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BOOK REVIEWS
Research Methods in Health Ð Investigat-
ing Health and Health Services by Ann
Bowling. Open University Press, Bucking-
ham, 1997, 448 pages, £16.99, ISBN: 0 335
19885 6.
The blurb on the back of this book lists an
impressive number of different people who
may ®nd the book useful. Normally a
suspicion is immediately raised as to how
a book which claims to be suitable for so
many people will achieve this. In this case,
this comprehensive and succinctly written
book does achieve the near impossible. The
author, a respected social scientist, has a
very clear writing style that allows the
inclusion of a mass of information on
research methods in under 450 pages.
There is no need to cut through swathes
of verbiage that one ®nds in some heavy-
weight research textbooks to ®nd informa-
tion that you may be seeking. Another
positive feature is the inclusion of aspects
of health and health service research that is
not found elsewhere in the literature or is
inadequately covered. One example of this
is the chapter on costing health services
which is apposite at present given the drive
to provide effective and cost-effective
health-related services. The author alludes
to the differences between health research
and research into health systems and
health services. She suggests that health
service research needs to be translated into
action to be of value and needs to tran-
scend what she refers to as the research and
development divide. This view is fully
supported and elaborated upon within
section 1 thus making this a useful text
for those who have responsibility for im-
plementing ®ndings into practice and mak-
ing judgements of the value of research as
well as students and researchers.
Section 2 sets a framework for the
remainder of the chapters by reminding
the reader of the philosophical back-
ground of research and the principles of
the research process itself. The informa-
tion on the principles is fairly standard
and brief; however, this does not detract in
any way from the overall text. The remain-
ing chapters, encompassing methods and
analysis in both quantitative and qualita-
tive research are comprehensive, well
written and excellently laid out. I used
Section 3 on sampling and research meth-
ods in quantitative research as the basis for
a lesson for BSc Specialist Practice stu-
dents and it proved useful and informa-
tive. Again the succinctness of the writing
eliminated the need to search endlessly for
information and this made for an easier
task. There is an extensive glossary of
terms and reference list and at a price of
£16.99 this book should be an essential
buy for all those concerned with learning
about and understanding research into
health and health services.
Douglas Allan
MN BEd RGN RMN RNT
Lecturer,
Department of Nursing and
Community Health,
Glasgow Caledonian University,
Glasgow
Basic Concepts for Qualitative Research by
Immy Holloway. Blackwell Science, Ox-
ford, 1997, 186 pages, £11.99, ISBN 0 632
04173 0.
There have been many recent books on the
subject of qualitative methods. This book
is somewhat different from the norm as it
is a dictionary of qualitative terms and
concepts. Therefore it is not the type of
book to be read from cover to cover. The
book starts with an overview of qualitative
research, considering the historical and
epistemological foundations of these ap-
proaches. Such an introduction is a useful
strategy as it plots the progress of ideas.
Moreover, it is well presented in an acces-
sible style. My only quibble with this
section is that it makes an assumption that
grounded theory is the paradigm for all
qualitative research, when in reality it is
but one approach.
The majority of the book is made up of
an alphabetical list of key concepts and
terms. These are also cross referenced.
Each concept is de®ned and described
with references given if appropriate. It
would be easy to be critical because a term
was not de®ned in a particular way or
another term was missing but that would
be an injustice to a very comprehensive
text. Indeed the comprehensiveness pre-
sents a problem because each concept by
necessity only has a little space devoted to
it. For example, discourse analysis is
summarized in approximately two pages
which in my view does not adequately
capture the debates and differences be-
tween the evolving discursive approaches.
This highlights another problem with a
dictionary of qualitative concepts in that it
will need to be up-dated regularly. Re-
search methods are constantly evolving
and can be adapted by researchers to
address their research challenges. It would
be inappropriate to infer that particular
methods become ®xed and prescriptive.
The ®nal section contains lists of books
grouped into categories such as general
texts, ®eldwork and theory and philoso-
phy. There are also lists of text books in all
the major qualitative approaches and those
books written for speci®c professional
groups.
It is dif®cult to know who to recom-
mend this book for. I see it as an important
library resource for students and practitio-
ners who may be faced with certain terms
in their reading of nursing research. How-
ever, for students at higher degree level,
this book would have limited appeal as
each term would need further reading
before the student could go on to use the
methods in an actual research project. My
postgraduate students found the reference
lists the most useful aspect of the book. At
postgraduate level most students will re-
alise that the de®nition of terms is more
contentious that the way it is presented
here. I recommend this book as a quick dip
into the world of qualitative research with
the warning that it is not a recipe textbook
of research methods. It can usefully ®nd a
place in a nursing library and would be a
valuable guide in reading completed qual-
itative research studies.
Sheila Payne
BA RN DipN PhD C Psychol
Director of Research,
Health Research Unit,
University of Southampton,
Southampton
Journal of Advanced Nursing, 1998, 28(4), 918±924
918 Ó 1998 Blackwell Science Ltd
Completing a Qualitative Project: Details
and Dialogue edited by Janice M. Morse.
Sage, Thousand Oaks, California, 1997,
416 pages, £23.00, ISBN 0 7619 0601 0.
Janice Morse is inextricably linked with
qualitative approaches to research in
nursing and her contribution to this ®eld
is widely respected. This book really
builds on two of Morse's previous vol-
umes, namely, Qualitative Nursing Re-
search: A Contemporary Dialogue and
Critical Issues in Qualitative Research. In
this latest edited text she draws together
the contributions of some 22 authors, who
are active in the ®eld of qualitative re-
search, to address issues which arise once
qualitative data have been collected and
analysed. Anyone who has been involved
in qualitative research will be familiar
with the dif®culties of developing theory,
generalizability, writing up the research,
and disseminating ®ndings. This book
helps us to begin to ®nd answers to the
questions raised by these and other dif®-
culties.
Although each of the 18 chapters has
been written by one or two of the team of
22 authors each chapter does in fact re¯ect
the contribution of all 22. This has been
achieved by subjecting the drafts of each
chapter to discussion and review at a 2-
day workshop/seminar. This approach is
to be commended on a number of fronts;
®rstly it ensures that readers are not sub-
jected to one perspective alone but sec-
ondly, it helps to maintain a consistency of
approach which can be dif®cult to obtain
in an edited volume. The book covers a
wide range of issues associated with the
later stages of a qualitative project and just
naming some of the chapter titles may
serve to give an indication of the range of
topics covered: The Politics of Publishing:
Protecting Participant's Con®dentiality;
Responding to Criticism; Linking Qualita-
tive and Quantitative Research; Clinical
Utilisation/Application of Qualitative Re-
search; and Qualitative Research in Policy
Development.
As might be expected of qualitative
writers, all of the chapters are written in
an approachable, articulate and readable
style. Each chapter ends with what is now
becoming customary in Morse's texts, a
short dialogue. In this case the dialogues
are taken from the two-day workshop held
for authors. Morse says that she originally
used these dialogues to prevent the text
from becoming too dry but I found they
helped to draw together or encapsulate
some of the issues under discussion. Cer-
tainly they help to punctuate the text as a
whole. In considering who would bene®t
from reading this text, the small dialogue
set out on the ®rst page of this book asks
Who's the audience for this book? Hutch-
inson replies: The World. At large. This
may be somewhat of an exaggeration.
