1. Caboral, Meriam F. MSN, RN, NP-C

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I enjoyed reading the article "Preserving a Positive Image of Nursing in a Complicated Healthcare Environment" by Dawn Yetter in the March/April 2010 issue. I agree with the author's intent to preserve a positive image of nurses because the media doesn't always depict nurses' roles correctly. However, I have ambivalent feelings about what the acronym IMAGE stands for in the article: Introduction, Medications, Assessment, Goal, and Explain and Educate.

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I'm concerned about the ordering of the nursing care actions in this acronym. Does the acronym suggest that administering medication is more important than assessment, establishing and meeting patient goals, and educating? Furthermore, administering medication is the only nursing action that's explicitly identified. We, as nurses, need to understand that our primary function isn't administering medications. We're already so inundated with paperwork that we're becoming mechanical in our practice. When you hear a bedside nurse say she's trying to finish her shift, this probably means that she's completing paperwork. We must not forget that the major focus of our nursing care is the patient.


I believe an alteration to the acronym IMAGE could be:


I: Introduce (establish rapport)


M: Monitor/assess


A: Administer intervention or care


G: Goal achievement at the end of the shift


E: Educate and Evaluate outcomes.