime,” Decker said. “So if nurses have rotating shifts, they’re in a state of chronic sleep restriction.”
Other strategies that can enhance your ability to get the sleep you need include dialing back on the caffeine in the later part of the day and getting some exercise. Exercise has been shown to enhance the slow-wave sleep that’s restorative for your body and brain, Decker said, and you need to get enough of that to be well-rested.

---

Signs You Are Not Getting Enough Sleep
Many people don’t realize they are sleep-deprived, said psychologist James Maas, Ph.D., author of the books Sleep for Success and Power Sleep. “They get habituated to low levels of alertness,” he said.
If you are experiencing any of the following signs on a regular basis, you might be experiencing the effects of sleep restriction--which means you’re not getting an adequate amount of rest.

1. Irritability
2. Difficulty concentrating or remembering
3. Mood swings
4. Dependence on an alarm clock to wake up each day
5. Drowsiness in a warm room or during a meeting
6. A regular feeling of fatigue or tiredness
7. You fall asleep within five minutes of getting in bed

 

Utah CNA class funny stories

Today's get to know each other game:
A student was accused of planning to assassinate the president. The secret service came in and everything. She was a phlebotomist and a patient with Alzheimer's made the accusation.
One girls mother threw a spoon at her and it stabbed her in the leg.
Skied from Alaska to Canada as part of a glacier research expedition.
Stuck a sponge up their nose when they were two and had infections until the discovered it six years later.

From classical music to fantasy novel, students think outside the box

---

From classical music to fantasy novel, students think outside the box

Program • International Baccalaureate aims to develop a peaceful world.

By Carol LIndsay

Special to The Tribune

Published: May 17, 2012 10:31AM
Updated: May 17, 2012 10:21AM

Courtesy Carol Lindsay Gemma Clark displays an enlarged cover of her 25-chapter fantasy novel and Tyler Bayn displays his alien skull painting, both projects for their International Baccalaureate project.

A Bach performance, an oil painting of an alien skull, environmentally friendly green houses, artist, writers and a television series pilot.

The diverse group of projects were presented by Clearfield High School 10th graders as part of their graduation from the International Baccalaureate Middle Years Programme.

Students in seventh through ninth grade at Syracuse Junior High and 10th graders at Clearfield High School were honored on May 1.

Syracuse is the only junior high in Davis County that offers the program.

One of the tangible benefits for students who graduate with an IB is they are able to graduate high school with 30 college credits earned. Students who enroll in concurrent Advance Placement can graduate with twice the credits.

Tenth grade students enrolled in program’s fifth level presented projects at the awards presentation. Many of the projects were the culmination of years of work.

Next year, the students will enter the High School IB program.

Rebecca Reed, Middle Years Programme coordinator, sees the program as a tool to help students focus on their futures and have a global perspective of the world.

“Our kids learn to think outside of the little box they are in,” she said. “They learn to think for themselves and how to apply what they’ve learned.”

Paulette Hopfenbeck, the diploma coordinator for Clearfield High School, believes the program helps students learn how to ask questions. The program is self selective, so students choose to join the program. While Hopfenbeck describes her students as high achievers, she says it’s not necessarily because they are the brightest students, but rather are the hardest workers.

When students from local junior high schools enter Clearfield High School, the IB programme becomes a melting pot of successful students. Hopfenbeck enjoys teaching the students.

“We mix in a lot of our other high achievers, and they are learning how to analyze and ask questions,” she said. “They are familiar with the requirements. They don’t moan as much because they are used to work and in-depth studies.”

Tyler Bayn, 15, said the program has made a big difference in his life.

“This program has made me outgoing. I would probably be the kid in the corner not talking without it. It got me out of my comfort zone,” he said.

Tyler’s mother, Laura, agrees that the program has benefited her son. “It has helped him discover his strengths and weaknesses as a student,” she said. “He is more aware of how he learns and where he needs to study more.”

The projects presented at graduation were chosen totally by interest of the students giving them the opportunity to explore subjects they want to learn more about.

Gemma Clark wrote a 25-chapter fantasy novel based on the Chinese five elements, fire, earth, metal, water and wood.

“The IB program has been most of my life the past year or so because I’ve either been working on my book or one of the other assignments,” she said. “It has definitely made a difference in my life — I’ve learned to prioritize discipline.”

closeup@sltrib.com

---

© 2012 The Salt Lake Tribune

From classical music to fantasy novel, students think outside the box

By Carol LIndsay

Special to The Tribune

--> --> --> -->

Farmington custodian earns her citizenship with support from staff, students

---

Farmington custodian earns her citizenship with support from staff, students

Dream job • Co-workers surprised her with the money needed to file her application.

