Once again I find myself apologizing to faithful readers. It was rather shocking to wake up one morning and find my nursing web sites, projects that had been coddled and nurtured for a long time, suddenly evaporated into the limbo of the virtual world. Thank you to the many emails and faxes voicing concern about the web pages.

Why did this happen? My old Internet Service Provider (ISP) decided to move all the web pages on their server to another location, and claim they mailed everyone with this information months ago. Well, I never received that information, nor could I find it on their support website. Thus the old TNT site sank into sudden oblivion. Not unlike waking up in Florida and finding all your personal belongings had been shipped to Omaha during the night. Yes, I CAN laugh now!

The good news? Change can be a wonderful thing! I had vowed if I ever had to move my website again it would be to its own domain, a location that would never change even if I decided to change servers. Thus KATSDEN.COM was created and registered with the Internic. Please note that the preferred e-mail address for communication with TNT is tnt@katsden.com This change will bring stability to TNT and all my nursing websites. So go ahead and bookmark it, knowing it won't be finding a new home again!

Enjoy the June/July edition of TNT, at its cozy new home...and I hope you feel it's better late than never. As I'm working hard updating the new website, expect to see the ezine back to a monthly status for August 1st. And enjoy your summer!

Prostate Problems

By Tony Dombroski RN BSN, Contributing Editor

Now that reports are in that there has been a decrease in the incidence of prostate cancer deaths, it might be a good time to examine the prostate as it presents to triage/advice nurses and seek a better understanding of the anatomy/pathology of this gland. It is my feeling that our work in encouraging frequent checkups and exams may in some way be responsible for the decrease in mortality. The experts say that better diagnosis and screening i. e. finding the problem early while it is curable is the reason for the declining numbers. The importance of the development and use of the PSA blood test can also be thought to contribute to that decline.

Since we've mentioned PSA lets start with a discussion of just exactly what we can know from measuring levels of Prostate Specific Antigen. It is widely thought that PSA is a blood test used to screen for the presence of prostate cancer. More specifically PSA is a protein found in the serum that is unique or specific for the prostate. An 'antigen' protein, it stimulates the development of antibodies. Your liver or adrenal glands can't malfunction somehow to make your PSA rise, therefore the 'specific' in the name. We are not tasked to rule out other diseases when we measure a rise in the PSA. The normal prostate cell holds onto most of the PSA and lets very little leak into the blood stream. The small amount that does leak out is what me measure in the blood stream. We measure therefore the integrity of the prostate cells, how well they are hanging onto this chemical PSA.

We know from examining prostate cancer cells that they have less PSA in each cell than a normal prostate cell. However prostate cancer cells tend to leak more of this chemical into the blood stream hence the correlation with elevated PSA levels and prostate cancer. Current studies lead us to believe that a level of 4.0 or less is expected in men with normal prostate glands (normal to digital rectal examination). The "gray" word in all this explanation however is "normal". Any condition with inflammation of the prostate (prostatitis) can cause the PSA to rise. Most men with mild chronic prostatitis have no symptoms but PSA leaks out of the cells causing those individuals to have a higher 'than expected' serum PSA level. Even a simple rectal exam can cause the PSA to rise somewhat.

What this means is that the PSA is NOT a cancer measurement, and that an elevated PSA does NOT mean you have cancer. The only test that will determine the presence of cancer is to examine tissue recovered from a biopsy of the prostate gland. This means that it is possible to have a "HIGH NORMAL PSA". High empirically because the number is higher than expected and normal because adequate work up has been done to rule out any presence of suspicious nodules. This work up may include digital rectal exam, trans-rectal ultrasound with or without specific or random biopsies.

With a normal rectal exam and the luxury of serial PSA determinations we can forecast better the portent of these values. PSA will almost always rise in the face of growing cancer. A yearly surveillance PSA level of 15 over a three year period (15,15,15,) is probably at less risk than a PSA level of 2,3,4 over the same period. The rising PSA has to be suggestive of growing cancer versus the stable high level that has had adequate work up to rule out cancer possibly including biopsy. If the level of 15 jumps to 20 or 25 with no related symptoms then repeat work up would be indicated. Recent studies suggest that a 20% rise in PSA in one year should set off the alarms to look more closely with a possible ultrasound and biopsy.

