Handbook of School Health

Journal of Advanced Nursing, 1993, 18, 2015-2019

BOOK REVIEWS

Economics of Health Care Financing: The Visible Hand by Cam Donaldson & Karen Gerard. Economic Issues in Health Care Series, Macmillan, London, 1993. 166 pages, £14.99, ISBN 0-333-53870-6 (pb).

At a time when finance and economic issues are becoming increasingly important to those who deliver health care, books explaining these subjects have proliferated. This text aims to explain how ideas of markets in health care, delivery systems and government interven- tion in health care have been enacted throughout the world. Considerable attention is given to the workings of markets, alternative methods of health care funding, and the economic objectives of health care. A large amount of empirical data are presented to detail thesuccesses (and failures) of worldwide approaches to managing health care financing.

The text is well written and generally free from econometric complexities. Plenty of clear examples are presented which make the concepts readily accessible to the non-specialist reader. The strength of this book is in its clear accounts of how markets do and don't work when considering health care. Yet the discussions of economics convey a cold and unsympathetic view of health which perpetuates stereotypes. Doctors are seen as major players in the management of health care financing and important contributors to 'supplier-induced demand'. Control of physicians and their costs are therefore a high priority in any policy of cost-containment; however, viewing doctors and other health care groups as perpetrators of rising costs fails to take into account the profession- alism and the moral standing of practitioners.

Some simplistic models of the behaviour of individuals during times of health and illness are presented, and generaliz- ations are made that funding mechanisms that ensure free care at the point of delivery or private insurance schemes

lead to over consumption. Such approaches fail to take into account that some people may also consider the needs of others, thus introducing some element of self-limiting demand for care. This book does attempt to take into account some philosophical aspects of health care funding, considering the needs of equity of access for equal need and progressive financing based upon ability to pay, but it has little to contribute to the discussion of wider ethical and finance issues such as what price a life is worth.

United Kingdom readers will be dis- appointed that the timing of this publication has not permitted a detailed discussion of trusts, funding-holding general practitioners and contracting from an economic and market perspective. Despite these reservations, this book offers good accounts of essential economic principles being used throughout the world to manage health care financing. It has also collected together empirical evidence about the effectiveness of various health care delivery systems from many different countries, making it a valuable text for inter- national comparison. Much of this book could be used for undergraduate-level nursing and health courses, and it is strongly recommended as a text for libraries.

Stephen J. Cavanagh RGN MS MPA PhD

Professor of Nursing, and Head of Division of Health and Nursing Studies,

University of Wolverhampton

Lecture Notes on Ger~trics 4th edn by Nicholas Coni, William Davison & Stephen Webster. BlackweU Scientific Publications, Oxford, 1993. 242 pages, £12.95, ISBN 0-632-03369-X.

The 1980, 2nd edition of this book is an old and valued friend of mine. I am pleased to have had the opportunity to see this new edition. I am a little uncom-

fortable with the title, but the term 'geriatrics' is used correctly here. The authors are at pains to point out that 'geriatrics' is a medical speciality concerned with the dinical, preventive, re- medial and social aspects of illness in el&fly people (and is not a term referring to old people in general). The text is intended primarily for doctors and as- sumes a basic medical competence. It aims to provide a concise but comprehensive and practical guide to the medicine of old age.

The early chapters discuss the role of geriatric medicine and broader issues concerned with ageing; a contextural education in which to aid the under- standing of sick old people. Chapters 6 to 10 look at the major areas of difficulty experienced by sick older people, e.g. disability and rehabilitation, falls and im- mobility, locomotor diseases, and there is a chapter entitled q'he Ageing Brain,' which includes the dementias, depression and other psychiatric conditions.

Chapters 11 to 17 look at the diseases of the major systems and the final chapters cover cancer, blood and sensory disorders, medical and surgical treatment and finally death and dying. There are 10 useful appendices. The presentation is very clear, and the tables, figures and shaded inserts are helpful. The occasional cartoons serve to underline important issues.

