State Examination of Nurses

Kai Tiaki : the journal of the nurses of New Zealand, Volume IV, Issue 1, 1 January 1911, Page 11

State Examination of Nurses

G. W. A. Lester

The State examination of nurses took place on December 7th and Bth. There were 74 candidates, and 66 passed the examination. Of the eight who failed two were successful m passing the practical oral examination, and will only need to sit again for the written portion.

In connection with the oral examination m one centre, some extracts from the reports of the examiner are instructive : —

" They show at once the benefits and the limitations of institution training. I may illustrate my meaning by an example : One candidate when describing the after treatment of a certain operation, said the wound should be regularly irrigated with a very weak carbolic lotion. On my inquiring the strength she said she did not know exactly, as the lotion was supplied from the dispensary, and they added so much to a pint of water. It may be said that this is an isolated case, but as a matter of fact most mistakes were made m reply to the question of how to dilute stock lotions to a given required strength. There were really very few who did this quite accurately.

" Another section m which there was much inaccuracy was the urine analysis. Some few candidates were quite proficient ; but too many showed deficient observation of ordinary physical characters, such as colour, cloudiness, deposit, etc., and the probable inferences from its appearance. In particular, when shown a sample of cloudy urine, most candidates at once suggest that it may be phosphates. Few even seem to think of ordinary mucus. Most of the test work was of too mechanical a character, without realising the general underlying principles. But I have made due allowance for the fact that nurses naturally cannot be taught chemical physiology, and have not required a high standard of knowledge ; but I do think that many of them should cultivate habits of more accurate physical observation.

' In the questions dealing with instruments, splints, and other appliances ; preparation and after care of surgical cases and methods of general nursing, most of the candidates showed a very commendable degree of proficiency and intelligence. "

The State examination of nurses took place on the 7th and Bth of December, 1910. There were 73 candidates, out of which number eight failed ; two of these passed part of the examination.

The names of the successful candidates m order of merit are as follows : —

Clare Lambert, Wellington Hospital ; Mary Wilson, Christchurch Hospital ; Zaida Hair, Napier Hospital ; Lucy Hayward, Dunedin Hospital ; Susan Nicoll, Christchurch Hospital ; Ethel W. Taylor, Hawera Hospital ; Jane Miller, Southland Hospital, and Constance E. Cutforth, Auckland Hospital (equal) ; Flora Robertson, Wellington Hospital ; Mary E. Hobbs, Wellington Hospital ; Agnes M. Buttle, Wellington Hospital ; Mabel Stewart, Dunedin Hospital, and Veronica Marotti, Kumara and Napier Hospitals (equal) ; Constance Jenkins, Wellington Hospital ; Lily Eddy, Thames Hospital ; Jessie James, Wellington Hospital ; Eleanor D. Carter, Masterton Hospital ; Lucy J. Miller, Wanganui Hospital ; Maggie Risk, Auckland Hospital ; Catherine Ferguson, Dunedin Hospital ; Mary C. Duncan, Greymouth Hospital ; Maud Temple Brown, Wellington Hospital ; Mary E. Bryant, Wellington and Waipukurau Hospitals ; Edith Malcolm, Hamilton Hospital ; Ina M. Rolling, Wanganui Hospital ; Agnes Brodie, Wellington Hospital ; Ivy M. Smale, Hamilton Hospital, Adeline Gilmore, Auckland Hospital, Mary Mills, Christchurch Hospital, and Myrtle Galloway, Timaru Hospital (equal) ; Rebekah Takle, Nelson Hospital ; Georgina Dickson, Nelson Hospital ; Nellie E. McMaster, Auckland Hospital ; Winifred Scott, Christchurch Hospital ; Sara Graham, Christchurch Hospital ; Florence M. Gittens, Auckland Hospital ; Emily Hodges, Christchucrh Hospital, Rachel Henderson, Wellington Hospital (equal) ; Edith Edwards, Picton Hospital, Eliz. M. Williams, Auckland Hospital (equal) ; Kathleen Carter, Wellington Hospital ; Eva Wirepa, Napier Hospital ; Mabel Hamilton, Hokitika Hospital ; Ellen T. Gallagher, Auckland Hospital ; Rachel Neels, Waimate Hospital ; Cecily A. Dromgool, Auckland Hospital ; Marion C. Paterson, Gisborne Hospital ; Louie Tilyard, Wellington Hospital ; Margaret Samson, Oamaru

