Document wKDgqRoBkJd1GgmyMNvEpprv6

WEDNESDAY AFTERNOON SESSION ; ; October 12,;!1938f The sessioiis on lndustrial Nursing prob-. ecfitive Committee, . Industrial Section, lems wereTield in- cooperation with the Na- N.O.P.H.N., called' the opening meeting to tional Organization foe Public Health Nurs-. order and outlined in. brief "the two-day' ing,"Incorporated. Chairman LaVbria "Babb, ' interesting, program -of sessions.. She -then. R. N.* of-the Quaker Oats Company,. St.', introduced the speakers scheduled for the Joseph, Missouri, and. Member of the Ex-, first session.. Problems in the First Aid Treatmentof Fractures. \ j ;< By EDWAEP.Cj HOLMBLAD, M.D. l . Consultant in Iudustrial Medicine and Surge.ry, Chicago, 111. . While, some .organizations may criticize. tion splints to legs and "arms: Some of these* the industrial nurse for doing. too much atje: treatment, every'physician and surgeon with' "Emergency Care for Safe Transporta practical industrial experience knows. how tion in Fractures of the- Long Bones." important, a part she'plays'in the efficiency- Fracture Clinic; Massachusetts' General *o a; competent medical. department.. Al- Hospital, Boston, Mass: - though this material- may be thought ele mentary and a repetition of .information . "Transportation of Fractures b the Ex tremities." . Dr. Hiibley .R. Owen, Chief taught-before, I am sure you will pardon , .'Surgeon, . Department . of . Public . Safety, this.repetition for the-henefit of those who haVe not had the opportunity to learn some Broad -and Spruce Streets,. - Philadelphia, Pa. of these'fundamentals; / In your safety meetings and programs as well as in teaching first aid classes you will want'to know about material for the teach "First Aid Treatment in Fractures of the Lower Extremity." Dr. Kellogg -Speed, 122 South Michigan Avenue, Chirago, Illinois. ing of first aid treatment of fractures. :Do not overlook' the opportunity of hav .Some of the'available text books worth ing some physician from your medical de while. are :' ' partment or consulting staff give you a . American Red Cross, First Aid Text half-hour or hour discussion-of .this sub Book, Chapter VIII, pages 131-175. ject before your first aid-classes^ 7 Dr. Eljason's Book,-Firs? Aid in Emer .There are a few very fundamental prin gencies, Ninth Edition,- Chapter Vl> .pages ciples in-First Aid fracture treatment that 105-137. . - . will apply to practically'all cases: Pamphlet on. First Aid Instructions for Railrbad' Employees. '* . Another gredf. help, in' teaching this sub ject .are- the splendid .moving pictures that can be obtained in 16 mm. sizes..and are . excellent demonstrations of the first aid' treatment such' as the application of trac- Support the'injured parts and-make no effort to use them until assured that-there is no dangerous nor serious fracture: pres ent. , ., Rest avoid hasty pulling or jerking of injured extremity as frequently. requested by. the injured person. ' 139! : 140 Silver Jubilee Safety Congress Medical care should, be called for sterile dry dressing or such a sterile dress-' . promptly. Have the'.jloctof-responsible^for. mg-moistened.with some antiseptic solution. the case know about`it right away;' if not ,;jas'.m^curoc|irome, metaphen, mercresin, practical for him to come to. the site' of `Cmerttiiplate,^ etc. may be .used. Adequate" accident-'immediately, promptly get his in ,, sterile padding to absorb the bleeding from structions over .the. telephone, about the ooring should be applied over the dressing.! first aid care "of the patient. If the case .is. Control bleeding by tourniquet only in se-. ambulatory', telephone the doctor so that he vere bleeding cases: Remember adequate will be available as soon as your patient tourniquet pressure to control all arterial > arrives sit his office or. at the hospital. bleeding is very painful. Shock should be treated by keeping the , Jn fractures Of. the skull where-uncon patient warm. Avoid chilling and unneces sciousness is present, see that .the air pas sary exposure! -Many patients when in sages are not obstructed by the tongue fall- jured break out in a .cold sweat vi'hich is . ing back . into' the mouth; - remove false really part of the.condition of shock. Their teeth; avoid aspiration of blood running- underclothing and even shirts and trousers . hack into the phaiiynx from laceration in may be.wringing wet with this perspira- the mouth or from nose .bleeds which so' ' tion. Application of . warm blankets and ' frequently accompany.:, serious' skull frac- , `overcoats and the avoidance of direct,' tores. In , those skull . fractures not uncon draftXfrom wind,- ventilat&g currents or. scious, remember thafthqy. may.-: become electric fans are indicated. unconscious .at any-moment; and,, therefore,. Pain^and restlessness justify'the admin-, should not be allowed to walk about or onT istration of hypodermics stich as morphine stairs without adequate, support or assist or codeine in all severe cases, Get instruc ance. Be prepared for vomiting which fre- tions from your attending physician and do quently occurs in skull fractures, and avoid -. not hesitate to seek his consent to give having the patient aspirate any of this ma-. .. such , a hypodermic sedative if you have terial during such Vomiting. ^' . not-already been given such.instructions in Fractures of. the cervical spine- of the . cases of emergencies.. The administration dorsal and lumbar.-spine as well, as fracr . of medicine' by mouth to relieve pain in tures^of the pelvis and extensive rib .frac-. these cases is not advisable because, first, - tures must be moved cautiously. Do not it takes too long to.act; second, the process. "try. to raise, such patients into sitting, posi of assimilation of the medidhe from the tions, they' should not be lifted by the arms stomach is slowed up and about stopped : 'nor.legs. A stretcher may be placed/tihder& while patient is in.shock; third, it may in-, the', patient by; gently, rolling him oq one . terfere with subsequent <treatment of the side' and then gently Allowing him to roll patient's fracture by. a general anaesthetic back onto the- stretcher.; Another satisfac or interfere with shock treatment. tory method .of moving such^eases is by. Transportation of fractures in the most comfdrtable method possible should always . be arranged! It is much more, vital to the . patient's welfare that he be transported comfortably than hastily. the muitipkucarry method, thus avoiding .< bending of the patient In cases of frac- tued or dislocated cervical spine the head should be adequately and gently supported during all movements .of the-patient There is a short .stretcher manufactured-,on which Many years ago I experienced the truth such cases -can be -moved into trains, down of this statement A fractured collarbone narrow^qr tortuous stairways, or up nar-'- on the football field resulted ifipray ..being fow. shafts from' tunnels, or mines. , hurried off and into a waiting automobile. I shall- never fbrget the pain I experienced as. the ends of the fractured bone grated past one-another almost continuously as my frantic yet sincere driver speeded the three miles .to the doctor's office.. \ Fractures. of --the collar bone* shoulder blade and fractures of the humerus: at.or .. near `the'shoulder joint are heft supported by placing -the hand tif;the uninjured or. good- arm under- the elbow of, the injured arm, allowing, the forea'rm to rest on the ' 'Compound fractures, those in which the good arm. | Slings inay be used for support skin' has-, been perforated by the bone or and should always make the patient more lacerated or crushed in the accident, should . comfortable. than without it. I notice .that not be manipulated. The application of a some of the first aid .books on fractures Industrial Nursing 141 and. dislocations show the methods of re-:.. may . be added, where necessary, to give ri duction .of.dislocated. shoulder; and- elbows.' gidity.: and adequate stiffness - to' the- splint. I would ativise against these'efforts to-reduce dislocations Units', absolutely neces-' sary by/ distance -or isolation. .Many dis- located shoulders and'-elbows' are compli- ' ;:In the blanket, splint a- blanket is folded so. as to be about three feetwide by. five or six- feet long.. A'broomstick,, cane, rod or other stick is placed at each end and. these cated by fractures and tee danger of dam--., are rolled towards the center from each aging nerves . arid-; bipod vessels, in these . end leaving a trough, in which the extrem cases'is very great and-x-rays should be ity is placed and then held together by in made whenever/ reasonably possible before - dividual circular .hands of muslin , or gauze ' reduction is attempted and then by the re-. bandage, about two inches wide placed at sponsible siirgeoa \ ; intervals of four to six inches. These are 1. *> # `, The next group of fractures are -those of / then -pulled-as tight as is comfortable to ' the long bones of.'the extremities. These the patient / - include -fractures ,of "the .femur; the tibia In the use of the pillow splint we take a and fibula-and fractures of the humerus-in. .pillow that; is quite soft, and pliable and 'the-aim I.purposely do not include frac-. : not too thick. It . is placed; under the af . tures of-the radius'-and ulna as . I believe fected leg,' ankle,. elbow or .-forearm and they are given better-first, aid .teeatinent circular bands Of! muslin or gauze are 1 without' traction.. In Cases of .fractures , of placed at intervals' of four to'six inches the humerus, femurf-tibia and fibula we and pulled up as' taut as 'the patient's com- - have an excellent first aid rule "Splint, them - fort permits. A double' or triple surgeon's - .where-they lie" -This'means that.traction . knot, gives, the advantage of a gradual should be applied'by means of the Thomas tightening, or they din be loosened gradu full, ring or the Kelfer-Blafce hinged half ally and easily. -We have found, it adVan-. riiig ' te the leg and the .:Th6mas-J0nes_ . tageoiis. to pin" the corners -of the pillow - splint'to the arm fractures. The details. of\ around the ankle, thus immobilizing the application of. this traction halter and splinf fbot and ankle. ; -ctciattdprissnhhimeooopnieteesammnl!iartiotynhm,ea.pfnftpemdomrsiltvaatiohrseabcltcioahmaenautdrthnatybutlraaa.o'tslrysmihenyeosd.socead,fopmbetl.gh.imp,oefseeefats'auresixctanimtwutlotascilrgrop;ehetroteanuapadnmtorrootuim/eeof.cfrit!rot>s.tbnhe-iyenruttaueshdrilrtTmtatueyt,r.eh-thafcauxretpinokomlrshtleasr;rmdaes!ptoami.timfeto,Ss.nirxentriuwighsttetttacy,heteh,dihhttaoriehepobndfsoo'oenudsmpfbtpy-etrlaijtoaonatneainhcdnondstccs-ds?deftgt,!.':,,-.c'captpaoaifaenioonuenniofsd,mIrdrddnssrn.pmtuetissowvstwochepuseftrhfreretlppoiaiaisnwstapolchu,otattioohtesufuhoreofetrrfesatrtdaaeah-c'auro's.scelImsavalfhtnppyluat-lfitapyohloirrwhiroeenlbninisenaaesrottsn`kl.auualght-csshtaosptateWe.hhiueodvidttlaachdewlhoohbtteteoriwoadtiaeninash.aernealsmrfolcletdnttbwhrmrhtbeaseooeaehoepteawoesnaaidicnsesdl,rdrelheodtpeod'."tf.sflfwfhotitootn,ahAiehesrrrtpenesseesepvtspaafarleieppubliirrrrepixmmarnasempdsy-tt-*. The traction' method of splinting these ,/.tient is more uncomfortable than rhe. was fractures where they lie was found most before it was put. on is worse than up splint effective during , the - World War and has. at all. Remember, that in many fractures . become! a recognized.: .procedure. ' These , the bones are not out .of place and subse splints-are standard equipment in the.ambu- . quent ordinary movements are not going to lances of nearly' all large cities and rail- . displace, those fragments,if-the.violence of. roads carry, tfi&e splints bn hand'and avail the original injury did' not displace them. able at frequent ihtervaf stops. All one needs in these cases is support.to i Now1 there are some other types of splints'and other fractures where they may /.relieve the bone of its weight bearing'or ' supportive function. ' ^ be applied to great-advantage.,. Take for Fractures of the ribs are readily. sup- instance, fractures about-the ankle and frac-. . ported by placing the -flexed arm 'and elbow tures -about the elbow. In these? we have against the affected side "and using the op found the. pillow `splint and the blanket posite arm to lend.., support, rigidity' and splint of -great advantage. Board splints fixation. - This procedure aids greatly when cs - 142 Silver Jubilee Safety Congress . the patient coughs or sneezes and also in riding in automobiles, trucks, etc. to the doctor's office. definitely that the. resulting enlargement of the finger might have bisen smaller had he : been immobilized from the start. - Fractures of the bones of the hands or Now, this happened to a `first, aid man . feet rarely need first' aid splinting. In niost and not to an industrial nurse, but it might of these cases adeqiiatelfcheet wadding' or . have been an industrial, nurse just, as .easy.