2. • The College of Intensive Care Medicine
aims to maintain the highest standards of
practice, teaching and research in Intensive
Care Medicine. The College also
recognises that the overall welfare of the
patient is the principal goal of Intensive Care
management
3. Critical Care Nursing
• A Team Approach to Care
• A Multidisciplinary Perspective
• A Holistic Approach to Care
• A Synergistic Approach to Care
• A Highly-Motivated Environment
• An Environment of Education
4. Standards of Care
• Assessment – relevant data
• Diagnosis – analyzes assessment data
• Outcome Identification- individualized
• Planning- plan of care that prescribes
interventions
• Implementation
• Evaluation
5. Standards of Professional Practice
• Quality of Care – evaluates quality
• Individual Practice Evaluation
• Education – maintains current knowledge
• Collegiality
• Ethics
• Collaboration
6. Standards of Professional Practice
(cont’d)
• Research – practice based on research; inquiry
approach to care
• Resource Utilization
7.
8. Critical Care Environment
• Psychosocial issues: self-esteem, body image,
personal identity, & role performance
• Stressors in the ICU?
• Coping Mechanisms: regression, suppression,
denial, trust, hope, hardiness & resilience,
spiritual beliefs & practices, family support, &
sharing
9. Sleep Alterations/Pain Control
• Somatostatin released in deep sleep which inhibits
pain (prostaglandin release)
• Pain Control – “the 5th vital sign”
• Sedation – Ramsey Scale and others
• Ramsey I – awake, II- cooperative and oriented,
tranquil, III- responds to commands, IV- Asleep, V-
sluggish response to light tap or loud auditory
stimulus, VI – no response to light tap or loud
auditory stimulus
10. Medical Legal and Ethical Issues
Introduction:-
A basic principle of emergency care is to do no
further harm, any health care provider who acts
in good faith and according to an appropriate
standard of care usually avoids legal exposure.
11. Medical Legal and Ethical Issues
• 1-Scope of practice, which is most
commonly defined by law, requires you to
act or behave toward other individual in a
certain, definable way, regardless of the
activity involve ,so you must be concerned
about the safety and welfare of others.
12. • 2-Standard of care: - is a written, accepted
level of emergency care expected by legal or
professional organizations so that patients
are not exposed to unreasonable risk of
harm.
13. • Negligence: - is the failure to provide the
same care that a person with similar training
would provide it is deviation from accepted
standard of care that may result in injury to
patient.
14. • Abandonment is the unilateral termination
of care by the first aider without the
patient's consent and without making any
provisions for continuing care.
15. • Abandonment is the unilateral termination
of care by the first aider without the
patient's consent and without making any
provisions for continuing care.
16. • Consent: - Granting permission to another to
render care. Consent is required from every
conscious, mentally competent adult before
care be started.
17. • Expressed consent: Is the type of consent in
which the patient expressly authorizer you to
provide care or transport
18. • Implied (indirect) consent: - When a person
is unconscious and unable to give consent or
when a serious threat to life exists, the law
assumes that the patient would consent to
care and transport to medical facility.
19. • Notes: Minors (infants and children) and
mentally incompetent adults are unable to
signs a consent.
20. Ethical principle
• Ethics are related to moral actions conduct,
motive or character, ethics are related to what
the profession of emergency medical service
providers deems (thinks) right, so treating a
patient ethically means doing so in a manner
that conforms the professional standards of
conduct.
21. Ethical principle:
• Caring for all patients with a sense of
excellence (quality), so you must strive to be
at your best at all times.
22. • Improve your performance through hand-on
experience and continuing education.
23. • Honest reporting is essential which
important for quality improvement.
24. • Confidentiality: communication between
you and the patient is considered
confidential and cannot be disclosed without
permission from the patient or a court order
27. Legal Issues
• Negligence – unintentional breach of duty or
failure
• Malpractice – held liable for negligence
• Essential elements – duty and standard of
care, breach of duty, causation, injury &
damage
• Understaffing? What do you do?
28. Legal Issues
• Nurse-patient ratio law
• Advance Directives for health care Power of
Attorney & Living Wills
• Withholding and Withdrawing treatment
• Do Not Resuscitate Orders
29.
30. The relationship between the Intensivist and the
patient must have regard to the following
concepts:
• patient autonomy, meaning the patients have
the right to decide their own treatment, with
Intensivists respecting the principles of truthful
disclosure and informed consent;
• the principle of beneficence, or the obligation to
do good;
• the principle of non-maleficence, or the duty to
do no harm; and
• the principle of social justice, as it applies to the
fair distribution of resources
31. Other important ethical principles include:
• Fidelity (faithfulness) to duties and
obligations. This principle underlies
confidentiality, truthfulness, a commitment to
ongoing education, vigilance and devotion to
patient care.
• Paternalism, which may be justified or
unjustified, but always tends to negate
patient autonomy.
• Utility or the principle of achieving maximum
benefits, with the best use of resources.
