children’s nursing in practice: the nottingham model

Journal of Advanced Nursing, 1995, 22,610-615

B O O K R E V I E W S

Nursing Adolescents: Research and Psychological Perspectives by Jayne Taylor & Dave Mfiller. Blackwell Science, Oxford, 1995. 174 pages, £10.99 (pb), ISBN 0-632-03625-7.

For a new book this already has a curiously dated feel to it. The project is worthy enough since nursing adolescents is an area in real need of new and enlightening publications. This is particularly so in view of the UK's rather poor record in recognizing the special needs of adolescents in relation to almost every area of heal th care. The format is familiar and reassuring; various aspects of adolescence are taken and ' the research' related to each of these areas is used to support the discussion. Family relationships, develop- mental tasks, adolescent heal th care, heal th promotion, eating disorders, sub- stance abuse, HIV/AIDS and suicide are all here.

Maybe I have been reading too many student dissertations 'reviewing the literature', but this book reminded me of a series of such reviews combined to make a book. I also came away wi th the impression that some of the discussions were less critical and evaluative than would have been expected of a book highlighting 'research and psychological perspectives' . The discussion of adolescents ' moral development is perhaps an example, where Kohlberg's levels were reiterated once again with a brief rider that 'his theory has been the subject of some criticism mainly because much of his experimentat ion was carried out on male subjects'. Carol Gilligan's work here receives a two-line ment ion as an afterthought, surprising when we consider that this particular debate on sex differences in moral development has been one of the most significant in psychology/ e thics /phi losophy in recent years (see e.g. Larrabee 1993).

The range of research reported in the book also seems limited in its focus which gives the writing a rather stilted, 'outside looking in ' perspective. For example, there seems to be a comparative lack of reporting of more interpretive studies and studies where we actually hear the voices of the adolescents themselves. There must be

more research into the experiences of adolescents similar to Smithbattle 's (1994) study of teenage mothers. It would certainly be worthwhile having this book in the nursing library but I would not rush out to buy a copy or expect too riveting a r e a d .

Philip Darbyshire MN PhD DipN RNMH RSCN RNT

Senior Lecturer in Nursing, Glasgow Caledonian University

References

Larrabee M. (ed.) (1993) An Ethic of Care: Feminist and Interdisciplinary Per- spectives. Routledge, New York.

Smithbattle L. (1994) Beyond normalising: the role of narrative in understanding teenage mothers ' transition to mother- ing. In Interpretive Phenomenology: Embodiment, Caring and Ethics in Health and Illness (Benner P. ed.), Sage, London, pp. 141-166.

Treating AIDS with Ch&ese Medicine by Mary Kay Ryan & Arthur D. Shattuek. Pacific View Press, Berkeley, California, 1995. 384 pages, £29.95 (pb), ISBN 1-881896-07-2.

Western medicine depends on the accept- ance of rational, scientific explanations for the causes of human illness. The scientific method, with its emphasis on the acqui- sition of knowledge derived inductively and deductively, has been the systematic approach in which western medicine attempts to meet the challenge posed by diseases and ill-health. This book is an attempt to demonstrate the importance of looking for alternative approaches and the growing populari ty of alternative medicine in recent years is now widely acknowl- edged. The HIV/AIDS pandemic has tested the ingenuity of scientists for the discovery of causes and treatments of the multiple pathology of the infection and its ter- rifying, terminally fatal sequelae. The authors are two medical practitioners working for and with people with AIDS. They accept the contributions made by western medicine to the alleviation of the

sufferings of people with AIDS but have sought to widen their therapeutic clinical interventions by embracing the traditional Chinese medicine (TCM) model for the treatment of AIDS.

This is a formidable and challenging text to read. There are seven densely packed chapters exploring, explaining, discussing and illustrating various aspects of AIDS and the use of TCM in its management. Chapter 1 provides the reader with comprehensive background information on why the authors have chosen this approach in responding to the AIDS challenge. The differences between Chinese and western medicine are clearly demon- strated and many examples are offered of how their combined response to the care needs of people with AIDS can bridge an otherwise widening gap. A starting point for such an understanding of AIDS is presented in chapter 2 which also provides a comprehensive coverage of the symptoms of the disease. In the absence of a western medical cure for AIDS, the authors have turned to Chinese medicine and chapter 3 discusses the various methods used and the application of herbs based on a centur- ies-old Chinese approach to dealing with human illness. There are many technical terms but these are painstakingly explained to provide an understanding of the TCM model.

