Journal of Advanced Nursing, 1993, 18, 1849--1853

BOOK REVIEWS

Health Care Research by Degrees by Norma Reid, Blackwell Scientific Publi- cations, Oxford, 1993. 176 pages, £13.99, ISBN 0632-03466-1.

This book provides an excellent intro- duction to the research process for new students in nursing, occupational therapy, physiotherapy, or other health professions. The author emphasizes the importance of learning to evaluate re- search as a key component of pro- fessional practice. The basic steps in the research process are described accurately, and the reader is provided with sufficient information to begin to critique written research reports. A particular strength of the book is the description and critical appraisal of three studies representing different research designs: a quasi- experiment, a true experiment and a qualitative study.

The use of examples from nursing, occupational therapy and physiotherapy enriches the book and promotes an ap- preciation of the similar interests and concems of the three disciplines. The author questions the recent emphasis within each of the three disciplines on the development of research that is based on theories generated within the discipline (i.e. nursing, physiotherapy or occupational therapy theories). This book is based on the refreshing premise that 'theory ought not to be plucked from the air, but based on practical utility and relevance' (p. 3).

Although the focus of the book is on providing readers with skills necessary for evaluation of research, the author also provides practical and useful sugges- tions about how new students might conduct research and disseminate the findings. Questions at the end of each chapter challenge readers to review re- search papers within their disciplines and to identify clinical problems that might be amenable to research.

Three of the 10 chapters focus on quantitative data analysis, and one chap-

ter includes a very general introduction to methods of qualitative analysis. There is a very brief discussion of levels of measurement and the uses of parametric and non-parametric statistics. Although the importance of ensuring a normal distribution of data prior to using para- metric statistics is articulated clearly, there is no discussion of the need to ensure interval or ratio level data in order to use parametric tests. The author provides detailed examples illustrating how data might be analysed using the M1NITAB computer program. Although this program may not be familiar to all readers, the examples and concepts are presented dearly and can be understood even without access to the computer program that is described.

Even though the information in the book is not as detailed as that provided in some other available introductory re- search texts, the relative simplicity of this text is one of its strengths. This text would be an excellent resource for intro- ducing health professional students to the research process.

Lynda Law Harrison RN PhD

Professor and Director of Research, University of Alabama,

Capstone College of Nursing, Tuscaloosa, Alabama, USA

A Handbook of Drugs in Nursing Practice 4th edn by C. R. Henney, R. J. Rowe & A. M. McConnachie. Churchill Livingstone, Edinburgh, 1992. 384 pages, £10.95, ISBN 0-443-04378-7.

This is the fourth edition of a standard library textbook that many of us have used to look up drugs that we have come across during dinical work. Bearing in mind the subject of the book, 4 years between editions is probably too long to wait and so its appearance now is all the more welcome. The main body of the book is given over to descriptions of common drugs in use today and,

although a book of this small size must have omissions, it appears to be quite comprehensive in the range of drugs described. For each drug there are brief notes on the presentation of the drug, its uses, doses and, most importantly perhaps, the nursing implications of each drug.

There are also sections dealing with related topics such as intravenous therapy, parenteral nutrition, cytotoxic drugs, and HIV. It also contains a useful cross-reference guide to drug trade and generic names. Unlike other reference books on the same subject, the drugs in this book are listed alphabetically using the generic name rather than by drug classification which provides easier refer- ence if the generic name is known, al- though it is very easy to find the generic name of most drugs from the guide in the book.

The layout is clear and the text un- ambiguous, particularly in the way that the nursing implications of each drug are stated, and it is this aspect of the book that makes this a very useful reference guide. Few nurses can remember the side-effects of every drug used in prac- tice; this book gives that information clearly and concisely and so it will help clinical nurses to comply with the re- quirements set out in the UKCC (1992) Standards for the Administration of Medi- cines, as well as being a useful reference for students and junior nursing staff.

One minor criticism is that, in embla- zoning the cover with the words 'Project 2000', the publishers may give the im- pression that this is a book solely for project 2000 nursing students. It is not. This book has a place not just in the library, but in every ward and on every drug trolley in every hospital.

Reference

United Kingdom Central Council for Nurs- ing, Midwifery and Health Visiting (1992) Standards for the Administration of Medicines. UKCC, London.

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Book reviews

Edward Purssell RGN

Post-basic Paediatric Nursing Student, Queen Elizabeth College of Nursing,

Birmingham

'There is Nothing More I Can Do'. An Introduction to the Ethics of Palliah've Care by David Jeffrey. Patten Press/Lisa Sainsbury Foundation, London, 1993. 116 pages, £5.95, ISBN 1-872229-11-5.