I am pleased that ethical dilemmas are addressed, if briefly. 'Cranking up the health of flail elderly people from the fourth age to the third age is a blessing, but from the fifth age to the fourth age is by no means necessarily so' is nicely illustrated on p. 35. This is a topic that is very important, that needs much more informed and thoughtful public and professional consideration. Coni and his colleagues have long been advocates for older people. They understand that medical conditions are only part of the picture. They give every indication of recognizing that 'the elderly' are actually

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Book reviews

very various individuals in differing social contexts.

I do have some reservations. I couldn't find even a passing reference to ethnic minority elders, of whom there are now increasing numbers. I think that is a weakness. Nor do I think this edition is quite so accessible as the second; the audience focus seems to have narrowed and it is shorter. The language seems to have become more technical and I am sorry about that. Although I believe this book will remain useful for a wide range of health professionals, sick and frail older people are increasingly dispersed 'in the community' as the authors ac- knowledge. Therefore, continuing care locations of all types need an accessible practical reference to help carers respond appropriately and sensitively, e.g. when faced with sudden confusion or changed sleep patterns.

The further reading lists are up to date though often minimal. But the authors are cavalier in the body of the text in their lack of specific reference to cited surveys: for example, p. 29 on abuse. Where do they get their evidence? Nev- ertheless, this does remain a useful, concise, practical text: helpful, often invaluable (sometimes with the aid of a medical dictionary) to all professionals who provide services to older people.

Janet James DipCOT SROT BA(Hons) PGCE MA

Course Leader, ~'ISc in The Care of Elderly People,

Institute of Nursing Studies, University of Hull

Library and Information Services to Sup- port Project 2000. British Library Research and Development Report 6088. Nursing Library Information Services phase I. Capital Planning Information, Stamford, Lincolnshire, 1992. 138 pages, £19.90, ISBN 0906011-85-X.

In his foreword to this important report, Tony Shepherd, the project director, sets out the background to its development, design and implementation. The much quoted part of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting's (UKCC) Project

2000 Report in 1986 is the assertion that 'The status quo is not an option' for nursing. Yet the provision of good library and information services to support its implementation has received less attention in discussions about resources in subsequent validation discussions.

This report covers the work of a project funded by the British Library and commissioned by the Royal College of Nursing. It surveyed library provisions in colleges of nursing and midwifery throughout the British Isles as Project 2000 was being implemented. The over- whelming response to the survey con- firmed the concern of institutions about the inadequacy of provision for the preparation for practice. It provides a comprehensive coverage of the background and evolving development of Project 2000 and its subsequent implementation in 1989.

This report sets into context the source of much of the concerns often expressed on validation visits to colleges of nursing and midwifery and institutions of higher education providing the higher education diploma linked qualification for the courses. It demonstrates that the amalgamation of schools of nursing and midwifery to form colleges was perhaps haphazard and was seriously constrained by regional bound- aries. The effect of this on links with higher education--a crucial require- ment for the implementation of Project 2000- -was not adequately addressed. The resulting support for library and information services for students was therefore seriously undermined from the outset.

There are eight sections in the report covering background issues, method- ology, patterns of provision, strategic planning, curriculum development, organization of colleges and funding. The final section takes a prospective look at future developments and offers a chal- lenging agenda for action.

The findings from this survey and those arising from recent research on implementation of Project 2000 in England suggest that much remains to be done by the national bodies. As a member of validation panels to many institu-

tions which implemented the programme between 1989 and 1992, I have been impressed by the demonstrable efforts made to ensure that students receive the support they need from the institutional libraries but the needs of large numbers of students on Project 2000 programmes inevitably impose severe demands on available resources. The newly consti- tuted UKCC has an opportunity to ad- dress many of the issues highlighted in this report. Although many colleges are now fully integrated into higher education institutions, it cannot be assumed that library and information services will necessarily meet the needs of students as adequately as they should do. This partly a result of the service-led ethos dominat- ing nursing education contracts at all levels and partly due to the current economic stringency which affects higher education funding.

This is not a report to be left on the shelf. It should be the subject of discussion in every institution now that Project 2000 is fully implemented throughout the country.

