Journal of Advanced Nursing, 1993, 18, 847-851

BOOK REVIEWS

Clinical Nursing Practice-- The Promotion and Management of Continence edited by Brenda H. Roe. Prentice Hall, London, 1992. 254 pages, £16.99, ISBN 0-13-138207-1.

Clinical nursing practice for continence has, rightly, attracted much attention at all levels of health care in recent years. So a text that has successfully drawn together the expertise and research evidence from which clinical practice for the promotion and management of continence should be based is very welcome.

The aim of this book is to present contribution chapters by specialists within this field who have undertaken research or who have a critical command of the research into incontinence. Each chapter presents their subject along with a critical review of the literature and research evi- dence. Chapters include: the prevalence of urinary incontinence, bladder re-education for the promotion of continence, intermit- tent self-catheterization and the setting up of a continence advisory service.

This style of developing a text is not always successful, particularly with regard to accessibility. This is happily not the case here. The editor has successfully guided the contributors to produce a book which will communicate effectively to a wide-ranging, multidisciplinary reader- ship. It is both sophisticated in its ideas, and clear in its messages.

Worth a particular mention is the attention to detail in the text. There is a wealth of reference material, useful diagrams and an awareness of policy implications, all of which combine to make it a worthwhile investment.

It really is with pleasure that I can recommend this book and praise the valuable contribution it will make in an area of care which continues to be under- estimated as to its impact on the health of the general population.

Susan Hamer RGN DN Cert FETC BA

Assistant Regional Director of Nursing {Education and Research}

Yorkshire Health Authority

Research Methods for Nurses and the Caring Professions by Roger Sapsford and Pamela Abbott. Open University Press, Buckingham, 1992. 173 pages, £10.99, ISBN 0-335-09620-4.

Sapsford and Abbott 's book is divided into sections. The introductory section addresses the nature of research; the second section is intended to help the reader to engage in the critical assessment of research reports; and the third and fourth are about doing research and writing it up.

The authors appear to have been unable to make up their minds about the kind of book they wanted to write. Was it to be a long book or a short one; a book for the newcomer to nursing research, or one for the experienced researcher? Or a practical book, or one that explores the philosophical assumptions which underlie the various research methods? A book for the student, or one for the seasoned scholar? In the reviewer's view, the book is the unsatisfactory result of a compromise between these various positions.

For instance, whereas some research books concem themselves principally with method, others explore the philosophical assumptions which lie behind and ulti- mately justify these methods. A few books do both of these things, but Sapsford and Abbott do neither, failing on the one hand to give us enough infor- mation to enable us to do some research and, on the other, to give a proper account of the deeper issues of social research. There can be no doubt that beginning students need to understand the underly- ing assumptions if they are to answer the authors' quite reasonable question: 'Does the way in which the research is framed embody ideological presuppositions such that the outcome is "written in" or "predetermined" by the original conceptual analysis and design?'

Furthermore, I am not sure that the book is balanced in its treatment of the various styles of research. Authors who survey the whole field of social research

should surely be even-handed in their analysis of the strengths and weaknesses of the positivist and interpretive para- digms. However, Sapsford and Abbott's comment (made with reference to an ethnographic study which they had con- ducted themselves) that 'Chief among the strengths [of the study] was the sheer naturalism of the situation', and their warning that 'However perfect the design, experimental research very often suffers from a tendency to trivialize or "artifi- cialize" the real situation', leaves one in little doubt as to their sympathies.

Despite these critical comments, there can be no doubt that a book which encour- ages students of nursing to engage with the research-based literature in a critical way is worth reading. But I suspect that the exercise will be more fruitful if the student has access to the companion volume of readings (Sapsford and Abbott (1992) Research into Practice: A Reader for Nurses and the Caring Professions and does not have to rely on the pre-interpreted summaries contained in the book reviewed here.

Peter Draper BSc RGN Cert Ed

Lecturer in Nursing Studies University of Hull

From Fetus to Child: An Observational and Psychoanalytic Study by Alessandra Piontelli. Routledge, London, 1992. 260 pages, £12.99 (pb), £35.00 (hb), ISBN 0-415-07436-3 (hb), 0-415-07437-1 (pb).