So let's pause a moment and reexamine our discussion so far. The major points applying to triage are that one needs to be able to in a convincing and understandable way explain PSA. Examine the above discussion until you understand it well enough to win an argument with a caller who believes that because he has high PSA he has cancer and is going to die. It is necessary to be confident enough of your understanding of PSA to address simultaneously the fear of death, fear of treatment, negative thought patterns, cultural misinformation issues while still making the point that diagnosing prostate cancer is much more involved than ONE blood test determination.

In the above postulated scenario we also need to include a sensitivity to issues surrounding rectal examination. These may include but are not limited to homophobia-macho continuum of delusional thought (falsely held belief), the Freudian underworld connection to anal control issues, the general male disdain for medical care specifically submission to violation and loss of control. Our challenge then when confronted with a patient statement "I'd die first before I let someone shove things up me!" is to recognize both the necessity of this belief and the necessity of possibly suspending that belief temporarily to save one's life. As both an advice nurse and a clinical screening Sigmoidoscopist I know well those long looks and slow words that indicate a patients reticence to undergo our procedures. Whatever your method to gain trust and influence the acceptance/compliance of patients is, I can not stress enough how vitally important it is for you to do so. In my mind subtly addressing the undercurrent of compliance resistance is a part of the foundation of the success of triage/advice. In this way we resemble advertising in that we create the idea for the necessity of a product or service. Trust me on this one, selling a refrigerator to an Eskimo is easier than selling a yearly screening rectal exam to any guy like me in the 40+ age range. We want to buy power tools.

So the problems affecting the prostate fall into three categories. Many of the symptoms are similar if not exactly the same. It behooves us then in our role as advocate to know the categories of prostate disease and methods used to determine the differences so as to help our clients to prepare for and understand the importance of these diagnostic modalities. The three categories of prostate disease are: 1. Prostatitis, an acute or chronic, bacterial infectious or non-bacterial inflammation of the prostate. 2. Benign Prostatic Hyperplasia (BPH) , the nonmalignant growth of the prostrate gland that is responsible for blocking the flow of urine out of the urinary bladder. 3. Cancer of the prostate, the most common type of cancer among American men and the second leading cause of cancer deaths among them. It's estimated that one out of every 10 American men will develop prostate cancer before age 85.

A discussion of what the prostate is and what it does is essential in teaching our clients about this part of their body. The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the bladder. Because of it's location it is palpable with a finger inserted in the rectum. What we feel is the back surface of the prostate through the wall of the rectum. Digital rectal exam never touches the prostate directly but feels the inside surface of the rectum as it overlies the prostate. The prostate is quite small (it weighs only about an ounce) and is nearly the same size and shape as a walnut. In my practice I find that it is most helpful to describe the prostate as a teensy donut shaped gland thereby the conceptual necessity of having a hole in it is introduced. When this donut swells therefore not only does the outside get larger but the hole in the donut gets smaller. This usually brings an "Aha a" of response indicating that the patient grasps the concept of why he has difficulty urinating since the hole in the donut has swollen shut and the urine leaves via the urethra which passes through the donut hole. Most illustrations show the prostate as it wraps around the urethra. Be sure to validate the words you use to describe anatomical structures. When you say urethra follow with, "the tube that carries urine from the bladder out through the tip of the penis".

The prostate is made up largely of muscular and glandular tissues. Its main function is to produce fluid for semen, which transports sperm and also increases their chance for survival in the vagina. During the male orgasm (climax), muscular contractions squeeze the prostate's fluid into the urethra. Sperm, which are produced in the testicles, are also propelled into the urethra during orgasm. This sperm-containing semen leaves the penis during ejaculation shortly followed by the urge to smoke a cigarette and fall asleep. Since this paragraph has deteriorated into humor let's have a word about this issue.

