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Psychological approaches to the care of the elderly
hf. J. Nurs. Stud., Vol. 21, No. 3, pp. 229-231, Pergamon Press Ltd. Printed in Great Britain.
1984
Book Reviews Psychological Approaches to the Care of the Elderly. Ian Hanley and John Hodge (eds). Croom Helm, Beckenham (1984). 287 pp. Price f 15.95. Written by clinical psychologists, this book leaves one in no doubt as to the application of psychological theory to many of the problems facing the elderly and their care givers. There are several aspects which make this book particularly noteworthy. Each author provides a comprehensive review of theory and research. Several chapters include tables to illustrate the findings of different studies, others include lists or examples of instruments. Discussions of underlying constructs and evidence of reliability and validity are also included. As an additional bonus some authors indicate areas for further study. There are chapters on the assessment of cognitive function, performance (A.D.L.), behavioural competence and engagement. Highlights of these chapters include discussions on the usefulness of cognitive tests as measures of intervening constructs between behavioural deficits and pathology and the advantages of using Guttman scaling procedures to reduce the length of assessment required. Arguments against a single-dimensional model of impairment are also presented. The lack of a strong relationship between staff ratings of cognitive impairment or mental status suggests that lack of activity is not simply another aspect of dementia. The observation techniques described in the chapter on engagement can be used to monitor the effect of planned interventions. Similarly the lack of a close relationship between cerebral damage and the severity of dementia suggests that other factors are important. These are examined, together with the social and psychological consequences of dementia for both sufferers and care givers. A behaviour modification approach to dealing with the demented patient is explored in another chapter in which it is stressed that a thorough assessment must be made to ensure the setting of realistic behavioural goals. Distinguishing between depression and dementia can be problematic. The nature of depression, predisposing factors and cognitive and behavioural theories are examined by one author, together with possible treatment strategies for use in the community or in institutions. There are two chapters on reality orientation, one dealing with theoretical and practical considerations, the other looking more specifically at the design of trials and their evaluation. The suggestion that the benefits of reality orientation may lie in its effects on the behaviour of staff rather than patients underlines the need to examine the attitudes of staff before planning interventions. Negative stereotyping or ageism, together with lack of privacy, militate against the expression of sexuality by the elderly, particularly in institutions. There is a paucity of research on sexuality and ageing but the review presented here suggests that many of the reasons for sexual problems in young adults are also relevant to older people who might benefit from more open discussion or even counselling. 229
230
BOOK REVIEWS
Although each author deals with a different topic or a different aspect of the same topic, the net effect is a coherent whole from which several themes emerge. The most important of these is the suggestion that it is now time to focus on physical and socio-cultural aspects of the environment. There is a disparity between what we know and believe and how we act. This volume demonstrates that therapeutic nihilism is unjustified and that action research is now required wherein efforts are made to influence systems. This is not a book for those who seek simple explanations, it requires concentrated effort to comprehend the many concepts contained in the text, but the effort proves well worthwhile. This book will be invaluable to nurses researching into the care of the elderly and to those who plan to introduce change and wish to monitor the effects. I thoroughly recommend it. BARBARA WADE
The Process of Patient Education. Barbara K. Redman. (5th edn). Mosby, St. Louis (1984). Price E15.00. ISBN o-8016-4185-3. It is generally accepted that nurses must become increasingly involved and competent in health education. This book will enable practising nurses, midwives and community health workers to be more aware of the theoretical principles underlying the teaching-learning process and provides many ideas for project work and personal experimentation that should facilitate the development of skills. In this edition, there is an increased use of transatlantic reference material and the study questions at the end of each chapter should enable the book to be used as effectively in the U.K. and elsewhere, as in America. The author’s belief that health care providers ought to explain things to the patient, leads to an exploration of the scientific basis of the learning-teaching process, changing attitudes towards the relationship between teacher and taught and an examination of the programmes devised for patient education. She emphasizes the limitations of the “disease model” and points to increasing emphasis on health maintenance and the use of concepts and techniques from adult education which support the right of self-determination. Models are explored which enable predictions to be made about health behaviour. Readiness for patient education and the factors which influence this are examined and ways of determining learning objectives and the development of teaching strategies are discussed in detail with many excellent illustrations from recorded discussions. The specific learning needs of those with perceptual difficulties, e.g. the brain injured, are also highlighted. A range of teaching tools is examined, particular attention being paid to the preparation and use of written material. An important later chapter on evaluating health teaching encourages the reader to identify appropriate measurements of outcomes in all domains: cognitive, psychomotor, affective and behavioural, identify the origins of any errors, interpret and replan. This book is of particular relevance to those undertaking post-basic continuing education in hospital or community,. especially those who may also be involved in teaching colleagues as well as patients and their families. M. A. THWAITES
