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As a busy nurse, you may not sit down with a book as much as you’d like—much less one about your chosen field. Don’t worry. Here’s our annual survey of healthcare titles to help you stay on top of your profession. Getting a Good Read onThings

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ead a good book lately? Chances are, probably not. Between juggling work, family, household chores, all your volunteer obligations, and trying to have a few moments to yourself once in a while, who has time to read an honest-to-goodness book Ranymore—much less one about the healthcare industry or medical field? That’s fine, because every summer we round up the titles most interesting and relevant to nurses and review them here. This year, authors are discussing how technology is supplanting human relationships and caring, revealing how the public relations machine works, and talking about how to stop bullying in the workplace—among a host of other topics. Some of the books are even written by nurses. So even if you can’t read the whole book, you can pretend you have by simply reading these reviews. We’ll never tell. And who knows? Maybe reading these will inspire you to pick up a book.

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Alone Together: Why We Expect robotic companions for their grandparents, they immediately won- More From Technology and Less dered, “Don’t we have people for these jobs?” The robots-or-no-one From Each Other By Sherry Turkle; Basic Books quandary takes social and political choice out of the picture when it belongs at the center of the picture, according to Turkle. “While the children only began that conversation, we, as adults, lone Together is a thought-provoking book that fires a seri- know where it might go. We know that the time we spend caring for ous shot-across-the-bow, black-box warning and eye-opening children, doing the most basic things for them, lays down a crucial A wakeup call for technophiles, armchair intellectuals, and substrate. On this ground children become confident that they are humanists alike. Author Sherry Turkle is a professor at the Massachu- valued, no matter what. The ill and the elderly also deserve to be con- setts Institute of Technology, where she is the founder and director of firmed in this same sense of basic trust.” If we divest ourselves of such the MIT Initiative on Technology and Self. She holds dual doctorate things, we risk being desensitized and hardened. Turkle observes, degrees in sociology and clinical psychology from Harvard, and has “When we lose the ‘burden’ of care, we begin to give up on our social been studying the unique interface and effects of social media and compact that human beings will care for other human beings.” And, artificial intelligence programs on people for more than 30 years. once you have elder bots and nurse bots, why not nanny bots? Turkle’s book is written in an engaging anthropological style. It During one of her seminars at MIT that focused on the role of contains a well-documented history of our computer culture and robots and computers in medicine, her class considered a robot that observations from her research into human interaction with com- could help turn puters, hand-held technology, and so-called “sociable humanoid weak or paralyzed robots” in a variety of settings, including schools and nursing homes. patients in their The book is organized into two main sections. In part one, subti- beds for bathing. A tled, “Towards Embodied Intelligence,” Turkle tells of being troubled robot now on the about the true costs of life with simulation in a virtual environment market is designed and the manipulation of society’s bending toward the inanimate as a kind of “double with a new solicitude. In part two, subtitled, “Networked: In Intima- spatula”: one plate cy, New Solitudes,” Turkle voices concern about the loss of authentic slides under the relationships between people—the result of technological screens patient; another is that transform how and with whom we interact. placed on top. Some She describes a brave new world on a digital terrain, and the students insisted inherent risks of allowing technologies to shape us and redefine our that it is inevitable understanding of privacy, intimacy, and community. At the thresh- for robots and old of what Turkle calls “the robotic moment,” she asserts our telemedicine to take devices should prompt us to recall that we have human purposes, over nursing and needs, and desires. Based on interviews with hundreds of children monitoring roles and adults, she invites the reader to consider the value of face-to- (they cited cost, effi- face communication, the importance of human touch and hands-on ciency, and the work within the context of our everyday lives. Turkle explores the insufficient numbers concept of emotional dislocation and social isolation enabled by of people who want unquestioning faith and reliance on technologies, and the impact on to take the job). Oth- our sense of self-worth and human dignity. She writes, “We don’t ers countered that need to reject or disparage technology. We need to put it in its place.” the elderly and disabled deserve the human touch and that anything The most provocative, compelling, and horrifying part of this else is demeaning. book was reading about the sickening rationalizations technology Turkle aptly quotes philosopher Kwame Anthony Appiah: “In the industry proponents use as justification in experiments where “care” real world, the act of framing—the act of describing a situation, and has been delegated to robots. During the course of her research, thus of determining that there’s a decision that must be made—is Turkle visited several nursing homes where residents had been given itself a moral task. It’s often the moral task. Learning how to recognize robotic dolls, including one called “Paro,” a seal-shaped stuffed ani- what is and isn’t an option is part of our ethical development.” When mal programmed to purr and move when it is held and talked to. She caught up in a discussion about robot caregivers her class turned away describes how, in many cases, seniors apparently “bonded” with the from the dilemma at hand and began asking different questions. toys and were observed privately sharing their life stories with them. “What about hiring people to do the work?” And, “What must be done In arguing for “caring machines,” roboticists often make their to get them where they are needed?” case by putting things in terms of quandaries. So, they ask, “Do you As many have observed, one place to start would be to elevate want your parents and grandparents cared for by robots, or would elder care above the minimum-wage job that it usually is, often you rather they not be cared for at all?” And alternatively, “Do you without benefits. How can we revisit social priorities so that funds want seniors lonely and bored, or do you want them engaged with a are made available? We have the unemployed, the retired, and robotic companion?” Turkle identifies a technique for breaking out those currently fighting in wars—some of these people might take of this kind of thinking. For example, when fifth graders considered these positions. Many have a heart for service, valuable skills, and

