Journal of Advanced Nursing, 1995, 22, 193-197

B O O K R E V I E W S

Focus Charting: Documentation for Patient-Centered Care 6th edn by Susan Lampe. Creative Nursing Management Incorporated, Minneapolis, Minnesota, 1994. 304 pages, $25.00, ISBN 0-9621520-5-6.

Focus charting is a patient-centred process form of clinical documentation that has been in existence in the USA since 1981. It has immediate relevance for the delivery of personalized care to patients not only through its concentration on the recording of observations and treatments but also because of the high value it places on the patient's response to the experience. In addition, it provides a form of documen- tation which can improve continuity of care and reduce the wasted effort and duplication arising from the maintenance of individual records by each health professional involved. Focus charting is claimed to be legally sound. Its compre- hensive nature also makes it a valuable tool for reaping clinical data from records for the purposes of research and audit.

This work provides a lucid step-by-step account to understanding and operating the focus charting approach to documen- tation. It becomes clear that the system has application in all clinical areas and the author provides convincing evidence that its use is less time consuming and more economically effective than conventional problem-oriented types of documentation.

The book commences with the descrip- tion of a set of fundamental practical guidelines and principles governing sound clinical record keeping. These take full account of important ethical and legal aspects of record keeping. As with all chap- ters in the book, there are exercises to test the reader's grasp of the subject and also a detailed list of the supporting literature.

Subsequent chapters explain the logis- tics of focus charting and then relate this in a detailed way to data gathering, analy- sis, care planning, implementation and evaluation. What emerges is a systematic approach to documentation which con- stantly questions the appropriateness of care, addresses the standard of it and pro- vides a rigourous appraisal of its outcomes.

The book concludes with a consider-

ation of the relationship between focus charting and the maintenance and auditing of quality. In this respect it is especially valuable to those who are developing multi-professional approaches to evalu- ation such as clinical audit. Audit can only be successful if it is part of an overall strat- egy for quality monitoring that takes account of the contribution of all who deliver care. The narrow concentration, for example, on medical audit which has been pursued in the United Kingdom in the recent past has concentrated exclusively on diagnosis and treatment. Crucial though these are, the methods suggested in this book broaden the analysis in ways that enable quality of life to be evaluated and cost comparisons to be made.

Clinical audit can build on what has been learned from medical audit. To be effective it needs to be given high priority and receive high commitment in the plans for quality assurance of all health care pro- vider organizations. Perhaps most import- ant of all, its costs should be built into service prices to ensure that it is properly led and resourced, and enabled to feature at the centre of health provision rather than simply being a private game for doctors to play. This book provides rich insights into how these can be achieved.

Peter Bradshaw MA BNurs RGN RMN RHV RNT

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

University of Huddersfield

Teaching and Assessing Nurses. A Handbook for Preceptors by Robert Oliver & Colin Endersby. Baillibre Tindall, London, 1994. 92 pages, £12.95 (pb], ISBN 0-7020-1720-5.

This handbook has been produced to sup- port the English National Board course on teaching and assessing in clinical practice but it has a much wider application and a much wider audience. Readers, I believe, will be drawn from those nurses, midwives and health visitors whose role involves any kind of clinical teaching. The price and presentation are right for a clinical- level book which will be used extensively

as it can be expediently dipped into and out of or used as a reference source. Twelve chapters cover a variety of skills from com- munication to study skills. The format and presentation make it easy to read and refreshingly free from jargon. The first part of the book deals with factors which affect teaching and learning. Factors such as communication skills, memory perception and motivation are presented in a straight- forward and logical fashion. Each chapter is followed by a selection of activities either to be carried out as group work or individual study.

Chapter 4 on 'Mentors and Preceptors' helped to clarify the debate on what is a mentor. This chapter covers a lot of ground, albeit briefly. I felt that the very brief paragraph on supporting the precep- tor/mentor was inadequate as the support required is seriously underestimated especially in new mentor/preceptors who need training and support to help them feel safe in the role.

