The Psychology of Nursing Care

Journal of Advanced Nursing, 1995, 22, 393-398

B O O K R E V I E W S

Simon's Nursing Assessment (Manual)--- For the Care of Older People With Dementia by Simon O'Donovan. Winslow Press, Bicester, Oxfordshire, 1995. 150 pages, £79.95 (ringbinder), ISBN 0-86388-128-9.

This comprehensive manual has been devised to assist in the assessment of the nursing care needs of older people suffering from severe to moderate dementia. It has been written and compiled primarily to be used by first-level registered mental nurses and other specialist workers caring for mentally sick people. However, on reflection, the information contained in this manual will also be of considerable benefit to general nurses caring for elderly people in hospital and community settings and Project 2000 nursing students.

The manual has been written with the intention of facilitating change, and thereby acting as a catalyst to improve standards of patient care and the quality of nursing practice within specialist nursing care settings for people with dementia. Additionally, it seeks to improve the image and status of nursing older people with dementia and to promote elderly care as a specialist area in its own right. The author has written this manual from personal experience, drawing on the concepts of Orem's 'Self-Care' Nursing Model as a theoretical framework.

This assessment tool is presented in an attractive sturdy A4 folder which can be divided into two sections. Section 1 com- prises the actual assessment manual con- taining information on the development and implementation of a nursing philos- ophy for caring for people with dementia, changing the nursing approach from 'task' allocation to ' individualized patient care', the application of Orem's 'Self-Care' Nursing Model to people with dementia, the development of Simon's Nursing Assessment as the means of patient care and nursing practice, and detailed guide- lines for the development of the assessment tool as a care management system. Finally, a nursing care study is presented to highlight how the various facets of the assessment can help to improve the quality

of life for an older person suffering from dementia.

Section 2 is subdivided into six sections to facilitate quick reference. Specimen laminated documentation is contained in this section which can be photocopied without the author's approval. This section has information about 'getting to know' the patient and the carer, a specimen admission document, information to guide the practitioner in the assessment, planning, implementation and evaluation of patient care, pressure area care and, finally, documentation relevant to the patient's physical health and possible pain profile.

Throughout the manual the text is written in a lively, informative manner. Diagrams and charts are used to highlight relevant areas of the text. Pertinent references are given throughout the book and a reference list is supplied at the end of each chapter in the assessment manual. The manual does not contain an index. However, a list of contents and page references is given at the beginning of the text.

This manual should be placed in nursing libraries and in hospital and community settings where older people with dementia are cared for. Additionally, it may serve as a catalyst to encourage nurses in elderly care to develop research-based tools that will serve to enhance patient care and nursing practice and help to improve the status and image of nurses who care for elderly people.

Andrew Oldnall BSc(Hons) DPSN RGN

Charge Nurse, The City Hospital NHS Trust,

Birmingham

Breast Cancer: A Psychological Treatment Manual edited by S. Haber. Springer, New York, 1994. 162 pages, £27.95 (hb), ISBN 0-8261-8790-0.

This book is written by 10 women psychol- ogists and, according to the foreword, they 'provide guidance for mental health pro- fessionats in dealing with clients and friends with breast cancer'. The contributors are all working in the USA as psychol- ogists, largely in private practice.

The book is divided into five sections. The first of these covers Medical Aspects of Breast Cancer. It briefly covers the diagnosis, staging and treatment of the disease, giving a broad overview. The second chapter in this section examines relationships between the patient, doctor and psychologist in five or six pages. This chapter clearly demonstrates that the book is very much written from the psychologist's rather than nurse's viewpoint, although a couple of the contributors are also nurses.

Section 2 covers patients' experiences and treatment at various stages of the disease, i.e. at diagnosis, post-treatment, at recurrence and in the terminal phases of the disease. These aspects are covered quite briefly, in about 16 pages, but they do give a useful insight into the experiences of women with breast cancer at these key stages.

The third section addresses psychother- apy in relation to patients with breast cancer, with chapters on the relationship between the patient and psychologist, group therapy and support groups, special populations and countertransference. Again, most of the issues are covered very briefly.