By Carol Lindsay

Special to The Tribune

Published: May 16, 2012 04:09PM
Updated: May 16, 2012 04:09PM

Janet Gundry, a fourth-grade teacher at Farmington Elementary, with Walkiria Martinez at a citizenship ceremony on April 18. Courtesy Janet Gundry

A 2-month-old baby was left alone in Nicaragua — malnourished, unwanted and living in squalor.

The baby’s grandfather, alerted by neighbors, broke down the door and rescued her 49 years ago.

He whisked her away and dropped her off at his mother’s house.

Walkiria Martinez’s life, though, would take several more twists and turns before she found herself in the quiet town of Farmington.

Her great-grandmother raised her in Nicaragua. She attended school, but was unable to complete her education because in 1978 her high school was burned down as the country was ravaged by war.

She married and had children with a man who she says abused her and left her destitute on the streets of Central America — pregnant and with a 3- and 6-year-old in tow.

She said she had no options in her homeland, and decided to make the month-long trek to the United States, where she crossed the border illegally.

She eventually found herself in Utah, where she settled down.

In 1992, she married her husband, Larry, and in 1996, she became a legal resident. Together, the couple has raised six children.

About a decade ago, Martinez began working for the Davis County School District. For the past three years, she has been the head custodian at Farmington Elementary.

Since earning her residency, she has wanted to become a citizen. But she has not had the time or the money to do so.

Her coworkers, though, wanted to make Martinez’s dream come true.

Secretly, they saved up the $800 Martinez needed to file her citizenship application and presented it to her at a Christmas party.

Martinez was shocked by the gift.

“I was, oh my goodness; I was so excited. I was crying. It was amazing. All these people are so sweet, so loving. I love the children, I love the staff,” she said.

Martinez said her heart was pounding when she put her citizenship application in the mail. Then the studying began.

“I was not going to let the children at the school down by failing a test,” she said.

Her coworkers and school faculty and staff helped her prepare.

“I would go in and quiz her and she could just rattle off the answers. It was cute,” said Principal Bryan Tesch.

Martinez passed, and on April 18, Martinez took her oath to become a citizen.

“Heavenly Father had a plan for me. He didn’t let me out of his sight. My great-grandmother always told me keep the faith, and I did,” she said.

Janet Gundry, a fourth-grade teacher, surprised Martinez by attending the citizenship ceremony. Gundry, who teaches her students about citizenship, said she was honored to witness first-hand the work and emotion that goes into the process.

“It was one of the most, amazing, fantastic, sweet, tender and moving experiences of my life,” Gundry said. “It was so fun to watch someone I care for and love, to see her joy. She couldn’t stop crying. She would turn around and wave and she couldn’t wipe the smile off her face.”

Gundry also was touched by the attitudes of all those who took their oaths that day.

“To hear the gratitude the new citizens felt in their hearts to be a part of this great country was so moving,” she said.

Students supported Martinez’s journey to citizenship, too.

They made a book of poetry and cards for her, along with a huge banner declaring her their “Mrs. America.”

Fourth-grader Amberly Morrow, 10, explained what she learned about citizenship.

“You think to yourself it’s not that big of a deal because you were born with it and take it for granted. But to actually see someone do it and how much they want it is cool. You actually get to experience it through other people,” Amberly said.

Travis Barton,9, was surprised when he found out Martinez had to give up her citizenship to Nicaragua to become an American.

“It’s like getting something you really want, you have to give up something to get it,” he said.

Martinez was overwhelmed by the support and joy she felt through her citizenship process.

“I feel so patriotic; my own kids are in the military. This year at the 4th of July, my house is going to be red, white and blue like crazy. It is so meaningful. Never in my wildest dreams did I think I was going to be where I am,” Martinez said. “This is appreciation week at the school, and I appreciate everyone — I feel part of a family. It’s amazing.”

closeup@sltrib.com

—

Poems from students honoring Walkiria Martinez

Mrs. America Martinez

Roses are pink

Our floor has no dirt

You are so cool

You play a big part in our school

You just became a citizen

And that is so cool

You went to a big party and

All of a sudden you could vote

You live in the US legally now

You’re the best American in the world.

— Sarah Gregory, sixth grade

You’re wonderful to this school

You’re better than a shiny jewel.

We love having you around

It’s better than the most beautiful sound.

You’re such a great lady,

You’re very far from shady.

You make me want to sing,

And fly like I had wings.

You’re so awesome,

You smell like a blossom.

You’re so sweet,

You’re the woman on the street.

