- Email: [email protected]
Clarifying concepts in nursing research
224
Clinical Effectiveness in Nursing
from a range of disciplines, including paediatricians, anaesthetists, pharmacologists, nurses and others. It begins with some general considerations, the most cheering of which is the recommendation that all children's units should have (or develop) a pain control service, run by a multidisciplinary team. The remaining 10 chapters cover topics such as the assessment of pain in infants; methods of pain relief; pain management in the emergency department, after surgery and in intensive care; the management of chronic pain in children; and management of the pain of sickle cell disease. This book is easy to find your way around, since it is clearly written and structured. Its greatest strength, though, is that it is packed full of excellent, well-organized information about the pharmacological control of pain. It clearly sets out the appropriate uses, possible routes of administration, dosages and side-effects of each of the main types of analgesic. A small wall poster is included, which presents an overview of this information. It does not go into great detail about complementary methods of pain control, but it does provide 2 pages on the topic. Some nurses may be disappointed at this lack of emphasis on non-pharmacological therapies, but a research-based book cannot be expected to recommend therapies which have not been well-validated as clinically effective. Unfortunately, the jury is still out concerning many of the alternative approaches available. There is, however, a section on further reading and resources which covers not only standard books and journal articles, but also more generally available booklets and videos, and sources of advice on hypnosis and complementary therapies for children. The role of parents of children in pain is not a major concern of this book, but they are mentioned when they have a part to play. For example, the desirability (or otherwise) of parents' presence during the induction of anaesthesia, their accuracy in assessing their child's pain, and in restraining, supporting and distracting their children. In the appendices there are two examples of information leaflets for parents which explain epidural anaesthesia and the effects of morphine. There are several other useful appendices, which provide examples of scales for pain assessment and the charting of pain, analgesic provision and pain reliefi Much of the information contained in this book is obviously evidence-based. However, chapters v a r y considerably in terms of referencing - some have none, while others cite more than 50, so the evidence base for practice is more explicit for some topics than for others. This is really a technical manual aimed mainly at medical staff and specialist nurses caring for children. As a clearly written
reference book it would be very valuable to such practitioners, and a useful addition to those libraries serving them.
S.J. Closs Clarifying concepts in nursing research A. G. Gift Springer 1997 ISBN 0-8261-9980- I, Price s The goal of clinical effectiveness can be hampered if practitioners do not have a clear understanding of the concepts with which they deal. The importance of concept clarification is made clear in the first sentence of this book, as the editor explains that it is 'through the delineation of the phenomena with which many is concerned that a language is formulated to facilitate the communication of nursing practice. Concept clarification is also important for the development of theories.' This book, however, is for researchers, not practitioners, although the latter's contribution to concept clarification is acknowledged. Written by a number of experienced nurse researchers and authors, it does two things. First, it provides a discussion and a critique of current techniques and approaches to concept analysis and development. In particular, Chapters 1 and 4 will be useful to those who wish to have an overview of methods of concept analysis in nursing research, their strengths, limitations and the way forward. While its language and style are clear and easy to follow, some of the chapters presume prior knowledge of some of the terminologies associated with concept analysis. Therefore the book is not for beginners. Conceptualization depends on the analysis and synthesis of information from a variety of sources (including literature review, case studies and research) and on a variety of techniques including both qualitative and quantitative approaches. Postgraduate research students often find that tasks such as literature review and conceptual clarification are difficult. This book provides imaginative ideas on how these could be addressed. It will also appeal to experienced researchers searching for new ways to clarify concepts and develop conceptual frameworks, models or theories. Second, it gives examples of the process of concept analysis, exploration, clarification and development. Chapters 2, 3, 5 and 6 deal with such concepts as 'Pediatrics Physiologic Stress Response', 'Undocumentedness', 'Postpartum Fatigue' and 'Quality of Life', respectively. Other useful features include an informative and useful introduction, and well laid out tables which, for example, make such tasks as 'the comparison of the steps of the major methods' of concept analysis easily accessible to readers. There is
Book reviews
also a strong emphasis on the need to find new strategies of concept analysis and development in nursing research. It is interesting to note, however, that in a book which deals with concept clarification, the editor admits that the authors 'do not all use the same term to describe the process (of concept analysis)'. It is imperative that the concepts used to advance concept clarification are themselves clarified. Overall, this book is recommended to postgraduate research students and experienced researchers who embark upon developing this aspect of research. It has a lot to contribute, not least because it questions current techniques of concept clarification and challenges nurse researchers, theorists and clinicians to devise new and rigorous ways to advance nursing knowledge. At a price of s it is good value as a reference text.