1984
Book Reviews Psychological Approaches to the Care of the Elderly. Ian Hanley and John Hodge (eds). Croom Helm, Beckenham (1984). 287 pp. Price f 15.95. Written by clinical psychologists, this book leaves one in no doubt as to the application of psychological theory to many of the problems facing the elderly and their care givers. There are several aspects which make this book particularly noteworthy. Each author provides a comprehensive review of theory and research. Several chapters include tables to illustrate the findings of different studies, others include lists or examples of instruments. Discussions of underlying constructs and evidence of reliability and validity are also included. As an additional bonus some authors indicate areas for further study. There are chapters on the assessment of cognitive function, performance (A.D.L.), behavioural competence and engagement. Highlights of these chapters include discussions on the usefulness of cognitive tests as measures of intervening constructs between behavioural deficits and pathology and the advantages of using Guttman scaling procedures to reduce the length of assessment required. Arguments against a single-dimensional model of impairment are also presented. The lack of a strong relationship between staff ratings of cognitive impairment or mental status suggests that lack of activity is not simply another aspect of dementia. The observation techniques described in the chapter on engagement can be used to monitor the effect of planned interventions. Similarly the lack of a close relationship between cerebral damage and the severity of dementia suggests that other factors are important. These are examined, together with the social and psychological consequences of dementia for both sufferers and care givers. A behaviour modification approach to dealing with the demented patient is explored in another chapter in which it is stressed that a thorough assessment must be made to ensure the setting of realistic behavioural goals. Distinguishing between depression and dementia can be problematic. The nature of depression, predisposing factors and cognitive and behavioural theories are examined by one author, together with possible treatment strategies for use in the community or in institutions. There are two chapters on reality orientation, one dealing with theoretical and practical considerations, the other looking more specifically at the design of trials and their evaluation. The suggestion that the benefits of reality orientation may lie in its effects on the behaviour of staff rather than patients underlines the need to examine the attitudes of staff before planning interventions. Negative stereotyping or ageism, together with lack of privacy, militate against the expression of sexuality by the elderly, particularly in institutions. There is a paucity of research on sexuality and ageing but the review presented here suggests that many of the reasons for sexual problems in young adults are also relevant to older people who might benefit from more open discussion or even counselling. 229
230
BOOK REVIEWS
Although each author deals with a different topic or a different aspect of the same topic, the net effect is a coherent whole from which several themes emerge. The most important of these is the suggestion that it is now time to focus on physical and socio-cultural aspects of the environment. There is a disparity between what we know and believe and how we act. This volume demonstrates that therapeutic nihilism is unjustified and that action research is now required wherein efforts are made to influence systems. This is not a book for those who seek simple explanations, it requires concentrated effort to comprehend the many concepts contained in the text, but the effort proves well worthwhile. This book will be invaluable to nurses researching into the care of the elderly and to those who plan to introduce change and wish to monitor the effects. I thoroughly recommend it. BARBARA WADE
The Process of Patient Education. Barbara K. Redman. (5th edn). Mosby, St. Louis (1984). Price E15.00. ISBN o-8016-4185-3. It is generally accepted that nurses must become increasingly involved and competent in health education. This book will enable practising nurses, midwives and community health workers to be more aware of the theoretical principles underlying the teaching-learning process and provides many ideas for project work and personal experimentation that should facilitate the development of skills. In this edition, there is an increased use of transatlantic reference material and the study questions at the end of each chapter should enable the book to be used as effectively in the U.K. and elsewhere, as in America. The author’s belief that health care providers ought to explain things to the patient, leads to an exploration of the scientific basis of the learning-teaching process, changing attitudes towards the relationship between teacher and taught and an examination of the programmes devised for patient education. She emphasizes the limitations of the “disease model” and points to increasing emphasis on health maintenance and the use of concepts and techniques from adult education which support the right of self-determination. Models are explored which enable predictions to be made about health behaviour. Readiness for patient education and the factors which influence this are examined and ways of determining learning objectives and the development of teaching strategies are discussed in detail with many excellent illustrations from recorded discussions. The specific learning needs of those with perceptual difficulties, e.g. the brain injured, are also highlighted. A range of teaching tools is examined, particular attention being paid to the preparation and use of written material. An important later chapter on evaluating health teaching encourages the reader to identify appropriate measurements of outcomes in all domains: cognitive, psychomotor, affective and behavioural, identify the origins of any errors, interpret and replan. This book is of particular relevance to those undertaking post-basic continuing education in hospital or community,. especially those who may also be involved in teaching colleagues as well as patients and their families. M. A. THWAITES