]ournal of Advanced Nursing, 1993, 18, 680--683

BOOK REVIEWS

The Anthropology of Breast-Feeding: Natural Law or Social Construct edited by V. Maher. Berg Publishers, Providence, USA and Oxford, 1992. 185 pages, £25.00, ISBN 0-854-96-721-4.

This book is published as part of a series giving 'cross-cultural perspectives on women'. The authors of the chapters have backgrounds in sociology, anthropology and psychiatry, the editor being the associ- ate professor of cultural anthropology at the University of Turin, Italy.

The stated aim of the book is to restore a social and cultural dimension to the dis- cussion of breastfeeding and, in the light of this, to cast doubt on the accepted medical wisdom of many intemational agencies as to how women in developing countries should be feeding their young. Much of the information and discussion that follows is fascinating, although it could not be described as an easy read!

The first chapter is by the editor and introduces and distils many ideas, the evidence for which is provided in the chapters that follow. These include detail about early infant feeding among the Baraka in Northern Tunisia, working mothers in rural Nepal, Turinese mothers in 1982, Icelandic mothers in the 17th and 18th centuries and about milk kinship in Shi'ite Islamic Iran. In the final chapter, the editor discusses the arguments in more depth. The book is extensively referenced and has an index.

The editor stresses that 'we should view women's behaviour in the field of reproduction and childbearing not as determined by "nature" but as con- ditioned by cultural priorities (not always to the advantage of women and children) and by personal choice'. Breastfeeding is more likely to take place, for example, in societies where relationships with kin are important, and less likely in those where marriage and having children are pre- dominantly institutions for the confir- mation of wealth and status, and where women are dependent on their husbands both economically and socially.

A great variety of important topics is discussed with authority, including breastfeeding and male sexual privilege, breastfeeding and the political order, patriarchal institutions and the interrup- tion of breastfeeding. Many of the per- spectives offer a refreshing challenge, for example that the medical literature rarely considers the possibility that a mother can overtax herself by breastfeeding and that it only appears to be when a mother undertakes paid work outside the home that 'the work' is considered potentially damaging to childbearing and breast- feeding.

However, I cannot agree with the edi- tor when she implies that complementary feeding from a very early age may be best for the baby when the mother is mal- nourished. There is evidence that, except in the most severe circumstances, there is no significant decline in breast milk, quality or quantity (Prentice et al. 1986) and indeed in continuing to breastfeed fully may protect the mother from further depletion through another pregnancy. Likewise, while I agree with the under- lying plea that health care workers should be sensitive to the social and cultural influences on breastfeeding and treat women as individuals, I do not think that adequate evidence is put forward to sup- port the view that international agencies are concentrating too much on the crucial topic of the nutritional value of breast- feeding.

Despite these important disagreements with the editor's views, I learnt a great deal from the book and would recommend it to any library serving those interested in midwifery or health visiting. It does, however, seem expensive for its size!

Jo Alexander RGN RM MTD FP Cert PhD

Lecturer in Midwifery and Nursing University of Southampton

Reference Prentice A.M., Paul A.A., Prentice A., Black A.,

Cole T. & Whitehead R. (1986) Cross-

cultural differences in lactation performance. In Human Lactation 2: Maternal and Environ- mental Factors (Hamosh M. & Goldman A.S. eds), Plenum Press, New York, pp. 13--44.

Living Proof: Views of a World Living With HIV and AIDS by Nicholas Lowe & Michael McMillan. Artists' Agency, Sunderland, 1992 (distributed by Bloodaxe Books, Newcastle upon Tyne). 107 pages, 6"10.00, ISBN 0-9509797-2-4.

There is now so much literature about HIV/AIDS - - the pathology, prognosis and prejudice-- that it is a pleasure to welcome this rather positive publication. Its message is realistic and positive, even though it does not avoid references to the inevitable pain and sadness associated with death, dying and separation.

Nicholas Lowe is a photographer and Michael McMillan is a black playwright. They worked together for 9 months on a project set up by the Artists' Agency. The aim of the project was to provide an opportunity for those affected by HIV/ AIDS to work in an art form.

The project entailed them facilitating workshops with prisoners, black and white community groups, and relatives, friends and lovers of people infected with HIV/AIDS. There were also some exhi- bitions and public performances. This publication records and collates the out- come of the project's many activities: interviews, plays, prose, poems, art and some 77 photographs.

