nursing management. J Nurs Adm.

9. Baretich, D.M., and L.B. Anderson 1987. Should we d iagnose strengths? No: Stick to the prob- lems. A m J Nurs. 87:1211-16.

10. Popkess-Vawter, S., and N. Pin- nell. 1987. Should we diagnose strengths? Yes: Accentuate t h e positive. A m J Nurs. 87(9):1211- 16.

11. Stolte, K.M. 1986. Nursing diag- nosis and t h e childbearing woman. MCN. 11, 13-15.

12. Neeson, J.D. 1987. Clinical manual

16(12):39-42. of maternity nursing. Philadelphia: J.B. Lippincott.

13. Lunney, M. 1982. Nursing diag- nosis: Refining the system. A m J Nurs. 456-59.

14. Baccalaureate Curriculum Sub- committee School of Nursing, The Catholic University of America. 1978. CUA-Systems adaptat ion model. 2nd ed. Washington, D.C.: Catholic University.

15. Hoffnung, M. 1984. Motherhood: Contemporary conflict for women. In Women: A feminist perspective,

(Letters continued from page 305)

Ethical Voices

I agree with the contents of your editorial “The Ethical Voice of Nursing-I Can’t Hear It, Can You?” (May/June 1988). We must confront disturbing issues to pro- tect the public.

I am writing to share with you the information that at our health center, three members of the Ethics Committee are nurses. These three voices are heard. I urge other health-care facilities to give attention to the experience and knowledge of their nurses.

PATSY CHRISTEN DUKE, RN Creve Coeur, Missouri

Unpublished Preterm Infant Stimulation Papers Sought

Intense interest in preterm in- fant stimulation has been gener- ated during the last few years. Much of the interest is a result of the poor cumulation of research findings, and the commonly held belief that the environment in which these infants are placed is not conducive to optimal growth and development. Thanks to NAA- COG and the University of South Alabama, funds have been secured to conduct a meta-analytic inves- tigation in this area. Meta-analysis examines data generated from

3rd ed., ed. J. Freeman, 124-38. Palo Alto, California: Mayfield.

Address for correspondence: Karen A. Stevens, R N , MSN, FNP, The Catholic University of America, School of Nursing, Washington, DC 20064.

Karen A. Stevens is an assistant professor at the Catholic University of America School of Nursing in Washington, D.C. Ms. Stevens is a member of NAACOG, Sigma Theta Tau, and the National League for Nursing.

various research reports to arrive at meaningful conclusions. The meta-analytic method suggests that unpublished research be ob- tained for data analysis in addition to published studies. Therefore, the purpose of this letter is to so- licit from JOCNN readers any un- published studies on preterm in- fant stimulation in which a control and experimental group were used. All correspondence should be directed to Deborah Nelson, R N , MSN, Assistant Professor, University of South Alabama, Col- lege of Nursing, Mobile, Alabama 36688. Your cooperation in this matter is greatly appreciated.

DEBORAH NELSON, RN, MSN Mobile, Alabama

Nipple Tenderness and Breast Massage

Gail Blair Storr’s article, “Pre- vention of Nipple Tenderness and Breast Engorgement” [May/June 19881 brought several questions to mind for me. I applaud her moti- vation to increase breastfeeding duration by decreasing the inci- dence of soreness. Nipple rolling can certainly increase graspability and make the mother more com- fortable handling her breasts. This technique may also promote bet- ter latching on technique, which would decrease nipple trauma. However, promoting manipulation

of the nipples prenatally may dis- suade many mothers from breast- feeding. Storr points out that all her subjects were biased in believ- ing that preparation would help. Perhaps the recommendation should be to teach preparation ex- ercises to mothers who desire to do so, not all pregnant mothers.

I am concerned at the emphasis on prenatal exercises to prevent soreness, as opposed to ensuring correct breastfeeding technique. We have had a significant de- crease in the incidence of nipple soreness since our hospital adopted probreastfeeding prac- tices, such as immediate suckling, unlimited access to the breast, the elimination of supplementation, and the elimination of duration of nursing rituals. Although I see some value in nipple rolling, the use of a towel concerns me. Fric- tion removes the keratin layer. It is pressure that forms calluses that protect the skin.

Regarding prevention of en- gorgement, 1 am puzzled as to why the author had the subjects mas- sage their breasts after feedings. Since massage is widely used to stimulate the milk-ejection reflex, it seems that massaging the breasts before feedings would be more effective. In her article, Storr makes no mention of the fre-

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336 September/October 1988 JOCNN