Media Reviews

The Project 2000 Nurseby Ann Bradshaw.Whurr, London, 2002, 230 pages,£24Æ50, ISBN 0 861 56222 5.

This is probably the most significantbook about nursing to be publishedsince 2000 and is likely to be one ofthe most significant books of the decade.Modestly titled The Project 2000 Nurse,it is subtitled The Remaking of BritishGeneral Nursing 1978–2000 and isreally a recent history of nurse educationin the UK. The pivot of the book isProject 2000 and it traces the reasonsbehind Project 2000 up to its inceptionand then its abandoning in the wake ofthe UK government reforms of nursingin 1999 which were based on the allegedfailures of Project 2000. It is ironic thatProject 2000 was actually abandonedbefore the year 2000 arrived.

Project 2000 heralded the move ofnursing education in the UK into highereducation concomitant to the ending ofthe apprenticeship style of training andthe introduction of supernumerary sta-tus. Project 2000 was designed to pro-duce nurses who had more of aneducational experience before registra-tion and, as such, would be more‘knowledgeable doers’. The move awayfrom the traditional style of nurse train-ing raised many hackles and those of uswho thought that the critics wouldeither eventually be silenced or run outof energy were wrong. Criticism rangedfrom the allegation that there wasinsufficient practical experience withinProject 2000, something that wasentirely false, to the point that Project2000 nurses lacked confidence in theirclinical skills when they entered prac-tice. There was some evidence for thesecond criticism. However, it is hardlysurprising that this was the case asProject 2000 nurses were continuallybeing told that they lacked experienceand skills by those who had trainedbefore them, by tutors and lecturers whowould reflect on the ‘good old days’ and

by the press, whose criticism of univer-sity level education for nurses has beenregularly aired. At the same time therewere reports of lower standards of care.Despite the fact that such reports wereat least partly the result of increasingcomplexity in health care, lower staff-ing levels and an increasingly vocalpublic – the ‘consumers’ – who hadbeen provided with charters and lists ofraised expectations with which to beatthe NHS, nurses were the obvioustarget.

The UK Conservative governmentwhich introduced Project 2000 defen-ded the changes in nurse educationvaliantly but did begin a review pro-cess. The arrival of a Labour govern-ment in 1997 determined to listen toand please the public, without reallyexamining the evidence from aroundthe world and in the UK of the benefitsof better educated nurses and led by aHealth Minister who never made anysecret of his dislike of university edu-cation for nurses, administered thecoup de grace to Project 2000 turningthe clock of nurse education back20 years and introducing a skills-basedcurriculum. Ironically, nurse educationremained in higher education but withfew of the trappings of higher educa-tion in the curriculum.

All of the arguments are aired inBradshaw’s book using excellent primarysources including parliamentary recordsof debates (Hansard). It is frustrating toread some of this as the obvious remedyto lack of confidence: an intern period,is mentioned frequently but the nettlewas never grasped. Nurses had to becompetent from the first time theyappeared on the wards as nurses. Thoseof us who trained under the old systemwill remember that few of us were fullycompetent on day 1 and few of us recallthe halcyon days of high standards ofnursing care. Systematic abuse ofpatients was frequent and some of theso called standards were, quite frankly,appalling, if easy to achieve.

The book is preceded by a forewordfrom Lord Morris, who is liberallyquoted in some of the recent debates.The foreword demonstrates some of thedangers of inviting such a person towrite one. Nevertheless, he is correct inhis praise of Bradshaw’s scholarship andstyle of writing. Bradshaw herself doesnot take sides but lets the readers drawtheir own conclusions. I think I detectwhich side of the argument Bradshawsupports and I disagree, but I may bewrong. The penultimate chapter can beread in isolation and should be readsoon by anyone with an interest in thisarea. Apart from anything else it dem-onstrates the fickleness of politicianswho said one thing in office only tocontradict it in opposition.

This is a book which deserves to beread widely and will serve as a ‘goldstandard’ in the history of nurse educa-tion. I look forward to a similar volume,perhaps from Bradshaw, in a decade orso on the success or failure of the currentexperiment in nurse education.

Roger WatsonMedia Reviews Editor

Paediatric Neurosurgery. A Handbookfor the Multidisciplinary Teamby Linda May.Whurr Publishers, London, 2001,210 pages, £25Æ00, ISBN 1 861 56053 2.

This book has the subtitle of ‘a hand-book for the multidisciplinary team’.Despite this, it is definitely a book fornurses, although others such as playspecialists and social workers may alsofind parts of it interesting.

