Book reviews

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© 2001 Blackwell Science Ltd

Blackwell Science, Ltd

Book reviews

Bridget Young, Catherine Exley and Mary Dixon-Woods

Department of Epidemiology and Public Health University of Leicester 22–28 Princess Road West, Leicester, LE1 6TP, UK

Open University Course:

K302 Critical Practice in Health and Social Care

Textbooks:

Critical Practice in Health and Social CareUsing Evidence in Health and Social Care

Readers:

Changing Practice in Health and Social CareEvaluating Research in Health and Social Care

Introduction

This Open University course and itsfour associated texts are about whatit means to be a professional, thechallenges professionals face, and thesocial, political and historic context inwhich they work. While recognisingthat the term ‘professional’ is prob-lematic for some sectors of its potentialaudience, particularly those workingin social care, the course and its textsambitiously aim to appeal to a widerange of professionals in the health andsocial care sectors, including voluntaryand private agencies, as well as statutorybodies. In practice the material coveredis most relevant to nursing and socialwork, and it is for these two professionalgroups that these materials probablyhold most appeal.

The course is divided into twoparts, each with an associated text-book and reader. Given the diversityof its target audience, a unifying themeis needed, and this takes the form ofthe notion of ‘critical practice’. It isdefined as practice that is ‘open-mindedand reflexive, built on a sound skillsand knowledge base, but taking accountof different perspectives, experiences,assumptions and power relations’.This concept forms the basis of part 1

of the course and its textbook,

CriticalPractice in Health and Social Care

, andreader,

Changing Practice in Health andSocial Care

. Part 2 of the course isabout the knowledge base that criticalpractitioners will draw upon. Its aimand that of its associated text,

UsingEvidence in Health and Social Care

andreader,

Evaluating Research in Healthand Social Care

, is to help professionalsdevelop skills in using research, andwork towards becoming evidence-basedpractitioners.

We present a review of each of thetextbooks and readers as ‘stand-alone’texts before moving on to consider thecourse itself.

912001277Book reviewsBook reviewsBook reviews1000Graphicraft Limited, Hong KongBook reviews

Critical Practice in Health and Social Care

By A

Brechin, H

Brown and MA

Eby. Sage/Open University Press, London (2000) £16.99, 332 pp. ISBN 0-7619-6493-2

The textbook is divided into threeparts, a division that is only partlyjustified in terms of content, but whichis useful for navigational purposes.In part 1, ‘Professional Development:Contexts and Processes’, Jones andTucker set the scene by tracing thedevelopment of health and socialpolicy and practice since the 1940s. Withthe rise of the 1980s contract culture,services are seen as moving from thelargely unquestioned, professional-ledmodel of the postwar era to an increas-ingly regulated model of service withprofessional accountability, consumerresponsiveness and cost-effectivenessat its heart. This chapter provides agood overview of these changes, andthe complex myriad of political, eco-nomic and social influences thatbrought them about.

A shift from the political to thepersonal is evident in chapter 2,

‘Introducing critical practice’, in whichBrechin delineates the role of a criticalpractitioner. Some useful insights arepresented, but critical practice, as askill that is developed and practisedin a social arena, is inherently difficultto represent through textual meansalone. Greater recognition of the harshrealities of the ‘lived experience’ of healthand social care workers may have lentgreater palatability to this chapter.Chapter 3, ‘Understanding professionaldevelopment’, further develops theconcept of critical practice, but itsfocus moves beyond the individualpractitioner. Eby provides a usefuloverview of the philosophy that under-lies continuing professional develop-ment and acknowledges the structuraland employment constraints faced bymany practitioners.

Part 2, ‘Challenging Practice’, ismore technical in content than theexploratory chapters of part 1. Differ-ent approaches to theorising profes-sionals are explained and evaluated inchapter 4, and the tensions and com-peting forces that are currently shap-ing the professions are outlined. Oneof these forces, the challenges fromservice-users, is the topic of chapter 5.Buoyed by the drive for services tobecome more user-orientated, Browncites the experience of disabled groupsto illustrate how users have come toplay an increasingly pivotal role inredefining models of service delivery.Models of social care are seen asincreasingly moving from professional-defined notions of provision built aroundthe ‘inadequacies’ of disabled peopleto user-defined notions of adequateservices. Chapter 6, ‘The challenge ofvalues and ethics in practice’, providesa valuable review of definitions andapproaches to ethics, which are illus-trated and explored through severalcase histories.

