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Doody's Review ServiceReviewer: Mary Ellen Wurzbach, RN, MSN, PhD (University of Wisconsin-Oshkosh)
Description: This book is an expansion of the ideas of a research study about cultural differences between medicine and nursing with implications for primary care in the U.K. An overview of the structural, functional and professional changes occurring in the U.K. health system is provided.
Purpose: According to the author, the starting point of view is that doctors and nurses have strong passions about their various contributions to the health of society. She is concerned with how professional ideas and interests are weighed against the need to operate a system that works for the greater good of society.
Audience: The audience includes nurses who practice in the U.K., and nurse educators as well as doctors interested in a nursing perspective of current healthcare changes in the U.K. In addition, U.S. nurses or sociologists interested in an international cultural perspective of healthcare in the U.K. will find it of interest.
Features: Contributors describe primary care, its background, and policy issues in the U.K. The process of "substitution" is discussed. Substitution in the U.K. means replacing the general practice doctor with a nurse practitioner to contain healthcare costs and provide care for the general public. Contributors also analyze the boundaries of the professions, uncertainty in the nurse's role, innovation in primary care, and the cultural differences between medicine and nursing in primary care in the U.K.
Assessment: Several books recently published in the U.K. include examination of changes in their healthcare system. Norman and Crowlay wrote The Changing Nature of Nursing in a Managerial Age (Blackwell Science, 1999), and Walsh wrote Nursing Frontiers: Accountability and the Boundaries of Care (Butterworth-Heinemann, 2000). Norman and Crowley emphasize managerialism with its accompanying changes; Walsh and Williams describe the changing, expanded role of the nurse; and Williams emphasizes the expanded role of nurses in primary care. In each of the texts U.K. healthcare is viewed from a slightly different perspective. Williams and Norman and Crowley provide more scholarly views and Walsh a more practical view, but all chronicle the development of nursing in the U.K., providing helpful sociological analysis.