-. combination pad with. bandages gives all as not; in fact, it might have-been some . the splintage necessary , until tpe physician physician. lias-had an opportunity' to outlin$?thq trfeat- Laymen have a -peculiar attitude . or- a hient of choice. Sonie'finger and hand frac perpetuated 'misunderstanding about frac tures'are best treated by fraction, others tures. Most' every week w"e; see someone by being fiexed over circular'- drums or coming into -the office with an' injured bandages. . finger,- wrist or foot and one of the -first Quite frequently -in -industrial practice . things they say- is, ''See,-1.'can move it, and even more often in private-practice we it isn't-broken."'. Th|s>is a-: very erroneous .see fractures that have .been- completely statement because many fractures of bones- overlooked. There are-several-reasons'-for about the hafids, wrists, feet, ankles- and-' this. ,. even' -elbows and knees do not prevent movements of .the extremity or injured part.' Just about two months ago I saw a?pa- Fracttfrfcs of the scaphoid bone in1 the wrfo tient who operated a seating machine used are very frequently, overlooked, and-called'- in sealing packages. In', the course of his -sprains- of -the wrist.,until 'their failure to w}>rk his middle: finger.w.as caught in .the. heal prompts adequate x-ray study; We ^.. - machine.' Thire was no bleeding although' hear every now and then of someone who' ' it was - quite. painfpi. .and- the patient ad has been 'thrown-: from'a horse or fallen mitted that he sat down for a while, held from a step ladder who. comes walking. his finger and /became' a little weak. JEIe . into a 'physician's office' a few days or a . was-comparatively new .on this 'job and his : Week later with, a compression-fracture of - desire to make good arid keep' his employ? one of the vertebrae in. his spine. Some-' ment urged him tbkeep on.-working which times the embarrassment caused by the.. he did to, the regular, quitting' time that . injury such` as falling ..down on a~.dahce night He failed to make out' a report of floor or falling while skating on ice result's the injury that' night as he believed it ,in a temporary heroic attitude ofthe'ih- would .be held against.him and even might jured person: . -. - jeopardize his job. The following morning,' because .of the pain and swelling, he did Also there are the' cases -of- head injur- - report- his_injury to his., foreman who. re . ies, such as* fails, striking the head on snap^ - ferred him to the First Aid Department of ...back type of {njury to-the head, or direct the plant. As this was -a small plant the blows , from falling objects, persons struck first aiid man was. one-of the office -em by. baseball or driven golf balls; These pa-' ployees.-He made out the report, applied tients quite' frequently may be fully con . some ibdine and' bandages and told' .the scious and manifest- none o'fa the usual ' . young man to resume work which , he did. symptoms of. skull fracture.. These, patients This finger-was redressed arid new .band- - -should be given, an adequate period of ob- ages' applied each morning for- two suc- servatidh- and a careful-history' of the exact ceeding weeks; -The boy. was .anxious, to . mechanics of the".injury should be recorded keep at work, the first aid man Was anxious . so -that the attending surgeon can deride ' to show a good'record and wanted tb keep . whether x-rays are necessary or not. . down hi$ reportable injuries to. a minimum. Sprained'ankles' are another type of in - It was two weeks' and. tyro Hays before* it jury that needs careful observation; we 'was deemed'advisable to. send this'boy: to should always be on our toes so as not to a-physiaan because of_ enlargement of his overlook a.possible fracture. . Many frac- ..finger, and persistent pain. The x-ray re^ tures of. the internal or external-'malleoli .yealed a fracture of . the middle phalanx, about the ankle walk without .much diffi- extending into the joint between the middle cuity and it . is always wise .to. rule out :i said proximal phalanges. .Immobilization ..fractures by x-rays of these, injuries early." . gave the. desired relief from pain but ! -feel It Is /-false economy to try to save x-ray" i industrial Nursing 143 expenie in'these cases of potential frac-. ways.than-:the-patient would have you -be tures. ' -, lieve. Injured wrists and. ankles in the Injured swollen fingers or wrists, may; summer time may be due to .non-compen-. have fractures that .delay,the recovery. An- sable injuries such as baseball, football,, etc.' other problem thajt the industrial nurse will ' In winter such , injuries may occur from have to contend with js the. problem of falls on t icy sidewalks- or Across walks. verifying some of the injuries; A patient Wherever you observe .that the findings are may come in;giving a'history/pf a.trivial in- excess of the injury expected from the ! wrist injury and-the physical findings such history^be on the alert to-the possibility of as pain, swelling" and. tenderness may not-, -:a fracture -the result: of some , hidden or be consistent .with' the .history. ^Some of suppressed accident. ' - these, cases, may have Occurred in Other * . The Nurse'aPart in the Industrial Relations Program / IBy BLANCHE tLOYD FRANCIS, R. $. . . Industrial Nurse, Carpenter Steel Co./Reading,Pa. '. industrial relations; work hasp outgrown with the medical department at this time, ^original limited scope as a metiihs'of deal and-it is a very important one.- ing'with unusual difficulties1 in Employment '. The nurse cah either'galn his .confidence relatjotrsi and js-'now a definite-part of ad- ,, or- lose it by the manner-..in which she: ap nimistrative practice. Its purpose is to ere- proaches him. It is.part of :her; job.to put. ate and maintain, a' friendly and understand-. . .the'man at ease, . to '. allay, his perfectly ing relationship between employer and. natural fears, and make him understand the employee that will promote the. best inter purpose of the examination. .The appli ests of both. .... . cant's first impression-is likely1 to linger with The usual industrial relations program ' him ` and color his future attitude toward might b outlined as follows . the.company.- 1. Employment,.which will include selec- The mirse, probably will- be. the one.to . -tion and job placement! . . -take his medical history, and .while doing ' 2. Education, which includes! lectures, vo'-' cational training, thrift, instruction.in. . .company policies, etc: . ' ' ' 3. Health. ' ; 4: Safety. . 5. Welfare. ' 6. Sanitation. this, she may also use her powers of -ob- . servation to get a line on the man's morale.. Frequently she makes notes, which when' passed on to -the. physician or personnel' manager," will aid in the proper placement of the .man.* r . . ... - 'Of'course, the nurse assists the doctor in eveiy. way possible. She keeps detailed rec ' . -7. Recreation.. ords of his findings. Frequently! he advises 8. Rehabilitation: ` ; correction of certain-conditions which may . Let's s$e what the nurse- can.do to assist' - the ..supervisor hi forwarding his program. . along each of.these lines!.. -. undermine the: workers health and interfere with.his work. The man may be in straitened circumstances and be totally unable to pay. fpr. suggested corrections. The hurse must Employment' 'be familiar with: local' welfare- and- clinic . .-Practically..all.-industries now;require -a - .facilities so she can directhim to the proper, rather complete pre-employment' physical agencies in order that he can follow the. ' examination of, applicants' for' work.' Qf . doctor's advice. .' course, most of the actual examination-will' be done by the physiclhn ; however, there is. some'; very important preliminary , wprk which may be done by'the nurse;: The pros pective employee ;makes :his .first- .contact Education ... The. usual purpose of employee training is to mal|e a better workman' and citizen of him. It will probably include: f ) v* -..h \Ml 144 Silver Jubilee Safety, Congress Apprenticeship training.' . light poor ^ventilation, etc The men'may: * Training unskilled employees. . . attribute^ headaches1 to fumes, or dermatitis'. Special training for handicapped or.dis-- to cutting oils or abrasive substances.-. > , aibled employees. ..... Training in .foremanship. Americanization,. etc.; " Bring-these comments to.the doctor-andv '. ' he will, decide. whether or not to. pass them on to :flie supervisor. Most health hazards rare correctable, and if the .nurse, is alert Generally speaking, the personnel direc she can help locate thCpi. Their correction --ii tor andthe general- manager are entirely .not only'saves the company money but also' . responsible for these activities. ' The nurse, .aids ini the. establishment.and-maintenance because-she understands the. purpose back . of better personal 'relationships. .-: ^ , of each training class, can encourage, the i. The medical department in industry has men to make the most of their opportunities. . no desire to usurp the place of the'family" . By her interest, she may stimulate. their . ' physician. If'can aid him, however, and at ambition and their appreciation of the value . the' same .time be: of' real service1 to the of the special training offered. . .. > workman. . As a. rule people put off seeing a' When a nurse thinks of - an educational doctor until stricken by serious .illness. *. program- in industry, 'she immediately ties it up with the -health- and; safety program.. - From her viewpoint.'these seem ofpara.-. mount importance; -Howeyer, we have -need for another kind- of education, for workers-, also. The personnel department tries* to', stimulate a- healthy mental. attitude' in -all employees, and the nurse can. help -in this endeavor if she has retained a serene,- con fident and.cheerful outlook herself. She,-if anyone, knows how dosely allied ,are the interests of employer and employee. No one. in the plant is more capable of^acting as-the - plant barometer.. If a workman imagined he. has a small grievance, he often, feels, im-, pelled to confide in the nurse while she is. doing a redressing or taking the history of The plant doctor and. nurSeare in.aforto-.' - nate. position/because they are right-in the .'. plant, and because there is-rip, charge.for' consultation'-a worker - wijl cometoTthem: -. with, minor symptoms and illnesses. .They ..have an opportunity to advise him concern-^ ing his herilthaiid mode of firing, often.". while dressing a bruised .toe or a cut finger. Diseases are diagnosed bythe.doctor during.' their earlier stages:-'The nurse must be very observant; especially when a full-time physic dan is not employed. -. She must .be familiar . With symptoms of diseases,.not that she may -. attempt to diagnose, but that, .she may rec- ognize serious-symptoms and bring -them to-' the.'doctor's, attention: > . .'- an injury. . -For instance, a man came into .the dis - Sonjetimes the nurse selects, certain.ind-. dents; that, she; feds are worthy of passing on to the supervisor or to the plant physician, and- by so doing may .help to iron out some difficulty or dissatisfaction, which, if left alone, might generate more serious trouble. She also has an opportunity to interpret, the worker to management and management to the worker, thereby increasing mutual. understanding and good will.. pensary 'some time ago-with a slight injury, arid while the nurse was . dressing the .wound, he called bet; attention-to .swollen, ..' -glands in his neck. .' She had already noticed - his peculiar color, and the two symptoms to gether caused her to suspect he was . suffer ing from a serious ailment >She asked him to see the plant physician the'next day, He did so and a tentative diagnosis of. Hodg kin's disease was made,'and the man re ferred to .his family doctor. The diagnosis- Health was copfirmed-and the. man placed under a Health- and contentment march'hand in hand. An fmhealthy body., interferes'with' a -man's' mental reactionsarid nearly 'always specialist's .care. He was assured that -the , early diagnosis of, his ailment would- cer tainly be a.