Relationships and care are acknow-ledged to be at the heart of practice in

HSC277.fm Page 118 Wednesday, April 4, 2001 1:48 PM

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health and social care, and models of‘care’ and caring relationships aredeveloped in chapter 7. Tensions betweenthe frequently competing needs forempowerment, autonomy and protec-tion in caring relationships are discussed,but situations involving conflict aretouched upon perhaps a little too brieflybefore the chapter moves on to a moreethereal discussion of issues aroundemotional literacy. The theme of relation-ships continues in chapter 8, ‘The chal-lenge of working in teams’, whichquestions the knee-jerk assumption thatteamwork is necessarily desirable, pro-viding a thought-provoking criticalappraisal of teamwork, together witha discussion of the divisions andconflicts that may beset teams andhow these may be overcome. Part 2concludes with a technical but usefulexploration of the different dimensionsof accountability and its impact uponpractice.

Themes of policy, relationships,quality and accountability are revisitedin part 3, ‘Working with ChangingStructures’, but this time with an explicitaim to locate these concepts firmly intheir socio-political context. A changeof tempo to a more academic or ana-lytic approach is evident in Davies’chapter on the policy process. Thisserves well in illuminating how policiesare developed and the forces andstructures that shape them, but it willcome as no surprise to those workingat the ‘care face’ that policies are some-times less than rational. Guest andScarff’s chapter, ‘Counting the costs’,though slightly out of kilter with theothers in the technical nature of theground it covers, provides an engag-ing, reader-friendly introduction to anarea of practice not renowned for thesequalities – budget management. The‘futility of exhortation’ forms the back-drop to Hudson’s lively chapter onthe relationships between the healthand social care sectors, a relation-ship characterised by mistrust andorganisational self-interest. Govern-ment strategies since the 1960s haveaimed to provide more coordinatedservices, but the reasons for their fail-ure become clear as Hudson’s reviewprogresses. Perhaps with a deliberatetouch of irony, the chapter concludeswith an implicit call for future strategies

to be based on an understanding of indi-vidual and organisational behaviour.The experiences of the two sectors inrelation to quality and accountabilitydevelopments over recent decades arecompared in Davies’ final two chapters.This exercise is not purely academicand the comparative parables do muchto illuminate the complexities andparadoxes that abound in striving foraccountability and quality in healthand social care services.

This is a very clear, well writtenand accessible text, with minimal useof jargon. For a multiauthored text thebook is well integrated, with the differ-ences of style adding a certain charm. Theeditors claim each chapter is sufficientlyfree-standing to be read independently,but the first and last parts would prob-ably benefit from being read as a wholeto gain an understanding of the conceptof critical practice, and of the contextualchanges and processes that have shapedthe development of health and socialcare. Read as a whole, some of the shiftsof focus in this book are quite jarring,but, in general, the complex, multi-layered nature of the subject matter ishandled very well.

Ultimately, this is an aspirationaltext that aims to set out a new vision ofprofessionalism, one that moves beyondthe self-serving mentality, which forsome has traditionally characterisedthe professions, to a style of ‘new’ pro-fessionalism that is certain of its identitybut flexible and accepting of change.While recognising some of the com-plexities, paradoxes and conflicts ofprofessional life in the health and socialcare sectors, this book is a product ofthe politics of consensus and as such itmay not always strike an immediatecord with its audience of professionals.Relatively little space is devoted toacknowledging the ‘harsh realities oflife at the care face’ and it does not shyfrom taking a tone that in places is nottoo far removed from a professionalself-improvement manual. Neverthe-less, it is difficult to dispute the logicof many of the views expressed and itis important to remember that a keyaim of this text is to provoke self-reflection: in this respect it is certainlysuccessful.

Bridget Young


Changing Practice in Health and Social Care

By C Davies, L Finlay and A Bullman. Sage/Open University Press, London (2000) £15.99, 390 pp. ISBN 0 7619 6497 5

This is a complex book, capable ofbeing used in many different ways; theambiguity inherent in its title is the firsthint of the multilayered and uncom-promising nature of the challenge thatits material will present. Althoughcertainly available for dipping intoaccording to interest and serendipity,this book is structured as an evolutionarytext around six sections. The individualchapters are themselves drawn mainlyfrom previously published material, witha smaller number of chapters commis-sioned specifically for the book. Thediverse contributions have been groupedaround the thematic structure of thebook, but it is plain that this is no cosyattempt at a road map for those seek-ing to negotiate the uncertainties ofcontemporary practice. Rather, the readeris confronted with one perspectiveor analysis, only to face a counter-perspective and competing evidencelater, and is therefore prompted to engagein personal reflection and resolution.

