Stress: Perspectives and Processes by

D. Bartlett. Open University Press, Buck-

ingham, 1998, 187 pages, £14á99, ISBN 0

335 19927 5.

Designed for a readership which includes

both postquali®cation and postgraduate

nurses, this short book covers a complex

and expansive topic in a concise and ef®-

cient manner. The introductory chapters on

Stress and Health, A Historical View of the

Stress Field, and Frameworks for Studying

the Stress Phenomena, provide the neces-

sary preparation for sections on The Vari-

ables Involved in the Stress Process and The

Role of Stress in Health and Illness. These

introductory chapters do indeed outline a

representative selection of the main

approaches to the study of stress, and elabo-

rate the complexity of this elusive concept,

establishing both the predominance of the

transactional approach, whilst elaborating

several weaknesses. Despite only a limited

reference to the literature linking occupa-

tional stress and distress, clari®cation of

some of the more dif®cult methodological

issues in this ®eld can be found, with the

provision of an accurate distinction

between variables with mediating and/or

moderating roles in the stress process.

The ®nal integrative chapter, A Cogni-

tive-Phenomenological Perspective adopts

and extends this transactional approach,

emphasizing the importance of self-regu-

lation and goal-directed behaviour in the

generation of stress perceptions, and in a

ruminative account of coping. This ®nal

chapter provides a highly theoretical

account of such psychological homeostatic

processes. While previous sections of this

book may be appropriate for postqualify-

ing students, the level of explanation of

this ®nal chapter may be more appropriate

for nurses undertaking postgraduate study,

introducing as it does a range of concepts

likely to challenge the majority of those

studying for basic degree.

Martyn C. Jones

PhD BSc RNMH, Dip Ed Dip NBS

Lecturer in Applied Social Sciences

University of Dundee

School of Nursing and Midwifery

Dundee

Scotland

Eating Disorders, Food and Occupational

Therapy by Joan E. Martin. Whurr Pub-

lishers Ltd, London, 1998, 168 pages.

£22á50, ISBN 1 861 56078 8.

This book outlines aspects of the disorders

anorexia nervosa and bulimia nervosa, and

the use of occupational therapy during

treatment. The ®rst two sections describe

the history, epidemiology, aetiology, clin-

ical features, treatment, complications and

outcomes. Risk factors and prevention in

the development of anorexia nervosa, and

bulimia nervosa and aspects of abuse are

also outlined. These sections give a fairly

useful basic overview, although some

aspects of recent research are not dis-

cussed in detail. The third section exam-

ines sociocultural perspectives of food and

eating disorders, and includes an interest-

ing examination of eating disorders in

various cultures.

The fourth and ®nal section is the

shortest and examines aspects of occupa-

tional therapy used in treatment. The

analysis in this section appears rather

limited, for example, the treatment regime

outlined for anorexia nervosa appears to

be a description of treatment speci®c to

one practice area rather than a general

overview. The language is sexist in places

in that the author refers to both therapists

and patients in the female form. There is

generally little discussion concerning the

evaluation of practice. The interface

between hospital and primary care is not

detailed. Additionally the trend for people

to be treated in the community and the

impact this may have on treatment is not

discussed in detail. Overall this book pro-

vides a fair review and may be of interest

to those who wish to develop their know-

ledge of some aspects of anorexia nervosa

and bulimia nervosa and the use of occu-

pational therapy in treatment.

Sue M. Green

RGN BSc MMedSCi PhD

Lecturer

School of Nursing

University of Hull

Hull

England

Managing Public Involvement in Health-

care Purchasing by Carol Lupton, Stephen

Peckham and Pat Taylor. Buckingham,

Open Universtiy Press, 1998, 176 pages,

£16á99, ISBN 0 335 19632 2.

At a time when there has never been so

much political mileage made out of

involving health service users in develop-

ing services, it remains surprising and

somewhat disappointing to ®nd the voice

of the patient remains so mute in health-

care discourse. In Managing Public

Involvement in Healthcare Purchasing,

the authors serve to contextualize and

unpick the intellectual and organizational

infrastructure that has allowed the health

service users to receive little more than lip

service over the years when healthcare

programmes and services were being

developed. Although still publicly funded,

the NHS has been remodelled more closely

along private lines, with separate purchaser

and provider organizations, operating in

market-like conditions. The decentraliza-

tion of decision-making, the rise of prima-

ry care-based purchasing and the formal

role of healthcare purchasers as `champi-

ons of the people', may all be seen to have

enhanced the potential responsiveness of

the service to local needs and afforded the

public a more visible and in¯uential role

in its development. This book carefully

lays out how this has not always hap-

pened.