Section 4 encompasses psychological interventions with the family, particularly covering husbands and significant others and children. These chapters are particularly helpful and include strategies of how best to help. The final section covers specific interventions, including some exercises and techniques to be used, and advice on how to facilitate a support group. Chapter 13 provides a useful insight into some of the research on the effectiveness of some psychological interventions. This is followed by a section on resources (specific to the USA) and medical glossary.

A positive attribute of this book is the personal touch, given that one of the contributors, Michele Siegel, experienced breast cancer herself and died in 1993. Her experiences add to the depth and feeling of the book which is dedicated to her. There is an important focus on the emotional and social responses of patients and their family/friends.

Although this book is intended for psy- chologists it will be of interest to nurses

© 1995 Blackwell Science Ltd 393

Book reviews

working wi th patients with breast cancer, and those generally interested in psychological approaches to treatment and care. It is somewhat disappointing to see little reference in the book to some of the valuable work undertaken by nurses in this field. The book is well presented and easy to read but, at £27.95 for a relatively short text, it is probably going to be accessed largely via libraries.

Denise Bircumshaw RGN MN BA(Hons) Oncology Cart

Macmillan Nurse Specialist, University Hospital,

Nottingham

Measuring Disease by Ann Bowling. Open University Press, Buckingham, 1995. 398 pages, £16.99 (pb), ISBN 0-335-19225-4.

Anyone familiar wi th Ann Bowling's pre- vious volume Measuring Health will turn, as I did, eagerly to this book. It is hard to find fault wi th this new volume as it is comprehensive and very detailed. It is comprehensive in the sense that it deals with well over 100 different scales for measuring the effect of disease on quality of life. It is detailed in the way in which the vast majority of the scales are described in detail.

However, this is not a handbook of scales. The actual questionnaires are not reproduced. Nevertheless, examples of the kind of questions included and the subs- cales for the measurement of underlying dimensions are often given. Further- more, the method of administrat ion and responding are covered with details of reliability and validity of scales wherever these are available from publ ished applications.

If anyone involved in health research wanted to know what it was possible to measure and what could be used to measure it, then this is the book to refer to. Some important supplementary material is included in the preface, such as information about copyright. There is also a paragraph which is both sensitive to those who develop scales (it is easier to criticize than to develop one) and very wise in its advice to researchers to use existing scales and to carry out further reliability testing and validation.

Other than the general chapters on scale use and development there are seven chapters covering cancer, psychiatric conditions, respiratory conditions, neuro- logical conditions, rheumatological conditions, cardiovascular disease and other

diseases. Within these chapters there are often scales which are specifically useful for children and elderly people.

The final chapter, while consisting of only 10 pages, is really a treatise on all the issues which should be considered in the development and use of scales. While the book is mainly aimed at researchers, I can envisage this chapter being very useful for students on research methods courses. If all of these points were included in an essay on questionnaire development it would be hard to deny a meritorious mark.

My only query, however, is in regard to the section in the final chapter on factor structure of questionnaire development. The criteria given on Eigen values (essen- tially those above 1-5 being preferred for the selection of factors) seem very con- servative. The latest texts on the subject (e.g. Child and Kline), in accordance with tradition, continue to advocate the use of Eigen values greater than 1 or, alterna- tively, the use of the scree slope method.

For the researcher there is a useful appendix of addresses of scale distributors. The references are extensive and, unlike many books of this nature, the index is adequate for the purposes of quickly locat- ing scales with which the reader may be familiar. This is a very useful book.

Roger Watson BSc PhD RGN CBiol MIBiol

Senior Lecturer in Nursing Studies, University of Edinburgh

Community 'Prep" Conference Report by S. Jos6 Closs, Senior Research Fellow, Institute of Nursing, University of Leeds. Northern and Yorkshire NHS Executive, Leeds, 1995. 16 pages, free from the publisher.