The first section of the book, onworking with changing structures, pro-vides much of the context, grounding,language, and stimulation for the restof the book. Jones’ account of reshapingwelfare draws a skilful thumbnail sketchof the history of individual and collectiveresponsibility for welfare, with usefulcontemporary context. This chapterprovides a nonpatronising introduc-tion for new initiates, together with anaccessible vocabulary. The history ofthe social security budget from the 1980spresented by Lewis and Glennerster iswritten in a refreshing style that con-trasts with the rather turgid toneadopted by Butcher’s analysis of theorganisation of welfare, but both ofthese chapters are successful in provid-ing vocabulary and context. Le Grand’sreflections on knaves, knights and pawnsallows thought-provoking insight intothe assumptions underlying welfarestates, and emphasises the need forstrategies that are robust to whateverassumptions are made about humanmotivation. The chapter by Brooks on


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changes in maternity policy sits slightlyoddly among the others in this section,being focused away from bigger Insti-tutional arrangements and towards asingle user area. It offers nonetheless afascinating exploration of how policyis formed, and the problems of localimplementation of rhetoric-basedpolicies, and helps health-orientedreaders to feel that there is somethingfor them here too.

Section Two, on theory, value andpractice, contains eight chapters andcould reasonably have done with hav-ing fewer. Thompson argues againstthe fallacy of theoryless practice, andmounts a comprehensive rejection ofpositivism and an exploration of altern-atives. However, it may remain diffi-cult for more inexperienced readers tomanipulate the concepts introduced inthis chapter; the explanations offeredare not particularly accessible, and theagenda of promoting existentialism isunhelpful as the opening chapter in asection aimed at ‘connecting’. Equally,it is hard to remain engaged withKitwood’s piece on the requirementsof a caregiver, with its rather arcaneand waffly treatment of the role ofpsychotherapy in the personal andmoral development of caregivers. Nash’sdiscussion of applying critical practice,by contrast, offers a potent example thatencourages the reader to recognise thevalue of reflection and of a dialoguebetween practice and theory. Quinn’schapter challenges the reader whomay by now have happily settled intothe idea that reflection is a goal of goodpractice, but whether the note of cautionsounded is really justified is somethingthat readers must resolve for themselves.Barnit’s chapter on the tension betweenpractitioners acting honourably to thehighest ethical standards and attendingto their own needs brings a welcomebreath of empirical air into this section,and offers an interesting historicalperspective. A similar perspective isalso presented by Banks’ explorationof the philosophical foundations of thekey values of social work, togetherwith a useful overview of justice andinequality. The turbulent history of anti-oppressive practice throughout thepolicies, practices, and theory of socialwork is traced impressively by Pinkney,and helps to set the scene for the very

valuable discussion and thoughtfulsummary of a large literature on theproblematic issues of engaging withethnic and racial diversity presentedby Culley.

The third section of the bookmoves to the theme of collaboration ina time of shifting boundaries. Braye andPreston Shoot advocate a systems-basedapproach to the keys to collaboration,and describe tools for practitionersseeking to implement collaboration.At this point in the book it comes aslittle surprise to discover that it isunlikely that reality will be this straight-forward, as shown by Finlay’s qualit-ative study of occupational therapists’battles for territory, lack of recognitionand status, and lack of trust. Similarly,Cott’s exploration of the underlyingideologies of two different types of teamsdemonstrates some of the profoundimplications for implementing decisionsif team members do not share under-standings of roles, norms, values orteamwork. The extension of the conceptof collaboration to include users ofservices is very welcome, and Beresford

et al

. offer interesting insights into userinvolvement in the debate about qualityof services. Some of the other papers inthis section work less well. Dent’s ana-lysis of two mutually exclusive explana-tions for the condition of ‘difficult’patients is hard to take seriously as anexample of the contribution of psycho-therapy to the insight and resolution ofproblems, particularly in the absenceof a more detailed literature to supportthe analysis. A concern of this sectionis the need for an alternative to busi-ness, industry or professional modelsof quality, but it is unclear whetherPriestley’s arguments about the linksbetween quality and equality, and therole of quality of life measures in qualityassurance systems, are sustainable.

The fourth section attempts to lookat the practice in ‘real world’ settings,where applications of theory and policyin day-to-day practice may mean engag-ing with constantly negotiated, shifting,and contested debates with no easysolutions. Some of these chapters arein the form of advice on how to handlethese situations; for example, Corkishand Heyman’s discussion of riskmanagement for people with severelearning difficulties offers an agenda

for professionals faced with challengesof both protecting and encouragingthe social integration of vulnerablepeople. Leat and Perkin’s paper on thecreativity that characterises the purchas-ing of care packages suggests a lessclear way forward, and would havebenefited from more contextualisation.Perhaps more interesting and thought-provoking are some of the chaptersthat provide a microlevel perspective onspecific examples of professionals facedwith complex challenges. Thompson

