Chapter 1 Overview of Critical Care Nursing Critical Care Nursing Deals with human responses to life-threatening problems (critical illness or injury) Physiological Psychological 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 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 Specialization Variety of settings Cardiovascular, neurological, trauma, burn units Pediatric Neonatal Inpatient Outpatient Home care eICU Professional Organizations Support critical care nurses and practice Key organizations American Association of Critical-Care Nurses Society of Critical Care Medicine American Association of Critical-Care Nurses (AACN) Founded in 1969 Largest specialty organization in world Mission Values 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) Founded in 1970 Multiprofessional membership 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 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 ACCNS Acute and Critical Care Clinical Nurse Specialist ACNPC-AG Acute Care Nurse Practitioner Subspecialty certification CMC Cardiac medicine CSC Cardiac surgery Standards (1of 2) Guide clinical practice Establish goals for patient care Provide assessment of outcomes AACN Standards for Acute and Critical Care Nursing Practice Nursing Process Expectation of the nurse Standards of Practice (Bell, 2008) (2 of 2) 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 Multisystem organ dysfunction Complicated by aging population Increasing costs for care 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 Technical competence Relationship building Ability to multitask and set priorities Critical Thinking Challenge Discuss strategies for reducing or preventing stress and burnout in critical care nurses. Focus on Quality and Safety Errors and harm must be prevented Nurses are challenged to reduce errors and promote a safe environment Several initiatives 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 Adverse drug events Infections 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 Implement practice based on evidence Evaluate research Hierarchy of evidence Communication Communication important for safe care Much information derived from airlines Crew resource management Barriers to Effective Handoff Communication Standardized approaches 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 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 A. Collaboration. Trends and Issues (1 of 3) Reducing hospital readmission rates Increasing use of technology Electronic medical records Physician order entry Ethical issues associated with prolonging life and futile treatment Telemedicine and eICU Trends and Issues (2 of 3) Aging population Transfer of patients from the critical care unit while still acute Aging workforce Trends and Issues (3 of 3) Shortage of critical care nurses Importance of recruitment, orientation, and retention Ongoing debate about hiring new graduates to work in critical care units