This brief report summarizes a study that was conducted in the Northern and Yorkshire Regional Health Authority. Its aims were to examine the future skill requirements and the corresponding training and educational demands of community nurses in that part of the UK. A hundred participants were gathered together for a 1-day conference and a survey was conducted to study their beliefs about future training needs.

The report of the study lacks a system- atic literature review. The nature of the sample of conferees was diverse. Participants came from many different heal th service occupations with widely differing political agendas. It is reasonable, therefore, that no claims are made for the representativeness of the sample in

relation to any specific universe. The per- centage of respondents is unreported. In addition, the means of data collection are not fully explained nor are the survey instruments demonstrated and it is thus impossible to see how bias was avoided.

Data analysis is not described and it is difficult to know whether the data support the findings. Nevertheless, these are reported fully under four headings which presumably relate to the investigators' initial undivulged research questions. The findings attempt to answer the following:

I 'What skills are currently being provided within the workforce?

2 What will be the future education and training needs of the workforce?

3 What remedial and upskilling work is now being undertaken?

4 Where are the gaps in workforce preparation?'

The findings end with a four-stage model which is proposed to guide the future training of community nurses. It is concluded that cohorts of staff will need to be trained to differing levels of cognitive skill. These are the helper grade, the basic registered nurse, the specialist practitioner and the advanced practitioner. The proportions of each grade that will be required within the workforce are vague and the skills which each group will possess are unstated.

The introduction to the study claims that it is intended to discover the key elements required in future programmes of education and training of a 'new breed' of community nurses. But the choice of study design, the methodology used within it and the apparent lack of control in its execution suggest that only anecdotal evi- dence has been discovered. It will be a brave individual who plans any substan- tial education and training strategy for this 'new breed' on the basis of this work!

Peter Bradshaw MA BNurs RGN RMN RHV RNT

Head of the Division of Health, Social Work & Community Studies,

University of Huddersfield

The Psychology of Nursing Care by Nell Niven with Jill Robinson. Macmillan Press, Basingstoke, in the series, Psychology Applied to Nursing. 408 pages, £14.99, ISBN 0-333-58355-8.

This book covers a great deal of the subject matter of psychology, including chapters on life span development. Some of the arrangement of chapters seems to be

394 © 1995 Blackwell Science Ltd, Journal of Advanced Nursing, 22, 393-398

Book reviews

idiosyncratic. For example, psychophysi- elegy and personality are together in one chapter. The effect of groups on behaviour merits a chapter of its own but the next but one chapter covers learning, memory and social influence. The latter contains material pert inent to the effect of groups. Overall, as can be seen, the book covers some areas of cognitive psychology, physiological psychology, pain, stress and social psychology as well as the life span development referred to above.

What of the application to nursing care ment ioned in the title? There are a number of applications, some of which are separ- ated out from the text in 'boxes'. Not all applications are to nursing care but some to everyday life. Whilst many of the examples are well chosen there is a tend- ency to present an issue to the reader and then never to resolve it. If I were a student I would find this irritating but perhaps it is in tended to encourage a questioning attitude.

There are also exercises in the book for students to carry out as group work or indi- vidually. These seem good and would certainly encourage 'research mindedness ' . One of the parts of the book to be particularly commended is the part of chapter 9, 'Adolescence, adul thood and ageing', which deals wi th ageing. This is an important topic today and it is well done.

Overall, I have to say that the authors have at tempted to cover too broad an area of psychology and as a result much is superficial. However, a point of particular criticism is the number of misprints in the book. Some of these are trivial, but others are important. For example, to begin with I thought that there was an error in the text which no one wi th the qualifications of these authors should commit. This occurs on p. 289, where there is a claim that the hormone ACTH stimulates the adrenal gland to secrete adrenaline. However, in the light of the other misprints I believe now that there is probably a line or so of text missing. I also had occasion to want to refer to one of the references listed on p. 309. This is a reference to McCaffery, 1990, cited as in this very journal, (J. Adv. Nursing, vol., 27, 1-5}. Not only is it not in this journal for 1990 but even the 1995 volumes of the journal are only at volumes 21/22.

