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Nurse education and the curriculum
166
BOOK RE VIE WS
Nurse Education and the Curriculum. Fred Greaves. Croom Helm, Kent (1984). 106 pp. Price f6.95. In many respects this book is a welcome addition to the literature, particularly since the author believes the central focus of curriculum building is nursing itself. The nursing process is explored as a coordinating element in the nursing curriculum. A clear distinction is made by the author between ‘process’ (i.e. a logical sequence of actions) and models and theories of nursing, which can be used to derive the dimensions of assessment and to provide the overall aims and purposes of nursing. A rather uncritical review of the literature on curriculum theory provides a good source of reference titles. In the second half of the book the author explains a nursing curriculum model of his own. I found the writing style used made for hard work in reading the book. Explanations and descriptions are written in very abstract language and there is much repetition of the same or only slightly different points, in slightly different terms. The use of concrete examples as illustrative material would have been much more telling and would have made the book both more interesting and more easily understood. The author attempts to relate the stages of the nursing process with the stages of the curriculum design process. As far as I am concerned this added little clarity to the exposition. Theexampleof a curriculum based on the nursing process developed by the author is based on his experience of teaching the diploma in Professional Studies. This origin of the model is very apparent and although the author claims that his model could be used in the pre-registration phase of nursing education, I believe it would require considerable adaptation to serve this purpose. I say this from my experience of being responsible for a degree course in nursing which ltads to a first level nursing qualification. The Greaves model appears to me to assume a degree of nursing knowledge at entry to the course not possessed by the students, whose experience at best is mainly that of caring as a lay person for sick relatives within the family. For such people, one needs to start at a different point and to build up knowledge and skills more slowly, using the experience they bring to the course. For example, we get our students to practice first interviewing patients about the type of thing which is within everyone’s experience such as sleeping and eating. Later they identify problems at a commonsense level and suggest solutions before we begin to introduce complex theoretical and pathological dimensions. Greaves suggests in a brief overview of patient assessment (within the curriculum), “This involves the student in attempting to make a comprehensive theoretical and actual patient assessment by defining the patient’s range of physical, emotional and social problems by developing a data base and using known data bases”. Surely, whilst this is appropriate to trained nurses it is not appropriate to students with little or no experience. I am unhappy with some of the statements about nursing in this book, e.g. “. . . the nursing events are designed to adapt the patient within certain limits with respect to the activities of daily living but below full health capacity”. The process of adaptation to anything is surely something that only an individual (in this case the patient) can do himself. All that the nurse can do is to be aware of the need and to assist where possible. A further quote takes up the same point but also illustrates the unnecessarily complex language used in the book, “Such knowledge and skills must also help in the adaptation of the patient to illness, return to health or death, by adapting to the needs and problem alleviating measures with the care to be given”.
167
BOOK RE VIE WS
Whilst it is important that a curriculum is built up on a sound logical basis, I wonder whether in an attempt to make themselves academically respectable the educationists are not becoming over abstract: hiding their lack of theory with a complex and rather meaningless language. If that is so, we in nursing should beware, since we appear to be going through a similar process of ‘academicising’ nursing. I believe there is more than enough academic content in nursing without inventing where none exists. Whilst a special language is necessary in order to express concisely an idea that otherwise might take a paragraph or a page or more, it is important to beware the use of jargon for its own sake. I also wonder if settling too firmly upon one particular curriculum model rather than following the curriculum planning process would not confine nursing too rigidly, preventing creativity. In summary, there are stimulating and interesting ideas in this book but one also has to read much material which seems pointless and some which is questionable. MARGARETCLARKE, S.R.N., R.N.T.,
B.Sc., M.Phil.
Tales From Chirgwin Hospital: A Question of Management. Courtenay Macmillan, London (1983). Price f 12.00 (hardback), f4.95 (paperback).