The clinical manifestations of AIDS relate to different groups in society and chapter 4 explores various aspects of serv- ing special populations. The final three chapters offer extremely useful and well- researched information on diet, non-TCM alternatives and the future of caring for people with AIDS, including current research activities.

This comprehensive book has five appendices on setting up and maintaining clinics, drugs and their side-effects, the use of herbs, efficacy of treatment and a selec- ted bibliography. An index of diseases, disorders, symptoms, treatments and herbs complete a remarkable contribution to the HIV/AIDS literature. This is an important reference text which should be available in all libraries. It is addressed to professional corers, general readers and all those concerned with the continuing challenge

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Book reviews

posed by the AIDS pandemic. It is an excellent publication concerned with the difficult problem of the contribution of alternative medicine to modern medical practice. It certainly brings the interested reader up-to-date with the Chinese medicine approach to dealing with what is undoubtedly the most difficult condition facing doctors, nurses, other health professionals, families and the general public today.

Cynthia Y. Akinsanya RGN RFN SCM DN Cert DipEd(P) Celt

Psychol PGCEA PWT DNT RNT Senior Lecturer,

Anglia Polytechnic University

Children's Nursing in Practice: The Nottingham Model by Fiona Smith & Nottingham Children's Nurses. Blackwell Science, Oxford, 1995. 240 pages, £14.95 (pb}, ISBN 0-632-03909-4.

This book is an account of how nurses in one hospital have implemented their own model of nursing, and as books about paediatric nursing theory are quite rare this is a welcome addition to the paediatric nursing literature. It is arranged in four sec- tions, each dealing with a different aspect of the model in practice.

The first section dealing with how the model was developed is interesting, especially for those who wish to develop a model in their own area as much of the theoretical information they will need is here. The authors also make a good case for the use of their model and show clearly that nursing theory can be both interesting and relevant to practice. They do this by avoiding unnecessary jargon, illustrating the text clearly and keeping the whole thing sharp and to the point.

Following this, the book looks at how the model is integrated within the nursing process, and again for those who have doubts about the relevance of models and ' the nursing process this will make useful reading. For others, particularly those experienced in paediatric nursing, it may be that this part of the book is too basic as it really is most suitable for students and those new to either paediatrics or basic nursing theory. Again it is well illustrated, with examples of the documentation used, and case studies pull the whole thing together well.

For nurses working within paediatrics the third section, looking at specialist areas such as accident and emergency and day surgery, may be more useful, particularly as these areas offer challenges that have not

always been so widely investigated. The solutions presented seem very sensible, and accident and emergency departments where nurses are not always trained in paediatrics may find this a useful introduction to paediatric care.

Finally, the authors look at home care and the transition from hospital to home. For those who think that use of a nursing model has to end at the hospital gate this will come as a shock, because this book shows that this need not be so. One of the ongoing problems within paediatrics is the difficulty of managing discharge and community care, and the details of how it has been done will be both an inspiration and a challenge to many of us.

This book is well written, clear and relatively jargon-free. Although I have some misgivings about large, relatively well endowed units telling others 'how to do it', this book is genuinely interesting. Some of the information is very much Nottingham-based, but it would be fairly easy to adapt this for local use and it could act as a resource for other units undertaking a similar exercise. With these few reservations this book can be recommended, although I would like to know who the 'Nottingham Children's Nurses' are!

Edward Purssell RGN RSCN

Senior Staff Nurse, Paediatric Unit, St Thomas' Hospital London

Emphasis: Nursing. Leadership Part II volume 5, number 1, 1995. Harbor-UCLA Medical Center, Department of Nursing, Los Angeles, California. 104 pages, ISBN 0886-7143.

Emphasis: Nursing is a twice-yearly publication by the Department of Nursing, Harbor-UCLA Medical Center, Los Angeles. The centre is a 553-bedded acute hospital that provides care to a population of approximately two million residents south-west of Los Angeles County.

