No abstract

Demographic, health, and psychosocial data from two studies are presented on military nurses assigned to Vietnam. Army nurse subjects in the first study were grouped for comparison on three major variables: assignment to Vietnam before versus after the 1968 TET Offensive, type of nursing duties performed, and years of experience as a registered nurse (RN) prior to assignment in Vietnam. The second study compared another group of Army nurses with a group of Air Force and Navy nurses also assigned to Vietnam. Army nurses with less than two years RN experience prior to their assignment were found to be more at risk for such negative outcomes as difficulty establishing personal relationships and difficulty coping with stressful situations. Stress experiences, career dissatisfaction data, and health problems of military nurses and their children are reported. Also described are positive experiences of nurses in developing personal relationships in a rewarding professional environment.

IN a cold environment, man, like other homeotherms, attempts to limit heat loss by reducing perspiration and increasing cutaneous vasoconstriction. Below a point termed "the critical environmental temperature," these heat-conserving measures become insufficient to maintain core temperature. Only when this "cooling state" is reached does a compensatory rise in heat production (i.e., metabolic rate) occur.8It is well documented that, when exposed, extensively burned patients have a greatly increased evaporative water loss and, therefore, an increased evaporative heat loss. It is also well documented that such individuals have an increased metabolic rate which correlates to some extent with their evaporative losses.5 A widely accepted hypothesis is that the two phenomena are causally related; i.e., the heat lost by evaporation from an extensive burn is so great that, like a man in an environment below his critical temperature, the burned patient is forced to compensate by increasing his metabolic rate. Explicit proof of this hypothesis, however, is not well documented.Frequently cited as supporting this hypothesis are studies in which blockage of evaporation by application of a waterproof plastic film to the burn resulted in a concurrent reduction in metabolic rate.9 11 These studies were reported for one burned rat and one burned patient, respectively. Unfortunately, the actual data describing the one patient's reduction in metabolic rate were not included in the publication. Other studies cited in support of this hypothesis offer evidence which is indirect and obtained from experimental animals.2 7The present study reappraises the hypothesis that increased evaporative heat loss is a major cause of hypermetabolism in burns. This was done by reducing evaporative water loss in burned human patients and observing the effect on metabolic rate. Materials and MethodsTwelve patients (Table 1) with thermal burns varying from 17.0 to 67.5%o of body surface area were studied. On two consecutive days, simultaneous determinations of rate of oxygen consumption and rate of insensible weight loss were made in each patient after equilibration under the following conditions:1. On one day, the burned areas were covered with Sulfamylon cream * and a * An antibacterial preparation containing 10% alpha-amino-p4toluenesulfonamide acetate; manu-

No abstract