The practicing nurse is almost invisible in the nursing literature. Case studies appear from time to time that reflect the intimacy of the nurse- patient relationship. These often relate the extraordinary experiences of nurses with, for example, dying patients, patients waiting for transplant, or children with leukemia. While the views of nursing's practice, education, and labor management leaders are well known, the evaluation of clinical practice has received less attention. For example, the literature may describe appropriate clinical management of a patient having heart surgery, but reveal nothing about the personal experiences of the nurses and patients during the actual caretaking. The stories of physicians and their patients have been more often told. The writings of Lewis Thomas ( 1983) and William Carlos Williams ( 1932) provide many examples of the range of human emotions and experiences in the medical care of patients.
The critical care nurses interviewed for this study spoke openly and often passionately about their beliefs and commitments about nursing and the rewards and frustrations of patient care. This chapter provides a forum for those nurses to speak about their perceptions of the essence of nursing practice. Many factors contribute to the nurses' perceptions about themselves and their practice. Several of these that have particular impact on the practice setting were selected for discussion: the roles that nurses assume; the values that permeate nursing education and practice; the accepted model of decision making in nursing; the ways that nursing has been defined by nursing leaders and others (because of the influence these definitions have on the formation of a professional self-image); and, finally, a research study examining clinical nursing practice from the perspective of practicing nurses.
Various disciplines have described the role of the nurse in critical care settings in relation to the medical, nursing, administrative, legal, historical,