This is an excellent publication created to highlight the professional practice of nursing at the hospital with a focus on sharing clinical practice, nursing research and professional nursing activities. Manuscripts are submitted from all nursing staff, affiliating faculty and nursing students and are reviewed by experts. The publication is research-based and demon- strates the hospital's support for professional nursing practice. It incorporates 10 articles that relate to different aspects of nurse leadership. It also includes book

reviews and guidelines for nurse authors and editors.

The manuscripts focus on different aspects of nurse management and address the importance of good leadership. The article on 'Leadership and the instrument of Self' illustrates that the most important factor in developing leadership is the opportunity for growth through self- exploration.

Articles also include clinical nursing and how caseloads can be managed better. 'The AIDS Epidemic: it ain't over yet' describes the development of the role of the nurse practitioner providing primary care to patients with AIDS in the out- patient clinic. 'Developing a Community for Patients with Sickle Cell Anemia at Harbor-UCLA' is an article which discusses how a team approach was developed. The team involved patients with sickle cell disease, who together with health care professionals facilitated better communication and developed a positive, patient-centred community approach to caring. 'On the Road to Perinatal Case Management' describes how the role of the case manager was developed. The results showed that the group of women who benefited by the case management concept were the largest high-risk group of patients with antepartum diabetes. Another article discusses the merits of the clinical nurse specialist as a case manager and how the length of patient stay was reduced by this type of nurse management.

The publication also provides the reader with a flavour of the culture of the organization. Two manuscripts focus on the recognition of employee's good practice. One article describes the implementation and progress of the hospital's 'Nurse Recognition Committee'. The group was formed to promote the importance of self, peer and organizational acknowledgment of the quality of patient care provided by the nursing staff at the annual National Nurse's Week. Another article looks at 'Employee Recognition Activities on the Harbor-UCLA Campus'. It describes the employee-recognition programmes that departments have developed for their staff and how these initiatives enable staff to feel valued by the organization.

This type of publication could be adapted by any hospital and used posi- tively to communicate recent clinical developments within the organization.

Susan E. Osborne MSc DipN SRN SCM

Management and Nursing Consultant, London

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Book reviews

Mastering Documentaffon edited by J. Wallis. Springhouse Corporation, Pennsylvania, 1995. 418 pages, £23.00 (hb), ISBN 0-87434-749-1.

The prime merit of this text lies in the clear and well organized way in which infor- mat ion about nursing documentat ion is presented. The layout is very user-friendly; clear exposition of the topics in the main text is supplemented by boxes summarizing points or providing useful tips. In short, this is an attractive book which deals with a potentially foreboding issue in an encouraging way.

However, while the book's form is beyond reproach its contents are subject to some inevitable limitations. The problem lies in the international variability of nursing bureaucracies and, as a consequence, nursing documentation. This book ema- nates from the USA and, understandably, it addresses documentary issues of concern to American nurses. For nurses working in the USA, Mastering Documentation will provide a very useful guide to their work. However, for nurses working elsewhere, its use will be more limited. That said, a number of chapters are universally applicable, making the book a useful addit ion to nursing reference libraries.

The gulf between the sort of documentation used by US nurses and that used by nurses working in more socialized forms of heal th care lies in the sort of people that nurses expect will read what they have written. Throughout Mastering Documentation, the reader is given the impression that nurses should be writing primarily for lawyers, judges, hospital accountants and medical insurance com- panies, rather than for fellow nurses, to say nothing of patients.

The book provides an unintended, and rather depressing, reflection of the conse- quences of market-driven nursing care. The main purposes of much American nursing documentat ion seem to be two- fold. First, documents are used to facilitate the making of money. This is done through the i temization of nursing care, so that the organization that the nurse works for can charge for it. Second, documents are produced with an eye to preventing the loss of money by providing a defence against possible patient litigation. These two aspects are closely related. In a heal th care system where the providers construct their relat ionship wi th clients as a commercial one, they can hardly be surprised when many of those clients take a commercial approach to what they perceive as inad-

equacies in their care. In this commodifi- cation of heal th care, nurses come under fire from both sides, and this is reflected in nursing documentation.