Chapters 5 and 6 on learning theories and organizing material are at the right level and well planned, making an interesting dip into some of the learning theories which are explained in a straight- forward and simple fashion, enough to whet the appetite for the more in-depth reading offered in the end-of-chapter bibliographies.

Chapter 7 on the 'PlAnning and Learning Experience' looks at the contribution of the lecture in clinical practice and comments also on the drawbacks of this method of teaching in the clinical area. I am not an exponent of lectures in the sideward; I believe that the role of the mentor/precep- tor is to teach where the care takes place either preceding or ending in a short sem- inar/discussion. The inclusion of the client in the teaching 'event' was not addressed which I feel is regrettable.

Chapters 8 and 9 examine planning a learning experience and the process of assessment. These are good informative chapters with case studies which add interest. Chapter 10 on 'Education Resources' offers a useful introduction to the use of educational resources. The use of the patient as a visual aid is introduced briefly and the value of building a social

© 1995 Blackwell Science Ltd 1 9 3

Book reviews

interaction between the mentor/preceptor and the client is explained. Chapter 11, 'Participating in Curriculum Planning' , is a very valuable chapter. The inclusion of clinical experts on curr iculum develop- ment teams is mandatory to receive vali- dation, and a knowledge of this area in clinical expertise is a valuable asset to any curr iculum development team. The final chapter offers useful hints on study skills, and includes help in designing a Buzan diagram conducting a literature search and writing references.

The book also incorporates a number of blank pages at the end for notes which I personally find very useful. This handbook will be a useful tool to any nurse or PAM who wishes to teach in the clinical area or act as a preceptor or mentor. It is priced in the right range to allow professionals to own individual copies and for heal th libraries to own several. I wish this book had been available to me when I was a clinical teacher.

Margaret Dobson MSc BA(Hons) RNT Cert Ed RGN SCM

ONC Regional Nurse Adviser (Education),

Northern and Yorkshire Region Health Authority

Understanding and Management of Nausea and Vomiting by Jan Hawthorn. Blackwell Science, Oxford, 1995. 192 pages, £12.99 (pb), ISBN 0-632-03819-5 .

This book may well become a key text for those involved in the management of symptom control. It is useful to be able to pick up one book knowing that it covers the subject in adequate depth and that it discusses all causes of nausea and vomit- ins as so many other books on symptom control appear to concentrate on the cancer patient.

The chapters follow a logical sequence commencing with the physiology of nausea and vomiting, progressing to the aetiology, the treatments available and finally the management of the patient suffering from these distressing symptoms.

The text is clear and readable al though the reader may initially find the unfamiliar abbreviations off-putting, e.g. LOS (lower oesophageal sphincter). All of the chapters are 'discrete' wi th in the text allowing the reader to select the chapter of interest to be read, al though one may need to read the physiology chapter first to gain full advan- tage from the other chapters.

The tables highlighting key points wi th in the chapter and the summary at the

end of each chapter are useful in allowing the reader quickly to identify the chapter 's content and salient points. The tables may be useful aids when teaching about nausea and vomiting, e.g. Table 3.7: Factors influ- encing postoperative nausea and vomiting.

While the self-assessment questions at the end of each chapter may lead one to th ink this book is aimed at students, anyone reading such a textbook would find it useful to assess their individual under- standing of the chapter just read.., one quick read through is rarely enough to assimilate all the information within the text. Indeed, the questions guided me to re-read those 'bits' that I needed to in order to benefit fully from the chapter that I had just read.

The book is extensively referenced especially to the research that has been per- formed and the author guides the reader to other texts to be studied. Although some of the research mentioned may be 'old', e.g. 1956, most of that refer- enced has been performed in the last 5 to 10 years making it useful to compare one's own current practice with the available research.

The book encourages full assessment in order to unders tand properly, treat and support the patient whether that patient be a baby, a pregnant woman, a surgical patient or someone suffering from ter- minal disease.

