Where Night Is Day: The World of the ICU (The Culture and Politics of Health Care Work)

Nearly every page had medical terms that a lay person would not know. The book had no glossary so you had to guess the meaning from context or keep your dictionary close at hand. Also, many of the patients did not speak English. Kelly worked with translators for those who spoke Navajo so I could understand those scenes as well as Kelly could. When the patients or family members only spoke Spanish, he did not translate. This is fine for a common word or two but is pretty frustrating if there is a full paragraph in Spanish where a family is dealing with discussing whether to withdraw life support.

The average of 4 and 1 is 2. I'm going to round up to three but this is not a simple middle of the road liked it book. Jan 20, Tracy rated it did not like it. I really enjoy medical books, especially those of stories by "insiders," but I really disliked this. In an effort to convey the same fast pace experienced by ICU nurses, it's written using medical lingo and shortcuts, incomplete sentences, and little explanation.

I know at least as much as the average person about medical issues and treatments, and I had trouble just understanding what the author was describing. And the breakneck style of moving from patient to patient with no reminders of who i I really enjoy medical books, especially those of stories by "insiders," but I really disliked this. And the breakneck style of moving from patient to patient with no reminders of who it is and what they're condition was means I was constantly confusing one for another. I also sensed an element of disrespect, if not by the author himself, than by his co-workers.

I hesitate to say this, because I think nursing is one of those things that outsiders can never really understand, and just being able to do it for any length of time indicates some characteristic of caring.

But referring to patients only by a room number or last name, spending more time analyzing their ethnic background than their medical condition, and referring to them by some disparaging terms that float in the medical community makes me think he's int he wrong profession. If there's compassion, I didn't see it. I also didn't like how he very deliberately separated nursing from medicine, almost offering a defensive point of view of nursing. Doctors and nurses have different roles, but surely they're all compatible roles int he world of medicine? And he constantly put down the doctors around them.

I find it hard to believe so many people in the field are as uncaring as they are depicted.

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I do recognize that I can't know what it's like to work in health care, and that some degree of separation is necessary to survive,but there were too many generalizations here. It's not why I picked up the book. Jun 30, Josephine Ensign rated it liked it. I've included this new book in my reading list for a summer narrative medicine course I'm teaching for nursing students. I like the structure of the book with ICU patient vignettes interspersed with more introspective passages exploring a range of related topics ranging from the history of hospitals to nursing theories of caring.

I usually love stories involving patients and patient I've included this new book in my reading list for a summer narrative medicine course I'm teaching for nursing students. I usually love stories involving patients and patient care, but the ones included in this book are too brief and too high tech med-surg'y' to hold my attention. A useful addition to the growing nursing narrative nonfiction literature.

Apr 27, Vern rated it really liked it.

Where Night Is Day: The World of the ICU by James Kelly

I feel Jim's book is an accurate and sound depiction of the activities and operation of the ICU. It would be beneficial reading in critical care courses for those interested in the work. I really enjoyed his analogies and descriptions of many of the behaviors and culture that is critical care nursing. His descriptions of the Southwest and our people are touching, insightful and resonates ap I feel Jim's book is an accurate and sound depiction of the activities and operation of the ICU. His descriptions of the Southwest and our people are touching, insightful and resonates appreciation of those he serves.

The book is an easy read and pulls you into the stories he shares. Obviously a bedside nurse and not an academic separated from his material. Apr 20, Becca rated it liked it Shelves: Fascinating book for even non-medical personnel. It would be fun to have a medical person next to you to explain some of the terms or things going on, but even without, I was able to figure this out In the health care delivery system, as in day to day living, healthcare providers interact with people of similar as well as diverse cultural backgrounds. People may have a different set of criteria and various preferences regarding their health and health care needs, depending on their cultures.

The meaning of illness and treatment are rooted deeply in particular cultural beliefs and values. Therefore, health care professionals must possess the requisite knowledge and skill to provide care to patients from different cultures. Health care should be culturally congruent. To attain this, the medical community may need to reconsider the moral significance of individual standard values, in particular, the status of patient autonomy and patient care outcome.

Leininger and Mcfarland define transcultural nursing as a comparative study of cultures to understand their similarities and the differences among them [ 1 ]. The objective of transcultural nursing is to deliver culturally congruent care or care that fits a person's lifestyle, values, and system of meaning.

