Critical Care, Technology, Ethics

by Scott Erdley

A course I've taught at UB dealt with issues of the critical care environment, technology, and ethics.

We read a book called Bed Ten. It's not a new book, but it's important. It was written by a nurse who got a disease called Guillian-Barre, which is a progressive, debilitating, paralyzing condition. It starts at the feet; it works its way up the body. It can go all the way up to the neck. Then it goes back down, and you may or may not have residual effects from it.

During that time frame, you're trapped in a non-cooperative body and environment. The author writes about her experiences as a patient in a critical care unit with this condition. The book is very insightful, because it addresses issues that nurses have often taken for granted: issues of choice, stimulation, conversation, including the patient when you talk to them. Turning the lights out when you go at night. Letting visitors come in when they have time, not when you need to have them in there.

Regarding technology, the earliest example that you can really think of is the stethoscope. A gentleman rolled up a piece of paper, put it to the chest of a patient, voila. The stethoscope was born. Pretty cool. We went on to develop questions about technology and ethics. Have we lost the humanness in an environment that's all bells and whistles?

For example, you may be asked to care for multiple patients, depending upon their severity. In the next room you can bring up a screen and see how your patients next door are doing, from a vital signs standpoint. You are doing remote care. Does that excuse you from paying other kinds of attention to the patients?

Other examples: you do a lab test. It generally means that you have to do something about your findings. At what point do you ignore lab results? What about the DNR, the Do Not Resuscitate order, in the highly technological environment of a critical care unit?

I found the class very refreshing. Our discussions blended ethics with personal issues, and they brought out the fact that students now are an interesting mix. More of them than ever before are going into nursing as a second career, so the median age is higher.