In this absorbing and challenging book Dr Piontelli, who is visiting professor at the Department of Child Psychiatry at the University of Turin, describes a very sub- stantial piece of qualitative research. She observed 11 fetuses (three singletons and four sets of twins) ultrasonically from about 16 weeks of pregnancy; each exam- ination lasted an hour and was carried out monthly. After delivery she made partici- pant observations of the mother-infant relationship(s) in their home, weekly for

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a year, then monthly for a second year, and then two or three times a year until the child(ten) were aged 4.

In addition, she describes the psycho- analysis of six children aged under 5 whose behaviour suggested preoccupation with intra-uterine experiences. Dr Piontelli's training in medicine, neuropsychiatry and child psychotherapy seem to put her in an ideal position to carry out this work.

The book begins with a review of the literature relating to fetal behaviour and its environment, and to the safety of ultrasonic examination. An explanation of the meth- odology is followed by a description of the observations of each child (or pair of twins) in turn. The discussion of psycho-analytical theory is supported by references and there are name and subject indexes.

On the basis of her work, Dr Piontelli suggests that, as soon as the fetus begins to move, it shows highly individual preferences and reactions, and that behavioural and psychological continuity extend into childhood. (This was observed, not least, in the way in which twins interacted.) Whereas most psychologists consider that psychological life starts after birth, she suggests that birth is rather the 'climax' of the prenatal state, and that subsequently children constantly re-live and re-work their prenatal and intranatal experiences. Certain experiences, such as threatened miscarriage or antepartum haemorrhage, appeared to have a pro- found effect, especially if reinforced postnatally, and she suggests that autism may have prenatal roots.

The author stresses that her work was about hypothesis formation and not test- ing, and makes important criticisms of her methodology. Indeed, it is noteworthy that two of the three singletons studied were born by Caesarian section and with congenital talipes and I would certainly support her plea that further studies should be conducted. However, this seems likely to prove to be a work of fundamental importance to all those who work with parents, children and indeed all those of childbearing age.

Jo Alexander RGN RM MTD EP Cert PhD

Lecturer in Midwifery and Nursing University of Southampton

Bones and Joints: A Guide for Students 2nd edn by Christine Gunn. Churchill Livingstone, Edinburgh, 1992. 186 pages, £12.95, ISBN 0-443-04399-X.

The first edition of this book was published 8 years ago and this new edition maintains the same approach to the study of bones and joints. Orthopaedic nursing has always been regarded as one of the most professionally rewarding areas of practice since the team approach is at its most compelling in the care of orthopaedic patients. This is partly because locomotion is a readily observ- able activity of living and all concerned (including the patients) can see for them- selves the direct effects of pathology or trauma affecting bones and joints. It is also partly because of the logic of the system and the accessibility of bones themselves for individual study.

The author's aim is to help students in their study of osteology and arthology. This is done admirably through simple text supported by line diagrams and radiographs.

The 10 chapters are arranged in easily understood sequence, beginning with the structure of the bone in chapter 1. Terminologies are next explained so that students can grasp their nature and pur- pose at the outset: This is followed by introductory notes on joints. Chapter 3 introduces the reader to general patho- logical concepts associated with bones, including hormonal changes. The student is thus in a position to learn the more detailed information presented by the author.

The remaining chapters cover structure and functions of bones in the upper limb, shoulder girdle, lower limb, pelvic girdle, thorax, vertebral column and the skull. The chapter on the skull includes an instructive section on the teeth so the student can see these in their structural and functional contexts.

This is an attractively presented book. The line diagrams are clear and appropriate, the radiographs support the text well and all are fully labelled for ease of understanding by the student. A short index completes the book. It is suitable for students undertaking Project 2000 courses. It is also a suitable source

of reference for all students with an interest in the subject.

Justus A. Akinsanya PhD BSc RGN ONC BTA Cert

RNT FRCN FWACN FRSH Dean and Professor

Anglia Polytechnic University

The Making of a Counsellor edited by Ellen Noonan and Laurence Spurling. Routledge, London, 1992. 212 pages, £12.99, ISBN 0-415-06768-5.