et al

. offer a particularly challengingand sometimes disturbing account ofhow women who work with men withlearning disabilities have to negotiatea minefield of often conflicting rights.The tensions experienced by thosewho have to make judgements aboutwhose rights to prioritise, and betweenprofessional aspirations, accountabil-ity, and individual clients’ needs, arealso sensitively and carefully exploredby other chapters in this section,including Smith and Agard’s chapteron the gendered and marginalizednature of nursing work and Shardlow’sunusual but effective treatment of issuesof confidentiality. Black and Thompson’sclassic piece on medical audit is a care-fully observed analysis of how policiesimposed from above are mediatedthrough attitudes and beliefs of those‘on the ground’. Scrivens’ paper onmanagers’ experiences of Hospital accred-itation covers much of the same groundbut is likely to appeal mainly to managers.Harris’s account of the pressures onthe voluntary sector is an especiallywelcome reminder of the difficultiesencountered by unpaid managers andcarers in an era of rapid public policychanges and new and often demand-ing requirements for accountability.

The fifth section looks forward tothe (re)construction of professionalidentities, and begins to apply some ofthe theoretical insights introduced ear-lier in the book to the explanation andillumination of some of the constantbattles with which professionals have toengage. Saks’ discussion of the historyand processes of professionalisation ofmedicine and other professional groups,and Rashid’s masterful analysis of socialwork as a professional group areclassics of their kind and should berequired reading for any undergraduate


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professional education. Fish and Coles’exploration of two competing views ofhow professionals should behave is aninteresting example of how theory canhelp practitioners to understand someof the frustrations they experience,although it is short on advice abouthow to move forward, given the kinds ofconstraints within which professionalsmust work. The theme of uncertaintyand the need to avoid reducing profes-sional practice to lists of tasks and com-petencies are also evident in Southonand Braithwaite’s paper, although theirarguments are rather less accessibleand less grounded in terms or situ-ations that practitioners would easilyrecognise. Dowling

et al.

’s paper, bycontrast, offers a graphic real-life illus-tration of how reluctance to engagewith issues of boundary definition inrelation to professional practice resultsin personal, professional, and organ-isational risks, and Archer demonstratesthe need for soundly based ethicalframeworks within which to developprofessional practice. Davies inter-rogates the concept of professionalismas it applies to nursing, exploring howissues of gender, class, and ethnicityare beginning to confront and challengepreviously uncritical views of what con-stitutes a profession. She revisits theconcept of reflexivity, but applies it tothe ‘new professionalism’, rather thanto individual practice.

The final section of this book looksto the future. Barnes and Prior’s ana-lysis of the characteristics of public trustis a useful checklist that picks up someof the themes of solidarity and needfor inclusive structures introducedearlier in the book. Bigg’s darker post-modern perspective on moves towardsinterprofessionalism and user parti-cipation reminds us again that there arefew easy solutions, and that much thatappears superficially as an unqualifiedgood warrants careful and theoreti-cally sound analysis. This section, andthe book, concludes with Clarke andStewart’s recognition of the intractablenature of many ‘wicked’ issues repres-ented by many public policy problems,and emphasises that what is requiredis the management of uncertainty.

This need for practitioners tomanage uncertainty is perhaps the keytheme of the book. The recurrence of a

number of other types of theoreticaland substantive themes throughoutthe book – the tension between reflectivepractice and policy imperatives, thepolitics of trans-racial adoption, thevulnerability of groups such as nursingto squeezing and expansion of theirprofessional status and roles, forexample – adds to the sense that import-ant questions are being tackled thatimpact on everyday lives and everydaypractice, as well as the loftier heights oftheory and analysis. The book beginswith the contention that many of theissues of practice, policy, and profes-sionalism cannot be resolved withinthe confines of a single occupationalgroup, but there is always the risk thatnurses, occupational therapists, socialworkers, and so on will choose onlythose chapters that appear directlyrelevant to them. If they do, however,they are unlikely to benefit from thediversity and range of the book, andmay miss out material that would helpthem to reflect on those challenges thatincreasingly cross disciplinary bound-aries. In summary, this book, though alittle uneven in places, is a valuableresource for those seeking to analyseand understand practice in a time ofuncertainty.

