- Email: [email protected]
Mental health legislation in psychiatric nurse training: survey of nurse tutors
NURSE EDUCATION TODAY
Mental health legislation in psychiatric nurse training: survey of nurse tutors Patrick Nash Nurse Tutor, St Nicholas Hospital, Gosforth, Newcastle upon Tyne
THIS SURVEY was undertaken as part of an assignment for the Certificate of Education course, in preparation for registration as Nurse Tutor; it was carried out five months after publication of the Mental Health (Amendment) Act 1982. The aim was to assess information and understanding of the current legislation among nurse tutors involved in the training of students for whom knowledge of the legislation is a syllabus requirement. Method The method chosen was the structured individual interview based on a prepared questionnaire. The questionnaire was in two parts; part I related to biographical information and served as a 'warm up' for part 11, which consisted of questions directed at curriculum content and method, and mental health legislation and the rights of patients. The avoidance of personal bias in the construction of research instruments is essential. \X'hile awareness of the problem on the part of the researcher will assist, of greater value are the comments of disinterested colleagues, in this case tolerant fellow-students and an experienced tutor; their co-operation at the pilot stage was of great assistance. They were generous with their time. Other difficulties with ambiguity in the phrasing of questions were identified and corrected, and in addition items were tested for acceptability and comprehension by tutors from a variety of ethnic backgrounds. Equally valuable was guidance on relevance and 'fairness' of items, ie whether it was reasonable to expect a tutor to have that knowledge. To ease initial tensions and gain the conficence of the participants, each interview was conducted in private and, following an explanation of the purpose of the survey and of the form the interview would take, an assurance was given that the anonymity of the participants and of the schools of nursing would be preserved. Participants were requested to delay any discussion of items until the questionnaire was completed. This n 198·1 Longman Group Ltd.
delay was necessary to avoid inadvertent priming of participants that might have affected responses to subsequent items. The questions were then addressed to the participants, and no comment was made by the interviewer on anything said in. reply. The questionnaire, completed by the interviewer, listed for each legislative item the probable range of replies-e-correct, incorrect, and 'don't know', each coded to facilitate subsequent analysis. Information given in replies other than that coded was coded additionally for that item; in the event, only on 'teaching methods' did significant additional material emerge. Eighteen interviews were carried out by the writer, two by a colleague. Sample The survey was carried out among staff of eight schools of psychiatric nursing, in two Regional Health Authorities. Selection of schools. and of participants was on an opportunity basis, ie schools that were accessible and tutors who were available and willing to participate; only some tutors in each school participated. In all, 20 nurse tutors were interviewed-I8 men, two women; 17 were of UK origin, three were from Commonwealth countries. This article is limited to results which give information on curriculum, and indicate level of knowledge about mental health legislation, as well as opinion on related issues. The small number involved does not allow for generalisation, nonetheless the results are interesting and highlight some important issues. A: CURRICULUM Time allocated All tutors were in schools which provided teaching on mental health law but estimates of time allocated to it varied considerably, both among tutors generally and among tutors in the same school. It must be
69
NURSE EDUCATION TODAY stressed that the times given are estimates, as the participants had no opportunity to check prior to interview. Another factor is the practice in some schools for one tutor to take complete responsibility for one Intake, from introductory block to final examination, so that a 'micro' curriculum is structured by different individuals, and the time allocated to a topic becomes a decision for individual tutors. Nonetheless, the disparity is considerable, from four hours to more than 10 hours for overall allocation of time to mental health law, and from one hour to more than five hours allocated to teaching about informal status. 'Don't know' replies are explained by the reluctance of some participants to commit themselves to an estimate of allocated time. \X'hat becomes clear is that mental health law does not feature as a major component in the training of psychiatric nurses; the time is insufficient to deal adequately with the fairly complex legal questions involved, and, perhaps more important, with the major ethical and philosophical questions that are implicit in laws which address directly issues like freedom of movement, consent, and integrity of the person. \X'ith the added complexity of new legislation in the Mental Health Act 1983, and the additional roles for nurses which it creates, the need for some review of curriculum is apparent. TABLE I: Teaching time allocated to mental health law Estimated allocation of teaching time Mental Health law 2-4 hours 2-8 hours 10 hours
'Don't know'
Number of tutors (11=20)
Number of schools
4 6 8 2
2 4 6 2
13 3 1 3
7 3
Informal status 0-1 hour
2-4 hours 5-8 hours
'Don't know'
1
3
Methods of teaching The term was interpreted fairly loosely by participants, and all suggestions were recorded. In all, 19 different methods of teaching mental health law were offered, ranging across the whole spectrum of teaching expertise. At least two methods ·were offered by 19 of the tutors interviewed, one suggesting five different methods. Most popular were group discussion (suggested by 12 tutors, in combination with one or more other method) and lecture (suggested by eight tutors, again in combination with at least one other method). The full list is given in Table 2. In view of the limited time available, it is possible that some methods may be 70
TABLE 2: Methods of teaching used Case studies Directed reading Discussion with patients Film and video Group discussion Guided study Handouts Integrated to curriculum Informal Lecture Objective items Project Role play Self-directed study Syndicate work Workshops·
more useful than others; without doubt, thought needs to be given by tutors to identifying the most useful methods relative to the time constraints which appear to apply.
