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To the Editors:
Having read the November 2005 issue, there are several things I want to address. My colleague, M. Jean Reed, RN/BSN, and I conducted extensive research over 2 years’ time on end-of-life care in our ICU. Not only did we identify the ongoing lack of communication between nurses/physicians and families, we noted the significant increase in indirect costs when life is prolonged without a goal, an end point, or any realistic hope of improvement. Projected savings over the course of a year, if the program we designed had been put into place, was estimated in the millions.
In the journal articles, the authors make a specific distinction between ICU end-of-life issues and palliative care. We wholeheartedly agree. They are not, and have never been, the same thing. This was always difficult to make people understand in the course of our research and development of the Family Support Services program, and it continues to be an issue as evidenced by the hesitancy of our administration to implement a distinctive end-of-life program for the ICU. The people with the authority to implement change continue to be intimidated by a litigious society and are afraid to do what is morally right out of the fear that it may initially be unpopular.
The editorial in the November issue stated, "We believe that end-of-life issues in the ICU are among the most serious problems facing the nursing and medical professions today." That statement has huge implications for the future of ICU clients and their families. Nurses have been leaving the profession altogether because of issues of moral frustration; this will contribute significantly to an already evident nursing shortage unless something is done.
Our 26-bed unit, at any given time, has between 4 and 8 patients who we would say require the services we wish to provide. This number amounts to an average of 6 patients per week whose suffering is needlessly prolonged, whose families are horribly uneducated and uninformed and "unsupported" in this most difficult time. One of our favorite mottos is "Just because something can be done, doesn’t mean it should be done."
The human body is a machine. The machine eventually breaks down, wears out, and parts go "haywire" and cannot be repaired. We need to educate the public that this is normal, that life is a circle, not an indefinite straight line. We need administrative support to do that and a willingness to stick our collective neck out to do the right thing.
My colleague and I are determined to effect change, one way or another. We continue to pursue other avenues in hopes of shifting the long-standing paradigm of end-of-life care in the ICU. The articles published go a long way in supporting our efforts and have helped us to remember that we are not alone in our quest for change. So thank you, and wish us luck.
Mount Holly, NJ
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