The degree to which litigation haunts the working lives of American nurses can be seen in the final paragraph of the book, which I took to be an attempt at reassur- ance and encouragement: 'As you expand your nursing expertise and take on more patient care responsibilities, you'll also be accepting greater legal risks. But you don' t have to accept the inevitabili ty of being sued. If you give high-quality care and chart meticulously, you'l l be doing every- thing in your power to avoid a lawsuit. ' Hardly the stuff to send nurses striding confidently onto the hospital ward. One can only hope that this book is not a sign of things to come for the rest of us. Unfortunately, given the precarious pos- ition of the British National Health Service, it could well be.

Sam Porter RGN DipN BSSc PhD

Lecturer in Sociology, The Queen's University of Belfast

Illuminations: The Human Becoming Theory in Practice and Research edited by Rosemarie Rizzo Parse. National League for Nursing Press, New York, 1995. 300 pages, $37.95, ISBN 0-88737-637-1.

Critical examination of the relationships experienced by nurses and the individuals, families and communit ies they encounter is the focus of this book. It explores the human becoming theory and its application in practice and research. Professor Parse states that the purpose of the work is to postulate the research and practice methodologies that evolved from the ontological base of her nursing theory of human becoming. Her co-authors are nurses from Australia, Canada and the United States, who attempt to explain how this theory has influenced the way they nurse.

The book is divided into three themes, namely theoretical conceptualizations, applying theory into practice and research applications. Part 1 examines such concepts as the view of freedom and the view of suffering. Part 2 explores the concept of 'true presence' and its application with individuals and families. Part 3 focuses on ' l ived experience' and an evaluation of the human becoming theory.

However, despite the impressive array of nursing talent the book is something of a disappointment. It claims to be an explo-

ration of a h u m a n science that reveals the eloquence of the nurse-person encounter, yet for the most part the text conceals more than it reveals.

Phrases such as the following are common: 'cocreating rhythmical patterns of relating is living the paradoxical unity of revealing - - concealing and enabl ing- l imiting while connecting-separating' . Another example is: ' the principles of the human becoming theory specify the view of the human-un iverse process as a rip- pling, risky flow weaving together the changing fabric of the now moment, incar- nating the side waters of remembering and anticipating, while forging the present yet to be'. This is a pity, as h idden within this tortured text are concepts worthy of further study. Overall, this book gains only a quali- fied recommendation as a book likely to be of interest or benefit to students and practitioners.

Roderick P.M. Thomson IviEd DipAdEd DipHV RMN RGN RHV

FPCert Health Policy Consultant,

North West Regional Health Authority, Merseyside

Ethics. Professional Issues edited by Verena Tschudin. Scutari Press, Harrow, 1995. 126 pages, £12.99, ISBN 1-873853- 14-9.

Tschudin is well known for her writing on ethics for the nursing profession and it was with pleasurable anticipation that this book was approached. Unfortunately her only contribution appears to have been the preface, the other chapters having been writ ten by three other writers. Their brief was that what they wrote should be applicable to practising nurses. While Tschudin claims that their contributions are remark- ably similar in that they all stress that the individual matters and that care has to be h u m a n and humanizing the book is strang- ely disappointing.

Ann Young writes on 'The Control of Professional Behaviour', dealing largely wi th the law and the UKCC, concluding with 1 V2 pages on the question of 'Control versus Autonomy'. While she acknowl- edges the changes produced by the developments in the management of the British National Health Service the discussion is brief and superficial.

Kershaw contributes two chapters. The first on 'Standards of Practice' endeavours to relate standards to social and organizational change and deals with such topics as ' the right to know', 'conflict', 'advocacy'

612 © 1995 Blackwell Science Ltd, lournal of Advanced Nursing, 22, 610-615

Book reviews

and 'public issues'. Many of the points raised in this section are of vital importance, as are the ethical issues involved, but unfortunately these are not dealt wi th in depth. Her second chapter deals wi th 'Professional Issues and Professional Qualifications; covering education, com- mitment, autonomy wi th reference to the UKCC's Code of Professional Conduct and the RCN's stance on the issues. Again this covers topics of great importance which require rather more debate than that offered.