Justus A. Akinsanya PhD BSc RGN ONC BTA Cert RNT

FRCN FWACN FRSH Pro Vice Chancellor and

Academic Dean, Anglia Polytechnic University

Review of Repetitive Strain Injury: The Keyboard Disease by Edward Huskisson. Charterhouse Health Series, Charter- house Conference and Communications, London, 1992. 98 pages, £10.00 (incl. p&p), ISBN 0-9519807-0-X.

The presentation of the book is eye- catching, although three females on the front suggest that it is a gender injury, when many men now also spend long periods at a computer keyboard. It is a very good explanation of the repetitive strain injury process and it is clearly presented and easy to read. It is not a book aimed at the professional but the information is interesting to read and looks at the injury from a physiological and psychological perspective.

The book is well illustrated with dia- grams and cartoons, large print and

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Book reviews

double spacing made for easy reading and assisted in reducing my repetitive eye strain which I am sure is akin to RSI. We are told quite amusingly that RSI has been documented since the ancient Egyptians. Reading the explanation, I don't wonder that we all have it.

Chapter 5 on occupations at risk listed everyone who was at risk from RSI, but omitted to mention nurses. I found this interesting as RSI is causally linked to backpain in nursing staff, following re- peated lifting and inappropriate clothing. It is believed that as much as 40% of back injuries in nursing staff could be attributed to RSI.

The chapter on ergonomics was particularly good, with clear explanations and guidelines on how to avoid RSI. I recommend the book for its clarity and easy reading style, as well as a useful manual on how to avoid RSI.

Margaret Dobson BA MSc RGN SCM DipN RNT ONC

Regional Nurse Advisor (Education), Northern Regional Health Authority

Handbook of School Health 17th edn edited by Peter McWilliam. Trentham Books, Stoke-on-Trent, 1992. 236 pages, £18.95, ISBN 09480663.

This book represents the official publication of the Medical Officers of Schools Association. It is written primarily for school medical officers in independent schools, maintained schools and board- ing schools. It seems a great pity that school health in the public sector is not included and that the role of the school nurse appears so little understood in this publication.

The book comprises 10 informative chapters given comprehensive coverage on a range of preventive child health issues. The opening chapters focus on the responsibilities of medical officers and preventive medicine in schools. Other chapters embrace issues such as child development, childhood ailments, common medical conditions and com- municable diseases. These chapters provide the reader with considerable detail and advice.

Chapters of particular interest indude those on children with special needs, sports injuries, and safety at school. It is regrettable, and perhaps predictable, that the style of presentation for most of the book is prescriptive. This applies particularly to the chapter on child abuse which would be considerably enhanced by a multi-disciplinary approach to the subject.

Merits of the publication include the excellent references and further reading given at the end of each chapter. The appendices also provide readers with much useful information including incu- bation periods, percentile charts, and a school nurse job specification.

This is a highly readable, succinctly written handbook which provides a wealth of up-to-date information on many medical and school health issues. The book merits a place in college libraries and provides an invaluable reference source for all school medical officers and school nurses working in both the public and private sector.

Valerie Chapman RGN RM RHV RNT MSc Dip Soc

Executive Principal, St George's and Roehampton College of

Health Studies, London

'With This Body'. Caring and Disability in Marriage by Gillian Parker. Open Uni- versity Press, Buckingham, Philadelphia, 1993. 146 pages, £12.99 (pb), £37.50 (hb), ISBN 0-335-09946-7.

Gillian Parker has managed to present a report of a piece of research as a very readable worthwhile text which should be compulsory reading for the caring professions, e.g. nurses, doctors, social workers, and also for all those bureau- crats who make funding decisions that affect those members of our community with disabilities.

The initial research involved a quali- tative survey of 22 couples where one spouse had become disabled after marriage and the other had assumed the role of 'carer'. In particular, it concentrated on the changes that had happened to the

married couples as a result of the disability and the disruptions to previous ex- pectations of their life together that had followed.

The book presents the findings in a straightforward format that has a refresh- ing lack of jargon. The facts are presented, on the whole, in an unbiased manner and there is little attempt made to influence the reader with opinions.