This book has a title which immediately attracts the attention of those working in the field of palliative care, since it is alien to their philosophy. Its author (who is well qualified to write on the subject, being a medical officer of a hospice and holding a master's degree in medical ethics) goes on to demonstrhte that there is much which can be done.

The book is aimed mainly at doctors and nurses working in the community, but the author hopes it will be of interest to those based in hospices and hospitals, which I am sure is correct. Many inter- esting ethical aspects are considered including autonomy, quality of life, breaking bad news, informed consent and euthanasia. These, and other issues, are discussed in relation to the palliative care setting.

The book's strongest attribute is that it links ethical principles to clinical situ- ations which are very familiar and very real. The final chapter presents a work- able and useful ethical model of appro- priate palliative care, applicable to all care settings. The author places much emphasis on the importance of all mem- bers of the interdisciplinary team and dearly recognizes the contribution of nurses in palliative care.

In my opinion, the book only briefly covers several important issues, as one might expect from 'introduction to the ethics of palliative care'. It is dearly not an exhaustive publication but it should stimulate thought and interdisciplinary discussion.

Denise Bircumshaw MN BA(Hons) RGN Oncology

Certificate Macmillan Nurse Specialist,

University Hospital, Nottingham

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Paterson and Zderad: Humanistic Nursing Theory by Nancy O'Connor. Series: Notes on Nursing Theories. Sage, Newbury Park, California, 1993. 52 pages, £6.50, ISBN 0-8039-4489.

This small book is a monograph about the development of Paterson and Zderad's 'humanistic nursing theory'. The text is informative and encapsulates a vast amount of detail about this par- ticular nursing perspective. The book is one of a series, the aim of which is to provide a series of monographs which have been designed to provide the reader with a concise description of conceptual frameworks and theories of nursing. They are not intended to replace the primary works of the nurse theorists, but to provide direction of their use by graduate and undergraduate nursing students.

Although the book is informative, it does appear to have two major dis- advantages which it shares with a great deal of nursing theory perspectives, namely, the text is predominantly American and uses a great deal of jargon which at times appears to have difficulty crossing the Anglo-American divide and appears to make the assump- tion that all its readers are going to be well-versed in the idiosyncrasies of nursing theory. However, the author has attempted to give an informative overview about humanistic nursing theory in 52 pages and for that she should be congratulated.

The text contains biographical sketches of Paterson and Zderad and seven brief chapters which discuss vari- ous aspects of humanistic nursing theory. These chapters examine issues surround- ing the historical development of the model its implicit assumptions about the nature of reality together with sum- maries concerning existential thought and phenomenological tradition. In ad- dition, the author analyses Paterson and Zderad's perspectives of the metapara- digm elements that form the basis of their model namely, the person, nursing, health and the environment, before briefly discussing the general theory of nursing and what other nurse theorists say about the various metaparadigms

and concepts that contribute to the wealth of nursing theory.

The text devotes two chapters to the application and future development of humanistic nursing theory and briefly discusses some of the ethical issues sur- rounding the nurse--patient relationship, In addition, the text contains a useful glossary and a comprehensive reference and bibliography section.

Throughout the book, the text has been presented in short chapters and, where necessary, divided into sections and sub-sections to clarify certain issues for the reader. The text has been well referenced using the Harvard system to provide evidence for points made in the text and to enable the reader to access the academic sources of information for further reflection and study.

Although the monograph is informa- tive and provides a concise overview of this nursing perspective, it is arguable whether anyone who has not got an in-depth knowledge of nursing theory would find this text beneficial in apply- ing humanistic nursing theory in the clinical environment. However, the text is primarily designed for nurses studying at degree level and the information con- tained in this small book may prove to be invaluable to them.

Andrew Olclnall RGN DPSN

Charge Nurse, Dudley Road Hospital, Birmingham

Psychology, Psychiatry and Chronic Pain edited by S.P. Tyrer. Butterworth- Heinemann, Oxford, 1993. 212 pages, £35.00, ISBN 0-75060573.

As an introductory text on chronic pain this book is a very valuable and welcome contribution which will not only be of interest to nurses and other health care professionals but also to chronic pain sufferers. According to the editor, 'the language used is intended to be free of jargon and should be understandable by lay persons' and in this it is very success- ful. Although there is considerable over- lap with existing literature, this book is particularly useful because it offers a

Book reviews

practical non-academic guide for the management of chronic pain. There is a wide collection of topics ranging from basic psychological concepts to the more applied aspects of cognitive and behav- ioural techniques, as well as a consider- ation of the use of hypnosis, acupuncture and physiotherapy.

