Intensive care or merely therapy?
Article Outline
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 requiring intensive care or therapy are at their most vulnerable, often unable to perform the most basic of human functions 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 compassion. 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 inextricable 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 interventions 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 paradoxical 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 discusses 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 practised in purpose-built hospitals served by armies of paramedics, technicians, ancillary staff, managers, accountants, fund-raisers and other white collar workers, all held in place by rigid professional hierarchies and codes of conduct. In the light of this massive bureaucratisation, 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 publications alone do not demonstrate the adequate provision of nursing care. The Point of Care Review Paper and the aforementioned editorials throw a challenge to nursing to reflect on what our patients and their relatives; and what we as a profession consider caring to be in the 21st century. Intensive care nurses must rise to that challenge; we may then be able to confidently state that we provide intensive care and not merely therapy.
References
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PII: S0964-3397(09)00002-0
doi:10.1016/j.iccn.2009.01.001
© 2009 Elsevier Ltd. All rights reserved.
