JAPAN Nurses struggle to show that OR nursing is nursing
Text and photographs by Elinor S Schrader
When we visited Japan for the International Council of Nurses, we were anxious to talk with Japanese operating room nurses, yet we were not sure what to expect. Were they even called operating room nurses? Would their roles be similar to those of OR nurses in the United States? Would the level of their education and practice be comparable to that in the United States? During the week we were in Tokyo, AORN President Nancy Ertl, Assistant Director of Education Gwen Dodge, and I had a n opportunity to talk with several operating room nurses and to visit some hospitals. Two operating room nurses who had attended the AORN Congress in Anaheim-Utako Kubota, supervisor, and Sumiko Iihama, staff nurse-and Hiroyoshi Kobayashi, MD, arranged In her office, Utako Kubota, OR supervisor at Tokyo University Surgical Center, talks to us about OR nursing in her hospital.
for us to visit their Surgical Center a t the University of Tokyo Hospital and the National Children’s Hospital in Tokyo. Nancy Ertl also visited Kitasato University Hospital. Before the hospital tours, we spent an evening chatting with Mrs Kubota, Miss Iihama, Dr Kobayashi, and OR supervisors from two other Tokyo hospitals, Yasuyo Goto and Atsuko Ueno. Our conversation had to be translated, and our translator was Ken Hirata, who had attended the AORN Congress as Mrs Kubota’s interpreter. As manager of the international division of a surgical equipment company in Tokyo, he is knowledgeable of nursing and medical terminology. As we talked, we quickly discovered that operating room nursing in Japan is not so different. “We all seem to have the same problems worldwide,” commented Nancy Ertl, who had just come from the First Australasian Conference of Operating Room Nurses. The Japanese OR supervisors told us
AORN Journal, September 1977, Vol 26, No 3
50 1
As we entered the Surgical Center (above), we exchanged our street shoes for plastic slippers (left).
their biggest problem was convincing others that “operating room nursing is nursing.” In 1971, a change in the curriculum in nursing education eliminated operating room nursing in part as a result of the influence of Japanese physicians trained in the United States who advocated use of technicians or assistant nurses in surgery instead of registered nurses. “Those who work in surgery are trying to recapture the attention of nurses and physicians to convince them of the importance of OR nursing,” the supervisors said. Other nurses, they felt, did not grasp the real meaning of OR nursing. For instance, they may think the circulating nurse only does such tasks as weighing sponges. Younger nurses especially question whether “we are doing nursing.” 502
When we discussed the prospect of an international meeting for operating room nurses, the supervisors asked for programs on “What is OR nursing?’ so they could have information t o convince government officials to put OR training back into the curriculum. Such programs would also help their staffs begin to function on a less technical level. In Japan, the operating room team includes the operating physician, his assistant, scrub nurse, and circulating nurse. Both nurses and assistant nurses, who would be comparable to technicians, work in the OR and are assigned to the same functions. Only nurses can become supervisors or train others, but there is little distinction in Pay * Whereas nurses have a three- or four-year educational program, assis-
AORN Journal, September 1977, Vol.26, No 3
During a procedure at the Surgical Center, the sponge count hangs on the OR door (left).
t a n t nurses have a two-year nursing school course or a three-year health and nursing course in high school. The Japanese Nursing Association ( J N A ) is advocating the abolition of nursing assistants because of the quality of some education programs as well as decreasing interest among students. JNA believes that eliminating assistant nurses will raise the level of the Japanese nursing profession. As we discussed nursing education, the nurses told us that there is interest in formal graduate education, but few steps have been taken. There are some six-month courses for nurses who want to become supervisors or teachers. Before World War 11, nurses served primarily as assistants to physicians. But the US Army occupational officers in charge of nursing encouraged a n
education system t h a t would enable nurses to perform unique nursing functions. The 1948 Public Health Nurse, Midwife, and Nurse Law, which governs both education and practice, directs “ t h a t medical treatment and nursing should assume a balanced order of mutual cooperation.” Although the OR supervisors felt t h a t there was good rapport between physicians and nurses in some hospitals, especially the national hospitals, they acknowledged t h a t in other hospitals, cooperation and mutual support do not exist. “Doctors a r e not willing to back nurses,” they said. As we attempted to find out where Japanese OR nurses are in terms of applying the nursing process to OR practice, we asked whether they saw patients preoperatively or postoperatively. We learned t h a t in some of the
AORN Jimritcil, Septrrnher 1977. Vid 26. N o .3
503
Although the functions of registered nurses and assistant nurses in the OR are similar, only the RN can supervise.