However, you may already have reached
the reasonable conclusion that this is a
book for all those who are engaged in or
who are about to engage in, qualitative
research. There is no doubt in my mind
that all college and university libraries
should possess a copy but the book is of
such practical value that students and
researchers would be well recommended
to purchase their own copy.
Alan Weale
MA RGN DNT
Head of Department,
Courses Allied to Health Studies and Care,
Worcester College of Higher Education,
Worcester
The Mental Health Nurse. Views of Prac-
tice and Education edited by Stephen
Tilley. Blackwell Science, Oxford, 1997,
240 pages, £14.99, ISBN 0 632 03999 X.
The Mental Health Nurse: Views of Prac-
tice and Education is a book edited by
Stephen Tilley which attempts to access
the views of a variety of mental health
workers about their current perceptions
about the nature and state of the art of
psychiatric nursing. Contributors are
drawn from a variety of backgrounds
including practitioners, academics, man-
agers and educationalists, with each be-
ing given the task of answering two
fundamental questions: What is your ver-
sion of the mental health nurse? and How
is the nurse trained, educated, found,
(whatever is appropriate to the version)?
Each chapter is framed and in¯uenced by
the background of the contributor and
their professional role, and this promotes
a text which has a wide range of mental
health perspectives drawn from a variety
of theoretical and practice-based para-
digms.
The book sets out to inform readers
contemplating mental health nursing as a
career option as well as stimulating exist-
ing practitioners to re¯ect upon their
practice philosophy.
The style and presentation of the book
re¯ects the diversity of the contributors'
backgrounds with the readers able to align
themselves to certain aspects or views
dependent on personal and professional
perspectives and values. This provides an
eclectic and stimulating diversity of views
about the evolution and current issues in
mental health nursing which is not dis-
similar to my early experiences of trying to
uncover the meaning of what mental
health nursing is all about.
The book does not set out, like many
text books, to provide a balanced and
comprehensive overview, but rather a se-
lected menu of critiques about issues per-
taining to current practice, in an attempt to
create clarity and insight in the work of the
mental health nurse. Consequently, I think
the person reading this book needs a
reasonable insight into the cultural pre-
requisites which underpin practice and
education, to promote a conducive envi-
ronment in which the text can facilitate
informed criticism, debate and under-
standing. Authors provide considerable
food for thought, in examining current
trends of practice and education, with
illuminating insights into concepts such
as re¯ective practice and mentorship, for
example, which has been adopted in nurse
education, often without adequate consid-
eration as to the processes involved and
the resulting effects it has on the student's
learning.
It is slightly surprising that in a period
of increased user in¯uence into practice
and education, that a chapter was not
offered to provide a user perspective of the
mental health nurse. Overall, this is a
stimulating and thought-provoking book,
which is competitively priced to the con-
sumer. If my experience is anything to go
by, it will remind nurses about their his-
torical heritage as well as exploring con-
temporary issues from a variety of
perspectives and provide a useful addition
to a textbook collection.
Richard Frisby
MSc PGCEA RMN RNT
Lecturer,
The Nightingale Institute,
King's College London,
University of London,
London
Book reviews
Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924 919
Choice, Information and Dignity Ð Invol-
ving Users and Carers in Care Manage-
ment in Mental Health by John Carpenter
and Silvia Sbaraini. The Policy Press,
Bristol, 1997, 108 pages, £13.95, ISBN 1
86134 069 9.
Since 1960 the Department of Health has
been promoting a policy of user participa-
tion in mental health care. A number of
principles have been listed as underpin-
ning the concept of user participation.
Among these, systematic assessment of
the user's health, multidisciplinary coop-
eration, involvement of carers, allocation
of key workers, and the creation of an
agreed plan of care were seen to be essen-
tial. Regular reviews of the user's progress
were taken for granted. Over the years lip
service has increasingly been paid to the
concept of a care programme approach.
The government intended this approach to
apply to all people in contact with mental
health services, however, the Audit Com-
mission (1994) indicated that its use was
likely to be particularly relevant to those
with serious problems, in particular to
those who were in danger or who put
members of the community at risk. A report
issued by the Department of Health, Build-
ing Bridges (1995), spells out details of the
government's expectations. However, very
little research has been carried out to test
the effectiveness of the approach where it
has been put into practice, or indeed to ®nd
out the extent to which the government
directives have been implemented.
This book is a report of one investiga-
tion, carried out in one mental health
service in the South of England. The
authors describe their work as `participa-
tory research'. Initial training was offered,
progress was monitored and results fed
back to the services and to user groups.
Management action was prompted as a
result. Evaluation of carers' and users'
experience was continuous. Interviews
and questionnaires were used. Follow up
was carried out after 6 months. The results
are well summarized on pages 7 and 8. The
rest of the report provides details of the
method employed, cites speci®c case ex-
amples, highlights details of users' and
providers' expectations and draws conclu-
sions about the way the project might
become more generally applicable.
In essence the report shows that every-
one was in favour of the care planning
approach even if they did not know how to
use it. There was widespread variation in
the way the concept was understood. As
the project got under way users realized
that they were meant to be actively in-
volved in planning their own care and, by
signing, to agree to abide by it. In fact users
were keen, saw the advantage, felt more
respected and listened to. Nevertheless,
more than half of them no longer had a
plan 6 months later, more than half had
plans changed, more than half had been
readmitted to hospital, many compulsorily
under sections of the mental health act.
Many wanted carers more involved, many
carers were enthusiastic about being in-
volved. However, 6 months later very few
of the carers were in fact involved and
contact with patients had greatly dimin-
ished. Most staff were enthusiastic and
realized the potential bene®t to patients,
but found care plans time consuming and
were erratic in the way plans were updat-
ed or maintained. General practitioners
liked the idea but failed to participate in
planning meetings or in carrying out
plans. Users for whom plans were made,
felt they received more respect, had more
choice and self-determination. Carers'
own needs were rarely addressed by ser-
vices. I think this is an important piece of
research. It should be taken notice of an
unrealistic expectations should cease to be
voiced. I cannot claim, however, that I
enjoyed reading the book. It says all there
is to be said early on. I am old fashioned
enough not to respond favourably to end-
less repetition, especially if it is presented
in picture book format, with coloured
®gures and tables, with summaries before,
in the middle and the end of the text. I
think this research deserves a substantial
article in a reputable journal, but not 105
pages at £13.95 of anyone's money.
References
Audit Commission (1994) Finding a
Place: A Review of Mental Health Services
for Adults. HMSO, London.
Department of Health (1995) Building
Bridges: A Guide to Arrangements for
Inter-Agency Working for the Care and
Protection of Severely Mentally Ill People.
DoH, London.
Annie T. Altschul
CBE FRCN BA MSc RGN RMN RNT
Emeritus Professor of Nursing Studies,
University of Edinburgh,
Edinburgh
Addiction Nursing. Perspectives in Profes-
sional and Clinical Practice edited by G.