-factor in prolonging bis- life! - sours , his disposition.' It is the dirty .of the. Most of our .industries now extend-their medical department in industry to see that . industrial relation activities into-the homes.-.' the man's health:, is protected while he is at . of the employees,- and there certainly-the ' work. TheHnurse must know the health nurse can be helpful. Usually she knows the hazards -of her own plant Each industry . families of the employee through yarious presents its- individual problemsj. She may avenues of contact* The children-^t least hear the men complain of dampness, lade of.. those who live- near the plant--will. fre- 4 Industrial Nursing 145 .queaitly run to -her with small injurifes to be. `.Safety today, includes notionly elimination dressed. The; nearby school or playground of- accidents but. protection . from occupa^ will send the-idildren-*to"her for first aid. -tional; disease hazards also. Know, your when fhey are hurt at play.. The wife often . plant an.d',its danger spots.;' If headaches, - consults her* about the .care' of die new sore throats, bronchial coughs, , upset stom baby, or she may call on the nurse for. ad-' achs or, dermatitis are markedly prevalent yfce aboutjohnny's' tonsil operation which' . in any one department, note it and call the the school doctor has. advised. Perhaps she ` .dpctor's attention to'it sp : that , the .cause has been-in thehome -when big 'John was. jm.ay be determined and.corrected if possible. injured at the plant, or it' is possible site' has Our. Company has a group health.insur come in .contact with .-them through some ance plan and we. file a copy of each, form ^recreational activity- of - the plant. Atany "that passes through.the office. These files .rate, she is'-pretty. sure to know:.many, .of .have been a definite aid in Helping us locate . v thepi and usually .enjoys their .confidence, \ some of ;bur health hazards. . and,. therefore, 'is. the,logical one'-.to' assist the- personnel -department\witb problems - Welfare -. concerning,the family agd its welfare! (.In the smallerjrtantsf.much or !all pf the ' *> . Safety welfare worl$ mity be- thecresponsibility of ',The nurse's part in* the. safety program tjhe-'.fibrse. Ta the larger plants' the' per-., has. been frequently stressed*- sonnel manager probably -mil be the one to She reports any unsafe' practices or any.,- . hazards- brought to her attention. She.pre`pares accident, reports for the safetycora- ' mittee of; whidr-she. should be'a perinanent -.member. She aids in the selection of safety direct'it- However, I'feel sure the-nurse will be. keenly .ititegested^in this phase of`the-work and Will- do all in, her power tq . .aid in it when, she has -the opportunity whether it. is Her responsibility pr hot ' posters.-and safety literature.,It is her duty Under welfare we might-list group in-' -to;preach safety at every opportunity. In - surance,' relief..plans, pensions, loans, com - the'-waiting roomsheban arrange a display pensation .'and vagous mutual aid associa of safety equipment furnished by the! com tions. ) .. .J - . . pany .to- protect-, ihe. worker. ;Matay a ser - If there-is a cafeteria' the nurse'should mon ;dn safety; .can" be . preached silently see 'that it is kept dean and attractive. She .there... J .'\ ' should be sure-that well balanced! appetiz If there, is a -plant publication, she can ing meals'are served. Spedal care should : write articles' oh.safety, using recent.acta' .be taken.with-me.physidd-examination of dents, in the. plant asa basis for. the article. all'..who prepare or-serve-food. The nurse X-ray reproductions Or photographs may will probably be the first one to hear that be used as' illustrations. She should always this or-that person-has a-sore throat; coughtalk to the injured Workman she intends-to or' skin -rash and should not be handling use as ah example ahd'get his consent.'mid food.' . She, -of course, .will ask' the workerhearty co-operation before using his name-- to. report to the doctor at the earliest pos or photograph. If he is not perfectly will-; sible .moment- Frequent re-examinations ing, his name should not be mentioned nor will-he required of all cafeteria workers,. should he be identified, in`any way,, or more haim thangood will be done. - Sanitation. - . -' She can stimulate.interest in safety cam-' - - Where there .is a full-time physician empaigns. .Nothing breaks downthe_mprale.of. ,. ployed he'probably, will assume responsihil-'a department so.quickly.as frequent acci . ity.for plant sanitation. If his time is limited dents! ;She can. help keep up interest ip 'to one or two hours a day the nurse and . safety by enclosing "congratulatory notes to the personnel manager usually divide' the the superintendent ofa .department-with his responsibility. 'The ' nurse inspects the monthly'accident report. If His department : .women's.rest.rooms and the cafeteria, and .has an cnviable record givis him,a "pat on tiie supervisor- will'designate someone to the back!' by-letter; if his -department has ' oversee .general plant' sanitation mid the -slipped in its standing call his attention to it men's "wash rooms, A dean plant is not- diplomatically and hope for a better record;... only a positive health and safety factor but next month. *. . , it also increases 'a man's self respect and .146 Silver Jubilee Safety Congress ..sometimes is' a direct, aid in maintaining in town, for the Christmas Party and the higher standards in personal hygiene. largest dance, floor in town for the card . A recreational progratf? in industry ' is party. All our people take pride in helping recognjzed as an excellent niethodof pro their nurse put these affairs across. moting loyalty, team work and cooperation. Rehabilitation' - It creates a happier spirit, and provides an emotional outlet. -Most plants now sponsor interdepartmental contests such as soft ball, bowling, basketball, quoits, rifle teams,, fenc ing, etc. . ^ Doctors and nurses agree that one of ' their most trying, and at the. same time, -most important jobs, is to get a man who has been badly , injured and who has per haps partially or totally lost the use of some ' In the small plant the nurse may be ex member of his body,' back to work and. pected to organize some of these activities', happily' placed. He has had., a tremendous especially if many girls are employed. She shock, both mentally and: physically, and at can take an active part by seeing that each times, all our resources are taxed to bring one has' a chance, to try out for the par- him through to the; point where he can face ' ticular sport in which he or she is inter the future with courage, and adjust himself, ested. Even if most of the workers, are to changed conditions. men she should show an interest in their sports; She should remember what each man does best--whether he is a pitcher, a: godd first baseman, a crack shot, an excel lent coach or a champion pinochle player.'If she can talk intelligently to him about his game she has established a valuable contact ' that may stand her atid his department in good stead should difficulties ever arise concerning, the man's relationship to- the Company. If the resultant disability is of, such na ture that the man can.be placed in any kind of a job in his. own plant, a sincere effort, will no. doubt be made to do so. Our com~k pany has .always assumed the attitude that--' no.expense.is to be spared in restoring.the workman to the highest attainable peak of usefulness. If physio-therapy treatments,, artificial limbs, mechanical-braces, glass eyes, etc., are needed, there is jifeyer a question of . cost -r- We. must not forget the plant outings. They are invaluable in promoting good fel lowship. This is especially true when the plant officials, superintendents and foremen mingle with the men and their families. . Throughout, his period of convalescence the nurse must encourage him to believe - ' that even though one door may'be'closed .for him; another will, surely be opened, and. iife for him and his family will continue .on ; In the fall we hold our annual card party, a secure basis. which is a huge affair and one in which all The possibilities of industrial nursing ` our people take pride. We usually make a service are not yet fully realized. It is .one. profit of three or four hundred dollars, and of the most highly, specialized-branches , of. the proceeds are used to defray, expenses nursing. Its value to the worker, to Indus- for our annual children's Christmasv,arty. - . try,;and to- the community at'large, will de -These two events, began in a small way sev-t- pend to'a great extent'Upon the wise selec-. eral years :ago and have now grown to. such tion of the nurse and upon her.qualifications proportions that we need the largest theater and preparation' for the work.. Industrial Nursing from the Viewpoint of the Plant Management By CHESTER S. JOHNSON - Personnel Manager, The.Quaker Oats Co., Cedar .Rapida, Iowa . _ ; ' ... . Considering industrial nursing fromthe employee. She is. in a strategic position to viewpoint of plant management, I would aid in bringing about good. feeling - and say, -first'of-all, 'that the industrial nurse .. .building up. morale among the workers of... should appreciate: that she and her ..work a plant. She should look far. beyond, her are extremely important in the program of duties of first aid, important as they are.; harmonious relations between employer'and ,, She should bear in mind at all .times-.that , Industrial Nursing 147 the major problem of industry is .that of loss, of blood inay Jesuit fatally. The em- -- huriiari relations. ployer- who has provided no- better facil The most common duty of the industrial ities for the care of his people than..that .. nurse is, of course, the administration of may find decided ill will engendered on the * first aid. In her performance of that .task part of the survivors w the deceased. Such-' she will find that her kind and considerate a-situation may even cause, adverse .public . treatment .of employees will earn afr full. `opinion in the community. , . ,.v measure of^good will for the company. In smother case a:,man may be injured, . When the nurse is called on to adminis ; seriously but not gravely., Well-intentioned, ter to those whose injuries may be: more but untrained- persons, ;may move him and serious, her sympathy; and kind words may by; incompetent handling do irreparable do much, to allay fear and to neutralize the.. damage which results in permanent disabil? .. pain attendant to the injury. The patient Ity: The victim of such circumstances may .will not soon forget the . kindly .considera-r question whether the employer had his in^ ,s ,tion shown him and this cannot help but . terest at heart to have allowed such a con- 'K " " react.favorably to the employer. ditiori. Many times- during convalescence* the In still ano'ther instance an. employee, - nurse will Visit the injured employee at his may be so seriously'injured as to require home. The,re .she meets his wife and chil- transportation to a hospital. -Without the . dren, and she may aid. and advise them. In . ..proper facilities, it is probable that he .such capacity: she serves, as ^an ambassador . would be picked up by his fellow work of good will.for the company. '-. men, loaded on a truck, and jostled over I .Sometimes an employee may be burdened rough floors-to one of the plant exits. : with the problem , of ill health, either-of There he jnight . lie, subject (to cold: or - hiriiself ^or a member of his family. .The:- . other elements, and to. the eyes of the . nurse who may intelligently advise him uh-; curious until the arrival of the ambulance. der such circumstances will have. gained . Contrast such a condition with the man 'his sincerest appreciation, ner in which it would-be conducted under .- -The employee ..who is absent from work direction of the; trained nurse. The pa.because of; serlou^-illness' will appreciate. tient. would be carefully lifted to a clean tjie 'visits' ^of the nurse, hot-only for .the, stretcher. He would be made comfortable .. advice and assistance she may give but also and treatment for shock would be started because- it demonstrates to him that the- at once. Carefully he, would-be transported . 