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Deadly Spin: An Insurance Company Insider Speaks Out About How Corporate PR is Killing Health Care and Deceiving Americans By Wendell Potter; Bloomsbury Press

n his book, Deadly Spin, former pri- movie a standing ovation, just as the vate health insurance executive Wendell people at Cannes did when it was first I Potter credits the nurses of the California screened.” Nurses Association and their protest on behalf Most of Potter’s book provides a of Nataline Sarkisyan in December 2007 as one bird’s-eye view of the inner workings of of the primary reasons for the “crisis of con- the private health insurance industry’s science” that led him to speak out. spin doctors—the folks like Potter who The year 2007 was a time of undeniable make sure even the most horrific denials soul-searching for Potter. The book gives an and decisions are painted in the most intimate glimpse not only into Potter’s world positive light possible. of corporate power and privilege but also Many sections of the book give into his personal journey. He is an accom- readers insights about the political plished writer and journalist, so the book is maneuverings of the for-profit health well researched and written with clarity and insurance industry and the work of purpose. shadowy front groups to advance the During that time, Potter worked for propaganda Potter helped fashion and CIGNA, the insurance giant based in to craft the healthcare reform legisla- Philadelphia and the Sarkisyan family’s tion that would best benefit the health insurer. Nataline’s story was a classic case insurance industry—not patients and that nurses hear all too often. The 17-year- not nurses. One of the more fascinat- old’s doctors believed she had enough of a ing sections of his book outlines the chance for survival to want to give her a liver strategy as follows, “All of the tactics transplant, but CIGNA denied the proce- used by the oil, beverage, and banking dure. With media help from the California industries to influence lawmakers at Nurses Association and the support of every level of government were pulled Southern California’s extended Armenian of several insured patients (including yours straight from the cigarette makers’ play- community, the family protested and raised truly) and their families through the broken book: Distract people from the real prob- a huge public outcry. and brutal healthcare system nurses con- lem; generate fear; split communities with On page 154 of his book, Potter writes, “My front every day. In , Moore challenged rhetoric, pitting one group against another; phone started ringing off the hook as soon as the notion that simply having insurance encourage people to doubt scientific conclu- the nurses’ release went out. I knew I had a cri- means having the single-standard of high- sions; question whether there really is a sis on my hands when calls poured in not only quality care that nurses strongly support as problem; and say one thing in public while from local TV and radio stations but also from patient advocates. working secretly to do the opposite.” the Los Angeles Times, CNN, and NBC—and Potter was charged with making sure No matter what Potter was paid to spin, even from the general public. The release, Moore’s film was maligned, and he traveled he just could not overcome the truth of the which was posted on the homepage of CNA’s to places the nurses had arranged for early cry nurses helped raise. As he closes out his Web site, also appealed to the public to call showings of the film and even to Sacramen- book, Potter thanks that young, beautiful CIGNA demanding that it ‘provide the care to, where the nurses helped arrange for an woman whose life was cut short. One life Nataline needs.’” early screening of the movie and for Moore can and does make a difference in this CIGNA eventually relented, but it was too to testify at a hearing held by California Sen. world, and registered nurses often stand late. Nataline was too ill to receive the new Sheila Kuehl, then chief sponsor of the with patients and their loved ones at the liver and on Dec. 20, 2007, she died. state’s single-payer legislation. most difficult moments and during times Potter’s book recounts the story of that Potter was a “spy” for the for-profit health when other support systems have forsaken protest and its impact, not only on CIGNA, insurance industry and an audience member them. That power and the absolute dedica- but on the entire national healthcare reform in Sacramento for that nurse-sponsored, tion to patient advocacy showed Wendell debate. The nurses, and their steadfast West Coast premiere of the film. “Moore had Potter a whole new world over which even protest and clear-minded press work on been persuaded by the California Nurses the “deadly spin” of the insurance industry behalf of the family and the issue, had Association and Physicians for a National held little sway. changed the course of history. Potter would Health Program—both advocates of a single- The book provides a great history of the never be the same. payer health care system in the United reform effort and helps us see even more In another section of Deadly Spin, Potter States—to show the movie in Sacramento clearly how critical nurses are to hastening outlines in great detail his participation as a first because California lawmakers had twice the day when a single standard of high- CIGNA executive in the efforts to discredit approved bills creating a single-payer system quality care for all without financial barriers and the 2007 documentary in the state...I probably would have joined all will be the law of the land and not the result film, SiCKO. The film chronicles the stories the others in the audience in giving the of deathbed protests. —Donna Smith