The final chapter by Flint is on ' Independent Midwifery Practice' and is probably the most satisfying, written, as it is, from deep conviction. She emphasizes the right of the woman to have control over her delivery and the satisfaction to be obtained by the midwife in assisting in this event. She confronts the issues raised by this type of practice and the controls both external and internal for ensuring safety. She also deals wi th the conflict raised by writing in a book for nurses when she pas- sionately believes that midwifery and nursing are quite separate professions. Nurses will, however, benefit from reading her account and it may lead to greater understanding.

The book is slim and while I appreciate the value of th in books which people will read I feel that this is one that has suffered from the restriction on size. Some topical items have only been touched upon, for example the debate on advanced directives or living wills which is becoming an increasing concern to many. Other topics in the book require more detailed discussion than has been possible in the space allowed.

I am unsure who will wish to buy this book. The price is quite high for a publication wi th so many omissions and library money will more likely be spent on more comprehensive texts.

Christine M. Chapman CBE BSc(Soc) MPhil SRN SCM RNT FRCN

Emeritus Professor of Nursing Education, University of Wales

Analysis and Evaluation of Conceptual Models of Nursing 3rd edn by J. Fawcett. F.A. Davis, Philadelphia, 1995. 592 pages, £29.00 (hb), ISBN 0-8036-3411-0.

In her preface Jacqualine Fawcett states that this book has been 'Written for all nurses and nursing students who are interested in the development of nursing knowledge and the use of that knowledge to guide nursing research, education,

administration, and practice'. She goes on to suggest that the book 'attempts to clarify the continuing confusion between conceptual models and theories that remains in the nursing literature' and, in my opinion, this she has achieved in doing. In this edi- tion, each chapter has been revised in order to make objective evaluation of the most recent works of principal authors in this area.

There are 10 chapters. Chapters 1 and 2 focus on conceptual models and contem- porary nursing knowledge and the analysis and evaluation of such models. Chapters 3 -9 visit the following nursing models: Johnson's Behavioural System Model, King's General Systems Framework, Levine's Conservation Model, Neuman 's Systems Model, Orem's Self- Care Framework, Rogers' Science of Unitary Human Beings, and Roy's Adaptation Model. The final chapter discusses the substantive and process elements of the implementat ion of conceptual models of nursing on clinical practice.

At the commencement of each chapter the key terms or concepts are identified which are then defined and discussed wi th in the text, concluding with an extensive reference list and bibliography relating to concepts under discussion. Much of the narrative in these chapters is drawn from original work and does not therefore depend on secondary analysis or others' interpretations of the presented model. Many of the chapters are well supported by tables and diagrams which relate well to the text and help to clarify and enhance certain narrative points. I certainly feel that the tables summarizing the nursing process format for each conceptual model will be of great value to nurse practitioners when contemplating implementat ion of models into practice. The book concludes wi th an invaluable appendix of resources, including relevant audio and video pro- ductions, computer search strategies and, finally, societies for conceptual models of nursing.

A central feature throughout this text is the t ime given to the implementat ion of each model into clinical practice, the relationship between models, research, education and practice; and the ability of the author to demystify some of the common misgivings surrounding models for nursing. Overall, this is an excellent and highly readable book which provides a wealth of up-to-date information and debate relating to conceptual models for nursing. I would strongly recommend it to all nurses involved with implementing

models into practice, their managers and any libraries that serve a nursing population.

John C. Sheperd PhD MSc RGN RNT eND Cart Ed(FE)

DMS Head of Research and Consultancy,

Birmingham & Solihull College of Nursing and Midwifery

Intensive Care and Clinical Biochemistry by Peter Gosling, Will iam J. Marshall & Michael C. Clapham. ACB Venture, London, 1994. 162 pages, £15.00, ISBN 0-902429-06-X.

The title of this book is misleading unti l you realize that it has been writ ten by clinical biochemists and looks at intensive care from that perspective. It is a concise, even terse, textbook on shock and this is immediately obvious from the contents.

There are five chapters but, essentially, the book is divided into three parts. The first is background biochemical material, the second looks at vital organs in shock and the third part presents case studies. The text is obviously aimed at medical practitioners in intensive care but could be appreciated by non-medical biochemists, physiologists and nurses trained in intensive care.

The first section attempts to be an 'all you need to know' text on the basics before applying these concepts to specific organs. As such it works quite well for someone with a biochemical background but could be hard-going for others. I th ink that many medical students, physicians and nurses would have to refer to basic texts. There are no references but an extensive bibliography is given wi th each section.