Mary Dixon-Woods


Using Evidence in Health and Social Care

By R

Gomm and C

Davies (Eds). Sage/Open University, London (2000) £15.99, 260 pp. ISBN 0 7619 6495 9

This text sets out to be a book for peoplewho want to read research and apply itin practice. Its methods of achievingthis aim appear confused for the firsthalf of the book. Where we might expectan explanation of different researchmethods and guidance on how studiesthat use these methods should be critic-ally appraised and assessed for localapplicability, we are offered insteadpapers that attempt to explain anddiscuss the methods themselves, of thekind that we might see in the introduc-tory chapters of methods textbooks(although we are told that the book isspecifically

not

attempting to be amethods textbook). The chapters covertopics such as survey, experimental,

qualitative and action research, andsome – particularly the chapter on experi-mental research – are interesting andwell presented in their own right, thoughthe case study approach used as anexplanatory device is sometimes overlylaboured and limiting. The issue ofhow the quality of published studiesshould be appraised is left largely tothe companion book on

EvaluatingResearch in Health and Social Care

, butwould perhaps have been better integ-rated here. The practitioner who hasbeen convinced of the value of qualitativeresearch by the chapter on ‘interpret-ing meanings’, for example, may bebemused to find that there is little toguide his/her assessment of the qualityof qualitative studies.

The book begins with the claimthat the development of knowledge isnot value free, and that an understand-ing of ‘ways of knowing’ is essential tothe interpretation and application ofresearch. It is damaging to this claim,and disappointing for readers whohave ploughed through the difficultmaterial in chapter one on epistemology,hermeneutics, positivism and inter-pretivism, that there is so little refer-ence to these concepts throughout therest of the book. This lack of integrationis a feature of the first half of the book;for example, more discussion of howqualitative research might be used togenerate questions for use in question-naire surveys might have enhancedthe feeling that there was a genuinedialogue between the chapters. Thisweakness is compounded by the sensethat the chapters are trying to cover fartoo much ground. A comprehensivetreatment, for example, survey research,including definitions and discussionsof reliability and validity, cannot beattempted in the bounds of a singlechapter, and it is worth remembering thata little knowledge is a dangerous thing.

The second half of the book ismuch more successful. Leading on theexcellent, thought-provoking and fear-less concluding chapter of Section I onthe ethics of research, Section II of thebook appears to be much better inte-grated, with more references to otherchapters and a clear sense of develop-ing themes. Its discussion of the issuesin implementing research in practicecovers much familiar ground but in an


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accessible and interesting way, and theimportance of information managementsystems is appropriately emphasised.There is an impressive discussion ofsome of the detailed and thorny ques-tions that need to be addressed inapplying the results of research donein one context to another. The case studyapproach seems particularly successfulin the chapter on ‘should we afford it’.It makes the important point that cost-effectiveness is sensitive to local cir-cumstances, but that published localcost-effectiveness studies can providemodels which can be tweaked to fit cir-cumstances elsewhere by substitutinglocal costings for the ones used by theresearchers. The discussion of QALYsin this chapter is, however, rather biasedtowards their benefits with too littleexploration of their disadvantages. Auseful guide to the kinds of evidence,such as deprivation indices and epide-miological data, which are importantin planning and organising services, isoffered, together with a discussion ofthe costs and limitations of local firsthand research. The book concludes witha list of resources for evidence-basedpractice. This list, like the rest of thebook, reflects a heavy leaning towardsevidence from the healthcare worldrather than the social-care world, per-haps reflecting the pace of evolutionof evidence-based health care.

Overall this is a rather uneven bookthat would have benefited from clearerformulation of its objectives and betterintegration of its constituent chapters.Many of these chapters are individuallystimulating and valuable, and perhapsthe whole is less than the sum of its parts.

Mary Dixon-Woods


Evaluating Research in Health and Social Care

By R

Gomm, G

Needham and A

Bullman. Sage/Open University Press, London (2000) £15.99, 352 pp. ISBN 0 7619 6491 6

Evaluating Research in Health and SocialCare

is not simply a(nother) methodo-logy textbook; rather, the book aims tohelp practitioners develop the necessaryskills and knowledge with which toappraise published research. A guidingprinciple seems to be to try to dispel

some of the ‘mystique’ that can sur-round published work, and to encour-age practitioners to engage with suchmaterial to enable them to develop goodevidence-based practice. It is an inno-vative book, which attempts to bridgethe gap between learning about researchmethods from a textbook and trying toapply such knowledge to published workin order to appraise it and incorporateit into evidence-based practice.

The book is divided into four sec-tions. The first three sections addressdifferent research methods: experi-mental approaches, survey researchand qualitative research. In line withthe multidisciplinary nature of thecourse, examples of research relevantto different professional groups are usedthroughout. The final section of thebook contains a list of research appraisalquestions. The appendix comprises acomprehensive list of assorted journals,web-based resources and organisations,to encourage practitioners to continueto develop their skills in finding andappraising research and becoming anevidence-based practitioner.

