Nursing Management for the Elderly by Doris L. Carnevali & Maxine Patrick, J.B. Lippincott Company, Philadelphia, Pennsylvania, 1979, 569 pps, $18.75.
With geriatrics and gerontology receiving increased attention in the areas of nursing and medicine, a multitude of texts are now available and nurses face the difficulty of selection. I suggest that nurses will find this text by Carnevali and Patrick a useful addition to both their personal and institutional libraries. A compendium of information is provided not only for nurses in the fields of gerontology and geriatrics but in other specialty areas as well.
The book contains 30 chapters in five parts that focus upon the areas of gerontology, geriatrics, and nursing's role in these areas. Although there are 28 contributors to this volume, the editors have achieved the feat of providing for logical consistency of reading between chapters without sacrificing the creativity of the individual authors.
While the text provides information that is invaluable for nurses caring for the aged in long-term care settings, nurses in other practice settings will find many chapters useful. Forexample, the comparison and differentiation of nursing and medical diagnosis and management and the discussion of the medication history in nursing assessment are appropriate reading for nurses in nearly all practice settings.
The text focuses upon care of the over-70 age group. Section I provides a strong foundation in the areas of nursing accountability, the philosophy of aging, role differentiation in medicine and nursing, and nursing assessment of the elderly. Having provided a clear and strong foundation for the role of nursing, the editors proceed to present a foundation in gerontological knowledge in Section II. This section presents content on normal age changes in structure and function, including a chapter on laboratory values, oral health, nutrition, drug use, and factors influential in the responses of the elderly to aging.
In both nursing education and nursing service, there is an increased emphasis upon use of the nursing process and advanced nursing assessment skills. The book reflects this trend and nurses will find many chapters useful to increase their clinical skills in assessment. Content on assessment is comprehensive and many charts and sample forms are presented to aid the reader. It was refreshing to see the inclusion of such items as a nursing history for alcoholic patients and an indepth assessment of the oral cavity, areas usually neglected by most texts.
The pathophysiology of selected disease states is presented in the third section. Nurses in long-term care facilities will appreciate the detailed attention presented on genitourinary problems (chapter 17) and incontinence (chapter 20). Today, nurses are expected to be more accountable for knowledge of the pathophysiological processes underlying their patients' disease states and will find the text's numerous diagrams and flow charts helpful in clarification of these processes. Forexample, chapter 20 on respiratory problems presents a most lucid explanation of the complexities of respiratory physiology. Some specific and specialized data in section III such as values of the serum enzymes LDH and SGOT and tables on the components on a pulmonary function may be more useful to nurses in more specialized settings. Clinicians often find data on laboratory values inconsistent and tedious reading. Chapter 7 deals with lab values, presents a plethora of tables and yet is one of the most readable presentations of this type of material in print. The chapter on oral health is useful and presents detailed assessment information, the differential diagnosis of oral problems, and a useful appendix of self-help devices. A question arises as to why the author discourages the use of disclosing agents as many others have found them to be safe and useful in facilitating oral assessment.
While Parts IV and V are entitled "Other High Risk Problems of Aging" and "A Look to the Future," these sections could have appropriately been entitled "Humanistic Health Care of the Aged." The authors present a humanistic approach throughout the text that culminates in these final sections. Contrary to that seen in other texts, the authors do not leave the reader focusing upon disease entities but close rather with attention to issues such as loneliness, loss, pain, andpowerlessness in the aged. Readers who believe that optimal nursing care of aged adults mandates the blending of physiological and humanistic care will find these final chapters exciting and thought provoking.
The main weakness in this text is the lack of attention to organic brain disease, the complexities of research in studying aging, and the biological, psychological, and sociological theories of aging. Another weakness is that some chapters present very short reference lists, particularly in parts I and IV, which may frustrate readers who wish to further pursue those topics. A useful item to readers is the quick reference guides at the beginning of chapters dealing with laboratory values and health problems. The guides briefly highlight such items as description of the problem, etiologic factors, signs and symptoms, differential diagnosis, management, and evaluation. Black markings on the edges of the review pages make their location readily discernable, even with the book closed. The presentation of models, tables, diagrams, and appendices combined with the logical flow of content make this one of the most readable and useful texts in the area of geriatrics and gerontology for nurses.
The book's size makes it portable and the cost is moderate. I wouldrecommend the book as a primer for nurses new to the field of aging. Faculty will find this item useful as a quick reference and as a text for students. Graduate students will f i nd the updated presentation of research findings useful while clinicians will most probably be impressed with the chapters dealing with assessment and management of clinical problems. While obviously of most use to nurses in long-term care settings, it is hoped that nurses in home health, primary care, coronary care, and any acute-care setting where older adults comprise the patient population will discover that this book is also for them. The editors have stated that they do not cover all content and readers will find some important items missing. It should be noted however that the content that is covered is done in a most comprehensive and highly readable manner.