Starling's law of the heart, the oxygen dissociation curve, intermediary metabolism and the renin-angiotensin system are all included in the first section. One figure is titled ' Intermediary metabolism in shock' while the material contained in the figure is general and not unique to shock. This section contains an error inasmuch as it is stated that the oxidation of two moles of pyruvate by the TCA cycle yields 6 moles of ATP; in fact, this yields 36 moles of ATP. More caution should have been exercised in stating that ketone bodies are the product of the ~-oxidation of fats. The intermediates of I~-oxidation are coenzyme A derivatives and not ketone bodies.

The terseness in style works very well in some parts of the book for the less bio- chemically literate. However, explaining the sodium/potassium ATPase in terms of

© 1995 Blackwell Science Ltd, Journal of Advanced Nursing, 22, 610-615 613

Book reviews

the 'cleavage of one molecule of ATP to ADP and the liberation of a high energy phosphate group produces a confor- mational change in a carrier protein. . . ' does not work too well.

The figures and tables which accompany the text are, on the whole, excellent in the first section and the second section on organs in shock. A notable example is the three-page section of the autonomic ner- vous system which includes the use of adrenergic antagonists in shock. This is a model presentat ion of the pharmacology of the adrenergic system and could have applications beyond intensive care and shock.

The fourth chapter which presents case studies is really for the diagnostician or the highly specialized nurse. The fifth chapter and the second appendix are interesting in that they look at the principles of near pat ient and laboratory testing of biochemical parameters. A book can often be judged, in terms of its usefulness, by the quality of the index. In the case of the present text the index is clear and comprehensive with regard to the contents of the book.

I cannot judge its usefulness for clinical biochemists but can envisage this text becoming a popular pocket book for medical students and a recommended text for nurses studying intensive care at an advanced level. The price is high for the size of the text but I would encourage nurse educators in this area to consider its place on their library shelves.

Roger Watson BSc PhD RGN CBiol MIBiol Lecturer in Nursing Studies,

University of Edinburgh

Stress and Coping in Mental Health Nursing edited by J. Carson, L. Fagin & S. Ritter. Chapman & Hall, London, 1994. 232 pages, £14.99 (pb), ISBN 0412-59270-3.

Stress, or the inability to cope wi th stress, is becoming increasingly recognized as an occupational hazard in the heal th care professions. This book sheds light on the kinds of stress imposed throughout the rapidly changing market-oriented heal th service and the association of stress with the transformation of the professional responsibilities of mental heal th nurses. This is a concise account of a range of research studies into stress in mental heal th nursing and places it in a historical, personal, social and political context.

The book, organized into 11 chapters, is written by different authors from the disci-

plines of nursing, psychology and psy- chiatry. The text is of a high quality with clear presentation and this is supplemented with a comprehensive list of references at the end of each chapter.

Chapter 1 provides an overview of the historical development of mental health nursing and examines its implications in clinical practice. Chapter 2 discusses issues raised in community services development and highlights the specific core skills of mental heal th nurses that are applicable to the variety of specialist client groups. In chapter 3, the book focuses on a critical review of the literature on stress in mental heal th nursing and the methodological problems and limitations of the existing literature.

In chapter 4, the relationship between occupational stresses and the 'total insti- tut ion' is examined, using an in-depth case study. The ensuing chapters (chapters 5-8) deal with the background, methodology and findings of the Claybury study. The findings include demographic data, stress levels and coping mechanism of ward- based psychiatric nurses and community psychiatric nurses (CPN). It is cause for concern that CPN are experiencing high levels of stress and high levels of long-term emotional burnout. The study indicates that 41% of CPN have crossed a threshold level of so-called psychiatric caseness.

Chapter 9 deals briefly with the strategies for management of stress in mental heal th nursing and includes the evaluation of a social support intervention. Chapter 10, which is by far the most interesting chapter, examines the future direc- tions in community psychiatric nursing research, and the limitations of previous studies in community psychiatric nursing are outlined. The priorities in future research development include using methodology such as the randomized controlled trials, case study, and the use of statistical methods and analyses. In chapter 11 each editor has writ ten a separate contribution on issues of stress and mental health nursing. The concluding remarks and implications raise issues in research and practice; conflicting demands on com- muni ty mental health nurses and the examination of the relationship of the theories of nursing practice to the theories of stress.