This book is an introductory text for would-be counsellors. It conveys the experience and some thinking as to what working as a counsellor is like by pre- senting the process of treatment in 12 thought-provoking essays. These case studies were developed from written work towards the award of a Diploma in Adult or Student Counselling and show something of the growth of each coun- sellor and the probing test of their own reality in the relationship with their clients.

The possibility and value of counselling is explained in a variety of settings and includes addressing the wide problems of orphans, debtors, accountancy trainees, mathematicians and musicians. Two studies in particular illustrate how good work may be done with seeming 'imposs- ible' states of mind, and although there is no suggestion about a cure had been found and there was nothing ambitious about the approaches they demonstrated the human condition of both client and counsellor clearly and poignantly.

The editors state that 'whether they are engaged in explicit counselling or in work with a counselling component, or applying a counselling perspective in a particular setting, the authors recount their experiences with that mixture of candour, humour, anguish, bemusement and exuberance which often characterizes this stage of gaining a qualification but losing one's innocence'. The liveliness of the writing is proof of this and throughout a keen cutting edge of the presence of mind of the counsellors is apparent.

Although the papers do show the way in which the countertransference is recog- nized and used, I was left feeling that there

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would be some benefit in developing this aspect more fully. In particular, this might have helped nurses more as there is still considerable ignorance in the profession with regard to the use of one's own feelings in a counselling situation. The personal impact of dealing effectively with others' emotions is often denied and the inevitability of personal transform- ation, pain and excitement is something which is not always recognized. This is addressed in the book but might be missed if nurse readers are too heavily defended.

This is a book well worth reading and should be added to the nurse tutor's library. As counselling is a subject in the present curriculum, it might be regarded as essential reading. It certainly gives a balanced aspect of counselling work and clearly shows that it cannot be short- circuited by a few seminars, but how theory and practice, knowledge and experience is an internal process which takes time to absorb before it can be applied to work in non-counselling set- tings and counselling skills alike. It also helps to recognize that counselling is not work we all want to do - - or should do.

Hazel O. Allen BA Member of Lincoln Centre & Institute for Psychotherapy

SRN SCM RNT PsychotherapisL London

Nursing Beds: An Evaluation of the Effects of Therapeutic Nursing by Alan Pearson, Sue Punton and Ismere Durant. Scutari Press, London, 1992. 143 pages, £13.99, ISBN 1-871364-64-7.

The current climate in the United Kingdom for raising the quality of care and the advancement of both academic and clinical nursing has increased the need for evaluation and auditing. Evaluation research has thus assumed major import- ance and the intention of Nursing Beds is to address the evaluation of therapeutic nursing and the effectiveness of nursing therapies.

This book is published under the Royal College of Nursing series of research reports. It is well organized and provides a clear construction in dealing with the pro-

cess and product of evaluation research. The literature review also generates new insights on the concept of nursing beds and models for practice. The chapters are comprehensive and well written and complemented by a number of diagrams to facilitate the conceptualization of the texts. Up-to-date references and an appendix containing the tools used for the survey are presented at the end of the book. The inclusion of an index would have been useful.

The present research project is based on the recommendations of the pilot study conducted, from 1983 to 1985, at the Burford Nursing Development Unit, Oxfordshire. The content of the book is organized into 10 chapters corresponding to the process and steps in a research project. Chapter topics include an intro- duction and background to the study; literature review; description of the nursing unit in terms of purpose, philos- ophy and the model of nursing practised. Subsequent chapters focus on the main part of the study incorporating the study designs, procedure and methods; results on both quantitative and quali- tative data; discussion, conclusions and recommendations.

The real value of this publication lies in the breadth of the evaluation and testing of a number of hypotheses using a large sample. The purpose was an attempt to validate the findings of the pilot study and to test effectiveness of therapeutic nurs- ing. In the study design the randomized procedure used was quite adequate for this study. However, a mention of the psychometric properties of the nursing dependency index and the life satisfaction profile would have been appropriate.