'employer maintains his interest in him, even to the privacy of the Plant Hospital where though, he. is riot at.'work. The nurse may further treatment might be carried on. bring him information about die plant and There he wotild remain until the arrival of the people with whom he (worked; This will the ambulance; tend to bolster his morale and counteract Which of .the two riien -is. more likely to the depressing effect of illness. It may feel that the employer has a sincere inter- , hasten his desire to- return to work. .1 c' C est in his Welfare?- Which is likely to re ' The features- .1. hVe, pointed out have- spond mare, favorably to treatment after been positive ones. They indicate^jipw in- , his amval at the hospital? dustrial nursing has proved to. a force " But'aside from- its humanitarian, aspects in the creation of good, will toward the and its influence in the cultivation Of good . company and-'the improvement of morale . will toward the - employer,- industrial, nurs 0 of . the-workers. It "may be .well. to consider ing justifies- itself-in a, monetary sense. also how a l&k `of these facilities may - Proper treatment of, minor wounds pre-. react adversely arid actually, cause' ill'feel-' vents .infection arid its..accompanying loss - ing toward the employer .and low.morale of time. -The employer saves money repre- ; -among the workers. , sented in the cost of training' a new man to Let'us consider the,.case of.the man who .-.take, the1 place of. the one incapacitated. In is injured at work--perhaps a severe'cut surance^ costs are less as every employer's ' -in which arterial hemorrhage is-involved. premium for workmen's compensation is If therp is an absence of compejerit{ first- based on the success he has had in pre- V aid preceding the arrival of the doctor, the venting irijuries with loss of time. 148 Silver Jubilee Safety Congress Where employees - have goffered serious care, care of teeth, and many, other health injury ' the proper. handling, transporting matters. ... > and first .aid measures insure, the patient's, The industrial nurse' also stands as a de arrival at the. hospital/and under die doc fender. against contagious disease within tor's care, in the very best possible condi the factory. She quickly recognizes symp tion.' Under such favorable circumstances toms of infectious disease and sees that his recuperation starts with a minimum of the patient is..sent, home promptly, thus delay and the period of .disability, is meas preventing spread of the disease to. eph urably diminished. This' likewise affects demic proportion. . insurance costs. . The industriaPnurse will also be the In both of these instances there, is an first- to recognize any injurious effects of a other money factor involved and that, is man's' employment on this health and she. the loss of wages to the employee when he. may aid him - by advising: transfer to an is disabled. Naturally the employee- wants other type of/work which he may perform to. avoid disability,- or, suffering serious ac Without injury to himself - cident, is anxious for early- return to his. job so that his earning ..power ,,Will.be re stored. Long disability may. mean serious change in' the economic status of the fam. ily. If the father is unable to. work for a long time it :may be necessary for son- or daughter to leave school to help provide .for the family. The wife may be forced to ' take her -place as the breadwinner. . - In the last few years another problem has presented its.elf to the employer, hnd that is the matter of occupational-disease. Many states have already passed laws providing .compensation for such .disease'and doubtless many others wjll do .the same, in the future! The industrial nurse can' beof inestimable value in this -field. She may closely watch those- employees; who are, ; Then there is the. field. of - health- con subject to occupational diseasfe hazards and servation in which the nurse is in position advise them as to measures Tor conserva to render genuine, service. Management ap tion of their health. She .will note any preciates that health conservation'involves ' gradual, lowering - of their physical. condi two important monetary factors as follows:. tion and take whatever steps !are necessary; 1. Reduces the cost of' production be whether transfer to other ..work; or med cause it. increases the efficiency of the ical .care;, to prevent an actual breakdown worker. of health- By hec dose supervision of the 2. Increases the earning power, of the people on' the. job, which may be hazardous workman due to his added efficiency. tp. health she.will be able.to reduce mate The industrial nurse's opportunity' to rially the daims for occupational; disease take the d&itiative in carrying on a program compensation.'' , . . of health/conservation is unlimited...In her . In cotidusion, I repeat that management frequent contacts with employees of the plant she will observe change in the physi- cal condition of an employee and may find it possible to advise him in the matter of diet; oral hygiene, or the necessity of con sultation with a physician. of . industry believes that the industrial nurse more than justifies; herself in the saving of money which results from proper care and treatment of- people who. are in jured or sick. These savings accrue! not only to the employer, but to the. employee - During her visits to the home of an em as-well. z ployee she may offer assistance in the mat As a final word, I would also repeat, that ter oLhealth problems of a! member* of his management believes that the nurse has-a family. She may aidjin. procuring needed real function to/perform in the fhodera surgical.attention for him.br a. member of/ program of industrial relations. She is his family. r* ' important in establishing and maintaining ' The industrial nurse. may also arrange . good will toward the' employer. -And' that clinics for members of employees', families. employee'good will is important--it is the She may give them - instruction, in infant very essence of industrial harmony.  Industrial Nursing 149 THURSDAY LUNCHEON SESSION * October 13, 1938 The Thursday Luncheon session was pre-.: . Miss Jaeger extended "Greetings f . sided dyer .by Miss Ruth HOuIton; Associate President, Chicago Industrial Nurses Xlub,' Director, National Organization for Public to the visiting nurses and other .'guests. She Health Nursing, Inc.j New York City.She spoke extemporaneously, and no adequate introduced as the first speaker Miss Ger record of .her greeting is available. The trude Jaeger, R.N., Swift & Company, Chi Chairman then introduced the next speaker. cago. . --:- The Pasty Presenand*Future of Industrial Nursing .' ,, By DR. M. N. NEWQUIST Assistant Director, American College of Surgeons, .Chicago During the past'several years it has been;., would be called: upon to do other nursing my privilege to visitmedical services in in-. and doctoring duties in the plant Not in dustry* throughout' all -parts of this`.country. frequently tile. distinction of being the This has been done as a representative of -: "handy man" at; times of industrial injury .the. American.'College of Surgeons. Thus ' or.Illness would accrue' to a worker who an-opportunity has. beenafforded ine of see- . had tried out his home remedies on his- . ing the' conditions, under which nursing large and growing family and was ever- service in. industry is conducted and evalu 'ready to foist his cures on his fellow work-, ating the character of the service''rendered ers. Or perhaps the. foreman or the plant 'by the nurses. superintendent would be the Good Samari- ' It was soon realized that there- was a great lack of. uniformity hi the character - and scope of the nursing service-in differ ent, plants, and-that- in some places nurses rtan. Of course^ a doctor would always be called should an accident causea real seri ous injury or give rise '.to sufficient excite . ment ~ . ;" were bejng called'upon to assume respon-' . In that early day visiting nurse service, libilities which* should not be assigned to as ; we now know it, was non-existent Visi them; in' other "places they did . not grasp '. tations from the plant to the home of an their full opportunities for service. . Re ilk or injured' employee would consist of sponsibility for-this condition is npt' all to fellow workers or ] possibly- the superin be attributed to the nurses themselves, for." tendent .who would tender , flowers and sym in most, instances; their sphere of. activity . pathy 'to the potential widow and occasion has, not. been accurately defined' for. them.' ally financial assistance as a result of "pass As a result of -th,e experience, gained' in ing the hat." : * .;. *. ' .the course of this-work it would seem ad-' Infections,,complications and disabilities visable to attempt to fonnulate a statement following industrial injuries. were so fre which' will, embody as accurately as p.os- quent and so vexatious that.'even some of siblethe past, present and future of indus die pioneer^employers were forced to intro? trial nursing. ' ' duce corrective^measureS in their plants, to In the earlier days of industry, very, few employ, better qualified first aid attendants, women worked'in the industrial plants-and and to change . doctors at times. Industry a trained , female nurse, in the plow works became more and more mechanized and - was not only considered .a useless extrava- : women were employed in increasing num-r, gauce Jbut a veritable encroachment upon a bers.' -From 1870 to 1930, for instance, the man's.'world. Frequently an employe? ;who gainfully, employed male workers increased had developed a shop reputation for.being only 12 per cent-while the .female workers adept at removing'foreign bodies from the increased approximately'85 per cent in. the eye with a. hprse hair .loop or a jack-knife same period. .. Gradually the trained, female 2 G i. 150 Silver Jubilee Safety Congress nurse- clad <in her white uniform filtered through team .work or. 'Inoperative inter into industry. As was to be. expected the departmentalworking-relationships. ' . brass cuspidors began to disappear-from the first aid rooms and a state of cleanli ness in the dispensaries replaced their for mer appearance of^bachelor quarters. It required, however, thef introduction of So much, of the-first aid service in a plant overlaps, that which constitutes med ical service that it is impossible, to separate the two. Therefore, medical supervision of the entire first, aid, nursing and. medical the workmen's compensation laws and the service is indicated. Anyone may render launching of-the safety movement in which first aid in emergencies--iut when one is the National Safety Council has played the established in a; plant to treat ill and in leading role to give industrial nursing tHe. jured workers who' are hot only expected stimulus and the opportunity which it de- but are .required to report to the first aid. < K served. Faced with the immediate costs of station, a different light is thrown upon- the disability arising from industrial injury, situation. Furthermore, redressings tinder actual and .alleged, employers introduced such' conditions cease to be first aid. It be preemployment physical examinations as a. comes a practice of medicine. protective- measure and established more first aid rooms and employed additional : An aspirin tablet,' for instance^ may safely first aid attendants. The full time sendees be . given to an .employee upon ,his specific of first aid attendants became a necessity, request. On the other hand, , ah employee now that injured employees were being' -who complains of' abdominal -distress and required, to report promptly to the first aid room for treatment regardless of how who is given a dose of epsom salts by the first aid attendant may -suffer :a ruptured . trivial the injury. . e-. c' .Jay> first.' aifl. attendants jehrly predom- hated, but it whs gradually:;'demopstrated that the superior training of :the graduate nurse, her knowledge' of sepsis ^and asepsis, . of illness and injury, of first aid technique appendix with .peritonitis 'and may .present the first aid. attendant -and'the' employer with, a nice lawsuit for malpractice to which may be added one for practicing medicine without a license. Such legal-complications are hotfinfrequent and record keeping, and a better knowledge Physicians should formulate and Sign of first aid' limitations, made her -employ general standing orders fOr the first aid ment not only advisable but profitable.