Intensive care or merely therapy?
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Intensive and Critical Care Nursing (2009) 25, 55—56 available at www.sciencedirect.com journal homepage: www.elsevier.com/iccn EDITORIAL Intensive care or merely therapy? The names ‘intensive care’ and ‘intensive therapy’ units along with their abbreviations ICU and ITU, are often used interchangeably, should this be so? The word ‘care’ describes the act of looking after and being concerned about another individual, whereas ‘therapy’ is about the treatment or actions one might need to become well. Patients requir- ing intensive care or therapy are at their most vulnerable, often unable to perform the most basic of human func- tions adequately. These patients require excellent therapy or treatment and they have the right to expect treatment to be provided in a caring manner, with kindness and compas- sion. This suggests that act of ‘therapy’ should be subsumed within the acts of ‘caring’. Phenomenological studies have highlighted the meaning of caring to the intensive care nurse, linking inextrica- ble therapy and caring. Beeby (2000) suggests that caring involves physical, technical and emotional labour: good care results from an empathetic rapport between the nurse and the patient without which care is reduced to just ‘doing to’ rather than ‘being there’ for the patient. Similarly, Wilkins and Slevin (2004) propose that caring is an essential function of intensive care nursing, enabling individualised interven- tions to meet the patients’ needs and that mastering the technology enables rather than limits caring. Walters (1995) proposes that nurses work to balance the apparent paradoxi- cal relationship between technology and care by humanising the patient through making the ‘person’ visible. Recent editorials have questioned the ability of nurses to deliver the caring part of the nursing role (Corbin, 2008; Griffiths, 2008; Scholes, 2008). Specifically, management bureaucracy limits the time available to care (Scholes, 2008), increasing technology threatens the ability of nurses to care (Corbin, 2008) and that caring for suffering people is hard (Griffiths, 2008). Corbin (2008) argues that caring has ‘to be put into practice through behaviours that address the specific needs of the person being cared for. Needs that can only be known by getting in touch with the ‘‘person’’ behind the ‘‘patient’’’. A recent Kings Fund review (Goodrich and Cornwell, 2008) reflects on the experience of patients in English hospitals, highlighting the issue of a perceived lack of care and compassion. The report is divided into three sections, each addressing a different area. The first section describes the experience of patients as evidenced by patient stories, surveys and complaints, interestingly these provide a contradictory picture that leads the authors to suggest that further more detailed data is required in order to understand this complex sphere. The second section dis- cusses the language of the patient experience, discussing in particular the themes of quality and patient centred care. It reports on research demonstrating the understanding of language attributed to these themes by healthcare professionals. The final section recommends some possible solutions. The report was informed by the Point of Care Programme (www.kingsfund.org.uk/current projects/the point of care/index.html) that reviewed the available literature and commissioned qualitative research with staff, patients and families. The introduction is preceded by a quote from Porter (2002) that provides the reader with an excellent induction into what is to come. ‘‘In our times, cutting-edge medicine has been prac- tised in purpose-built hospitals served by armies of paramedics, technicians, ancillary staff, managers, accountants, fund-raisers and other white collar work- ers, all held in place by rigid professional hierarchies and codes of conduct. In the light of this massive bureau- cratisation, it is a small wonder that critiques once again emerged. The hospital was no longer primarily denounced, however, as a gateway to death but as a soulless, anonymous, wasteful and inefficient medical factory, performing medicine as medicine demanded it, not as the patient needed it.’’ Despite this not being a publication directly related to intensive care nursing, there is much in here for intensive care nurses to both reflect and act upon. Judging by the range of manuscripts published in the Journal of Intensive and Critical Care Nursing there is much to be celebrated in intensive care nursing, however publi- cations alone do not demonstrate the adequate provision of nursing care. The Point of Care Review Paper and the afore- mentioned editorials throw a challenge to nursing to reflect 0964-3397/$ — see front matter © 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.iccn.2009.01.001
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Transcript of Intensive care or merely therapy?
Intensive and Critical Care Nursing (2009) 25, 55—56
avai lab le at www.sc iencedi rec t .com
journa l homepage: www.e lsev ier .com/ iccn
EDITORIAL
Intensive care or merely therapy?
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The names ‘intensive care’ and ‘intensive therapy’ unitsalong with their abbreviations ICU and ITU, are often usedinterchangeably, should this be so? The word ‘care’ describesthe act of looking after and being concerned about anotherindividual, whereas ‘therapy’ is about the treatment oractions one might need to become well. Patients requir-ing intensive care or therapy are at their most vulnerable,often unable to perform the most basic of human func-tions adequately. These patients require excellent therapyor treatment and they have the right to expect treatment tobe provided in a caring manner, with kindness and compas-sion. This suggests that act of ‘therapy’ should be subsumedwithin the acts of ‘caring’.
