282

care to the centre of national health policy between 1918 aad 1939. Particularly relevant is the author’s record of the failure of a Royal Commission appointed in 1925 to “erode the states’ control of public health” (p. 44). In 1992, the equivalent failure is that of a National Health Strategy Review to set a reform agenda by which the states can obtain from the tax revenue on adequate financing for public hospitals, achieve a balaaced use of public aad private hospitals and reduce unaecessary Commoawealtb interference in the planning of health services for an ageiag society.

chapter 3 contains a powerful account of the battles of medical politicians with the government between the two world wars. The evolution of Queensland’s unique public hospital system is traced in some detail. It remains today an example of how one state govenuneat in a federation of states can pursue goals that are not necessarily those of aatioaal govemmeat. Chapter 4 documeats the defeat of the Fast proposals for aatioaal bealtb insurance in Australia. In some nations of Asia where governments are now reviewing the need for national health iasuraace, the same political gaa~ea are being - or will be - played out. The book should wam thea~ of the path that lies ahead.

Part II of the book tracea the period of 1940 to 1949. It traces the role of the British Medical Association (Chapter 5), the abandonment of salaried medical practice (Chapter 6), the transition between salaried medicine and fee for service (chapter 7), the growtb of tbe hospital honorary system (chapter 8), the battle over formulariea in the Pharmaceutical Beaefits Act (chapter 9) and the Chifley (Labor) Government’s eadorscmeat of the National Health Service in tbe period 1945-1949 (Chapter 10).

Part III covers the Page Health Scheme of voluntary insurance introduced by a Liberal govenzmeat that took oflice in 1949, its evolution as part of a ‘tease struggle over the control of medical services’ (p. 254), the initial surge in the supply of pharmaceuticals under the aew Pharmaceutical Beacfits Scheme, the evolution of the Peasioaer Medical Scheme (still a model for other nations that want to promote funding based on ‘categorical seed’ rather thaa universal coverage), and tbe creation of a fee-for-service based medical rdmb ursemeat system based on the experieaoz of tbe U.S. Blue Cross health insurance funds. That policy abandoned mcaas testing, a mistake that still haunts Australian social welfare policy today.

The author doea not canvass in aay detail which, if any, of these ‘reforms’ most shaped the current health policies or health financing methods in Australia. One hopes tbat Gillespie might analyze such matters in a second book on the period 1960 to 1992. Gillespie’s book is sufficiently precise and relevant that policy analysts in other nations who believe that history is a good predictor of the speed of reform of social policy should read that second book as soon as it is published.

Paul Gross, Director

Health Group Strategies Pty. North Sydney, Australia

*****

Tbeorieh en Principes van Verpleegkunde. Inleiding voor bet Wetenscbappelijk Onderwijs en Onderzoek (Theories and Principles of Nursing: A Primer for Research and Education) By G. Evers Leuvea (Belgium), Uaiversitaire Pers 238 pp., 1991, ISBN 90-6186482-8, BF 750,-.

Nursing, an old profession but a young academic aad scientific discipline, has beea developing rapidly along clinical, reaearcb, aad theoretical liaes. Along with aew developmcats in medicine, there have been significant changes in scope and depth of cliaical nursing practice. The integration of scieatific methods to describe or predict clinical phenomena, or to extiae tbe efficacy of nursing interventions, has generated an emcrgiag body of empirically-based knowledge. Refiectioa, both through induction and deduction, has eageademd coaceptual and theontical perspectives on aspects of nursing as well as on the nature of nursing itself. Unfortunately, synthesis of these three treads into co&&e and justified uaderstaadiags about patient care are quasi absent. This preaeat text (in Dutch) by Georgea Even aims to remedy this

283

significant gap in the dcvclopmcnt of musing a8 a clinical profession and a scicnt.& diaciplim. It 8uc4~&3 in presenting an integrated view on conceptualixation in numing by demon&rating how the integration of clinical scholarship, scientific inquiry, and theory development arc essential components of proftional and scientific progrcas. As such, this book is a uniqnc contribution to a growing and incrcaaingly unfocused market of mostly English-language texts: clinical nursing man&, texts on methods for nursing inquiry, and books on nursing theory and theory development. Importantly, this integrative text by Evera seems to do exactly what so many people in (American) nursing continue to advocate, but for somerenaonfailtodothcmsclvcs.

This book is organized in two parts. Part I focuses on how w conceptualize and reason. Departing from the premise that nurning is a tient.i& discipline with a practice referent, it arguea the importance of conceptual/theoretical support and justification to professional nursing. This is followed by several chapter8 that migrate from the thwmtical to the technical aapccta of knowledge development in nursing: level8 of th6orcticaJ thinking, atrnctum of thcoric4, and stratcgi~ for knowledge development (in&ding, concept development and concept analysis; analysis of propositions, theories, and conceptual frameworks). Intended to serve a~ an (admittedly appropriate) example of concept development and analyuis, but perhaps a bit out of place in the int&ctual throat of this part of the book, is a chapter on nursing diagnoacs.

Part II focnaes on specific conceptual framework~~ and theorica in nursing. Evuu had U, find a tcnuo~ balance between an encyclopedic review of fmmeworks and theories in nursing; and the application of ticntific and knowledge development methods to frameworks and theories that help u8 interpret and structmz clinical numing care. The forma is the focus of many English-language texts. The latter, in contra@ um.stituteu a potentially innovative approach to the synthcsia of nursing knowledge infimcrion of patient care. The present text taken the innovation a step further. By carefully selecting the work of four nurse theorista (King, Roy, Orem, and L&k&), Even puts together, not only knowledge, but also major dynamic aspccta central and generic to all numing: interaction, goal attainment, adaptation, self care and a&care deficits, and cultural diver&y. The chapters devoted to these topics bahmcc presentation with critique, discw&on with application. It guide3 the reader, including the novice, fnrm the theoretical to the practical, from idea to application in nursing care.

This book grew out of the author’s lecture notes at the University of Limburg (Maastricht, The NctherhuuL~) and the Catholic Unitity of Lcuvcn (Leuvcn, Belgium). Attention to the novice learner is evidenced by the clarity and systcmaticity of the text. Appeal to the advanced practitioner, scholar, or scientist ia evident from the fact that chaptera gradually move from the elementary to the complex, while consistently building linka to patient cam, conc@&ixation, and inquiry.

These liti arc also important for another nasc)n. Ae a synthesis text, this book ia not a text about nursing or nursing care to specific patient populations. It is a treatise on the generation and utilization of knowledge in nursing aa a broad and highly diver#ed clinical field, yet with a concepllc~rl core that tranaccnda pcoplc, health, illn#ls, and wtting. Thus, this book presumea that the reader has clinical training; has been exposed to the principla~ and methods of scientific inquiry; and undcmtands the interdcpeadency of clinical scholarship, inquiry, and knowlcdgc. Further, Evcm’ conscious choice to emphasize eynthc& of eJected areaa of knowl- over an encyclopedic review of all (generic) &or&al nursing knowledge requirea additional study on the part of the reader aa well.

This text, then, is truly an introduction to ayntheaia Nursing indeed needs synthesis - as an avenue for rethinking how BT care for patients; aa an avenue for resbucturing how w educate practitioners; and aa an avenm for reorganizing how we investigate and theorize. This synthesis is needed in nursing both in Europe and on the North-American continent - which only bcga the qua&ion as to when English, if not other translations of this excellent book will be available.

Professor I. Abraham, Ph.D. RN Schools of Nursing and Medicine and Center on Aging and Health

University of Virginia Charlottesville, U.S.A.

*****