Scope Of Critical Care Nursing Practice PDF

Faculty of Nursing, Alexandria University Scope Of Critical Care Nursing Practice  Critical Care & Emergency Nursing Department  Intended Learning Outcomes of the Course (ILOs)   Desc...

Faculty of Nursing, Alexandria University Scope Of Critical Care Nursing Practice  Critical Care & Emergency Nursing Department  Intended Learning Outcomes of the Course (ILOs)   Describe the scope of critical care nursing practice.  Identify critically ill patient' needs and problems.  Illustrate the impact of illness and environment on critically ill patient’s family.  Use a range of assessment techniques appropriate to the situation to identify patients’ needs/ problems.  Execute nursing interventions to meet needs of critically ill patients & families.  Employ care for critically ill patients with physiological alterations.  Communicate effectively with patients, family, and health care providers.  Introduction  Critical care nursing practice occurs at the interface of the nurse with the patient and family in an environment that requires humanism and compassion, despite aggressive technology.  Definition  In 1984, American Association of Critical Care Nurses’ (AACN) defined Critical Care Nursing as: “Critical care Nursing is that specialty within nursing that deals specifically with human responses to life- threatening problems”  Goals of Critical Care Nursing  1- Promote optimal delivery of safe and quality care to critically ill patients and their families. 2- Care for critically ill patients with a holistic approach.  Goals of Critical Care Nursing  3- Use appropriate and up-to-date knowledge, caring attitude and clinical skills, supported by advanced technology for prevention.  Goals of Critical Care Nursing  4- Provide palliative care to critically ill patients in situations where their health status is progressing to unavoidable death, and to help patients and families to go through painful sufferings.  Scope of critical care nursing practice  A scope includes a framework within which an individual can provide care and it describe who, where, what, when, why and how of the practice of holistic nursing  Scope of critical care nursing practice  Scope of critical care nursing practice is described as a dynamic interaction of the three components Components Scope of critical care nursing practice 1- Critically 2- Critical ill patients care nurse. 3- Environment where critical care nursing is practiced.  Critically ill patient  American Association of Critical Care Nurses (AACN) described critically ill patient as follows: “Critically ill patient is characterized by presence of actual and / or potential (being at risk for developing) life-threatening health problems.”  Critically ill patient  Critical illness may lead to extraordinary dependence on health care providers, and possibly technology for health maintenance or life support AACN defining characteristics of Critically ill patient’s  Resiliency: The capacity to return to a restorative level o function using compensatory coping mechanisms; the ability to bounce back quickly after an insult Vulnerability: Susceptibility to actual or potential stressors that may adversely affect patient outcomes.  Critically ill patient’s minor defining characteristics include:  Stability: Ability to maintain a steady-state equilibrium. Complexity: The involved entanglement of two or more systems (e.g., body, family, therapies)  Critically ill patient’s minor defining characteristics include:  Participation in care: Extent to which patient and family engage in aspects of care. Participation in decision making: Extent to which patient and family engage in decision making  Critically ill patient’s minor defining characteristics include:  Predictability: a characteristic that allows one to expect a certain trajectory of illness course of events or course of illness  Needs of Critically ill patient  1- Physical needs:- Are equated with basic physiological or biological needs for ex, for air, nutrition, and elimination. 2- Non-physical needs:- may include social, spiritual, and psychological needs, social integrity (self-esteem), information, and communications.  Needs of Critically ill patient 2- Non-physical needs  - “Identity & social integrity can be very difficult to maintain when a person is in a strange situation without their usual clothes, hair style, and when work and conversation or discussion goes on around and over them without including them as a person.” - Obstruction of these non-physical needs increases the stress experienced by , critically ill patients.  Critically ill patient’s family  The social role that patient plays in family is absent during the critical illness. Circumstances surrounding the nature of patient’s illness can also be a stressor for family.  Critically ill patient’s family  Prolonged critical illness can present emotional difficulties for the family, which may increase the likelihood of crisis. The critical care nurse is a caregiver to both the patient and family  Nursing interventions for Care of Family in Crisis Guide family in defining current problem. its strengths and sources of Help family to identify support. Prepare family for critical care environment, especially regarding equipment and purposes of equipment.  Nursing interventions for Care of Family in Crisis  Speak openly to patient and family about critical illness. Convey feelings of hope and confidence in family’s ability to deal with situation.  