Critical Care Nursing - MODULE 1 PDF

What is Critical Care Nursing As defined by CCNAPI: Critical care nursing is the specialty within nursing that deals specifically with human responses to life-threatening problems¹. These problems deal dynamically with human responses to actual or potential life-threatening illnesses. It util...

What is Critical Care Nursing As defined by CCNAPI: Critical care nursing is the specialty within nursing that deals specifically with human responses to life-threatening problems¹. These problems deal dynamically with human responses to actual or potential life-threatening illnesses. It utilizes the nursing process and is based on a scientific body of knowledge and incorporates the professional competencies specífic to critical care nursing practice and is focused on restorative (1st- restore stability of ptx), curative, rehabilitative, maintainable, or palliative care, based on identified patient's need³. Development of Critical Care Nursing Practice, educational and Professional Activities in the Philippines Historically it came about as just an area of practice and CCNAPI was created to convene nurses in the Philippines working the critical care setting. CCNAPI is the national organization of nurses interested in the field of critical care nursing. It was founded in February 1977 with approved SEC registration (CN 200813601), a founding member of the World Federation of Critical Care Nurses (2001) and accredited as a Provider of Continuing Professional Education by the Professional Regulation Commission (Provider Number 2009-019) The CCNAPI Standards of Practice of 1982 has been revisited and revised to be aligned with the 2005BON statements of the 11 Core Competencies for Entry Level for Safe and Quality Nursing Care. The CCNAPI Core Competencies of a Critical Care Nurse are stated according to the levels of expected behavior defining the actual knowledge, skills and abilities in the practice of critical care by a nursing professional. These statements cover expected behavior of a Nurse Clinician I, Nurse Clinician II and Nurse Specialist that will serve as the basis for assessing competence in critical care practice. The st atement of the goals, scope of practice, competencies and standards on the care of the critically ill are all important aspects that are emphasized in this paper. LEVELS & CATEGORIES OF CRITICAL CARE PROVISIONS WITHIN PHILIPPINES (CCNAPI) Level 1 Should be capable of providing immediate resuscitation for the crifically ill and short term cardio- respiratory support because the patients are at risk of deterioration; Has a major role in monitoring and preventing complications in "at risk" medical and surgical patients; Must be capable of providing mechanical ventilation and simple invasive cardiovascular monitoring:  Has a formal organization of medical staff and at least one registered nurse. A certain number of nurses including the nurse in- charge of the unit should possess post-registration qualification in critical care or in the related clinical specialties; and Has a nurse: patient ratio of 1:1 for all critically ill patients. Level 2 Should be capable of providing a high standard of general critical care for patients who are stepping down from higher levels of care or requiring single organ support/support post-operatively; Capable of providing sustainable support for mechanical ventilation, renal replacement therapy. invasive hemodynamic monitoring and equipment for critically ill patients of various specialties such as medicine, surgery, trauma, neurosurgery, vascular surgery: Has a designated medical director with appropriate intensive care qualification and a duty specialist available exclusively to the unit at all times; The nurse in-charge and a significant number of nursing staff in the unit have critical care certification; and A nurse: patient ratio is 1:1 for all critically ill patients. Level 3 Is a tertiary referral unit, capable of managing all aspects of critical care medicine (This does not only include the management of patients requiring advanced respiratory support but also patients with multi-organ failure); 90% training Has a medical director with specialist critical / intensive care qualification and a duty specialist available exclusively to the unit and medical staff with an appropriate level of experience present in the unit at all times; A nurse in-charge and the majority of nursing staff have intensive care certification; and A nurse: patient ratio is at least 1:1 for all patients at all times. Scope of Nursing Practice as defined by CCNAPI: The scope of critical care nursing is defined by the dynamic interactions (highly volatile) of the critically ill patient/family, the critical care nurse and the critical care environment to bring about optimal patient outcomes through nursing proficiency in an environment conducive to the provision of this highly specialized care. Goals of Care as per CCNAPI To promote optimal delivery of safe and quality care to the critically ill patients and their families by providing highly individualized care so that the physiological dysfunction as well as the psychological stress in the ICU are under control:  To care for the critically ill patients with a holistic approach, considering the patient's biological, psychological, cultural and spiritual dimensions regardless of diagnosis or clinical setting: To use relevant and up-to-date knowledge, caring attitude and clinical skills, supported by appropriate technology for the prevention, early detection and treatment of complications to facilitate recovery. To provide palliative care to the critically ill patients in situations where their health status is progressing to unavoidable death, and to help the patients and families go through their paintul sufferings. On the whole, critical care nursing should be patient-centered. safe, effective, and efficient. The nursing interventions are expected to be delivered in a timely and equitable manner System Operation of Critical Care Units (CCNAPI) A. Open System In an open system, the admitting and other attending doctors dictate management, change management, or perform procedures without consultation or communication with a Critical Care Specialist. A Critical Care Specialist may be available for advice or may be consulted to provide interventional skills (optional). There is no designated person who assumes the "gatekeeper" role. B. Closed System Management is coordinated by a qualified Critical Care Specialist. The Critical/Intensive Care Specialist has clinical and administrative responsibility. There is a multidisciplinary team of specially trained critical care staff. The intensivist is the final common pathway for medical decision-making, including decisions to admit or discharge a patient. CCNAPI Standards The following 11 standards are intended to provide nurses with guidelines for delivering quality care and excellence in Critical Care Nursing: 1. Legislative Compliance The critical care nurse functions in accordance with legislation, common laws, organizational regulations, and by-laws, which affect nursing practice. 