Finally the authors in their own words stress that 'At some point in their careers, all nurses will be called upon to care for patients suffering from nausea and/or vom- iting. It is essential therefore... ' they' are equipped to deal with them. ' This book, if read and used, should hopefully start to address the research findings that nurses may not be adequately equipped with the knowledge to give patients the best avail- able care and treatments when they are nauseated and/or vomiting.

Janet R. Graham RGN FETC

Senior Nurse-Surgery, Luton and Dunstable NHS Trust Hospital, Luton

Leg Ulcers. Nursing Management: A Research-Based Guide edited by N. Cullum & B. Roe. Scutari Press, Harrow, Middlesex, 1995. 172 pages, £13.99, ISBN 1-871364-97-3.

Much has been written about leg ulcers in the nursing journals. To date, no single text has tried to encompass all aspects of leg ulcers and their management. However, the editors of this text have successfully

achieved this. Having pooled together a range of contributors from the multi-disci- plinary team (nursing staff, researchers, lec- turars and pharmacists}, they have utilized each author's experience and knowledge to create individual chapters that read as singular texts within one text, thus creating an excellent reference textbook.

Throughout, this easily readable text is well researched and up to date, making it applicable for current clinical practice, not only in terms of treatment but also in aspects such as prevention and patients ' perceptions of chronic leg ulceration. Where relevant, readers are aided in their understanding with appropriate diagrams and colour plates.

The text begins with an extensive chap- ter describing the anatomy and physiology of the circulation of the leg. Following chapters deals with aetiology and epidemi- elegy of leg ulcers. The aesthetic layout of the text allows for pleasurable reading. The subjects are easily understandable using individual subheadings. Again dia- gramatic representation aids the reader.

Included in the chapter regarding nursing assessment is an example of an assessment form. This looks at the patient holistically, i.e. physically and psychosoc- ially. It then describes how to record a very detailed history of the ulcer.

The bulk of the text deals with treatment of leg ulcers. This covers topical treatment such as lotions and dressings based on cur- rent research and practice. It begins with a brief description of wound healing prior to describing treatment such as chemical cle- ansers, debriders, hydrocolloid dressings, paste bandages, etc. Further chapters deal with types of bandages used in the treat- ment of leg ulcers, and their application.

A final chapter describes future research and practice. It outlines current develop- ments and research. By discussing deficits in current practice the author then describes how best to resolve these deficits by changing our practice and competence.

This is a very commendable text, well presented, researched and narrated, with a detailed index which allows for easy refer- ence to the appropriate subject. This book would make a welcome addition to all ward libraries. However, I would rec- ommend this valuable text to adorn the personal bookshelves of all nursing staff.

Chris Buswell QARANC RN Diploma in NtLrse

Counselling Staff Nurse,

The Princess Mary's RAF Hospital, RAF Akrotiri

194 © 1995 Blackwell Science Ltd, Journal of Advanced Nursing, 22, 193-197

Book reviews

ECG Curds: The Indispensable Guide to ECG Interpretation 2nd edn. Springhouse, Sidcup, Kent, 1995. £15.50, ISBN 0-87434-758-0.

The most striking point about this book is its presentation: 125 'postcards' with a hole in one corner, held together by a hinged metal ring. I doubt if it would sur- vive intact for very long in any clinical area. However, it is clearly written and well illustrated in the main and could be kept in a generously sized coat pocket.

The cards cover basic cardiac anatomy and physiology, the fundamentals of elec- trocardiography, recognition significance and management of specific arrhythmias and characteristic 12-lead ECG findings in myocardial infarction and other conditions causing chest pain. As such, its appeal is probably limited to those working in cor- onary care units or areas where ECG moni- toring and interpretation is commonplace, such as accident and emergency and gen- eral cardiology wards.