- Her ability to handle people' and- finally; her white uniform proved to be of additional psychic value. and. medical service in the plants which they serve and they should follow up by -making periodic visits to the plant in order to make the intended supervision effective. Placeof Nursing Service A. change of plant physician implies 'stand ing! orders, signed by the-, new doctor. A The nursing service in an industrial or niimber of nurses have jrefused to assume ganization is a part of' the health sendee their duties in the plantuntil the above r..and not all. of it.. A-properly organized') described supervision and protection were health service should have'a qualified physic .'provided. Many leaders in the medical and cian at its head and all- Health activities nursing fields;.-and organizations such as should be supervised by him. The nurse in the National Organization for. Public Health industry should cooperate with the plant Nursing Save repeatedly stressed this point physician, the safety engineer and the man ager of industrial relations, but she should not replace them. The sole^piirpose of requiring, ^adequate medical supervision of first aid services is to. protect ill of injured workers from be Over-enthusiastic. individuals have pro ing treated .by .incompetent or- unqualified mulgated nursing programs so complicated persons! In this.connection specific pro and extensive that it -would seem in these vision has recently been made in the New instances that the physician and the safety York Workmen's Gomfiensation Law to the engineer were no longer needed.- It should effect that laboratories and bureaus;. includ- ' .be emphasized that ample opportunity still ingfirst aid departments, in industrial estab remains for rendering -constructive sendee - lishments'which participate in the diagnosis within the intended fieldof industrial nurs or treatment of injured' workmen, shall ing and furthermore that the ultimate goal. have medical supervision. Similar coverage is more quickly and efficiently Hcbomplished exists in all states in their respective med- Industrial. Ntirsing 151 leal practice acts. In most instances physi cians are yrilling.to render tills supefvisory . . service to the plants which, they serve with out additional expense to the employer. ,4. To cooperate with the safety depart-. t meat byt" *. a. Rdterating safety.prindples to employ- ees at the time of .dispensary visits. Functions b'. Reexplaising arid reemphasizing to em ployees the program in plant sanita- It is presumed that the nurse will- visit the various plant departments early, in her assignment to familiarize herself.in a gen. eral way with working conditions and haz ards. Thereafter^the indicated present day duties of an industrial nurse are as follows: 1. To assist the physician in making pre employment and periodic' physical ex aminations. These examinations are not to be' made by the nurse or the lay .first aid attendant as has been done-frequently by the latter in. the past. A 2. To render first aid and subsequent care of , industrial" injuries . and occupa- ,, . tiorial disease as directed and super vised by the physician in charge. In most manufacturing plants this is still* the -most Important function of . the nurse and the reason'for'her em- ployment ' ) , The suturing of lacerations, the anesthetizing of eyes :iu order to re- .-. move with a. spud foreign'bodies im bedded in the cornea, and other simi lar procedures are still being done,., by. lay first aid attendants but sel- dom by tiurses-^-they know their'llmi- . tations. Obviously such*unsafe prac. tices should be discontinued. . : v;; tion when inaicated.(; V : c. Reporting all accidental injuries and , occupational diseases .that .should be investigated from, the standpoint of causal relationship and. prevention. . & Reporting to the physician for ex amination, and also to the safety di- . rector, those employees, who are acd--. dent repeaters or who seem , to be aeddent prone on account-of mental, or physical defects. 5. To cooperate- in promulgating an ac. ceptable program in health preserva- ' tioii and health education by: - a.' Giving appropriate advice to individual employees. Every' nurse should, be a - competent psycho-therapist^ b. Givihg talks to groups on appropriate . 'nursing subjects. T .' c. Distribution of literature on health sub- -.' jects. ; y . ;; d ` Encotiteging workers to . have periodic physical examy&tioris where such-ex- . ' ' aminations art not already, being - made.. ,. . ' e.~ Assisting in. developing- adequate rec-.. rational programs and fadlities.' i. Assisting in maintajhing certain phases 'of the sanitation program by. inspect-, rag the plant cafeteria and ldtdien, 3. To render reasonable first aid and ad- . vice to employees " suffering from . women's toilets, lockers and other indicated departments. V non-industrial injuries - and fitnesses. . g.^Cooperating with- private physicians . while on duty according to the pol- . - and With-local health and welfare ides -and standmg. orders for such agencies in activities designed to bene service. For further- professional . fit the health of the worker, ahd of service- employees . suffering from - the.community,as a .whole. - such conditions should be referred to 6. To kdep adequate records by:' their private physidans., Here again a. Recording all industrial injuries and ' the nurse can and does play ah im- ~ occupational diseases. portent^ role Many of the workers,1. . particularly females, who-, come' to" ' . the dispensary, may. not- sice the doc-- b.. Recording all employee visits to the dispensary for non-industrial'injuries. tor. The nurse, however,1: who is alert ' . and*-illn. ess" es. ****'' & recognizes, the cases : that may. be- c. Maintaining physical examination, rec . come more , seriously ill and .die re ords a&-confidential informafioni. It efers them to. the plant physician for is presumed that tire physician is re 'examination and advice or directly.. sponsible for the completeness of to tHffamfiy physician. * \ '.i such records. <- " 152 Silver. Jubilee Safety Congress d. Compiling statistical , summaries at in ployed by the industrial" organization, or tervals of the injury and .illness ex such service may be provided' through the perience and reporting it to the in employees mutual aid association, through dicated officials.' Such studies will the carrier of the group insurance; or serve to demonstrate future obj.ec-. through local public health nursing associa fives of the service. tions,. It is needless to say that the visiting. e. Computing or obtaining annually the nurse.service should be closely integrated injury frequency and severity rate. with the.health service in the plant in order These rates are not only ari index of to obtain the greatest benefits. the efficiency of.' the .safety service Jiuf also of the medical and nursing . . Future of Industrial Nursing , "or first aid service. ' The number of graduate nurses in the Functions Outside the Plant field of industrial nursing has ' hot-' yet readied the - saturation point ; their .per Home Visits. After the health servicehas been well organized-within the plant ' the opportunity- of detending, a worthwhile nursing service outside of the plant, should formance in industry has been so commend able and valuable in the past that' their employment in greater number in the future is assured. While eihplQyers.wiI.l continue npt be overlooked. Visiting nurse sendee can and will reduce absenteeism. How? Firs^ by reducing' the actual' sickness dis ability.. by arranging for more prompt and' adequate medical, hospital dr nursing serv ice; and second, Which is a concomitant to select their nurses on the basis of .gen. eral nursing qualifications, character, ap pearance,- personality- and administrative .ability, they will also inquire as to their .special-`training,;which is, applicable to this, field.' . ' result; by reducing absenteeism due to un- ; Notwithstanding the fact that better necessary personal reasons. trained' nurses' are being graduated each When visits are made to the homes of ill' or injured employees they should be made in the spirit of. helpfulness) never for the purpose of espionage. The'nurse may. find the absent worker badly in need of medical or hospital .care but whether ignorance or poverty caused the delay she tactfully andpromptly arranges for such service through the family, physician if..possible, or through charitable hospitals or local health and wel fare agencies. Possibly some nursing care is all that is needed; and in such instances she hot only renders this - service' at the timet but of greater importance, she. teaches ' some member of the household how to con year, it would-appear that if standards for industrial niirses and nursing were formu lated and more-widely promulgated they would serve as a guidefor nurses' training, schools itii arranging their, curricula and would'provide a'stimulus for growth and `greater accomplishment, in this particular field of. endeavor. Applicants ho contem plate going into.industrial nursing and who. have the. preliminary academic training re-, .qtiired for entrance to an accredited nurses' training' school vftll find that a knowledge of typewriting .acquired in ;high school will later prove-to he an asset in their industrial work; tinue the care,; how to prepare nourishment . For. industrial purposes it, is highly de- or how to prevent spread of the disease; , sirable"that the' nursing curricula provide ' for: instruction'and experience in- caring The nurse can be of aid in correcting, . for both men and"women) opportunity fbr. social) home and other maladjustments and . learning nursing techniques in the surgical finally by spreading cheer, by giving encour department, experience in the out- patient agement and reassurance she will not only, department; and.particularly Jn the' emer be a helpful psycho-therapist but she mil also serve as a perpetual ambassador of good will.: gency department ofthe hospital, where in struction in.first aid is given and some! expe rience in public health nursing. The student' While the plant nurse .may make oc- . nurse'in.the past has.been informed as to casional home yisits, providing the service the role played by bacteria and trauma in in the plant is adequately covered during the cause of disease.. It is hoped that the her absence, this service is best rendered nurse of the future, will'alsahave a work by nurses who are specifically assigned to' ing knowledge of occupational disease and such duties. Visiting nurses may. be em of the broad subject of[mental hygiene. In-  ... ; - v . Industrial Nursing 153 dustrial nurses should be registered in the are still human beings and as such they states in which they areemployed and they should receive individual .consideration , and should continue to enhance their knowledge ,,> kindly treatment--not paternalism. Indus- by-keeping'abreast of scientific Uterature ap- trial nurses should.' continuously strive to plicable to this field and by attendance and . inculcate in' the minds of the workers a . active participation at meetings of industrial desire-to work safely, to maintain their nurse associations.. . greatest asset--health--and to render a'life With ali of the refinements-arid elevated of . usefur service. If this is ..done it Cannot " standards -for .industrial nursing, however,, be said'that Industrial Nursing has lost its we should not lose sight of- the fact that art and that if has wandered too far from . the.workers though considered "en- masse,"-home. . . , .... - V ' .- =' THURSDAY AFTERNOON SESSION 'October 13, 1938 -- ' ' ' Chairman Joanna M. Johnson, R.N., Mrs.. Sidney Hook, R.N., -Plant Nurse, Nursing Service, Employers -Mutuals,-Mil Abbott'Laboratories, North Chicago; 111. waukee, and Chairman, Industrial Nursing - Mrs.. Hazel H. Leedke, R.N., Shell Pe . Section, N.O.P.H.N.,- called the Thursday troleum Corporation, East Chicago, 111. afternoon session to order; With, a'state-: ment that theimeetmg was. to progress as-an Open Fprum on Industrial. Nursing Prob-. lenis, Miss Johnson introduced the follow^ ing- scheduled 'participants: G O. Saippington, M.D., Dr. P. H.; Con sulting Industrial Hygienist, Chicago. -. . Mrs. Christian Seabrook, R.N., Group Nursing Supervisor, Metropolitan Life In surance Company, Chicago. - F. W. Braun, Vice-President,'and Chief Frances E. Silbaugh, R.N., Oscar Mayer } Engineer, EmptoyersMutuals,1 Wausau; Wis. & Company, Madison, Wis.. .. Doris Craig, R.N., .Supervising Nurse, Chairman Johnson then introduced the Koppers Coal Company, Mt. `Hope, W, Va/ problem, speakers. How tiie Nurse May Aid the Safety Department ; ^ By MRS. SIDNEY HOOK, R.N. PlantNurse, Abbott Laboratories, North Chicago, 111. s.