newer hospitals, nurses did make preoperative visits, and nursing schools were teaching “that it should be that way.” When Nancy Ertl later visited Kitasato University Hospital, she learned that surgery patients are “given visits by nurses.” The supervisors expressed concern about keeping “the younger nurses as near to the patient as possible.” However, there did not appear to be any follow-up evaluation of surgery patients. We learned that although national university hospitals have recovery rooms, smaller hospitals do not, and not many hospitals have intensive care units (ICU). Nurses in the recovery room may “belong” t o surgery or to another department. A modern 1,050bed hospital, Kitasato has a n ICU with 17 beds and a coronary care unit with 4 beds. 504
The OR supervisors told us that they do not have nationally accepted standards for nursing practice in the operating room. Each hospital sets its own standards. Some of these have been published and other hospitals use them as references. Sterile supplies, the nurses told us, are handled in one of three different ways. Everything can be sent back to central supply, or instruments can be washed and packed before being sent to central supply, or everything can be done in surgery. At one hospital, the instruments are picked by central supply from a written requisition filled out by the surgeon. The director of surgery, who is a physician, has the ultimate say on sterilization, but the OR supervisor has input. The OR supervisor is responsible to the director of nursing, but the nurses
AORN Journal, September 1977, Vol26, No 3
I
Dr Kobayashi (left) explains why the use of disposables is limited. Above, Sumiko lihama and Nancy Err1 listen intently.
explained that they have a “dual responsibility” in that they also have to “talk to the doctors.” Supervisors cannot hire or fire, so they find it difficult t o get rid of poor nurses. With this brief introduction to operating room nursing in Japan, we visited the University of Tokyo Surgical Center. As we entered the operating room suite, we changed our street shoes for plastic slippers. Although we covered these with plastic shower-caplike shoe covers, we noted that others did not use the covers. We saw bare feet and sandals in the operating rooms. When we visited National Children’s Hospital in the afternoon, we exchanged our shoes for plastic slippers at the front door as is the old Japanese custom. The nurses wore neatly pressed scrub dresses, but we were supplied
with surgeon’s scrub suits that would fit the larger Western women. Although we were given disposable caps, the nurses wore cotton turbans. Later in the operating room, we observed that the surgical team wore gauze masks. At Kitasato University Hospital, the nurses did wear disposable caps and masks, but the drapes were cotton. Before touring the operating rooms, we talked over tea with Mrs Kubota, Miss Iihama, and Dr Kobayashi. Dr Kobayashi apologetically explained that the hospital was not modern, having been built 22 years ago. This presented, he explained, some problems in infection control. Questioned about the use of disposables, he said they use cotton drapes except with the laminar airflow system. He explained that the insurance
AORN Journal, September 1977, Val 26, No 3
505
At the entrance to National Children’s Hospital, street shoes are exchanged for special shoes.
system limited the use of disposable products because it would not reimburse the expense. Japan has national health insurance with private insurance available for extra coverage. For the 19-room operating room suite, Mrs Kubota has a staff of 47 nurses, six of them assistant nurses. Some have been on the staff as long as ten years. Because of the lack of OR experience in nursing school, it is difficult to get nurses to work in the OR. However, “because of her efforts,” Mrs Kubota is able to make a selection, Dr Kobayashi told us, complimenting her ability as a supervisor and teacher. The University of Tokyo is one of the few universities to have a school of At National Children’s Hospital, an emergency open heart procedure is performed on a 3-month-old infant.
These drums, no longer used in this country, are used to sterilize equipment, linens, and other supplies.
A O R N Jorrrnnl. September 1977. Vol 26, N o 3
507
At right, Shizue Kagawa, director of the nursing department, National Children’s Hospital, discusses staffing problems. Below, she shows us charts she keeps to convince the Ministry of Health of her staff needs. Holding the chart are Ken Hirata, translator, and Miss lihama.