Many of you know how special the relationship you develop on the phone with a client can be. Emotional, fearful, inspiring, instructive are a few adjectives describing this meeting of minds. In our attempt to be significant, humor often helps to address the nature of cognition as it often presents as the "human comedy", accepting the inevitable with a shrug and a smile. I can not stress strongly enough how careful you must be in developing a familiarity with a caller/patient. A failed attempt discredits your professional knowledge and credibility. Conversely a scientific lecture in an "out of the box" demeanor diminishes the humanity of the service we perform and can easily be replaced by a good reference book. So it is a fine line we walk when invited into someone's life in a role involving trust and confidence and a shame when the questions of a human heart and mind are answered with only cold naked facts of science. Nursing translates science into humanity. Remember the sacred nature of this human interaction includes a smile as well as a tear.

**********

OK Back to the topic. The first of the three categories above, prostatitis, is itself divided into further categories. We define prostatitis, again, as inflammation of the prostate. This inflammation is further divided into three subcategories.

• Acute infectious prostatitis is caused by bacteria and is treated with anti microbial medication. Acute infectious prostatitis comes on suddenly, and its symptoms, including chills and fever and inability or difficulty urinating are severe. Often a visit to your doctor's office or the emergency room is necessary.
• Chronic infectious prostatitis is also caused by bacteria and requires anti microbial medication. Unlike an acute prostate infection, the only symptoms of chronic infectious prostatitis may be recurring bladder infection.
• Non infectious prostatitis is not caused by bacteria its cause is not known. Anti microbial medications are not effective for this type of prostatitis but other treatment modalities are available.

Prostatitis is not a sexually transmitted disease. Further discussion of the treatments available and diagnostic tests involved can be viewed at the reference sites listed below.

**********

The second big category of prostate disease is Benign Prostatic Hyperplasia, the nonmalignant growth of the prostrate gland. Prostate development and growth changes at various hormonally controlled stages. The prostate remains small after birth and then grows to adult size as reproductive ability develops at puberty. At about age 45, the prostate often starts growing again and, in some cases, can continue to enlarge for the rest of a man's life. It's generally accepted that this growth later in life is influenced by hormonal changes.

Not every man develops an enlarged prostate, and, in those men who have the condition, it's not always progressive. However, a major medical study showed that 4 out of 10 men over age 55 have an enlarged prostate. The number jumps to 7 out of 10 in men in their 70s; by age 80 it's even higher.

The symptoms commonly associated with an enlarged prostate are frequent urination, especially at night, or the sudden, almost uncontrollable urge to urinate. In the early phase of prostatic enlargement, the bladder muscle has to force urine through the narrowed urethra by contracting more forcefully. Gradually, this forcing causes the bladder muscle to become stronger, thicker, and overly sensitive creating the need to urinate more frequently

The treatment of BPH is a complex and involved subject. For a thorough discussion of the vast array of treatment modalities please view the reference sites listed below.

**********

The third major category of prostate disease is prostate cancer. In the very early stages of prostate cancer, there usually are no symptoms. When symptoms do develop, they vary according to the size and location of the tumor, and are often the same as those for benign prostate conditions. Early detection and treatment increase the chance of a cure so it is vitally important that any symptoms reported be properly investigated diagnosed and treated by a physician to determine for sure whether the condition is cancerous or benign. Encouraging compliance therefore become a very important component of our task as advice nurses. An exhaustive discussion of prostate cancer can be viewed at the reference sites listed below.

To review then, the symptoms of prostate problems include:

• Weak or interrupted urine flow
• Inability to urinate
• Difficulty in starting or stopping urination
• Need to urinate frequently, especially at night
• Blood in the urine
• Painful or burning urination
• Continuing pain in lower back, pelvis, or upper thighs

Unless you are a urologist, the prostate doesn't come up in casual conversation often many of our caller/clients know little about this internal organ. Many men are prompted to learn about it because they have heard that men over age 50 are more likely than younger men to have "prostate trouble." They may also have noticed changes in their urinary habits that have made them wonder, "Is something wrong?" or "Should I see my doctor?" Hopefully you will now be better able to teach/inform them about those diseases and symptoms that indicate prostate problems.