It is difficult to recommend this book, in spite of its many good qualities. I have no doubt that a new, carefully, proofread edi- t ion would be valuable but I also believe that the opportunity to cut out some of the content and to give greater depth to the remainder would make for a better book.

Margaret Clarke RGN RNT BSc(Hons) MPhil

Emeritus Professor of Nursing Studies, University of Hull

Professional Ethics and Organisational Change in Education and Health edited by Christine Henry. Edward Arnold, Sevenoaks, Kent, 1994. 160 pages, £16.95 (pb), ISBN 0-340-60142-6.

Most of us are familiar with the cynical ovation which greets many charters, mission statements and philosophies of wards, colleges, and so forth. They are often seen as 'paper exercises' wi th nei ther hope nor intent ion of changing anything. Professional codes are, perhaps, greeted with less hostility, although they too may be seen as far removed from reality.

This book concerns an exercise which was aimed at examining the purported values of an organization and the professionals within it, and comparing these wi th the values actually displayed. The exercise was called the Ethics and Values Audit (EVA) and was conducted over 6 months in 1992 at the University of Central Lancashire, England. The chief question it addressed was, 'Do we practice what we preach?', al though a number of subsidiary questions appear to have been covered by the audit.

'What we preach' was examined by looking at the values embodied in charters, mission statements, philosophies and codes. 'What we practice' was audited using a number of research techniques. Chief amongst these were questionnaires, interviews, value identification grids, case studies, examination of curricula and policies (such as equal opportunities policies) and, according to one of the writers in this book, a 'hotline' .

The report identified 10 ' themes' emerg- ing from the audit. These seem to be issues which gave a flavour of the ethical condition of the university. Four of these were positive and included the sort of informal support networks and integrity amongst colleagues wi th which many will be familiar. The other six were negative including 'gamesmanship ' and abuse of power with which many will also, unfortunately, be familiar.

From this thematic snapshot the report made a series of recommendations aimed at a synthesis of what is preached and what is practised. Of course, theoretically this could be done by 'downgrading' values so that practice can meet them without changing. However, the audit was not performed from a neutral standpoint. An ethi-

cal s tandpoint based on sets of principles, including an over-arching 'respect for persons', underlies the report. Therefore, the recommendations were in line wi th this and in line with many of the codes and mission statements which also have such principles as their basis. The recommendations included the development of more visible and personal management, and the development of a 'management charter'.

Whilst the exercise was performed in an area of higher education which had recently undergone change, its relevance to nursing, particularly nursing education, is suggested in chapter 7 by Apps and Yeomans. They show how this is a t ime of rapid change in nurse education (with Project 2000 pro-registration nursing programmes and the move into higher education at a t ime when that, too, is changing) and a t ime of new managerial models and pressures. As such, it is a t ime when the distance between what we pract- ise and preach, and the distance between the values of organizations and the values of those within the organizations, may be widening. This being the case, the value of EVA may be immense.

The book itself is a series of chapters wri t ten by different people who were involved in the project. It is divided into three sections. The first concerns the theoretical framework, the second, the practice of the EVA, the third, a return to theoretical issues in the light of the EVA (including an interesting, controversial chapter on equal opportunities).

I found myself out of sympathy wi th much of the theoretical debate, such as the emphasis on the principle of 'respect for persons' , which seems to amount to no more than the principles of 'respect for autonomy' and 'beneficence'. I also found some of the writing hard to follow. Nonetheless, between the hard-to-swallow and hard-to-follow there is much to interest the reader concerned wi th such issues. The question the EVA addresses is an important one. Whether the EVA is the way to approach the question is also worthy of discussion.

Peter Allmark MA PGDE RN

Nursing Lecturer, She,'old and North Trent College oJ

Nursing and Midwifery

Whistleblowing in the Health Service: Accountability, Law and Professional Practice edited by Geoffrey Hunt. Edward Arnold, Sevenoaks, Kent, 1994. 200 pages, £12.99, ISBN 0-340-59234-6.

