Radcliffe Medical Press, Oxford: 2002,
ISBN 1 85775 5847
Rarely can there have been publications in recent years which have not included any references to the changes emanating from either central government or the reports of central professional associations. Jean Lugton's valuable new textbook is such a book. Death is the ultimately consuming subject and the book's single-minded focus on the issues for professional communication is unwavering. It is the book's great strength; and perhaps too its achilles heel.
The author has woven together her deep personal experience of practice, teaching and research in the care of dying people in such a skillful and accessible fashion that, in the long term, she may well have produced required reading for those in the palliative care sector. Certainly at both an individual and international level the book has a considerable appeal. But, it is a policy free zone. No mention in its pages of, for example, integrated care pathways or shared protocols, let alone National Service Frameworks or primary care trusts. The absence of real life context is disarming in such a real life subject.
This limited focus applies to the author's approach to communicating with her readers. She writes strictly as a nurse for other nurses. The regular use of the word ‘we’ is always in the context of the nursing experience of dying. While promoting multidisciplinary teamwork, the book makes no attempt to explore parallel perspectives and professional developments in, for example, social work and general practice. This is a pity as so much of Jean Lugton's material, and personal wise counsel, is eminently transferable. It is also a pity that the book's primary purpose of nurse education is not clarified in either the publisher's cover notes or the author's own introduction.
The nine chapters of the book are structured around the critical relationships for nurses during terminal illness: with family and friends, other professionals and agencies, and the patients themselves. Difficult situations and special needs cases are bravely and directly addressed with, for example, helpful sections on meeting the needs of patients suffering from mental confusion and learning difficulties. Quotations and illustrative case examples are adeptly included. The content is essentially non-clinical although a knowledge of medical diagnostic terms is assumed (e.g. dyspnoea), and the closing chapter captures the essential casework orientation of the writer. Based on Logan's model of counselling it sets out an extended three stage model for assisting those who are terminally ill to progress through phases of continuous adjustment that enable them to preserve their self-identity and sense of personal worth.
The author is never trite or sentimental. As a writer she is true to her injunction to practising nurses on page 23 “that empathy is not confused with identification.” Her objectivity on such a difficult subject pays off. It does lead to one or two curiously dispassionate statements of the self-evident—“an association has been found between multiple distressing symptoms and depression” for example—but overall the objectivity allows a comprehensive and impartial sweep of both the academic research findings and the lessons from personal experience. The latter come to the fore in Chapters 7 and 8, the most powerful in my view in the book, where the author writes with real conviction and authority about how the personal resources of nurses can be legitimately released to make communication more effective and to overcome problems arising from, for example, administrative procedures or professional boundaries. The section on spiritual care (131–134) leads directly to the book's conclusions and its location neatly reflects the subject itself.
As an example of integrated nursing care this is a book to be recommended. Its likely success as such, we may hope, should lead to a further volume in which other professionals are part of the author's integrated approach to practice, research, teaching and perhaps policy developments as well.