Critical Care Research: Weaving a Body-Mind-Spirit Tapestry

Our favorite unproven ideas for future critical care

The future of critical care medicine will be shaped not only by the evidence-validated foundations of science, but also by innovations based on unproven and, in many cases, untested concepts and thoughtful visions of scientists and clinicians familiar with the complex problems actually faced in clinical practice. Clinical investigations and trials often lag behind collective experience and impressions, in a well-intentioned and necessary quest to determine the fallacy or validity of ongoing practice. Progress made in this way can be painfully slow, and imperfect theory may prove difficult to challenge. On occasion, an innovative paradigm shift fostered by a novel approach can reorient the forces of academic investigation toward generating an evidence base upon which such concepts and interpretations can find scientific justification. This discussion presents a selected set of ideas to improve the future practice of critical care - each having a defensible rationale, but unconfirmed validity.

Innovative solutions: family presence at codes: a protocol for an oncology unit

Family presence at codes is a concept that often elicits differing opinions from healthcare workers with regard to implementation, evaluation, and efficacy of the process. The oncology nursing service at Banner Good Samaritan Medical Center created a protocol to operationalize the guidelines of family presence at codes. The protocol was based on the Emergency Nurses Association guidelines from 2001 and modified to complement the current practice environment and culture of the units. Evaluation surveys were created for both the family members present and staff involved in the process.

Biobehavioral measures in a critical-care healing environment

Critical-care settings have an opportunity to create healing environments (HEs). For the last decade, achieving this goal has been the task of the American Association of Critical Care Nurses. Today, several models used in these settings embrace synergistic care, healing therapies for patients, and the development of organizational models to improve the HEs for nurses themselves. Creating the HE is not impossible; however, researching the patient's experience within it is complex. This complexity requires researchers to consider biological, behavioral, and social variables on the unit. This article will describe biological and behavioral measures that may be used to examine the critically ill patient's response to an HE. Limitations of these measures are considerable. Future researchers will need to consider a multiplistic approach to the study of this construct.

Health care practices, professions and perspectives: A case study in intensive care

This paper makes the case for bringing empirical analysis to the heart of conceptual work about health care practice. Drawing on ethnographic observations in intensive care units in the UK, it identifies and analyses a mismatch between the practice of a particular health care specialty and its associated professional and academic discourse. As a result, two claims in academic nursing discourse are criticised: first, that nursing practice is (or should be) focused on individual patient care; and second, that nursing is (or should be) radically distinct from medicine. By raising the analytical profile of situated practice, health care workers (in particular, but not exclusively, nurses) are shown to undertake important caring work with patients' relatives. Their work includes caring not only for an individual patient's social self, but also for patients'social contexts. The paper also argues that theoretical emphases on nursing's unique perspective and on differences between medicine and nursing are exaggerated in clinical practice, for example there are many similarities between what nurses and doctors actually do. Reasons for the persistence of these claims in academic nursing discourse are put forward-nursing seems to be quite unusual in needing an explicit theory of practice, and the paper speculates on why this is the case. The general lesson of the paper is that analytical evidence about the context and content of practice needs to be afforded a more fundamental role in the development of theories about practice-based disciplines.