Critical care
Critical care units in hospitals are a relatively recent phenomenon. Such units could not have developed without a host of technological advances in life-support equipment. The actual units were generated in response to epidemics that required the widespread use of this technology. A dramatic example was the worldwide poliomyelitis epidemic of the 1950s. During this epidemic, many young, previously healthy patients stricken with polio required breathing machines to avoid death from acute respiratory failure. Doctors and nurses were specially made available to deliver such intensive care.
To attain technological competence, critical care nurses must use discretion in care, independent judgment, communication and technical skills, and communicate frequently with physicians. Indeed, such communication is so integral to patient management in critical care units that both the American Association of Critical Care Nurses and the Society of Critical Medicine have incorporated into their mission statements assertions that professional collaboration is essential to critical care practice.
The channels that relay information to, and among, patients, families and physicians are complex. Many times, families, experiencing the crisis of having a critically ill relative need information repeated or framed in a different way. In addition, physicians frequently rely on nurses to ensure that timing is optimal for giving the family updates on a patient's condition.
Dr. Jezewski (Do-Not-Resuscitate Status: Conflict and Culture Brokering in Critical Care Units. Heart & Lung, 1994) suggested that critical care nurses are "culture brokers", bridging the complex cultural environment of the critical care unit between the physicians, patients and families. When patients, families and caregivers share common perceptions and goals, this particular role is often simplified to that of translator, ensuring that communication is timely, accurate and consistent. In contrast, when the perceptions and goals are dissonant, the brokerage role often requires nurses to assume additional responsibility of arbitration and diplomacy.
When critical care physicians and nurses believe that a patient's demise is evident, they tend to reformulate their priorities. The collaborative goals focusing on recovery change to ensuring a peaceful death. Frustrations easily arise when one believes that death is inevitable, and either the patient's family is in denial or the physician does not agree that the patient's condition is terminal.
The focus on the idea of accountability for the imminent death will be discussed at the 12th Congress of Western Pacific Association of Critical Care Medicine, Bali, Aug. 21 through Aug. 25. For further information, please contact the WPACCM Headquarter at Pacto Convex Ltd., Jakarta Hilton International Lagoon, Tower Level B1. Ph: (021) 570 5800. Fax: (021) 570 5798. E-mail: pactoltd@idola.net.id.
DR. HAFIL B. ABDULGANI
Jakarta