Uploaded by Mahmoud Sbaih

ch1

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Chapter 1
Overview of Critical Care Nursing
Critical Care Nursing
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Deals with human responses to life-threatening
problems (critical illness or injury)
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Physiological
 Psychological
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Focus on both the patient’s and family’s
responses
Critical Thinking Challenge
What comes to your mind when you hear the
following terms?

Intensive care
 Critical care
 ICU and CCU
 Trauma
Evolution of Critical Care
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Began with polio units (1950s), recovery rooms,
and coronary care units (1960s)
Patient outcomes improved
Intensive Care Units (1970s)
Critical Care in the 21st Century
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Specialization
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Variety of settings
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Cardiovascular, neurological, trauma, burn units
Pediatric
Neonatal
Inpatient
Outpatient
Home care
eICU
Professional Organizations

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Support critical care nurses and practice
Key organizations

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American Association of Critical-Care Nurses
Society of Critical Care Medicine
American Association of
Critical-Care Nurses (AACN)

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Founded in 1969
Largest specialty organization in world
Mission

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Values
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Assist acute and critical care nurses to attain
knowledge and influence to deliver excellent care
An ethic of care that focuses on compassion,
collaboration, accountability, and trust
Web site: https://www.aacn.org/
Society of Critical Care Medicine
(SCCM)
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Founded in 1970
Multiprofessional membership

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Physicians
Nursing section
Other critical care team members
Web site: https://www.sccm.org
Journals: Critical Care Medicine
New Horizons: The Science and Practice of
Acute Medicine
Pediatric Critical Care Medicine
Critical Care Certification

Purpose

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Validate knowledge
Promote professional excellence
Help nurses to maintain up-to-date knowledge
AACN Certification Corporation oversees CCRN,
CCRN-E, and PCCN certification
Based on AACN synergy model for patient care

Needs of patients and families drive practice
AACN Critical Care Certification

Bedside practice

CCRN: Adult, Neonatal, and Pediatric
 PCCN for those working in step-down units
 CNML Critical Care Managers and Leaders

Advanced practice
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ACCNS Acute and Critical Care Clinical Nurse
Specialist
ACNPC-AG Acute Care Nurse Practitioner
Subspecialty certification

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CMC Cardiac medicine
CSC Cardiac surgery
Standards (1of 2)
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Guide clinical practice
Establish goals for patient care
Provide assessment of outcomes
AACN Standards for Acute and Critical Care
Nursing Practice

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Nursing Process
Expectation of the nurse
Standards of Practice (Bell, 2008)
(2 of 2)
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Evaluate quality of nursing practice
Evaluate own practice
Acquire knowledge and maintain competency
Contribute to professional development of peers
Act ethically
Use skilled communication
Use clinical inquiry and integrate research findings
Consider factors related to safety, effectiveness, and
cost
Provide leadership in clinical setting
Trends and Issues

Critical care patients more complex

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Multisystem organ dysfunction
Complicated by aging population
Increasing costs for care
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Challenged to reduce costs and length of stay
Transfer of higher acuity patient from the critical care
unit to other units or home
Critical Care Nurse Characteristics
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Technical competence
Relationship building
Ability to multitask and set priorities
Critical Thinking Challenge
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Discuss strategies for reducing or preventing
stress and burnout in critical care nurses.
Focus on Quality and Safety
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Errors and harm must be prevented
Nurses are challenged to reduce errors and
promote a safe environment
Several initiatives
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The Joint Commission National Patient Safety Goals
Institute for Healthcare Improvement
Quality and Safety Education for Nurses (QSEN)
National Patient Safety Goals
(1 of 2)

The Joint Commission National Patient Safety
Goals for 2020 are located at:
https://www.jointcommission.org/en/standards/n
ational-patient-safety-goals/hospital-2020national-patient-safety-goals/
National Patient Safety Goals
(2 of 2)

Examples relative to critical care nursing
• Communication
• Medication safety
• Reduce infections
• Reconcile medications
Harms Targeted for Reduction
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Adverse drug events
Infections
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Catheter-associated urinary tract infections (CAUTI)
Central line–associated bloodstream infections (CLABSI)
Surgical site infections
Ventilator-associated pneumonia (VAP)
Injuries from falls and immobility
Obstetric adverse events
Pressure ulcers
Venous thromboembolism (VTE)
Importance of Evidence-Based
Practice
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Implement practice based on evidence
Evaluate research
Hierarchy of evidence
Communication
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Communication important for safe care
Much information derived from airlines
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Crew resource management
Barriers to Effective Handoff Communication
Standardized approaches
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SBAR and SBAP
• Situation
• Background
• Assessment
• Recommendation (Plan)
Quick Quiz!
During report using SBAR, the nurse states, “Since
we have just initiated a potassium replacement
protocol, the patient will need a potassium level
drawn at 1300.” This depicts:
A. Situation
B. Background
C. Assessment
D. Recommendation
Answer to Quick Quiz

D. Recommendation.
Collaboration

Create a culture of safety where everyone works
together

Mutual respect
 Mutual recognition

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Aim during multiprofessional daily rounds at the
bedside
Briefings are another approach
Quick Quiz!
Which of the following is a component of a healthy
work environment?
A. Collaboration
B. Use of many agency nurses
C. Crew-resource training
D. Evidence-based practice
Answer to Quick Quiz
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A. Collaboration.
Trends and Issues (1 of 3)
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Reducing hospital readmission rates
Increasing use of technology
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Electronic medical records
Physician order entry
Ethical issues associated with prolonging life
and futile treatment
Telemedicine and eICU
Trends and Issues (2 of 3)
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Aging population
Transfer of patients from the critical care unit
while still acute
Aging workforce
Trends and Issues (3 of 3)
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Shortage of critical care nurses
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Importance of recruitment, orientation, and retention
Ongoing debate about hiring new graduates to work
in critical care units
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