Hospital ; Annie Maclean, Dunedin Hospital ; Annie Clarke, Dunedin Hospital ; Lucy Atkinson, Hokitika Hospital ; Jean Jenkins, Ashburton Hospital ; Nellie Nickless, Riverton and Greymouth Hospitals ; Elizabeth Stothart, New Plymouth and Waipukurau Hospitals ; Frances N. Warren, Wellington Hospital ; Florence Gill, Gisborne Hospital ; Meliora Coffey, Picton Hospital ; Aileen Holmwood, Wellington Hospital ; Christina Campbell, Thames Hospital ; Joanna C. Lodge, Auckland Hospital ; Sybil Porter, Wanganui Hospital ; Florence Sugden, Wellington Hospital ; Catherine Walker, Stratford Hospital. The questions for the written papers were as follows : — surgical Nursing 7th December, 1910. Time : Three Hours. N.B. — Candidates are expected to answe r every question. Answers must be brie^ and to the point. 1. (a) What is meant by " asepsis," " antisepsis/ " sepsis ? ' (b) Give a list of some of the best known antiseptics, and the strengths m which they are most commonly used, and the symptoms which would lead you to suppose they are causing poisoning. 2. Give a brief outline of the after-treat-ment of a laparotomy case. 3. Briefly state the difference between a simple, compound, and comminuted fracture ; the special dangers to be guarded against m each, and how these dangers are best prevented. 4. Give a list of the instruments and materials usually employed m an operation for gastro-enterostomy. 5. (a) In what cases is rectal feeding employed ; (b) What are the ways this may be done ? (c) State the composition of a few nutrient enemata. Medical Nursing 7th December, 1910. N.B. — Candidates are expected to answer every question. Answers must be brief and to the point. Time : Three Hours. 1. Give the signs, symptoms, and nursing management of a case of rheumatic fever. What are the complications to be feared ?

2. You are away m the back-blocks, and some miles from a doctor. Give the line of treatment you would adopt m a case of (a) opium poisoning, (b) carbolic acid poisoning. What symptoms would lead you to a diagnosis of these conditions ?

3. What are the requirements of a good sick room ?

4. How would you guard against infection m (a) typhoid fever, (b) scarlet fever, (c) measles ? Enumerate the most serious complications that might arise m each of these fevers, and give the signs and symptoms by which they may be recognised.

5. You are on the spot when a man has an apoplectic seizure. Give the treatment you would adopt prior to the arrival of the doctor, and describe the nursing management of the case subsequently. In our next issue we hope to publish some comments by the examiners. Midwifery At the recent examination for the State registration of midwives the following pupils were successful m passing, and are now eligible to be placed on the Register. The names appear m order of merit : — Winifred Stubbs, St. Helens Hospital, Christchurch ; Eliz. M. Allen, St. Helens Hospital, Dunedin, and Annette Hetley, St. Helens Hospital, Christchurch (equal) ; Eliz. Ronald, St. Helens Hospital, Wellington ; Helen P. Every, St. Helens Hospital, Auckland, and Ethel Mclyachlan, St. Helens Hospital, Christchurch (equal) ; Myra F. Dickinson, St. Helens Hospital, Wellington ; Margaret Sinton, Salvation Army Home, Christchurch ; Sarah A. Harkness, Helen M. Berry, St. Helens Hospital, Auckland : Annie Barr}', St. Helens Hospital, Auckland, and Charlotte Marryatt, St. Helens Hospital, Dunedin (equal) ; Fanny Macdonald, Annie Angel, Henrietta B. Maberley, St. Helens Hospital, Auckland ; Rachel A. Anderson, St. Helens Hospital, Dunedin; Isabella Scott, and Mary 1,. Harrison, Medical School Maternity Hospital, Dunedin (equal) ; Clara Honeyfield, St. Helens Hospital, Wellington ; Amy Holmes, St. Helens Hospital, Auckland ; Frances ShirtclifT, St. Helens Hospital, Wellington.

The questions, and some comments by the examiner (Dr. Lester) on the papers sent m are published below. The examiner's remarks should be noted not only by the

nurses who went up for the examination, but by those who are now studying, and their teachers. — Editor.

Report on Answers to Questions m Paper on Midwifery, set December Bth, 1910. The paper was on the whole well answered, the answers giving evidence of careful training, and an intelligent appreciation of the important principles which underlie the art of midwifery. As is generally the case m paper work there was an undue eagerness to crowd m detail, but except m a few cases the real point of the question was grasped, and adequately answered. In all but a few papers the candidates seem to have realised the conditions suggested m the question, and to have met them with both commonsense and skill. To go more into detail — Question I. — " How would you guard against haemorrhage m the third stage of labour ; and how treat it if it occurred ? " This was well answered by nearly all. The primary importance of waiting for the detachment of the placenta before expressing it ; of expressing it only m the approved method ; of thoroughly emptying the uterus, and stimulating that organ to contract and keep empty, was grasped by all the candidates, and expressed m most papers clearly and well. The methods of dealing with P.P. haemorrhage when it occurred were also well dealt with, although m many of the best answers there was a tendency to lose sight of the fact that m P.P. haemorrhage there is no time for elaborate methods of meeting it. And there also seemed to be too great a tendency to conclude that the cause of P.P. haemorrhage is retained placenta fragment, and to introduce the hand into the uterus for their removal. It is only m rare cases that manual detachment of the placenta is called for ; and these cases, when they do occur, elaborate sterilisation of the hand is rarely possible when every minute is of value.