K. Pavahoo Emergency Triage Manchester Triage Group BMJ Publishing Group, 1997 ISBN 0 7279 1126 0, Price s 12.95 The concept of triage within the hospital emergency service has gained increasing attention in recent years. Much of the preparation of nurses and allied health care professionals for triage has been sporadic and variable. Emergency Triage is the first British text of its kind to formally address this issue and is the cuhnination of the work of a multidisciplined group of professionals (the Manchester Triage Group) who work in the emergency setting. The intention of this publication is to provide practitioners of triage with a framework that they can apply when patients present to their departments, enabling them to work to a set standard when applying the National Triage Scale. This, it is proposed, will help them to make reliable and reproducible triage decisions. It is also intended as a supplement to the triage training course devised by the Manchester Triage Group, and as a useful aide-memoir to the practising clinician. In the introduction we are advised of the multidisciplinary basis for this publication. The use of discriminators that relate closely to British Association of Accident and Emergency Medicine (BAEM) and RCN guidelines is welcomed, in particular the emphasis given to pain assessment. Throughout the text, emphasis is placed on the process rather than the outcome of the triage decisions made, and the importance of training and experience for the practitioner performing this role. For the most part, triage in hospital emergency departments falls within the realm of
225
nursing staff; this is reflected in the composition of the working group. The text itself is presented in an easy-to-read, clear, logical format. One of the aims is to provide a reference guide to professionals as they acquire triage skills. The layout of the text, with its variety of alphabetically sequenced presentational flowcharts each denoting a different clinical presentation, is such that cross referencing from one section to another is facilitated. The standardized format of each flowchart also serves to instil confidence and familiarity in the readers, and provides an easy source of reference. The volume size is appropriate for its intended purpose. The choice of language and use of generalizable terms that are free from jargon also makes the text suitable for a wide target audience, as does its attractive price. The inclusion of a glossary of terms at the end further enhances the acceptability and usefulness of this text for the inexperienced practitioner. While the text is informative and makes for easy reading, its weaknesses are evident. A complete lack of systematic evidence on which to base or substantiate findings coupled with the lack of a clearly identifiable assessment tool and the absence of formal evaluation render its reliability open to question. As the origin for the concepts proposed lie in consensus opinion and not on empirical data, its reliability can be further questioned. On more than one occasion we are reminded by the authors of the need for a robust audit method; they state that this is essential to the future of any standard methodology, since reproducibility between individual practitioners must be shown to exist, and that there is a need for a framework that is methodologically sound. Surprisingly, despite the range of existing material from overseas and within the UK, this publication lacks any research ol- evidence on which to base its findings. While indirect reference is made to the work of Benner and Blythin, no formal reference or list of recommended texts for further reading have been provided. Evidence-based literature on decision-making, in particular, is in abundance, yet reference to and acknowledgement of this is scarce. Pain assessment is also included as a key discriminator, yet glancing reference only is given to valid research. The pain assessment method selected is based on consensus opinion. No critical analysis is presented as to why the method selected was favoured in relation to the others. The same argument holds true for the flowcharts presented in the text. It is also of interest to note that the content of particular components of some flowcharts may be considered susceptible to challenge and debate. For example, many experienced emergency personnel advocate that all children are categorized into higher priority groups irrespective of age or clinical condition. Accepting this premise, this text will have limited value for those working in children's A&E departments.
