Icu Nurses
Running head: RESEARCH PAPER
Research Paper
Darrell Ragan
Valdosta State University
School of Nursing
Dr. Maura Schlairet
Nov 23, 2008
Intensive care units (ICUs) were designed to provide highly skilled, lifesaving nursing care to viable patients with acute illnesses or injuries. Patients with chronic and/or terminal illness were not expected to be admitted to these units, with the possible exception of acute exacerbations of reversible complications. Patients whose care needs changed from curative to palliative were intended to be transferred out of critical care to patient care environments more suited to end-of-life care. However, as more patients become “chronically critically ill”, critical care nurses are being asked more often to provide care to patients on their deathbeds (Puntillo et al., 2001). Deciding which ICU patients are actually dying remains an extremely inexact science, and the transition to palliative care is not one easily made. ICU mortality rates are as high as 69% (Puntillo et al., 2001); almost 20% of Americans die in intensive care units (Hodde, Engelberg, Treece, Steinberg, & Curtis, 2004). The majority of patients who die in ICU have had DNR orders written, many of them within a day or two of their deaths. There are a number of reasons these patients are not transferred out: it may be too disruptive to the patient and/or family; there may be no appropriate bed available; or the level of care may still be such that a med/surg or hospice-type floor is not equipped or staffed to handle it (Puntillo et al.). Evidence shows that end-of-life care in ICUs is highly inconsistent, indicating that caregivers are not in agreement on how best to care for this patient population. There is evidence that dying patients experience inadequate relief of pain and other undesirable symptoms, and also that their wishes concerning end-of-life care are not always taken into account (Hodde et al.) Most ICU nurses did not enter
Research Paper
Darrell Ragan
Valdosta State University
School of Nursing
Dr. Maura Schlairet
Nov 23, 2008
Intensive care units (ICUs) were designed to provide highly skilled, lifesaving nursing care to viable patients with acute illnesses or injuries. Patients with chronic and/or terminal illness were not expected to be admitted to these units, with the possible exception of acute exacerbations of reversible complications. Patients whose care needs changed from curative to palliative were intended to be transferred out of critical care to patient care environments more suited to end-of-life care. However, as more patients become “chronically critically ill”, critical care nurses are being asked more often to provide care to patients on their deathbeds (Puntillo et al., 2001). Deciding which ICU patients are actually dying remains an extremely inexact science, and the transition to palliative care is not one easily made. ICU mortality rates are as high as 69% (Puntillo et al., 2001); almost 20% of Americans die in intensive care units (Hodde, Engelberg, Treece, Steinberg, & Curtis, 2004). The majority of patients who die in ICU have had DNR orders written, many of them within a day or two of their deaths. There are a number of reasons these patients are not transferred out: it may be too disruptive to the patient and/or family; there may be no appropriate bed available; or the level of care may still be such that a med/surg or hospice-type floor is not equipped or staffed to handle it (Puntillo et al.). Evidence shows that end-of-life care in ICUs is highly inconsistent, indicating that caregivers are not in agreement on how best to care for this patient population. There is evidence that dying patients experience inadequate relief of pain and other undesirable symptoms, and also that their wishes concerning end-of-life care are not always taken into account (Hodde et al.) Most ICU nurses did not enter
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