C. Wade.
What a delightful and unusual book this is! It is difficult to know exactly for what audience it was written but many nurses will find this little book amusing and with something to say for them. At times, though, the author can be patronising and therefore somewhat irritating. For this book, the author’s aim is to make nurses and others more aware of problems in the hospital service, more aware of management issues, more aware of the perspective of others. The book is written in nine chapters-nine ‘tales’ about the imaginary Chirgwin District General Hospital. The first tale, “Administration”, is dull and would put off many readers, but the tales improve. The second: “Acute Surgical Ward”, is typical and describes one night on a ward from the perspective of two patients, the student nurse in charge that night and the night sister. The tale concludes by drawing out the issue of bed management when there are emergency and planned admissions, discharge arrangements and complaints, and raises questions on these for the reader to consider and debate. The tale from the geriatric ward and the appropriate placement of an old lady for long-term care, and that on an outbreak of salmonella in a medical ward, are particularly good at drawing out the different attitudes and perspectives when there are complex problems and communication difficulties. The tales from the outpatients and accident and emergency departments are extremely good at identifying the organisational skills required in managing such departments. The tale entitled “Cracked Cup” will be warmly received by many nurses as it details the irritating difficulties of supplies, repairs, storage, heating and flower arranging and catering: this tale could form the basis of a discussion at some multidisciplinary management course! The same tale raises some difficult ethical considerations of
BOOK RE VIE WS
Nurse Education and the Curriculum. Fred Greaves. Croom Helm, Kent (1984). 106 pp. Price f6.95. In many respects this book is a welcome addition to the literature, particularly since the author believes the central focus of curriculum building is nursing itself. The nursing process is explored as a coordinating element in the nursing curriculum. A clear distinction is made by the author between ‘process’ (i.e. a logical sequence of actions) and models and theories of nursing, which can be used to derive the dimensions of assessment and to provide the overall aims and purposes of nursing. A rather uncritical review of the literature on curriculum theory provides a good source of reference titles. In the second half of the book the author explains a nursing curriculum model of his own. I found the writing style used made for hard work in reading the book. Explanations and descriptions are written in very abstract language and there is much repetition of the same or only slightly different points, in slightly different terms. The use of concrete examples as illustrative material would have been much more telling and would have made the book both more interesting and more easily understood. The author attempts to relate the stages of the nursing process with the stages of the curriculum design process. As far as I am concerned this added little clarity to the exposition. Theexampleof a curriculum based on the nursing process developed by the author is based on his experience of teaching the diploma in Professional Studies. This origin of the model is very apparent and although the author claims that his model could be used in the pre-registration phase of nursing education, I believe it would require considerable adaptation to serve this purpose. I say this from my experience of being responsible for a degree course in nursing which ltads to a first level nursing qualification. The Greaves model appears to me to assume a degree of nursing knowledge at entry to the course not possessed by the students, whose experience at best is mainly that of caring as a lay person for sick relatives within the family. For such people, one needs to start at a different point and to build up knowledge and skills more slowly, using the experience they bring to the course. For example, we get our students to practice first interviewing patients about the type of thing which is within everyone’s experience such as sleeping and eating. Later they identify problems at a commonsense level and suggest solutions before we begin to introduce complex theoretical and pathological dimensions. Greaves suggests in a brief overview of patient assessment (within the curriculum), “This involves the student in attempting to make a comprehensive theoretical and actual patient assessment by defining the patient’s range of physical, emotional and social problems by developing a data base and using known data bases”. Surely, whilst this is appropriate to trained nurses it is not appropriate to students with little or no experience. I am unhappy with some of the statements about nursing in this book, e.g. “. . . the nursing events are designed to adapt the patient within certain limits with respect to the activities of daily living but below full health capacity”. The process of adaptation to anything is surely something that only an individual (in this case the patient) can do himself. All that the nurse can do is to be aware of the need and to assist where possible. A further quote takes up the same point but also illustrates the unnecessarily complex language used in the book, “Such knowledge and skills must also help in the adaptation of the patient to illness, return to health or death, by adapting to the needs and problem alleviating measures with the care to be given”.
167
BOOK RE VIE WS
Whilst it is important that a curriculum is built up on a sound logical basis, I wonder whether in an attempt to make themselves academically respectable the educationists are not becoming over abstract: hiding their lack of theory with a complex and rather meaningless language. If that is so, we in nursing should beware, since we appear to be going through a similar process of ‘academicising’ nursing. I believe there is more than enough academic content in nursing without inventing where none exists. Whilst a special language is necessary in order to express concisely an idea that otherwise might take a paragraph or a page or more, it is important to beware the use of jargon for its own sake. I also wonder if settling too firmly upon one particular curriculum model rather than following the curriculum planning process would not confine nursing too rigidly, preventing creativity. In summary, there are stimulating and interesting ideas in this book but one also has to read much material which seems pointless and some which is questionable. MARGARETCLARKE, S.R.N., R.N.T.,
B.Sc., M.Phil.
Tales From Chirgwin Hospital: A Question of Management. Courtenay Macmillan, London (1983). Price f 12.00 (hardback), f4.95 (paperback).
C. Wade.
What a delightful and unusual book this is! It is difficult to know exactly for what audience it was written but many nurses will find this little book amusing and with something to say for them. At times, though, the author can be patronising and therefore somewhat irritating. For this book, the author’s aim is to make nurses and others more aware of problems in the hospital service, more aware of management issues, more aware of the perspective of others. The book is written in nine chapters-nine ‘tales’ about the imaginary Chirgwin District General Hospital. The first tale, “Administration”, is dull and would put off many readers, but the tales improve. The second: “Acute Surgical Ward”, is typical and describes one night on a ward from the perspective of two patients, the student nurse in charge that night and the night sister. The tale concludes by drawing out the issue of bed management when there are emergency and planned admissions, discharge arrangements and complaints, and raises questions on these for the reader to consider and debate. The tale from the geriatric ward and the appropriate placement of an old lady for long-term care, and that on an outbreak of salmonella in a medical ward, are particularly good at drawing out the different attitudes and perspectives when there are complex problems and communication difficulties. The tales from the outpatients and accident and emergency departments are extremely good at identifying the organisational skills required in managing such departments. The tale entitled “Cracked Cup” will be warmly received by many nurses as it details the irritating difficulties of supplies, repairs, storage, heating and flower arranging and catering: this tale could form the basis of a discussion at some multidisciplinary management course! The same tale raises some difficult ethical considerations of