Critical care nursing

The research pertaining to the delivery of nursing care in the ICU was reviewed to describe: the impact of the unit structure and organization, including policies and procedures, on patients, nurses, and families; the process of critical care nursing; the outcomes of critical care nursing; some of the ethical issues germane to the care of the critically ill patient. Although these areas of inquiry are quite diverse, a number of similarities can be identified. The most obvious of the similarities was that, with few exceptions, the studies pertaining to delivery of nursing care were performed by researchers from a variety of disciplines other than nursing, including medicine, psychology, public health, and economics. In many instances, such as the studies of patients' stress experiences in ICUs, these efforts enhanced our knowledge of the phenomena and complemented or replicated the efforts of nurse researchers. Unfortunately, in some areas nurse researchers were quite absent, with the result that the studies lacked a nursing perspective. For example, the large body of knowledge related to the effects of critical care on patient outcome reflected medicine's orientation toward cure. While it is important to measure the effect of nursing care in the ICU on patient survival, the effect of nursing efforts on short- and long-term quality of life, functional status, and health maintenance is also critical and remains unknown. Nurse researchers need to build on the data base already acquired about critical care. Even more important, they need to fashion programs of research focused on the concepts central to the discipline of nursing. A second similarity relates to the increasing quality of the reported research over the past decade. In general, early descriptive studies were conducted in a single critical care unit with a small and often biased sample. These gave way to more carefully designed, multicenter studies, although lack of randomization procedures continued to be a significant problem. Increasing attention was paid to the psychometric properties of instruments, and the validity and reliability of these instruments were appropriately discussed by the researchers using them. However, the area of family stress is a remarkable exception to this positive trend. Investigators also began to address the problem of sample homogeneity in some of the areas of inquiry by replicating their work outside the often favored CCU. The third and final similarity lies with the preponderance of descriptive studies in all areas reviewed.(ABSTRACT TRUNCATED AT 400 WORDS)