**********

For further information about prostate disease please visit these sites:

• The Prostate Center of South Florida has a thorough discussion of topics touched on in the above essay. Please visit and read in depth the discussion of treatments available for all the above prostate problems.
  Go to: http://www.netpoint.net/prostate/index.html

• Dr Ivo Tarfusser discusses chronic prostatis in great detail. Although the logo looks like a mosquito head from outer space, you will find that the illustrations and discussion of anatomy and physiology will lend an understanding of exactly why the prostate is prone to the condition chronic prostatis.
  Go to: http://www.parsec.it/summit/p0.htm

• The National Institute of Health posts a page describing BPH. Although the illustrations are somewhat crude compared to the above site, this public domain fact sheet is freely reproducible for handout to your patients.
  Go to: http://www.niddk.nih.gov/ProstateEnlargement/ProstateEnlargement.html#pros

• The Male Health Center was founded in 1989 by Dr.. Kenneth A. Goldberg, a board-certified urologist. Dr.Goldberg created the center because there was a need to provide men with an integrated system of care that addressed all their needs. This is a site linking to all sorts of information on all sorts of concerns surrounding the topic of male health.
  Go to: http://www.malehealthcenter.com/

• For my CEU credit course on prostate problems, currently available at my website...
  Go to: Nurseone select "List of courses available" and follow the links from there. This is my home page so sign in the guest book one way or the other.

**********

Hope this has been instructive and fun.

Tony Dombroski RN BSN
E-mail at Nurseone@nurseone.com

Visit Tony's NurseOne Website at: http://www.nurseone.com
where you can find interesting articles, links and CE courses related his GI advice specialty.

Men's Health on the Web

By Kathi Webster BSN RN, Editor

National Men's Health Week was celebrated from June 9-15 in 1997, with the last day being Father's Day. The goal was to raise national awareness among society and especially among men, of the importance of preventative health behavior in the early detection and treatment of health problems affecting men.

According to 1994 statistics, the average man dies sooner than 6 years before a woman in the United States. Leading causes of death in men include: heart disease, cancer, accidents, stroke, obstructive lung disease, pneumonia and flu, HIV infection, suicide, diabetes, homicide, cirrhosis, and injuries. In all these categories, men are effected more often than women.

Even more concerning, men have fewer contacts with their physicians over their lifetime than their female counterparts, although some female visits can be attributed to birth control and pregnancy. It is well known by nurses who staff health or advice lines that the largest percentage of their callers are women, calling about themselves or their families. Realizing that men may make fewer contacts with the health care system, special efforts should be made to promote programs geared and marketed specifically toward men, addressing their high risk health areas.

Where can you find resources specific to Men's Health on the Internet? In fewer places than I suspected -- I had to dig deep. To continue briefly on where Tony left off in his excellent article on prostate problems, I did locate an additional prostate web site that is worth mentioning. The Medical Pages on Rattler offers Prostate Pointers maintained by Gary Huckabay along with other important and related resources. Good work!
Medical Pages at Rattler --> http://rattler.cameron.edu/medical.html

Moving on, Tulane University has a small section on Men's Health via their web page geared toward student health. However, it more closely resembles Sex Ed I, focusing on describing the male anatomy in some detail. Helpful perhaps to students, but less so to a health professional -- unless you missed those required labs. The college fraternity group Sigma Alpha Epsilon has a web page focusing attention on their Men's Health Issues Committee. This group has created workshops and modules that address Alcohol and Substance Abuse, Sexual Responsibility, AIDS, Diversity, Racism, and Ethics and Values.
Sigma Alpha Epsilon --> http://www.rpi.edu/~wittej/SAE/Orgs/mnhealth.htm

Duke University's Healthy Devil has a nice presentation of four problematic areas in men's health: erectile dysfunction, premature ejaculation, testicular self exam, and urinary tract infections in men. Excellent information -- although I did wonder if the use of a banana in their illustration of the topics was a new form of Internet censorship or simply for the student amusement factor.
Healthy Devil/Men --> http://h-devil-www.mc.duke.edu/h-devil/men/men.htm

Luckily I came across this next site before coming to the conclusion that all of men's health had to be focused on the genitalia. Men's Health Magazine is a hardcopy publication with a fit and trim web page. Feature sections include: Ask Men's Health, Ask the Sex Doctor, Daily Tips and more. Geared toward being fit and eating well, this pro-health magazines looks fit for a king.
Men's Health Magazine --> http://www.menshealth.com

The MEDIC site [aka Medical Education Information Center at University of Texas - Houston Medical School ] has a section on Men's Health Issues that deals with heart health and cholesterol issues, along with the now infamous prostate gland (thanks Tony).
Mens Health at UTH --> http://dpalm2.med.uth.tmc.edu/ptnt/00000391.htm

