Early on in my Edinburgh residency, I met
Susanne Kean, a former critical care nurse and now a research academic. It was
Susanne who first sparked my interest in the world of intensive care, a thread
that has run through my writing over the past few months. Over coffee that
morning, she talked about the experience of the patient in ICU, mentioning delirium as one of the worst aspects.
‘What’s the difference between delirium and
dreaming?’ I asked.
‘You can wake up from a dream.’ said
Susanne.
It reminded me of a time, years ago, when
my father was in intensive care in Dublin. The line our family took was that his
delirium was a kind of blessing – he knew nothing of his illness, was ‘out of
it’ in a dream of his own making. Looking deeper into the ICU experience I now realise
we were comforting ourselves with a falsehood. Delirium is more usually
terrifying for patients, nightmarish, and incorporates strange interpretations
of the uncomfortable procedures necessary for their medical care. Patients
often think they have been kidnapped, or subjected to torture.
Susanne’s current work is to look at the experience
of ICU survival for patients and their families. When I asked what had
motivated her to enter nursing, it turned out that concerns of families and
intensive care were there from the very start. When Susanne was eight , her
two-year old brother became dangerously ill with meningitis. At that time,
children were not allowed to visit the ICU, so Susanne and her sister knew what was happening only through
witnessing the upset of their parents. She hated being excluded and she
resolved to become a nurse.
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| "I am the knitting one – this being ‘in’ in the 1980s. The other two are my friends and we were waiting for exams. We had to ‘dress up’ for those." |
Susanne graduated in Germany in the 1980s, when
the hospital system was very task based – wards served 38 to 50 people, which
meant taking up to 50 blood pressures or temperatures each round, and not
getting to know the patients very well at all. She then moved to Switzerland
where a very different system was in operation. Nurses looked after all the
needs of fewer patients, and planned the care with the patients. It was a
radical change for Susanne, who at first found the new system very slow, until
she realised it was not about completing tasks in an efficient time, it was
about basing care around the patients needs, rather than the system’s. This
principle has defined her work ever since.
This interest in developing a quality
relationship with her patients brought Susanne into intensive care nursing,
where there is a one-to-one relationship between nurse and patient. I’m struck
by the way that Susanne, throughout her career, has constantly moved forward,
questioning the way healthcare is practiced and searching for ways to improve
the experience of patients.
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| "Shift handover in our kitchen. I was working as a nurse on a septic surgical ward and loved it! The other person is our charge nurse." |
Her bedside nursing career ended when she
developed back problems – sadly common among nurses. She went into management
and teaching, but was soon drawn to the relatively new area of nurse-led
research. Britain was further
ahead of Germany in the development of this and Edinburgh University was
especially strong. Susanne learned English to access the research and did her
Masters, and Phd here. ‘Research gives you evidence, and evidence gives you
clout.’ she says. ‘Otherwise, people will not listen to you.’
She is now part of the inter-disciplinary
critical care research group based in the School of Health in Social Science,
carrying out a ‘longitudinal’ study looking at how patients who survive the ICU
experience fare over time, not only their physical health, but the
psychological, emotional and social effects of the stay. A recurring theme of her interest is
not just the patient’s health, but also the effect on the families and circles
of friends who support the survivor.
‘An important but invisible aspect of
nursing is establishing a relationship with the patient. In an ICU it is
difficult to establish a relationship with the patient as they are normally sedated
and attached to a ventilator which prevents speech. Even so, you talk to them,
explain what you are doing, even if you don’t know if they hear you or what
they can make sense of.’
In this setting, families provide the opportunity
to get to know the patients.
‘In an ICU you don’t withdraw when the
family visits, you have to stay with your patient. Nurses get to know family
members well, and the families have someone on hand to talk to about the
patient’s condition.'
'Families are fascinating. Each family
member is different, and have different needs. One may want to know absolutely
everything in the tiniest detail, others want to know no
more than the general direction we are travelling in. Balancing those needs in
a single communication is difficult, but they are part of the story, they are
the people we discharge the patient to, you need to include them.'
A lot has changed since Susanne was kept
from her tiny brother’s bedside by a system more concerned with it’s own
efficient running than the wider effects on the families concerned. A stay in
ICU is always a traumatic event, and the ripples of that event change patients
lives for a long time, and those of their friends and family too.
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| "I grew up and for a while I loved to ride motorbikes. This was while working in ICU!" |
