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Nursing care planning: Diagnosis and management
BOOKREVIEWS
63
personality which express maleness or femaleness”. It outlines many of the myths associated with disabled persons, such ,as “disabled people are ‘asexual’ or ‘over-sexed and have uncontrollable urges’ “. It goes on to support the view that individuals suffering physical or intellectual disablement have the same needs as individuals without such disablement. The language of the book is slightly ‘campaigning’, outlining the “rights” of disabled people to “privacy”, “to have or not have children”, “to develop to one’s fullest potential” etc. The survey outlined the need that disabled people have for advice regarding sexuality which is unmet. This unmet need often results from the caring profession’s inability to broach this subject in a suitable manner, and one of the excellent sections outlines different ways in which the subject can be broached. The survey makes clear that medical and para-medical professionals are expected by their patients to give this form of advice and that often they neglect to do so. Other surveys asked directly about the role of nurses as counsellors to disabled people, and there are only oblique references to the nursing profession throughout the book. Another excellent section describes the preparations that ought to be taken to ensure suitable access for disabled people to meetings. The need for self help is stressed, and there is plenty of advice on training professional persons involved in giving advice on sexual matters to disabled individuals. This book will be especially valuable to American readers, as some of the jargon is a little unfamiliar: “. . . have trainees brain storm desired competences”. The bibliography is almost exclusively American with a few English references. The bibliography is, however, extremely extensive. Lack of reference to the British Journal of Sexual Medicine, and the International Rehabilitation Medicine Journal suggest, however, that the authors have not searched extensively beyond the U.S.A. There is a useful section for disabled people suggesting how they can get the advice they need. This section is not, however, extensive enough to recommend purchase of the book. It does not give clear guidance of sexual needs of patients with defined disabilities (ischaemic heart disease, stroke, multiple sclerosis etc.) and concentrates entirely on ‘disabled people’. I am glad to have read this book. It has pointed out areas in my practice that I neglect all too often. This will be a useful addition ~-to the library of any centre offering comprehensive rehabilitation facilities, and will be useful to nurses extensively committed to rehabilitation. I would recommend reading it from a library, but few will wish to purchase it. A.O. FRANK
Nursing Care Planning: Diagnosk and Management. D. Carnevali. 3rd edn. J. B. Lippincott, New York (1983). This book is the successor to Nursing Care Planning by D. Little and D. Carnevali, the second edition of which has become a widely used and respected textbook for those interested in care planning using the nursing process. The author indeed calls this book
64
BOOK RE VIE WS
the third edition, although in this instance it is the work of a single author and not a joint effort. It is a very stimulating and interesting work which reflects the way nursing is evolving as an independent profession, and shows clearly how much more sophisticated nurses have become in the way they identify their contribution to health care. It is also a challenging book, an advanced rather than a beginner’s text, but very worth while reading. Dr Carnevali has almost discarded the use of the nursing process with its concept of nursing problems and needs, and adopted the terms of diagnosis and treatment or management. Although this will raise fears among some nurses (and no doubt some doctors as well), she justifies this change on the grounds of sharing commonly understood and accepted terminology. The risk, of course, is that nurses will also adopt the medical model of care. The book is divided into three sections: 1. The Domain for Nursing Diagnosis and Management; 2. Diagnostic and Care Planning Skills; and 3. Nursing Diagnosis and Management within the Health Care System. The first section contains three chapters. The first is an introduction. The second is a seminal one in that it describes the conceptual framework which forms the basis for the whole process of diagnosis and management. It begins with an assumption that nursing is distinct from other health care disciplines and then goes on to describe a dual-direction model for nursing which links daily living, environment and health status. The latter has three components: the normal biologic development at any given age; the normal development tasks of any given age; and any pathology present. This linking of daily living and health status seemed to me to be very helpful and illuminative. The third chapter in this section briefly outlines how knowledge can be most efficiently and effectively stored and used. Section 2 has ten chapters which provide in-depth description of the process of care planning. One of the most stimulating chapters is that entitled ‘Cues and Inferences’ (chapter 5) which looks at the differences between cues (described as a unit of sensory input) and inferences (described as subjective personal meanings assigned to a situation). As the author points out, we frequently use the two interchangeably and do not keep them separate, and demonstrates this with relevant examples. Ways are suggested too for increasing one’s own ability to recognize and use both cues and inferences. Two chapters are devoted to nursing assessment. The first (chapter 6) goes through the major factors to consider with a focus on activities of daily living, plus three other main aspects, demands of daily living, external resources and goal setting. The second (chapter 7) looks at ways and strategies of collecting the information in terms of techniques of communication, the setting and the involvement of the patient. Chapter 9 ‘The Diagnostic Statement’ is also a critical one since it deals with the core of care planning. Again, the approach is stimulating, although some of us may well disagree with the suggested use of abbreviations! Further chapters describe goal setting, nursing orders or prescriptions and evaluation. Dr Carnevali differentiates quite clearly between standard orders, the commonalities of care, and nursing orders which indicate how approaches should be different or modified in order to meet a patient’s individual needs. She insists too on the necessity of such orders being precise and clear and suggests that they have five components: date; precise action verb and possibly a modifier; content area; time element: and signature. Again, relevant examples are given and suggestions made for practical exercises. The final chapter in section 2 is about evaluation, stressing
BOOKREVIEWS
65
its importance and identifying the different factors, e.g. knowledge and skills, the criteria to be selected and the process to be utilized. Section 3 consists of two chapters. The first considers the implementation of care planning within the health care system with a brief outline of the influences of the nursing department’s philosophy and objectives. The second, the final chapter of the book, takes a brief look at relationships between nurses, patients, doctors and other disciplines and the effect changes in nurses’ definition of nursing have upon these. Each chapter has its own bibliography, although, perhaps, a total bibliography at the end of the book might have been useful. There is also a good index. I found the book very stimulating and challenging so that despite its complexity my attention and interest were retained. As mentioned at the beginning, it is not a beginner’s book, but for those who have been involved in the nursing process and who want a pragmatic yet intellectually satisfying approach to care planning, this book could well meet their need. JENNIFERM. HUNT
Nurses and the Mentally Handicapped.