It is extraordinarily well produced, beautifully printed and nicely illustrated. The recorded interviews make a particu- larly valuable contribution. The photo- graphs and other illustrations tell their own stories well, without words. The text conveys, with sensitivity and empathy, the mental and physical pain and anguish; but this is buffered by wit and humour and hope. This new publication is unique. It is creative, caring, communicative and contemporary.

Where a message is necessary, it is clearly stated in very concise and very

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basic language, especially when providing information about safer sex techniques. I like the term 'safer' sex techniques. The pervading message is that, even when there is prejudice and ignorance, that should not prevent people from taking care. Otherwise, as one poet puts it:

The same we now play, is Russian roulette...

It is a model publication for health educators. In my view, it is an excellent example of 'good practice' of the pro- vision of health information and health promotion. It communicates real infor- mation about the real world in a detached, non-sexist non-racist way. Whilst it cer- tainly does not beat about the bush about possible outcomes, it leaves choices in the hands of the reader. It would make a useful present for teenagers and friends.

I sincerely hope that copies will be available in all public libraries. In particu- lar, I hope that it will be available in any library used by students of any discipline. It is essential reading for those involved in health and social care. It is a very commendable publication, derived from a very worthwhile project.

James P. Smith OBE BSc(Soc) MSc DER SRN RNT

BTA Certificate FRCN FRSH Editor, Journal of Advanced Nursing

Orthogeriatrics: Comprehensive Orthopaedic Care for the Elderly Patient edited by Raymond J. Newman. Butterworth- Heinemann Ltd, Oxford, 1992. 234 pages, £50.00, ISBN 0-7506-1371-8.

This edited book is primarily for surgeons, medical students, general physicians and physicians specializing in elderly care. However, the editor expresses the hope that general practitioners (GPs), nurses, physiotherapists and occupational thera- pists will also read it to find out how and when orthopaedic surgery can help an 'aged patient'. All the contributors (20 in total) except three have medical qualifi- cations and 12 of the medically qualified writers are orthopaedic surgeons. The non-medical writers are a barrister, a senior lecturer in health economics and a researcher.

There are several chapters which can be wholeheartedly recommended to nurses who specialize in the care of elderly people, in spite of the fact that many of the conhibutors to the book fail to acknowl- edge this as a nursing speciality. The chapters which are particularly useful are: Chapter 1: Demographic Processes and Health Forecasts, Chapter 2: The Economic Implications of An Ageing Population, Chapter 3: General Medical Problems of the elderly Patient and Chapter 19: Medicolegal Aspects of Care of the Elderly. Chapter 3 in particular includes a good account of the physio- logical changes which occur with ageing, albeit briefly since this is the only chapter concerned with this. Chapter 4, which dis- cusses clinical pharmacology and ageing, is also helpful. Those chapters written by surgeons would be useful for reference purposes only.

It was particularly interesting to note that chapter 12 Tractures of the Femoral Neck' includes a brief paragraph on press- ure sores. It states, 'These are an expensive and totally preventable complication .... They can readily be prevented by turning the patient two-hourly in appropriate cases, or getting them to turn themselves'. The author goes on to quote the unit with which he was associated where the inci- dence of sores was only 2% and attributes this to careful nursing. Whilst what the author says in this passage is accurate, he fails in his chapter to draw attention to the medical role in the prevention of pressure s o r e s .

Yet another contributor to the book states, on p. 206, 'Why do these sores occur and how can they be prevented'/ Most are the result of long periods of immobilization on high pressure surfaces on trolleys in accident and emergency de- partments, wards, and operating theatres (Versluysen, 1988). They are therefore partly the responsibility of the doctor. . . ' . Clearly, therefore, the reader of this book should take a critical stance; the more so since many of the chapters are extremely narrow in focus, and not in the least bit holistic. As far as I could detect only one author quoted any nursing research.

The book would be useful in a nursing library for the introductory and final

chapters. Other chapters would probably be used infrequently.

Margaret Clarke RGN RNT BSc MPhil

Director of Nursing Studies University of Hull

The Nursing Experience, Trends, Challenges and Transitions 2nd ecln by Lucie Young Kelly. McGraw Hill, New York, 1992. 638 pages, $3.00, ISBN 0-07-105390-5.