Despite appearing to begin with basics, the cards would be more useful as an aide- m~moire for experienced coronary care nursing and medical staff than as an intro- ductory text. This is largely because of the unstated assumptions made about the readers' knowledge base and differences in nursing practice in the USA and the UK. For example, knowledge of cardiac action potential is required but not available from the text and arrhythmia management guidelines are generally directed toward doctors, rather than nurses. Having said that, the guidelines are surprisingly con- sistent with those used in the UK.

In short, this Springhouse publication offers nothing new apart from the format which is of dubious practical value but could be useful to doctors and coronary care unit nurses needing readily available information about the management of specific arrhythmias.

Alison McWilliam BSc RGN MBA(Health)

Senior Sister, Coronary Care Unit, University Hospital, Nottingham

The Social Meaning of Midwiferyby Sheila Hunt & Anthea Symonds. Macmillan, Besingstoke, Hampshire, 1995. 192 pages, £12.99 (pb), ISBN 0-333-60877-1.

The famous Scottish poet Robert Burns, in his poem 'To a louse', wrote 'Oh wad some power the girlie gie us tee see ourselves as ithers see us'. Some 200 years later this sentiment is endorsed by midwife Sheila Hunt in her account of ethnographical

research into midwifery practice, entitled The Social Meaning of Midwifery. Written at a time when nursing and midwifery edu- cation is experiencing the birth pangs of merging with/being taken over by the higher education sector in the United Kingdom, it is perhaps significant that this volume is co-authored by a sociologist.

The first two chapters are written by sociologist Anthea Symonds and seek to explain sociological concepts such as professionalism, authority autonomy and adduce the extent to which midwives reflect these characteristics in their clinical practice. In examIning political and cul- tural influences on midwifery practice, an Interesting cameo of the history of mid- wifery is provided.

Chapter 3 gives helpful insights into the intracacias of the ethnographical approach to research. That there are benefits is certain but the overriding impressions are of the phenomenal workload and committment required of the researcher, impressions that are confirmed by reading the account of the data collection in chapters 4-7.

As predicted by the author in the intro- duction, this midwife reader experienced vascillating emotions. Tears of laughter, pathos, anger vied for expression in recog- nition of the realism presented in these vig- nettes of life in a labour ward.

Chapter 8 comprises analysis and dis- cussion during which searching questions are posed. 'Is skill determined by gender?' 'What are the essential skills of mid- wifery?' 'Is either continuity of care or cater a realistic proposition?' 'Who are the winners and who are the losers in the battle for autonomy and freedom of choice, mother, midwife, doctor?'

A disturbing but hardly unfounded anal- ogy made throughout is that of the simi- larities between midwifery and industry: e.g. the role of market forces in dictating the quality of the product. Probably the greatest benefit from this book will be gle- aned by midwives who are encouraged to reflect upon their practice or by mothers, if this reflection leads to improved stan- dards of care, whatever the setting.

Many of the principles discussed could however be extrapolated to nursing disci- plines. Therefore the book has a wider appeal than to those employed or inter- ested in midwifery. For those who, unlike Sheila Hunt, are true 'cultural strangers' to midwifery a glossary of terms is included.

Anne C. Halliday RN RM RMT

Midwife Teacher, Glasgow College of Nursing & Midwifery, (East Division),

Glasgow

At a Loss. Bereavement Care When a Baby Dies by Alan Stewart & Ann Dent. Baillibre Tindail, London, 1994. 272 pages, £10.95 (lab), ISBN 0-7020-1682-9.

Books about the subject of childhood bereavement are few, and those that do exist often come from a psychology, medi- cal or social work background. A new book from two nurses about an important part of this subject is therefore something very interesting indeed, and this comprehen- sive book lives up to expectations.

The subjects range from a very brief general discussion of issues surrounding bereavement and loss, through a variety of different situations where babies may die, to caring for families, other children, and health workers. The range of situations covered by the authors is very wide and covers areas that are not always considered such as therapeutic abortion, infertility and adoption, as well as the more expected areas such a cot death and miscarriage. This is a strength because it is convenient to have all of these subjects covered in one volume, but it may also mean that some subjects are not really treated in enough depth for some readers. Such people are likely to be small in number, however, and this book should be suitable for most nurses, both as an introduction to the sub- ject and as a reference source.