Hidden within the pond of the Internet is the Reservoir, from the Medical Reporter... one Joel R. Cooper, a medical/healthcare writer/reporter and pre-med student at The University of Denver. In his Men's Health section are several articles -- the best instructing men how to select a primary care doctor.
Reservoir --> http://www.coolware.com/health/medical_reporter/indx.html

Holy Name Hospital in Teaneck New Jersey serves up a nice, concise chart called the Men's Guide to Health Tests and Screenings, clearly listing how often to have what part checked. And their testicular self-exam is concise and properly illustrated (sans banana).
Guide for Men --> http://www.holyname.org/patinfo/mensguid.htm

Any form of sexual abuse can be horrifying to the victim. The website Sexual Abuse of Males, the focus is on prevalence, lasting effects and resources on the sexual abuse of boys and the lasting effects of childhood sexual abuse in the lives of men. Jim Hopper MA is a Ph.D. candidate in clinical psychology and does a wonderful job presenting this information.
Sexual Abuse --> http://www.jimhopper.com/male-ab

How men handle grief and bereavement (along with the associated stress) are focal points for two sites. First, Tom Golden's Crisis, Grief and Healing website, packed with resources including Swallowed by a Snake: The Gift of the Masculine Side of Healing. Another site, the Bereavement Research Network hosts a private forum where men can share concerns, wounds and insights.
Tom Golden --> http://www.webhealing.com
Bereavement Research Network --> http://bereavement.org

I had originally planned as a final note to include here links to resources on male baldness. In celebration of Father's Day and as a final note to all men reading this...with or without hair...we love you the way you are.

May you live long and healthy lives.

Men in Nursing

Do real nurses wear caps?

ANSWER: No. Most nurses don't wear caps anymore, at least in the U.S. Not only do they get caught in IV tubing, smack against overhead monitoring equipment, and generally cause a nuisance from falling bobbypins, many modern nurses find them archaic remnants of the lost world of handmaiden nursing. Besides, they look strange with a crew cut. [collected comments from nurses chatting in #4Nurses]

• Bruce Wilson shares an online slideshow entitled The Story of Men in American Nursing.
  Men in Nursing --> http://www.geocities.com/Athens/Forum/6011/index.html

• The American Assembly for Men in Nursing. The objectives of this organization includes encouraging men to become nurses and join with other nurses in strengthening and in humanizing health care. They support those men already in nursing and the education of society to the benefits of men nurses. In addition, they advocate for men's health issues and enhance nursing by increasing the visibility of men in the profession.
  AAMN --> http://www.ajn.org/ajnnet/nrsorgs/AAMN/

• An interesting CE offering article entitled Nurse Executive Characteristics Gender Differences is offered at the Springhouse site in the December 1996 online issue of Nursing Management.
  CE article --> http://www.springnet.com/ce/m612a.htm

Words of Advice - Red Alert!

• All telephone triage nurses and interested parties should be continuing to watch carefully the website of the National Council of State Boards of Nursing. Their Multistate Regulation (MSR) Task Force has issued a Special Communique as of June 1997. To quote:
  

  "The National Council contracted with TVG Inc. to conduct qualitative, structured interviews of 40 thought leaders in health care, including representatives from managed-care organizations, demand-management companies and large university health care centers. Most respondents have few nurses who practice in multiple states, although they may contract with an out-of-state company to provide telephone advice services. While demand-management companies surveyed employ nurses who speak with patients in many states, they do not seem concerned about these nurses having licenses in states other than the one in which they are situated, largely due to the way they define nursing practice."

  "The task force has developed a draft definition of telenursing to clarify when advice provided via phone is nursing practice: Telenursing is the practice of nursing over distance using telecommunications technology. Telenursing occurs at any time nursing skills and judgments are used to address the needs of a specific health care client."

  This definition and decisions related to multi-state licensing could effect many advice nurses working in large organizations that take calls from patients from multiple states.

  To voice your opinion on the importance of multi-state licensing and telenursing, and to receive updates on the task force activities, send your name and address via e-mail to msr@ncsbn.org. And pass the word along to your colleagues, NOW.