Hussein Rassool & Mike Gafoor. Stanley
Thornes, Cheltenham, 1997, 294 pages,
£16.99, ISBN 0 7487 3179 2.
This book aims to provide a comprehen-
sive picture of issues and interventions in
addiction nursing, and contains chapters
from 18 contributors, all of whom are
active in the ®eld, with an emphasis on
clinical involvement. On balance, I feel
positive about this book, which offers a
commendable breadth of information for
the interested clinician. It will be useful to
students and to nurses working, or con-
sidering working in the ®eld of addiction
nursing. Additionally, it provides a wealth
of information which will be useful for
members of other disciplines, although the
focus is very clearly on nursing, particu-
larly on the section concerning clinical
practice. The book is divided into six
parts: themes and perspectives; clinical
practice in action; special populations;
prevention, health education and collabo-
ration; service development and manage-
ment; and professional and personal
development. The editors are to be con-
gratulated on organizing these often di-
verse areas into a well-integrated text. The
book as a whole is well edited, and man-
ages to maintain a consistent approach
across its 25 brief chapters.
There are occasional irritating minor
grammatical errors which have slipped
through the editing process, but these are
rarely too intrusive. As might be expected
with such a far-reaching text, the actual
quality of the contributions is variable.
The sections on themes and perspectives
and health education are the strongest, and
are uniformly successful in orienting the
reader to a number of complex issues with
brevity, but without super®ciality.
By contrast, the sections on clinical
practice and professional development
are variable in quality. In the case of
clinical practice, some chapters are super-
®cial, and would be of little use to the
clinician other than at a very introductory
level. Two examples of this are the chap-
ters on psychotherapeutic approaches and
on complementary therapies. In the ®rst
instance, the title is misleading, since the
chapter focuses almost entirely on psycho-
analytically oriented psychotherapy,
which is only one of a broad range of
possible approaches. Despite this, the
description of it is both sketchy and un-
Book reviews
920 Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924
Choice, Information and Dignity Ð Invol-
ving Users and Carers in Care Manage-
ment in Mental Health by John Carpenter
and Silvia Sbaraini. The Policy Press,
Bristol, 1997, 108 pages, £13.95, ISBN 1
86134 069 9.
Since 1960 the Department of Health has
been promoting a policy of user participa-
tion in mental health care. A number of
principles have been listed as underpin-
ning the concept of user participation.
Among these, systematic assessment of
the user's health, multidisciplinary coop-
eration, involvement of carers, allocation
of key workers, and the creation of an
agreed plan of care were seen to be essen-
tial. Regular reviews of the user's progress
were taken for granted. Over the years lip
service has increasingly been paid to the
concept of a care programme approach.
The government intended this approach to
apply to all people in contact with mental
health services, however, the Audit Com-
mission (1994) indicated that its use was
likely to be particularly relevant to those
with serious problems, in particular to
those who were in danger or who put
members of the community at risk. A report
issued by the Department of Health, Build-
ing Bridges (1995), spells out details of the
government's expectations. However, very
little research has been carried out to test
the effectiveness of the approach where it
has been put into practice, or indeed to ®nd
out the extent to which the government
directives have been implemented.
This book is a report of one investiga-
tion, carried out in one mental health
service in the South of England. The
authors describe their work as `participa-
tory research'. Initial training was offered,
progress was monitored and results fed
back to the services and to user groups.
Management action was prompted as a
result. Evaluation of carers' and users'
experience was continuous. Interviews
and questionnaires were used. Follow up
was carried out after 6 months. The results
are well summarized on pages 7 and 8. The
rest of the report provides details of the
method employed, cites speci®c case ex-
amples, highlights details of users' and
providers' expectations and draws conclu-
sions about the way the project might
become more generally applicable.
In essence the report shows that every-
one was in favour of the care planning
approach even if they did not know how to
use it. There was widespread variation in
the way the concept was understood. As
the project got under way users realized
that they were meant to be actively in-
volved in planning their own care and, by
signing, to agree to abide by it. In fact users
were keen, saw the advantage, felt more
respected and listened to. Nevertheless,
more than half of them no longer had a
plan 6 months later, more than half had
plans changed, more than half had been
readmitted to hospital, many compulsorily
under sections of the mental health act.
Many wanted carers more involved, many
carers were enthusiastic about being in-
volved. However, 6 months later very few
of the carers were in fact involved and
contact with patients had greatly dimin-
ished. Most staff were enthusiastic and
realized the potential bene®t to patients,
but found care plans time consuming and
were erratic in the way plans were updat-
ed or maintained. General practitioners
liked the idea but failed to participate in
planning meetings or in carrying out
plans. Users for whom plans were made,
felt they received more respect, had more
choice and self-determination. Carers'
own needs were rarely addressed by ser-
vices. I think this is an important piece of
research. It should be taken notice of an
unrealistic expectations should cease to be
voiced. I cannot claim, however, that I
enjoyed reading the book. It says all there
is to be said early on. I am old fashioned
enough not to respond favourably to end-
less repetition, especially if it is presented
in picture book format, with coloured
®gures and tables, with summaries before,
in the middle and the end of the text. I
think this research deserves a substantial
article in a reputable journal, but not 105
pages at £13.95 of anyone's money.
References
Audit Commission (1994) Finding a
Place: A Review of Mental Health Services
for Adults. HMSO, London.
Department of Health (1995) Building
Bridges: A Guide to Arrangements for
Inter-Agency Working for the Care and
Protection of Severely Mentally Ill People.
DoH, London.
Annie T. Altschul
CBE FRCN BA MSc RGN RMN RNT
Emeritus Professor of Nursing Studies,
University of Edinburgh,
Edinburgh
Addiction Nursing. Perspectives in Profes-
sional and Clinical Practice edited by G.
Hussein Rassool & Mike Gafoor. Stanley
Thornes, Cheltenham, 1997, 294 pages,
£16.99, ISBN 0 7487 3179 2.
This book aims to provide a comprehen-
sive picture of issues and interventions in
addiction nursing, and contains chapters
from 18 contributors, all of whom are
active in the ®eld, with an emphasis on
clinical involvement. On balance, I feel
positive about this book, which offers a
commendable breadth of information for
the interested clinician. It will be useful to
students and to nurses working, or con-
sidering working in the ®eld of addiction
nursing. Additionally, it provides a wealth
of information which will be useful for
members of other disciplines, although the
focus is very clearly on nursing, particu-
larly on the section concerning clinical
practice. The book is divided into six
parts: themes and perspectives; clinical
practice in action; special populations;
prevention, health education and collabo-
ration; service development and manage-
ment; and professional and personal
development. The editors are to be con-
gratulated on organizing these often di-
verse areas into a well-integrated text. The
book as a whole is well edited, and man-
ages to maintain a consistent approach
across its 25 brief chapters.
There are occasional irritating minor
grammatical errors which have slipped
through the editing process, but these are
rarely too intrusive. As might be expected
with such a far-reaching text, the actual
quality of the contributions is variable.
The sections on themes and perspectives
and health education are the strongest, and
are uniformly successful in orienting the
reader to a number of complex issues with
brevity, but without super®ciality.
