Humanity in intensive care

Establishing an action research group to explore family-focused nursing in the intensive care unit

This paper presents the first phase of a four-phase collaborative action research study which aimed to facilitate family-focused nursing in the intensive care environment. The purpose of phase one was to determine intensive care nurses' perceptions of family-focused critical care nursing and the appropriateness of family-focused nursing in the intensive care unit. A collaborative action research group was established with six registered nurses working in the intensive care unit of a metropolitan tertiary referral hospital. Data were collected through group discussions and analysed using open coding. Findings revealed two categories related to perceptions of family-focused intensive care nursing: partnership in care and maintaining a balance. The group unanimously agreed that family-focused nursing was appropriate in the intensive care environment. The three subsequent action research phases of this study are reported elsewhere.

Maintaining clinical credibility as a nurse teacher in a postgraduate tertiary specialization program

This paper addresses the issues surrounding clinical credibility and describes how a Hong Kong specialist nurse teacher maintains clinical credibility. The aim is to explore the credibility of the nurse teacher in relation to the clinical knowledge and skills that will enhance postgraduate students' clinical scholarship. The paper describes a model for maintaining specialist teachers' clinical credibility and innovative strategies to achieve this goal.

Reflections on technology: increasing the science but diminishing the art of nursing?

Technology has had a huge impact on the delivery of health care over the last 10-20 years and although this has been, in general, in the Intensive Care (ICU) environment, the Accident and Emergency (A & E) department has not been immune from technical developments and innovations, a trend that looks destined to continue. The impact of technological developments has given rise to much nursing literature relating to the effects technology has had in 'dehumanizing' the patients in their care, as critical care nurses in all fields endeavour to balance the need for technical competence with the traditional and still important traditional arts of nursing. This paper explores some of the definitions and terminology surrounding technology, nursing, art and science in an attempt to illustrate that technical proficiency, scientific knowledge and nursing artistry can be combined by skilled nurses to achieve a balance of care which preserves the humanity and dignity of patients and their relatives in a critical care environment.

Nursing perspectives for intensive care

Within health care, market forces increasingly determine what services have economic value. For nursing to survive this economic onslaught, nurses must clarify their values and roles. While nurses working in intensive care develop useful technical skills and normally work within a constructive multi-disciplinary team framework, they have a potentially unique contribution to care, focusing on the patient as a whole person rather than intervening to solve a problem. The need for both physiological and psychological care creates a need for holistic values, best achieved through humanistic perspectives. Humanistic nursing places patients as people at the centre of nursing care, as illustrated by the limitations of reality orientation compared with the potentials of validation therapy. Intensive care nurses asserting and developing such patient-centred roles offer a valuable way forward for nursing to develop into the 21st century.

An investigation into the attitudes and practices of intensive care nurses towards verbal communication with unconscious patients

This study attempted to investigate the attitudes and practices of intensive care nurses towards verbal communication with unconscious patients. A sample of five staff nurses working in an intensive care unit in Northern Ireland formed the basis for the study. The research design was non-experimental and descriptive-exploratory in nature, incorporating 4-hourly observational periods and structured interviews. Qualitative and quantitative analysis indicated that intensive care nurses spend on average 5% of their time verbally communicating with unconscious patients. Most of this communication involves informing the patient of immediate procedural matters or providing reassuring statements. Most intensive care nurses claim that verbal communication with unconscious patients is very important, and some ambiguity is apparent as to the unconscious patient's level of awareness. Major factors influencing communication are the patient's level of consciousness, the amount of physical care being given and the presence of relatives.

Involving families in care within the intensive care environment: a descriptive survey

A descriptive survey design was utilised within a general intensive care environment, to describe the attitudes of nurses and relatives towards the provision of care by relatives to their critically ill loved one. Triangulation was employed utilising a questionnaire comprising a Likert scale, a checklist of participatory care activities, open questions and biographical questions. The total nurse population of the intensive care unit (ICU) was surveyed. 27 questionnaires were returned (a response rate of 75%). Of a possible 45 relatives surveyed, 20 returned questionnaires (a response rate of 44.4%). A high proportion of both the nurse and the relative samples (96.3% and 85% respectively) indicated their agreement with the concept of involving relatives in the physical care of their critically ill loved one. The results highlighted issues of personal choice for individual lay involvement and adequate information for families to become involved. For the nurse sample the major themes emergent were the problems of role adaptation for nurses and families involved, and building relationships. For the relative sample the categories emergent were adapting to the demanding ICU environment and identifying the parameters of their new caring role. The study suggests benefits, to both nurses and relatives, of lay participation in physical care of critically ill patients on the ICU environment.