Areas such as the absence of marriage from the debate on community care, the lack of research into younger married couples with one partner disabled, the growing recognition that women can be more disabled than men in comparable circumstances and the role of younger men as carers are highlighted.

However, I think the area of this book that appeals most is the recognition of the unpaid help and support provided by parents of disabled children, by spouses, and by the offspring of mentally and physically impaired older people, and the need for provision of support for them, as well as for the disabled people they care for.

C. Ann Lowis MEd DipN SRN OHNC Teaching Cert

Director of Nursing, The Robert Gordon University,

Aberdeen

Life-Threatening Problems in the Emer- gency Room by Anne Sutdiffe. Problems in Anaesthesia series, Butterworth- Heinemann, Oxford, 1993, 252 pages, £15.95, ISBN 0-7506-0370-4.

This book is the latest in a series entitled Problems in Anaesthesia and it is clearly aimed primarily at trainee anaesthetists. The author, a consultant anaesthetist at Birmingham Accident Hospital, England, also hopes it will be of interest to doctors, nurses and other staff in accident and emergency departments.

The book is divided into four main parts, covering major trauma, bums, medical and surgical emergencies and special considerations relating to paedi- atrics. Theoretical and practical aspects of pathophysiology are covered in considerable detail along with the principles of patient management and specific

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issues which are of importance to the anaesthetist. The author's style is very readable and the book is well indexed: there is a large amount of cross- referencing.

Although this is a book so obviously aimed at those in the field of anaesthet- ics, it may well be of benefit if used selectively and appropriately by nurses working in accident and emergency situ- ations. It clearly does not aim to cover many aspects of the nurse's role, but it gives a useful insight into the principles of medical assessment and management of patients. Much of the information included can be utilized effectively by nurses.

Denise Bircumshaw MN BA(Hons) RGN Oncology Cert

Macmillan Nurse SpecialisL University Hospital, Nottingham

Community Psychiatric Nursing. A Re- search Perspective vol. 2 edited by Charles Brooker & Edward White. Chapman & Hall, London, 1992. 246 pages, £15.95, ISBN 0-412-43600-0.

Recent developments in the field of mental health have posed new problems for community services. The shift of resources (and clients) from large outdated institutions to the community has coin- cided with the realization of a major problem of the homeless mentally ill. Recently, well publicized cases have un- derscored this phenomenon. H1V has emerged as an area of concern in mental health. Finally, in the United Kingdom particularly, has come recognition of mental health as a priority for action (viz. The Health of the Nation (Department of Health 1992)).

Community psychiatric nursing is thus needed more than ever. One hopeful sign is in the upsurge in papers and other publications on this topic in recent years. This raised professional profile is to be strongly welcomed. To be effective, community psychiatric nurses (CPNs) need a body of research. This book, which follows a previous, successful volume, is a timely manifestation of increased professional confidence.

There are similarities between the two volumes in that a range of issues is addressed. However, while volume 1 leaned heavily towards educational issues, this focuses upon themes of advanced professional skills and methods of reviewing the service. As with any compendium, styles of presentation vary. However, there is a unifying thread in that the first paper is a 10-year review of the organization, education and practice of community psychiatric nursing. This chapter is as authoritative as one would wish. If only it were not so turgidly written!

Among other notable contributions, the difficult subject area of HIV and drug misuse is tackled in a vivid elucidation of the research issues for CPNs. I particularly enjoyed a paper which impinges upon the topical motif of community care, by involving clients and carers in a study of discharge arrangements. To prove that there is willingness to embrace scrutiny, there is an excellent chapter which describes a framework for clinical audit of CPN services.

I could go on. There is something here for all CPNs. Well referenced, it will be both a valuable source-book and genera- tor of ideas for good practice. I would recommend it to all CPNs as well as those studying for the CPN qualification.

Reference

Department of Health (1992) The Health of the Nation. HMSO, London.

John C. Hooker BSc RGN RMN DNCert

Primary Health Care Facilitator, Gateshead Family Health

Services Authority

Counselling in General Practice edited by Roslyn Comey & Rachel Jenkins. Rout- ledge, London, 1992. 120 pages, £9.99, ISBN 0-415-05956-9.