By contrast, the sections on clinical
practice and professional development
are variable in quality. In the case of
clinical practice, some chapters are super-
®cial, and would be of little use to the
clinician other than at a very introductory
level. Two examples of this are the chap-
ters on psychotherapeutic approaches and
on complementary therapies. In the ®rst
instance, the title is misleading, since the
chapter focuses almost entirely on psycho-
analytically oriented psychotherapy,
which is only one of a broad range of
possible approaches. Despite this, the
description of it is both sketchy and un-
Book reviews
920 Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924
critical. The general status of psychoana-
lytical theories and the treatments said to
be derived from them has never been more
in doubt than currently, but the authors
offer no real evidence for the ef®cacy of
treatments either generally or in the addic-
tions. The situation is generally similar in
the chapter dealing with complementary
therapies. Here, a number of possibly use-
ful therapies are described: acupuncture,
aromatherapy and re¯exology. Once again,
little reference is made to any evidence for
the effectiveness of these approaches.
However, to their credit, the authors do
note the lack of such evidence at present.
Unfortunately, this is not re¯ected in some
of the assertions made within the chapter.
For example, we are told that complemen-
tary therapies are a `valuable option' avail-
able to addiction nurses, yet nowhere do
the authors offer convincing evidence ac-
cording to which we might judge the value
or otherwise of such therapies. This lack of
an adequate evidence base is also present
in other elements of the section on inter-
vention, but to a lesser degree. Clinicians
looking for an examination of interven-
tions based on their effectiveness or other-
wise will need to look elsewhere.
The ®nal section includes a chapter on
research. This is simplistic and lacks focus.
This is unfortunate, both since it could give
rise to the impression that research is an
afterthought (particularly damaging given
the lack of emphasis on evaluation re-
search in much of the intervention sec-
tion), and because it ends the book on a
weak note. The text as a whole, however, is
not weak and as a general introduction to
the ®eld, may be recommended.
Rob Newell
RGN RMN RNT BSc
Senior Lecturer,
Research Support Team,
School of Healthcare Studies,
University of leeds,
Leeds
Public Sector Managerial Effectiveness.
Theory and Practice in the National
Health Service by Hugh Flanagan and
Peter Spurgeon. Open University Press,
Buckingham, 1996, 144 pages, £14.99,
ISBN 0 335 15776 9.
Although the title suggests a more general
focus this book is particularly aimed to-
wards those working in the NHS, espe-
cially those working within general
management. It is quite dif®cult to get
any sort of immediate feel for what the
book is about perhaps due to the fact that
there is no introduction as such, rather the
authors move straight into the ®rst chapter
although that does contain on its ®nal page
a short paragraph outlining the contents of
the succeeding seven chapters. There is a
need for texts which look at management
within the context of public sector and
service organizations rather than assuming
that concepts and theories from private
sector and manufacturing industry can be
transferred across. Managerial effective-
ness is clearly an important issue within
the area of management perhaps particu-
larly so within the public sector. The ®rst
chapter lays out some of the background to
ideas about management and managerial
effectiveness placing these within the
public sector context. The importance
currently given to the concept of perfor-
mance management is stressed leading to
the need to clarify, understand and in¯u-
ence managerial effectiveness if the orga-
nisation for which those managers work
are to be successful.
The next three chapters (2±4) explore
the theme of managerial effectiveness be-
ginning with trying to de®ne it and then
going on to examine both how it has been
used in practice and also how personal
models of such effectiveness are devel-
oped by managers themselves. A constant
theme is the dif®culty inherent in coming
to an agreed de®nition and of the subjec-
tivity of any such de®nition when it is
proposed. Another theme is the impor-
tance of others' expectations on what is
perceived as effective performance. This
theme of others' perceptions is further
explored in chapter 5 which looks at the
organizational and cultural factors that
in¯uence it. Among these it suggests is
the role of the human resource function,
especially the role of appraisal in linking
expected behaviour and performance. This
aspect is then taken further in the follow-
ing chapter in which appraisal is discus-
sed in detail. Nurses in general and those
with managerial responsibilities in partic-
ular will ®nd much of the content of this
chapter very familiar.
The penultimate chapter presents an
account of a study and its ®ndings. This
was carried out in two stages. The ®rst was
a fairly intensive study using repertory
grid techniques to elicit constructs de-
scribing perception of effectiveness from a
group of 20 participants from ®ve health
authorities. The participants included
chairmen and chairwomen, district and
unit general managers. No details are given
of how the participants were selected or
exactly how and when the process was
undertaken. The second stage was a larger
study using a questionnaire based on the
repertory grid data. Precise details of re-
spondent numbers are not given. The ®nal
chapter provides both what the authors see
as key action points arising from the liter-
ature and the research and also the key
issues which need to be addressed.
Overall the book is not as interesting or
as valuable as might have been anticipat-
ed. Although a wide range of literature is
quoted it sometimes was not used to best
effect. It is perhaps because of the current
emphasis on evidence-based practice and
on the critical appraisal of all evidence
that the lack of both research evidence and
of systematic and rigorous appraisal of the
evidence that is available becomes very
noticeable.
Jennifer M. Hunt
BA MPhil FRCN
Director,
Nursing Research Initiative for Scotland,
Glasgow
Nursing Knowledge and Practice: A Deci-
sion-Making Approach edited by Maggie
Mallik, Carol Hall and David Howard.
Bailliere Tindall, London, 1988, 682 pag-
es, £19.95, ISBN 0 7020 1991 7.
The long list of contributors to this book
suggests that practically all the faculty
members of the Nottingham University
School of Nursing have collaborated in
its production. Apparently, the book's
contents re¯ect the way their pre-registra-
tion nursing diploma curriculum is devel-
oped. The book's aim is to provide a
comprehensive core textbook for `founda-
tion nursing studies'. That aim is certainly
achieved to a great extent but it is a very
large and weighty book. I hope that future
editions will contain some evaluation of
its effectiveness in terms of student and
patient outcomes.
The basic premise of the many authors
is that nursing students need to integrate
knowledge from theory to observed prac-
tice to encourage them to think critically
Book reviews
Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924 921
critical. The general status of psychoana-
lytical theories and the treatments said to
be derived from them has never been more
in doubt than currently, but the authors
offer no real evidence for the ef®cacy of
treatments either generally or in the addic-
tions. The situation is generally similar in
the chapter dealing with complementary
therapies. Here, a number of possibly use-
ful therapies are described: acupuncture,
aromatherapy and re¯exology. Once again,
little reference is made to any evidence for
the effectiveness of these approaches.
However, to their credit, the authors do
note the lack of such evidence at present.
Unfortunately, this is not re¯ected in some
of the assertions made within the chapter.
For example, we are told that complemen-
tary therapies are a `valuable option' avail-
able to addiction nurses, yet nowhere do
the authors offer convincing evidence ac-
cording to which we might judge the value
or otherwise of such therapies. This lack of
an adequate evidence base is also present
in other elements of the section on inter-
vention, but to a lesser degree. Clinicians
looking for an examination of interven-
tions based on their effectiveness or other-
wise will need to look elsewhere.
