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Title: Life in the balance : critical illness and British intensive care, 1948-1986
Author: Nicholls, Alice
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2011
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A series of life and death decisions, in a high-tech hospital unit, made by a multidisciplinary team of specialists and the patient's family - intensive care is the epitome of modern medicine. What better encapsulates the ambivalence of medicine in the twentieth century? From the beginnings of intensive care units in the 1950s to the institution of specialist societies, journals and training by the mid-1980s, so many of the tensions of modern medicine have been articulated in this story. The development of British intensive care has involved collaboration and conflict - the benefits of multidisciplinary knowledge and experience, with the competition for status and 'ownership' of patients. It has utilised the high-tech - striving to advance therapeutic capabilities balanced against the risks of iatrogenesis and loss of patient identity and autonomy, as well as the low-tech - the importance of clocks and windows with a view of the outside world for temporal orientation and sensory stimulation, for example. At times, the 'scientific' pathophysiology of critical illness has been pitched against 'intuitive' nursing care. At other times, the nurse has been acknowledged as the primary therapist. Critically ill patients have been the subject of a hospital specialty based on generalism rather than a single organ system or age group. Expanding and contracting notions of reversibility and salvageability have informed decision-making in a resource-intensive field. Using archives, journals, newspapers, oral history interviews, films and museum objects, this thesis challenges the view that intensive care originated from the 1952 Copenhagen poliomyelitis epidemic or the postoperative recovery room. Instead, it argues that intensive care was not just a response to illness, but that it grew alongside a new category of illness created by practitioners and policymakers - critical illness. Changing notions of critical illness in turn shaped the practice of intensive care. Until the mid-1960s, critical illness was seen as phase of illness, with the highest degree of nursing dependency. As therapy developed, it began to be measured as the highest degree of medical and technological dependency. With research and symposia on pathophysiology, critical illness came to be regarded as a physiological state, imbalanced and in need of correction. Such notions informed questions of who should care for the critically ill, where, and how.
Supervisor: Pickstone, John Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available