This excellent and highly topical book

© 1995 Blackwell Science Ltd, Journal of Advanced Nursing, 22, 393-398 395

Book reviews

highlights the basic di lemma between maintaining loyalty to an employer, so highly valued in a corporate culture, and publicly voicing concern about unaccept- able aspects of heal th service practice. Moral principles can be advanced in defence of both positions and the 'whistleblowing' employee is often caught in cross- fire between the various agencies involved and conflicting moral principles in her /his own consciousness.

This d i lemma is clearly demonstrated in the case of Graham Pink who, in obeying his employer, would have been in breach of the UKCC Code of Practice, which demands that nurses should report cases where pat ient interests are disregarded, but could at the same time be disciplined by his manager for making such a report.

There are no off-the-shelf answers about the rights and wrongs of disclosure. Each case must be judged on its own merits and the potential whist leblower often takes great personal risks in deciding to 'go public' . The book is edited by Geoffrey Hunt, himself a past whistleblower, who sets out the main issues for consideration in the introduction.

In part I: The Actors Speak, the first main chapter by Geoffrey Hunt and Barbara Shailer provides an account of a pilot survey of 30 whist leblowing heal th care professionals. Issues raised by these individuals fall into the following categories: (a) patient abuse, (b) inadequate care, (c) unethical research, (d) fraud/theft, (e) staff/resource shortage, (f) unfair treatment of staff members and (g) poor practice. In chapter 2 Andrew Wall and Ray Rowden discuss the very important area of managerial accountability. Caring managers view themselves as equally account- able to the patients they serve as to the organization they represent.

Chapter 3 by Margaret Stacey concerns the thorny issue of 'medical accountability' and the role of the General Medical Council in enforcing its demands. Jean Orr provides a parallel summary of accountabili ty in nursing and the role of the UKCC in the following chapter. Then Toby Harris discusses 'Community Representation', highlighting the role of Community Health Councils as pat ient watchdogs. Attempts to abolish these bodies in recent years are discussed. 'Charterism' has been presented as the government 's response to concern about decreasing democracy in the NHS.

The final chapter in part I by David Pilgrim centres on the important issue of 'abuse and inadequate care', drawing on examples from large UK mental illness and

mental handicap hospitals. Ethical principles are discussed in the light of Nazi abuse of mental ly and physically handicapped people and widespread adherence to the tenets of eugenics in, for example, the USA and Denmark during the 1930s.

Part II: The Workplace and the Law commences with chapter 7 by Marlene Winfield, in which she discusses 'Self- regulation through employee vigilance' in the NHS. In the next chapter issues related to 'Freedom of information' are raised by Diane Longley. A comparative account of whist leblowing in American heal th care is provided by Jean McHale in Chapter 9. The same author describes 'Two initiatives to reform accountability' in the next chapter, outlining the main components of the 'Department of Health Guidance for Staff on Relations with the Public and the Media' (1993) and the 1992 Fatchett Bill, entitled 'The National Health Service (Freedom of Speech) Bill' which was intro- duced by a Labour MP.

Confidentiality and the public interest ' is the theme discussed by Alan Hannah in Chapter 11. The book is concluded by Geoffrey Hunt under the title 'A new accountability?', in which he summarizes the main issues identified concerning whistleblowing in the NHS and the response to such action.

This volume should be judged essential reading for all who are concerned about ethical practice in the heal th service and primarily about effective means of pro- tecting vulnerable individuals, be they patients in danger of abuse or whistleblowing employees, who risk losing reputation and sometimes their means of l ivelihood by highlighting matters which they view as damaging to patients, staff, the NHS and the public at large.

Maria Lorentzon Phi3 MSc(Soc) RGN RM

Research Manager, Departm en t of General Practice,

St Mary's Hospital Medical School, London

The A-Z Reference Book of Childhood Conditions by Patricia Gilbert. Chapman & Hall, London, 1994. 208 pages, £14.99 (pb), ISBN 0-412-57470-5.

