Towards definitions of critical illness and critical care using concept analysis

Objective As critical illness and critical care lack consensus definitions, this study aims to explore how the concepts are used, describe their defining attributes and propose potential definitions. Design We used the Walker and Avant stepwise approach to concept analysis. The uses and definitions of the concepts were identified through a scoping review of the literature and an online survey of 114 global clinical experts. Through content analysis of the data we extracted codes, categories and themes to determine the concepts defining attributes and we proposed potential definitions. To assist understanding, we present model, related and contrary cases concerning the concepts, we identified antecedents and consequences to the concepts, and defined empirical referents. Results The defining attributes of critical illness were a high risk of imminent death; vital organ dysfunction; requirement for care to avoid death; and potential reversibility. The defining attributes of critical care were the identification, monitoring and treatment of critical illness; vital organ support; initial and sustained care; any care of critical illness; and specialized human and physical resources. Our proposed definition of critical illness is, a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility. Our proposed definition of critical care is, the identification, monitoring and treatment of patients with critical illness through the initial and sustained support of vital organ functions. Conclusion The concepts critical illness and critical care lack consensus definitions and have varied uses. Through concept analysis of uses and definitions in the literature and among experts we have identified the defining attributes of the concepts and propose definitions that could aid clinical practice, research, and policy making.

Irish Bards in Shakespeare’s Richard III and As You Like it

Shakespeare alludes twice to Irish bards. In Richard III, the king mentions a prophecy by one of his imminent death; in As You Like It, Rosalind jokes on how Irish bards can supposedly rhyme rats to death. Both refer to supposed bardic powers of seeing the future and of ritual cursing of enemies. A survey of the literature shows satire and prophecy as going back to ancient times. There is in addition ample material on the (sometimes deadly) effects of satire in medieval and later Ireland, where it is known from chronicles, legal tracts, handbooks of poetry, and various surviving poems. There are in addition comic tales on how bards exploited their power, including an eleventh-century one on King Guaire's Burdensome Company, wherein the poet Senchán rhymes to death certain mice that had spoiled an egg reserved for him. Shakespeare's references can thus be related to traditions well-known in Gaul and medieval (or early modern) Ireland and Scotland.

Parental experiences of the liminal period of a child’s fatal illness

The article offers a description of parents’ experiences of their child’s ultimately fatal illness as it unfolds over the successive stages of medical treatment, in the context of the liminality theory. The parents ( N = 23) were interviewed 1–4 years after their child’s death. The research method involved conducting narrative interviews with parents in order to obtain a spontaneous narration of the child’s illness as it unfolded. The grounded theory approach, including the narrative and performative aspects of such parental utterances, was applied as the main research strategy. The results provide insight into the main areas and processes of common parental experiences, such as the pervasive sense of becoming trapped in timelessness and ambiguity. Further states reported by parents included oscillating between a distancing stance and involvement, and a dualistic relationship with medical staff and the medical system: between alignment and disharmony. The study indicates the importance of treating delivery of such a diagnosis as a process rather than as a one-time event. The sense of ambiguity is treated as a kind of necessary parental coping mechanism, whilst the sense of timelessness gives parents a unique sense of time in which they do not have to think about the child’s potentially imminent death.

Older Adults’ Experience of Meaning at the End of Life in Two Danish Hospices: A Qualitative Interview Study

The aim of this study was to explore how older adults (aged > 65) confronted with imminent death express their thoughts and feelings about death and dying and verbalize meaning. Furthermore, the aim was to investigate how health professionals could better address the needs of this patient group to experience meaning at the end of life. The study applied a qualitative method, involving semi-structured interviews with 10 participants at two hospices. The method of analysis was interpretative phenomenological analysis. We found three chronological time-based themes: (1) Approaching Death, (2) The time before dying, and (3) The afterlife. The participants displayed scarce existential vernacular for pursuing meaning with approaching death. They primarily applied understanding and vocabulary from a medical paradigm. The participants’ descriptions of how they experienced and pursued meaning in the time before dying were also predominantly characterized by medical vernacular, but these descriptions did include a few existential words and understandings. When expressing thoughts and meaning about the afterlife, participants initiated a two-way dialogue with the interviewer and primarily used existential vernacular. This indicates that the participants’ scarce existential vernacular to talk about meaning might be because people are not used to talking with healthcare professionals about meaning or their thoughts and feelings about death. They are mostly “trained” in medical vernacular. We found that participants’ use of, respectively, medical or existential vernacular affected how they experienced meaning and hope at the end of life. We encourage healthcare professionals to enter into existential dialogues with people to support and strengthen their experiences of meaning and hope at the end of life.

Explaining rule of rescue obligations in healthcare allocation: allowing the patient to tell the right kind of story about their life

I consider various principles which might explain our intuitive obligation to rescue people from imminent death at great cost, even when the same resources could produce more benefit elsewhere. Our obligation to rescue is commonly explained in terms of the identifiability of the rescuee, but I reject this account. Instead, I offer two considerations which may come into play. Firstly, I explain the seeming importance of identifiability in terms of an intuitive obligation to prioritise life-extending interventions for people who face a high risk of an early death, and I explain this in turn with a fair innings-style principle which prioritises life-extending interventions for people expected to die young. However, this account is incomplete. It does not explain why we would devote the same resources to rescuing miners stuck down a mine even if they are elderly. We are averse to letting people die suddenly, or separated from friends and family. And so, secondly, I give a new account that explains this in terms of narrative considerations. We value life stories that follow certain patterns, classic patterns which are reflected in many popular myths and stories. We are particularly averse to depriving people of the opportunity to follow some such pattern as they approach death. This means allowing them to sort out their affairs, say goodbyes to family and friends, review their life, or come to terms with death itself. Such activities carry a lot of meaning as ways of closing our life story in the right way. So, for someone who has not been given much notice of their death, an extra month is worth much more than for other patients. Finally, I review the UK National Health Service's end of life premium, which gives priority to patients with short life expectancy. I suggest it falls short in terms of such considerations. For example, the NHS defines its timings in terms of how long the patient can expect to live as at the time of the treatment decision, whereas the timings should be specified in terms of time from diagnosis.

