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Practice guidelines for obstetrics & gynecology, 2nd ed.
MEDIA REVIEWS
Cheri Van Hoover, CNM, MS
Ethics in Nursing: The Caring Relationship, 3rd ed. By Verena Tschudin. Edinburgh: Butterworth Heinemann imprint of Elsevier Science Limited, 2003. 218 pages. Paperback. Reviewed by: Joyce Beebe Thompson, CNM, DrPH, FAAN, FACNM, Lacey Professor, Community Health Nursing, Western Michigan University, Kalamazoo, Michigan. This text, in its 3rd edition, is written primarily for nurses who desire to explore the situation-based ethics of being human, with a strong emphasis on the nature of the relationship between health professionals and persons seeking their care. It is a basic text on health care ethics written by a U.K. nurse and midwife who has a growing international reputation in writing and teaching ethics. The text focuses primarily on the ethics of caring and is applicable to a variety of health professionals. The 3rd edition includes the author’s expanding international perspective and her exploration of different approaches to ethical nursing practice. The text begins with exploring what it means to care about and for oneself and others, including the nature of human relationships and the values inherent in practicing in an ethical manner. The author’s in-depth analysis of the concept of “caring” draws from a variety of disciplines and makes this ethics text different from many others written by nurse ethicists and other philosophers. An equal emphasis on the importance of understanding one’s personal and professional values is another strength of the text. Ethical theories reviewed from a Western perspective include normative or prescriptive approaches that explore how professionals should act and what they should do (teleology and deontology) and descriptive ethics that reflect what one actually does in daily living and professional practice. The author is very adept at making the sometimes ethereal philosophical concepts clear, down-toearth, and understandable. However, this would not be the best resource for understanding in-depth the moral philosophical bases of ethics theories. The author briefly notes that there are other approaches to ethics contained in a companion volume, Approaches to Ethics: Nursing Beyond Boundaries 2003. These theories include care ethics, virtue ethics, narrative ethics, casuistry, and feminist ethics, among others, though the few sentences about each could have been expanded to make this text a bit more comprehensive. Codes of professional conduct are addressed and the UK Nursing and Midwifery Council (NMC) Code of Professional Conduct 2002 is included as the focus of this discussion. Inclusion of the International Council of Journal of Midwifery & Women’s Health • www.jmwh.org © 2004 by the American College of Nurse-Midwives Issued by Elsevier Inc.
Nurses’ and the International Confederation of Midwives’ codes of ethics would add to the book’s value with an international audience. The discussion of the moral “shoulds” and “oughts” of professional practice are complemented by a discussion of how one makes ethical decisions. A four-question model is described: 1) what is happening?, 2) what whould happen if . . .?, 3) what is the fitting answer?, and 4) what has happened? This model is subsequently used with all case examples that enhance the novice reader’s ability to comprehend the need for critical thinking and moral analysis of the common ethical problems raised in nursing practice. A minor limitation of decision analysis is that cases selected are obvious ones (e.g., abortion, euthanasia) rather than focusing on ethical issues faced by nurses on daily basis, such as how to allocate one’s time to a group of patients, especially in times of shortage of staff. The final two chapters provide a brief overview of common ethical issues raised in nursing practice and the author’s view of the future of ethics including genetics, spirituality, and the increasing need to understand ethical nursing practice in a global context. The author’s writing style is easy to read, her explanations of complex ethical concepts and issues are complete and understandable to those with limited understanding of ethics theory, and the progression of thoughts is logical. References are primarily current and Western European, with a few of the relevant historical citations from the nurse ethicists of the 1970s and 1980s when nurses began to focus on writing about health care and nursing ethics. Overall, this text was exciting to read and very suitable for a reader new to nursing and health care ethics, as well as to those with many years experience in the field who need a different perspective on the ethical practice of health professionals based on caring. Practice Guidelines for Obstetrics & Gynecology, 2nd ed. By Geri Morgan and Carole Hamilton. Philadelphia: Lippincott, Williams & Wilkins, 2003. $42.95, softcover (spiral). Reviewed by: Barbara Camune, RNC, CNM, WHNP, DrPH, Program Director for Nurse-Midwifery and Women’s Health: The University of Texas Collaborative Nurse-Midwifery Education Program, Galveston, Texas. Practice Guidelines for Obstetrics & Gynecology, 2nd ed. by Geri Morgan, CNM, ND, and Carole Hamilton, CNM, MA, is an excellent resource for nurse-midwives and nurse practitioners using a holistic model of care. The guidelines address a variety of women’s health topics from domestic violence and sexual coercion to complementary therapies. The outline format makes information easily accessible and 269 1526-9523/04/$30.00