* \ v .. ' * ' . We"all know by experience that our ., will be able to judge just what His mental safety managers are mosf interested' in process would be in a given-circumstance; WHAT caused the accident? First; whether The best way to^actually -know each person the machine was defective;* and. then .what in. your plant is to make little notes about ; . is'to be done to.make- the madiine more him. For- example,' when a new man is mechanically perfect? ` This1.is ail well; and . given his physical examination, we all have good,' but there is more to the.picture than- -at least a. small opportunity to Geatchpbis the -defective machine. It concerns the per- . particular attitude. Is he a "smart Alex;" son who was. injured, whether he was de- ' slow in-following directions; does he hurry fective inhis. mental attitude* r.i if h.e : to conclusions'or does he answer intelli- ' simply- did not have the' ability'to-do-the gently and in not-too much-of a hurry? job-safely. These little characteristics may be caught, "You nay ask--"How am I to knpw the;: and for safe; keeping make a short note condition of the man's, mind justr before ?n each Physical examination cgrd. _ the accident occurred?" Of course, ho one ; During the physical examination we also can read the- man's mind'; but the nurse, have an excellent, opportunity to fire our by acquainting herself with each worker, first guns at future unsafe activity;- Know-. .154 ing in which department the man will be ' your, fellow workers top strongly. You have working and . die conditions to which he a much betteropportunity to become ac- ` will be exposed; we can give him a .little'' quainted vtithjeach of them, than has, the , safety instruction which is very beneficial, safety manager. By khowmg each mw^and - since a man who is looking forward to work } something .of^This job you will fimFthat will always be^mosf eager, and willing to these menwill yolunteer lmapy ideas abpiit. ; - cooperate withanything you may demand, safeguarding situ^ons infheir departments. O' of him. . Of course not all. of these tips 'will be Therefore, if your man is to be. working Practical but they will: be good' to know where there is a dust hazard^tell him-that and if you discuss them with ydiir safety: in', that department he mustwear Ms-res-' ."an. some may be found worth investigat- piiator. If he is ^subject to work around mg and using. '' . .machinery, instruct him in the proper dress, ' When an accident does occur, do you sit ' and in all cases give definite instructions in-the office and make out the routine re regarding the treatment of cuts and burns .port, or do you investigate? It may.be all which might occur. In our plant-it is the. right to sit comfortably at your desk all * practice, to: report all injuries, be they . day long and keep-neat, orderly files, BUT, ' small or larg^'to the first aid department- if you- are keeping'neat orderly files of However, if it is customary to report them ^material of' whichyou know nothing, then to a first aid man' in the. department you it is time that you did investigate. When can emphasize this also. Too often a tieyr .X. first entered-industrial'nursing J*had no. .man is hurried through a physical examina- 'more idea of what, constituted a centri- ' tion and started on a new job so rapidly- fuge, 'tappin or band-saw than I-did of that he feels he is never allowed to return Greek. But since that day. I haveflearned.. -to the doctors office. Correct this feeling inyestigation of accidents (is particularly before.it has a chance to grow. necessary if the plant , employs many.wo- . Just as important as your opinion of the men. Every guard-must be employed which - f new. worker, is the new worker's opinion will, protect., these. girls.^By actually visit-. of you. Make him. fed that he has made ing the place of accidentwe are"able to a friend. You are the first person he meets picture our own readions to this situation . in his new. work and of course first impres- .- and by careful questioning of fellow work- . sions are always most lasting. Make his . ers -we are able to get the completed story. impression one that will inspire confidence It'is'natural for a woman worker to talk ~ in yoursdf. After ati accident a.man is. confidentially with another woman. What ' more likdy to volunteer-complete truthful . man'-could appreciate the . sick headaches' - information to the nurse he likes than to which seem to be so peculiar to. women?! the one whom he dislikes. By careful questioning we may piece ther. Another way in Which you will become compIefc: picture together bit by bjt Whdi. 1 better acquainted, with each employee is to ' the picture, of tiie human eletnentiscomREMEMBER NAMES. For some people pfete, .thehC&mpare(youi;. report mto that. . this is a hard task but it will pay extra. of the safety ^anager, and together make . dividends every time. When you . remember up the complete stoty. .. an employee's name, that man has the fed- J In . our . plant we have* a functioning ing that he knows you, and since. each of "Safety Committee" whidi meets once a us thrives on. personal attention, this will month-and consists of the safety manager, cement your friendly attitude with each assistant plant superintendent, company employee. Keep your ear attuned to the. physician and myself. This committee gath"Grapevihe" and if it says that Joe Brown . ers. material for action and, dismission from ` in the machine shop is the proud possessor o*f a new baby^oy, `don't be shy about congratulating Into the next , time you see him.. It takes only a minute, but how proud it makes Mr^rown/and at the same tjine strengthens his respect for you and your the safety representatives* who are appointed in each, department These sugges-. turns are written .'and presented to the Safety Committee.. However, .the foreman; >>. and his safety; representatives are present / . at a round table discussio^.as often as it- . principles. . :- . .appears to be necessary. I cannot emphasize tinspoinfrof^knbwing In some instances we fed that it is neces-. - -A, Industrial Nursing 155 saiyfor the injured employee to be, pres- ; was discharged from, the; hospital. As we ent .at . the committee meeting to tell his expected,'. there was much -aiscUssipn of storyof thejfccddent. In such a case we try; safety among the^employees:-During this .`to,'impress "on. the worker. that' he is not` week.we talked,.thcfught and acted as safely th4re to^be.held up.as-the."horrible" ex- as any plant: could. \ ample,' but"rather as ope of a group of in .. In September- we' emphasized the .health dividuals interested in, making his life mo.re program, blit'also had an exhibit of safe- .safe. This^will often influence huh tp be guards as related to industrial hazards. '. come. anindependent safety representative . Another place where .you can aid the who will be invaluable.^ . safety department. and help cut . your ac- . We had been unsuccessful in selling the : cident. fate,.'is in the use of material for story of safety shoes- in'one of .our de-. safety, bulletins. I; know that .in .some, partmehts, until one of the most popular; plants the nurse is not concerned with this men of that department dropped'an iron; question.; but for those who kre concerned, damp;oh to his great toe, breaking-it, and' I-find, that each departmental bulletin board ' causing,two weeks' loss of' time. When the'. can he' made-to., show, the particular safety man. reported back to work we were able problem, in that department For example 'to sell.him a pair of safety shoes. Before if you' have records. 'of several ' back in- the month was over, every man in that de- ' - juries in ope department.. that*, department. partment was wearing-safety shoes. . should be given material on thdr'bulletin' The nurs$ must be more ror 'less of a . board that will keep the problem of safe "Safety Salesman" % any plant.-; To be. a lifting always before themV good'salesmart she must' be interested in . Right here is a good time,.to say that exchanging ideas among the people whom the material on the board, should be kept she would teach to be healthier and safer up to the minute and ever changing. .1 find workers. Do not be afraid to express your that unless there is something hew to look individual ideas.' The safety manager will forward to on the board, themen soon get * be more-.than glad to'help .you work out a out.of -the habit- of looking:'-Sometimes a program. We had such an improvement in little praise will. go a long way to making >ur rate of;accidents following one' week a -better record in a department If a de- which we set aside in.February and called .- partment has improved its record, show the "Safety 'Week?' that we repeated--this pro improvement in-. terms. of figures . for. a gram in September. . "given time. This will lend encouragement The first program .consisted . of an ex? and create a type, of pride.- ,, hibit of safety'equipment, such as', goggles, Like most nurses, I have a healthy.,dif- respirators; safety shoes,'guardsvand saws respect for rows and rows of filing cab- and such. Each exhibit .was flanked. Or the inets. but l also have .a very healthy^ re idea-carried out,-with posters. At the noon spect for precise and up to the. minute rec hoUr we ran a five-minute movie' showing . ords. These records must, be/available to the results of an untreated pin prick, from . the'safety manager at all times mid in such the time of the accident until the patient a form as to be easily understandable. . How Can the Nurse Aid the Safely Department By HAZEL H. LEEDKE, R.N. Shell . Petroleum Corp., East Chicago, Ind.. &1* In thiiikiiigrabout this subject, T shall be- . should she be . trained in emergency first gin 'with The tangibles; as/these are. the aid. . It is unfortunate that .upHo now^c basics.upo.n which the nurse.must start her 'professional nurse has been, trained:only.in job; they areTthe fundamentals, or rtools,- hospital technique,- and what she- knows. in with w-hich she must work/ ` ; . - . ; emergency first aid. she has obtained outside, To .begin with, of course; she must have. of the. training school, and on her..own.in s' good, technical training, .and .especially..,. iti^tiye.'. - 156 > SilverJ-abU^e Safety Congress When the nurse takes over a private,' 2. A fairly good knowledge .of the kirid . case In the hospital, her very -first - proles- :of workd<^e!m^ of. sionakactistofind put wjh^tkind of'a case - the plant , equipnieiit^ andhazards' in the ' shehas and what the orders are. What are. -plant.; ; the procedures to be carried out ip this. 3. Recognition bf,.flagrant.violations.of- case as ordered by the doctor? Regardless safety rules; Iackof use of protective. deV of the first -aid setup,- tbe> first tangible vices, etri = ' means of offering aid to the safety depart-? ment is to obtain definite orders Vfrorfa the company physician, definite and approved yiingof emotional<factors involved ^ me accidents. ' first' aid. procedure No nurse should* take . Let us'dissect an.acrid^at report and\see upon herself<^he|duties of a physician, and though she mustntt in a emergency, using' how the above -apply... t-shall use my own. ` "InjttryrReport" formas'anexamjrie. her judgment far in'excessof that required .Our .'first tfuestionsand repowungs are; in die hospital,..she-both protects herself, probably routine in every, plants injiqy' and her company by working ..under ap- . record': :name, badgej,number,- department,' proved-first aid methods.. . .' occupation, and. foreman; however; but very - Our next .tangible is to "know your lim first . point of'information? is the-.date .of itations." I have a. lawyer friend who'goes injury--the mohtiv -day, hour, and year.' oh a real tangent on tills subjects Doubt- .. If 'the employee' can- give, the .exact- date less, he knows whereof he. speaks, since* he and-tiine you have a starting point for your is the one who writesfinis to some of these record andinvestigation./Nextis the place cases .which. I-shall mention.' We nurses or location.' in.