DIALOGUE

IMAGE welcomes letters in response to Previously published articles. Letters should be addressed to the Editor, should be typed double-space and should not exceed two typed pages. The Sigma Theta Tau affiliation (ij applicable) of the letter Wn’ter should be noted. Anonymous letters will not be considered for publication, but names may be withheld upon request. In general, letters in response to articles published more than two issues previously will not be considered. The orignal authors may be asked to respond to letters.

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To the Editor: As staff nurses practicing in a pediatric general clinical

research center (GCRC), we read with interest your edito- rial, “On Mischief” (IMAGE, Fall, 1990). Many of your questions regarding nurses caring for patients participating in medical research are questions we have asked ourselves. Although we are usually able to resolve problem situations, the occasional clash over care leaves us reflecting on the role we play as patient advocates (first!) and the importance of medical research.

We are currently working on guidelines for care of pa- tients enrolled in a clinical research study as well as doing the preliminary work to study care dilemmas. Because of our mutual interest and your request for situations involving questionable research practices, we would like to share the following episode.

A three year old child was admitted for a fasting study in an effort to rule out hypoglycemic episodes. The investiga- tor was a physician with admitting privileges but without prior use of the GCRC and unknown to our staff. The original study was to involve a six hour overnight fast during which the child would be observed and blood work drawn if and when the child became hypoglycemic. When the child in question did not become hypoglycemic in the given time period, the investigating physician began to prolong the fast in small time increments. Although nurses advocated termi- nation of the study for this child, the parents believed that extension of the study was warranted because their physician explained it so. As the child got more hungry and nurses more adamant, the senior and attending physicians were notified, but without aid to ending the dilemma. (It should be noted that this was a weekend evening when the usual hospital resources - the IRB, the Clinical Director of the CRC, senior attendings -were not available). By evening, the child had been NPO for 24 hours, was hungry and distressed. Eventually, the nursing staff was able to convince

the investigator that the study needed to end for this child, and although he wanted to continue, he finally allowed [sic] feeding.

Some good did result from this incident. In addition to formal ethical discussions about the case, the line of respon- sibility for contact in these situations was made more clear, individualized protocols now have a standard form to be completed by the investigator which must be approved by the director of the GCRC, the nurse manager and a staff nurse, and a policy is in the works to set criteria for fasting studies.

We hope this is the type of event you were interested in hearing about. We, too, are researching the subject and find little written. If anyone can share any information with us, it would be greatly appreciated. Feel free to write, we would be interested in hearing your ideas.

Thank you. Cathy Murphy, RN, B.S.N. Kathy Vitale, RN, B.S.N. General Clinical Research Center Children’s Hospital 300 Longwood Avenue Boston, MA 02115 FAX: (617) 735-7429

To the Editor: I would like to correct an error in Swanson, McCloskey

and Modensteinger’s otherwise informative survey of nurs- ingjournals (IMAGE, Spring, 1991).

The notation in Table 1 that the Journal ofEmergency Nursingsolicits 95% of its manuscripts (we apparently inad- vertently noted that figure on the survey) is incorrect, as other data in the article reflect. Table 2 accurately notes that we received 70 manuscripts in 1988, that 40 of them were unsolicited, and that we have a 57% acceptance rate. S u b missions, as an aside, have almost doubled since then.

Apparently drawing from the 95% figure, the text then summarizes that several journals, ours among them “...are completely staff written, or publish only commissioned pa- pers.”

There may have been some confusion about how “solicit” was defined by the responding Journals (ours included) or by the authors. I notice that several other journals which strongly encourage unsolicited manuscripts are listed as soliciting high percentages while Nursing Clinics of North Am‘cuis listed as soliciting 0% but the number ofunsolicited manuscripts they publish is also noted to be “0”.

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