Managing and Leading Innovation in Health Care

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    Procedure-Related Cancer Pain inChildrenby Christina Liossi.Radcliffe Medical Press, Oxford, 2002,220 pages, 1995, ISBN 1 85775453 0.

    Books on pain management are alwayswelcome and this is no exception.Christina Liossi has developed a usefultext, which I have no doubt will beuseful in the management of childrenwith pain, either procedure-related orotherwise. This book offers a frame-work for understanding how childrenperceive pain, how childrens pain canbe assessed, and pharmacological andpsychological pain management. Thebook has two main themes; first, integ-rating pharmacological and psychologi-cal management and second, integratingresearch and clinical practice in thisarea. As you might expect, the bookdiscusses the physiology and psychologyof procedure-related pain and worksthrough the other main themes, conclu-ding with the integration of manage-ment options related to the clinicalsetting.

    What makes this book useful is theorganization of the text. Each chapteris clearly broken down with sub head-ings, key words are explained as foot-notes, and summary points arepresented in boxes. Each chapter haswithin it, or concludes with, a casestudy to demonstrate the subject underdiscussion. This is invaluable whenattempting to assimilate the very wellreferenced theory into a practicalapplication.

    The author attempts to integrate theavailable research in this area and applyit to clinical practice, and I think in thisbook she succeeds. A useful text foranyone working with children.

    Tracey McCreadyUniversity of Hull, UK

    Managing and Leading Innovation inHealth Careby Elizabeth Howkins andCynthia Thornton.Bailliere Tindall, London, 2002,432 pages, 1799, ISBN 0 702 02552 6.

    This book suffers with the ailment of somany compilations before it. It lacksboth a tight enough structure to ensureconsistency in style and format, andsufficient critical editing to ensure thestandard of chapters. The book is splitinto five sections, each section contain-ing a number of chapters, some ofwhich are described as theory and someas application. I found this book aquixotic mix. The links between chap-ters were tenuous at times and theapplications, as the book itself acknow-ledged, were examples of innovationsdescribed by the individual in their ownwords. This does not make for stimula-ting reading. I was particularly disap-pointed in the last section entitled OldProblems, New Solutions. As a seniornurse always willing to take advantageof others ideas, I found nothing new toexcite colleagues or myself in terms ofinnovations. I was also interested tonote that in a number of chapters in thebook there is a ready acceptance ofcurrent government policy and soundbytes. No distinction was made betweendivergent UK policy developments anddifferences in approach between healthcares constituent bodies. The bookfailed to take account of how rapidlypolicy initiatives and terminologychange, so that what is well knowntoday can be completely unfamiliar intwo years time.

    I can see a use for the book as an earlyintroduction to its key themes of man-agement and innovation for studentnurses, but most of the theoreticalinformation is already available in otherbooks or on the Internet.

    Georgina GordonSwansea NHS Trust, UK

    Safety Issues for Research in theCommunityby Lucy Simons and Tony Kendrick.University of Southampton School ofMedicine, Southampton, 2002, Videocassette, 12 minutes 33 seconds.

    This is a short video, made by researchersat the University of Southampton Schoolof Medicine, who give some examples ofwhen and how they felt under threatwhen conducting research in the commu-nity. These examples are all from inter-view situations in participants homes,and illustrate for the non-communityresearcher how, in an attempt to securewidespread and appropriate participa-tion in research studies, and to conductinterviews in as non-threatening a man-ner as possible, the researcher can putthemselves at considerable risk.

    The video makers offers four practicalideas for reducing the threat of harm toresearchers, and although these appearto be common sense, in my opinion,viewing the video is well worth 12minutes and 33 seconds of anybodystime if community researchers are put atless risk as a result. However, therecommendations raise a couple ofissues, and these need to be highlighted.

    Firstly, assessment of the situation isrecommended: researchers should findout about the background and medicalhistory of the person to be visited, ifpossible. This is good advice, but thereare real concerns about a potentialparticipants confidentiality in this: Iknow the researcher will maintain thehighest discretion with the informationthus gained, but the video makers saythat they would ask a medical practi-tioner to disclose details of the patientsmedical history; surely this is not legalor ethical?

    Secondly, and of more relevance, isthe sensible recommendation to exam-ine prevention strategies. Carrying amobile phone and a safety alarm isadvocated. Particularly useful is theadvice to establish an action plan if

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  • under threat: someone back at baseshould know where the researcher hasgone, and should be expecting a phonecall by a set time. If that call does notcome, there should be clear lines ofresponsibility for alerting the police.

    Thirdly, there is practical advice foridentifying and responding to a threat:the researcher should not ignore intim-idating verbal and non-verbal signals,and the video makers repeatedly say:listen to your instincts. If there is realdanger, phone base and activate theaction plan to get help; try to leave, but

    if this is impossible, make a lot of noise.This is all good advice, but in extremesituations it might be very difficult touse a mobile phone, and I think therecould be a tendency to overestimate thedegree of protection that a mobile phoneoffers. It might be more useful to advo-cate that community researchers go outin pairs.

    Lastly, the video makers discuss fol-low-up: if there has been an incident,there needs to be a system of writtenreporting, but I question the view thatacademic supervisors would be appro-

    priate people to discuss such eventswith, or even be available to do so.

    Overall, this is a useful video, whichhighlights the very important issue ofsafety for community researchers, andits recommendations should be takenseriously. That there are a few problemswith the detail is to be expected, andshould not detract from the underlyingprinciple of safety first.

    Graham R. WilliamsonJAN Media Reviews Editor

    Media Reviews

    422 2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(4), 421422


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