Letters to TNT

Readers should feel welcome to respond directly to any letters with e-mail addresses provided

Dear TNT

We are searching for the right candidate to work at a high level in a health care corporation in the New York City Metropolitan Area. The person selected for this Nurse Educator/Executive position will have a strong background in clinical nursing, and proven experience in nursing education, especially in curriculum development. Masters level of education is a must.

The position requires residence or relocation to the New York City Metropolitan area. Qualified and seriously interested candidates please contact:
Peter Ramme RN (805) 682-1470 please leave message or email- peter@silcom.com
Or write: PO Box 3307, Santa Barbara, CA 93130-3307

Please include a phone number where my associate or I can contact you. This corporation is highly interested in finding the right Nurse for this position as soon as possible.

Thank you,
Peter Ramme RN

**********

Dear TNT

I am an advanced practicing registered nurse seeking a career opportunity in telephone nursing. I have a strong clinical background in health information services (maternity and general health information) that were marketed to several large companies via 1-800 numbers. I would be interested in any opportunities in the Maryland/DC suburban areas.

Please email me at ericlauramarshall@msn.com

Signed,
Laura Marshall MS, RN

TeleNursing Organization

According to e-mail I have received, there is still much interest from TNT readers in a NEW nursing organization devoted entirely to Telephone Nursing.

There is a group of nurses currently working on forming such a specialty organization. This would be an organization that IS NOT part of any existing nursing organization. Instead would be an effort to recognize that telephone nursing occurs in many different specialties but is united in its approach: using the telephone as a primary tool in health care education and advice by nurses.

If you have an interest in either working with or joining such an organization, there is now a special e-mail address JUST for that correspondence.

Send your name and level of interest to ITNA@katsden.com

Many of us involved in this new organization plan to meet at the WASHINGTON DC conference planned by Contemporary Forums listed below on November 6-8th. Information will be available *at the conference* as to the exact meeting place. It will be on Friday Nov. 7th at 5:30pm, right after the conference adjourns for the day, in the same hotel. Please, if you are attending this conference and want to be included in the preparation for the meeting, include that in your e-mail to me.

I look forward to hearing from all of you! ...Editor TNT

Selected Conferences

Contemporary Forums - Telephone Triage Conferences
When/Where: September 28-30, 1997 in Seattle WA
October 12-14, 1997 in St. Louis, MO
November 6-8, 1997 in Washington DC
Intended audience: all telephone triage practitioners, no matter what the setting,HMO, Home Health, ED, Public Health, Community clinic or office. For nurse entrepreneurs, system managers and administrators
For more information contact: Contemporary Forums at (510) 828-7100
URL at: http://www.cforums.com
*****THIS IS A CONFERENCE THAT IS NOT TO BE MISSED
BY ANY TELEPHONE NURSES! THE BEST!**** [Editor's comment]

PSA - People Seeking Answers in Prostate Cancer
A special prostate cancer symposium is planned for the patients and their families.
When: September 12 & 13, 1997
Where: Westin Hotel, Renaissance Center in Detroit Michigan
What: A patient- focused event presented by nationally recognized medical authorities on prostate cancer discussing the pros and cons of all available treatment modalities and, What to do if treatment fails.
Sponsored by: Crittenton Hospital Prostate Center and supported by the American Cancer Society, Man to Man, Us Too, PAACT, and ECPCP
For more information contact the Crittenton Prostate Center at (248) 652-5611
URL at: http://www.cancernews.com/conferences/

IBC USA is proud to announce the following 2-day conference:
Facilitate Communication Between Patient, Provider and Payor through Interactive Health Care Web Sites
When: July 24-25, 1997
Where: Washington, DC
What: In-Depth Coverage from: United HealthCare Corp, Kaiser Permanente, PacifiCare of Oregon, InteliHealth, SmithiKline Beecham Pharmaceutical, Greenstone Healthcare Solution on the following topics:
*Interpreting visitor stats to measure ROI of internet marketing
*Analyzing legal status of conducting business in Cyberspace
*Collect and analyze risk factors through on-line assessment
*Employ information from state and federal regulatory agencies
Plus, an exclusive pre-conference workshop - "Using the Intranet to Facilitate Information Flow in a Health Care Environment"
For more information, visit http://www.ibcusa.com/conf/healthnet
Or for a full conference brochure, contact Jonathan Gerson at: jgerson@ibcusa.com