This book is a brief guide to many of the most common childhood illnesses and conditions that would be seen both in hospital and the community by various child care professionals. Some idea of the range of conditions included in the book can be gained if I say that it goes from acne

and coeliac disease to tonsillitis and tuberculosis.

For each the author writes about the inci- dence and history, causation and charac- teristics, management, and prevention. The amount of information about each condition is limited both by the size of the book and the popular style in which it is written. For example, asthma receives just over six pages, but much of this is taken up with a very basic description of what asthma is which leaves little space for discussion of care and treatment.

In a book like this there obviously have to be some chi ldhood conditions that are left out. But it is a little surprising to see no separate ment ion of infant bronchiolitis (although bronchitis does get three pages) or croup, two of the more common ail- ments amongst young children. However, the information about the conditions that are included is very clear and is remark- ably f~ee from medical jargon, and all of the advice seems to be sensible and appropriate.

Although the publishers state that the book is aimed at everyone from general practitioners and paediatric nurses to chi ldminders and parents, I suspect that it is amongst the latter groups that it will be of most use. However, that is not to say that it will be of no use to professionals. Indeed, its brevity and clarity make it ideal as a teaching tool for parents, children and students who need a brief and quick insight into a subject.

it is particularly appropriate for parents because it deals wi th issues that are often important to them, like when the child can go back to school, what to do if managing the condition at home, and what to look out for in the future. It is these very issues that are often left out of more established medical and nursing books, and with the move towards caring for children in the community gaining pace this aspect is very commendable.

This book is therefore a useful addition to the bookshelves in the child care department, and is highly recommended for the uses already mentioned. Certainly every public library should have a copy, as should paediatric wards and accident and emergency departments.

Edward Purssell RGN RSCN

Senior Staff Nurse, Paediatric Department,

St Thomas' Hospital, London

The Legal Aspects of Midwifery by Bridgit Dimond. Books for Midwives Press, Hale,


Book reviews

1994. 360 pages, £12.95 (pb), ISBN 1-898507-16-3.

The Law and the Midwife by Rosemary Jenkins. BlackweU Science, Oxford, 1995. 224 pages, £12.99 (pb), ISBN 0-632-03629-X.

The fact that two new books dealing with the law and the midwife in the UK have appeared recently indicates that this is an area of health care provision which is being forced to become more aware of its legal situation. Firstly, in the context of the reorganization of the British health service, midwifery is confronted by the possibility of changes in the way it is organized, with perhaps the appearance of more indepen- dent midwives. Secondly, and perhaps more importantly, in an increasingly lit- igious society, it is becoming evident that obstetrics generates among the most expensive litigation. With considerations such as these in mind, no midwife can afford to ignore her/his situation with regard to the law.

While the titles of these two books suggest that they attempt precisely the same objective, closer inspection reveals important differences not least because Rosemary Jenkins' background is as a midwife and Bridgit Dimond's is as a lawyer. Another difference is the amount of space available to the authors. Dimond has many more pages than Jenkins.

Beginning with Jenkins' book, she very literally assumes no knowledge of the law on the part of the reader and devotes the first chapter to a concise but comprehensive overview of the legislative process and the structure of the law. This introduction provides the foundation for her discussion of the statutory aspects of the profession of midwife, the supervision of midwives and the legal basis of health care in the immedi- ately following chapters. In the fifth chapter, Jenkins discusses what happens when things go wrong, firstly with regard to the professional conduct implications and then as regards litigation. In the following two chapters the issues of consent to treatment and the holding of information are covered.

In chapter 8 which covers statutory rights in pregnancy, as well as the woman's right to midwifery care, there is a discussion of other maternity entitlements in recognition of the fact that midwives are often the primary source of such information for many women. There is then a chapter covering other statutory issues which affect the midwife, including abor- tion, surrogacy, adoption, as well as the

Children Act 1989 and the Human Fertilisation and Embryology Act 1990. In the final chapter, aspects of employment law are considered, including issues affecting self-employed midwives.