The book is divided into two sections. The first is concemed with descriptive issues in psychology and psychiatry whilst the second provides details of assessment and intervention techniques, and an overview of the organization of services within a pain clinic. The presen- tation is ordered in a logical manner that enables the reader to dip in at various points to locate aspects which might be of particular interest.

As a whole the book is very readable and informative with some chapters out- standing in this respect. For example, chapter 4, which addresses chronic pain problems and psychiatry (Merskey and Chandarana), is particularly impressive. This interesting chapter tackles among other things the mind/body interactions, and suggests that, whilst both dimen- sions are essential to the aetiology, a separation is necessary when trying to make sense of pain experience. Such an approach, the authors argue, would pre- vent the common and incorrect practice of labelling the chronic pain patient as being mentally ill in the absence of a physical illness. The inadequacies of diagnostic criteria (DSM 111: R) in con- tributing to the unjustified diagnosis of psychogenic pain are also highlighted.

Chapter 6 which reviews the literature on chronic pain and compensation (Mendelson) is also very good. Here, the relationship between the complaint of chronic pain and accident compensation is explored, suggesting that litigation and compensation systems influence pain behaviour.

The main drawback to this text is the reticence with which the authors use research to inform their writing. For example, it would have been useful to know whether research has identified a particular cognitive strategy or combi- nation of strategies that are especially beneficial in the context of chronic pain.

References are also used in a very economical fashion; for example, in de- scribing the phenomenon 'learned helplessness', it is surprising that no reference is made to Seligman. Addition- ally, the appendix could be extended to include some examples of the variety of assessment measures.

These points represent minor criti- cisms and only detract slightly from the value of the book as a whole. I would recommend this book as a useful text for clinical and teaching departments.

Veronica J. Thomas BSc PhD DipN RGN

Lecturer in Nursing Studies and Health Psychology,

Kings College, London

Review of Nursing: Art and Science edited by Alison Kitson. Chapman & Hall, Lon- don, 1992. 140 pages, £14.95, ISBN 0-412-47070-5.

This is a well laid out book containing short chapters by some notable authors. The papers that make up the chapters were presented at a series of seminars hosted by the Institute of Nursing in Oxford, England, and each chapter is followed by a discussion section which could stimulate points for further discus- sion in seminars and workshops. Each chapter contains good references.

This thought-provoking book con- tains many complex ideas about what nursing is, and will certainly add to the body of nursing knowledge. It covers many different aspects and areas of care, both in the hospital and community setting. Chapter 1 is particularly thought-provoking and will stimulate much notable discussion on values ver- sus so-called universal truths.

This book will appeal to qualified nurses who wish to examine their areas of practice and to students undergoing advanced/higher education. From some of the points raised in the book it seems thaL until nurses decide what nursing is, the science/art debate, the professional role and whether nursing is or not hostage to past tensions in society will not be fully resolved. It is a welcome

addition to the library shelf and a text to be recommended to honours nursing students.

C. Ann Lowis MEd DipN SRN OHNC Teaching

Certificate Director of Nursing,

The Robert Gordon University, Aberdeen, Scotland

Families of Schizophrenic Patients. Cogni- tive Behavioural Intervention by Christine Barrowclough & Nicholas Tarrier. Chapman and Hall, London, 1992. 264 pages, £15.95, ISBN 0-412-36220-1.

Because the topic of this book is so important and because the authors are acknowledged authorities on it, I read the book several times, in the hope of learning from it and of being able to recommend it. I ended up being rather disappointed.

The first part gives a clear and concise overview of thinking about schizophre- nia, treatment, management problems, theories and, in particular, about the significance of 'expressed emotion' (EE). After that, however, the attempt to con- vey to the reader how the cognitive behavioural approach can be used fails to have any impact. The text is based on the Salford Family Intervention Project (England) which was designed to evalu- ate the effectiveness of different inter- ventions, but the project is not described nor is it clear what specifically character- izes this particular approach or how its effectiveness was demonstrated.

The writers are psychologists, but they deny that 'therapists' should be psychologists. It would seem that all kinds of professionals were 'key workers', 'case managers', 'clinicians' in the project. Their skills are not identified and the book will not help anyone to develop them.

The authors deal comprehensively with assessment of the needs of patient and family. Specimens of the tools used are provided in appendices. Particular emphasis is on education of relatives and on stress management. Problems of viol- ence and suicidal risk are addressed. For illustration of the approach used, the

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Book reviews

authors rely on case examples, suitably organized to fit the theoretical frame- work. First and second interviews are described in some detail, thereafter it is left to guesswork to understand any treatment plan. There is no help offered to the reader who tries to understand how often families should be seen, by whom, for how long and for what pur- pose and certainly there is no hint about how to evaluate intervention.

