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Acute Care Chapter 20 20-2

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  • 1. Acute Care Chapter 20
  • 2. Acute Care
    • A type of nursing, as well as the place for the delivery of nursing care.
  • 3. Acute Care
    • Most expensive of health care settings
    • Includes the full range of physical and mental alterations afflicting individuals
    • Saving life, prolonging life, palliative care
  • 4. The Focus of Acute Care Nursing
    • Management of crisis
    • Detection of disease in a pre-symptomatic stage (secondary prevention)
    • Management of chronic disease
  • 5. Arenas of Acute Care
    • Proprietary or not-for-profit
    • General or specialized
  • 6. Arenas of Acute Care
    • ICU
    • Long-term acute care (LTAC) facilities (for survivors of acute ICU interventions)
    • Post-acute rehabilitation (subacute services)
  • 7. Providers of Acute Care Nursing
    • Registered Nurses
    • Licensed Practical Nurses
    • Nursing Assistants
    • Unlicensed Clinical Assistants
  • 8. Providers of Acute Care Nursing
    • Registered Nurses
      • Associate, diploma, baccalaureate
      • Certification
      • Master’s and doctoral level
      • Advanced Practice Nurses
  • 9. Providers of Acute Care Nursing
    • Advanced Practice Nurses
      • Nurse Practitioner
      • Nurse Midwife
      • Nurse Anesthetist
      • Clinical Nurse Specialist
  • 10. The Importance of Critical Thinking in Acute Care Nursing
    • Use the nursing process with respect to specific acute problems.
    • Master the facts and concepts concerning commonly encountered problems.
  • 11. The Importance of Critical Thinking in Acute Care Nursing
    • Apply principles of critical and ethical decision making in a complex environment.
    • Understand aggregates of clients.
      • Specialty populations with special needs
  • 12. Regulatory Organizations for Acute Care Nursing Practice
    • American Nursing Association (ANA)
    • Canadian Nurses Association (CNA)
    • American Association of Critical Care Nurses (AACN)
    • Intravenous Nurses Society (INS)
    • American Association of Neuroscience Nurses (AANN)
  • 13. Regulatory Organizations for Acute Care Nursing Practice
    • Allied Disciplines and Acute Care Nursing
      • Medical Technologists
      • American Heart Association
      • The American Occupational Therapy Association (AOTA)
      • The American Physical Therapy Association (APTA)
  • 14. Regulatory Organizations for Acute Care Nursing Practice
    • Standards for Care in Acute Care Nursing
      • Organized, and explicit expectations for providers and clients
      • Scientific rigor applied to common diagnoses
      • Development of critical pathways (care maps)
  • 15. Quality Control Agencies for Acute Care
    • Hospitals
      • Occupational Safety and Health Administration (OSHA)
      • Clinical Laboratory Improvement Amendments (CLIA)
      • Centers for Medicare and Medicaid Services (CMS)
  • 16. Quality Control Agencies for Acute Care
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
      • Monitors and evaluates appropriateness of care
      • Evaluates quality of service
      • Resolves existing problems
      • Educational and supportive
  • 17. Quality Control Agencies for Acute Care
    • State and Federal Agencies
      • National Committee for Quality Assurance (NCQA)
      • The California Department of Managed Health Care
      • Ombudsman for the Managed Care Consumer Advisory Board (Massachusetts)
  • 18. Quality Control Agencies for Acute Care
    • Institute of Medicine of the National Academy of Sciences Report
      • Error incidence, detection, analysis and prevention
      • Four-tiered approach to improve safety in health care
  • 19. Evidence-Based Practice in Acute Care Nursing
    • Conscientious, explicit, and judicious use of current best evidence in making decisions about individual client care
  • 20. Evidence-Based Practice in Acute Care Nursing
    • Outcomes Research in Acute Care Practice
      • Links care delivered to individuals to the outcomes achieved
      • Means of monitoring and improving quality of care in the acute care setting
  • 21. Evidence-Based Practice in Acute Care Nursing
    • Mastery of Knowledge in Acute Care Nursing
      • Wide range of pathologies
      • Broad range of assessment skills
      • Different laboratory and radiologic correlates
      • Multiple drug classes, and agents to manage possible treatment complications
  • 22. Evidence-Based Practice in Acute Care Nursing
    • Mastery of Knowledge in Acute Care Nursing
      • Technical demands
      • Cultural and age-related concepts
      • Common diagnostic and complication-related signs and symptoms
      • Collaboration with other members of the health care team
  • 23. Value Orientation and Acute Care Nursing
    • An essential component of acute care nursing
      • Making difficult ethical decisions that are accompanied by potentially serious consequences
      • Justifying how resource expenditure decisions are made
  • 24. Capitalism and Acute Care Nursing
    • Philosophy of Capitalism and Health Care
      • American health care is considered and treated as a market commodity to be bought and sold rather than as a right.
      • There is infinite demand for finite resources.
  • 25. Capitalism and Acute Care Nursing
    • Managed Care Concepts in Acute Care
      • Health care financing and delivery arrangement designed to provide appropriate, effective, efficient health care
  • 26. Managed Care Concepts in Acute Care
    • Many managed care institutions are strong allies with other groups interested in quality health care.
  • 27. Social Influences Influencing Acute Care Nursing
    • Culture and ethnicity
    • Human genome mapping
    • Aging trends
    • Third-party payment systems of insurance
  • 28. Social Influences Influencing Acute Care Nursing
    • Human Genome Mapping
      • Sequencing of DNA in the human genome
      • Focus of diagnostics and therapeutics is shifting to genetic and molecular levels.
  • 29. Human Genome Mapping
    • Fundamental issues include:
      • How will the knowledge affect the acutely ill?
      • Will insurance cover illness in client’s with a predisposition for a particular disease?
  • 30. Aging and Acute Care
    • Appropriate use of technology and other healthcare resources
    • Treatment and resuscitation decisions
  • 31. Social Influences Influencing Acute Care Nursing
    • Insurance and Acute Care
      • The uninsured often experience major decompensation as a result of lack of attention to originally manageable problems.
  • 32. Insurance and Acute Care
    • Preventive services can be far less expensive to provide than emergency acute care services.
  • 33. Current Issues in Nursing and Effect on Acute Care Nursing
    • Entry into practice
    • Use of variably trained caregivers
    • Critical thinking in the acute care setting
  • 34. Entry Into Practice Issues and Acute Care
    • Who should bear the cost of continuing education?
    • Qualification profile of practicing nurses
    • Debate concerning highest nursing credential
    • Is education adequate to address the complexity of care demands?
  • 35. Current Issues in Nursing and Effect on Acute Care Nursing
    • Nonstandardized Care Providers in Acute Care
      • Challenge is to provide quality care in an acute care environment with fewer nurses.
        • Education is not standardized.
        • Roles are not clearly defined.
        • Nursing professionals are ultimately responsible for defining their capabilities.