Journal of Advanced Nursing, 1993, 18, 334-337

BOOK REVIEWS

Clinical Electrocardiography 2nd edn by Ken Grauer & R. Whitney Curry, Jr. Blackwetl Scientific Publications, Boston, 1992. 602 pages, £29.50. ISBN 0-87489-594-4.

This book is a useful text for any nurse involved in aspects of clinical electro- cardiography. It is particularly valuable for nurses working in critical care and accident and emergency settings. The book can be used as a reference text or utilized as a self-teaching guide to enable the nurse to build up skills in ECG interpretation.

The authors state that the book is aimed at beginner and experienced family phys- icians, and some of the content does require considerable depth of understanding. The book is a revision of an earlier edition and has benefited considerably by the addition of material on recent developments in the field of electrocardiography.

The text is clearly and attractively pre- sented. A range of diagrams and tables are used to illustrate points. Flow charts are utilized to explain the sequence of analysis of some ECG tracings. Some 250 ECG tracings are contained in the book. These are used both to demonstrate basic prin- ciples and to test the reader in his under- standing of the material covered. All test tracings receive a full interpretation of analysis which enables the reader to review his progress.

The book is divided into four parts. Part one introduces the reader to the basic concepts of electrocardiography includ- ing related physiology and terminology. A systematic approach is emphasized. The first part also serves as an introduction to a range of other topics which are covered in greater depth in later parts.

Part two focuses on the ST segment; it also covers intraventricular conduc- tion defects, myocardial infarction and chamber enlargement. Part three is a new section which did not feature in the first edition. It covers recent developments in the field of electrocardiography. The section discussing the practical use of computerized ECG interpretations is

interesting. The use of thrombolytic therapy in acute myocardial infarction is explored with good coverage of patient selection criteria and the use of ECG in- terpretation in this context. As thrombo- lyric therapy is being increasingly utilized in a range of care settings, this chapter has widespread application.

Part four seeks to enable the reader to develop competence in ECG interpret- ation. A large number of tracings are presented for the reader to test himself. They require a good grasp of electro- cardiography and nurses may need to exercise some discretion in selecting appropriate tracings for interpretation.

Some excellent summary charts are contained at the end of the book. Refer- ences are included at the end of each chapter but these are predominantly American in origin. The book would be a useful reference text for any nursing library.

Linda C. Hopps BSc RGN DNCert INCCert

Clinical Lecturer in Nursing King's College London

Introduction to Sterilization, Disinfection and Infection Control 2nd edn by Joan F. Gardner & Margaret M. Peel. Churchill Livingstone, Edinburgh, I992. 264 pages, £24.95, ISBN 0-443-04286-1.

This book is intended primarily for a wide range of hospital staff who have responsi- bility for the prevention of infection. It has as its central concern the needs of health professionals for a knowledge base in microbiology in order to obtain, use and dispose of sterile equipment and pharmaceuticals in the care environment.

The preface to this second edition acknowledges the growth in the knowl- edge of microbial agents in recent years and the challenge posed by the HIV epidemic. There are 14 chapters covering every aspect of sterilization~ disinfection and infection control. The inclusion of technical details on sterilization can be

justified given the readership identified by the authors.

Throughout the book, the authors stress the need for an understanding of the principles and practice of infection control. The text is economical with details but extensive references have been included to encourage readers requiring more in-depth information to follow up topics that interest them.

Chapters 1 to 8 provide a comprehen- sive account of sterilization as a method of disinfection. The effectiveness of this method of various methods in use is dis- cussed and evaluated against the back- ground of substantial literature in the field.

The principles of chemical disinfectants and their use in clinical practice are clearly presented and concepts underlying the principles explained. Nurses and midwives will find chapters 9 to 14 particularly help- ful as they put disinfection in its clinical context. At a time when external agents are contracted to take responsibility for the maintenance of the cleanliness of clinical environs, the authors have demonstrated the need for health professional staff to be knowledgeable in order to ensure that microbial control is maintained.

One noticeable and welcome aspect of the book is its layout and overall structure. Each chapter presents a summary of the main points for the reader, followed by the text. This approach helps to focus on essential issues and readers can be selec- tive in relation to their own interests.

Despite the technical details of some of the chapters, this book can be rec- ommended for nursing and midwifery libraries. It provides a valuable source of reference on microbial ecology and offers a scientific background for an understand- ing of current issues in infection control.

Justus A. Akinsanya BSc PhD RGN RNT FRCN

FWACN FRSH Professor and Dean

Faculty of Health and Social Work Anglia Polytechnic University

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Book reviews

Effective Approaches to Patients' Behavior 4th edn by Gladys B. Lipkin & Roberta G. Cohen. Springer, New York, 1992. 296 pages, $24.95, ISBN 0-8261-1496-2.

This book was first published in 1973. The preface to this fourth edition highlights the proliferation of homelessness in many parts of the USA which may be related to the closure of large psychiatric hospitals. Promised community services have not materialized and the community con- tinues to look upon emotionally disturbed patients with suspicion and fear. Health care providers, the authors say, are now likely to encounter psychiatric patients outside traditional settings and health workers need to recognize psychiatric symptoms.

