The environment of the critical care unit and the role of the nurse in that setting are portrayed by Hay and Oken:
A stranger entering an ICU is at once bombarded with a massive array of sensory stimuli, some emotionally neutral but many highly charged. Initially, the greatest impact comes from the intricate machinery, with its flashing lights, buzzing and beeping monitors, gurgling suction pumps, and whooshing respirators. Simultaneously, one sees many people rushing around busily performing lifesaving tasks. The atmosphere is not unlike that of the tensioncharged strategic war bunker. With time, habituation occurs, but the evercontinuing stimuli decrease the overload threshold and contribute to stress at times of crisis.
As the newness and strangeness of the unit wears off, one increasingly becomes aware of a host of perceptions with specific stressful emotional significance. Desperately ill, sick and injured human beings are hooked up to that machinery. And in addition to mechanical stimuli, one can discern moaning, crying, screaming, and the last gasps of life. Sights of blood, vomitus and excreta, exposed genitalia, mutilated, wasting bodies, and unconscious and helpless people assault the sensibilities. Unceasingly, the ICU nurse must face these affect-laden stimuli with all the distress and conflict that they engender. As part of her [sic] daily routine, the nurse must reassure and comfort the man who is dying of cancer; she must change the dressings of a decomposing, gangrenous limb; she must calm the awakening disturbed "overdose" patient; she must bathe the genitalia of the helpless and comatose; she must wipe away the bloody stool of the gastrointestinal bleeder; she must comfort the anguished young wife who knows her husband is dying. It is hard to imagine any other situation that involves such intimacy with the frightening, repulsive, and forbidden. Stimuli are present to mobilize literally every conflictual area at every psychological developmental level.
But there is more: there is something uncanny about the picture the patients present. Many are neither alive nor dead. Most have "tubes in every orifice." Their sounds and actions (or inaction) are almost nonhuman. Bodily areas and organs ordinarily unseen are openly exposed or deformed by bandages. All of this directly challenges the definition of being human, one's most funda-