-the.plant where the, injury: are not doctors ;-we are their able aids, was sustained--can the . injured ..definitely their assistants ; we must of necessity act<, locate-the.place of acrideht and the-exact upon our own - best judgment, and must . "place in the plant, and''piece of equipment know :,what to do; but of greater impor-. .involved? TheUurse* if she has.obtained tance', we must know.what not to dol and recorded .the information accurately, In the nurse's'handling of eye cases this . particularly applies. ' The lawyer' friend I ! mentioned above can cite the costliness .to '_dheasfi.nfuitern'sisehtteindg;thOef. safest department with a the accidents The safety . department has the-locale.' ... the. company of mishandled cases: I have- ' Next on qtir form is the "Cause of .the' Heard fids man-rite the eye case in .which accident" .Here is recorded. the man's state- - an ^embedded, foreign body 'was removed mfent as to how the acridmit occurred. It' by one, other than the -doctor,' followed by is. wise to record the exact statement of the . infection, .nearly costing the eye of the patient.in this matter;.vho.wever, after* this. workman."'Nurses, know your, limitations! -' is obtained subtie questioning by. the nurse, Save your .safety department the expense dependent upon 'her- knowledge, of "the of settling' a-claim-as well as criticism, -'plant, its hamrds, and safety regulations, misunderstanding, and prejudice. " may bring out tire cause of the accident Again,'she may not- be, able, to elicit the The third tangible, and extremely ira- . .causerbut she has something at least , for poriant is the lmepingof records..Records, the. safety" department`to start work on .In I believe, could'be a'complete-paper in it- ^. order to determine tire cause. It'is said that seif. I am particularly grateful to my owii the statement given the first few minutes department head'for his aid in'showing me " 'following the'accident, and thereforeusti-* what to get in a record.!-After almost ten ' ally to the nui;se, is- .the mostneariyac- years, I think I.am beginning to get the curateaccountofthe'accident.^' essence of good technique in/record writ-; .ing^.as. far as, the record's value to the safety department is .concerned ; *The skill-- of accurate and valuable record writing can not be attained in a. day,'-and it depends-- upon basic principles the same as almost anything -rise you Undertake. What are they? ' .An exatriple of what she cah .do is shown hi. the following. '^While lightening bolts,. .the wrench 'slipped." The cause of . the ' wrench slipping. will probably give the key" to the accident. 'What are.the factors which might make the. wrench slip?\A:. defec-' five tool, the' wrong tool, a crystallized `nut,: cramped and-inadequate space in which ` 1. Accuracy in recording what is told: jto work, and Iack of attention are some of. Industrial Nursing 157 '. the fartoro:slte<^;get! amiaddto jfee.Tq- '. ' to. .the. sa^/"department ih.'drtrtminihg the port^allof whi<fe;nder ;an';#dm6st vatj|- ' prqhability offits hayinghappened, and in - lcss rccord "feeWtench 'slipped,?' into xme : malting/ at*.tetohfejpq^ - of vp3tticr''f.; ' ^ reporting of ihjuriesas aprevehtioti of . ^hoaid' infection. - " .r'- !v_' : never overijra^'ls, ``Witaesses.to tile'ac - - .We have noted the ;tangible^' the . things cident* Ttfe' nafaft ^ its im-, you "can. puCydur - set 1' portance. ; .- ` -; "*-. ' . apart 'and lpok at, the fundamental: qualifi- "Were 'protective; devices; Used?" The', cations feat make feeindnstrial nurse of "answer ; to! this;- question >Cah::be obtained \ value' . to' cthe; safety departmehV.Yet ail . while ta|li^g ovM the catis<;of the ac-V .- these are meaningless without hnintangible cidehtj) and i knowleiig^eVof 'thfe safety regr ; something, which-, doubtless^ comes ' from ulatibns-.'inctiie - user of' iafety^appliahces `- within' her.' own makeup) and whitfe fur will. Kelp:;tte niirse\tdi': pick up a. violation , nishes a! most valuable link - between the oftheserfcgulations, oradefectin the pro?.- safetyj departmcnt,- fee. company itself and __ tective equipment. ``Ax^rdmg;bf;thia^nes-- the injured employee. It; is the. something. tion will: doubtless aid .the ' safety 'depart feat spells success or failure.'; ment in enforcing or majongnew [ safety . Doubtless the reason'for: fee greitpre- - .. regulations, or . in improving or installing - ; ponderance.of women in fee-field of nurs-' * better safety equipment. . *' . ing^is-that, the feminine nurse;is. endowed -. We now have'ai'picture of wfaat hap- with certain outstanding /attributes of . ' pened and when and where. Next weTearn . ^understanding. mtuitiom tympafey. and Wife what happeried.tb the employee or "The. that ^elusive sense of motherhood towards . . .nature of the. injury.'' ' Herethe nurse can , all inaidond which give^her priority in .fee . malce 'the .rebbrd: eyen inpie valuable tb' the " handling, of the sidk. and' injured. . How . safety department AQt sq much ih`lpreven-\- does this apply.wife rein'd to her value to. - tidiv as fo-;the.. ultimate;disposition of the vthe safety department? . : case.! The.atxuiate.location df fee phys- When ' the' injured employee -comes' to 1 ical- injury, .(and while - there are -many fee plant first, aid hospital, his most vivid " examples, ! shall dte oniy one/ because. it , and. lasting- impression: is - his-first one. has cdme up in, my own experience)''may; What is it going to be?; That depends- on .mean the payment for. .a "disability hot fee. nurse.- -If the, purse' greets.'him pleas- -V - rightly charged; as".a`compensable injury,;- ahtiy;; in' a manner that. is sincere, .and T .have .inmind an!eye case: in which-there . capably easeshispairi . and,'dresses bis. had. been a foreign body - in .the-'eye com-, ' wound), he immediately;...says. to himself, plicated by a slight abrasion to the corhea, "I've sure' eome to fee right place. Here / but located so feai"bad there been a- scar, 'is.'a place whererfety know what to do for* no disability or loss of vision . would have a fellow"- At'once hebegins to feel-better, resulted.}- However, - the. point I- ...want to alnd his .confidence in: and respect for, fee make, is,' the `designation of;which. eye was nurse and the safety; department have gone involved, right or left; Whai", later this up. Wife this respect comes a receptiveness patient. Complained,;of'vision defects,--blam- to what-fee .nurse has tp-'say. 'She has . ing . it- on the. injury; Jie had sustained, he . sold-herself, and as a part of it, the safety, whs indicating; the uninjured eye.?'The. department.'-... . .. JUirse's. records, as well as : the doctor's - Giving the injured employee the right ; Kpre outthii fact. . impreision and wjnning hls confidence and . The wncluding^queatiohs,- except for the: jespect. sounds .very, simple,- but;is it? Mr. vety. last, are more* important for record Lloyd R.- Sherrill, personhd. .manager of . purposes'" only,;than In Vtheif value in de- ' Montgomery Ward and Company, Kansas . ' termining prevmtion'.or <ause.; lithe .case .; v City,Missouri) speaking beforetheNOPHN - is disabling)' if -hospihdizatibn or medical Bieimial .Convention in Kansas City last . attention is accorded;1 that should he noted April) Mid:;. ' / ,, on tb'd;.record. "The patient's length ;of dis-f. 4 "It has:, been mentioned that the .nurse ability and his return to work are of course is. charged with the -responsibility for' fee . necessaVy. -Tht last questifev fee time fee. physical, nietital and , spiritual well-being . case was reported," is extremely, important. of the employees. Carrying out this task 158 Silver Jubilee Safety Congress. requires the application o practical psy a vital bearing-oii the workman's:accident chology. It'requires especially an- under record, .and which the nurse' who uhderr standing that no two individuals are, the stands her job and applies her knowledge- .same; that each person is made up^of a J of practical psychology can draw out .and mixture of qualities to such an Extent that pass on to the safety and welfare depart he reacts in'his own . individual way to dif ment, as weiras do her part toward, help- ' ferent stimuli or methods.- of approach...: ing the worker with Ms. problems; ': The nurse has one rof the biggest selling However, while-the-nurse is attempting jobs in-business."' to build up confidence and good will within: Notwithstanding the' nurse's' opportunity as. the personal representative q the com pany to build up the ednfidehee of the man in die company's interest in hip well-being and protection, she has an equally, valuable opportunity to learn something of his hornier . his. environment,* and habits, and sometimes better evaluate the emotional factors .con tributing to the accident. -' . the patient she should be-ever mindful that within-this type of patiehti there is -a tendency to exaggerate his tils and injuries, and a wrong.or misinterpreted, statement as to the severity or.minority of his-injuries may give rise in Ms mind'to a false'idea,, thereby encouraging the. , development of ,a neurosis which at timei has been extremely., costly to industry.- Dr. N. K. Forster in. the. April,' 1937, issue of Industrial Medicine, says that `*90 .per cent of accidents are known to be of mental origin, ^though not the Result of in sanity or 'mental incoinpetency,- but from thoughtlessness^or': carelessness.' Whatever, may be the immediate proximal cause of an -accident, on thorough investigation the underlying- cause will, in the majority of cases, be found to-be some mental abberration on the part , of tiie worker, resulting in inattention, carelessness, confusion or bad judgment" The ramifications of . this subject seem ' endless. There is' one thing, more which :jthe nursed "as well as; every job - holder, needs ; that is the stimulation of counsel and conference with tiie safety; department '-She must know-the safety, rules -and reg ulations, the accident; hazards in the plant, the company^ policy towards its employ ees, and it is'only the safety and industrial relations department that can give her that. Give her your- sympathetic understanding, your cooperation, and make her feel that she belongs in the-chain, and I am sure, that together you can vitally influence the safety , " As Dr. Forster'states, these persons are . record in your plant; as well as give to the not mental defectives, but; those in whom workmen a real service department^ a -link there. are frustrations, confusion, malad of inestimable strength in the.^iain of in-, justments; and emotiondl factors which have dustrial relations.- ; Who Should Supervise the Nurse's Activities? By C. O. SAPPINGTON, M.D., Dr.P.H. Consulting. Industrial Hygienist, Chicago - The obvious answer to this .question of . he has not had the medical training and who should supervise the nurse's activities does not possess the viewpoint which are is, the physician, because physicians-and necessary for successful supervision. Cer nurses have always worked together and tainly, not the safety man, for he probably have probably the best understanding of. has less training in personnel relationships- each other's aims and-objectives. and certainly is not trained either.medically' For the moment, let us consider if there are other persohs who might be capable of supervising the nurse's activities in indus try. ' ' ; _' .. or in. ainy other .capacity which wouldnmake. him mi efi&cient'supervisor for. this particu lar work.;- Certainly not the plant manager, for he is engaged in other activities and; -has such broad general interests>-4hat he Certainly not-the personnel manager, for would. not I believe, be interested* in' as- Industrial Nursing .159 suming the : responsibility of directing the -custom of the plant- manager ,to encourage ^-nurse's activities, r-- ' ` . - ; the use of the medical arid nursing services, So we are right hack: where we started. --the physician is ,,:the, person yrtiq is ca- instilling confidence direct methods., i V: in. the '-employees *' by pableof' properly supervising the industrial One .of'these direct methods was the fret nurse's activities because of the very nature quent use by the-plant manager of the of his training and experience. 