Supplementary material Fourteen tutors offered at least one suggestion for supplementary learning material for students, other than the Mental Health Act itself or a resume; five suggested only the Act or a resume, while one tutor had no suggestion except the advice to 'use the library'. The suggestions listed in Table 3 indicate that mental health legislation is not at the forefront of the tutors' priorities, although there is considerable general interest in the area. The three books suggested by title and author arc: Beardshaw V 1981 Conscientious objectors at work. Social Audit Goffman E 1961 Asylums. Penguin, Harmondsworth Whitehead A 1982 Mental illness and the law. B1ackweII, Oxford. Those works were also given by title only, with, in addition: Fleming A, Paterson H 1966 Mental disorder and the law. Livingstone, Edinburgh While it might appear a limited selection from 20 tutors, when seen with the range of authors suggested
TABLE 3: Supplementary material suggested Number of tutors Item
(11=20)
Mental Health Act 1959 Resume of Act Official enquiry reports Book by title/author Book by title only Book by author only Journal by title MIND publications
13 4
1 3 4 4 2 2
D
1981 Longman Group Lr d.
NURSE EDUCATION TODAY
TABLE 4: Definition of informal patient Response
Voluntary
Number of tutors Response
6 Agrees to admission 2
Number of tutors
Voluntary (and) agrees to admission
Not unwilling
(without specific reference to a particular work of theirs), ie Anthony Clare, Larry Gostin, Ruth Schrock and Thomas Szasz, it is clear that for many the topic of mental health law is seen within the context of the ethical and philosophical issues that are inevitably related to it. Other material did not feature strongly; of the journals only Nursing Times and Nursing Mirror were mentioned by name, and only by two tutors, and use of Official Inquiry Reports was suggested by only one tutor-which is in line with the findings of Beardshaw (1981), who found that such documents arc little used by nurse educators as material in the teaching of ethics. Most reassuring, from the point of view of curriculum change, was the unanimous view of the tutors interviewed that students should be introduced to the whole range of issues raised by mental health law and patients' rights, if possible within their first year of training.
B: CONCEPTUAL PROBLEMS Two of the questions dealt with the concepts of Informal and Voluntary, as applied to patients:
'Houi would you define all informal patient?' 'How would you define a voluntary patient?' While obvious answers come easily to mind and for ordinary purposes are adequate, it is more difficult to tease out the differences between 'informal' and 'voluntary' for the purpose of teaching mental health legislation at the level required for students. Such difficulties are apparent in the responses from tutors to these items, indicating that the concepts arc confused. Voluntary is used as a synonym for 'informal', which for professional purposes is not acceptable insofar as 'voluntary' implies consent on the part of the patient. Consent is not required for informal status; the only requirement is that the patient 'is not unwilling' to enter or remain in hospital, a response that was given by just three tutors. Voluntary or/and positive agreement is clearly the focus for the majority of respondents.
Voluntary (and) does not indicate opinion
3
These responses underline widespread misconception among tutors about the legal realities of informal status, and its relationship to voluntarism, legally and conceptually. That view gains some support from responses to the question: 'How would you define a voluntary patient?' While some indicate a sophisticated understanding of what is implied by 'voluntary'-ie knowledge, freedom-another says there is 'no such thing'. One tutor gave, apparently verbatim, a definition from the Mental Treatment Act 1930, while three responded 'don't know', and two 'passed' the question; five gave 'informal' as their definition.