nursing. The nursing course is three years, and during the second year, ten days are spent in the OR. Nurses’ salaries are generally considered low. A new graduate might make about $300 a month with two bonuses each year, one in the summer and the other in the winter, equal t o 2% months salary, which is customary in Japan. Vacations and holidays are generous and benefits include 12 weeks maternity leave for nurses. Miss Iihama pointed out that there is not much salary distinction between two- and four-year nurses. Four-year graduates usually go into teaching or work for the government. Better pay, the nurses suggested, might alleviate the shortage of nurses. Dr Kobayashi added that the “doctor is also poorly paid.” In government hospitals, physicians do not have any private practice. Increasingly, Japanese women are working after marriage, and nursing 508
is one of the most popular professions for women. Mrs Kubota explained that better working conditions, maternity leaves, and day-care centers encourage Japanese women to stay in the work force. Inflation also creates pressure for a second income. As we toured the operating rooms, we were impressed with some of their facilities. They had a laminar airflow room, an image intensifier, heart-lung machine, and most modern monitoring equipment. We were aware, however, that they were less advanced in aseptic practice. Here and at Kitasato Hospital, both the eye and orthopedic rooms have two tables so that cases can be scheduled immediately following each other. After lunch at the Old Boys’ Club a t Tokyo University, we drove t o the National Children’s Hospital in another section of the city. Shizue Kagawa, director of nursing, welcomed us with green tea and then showed us around
AORN Journal, September 1977, Vol26, No 3
the 400-bed referral hospital. This is the only national pediatric hospital in Japan, and the patients are primarily acute care patients under 6 years of age who stay from one to eight days. The hospital was built in 1965 and will be replaced by a new building to be opened in April 1979. When we toured the hospital, it was visiting day. Parents are permitted to visit one to three hours two times a week. On the coronary care unit, parents stood in a hallway separated from their infants by a glass partition. We asked about this later, and it was explained that one reason was infection control. In another unit, parents were able to be with their children. When we asked about the restricted visiting hours, which are much in contrast to the practice in the United States and many other countries, we were told they had conducted a survey to find out if parents wanted to spend the night with their children. Al-
though the physicians thought it was a good idea, we were told most of the families indicated they did not want to stay with their children in the hospital. Miss Kagawa said that some parents found it difficult emotionally. She also explained that with smaller, nuclear families, it is often difficult for parents to stay with children. It was pointed out that there are different kinds of hospitals, some with complete nursing and others where families are more involved. In rural areas especially, the family might spend more time with the patient. In the pediatric hospital operating room suite, 13 nurses staff four operating rooms. There will be nine operating rooms in the new hospital. There is a critical care room on each unit but no central ICU. Back in her office over coffee ice cream sodas, the director talked about some of her frustrations. Number one was probably staffing. Despite a case
AORN Journal, September 1977,V o l 2 6 , No 3
509
load that has almost quadrupled since 1965, there has been no increase in the number of nurses, who must do housekeeping and clerical work as well as nursing. Each nurse works one 44hour week plus 13 night shifts each month. Miss Kagawa eagerly showed us the charts she keeps to convince the Ministry of Health of the need to increase the number of staff positions. She has no assistant and “has to do everything herself.” She explained to us that there are no special courses for pediatric nurses and that the first year a nurse spends at National Children’s Hospital is primarily for training. “It is hard for the nurses who have to do their own jobs and train new graduates,” she commented. Despite the hard work
and the intense emotional aspect of working with acutely ill children, however, there is little turnover on her staff. “They are proud of what they do,” she told us. The special nursing care required by these patients is not reflected in any special pay. As we visited these hospitals and talked with these gracious and hospitable nurses, we were aware of the common concerns that Japanese and US nurses share. At the World Conference of Operating Room Nurses sponsored by AORN next October in Manila, operating room nurses from all over the world will be able to discuss, for the first time on an international level, the specialty of operating room nursing.
APHA to meet in October “Toward a national health policy” is the theme of the 105th annual meeting of the American Public Health Association (APHA), Oct 30 to Nov 3, in Washington, DC. The five-day meeting will have about 400 sessions. Speakers will include Congressional leaders; federal, state, and local government officials; spokesmen from labor, industry, and the private sector; and national health professionals representing over 45 disciplines in public health. About 200 sessions will be theme-related, with remaining sessions addressing a wide variety of topics related to personal, environmental, and social aspects of health. Eight special sessions on the meeting’s theme are scheduled for discussion by national health experts, legislators, and other public officials. Topics include 0 national health insurance vs national health service: a debate 0 aging-Congressional hearing on the problems that health care fragmentation causes for the elderly translating research into health policy and practice
510
environmental impact on human health human issues in health policy health policymakers and the process prevention and health promotio+viable alternatives a brighter world for those who live in shadows (meeting the needs of the handicapped). In addition to theme-related symposia, a varied program of sessions will report current findings in all areas of personal, environmental, and social aspects of health. For information regarding registration fees and housing, contact the APHA Convention Office, 1015 18th St, NW, Washington, DC 20036.