The ®nal section includes a chapter on
research. This is simplistic and lacks focus.
This is unfortunate, both since it could give
rise to the impression that research is an
afterthought (particularly damaging given
the lack of emphasis on evaluation re-
search in much of the intervention sec-
tion), and because it ends the book on a
weak note. The text as a whole, however, is
not weak and as a general introduction to
the ®eld, may be recommended.
Rob Newell
RGN RMN RNT BSc
Senior Lecturer,
Research Support Team,
School of Healthcare Studies,
University of leeds,
Leeds
Public Sector Managerial Effectiveness.
Theory and Practice in the National
Health Service by Hugh Flanagan and
Peter Spurgeon. Open University Press,
Buckingham, 1996, 144 pages, £14.99,
ISBN 0 335 15776 9.
Although the title suggests a more general
focus this book is particularly aimed to-
wards those working in the NHS, espe-
cially those working within general
management. It is quite dif®cult to get
any sort of immediate feel for what the
book is about perhaps due to the fact that
there is no introduction as such, rather the
authors move straight into the ®rst chapter
although that does contain on its ®nal page
a short paragraph outlining the contents of
the succeeding seven chapters. There is a
need for texts which look at management
within the context of public sector and
service organizations rather than assuming
that concepts and theories from private
sector and manufacturing industry can be
transferred across. Managerial effective-
ness is clearly an important issue within
the area of management perhaps particu-
larly so within the public sector. The ®rst
chapter lays out some of the background to
ideas about management and managerial
effectiveness placing these within the
public sector context. The importance
currently given to the concept of perfor-
mance management is stressed leading to
the need to clarify, understand and in¯u-
ence managerial effectiveness if the orga-
nisation for which those managers work
are to be successful.
The next three chapters (2±4) explore
the theme of managerial effectiveness be-
ginning with trying to de®ne it and then
going on to examine both how it has been
used in practice and also how personal
models of such effectiveness are devel-
oped by managers themselves. A constant
theme is the dif®culty inherent in coming
to an agreed de®nition and of the subjec-
tivity of any such de®nition when it is
proposed. Another theme is the impor-
tance of others' expectations on what is
perceived as effective performance. This
theme of others' perceptions is further
explored in chapter 5 which looks at the
organizational and cultural factors that
in¯uence it. Among these it suggests is
the role of the human resource function,
especially the role of appraisal in linking
expected behaviour and performance. This
aspect is then taken further in the follow-
ing chapter in which appraisal is discus-
sed in detail. Nurses in general and those
with managerial responsibilities in partic-
ular will ®nd much of the content of this
chapter very familiar.
The penultimate chapter presents an
account of a study and its ®ndings. This
was carried out in two stages. The ®rst was
a fairly intensive study using repertory
grid techniques to elicit constructs de-
scribing perception of effectiveness from a
group of 20 participants from ®ve health
authorities. The participants included
chairmen and chairwomen, district and
unit general managers. No details are given
of how the participants were selected or
exactly how and when the process was
undertaken. The second stage was a larger
study using a questionnaire based on the
repertory grid data. Precise details of re-
spondent numbers are not given. The ®nal
chapter provides both what the authors see
as key action points arising from the liter-
ature and the research and also the key
issues which need to be addressed.
Overall the book is not as interesting or
as valuable as might have been anticipat-
ed. Although a wide range of literature is
quoted it sometimes was not used to best
effect. It is perhaps because of the current
emphasis on evidence-based practice and
on the critical appraisal of all evidence
that the lack of both research evidence and
of systematic and rigorous appraisal of the
evidence that is available becomes very
noticeable.
Jennifer M. Hunt
BA MPhil FRCN
Director,
Nursing Research Initiative for Scotland,
Glasgow
Nursing Knowledge and Practice: A Deci-
sion-Making Approach edited by Maggie
Mallik, Carol Hall and David Howard.
Bailliere Tindall, London, 1988, 682 pag-
es, £19.95, ISBN 0 7020 1991 7.
The long list of contributors to this book
suggests that practically all the faculty
members of the Nottingham University
School of Nursing have collaborated in
its production. Apparently, the book's
contents re¯ect the way their pre-registra-
tion nursing diploma curriculum is devel-
oped. The book's aim is to provide a
comprehensive core textbook for `founda-
tion nursing studies'. That aim is certainly
achieved to a great extent but it is a very
large and weighty book. I hope that future
editions will contain some evaluation of
its effectiveness in terms of student and
patient outcomes.
The basic premise of the many authors
is that nursing students need to integrate
knowledge from theory to observed prac-
tice to encourage them to think critically
Book reviews
Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924 921
before making decisions about their nurs-
ing practice. To that end, the reader is
exposed to a discussion and assessment of
knowledge derived from the biological and
psychological sciences together with in-
formation from `practice', `professional'
and `re¯ective' knowledge.
It is indeed a novel approach that might
have great appeal to nursing students (and
curriculum developers). The attempts to
apply knowledge to practice are com-
mendable, enhanced by the appropriate
use of case studies.
The text is effectively presented by an
excellent use of print, illustrations, deci-
sion-making `boxes' and comprehensive
index. A valiant attempt is made to em-
brace the sound educational principles of
moving from the known to the unknown
and from simple to complex information.
But I think I might have chosen to place
the chapters in a slightly different order.
The fact that regular reference is made
throughout the book to United Kingdom
legislation and government reports Ð as
well as to directives and regulations of the
UK statutory nursing organizations Ð
makes the text somewhat Anglo-centric.
That might limit its international appeal.
But, in the UK at least, the book could
make a useful impact on the facilitation of
knowledge-based, safe, re¯ective practice
among neophyte British nursing students.
I suspect it will be a best-seller in Notting-
ham, England.
James P. Smith
OBE BSc(Soc) MSc DER SRN RNT
BTA Certi®cate FRCN FRSH
Editor-in-Chief
Journal of Advanced Nursing
Understanding the National Health Ser-
vice Reforms Ð the Creation of Incen-
tives? by Peter A. West. Open University
Press, Buckingham, 1997, 208 pages,
£14.99, ISBN 0 335 19243.
Asked to explain the British National
Health Service reforms most people would
prefer to tackle Einstein's theory of rela-
tivity. In spite of their Byzantine complex-
ity Peter West has produced an exposition
of admirable clarity that should be of
interest to all students of health care
policy. The chapter Policy Context traces
the various economic policies of the
Thatcher government towards the public
services and why, because the health ser-
vice resisted the usual selling off to share-
holders, other ways had to be found to
make it sensitive to market forces. The ®rst
step, the Griffths reforms in 1982, aboli-
shed the consensus approach and estab-
lished clear management responsibility.
This, for a variety of reasons, did little to
change the culture of the service and the
next 15 years saw a series of reforms
including the separation of the providers
from the purchasers and the concept of
fundholding for general practitioners.