Turning now to Dimond's book, the first thing one notices is that this is a much more comprehensive text. Fundamentally, most things that Jenkins covers are covered here in more detail. While again the author assumes no knowledge of the law, her discussion of the sources and the structure of the law is confined to a couple of pages in the introduction before one is launched into the text proper. The book is divided into six main sections covering professional issues, client rights, litigation and accountability, management issues, statutory provisions and childbirth and a final section looking at specific situations such as midwifery research. Each section is divided into several chapters devoted to individual aspects, giving 33 chapters in total.

I tried to approach these books as a non- lawyer to see how easy they were to approach. There is no doubt that Jenkins' book is the more readable in this respect. It is shorter and less technical and takes the reader from the very basics of law from the outset. In contrast, the non-lawyer might find Dimond's book just a little more daunting. For example, the concept of vicarious liability is mentioned in the second chapter and while one might well work out what this meant from the context the full discussion of what is meant by this term does not appear until chapter 12. Furthermore, looking under 'vicarious' or 'liability' in the index would not help you - - although if you knew to look under 'employers' or found the glossary you would be alright.

Similarly, the impact of the internal market on choice is discussed in chapter five on woman-centred care but the internal market itself is not discussed until chapter 20 dealing with the structure of the British NHS. In this case, however, the index will lead you to what you want to know. All of this said, a short time spent with the book will acquaint you with its layout and the forthcoming Workbook to accompany the text can only be of value.

So does this mean that you should choose the Jenkins book over the Dimond? The answer is no. As I said, the books reflect their author's respective back- grounds and this is their great merit. You will find Jenkins easier and faster to read. She provides you with the basic knowledge you need and you won't have to move backward and forward through the text to

check definitions. She also gives you more historical information, describing the influences which have produced the current situation. Furthermore, as a midwife, she gives practical, common-sense advice on what to do in certain situations - - and, more importantly, what to do to avoid getting into those situations. She also ident- ifies the points in the legislative process where midwives and their representatives can intervene. The 'downside' of the greater amount of history and practical advice is less space for the law as it is now. Dimond as a lawyer is concerned more with the legal situation as it is now and is not in a position to provide the kind of practical advice which Jenkins is at home with. But, in terms of coverage of the law, she provides a superior account. It is, indeed, an extremely rich text with a great deal of information.

My advice, then, is this: buy both books. They are not expensive and to my mind represent excellent value. Read Jenkins first and get a feel for the area. Then read Dimond. After that you will be extremely well informed about the history of the legal treatment of midwifery and the current legal situation. Keep both on your bookshelves: you will have (in Jenkins) practical advice on what to do if something goes wrong and (in Dimond) a rich source of detail to understand the legal implications fully.

John Beattie Paterson LLB(Hons) DipLP LLM Solicitor (non-

practising) Researcher, Law Department,

European University Institute, Firenze, Italy

The Emotional Effects of Childbirth by May Johnstone. The Marc~ Society, Doncaster, 1994. 104 pages, £55.00 (incl. p&p) (folder format), ISBN 0-9522898-0-6.

Holistic care is an ideal ostensibly being pursued by all those currently employed in the caring professions. Use of the word 'holistic' emphasizes the importance of catering not just for physical needs but for emotional, social and spiritual needs as equally deserving of attention. Indeed, for want of such attention physical healing may be impeded.

How many readers remember that in examination questions on patient care a sure way of gaining a few extra marks was to include somewhere in the answer 'reassure the patient'. The mechanics of how it should be done remained largely untaught and unexplained. Evading

© 1995 Blackwell Science Ltd, Journal of Advanced Nursing, 22, 393-398 3 9 7

Book reviews

up-front confrontation of emotional needs of those for whom we care, under cover of cultural more or fear of embarrassment, may in reality stem from lack of knowledge of what those needs are, how to approach our clients, and a fear of our inability to cope with the tidal wave of emotions which may be unleashed. Particularly for midwives who concur with this point of view, this volume should prove helpful in redressing past deficiencies.