TABLE 5: Definition of voluntary patient Number of tutors Term used Knowledge/no coercion No coercion Knowledge Freedom/acceptance Own free will Informal As in Mental Treatment Act 1930 'No such thing' No response and 'don't know'
(n=20) I
4 I I I
5
5 I
5
The apparent lack of understanding and misconception is important when it is remembered that some 95 per cent of patients in mental hospitals arc 'informal'. When the concept is examined critically it is clear that for many its effect in practice is involuntary admission . or stay in hospital (Gostin, 1976; Hoggett, 1976). Furthermore, the informal patient, unlike 'a patient in any hospital' will be subject to considerable curtailment of rights and liberties, from the Mental Health Act and other legislation.
Other phrases used by respondents included: 'Admitted without formality; no loss of rights.' 'Admitted willingly; accepts treatment.' 'Like a patient in any hospital .' 'Has the right to leave.' cl) 1981 Longrnan Gr oup Lid.
Conclusion Few would disagree that 'true voluntarism like its relative informed consent is an ideal to be striven for-it is rarely achieved' (Bloch & Chodoff, 1981); 71
NURSE EDUCATION TODAY for that reason it is important that students be aware that it is not achieved necessarily by our Informal process, which despite its many advantages, ~vill involve many patients incapable of knowing, understanding, or exercising choice. The survey overall, despite the weaknesses in curriculum and information which it identified, highlighted for the writer the enthusiasm of t~e tutors for the subject, their concern for their students, and their goodwill in cooperating in the survey.
Bcardshaw V 1981 Conscientious ob jectors at work , Social Audit. B10ch S, Chodoff P (Ed s) (1981) Psychiatric Ethics Oxford University Press. Gostin L 1976 A human condition. MIND, London. Hoggctt B 1976 Mental health . Seric s: Law for social workers. Sweet and Maxwell, London.
ACKNOWLEDGEMENTS I th ank Mr J Sheehan, Huddersfield Polytechnic, for his SUPP?rt and guidance, and Mr P O 'Loughlin, Nurse Tutor, for help with qu estionnaires.
MULTIPLE BIRTHS Preparation-Birth-Managing afterwards Judi Linney 1983
Books
WHey, Chichester pp 124, £3.95 (paperback)
OPERATING THEATRE NURSING Mary C Warren 1983 Harper and Row, London pp 154, illus, £5.50 IN RECENT YEARS a number of short textbooks have been written about operating theatre nursing-this is one of the better ones. The aim of the book is to emphasise the importance of individual patient care in operating theatre nursing and to encourage a systematic and logical approach to the performanc.e ~f practical procedures. In this It succeeds admirably. By relating the objectives f~r eac:h chapter to the objectives contained In the outline curriculum for the JBCNS Course 176 the book is able to provide an excellent introduction to operating theatre nursing for all learners, be they student nurses, pupil nurses or qualified nurses undertaking a theatre course. The subject is presented in a logical concise, informative and manner. Each chapter is prefaced by the learning objectives specific to that action thus enabling the nurse to know' what · to achieve-something omitted from most nursing textbooks. In addition, each chapter ends with d appropriate references recommended further reading, information useful to the nurse who wishes to build on the basic principles and concepts of care found within the text. Mary Warren is to be co.mplimented on producing a good baSIC textbook, which I would recommend fir stly to all learners as an excellent introduction to operating the atre nursing and secondly to the experienced theatre nurse as a use.ful addition to her armoury of teaching resources.
