British Community nurses. The chapter on

the economic forces in¯uencing health

care is naturally US-speci®c. The chapter

on environmental forces adopts a broad

stance including the role of the nurse in

addressing the problems caused by factors

such as radiation, noise and toxic waste,

advocating a strong political role. In

contrast, the section on violence is propor-

tionately very brief and, in my view,

inadequate. The authors presents the

Helvie Energy Theory as a framework for

the book and as a model for practice.

Unfortunately, this new variation on a

systems model contains the kind of

language and concepts which tend to make

practitioners' eyes glaze over. I found

some of the examples, aimed at clarifying

how the model might be relevant to prac-

tice, less than illuminating: increased inci-

dence of measles as an energy de®cit?

The book is well-written and coherently

organised, but there is a lack of analysis of

the ideas presented. The book ends rather

abruptly with no summary of the main

issues or indications of future directions.

On balance, I cannot recommend this text

as essential to individual community

nurses and believe that the scare resources

of academic libraries would be better spent

elsewhere.

Allison Worth

BSc RGN RMN RHV

Lecturer,

Department of Nursing Studies,

The University of Edinburgh,

Edinburgh,

Scotland

The Psychology of Health; An Introduction

2nd edn edited by Marian Pitts and Keith

Phillips. Routledge, London, £50á00, 436

pages, ISBN 0 415 15023X.

Health psychology is one of the fastest

growing sub-categories of behavioural

science and is thus increasingly incorpo-

rated into both undergraduate and post-

graduate courses. While its impact on

nursing has been relatively slight hitherto,

there seems little doubt that it will even-

tually make its presence felt in our disci-

pline, as it already has in others. The ®rst

edition of this book has already become a

standard text on many courses, and

deservedly so. The authors begin with an

introduction to health psychology, which

has been de®ned as `the aggregate of the

speci®c educational, scienti®c and profes-

sional contributions of the discipline of

psychology to the promotion and mainte-

nance of health, the prevention and treat-

ment of illness, the identi®cation of

etiologic and diagnostic correlates of

health, illness and related dysfunction,

and the analysis and improvement of the

health care system and health policy

formation'. While such a broad agenda is

perhaps to be applauded for its ambition,

one might argue that, in practice, it makes

for a certain lack of focus.

As a branch of psychology, health

psychology is decidedly on the behav-

ioural, even biological side of the tree,

rather than the psychoanalytic or human-

istic, and this is both a strength and a

weakness. It is strength insofar as it brings

the mind and the body into some kind of

meaningful relationship, but a weakness

insofar as it at least implies the primacy of

soma over psyche. At a time when the

revolution in subatomic physics is bringing

about a radical reappraisal of conventional

models of the self, and the consciousness,

in some sense, of even electrons can be

seriously debated, an approach rooted, as

health psychology appears to be, in the old

Newtonian physics and the dualism of

Descartes may be offering rather too many

hostages to fortune.

Clinicians, of course, tend to be more

concerned with the particular than the

abstract, with the suffering individual

rather than the philosophical rationale of

a given treatment modality, and the value

of this text lies in the detail. Sections on

pain control, coronary heart disease, stress

and the primary prevention of AIDS are all

likely to prove helpful to nurses in the

®eld, and the book is consistently clear

and readable, which cannot be said of all

psychology texts. On those grounds the

book can be recommended, though I

suspect it may be of more practical use to

general nurses who wish to develop more

sophisticated psychological strategies in

the care of physically ill patients than to

psychiatric nurses working with either a

neurotic or a predominantly psychotic

clientele.

Brendan McMahon

SRN RMN BA MSc

Clinical Nurse Specialist in Dynamic

Psychotherapy,

Derby,

England

Symptom Management in Advanced

Cancer, by Robert Twycross. Radcliffe

Medical Press, Abingdon, 1997, 394 pages,

£24á50, ISBN 1 85775 282 1.

This is the second edition of a renowned

book by a highly respected clinician and

author in the ®eld of palliative care. As the

title suggests the book provides a compre-

hensive resource on symptom manage-

ment. It is primarily aimed at doctors,

and the preface states that it `will also be of

interest and value to nurses working with

cancer patients, particularly in palliative

care'. The book is written in a very easy to

read and user friendly style. It comprises

14 chapters and includes an extensive

index. The ®rst chapter covers general

principles of symptom management, with

other chapters covering the symptoms

from various body systems, and pain relief

and oral morphine in advanced cancer.

There is also particularly useful material

on lymphoedema, therapeutic emergen-

cies and drug pro®les. For each symptom

the information given usually includes

descriptions, de®nitions, any relevant

physiology, causes and management

guidelines. This makes the text logical

and it is presented largely as bullet points.

There are numerous helpful diagrams

included in the text, along with boxes

containing key points.

Although the evidence base for the

suggested management guidelines is not

clear, it is probably unrealistic to expect

this. Numerous references are cited in the

book and a reference list appears at the end

of each chapter.

This book is clearly aimed at doctors but

it is very much of value to nurses, to use

alongside other texts and papers focusing

speci®cally on nursing care for this group

of patients. There now is a growing

number of texts of this nature available.

One disadvantage of this one is that it is a

little bulky to be carried around for daily

use. Nevertheless, those involved in

palliative in any setting would bene®t

from access to a copy, and those with a

speci®c remit relating to palliative care

will ®nd it an invaluable resource.

Denise Bircumshaw

MN BA RGN Oncology Cert Dip Palliative

Nursing

Macmillan Nurse Specialist,

University Hospital,

Nottingham,

England

Book reviews

530 Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 30(2), 526±531