- Email: [email protected]
Nursing the dying
320
BOOK
REVIEWS
that ‘Many readers will find some of the material unfamiliar and difficult: this is because few of us have benefitted from the multidisciplinary training which the Institute and this series seeks to produce’- readers should not be put off from trying to give consideration to those chapters which have a poor writing style and do not obviously convey enthusiasm for their topic. Of particular interest to nurses may be the chapter on ‘Key issues in nursing elderly people’. It is, perhaps, unfortunate that this is far too biased towards the role of the nurse for patients requiring continuing care and conveys a sense of done-down, bruised professionalism. An excellent opportunity appears to have been lost here, since (with their ultra-close patient contact, a willing awareness to respond to human needs, and an increasing understanding of the scientific basis of clinical practice) who but nurses could be better advocates for the total needs of elderly people in acute wards or resettling in their own homes-let alone those who may be dying. The final chapter, ‘Responding to the challenge of ageing’, touches on some of the issues related to the growth in the numbers of elderly people. Regretfully, in identifying the elderly population as a separate group we are promoting the very attitudes of ageism which for years many of us have been seeking to defeat. Perhaps, the next edition of this book will take a broader view of the study of ageing and include topics from the cradle and not only those leading to the grave. After all, if within the vast topic of ageing we can embrace the challenges posted by a/l vulnerable people then of necessity we will need to seek solutions to help all who are old and frail as well as those who are young and weak. BRLAT LIVESLEY
The University of London’s Professor in The Care of the Elderly (Geriatrics), based at Charing Cross and Westminster Medical School.
Nursing the Dying. David Field. Tavistock/Routledge, (paperback), f25.00 (hardback). ISBN O-415-01053-3/5.
London
(1989). Price f8.95
It is refreshing to have some new material on the patterns of care for the dying, which reflects both the attitudes and the communication patterns of health carers (mostly nurses) and the organizational provisions and constraints within which they work. Written by a lecturer in sociology in the United Kingdom, who regularly teaches medical and nursing students, this book focuses on how hospital and community nurses deal with the psychosocial aspects of care for the dying. Nurses reveal how their attitudes to and communication patterns with the dying can be enhanced or compromised by the structure of their nursing work. Some introductory comments provide a foundation from which to proceed. The state of the art and the scope of nursing are reviewed, and contraditions between education and practice reiterated. Nursing work patterns are described and how these have evolved within organisational structures. To focus even more closely on dying, the history of the hospice is reviewed. Whereas the model of hospice care is seen as valuable, the point is well made
321
BOOK REVIEWS
that the main source of care for dying people in the foreseeable future will not be provided by free-standing hospices because of the high cost of this care and the current economic constraints in health care generally. The bulk of the text records fascinating interviews with nurses working in three different settings. Two are in a general hospital and the third in the community. The structure of the interviews elicits information about the influence of each setting on the nurses’ work. During these chapters, the author compares and contrasts his observation with those of McIntosh in his book ‘Communication and awareness in a cancer ward’ (1977). which was the last published work on this specific theme and is a much quoted classic. In Field’s book, the message comes through clearly from nurses that frank and open communication with patients is vital at all stages of their illness and their dying. Emotional involvment is not seen by nurses as undesirable but rather as inevitable and conductive to good care. This is a compelling read for all those working with the dying and their managers. The details of actual locations and particular roles in the hierarchy are discussed openly, together with the effect that both have on nurses’ work. A clear index and comprehensive reference section complete an attractively produced and valuable text. P. A.
WEBB,
National Training Co-ordinator, Help the Hospice, BMA House, Tavistock Square London WCiH 9JP.
Older Bereaved Spouses: Research with Practical Applications. Dale A. Lund. Hemisphere, New York (1989). Price f22. ISBN o-89116-803-6.
