Book Review
Manual of standards of care
Joanna Luthert, and Lorraine Robinson
ISBN: 063203386X; 1993; 240 pages; Blackwell Science;
Jeanne Madison
School of Health, University of New England, Armidale NSW
At the outset Stein-Parbury declares her awareness of the challenge of negotiating a sensitive and practical space in between the concrete recipe approach to interpersonal skills and an impractical abstract orientation. In my opinion she has situated the text in the viable middle ground and provided experiential learning activities for lecturers to facilitate and/or students to take up as individuals or in groups. I will outline the contents of the book because they convey most clearly how this text differs from others and where its strengths lie. In the very brief first chapter Stein- Parbury articulates some common problematic interpersonal patterns in nursing practice.
These include a focus on doing; controlling patients; not listening; speaking precipitously; and fear of feelings-our own and others'. This introduction could/should alert any student or practising RN to the importance of conscious awareness of communication intentions and outcomes. Having been convinced by her beginning exemplars I was easily led into the second chapter wherein the self of the nurse and the patient are placed on centre stage, and processes such as values clarification and reflection on and in practice are highlighted. The third chapter focuses on listening which is a simple but powerful aspect of communicating which can make the difference between patient satisfaction and patient disgruntlement. Chapter 4 devolves on empathy and other basic counselling skills.
Having concentrated on the processes intrinsic to therapeutic communication for four chapters the author leads into the fifth chapter on data collection wherein she confronts the perennial penchant asking 'why?'. In the sixth chapter she investigates the how of 'reassuring the patient' rather than reassuring the nurse. Continuing with issues vital for undergraduate students, the author compares and contrasts 'social' and 'professional' relationships and pursues the complex and practical aspects of 'closeness' vis-avis 'distance'.
The eighth chapter is contributed by Crisp and Nagy. They deal with the influence of culture and age on nursing activities. As a sociologist I find it disconcerting that gender is sues are outside the authors' agenda. Nursing is permeated with gender-power issues and it is most unfortunate that a complex text would ignore these facts and thereby deny their existence. Chapter nine investigates crisis intervention drawing on Donna Aguilera's excellent model.
It also deals, perhaps too succinctly, with patterns of human response to illness and hospitalization. The book concludes with an important chapter on collegial relations. Stein- Parbury discusses the serious issues of lack of time and support for nurses in the workplace. Proactive (rather than reactive) methods of confronting these factors will devolve on the confident and assertive use of the skills that the author has outlined in this superior textbook.
Manual of standards of care is a guide for health care practitioners who are contemplating developing either standards of care or the auditing tools to measure those standards. Luthert and Robinson have set out to achieve a fairly comprehensive set of standards of care, representing a multidisciplinary approach to patient care in the acute care setting. Included, in a first section, are standards (and in the second section their related audits) associated with chaplains, dietitians, nurses, occupational therapists, physiotherapists, social workers and speech therapists. Because the health care organization used in developing the standards and auditing tools specialises in the care of patients with cancer, the range of diagnoses is necessarily restricted, which may limit its usefulness for a general hospital.
It is evident by the detail reflected in each standard and audit that, most appropriately, they have been developed by the practitioners responsible for them. An insightful example is noted under the section on 'Experiencing an alteration in body image,' (pp 52-56), where the standards are inclusive of the range of issues associated with this difficult nursing diagnosis. A realistic question always exists regarding texts from overseas, as to whether the information successfully crosses the international dateline. In this case it does.
The nursing standards are fairly universal and, with only minor exceptions, responsibilities of the various professional groups represented are so similar that this British text will be useful in Australia. The authors clearly indicate that this work should serve as a guide or reference only and that each standard must be revised and adapted to each institution to reflect current standards of practice. The text does not pretend to be a resource for the development of quality assurance or quality management programs and should not be viewed as such. What it does successfully address is the important part of all quality management programs, a framework for setting measurable, attainable standards.
Some Australians may find the introductory chapters reflect a slightly dated approach to quality assurance in light of the frequently quite progressive Total Quality Management (TQM) programs found in many Australian health care organizations. Information is quite easy to access in this text, with a clear and readerfriendly table of contents and index. The standards and auditing tools are arranged alphabetically by discipline and then alphabetically again according to the subject of the standard or audit.
For the most part, careful attention to non-sexist language and contemporary health care language prevails throughout the text. Although other resources are available, this text will be an important addition to a multidisciplinary spectrum of health care practitioners interested in assuring the quality of their professional services. It could save many hours of work, as well as human and financial resources by providing a framework within which to work on standards of care and audit development. The whole frustrating experience of 'where do we start' can be eliminated by using this quite excellent resource. I highly recommend it for your library.
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