It is a comprehensive introduction tothe subject containing as much detail asmost general nurses are likely to need.The text is accessible and easy tounderstand, with clear if somewhat sim-ple diagrams. Unfortunately, althoughthere is a reasonable discussion of theGlasgow Coma Scale, there is littleabout alternative paediatric coma scales,beyond the reproduction of the Great

314 � 2003 Blackwell Publishing Ltd

Ormond Street version, and this subjectdeserves much greater discussion than itis given.

An interesting idea is the presentationof family issues in the form of casestudies. However the author has an oddview of family-centred care, whichseems to involve only a child and amother. The views of fathers are notgiven, nor other relatives, suggesting alack of awareness of how many familieslive today. This is unfortunate becausethis is a good idea.

Despite all of these things, this is nota bad book. It simply appears to bestuck in a time warp when nurses werenot worried about things like validity,and the NHS believed that everyonelived in the two parent plus twochildren family. These things aside thisbook has much interesting informationto offer for the neurosurgical nurseand general nurses interested in thearea.

Edward PurssellKing’s College London, UK

Pathways of Care in Vascular Surgeryedited by Jonathan Beard andShelagh Murray.TFM Publishing Ltd, Worcester, 2002,364 pages, £30Æ00, ISBN 1 90337809 5.

The importance of evidence in clinicaldecision-making cannot be underestima-ted given the impact of current UKhealth care policy. Given the demandsof the clinical arena, it is imperative thatpractitioners are able to have easy accessto clear syntheses of robust evidence.This book was developed under theauspices of the Joint Vascular ResearchGroup, based on a recent consensusconference on best practice in vascularsurgery. Each chapter is organized tocombine a discussion and summary of aspecific clinical issue. Where there arerelevant algorithms for practice deci-sions, and these are useful as a basis for

multidisciplinary pathways of care, theyare included in the text. The strength ofevidence on which recommendationsare based is reflected in a speciallydeveloped coding system. The reasonswhy established coding systems havenot been used are not included in thebook.

Vascular surgery is considered interms of four practice themes whichreflect the traditional, bio-medical focusof health care services. Whether thisbook will support multidisciplinarypractice remains to be seen: certainlythe contributors would appear to bemostly medical. There is however, asection on organizational aspects of carethat will have clear multidisciplinaryrelevance. Assessing the credibility ofevidence includes careful assessment ofthe degree to which all potentialresearch, including unpublishedresearch, has been scrutinized for inclu-sion. Limited information is given in thebook on the process of evidence colla-tion, review and synthesis. A furthercritical factor in determining the qual-ity of reviews of evidence are thearrangements for the maintenance andupdating of their content and recom-mendations (National Health ServiceCentre for Reviews and Dissemination1996). How these issues have beenaddressed is unclear. The book willhowever, be a useful and reasonablypriced addition to the resources avail-able to practitioners and students ofvascular surgery.

Christopher R. BurtonUniversity of Leeds, UK

Reference

National Health Service Centre for Reviews

and Dissemination (1996) UndertakingSystematic Reviews of Research on Effect-iveness: CRD. Guidance for Those Carry-ing Out or Commissioning Reviews. NHSCRD, University of York, York.

Dying and Death in Canadaby Herbert C. Northcott andDonna M. Wilson.Garamond Press, Ontario, 2001,189 pages, $24Æ95, ISBN 1 551 93023 4.

Written by professors of sociology andnursing, the title and contents reflect thenatural sequence of events, namely thedying process followed by the deathevent of which the authors explicitlymake readers aware. This book targetsstudents of palliative care and socio-cultural studies as well as practitionersand lay people. It is of interest to thosewho work and live in Canada and willbe of some value to students from othercultures who wish to make comparisonsbetween care settings and political in-fluences on the care of the dying andbereaved. There are six chapters rangingfrom 18 to 31 pages each. The book isdivided into three parts. The first ad-dresses causes of dying and death inCanada. Part 2 explores the societal andcultural responses to dying and death,and Part 3 examines dying and deathfrom the individual’s perspective.

Each chapter is well referenced, tosuch an extent that it reads rather like adissertation. Some chapters contain asummary and/or conclusion which, inaddition to the references, are a helpfulguide to a student. The authors draw ona valuable range of evidence includingclassic research studies, personal com-munication with patients and referenceto TV programmes. These illuminate thefinal chapters relating to individualresponses to dying and death, makingthese chapters relevant to cultures otherthan Canada. The book concludes withan appendix containing useful sources ofinformation on dying and death inclu-ding associations, books and websites.

Moyra A. BaldwinChester College of Higher Education,UK

Media Reviews

� 2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 41(3), 314–315 315