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perhaps, the willingness to perform these satisfying jobs if there asserted that federal agencies should provide support for the devel- were salaries at living wages to pay them. opment of technological advancements, to include the use of assis- The baby boomer generation begins to turn 65 this year, which tive health information technologies and remote monitoring will create many challenges for our healthcare system. This genera- technologies “that may reduce the need for formal care” and “enable tion of older adults will be the most socioeconomically and racially health professionals to be more efficient.” The committee’s report, diverse the nation has ever seen. They are more educated, with more and its title, all but eerily foreshadows the subject matter of Turkle’s widely dispersed families, and increased longevity. The majority will comprehensive body of research. suffer from one or more chronic conditions and will need to rely on It is against this “embrace technology” backdrop and the industri- healthcare services with a greater frequency than other segments of al-manufacturing encroachment into the for-profit acute-care and the population. It is estimated that the number of older adults in the long-term care environments that Turkle’s book should become will almost double between 2005 and 2030, yet there required reading for all who value the art and science of nursing. is a dramatic shortage of all types of healthcare workers, especially Turkle observes that technology presents itself as a one-way street; those in long-term care settings. discontents about its direction are dismissed because it’s assumed In 2008, the Committee on the Future Health Care Workforce their reactions are borne of nostalgia, or a Luddite impulse, or simply for Older Americans published a report titled, “Retooling for an in vain. But when we ask what it is we’ll “miss,” we may discover what Aging America: Building the Health Care Workforce.” The report we care about, what we believe to be worth protecting. Technologies