The authors hope that this book will help. But the only concession in the book to all this preamble is one chapter of 12 pages which refers to the community. This chapter rehashes the ancient classifi- cation of prevention and follows this with case examples of an 8-year-old who wets her bed and a 10-year-old who has sexual fantasies. Mention of community centres for elderly people rounds off this chapter.

The book is entirely based on the assumption that nurses, in a one-to-one interaction, are able to influence patients' behaviour. The first few chapters explain the underlying factors which may exist when patients display disordered behav- lout, what health workers can do for patients and how they can learn to recog- nize their own limitations and cope with stressful experiences. 'Crisis Intervention' is the title of one chapter, which lists all the developmental events which could be said to constitute a crisis, for example birth, weaning, toilet training, starting school, beginning menstruation, marriage, pregnancy, as well as more unusual events such as divorce, hospitalization, home- lessness.

The rest of the book deals with specific approaches in 32 very brief chapters. The book's title promises that it will deal with behaviour, but the chapter titles reveal the authors' belief in problems being attributes of patients, using expressions such as 'the hostile patient', 'the paranoid patient', 'the borderline patient'. Most chapters deal with emotional difficulties

arising from psychiatric problems but some are related to physical disorder, such as coronary heart disease or mastectomy, and some seem to be viewed as concomi- tants of the patient's age, such as 'the pediatric patient' or 'the aged patient'.

Each of these short chapters starts with a few paragraphs of explanation and examples, and ends with a list of dos and don'ts. All these instructions about how or how not to approach the patient amount to good advice. It is difficult to imagine, however, how the reader is meant to use it. One cannot envisage a student learning it all by heart for use if and when required, nor can one imagine its use like that of a recipe book, open in front of the worker while assessing the patient. Fortunately, much advice could be used at all times, such as 'do not be judgemental or rejecting', 'help the patient change his maladaptive thinking', 'be aware of yourself', 'respect the patient's individuality'.

As I read this book I found myself continuously saying: yes, yes, I agree, I approve. But I ended with profound misgivings, hoping the authors do not really hold quite as simplistic a view of emotional disorder as they present and that no reader will end up seriously believing that a response, however well intentioned, has the power of affecting deep-seated emotional problems.

Annie T. Altschul CBE BA MSc RGN RMN RNT FRCN

Emeritus Professor of Nursing Studies University of Edinburgh

The Royal Marsden Hospital Manual of Core Care Plans for Cancer Nursing by Alison Richardson. Scutari Press, London, 1992.147 pages, £11.50, ISBN 1-871364- 68-X.

The expectation is that any volume bear- ing the imprint of the Royal Marsden Hospital ought to be self-recommending, and such is the case with this book. Alison Richardson, who is Macmillan Lecturer in Cancer Nursing and Palliative Care at King's College, London, was formerly a ward sister at the aforementioned centre of excellence. This fact is reflected in the very practical format of the book.

There may well be a reservoir of con- troversy surrounding the use of core, or

standard, care plans. I would have had to count myself among the sceptics, but this book has won me over. For those in any doubt concerning the validity of core care plans, the excellent and well-researched introduction should dispel any reser- vations. With the increased emphasis on technology in health care, and especially in the field of oncology, there is no room for error. Many of these core care plans relate to the potentially hazardous, but nevertheless life-saving treatments offered to cancer patients today.

The dilemma of individualization ver- sus conformity is one which all nurses must grapple with. The argument, as pre- sented here, is that nurses committed to treating patients as individuals will have internalized that fact. For them, a manual such as this is no more than a pragmatic and time-saving way of planning indi- vidualized care. This book becomes for them a menu, much of it set, but with scope for ~ la carte choices.

Three of the manual's sections relate to the modem mainstays of oncological treatment. The subdivisions concerning chemotherapy, radiotherapy and biologi- cal therapies are well supported by refer- ences and, because of their nature, tend to be somewhat 'black and white'. This is no bad thing, given the potential hazards of these treatments. The fourth section, on bone marrow suppression, could apply to whole body irradiation techniques, as to the side-effects of other therapies. The author calls these 'Situations requiring nursing intervention', which applies to the remaining sections also.

Oncological emergencies again de- mand rapid and well-rationalized action. The consequences of oncological treat- ments are numerous, and there are no obvious omissions here. The interventions listed here are less prescriptive than those elsewhere, but, as usual with this text, they are well rehearsed, and given back-up in the h)rm of references. It was particularly good to see deficiencies in knowledge, on the part of the patient, recognized as a situation requiring intervention.

As a bonus, the book contains a useful bibliography, and it is helpfully indexed.

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Book reviews

The layout of the individual core care plans is very user-friendly. The format is one of common potential problems, nurs- ing intention, core care and references. The phrasing of the core care contains a nice blend of nursing interventions, offer- ing support and advice and encouraging self-care.