[Some conference information is obtained directly from the Web. The editor of TNT is not responsible for any errors related to conference detail and all information should be confirmed with conference directors]

Internet On the Line

Life isn't Safe

The National Safe Kids Campaign Online represents the first and only national organization dedicated solely to the prevention of unintentional childhood injury-the number one killer of children ages 14 and under. Fact sheets are available on 16 different type of childhood injuries..from airway obstruction to toy injuries. A family safety checklist is available online, where you can check YOUR safety factor!
Safe Kids --> http://www.safekids.org

July Heats Up

The USA CityLink 4th of July site helps you get in the right festive mood! For international readers, on July 4, 1776, the US claimed independence from England and gave birth to a democratic society. Now the 4th is a US national holiday featuring great food at barbecues, dazzling fireworks and parades, and general insanity in the heat of the American summer.
CityLink July 4th --> http://www.usacitylink.com/usa/

Sheer Smear

Recently I was asked for an Internet resource on abnormal PAP smears, and had to do some searching for a good resource. The Pap Exam: It Can Save Your Life page is in the public section at the web site of the College of American Pathologists. Excellent material worth surfing to!
Pap Smear Info --> http://www.cap.org/html/public/pap.html

Yankee Doodles

A wonderful website about New England is brought to you by Yankee Publishing Inc, better know for Yankee Magazine and Farmer's Almanac. Whether a resident of New England or just wanting to know more, you'll find this site entertaining. And an appropriate pitstop around July 4th...!
New England --> http://www.newengland.com

Humor in FrontLine Stories

Split Screen Personality

I am the Lead Behavioral Specialist on a 24-hour Behavioral triage line, within a department of triage Nurses. Our phone number was one digit off from a 24 hour computer help line, so we were forever getting wrong numbers from people who had computer problems.

One night, a gentleman called in quite upset that his computer kept flashing a light at him. The counselor asked many of the typical questions, How often does this happen? Are you under any particular stress? ... When she asked him if he was alone when it happened, he replied, "My wife is sitting right here." She then asked to speak to his wife and went forth with the same type of questions, How long has your husband been having this problem? Does he have a mental health history?

It wasn't until she talked to the wife that they discovered the gentleman was not psychotic, but rather they had called the wrong number and gotten a behavioral crisis line!

They later said they wondered why a "computer help line" would need to know about their mental health history.

Submitted by Jennifer e-mail: jenv@samaritan.edu

Employment Line

==Florida==

All Children's Hospital in St Petersburg FL is seeking RN's for their telephone triage program which is currently setting the clinical standard of excellence for Pediatric services. This position offers RNs the opportunity to manage after hour pediatrician office calls providing education, information, guidance, emotional support, and counseling.
For more information contact: Wendy Smith RN, Nurse Recruiter at 813-892-8222. Resumes may be sent to All Children's Hospital, Human Resources, 500 6th Street South, POB 31020, St Petersburg FL 33731-8920.

==Texas==

JOB TITLE:SUPERVISOR, PHYSICIAN REFERRAL SERVICE
JOB ORDER NUMBER: UCHOTX01
SALARY RANGE: $40,000 - $50,000 / ANNUM
WORKSITE: HOUSTON TX
JOB STATUS: FULL-TIME HIRE WITH BENEFITS
POSITION SUMMARY:
This position is for a healthcare professional who will provide specialized physician referral information to all callers needing additional information about member physicians and facilities for making appointments. The position requires a high degree of proficiency in simultaneous multiple task operations and projects with self-initiated follow-through.
REQUIRED QUALIFICATIONS:
The ideal candidate will have a high degree of experience setting up and managing a physician referral call center and communicating with physicians and health plans. Associate’s or Bachelor’s degree required; advanced degree preferred. RN or LVN preferred, however, strong non-clinical or other clinical candidates with strong call center experience will be considered.
PREFERRED QUALIFICATIONS:
Advanced degree, RN or LVN licensure, Texas
Contact us for specific information on position responsibilities.
Reply to:
ScienStaff, Inc., 7007 Gulf Freeway, Suite 239, Houston, TX 77087, 713/640-1929
or e-mail: ssihouston@aol.com