— Amelia Stephens, sixth grade

---

© 2012 The Salt Lake Tribune

Farmington teacher earns her citizenship with support from staff, students

By Carol Lindsay

Special to The Tribune

--> --> --> -->

UTAH CNA CLASS FUNNY STORIES

Something different about you:
18 year old: ate six live grasshoppers at girls camp on a dare. Had to chew them. "They taste like raw chicken smells."
Guy ate eight live goldfish for $150 had to chew the last three.
Comes from a family of redheads. Someone dyed their white cat red to be funny. The cats fur stayed pink until it died years later.
Father raises buffalo and kangaroos. (Yes these are where the kangaroos that visit the nursing homes come from)
Walked from Logan to Lagoon. (To see his little brother who had just been diagnosed with a brain tumor)
Arrested in high school for streaking at homecoming.
Bitten by a lion (Nope not the missionary in Guatemala)

Key Ideas in Nursing's First Century

   AJN, American Journal of Nursing:

• May 2012 - Volume 112 - Issue 5 - p 48–55

  doi: 10.1097/01.NAJ.0000414321.10073.c8

  Feature Articles

  Key Ideas in Nursing's First Century

  Baer, Ellen Davidson PhD, RN, FAAN

  Author Information

  Ellen Davidson Baer is professor emerita at the University of Pennsylvania School of Nursing, Philadelphia, and cofounder and former associate director of the university's Barbara Bates Center for the Study of the History of Nursing. Contact author: ellendbaer@aol.com. The author has disclosed no potential conflicts of interest, financial or otherwise.

  Abstract

  OVERVIEW: This article identifies some of the major ideas underpinning modern American nursing in its first 100 years, and postulates that distinct periods in nursing's early formal development were dominated by a particular theme or set of ideas. The themes, which were largely determined by social priorities, scientific advances, and national emergencies, overlapped, enriched each other, and provided an impetus for nursing to evolve into the highly skilled profession it has become.
  With America's transformation following the Civil War from an agrarian society to an industrial state, much of the care of the sick, formerly provided by relatives in the privacy of a home or village, was performed by strangers in public institutions. Social reformers, such as Abby Howland Woolsey, sought to create a reliable workforce that could meet people's need for basic sick care, safety, and protection in those institutions.¹

  Figure. Bandage roll...

  Figure. A nurse care...

  Social assumptions about gender, race, and class are woven throughout nursing's first century. The female social role provided the domestic model on which nursing was built.² Wealthy patrons visualized domestic workers performing the more laborious, “dirty” tasks under the supervision of a more educated “lady” nurse.³ But within a generation, such nursing leaders as Isabel Hampton Robb had replaced the wealthy patrons, and nursing began to manage itself, expanding its breadth and depth of knowledge over subsequent decades.^{3, 4} Born out of a concern for patient safety and shaped by an appreciation of domestic skills, scientific knowledge, professionalism, pedagogy, nurturance, compassion, research, and theory, nursing could no longer be perceived merely as “work performed by nice people.” Within its first 100 years, the profession of nursing had unquestionably evolved into one that employed highly skilled experts to provide lifesaving and technical care to people who were ill or injured.

  Figure. Pediatric NP...

  Figure. NP Loretta F.

  PATIENT SAFETY, KNOWLEDGE, AND REFORM

  “When the visitor entered the ward … a little boy of five years old had just been operated upon for stones in the bladder, an old woman [a patient] was sitting by him trying good naturedly to soothe his cries but doing nothing to staunch the blood which was flowing from the wound.⁵”

  This quote from Elizabeth Hobson's Bellevue Hospital Visiting Committee notes of 1872 reflects the author's concern with patient safety, the primary goal underlying the adoption of formal nursing in the United States. Overwhelmed, chaotic, and underfunded public institutions had become prime targets for the reform efforts of well-meaning citizens whose consciences had been awakened by the Civil War. One such group of reformers was the Visiting Committee of Bellevue Hospital, of which Hobson was a member. But Hobson's observation also underscores the importance of a second concept central to nursing's foundation: knowledge, having the information required in order to “staunch the blood which was flowing from the wound.” Finally, Hobson's very presence in the hospital ward testifies to a third seminal idea in modern nursing: reform, the desire of citizens to improve the social services provided, or, more typically, not provided, to needy citizens. The “age of reform,” as this period was described by historian Richard Hofstadter in his book by the same name, had come to American hospitals.⁶

  A decade or two earlier, Florence Nightingale had written that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper selection and administration of diet—all at the least expense of vital power to the patient.”⁷ In Hobson's time, the main knowledge underlying care of the sick was related to such domestic matters as hygiene, nutrition, various poultices, rest, and potions built around alcohol or opium derivatives, the benefits of which were mainly to numb the pain rather than cure the malady.

