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By examining and predicting dimensions of job satisfaction of community-based nurses, this study sought to provide information for recruiting and retaining community nurses. Data were collected from a sample of 104 community health, school health, and home health nurses. Prestige had the highest positive correlation with and was the single significant predictor of job satisfaction. Three other subscales, autonomy, social interaction, and organizational requirements, correlated with job satisfaction as moderately positive. Weak positive relationships were found with years of work, years on the job, age, and years of education. Pay was not associated with job satisfaction for these nurses.

The resources of motivation and knowledge that make the nurse a valuable support to the new mother initiating breastfeeding are needed again, equally as much, as the nurse prepares the mother for self-care at home and remains available for counseling afterwards. There are general guidelines for promoting continued breastfeeding success and for avoiding potential problems. The nurse should be familiar with these and with how to proceed in special situations and with specific breastfeeding problems. “Self-Care for Continued Breastfeeding” and “Some Breastfeeding Problems and Solutions”, presented below, end the series on breastfeeding begun in the July/August issue. The advantages of continuing breastfeeding beyond the neonatal period are reviewed and general guidelines for selfcare at home are discussed. Developmental changes in the instant and psychological and physical changes in the mother are outlined and related to breastfeeding success. Advice for working mothers and for weaning is also presented.

The principles and techniques of prenatal assessment and preparation of the breasts for breastfeeding are discussed. A section on teaching self care skills during the early postnatal period follows and includes the importance of early attachment, guidelines for initial feeding, and tips on positioning and suckling patterns. A discussion of nutrition during lactation concludes Part IV.

To test the effectiveness of two topical treatments in preventing and treating sore nipples, eleven breastfeeding primigravida women applied lanolin cream or tea bags on one breast in the immediate postpartum period. The subjects' treated breasts served as the experimental group; the contralateral breasts served as the control group. Following delivery, a baseline of nipple soreness was recorded and treatment was begun. Nipple soreness ratings were recorded twice daily by the subjects from the third to the eighth day postpartum. Nipple soreness for both groups peaked on the fourth day postpartum. When nipple soreness ratings of the untreated and treated breasts were compared using a t-test, no significant differences were found. Use of these agents neither prevents nor reduces nipple soreness.

The major anatomical structures of the lactating breast are identified and related to the psychophysiologic mechanisms of lactation. Hand expression of breast milk is explained in a practical manner and some causes of lactation dysfunction are described.

The Therapeutic Intervention Scoring System (TISS) was evaluated as an instrument to determine appropriate use of an air medical program (AMP) from a retrospective standpoint. TISS scores of 376 consecutive patient transports to the sponsor institution were compared to two other methods of judging appropriateness of air transport: a chart review and a review of patient outcome which included length of hospital stay, need for emergency surgery, mortality rates, and Trauma Scores. Statistically significant correlations were found between the TISS and the other two methods. We concluded that the TISS is a valid instrument for use in determining the appropriateness of air medical transports. The TISS is used as a quality assurance tool during retrospective, bi-weekly patient review sessions; and follow-up on appropriate use of the helicopter is provided to referring and receiving agencies accordingly.

One of the great medical advances of the past decade has been the scientific validation of the importance of species-specific milk. This "discovery" has led to a growing general awareness of the value, during the first year of life, of the milk of the baby's own mother for optimal physical and emotional development. These benefits of breastfeeding may last a lifetime. The need to understand and assist the mother in maintaining this relationship presents a major challenge to the nurse. Beginning with this issue of JOGN and continuing in two subsequent issues a series of six articles is being presented that gives an overview of breastfeeding, from historical perspectives to specific problems nursing mothers may encounter. The initial installment consists of "Infant Feeding Patterns Past and Present" and "The Anatomy and Psychophysiology of Lactation." Following in September/October and November/December will be "The Biologic Specificity of Breast Milk," "Preparation for Breastfeeding and Early Optimal Functioning," "Self-Care for Continued Breastfeeding," and "Some Breastfeeding Problems and Solutions." The cultural pattern of breastfeeding in ancient and contemporary cultures are compared, and changes during the Industrial Revolution that led to the decline in breastfeeding are outlined. Also described are the consequences of the trend away from breastfeeding in Third World countries and current breastfeeding patterns in the United States.