Learning Journals and Critical Incidents:

Re¯ective Practice for Health Care Profes-

sionals by Tony Ghaye and Sue Lillyman,

Quay Books, Wiltshire, 128 pages, £12.95,

ISBN 1 85642 153 8.

This book gives the reader a useful intro-

duction into re¯ective practice. Although it

forms part of a series of nursing texts on key

management skills in nursing, the authors

set out to bring re¯ection into the wider

arena of health care workers, not just nurs-

es. However, the points of reference given

are mainly drawn from nursing, e.g. English

National Board and United Kingdom Cen-

tral Council for Nursing, Midwifery and

Health Visiting. There may be little written

about other health care workers and their

use of re¯ection but in this the title may be

misleading. The critique of models of re-

¯ection contains some useful points sum-

marizing much of the current literature.

Carper's work is concisely explained, al-

though some examples from practice might

be bene®cial to the novice at re¯ection. The

diagrammatic representation of the models

is both helpful and informative. There is a

good variety of models cited; it is left to the

reader to expand on their use.

Journal writing is explored from a the-

oretical perspective, as in what might be

included and the subsequent chapter gives

some examples; this would be a useful aid

to someone trying out different types of

writing, as in the use of prose or concept

mapping. A variety of examples are given,

but perhaps the authors could include a

greater level of analysis as to what learning

might be linked with these speci®c exam-

ples. Critical incident analysis is reviewed

in some detail and this is a valuable part of

this book. Examples are given of incidents

with an analysis of each example provid-

ed. This will help the reader apply the

technique to their own incidents and there

are a variety of incidents provided; there is

a good example where the incident centres

upon good practice being observed and

learnt from, rather than the writer review-

ing their own practice. The last section

looks at outcomes; how we may use re-

¯ection to move our practice forward, but

also how it may be used in preparing

accreditation of prior learning claims. Is-

sues such as re¯ection within clinical

supervision are also referred to, albeit

brie¯y. With the great emphasis placed

on the importance of re¯ection, both in

pre-registration courses, continuing edu-

cation and up to date practice it is impor-

tant that a reader can see what use the

process of re¯ection might be. I think this

is an area where more detail could be

given.

This book will probably be most valued

by those who are not that experienced in

re¯ection; those who already are experi-

enced journal writers may not ®nd very

much that is new but the information is

simply presented and can be read in easy

sections. I am not sure it would draw non-

nurses to re¯ection. Overall this is a

straightforward text which would serve

as a good introduction and due to its

small size certainly would not put people

off. It would be a useful text to recom-

mend.

Mary Crawford

RGN RM RNT BA MSc

Lecturer,

Nightingale Institute,

King's College London,

London,

England

Evaluating Nursing Interventions. A The-

ory-driven Approach by S. Sidani & C.J.

Braden. Sage, London, 1998, 190 pages,

US $46, ISBN 0 7619 0316 X.

The publication of this book is very timely.

The current push for evaluative research

which focuses on clinical effectiveness

demands elucidation of the links between

nursing interventions and their outcomes

and this book presents an alternative ap-

proach to the tightly controlled experi-

ment, the method which is currently being

promoted as the gold standard in effec-

tiveness research. Its subject is the use of

theory in evaluative nursing research as a

more realistic alternative to randomized

controlled trials (RCTs).

The content is organized within eight

chapters and begins with a discussion of

what constitutes high quality care, and the

weaknesses of outcomes-focused evalua-

tion of care. Limitations of the conven-

tional approach in providing causal

explanations are made explicit, due for

example, to multiple causes, multiple ef-

fects, mutual causation and context vari-

ables. These problems will be unhappily

familiar to researchers who have under-

taken evaluative research in the ®eld. Not

only do they create practical headaches in

the design and execution of studies, but

often limit the validity and generalizability

of ®ndings.

Chapter 3, The Theory-Driven Ap-

proach to Effectiveness Research, is key.

This is not, as some might suppose, the

application of popular (and generally un-

substantiated) nursing theory to empirical

research. Instead, the importance of shift-

ing the focus of effectiveness research

from causal connection to causal explana-

tion is discussed. The simplistic black box

notion of cause and effect, which consid-

ers only the net effects of an intervention

is jettisoned in favour of explaining the

intricate relationships between cause and

effect in the clinical situation, and, as the

authors state, `causal explanation requires

theory'.

Subsequent chapters then expand on

different aspects of the multi-dimensional

nature of clinical research, discussing the

characteristics of, and in¯uences exerted

by clients, setting, intervenor, intervention

and outcomes. The role of theory in plan-

ning the research design, method/s, the

nature and timing of the intervention un-

der scrutiny, the type and timing of data

collection and analysis are all considered.

What emerges is a non-prescriptive ap-

proach, where appropriate theory is se-

lected or developed and used to underpin

each aspect of the research. Throughout,

the emphasis is on the complexities which

inevitably confound the RCT approach in

the real world.

This book is not an easy read, and

would be of most interest to experienced

researchers. A good understanding of the

research process is assumed, and without

this the reader would not get the most

(which is, in fact, quite a lot) out of this

book. The text is scholarly, but rather

dense and often technical, and in virtually

every chapter there are long paragraphs

consisting mainly of lists. The authors are

North American, but they have drawn on

European as well as North American liter-

ature, and the issues covered are directly

relevant to nursing in the UK. This is a

very `now' book which adds constructively

to the ongoing debate about appropriate

research methods for complex aspects of

nursing care and their effectiveness for

patients.

S. Jose Closs

BSc RGN MPhil PhD

Senior Lecturer,

Nursing Research University of Hull,

Hull,

England

Book reviews

Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(1), 263±268 267