  Of hygiene practices at one public institution, Hobson wrote, “The visitor found a woman with a broken leg twelve days after she had been brought to the hospital in the same miserable garments in which she fell.”⁵ In describing an almshouse (poorhouse) hospital, she said, “The condition of the patients was unspeakable; the one [untrained] nurse slept in the bathroom, and the tub was filled with filthy rubbish.”¹

  On the subject of nutrition, Hobson recounted a Friday meal in the same hospital, wherein “the dinner of salt fish was brought in a bag to the ward and emptied on to the table; the convalescents helped themselves, and carried to the others their portions on a tin plate with a spoon.” She described the kitchen as follows:

  “A … cook was ladling out soup into great tin basins which the workhouse women were to take up to the wards, and I learned that those same cauldrons were used for the tea and coffee in the morning. Some pauper women were huddled together in a corner, peeling potatoes, and the whole place reeked with the smell of foul steam and food. I had to escape, it was too dreadful!¹”

  Because sick people had traditionally been cared for by female family members, women had developed strong information networks, passed down from mother to daughter, usually in verbal form. Based on her observations, Hobson concluded that the workers she had observed in institutions often lacked the domestic skills farm and town women had used to manage their private households. Hospitals needed workers who could clean patients and wards, prepare and serve decent meals, launder clothes and bedding, and petition administrators to purchase such necessary supplies as soap, clean linens, bandages, proper food, and other household products—all of which fit within the realm of skills taught to most women from birth.² As Nightingale wrote in the late 1800s, “Every woman … has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid—in other words, every woman is a nurse.”⁷

  DOMESTIC SKILLS

  To correct the deficiencies of the sick care system, Hobson and her fellow Visiting Committee members started the Training School for Nurses at New York City's Bellevue Hospital in 1873, attempting to base it on Nightingale's work in England. Similar schools opened in Massachusetts and Connecticut later that year.⁸ All of these schools functioned as nursing-service delivery agencies in the hospitals with which they were affiliated. Pupils delivered care, while instructors supervised and, when time permitted, taught minimal basic nursing skills, such as bandaging and poulticing. From the outset, the schools struggled with the double obligation of trying to ensure patient safety while teaching fledgling nurses what they needed to do to reform the institutions. Ultimately, their solution was to recruit women “of character” with domestic capabilities, while developing “rigid rules and detailed procedures” that created order and served to “protect patients from harm.”⁹

  Susan Reverby created a play on words to capture this conundrum in her historical work, Ordered to Care: The Dilemma of American Nursing, 1850-1945.¹⁰ Its title reflects the idea that society had ordered nurses to provide care to hapless patients, while also conveying the notion that nurses could provide care only if they first achieved order in the chaotic institutions in which the sick resided. The entire first generation of formally trained nurses focused on that task: bringing order to the institutions and systems of care while establishing the purview of nurses on the basis of domestic knowledge available to ordinary women. Some, like Nightingale, saw themselves as sanitarians. Others, like Linda Richards, saw themselves as missionaries, infused with evangelical enthusiasm.¹¹ By the late 1800s, however, domestic knowledge was no longer adequate to the task of nursing.

  THE INFLUENCE OF SCIENCE

  Scientific knowledge, gained in the bacteriologic laboratories of Europe, began to influence American medical and nursing practices by the close of the 19th century. In Europe, Ignaz Semmelweis reduced childbed fever by 90% in the 1840s merely by insisting on handwashing.¹² In 1864, Louis Pasteur introduced the germ theory, and Joseph Lister began using carbolic acid to clean wounds.¹² In 1882, Robert Koch saw tuberculosis bacteria under a microscope, and by 1890, ether, morphine, digitalis, diphtheria antitoxin, smallpox vaccine, iron, quinine, iodine, alcohol, and mercury were the 10 most important medicines in use.¹² Although the germ theory had not yet been accepted by society (or by Nightingale, who rejected it her entire life),¹⁰ the need for nurses to know and apply new scientific information became apparent.

  The Johns Hopkins Hospital opened in 1889 with a training school for nurses directed by Isabel Hampton. When its medical school opened in 1893, Hopkins became the first American medical institution to include training in the sciences of bacteriology, chemistry, pathology, and physiology and to focus these growing bodies of knowledge on the day-to-day management of patient care. At the opening ceremonies for the training school,

  the hospital's superintendent, Dr. Henry M. Hurd, assured the gathering that in this training school, “service in the Accident Department and in the Dispensary; in the Medical, Surgical, Gynaecological and Pay Wards” would be accompanied by “carefully devised courses of study and systematic mental training…. In the eyes of the Trustees,” he added, “nursing the sick is not to be considered a trade but a learned profession.”¹³