This American book is a smaller and more accessible version of a book called D/men- sions of Professional Nursing by the same author. The stated aim of the book is to inform and stimulate discussion about the historical, legal, ethical and theoretical aspects of nursing.

It does this by looking at various aspects of nursing in five chapters, begin- ning with the history of nursing and health care from the ancient Egyptians to the present day. Although the history is mainly about America, it does describe early British influences and Florence Nightingale in particular. Despite the American slant, this concise and readable history proves interesting reading.

The second chapter deals with the American health care system and nursing theories. The description of the American health system and the book's apparently objective discussion of the system's fail- ings provide an interesting insight into what a totally market-oriented health system is like. There is also a description of a number of nursing theories and defi- nitions of nursing, although in a book of these modest proportions these are covered only briefly.

The sections on education and ethics and law are not directly applicable outside the USA because of the very great differ- ences that exist between the practices in other countries. But ethical issues are introduced and discussed with darity and I found this very thought provoking.

It was particularly interesting to read of the American Bill of Rights for both patients and nurses. With the patient's charter currently being introduced in the United Kingdom, perhaps British nurses should be pressing for a nurses' charterl

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The part of the book dealing with legal aspects reflects the somewhat defensive nature of American practice and deals in some depth with the subject of political lobbying. This is one area where American nurses seem to be far more effectively organized than nurses in Britain. Again, although the book gives good general advice it obviously needs adapting for very different systems in other countries.

Finally, the book deals with the diffi- cult subject of the newly qualified nurse making the transition from student to registered nurse. Again, differences apart, it proves useful reading, with sections on stress and leadership being particularly good.

Each chapter is preceded by clear and concise objectives and the key points are summarized at the end of each chapter. Additionally, there is a good bibliography and each chapter is comprehensively referenced.

This very good book certainly achieved its aim of informing and stimu- lating on general issues, but large parts of the text are simply not appropriate for a non-American readership. If a British version were available I would have no hesitation in recommending this book as an essential part of any British nurses' collection. In its present form, however, readers outside the USA may prefer to borrow it from a library, unless, of course, they are thinking of working in America.

Edward Purssell RGN

Post-registration RSCN Student Queen Elizabeth College of Nursing and

Health Studies Birmingham

Health Policy: Development, Implemen- tation and Evaluation in Australia edited by H. Gardner. Churchill-Livingstone, Melbourne, 1992. 370 pages, £17.50, ISBN 0-443-04394-9.

This volume of papers, addressing various aspects of health and social policy in Australia, includes chapters related to theoretical issues as well as case studies of particular planning exercises.

Part 1, entitled 'Approaches to Policy Development, Implementation and Evalu- at-ion', includes four chapters. The first, by Gardner and Barradough, on q'he Policy Process', contains material of general interest to policy makers and students alike, be they in Australia or elsewhere. Chapter 2 by Considine addressing the question "Policy: Managed of Export?' includes topical discussion about various aspects of corporatism, which is of special relevance to British NHS managers at the present time. Degeling and Anderson likewise address issues of intemational application in the third chapter on 'Organ- isational and Administrative Dimensions'. The authors provide clear definitions of 'policy', its actors and operational processes. The final chapter in part 1, by Thomas, deals with 'Evaluation Methods in Health Care Programmes', providing a useful overview of the current approaches to measuring effects of particular programmes against goals.

While all chapters included in part 1 are of relevance outside the borders of Australia as well as intemaUy, part 2 has more local application. This does not mean that the material presented is of no interest to intemational readers, who are studying comparative aspects of health policy and its formation. In addressing topical issues such as 'Health for All' and 'AIDS Prevention', authors provide relevant material for debate, crossing national boundaries. Specific topics are addressed within three sub-sections deal- ing with Australia health issues related to national, state and community policies.

The section addressing national pol- icies contains three chapters. The first, by Brown, which deals with q-lealth Care Policies; Health Policies or Policies for Health?' poses some questions of interest to the international reader, but is mainly relevant to Australians. Chapter 2 by McPherson, entitled q-Iealth for All Australians' sets the general discussion about Health for All (WHO) targets in a local context. The final chapter on 'Financing of Health Care' by Duckett is interesting, but deals with specifically Australian health care systems. It is there- fore mainly of local interest, although may constitute useful comparative data

for students of comparative systems of financing health care.