This book is a collection of papers from nine research studies in the U.S.A. about the bereavement experience and methods of assisting the bereavement process of older people. It aims to draw together original work which otherwise would have found its way into a wide range of journals. Research generated knowledge is presented in sufficient detail to be useful to researchers and those wishing to consider its methodological features, while the practical implications of the findings are stressed to assist those who are involved directly with elderiy bereaved people as well as policy makers and planners. Importantly the research is multidisciplinary, stressing that no single discipline has a monopoly in knowing how to study bereavement nor in helping those who are bereaved. Its focus on older adults is a useful reminder that the bereavement experience is as poignant for them as it is for younger people. The similarity of the issues facing them points to the common features of bereavement as well as to other kinds of loss. The book comprises 16 chapters divided into sections dealing with the impact and course of bereavement (four chapters), factors influencing bereavement adjustment (seven
BOOK
REVIEWS
that ‘Many readers will find some of the material unfamiliar and difficult: this is because few of us have benefitted from the multidisciplinary training which the Institute and this series seeks to produce’- readers should not be put off from trying to give consideration to those chapters which have a poor writing style and do not obviously convey enthusiasm for their topic. Of particular interest to nurses may be the chapter on ‘Key issues in nursing elderly people’. It is, perhaps, unfortunate that this is far too biased towards the role of the nurse for patients requiring continuing care and conveys a sense of done-down, bruised professionalism. An excellent opportunity appears to have been lost here, since (with their ultra-close patient contact, a willing awareness to respond to human needs, and an increasing understanding of the scientific basis of clinical practice) who but nurses could be better advocates for the total needs of elderly people in acute wards or resettling in their own homes-let alone those who may be dying. The final chapter, ‘Responding to the challenge of ageing’, touches on some of the issues related to the growth in the numbers of elderly people. Regretfully, in identifying the elderly population as a separate group we are promoting the very attitudes of ageism which for years many of us have been seeking to defeat. Perhaps, the next edition of this book will take a broader view of the study of ageing and include topics from the cradle and not only those leading to the grave. After all, if within the vast topic of ageing we can embrace the challenges posted by a/l vulnerable people then of necessity we will need to seek solutions to help all who are old and frail as well as those who are young and weak. BRLAT LIVESLEY
The University of London’s Professor in The Care of the Elderly (Geriatrics), based at Charing Cross and Westminster Medical School.
Nursing the Dying. David Field. Tavistock/Routledge, (paperback), f25.00 (hardback). ISBN O-415-01053-3/5.
London
(1989). Price f8.95
It is refreshing to have some new material on the patterns of care for the dying, which reflects both the attitudes and the communication patterns of health carers (mostly nurses) and the organizational provisions and constraints within which they work. Written by a lecturer in sociology in the United Kingdom, who regularly teaches medical and nursing students, this book focuses on how hospital and community nurses deal with the psychosocial aspects of care for the dying. Nurses reveal how their attitudes to and communication patterns with the dying can be enhanced or compromised by the structure of their nursing work. Some introductory comments provide a foundation from which to proceed. The state of the art and the scope of nursing are reviewed, and contraditions between education and practice reiterated. Nursing work patterns are described and how these have evolved within organisational structures. To focus even more closely on dying, the history of the hospice is reviewed. Whereas the model of hospice care is seen as valuable, the point is well made
321
BOOK REVIEWS
that the main source of care for dying people in the foreseeable future will not be provided by free-standing hospices because of the high cost of this care and the current economic constraints in health care generally. The bulk of the text records fascinating interviews with nurses working in three different settings. Two are in a general hospital and the third in the community. The structure of the interviews elicits information about the influence of each setting on the nurses’ work. During these chapters, the author compares and contrasts his observation with those of McIntosh in his book ‘Communication and awareness in a cancer ward’ (1977). which was the last published work on this specific theme and is a much quoted classic. In Field’s book, the message comes through clearly from nurses that frank and open communication with patients is vital at all stages of their illness and their dying. Emotional involvment is not seen by nurses as undesirable but rather as inevitable and conductive to good care. This is a compelling read for all those working with the dying and their managers. The details of actual locations and particular roles in the hierarchy are discussed openly, together with the effect that both have on nurses’ work. A clear index and comprehensive reference section complete an attractively produced and valuable text. P. A.
WEBB,
National Training Co-ordinator, Help the Hospice, BMA House, Tavistock Square London WCiH 9JP.
Older Bereaved Spouses: Research with Practical Applications. Dale A. Lund. Hemisphere, New York (1989). Price f22. ISBN o-89116-803-6.
This book is a collection of papers from nine research studies in the U.S.A. about the bereavement experience and methods of assisting the bereavement process of older people. It aims to draw together original work which otherwise would have found its way into a wide range of journals. Research generated knowledge is presented in sufficient detail to be useful to researchers and those wishing to consider its methodological features, while the practical implications of the findings are stressed to assist those who are involved directly with elderiy bereaved people as well as policy makers and planners. Importantly the research is multidisciplinary, stressing that no single discipline has a monopoly in knowing how to study bereavement nor in helping those who are bereaved. Its focus on older adults is a useful reminder that the bereavement experience is as poignant for them as it is for younger people. The similarity of the issues facing them points to the common features of bereavement as well as to other kinds of loss. The book comprises 16 chapters divided into sections dealing with the impact and course of bereavement (four chapters), factors influencing bereavement adjustment (seven