When A Loved One Falls Ill: How to be an Effective Patient Advocate By Gerri & Brian Monaghan; Workman Publishing

s a prominent, successful San Loved One Falls Ill is a needs single-payer health- Diego trial lawyer, Brian Monaghan great book that simul- care so that people can A was a pro at being a fierce advocate taneously tells their marshall all their and winning big cases for his clients. But the story from both Brian resources toward fighting tables turned in May 1998 when Monaghan and Gerri’s perspec- the illness and not worry learned that he had Stage IV melanoma and tives, and offers 50 about money or the insur- two metastasized tumors in his brain. Now “advocate tips” to fol- ance company. As an RN he was the one that needed an advocate. low. Some of the tips with many friends and Luckily for him, his smart and strong wife address practical mat- colleagues still working in Gerri filled that role perfectly. ters, such as starting the healthcare system I After a 13-year battle involving much an advocate’s notebook mainly use, the book research; consulting of specialists for second to keep all of the opened my eyes as to just and third opinions; Gamma Knife, brain, patient’s information how inadequate my and other surgeries; experimental vaccines; in one place or making resources would be if I and intensive therapy, Monaghan is still sure to get copies of had to navigate this world alive, doing well, and his cancer appears to every record. Some of without my connections— be indefinitely in remission. He attributes his the tips address mat- as most patients do. success in fighting such a devastating diag- ters of the spirit, such What I liked best about nosis to having such a powerful personal as advising readers to this book was that it laid advocate, Gerri. trust their intuition, to stay optimistic out all the things patients and advocates To help other patients facing serious through inspirational stories, and to keep need to be aware of, as well as answering medical challenges and share all the lessons laughing in order to stay sane. Some of the those questions and supplying the resources they learned while battling Monaghan’s can- tips, such as using your networks and every to address those concerns. My only quibble cer, he and his wife wrote When A Loved One contact available to you to get what you about the book is that it was written from Falls Ill: How to be an Effective Patient need, are just common sense yet something the perspective of an unusually prominent Advocate. Every patient needs an advocate, that people don’t apply when it comes to and wealthy person who was able to do they argue, “to have someone other than the their medical treatment. Very importantly, things like call up CEO friends to get patient question what’s being done and why. they remind readers through tip #40 to treat appointments with specialists and go on You need to have someone stand up for you doctors, nurses, and medical staff well! European vacations in between treat- when something doesn’t sound right, some- Even as an RN, I learned a lot from this ments—hardly the situation of most one who’s not intimidated by the fact that book. It really brought home for me how patients. Still, the lessons and advice ring the person standing in front of her is wear- the medical system offers so little support true. Since we will all be patients one day, ing a white coat.” for patients, how much the medical system this book is well worth the read. Written in a colloquial style, When A needs to change, and how much the country —Kay McVay, RN

