Critical caring. Promoting good end-of-life care in the intensive care unit.

Changing the culture in the ICU to include palliative care interventions along with curative interventions is already underway. Further work is needed, however. This is a role for the critical care nurse. Critical care nurses can be involved in research and education to enhance their future practice in end-of-life care. Research to establish evidence-based protocols for use in patients who require palliative care in the ICU needs to be done. Critical care nurses can prepare themselves for carrying or dying patients by attending palliative care seminars and continuing education courses or by taking a short clinical sabbatical or internship in a local hospice to observe and help give end-of-life care. Hospice nurses can be invited to the ICU to give inservice sessions and to help nurses and other staff understand the transition to dying, including the services that need to be offered to the patient and the family. Nurses from the hospital palliative care team can consult and be available for follow-up. Promoting good end-of-life care should be a goal for all intensive care nurses and critical care units. This goal is reached one patient at a time.

In-hospital care and post-hospital followup.

PIP: Guidelines are given for nurses and social workers involved in abortion care before and after the in-hospital procedure. The California Nurses' Association Maternity Conference Group established guidelines for such care in October, 1970 as follows. The nurse should keep the patient informed of all aspects of the procedure, provide a supportive presence, perform standard physical monitoring during the operation and afterwards, provide contraceptive counseling, and act as a sounding board for discussion of interpersonal relationships and future plans. High quality nursing requires understanding the physical and psychosocial aspects of abortion reflecting the nurse's recognition of the cultural, religious, and socioeconomic factors involved. This requires a nurse who is fully aware of her own feelings and can adapt or defer them to the patient's needs. In cases of suction or dilation abortions, these actions are particularly important, since the patient is in the hospital only a short time and can be easily ignored. In cases of saline infusion, the nurse should be fully aware of possible complications, including retained placentae, hemorrhage, infection, or uterine perforation. If the patient is readmitted for any of these complications, the nurse should continue to play the informative, supportive role. The nurse and social worker should also be aware of the possible psychological sequelae of abortion and watch for mental health problems. It is concluded that postabortion counseling is the best time for contraceptive counseling. Conscientious professional support along these guidelines should insure a positive experience for the abortion patient.^ieng