Readers will find the book enjoyable, but they should not expect too much from an educational point of view.

Annie T. Altschul CBE BA MSc RGN RMN RNT FRCN

Emeritus Professor of Nursing Studies, University of Edinburgh

New Ways of Doing Things: The Training and Development Needs of Nurses for Senior Management Roles by Ruth Balogh & Senga Bond. Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, 1993. 54 pages, £10.00, ISBN 1870-399-51X.

Balogh and Bond have produced an in- teresting and topical report on training needs of senior nurse managers in the 1990s. The writers base their account on information gained during workshops in the Northern Regional Health Authority, which funded the research.

The main research brief related to study of issues concerned with manage- ment development for nurses and the project was conducted over a 6-month period. Focus group workshops were convened, with membership drawn from the ranks of senior nurse managers and general managers in the region. Findings indicated that the purchaser/provider split had important implications for man- agement development in nursing. There appeared to be a tendency to emphasize provider roles with consequent neglect of the purchaser perspective.

This comparative lack of interest in purchaser/strategic roles has worrying implications for this reviewer, in that the hands-on/executive orientation feeds into anti-intellectualism, which is already rife in nursing. Thinking/planning are

rated as less important than doing/ managing when they are, in fact, two sides of the same coin. This tendency may be viewed as linked with the anti- professionalism which has pervaded British public services post-1979.

Respondents indicated that retrospec- tive rather than prospective management training was the rule. Appropriate roles for nurse managers in the current British National Health Service (NHS) formed a main topic for discussion. Distinction between management and advisory roles was explored. Development of G-grade nurses was viewed as crucial.

It is interesting to note the emphasis on the stressful nature of the ward sister's role, without exploration of the impact made by resource management and the potential role ambiguity intro- duced with primary nursing. The type of training recommended was discussed and stress was placed on the importance of equal access in this regard.

This short report is highly relevant to the current situation within nurse man- agement. Issues raised are crucial. Unless nurses and other stake-holders facilitate younger and less experienced nurses in management/leadership preparation, nurses will continue to rely on ad hoc, on-the-job experience in order to learn management skills. It is clearly essential to place more emphasis on nursing roles in purchasing, which is crucial to rational health care planning and provision.

It is hoped that the report will be purchased, read and applied to nursing in the NHS, where its recommendations are in urgent need of implementation.

Maris Lorentzon PhD MSc(Soc) BSc(Soc) RGN RM

Departmental Manager/Researcher, St Mary's Hospital Medical School,

London

International Comparative Study of Com- munity Nursing by Robert A. Verheij & Ada Kerkstra. Avebury/Ashgate, Aldershot, Hampshire, 1992. 210 pages, £32.50, ISBN 1856284158.

This publication provides the results of a research project funded by the Dutch Ministry of Welfare, Health and Cul-

rural Affairs and conducted by the Netherlands Institute of Primary Health Care (NIVEL).

The purpose of the research was to provide information about the organ- ization, funding and functioning of com- munity nursing services in various industrialized countries. Nine countries are included in the study: these are, Belgium, Canada, Finland, France, Germany, The Netherlands, Norway, United Kingdom and United States of America.

The authors are to be congratulated on the readability of the book. There are 10 chapters in all. Each chapter provides an analysis of community services in the country under scrutiny. This enables readers to compare and contrast the services offered or not offered.

Nine chapters provide comprehensive information on the population and demographic trends of each country. The prevailing health care system is then described and details of total public ex- penditure on health care are given. De- tails of the types of health care personnel in post are provided and the authors attempt to describe the kind and content of the care given.

Even though this book is extremely valuable in providing a range of infor- mation about the services offered, the reviewer has some reservations about the interpretation and superficial analysis given by the authors on some of the issues under discussion. One issue where the analysis is questioned is that of underperformance, as is the daim that there is a tendency to assign home helps to the delivery of hygienic care: what- ever that means. Despite these reser- vations, the book provides a wealth of information with excellent references, tables and helpful appendices.

The final chapter in the book provides a useful summary on the comparisons within and between the nine countries. It explores population and manpower is- sues, and examines and compares the education, training and practical prep- aration of nursing staff. Key problems for the future provision of care are identified. Solutions are presumably left to the countries concemed.

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Book reviews

This is a most useful reference book which merits a place in all college librar- ies. One hopes that its content will stimulate recognition of the need to complete a detailed analysis of the nature of community nursing care needed over the next decade for our many vulnerable patients and local communities.

Valerie Chapman RGN RM RHV RNT MSc Dip Soc

Executive Pn'ncipal, St George's & Roehampton College of

Health Studies, London

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