ALL O F U S H E L P E D In "Restraint-Free Care: From Dream to Reality" (May/June, p. 122), Con- nie Cheren, the director of the Office of Licensure and Certification of the state of Florida, was commended for almost single-handedly releasing more than 3,000 nursing home residents from restraints.

We feel the credit for this accom- plishment should be given to all the di- rectors of nursing, their assistants, and their concerned, hard-working staffs who had to educate each other and lis- ten to irate physicians and confused family members.

Ms. Cheren may have put the "in- dustry on notice" but we, the industry, "multi-handedly" removed the inap- propriate restraints.

THE NURSING STAFF Manor Care Nursing Center

Boynton Beach, FL

U N T I E T H E E L D E R L Y I am very interested in the program "Untie the Elderly'.' you wrote about in your March/April editorial.

I. would like to obtain more informa- tion on this program offered by The Kendal Corporation.

BARBARA KING, RN Director of Nursing

Delaware County Health Center Muncie, IN

Editor's Note: Information about the Untie the Elderly program is available

from The Kendal Corporation, P.O. Box 100, Kennett Square, PA 19348; (215)388-7001.

W I T H T U B I N G , P O S I T I O N IS E V E R Y T H I N G Catheter drainage tubing frequently does not stay in the' proper position for draining into the collection bag, espe- cially in residents in Geri chairs. Our solution is to use two self-adhesive

• hook-and-loop patches attached verti- cally on the side of the Geri chair. Use a 3-inch loop, place the tubing hori- zontally between the patches, and hold it in place with.the loop against the

patches. The adhesive patches should be

placed on the left side of the Geri chair, just below the armrest. The drainage bag is then placed toward the back of the chair in a privacy bag. This way the tray can be used without interfering with the catheter tubing, and the resi- dent may be in either a reclining or upright position.

TONI DERYKE, RN Quality Assurance Consultant

for Britwill Company Dallas, TX

A L W A Y S D O W H A T T H E P A T I E N T W A N T S In her Conflicts in Ethics column, "Is Giving Pain Relief Always Right?" (March/April 1990), Mary Lund de- scribes the patient as alert and able to articulate her wishes. Yet, when her condition changed (decreased respira- tions) and a new decision about her medication was necessary, there was no indication that either the patient or her family were involved in the deci- sion to give the morphine dose that might have a double effect. As written, this may be interpreted as a breach of informed consent.

In Step 3, the charge nurse is defined as the decision maker. What of the rights and responsibilities of the pa- tient and family?

In Step 4, it is noted that the nurse is expected to carry out the treatment de- sired by the patient. The wishes of the patient in this particular circumstance within the large picture of dying are not known. And, in Step 8, Ms. Black decides to give the extra dose in part due to the fact that she "feels very deeply that no person should die in pain."

This approach to decision making undermines the importance and ne- cessity of a patient's right to be in-

Agree or disagree with an article or editorial? Have a nursing tip or in- sight to share?. Write to us at Geriat- ric Nursing, 555 West 57th Street, New York, N Y 10019.

170 Geriatric Nursin~:J ulylAugust 1990

volved in the decisions that affect their life and death. Wouldn't another re- sponse to the situation be to present the facts and possibilities to the patient and family and let them express their explicit choice between pain relief and possible death?

KATHLEEN FREUDENBERGER, RN-C, MSN

Gerontological Clinical Nursing Specialist Shands Hospital at the

University of Florida Gainesville, FL

I N L O V E W I T H G E R I A T R I C S I walk into Room 254 and a pair of clear blue eyes surrounded by a wrink- ly face and soft curly white hair look at me and I smile and say "Good Morn- ing." As I run my hand across her shoulder, she smiles but comments "It's no fun growing old." I hug her and tell her that every year she has lived counts to me.

By my fifth year in nursing I knew gerontology was my love. The older patients need me and I sense it; I need them and I know they feel it. Our older adults can get lost in this shuffle of life. So many times we forget they need to be loved. They need to be hugged. They need to know that we're happy they're here and that we think they are very special people.

I'm thrilled that I became a nurse. I find more satisfaction seeing an older patient eat three-fourths of a well-bal- anced diet than receiving a new dress. I can't describe the warmth that comes over me when I hug an elder and he or she "clings" back to me.

I enjoy listening when elders talk about how things used to be, what things used to cost, and all the experi- ences they have had in their lives. I re- spect what they've learned. Whenever I can, I steal five or ten minutes I may not really have to pull up a chair an~ just listen. My heart is full and I'm at my happiest when I bring a smile to an elder's face--and they keep my smile shining.

DIANA PHILLIPS, RN. Geriatric Consultant

Jones, McCants, and Phillips, Inc. Detroit, MI