Psychological and psychiatric disorders are the third most common diagnosis in consultations in primary care. The num- ber of general practitioners who employ counsellors to help with the psychological and emotional problems of their

patients is increasing. The editors have brought together a variety of contributors to present a balanced overview of the key issues associated with counselling, particularly in general practice.

The text includes chapters on the extent of psychiatric and psychological disorders, a description of what counselling is and the ethical consideration it evokes. There is an interesting section on whether counselling has been shown to bring about client improvements. There are also highly descriptive sections on how to evaluate a counselling attach- ment with a clear presentation of the practical and training implications.

The text is well referenced throughout and is of a consistently high quality. It is particularly valuable to find such a balanced view of the effectiveness of counselling, which clearly demonstrates some of the difficulties for the researcher in this complex area. Suggestions as to the way forward which consider the future role of British Family Health Service Authorities, standard setting, and the role of the counsellor as a working member of the community team are interesting and could be usefully debated in a wider arena.

Although by no means comprehensive, this text will help as a guide for general practitioners, counsellors and nurses to enable them to make best use of the counselling resources. Addition- ally, it will enable individuals to evaluate current practice critically within this a r e a .

Susan Hamer BA(Nursing) RGN DNCert FETC

Assistant Regional Eh'rector of Nursing,

Harrogate Regional Health Authority

Conflicts in Care: Medicine and Nursing by Lesley Mackay. Chapman & Hall, London, 1993. 298 pages, £13.95, ISBN 0-412-47860-9.

The interpersonal relationship between nurses and doctors has rarely been examined in the context of the health care system. Collaboration between the two disciplines is an essential re- quisite for good practice in the delivery

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Book reviews

of health care. This study, based on interviews, explores the dynamics of this relationship and its effect on the disciplines of nursing and medicine and the consumers of health care. The data it presents provide reinforcement for professional concern regarding the conflicts between nurses and doctors.

The book is written in a dear and jargon-free style. There are 12 chapters, with a well-endowed reference list, and both the subject and author index are accurate and comprehensive. It is dis- appointing that the author did not consider introducing the tabular information within the text as this would have broken down the monotony of the complexities of the issues.

The chapters vary in their aims and subject treatment. In the introductory chapters, the conflicts, dilemmas and con- trasting cultures and education between the two disciplines are well described. On a minor point, on page 38 in a paragraph dealing with staff nurses, it is stated that 'staff nurses have undertaken three years of training and are registered

with the Royal College of Nursing'; this needs clarification.

A particularly useful chapter is that on caring for the dying, looking at the considerable dispute and conflict between doctors and nurses. This also reminds us that nurses have a tendency to reflect the priorities of the medical profession, thus promoting the medical- ization of nursing. The ensuing chapters continue with the same theme and consider what makes a good nurse and doctor, examining the question of gender and status, Project 2000 and the graduate nurse, and take a broader look at the nursing profession.

Arguably the most interesting aspect of the book is the chapter on a broader look at work and occupations. This section considers the profession of nursing versus medicine, the extended role of the nurse, professional agenda, nursing process and research.

The author has done a remarkable job in welding the perceptions of nurses and doctors, and deserves commendation for a balanced inclusion of a wide range of

issues. It is dear that the author had to be selective in the samples of nurses and doctors and could not do justice to all the specialities within the nursing professions. But the strength of this book would have been greater if it had con- sidered a larger sample of nurses and doctors working within the mental health field.

This is a well-researched and informative book which provides a helpful insight into the inherent conflicts of nursing and medicine. Overall, the book would have benefited from a conclusion which stated the future agenda along the lines of interprofessional collaboration, education and shared learning. I am not certain that this book could be used as a checklist for good practice, but it should find a place in most health care libraries.

G. Hussein Rassool MSc BA RMN RNT CertEd CertCouns

Lecturer in Addictive Behaviour, St George's Medical School,

London

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Handbook of School Health

Documents

Transcript of Handbook of School Health