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present opportunities to reflect on our shared values and direction. her head bashed in with a hammer by a crazy customer, drug addicts So, before we embrace technology, we must ask, “Does it really meet who’ve witnessed ex-boyfriends kill their children, or teens from the our human needs, serve our human purposes, and enhance our local housing projects who’ve been shot multiple times. In her new human values of caring, compassion, and community?” job, Barkin is surprised to learn that there is no therapeutic support Some believe that today’s technology trends are fueled by our system in place for the staff, who listen to and must confront unspeak- own unstoppable urge to make a difference and improve things able horrors and sadness day in, day out. Instead, she discovers a around us. But in the arena of healthcare, let us not forget that the beautiful garden on the grounds of the hospital where cedars, pines, goal of health industry business owners is to make more and more and a myriad of flowers money, not to create jobs or raise wages. grow. When she feels over- One of the basic needs of all human beings is the need for nurtur- whelmed by the job, she ing and caring touch. Caring touch helps people compensate for retreats to “the comfort bereavement, dependency, and altered body image. It has also been garden” to calm down, gain found to be therapeutic as a form of nonverbal communication. perspective, and renew When we touch we form a bond. That bond affirms our interde- herself. pendence and connectedness with one another. In this day of tech- As time goes by, it’s nological encroachment into the care environment, touch is perhaps apparent to Barkin that the the only remaining caring, therapeutic tool that actually helps patients desperately need patients feel better. It has the potential to help heal our patients and some kind of support group make the work of practitioners more satisfying due to the observed so that they can continue to and quantifiable therapeutic response of the patient. heal psychologically after Congruent with our crucial role as patient advocates and propo- they have been discharged nents of healthy public policy, CNA/NNU has adopted a position by the hospital. When she statement that explores the potential of technology replacing human arrives, no such services interaction in the delivery of healthcare and supplanting critical exist. One of Barkin’s great thinking and independent clinical judgment with critical pathways triumphs during her time and other forms of artificial intelligence. As the development of at The General is that she technologies continues its rapid evolution, particularly in health- succeeds in creating such a care, it is important that it is harnessed to best serve the individual group. Later, she also healthcare needs of patients. Registered nurses have a unique role in attempts to carve out time and space for the psychiatry staff to process assuring the provision of safe, therapeutic, effective and efficient the emotions they feel treating these difficult trauma cases, though the care in the exclusive interests of the patients we serve. lasting effects of that effort are more unclear. Turkle concludes, “We have to be concerned that the simplifi- Through the stories, which are told chronologically, Barkin also cation and reduction of our relationships will no longer be some- raises larger questions about where the modern practice of psychiatry thing people complain about. It may become what we expect or is heading and how managed care undermines the quality of care. In even desire.” We are at a point of inflection, where we can see the her later years at San Francisco General, she finds that she is under true costs of technology and start to take action. She makes a constant pressure to increase her billable hours. She also witnesses, to credible claim that we have already unknowingly embarked on an her dismay, the entire institution of psychiatry becoming much more experiment, indeed, a whole series of experiments: robots for chil- focused on pharmacological solutions instead of traditional talk thera- dren and the elderly, and technologies that denigrate and deny py. As a fellow psych nurse friend put it, “Forget feelings. It’s all about privacy, deskill, and replace people with a seductive form of elec- pills and quick fixes.” tronic simulation. We are unwitting human subjects in a techno- Often, Barkin takes refuge in her garden at work, and sometimes in logical matrix. As human beings, we deserve better. When we her garden at home. But after five years of vicarious exposure to the remind ourselves that it is we who decide how we should use tech- stress and trauma of her patients, Barkin needs a break. She is begin- nology, we shall have better. —DeAnn McEwen, RN ning to have nightmares and irrational daydreams and fears for her family. “A part of me feels dead...I feel ravaged by overexposure to human cruelty and suffering,” she writes. But she knows that, like a The Comfort Garden: Tales From the plant that momentarily lies dormant to take a rest and gather energy Trauma Unit By Laurie Barkin; Fresh Pond Press for the spring, her “roots as a nurse [are] deep and unscathed. Come the next rain, I know I will rebloom.” psychiatric nurse consultant, Laurie Barkin, RN has Barkin also reveals a lot about herself in the book, frequently written a fascinatingly vivid account of her five years working depicting her busy family life with her lawyer husband and three A at San Francisco General Hospital, the main public hospital young children, and how her work and personal lives influence each for the city’s low-income, uninsured residents as well as its primary other. She weaves the stories about her two worlds together seamlessly. trauma facility. A transplant from Boston, Barkin’s job is to provide The Comfort Garden is a beautifully written book, at times joyous psych consults: talk to, give referrals, and suggest services for patients and poignant, at times incredibly depressing and somber. But, above suffering from trauma—whether it’s a 19-year-old prostitute who gets all, it is honest. —Lucia Hwang

