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Tom Kitwood on dementia: a reader and critical commentary

Edited by Clive Baldwin and Andrea Capstick
Open University Press McGraw-Hill Education; 2007
Price £21.99
ISBN-10: 0 335 22271 4

Picking up an eagerly-awaited book can draw upon a range of emotions: having recently been discussing the roles of music in dementia care with a colleague, I've found myself listening to quite a lot of Ry Cooder's music, drawing on his evolution from teenage maverick to the maturity of his jaw-droppingly-wide influences. Listening to the sheer exuberance of his reading of Johnny Cash's Get Rhythm threw up an interesting comparison. Cash and Kitwood - perhaps it all sounds a bit fanciful, but both made dramatic marks on their respective fields.
Indeed, it doesn't take much of a leap-of-faith to see intriguing comparisons: luminous, charismatic and yet strangely unassuming and occasionally self-effacing - both have left legacies that are regularly being reevaluated. As with Cash's final series of American recordings, Kitwood's untimely death came within a year of the publication of what many felt was a point of reflection and renewal - his groundbreaking Dementia Reconsidered (1997).
Baldwin and Capstick have produced an honest appraisal that is undeniably a reader and critical commentary, and have not shirked from any responsibilities. As they put it in the introduction: "with the exception of Dementia Reconsidered, there is no one place that covers the breadth and extent of his work - and even then (it) cannot be viewed as all-encompassing or the definitive statement."
What that serves to remind us of is that feeling of anticipation of what the next developmental stage might have brought. As it transpired, it fell to these two and their fellow workers in the Bradford Dementia Group to collectively broaden the appeal, and in some respects widen the scope, of the Kitwoodian ethos of what it might feel like to experience dementia, and from there to clarify and quantify care practices.
Four key areas are considered in the ensuing discussion and debate - his theories of dementia, the twists between ill-health and wellbeing, the concept of personhood and finally, the widest ranging, that of organisational culture. If one legacy merits acknowledgement, it surely has to be his idea of personhood. Kitwood was sometimes heard to muse about the relative clumsiness of the phrase, but throughout his extensive and exhaustive writings, he maintained an academic's eye and ear for how to integrate and amalgamate language.
Particularly telling here is the point that as integral as "personhood" was to person-centred care, it was formulated over a period of years and only really formed in the mid-1990s by drawing together and articulating "a relatively cohesive theory of personhood to underpin developments in person-centred care. In so doing, Kitwood conflated the notions of metaphysical personhood (personhood as a purely descriptive category) and moral personhood, that is, the moral standing of those who are defined, metaphysically as persons."
As insiders, Baldwin and Capstick are particularly well-placed to unpick the technicalities of dementia care. Occasionally viewed as a predominantly emotive view of empathy, and incorporating support and understanding, genuine dementia care effectively has the individual at the epicentre.
My starting point for this review was a sequence of echoes that ran through two lives - where religion also played a not-insignificant part. Cash's final video, for Hurt, was drenched in symbolism, and it is worth remembering that Kitwood was trained in the priesthood and ordained in 1962. Throughout his life he questioned and teased out his ideas, eventually renouncing his Christian belief. That was replaced by an interest in Buddhism and Taoism - and his early experiences in Uganda led to his deep interest in what he described as "negritude" - the black experience.
This paperback would serve two distinct strands of readership equally well - those coming afresh to dementia care, or practitioners steeped in the concepts, who are looking to reanalyse and consider future developments. As such, it is difficult to underestimate its value.