:m
Roger E R Logue SRN RCNT, DipN(Lond), Cert Ed, , RNT 72
REFERENCES
JUDt LtNNEY is well qualified to write on multiple births, being a nurse, midwife and health visitor as well as mother of twins. The book is principally written for professionals but is also designed to be relevant to parents. There are eight main chapters, which progress from an introduction to the possible types of multiple births, through antenatal care and labour to the care of the children. There are three appendices containing relevant information, such as a description of Twin Clubs. This book is well presented and easily read. The subject matter, whi~e remaining straightforward, IS comprehensive and chapters are well referenced. The author succeeds best in her aim to aid professionals to prepare their clients emotionally, socially and financially. She pres~nts many original, sensible suggestions about the children's care, and continually emphasises the individuality of each family. The chapter on 'Feeding and Nutrition' should help professionals to encourage more breast feeding than at present. The experiences and opinions of parents that are cited add reality to the whole topic. I liked somewhat less the chapters relating to physical care of the mother and her care in labour: they seemed a trifle blunt and to lack the discussion which often surrounds the care of a wom an with a multiple 'pregn ancy. However, the ?asic information is given, and professional readers could follow-up the references. I would recommend this book particularly to midwives and health visitors but also to parents. Indeed, many mothers with only one child would find aspects of the book helpful.
Cathy Warwick SRN, SCM, MTD
GRIEF COUNSELLING AND GRIEF THERAPY J William Worden 1983 Tavistock Publications, London, pp 146, £2.95 A READA BLE BOOK lacking jargon and with reference to workers known on both sides of the Atlantic. I recommend this book to staff responsible for the environment .in which learners observe and practise interpersonal skills. William Worden's choice of words puts the process of mourning into perspective. He suggests '.tasks . of mourning' as a framework In whlc:h the client can achieve a new state In personal development. This give s hope to client and counsellor. The ch apter on 'Counselling and procedures' is principles fundamental : examples of how to open up specific avenues are helpful and simply put and should encourage nurses to talk to patients and not to walk away. 'Why not say what it is you miss about John?' There is a time for allowing patients to express anger or guilt. After reading Mr Worden's book we might all have more confidence to allow patients to grieve. Included is a comprehensive coverage of uncomplicated grief, abnormal grief, and grief associated Mr Worden with trauma. between grief differentiates counselling and grief therapy. Various methods us ed in grief therapy are suggested, but we are wisely rem!nde.d that the timing of our intervention IS all-important. The importance of maintaining the contact between client and counsellor and keeping the problem in focus. is stressed. Those who think counselhng is listening over a cup of tea should read this book, and learn the facts . Counsellors may take issue with the view that there are clients they cannot work with; others, like myself, will find comfort in the advice that sometimes they should refer clients.
P F Arkscy SRN, RNT, CertEd ~)
1981 Longman Group Ltd.
Mental health legislation in psychiatric nurse training: survey of nurse tutors Patrick Nash Nurse Tutor, St Nicholas Hospital, Gosforth, Newcastle upon Tyne
THIS SURVEY was undertaken as part of an assignment for the Certificate of Education course, in preparation for registration as Nurse Tutor; it was carried out five months after publication of the Mental Health (Amendment) Act 1982. The aim was to assess information and understanding of the current legislation among nurse tutors involved in the training of students for whom knowledge of the legislation is a syllabus requirement. Method The method chosen was the structured individual interview based on a prepared questionnaire. The questionnaire was in two parts; part I related to biographical information and served as a 'warm up' for part 11, which consisted of questions directed at curriculum content and method, and mental health legislation and the rights of patients. The avoidance of personal bias in the construction of research instruments is essential. \X'hile awareness of the problem on the part of the researcher will assist, of greater value are the comments of disinterested colleagues, in this case tolerant fellow-students and an experienced tutor; their co-operation at the pilot stage was of great assistance. They were generous with their time. Other difficulties with ambiguity in the phrasing of questions were identified and corrected, and in addition items were tested for acceptability and comprehension by tutors from a variety of ethnic backgrounds. Equally valuable was guidance on relevance and 'fairness' of items, ie whether it was reasonable to expect a tutor to have that knowledge. To ease initial tensions and gain the conficence of the participants, each interview was conducted in private and, following an explanation of the purpose of the survey and of the form the interview would take, an assurance was given that the anonymity of the participants and of the schools of nursing would be preserved. Participants were requested to delay any discussion of items until the questionnaire was completed. This n 198·1 Longman Group Ltd.