The first three sections of the bookare composed of a combination ofexemplar and resource chapters. Theexemplar chapters use examples of‘fairly typical’ research that is ‘moder-ately difficult to understand for thenonresearcher’, to encourage the readerto begin to develop skills of appraisingresearch. Initially, the reader is encour-aged to read each example beforeseeking further information from theresource chapters. The resourcechapters are essentially ‘companions’to the exemplar chapters, designed toprovide additional information to readersto help them to understand and appraisemore fully the research used in theexemplar chapters. Although the resourcechapters can be read from beginning toend, they are meant to be ‘dipped into’,providing the reader with additionalinformation or explanations about aparticular research approach or measure.In part I, ‘Experimental approaches’,the exemplar chapters include researchpapers based on four randomised con-trolled trials (RCTs) conducted inhealth and social care environments.For example, the third exemplar chap-ter looks at an RCT that sought toestablish the cost-effectiveness of a

Hospital at Home scheme, and thefinal one looks at a systematic reviewof RCTs on the impact of home visitingon childhood injuries. The resourcechapters that accompany these firstfour chapters include an introductionto experimental design, the use ofresearch instruments and how to inter-pret the results of experimental research.

The authors seem to set themselvesa difficult task in this book. They wantto encourage readers to try to engagewith published material, without feel-ing the need to have expert under-standing. At the same time, however,the book also seeks to provide thereader with sufficient information tofurther her understanding of research.Each exemplar chapter has a brief sec-tion introducing the research, whichexplains some of the issues that willbe discussed, and draws the reader’sattention to sections in later chaptersthat may be read in order to help makesense of the exemplar chapter. How-ever, before consulting later chaptersthe reader is encouraged to try to readthe research example first. Althoughencouraging the reader to ‘dip into’ laterresource chapters to help them under-stand the research paper more fully seemslogical, in practice it seems a littledifficult. I tried reading the suggestedrelevant parts of later chapters beforerereading the exemplar chapter, but Ifelt that had I not had some groundingin research methods already I wouldhave found it difficult to just readsections of the chapters rather than thewhole.

The final section of the book pro-vides the reader with some criticalquestions for future use when readingresearch. Seven sets of questions aregiven covering a broad range of differentmethodological approaches includingexperiments, systematic reviews andaction research. These lists are gener-ally very thorough. However, as theintroduction to this section notes, asmultimethod research becomes increas-ingly common, the reader may have touse more than one list in order to fullyappraise a piece of research. The readermay also find it difficult to decidewhich questions should have most‘weight’ when reading research (whichthe authors acknowledge). Further,although these lists are comprehensive,


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I am unsure to what extent the informa-tion needed to address these ques-tions is always readily available inpublished research where, given word-limit constraints, authors tend to bemore concerned with getting the mainfindings of their research across, ratherthan a detailed rationale of their method.(Perhaps an implicit message from thisbook for those of us involved in writingup and publishing research findingsis that we should try, as far as practic-able, to make our work accessible to awide audience, and not just to fellowresearchers.) I found some of the issues/questions suggested to consider whenappraising qualitative research ratherproblematic for a lot of qualitative work,e.g. triangulation and fallibility test-ing. It seemed unclear how the readershould judge research which does notfulfil a particular criterion. The authorsdo warn the reader of the danger ofapplying such questions too rigidly,but it is difficult for the reader to knowhow exactly to use such appraisal ques-tions. Perhaps this is merely a reflectionof the difficulty of drawing up such‘check lists’ for appraising research.

Evaluating Research in Health andSocial Care

is not a particularly easy bookto read because its format necessitatesthat the reader should move backwardsand forwards between different sectionsin order to further her understandingof the research methods being used.This is not, in my view, a book for thepractitioner coming to research for thefirst time. Despite the explanationgiven in the resource chapters, a cer-tain amount of basic methodologicalknowledge seems to be an advantage.However, for those with some ground-ing in research methods this is certainlya book innovative in style and approach,which enables practitioners to furthertheir skills and knowledge of evaluatingresearch before incorporating it intotheir practice.

Catherine Exley


Learning guide: K302 Critical Practice in Health and Social Care

The learning guide for this third level,full-credit Open University course isdivided into two parts, each made upof 3 modules. The first module in

part 1, ‘Professional Development:Contexts and Processes’, provides thefoundation for the entire course.Students are introduced to the changingstructures and forces that have shapedhealth and social care work in recentdecades, and the key concepts of criticalpractice and professional developmentare introduced and developed. Module2, ‘Challenging Practice’, builds uponthis foundation to explore issues ofprofessionalism, ethics, caring relation-ships, team working, accountabilityand service users. The challenges thatarise from these issues are a pivotaltheme, and there is much in thismodule that will be of value to healthand social care practitioners in under-standing the origins of these challenges.From this base of understanding, themodule aims to support professionalsin responding more strategically to thechallenges they face, at both a personaland professional level. This aim continuesin module 3, ‘Working with ChangingStructures’, which focuses on contex-tualising the structural changes thataffect professionals, the services theyprovide, and ultimately their clients.