Alison J. Tierney (Ed.). John Wiley, Chichester
(1983). One of the ways of judging the achievements of the health and social welfare services of a country is to look at the way the chronically disabled or handicapped are cared for. In the U.K., until recently, few nurses, doctors or members of the general public were informed about, or took responsibility for, the mentally handicapped, who were nursed in large isolated institutions. The past two decades have seen a dramatic change in the strategy of health and social services for the mentally handicapped and today more nurses carry professional responsibility for the prevention or treatment of the mentally handicapped in a wide range of settings, from the antenatal clinic to the labour ward, community clinic, school and paediatric ward. Alison Tierney’s book is addressed to all nurses and attempts to illustrate the aspects of their work relevant to the mentally handicapped. It includes contributions from a health visitor, midwife, mental handicap nurses, and briefer discussions from a clinical psychologist, educationalist, a social worker and a psychiatrist about their roles. A parent adds useful insight. I found this book easy to read and it contains much sound common sense. I was clearer at the end of it about current nursing roles and responsibilities for the mentally handicapped in the U.K. But I was also disappointed at the often superficial descriptive style, the lack of research references, and the almost total absence of critical discussion. One of the weakest and somewhat repetitive contributions is from the Editor, whose introductory chapter on the nature of mental handicap was unconvincing. Mental handicap was contrasted with mental illness on the rather shaky grounds that the latter ‘is most often a temporary illness’. The book fails to present any epidemiological data
63
personality which express maleness or femaleness”. It outlines many of the myths associated with disabled persons, such ,as “disabled people are ‘asexual’ or ‘over-sexed and have uncontrollable urges’ “. It goes on to support the view that individuals suffering physical or intellectual disablement have the same needs as individuals without such disablement. The language of the book is slightly ‘campaigning’, outlining the “rights” of disabled people to “privacy”, “to have or not have children”, “to develop to one’s fullest potential” etc. The survey outlined the need that disabled people have for advice regarding sexuality which is unmet. This unmet need often results from the caring profession’s inability to broach this subject in a suitable manner, and one of the excellent sections outlines different ways in which the subject can be broached. The survey makes clear that medical and para-medical professionals are expected by their patients to give this form of advice and that often they neglect to do so. Other surveys asked directly about the role of nurses as counsellors to disabled people, and there are only oblique references to the nursing profession throughout the book. Another excellent section describes the preparations that ought to be taken to ensure suitable access for disabled people to meetings. The need for self help is stressed, and there is plenty of advice on training professional persons involved in giving advice on sexual matters to disabled individuals. This book will be especially valuable to American readers, as some of the jargon is a little unfamiliar: “. . . have trainees brain storm desired competences”. The bibliography is almost exclusively American with a few English references. The bibliography is, however, extremely extensive. Lack of reference to the British Journal of Sexual Medicine, and the International Rehabilitation Medicine Journal suggest, however, that the authors have not searched extensively beyond the U.S.A. There is a useful section for disabled people suggesting how they can get the advice they need. This section is not, however, extensive enough to recommend purchase of the book. It does not give clear guidance of sexual needs of patients with defined disabilities (ischaemic heart disease, stroke, multiple sclerosis etc.) and concentrates entirely on ‘disabled people’. I am glad to have read this book. It has pointed out areas in my practice that I neglect all too often. This will be a useful addition ~-to the library of any centre offering comprehensive rehabilitation facilities, and will be useful to nurses extensively committed to rehabilitation. I would recommend reading it from a library, but few will wish to purchase it. A.O. FRANK
Nursing Care Planning: Diagnosk and Management. D. Carnevali. 3rd edn. J. B. Lippincott, New York (1983). This book is the successor to Nursing Care Planning by D. Little and D. Carnevali, the second edition of which has become a widely used and respected textbook for those interested in care planning using the nursing process. The author indeed calls this book
64
BOOK RE VIE WS
the third edition, although in this instance it is the work of a single author and not a joint effort. It is a very stimulating and interesting work which reflects the way nursing is evolving as an independent profession, and shows clearly how much more sophisticated nurses have become in the way they identify their contribution to health care. It is also a challenging book, an advanced rather than a beginner’s text, but very worth while reading. Dr Carnevali has almost discarded the use of the nursing process with its concept of nursing problems and needs, and adopted the terms of diagnosis and treatment or management. Although this will raise fears among some nurses (and no doubt some doctors as well), she justifies this change on the grounds of sharing commonly understood and accepted terminology. The risk, of course, is that nurses will also adopt the medical model of care. The book is divided into