AORN Journal, September 197i, Vol26, No 3
Text and photographs by Elinor S Schrader
When we visited Japan for the International Council of Nurses, we were anxious to talk with Japanese operating room nurses, yet we were not sure what to expect. Were they even called operating room nurses? Would their roles be similar to those of OR nurses in the United States? Would the level of their education and practice be comparable to that in the United States? During the week we were in Tokyo, AORN President Nancy Ertl, Assistant Director of Education Gwen Dodge, and I had a n opportunity to talk with several operating room nurses and to visit some hospitals. Two operating room nurses who had attended the AORN Congress in Anaheim-Utako Kubota, supervisor, and Sumiko Iihama, staff nurse-and Hiroyoshi Kobayashi, MD, arranged In her office, Utako Kubota, OR supervisor at Tokyo University Surgical Center, talks to us about OR nursing in her hospital.
for us to visit their Surgical Center a t the University of Tokyo Hospital and the National Children’s Hospital in Tokyo. Nancy Ertl also visited Kitasato University Hospital. Before the hospital tours, we spent an evening chatting with Mrs Kubota, Miss Iihama, Dr Kobayashi, and OR supervisors from two other Tokyo hospitals, Yasuyo Goto and Atsuko Ueno. Our conversation had to be translated, and our translator was Ken Hirata, who had attended the AORN Congress as Mrs Kubota’s interpreter. As manager of the international division of a surgical equipment company in Tokyo, he is knowledgeable of nursing and medical terminology. As we talked, we quickly discovered that operating room nursing in Japan is not so different. “We all seem to have the same problems worldwide,” commented Nancy Ertl, who had just come from the First Australasian Conference of Operating Room Nurses. The Japanese OR supervisors told us
AORN Journal, September 1977, Vol 26, No 3
50 1
As we entered the Surgical Center (above), we exchanged our street shoes for plastic slippers (left).
their biggest problem was convincing others that “operating room nursing is nursing.” In 1971, a change in the curriculum in nursing education eliminated operating room nursing in part as a result of the influence of Japanese physicians trained in the United States who advocated use of technicians or assistant nurses in surgery instead of registered nurses. “Those who work in surgery are trying to recapture the attention of nurses and physicians to convince them of the importance of OR nursing,” the supervisors said. Other nurses, they felt, did not grasp the real meaning of OR nursing. For instance, they may think the circulating nurse only does such tasks as weighing sponges. Younger nurses especially question whether “we are doing nursing.” 502
When we discussed the prospect of an international meeting for operating room nurses, the supervisors asked for programs on “What is OR nursing?’ so they could have information t o convince government officials to put OR training back into the curriculum. Such programs would also help their staffs begin to function on a less technical level. In Japan, the operating room team includes the operating physician, his assistant, scrub nurse, and circulating nurse. Both nurses and assistant nurses, who would be comparable to technicians, work in the OR and are assigned to the same functions. Only nurses can become supervisors or train others, but there is little distinction in Pay * Whereas nurses have a three- or four-year educational program, assis-
AORN Journal, September 1977, Vol.26, No 3
During a procedure at the Surgical Center, the sponge count hangs on the OR door (left).
t a n t nurses have a two-year nursing school course or a three-year health and nursing course in high school. The Japanese Nursing Association ( J N A ) is advocating the abolition of nursing assistants because of the quality of some education programs as well as decreasing interest among students. JNA believes that eliminating assistant nurses will raise the level of the Japanese nursing profession. As we discussed nursing education, the nurses told us that there is interest in formal graduate education, but few steps have been taken. There are some six-month courses for nurses who want to become supervisors or teachers. Before World War 11, nurses served primarily as assistants to physicians. But the US Army occupational officers in charge of nursing encouraged a n
education system t h a t would enable nurses to perform unique nursing functions. The 1948 Public Health Nurse, Midwife, and Nurse Law, which governs both education and practice, directs “ t h a t medical treatment and nursing should assume a balanced order of mutual cooperation.” Although the OR supervisors felt t h a t there was good rapport between physicians and nurses in some hospitals, especially the national hospitals, they acknowledged t h a t in other hospitals, cooperation and mutual support do not exist. “Doctors a r e not willing to back nurses,” they said. As we attempted to find out where Japanese OR nurses are in terms of applying the nursing process to OR practice, we asked whether they saw patients preoperatively or postoperatively. We learned t h a t in some of the
AORN Jimritcil, Septrrnher 1977. Vid 26. N o .3
503
Although the functions of registered nurses and assistant nurses in the OR are similar, only the RN can supervise.