  PROFESSIONALISM

  In its third decade as a formally trained occupation in the United States, nursing embraced the idea of professionalism in relation to its developing scientific knowledge base. Teaching became more intense and nursing instructors became interested in perfecting specific nursing care delivery systems, identifying methods of instruction, establishing curriculum standards, certifying the equivalence of nursing programs, registering graduates as licensed nurses, forming associations, and establishing higher education courses for teachers and administrators. The training schools had been so successful in organizing the hospitals that every hospital wanted one. Within the first 20 years of modern nursing, the number of training schools increased rapidly.⁸ Some of these so-called “training schools” opened in doctors’ private homes, where sometimes up to four patients resided. Since such a limited situation couldn't provide nurses anything approaching a well-rounded curriculum, the national body of nursing superintendents—through their organization, the American Society of Superintendents of Training Schools for Nurses, later known as the National League for Nursing (NLN)—sought to rectify the situation by clearly defining the term “trained nurse.” The Chicago World's Fair of 1893 offered nursing the perfect stage on which to address such issues.

  The superintendents’ society credited Ethel Bedford Fenwick of England with suggesting the inclusion of a nursing section at the World's Fair.⁸ Fenwick led an English group that was seeking to organize and register nurses—against the wishes of Nightingale, who fought professionalizing strategies her entire life, believing them to be contrary to the concept of nursing as a calling. Fenwick knew the American nurse leaders shared her views and, in promoting their inclusion in the World's Fair, she sought a wider audience for those views. When the idea for developing a nursing subsection of the International Congress of Charities, Corrections, and Philanthropy was introduced, John Shaw Billings of Johns Hopkins, who chaired the hospital and medical section of the congress, appointed his Hopkins colleague, Isabel Hampton, as chair.

  Many of the Nightingale convictions—such as the idea that nursing was a calling that could not be credentialed, registered, or licensed—and traditions—such as the practice of having hospital nursing matrons identify alumnae who demonstrated the calling to nursing—faded as American and Canadian nurses at the World's Fair presented newer, more independent professional ideas, rooted in a respect for science and a belief in education (see Presentations by Nurses at the Chicago World's Fair of 18933).³ In these presentations and the discussions that followed them, the framework for a new view of nursing was articulated by the superintendents of the larger schools, whose opinions and programs dominated the events.^{3, 14} In presenting their concerns to a wide audience on a world stage, the leaders hoped to demonstrate the importance of nursing work and the difficulties nurses confront in performing their work. Nursing work still centered on patient safety, but now nurses sought the legitimation of their work through licensure, accreditation, and other forms of societal approbation.

  

  PEDAGOGY

  The 1893 World's Fair would influence teaching methods in the training schools for generations to come. The superintendents’ society called its first meeting in 1894 and began the work of evaluating nursing education, which remains a focus of today's NLN. At its second meeting, Hampton presented a paper entitled “The Three Years’ Course of Training in Connection with the Eight Hour System,” linking nursing to labor reform movements that were spreading throughout other industries.¹⁵ This was not new ground for Hampton—her speech at the World's Fair had called for a uniform curriculum for all nursing schools and her first book documented the plan,⁴ advocating for a three-year nursing curriculum in its 1899 edition and for a probationary period for new pupil nurses in its 1911 edition.

  Alumnae associations of the various schools grew in number and, in 1896, joined to become the Nurses’ Associated Alumnae of the United States and Canada, which was renamed the American Nurses Association in 1911. Hampton's hope was that alumnae associations would offer nurses a means of banding together to seek better wages, hours, and working conditions after they had graduated and no longer had instructors to represent them.⁴

  Eventually, Hampton and Adelaide Nutting, who was then assistant superintendent at Hopkins, worked together to create graduate education courses for the teachers and administrators. As Hampton (who married Hunter Robb, an obstetrician and gynecologist at Johns Hopkins, and changed her name to Isabel Hampton Robb in 1894) argued:

  “It is generally conceded by instructors in other kinds of schools that in addition to the diploma secured, it is necessary for those who intend to teach to have a further course in a school of pedagogy or in a Normal school where they may supplement the knowledge they have acquired by learning the principles and the best methods of teaching and how to apply them. Why should not this hold equally well with a woman who elects to become a teacher in a school for nurses?¹⁶”

  Within two years of publication, the course described by Hampton Robb for nursing teachers was introduced at Teachers College of Columbia University in New York City. Called a course in “Hospital Economics,” the program began with seven students taught by Anna Alline. In 1907, Nutting left her position at Hopkins to take over the graduate course, which was endowed by Helen Hartley Jenkins in 1909 and renamed the Department of Nursing and Health.^{13, 17}

  These events supported the idea of standardization—for curricula, teacher training, and nurse training, all of which were necessary “to assure the public that nurses [would] conduct themselves in such a way that the public [could] have confidence in their work.”⁹ Hampton Robb was a primary force behind these movements. A Canadian teacher prior to becoming a nurse, Hampton Robb had what Nutting described as a “love of uniformity.”¹⁸ Unlike Nightingale, who sought women with a calling, who would know innately what was right to do and do it, Hampton Robb attempted to impose that character through rules and standards, rote learning, and what she later called “ethics,”¹⁹ a term she used to describe such qualities as respect, discipline, and what we might today call “manners.”