delay was necessary to avoid inadvertent priming of participants that might have affected responses to subsequent items. The questions were then addressed to the participants, and no comment was made by the interviewer on anything said in. reply. The questionnaire, completed by the interviewer, listed for each legislative item the probable range of replies-e-correct, incorrect, and 'don't know', each coded to facilitate subsequent analysis. Information given in replies other than that coded was coded additionally for that item; in the event, only on 'teaching methods' did significant additional material emerge. Eighteen interviews were carried out by the writer, two by a colleague. Sample The survey was carried out among staff of eight schools of psychiatric nursing, in two Regional Health Authorities. Selection of schools. and of participants was on an opportunity basis, ie schools that were accessible and tutors who were available and willing to participate; only some tutors in each school participated. In all, 20 nurse tutors were interviewed-I8 men, two women; 17 were of UK origin, three were from Commonwealth countries. This article is limited to results which give information on curriculum, and indicate level of knowledge about mental health legislation, as well as opinion on related issues. The small number involved does not allow for generalisation, nonetheless the results are interesting and highlight some important issues. A: CURRICULUM Time allocated All tutors were in schools which provided teaching on mental health law but estimates of time allocated to it varied considerably, both among tutors generally and among tutors in the same school. It must be
69
NURSE EDUCATION TODAY stressed that the times given are estimates, as the participants had no opportunity to check prior to interview. Another factor is the practice in some schools for one tutor to take complete responsibility for one Intake, from introductory block to final examination, so that a 'micro' curriculum is structured by different individuals, and the time allocated to a topic becomes a decision for individual tutors. Nonetheless, the disparity is considerable, from four hours to more than 10 hours for overall allocation of time to mental health law, and from one hour to more than five hours allocated to teaching about informal status. 'Don't know' replies are explained by the reluctance of some participants to commit themselves to an estimate of allocated time. \X'hat becomes clear is that mental health law does not feature as a major component in the training of psychiatric nurses; the time is insufficient to deal adequately with the fairly complex legal questions involved, and, perhaps more important, with the major ethical and philosophical questions that are implicit in laws which address directly issues like freedom of movement, consent, and integrity of the person. \X'ith the added complexity of new legislation in the Mental Health Act 1983, and the additional roles for nurses which it creates, the need for some review of curriculum is apparent. TABLE I: Teaching time allocated to mental health law Estimated allocation of teaching time Mental Health law 2-4 hours 2-8 hours 10 hours
'Don't know'
Number of tutors (11=20)
Number of schools
4 6 8 2
2 4 6 2
13 3 1 3
7 3
Informal status 0-1 hour
2-4 hours 5-8 hours
'Don't know'
1
3
Methods of teaching The term was interpreted fairly loosely by participants, and all suggestions were recorded. In all, 19 different methods of teaching mental health law were offered, ranging across the whole spectrum of teaching expertise. At least two methods ·were offered by 19 of the tutors interviewed, one suggesting five different methods. Most popular were group discussion (suggested by 12 tutors, in combination with one or more other method) and lecture (suggested by eight tutors, again in combination with at least one other method). The full list is given in Table 2. In view of the limited time available, it is possible that some methods may be 70
TABLE 2: Methods of teaching used Case studies Directed reading Discussion with patients Film and video Group discussion Guided study Handouts Integrated to curriculum Informal Lecture Objective items Project Role play Self-directed study Syndicate work Workshops·
more useful than others; without doubt, thought needs to be given by tutors to identifying the most useful methods relative to the time constraints which appear to apply.
Supplementary material Fourteen tutors offered at least one suggestion for supplementary learning material for students, other than the Mental Health Act itself or a resume; five suggested only the Act or a resume, while one tutor had no suggestion except the advice to 'use the library'. The suggestions listed in Table 3 indicate that mental health legislation is not at the forefront of the tutors' priorities, although there is considerable general interest in the area. The three books suggested by title and author arc: Beardshaw V 1981 Conscientious objectors at work. Social Audit Goffman E 1961 Asylums. Penguin, Harmondsworth Whitehead A 1982 Mental illness and the law. B1ackweII, Oxford. Those works were also given by title only, with, in addition: Fleming A, Paterson H 1966 Mental disorder and the law. Livingstone, Edinburgh While it might appear a limited selection from 20 tutors, when seen with the range of authors suggested
TABLE 3: Supplementary material suggested Number of tutors Item
(11=20)
Mental Health Act 1959 Resume of Act Official enquiry reports Book by title/author Book by title only Book by author only Journal by title MIND publications