Each chapter is well referenced, with addresses of useful organizations and details of other resources also given. The text is clear and easy to read, and manages to tread that very thin line between sensi- tivity and over sentimentality very well. It has a few illustrations that are always rel- evant, and has a lot of useful and very prac- tical information that many nurses will find of use, and it is perhaps this aspect of the book that is its greatest strength.

Because there are many places in both hospital a n d / the community where bereaved families may be cared for, this book should have wide appeal. It deserves to be widely distributed and read not just in neonatal and maternity units but also in accident and emergency departments, pae- diatric wards, and throughout the com- munity services.

Edward Purssell RGN RSCN Staff Nurse,

St Thomas' Hospital, London

© 1995 Black-wall Science Ltd, Journal of Advanced Nursing, 2g, 193-197 195

Book reviews

Work and Health: An Introduction to Occupational Health Care edited by Margaret Bamford. Chapman & Hall, London, 1994. 208 pages, £12.99 (pb), ISBN 0-412-48430-7 .

This book is a welcome addit ion to the occupational health care literature as there are far too few publications in this field. It is, however, unfortunate that it lacks an introduction which might offer some sort of conceptual framework to underpin the content.

The first three chapters are rather disap- pointing in their descriptive ]eve] and ]ack of internal cogency. Chapters 4, 5 and 6, which collectively form more than half of the text, are infinitely superior in terms of content, presentation and literary refer- ence, Chapter 7 is rather disappointing owing to its narrow focus, although given the scope of the subject perhaps this is inevitable, A rationale for the employment law issues covered is not explicitly stated and neither the European dimension or the way in which health and safety legislation is developed in the United Kingdom are addressed.

On balance and in view of its reasonable size and price, we would recommend the text to nursing students at both pre and post registration levels. It would also be a useful text for undergraduate students on business studies and human resource management courses. Occupational heal th practitioners of all disciplines should find the three middle chapters of interest. It would also be a useful book to give to new managers in organizations with a commit- ment to the promotion of the heal th of their workforce.

Fiona Begbie BSc RN DN Cert OHNC OHND

Lecturer in Nursing, and

Ann Lewis MEd DipN RGN OHNC Teaching Cert

Professor of Nursing, Robert Gordon University, Aberdeen

Tradition and Reality: Nursing and Politics in Australia by B. McCoppin & H. Gardner. Churchill Livingstone, Melbourne, 1994. 372 pages, £15.00, ISBN 0-443-04217-9 .

McCoppin and Gardner have produced a superb chronicle of Australian nursing in writing Tradition and Reality: Nursing and Politics in Australia. Beginning the histori- cal account during penal colony times, the writers describe 'convict nursing' at a t ime when 'able-bodied paupers ' cared for the

sick in British workhouse infirmaries. The professional journey from this low point to the present, when Australian nurse edu- cation has found a home at universities, is charted by the authors, drawing on a large number of documentary sources.

Chapter 1: 'Building a Tradition - Australian Nursing to 1960,' sets the scene in highlighting the main historical mile- stones from penal t imes unti l the point of real 'take-off' in the development of modern nursing in Australia.

The contradictions inherent in the pro- fessionalization of nursing are apparent in the title of chapter 2: 'Nursing - A Professional Obsession'. The introductory paragraph could well refer to nursing in the United Kingdom and most other coun- tries with an 'aspiring' nursing profession: 'Nursing in Australia, as elsewhere, has styled itself unambiguously as a profession in spite of having enjoyed nei ther the social and political influence nor the pay and conditions of occupations such as law, medicine and dentistry' (p. 37).