Clinical Effectiveness in Nursing
from a range of disciplines, including paediatricians, anaesthetists, pharmacologists, nurses and others. It begins with some general considerations, the most cheering of which is the recommendation that all children's units should have (or develop) a pain control service, run by a multidisciplinary team. The remaining 10 chapters cover topics such as the assessment of pain in infants; methods of pain relief; pain management in the emergency department, after surgery and in intensive care; the management of chronic pain in children; and management of the pain of sickle cell disease. This book is easy to find your way around, since it is clearly written and structured. Its greatest strength, though, is that it is packed full of excellent, well-organized information about the pharmacological control of pain. It clearly sets out the appropriate uses, possible routes of administration, dosages and side-effects of each of the main types of analgesic. A small wall poster is included, which presents an overview of this information. It does not go into great detail about complementary methods of pain control, but it does provide 2 pages on the topic. Some nurses may be disappointed at this lack of emphasis on non-pharmacological therapies, but a research-based book cannot be expected to recommend therapies which have not been well-validated as clinically effective. Unfortunately, the jury is still out concerning many of the alternative approaches available. There is, however, a section on further reading and resources which covers not only standard books and journal articles, but also more generally available booklets and videos, and sources of advice on hypnosis and complementary therapies for children. The role of parents of children in pain is not a major concern of this book, but they are mentioned when they have a part to play. For example, the desirability (or otherwise) of parents' presence during the induction of anaesthesia, their accuracy in assessing their child's pain, and in restraining, supporting and distracting their children. In the appendices there are two examples of information leaflets for parents which explain epidural anaesthesia and the effects of morphine. There are several other useful appendices, which provide examples of scales for pain assessment and the charting of pain, analgesic provision and pain reliefi Much of the information contained in this book is obviously evidence-based. However, chapters v a r y considerably in terms of referencing - some have none, while others cite more than 50, so the evidence base for practice is more explicit for some topics than for others. This is really a technical manual aimed mainly at medical staff and specialist nurses caring for children. As a clearly written
reference book it would be very valuable to such practitioners, and a useful addition to those libraries serving them.
S.J. Closs Clarifying concepts in nursing research A. G. Gift Springer 1997 ISBN 0-8261-9980- I, Price s The goal of clinical effectiveness can be hampered if practitioners do not have a clear understanding of the concepts with which they deal. The importance of concept clarification is made clear in the first sentence of this book, as the editor explains that it is 'through the delineation of the phenomena with which many is concerned that a language is formulated to facilitate the communication of nursing practice. Concept clarification is also important for the development of theories.' This book, however, is for researchers, not practitioners, although the latter's contribution to concept clarification is acknowledged. Written by a number of experienced nurse researchers and authors, it does two things. First, it provides a discussion and a critique of current techniques and approaches to concept analysis and development. In particular, Chapters 1 and 4 will be useful to those who wish to have an overview of methods of concept analysis in nursing research, their strengths, limitations and the way forward. While its language and style are clear and easy to follow, some of the chapters presume prior knowledge of some of the terminologies associated with concept analysis. Therefore the book is not for beginners. Conceptualization depends on the analysis and synthesis of information from a variety of sources (including literature review, case studies and research) and on a variety of techniques including both qualitative and quantitative approaches. Postgraduate research students often find that tasks such as literature review and conceptual clarification are difficult. This book provides imaginative ideas on how these could be addressed. It will also appeal to experienced researchers searching for new ways to clarify concepts and develop conceptual frameworks, models or theories. Second, it gives examples of the process of concept analysis, exploration, clarification and development. Chapters 2, 3, 5 and 6 deal with such concepts as 'Pediatrics Physiologic Stress Response', 'Undocumentedness', 'Postpartum Fatigue' and 'Quality of Life', respectively. Other useful features include an informative and useful introduction, and well laid out tables which, for example, make such tasks as 'the comparison of the steps of the major methods' of concept analysis easily accessible to readers. There is
Book reviews
also a strong emphasis on the need to find new strategies of concept analysis and development in nursing research. It is interesting to note, however, that in a book which deals with concept clarification, the editor admits that the authors 'do not all use the same term to describe the process (of concept analysis)'. It is imperative that the concepts used to advance concept clarification are themselves clarified. Overall, this book is recommended to postgraduate research students and experienced researchers who embark upon developing this aspect of research. It has a lot to contribute, not least because it questions current techniques of concept clarification and challenges nurse researchers, theorists and clinicians to devise new and rigorous ways to advance nursing knowledge. At a price of s it is good value as a reference text.