'medical, and nursing personnel in their ad-- . vlsory capacity. ` It is "'true that ..the plant 1 *t . manager should-have sufficient riioney to . In answer to- the question from the floor, have his private physician and his private as to-.the doubtful' advisa'bility of-the plant - nursing services, and against this I have manager* using the- set-vices. of- the 'plant, nothing to . say.j I believe, however, thafif nurse::' " the. plant manager uses the', plant .medical It happens. that; I haye had; considerable and nursing personnel in an advisory ca- experience with reference to this subject ; pacity and openly, but not tacitly; uses every particularly with, regard to. `the uses ofthe effort, to ! increase the . confidence :of the plant physician and'plant nurse by the plant employees in those services, the employees manager. At.one-of- the-plants where I was must be impressed by his example that such located as the plant physician, it was 'the services' are' really.^adequate , arid useful. -1.' .`/V-.- f-t* * The Scope of the Activities of the Nurse in Industry By. CHRIS'TIAN F SEAbROOK, R.N. Metropolitan Life iris. Co.V Chicago, 111. -The National. Organization for-. Public nurses devote the whole of their time to the Health Nursing has stated: *. supervision of the., work and where! the. "The basic objective of industrial nursing ..work is -well, organized the .duties, of the is to promote the inerital -arid .physical nurse -are likely to be . specialized.. One health of. the employee, through, health nurse will-be in-charge of. the.first-aid dis teaching, sb that the .time lost for. acci pensary, another will assist the doctor with dent, .and illness may be . reduced and . .pre preemployment arid periodic check-up ex vented." ' c-- ; -'/'; ' aminations, while a third nurse will be The .industrial health.-field offers a chai. Ienge to the nursing profession.. :The total responsible for visiting of the . homes of the. workers, ' economic loss occurring annually hi-the. - jt may happen.that the industry is the United-States. froin lost time of gainfully center of the civic life, of the community employed workers as a result of illness - and all their activities are built around it and .accidents amounts to nearly four bil- In' such cases, one or more .nurses will lion, dollars; we can hardly, estimate the' supervise in. the plant lunch rooms and ' amount of suffering that this!, lost time recreation rooin and . assist, m ail ,recrea brings to the average wage.earner and his' tional activities. family through the cessation of. the fariiily But. what-about the nurse who will be income, not' to mention the physical suf found in mercantile and manufacturing es fering causedhyinjuryor illness. ( ' tablishments with employment of 200 to . Functions of Nursing .Service ;i000 workers, working alone under the di rection of part time medical ..supervision? The duties and functions of the nurse in- It-is this nurse whose scope of activities industry -mll vary^according -tb the'policy . will be greatest and who should he well of,the.employer, the need of the industrial qualified to meet the demands made upon community prid systems on whichthe her service. Her activities may be' classi. health and welfare activities are. organized. fied as duties within and outside the in-: Inlarge establishments where doctors and dustnC . 160 ' Stiver Jubilee Safety Congress. f:> The. individual nurse, working under part time medical supervision may.perorm prac tically all of the following mentioned ac tivities:-- (e) Preparation of ^statistical .and narra tive monthly report, covering all ba$a-mural and extra-mural activities of the nursing service.- , . Duties Within the Industry ... - 1.. First aid and. subsequent care under . the direction of the physician. (In some business organizations such as banks, hotels and stores this may include First Aid . to patrons, guests and customers.)' (f) Analysis of data from'nurse's records, on morbidity and accident experience by departments--Cost of maintenance d.f' nurs- . ing service iand dispensary equipment" ' 9. Record- Keeping--Morbidity and Com pensation, statistics. ' 2. Care to workers under supervision of a private physician. This care-might`re quire, daily temperature for diagnostic pur Duties Outside the Industry. '\ poses, hypodermic injections of insulin, or' electrotherapy. 1. Cooperation with local Health Depart- 0 3. Assisting physician' .with . pre-employ ment and periodic examinations--responsi ble for history file--and call-up for em ment in the^ control .of disease by extending the program-jof the community to. the ' worker in the plant ... ployee for re-examination. . 2. Visiting ill employees 'when necessary--- . 4. Advising and assisting employees in Health instruction for family. securing correction.-of physical defects and social adjustments. ('' (M Provision of social service for- employee 5. Health education of the indhdduai^and- and his family--by . agencies.v' cooperation with, local \ ` group. ' . * - . . . ' st** * . 6. Compensation adjustments.. Qualified: nurses are sometimes. responsible for cor respondence with the Compensation Insur-. ance Companies involved in daim cases. The nurse,' perforce, must be*well informed re garding existing Compensation Laws of the State in which she is practicing. .' . 3. Cooperation .with community 'Nursingand Health Agencies concerned, with spe*.cific health-: programs, .such -as: Tubercu losis, cancer, heart disease and social and. mental- hygiene---insofar, as the Medical Director and Management are i willing to . extend this service to the employee. It. is - important to arrange with the local nursing 7. Inspection of rest rooms and lavato-, .- organization for jbedside nursing care ..for . ries, interpreting plant sanitation'; to the k employee where such service is:;heede<L worker. . .. Not all 'of' the duties outlined could be 8. Integration of service with the .in performed tty any one .nurse but all of them dustrial relations program byjf--r are"performed tty industrial'nurses today-- . (a) Assisting Safety' Supervisor, by. serv- Suffice it to say. that the employer'must ` ` mg on Safety Committee;--Submitting brief be'educated atid guided in-his selection of < narrative report either we_eldy,.er monthly a nurse :for,his medical and nursing de- v covering the occupational accidents treated partment,. who will be capahle.of. carrying- in. dispensary. ' v on a program involving" the duties which (b) Assisting Employment Manager. Con 'have been listedjn.this paper. sultations regarding personal problems of The' National . Organization for Public individuals concerning physical or emotional Health Nursing is prepared- to advise -the' . conditions. . employer, through;'tiie medium of a sug . (c) Supervision of diet for lunch room. gested outline of the - functions and qual- '' locations of. a'successful industrial nurse - (d) Responsibility for health articles for This outline may be obtained by writing " plant magazine. the Organization. Industrial Nursing . 161 How the Nurse can Aid in .the Off-the-Job Accident Program By FRANCES E. SILBAUGH, r'n. Oscar Mayer SCompany, Madison, Wis. When a report conies in .of accident off education service. The industrial nurse finds -the job, the niirse should visit the home, see working.with, men whose wives attend baby that the man .has adequate medical care, clinics, whose families listen to radio acci- . point out to the man and his wife therad- dent prevention and health talks; whose r ymtage of prompt medical service to reduce children are instructed by the school nurse ' disability. If finances are limited, see that in. safety and sanitation, quite a "different nursing care is provided,. visiting nurses*-., matter from -working .in rural districts , service; or if ,he has. a policy, for group . where these health privileges are not avail-: : inSurince, advise him to have claim papers able. It behooves us as nurses to cooperate niade out at once. - Consult his doctor, and . with all accident prevention .and health if'he wished, the-service of the nurse, call .agencies in our community in promoting one for^the-sanan' and make the . necessary safety and health consciousness whenever arrangements. . . the opportunity'- presents itself. ' Katherine Fisher, Director .-.of .Good The human Clement is the starting point -Housekeeping Institute,. tells ' us that home for all accident prevention work, and care-;-;, ' accidents lead , the" list inq; frequency, and lessness is . the., alibi' for most injuries : severity.' Bums; falls,.antielectrical shocks whether at home or in' industry. As' long lead thedist of accidents resulting in serious as there are steps to. trip on, ladders to fall 'injuries: in' the home; Inform the wife and from, slippery floors to-walk over, and mother in the - home of available nursing countless -possibilities that seem, to be a services in the . community. If necessary, part of our wo.rk-a-day life, accidents will help h?r to budget the reduced income suf be. a factor to reckon with in the home, on fered, through'accidents.; in the home. Ed the streets, highways, and in industry. ucation publicity, and "follow-up work h^jp r~ Rifejjj here, I am reminded of ah incident materially in; the prevention of .accidents /in my- own family circle; My cousin had in the home. The* nurse shoiilcj: Impress -fallen bn an,icy sidewalk and fractured her- upon the wife in the home that , a than must wrist. Her grandchijdof six came to visit ` have 'adequate ,rest and'.nourishing'-food. her. He'stared at the scatter-rugs on the Loss of sleep causes'slow mental, reaction, "bedroom floor for some time;with a very and many times social activities that k^ep thoughtful `expression 'on his face; then men up until' late hours depriving them 'pf -sajd, "Grandma, we'll;have to do something.. the necessary rest, makes`the employee, acr' about ybur. slippery floors and small rugs cident prone, n,ot. only- on' ;the job, but off ; or you are going to;, fairand break, your the job as'well. ; . arm all over again." How true 'it is "that >..Off the job accidents interfere With pro- . a little child, shalL.lead them." If we can. ` dilution in .industry -When adjustments must reach thb' children - in the home, we will be made- to-put another man on*the injured help Considerably in putting; across our no. ... workman's job,- and 'it- behooves us to see. accident programs. that the injured man has care and attention and is able to return to his work at the 'earliest possible time, not only, helping;.the _\man to regain. his earning power and'care - for his home and -family," but increasing production in industry by having an experi In our organization, health literature and small booklets on accident prevention in thehome are distributed on -payday with the 1 checks and-are taken home.by the men.. This 'literature is all- furnished free of cost by opr-group health and'accident insurance enced mail on the job; - Impress upon the company.' . 'wife and mother in,.the homethat'her hus-'. ..' In conclusion; I would say. that the in- band's success depends upon his good health ` diistrial nurse is. a public'health nurse, and and being a careful workman.. In this, way, she.should cooperate to the .fullest extent we can. stress the importance of t accident with ail health.agencies of the community prevention'in the home. in- which she . works. * Keeping in close .This alsb helps to build.up a strong health touch with, the -health department .at all f- 162 Silver Jubilee Safety Congress times, she is able to have an early diagnosis \in the health .betterment and service pro on all tuberculosis suspects, venereal dis-. grams-planned for the Commuhity ai large. eases, immunization for diptheria, whoop She contributes to the success'of <the better ing cough, smallpox, and other .contagious health program in. heir community, and and communicable diseases. The health de strengthens her\own position. We find the partment serves the industrial nurse by average worker inclined to listen to advice building up a strong health service in the on prevention of home accidents when we community and especially a strong" health can convince him that-they arevery costly education service. and cause' much unnecessary grief and- The industrial nurse can enlarge her serv trouble. Any agency which strengthens itr ices with'the men and women .in the in self strengthens all others as long as it keeps dustry for which she works by participating a cooperative attitude. * ; f* ' ADJOURNMENT n; If; 'Vs . * - ,y <j.