The division between 'nation' and 'state' in Australia can, perhaps, be likened to the distinction between England, Wales, Scotland and Northern Ireland in the British context, although the United States provides a more direct comparison. Health policy within Australian states is discussed in the following three chapters commencing with a paper by Petersen entitled "Policy in Rhetoric and Reality: Alcohol and Road Safety'. This chapter is of specific interest in highlighting var- ious vested interests underlying policy formation.

This also applies to the next chapter by Barraclough on 'Policy through Legis- lation: Victoria's Tobacco Act' in which legislation is set against the commercial interests of tobacco companies. The writer points to a common gap between the ideal and the practical in policy formation, which can lay policy makers open to accusations of illogicality, self- contradiction and unethical decision- making. The last paper in this section by Swerrison, entitled ~Breaking Even: Workers' Compensation under Pressure in Victoria' is mainly of local interest.

The final section of part 2 deals with community-based policy formation, in- duding papers on care of the elderly, mass screening, AIDS prevention and 'healthy cities'. Interestingly, these topics could all be considered at local, national and state levels. This applies to all topics discussed in part 2. The divisions between levels relate to Australian conditions, which do not necessarily apply in other countries. It is, however, interesting to distinguish between large and small scale planning, regardless of topic. Consumer partici- pation in decision-making at community level is of particular relevance.

Chapter I by Howe is entitled 'Partici- pation in Policy-Making: The Case of Aged Care' and highlights consumer involvement in local policies. Browning contributes a chapter on 'Mass Screening in Public Health', which focuses on com- munity participation in policy-making, while at the same time drawing on inter- national comparisons. 'AIDS Prevention in the Gay Community' is discussed by

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Parnell, providing interesting material for comparative analysis.

The final chapter in this section and of the volume is entitled 'Healthy Cities: The Noarlunga Experience' and is written by Baum, Traynor and Brice. On the surface, local interests predominate. However, it is noteworthy that one of the writers is based at the Royal College of Nursing, London. This provides an immediate cross-national link, facilitating comparative policy analysis.

Although part 1 is of more immediate relevance to the international reader, more locally orientated Australian material con- tained in part 2 provides useful data for comparative analysis. A concluding chap- ter by the editor, drawing together the various strands of the different chapters, might have been helpful, over and above the introductory summary. Nevertheless, it is a readable and well-researched volume, which will prove valuable to policy makers and students of comparative health and social policy alike.

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

Research and Quality Assurance Adviser London

Comforting the Confused: Strategies for Managing Dementia by Stephanie B. Hoffman & Constance A. Platt. Springer, New York, 1991. 208 pages, $21.95, ISBN 0-8261-7850-0.

This is a handbook for care-assistants in American institutions for long-term care of old people suffering from dementia. The first 100 pages give an overview of the various forms dementing disorders can take. There is emphasis on communication difficulties in part 1 and explanation of pathology in part 2. Part 3 has several short chapters on managing depression, solving difficult behaviour problems, wandering, relocation stress and safety guidelines.

The authors reiterate in every chapter that much can be achieved by listening, touching and other non-verbal communi- cation and that it is important to try to understand what message the confused person is trying to convey. In the final two chapters, the authors point out that some residents are not old and that families of residents may need understanding and help. Nowhere in the book is there any suggestion that it may be possible or desirable to care for people with dementia in their own homes.

The advice given in this text is mostly uncontroversial and much of it is useful. The general tone of concern is laudable but the vocabulary reveals that, in spite of the promising first half of the title, the authors, and on the authors' advice also the reader, are concerned more with disease conditions and man- agement issues than with confused people. The proper running of the insti- tution is foremost, for example in 'hand- ling wandering', 'safety guidelines'. The issues of restraint, fire safety, infection control staff safety are given consider- able weight.

Each chapter has learning objectives, pre- and post-tests in the form of true- false questions and also a few sugges- tions for learning experiences. It is a book which could be recommended to nursing auxiliaries, support staff, volun- teers and perhaps to beginners in any caring profession.

Annie T. Altschul CBE BA MSc RGN RMN RNT FRCN

Emeritus Professor of Nursing Studies University of Edinburgh

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