three sections: 1. The Domain for Nursing Diagnosis and Management; 2. Diagnostic and Care Planning Skills; and 3. Nursing Diagnosis and Management within the Health Care System. The first section contains three chapters. The first is an introduction. The second is a seminal one in that it describes the conceptual framework which forms the basis for the whole process of diagnosis and management. It begins with an assumption that nursing is distinct from other health care disciplines and then goes on to describe a dual-direction model for nursing which links daily living, environment and health status. The latter has three components: the normal biologic development at any given age; the normal development tasks of any given age; and any pathology present. This linking of daily living and health status seemed to me to be very helpful and illuminative. The third chapter in this section briefly outlines how knowledge can be most efficiently and effectively stored and used. Section 2 has ten chapters which provide in-depth description of the process of care planning. One of the most stimulating chapters is that entitled ‘Cues and Inferences’ (chapter 5) which looks at the differences between cues (described as a unit of sensory input) and inferences (described as subjective personal meanings assigned to a situation). As the author points out, we frequently use the two interchangeably and do not keep them separate, and demonstrates this with relevant examples. Ways are suggested too for increasing one’s own ability to recognize and use both cues and inferences. Two chapters are devoted to nursing assessment. The first (chapter 6) goes through the major factors to consider with a focus on activities of daily living, plus three other main aspects, demands of daily living, external resources and goal setting. The second (chapter 7) looks at ways and strategies of collecting the information in terms of techniques of communication, the setting and the involvement of the patient. Chapter 9 ‘The Diagnostic Statement’ is also a critical one since it deals with the core of care planning. Again, the approach is stimulating, although some of us may well disagree with the suggested use of abbreviations! Further chapters describe goal setting, nursing orders or prescriptions and evaluation. Dr Carnevali differentiates quite clearly between standard orders, the commonalities of care, and nursing orders which indicate how approaches should be different or modified in order to meet a patient’s individual needs. She insists too on the necessity of such orders being precise and clear and suggests that they have five components: date; precise action verb and possibly a modifier; content area; time element: and signature. Again, relevant examples are given and suggestions made for practical exercises. The final chapter in section 2 is about evaluation, stressing
BOOKREVIEWS
65
its importance and identifying the different factors, e.g. knowledge and skills, the criteria to be selected and the process to be utilized. Section 3 consists of two chapters. The first considers the implementation of care planning within the health care system with a brief outline of the influences of the nursing department’s philosophy and objectives. The second, the final chapter of the book, takes a brief look at relationships between nurses, patients, doctors and other disciplines and the effect changes in nurses’ definition of nursing have upon these. Each chapter has its own bibliography, although, perhaps, a total bibliography at the end of the book might have been useful. There is also a good index. I found the book very stimulating and challenging so that despite its complexity my attention and interest were retained. As mentioned at the beginning, it is not a beginner’s book, but for those who have been involved in the nursing process and who want a pragmatic yet intellectually satisfying approach to care planning, this book could well meet their need. JENNIFERM. HUNT
Nurses and the Mentally Handicapped.
Alison J. Tierney (Ed.). John Wiley, Chichester
(1983). One of the ways of judging the achievements of the health and social welfare services of a country is to look at the way the chronically disabled or handicapped are cared for. In the U.K., until recently, few nurses, doctors or members of the general public were informed about, or took responsibility for, the mentally handicapped, who were nursed in large isolated institutions. The past two decades have seen a dramatic change in the strategy of health and social services for the mentally handicapped and today more nurses carry professional responsibility for the prevention or treatment of the mentally handicapped in a wide range of settings, from the antenatal clinic to the labour ward, community clinic, school and paediatric ward. Alison Tierney’s book is addressed to all nurses and attempts to illustrate the aspects of their work relevant to the mentally handicapped. It includes contributions from a health visitor, midwife, mental handicap nurses, and briefer discussions from a clinical psychologist, educationalist, a social worker and a psychiatrist about their roles. A parent adds useful insight. I found this book easy to read and it contains much sound common sense. I was clearer at the end of it about current nursing roles and responsibilities for the mentally handicapped in the U.K. But I was also disappointed at the often superficial descriptive style, the lack of research references, and the almost total absence of critical discussion. One of the weakest and somewhat repetitive contributions is from the Editor, whose introductory chapter on the nature of mental handicap was unconvincing. Mental handicap was contrasted with mental illness on the rather shaky grounds that the latter ‘is most often a temporary illness’. The book fails to present any epidemiological data