Index:

PALLIATIVE CARE NURSING:
Principles and Evidence for Practice

This new textbook aims to draw together the principles and evidence that underpin palliative care nursing. It is organized in a novel fashion, following the trajectory of the illness, rather than the traditional physical, psychological, social and spiritual approach. The book is divided into four parts - Encountering illness, Transitions into the terminal phase, Loss and bereavement, and Contemporary issues, the last covering nursing education, research and practice. Each Part is prefaced by an editorial Overview that provides useful orientation, but the twenty pages spent listing what the authors say in the chapters that follow seemed unnecessary.

This book focuses on those facing death and emphasizes the nurses’ role in their care. There are some excellent chapters on access to palliative care, dealing with families, grief and bereavement and other topics. Some other chapters I found a little long-winded. There are also issues where the clinical evidence base has been overlooked. For example, in the two separate discussions on artificial hydration for the dying, the theories are presented but no reference made to the observational studies, never mind the randomized control trial, which suggest it is of no benefit.

The discussion on euthanasia is disappointing. The author describes a "conceptual mist", which I found to be a blinding smog. [John Keown’s "Euthanasia", recently reviewed here, provides an erudite and crystal-clear description]. There is repeated reference to Kuhse’s work that has been publicly discredited (incidentally, by the authors of two other chapters in this book), and very little discussion of what the Dutch and Oregonians have shown us. Only on page 14, in the final paragraph, is it noted that some Dutch patients were euthanized without request or consent. But as these cases fall outside the Dutch laws, they don’t warrant discussion. And the numbers of patients involved is "marginal". A thousand patients a year? Please!

My quibbles aside, this is a very impressive book that provides in-depth discussions on a range of issues that are less fully addressed in other palliative care books. It will be of great value to nurses practising palliative care or studying it at a postgraduate level. For me, it was a little too long on theory and short on clinical facts, so it complements but does not replace the ³treatment manual² type of book. And we need both.

 

THE STARTLED HEART: Ghazal Variations on Loss

Eve Joseph
Oolichan Books, 2004.
57 pp. ISBN 0-88982-191-7. RRP $CAN 15.95.
Available from [email protected]

Ghazal? Not in my O.E.D. But Google found it at poetrynet.

So what is a Ghazal? It is a poem of 5 to 15 couplets, written in a particular form, according to traditions originating in ancient Urdu and Persian.

Now that we’ve cleared that up, we can talk about the book. This is a wonderful collection of 45 ghazals that are a celebration of life, and death, written by a counselling psychologist who works at the Victoria Hospice in Vancouver, British Columbia. Her professional experience and insight made the poems, for me, feel authentic and real.

If you like poetry, or you want something to help you think about what you do everyday, buy this little volume.

The way the man dying of leukemia, said:

"Death has been here three nights
And tonight I think we’ll sleep together."

THE COMPLETE GUIDE TO RELIEVING CANCER PAIN AND SUFFERING Richard B. Patt and Susan S. Lang Oxford University Press 2004. 446pp. ISBN 019-513501-6 . RRP $US 35.00, £17.90

This book is the thoroughly revised and updated version of the 1994 book "You Don't Have To Suffer" by the same authors. It is a well-written and comprehensive handbook for cancer patients and their caregivers.

The first section deals with cancer pain - what it is, what causes it, and how it should be assessed. The fourth chapter in this section empowers patients and their families to actively participate in the management of pain and provides checklists of what to ask the doctor and what to expect. The second section gives detailed descriptions of analgesics, adjuvant drugs and there is a chapter on anesthetic procedures. The third section provides help in dealing with common symptoms and side effects and there is a chapter on mind-body approaches to easing pain. The last two chapters on "Dealing with Feelings" and "If Death Approaches" will be particularly valuable for caregivers and clearly explains what to expect and what you can do about it.

There are appendices that include where to find more information, the foreign (non-USA) names for the common drugs, instructions for relaxation exercises, and detailed information about advanced care planning.

This will be an invaluable resource for people caring for patients with cancer and pain, particularly if they are being managed at home. The information is well set-out and clearly explained, and there is a glossary of medical terms included.

PAIN AND PALLIATIVE CARE IN THE DEVELOPING WORLD AND MARGINALIZED POPULATIONS: A global challenge M. R. Rajagopal, David Mazza and Arthur G. Lipman (Eds) Haworth Medical Press, 2003. 249 pp. ISBN 0-7890-1556-0. RRP $US27.00

Two-thirds of those in need of palliative care live in developing countries that have less than ten percent of the world’s resources in terms of health care personnel, drugs and equipment. I have to admit I would have thought that the needs were even greater and the resources less. As Jan Stjernsward says in his introduction, this book offers a banquet of papers that describe pioneering work on the front lines of pain and palliative care service planning and implementation in developing countries. There are papers describing the development of programs in India, Chile, Argentina, Saudi Arabia, Hong Kong, Malaysia, Uganda, Papua New Guinea, and Kenya. There are also chapters on ethics, spiritual care, education and research in the context of developing countries. The book is enhanced by having a thoughtful two-page editorial commentary after each of the papers.

The importance of the IAHPC program of Travelling Fellowships is acknowledged in an editorial commentary following David Allbrook's report from Kenya and Nell Muirden's report from Papua New Guinea, although two of the other authors in this book were IAHPC Travelling Fellows and a third was a Travelling Scholar.

The enormity of the problems described in this book are daunting, but it is interesting to read because it is written by highly motivated people who are out there trying to do something about it.

KINDNESSES. A Journey Through the Seasons of Grief - Poems, Prayers and Joyous Observations Terry Walton Rosalie Ink Publications, 2001. 66pp. ISBN 0-971-1869-0-1. RRP $US 12.95

This is a well-written and beautifully presented little book that would be a most useful present for a friend or family member who is grieving.

I quote the comments of two other reviewers, which aptly describe this book.

"With tenderness and delicacy, Kindnesses exposes the raw wound of loss to the healing light of truth and memory. Terry Walton’s voice is singular and so very attentive to the small things that help the mourner heal." Rabbi Jeffrey K. Salkin

"I love the connection with flowers and plants, the enhanced feelings of renewal and rebirth." Hospice Patients Services Director.

Roger Woodruff
Director of Palliative Care, Austin Health, Melbourne, Australia