Behaviors and their meanings are generated by individuals themselves rather than from predetermined criteria. Acknowledging, respecting, and adapting to the cultural needs of patients, families, and communities are critical components of healthcare. Effective nursing care integrates the beliefs and cultural values of people, families, and communities with the views of a multidisciplinary team of health care providers. When you provide culturally congruent care, you bridge cultural gaps to provide essential and supportive care for all patients.

Consider the following cases.

A pregnant Indonesian woman in labor waits to be examined by one of the physicians. When a male resident arrives, she and her husband demand a female doctor and send the resident away.

Where Night Is Day

Fortunately, there was a female resident available. She was able to perform the examination but became frustrated when the woman deferred all decisions to her husband. A woman in labor is regarded as unstable from the latent phase through the delivery of the placenta. A complete evaluation of the woman and the fetus by a health care provider with skills and training appropriate to evaluate the woman in labour is warranted.

Evaluation usually involves some subjective questions regarding the mother and the fetus. In this case of the Indonesian woman, deferring all decisions to her husband could severely jeopardize the health of the fetus and that of the mother since the man cannot know what the subjective symptoms related to her pregnancy. The female resident providing care to the Indonesian woman should have done a quick culture assessment. Also being culturally aware of what to expect in this situation would alert the provider that while the husband is present the wife would defer all questions to her husband.

The resident should have asked the husband to allow his wife to answer the questions. The husband would most definitely comply in this case since care provided for his wife was by a female. Explaining the risk of not having the woman answer the subjective questions about her health and the fetus would also bridge the gap between culture and knowledge deficit. This would be delivering safe patient care in a culturally congruent manner. A year-old lesbian diagnosed with advanced stage cervical cancer.

The patient was seen by her gynecologist annually but never had a Papanicolaou Pap tests done because she was self-identified as a lesbian. According to the gynecologist, invasive speculum exam is not usually necessary for a lesbian patient. Although cervical cytology testing remains an important part of preventive health care for lesbians, Female-To-Male FTM transgender individual and non-transgender females, Pap tests can be challenging for these patients due to a disconnect between biological sex and gender identity.

Cancers of natal reproductive organs, including the cervix, can still occur and have been documented. The American College of Obstetricians and Gynecologists ACOG suggests that lesbians including transgender men with a cervix follow the same screening procedure as non-transgender females [ 2 ]. Additionally, patients should be informed before undergoing a Pap test to discuss any cultural issues that may concern them as heightened anxiety about undergoing genital exam may be present.

Providers needed to be culturally aware of their personal feeling and addressed them. A year-old Haitian immigrant hospitalized in the neurosurgical intensive care unit with a traumatic brain injury after a foot fall from a scaffold. His immediate family members and extended family insist on staying with him around the clock. His prognosis is poor, and when his attending physician discusses discontinuing life support therapy with his family members, they acquiesce but request that all family members be allowed to remain present to witness his death.

Policies in the intensive care unit do not permit more than two family members to be with a patient at any given time. The staff members complain that they have difficulty completing their tasks with other critically ill patients because of the distractions they face from the multiple family members visiting this man.

Drawing on the words of medical historians, doctor-writers, and nursing scholars, Kelly examines the relationship of professional and lay observers to the meaning of illness, empathy, caring, and the silence of suffering. Kelly offers up an intimate portrait of the ICU and its inhabitants.

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The Voyage into the Sea of Critical Illness 2. Diagnosis, Diagnosis, Diagnosis 3. Nursing Isn't a Journey 4. One More Day 5. The Dream of Cure 6. Medicine as Ghost Rain 9. Poetic and Tragic Murmurings of the Everyday They Tell Us Everything Leaving Ends the Love The Horizon Epilogue Notes.

Where Night Is Day. He also perfectly describes the experiences of the ICU patients and their families—what they see, do, and reflect on during this time. Lastly, he discusses his interactions with physicians, and explains how nurses and doctors collaborate to accomplish the common goals of keeping patients comfortable, sedated, and alive. He tells the stories of individual patients and families, and describes the ICU subculture in a graphic, realistic manner. He conveys the nurse's perspective on the grueling experience of having to make life-and-death decisions on a daily basis.

He clearly shows how emotional, and sometimes unemotional, a nurse must be to survive this type of professional setting.

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