Overall, the book would have benefited from further elaboration on coping mechanism and strategies in dealing with pre- vent ion and sequelae of stress. Although this the largest study ever conducted on stress and mental heal th nursing, it is extensively a 'Claybury experience'

(England) and selective in the context of the study. However, the real value of this publication lies with the examination of different perspectives of stress and the wide range of research methodologies used in the study. In addition, the editors and contributors have meaningfully and effec- tively set the agenda for further exploration of stress in mental health nursing.

This is a valuable addition to the literature in mental health nursing. I would recommend this research-based book to academics, clinicians and managers in mental health nursing. It is a valuable book for any researchers or practitioners seeking to extend their depth of knowledge and to undergraduate and postgraduate students undertaking courses in health care sciences.

G. Hussein Rassool MSc BA RMN FETC RNT Cert Ed Cart

Couns Cert in Supervision & Consultation Lecturer in Addictive Behaviour &

Nursing, St George's Hospital Medical School,

London

In Search of Nursing Science edited by Anna Omery, Christine E. Kasper & Gayle G. Page. Sage, Thousand Oaks, California, 1995. 320 pages, £18.95 (pb), ISBN 0-8039-5094-2.

Reviews of the scientific status of nursing knowledge usually contrast the traditional, deductive, quantitative approach with a humanistic, inductive, qualitative alternative. This book goes beyond this to reflect developments in the philosophy and methodology of the social sciences. Chapters on empiricism, pragmatism, paradigm revol- utions and 'paradigm' evolution are fol- lowed by chapters on hermeneutics, feminism and phenomenology. As a nursing text the book then breaks new ground, examining topics such as critical theory and post-structuralism. The chapters which provide examples of how critical theory and post-structuralism can be applied in nursing research should prove useful for nurses who need concrete examples of these newer approaches.

This book therefore provides a fairly comprehensive overview of the ways in which methodological issues can influence the development of theory, research and practice in nursing. However, there is little discussion of realism and no mention of structuration theory, both of which have been profoundly important areas of debate in disciplines such as sociology.

The editors chose to omit a chapter

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Book reviews

which covered the rise and fall of positivism. However, I feel a review of positivism, logical positivism and critical rationalism would have established the context for the debates presented in the book. In addition, a chapter which clarified key concepts such as philosophy, methodology, and method; ontology, epistemology and ideol- ogy; and induction, deduction, retroduc- tion and abduction would have provided a useful framework for understanding the differences in approach to enquiry.

The title of the book seems misguided. It implies a search for a holy grail: nursing science. Hermeneutics, phenomenology, feminism, critical theory and post- structuralism are very different approaches to 'science', and if done well they can all be systematic and rigorous approaches to enquiry. There is a plurality of approaches to enquiry across the social sciences and humanities. For some this is a nuisance;

for others it is the start of a stimulating intellectual journey. This book is a useful guide for those setting out to explore the relevance of the vast literature on the philosophy of social science to nursing.

This is not a book about the scientific basis of nursing practice but an important book on approaches to nursing knowledge. It can help shape the discipline because methodology provides the power and philosophy the rudder that guide both the research and theory which should under- pin research-based nursing care. To con- tinue the metaphor: without methodology we will lie becalmed, without philosophy we may circle aimlessly without direction.

The book should become required reading for postgraduate nursing students. It is a useful introduction to the sometimes eso- teric hut important debates on the nature of knowledge in the social sciences. For those who find themselves drowning in the

swamp of abstract ideas presented in this book, I strongly recommend the masterly critical overview of methodological debates in the social sciences by Blaikie (1993).

Steven P. Wainwright MSc BSc(Hons) PGCE RGN

Lecturer in Nursing Studies, King's College London

References

Blaikie N. (1993) Approaches to Social Enquiry. Polity Press, Cambridge.

Individuals wishing to order books reviewed should contact the publisher oJ the book direct.

© 1995 Blackwell Science Ltd, Journal of Advanced Nursing, 22, 610-615 615

children’s nursing in practice: the nottingham model

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