Vital Notes for Nursing: Research for Evidence Based Practice

Unfortunately, a discussion and rationale forthe method of data collection used is missing andthe authors have not identified in any depth, otherempirical research that might support these findingexcept for one similar report that preceded thisone. This has led to some criticism from otherresearchers who suggest that the research is weakand lacks validity. On the contrary, whileacknowledging these concerns of other research-ers, the authors have taken great care to point outthe strengths and weaknesses of this type ofresearch that could be addressed further in otherwork. As with all qualitative research thatexplores the subjective experience of participants,this project provides a reflective account through-out. This is commendable considering that thewhole team identified that the process had notbeen easy and required considerable support fromthe advisory team in the form of training, andsupport.

This report will be useful reading to anyoneconsidering developing participatory research toinvolve service users. However, in an attempt to betotally open and honest, it becomes confusing inplaces as it jumps from timeline to process and backagain. Consequently, much of the report consists ofthe process rather than the findings. The accompa-nying DVD has been produced in a sequentialprocess and perhaps provides a clearer overview ofthe process for those who might find the reportdifficult to read.

MARJORIE LLOYD RN RNT BSc MScSenior Lecturer in Mental Health Nursing

North East Wales Institute of Higher EducationPp20 Plas Coch Campus

Mold RoadWrexham LL12 2AW

UKE-mail: m.lloyd@newi.ac.uk

Vital Notes for Nursing: Research forEvidence Based Practice

R. Newell & P. BurnardBlackwell Publishing Ltd., Oxford2006, 256 pages, $29.95ISBN 9781405125628

A pervasive problem in nursing education and clini-cal settings is the difficulty of communicating

research concepts, methods and techniques to stu-dents and caregivers overwhelmed with their needto learn other things. The best nursing researchtexts are too long, too detailed and often leavestudents feeling they will never master the coreconcepts.

A book that covers most of the core material iseasily and quickly absorbed, and which readerscan complete before abject boredom overpowersintellectual curiosity is an excellent idea. As astudent during my BSN programme, I foundmyself constantly checking how many more pagesI had to read to ‘get through’ the current chapter.Chapter 7, Issues in Qualitative Data Collection,the longest chapter in the book, comes in at a slim15 pages. Even attention deprived readers will beable to complete this chapter without too manydistractions.

Newell and Burnard have produced an excel-lent primer. As I looked at Box 11.1 under theirdiscussion of coding qualitative research inter-views, I thought – If you change ‘Reflection’ for‘Research’, the transcript and coding describes theproblem with many nursing research books andcourses. I see the authors’ presentation as a gentleconversation with a learner in an informal setting,perhaps the office or after class. The discussion attimes is necessarily incomplete, some topics areglossed over or omitted, and in some cases thelogical sequence has gaps and/or missteps. Theflaws are inescapable. What the book does par-ticularly well is covering the basics of quantitativeand qualitative research, experimental design,surveys, research management, reporting andevaluation. In short, it covers everything in abbre-viated form.

The reader does need to be circumspect. Mas-tering this book is quite different than masteringresearch. But it is a great overview before tacklingmore comprehensive texts. I would recommend itas additional reading though I suspect some stu-dents would choose to use it as their primarysource.

Newell and Burnard cover all the most basicmaterial. They describe the rationale for evidence-based nursing practice and address ethics inresearch. The ethics chapter includes the Nurem-berg codes based on the atrocities of World War IIand refers the reader to Stanley Milgram’s experi-ments on obedience and interestingly includes oneof my favourite papers as a psychiatric nurse:Rosenhan’s On being sane in insane places. There

Book reviews

714 © 2007 The Authors. Journal compilation © 2007 Blackwell Publishing Ltd

are links for Internet references in most chaptersthough several I tried do not work. I went to visitthe site for William Trochim’s excellent ‘KnowledgeBase’: http://trochim.human.cornell.edu/KB but thelink did not work.

What is missing in the ethics chapter, for a USreader, is a reminder of the ethical failings andimplications of the Tuskegee syphilis experiments. Itis easy, if we are not reminded, to forget that theGerman eugenics programme borrowed from theCommonwealth of Virginia’s eugenics programme,where the involuntary and often uninformedsterilization of the intellectual and morally unfitcontinued until 1972.

The discussions of qualitative and quantitativeresearch are adequate for an overview. I oftenfound myself thinking: this is exactly what Iwould be inclined to say in class or during a 1–1session. The coverage of qualitative and quantita-tive sampling theory, data analysis and statistics isnecessarily limited. There is no simple way toexplain complex topics with many nuanced facets.But the book is an excellent starting point forstudents and working nurses with little priorexposure to research, and reading it shouldpay generous dividends when the reader consultsresearch reports or tackles the larger, morein-depth, research texts.

THOMAS COX PhD RN

PrincipalGreen Trees Consulting

1711 NW 55t TerraceGainesville, FL 32605, USA

E-mail: nurse.statistician@yahoo.com

Betraying the NHS: Health Abandoned

Michael MandelstamJessica Kingsley, London2007, 176 pages, $24.95ISBN 1843104822

Michael Mandelstam details the degradation of theBritish National Health Service, documenting theinevitable closures of facilities as local health enti-ties struggle to meet unrealistic operating targets setby centralized bureaucracies. Mandelstam identifiestragically flawed and deceptive decision-making atevery level and describes how these flaws havedestroyed the fiscal and clinical integrity of local

healthcare services, compromised care, and margin-alized the neediest and most vulnerable elderly andmentally ill. He faults politicians, bureaucrats, localboards and casts blame on efforts to privatize theNational Health Service as causative factors. All aretrue.

Mandelstam’s descriptions and analyses alsoapply to the French, Japanese, Canadian andAmerican healthcare systems and thus, his work isessential reading for healthcare planners, policyanalysts, healthcare providers, healthcare consum-ers and the electorate. That said, the book fails toanswer important questions: why are these localhealthcare systems struggling and failing? What canbe done to stop their slides down the slipperyslopes?

The problems Mandelstam describes are farmore general. His case studies could come frommany healthcare systems, despite seeming differ-ences in economic systems, social values, social con-science, sincerity of inter-generational commitmentsand superficially different political systems. Thesame things are happening in most national health-care systems. Mandelstam’s explanations fail totranscend nations, time and geography.

The British, French, Japanese, Canadian andAmerican healthcare systems suffer similar prob-lems: too much past success; too much demand;inadequate governmental/private funding; unrealis-tic expectations; diminishing service quality, quan-tity and effectiveness; and most important, the nearuniversal efforts to transfer clinical and financialrisks to small, financially incapable entities. Thereare explanations for what is happening. Mostpeople neither appreciate nor want to appreciate,the flawed reasoning underlying our health policy,and politicians and bureaucrats obfuscate thedetails of what they are doing and the resultingpain.

Globally, most consumers and providers are dis-appointed with their experiences. To understandthe inevitable problems/failures of local control,consumer-directed health care, and the seeminglygenuine efforts to promote fiscally sound, cost-effective, local healthcare delivery systems; we mustunderstand the fundamentals of risk manage-ment through insurance. Mandelstam describesthe trees, what remains is a need to describe theforests.

Modern healthcare systems face three problems:first, their past success in thwarting pestilence,disease and death. Second, their assumptions that

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