  At the time formal nurse training began in America, most professions and many skills were taught through a system of apprenticeship. Doctors, lawyers, farmers, bankers, teachers, and even mothers learned their skills alongside an expert. Novices apprenticed themselves to willing sponsors, who directed their reading and shared their expertise as the pupil participated in actual cases. Nursing's adoption of this technique made sense in its infancy and early years but not necessarily in the early 1900s, as other disciplines moved toward university study. Some nursing programs opened in universities, but as nurse leaders clung to the old model of training, the vast majority of schools remained embedded in the hospitals, in systems associated with vocational training rather than higher education.¹²

  NURTURANCE AND COMPASSION

  Although nurturance has always been understood as a part of nursing care, such qualitative attributes were not specifically taught in training courses until after World War II, when Hildegard Peplau introduced interpersonal process to nursing education. Nightingale had believed that the right kind of women, through their calling, brought such characteristics with them into formal nursing roles. But she also described some behaviors, desirable in nurses, that compose what we now call caring: ridding patients of “apprehension, uncertainty, waiting, expectation, fear of surprise”; assuring them of an “organized system of attendance”; preventing “unnecessary noise” and “thoughtlessness”; “always sit[ting] within the patient's view”; “let[ting] your thought expressed to them be concisely and decidedly expressed,” since they will find doubt and hesitation upsetting.⁷

  At Hopkins, Dr. Henry Hurd wanted to create “the development of kindly instincts and humane methods of thought among all employés [sic]” and believed that nursing should impart “sympathy, kindly feeling, enthusiasm and personal interest,” with the nurse “happy and contented in her chosen calling.”¹³

  Coinciding with the World's Fair events of 1893, Lillian Wald opened her Henry Street Settlement House on New York City's Lower East Side. According to the research of nurse historian Diane Hamilton, “Settlement houses, as outposts of education and culture within depraved cities, were intended to bridge the gulf between the classes, to lessen suspicion and hostility between diverse cultural groups, and to do more than just ‘hand out’ charity.”²⁰ When Lavinia Dock and Annie Goodrich joined forces with Wald at Henry Street, they merged “ideas of reform, progress, womanhood, justice and the public's health” into their construct of what nursing could and should be and wove it into a larger view of health, one that encompassed social progress and responsibility for the entire public.²⁰ Later, “their memoirs [would] reveal that nursing provided them with an opportunity for a personal relationship with others, a way of encountering humanity in a face-to-face relationship, and a way of doing good works through the care of needy persons…. Compassion … became an expected attitude … within the context of Henry Street Settlement House.”²⁰ In their view, at the turn of the century, compassion was the fundamental idea behind nursing.

  “Compassion was not sentiment, but making justice and doing works of mercy. Compassion was not a favor to the poor, but something to which patients had a right, and for the nurse, an opportunity. Compassion was not pity, but celebration of the kinship of the human spirit. Compassion was not private, but public service. Compassion was not simply knowing about the suffering of others, but entering into it, sharing it, and understanding it. Compassion was not anti-intellectual, but sought to know and understand the interconnections of all things. Compassion was not a commandment, but a spirituality that treated all creation with respect. Compassion was not an organized religion, but it was, for the nurse inventors, a way of life.²⁰”

  RESEARCH

  In 1926, 25 U.S. colleges and universities granted bachelor of arts or bachelor of science degrees in nursing, but their combined enrollment was only 368, compared with the 10,000 U.S. nurses who graduated from hospital diploma schools each year.¹² Because university faculty required advanced degrees, nursing instructors often sought training at Teachers College of Columbia University, where they were exposed to research, read scientific studies, and learned research methods. Some of the studies they read were directly related to nursing.

  Following the model created by Abraham Flexner when he studied the structure of medical education in 1910, nursing (with some funding support) commissioned its own studies during the first half of the 20th century. During this period, nursing was also shaped by such world events as the Spanish-American War, World War I, women's suffrage, the Great Depression, and World War II.