2. Patient-Centered Care The critical care nurse provides care to meet individual patient needs on a 24-hour basis. 3. Competence in Current Practices The critical care nurse practices current critical care nursing competently 4. Ethical Nursing Care The critical care nurse delivers nursing care in a way that can be ethically justified. 5. Accountability The critical care nurse demonstrates accountability for their professional judgment and actions. 6. Safety and Security The critical care nurse creates and maintains an environment that promotes the safety and security of patients, visitors, and staff. 7. Mastery of Essential Equipment and Services The critical care nurse masters the use of all essential equipment, available services, and supplies for the immediate care of patients. 8. Infection Prevention The critical care nurse protects patients from developing environmentally induced infections. 9. Utilization of the Nursing Process The critical care nurse utilizes the nursing process in an explicit, systematic manner to achieve the goals of care. 10. Health Education The critical care nurse carries out health education for the promotion and maintenance of health. 11. Professional Development The critical care nurse acts to enhance the professional development of themselves and others. Organization of ICU Design of ICU: 1. Geographical Location The ICU should be situated in a geographically distinct area within the hospital, with controlled access. 2. Entry and Exit Points There should be a single entry and exit. However, emergency exit points are required in case of emergencies and disasters. 3. Traffic Separation There should be no through traffic of goods or hospital staff. Supply and professional traffic should be separated from public/visitor traffic. 4. Proximity for Transport  Safe, easy, and fast transport of a critically ill patient should be a priority in planning the ICU's location. Therefore, the ICU should be located in close proximity to the Emergency Room (ER), Operating Room (OR), trauma ward, etc. 5. Accessibility Corridors, lifts, and ramps should be spacious enough to allow easy movement of beds/trolleys of critically ill patients. 6. Proximity to Diagnostic Services Close and easy proximity to diagnostic areas, blood bank, pharmacy, etc., is desirable. ICU Bed Strength: - The total bed strength in a hospital should typically range between 8-12 beds and should not be less than 6 or more than 24 beds in any one unit. The Concept of Holism Applied to Critical Care and Professional Practice Issues in Critical Care CRITICAL CARE NURSE A critical care nurse is a licensed professional nurse responsible for ensuring that acutely and critically ill patients and their families receive optimal care. SEVEN C'S OF CRITICAL CARE 1. Compassion Demonstrating empathy and concern for patients and their families. 2. Communication Effective exchange of information with patients, families, and the healthcare team. 3. Consideration Showing respect and thoughtfulness towards patients, relatives, and colleagues, and avoiding conflicts. 4. Comfort Preventing and alleviating suffering to provide comfort to patients. 5. Carefulness Exercising caution to avoid injury to patients. 6. Consistency Providing reliable and uniform care practices. 7. Closure Addressing ethical considerations and managing the withdrawal of care when necessary. Clinical Judgment Advocacy/moral agency Caring practice Collaboration Systems thinking Response to diversity Clinical inquiry Facilitator of learning four key ethical principles in healthcare: 1. Autonomy: Let patients make their own decisions about their health care and respect their choices. 2. Beneficence: Always aim to do good for the patient and help improve their health. 3. Non-maleficence: Avoid causing harm to patients and be careful with treatments to prevent negative effects. 4. Justice: Treat all patients fairly and ensure they have equal access to care and resources. Common Ethical Issues in Critical Care - Autonomy and Informed Consent Respecting patients' rights to make informed decisions about their own care. - Surrogate Decision-Making Navigating situations where decisions are made on behalf of patients who are unable to make decisions themselves. - Confidentiality Maintaining the privacy of patient information. - Resource Allocation Ensuring fair and equitable distribution of limited medical resources. - Advance Care Planning/End-of-Life Care Facilitating discussions and decisions regarding patients' preferences for end-of-life care. - Conflicts of Interest Identifying and managing situations where personal or professional interests may conflict with patient care. - Medical Futility Addressing situations where medical interventions are unlikely to benefit the patient. This comprehensive compilation encompasses the various aspects of critical care nursing, including system operations, standards, ICU organization, holistic care concepts, and ethical considerations. Adhering to these guidelines ensures the delivery of high-quality, ethical, and patient-centered care in critical care settings. Assessment: Measurement Criteria* Development of a holistic picture of patient's needs Prioritization based on patient's immediate condition and anticipated needs Use of appropriate evidence-based assessment techniques & instruments Use of analytical models and problem-solving tools Decisions are made by matching formal knowledge with clinical evidence Documentation of relevant data Communicating relevant data with other healthcare providers Common Nursing Diagnosis Impaired Gas Exchange r/t ventilation perfusion mismatch (specify) Decreased Cardiac Output r/t impaired myocardial contractility/reduced preload Dysfunctional Weaning Response r/t neuromuscular dysfunction Deficient Fluid Volume r/t massive vascular losses/ increased insensible water loss