It is presented in a user-friendly style and embodies another much-loved concept of care: freedom of choice. As explained in the user guide, the four units may be completed sequentially or any one can be studied as a separate entity.

In uni t 1, Emotions and Feelings, pre, intra and post natal needs are discussed. There is also a section for women with special needs, e.g. the unsuppor ted mother, those with unfulfilled pregnancy expectations, problems of ethnic minorit- ies, etc. Unit 2, Psychiatric Illnesses and Emotional Disorders, includes 'baby blues' , depression, psychoses. In unit 3, skills and attitudes and non-directive counselling are considered and unit 4 is devoted to practice.

The material within each uni t is attract- ively laid out, and offers a range of activi- ties to facilitate unders tanding of the topics under discussion. The inclusion of case studies allows for exploration of sensitive areas in the safe environment of the classroom or the individual s tudent 's study. Such considerations may enable the student to discover and work through his /her own attitudes, emotions before being exposed to real-life situations. Each uni t has a helpful list of key sources of further information.

Highlighted throughout is the need for meaningful relationships, wi th in the family unit, between the client and midwife and the midwife with other professionals. Familiar themes appear; 'cont inui ty of care', 'continuity of carer'. Is it perhaps a sad reflection of our society that this natural qualitative interaction is lacking when there is a burgeoning of formal and semi-formal support groups of

every kind? Addresses of many of these groups are appended.

Whether for use before or after com- pletion of the workbook is unclear, but included in this package is an audio tape of relaxation exercises to combat stress. This publication contains an Aladdin 's cave of useful information to help nursing and midwifery students and practitioners realize their ambition of providing holistic care.

A. Halliday RN RMRMT

Midwife Teacher, Glasgow College of Nursing

and Midwifery (East Division), Glasgow

Made to Care: The Case for Residential and Village Communities for People with a Mental Handicap by Caroline Cox & Malcolm Pearson. The Rannoch Trust, 8 Victoria Square, London SWlW oQY, 1995.17 pages, £3.50.

This pamphlet is a most timely publication. It is written by a m~rse, Baroness Cox FRCN, and the father of a daughter with a mental handicap, Lord Pearson. They aim to promote the provision of residential and village communit ies for mentally handicapped people in the United Kingdom.

The authors note that British health care policy has resulted in massive closure of long-stay facilities with the aim of integrat- ing their former residents into ' the community ' . This, they point out, was associated with a swing away from the medical model of care to the social model. But, they argue, that swing has obscured the fact that the health needs of many people with mental handicap are great and complex.

The authors concede that the experience of moving into the community has been a success for many - - but not all. Some of those transferred from large institutions to small community-based homes have found that for them there is no such thing as ' the community ' . Therefore, the authors

'believe strongly in the provision of wider choice' of services ' including residential or "village" communities ' .

About 194000 people in the United Kingdom suffer from severe mental handicap, 40000 of whom are children. Life expectancy for mentally handicapped people is increasing and elderly mentally handicapped people therefore comprise a growing group whose needs must be identified and met.

The pamphlet also focuses on the plight of family caregivers, claiming that the ' inadequate support for families is already causing serious problems'.

Concern is also expressed, based on observation, that many staff and managers of local authority social service departments may be out of their depth when dealing with severely mentally handicapped people.

The authors present a very convincing case for an expansion of village communities, 'based on the principle of choice'. Their costings demonstrate that these village communit ies offer opportunities for cost-effective quality of care. It is claimed that if only 10% of the UK's 154000 more impaired adults were to live in village communities the annual savings against community care casts would appear to be at least £770 million.

This well written and superbly produced and illustrated pamphlet makes a very balanced and valuable contribution to the debates about the appropriate care for adults and children who have a mental handicap. I commend it as essential reading for all nurses, managers and policy makers who have concerns about, and responsibilities for, the development of services for mentally handicapped people and their families.

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

BTA Certificate FRCN FRSH Editor, Journal of Advanced Nursing

Individuals wishing to order books reviewed should contact the publisher of

the book direct.


The Psychology of Nursing Care

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Transcript of The Psychology of Nursing Care