[Thoughts on nursing, based on observations made in a Rome intensive care unit]

Nursing in an intensive care unit is probably one of the most extreme and demanding forms of nursing. Here, the nurse is confronted by the highly dependent patients and the demanding technological forms of treatment associated with them. The most demanding challenge for the nurse doesn't arise from the technology but from her dealing with the weak and defenseless party: the patient. Many nurses argue that their major difficulties are the result of poor working conditions, with poor staff to patient ratios, and the need to carry out physicians orders promptly and efficiently. The following article, in focusing on concepts of shame and authority, reflects on the nurse-patient-doctor relationship and argues that the challenges that confront the nurse go beyond those of the poor staff to patient ratio etc. and are indeed tied strongly to the behaviour patterns, and subsequent patterns of care, as perpetuated by the institutions and often, by the nurses themselves.