Phenomenological studies have highlighted the meaningof caring to the intensive care nurse, linking inextrica-ble therapy and caring. Beeby (2000) suggests that caringinvolves physical, technical and emotional labour: good careresults from an empathetic rapport between the nurse andthe patient without which care is reduced to just ‘doing to’rather than ‘being there’ for the patient. Similarly, Wilkinsand Slevin (2004) propose that caring is an essential functionof intensive care nursing, enabling individualised interven-tions to meet the patients’ needs and that mastering thetechnology enables rather than limits caring. Walters (1995)proposes that nurses work to balance the apparent paradoxi-cal relationship between technology and care by humanisingthe patient through making the ‘person’ visible.
Recent editorials have questioned the ability of nurses todeliver the caring part of the nursing role (Corbin, 2008;Griffiths, 2008; Scholes, 2008). Specifically, managementbureaucracy limits the time available to care (Scholes,2008), increasing technology threatens the ability of nursesto care (Corbin, 2008) and that caring for suffering people ishard (Griffiths, 2008). Corbin (2008) argues that caring has‘to be put into practice through behaviours that addressthe specific needs of the person being cared for. Needs that
can only be known by getting in touch with the ‘‘person’’behind the ‘‘patient’’’.A recent Kings Fund review (Goodrich and Cornwell,2008) reflects on the experience of patients in Englishhospitals, highlighting the issue of a perceived lack of care
Jtcnm
0964-3397/$ — see front matter © 2009 Elsevier Ltd. All rights reserved.doi:10.1016/j.iccn.2009.01.001
nd compassion. The report is divided into three sections,ach addressing a different area. The first section describeshe experience of patients as evidenced by patient stories,urveys and complaints, interestingly these provide aontradictory picture that leads the authors to suggesthat further more detailed data is required in order tonderstand this complex sphere. The second section dis-usses the language of the patient experience, discussing inarticular the themes of quality and patient centred care.t reports on research demonstrating the understandingf language attributed to these themes by healthcarerofessionals. The final section recommends some possibleolutions. The report was informed by the Point of Carerogramme (www.kingsfund.org.uk/current projects/theoint of care/index.html) that reviewed the availableiterature and commissioned qualitative research withtaff, patients and families. The introduction is precededy a quote from Porter (2002) that provides the reader withn excellent induction into what is to come.
‘‘In our times, cutting-edge medicine has been prac-tised in purpose-built hospitals served by armies ofparamedics, technicians, ancillary staff, managers,accountants, fund-raisers and other white collar work-ers, all held in place by rigid professional hierarchies andcodes of conduct. In the light of this massive bureau-cratisation, it is a small wonder that critiques onceagain emerged. The hospital was no longer primarilydenounced, however, as a gateway to death but as asoulless, anonymous, wasteful and inefficient medicalfactory, performing medicine as medicine demanded it,not as the patient needed it.’’
Despite this not being a publication directly related tontensive care nursing, there is much in here for intensiveare nurses to both reflect and act upon.
Judging by the range of manuscripts published in the
ournal of Intensive and Critical Care Nursing there is mucho be celebrated in intensive care nursing, however publi-ations alone do not demonstrate the adequate provision ofursing care. The Point of Care Review Paper and the afore-entioned editorials throw a challenge to nursing to reflect
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Deborah Dawson
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n what our patients and their relatives; and what we as arofession consider caring to be in the 21st century. Inten-ive care nurses must rise to that challenge; we may thene able to confidently state that we provide intensive carend not merely therapy.
eferences
eeby J. Intensive care nurses’ experiences of caring. Intensive andCritical Care Nursing 2000;16(3):151—63.
orbin J. Is caring a lost art in nursing? International Journal ofNursing Studies 2008;45(2):163—5.
oodrich J, Cornwell J. Seeing the person in the patient: The Pointof Care review paper. London: The Kings Fund; 2008.
riffiths P. The art of losing. . .? A response to the question ‘iscaring a lost art?’. International Journal of Nursing Studies2008;45:329—32.
Editorial
orter R. Blood and guts: a short history of medicine. London: AllenLane; 2002.
choles J. Why health care needs resilient practitioners. Nursing inCritical Care 2008;13(6):281—5.
alters A. A Heideggerian hermeneutic study of the practice ofcritical care nurses. Journal of Advanced Nursing 1995;21(3):492—7.
ilkins K, Slevin E. The meaning of caring to nurses: an investigationinto the nature of caring work in an intensive care unit. Journalof Clinical Nursing 2004;13(1):50—9.
Associate Editor
St George’s Hospital, St George’s Hospital NHS Trust,GICU, 1st Floor St Jame’s Wing,
London SW17 0QT, United KingdomE-mail address: [email protected]