inclusion of a drug index for commonly used medications allows the reader to quickly find necessary pharmacologic information. Tables included throughout the book are comprehensive and could be reduced to pocket references. Information about using new methods of birth control, such as the contraceptive patch and vaginal ring modalities, have been added to this edition. An especially valuable and informative piece is Geri’s Gems-Obstetric Pearls of Wisdom, which includes a fundal height scale relating the size of common objects to uterine size and gestational age. This edition is divided into seven sections that move chronologically from well-woman care through normal and abnormal pregnancy. Part 1 includes normal conditions in well-woman gynecology through pregnancy, labor, and birth and concludes with guidelines for the management of menopause. The guidelines for well-woman care thoroughly address contraceptive therapy. Table 1-2 provides an excellent pocket reference for birth control pills including common side effects, recommendations for change, and a list of brand names that are current and commonly available. Separate shaded boxes for important information are inserted throughout the text. Contents of these boxes include toxic shock symptoms, warnings signs for oral contraceptive users, and emergency contraceptive formulas. Tips for the use of the different intrauterine devices (IUDs) are good; however, the authors fail to point out vital differences between insertion techniques. The information on oxytocin augmentation and induction of labor seems out of place, because it follows normal postpartum. Several omissions occur under the heading of labor induction, including a failure to mention Cervidil. Variations in oxytocin protocols are not explored. Contraindications to induction of labor are missing. Part 2: Common Discomforts of Pregnancy is written by a different author. The table format is very useful and alphabetically organized. Each discomfort is accompanied by danger signs that are important to consider in differential diagnosis. The table format could readily be changed into outline form if included in a protocol. This is one of the best sections in the book. Abuse, Domestic Violence, and Sexual Coercion or Assault, Part 3, is a very short chapter. Although the information is current and provides counseling measures, this section does not contain enough information to be used in protocol/guideline formation. Steps in rape evaluation are absent. An example of a screening tool for domestic violence is needed. In this reviewer’s opinion, the section lacks adequate information about a very important topic. Conversely, Part 4: Management of Common Problems and Procedures in Pregnant and Non-Pregnant Women was found to be cumbersome. Although this section is alphabetized, it was not as user-friendly as the rest of the book. “Diarrhea” is followed by “Dysfunctional uterine bleeding.” Two excellent parts of this section are worth noting. 270
The material on genetic screening in this section is an excellent addition to the book. The overview of genetics as well as the applicability to preconceptual and prenatal screening was well done. Although valuable, the information on genetics of breast and ovarian cancer seemed out of place and could be easily missed. This information should have been in a shaded box or added to breast/mammogram screening. HIV/AIDS is another interesting, current, and valuable section that provides information on counseling, testing, laboratory values, and management during pregnancy and labor. Part 5, which is the section on Management of Common Problems and Procedures Specific to Pregnancy, is easily the most accessible and useful section of the book. Tables with important information stand out. Isoimmunization, including uses of RhoGam in early pregnancy, is accurately and thoroughly explored. Text that addresses patient teaching is well done. Table 5-3 covers skin disorders unique to pregnancy and provides an excellent, concise resource. Inclusion of alternative therapies, a drug reference, and topical medication reference are well thought out additions to this book. Part 6 has a wonderful table covering herbal remedies that is comprehensive enough to be part of a protocol. The commonly used medications in Parts 7 and 8 could readily be incorporated into a protocol. Although I would recommend this book to those wanting to initiate or update protocols or guidelines, the book does have some problems. Consistent use of person would make this book more readable. The organization of Part 4 is not user-friendly for a quick check. Inconsistent presentation of data is found within sections of the book. More tables would have rendered the large amount of information more manageable. Overall, the information is current, informative, and accessible. That said, the reviewer will recommend this book as a pocket reference for midwifery and women’s health students. The Manner Born: Birth Rites in Cross-Cultural Perspective Edited by Lauren Dundes. Walnut Creek (CA): Altamira Press, 2003. 239 pages. $27.95, paperback, $75.00, hardback. Reviewed by: Lauren P. Hunter, CNM, PhD, Director of NurseMidwifery Education, San Diego State University, San Diego, California. The Manner Born provides fascinating insights into maternal and child rituals from a sociological cross-cultural perspective. The editor, Lauren Dundes, received degrees in health science and maternal and child health. The majority of the 18 contributing authors for the 13 chapters are anthropologists, though the book at times has a distinctly medical perspective. Of interest to this reviewer is the fact that the authors explore lesser known childbirth and early childhood rites. Volume 49, No. 3, May/June 2004