  The wars greatly expanded opportunities for nurses through military service. Then, with the Great Depression, graduate nurses, who had been working privately in home care, were unemployed en masse. Mounting social pressure prompted hospitals to hire graduate nurses to provide patient care instead of relying exclusively on pupil nurses. In the midst of this upheaval, the 1934 Grading Committee Report forever altered the perception of nursing preparedness by identifying “collegiate education … as the preferred professional base” for nurses.²¹ Finally, the Servicemen's Readjustment Act of 1944, commonly called the G.I. Bill, pertained to nurses. At the end of World War II, 70,000 nurses became eligible for the G.I. Bill and could finally afford to go to college.²¹

  “Once there, nurses scurried to belong, to gain the credentials that legitimate an academic presence, to do research. For some nurses, research represented a means to the political end of respect and position in academe that would, it was hoped, carry over to other settings. To others, research yielded answers to questions that directed knowledge-based nursing practice in clinical, educational or administrative roles.²¹”

  Learning to do research became a major preoccupation among nurses seeking higher education. In addition to college courses making information available, professional associations and nursing journals gave workshops, sponsored conferences, and provided lists of research activities. In June 1952, the first issue of Nursing Research was published. But defining what constituted nursing research confounded everyone. Articles such as “Attitudes of Student Nurses at the University of California,”²² and “The Behavioral Sciences and Research in Nursing,”²³ articles considering educational issues, and those describing nursing function all appeared under the broad category of “research.” The broad acceptance of almost any sort of problem solving as research exasperated nurses such as Virginia Henderson, who expressed her annoyance in a 1956 article entitled “Research in Nursing Practice—When?”²⁴

  By the early 1960s, nursing began to find the answers to Henderson's query. With exceptional nursing leadership from Lucile Petry Leone, Margaret G. Arnstein, and Jessie M. Scott, the U.S. Public Health Service initiated the Faculty Research Development Grants (1959), the Nurse Scientist Graduate Research Training Grants (1962), and the Nurse Training Grants (1964). Because there were no nurse researchers with whom to study, under these grants nurse faculty members and doctoral students received research training from experts in biology, sociology, anthropology, microbiology, physiology, and psychology. Once exposed to expert research in other fields, nurses began to identify the critical elements of nursing that needed study. In other words, nursing theory was born.

  NURSING THEORY

  In retrospect, it's obvious that theory was always inherent in nursing—in Nightingale's treatises on managing the environment in a caring and sanitary manner; Hobson's visits to ensure patient safety and her efforts to assemble a nursing corps to act on patients’ behalf; Hampton's endeavor to outline nursing actions in a uniform manner, incorporate science into those actions, and impose standards of care and reliability in all nursing programs; the zeal of Wald, Dock, and Goodrich for nursing reform, their inclusion of the broader community environment and the general public health in nursing actions, and their commitment to compassion as essential to nursing action. All these make up what we have come to know as the “metaparadigm of nursing,” which describes the interaction of person, environment, health, and nursing.²⁵

  But nurses needed time and study to understand these new ways of expressing old ideas. A survey of nursing research literature from 1950 through 1974 found 111 theory articles, exceeded only by education (166 articles) and the research process (121 articles).²⁶ As nurses grew more comfortable with the language of research and research methods, the number of “how to” articles in nursing literature declined, and actual research reports with outcomes began to be published. By the 1980s, more than half of the articles published in Nursing Research contained “fully developed, frequently funded, theory-grounded research articles.”²¹

  Hamilton has argued that the “nurse inventors needed an intellectual framework to guide their process of legitimizing nursing. To solidify the concept ‘nurse,’ to construct the phenomenon called ‘professional nursing,’ to fashion the boundaries of rightness and wrongness of nurse behavior, and to effectively negotiate acceptance of the validity of the trained nurse …”²⁰ I would argue that the development of nursing theory in the late 20th century is equivalent to the 19th-century effort to professionalize nursing. The changing language, format, and customs of the times have shaped nursing in various ways, but the goals of nursing have remained the same: to ensure patient safety through the knowledge of caregivers and to reform sick care and nursing education, which are integral parts of the process.

  In any profession, expertise requires practitioners to rely on an amalgam of knowledge that is sufficiently dynamic to withstand changing times. As practice evolves, lawyers borrow from philosophers and ethicists, while physicians build medical practice on the expertise of physical and laboratory scientists. Similarly, nursing incorporates the physical, behavioral, and social sciences into its efforts to assist people dealing with actual and potential health problems in an ever-changing world.

  FINDINGS AND CONCLUSIONS

  The professional status of nursing has been questioned over the years by people who see nurses as “nice people, mopping fevered brows.” My research into the first 100 years of American nursing provides a partial explanation for this misconception. Nursing was a 19th-century phenomenon, practiced primarily by women and affected by the restrictions and conditions that applied to women's activities until halfway through the 20th century.

  The G.I. Bill opened many educational doors for nurses, enabling them to expand their expertise and embrace behavioral, social, and biological sciences. Armed with the language and constructs of science, nurses began to ask questions, perform research, develop nursing theory, and apply research outcomes to nursing practice. Research has provided nurses with an intellectual framework to guide and explain their work, to answer questions about nursing's intellectual legitimacy, and, in the 21st century, to be recognized as the highly skilled experts they are.

