Considering the deeper aspects of Critical
Care Nursing: The overlooked foundation
of Caring and Healing.
Ayan Dalel Mack
Critical care and Trauma specialist
King Saud Bin Abdulaziz University for Health Sciences – Riyadh
Introduction
• Greek word for caring is CARITAS, which
means to cherish, to appreciate, and to give special attention
• The caring process is a deliberate choice
and it is a universal phenomenon that
Introduction
• Nursing involves interacting with a patient in
a complex process of teaching and learning. Lydia Eloise Hall ( 1963) , a nursing theorist, said that "any career that is defined around the work that has to be done, and how it is
divided to get it done, is a "trade" (rather than a profession).
Introduction
• In the critical care environment, non-urgent
care is often given low priority as staff focus on the bare essentials in an effort to keep patients safe.
• The nurses do not have time to care and
struggle daily with conflicting work demands
• The ability to be able to "nurse" patients has
Objectives
• Nurses’ perception of time devoted to
non-task oriented caring (Listening to the patient, support of moral and ethical decision making, Promoting patient well-being ) and what was perceived as facilitators/barriers to being
Methodology
• A non-experimental design was utilized, requiring the participants to answer open-ended survey questions that explored ICU nurses’ perceptions regarding time devoted to non-task oriented patient care .
• Written consent for the study was obtained from the nurses and the survey was handed out to a 90 RNs in both the Intensive Care and the ER Care units with 75% response rate.
Results
• 66 % of the nurses in the study had 9 years of
ICU/ ER experience, 29% had 5 years and 5% had 1.5 years.
• 51% of the respondents felt that time for non
task oriented such as listening to patient and family stories was lacking
• 49% felt there were limited time, but could
take the time to answer patient or family questions
Results
• 80% of the respondents stated that finishing
the task and looking after the patient’s
medical wellbeing was more important than emotional connection.
• Despite the fact that most nurses felt the lack
of adequately time for non task oriented care 95% felt that they valued caring as much as knowledge, but due to workload were unable to connect patients in a meaningful way.
Results
• 65% felt that Lack of communication between
services/MD and family when patients have various consulted physicians as well as the demands of their work task made impossible for them to be to be compassionate and
caring as they liked-they could not find time to care.
• 35% of the nurses said that they witnessed
uncaring behavior of colleagues and believed that there should be some kind of
Discussion
• “Actually caring and giving care is something
that people should be held accountable for. Getting a patient task oriented care requires that you care, however; nurses' daily struggle with conflicting demands has eroded much of the sense of satisfaction in a job well done
Discussion
• Nurses said that failure of leadership
complicated the lack caring matter. Accountability at the bedside is a self
governed attribute. Those who 'care' need to begin speaking up about the atrocities
occurring out there. Speaking up usually keeps you on the outside un-liked by the popular
crowd. Once exiled quality of work life goes down accordingly. So very few speak up.
Discussion
• Majority Many nurses felt there was a lack of
effective communication between physicians, nurses, and the families during patient care.
• Consider family conferences in a private
location. Increase proportion of time spent listening to families
• Develop supportive ICU/ER culture for ethical
Discussion
• Bedside Nursing staff has received many
compliments, but still need encouragement
and celebration as much as their counterparts such nursing researchers or education.
• Consider implementing non task oriented
care team
• Provide ICU/ ER nurses with the tools and
support to improve caring, remembering the bedside nurses are the experts
Discussion
• Technology have made some things easier but
has increased time spent away from the client.
• With these changes we must make sure that
we hold the caring and compassion along side the knowledge.
Recommendations
Patient-centred approach to improving the quality of care in acute care nursing units, by freeing up time for more direct patient care, thereby improving quality and efficiency of care, and enhancing patient safety is needed. This would increase patient satisfaction and safety, and improve work satisfaction and efficiency.
Conclusion
• Nurse should always be ready and available
for open exchanges for the patients
• You may have decided to be a nurse, thus you
have the responsibility to maintain the caring nature of nursing despite the workload.
• Providing presence is being in tune with your
patient---advocate quality time with your patients
Conclusion
• It is the same question that we came back to:
Is it possible to do the skills and tasks required of professional nurses well without emotional connection? Or is the emotional connection (i.e., caring) essential for doing the skills and tasks well?
Conclusion
• If caring is essential, how do we define it so
we can tell whether or not it is there? What does it look like, behaviorally? Can we ever achieve some consistency in defining and regulating?
Selected References
• George, J.B. (2000). Nursing Theories: The Base for
Professional Nursing Practice.
• Hall, L. E. (1963). Center for nursing. Nursing Outlook, 11,
804-806.
• Grandstaff, J., Gumm, S. Marriner-Tomey, A., & Peskoe, K. T.
(1994). Lydia E. Hall, core, care, and cure model. In Nursing theorists and their work (3rd ed., pp 138- ). St Louis: Mosby.
• Griffiths, P., & Wilson-Barnett, J. (1998). The effectiveness of
‘nursing beds’: A review of the literature. Journal of Advanced Nursing, 27(6), 1184-1192.
