Freda DeKeyser Ganz, PhD, RN
As an Intensive Care Nurse Researcher, I am particularly interested in studying all aspects of the critical care environment. This includes interactions within the medical and nursing staff such as the work environment, bullying, and inter-professional decision making. I have found that most interactions between physicians and nurses in the ICU involve the exchange of information that rarely includes discussions related to significant clinical and ethical aspects such as end-of-life decision making.
I have also studied end-of-life issues in the ICU. Up to 20-30% of ICU patients die in the ICU, the majority of which after a decision was made to alter the goals of care from cure to comfort or palliative care. My colleagues and I at the Israeli Cardiology and Critical Care Nursing Association have developed and researched the effects of a 112 hour course that introduces the use of Palliative Care into the ICU. We found that as a result of the course, nurses were empowered to initiate palliative care on their units. This model of introducing palliative care at a grass roots level is different than the usual consultant model. The effectiveness of this grass roots or 'integrative' model is also being studied by a doctoral student of mine on Multiple Myeloma patients.
The palliative care approach to patient care includes symptom management as well as the inclusion of family members as an integral part of patient centered care. I have also studied family centered care and family centered communication and its effects on patients and their family members. Lack of such communication can lead to questionable and even unethical clinical care behaviors. Healthcare team members often find themselves conducting partial cardiac resuscitations (coined 'slow or show codes'), considered as unethical. We have found that nurses in Israel attest to the use of such resuscitations, most often due to the breakdown of good communication between practitioners and family members. Other students are investigating other aspects of patient centered care such as discomfort in the ICU or the effectiveness of a tailored approach to patient education.