Part 2 opens with module 4, ‘Evid-ence for Practice’, which introducesstudents to research methodology todevelop their skills in evidence-basedpractice. It does not aim to train studentsin research skills, but rather to providethem with an overview of the varietyof methods used within qualitative andquantitative research, and an under-standing of the different epistemologicaldebates that surround each. Studentsare encouraged to see qualitative andquantitative methods as ‘part of a muchbroader continuum of attempts to developknowledge and understanding’, ratherthan as mutually exclusive and oppos-ing, as many other methods texts seemto imply. Module 5, ‘Putting Researchinto Practice’, explores how researchcan inform practice and identifies thefactors that can facilitate or hinder thisprocess. Continuing the reflective themeof this part of the course, which seeksto promote students’ professionaldevelopment as evidence-based prac-titioners, this module encouragesstudents to reflect on their own workand to consider how research is, or isnot, incorporated into practice within aparticular working environment. The

final module of the course ‘Readingthe Signs and Visioning the Future’draws upon material from both ‘halves’of the course and is designed to helpstudents prepare for their forthcomingexamination and to reflect upon theentire course.

Each module is made up of severalunits to structure and pace students’learning. End-of-unit reviews providespace for students to comment on theaims of the units, and to reflect on theirlearning and progress. Once completedthese reviews can be added to thestudent’s portfolio to provide a founda-tion for K302 assessments and to pro-vide evidence of continuing professionaldevelopment for practice-based pro-fessional and vocational training. Thefirst five modules each have a tutor-marked assignment to be completedbefore a given deadline. Students attemptone of the two available options, andeach option is accompanied by helpfulnotes to guide students on how toapproach the assignment. Module 6 isdesigned to help students prepare fortheir forthcoming exam and students areencouraged to work through a sampleexam paper as part of their revision.

Generally, we found the learningguide to be an extremely powerfullearning tool: it is certainly effective inleading the independent distancelearner through a diverse and complexrange of course material, in a style thatis supportive and accessible withoutbeing patronising. The guide is well‘signposted’ throughout: it is clear whatis required from students in eachsection of the unit; what should be reador listened to, and how much timeshould be set aside for each part (aparticularly useful guide for the busypractitioner). Although this is a distance-learning course, the guide manages toconvey the impression that the studentis part of a wider supportive learningnetwork. A commentary runs through-out to stimulate and guide independ-ent thought and reflection. As with alldistance-learning packages however,students need to be incredibly motivatedand self-disciplined in order to get themost from these modules. Further, asthe course is designed to appeal to awide range of professionals in healthand social services, it may be that peoplemay be tempted to ‘skip over’ parts of


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the guide that may ostensibly appearto have less relevance to their ownwork environment.

Conclusion

With the concept of critical practice atits core, this course is heavily skillsbased. While this is entirely appropriateto its objectives, and lends the courseimmediacy and relevance, it is importantto recognise that there are particularchallenges in developing and practisingskills through distance learning methods.Developing these skills needs inter-action with colleagues and managers toreflect on one’s own position, strengthsand weaknesses, and to gain insightsinto how structures might impact uponprofessionals, and the services theyprovide. Occasionally in this coursestudents are specifically requested todiscuss key ideas with colleagues, andthe thought-provoking case studies inthe written, audio and video resourcesgo a long way to providing a ‘surrogatetutorial group’. However, these areonly partial replacements for beingable to reflect on these issues withcolleagues and are less appropriate fordealing with some of the personalissues raised by the course. Nor can itbe assumed that the professionals tak-ing this course have colleagues andmanagers with the time and inclina-tion to provide this support (in fact,there might be grounds to believe theopposite is the case), and while tutorialsupport is provided this is unlikely toallow for in-depth reflection on themany issues the course will raise.

While encouraging the health andsocial care sectors to work in partner-ship has been a long running, but todate largely unsuccessful aim of recentgovernments, partnership between thesesectors is increasingly being promotedvia policy and resource incentives.This, together with increasing movesfor health and social care professionalsto receive at least some of their trainingtogether, makes K302 a timely andinnovative course, with the very realprospect that it could provide a modelfor joint professional training and

development initiatives. There is muchfor professionals to learn from theparallels and contrasts between thetwo sectors, and from working throughthe implications of changing struc-tures and processes outside their ownprofessional context. There are, of course,risks associated with the developmentof courses such as K302: are the parallelsacross the two sectors sufficient toappeal to students, and will they avoidthe temptation to skip elements of thecourse that fall outside their ownprofessional field? While the coursedevelopers have been very carefulto draw out the general relevance ofexamples from one particular sector,more explicit attention might havebeen given to the value of studyingbeyond one’s one professional demarca-tion lines, and of reflecting on howother sectors have responded to thechallenges they have faced.