Each step is examined from the eco-
nomic standpoint and an attempt is made
to assess the extent to which objectives
have been met, to look at the problems of
applying this approach to a service which
cannot be measured in terms of pro®t and
loss and whose professional practitioners,
doctors and nurses, persistently set their
own agenda. Above all, as nurse research-
ers know, there is a lack of reliable health
service data from which to make an anal-
ysis. The chapter on fundholding gives
guarded recognition to the bene®ts, but
admits that the ®rst fundholders were a
self-selected group and were probably
over-resourced. In examining the improve-
ments that have been made to the running
of practices there is not one word about
practice nurses and other members of the
primary health care team. On the other
hand nurses have an important signi®-
cance for the trusts who were promised
that they would be free to set local condi-
tions and pay. This was thwarted by the
doctors and then by the nurses. Nurses are
recognized as having a reasonably high
level of education and are available for
other job opportunities. The comment that
nursing will `become a predominantly
graduate profession' seems to imply that
they will be less amenable to downsizing;
not the best reason for a well educated
profession but an interesting one.
Looking at health care funding and
delivery into the next century one is glad
that the author has rejected the concept
that the burden of the ageing population
will cause the service to collapse. He
points out that the elderly are now ®tter
than previous generations and many of
their main needs lie outside the health
service. Having examined all the options
for ®nancing the service the author comes
to the conclusion that we must ®rst decide
what we want the health service to do and
how much of it and then agree on an
integrated care package that is universal
and not arbitary and local as at present.
Having decided we must then raise the
necessary taxes to meet the costs and this
is a concept with which Aneurin Bevan
would not disagree.
Monica E. Baly
PhD FRCN
Nurse Historian
Bath
Psychology and Health Promotion by Paul
Bennett and Simon Murphy. Open Uni-
versity Press, Buckingham, 1997, 192 pag-
es, £14.99, ISBN 0 335 19765 5.
The simple title of this book does not do
justice to the impact that it may have on our
approaches to health promotion and the
maintenance of good health. Psychological
models of health behaviour add another,
richer, dimension to our understanding of
individual and population level strategies
for disease prevention. Changing individ-
ual health beliefs and behaviours to pro-
mote good health has required strategies
aimed at and above the level of the indi-
vidual, including `economic and environ-
mental' considerations.Thisbookdescribes
the role of psychological theory at all
levels; for example, how our strategies
affect the individual, and the signi®cance
of individual psychological processes as
mediators of environmental factors.
The introductory chapter entitled Why
Psychology? adopts the same low key,
unassuming character as the title of the
book. Within a few short chapters we can
see a clear outline of the primary focus of
health promotion, from the prevention of
physical disorders such as heart disease
and cancer to the more recent attention to
mental health issues. The aim of this short
introduction is to show how psychology
can facilitate the goals of health promo-
tion. In addition, it plants a seed in you
mind, which grows as you read on ± the
authors call for health promotion to seek to
`improve the quality of life for individuals,
not merely reduce the risk of disease'. For
me this made what was already an up-to-
date authoritative textbook, very stimulat-
ing indeed. A timely insight into con¯ict-
ing commercial interests, given the current
debate on tobacco advertising in motor-
sport, is afforded by the review of research
in this ®eld. Whilst cigarette manufactures
claim that their advertising only in¯u-
ences market share, not the take up of the
Book reviews
922 Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924
before making decisions about their nurs-
ing practice. To that end, the reader is
exposed to a discussion and assessment of
knowledge derived from the biological and
psychological sciences together with in-
formation from `practice', `professional'
and `re¯ective' knowledge.
It is indeed a novel approach that might
have great appeal to nursing students (and
curriculum developers). The attempts to
apply knowledge to practice are com-
mendable, enhanced by the appropriate
use of case studies.
The text is effectively presented by an
excellent use of print, illustrations, deci-
sion-making `boxes' and comprehensive
index. A valiant attempt is made to em-
brace the sound educational principles of
moving from the known to the unknown
and from simple to complex information.
But I think I might have chosen to place
the chapters in a slightly different order.
The fact that regular reference is made
throughout the book to United Kingdom
legislation and government reports Ð as
well as to directives and regulations of the
UK statutory nursing organizations Ð
makes the text somewhat Anglo-centric.
That might limit its international appeal.
But, in the UK at least, the book could
make a useful impact on the facilitation of
knowledge-based, safe, re¯ective practice
among neophyte British nursing students.
I suspect it will be a best-seller in Notting-
ham, England.
James P. Smith
OBE BSc(Soc) MSc DER SRN RNT
BTA Certi®cate FRCN FRSH
Editor-in-Chief
Journal of Advanced Nursing
Understanding the National Health Ser-
vice Reforms Ð the Creation of Incen-
tives? by Peter A. West. Open University
Press, Buckingham, 1997, 208 pages,
£14.99, ISBN 0 335 19243.
Asked to explain the British National
Health Service reforms most people would
prefer to tackle Einstein's theory of rela-
tivity. In spite of their Byzantine complex-
ity Peter West has produced an exposition
of admirable clarity that should be of
interest to all students of health care
policy. The chapter Policy Context traces
the various economic policies of the
Thatcher government towards the public
services and why, because the health ser-
vice resisted the usual selling off to share-
holders, other ways had to be found to
make it sensitive to market forces. The ®rst
step, the Griffths reforms in 1982, aboli-
shed the consensus approach and estab-
lished clear management responsibility.
This, for a variety of reasons, did little to
change the culture of the service and the
next 15 years saw a series of reforms
including the separation of the providers
from the purchasers and the concept of
fundholding for general practitioners.
Each step is examined from the eco-
nomic standpoint and an attempt is made
to assess the extent to which objectives
have been met, to look at the problems of
applying this approach to a service which
cannot be measured in terms of pro®t and
loss and whose professional practitioners,
doctors and nurses, persistently set their
own agenda. Above all, as nurse research-
ers know, there is a lack of reliable health
service data from which to make an anal-
ysis. The chapter on fundholding gives
guarded recognition to the bene®ts, but
admits that the ®rst fundholders were a
self-selected group and were probably
over-resourced. In examining the improve-
ments that have been made to the running
of practices there is not one word about
practice nurses and other members of the
primary health care team. On the other
hand nurses have an important signi®-
cance for the trusts who were promised
that they would be free to set local condi-
tions and pay. This was thwarted by the
doctors and then by the nurses. Nurses are
recognized as having a reasonably high
level of education and are available for
other job opportunities. The comment that
nursing will `become a predominantly
graduate profession' seems to imply that
they will be less amenable to downsizing;
not the best reason for a well educated
profession but an interesting one.
Looking at health care funding and
delivery into the next century one is glad
that the author has rejected the concept
that the burden of the ageing population
will cause the service to collapse. He
points out that the elderly are now ®tter
than previous generations and many of
their main needs lie outside the health
service. Having examined all the options
for ®nancing the service the author comes
to the conclusion that we must ®rst decide
what we want the health service to do and
how much of it and then agree on an
integrated care package that is universal
and not arbitary and local as at present.
Having decided we must then raise the
necessary taxes to meet the costs and this
is a concept with which Aneurin Bevan
would not disagree.
