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Acute Care Chapter 20 20-2

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  • 1. Acute Care Chapter 20
  • 2. 20-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Acute Care  A type of nursing, as well as the place for the delivery of nursing care.
  • 3. 20-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Focus of Acute Care Nursing  Management of crisis  Detection of disease in a pre- symptomatic stage (secondary prevention)  Management of chronic disease
  • 5. 20-5Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Arenas of Acute Care  Proprietary or not-for-profit  General or specialized
  • 6. 20-6Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Arenas of Acute Care  ICU  Long-term acute care (LTAC) facilities (for survivors of acute ICU interventions)  Post-acute rehabilitation (subacute services)
  • 7. 20-7Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Providers of Acute Care Nursing  Registered Nurses  Licensed Practical Nurses  Nursing Assistants  Unlicensed Clinical Assistants
  • 8. 20-8Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Providers of Acute Care Nursing  Registered Nurses • Associate, diploma, baccalaureate • Certification • Master’s and doctoral level • Advanced Practice Nurses
  • 9. 20-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Providers of Acute Care Nursing  Advanced Practice Nurses • Nurse Practitioner • Nurse Midwife • Nurse Anesthetist • Clinical Nurse Specialist
  • 10. 20-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-11Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-14Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-15Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-17Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evidence-Based Practice in Acute Care Nursing  Conscientious, explicit, and judicious use of current best evidence in making decisions about individual client care
  • 20. 20-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-21Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-22Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-23Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-24Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-25Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-26Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Managed Care Concepts in Acute Care  Many managed care institutions are strong allies with other groups interested in quality health care.
  • 27. 20-27Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Influences Influencing Acute Care Nursing  Culture and ethnicity  Human genome mapping  Aging trends  Third-party payment systems of insurance
  • 28. 20-28Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-29Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-30Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Aging and Acute Care  Appropriate use of technology and other healthcare resources  Treatment and resuscitation decisions
  • 31. 20-31Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-32Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Insurance and Acute Care  Preventive services can be far less expensive to provide than emergency acute care services.
  • 33. 20-33Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-34Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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. 20-35Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

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