However, the answers to the second part of this question m the papers of those candidates who passed left no doubt m my mind that they would meet this grave emergency wisely and well.

[Note. — The great object of the teachers m the maternity training schools is to instruct nurses how to ptevent P.P.H., and so

successful is the teaching that the great majority of the pupils go through their whole training without seeing a case. A former examiner commented on the lack of practical knowledge of how to deal with this condition. These comments we must accept as a tribute to the teaching. — Ed.]

Question II. — " A patient sends for you when labour has just commenced :

How would you prepare (a) the patient, (b) the bedroom ? How would you ascertain if the labour was likely to be a normal one ? " The answers to this question were m nearly all cases good. There was scope for the introduction of much minute detail, which was taken advantage of to the full ; but the principles of emptying bladder and rectum, cleansing the patient, preparation of the bed, room, and apparatus on sensible lines, were all well and clearly set forth.

I was glad to see that most of the candidates realised how much valuable information may be gained by abdominal palpation m the early stages of labour, and to note that nearly all had been taught that a vaginal examination may only be made by a nurse with the express leave of the doctor.

On the other hand, many nurses neglected to mention the information which may be gained as to the future course of a labour from observing the character and frequency of the pains. Others laid undue emphasis on auscultating for the foetal heart-beat as evidence of foetal life. Nearly all erred through excess of zeal m stating that a nurse should wash a patient's hair ; scrub the floor and carbolise the walls and bed. These things may be counsels of perfection, but are neither possible nor desirable when labour has commenced. Question 111. — " The ' waters ' have broken prematurely m a first labour. What are the risks for (a) mother, (b) child ? How would you prevent a further escape of the ' waters ? ' This was a simple question, but was indifferently answered. The danger to the child of asphyxiation from pressure on the prolapsed cord was lost sight of by many, and there was a tendency to include under the heading of li risks for the mother J> every possible danger of a prolonged labour. Only a few gave a clear statement of the dangers which are definitely to be attributed to

premature rupture of membranes m a first labour.

Question IV, bearing on the treatment of the breasts when suckling a child is contraindicated, was well done by all candidates. Question V. — " What are the possible causes of delay m the first stage of labour ? "

In answering this question there was a tendency to enumerate without classification all causes of delay and all possible complications of labour m all its stages. In a few papers the causes of delay m the first stage were clearly tabulated m the order of their probable occurrence. It is important for nurses to realise that a question such as this is not meant merely to test their knowledge of a certain number of conditions, but to find out if they, faced by a case of delay m the first stage, would have m their minds a clear idea of the possible causes of that delay m the order of their probability. Question VI. — " What are the symptoms of (a) uterine inertia, (b) tonic contraction of the uterus ? What is the treatment of each condition, and what are the dangers of tonic contraction of the uterus ? J> This question was well done m six papers ; extremely well m two. In the rest there was much confusion between these two conditions, and m some papers grave mistakes

were made both m diagnosis and treatment, which if carried into practice might lose the patient her life. It is of the utmost importance for both doctor and nurse to realise the difference between uterine inertia and tonic contraction of the uterus. One condition — uterine inertia — has as its consequence harmless delay, and m most cases can be adequately treated by a skilful nurse ; the other — tonic contraction — if not recognised and promptly dealt with by a skilled medical man, may cost the patient her life. One condition entails practically no risk to the child ; m the other the life of the child is always endangered.

The treatment of the two conditions is absolutely different. Rest and delay, which m most cases cf uterine inertia is the wisest treatment, must m a definite case of tonic contraction end m grave disaster. On the other hand, immediate delivery of the foetus which is urgently called for m tonic contraction of the uterus, is the worst possible treatment for uterine inertia.

To sum up : The papers were on the whole good. Numbers 1, 20, 22, 7, 18, 16, excellent ; 23, 25, 9, 12, 24, 13, 19, 3, 21, 8, 25, good ; 17, 15, 4 showed sufficient knowledge to justify a pass; 26, 11, 10, 6 failed to obtain the necessary 50 marks to enable them to pass.