In conclusion, we found the courseto be very well designed and written,and to evolve in a clear and logicalfashion. Although some of the textsassociated with the course seemed tohave some shortcomings as ‘stand alone’books, when used in conjunction withthis guide they work very well. Wehave no hesitation in recommendingK302 to any professional committed tofurther developing their professionalpractice and their understanding ofresearch and research methodology.

Bridget Young, Catherine Exeley and Mary Dixon-Woods

Books received for review

Aiken C. (2000)

Surviving Post-Natal Depres-sion: At Home, No One Hears You Scream

.Jessica Kingsley Publishers, London,£14.95, 176 pp. ISBN 1-85302861-4.

Baggott R. (2000)

Public Health Policy andPolitics

. MacMillan Press Ltd, Basing-stoke, £14.99, 308 pp. ISBN 0-333-67649-1.

Bateman N. (2000)

Advocacy Skills forHealth and Social Care Professionals

.Jessica Kingsley Publishers, London,£15.95, 185 pp. ISBN 1-85302-867-5.

Biehal N., Clayden J. & Byford S. (2000)

Home or Away? Supporting Young Peopleand Families

. National Children’s Bureauand Joseph Rowntree Foundation,

London, £8.95, 106 pp. ISBN 1-900990-58 X.

Berry Gray C. (Ed.) (2000)

The Philosophyof Law: An Encyclopaedia

. GarlandPublishing, London, £16.99, 471 pp.ISBN 0-415-192633.

Davies B. & Fernandex J. with Nomer B.(2000)

Equity and Efficiency Policy inCommunity Care: Needs, Service Product-ivities, Efficiencies and their Implications

.Ashgate, Aldershot, £50.00 (hardback),494 pp. ISBN 0-7546-1281-3.

Davies H.T.O., Nutley S.M. & Smith P.C.(Eds) (2000)

What Works? Evidence-BasedPolicy and Practice in Public Services

. ThePolicy Press, Bristol, £17.99, 380 pp.ISBN 1-86134-191-1.

Green D.G. (Ed.), French J., Grieve J.G.D.,Ignatieff M., O’Brien M. & SkidelskyR. (2000)

Institutional Racism and thePolice: Fact or Fiction?

The Institute forthe Study of Civil Society, £4.80, 50 pp.ISBN 1-903-386-06-3.

Kemshall H. & Littlechild R. (Eds) (2000)

User Involvement and Participation in SocialCare: Research on Informed Practice

.Jessica Kingsley Publishers, London,£16.95, 256 pp. ISBN 1-85302-7774.

Manning N. & Shaw I. (Eds) (2000)

NewRisks, New Welfare: Signposts for SocialPolicy

. Blackwell Publishers, Oxford,£13.99, 158 pp. ISBN. 0-631-22042-9.

Moon G. , Gould M.

et al.

(2000)

Epidemio-logy: An Introduction

. Open UniversityPress, Buckingham, £16.99, 190 pp.ISBN 0-335-200125.

Morton-Cooper A. (2000)

Action Researchin Health Care

. Blackwell Science, Oxford,£14.99, 128 pp. ISBN 0-632-04091-2.

Murray L. & Simpson J. (Eds)

ProfessionalDevelopment and Management for Thera-pists: An Introduction

. £16.99, 160 pp.ISBN 0-632-0510708.

Nazarko L. (2000)

NVQs in Nursing andResidential Care Homes

. BlackwellScience, Oxford, £13.99, 288 pp. ISBN0-632-05225-2.

Quilgards D. (2000)

Low Intensity SupportServices

. The Policy Press, Bristol,£12.99, 130 pp. ISBN 1-86134-239.

Spackman P. (Ed.) (2000)

Helping PeopleCope with Crime

. Hodder & Stoughton,London, £6.99, 124 pp. ISBN 0-340-780495.

Williams A. (2000)

Nursing, Medicine andPrimary Care

. Open University Press,Buckingham, £15.99, 120 pp. ISBN 0-335-20167-9.

Wilton T. (2000)

Sexualities in Health andSocial Care: a Textbook

. Open UniversityPress, Buckingham, £15.99, 220 pp.ISBN 0-335-200265.


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