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D Seedhouse. John Wiley & Sons, 2000, £16.99, pp 222. ISBN NO: 0-471-49012-1
This book is clearly written and well laid out. The short summary at the beginning of each chapter is a useful guide to the reader and also serves as a valuable summary of key issues for revision purposes. The author offers a number of case scenarios for the reader to work through and provides many practical examples of situation analysis and possible steps to ethical decision making. Seedhouse accurately claims that in nursing, as elsewhere, philosophical analysis is useful in helping to clarify ideas. Unfortunately, as he also accurately points out, to date much that has been described as nursing philosophy has not in fact led to the clarification of ideas but rather to a greater mystification.
The author poses two significant challenges to nursing through the pages of his book: (i) use some of the tools of analytical philosophy to reconceptualise concepts central to nursing practice, and (ii) take a lead in developing a more humane approach to health care ethics.
Chapters two to five deal with the first of these two challenges. They offer a significant and necessary challenge to nursing academics and practitioners alike. Seedhouse accurately points to the many examples of inadequate conceptualisation of the so-called core concepts of nursing. He also makes lots of mileage out of what he refers to as nursing big ideas. I have to admit to being almost entirely in sympathy with the author's self appointed task. I suggest that of the four chapters considering concepts that have gained nurse academics' favour as being “central” to nursing, Seedhouse most successfully deals with the notion of advocacy; and the nurse as potential patient advocate. Seedhouse's analysis is one of the most comprehensive I have come across.
In terms of his second challenge regarding leading the way in a more humane approach to health care ethics, the author also provides interesting insights into some of the tensions, inconsistencies, and incompatibilities in nursing, particularly in mental health nursing. Seedhouse raises some important questions for practitioners to consider. For example, he asks if it is possible to promote the mental health of patients within the current structures of mental health service delivery—and if so how? Is it possible to balance care and control? In their defence, some practitioners might argue that Seedhouse has a somewhat antiquated view of the mental health service and indeed of mental health nursing.
The least compelling section of this interesting book is the final chapter. Two difficulties emerge here. Firstly, the focus on the individual practitioner, and his or her perception of the ethical, belies the significant influence of organisational structure and culture on accurate perception of the ethical. It also, by default, ignores the impact of professional socialisation. Secondly, while it may be accurate to suggest that “Ethics is a pervasive phenomenon of human life—every human action that can affect one or more of us has ethical content”, it is not very helpful. The usual difficulty remains: perceiving and forming judgments regarding those actions or situations where there is significant ethical content. I suggest that the failure to do the latter may either trivialise the moral domain of clinical practice or lead to a state of moral paralysis in the thoughtful practitioner.
None the less this is a useful introductory text that offers effective conceptual analysis of a number of important concepts in nursing. Seedhouse also raises some significant questions regarding the function and purpose of nurses and nursing practice.
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