Nursing interventions for Care of Family in Crisis  Try to perceive feelings that crisis evokes in family. Help family identify and focus on feelings. Provide opportunities for patient and family to make choices and avoid powerlessness and hopelessness.  Nursing interventions for Care of Family in Crisis  Assist family in finding ways to communicate with patient. Discuss all issues as they relate to patient’s uniqueness, avoiding generalizations. Help family to set short-term goals so that progress and positive changes can be seen.  Nursing interventions for Care of Family in Crisis  Advocate adjustment of visiting hours to accommodate needs of family as permitted by situation in the unit. Determine if there is space available in hospital near the unit where family can be alone and have privacy.  Critical Care Nurse  The critical care nurse is someone who directly administers nursing care to patients who are critically ill or injured.  Critical Care Nurse  Critical care nurse is a licensed professional, who is responsible for ensuring that all critically ill patients receive optimal care.  Critical Care Nurse  *Nurses practicing in critical care areas have to make clinical judgments to prevent clinical deterioration in their patients. *Anticipation and early prevention of patient problems and these mandate highly developed skills of assessment and clinical judgment.  Critical Care Nurse  *Prediction of patient problems must be based on a sound understanding of anatomy and physiology.   In order to set aside what is unique about critical care nursing, AACN has clearly defined critical care competencies:  Nurse’s Competencies Clinical judgment  Facilitator of learning Advocacy/moral Response to agency diversity Clinical inquiry or Caring practices innovator/evaluator  Critical Care Nurse’s Competencies Clinical judgment:  Clinical decision making (grasp of situation and application of acquired nursing knowledge and skills) Advocacy: Working on another’s behalf (patient, family, community) serving as a advocator in identifying and helping resolve ethical and clinical concerns in the clinical setting.  Critical Care Nurse’s Competencies  Caring practices (awareness, commitment, responsiveness) Apply nursing activities with the aim of creating concerned and therapeutic and healing environment for patient/staff to prevent unnecessary suffering.  Critical Care Nurse’s Competencies  system thinking The body of knowledge and tools that allow nurse to appreciate the care environment from a perspective that recognize the holistic interrelationship within health care system  Critical Care Nurse’s Competencies  Response to diversity The sensitivity to recognize, appreciate, and incorporate differences in provision of care; differences may include, but are not limited to, family configuration, lifestyle, socioeconomic status, age, values.  Critical Care Nurse’s Competencies Clinical inquiry or innovator/evaluator  the nurse engages in clinical knowledge development to promote best patient outcomes Facilitator of learning Ability to facilitate formal/informal learning for patients, nursing, physicians, members of other health care disciplines.  AACN Critical Care Nurse’s Role Responsibilities  1. Support and respect for patients autonomy and informed decision making 2. Intervening when it is questionable about whose interest is served 3. Helping patient to obtain necessary care  AACN Critical Care Nurse’s Role Responsibilities  4. Respecting values, beliefs, and rights of patient 5. Educating the patient/surrogate in decision making 6. Representing patient's right to choose 7. Supporting decisions of patient/surrogate or transferring care to an equally qualified critical care nurse.  AACN Critical Care Nurse’s Role Responsibilities  8. Interceding for patients who cannot speak for themselves and who require emergency intervention 9. Monitoring and ensuring quality care 10. Acting as liaison between patient/significant others and others on health care team Critical Care Environment   Critical Care Environment  Critical care nursing takes place in a specialized environments that are designed and organized to give best possible patient care in an area where significant change in patient morbidity can occur rapidly, and often does.  Critical Care Environment  should support interaction Critical care environments between patient, nurse and family  Critical Care Environment  Safety of both patients and staff in ICU is a primary consideration in designing the milieu of critical care.  Critical Care Environment is viewed from three prospective:  1- The circumstances and events surrounding the direct interaction between the critical care nurse and the critically ill patient. The environment must contain resources that constantly support this interaction. e.g. emergency equipment and supplies.  Critical Care Environment is viewed from three prospective:  2- The setting within which critically ill patient receive care. Critical care management and administrative structure ensure effective care delivery through provision of adequate human and financial resources, quality control systems, and maintenance of standard of nursing care.  Critical Care Environment is viewed from three prospective:  2- The setting within which critically ill patient receive care. Here critical care management and administrative structure ensure effective care delivery through provision of adequate human and financial resources, quality control systems, and maintenance of standard of nursing care.  Critical Care Environment is viewed from three prospective:  3- Factors that influence provision of care to critically ill include: - legal -Regulatory - Social - Economic and political factors.   Thank you