This book certainly fills a gap in the literature, and does so with the highest possible commendation. It will be an invaluable fund of help to those nurses caring for cancer patients.

John C. Hooker BSc RGN RMN DNCert

Primary Health Care Facilitator Gateshead Family Health Services Authority

Know Yourself! Self-Awareness Activities for Nurses by Philip Burnard. Scutari Press, London, I992. 189 pages, £12.50, ISBN 1-871364-45-0.

This 'do it yourself' handbook contains 10 chapters, covering the following topics: The Self, Self-Awareness, The Think- ing Approach, The Feeling Approach, The Sensing Approach, The Intuitive Approach, The Physical Approach, The Self and Others, Self-Presentation and A Miscellany of Self-Awareness Activities. Narrative sections are interspersed between exercises, which appear to be the focus of the book. Many sources are quoted from general literature, philo- sophical and psychoanalytical writings. The keen reader would certainly find many pointers towards further wide- ranging study.

The rich variety of reference material does, however, present a problem in making the book overloaded. Profound ideas are briefly introduced and then left, often supported by one or two references only. This creates a somewhat disjointed impression at times.

This book could have benefited from a more detailed introduction, which would have provided an opportunity for the writer to explain the many ways in which the exercises could be approached and prevented intellectual oversaturation in the reader.

Some exercises, which involve deep introspection on psychoanalytical lines,

might be disturbing to the solitary user. Group support and opportunities for indi- vidual counselling would seem necessary in order to counter this danger.

Controversial and comparatively unknown writers, e.g. Reich, are intro- duced very briefly and without mention of the problematic areas in their theories. Others, such as von Reistorff, are men- tioned without discussion. The wide variety of reference material is refreshing, but more 'health warnings' about some writers would have been helpful. This may not have been possible in such a slim volume. The answer may be a reduction in the number of less well-known sources quoted or publication of a second and more advanced volume.

Bias is apparent in some of the multiple choice statements, for example on page 22, where a section on views regarding sexual orientation starts with the state- ment: 'Most people would prefer to be heterosexual, given the choice'. This clearly implies an affirmative response and has homophobic overtones.

The chapter including advice about how to plan essays and list references sits uneasily in a book of this kind. Such information should be imparted through a different medium. Discussion about 'thinking' ought to be conducted in a more theoretical and general manner.

The rather disrupted pattern of this book is exemplified in the quick leap from discussion about personal relaxation to 'global' health education on pages 108-109.

This is an uneven book, which contains some excellent and thought-provoking material, albeit organized in an unco- ordinated manner. There are too many exercises without sufficient preparatory explanation of their purpose. Too many topics have been introduced, supported by insufficient or highly controversial source material. While it is refreshing to see unorthodox theorists quoted, they should not constitute the only reference point to support an argument.

However, encouraging nurses to look at themselves and their reactions is laud- able and provides a necessary balance against the traditional tendency to ignore emotions, which prevailed in nursing a

few decades ago. This book would prove valuable in group settings, in which expert guidance from a facilitator with the necessary knowledge and experience is available.

Maria Lorentzon PhD MSc BSc RGN RM

Research and Quali~y Assurance Adviser London

Quality Assurance: An Introduction for Health Care Professionals by Christine C. Wright & Dorothy Whittington. Churchill Livingstone. Edinburgh, 1992. 126 pages, £I9.95, ISBN 0 443-046810-6.

This is an A4-sized workbook which seems aimed at front-line care workers, tt is a British publication and its British style is fairly dominant. Nevertheless, it could be of use to other English-speaking nations.

The style of the book is very much a workbook written as a teaching tool rather than a textbook, although, of course, it can also be used for reference, It is divided into four units entitled 'Understanding Qual- ity', 'Assessing and Improving Quality', 'Following the Steps' and 'Looking to the Future' and covers concepts like quality, quality assurance, quality appraisal and action planning.

The style is basic and pedagogic. Nevertheless, as one works through it is clear that knowledge and skills regarding quality assurance are slowly but surely built up so that the reader who plods through the book can be greatly enriched by its contents. However, its style will not appeal to everyone. The approach seems to be a mixture of textbook (information giving), self-assessment questions, and programmed learning. This mixture of styles should make, for most people, an interesting read but, for some, particularly the passive learner, it will be heavy going and frustrating.

The size of books is an interesting prob- lem. The A4 format suits a workbook style extremely well. It is, nevertheless, very hard to get onto library shelves and not the sort of book you can tuck in your pocket. Conversely, whilst an A5 format suits library and pocket purposes very welt, it would not be such a useful workbook.

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Book reviews

Overall, this book is a very useful and timely contribution to health care literature in the United Kingdom. If UK ward-level nurses, or for that matter English-speaking nurses elsewhere, need

to be brought up to a good working knowledge of quality assurance quickly, with an understanding of standard writ- ing, etc., then this is probably the best book on the market.

Richard K. Ryland MSc BA RNT RGN RMN Quality Assurance Director

Eastbourne Health Authority

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