Monica E. Baly
PhD FRCN
Nurse Historian
Bath
Psychology and Health Promotion by Paul
Bennett and Simon Murphy. Open Uni-
versity Press, Buckingham, 1997, 192 pag-
es, £14.99, ISBN 0 335 19765 5.
The simple title of this book does not do
justice to the impact that it may have on our
approaches to health promotion and the
maintenance of good health. Psychological
models of health behaviour add another,
richer, dimension to our understanding of
individual and population level strategies
for disease prevention. Changing individ-
ual health beliefs and behaviours to pro-
mote good health has required strategies
aimed at and above the level of the indi-
vidual, including `economic and environ-
mental' considerations.Thisbookdescribes
the role of psychological theory at all
levels; for example, how our strategies
affect the individual, and the signi®cance
of individual psychological processes as
mediators of environmental factors.
The introductory chapter entitled Why
Psychology? adopts the same low key,
unassuming character as the title of the
book. Within a few short chapters we can
see a clear outline of the primary focus of
health promotion, from the prevention of
physical disorders such as heart disease
and cancer to the more recent attention to
mental health issues. The aim of this short
introduction is to show how psychology
can facilitate the goals of health promo-
tion. In addition, it plants a seed in you
mind, which grows as you read on ± the
authors call for health promotion to seek to
`improve the quality of life for individuals,
not merely reduce the risk of disease'. For
me this made what was already an up-to-
date authoritative textbook, very stimulat-
ing indeed. A timely insight into con¯ict-
ing commercial interests, given the current
debate on tobacco advertising in motor-
sport, is afforded by the review of research
in this ®eld. Whilst cigarette manufactures
claim that their advertising only in¯u-
ences market share, not the take up of the
Book reviews
922 Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924
habit, the authors show that advertising
increases young people's awareness of the
products and shapes their attitudes by
establishing social norms.
The bulk of the book is divided into
three main sections covering the mediators
of health and health behaviours, facilitat-
ing individual change, and facilitating
population change. A fourth, thought pro-
voking, section entitled What next? invites
us to look deeper at the interaction of the
individual with the environment, and the
effect of changing environments on other
individuals such as family members. I
found the layout exceptionally clear, with
¯ow diagrams enlarged to whole page size
rather than being compressed. Each chap-
ter is subdivided by titled paragraphs and
ends with a summary and conclusions. In
all there are eight chapters in just over 140
pages, so the book is easily accessible, and
a further 32 pages given over to references
makes it a valuable resource. The suggested
reading lists at the end of each chapter and
extensive referencing to support the text
make this essential reading for anyone
studying or responsible for aspects of
health promotion. It should have broad
appeal to advanced undergraduate and
postgraduate students of psychology, so-
cial policy and nursing.
Ramon Pediani
RGN BSc
Clinical Nurse Specialist for Acute Pain
Control,
Blackpool Victoria Hospital NHS Trust,
Blackpool
Genitourinary Surgery by Gratia M. Nagle.
Mosby, St Louis, 1997, 365 pages, £38.00,
ISBN 0 8151 7029 7.
This clearly written and comprehensive
book is certainly detailed, covering basic
and advanced principles of genitourinary
surgery. It is organized into two major
sections and consists of thirteen chapters
of varying length. The text is well organ-
ized, with clear presentations and there
are over 778 illustrations that are mostly in
colour. A useful feature of the book is the
inclusion of a glossary at the end of each
chapter. The wealth of information con-
tained in the textbook is up to date and
well produced.
Part one covers the foundations of ge-
nitourinary surgical nursing and consists
of six chapters. Chapter 1, which is the
shortest chapter of all, looks at the history
of genitourinary surgery and how it came
to be recognized as a speciality in its own
right, providing interesting and sometimes
extraordinary reading. Chapter 2 covers
the anatomy and normal physiology of the
urinary tract in great depth. The longest
chapter in this section is Chapter 3, which
covers genitourinary pathophysiology.
This chapter gives an overview of the
pathologically altered physiological char-
acteristics of the organs of the urinary tract
and the conditions that most commonly
lead the patient to the operating theatre.
Chapter 4 deals with diagnostic proce-
dures covering both invasive and non-
invasive interventions, and includes indi-
cations and complications that could re-
sult. The illustrations throughout are of
very high quality and provide valuable
visualisation. Chapter 5 focuses on peri-
operative nursing care and highlights the
responsibilities of each member of the
genitourinary surgical team. However,
one slight drawback of this chapter, for
readers outside the USA, is that some of
the information and jargon used is not
wholly applicable to the direction of nurs-
ing in other countries. The reader must
bear in mind that the book covers contem-
porary North American practices and this
chapter is the most signi®cant of all.
Chapter 6 covers genitourinary supplies
from equipment, instrumentation, im-
plants, endoscopy and laparoscopy sup-
plies to the care and handling of
equipment.
The second part of the textbook covers
surgical interventions and the strength of
this book lies in the clarity of the descrip-
tion of these interventions. Seven chapters
are contained within this section consist-
ing of: endoscopic, laparoscopic, open
interventions on the genital system, upper
and lower urinary tract and microscopic
interventions. Each procedure is dealt
with in great depth giving the steps taken
for each. Illustrations are included to
present and help clarify pertinent infor-
mation to the reader. Indications for the
procedure and the perioperative risks are
covered as well as pre-operative and post-
operative nursing care and also discharge
planning. The ®nal chapter discusses re-
cent advancements in urology taking into
account both invasive and non-invasive
procedures. Much work has gone into this
textbook which is well written and con-
tains a great deal of knowledge from some
of the leading North American doctors and
nurses involved in urological care. I would
recommend it as an excellent resource for
anyone working within a urological de-
partment.
Julie Hayhurst
RGN BSc DipHE
Lecturer/Practitioner in Urology,
University of Central Lancashire,
Preston
Essentials of Perioperative Nursing 2nd
edn. by Cynthia Spry. Aspen, Maryland,
1997, 316 pages, £42.00, ISBN 0 8342 0581
5.
This book is primarily written as a re-
source for the newly registered nurse or a
nurse new to theatre, written because the
author feels that the current nurse training
curriculum does not prepare the nurse for
work in theatre, especially as the theatre
placement during training is often very
short. Some assumptions are made about
the `learner' who may use the book, mainly
that they need self-motivation and a desire
to give excellent care to the patient going
through the perioperative experience. It
will however also be a useful reference
text for other theatre staff, such as operat-
ing department practitioners. It is primar-
ily a text written for the care of patients
actually within theatre as preoperative
ward care, care in the recovery unit and
subsequent transfer to the ward for post-
operative care is not explicitly described.
The care described within theatre is well
referenced, clearly written, and presented
in a logical manner.
Each chapter commences with clearly
stated learner objectives and ends with a
post-chapter test. All points in the chap-
ters are numbered which will be particu-
larly useful when the reader undertakes
the post-chapter tests, as each question is
referenced back to the text. The layout of
the chapters, the charts and illustrations
will prove particularly useful for teaching
sessions and will therefore be an extreme-
ly useful tool for the preceptors/educators
within the theatre complex. The reader
will need to use the book in close con-
junction with local practice guidelines,
protocols and policies as some of the detail
contained in it may not be in total accor-
dance with current UK practices. As the
content is well articulated and referenced
Book reviews
Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924 923
habit, the authors show that advertising
increases young people's awareness of the
products and shapes their attitudes by
establishing social norms.