It was interesting to note the discussion on the limitations of the study and the problems encountered as this is some- times lacking in many nursing research publications. The results of the study, both in terms of qualitative and quantitative data, were comprehensively discussed but the format in the presentation of the data could be improved.

The findings of the study, according to the authors, strongly indicate that therapeutic nursing has a positive effect on recovery, quality, satisfaction and

mortality. This also supports the study assumption that therapeutic nursing is effective and 'nursing in itself is a thera- peutic force'. It was unfortunate that the findings on the cost-effectiveness of therapeutic care were found to be incon- clusive. A significant lower cost per in-patient day in the nursing unit com- bined with the effectiveness of therapeutic nursing would have provided more empirical evidence for the development and expansion of further nursing beds.

The authors recommend that more nursing beds units be established within the National Health Service and that the therapeutic effects of nursing on patients should be further explored and evaluated.

This book is an important contribution to the development of professional nurs- ing. It will be of interest to both academics and practitioners of nursing who may be seeking ways to evaluate the effectiveness of nursing-orientated care.

G. Hussein Rassool MSc BA RMN FETC RCNT RNT

Lecturer in Addictive Behaviour and Nursing St George's Medical School, London

The Battle of the Nurses by Susan McGann. Scutari Press, London, 1992. 224 pages, £14.95, ISBN 1-871564-62-0.

This is a study of eight nurses who influenced the development of nursing between 1880 and 1930. They were among the first generation of post-Nightingale leaders, all of whom were in some way engaged in the great nurses' registration war. Susan McGann has given us fascinat- ing cameos of these formidable ladies who often conducted their campaign with no holds barred. The urge for nurses to be political was an unnecessary exhortation in the early twentieth century.

To further their aims they founded a number of new organizations, most of which were unrepresentative and undemocratic. When they disagreed amongst themselves, as the RBNA (Royal British Nurses' Association) did in 1894, a rival organization sprang up. Wedded to the idea of a uniform curriculum, a 3-year training (with a fourth year of compulsory service), limited entry to the nursing

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profession, and a stiff examination fee, they were largely at odds with demo- graphic reality. By the turn of the century there were less than 10 000 nurses who had received any training, while 67 000 were recorded on the census as nurses.

Not all the eight were registrationists. Miss Lfickes of the London Hospital main- tained that nursing needed diversity rather than conformity and that 2 years at the London Hospital was worth 3 else- where. Her evidence had a familiar ring for students of reports on nursing education. It is not the length of time you spend doing what Miss Nightingale described as 'pottering and cobbling about patients' that matters.

Some of the eight were less dogmatic than others. Sarah Swift and Ellen Musson were prepared to be more flexible and there is a division between those leaders who supported the foundation of the College of Nursing and those who were bitterly antagonistic. The chapter on Dame Sarah Swift gives an admirable account of this internecine warfare which, of course, in the end, handed state regis- tration and the control of nurse training over the British government.

The victory of 1919 (for registration) was pyrrhic. The standard set was low; training schools continued to set more value on their own certificates, the register was divided into general and supplemen- tar5, parts. There continued to be a strong medical bias in the examinations and the opportunity to provide a more com- prehensive and heuristic training was lost.

This book should be widely read, not only because it gives an insight into nursing in British general hospitals in the first half of the century and the issues of the day but because of the lessons to be learned. Disunity in the United Kingdom prevented the nursing profession from taking charge of its own education and planning to meet the needs of the future rather than the service needs of the day.

To ignore the lessons of history is to be destined t o repeat its mistakes.

Monica E, Baly BA (Hons) PhD FRCN

Editor, History of Nursing Journal

Colitis by Michael P. Kelly. Tavistock/ Routledge, London, I992. 127 pages, £10.99, ISBN 0-415-03839-1.

Ulcerative colitis affects 100 per 100 000 people. It is much more common among white people than black people and much more common among Jews than Gentiles.

This book is based on the experiences of men and women who have suffered from ulcerative colitis and subsequently needed surgery. Their coping mechanisms are identified and analysed. Much of the information is derived from interviews conducted by the author who himself had surgery for the treatment of ulcerative colitis.