newer hospitals, nurses did make preoperative visits, and nursing schools were teaching “that it should be that way.” When Nancy Ertl later visited Kitasato University Hospital, she learned that surgery patients are “given visits by nurses.” The supervisors expressed concern about keeping “the younger nurses as near to the patient as possible.” However, there did not appear to be any follow-up evaluation of surgery patients. We learned that although national university hospitals have recovery rooms, smaller hospitals do not, and not many hospitals have intensive care units (ICU). Nurses in the recovery room may “belong” t o surgery or to another department. A modern 1,050bed hospital, Kitasato has a n ICU with 17 beds and a coronary care unit with 4 beds. 504
The OR supervisors told us that they do not have nationally accepted standards for nursing practice in the operating room. Each hospital sets its own standards. Some of these have been published and other hospitals use them as references. Sterile supplies, the nurses told us, are handled in one of three different ways. Everything can be sent back to central supply, or instruments can be washed and packed before being sent to central supply, or everything can be done in surgery. At one hospital, the instruments are picked by central supply from a written requisition filled out by the surgeon. The director of surgery, who is a physician, has the ultimate say on sterilization, but the OR supervisor has input. The OR supervisor is responsible to the director of nursing, but the nurses
AORN Journal, September 1977, Vol26, No 3
I
Dr Kobayashi (left) explains why the use of disposables is limited. Above, Sumiko lihama and Nancy Err1 listen intently.
explained that they have a “dual responsibility” in that they also have to “talk to the doctors.” Supervisors cannot hire or fire, so they find it difficult t o get rid of poor nurses. With this brief introduction to operating room nursing in Japan, we visited the University of Tokyo Surgical Center. As we entered the operating room suite, we changed our street shoes for plastic slippers. Although we covered these with plastic shower-caplike shoe covers, we noted that others did not use the covers. We saw bare feet and sandals in the operating rooms. When we visited National Children’s Hospital in the afternoon, we exchanged our shoes for plastic slippers at the front door as is the old Japanese custom. The nurses wore neatly pressed scrub dresses, but we were supplied
with surgeon’s scrub suits that would fit the larger Western women. Although we were given disposable caps, the nurses wore cotton turbans. Later in the operating room, we observed that the surgical team wore gauze masks. At Kitasato University Hospital, the nurses did wear disposable caps and masks, but the drapes were cotton. Before touring the operating rooms, we talked over tea with Mrs Kubota, Miss Iihama, and Dr Kobayashi. Dr Kobayashi apologetically explained that the hospital was not modern, having been built 22 years ago. This presented, he explained, some problems in infection control. Questioned about the use of disposables, he said they use cotton drapes except with the laminar airflow system. He explained that the insurance
AORN Journal, September 1977, Val 26, No 3
505
At the entrance to National Children’s Hospital, street shoes are exchanged for special shoes.
system limited the use of disposable products because it would not reimburse the expense. Japan has national health insurance with private insurance available for extra coverage. For the 19-room operating room suite, Mrs Kubota has a staff of 47 nurses, six of them assistant nurses. Some have been on the staff as long as ten years. Because of the lack of OR experience in nursing school, it is difficult to get nurses to work in the OR. However, “because of her efforts,” Mrs Kubota is able to make a selection, Dr Kobayashi told us, complimenting her ability as a supervisor and teacher. The University of Tokyo is one of the few universities to have a school of At National Children’s Hospital, an emergency open heart procedure is performed on a 3-month-old infant.
These drums, no longer used in this country, are used to sterilize equipment, linens, and other supplies.
A O R N Jorrrnnl. September 1977. Vol 26, N o 3
507
At right, Shizue Kagawa, director of the nursing department, National Children’s Hospital, discusses staffing problems. Below, she shows us charts she keeps to convince the Ministry of Health of her staff needs. Holding the chart are Ken Hirata, translator, and Miss lihama.