The bulk of the book is divided into
three main sections covering the mediators
of health and health behaviours, facilitat-
ing individual change, and facilitating
population change. A fourth, thought pro-
voking, section entitled What next? invites
us to look deeper at the interaction of the
individual with the environment, and the
effect of changing environments on other
individuals such as family members. I
found the layout exceptionally clear, with
¯ow diagrams enlarged to whole page size
rather than being compressed. Each chap-
ter is subdivided by titled paragraphs and
ends with a summary and conclusions. In
all there are eight chapters in just over 140
pages, so the book is easily accessible, and
a further 32 pages given over to references
makes it a valuable resource. The suggested
reading lists at the end of each chapter and
extensive referencing to support the text
make this essential reading for anyone
studying or responsible for aspects of
health promotion. It should have broad
appeal to advanced undergraduate and
postgraduate students of psychology, so-
cial policy and nursing.
Ramon Pediani
RGN BSc
Clinical Nurse Specialist for Acute Pain
Control,
Blackpool Victoria Hospital NHS Trust,
Blackpool
Genitourinary Surgery by Gratia M. Nagle.
Mosby, St Louis, 1997, 365 pages, £38.00,
ISBN 0 8151 7029 7.
This clearly written and comprehensive
book is certainly detailed, covering basic
and advanced principles of genitourinary
surgery. It is organized into two major
sections and consists of thirteen chapters
of varying length. The text is well organ-
ized, with clear presentations and there
are over 778 illustrations that are mostly in
colour. A useful feature of the book is the
inclusion of a glossary at the end of each
chapter. The wealth of information con-
tained in the textbook is up to date and
well produced.
Part one covers the foundations of ge-
nitourinary surgical nursing and consists
of six chapters. Chapter 1, which is the
shortest chapter of all, looks at the history
of genitourinary surgery and how it came
to be recognized as a speciality in its own
right, providing interesting and sometimes
extraordinary reading. Chapter 2 covers
the anatomy and normal physiology of the
urinary tract in great depth. The longest
chapter in this section is Chapter 3, which
covers genitourinary pathophysiology.
This chapter gives an overview of the
pathologically altered physiological char-
acteristics of the organs of the urinary tract
and the conditions that most commonly
lead the patient to the operating theatre.
Chapter 4 deals with diagnostic proce-
dures covering both invasive and non-
invasive interventions, and includes indi-
cations and complications that could re-
sult. The illustrations throughout are of
very high quality and provide valuable
visualisation. Chapter 5 focuses on peri-
operative nursing care and highlights the
responsibilities of each member of the
genitourinary surgical team. However,
one slight drawback of this chapter, for
readers outside the USA, is that some of
the information and jargon used is not
wholly applicable to the direction of nurs-
ing in other countries. The reader must
bear in mind that the book covers contem-
porary North American practices and this
chapter is the most signi®cant of all.
Chapter 6 covers genitourinary supplies
from equipment, instrumentation, im-
plants, endoscopy and laparoscopy sup-
plies to the care and handling of
equipment.
The second part of the textbook covers
surgical interventions and the strength of
this book lies in the clarity of the descrip-
tion of these interventions. Seven chapters
are contained within this section consist-
ing of: endoscopic, laparoscopic, open
interventions on the genital system, upper
and lower urinary tract and microscopic
interventions. Each procedure is dealt
with in great depth giving the steps taken
for each. Illustrations are included to
present and help clarify pertinent infor-
mation to the reader. Indications for the
procedure and the perioperative risks are
covered as well as pre-operative and post-
operative nursing care and also discharge
planning. The ®nal chapter discusses re-
cent advancements in urology taking into
account both invasive and non-invasive
procedures. Much work has gone into this
textbook which is well written and con-
tains a great deal of knowledge from some
of the leading North American doctors and
nurses involved in urological care. I would
recommend it as an excellent resource for
anyone working within a urological de-
partment.
Julie Hayhurst
RGN BSc DipHE
Lecturer/Practitioner in Urology,
University of Central Lancashire,
Preston
Essentials of Perioperative Nursing 2nd
edn. by Cynthia Spry. Aspen, Maryland,
1997, 316 pages, £42.00, ISBN 0 8342 0581
5.
This book is primarily written as a re-
source for the newly registered nurse or a
nurse new to theatre, written because the
author feels that the current nurse training
curriculum does not prepare the nurse for
work in theatre, especially as the theatre
placement during training is often very
short. Some assumptions are made about
the `learner' who may use the book, mainly
that they need self-motivation and a desire
to give excellent care to the patient going
through the perioperative experience. It
will however also be a useful reference
text for other theatre staff, such as operat-
ing department practitioners. It is primar-
ily a text written for the care of patients
actually within theatre as preoperative
ward care, care in the recovery unit and
subsequent transfer to the ward for post-
operative care is not explicitly described.
The care described within theatre is well
referenced, clearly written, and presented
in a logical manner.
Each chapter commences with clearly
stated learner objectives and ends with a
post-chapter test. All points in the chap-
ters are numbered which will be particu-
larly useful when the reader undertakes
the post-chapter tests, as each question is
referenced back to the text. The layout of
the chapters, the charts and illustrations
will prove particularly useful for teaching
sessions and will therefore be an extreme-
ly useful tool for the preceptors/educators
within the theatre complex. The reader
will need to use the book in close con-
junction with local practice guidelines,
protocols and policies as some of the detail
contained in it may not be in total accor-
dance with current UK practices. As the
content is well articulated and referenced
Book reviews
Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924 923
it should prove to be a useful text when
writing clinical guidelines, policies and
protocols for perioperative care.
It is hard to select any one chapter for
comment as the chapters on prevention of
infection, prevention of injury±sepsis, po-
sitioning of the patient, and haemostasis,
were chapters felt to be especially useful
by my colleagues from theatre. As a ward-
based practitioner I was a little disappoint-
ed in the somewhat short chapter on
preparing patients for theatre as it very
much focuses on the role of the theatre
nurse who in most instances may have
very little input into the preparation. The
chapter does discuss the importance of
preoperative assessment and desired pa-
tient outcomes of the theatre experience
with the patient always being the focus.
The use of nursing diagnosis, knowledge
de®cit and anxiety, throughout the text
may be unfamiliar to some practitioners
but reading through this book one can get
a real feel of the usefulness of using such
a tool for assessment and identi®cation of
desirable patient outcomes. This book
would be a useful book to grace the refer-
ence bookshelves of any operating theatre
department and my theatre colleagues are
looking forward to my donating my copy
to them for the use of their staff as they
collectively see it not only as an excellent
text for the new staff but for more senior
staff to use as they teach and train within
the department.
Janet R. Graham
RGN BA FETC
Senior Nurse Ð Surgery,
Luton and Dunstable Hospital NHS Trust,
Luton
Book reviews
924 Ó 1998 Blackwell Science Ltd, Journal of Advanced Nursing, 28(4), 918±924