Michael Kelly also aims to demonstrate how the disciplines of sociology and psy- chology can make a contribution to the understanding of patients' experiences - - and help to promote holistic care. He achieves that remarkably well.

People's initial reaction to the symptoms of colitis is to explain them in common- sense 'bugs, nerves and stress' terms. But sometimes their lives become bound up in their illness in ways they find psycho- logically satisfying. Associated pain and uncertainty can affect their way of life and relationships with lovers and families. 'Collusive routines' may be developed and most attempt not just to learn to live with their illness but to carry on as normal.

The inevitable surgery was, for most of his interviewees, a 'life event of major significance; even with the passage of time it retained a degree of emotional charge which seemed to haunt them sometimes years afterwards.' After surgery, coping mechanisms became almost exhausted, a situation not helped by the 'cycle of contradictory identities' established in hospital.

The chapters on 'Living with an ileostomy' and 'The experience of colitis and colectomy' will certainly enrich the insights and practice of professionals. They are full of illustrations of how real people cope with the trauma of illness and the consequences of radical surgery.

The author's wise words are worth emphasizing:

Some coping behaviour is seen as good because it has beneficial or adaptive outcomes ...; the emphasis on the outcome of the behaviour rather

that the behaviour itself is a rather static way of conceptualizing human conduct ... it must be very dearly understood precisely whose values are being used as the yardstick--those of the coper or the observer.

Furthermore, he points out, when people cope, 'they use a range of strategies'.

This publication communicates its findings and its message extremely well. It is scholarly and people-centred. It is, in fact, one of the most interesting books I have reviewed for some time. Its 127 pages contain many pearls of wisdom.

The book is also a model of how knowledge from the disciplines of soci- ology and psychology, when related to the experiences of suffering and the care of those who have suffered, can enhance the insights and practice of professional health care workers. In that respect, teachers of nursing students on Project 2000 courses will find its structure, contents and message invaluable.

It is an ideal text for teachers, students and practitioners of any health care pro- fession. And I am sure that patients and their friends and families will find it very helpful as well.

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

BTA Certificate FRCN FRSH Editor, Journal of Advanced Nursing

High Risk Pregnancy edited by A. A. Calder and W. Dunlop. Butterworth Heinemann, London, 1992. 447 pages, £60.00, ISBN 0-7506-1324-6.

~Parental peace of mind should not be sacrificed on the altar of perinatal mor- tality statistics.' These are words which all members of the multidisciplinary team should remdmber when caring for women with high risk pregnancy.

Both maternal and fetal aspects of high risk are considered in this book and each chapter has a detailed reference list of specific research papers from world-wide sources. The chapters stand on their own and it is not necessary to read them in sequence from 1 to 13. The editors are well-known obstetricians whose own research is quoted by others but who do not themselves contribute to any chapter. Apart from a short paragraph on the back

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cover, there is no indication as to the tar- get audience and no overall introduction or preface to the book.

At first sight this seemed a dull book with closely written pages unrelieved by diagrams or illustrations. Further reading dispelled this impression and there is a wealth of material pertaining to both maternal and fetal aspects of high risk pregnancy from the obstetricians' and the paediatricians" points of view. There is a sense of puzzlement or perhaps frus- tration that, in spite of all the research, some of it on a global scale, there are still

some aspects of pregnancy which defy explanation as to their cause. Pregnancy- induced hypertension is one such, and neurological handicap another.

Many theories are put forward and explained in detail but there is no single identifiable cause. Increasing scope for intervention is not necessarily good, as one author states, and the same person suggests that the mother should not be subjected to unnecessary invasive pro- cedures. But the decision as to which procedures are necessary or not is not always the mothers.'

Physiology and pathology are dearly explained and although written primarily for obstetricians this would be a useful reference book for midwife teachers and students on advanced midwifery courses. It would be well worth having copies in the reference section of libraries in colleges of nursing and midwifery and colleges of medicine.

Beatrice Grant BA RGN RM MTD

Course Leader (Midwifery} Glasgow Eastern College of Nursing

and Midwifery

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