T h e judge asked me to explain what had happened. I told him about Sophie’s mental status exam; when she

was asked where the Middle East was, she said, “Isn’t that somewhere in New England?” He asked me what I’d done for her as a nurse, I told him that nursing is different from other health professions, that we do for others what they would do for themselves if they had the strength, will, or knowledge, and I told him about the escalator.

“She’s not good at abstraction,” I said. “For example, she can understand losing her check, bu t she can’t understand why saving money is bad.”

T h e judge’s eyes spun around. By now Sophie had fallen asleep in her chair. I continued.

“Look at her, Your Honor. She lives in a house that isn’t her own, she sleeps on a borrowed bed; even the clothes she wears aren’t her own. All she has to call her own are her checks. She grew u p in a time when people believed that if you had money in the bank you were somebody and you’d always be safe. Now we’re telling her it’s a crime.”

“Can you say this won’t happen again?” he asked. I assured him that the problem was a bureaucratic one,

that while she had been hospitalized the half-way house had not charged her for her room though they had held it for her, so she had simply saved the money.

Now that we knew what the situation was, we were on top of it.

H e ruled that she could keep her check and waived the repayment.

The court reporter returned and announced into the tape recorder, “Hearing adjourned a t 9:17 A.M.”

T h e judge turned to m e as he left the room and said, “Mrs. Schwartz, it’s good to know that there are people like you on earth.”

I replied, “There are a lot of people like me, Your Honor, and most of them are nurses.” 8

*Henderson, V. (1964). The nature of nursing. American Journal of Nursing, 64(8), 62-68. p. 63.

Dialogue To the Editor:

I was very pleased to read the contributions of both Drew and Kasch in the Summer issue of IMAGE (Vol. 18, No. 2). The profes- sional nurse is in an excellent position to establish that essential col- laborative nurse-patient relationship clearly described by Kasch and to maximize the positive aspects of nursing’s interactional influ- ence demonstrated by Drew.

One final point of clarification with regard to the nature of this collaborative relationship is necessary. Kasch refers in detail to the role of the professional nurse as “manager” of the collaboration effort. The American Heritage Dictionasy reminds us that “manage” may include the following definitions: “to exert control over; make submissive to one’s authority, discipline, or persuasion.” The dan- ger in this definition is clearly seen in the first phrases of Drew’s article: “Where there is an imbalance of authority and power, as in the patient-caregiver relationship. . . .” I propose that this assump- tion of unequal power bases between nurses and their patients must be corrected. For a collaborative effort to be truly a joint endeavor, patients’ knowledge of their own personal lived reality supports their possession of both expert and informational power. This power must be recognized and respected in all professional interactions. Furthermore, true patient advocacy mandates that nurses not only learn but also instruct their patients in the expert communications skills described. This will foster the patients’ maximal participation in a collaborative effort.

Barbara Lane, R.N., B.S.N. M . S. N. Candidate Duke University School of Nursing

To the Editor: I applaud Barbara Sachs’ scholarly approach to the issue of repro-

ductive decision making during adolescence (IMAGE, Vol. 18, #2). From a clinical standpoint, however, I feel the need to subject some points to further scrutiny.

The choice of the word “unwanted” in the second paragraph is a throwback to the limiting deviant behavior models. While most are

probably unplanned, many pregnancies which occur during adoles- cence are indeed “wanted’’ by someone (Rosenstock, 1980). Fur- ther, to assume that barriers to contraceptive services such as cost and accessibility of both clinical and health educational services have all been eliminated is naive and dangerous. In fact, the gap in access to education and services may explain why, with similar rates of intercourse, the U.S. adolescent pregnancy rate is significantly greater than in Western European countries and Scandinavia where contraceptive services are adequately accessible.

Urberg (1982) proposes a multi-dimensional model of problem solving which depends upon the adolescent’s ability to recognize a problem, motivation to solve it and capacity to generate, choose, evaluate and implement a solution. The intervening effects of the partner and other social structural variables, Uorgenson, King & Torrey, 1980) including the nature of the client/provider relation- ship (Nathanson and Becker, 1985) must also be accounted for. This multi-dimensional model would be more likely to capture the com- plex variables involved with reproductive decisions and behavior during adolescence. Theory and practice-based research are essen- tial; adolescent sexual decision making is not a simple issue.

Jane Tuttle, RN-C, M.S.N. Program Instructor Yale School of Nursing

References

jorgenson, S. R., King, S. L. , & Torrey, B. A. (1980). Dyadic and social network influences on adolescent exposure to pregnancy risk. Journal of Marriage and the Farnib, 42, I , 141-155.

Nathanson, C. A. & Becker, M. H. (1985). The influence of client-provider relation- ships on teenage women’s subsequent use of contraception. Amnican Journal of Public Hcalfh, 7 5 , I, 33-38.

Rosenstock, H. A. (1980). Recognizing the teenager who needs to be pregnant: A dini- cal perspective. Southem Mcdical J o d , 73,2, 134-136.

S d s , B. (1986). Reproductive decisions in adolescence. IMAGE: J o d of Nurring

Urberg, K. A. (1982). A theoretical framework for studying adolescent contraceptive SEhOlmhip, 18.2, 69-72.

use. Adohcmc, 17.67, 527-540.

176 IMAGE: Journal of Nursing SchofarSirip