1 Intro to Critical Care Nursing.docx.pdf

OUTLINE Skills Needed for the Next Century I. Historical Background of Critical Care Nursing Critical Thinking Skills II. Current Trends related to CCN Is u...

OUTLINE Skills Needed for the Next Century I. Historical Background of Critical Care Nursing Critical Thinking Skills II. Current Trends related to CCN Is used in analyzing client issues and problems III. Critical Care Nursing Include interpretation, evaluation, inference, and explanation Historical Background of Critical Care Nursing Guide clinical decisions, in the application of nursing 1800 – Advantages of placing patients recovering process to patient care from surgery in a separate area of the hospital ○ Florence Nightingale Collaborative Skill 1900 – Three-bed post-operative neurosurgical Implies shared attention to a problem in which the intensive care unit in Baltimore (John Hopkins unique talents and contributions of all parties are Hospital) and followed by a premature infant unit in considered Chicago Interpersonal skills are very important → ○ Word War II - Shock wards for critically multidisciplinary approach (respiratory, medicine, injured patients pharmacy) 1950 – New mechanical ventilation technology and the need to group patients receiving this new therapy Delegation in one location, less than 60 years ago Critical Care Process of transferring the authority and responsibility nursing was organized as a specialty. to another team member to complete a task while 1960 – Focused on coronary care, nephrology, and retaining the accountability intensive care 1965 – 1st specialty: coronary care 5 Rights of Delegation ○ Neurologic ○ Right task ○ Respiratory Noninvasive; delegate task to Surgical appropriate level of their capability ○ Burn (obtaining V/S) ○ Pediatric ○ Right circumstance ○ Neonatal Assess complexity of care required 1970s - 1980s – The impact of the shortage of CCN by client was notable ○ Right person 1990s – Increased demand for skilled CCN Assess and verify the competency ○ Filipino nurses went to the US due to this of the team member; task must be Filipino nurses were known to in the team member’s scope of empathetic and industrious practice ○ AIDS is pandemic You should know your people ○ Trauma ○ Right direction and communication ○ Substance abuse Expectation of follow-up ○ Cancer communication “A healthcare system driven by the needs of patients ○ Right supervision and evaluation and their families in which critical care nurses make Delegating the task while attaining their optimal contribution.” – American Association of the accountability Critical Care Nurses (AACN) Don’t delegate a task you can’t troubleshoot Current Trends Related to Critical Care Nursing Computer Skills Critical Care Nursing Computers are used to document patient care, to It is a specialty / area in nursing that aims to promote monitor physiologic data and to manage patient highly specialized and excellent care. information Standards in Critical Care Nursing Patients of Critical Care Nursing Units 1:1 or 1:2 Ratio Patients who are at risk for actual or potential ○ Nurse to Patient ratio because the patient life-threatening health problems. They require and requires constant attention. need intensive and vigilant care. 37% Following patients: ○ Nurses working in hospital settings are ○ Unstable critical care nurses. ○ Critically ill High Pay Status asthmaticus ○ 55 USD hourly mean wage rate Cancer patients ○ Injured Traumatic injuries (blunt trauma, vehicular) ○ Complex 1 bbg | 2025  ○ Life-threatening conditions Hospital units take care of stroke patients for diagnosis, treatment, and rehabilitation The Patient According to NHS, UK, Most common Step Down Units reasons/conditions requiring intensive care and Intermediate Care Units: treatment ○ Provide intermediate level of care for ○ Severe accident patients with illness severity not warranty ○ Heart attack ICU care but who are unstable enough to be ○ Cardiac arrest treated in the ward. ○ Stroke EX: Hypovolemic shock - altered ○ Head injuries level of consciousness ○ Others: burns, shock, MODS Transition Units: Requirements of a Critical Care Nurse ○ Transition care between ICU and general MS Basic Requirements ward/regular flood Nursing degree program Patients: Active license (PH, US) ○ Close monitoring, frequent assessment, ACLS certification serious, less critical injuries (Prin, 2014) Experience with other units Step Up: ○ Higher level of care for patients deteriorating Critical Care Registered Nurse (CCRN) on a ward Is a specialty certification for nurses issued by ACCN Step Down: who provide direct care to acutely ill or critically ill ○ Lower level of care for patients transitioning patients out of ICU Requirements for Eligibility: ○ Practicing RN or APRN Equipment in Critical Care Nursing ○ US-based facility / standard (acute / CCN) Basic Setup ○ Completed 2000 hours of direct care Multiparameter physiological monitor linked with ○ Passed the CCRN examination sophisticated centralised monitoring system Continuous Monitor Fields / Areas in Critical Care Nursing ○ ECG Intensive Care Unit (ICU) ○ Arterial Pressure Also known as critical care unit (CCU), intensive ○ Oxygen therapy / treatment unit (ITU) Special area in the hospital that provides the highest Invasive Monitor level of care to patients needing extensive monitoring ○ Arterial and intensive specialized care - ○ Venous (The Medical City, 2021) ○ Intra-abdominal ○ Intracranial Coronary Care Unit (CCU) Also known as telemetry unit, cardiac care unit Critical Care Team (CCU), cardiac intensive care unit (cardiac ICU) Advanced Practice Nurses (APNs) CCU is mainly for patients with cardiac disorders Nurse Practitioners (NPs) and other specialty (Manila Doctors Hospital, 2021) clinicians Example: coronary bypass surgery, heart failure Pharmacist Main feature: comprehensive coronary care Respiratory Therapist Procedures: availability of telemetry (way to monitor Social Worker vital signs remotely), cardiac rhythm monitoring Clergy (ECG), cardioversion, defibrillation Critical Nursing Roles Cardiac Catheter Laboratory Expanded Role Nursing Positions Also known as CathLab (UP Duke Health System, ○ They seek to provide comprehensive care to 2021) the client Performs cardiovascular diagnostic imaging ○ Relates to role expansion within nursing in procedures general and more specifically to CCN Performs specific minimally invasive advanced cardiac interventional procedures Advanced Practice Nurses Procedures: angiogram, angiography, angioplasty ○ Advanced critical care practitioners (ACCPs) (PTCA) Intra Aortic balloon pump, Swans Ganz are clinical professionals who have catheter pacemaker insertion / implantation developed their skills and theoretical knowledge to a very high standard Neurology ICU (Neuro ICU) Also known as neurology ward, acute stroke unit Assimilate and Prioritize An ICU/ward devoted to the care of patients with ○ Assimilate and prioritize information in order immediately life-threatening neurological problems / to take immediate and decisive disorder evidence-based client-focused action 2 bbg | 2025  Anticipate and Respond The critical care nursing practice is based on a ○ Anticipate and respond with confidence and scientific body of knowledge and incorporates, the adapt to rapidly changing client conditions professional competencies specific to critical care nursing practice and is focused on restorative, Respond curative, rehabilitative, maintainable, or palliative ○ Respond to the unique needs of clients and care, based on identified patient needs families coping with unanticipated treatment as well as quality of life and end-to-life Critical Care in the Philippines decisions In the Philippines, the Professional Regulation Commission - Board of Nursing (PRC-BON) is Establish and Maintain committed to provide need-driven, effective and ○ Establish and maintain safe, respectful, efficient specialty nursing care services of high healing, and caring environment standard and at international level within the obtainable resources. Acute Critical Care Nursing To respond to this mission and commitment, a Recognize the fiscal responsibility of nurses working PRC-BON Working Group in Developing the Nursing in a resources intensive-driven environment SpecialtyFramework was formed in the 1996 to take ○ manpower on the task of setting the process-based framework ○ materials and guidelines for specialty nursing services. Use health care interventions designed to restore, The expanding healthcare and nursing knowledge rehabilitate, cure, maintain, or palliate for clients, of all together with new and evolving healthcare sites, ages across the lifespan structures, and technologies all have contributed to The AACN defines acute and critical care nursing as the need and desire for specialty nursing the specialty that manages human responses to