Cheri Van Hoover, CNM, MS
Ethics in Nursing: The Caring Relationship, 3rd ed. By Verena Tschudin. Edinburgh: Butterworth Heinemann imprint of Elsevier Science Limited, 2003. 218 pages. Paperback. Reviewed by: Joyce Beebe Thompson, CNM, DrPH, FAAN, FACNM, Lacey Professor, Community Health Nursing, Western Michigan University, Kalamazoo, Michigan. This text, in its 3rd edition, is written primarily for nurses who desire to explore the situation-based ethics of being human, with a strong emphasis on the nature of the relationship between health professionals and persons seeking their care. It is a basic text on health care ethics written by a U.K. nurse and midwife who has a growing international reputation in writing and teaching ethics. The text focuses primarily on the ethics of caring and is applicable to a variety of health professionals. The 3rd edition includes the author’s expanding international perspective and her exploration of different approaches to ethical nursing practice. The text begins with exploring what it means to care about and for oneself and others, including the nature of human relationships and the values inherent in practicing in an ethical manner. The author’s in-depth analysis of the concept of “caring” draws from a variety of disciplines and makes this ethics text different from many others written by nurse ethicists and other philosophers. An equal emphasis on the importance of understanding one’s personal and professional values is another strength of the text. Ethical theories reviewed from a Western perspective include normative or prescriptive approaches that explore how professionals should act and what they should do (teleology and deontology) and descriptive ethics that reflect what one actually does in daily living and professional practice. The author is very adept at making the sometimes ethereal philosophical concepts clear, down-toearth, and understandable. However, this would not be the best resource for understanding in-depth the moral philosophical bases of ethics theories. The author briefly notes that there are other approaches to ethics contained in a companion volume, Approaches to Ethics: Nursing Beyond Boundaries 2003. These theories include care ethics, virtue ethics, narrative ethics, casuistry, and feminist ethics, among others, though the few sentences about each could have been expanded to make this text a bit more comprehensive. Codes of professional conduct are addressed and the UK Nursing and Midwifery Council (NMC) Code of Professional Conduct 2002 is included as the focus of this discussion. Inclusion of the International Council of Journal of Midwifery & Women’s Health • www.jmwh.org © 2004 by the American College of Nurse-Midwives Issued by Elsevier Inc.
Nurses’ and the International Confederation of Midwives’ codes of ethics would add to the book’s value with an international audience. The discussion of the moral “shoulds” and “oughts” of professional practice are complemented by a discussion of how one makes ethical decisions. A four-question model is described: 1) what is happening?, 2) what whould happen if . . .?, 3) what is the fitting answer?, and 4) what has happened? This model is subsequently used with all case examples that enhance the novice reader’s ability to comprehend the need for critical thinking and moral analysis of the common ethical problems raised in nursing practice. A minor limitation of decision analysis is that cases selected are obvious ones (e.g., abortion, euthanasia) rather than focusing on ethical issues faced by nurses on daily basis, such as how to allocate one’s time to a group of patients, especially in times of shortage of staff. The final two chapters provide a brief overview of common ethical issues raised in nursing practice and the author’s view of the future of ethics including genetics, spirituality, and the increasing need to understand ethical nursing practice in a global context. The author’s writing style is easy to read, her explanations of complex ethical concepts and issues are complete and understandable to those with limited understanding of ethics theory, and the progression of thoughts is logical. References are primarily current and Western European, with a few of the relevant historical citations from the nurse ethicists of the 1970s and 1980s when nurses began to focus on writing about health care and nursing ethics. Overall, this text was exciting to read and very suitable for a reader new to nursing and health care ethics, as well as to those with many years experience in the field who need a different perspective on the ethical practice of health professionals based on caring. Practice Guidelines for Obstetrics & Gynecology, 2nd ed. By Geri Morgan and Carole Hamilton. Philadelphia: Lippincott, Williams & Wilkins, 2003. $42.95, softcover (spiral). Reviewed by: Barbara Camune, RNC, CNM, WHNP, DrPH, Program Director for Nurse-Midwifery and Women’s Health: The University of Texas Collaborative Nurse-Midwifery Education Program, Galveston, Texas. Practice Guidelines for Obstetrics & Gynecology, 2nd ed. by Geri Morgan, CNM, ND, and Carole Hamilton, CNM, MA, is an excellent resource for nurse-midwives and nurse practitioners using a holistic model of care. The guidelines address a variety of women’s health topics from domestic violence and sexual coercion to complementary therapies. The outline format makes information easily accessible and 269 1526-9523/04/$30.00