13 4
1 3 4 4 2 2
D
1981 Longman Group Lr d.
NURSE EDUCATION TODAY
TABLE 4: Definition of informal patient Response
Voluntary
Number of tutors Response
6 Agrees to admission 2
Number of tutors
Voluntary (and) agrees to admission
Not unwilling
(without specific reference to a particular work of theirs), ie Anthony Clare, Larry Gostin, Ruth Schrock and Thomas Szasz, it is clear that for many the topic of mental health law is seen within the context of the ethical and philosophical issues that are inevitably related to it. Other material did not feature strongly; of the journals only Nursing Times and Nursing Mirror were mentioned by name, and only by two tutors, and use of Official Inquiry Reports was suggested by only one tutor-which is in line with the findings of Beardshaw (1981), who found that such documents arc little used by nurse educators as material in the teaching of ethics. Most reassuring, from the point of view of curriculum change, was the unanimous view of the tutors interviewed that students should be introduced to the whole range of issues raised by mental health law and patients' rights, if possible within their first year of training.
B: CONCEPTUAL PROBLEMS Two of the questions dealt with the concepts of Informal and Voluntary, as applied to patients:
'Houi would you define all informal patient?' 'How would you define a voluntary patient?' While obvious answers come easily to mind and for ordinary purposes are adequate, it is more difficult to tease out the differences between 'informal' and 'voluntary' for the purpose of teaching mental health legislation at the level required for students. Such difficulties are apparent in the responses from tutors to these items, indicating that the concepts arc confused. Voluntary is used as a synonym for 'informal', which for professional purposes is not acceptable insofar as 'voluntary' implies consent on the part of the patient. Consent is not required for informal status; the only requirement is that the patient 'is not unwilling' to enter or remain in hospital, a response that was given by just three tutors. Voluntary or/and positive agreement is clearly the focus for the majority of respondents.
Voluntary (and) does not indicate opinion
3
These responses underline widespread misconception among tutors about the legal realities of informal status, and its relationship to voluntarism, legally and conceptually. That view gains some support from responses to the question: 'How would you define a voluntary patient?' While some indicate a sophisticated understanding of what is implied by 'voluntary'-ie knowledge, freedom-another says there is 'no such thing'. One tutor gave, apparently verbatim, a definition from the Mental Treatment Act 1930, while three responded 'don't know', and two 'passed' the question; five gave 'informal' as their definition.
TABLE 5: Definition of voluntary patient Number of tutors Term used Knowledge/no coercion No coercion Knowledge Freedom/acceptance Own free will Informal As in Mental Treatment Act 1930 'No such thing' No response and 'don't know'
(n=20) I
4 I I I
5
5 I
5
The apparent lack of understanding and misconception is important when it is remembered that some 95 per cent of patients in mental hospitals arc 'informal'. When the concept is examined critically it is clear that for many its effect in practice is involuntary admission . or stay in hospital (Gostin, 1976; Hoggett, 1976). Furthermore, the informal patient, unlike 'a patient in any hospital' will be subject to considerable curtailment of rights and liberties, from the Mental Health Act and other legislation.
Other phrases used by respondents included: 'Admitted without formality; no loss of rights.' 'Admitted willingly; accepts treatment.' 'Like a patient in any hospital .' 'Has the right to leave.' cl) 1981 Longrnan Gr oup Lid.
Conclusion Few would disagree that 'true voluntarism like its relative informed consent is an ideal to be striven for-it is rarely achieved' (Bloch & Chodoff, 1981); 71
NURSE EDUCATION TODAY for that reason it is important that students be aware that it is not achieved necessarily by our Informal process, which despite its many advantages, ~vill involve many patients incapable of knowing, understanding, or exercising choice. The survey overall, despite the weaknesses in curriculum and information which it identified, highlighted for the writer the enthusiasm of t~e tutors for the subject, their concern for their students, and their goodwill in cooperating in the survey.
Bcardshaw V 1981 Conscientious ob jectors at work , Social Audit. B10ch S, Chodoff P (Ed s) (1981) Psychiatric Ethics Oxford University Press. Gostin L 1976 A human condition. MIND, London. Hoggctt B 1976 Mental health . Seric s: Law for social workers. Sweet and Maxwell, London.
ACKNOWLEDGEMENTS I th ank Mr J Sheehan, Huddersfield Polytechnic, for his SUPP?rt and guidance, and Mr P O 'Loughlin, Nurse Tutor, for help with qu estionnaires.