organizations like the Critical Care Nurses actual or potential life-threatening problems Association of the Philippines, Inc. (CCNAPI) to revisit Nurses rely on a body of knowledge, skills, and the existing statements of its Standards of Nursing abilities to: Practice to provide clear and updated statements ○ Restore, support, promote, and maintain the regarding the scopes of practice and standards of physiologic and psychosocial stability of critical care nursing clients This will ensure continued understanding and acknowledgment of nursing's varied specialty American Association of the Critical Care Nurse (ACCN) professional contributions to the healthcare American Association of Critical Care Nurse Roles environment. Monitor and safeguard the quality of nursing care that the patient receives. Philosophy of Critical Care Nursing Act as a liaison between the patient and the patient's The Critical Care Nurses of the Philippines, Inc. family. (CCNAPI) is responsible for the promotion of man's Critical Care Nursing Standard health and welfare for national development. ○ It describes the practice of the nurse who desires to support the professional and personal cares for acutely or critically ill patient in the growth and development of initial core nurses. healthcare environment.; CCAPI has organized itself into a national association Critical Care Professional Accountability committed to the ideals of service to the people, ○ AACN - created in 1969 - largest specialty equality,justice and social progress. organization ○ Focused on "Creating a healthcare system driven by the need of clients and their Holistic Critical Care Nursing families, where acute and critical care nurses Caring make their optimal contribution" ○ The aspect between nurses and clients is most fundamental to the relationship and to Critical Care Nurses Association of the Philippines, Inc the health care experience. (CCNPI) Non-caring CCNAPI is the national organization of nurses ○ Is indicated by physical and emotional interested in the field of critical care nursing. absence, inhumane and belittling It was founded in February 1977 with approved SEC interactions, and lack of recognition of the registration (CN 200813601), a founding member of client's uniqueness. the World Federation of Critical Care Nurses (2001) Holistic Care and accredited as a Provider of Continuing ○ Focuses on human integrity and stresses Professional Education by the Professional Nurses of that the body, the mind, and the spirit are the Regulation Commission (Provider Number interdependent and inseparable. 2009-019) AACN - created in 1969 - largest specialty Cultural and Linguistic Competence for Nurses organization Nurses should demonstrate cultural competence by: Focused on " Creating a healthcare system driven by Developing an awareness of one's own culture the need of clients and their families, where acute and without letting it have an undue influence on those critical care nurses make their optimal contribution" from other backgrounds Demonstrating knowledge and understanding of Critical Care Professional Accountability different cultures 3 bbg | 2025  Accepting that there may be differences between the cultural beliefs and values of the health care provider and the client Culturally Competent Care Cultural perspectives on death and dying and death are complex View a discussion of advance directives as a legal device to deny care Complementary and Alternative Therapies Guided Imagery Massage Animal-Assisted Therapy Music Therapy Guided Imagery Benefits Decreased side effects Decreased length of stay Reduce hospital cost Enhanced Sleep Increased satisfaction Holistic Critical Care Nursing Cultural Care Individual Care Caring Complementary and Alternative therapies Issues Related to Caregiver Role: Client care They contribute to the client’s well being by: ○ Providing a link to the client’s personal life ○ Advising the client in health care decisions or functioning as the decision maker when the client cannot ○ Helping with activities of daily living (bathing, suctioning) ○ Providing positive, loving and caring support Client-Centered Critical Care The critical care unit is a stressful environment for clients and their family members-with the understanding that family is whomever the client designates to be at their bedside. CCU - because of number of alarms, 24/7 routines, unfamiliar environment, and often an uncertain prognosis 4 bbg | 2025