==Utah==

Come and ski Utah while working for a busy and rapidly expanding 24 hour call center.
IHC TeleHealth Services is part of Intermountain Health Care (IHC), which is widely known for its community based health information, triage/referral service. IHC TeleHealth Services has expanded into facilitating personal health management across the health care continuum for IHC Health Plan members in Utah, Idaho and Wyoming, while maintaining our community service line. IHC TeleHealth Services answers between 1100-1400 calls per day.
We are currently hiring RNs for full and part time evening positions. Both these positions are benefit eligible. Minimum qualifications include a current Utah RN license with a minimum of 3 years high acuity nursing experience. Must enjoy working with people on the telephone. Must be able to sit for extended periods of time and talk while typing with few errors.
Send all inquires via E-mail to aajcall@ihc.com or call Jan at 801-978-4045.
Please include your name and phone numbers where you can be reached.

== AZ, CA, CO, IL ==

Access Health, Inc: With call centers in Sacramento, CA, Phoenix, AZ, Arlington Heights, IL and Broomfield, CO, we are a leading provider of consumer information and referral programs for the health care industry. Since 1986, our employees and products have been satisfying consumers' needs for the information necessary to make appropriate health care decisions. Our registered nurse counselors utilize our telephone-based products to provide reliable medical information, and help consumers find appropriate health care within a network of programs and services. We believe that when individuals are empowered with information about the condition their options and the resources available to them, they can make enlightened decisions before seeking treatment. Opportunities exist in a variety of shift options for Registered Nurses with exceptional communication skills. You must have a current license in the state you desire to work, with a minimum of 5 years acute care experience, and basic computer and typing skills. In return for your expertise, we offer you competitive salaries with shift and weekend pay differentials and premiums for holidays. If you're interested in joining a nursing team that is focused on contributing it's talents for a healthier population, give us a call or send us your resume.
Our job line is 800/246-5627. Or you may fax your resume to (916)856-3680. Our corporate headquarters is located at 11020 White Rock Rd., Rancho Cordova, CA 95670

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[EDITORS NOTE: All employment opportunities have been submitted directly to the Editor of TNT for inclusion. Please check with the manager or recruiter listed for all details and job requirements. TNT takes no responsibility for verifying information submitted. Applicants must deal directly with listed "reply to" or inquiry contacts. There is no fee charged for posting employment desired or available, but submissions must be of an acceptable size and format for the ezine.]

Can't Get Enough on Telephone Nursing?

Review Previous Issues of TNT

August 1996 - Introductory Issue
September 1996 - Featuring: OB Telephone Nursing
October 1996 - Hospice and Telephone Nursing
November 1996 - Telephone Nursing and Seniors
December 1996 - Special Holiday Issue
January 1997 - New Year, New Approaches [Telenursing/Telemedicine]
February 1997 - Spring Ahead!
March 1997 - Marching Forward
April/May 1997 - Celebration of Nursing

The Web Page

The Telephone Triage Nursing Web Site is at http://www.katsden.com/telenurse/index.html

Next months topic:
Summertime

WANTED!

Submissions of interest to Telephone Nurses in all occupations and environments. Preferred material is from Registered Nurses, Physicians and other health care professionals currently involved in the specialty.

Require all submissions by the 10th of the month for next issue inclusion.

Check out TNT Submission Guidelines

The contents of The WEBster's Telephone Nursing Telezine MAY be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording in information storage or retrieval systems, provided that all mention to TNT is maintained, the file is shown in it's entirety, no modifications whatsoever are made, and educational use is intended. This DOES NOT includes the option to "mirror" this web site or store copies at another Internet location. Photographs, graphics or inline images are not be used seperately from the publication in which they are imbedded nor download/modified for seperate use. This publication may NOT be sold or used in commerical publications or ventures without specific permission of the Editor. Mention of the existence and location of this web site and ezine in a commerical venture is acceptable and encouraged.

Telephone Nursing Telezine
is published on the Internet at:
http://www.katsden.com/tnt/index.html Copyright © Kathi Webster, 1996, 1997. All rights reserved.