By Patricia Carroll, R.N.
Perigree (Penguin Group)
The cover of Pat Carroll's valuable, engaging new book summarizes its contents as follows: "Practical Wisdom for Everyday Home Health Care." That is exactly what she delivers. The book deftly promotes public understanding of personal health care and nursing, advancing a nurse-oriented vision of basic health that is pragmatic, reasonable and preventative. It is marred only by a somewhat limited focus and that amazing title, which manages to both celebrate and denigrate nurses in 10 short words.
In clear, direct language, Ms. Carroll gives expert advice on how to handle the health problems her readers are most likely to encounter. She explains that one of the basic rules of health care is that "[i]f you hear hoof beats, look for horses, not zebras." Unlike some health books, Ms. Carroll's is organized around the hoof beats (symptoms), rather than the animals making them (the diagnosis), since it is the symptoms that actually tell us we have a problem. Ms. Carroll links this structure to her nursing orientation, which she says leads her to focus more on the human response to illness, as opposed to the medical tradition, which is more concerned with the illness itself. The book may be most useful as a quick, basic reference, but it is well-written enough to read straight through, with its flashes of humor and punchy features with headings like "Frequently Asked Questions" and "Did You Know?"
As promised, then, the book primarily addresses major groups of symptoms: head problems, body aches and pains, cold and fever, and stomach aches. It also covers how to prevent and treat injuries, the use of medications, negotiating the U.S. health care system, and some common medical tests and same-day surgical procedures.
The book is aimed at relatively non-controversial health problems of suburban middle class adults. There is a paragraph on "cruise ship travel," but little or nothing about issues like domestic violence, drug addiction, sexually transmitted diseases, or hazards such as lead paint. Ms. Carroll displays sufficient candor and sensitivity with the delicate subjects she does address (such as yeast infections) to have taken on some of the above issues. The book also neglects some potential root causes of the symptoms it addresses, such as poor diet and lack of exercise; in the United States, obesity is a key factor in many of the conditions and injuries Ms. Carroll discusses. Perhaps a decision was made to avoid controversial issues, though that would not explain the omission of growing problems like food allergies. Or it may be that there were constraints on the overall length of the book, though it might have made sense to provide some explanation if that was an issue.
Not surprisingly given the title, the expertise of nurses is a constant theme. Of course, the very fact that Pat Carroll, R.N., has credibly presented herself as a health care authority advances the profession. But she goes much farther. Many paragraphs have headings such as "Nurse's Note" and Nurse's Wisdom." The book is full of practical tips that nurses are more likely than anyone else to have come up with, such as the "fall prevention" tip in the "Home Safety" section advising readers not to pile laundry baskets so high that they can't see where they're going when they have to climb stairs. Ms. Carroll, an experienced emergency nurse, has clearly seen serious injuries result from things that are often overlooked. In a similar vein, she advises patients to make sure their prescriptions note why a medication is being prescribed, so that if there is any confusion about the prescriber's handwriting--a common and potentially deadly problem--the pharmacist should have little trouble determining the correct drug. Ms. Carroll also displays the depth of nurses' understanding of complex health issues, using her patient education skills to demystify difficult subjects such as the use of medications and health insurance, and noting that when you call a poison control center, you'll speak with a "poison expert" who is "usually a nurse."
Ms. Carroll is generally careful to show respect for the critical role nurses play in modern health care. She makes a point of including the growing number of advanced practice nurses. Rather than using the distressingly common terms "doctor" or "physician" to refer to all health care practitioners, she uses "health care practitioner" (HCP) and "primary care practitioner" (PCP) throughout the book, in order to include nurse practitioners and physicians' assistants. Her discussion of how to choose a PCP compares physicians and nurse practitioners briefly, though it could have benefited from more detail, especially with regard to the training and care orientation of nurse practitioners.
One especially praiseworthy feature of the book is its references to relevant nursing research, an important element given the public's lack of awareness that there is any such thing. We counted at least nine references to nursing "research" or "researchers"--seven of which are "Did You Know?" features devoting an entire paragraph to the relevant study--and there is a list of some nursing studies in a short "Research References" section at the end. The "Did You Know?" sections are slightly undermined by the use of the physicians' caduceus medical staff symbol; what about the nurses' lamp?
The title deserves special attention. We loved the first three words, which put the focus exactly where it needs to be if the public is to get the benefit of nurses' valuable knowledge, and if nursing is to start receiving the recognition and resources it needs. Unfortunately, the rest of the title--"And Doctors Don't Have Time to Tell You"--undermines what came before. First, it suggests that nursing knowledge is merely a subset of medical knowledge. Of course, Ms. Carroll knows that is not the case, and suggests as much with a reference to "things that only nurses know"--but that appears in the "Acknowledgments," where it will have relatively little impact. The title also suggests that physicians could give you this information, but they are simply too busy with their important work. Nurses, whose time is presumably less valuable, are here to try to fill in. The book as a whole belies this idea, as Ms. Carroll constantly stresses the critical role of nursing expertise in health care. But nothing about a book has a deeper or broader impact than the title, which in this case, sadly, is likely to reinforce some of the most damaging misconceptions about nurses.
The Acknowledgments present a similar problem. Ms. Carroll thanks a group of about 20 nurses who have been "generous in sharing their time and knowledge." But she also describes, individually, five physicians who "found the time" to help her; later, she mentions one again, noting that she'll "never forget the first doctor who took the time to explain things to me when I was a student"--as if nursing students learned primarily from physicians, or were more grateful to receive physicians' knowledge than that of their nursing instructors. Ms. Carroll lets us know that one physician "keeps me in line," another "makes me smile," another "took a chance" on her, and yet another "taught me it's best when a suffering patient dies." This last part is ironic, as it suggests that a nurse would need a physician to tell her something that nurses generally understand at least as well as physicians. Since it seems likely that Ms. Carroll has gained the vast majority of her health care knowledge from nurses, we wish she could have also found five nursing mentors who deserved these special heartfelt descriptions. [See Pat Carroll's comments on our review.]
In the sections on ED visits and hospital stays, Ms. Carroll presents a powerful description of the central role registered nurses play in hospitals, calling them the "leaders of the bedside health care team." She explains the different types of nurses, makes it fairly clear that nurses report to other nurses (though she might have explicitly noted that they do not report to physicians), and provides useful tips on how to find and promote good nursing care. She describes nurses' frustration at the nurse short-staffing and the related proliferation of unlicensed assistive personnel in today's hospitals. And she explains, briefly, how these trends can cause serious harm to patients, citing Linda Aiken's influential study of the effects of nurse short-staffing on patient mortality.
Ms. Carroll--who appears often in the mainstream media with health care advice--is no rabble-rouser, and she might have been more aggressive about the crisis in nursing. But that is not the main point of this book, and she does observe dryly that with regard to staffing levels, "[s]ome institutional administrators would be more responsive to complaints from the community--their customers--compared with concerns voiced by the nurses who work in a facility." It is that community to which Pat Carroll speaks so effectively, and her nurse-centric book is a notable part of efforts to build a profession that is better able to protect itself and the public's health.
Review by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed June 9, 2004
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.