Transit ion from ' learning on the job' to more structured education is described in the next chapter, entitled 'Nursing Education - Apprentice to Student' . Professional development in clinical nurs- ing is described in 'Nursing Work - A Few More Degrees of Freedom'.

The ideological divide between 'pro- fessional aspirations and industrial necessities' is described in a chapter entitled. 'Organised Nursing - Conflict and Cohesion' and the final chapter, 'Living with Reality', concludes the book. In the concluding part the writers seek to analyse the difference between perceptions and reality concerning medicine and nursing, concluding that in academic settings there is a tendency to overestimate what doctors do 'because their public image leaves out the more routine parts of their work' (p, 305}, whereas the work of nurses is under- estimated, since there is lack of knowledge about the complexity of their work.

This book may be mildly partisan and why not? It is a well-argued, welt- researched chronicle of nurse profes- sionalisation in Australia. It is written for nurses and others, who are disposed to look favourably at the struggle by Australian nurses to achieve justified status and authority. While not value free, the authors honestly seek to distinguish between tradition and reality, in order to assess the real situation of Australian nurses in the late 1990s.

This sensitive analysis of nursing history in Australia will be of great interest to his- torians of nursing, who are involved in

comparative research. It demonstrates both similarities and differences between the process of Australian and British nurse professionalization, which are rooted in socio-economic and historical factors. This is an excellent, scholarly book, which would be an asset to any reflective nurse and in particular to nurse historians and policy makers.

Maria Lorentzon BSc{Soc) MSc(Soc} PhD RN RM

Manager, Department of Genera1 Practice, St Mary's Hospital Medical School,

London

Applying for Research Funding: Getting Started and Getting Funded by J.B. Ries & C.G. Leukefeld. Sage, London, 1995. 272 pages, £14.95 (pb), ISBN 0-8039-5365-8 .

To make a successful application for the t r ad ing of your research project is to make your research project itself into a credible piece of work. That is the message that this beak spelled out to me.

Producing the quality of funding appli- cation required to out-class the compe- tition is no small feat; but the importance of knowing the rules and playing the fund- ing game has a benefit over and above simply increasing your chances of obtaining funding. Being forced to focus on your project as though through the criti- cal eyes of a grant provider is a sure way to produce an academically, as well as economically, viable research proposal.

The authors are wise, though, to caution that good presentation is not a substitute for a good idea, and that a good idea, or good science, 'if not presented in a logical, understandable, and compelling manner will not be successful'.

Ries and Leukefeld have brought together a wealth of experience in this field. They have produced a book which should greatly enrich the research-process literature. Others have written books on the submission of research proposals, and many journal papers have given advice on this topic. What this book promises is a comprehensive and structured form of coaching for the novice, and a clarification and sharpening up of the process for the more seasoned researcher.

The layout of the book reflects the ease with which it is intended to be read. The introduction gives a summary of each chapter and the important issues are repeated so that the book can be browsed through and read almost at any point, or accessed through the extensive index.

The book has its roots in American

1 9 6 © 1995 Blackwell Science Ltd, Journal of Advanced Nursing, 22, 193-197

Book reviews

health research; therefore specific refer- ences are made only to American funding organizations. But the concepts discussed and the actions advocated hold true for researchers in other countries. Funding organizations the world over require cer- tain assurances and, whether they be pri- vate organizations or government agencies, look for certain basic components. Not least is the credibility of the applicant, and

advice is given on how best to match the ideal profile of the principle researcher.

It is in this way that the value of this book becomes apparent. Even if one is not applying for funding, this book is worth reading prior to undertaking a major piece of research for the intelligent contribution it can make to structuring your thoughts and to making you look outside the confines of your study topic.

Ramon Pediani RGN BSc(Hons)

Clinical Nurse Specialist for Acute Pain Control,

Blackpool Victoria Hospital NHS Trust, Blackpool

Individuals wishing to order books reviewed should contact the publisher of

the book direct.

© 1995 Blackwell Science Ltd, Journal of Advanced Nursing, 22, 193-197 197