The usefulness of intensive care treatment: perspectives of medical and nursing staff

Which patients' states or circumstances effect the judgement of Intensive Care specialist (IC) medical and nursing staff as to how useful intensive care treatment is? Do IC medical and nursing staff differ significantly in their attitudes regarding the usefulness of IC treatment? Or do they show similarity in their attitude but differ as a group from broader community views of the usefulness of IC treatment? To gain insight into these questions a group of IC staff (35 medical, 108 nursing) and pre-clinical students (110 medical, 136 nursing) responded to a questionnaire asking them to consider how 12 patient factors including age, functional state, socioeconomic factors, length and cost of the IC stay, culpability, disease state and length of survival after IC unit discharge effected their judgement of the usefulness of IC treatment for an individual patient. Results indicated that: (i) medical and nursing students felt IC treatment more useful than IC staff regardless of the patient characteristic; (ii) IC doctor and nurse responses were very similar; (iii) IC staff considered that IC treatment "tended to be useless" or was "useless" if the patient had required "institutional care", was in a "vegetative" state before or after IC treatment, belonged to the pathology groups of "malignancy" and "diseases of ageing", belonged to the diagnostic groups "AIDS" and "quadriplegia", or where survival post discharge from IC was expected to be "< 3 months"; and (iv) cost and length of stay in IC were not factors that negatively effected any groups perception of the usefulness of IC treatment.

Ethical decision-making in intensive care: a nurse's perspective

Technology has increased our ability to sustain life, but to what end? Ethical dilemmas abound in intensive care units (ICUs), but in the author's experience nurses are rarely formally involved in ethical decision-making. Should nurses be involved? This article is an attempt to answer this question by considering the unique position of an intensive care nurse, the stress caused by ethical dilemmas, the ethical and legal responsibilities of the nurse and the educational and psychological factors influencing the decision-making process. The current involvement of nurses in ethical decision-making is reviewed and a framework for ethical decision-making is suggested. Implications for education and practice are drawn from the discussion.

Empathy and technology in the coronary care unit

This paper explores the emergence of nursing in the mid 19th century as a 'caring' or 'curing' occupation. Nursing evolved as the discipline of caring whilst cure was the doctor's domain. Important though caring was, it was perceived as women's work and therefore of low status and considerably less powerful than the male dominated curing role. The definitions and practice of caring have changed since the Victorian era, but it continues to be perceived by many as secondary to medicine's curing role. The paper explores this issue in the speciality of coronary care nursing and also whether coronary care nursing is more 'cure' than 'care' orientated. Coronary care nursing began as a technological and physical speciality--more 'cure'-orientated than 'care'-orientated and this has led to the specialty being especially attractive to male nurses. However, since the purpose of CCU began as the prevention of death, and the possibility of death is an inescapable part of the nurses' work, the ability to be empathic is essential. The paper concludes that coronary care nursing appears to contain both 'curing' elements (technological/physical) and 'caring' elements (empathy), both of which are practised by many coronary care nurses. The 'cure' elements of physical observation, treatment and technological maintenance may still be perceived by some as of primary importance, however both technology and empathy emerge as essential and equal components in the provision of quality coronary care.

The influence of high technology care on patients, their relatives and nurses

This article focuses on the potentially dichotomous relationship of caring for critically ill patients in a high technology environment. Does technology enhance or hinder the quality of patient care delivered by nurses in such an environment? The discussion within this article is initially at a societal level before focusing at an interpersonal level within a specific care setting. The author argues for finding a balance between high technology and humanity within the intensive care environment by highlighting the psychological impact that this may have on patients, relatives and nurses. Guidance as to how a balance may be achieved is also provided. Technology is an explicit theme within the text, whilst the concept of power that technology holds is discussed in an implicit manner.

Advocacy in critical care--an evaluation of the implications for nurses and the future

Patient advocacy is now considered an integral part of a nurse's role, however there is continued debate concerning whether a nurse can ever truly represent patients' views and interests. The purpose of this paper is to examine why it is necessary for nurses in critical care areas to consider patient advocacy from professional, ethical and moral perspectives. First definitions of advocacy are reviewed, and this is followed by a critical evaluation of the legitimacy of the idea that nurses are the ideal health care professionals to be patient advocates. In conclusion key issues are identified and recommendations made for preparing future nurse advocates.