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Caring for Older People in a Mixed Economy

The Social Context of Caring in a Mixed Economy Healthcare Active Learning, The Open Learning Foundation, Churchill Living- stone, Edinburgh, 1997 (ISBN 0 443 05734 6 and 0 443 05732 X), 145 pages each, €19.95 each.

The stated purpose of the Open Learning Foundation (formed in 1990) is t o help higher education institutions meet the need to provide part-time courses and continuing education and profes- sional development programmes for students from a wide rang of back- grounds and previous educational qualifications. The aim is to promote the greater use of open and distance learning to help make study more accessible and cost-effec- tive. These two books are taken from a series of units which includes lifespan development, psychological aspects of caring and caring for people with learning disabilities.

Each book introduces a unit and gives a guide to the study format. I t is proposed that each unit will take 20 study hours. The material is divided into session topics and further sectioned into specific areas. A profile of learning objectives helps students to rank their under- standing before and after each session. Sessions open with the learning objectives, a short synopsis of the underlying theory, and suggested student activities. A commentary section follows which guides student reflection on the learning gained from the activities and raises further questions for self- analysis. A summary of the key points of each session is given, and a resource section contains a selec- tion of papers and excerpts from textbooks along with a reference list and glossary.

The units cover the topic area a t a foundation level. Illustrations are helpful and explanations clearly expressed. The Social Context of Caring gives a useful background to issues of community care such as multi-disciplinary and multi-agency work and economics of care. The units need to be studied together for maximum benefit since the ‘mixed economy’ common to each title is not referred to or defined in Caring for Older People.

The term ‘health care profes-

sional’ is used throughout, but the team of authors for each book is drawn solely from the nursing profession. The models of care are nursing based and student activities are applied to general care. Although providing good contextual information, they are taken a t a broad, superficial level and lack depth of application for physio- therapy intervention. For example, the physiology of ageing session is focused on social aspects of care and age-related and age-associated changes; and maintaining homoeo- static equilibrium is related to lack of central heating, taking more than three medications, common infec- tions, and lack of fluids.

These paperback A4 size work- books are good value to help students gain a generic introduction to some fundamental features of

community care. The format is simple and easy to follow, and study time is realistic. They might be particularly useful to helpers, support workers, and physiothera- pists returning to work, although of more limited use to practitioners.

They need careful scrutiny as a system of self-education for on-going support of HE courses. The level of learning and critical analysis is not stated, nor clearly established within an academic programme, and although the material is contemporary, no papers or refer- ences are dated later than 1994.

The books perhaps serve as a model for physiotherapy educators to use in production of a series which is more tailored to specific needs.

Barbara Richardson PhD MSc MCSP

Exercise-based Cardiac Rehabilitation by Hugh Bethell. Publishing Initiatives, Dora1 House, 2b Manor Road, Beck- enham, Kent BR3 5LE, 1996 (ISBN 1 873839 32 4). Illus. 199 pages. f 19.95.

This book provides new and estab- lished cardiac rehabilitation pract- itioners with a wealth of infor- mation and practical guidance on the rehabilitation management of ischaemic heart disease (IHD) patients. Written by an acknow- ledged expert with invited con- tributions, the book succeeds in providing the wide range of knowledge, skills and insight needed by rehabilitation profes- sionals.

This is a well-illustrated book presented in an attractive, inviting style. By handling the diversity of topics in distinct chapters with clear sub-sections and headings it is very easy to access specific topics and thus use it as a quick reference manual. The wide range of informa- tion encompasses cardiac anatomy and physiology, IHD, treatment and investigation, cardiac drugs, rhythm disturbance, rehabilitation programme content and manage- ment with - as the title suggests - a particular emphasis on exercise training.

Early chapters outline the back- ground knowledge to and con- sequences of IHD, including useful

resumes on relevant medical issues and complications. Exercise phys- iology, training effects and exercise testing are well presented and clearly described (chapters 4 , 5 and 13 respectively) and would link together well as three consecutive chapters. The inclusion of detailed chapters on programme manage- ment and evidence for benefit make this text particularly useful for prac- titioners developing and evaluating rehabilitation programmes.

Risk factor modification and stress management are covered, and again if taken as consecutive chap- ters the link tha t the author describes would be enhanced.

Although stress management overviews the range of approaches which may be used by rehabilitation professionals it does not cover the broader psycho-social issues or indeed the specific psychological assessment and intervention which may be needed with some IHD patients.

Overall this is an excellent text and a much-needed contribution from a very experienced and respected cardiac rehabilitation practitioner. The wide-ranging content ensures Appeal t o the various disciplines involved in rehabilitation. I recommend it-as essential reading to any profes- sional working in this field.

Fiona Lough MPhil MCSP

Physiotherapy, May 1997, vol 83, no 5