Stephen Weeks
BA(Hons) RMN
Daytime Treatment Nurse
South West Yorkshire NHS Trust

Women's health

Carrie Sadler, Jo White, Hazel Everitt, Chantal Simon
Oxford General Practice Library; 2008
Price £5.99
ISBN 978 0 19 857138 4

Women's Health is one of a series from the Oxford General Practice Library, and is a useful, easy-to-read handbook aimed at general practitioners in primary care, but is just as useful for practice nurses and nurse practitioners in general practice.
The book covers all aspects of women's health and topics are matched to the Quality and Outcomes Framework (QOF). It includes sections on women in society, breast disease, gynaecological problems, contraception, pregnancy, mental health and a section on miscellaneous topics, such as insomnia. Clinicians involved in contraception and family planning will find this book particularly helpful as a quick reference guide to support their clinical practice.
Bang up-to-date the authors cover the new GMS contract and clearly identify the financial incentives for each (QOF) indicator and how these can be achieved.
There are clear, practical tables and drawings throughout and where relevant NICE guidance, useful references and resources are incorporated into the further information section as well as information for patients.
Written by doctors with a special interest in women's health, it may not be to every nurse's taste as it focuses on the medical model of care. Nurses, however, will find it useful as a reference book, and reasonably priced as a resource to support them in achieving QOF targets.

Donna Davenport 
RGN BSc(Hons)
Professional Development Nurse
Stockport Primary Care Trust/
NiP Advisory Panel Member

Managing obesity in the workplace

Nerys Williams
Radcliffe Publishing; 2008
Price £19.95
ISBN 1 84619 058 4

This easy-to-read book is aimed at anyone who is interested in the effects of obesity on business or any workplace environment. It should be recommended to occupational health professionals, public health departments and health promotion leads within primary care premises.
It gives examples of practical actions that can be taken to prevent employees becoming overweight as well as tackling the issue with those who already are. The implications for individuals (medical and psychological consequences) and employers (economic costs, health and safety, sickness and discrimination issues) are covered.
Current management of obesity - lifestyle change, medication and surgery - is mentioned briefly, but in enough detail for the readership of this book. Readers should be aware that the "Balance of Good Health Plate" model featured has now been replaced with the "Eatwell Plate", but this is a minor issue.  
Several chapters are devoted to case studies and practical examples of initiatives that can be taken by employers to improve the nutrition and physical activity levels of their staff. These range from simple ideas such as having a "no email" day, which encourages staff to walk around, to projects that take more setting-up or have a cost involved such as
organising a cycle loan scheme or providing free fruit to employees on a daily basis.
My one concern is that, although the book does cover motivation and behaviour change, I would recommend some further reading. Unless someone is ready to change, merely providing initiatives in the workplace will not necessarily work. Overall, however, I would recommend this as a good summary of the consequences of workplace obesity and its management. There are plenty of practical examples of changes that can easily be made to help employees lead healthier lives. The catch, however, is that they have to want to!

Tracy Hancock 

Breastfeeding: the essential guide

Sharon Trotter
TIPS Ltd; 2004
Price £5.99
ISBN 0 9548381 0 6

This book has been written both on a personal and practical level. Sharon Trotter is an experienced midwife with many years longevity within the profession. She is also a mother of five children who have all been breastfed.
Sharon has written this book for a target audience of midwives, student midwives, health visitors and nurses. The book is a necessary read if breastfeeding is to be encouraged and supported by healthcare professionals to expectant mothers. It is not overpowered by medical jargon and therefore mothers thinking about or setting off on the road of breastfeeding would also gain knowledge and understanding from the book.
The book is set out in easy-to-read columns rather than the traditional paragraphs one is used to seeing on the page. The sections of the book, some more personal than others, take the reader through the ups and downs of breastfeeding in the early days following birth, what to expect and how to deal with it. There is even a section on looking for the right bra prior to and following the birth; some mothers may fear that attractive underwear is left in the back of the drawer when breastfeeding, but Sharon Trotter assures us that this is not the case!   
Breastfeeding creates a special bond with the baby in the early days. That said it is not an easy task to undertake and women can become disheartened and disillusioned, and without the correct support the chances are they will stop breastfeeding. Breastfeeding is nature's way of getting mums to sit down and rest, spend time with their baby and enjoy the close bond. It is a joy once the initial few weeks is over and one that should be encouraged in its entirety.
Both healthcare professionals and expectant mums should be encouraged to add this book to their collection.

Helen Lewis 
RN BSc(Hons) BMid(Hons)
Practice Nurse
Brynderwen Surgery, St Mellons, Cardiff