inclusion of a drug index for commonly used medications allows the reader to quickly find necessary pharmacologic information. Tables included throughout the book are comprehensive and could be reduced to pocket references. Information about using new methods of birth control, such as the contraceptive patch and vaginal ring modalities, have been added to this edition. An especially valuable and informative piece is Geri’s Gems-Obstetric Pearls of Wisdom, which includes a fundal height scale relating the size of common objects to uterine size and gestational age. This edition is divided into seven sections that move chronologically from well-woman care through normal and abnormal pregnancy. Part 1 includes normal conditions in well-woman gynecology through pregnancy, labor, and birth and concludes with guidelines for the management of menopause. The guidelines for well-woman care thoroughly address contraceptive therapy. Table 1-2 provides an excellent pocket reference for birth control pills including common side effects, recommendations for change, and a list of brand names that are current and commonly available. Separate shaded boxes for important information are inserted throughout the text. Contents of these boxes include toxic shock symptoms, warnings signs for oral contraceptive users, and emergency contraceptive formulas. Tips for the use of the different intrauterine devices (IUDs) are good; however, the authors fail to point out vital differences between insertion techniques. The information on oxytocin augmentation and induction of labor seems out of place, because it follows normal postpartum. Several omissions occur under the heading of labor induction, including a failure to mention Cervidil. Variations in oxytocin protocols are not explored. Contraindications to induction of labor are missing. Part 2: Common Discomforts of Pregnancy is written by a different author. The table format is very useful and alphabetically organized. Each discomfort is accompanied by danger signs that are important to consider in differential diagnosis. The table format could readily be changed into outline form if included in a protocol. This is one of the best sections in the book. Abuse, Domestic Violence, and Sexual Coercion or Assault, Part 3, is a very short chapter. Although the information is current and provides counseling measures, this section does not contain enough information to be used in protocol/guideline formation. Steps in rape evaluation are absent. An example of a screening tool for domestic violence is needed. In this reviewer’s opinion, the section lacks adequate information about a very important topic. Conversely, Part 4: Management of Common Problems and Procedures in Pregnant and Non-Pregnant Women was found to be cumbersome. Although this section is alphabetized, it was not as user-friendly as the rest of the book. “Diarrhea” is followed by “Dysfunctional uterine bleeding.” Two excellent parts of this section are worth noting. 270
The material on genetic screening in this section is an excellent addition to the book. The overview of genetics as well as the applicability to preconceptual and prenatal screening was well done. Although valuable, the information on genetics of breast and ovarian cancer seemed out of place and could be easily missed. This information should have been in a shaded box or added to breast/mammogram screening. HIV/AIDS is another interesting, current, and valuable section that provides information on counseling, testing, laboratory values, and management during pregnancy and labor. Part 5, which is the section on Management of Common Problems and Procedures Specific to Pregnancy, is easily the most accessible and useful section of the book. Tables with important information stand out. Isoimmunization, including uses of RhoGam in early pregnancy, is accurately and thoroughly explored. Text that addresses patient teaching is well done. Table 5-3 covers skin disorders unique to pregnancy and provides an excellent, concise resource. Inclusion of alternative therapies, a drug reference, and topical medication reference are well thought out additions to this book. Part 6 has a wonderful table covering herbal remedies that is comprehensive enough to be part of a protocol. The commonly used medications in Parts 7 and 8 could readily be incorporated into a protocol. Although I would recommend this book to those wanting to initiate or update protocols or guidelines, the book does have some problems. Consistent use of person would make this book more readable. The organization of Part 4 is not user-friendly for a quick check. Inconsistent presentation of data is found within sections of the book. More tables would have rendered the large amount of information more manageable. Overall, the information is current, informative, and accessible. That said, the reviewer will recommend this book as a pocket reference for midwifery and women’s health students. The Manner Born: Birth Rites in Cross-Cultural Perspective Edited by Lauren Dundes. Walnut Creek (CA): Altamira Press, 2003. 239 pages. $27.95, paperback, $75.00, hardback. Reviewed by: Lauren P. Hunter, CNM, PhD, Director of NurseMidwifery Education, San Diego State University, San Diego, California. The Manner Born provides fascinating insights into maternal and child rituals from a sociological cross-cultural perspective. The editor, Lauren Dundes, received degrees in health science and maternal and child health. The majority of the 18 contributing authors for the 13 chapters are anthropologists, though the book at times has a distinctly medical perspective. Of interest to this reviewer is the fact that the authors explore lesser known childbirth and early childhood rites. Volume 49, No. 3, May/June 2004