When the going gets tough, the tough...
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Biomedical subjects
Publications and source records attributed to L L Curtin.
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Analysts hesitate to measure human services' productivity because crucial elements appear so intangible. Furthermore, during contacts or incremental exchanges, servor and served consume emerging products of mutual efforts as they are produced. The served, primarily the patient, inputs first a certain physical, psychosocial and economic status, then a stream of information and responses. The nurse, as the primary, inpatient servor continually present at the site of service exchange, personally applies certain professional competencies and material resources, schedules others' activities, diffuses technology, and gathers records and transmits information. The records nurses generate and/or keep can define leading indicators of all these inputs and their interrelationships. Thus, their various impacts upon nursing services--in general, in individual categories, and in individualized course--can be usably quantified. Outcomes, too, are definable through comparisons of actual results with common expectations shaped within the process and with the results achieved by others. Patient classification and staffing ratios are indicators of availability of a requisite variety of resources. Data on errors, recidivism and referrals act as reliability measures and also yield data on durability in achieving anticipated individual results. On this basis, the author proposes graded descriptions of factors conditioning productivity and a formula evaluating nursing's contributions to it.
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Nurses, individually and collectively, have an obligation to provide comprehensive and compassionate end-of-life care that includes the promotion of comfort and the relief of pain, and at times, foregoing life-sustaining treatments. The American Nurses Association (ANA) believes that the nurse should not participate in assisted suicide. Such an act is in violation of the Code for Nurses with Interpretive Statements (Code for Nurses) and the ethical traditions of the profession. There is a continuum of end-of-life choices that encompasses a broad spectrum of interventions from the alleviation of suffering, adequate pain control, do-not-resuscitate orders, withdrawing/withholding artificially provided nutrition and hydration, to requests for assisted suicide and active euthanasia. Throughout this continuum nurses can respond to patients with compassion, faithfulness and support. Yet, nurses must understand the subtleties and distinctions of these issues in order to respond in a reasoned and ethically permissible manner.
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