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My Imaginary Illness: A Journey Into myasthenia gravis and to prescribe her the medications she needs to Uncertainty and Prejudice in Medical suppress her immune system. The results were extraordinary. Though she still suffers from muscle weakness and tires easily, Atkins Diagnoses By Chloë G.K. Atkins; Cornell University Press regained the ability to walk and perform all the other functions of s nurses well know, medicine prefers that patients’ illnesses daily life. Today, she is an associate be easily identified, named, and treated—essentially, neatly professor at the University of Calgary. A boxed and wrapped with a bow on top. Unfortunately, many Atkins’ story offers many lessons to people’s health issues rarely present themselves that way. Such was the nurses and other medical providers. case with Chloë Atkins. Starting at age 21, Atkins began suffering Especially with modern medicine’s numerous health issues, including extreme fatigue, loss of muscle con- emphasis on “evidence-based practice,” trol, and other symptoms of a major neurological problem. Doctors patients who do not fit a standard, text- could not conclusively diagnose what was wrong with her, though, and book presentation of a disease may fall classified her disease as psychosomatic—a label in her charts that would through the cracks and be denied the doom her to life as a medical pariah. No medical providers would take treatment they desperately need. her illness seriously, and some even acted cruelly towards her as if to Atkins’ experience also provides insight punish her for wasting their time and resources. Over the coming years, into what might happen to a patient she continued to deteriorate and bounced from physician to physician, who is written off as psychologically hospital to hospital, and medical crisis to medical crisis without receiv- causing their own illness and whether ing the help she needed. Eventually, she became a quadriplegic and was those labels are more often, and unfair- confined to a wheelchair for years. Her body was at times so paralyzed ly, applied to women versus men. You can’t help but wonder if a middle- that she could not breathe on her own and had to be intubated. aged man suffering from Atkins’ same symptoms would have been told Only after more than a decade of mistreatment by the medical that “it’s all in your head”? profession did a doctor finally suggest that Atkins suffered from an Besides evoking these many ethical questions and dilemmas for autoimmune neuromuscular disease called myasthenia gravis. the medical profession, Atkins’ story is also, at its heart, a com- Atkins, however, still did not pass all the tests used to officially diag- pelling read about a patient struggling against a mysterious illness. nose myasthenia gravis. Through persistence, however, she was final- Along the way, she finds love, hope, and the closest thing to a cure ly able to find specialists who were willing to treat her as if she had that she can get. —Lucia Hwang

When Nurses Hurt Nurses: Recognizing profession expects employees to go for hours and Overcoming the Cycle of Bullying without food, drink or bathroom breaks?” By Cheryl Dellasega; Sigma Theta Tau International But despite explicitly recognizing these causes of nurse-on-nurse aggression, the very nurse has seen it at some patients from poor communication among author entirely fails to take the next step: To time. We all know that sometimes caregivers. The author tell us that taking power in E nurses are our own worst enemies. presents quite a number of our profession and changing We’ve all heard that “nurses eat their young.” anecdotal examples and those conditions is a critical At one time or another, most of us have had a case studies, several of part, perhaps even the critical bullying coworker, charge nurse, or supervi- which would be familiar to part, of the response to rela- sor—the nurse who seemed to live to make almost any nurse. tional aggression. others miserable. So when I saw the title of There is also some Instead, she offers a recipe this book I had great hopes for it. And the thought-provoking work on for individual transformation. author gets quite a lot right. the root causes of the prob- Rather than working to change Her analysis centers around “relational lem. Reading some of those oppressive conditions, nurses aggression,” defined as “gossip, exclusion, comments kept my hope are to learn to endure them in teasing, tormenting, undermining, cyber- alive for what this book a more functional way. Even slamming, and a host of other verbal and might have been: “Perhaps though she makes clear that social behaviors designed to wound another a sense of overt powerless- much of this aggression can be person.” This is described as being mainly a ness leads to more subtle attributed to the unreasonable female phenomenon which caused me, as a struggles through aggres- stresses of our work, the male RN, to approach this reviewing task sive behavior.” Here’s another: “According to author—typifying the academic nurse’s anti- with some sense of diffidence. the theory of oppressed groups (Fanon, union bias—shies away from the next logical I found considerable interest in the 1963; Friere, 2000), people who are domi- step: banding together to change those stresses description of the problem, the examination nated by others turn on each other and through collective action. of its extent, and the damage it causes: become self-deprecating because they have In sum, there’s a lot in this book of excess turnover, young nurses leaving the internalized the values of the group in con- interest. It’s too bad it fails to fulfill its full profession, even possible increased risk to trol.” And here’s a good one: “What other promise. —David Welch, RN

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