nursing. The nursing course is three years, and during the second year, ten days are spent in the OR. Nurses’ salaries are generally considered low. A new graduate might make about $300 a month with two bonuses each year, one in the summer and the other in the winter, equal t o 2% months salary, which is customary in Japan. Vacations and holidays are generous and benefits include 12 weeks maternity leave for nurses. Miss Iihama pointed out that there is not much salary distinction between two- and four-year nurses. Four-year graduates usually go into teaching or work for the government. Better pay, the nurses suggested, might alleviate the shortage of nurses. Dr Kobayashi added that the “doctor is also poorly paid.” In government hospitals, physicians do not have any private practice. Increasingly, Japanese women are working after marriage, and nursing 508
is one of the most popular professions for women. Mrs Kubota explained that better working conditions, maternity leaves, and day-care centers encourage Japanese women to stay in the work force. Inflation also creates pressure for a second income. As we toured the operating rooms, we were impressed with some of their facilities. They had a laminar airflow room, an image intensifier, heart-lung machine, and most modern monitoring equipment. We were aware, however, that they were less advanced in aseptic practice. Here and at Kitasato Hospital, both the eye and orthopedic rooms have two tables so that cases can be scheduled immediately following each other. After lunch at the Old Boys’ Club a t Tokyo University, we drove t o the National Children’s Hospital in another section of the city. Shizue Kagawa, director of nursing, welcomed us with green tea and then showed us around
AORN Journal, September 1977, Vol26, No 3
the 400-bed referral hospital. This is the only national pediatric hospital in Japan, and the patients are primarily acute care patients under 6 years of age who stay from one to eight days. The hospital was built in 1965 and will be replaced by a new building to be opened in April 1979. When we toured the hospital, it was visiting day. Parents are permitted to visit one to three hours two times a week. On the coronary care unit, parents stood in a hallway separated from their infants by a glass partition. We asked about this later, and it was explained that one reason was infection control. In another unit, parents were able to be with their children. When we asked about the restricted visiting hours, which are much in contrast to the practice in the United States and many other countries, we were told they had conducted a survey to find out if parents wanted to spend the night with their children. Al-
though the physicians thought it was a good idea, we were told most of the families indicated they did not want to stay with their children in the hospital. Miss Kagawa said that some parents found it difficult emotionally. She also explained that with smaller, nuclear families, it is often difficult for parents to stay with children. It was pointed out that there are different kinds of hospitals, some with complete nursing and others where families are more involved. In rural areas especially, the family might spend more time with the patient. In the pediatric hospital operating room suite, 13 nurses staff four operating rooms. There will be nine operating rooms in the new hospital. There is a critical care room on each unit but no central ICU. Back in her office over coffee ice cream sodas, the director talked about some of her frustrations. Number one was probably staffing. Despite a case
AORN Journal, September 1977,V o l 2 6 , No 3
509
load that has almost quadrupled since 1965, there has been no increase in the number of nurses, who must do housekeeping and clerical work as well as nursing. Each nurse works one 44hour week plus 13 night shifts each month. Miss Kagawa eagerly showed us the charts she keeps to convince the Ministry of Health of the need to increase the number of staff positions. She has no assistant and “has to do everything herself.” She explained to us that there are no special courses for pediatric nurses and that the first year a nurse spends at National Children’s Hospital is primarily for training. “It is hard for the nurses who have to do their own jobs and train new graduates,” she commented. Despite the hard work
and the intense emotional aspect of working with acutely ill children, however, there is little turnover on her staff. “They are proud of what they do,” she told us. The special nursing care required by these patients is not reflected in any special pay. As we visited these hospitals and talked with these gracious and hospitable nurses, we were aware of the common concerns that Japanese and US nurses share. At the World Conference of Operating Room Nurses sponsored by AORN next October in Manila, operating room nurses from all over the world will be able to discuss, for the first time on an international level, the specialty of operating room nursing.
APHA to meet in October “Toward a national health policy” is the theme of the 105th annual meeting of the American Public Health Association (APHA), Oct 30 to Nov 3, in Washington, DC. The five-day meeting will have about 400 sessions. Speakers will include Congressional leaders; federal, state, and local government officials; spokesmen from labor, industry, and the private sector; and national health professionals representing over 45 disciplines in public health. About 200 sessions will be theme-related, with remaining sessions addressing a wide variety of topics related to personal, environmental, and social aspects of health. Eight special sessions on the meeting’s theme are scheduled for discussion by national health experts, legislators, and other public officials. Topics include 0 national health insurance vs national health service: a debate 0 aging-Congressional hearing on the problems that health care fragmentation causes for the elderly translating research into health policy and practice
510
environmental impact on human health human issues in health policy health policymakers and the process prevention and health promotio+viable alternatives a brighter world for those who live in shadows (meeting the needs of the handicapped). In addition to theme-related symposia, a varied program of sessions will report current findings in all areas of personal, environmental, and social aspects of health. For information regarding registration fees and housing, contact the APHA Convention Office, 1015 18th St, NW, Washington, DC 20036.
AORN Journal, September 197i, Vol26, No 3