MULTIPLE BIRTHS Preparation-Birth-Managing afterwards Judi Linney 1983
Books
WHey, Chichester pp 124, £3.95 (paperback)
OPERATING THEATRE NURSING Mary C Warren 1983 Harper and Row, London pp 154, illus, £5.50 IN RECENT YEARS a number of short textbooks have been written about operating theatre nursing-this is one of the better ones. The aim of the book is to emphasise the importance of individual patient care in operating theatre nursing and to encourage a systematic and logical approach to the performanc.e ~f practical procedures. In this It succeeds admirably. By relating the objectives f~r eac:h chapter to the objectives contained In the outline curriculum for the JBCNS Course 176 the book is able to provide an excellent introduction to operating theatre nursing for all learners, be they student nurses, pupil nurses or qualified nurses undertaking a theatre course. The subject is presented in a logical concise, informative and manner. Each chapter is prefaced by the learning objectives specific to that action thus enabling the nurse to know' what · to achieve-something omitted from most nursing textbooks. In addition, each chapter ends with d appropriate references recommended further reading, information useful to the nurse who wishes to build on the basic principles and concepts of care found within the text. Mary Warren is to be co.mplimented on producing a good baSIC textbook, which I would recommend fir stly to all learners as an excellent introduction to operating the atre nursing and secondly to the experienced theatre nurse as a use.ful addition to her armoury of teaching resources.
:m
Roger E R Logue SRN RCNT, DipN(Lond), Cert Ed, , RNT 72
REFERENCES
JUDt LtNNEY is well qualified to write on multiple births, being a nurse, midwife and health visitor as well as mother of twins. The book is principally written for professionals but is also designed to be relevant to parents. There are eight main chapters, which progress from an introduction to the possible types of multiple births, through antenatal care and labour to the care of the children. There are three appendices containing relevant information, such as a description of Twin Clubs. This book is well presented and easily read. The subject matter, whi~e remaining straightforward, IS comprehensive and chapters are well referenced. The author succeeds best in her aim to aid professionals to prepare their clients emotionally, socially and financially. She pres~nts many original, sensible suggestions about the children's care, and continually emphasises the individuality of each family. The chapter on 'Feeding and Nutrition' should help professionals to encourage more breast feeding than at present. The experiences and opinions of parents that are cited add reality to the whole topic. I liked somewhat less the chapters relating to physical care of the mother and her care in labour: they seemed a trifle blunt and to lack the discussion which often surrounds the care of a wom an with a multiple 'pregn ancy. However, the ?asic information is given, and professional readers could follow-up the references. I would recommend this book particularly to midwives and health visitors but also to parents. Indeed, many mothers with only one child would find aspects of the book helpful.
Cathy Warwick SRN, SCM, MTD
GRIEF COUNSELLING AND GRIEF THERAPY J William Worden 1983 Tavistock Publications, London, pp 146, £2.95 A READA BLE BOOK lacking jargon and with reference to workers known on both sides of the Atlantic. I recommend this book to staff responsible for the environment .in which learners observe and practise interpersonal skills. William Worden's choice of words puts the process of mourning into perspective. He suggests '.tasks . of mourning' as a framework In whlc:h the client can achieve a new state In personal development. This give s hope to client and counsellor. The ch apter on 'Counselling and procedures' is principles fundamental : examples of how to open up specific avenues are helpful and simply put and should encourage nurses to talk to patients and not to walk away. 'Why not say what it is you miss about John?' There is a time for allowing patients to express anger or guilt. After reading Mr Worden's book we might all have more confidence to allow patients to grieve. Included is a comprehensive coverage of uncomplicated grief, abnormal grief, and grief associated Mr Worden with trauma. between grief differentiates counselling and grief therapy. Various methods us ed in grief therapy are suggested, but we are wisely rem!nde.d that the timing of our intervention IS all-important. The importance of maintaining the contact between client and counsellor and keeping the problem in focus. is stressed. Those who think counselhng is listening over a cup of tea should read this book, and learn the facts . Counsellors may take issue with the view that there are clients they cannot work with; others, like myself, will find comfort in the advice that sometimes they should refer clients.
P F Arkscy SRN, RNT, CertEd ~)
1981 Longman Group Ltd.