Emory researcher illuminates history of critical care nursing

If you read through the research reports in the nursing literature, you can find information on the procedures developed over the past few decades to advance the care of premature infants and monitor the heart rhythms of cardiology patients. If you study a hospital's records, you can find out how many patients spent how many hours in the ICU in a given year, and what procedures their nurses performed for them.

What you don't find in either place is a sense of what it's like to have an infant go into cardiac arrest and die after you have cared for her during all of your shifts for three weeks, or what a nurse feels when the family members of a dying patient don't understand why he must be continually poked and prodded during the last hours of his life. Capturing these kinds of experiences is the main purpose of the recently published book, Caring in Crisis: An Oral History of Critical Care Nursing by Emory nurse researcher Jacqueline Zalumas.

Zalumas, a nurse practitioner and clinical instructor in the Department of Family and Preventive Medicine at the Southeast AIDS Training and Education Center in the School of Medicine, conducted her oral history research on critical care nurses for her doctoral dissertation in the Institute of Liberal Arts. The work was subsequently published last year by the University of Pennsylvania Press.

Her interviews with 25 current and former critical care nurses from 20 states provide some in-depth insight into their experiences from critical care nursing's emergence in the 1960s through its evolution during the 1970s and 1980s. "I wanted to look at the intimacy of the nurse-patient interaction as medical technology progressed and ethical issues developed," said Zalumas. That's just what the study presents in the voices of the nurses who lived the experiences.

The interviews, which each lasted one to two hours, were conducted over a 13-month period in 1987 and 1988. They began with each subject giving an overall sketch of his or her life, and then focused on five major areas: the attitudes and values of the nurse, nursing education, nursing practice, technology and ethical dimensions of practice. The nurses were asked to provide specific clinical examples and personal experiences to illustrate points they made in their responses. The interviews were tape recorded and transcribed, and then a content analysis was performed on the interview data.

Zalumas states in her introduction that the nurses "very openly discussed their experiences, impressions and beliefs about critical care nursing." She also says that in conducting these interviews, she felt that "this research provided their first opportunity to speak so openly and in such detail about the meaning of nursing in their lives."

After the introduction, the book provides a history of the development of the concept of critical care, which emerged after World War II, and the second chapter presents nurses' stories that illustrate the issues raised in that first historical chapter. In chapter three, the nurses' motivations, satisfactions and frustrations with nursing care are explored, and in chapter four the ethical issues that the nurses identified as most important are discussed, including death with dignity, withdrawal of life support, organ transplantation issues, and quality of life issues concerning allocation of resources and decision making. The final chapter examines the underlying themes found running through- out the diverse topics covered in the interviews.

One interesting fact this research uncovered about the early development of critical care nursing was that these nurses had to take upon themselves the task of learning how to use the new technology that was making critical care possible. Zalumas explains that nurses told her how new techniques would be demonstrated to them once, and then they were responsible for them there-after.

She also found that the factors that nurses identified as the most stressful about critical care, such as getting personally involved with patients' families, were the same ones said to be most rewarding. Perhaps the most significant conclusion reached by the study, and the one that best sums up the experiences of critical care nurses, is stated in the book's final chapter: "The nurse became the most persistent treatment figure in the critical care unit because of skill, competence in judgment and round-the-clock presence."

--Peter Link, reprinted with permission of Nursing Research

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