Edward Said’s Memoir Out of Place: Postcolonial Tenets, Dissonant Voices, and Divided Loyalties

Edward Said’s Out of Place (1999), a memoir written after his diagnosis with leukemia in 1991, was begun in 1994 to document his sense of cultural displacement and imminent death. This article examines the divided loyalties and dissonant voices Said vents in this book through the lens of cultural theories. It argues that such a conflicting vision can provide a proper context for understanding Said’s contributions to cultural studies and literary theory via the construction of the other, the out of place, at the levels of language, religion, environment, and homeland. Said presents himself as a postcolonial subject par excellence with divided loyalties and “unhomely” feelings. He uses a confessional mode to convey a constant sense of exile and identity crisis. Said’s life negotiated the postcolonial parlance he preached in his academic life, which offers a unique case on the relationship between theory and practice. The memoir emerges not only as an autobiographical text but equally as a contribution to literary theory and overlapping postcolonial discourses. Thus, this autobiographical memoir is useful for the literature classroom due to its theoretical value as well as non-fictional import.

Living Dying in Gilead

The cultural force of Gilead stems from its powerful unveiling of how dying complicates the sensory and psychological dynamics of human perception, expelling Robinson’s aging and ailing narrator from the ordinary world his prose so beautifully illuminates. In his journal to his son, Ames uses language to compensate for his anticipated absence; however, the reader’s experience of this first-person narrative may achieve an aesthetic transcendence that belies the aching apprehension of loss that functions as its scaffolding. Gilead localizes Ames’s psychic struggle with his own imminent death in acts of perceptual processing that it both depicts and thematizes. Combining physiological, sociological, and psychological approaches to aging with phenomenology and cognitive theories of perception, this chapter explores how the novel pushes existential concerns into the realm of the everyday to explore the way that the lived experience of dying traps Robinson’s protagonist uncomfortably in the collapsing space between perception and representation.

Zoe Anderson Norris

Zoe Anderson Norris (b. 29 February 1860–d. 13 February 1914) was a Kentucky-born journalist, fiction writer, and poet who was also known for documenting immigrant poverty in her bimonthly magazine, the East Side. Norris was the eleventh of thirteen children of Henry and Henrietta Anderson. Her father served as a pastor and teacher in Kentucky who translated the New Testament from ancient Greek texts. Norris attended Daughters College, a girls’ high school in Harrodsburg, her hometown, and spent time with family members homesteading in Kansas. She was married at age eighteen to Spencer Norris, who ran a grocery store in Wichita, and they had two children. By 1898, Norris had divorced her unfaithful husband and begun writing journalism pieces (including a newspaper gossip column) and short stories. Her fiction drew on autobiographical material: deceived wives, struggling writers, gossipy neighbors, inhospitable farmland. Around 1900, Norris and her daughter Clarence traveled in Europe and then settled on New York City’s Lower East Side. In 1902, Norris married an illustrator, Jack Bryans (they soon separated when he refused to live with Clarence, who by then had a toddler son). Norris published two novels and a short-story collection while freelancing for publications, including the New York Times. Her interviewees ranged from chorus girls and wharf workers to prominent sculptors. In 1909, Norris launched the East Side, “to fight for the poor with my pen.” In her essays and poems, she raged against injustice: deadbeat fathers abandoning starving families, trash-strewn streets spreading disease, factory laborers trudging through toxic runoff, children killed by careless chauffeurs. She also wrote paeans to the beauty of the New York skyline and to industrious new arrivals from Italy and Russia, immigrants who could be seen sharpening scissors or sorting rags and who were determined to prosper. At times she dressed as a beggar, reporting undercover as policemen harassed her and wealthy passersby looked away. Meanwhile, she organized weekly dinners for a club she founded, the Ragged Edge Klub, and she became known as the “Queen of Bohemia.” Readers and members of her Ragged Edge Klub included the philosopher Elbert Hubbard, the photographer Jessie Tarbox Beals, the filmmaker Wray Physioc, and the activist Helen Hamilton Gardener. In early 1914, the East Side published Norris’s description of a recent dream that she had in which her mother appeared at her bedside and warned her of imminent death. Days later, Norris died of heart failure. She is buried in Harrodsburg. After her accurate premonition made headlines nationwide, she was largely forgotten, although some 21st-century books mention her fearless curbside reports on immigrants’ lives.

Clinical Processes and Symptom Management

This section describes condition-based clinical processes and symptom management. Shortness of breath, chest tightness, and air hunger (dyspnea) are often associated with findings of anxiety, panic, desperation, or impending doom. These symptoms are often more distressing than pain. As such, it is suggested to never delay palliative treatment for any reason. The section then explores the management of anorexia and cachexia; belching and burping (eructation); bleeding, draining, and malodorous lesions; confusion/delirium; constipation; coughing; depression; diarrhea and anorectal problems; dysphagia and oropharyngeal problems; and edema. It also looks at fatigue and weakness (aesthenia); fever and diaphoresis; hiccups; imminent death; insomnia and nocturnal restlessness; nausea and vomiting; pain; pruritus; seizures; skeletal muscle and bladder spasms; skin breakdown; urinary problems; and xerostomia (dry mouth).