K. Pavahoo Emergency Triage Manchester Triage Group BMJ Publishing Group, 1997 ISBN 0 7279 1126 0, Price s 12.95 The concept of triage within the hospital emergency service has gained increasing attention in recent years. Much of the preparation of nurses and allied health care professionals for triage has been sporadic and variable. Emergency Triage is the first British text of its kind to formally address this issue and is the cuhnination of the work of a multidisciplined group of professionals (the Manchester Triage Group) who work in the emergency setting. The intention of this publication is to provide practitioners of triage with a framework that they can apply when patients present to their departments, enabling them to work to a set standard when applying the National Triage Scale. This, it is proposed, will help them to make reliable and reproducible triage decisions. It is also intended as a supplement to the triage training course devised by the Manchester Triage Group, and as a useful aide-memoir to the practising clinician. In the introduction we are advised of the multidisciplinary basis for this publication. The use of discriminators that relate closely to British Association of Accident and Emergency Medicine (BAEM) and RCN guidelines is welcomed, in particular the emphasis given to pain assessment. Throughout the text, emphasis is placed on the process rather than the outcome of the triage decisions made, and the importance of training and experience for the practitioner performing this role. For the most part, triage in hospital emergency departments falls within the realm of
225
nursing staff; this is reflected in the composition of the working group. The text itself is presented in an easy-to-read, clear, logical format. One of the aims is to provide a reference guide to professionals as they acquire triage skills. The layout of the text, with its variety of alphabetically sequenced presentational flowcharts each denoting a different clinical presentation, is such that cross referencing from one section to another is facilitated. The standardized format of each flowchart also serves to instil confidence and familiarity in the readers, and provides an easy source of reference. The volume size is appropriate for its intended purpose. The choice of language and use of generalizable terms that are free from jargon also makes the text suitable for a wide target audience, as does its attractive price. The inclusion of a glossary of terms at the end further enhances the acceptability and usefulness of this text for the inexperienced practitioner. While the text is informative and makes for easy reading, its weaknesses are evident. A complete lack of systematic evidence on which to base or substantiate findings coupled with the lack of a clearly identifiable assessment tool and the absence of formal evaluation render its reliability open to question. As the origin for the concepts proposed lie in consensus opinion and not on empirical data, its reliability can be further questioned. On more than one occasion we are reminded by the authors of the need for a robust audit method; they state that this is essential to the future of any standard methodology, since reproducibility between individual practitioners must be shown to exist, and that there is a need for a framework that is methodologically sound. Surprisingly, despite the range of existing material from overseas and within the UK, this publication lacks any research ol- evidence on which to base its findings. While indirect reference is made to the work of Benner and Blythin, no formal reference or list of recommended texts for further reading have been provided. Evidence-based literature on decision-making, in particular, is in abundance, yet reference to and acknowledgement of this is scarce. Pain assessment is also included as a key discriminator, yet glancing reference only is given to valid research. The pain assessment method selected is based on consensus opinion. No critical analysis is presented as to why the method selected was favoured in relation to the others. The same argument holds true for the flowcharts presented in the text. It is also of interest to note that the content of particular components of some flowcharts may be considered susceptible to challenge and debate. For example, many experienced emergency personnel advocate that all children are categorized into higher priority groups irrespective of age or clinical condition. Accepting this premise, this text will have limited value for those working in children's A&E departments.