  REFERENCES

  1. Woolsey AHWoolsey AH. Hospitals and training schools A century of nursing; with hints toward the organization of a training school; and Florence Nightingale's historic letter on the Bellevue School, September 18, 1872. 1876/1950 New York G.P. Putnam's Sons

  Cited Here...

  
  

  2. O'Brien P. ‘All a woman's life can bring’: the domestic roots of nursing in Philadelphia, 1830-1885 Nurs Res. 1987;36(1):12–7

  Cited Here...

  
  

  3. Hampton IA Nursing of the sick, 1893, by Isabel A. Hampton and others. Papers and discussions from the International Congress of Charities, Correction and Philanthropy, Chicago, 1893, published in 1949 under the sponsorship of the National League of Nursing Education. 1949 New York McGraw-Hill

  Cited Here...

  
  

  4. Hampton IA Nursing: its principles and practice. For hospital and private use. 1893 Philadelphia W.B. Saunders

  Cited Here...

  
  

  5. Hobson EC Report of chairman of surgical wards for women, November 22, 1872. 1872 New York Frederick L. Ehrman Medical Library, NYU School of Medicine

  Cited Here...

  
  

  6. Hofstadter R The age of reform: from Bryan to F.D.R. 1955 New York Alfred A. Knopf

  Cited Here...

  
  

  7. Nightingale F Notes on nursing; what it is, and what it is not. 1859/1946 New York Appleton-Century

  Cited Here...

  
  

  8. Nutting MA, Dock LL A history of nursing: the evolution of nursing systems from the earliest times to the foundation of the first English and American training schools for nurses. 1912;3 vols. New York G.P. Putnam's Sons

  Cited Here...

  
  

  9. Lynaugh JED'Antonio P, et al. Work and knowledge: introduction Nurses’ work: issues across time and place. 2007 New York Springer Publishing Company:285–92

  Cited Here...

  
  

  10. Reverby S Ordered to care: the dilemma of American nursing, 1850-1945. 1987 Cambridge, UK Cambridge University Press Cambridge history of medicine.

  Cited Here...

  
  

  11. Richards L Reminiscences of Linda Richards, America's first trained nurse. 1911 Boston Whitcomb and Barrows

  Cited Here...

  
  

  12. Kalisch PA, Kalisch BJ The advance of American nursing. 1978 Boston Little Brown and Company

  Cited Here...

  
  

  13. James JWVogel MJ, Rosenberg CE. Isabel Hampton and the professionalization of nursing in the 1890s The therapeutic revolution: essays in the social history of American medicine. 1979 Philadelphia University of Pennsylvania Press:201–44

  Cited Here...

  
  

  14. Billings JS, Hurd HM Hospitals, dispensaries and nursing. 1894 Baltimore, MD Hopkins Press

  Cited Here...

  
  

  15. American Society of Superintendents of Training Schools for Nurses. First and second annual reports. 1897 Harrisburg, PA

  Cited Here...

  
  

  16. Robb IH Suggestions on qualifications for future membership in the Society of American Superintendents. American Society of Superintendents of Training Schools for Nurses; 1898.

  Cited Here...

  
  

  17. American Society of Superintendents of Training Schools for Nurses. Eighth annual convention. Harrisburg, PA; 1901.

  Cited Here...

  
  

  18. Nutting MA. Memorial services for Isabel Hampton Robb, who died April 15, 1910 at Cleveland, Ohio Johns Hopkins hospital bulletin. 1910;21(Aug):6

  Cited Here...

  
  

  19. Robb IH Nursing ethics: for hospital and private use. 1916 Cleveland, OH E.C. Koeckert

  Cited Here...

  
  

  20. Hamilton D. Constructing the mind of nursing Nurs Hist Rev. 1994;2:3–28

  Cited Here...

  
  

  21. Baer ED. ‘A cooperative venture’ in pursuit of professional status: a research journal for nursing Nurs Res. 1987;36(1):18–25

  Cited Here...

  
  

  22. Ingmire AE. Attitudes of student nurses at the University of California Nurs Res. 1952;1(2):36–9

  Cited Here...

  
  

  23. Sanford FH. The behavioral sciences and research in nursing Nurs Res. 1957;6(2):52–6

  Cited Here...

  
  

  24. Henderson V. Research in nursing practice—when? Nurs Res. 1956;4(3):99

  Cited Here...

  
  

  25. Fawcett J Contemporary nursing knowledge: analysis and evaluation of nursing models and theories. 20052nd ed. Philadelphia F.A. Davis Co.

  Cited Here...

  
  

  26. Taylor SD. Bibliography on nursing research, 1950-1974 Nurs Res. 1975;24(3):207–25