The ®rst three chapters of the book

address the broader issues and wider

context of public involvement in health in

terms of three key dimensions: agency,

structure and process. The different types

and levels of public involvement and the

different expectations and assumptions by

which they are underpinned are examined

in chapter 4. The history of public

involvement in the speci®c context of the

NHS and the changing context of healthcare

purchasing are examined in chapters 5 and

6. Chapters 7 and 8 are based on the ®ndings

of anumber ofdifferent empirical studiesby

the authors of the contemporary role of the

public in healthcare purchasing and the

book concludes by summarizing the key

issues for purchasers attempting to develop

public involvement in the face of the

different, and potentially contradictory,

imperatives of the wider consumerist/dem-

ocratic and policy/operational frameworks.

Managing Public Involvement in Health-

care Purchasing is a closely argued text

which is a must for all those involved in

commissioning roles. While not the easiest

of reads, perseverance pays its own rewards

as the authors have clearly done their

homework, putting their work neatly in

the context of wider public debates

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Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(5), 1265±1272 1271

about the concepts of citizenship and

accountability. For that they are to be con-

gratulated in grappling with some of the

more complex issues in current healthcare.

Brian Dolan

MSc MSc RMN RGN CHSM

Nursing Research Fellow/

Graduate Student

University of Oxford

Oxford

England

Social Work Services and Patient Decis-

ion-Making by Patricia Hansen. Ashgate,

Aldershot, 1998, 164 pages, £30, ISBN 1

840 14152 2.

Decision-making for discharge from hos-

pital is an important part of the day to day

work of hospital-based professional nurses

and social workers, yet is a topic that is

dif®cult to research. The ®ndings of this

book, though based on research carried out

in a different health and welfare system

(Boston, USA), will nevertheless be of

great interest to nurses and social workers

practising in both the hospital and com-

munity settings. The discussions of the

various issues involved transfer very ef-

fectively to the context in the United

Kingdom (UK) and echo many of the

dilemmas facing families and profession-

als in managing care. For example, the

description and analysis of practice with a

sample of patients receiving social work

services compared with another sample

who are not receiving social work help in

an acute care hospital in Boston would

encourage social workers in the United

Kingdom (UK) and nurses planning dis-

charge to think critically about their prac-

tice locally. The study was undertaken in

two parts: in the ®rst, a random sample of

patients was surveyed after hospital treat-

ment and discharge to collect data on

variables which facilitate decision-

making; in the second part, information

on the resources used by the social work

services was collected from the records of

those patients who had received a social

work service. The design entailed testing a

number of explicit hypotheses, for exam-

ple that the variables that facilitate decis-

ion-making, i.e. control over decisions and

family support are associated with higher

levels of psychosocial satisfaction.

Patients and families were interviewed

to ascertain their views on decisions about

discharge, and to explore the links

between disagreements about discharge

decisions. The cost of the service was also

measured. Patricia Hansen writes in a

lucid style. Readers not familiar with

quantitative analysis will ®nd the discuss-

ion of the methods and ®ndings readily

accessible. Implications for social work

practice management and research are

clearly stated and explored. The author

acknowledges that the context of admis-

sion and discharge is changing, with

shorter periods in hospital placing inevit-

able pressure on social work staff and on

the family of the patient at the point of

discharge. Hansen's account is sensitive to

the complexities of practice, and informa-

tive about the hallmarks of good practice.

She highlights both the pressures profes-

sionals face in trying to provide a respon-

sive service, and the types of service that

are recognized as working well for patients

and their families.

UK readers may think that some con-

textual factors, for example the debate

about where social workers should be

deployed to ensure the best transition

home is perhaps more advanced in the

UK. By comparison with the settings

described by Hansen, liaison between hos-

pital and community-based social workers

in the UK is the norm under the policy of

community care, with lines of responsibil-

ity clearly identi®ed. This book raises

important issues for both nurses and social

workers and it is likely to be read and

debated with interest by students, practi-

tioners and educators in both ®elds. While

not de®nitive, the ®ndings point to the

development of new models of care. Those

planning and providing the hospital and

community services for people following

discharge could draw from both the vari-

ous models of service provision outlined

here and the accounts of users' and carers'

experiences of discharge. This book would

be a useful addition to both college and

university libraries, and to libraries in

social work, social service and nursing

practice settings.

Marion Ulas

BA MPhil DASS

Lecturer

Department of Social Work

University of Edinburgh

Edinburgh

Scotland

Media reviews

1272 Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 31(5), 1265±1272