In 1961, Heinlein described a "stranger" from another planet struggling to comprehend and integrats the cultural idiosyncracles of earthlings in his adopted land. One could compare that situation with what confronts acute-care nurse practitioners (ACNPs) as they embark into the practitioner’s world of acuta care. Rather Irian embrace the expensive and fragmented patient-care world through coIlaboration with its "strangers," ACNPs would benefit from clinging to elements of their own native nursing culture and become “nesters” rathet than "perchers" in the quest for improved health care.
Futility is a complex concept with several possible meanings. It has become an important concept in acute care as situations arise in which patients or their families request interventions that caregivers believe serve no purpose. Resolving these dilemmas requires an understanding of the concept of futility, knowledge of empirical data relevant to the particular situation, and unambiguous communication. The definitions, criteria, and application of the concept of futility are presented, followed by a discussion of the implications of decisions about futile care for nurses and others
John S. is a 72-year-old patriarch of a large, extended family. He underwent a mitral and aortic valve replacement, followed by a complicated postoperative course. His recovery was complicated by hemodynamic instability, several cardiac arrests, acute renal failure, and sepsis. He has been in the ICU for 14 weeks and has been unable to wean from mechanical ventilation. After many conferences between the patient’s family and the ICU staff, a decision was made to remove ventilator support. This was done 3 days ago. John’s condition seems stable now, but it is clear that he will not regain his former state of health. He is very debilitated, may require chronic dialysis, and has suffered some anoxic brain damage during his arrests. The nursing and medical staff are now faced with the question of further withdrawal of treatment and are considering whether or not to discontinue his parenteral nutrition and all IV fluids.