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Trends in critical care nursing
1. TRENDS IN CRITICAL
CARE NURSING
JOHNY WILBERT, M.Sc[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL
MANAGEMENT AND ALLIED SCIENCE
2. INTRODUCTION
What is Critical Care Nursing?
Critical care nursing is a specialty within
nursing that deals specifically with human responses
to life-threatening problems.
What is the responsibility of critical care nurse?
Critical Care Nurses are responsible for making
sure that critically ill patients and members of their
families receive close attention and the best care
possible.
3. What critical care nurses do?
Critical care nurses fill many roles in the critical care
setting, such as staff nurses, nurse-educators, nurse-
managers, clinical nurse specialists, nurse practitioners and
nurse researchers.
Where do they work?
Critical Care Nurses work wherever critically ill
patients are found, including:
• Adult, pediatric, and neonatal CCUs
• Coronary care and progressive coronary care units
• Emergency departments
• Post anesthesia care units
4. What makes them special?
As a nurse who specializes in critical care, she has to accept a
wide range of responsibilities, including:
• Being an advocate
• Using sound clinical judgment
• Demonstrating caring practices
• Collaborating with a multidisciplinary team
• Demonstrating an understanding of cultural diversity
• Providing patient and family teaching
5. EVOLUTION OF CRITICAL CARE AND CRITICAL
CARE NURSING
Critical Care
Critical care evolved from recognition that the needs of
patients with acute, life-threatening illness or injury could be
better met if the patients were organized into distinct areas of
the hospital.
In the 1800s - Florence Nightingale insisted
In the 1900s - First Critical Care Unit at Johns Hopkins
Hospital in Baltimore
During World War II, shock wards were established
6. The 1950s - mechanical ventilator was invented and patients
were grouped receiving this new therapy in one location.
Critical Care Nursing
Critical Care Nursing was organized into a specialty only less
than 40 years ago;
The development of new medical interventions and technology
resulted in an increasing recognition that nursing was important
in monitoring and observation of critically ill patients.
Physicians depended on nurses to watch for critical changes in
the condition of patients in the physicians’ absence and,
sometimes, depended on the nurses to initiate emergency
medical treatment.
7. Medical and Surgical intensive care units were established
for most critically ill patients where they could be cared for
by nurses with specialized knowledge in those areas of care.
By 1960s nurses had begun to specialize their knowledge
and practice into focused areas such as coronary care,
nephrology, and intensive care.
Nurses assumed many functions and responsibilities formerly
reserved for physicians and assumed a new authority by
virtue of their knowledge and expertise.
8. CRITICAL CARE NURSING STANDARDS
Standards of Care
Standard of Care I: Assessment
The nurse caring for acute and critically ill patients collects
relevant patient health care data.
Standard of Care II: Diagnosis
The nurse caring for acute and critically ill patients analyzes
the assessment data in determining diagnoses.
Standard of Care III: Outcome Identification
The nurse caring for acutely and critically ill patients
identifies individualized, expected outcomes for the patient.
9. Standard of Care IV: Planning
The nurse caring for acutely and critically ill patients
develops a plan of care that prescribes interventions to attain
expected outcomes.
Standard of Care V: Implementation
The nurse caring for acutely and critically ill patients
implements interventions identified in the plan of care.
Standard of Care VI: Evaluation
The nurse caring for acutely and critically ill patients
evaluates the patients progress toward attaining expected
outcomes.
10. Standards of Professional Practice
Standard of Professional Practice I: Quality of Care
The nurse caring for acutely and critically ill patients
systematically evaluates the quality and effectiveness of
nursing practice.
Standard of Professional Practice II: Individual Practice
Evaluation
The nurse evaluates that the care reflects knowledge of
current professional practice standards, laws, and
regulations.
Standard of Professional Practice III: Education
The nurse acquires and maintains current knowledge and
competency in the care of acute and critically ill patients.
11. Standard of Professional Practice IV: Collegiality
The nurse caring for acute and critically ill patients interacts
with and contributes to the professional development of peers
and other health care providers as colleagues.
Standard of Professional Practice V: Ethics
The nurse’s decisions and actions on behalf of acutely and
critically ill patients are determined in an ethical manner
Standard of Professional Practice VI: Collaboration
The nurse caring for acute and critically ill patients
collaborates with the team, consisting of patients and family,
and health care providers, in providing patient care in a
healing, humane, and caring environment.
12. Standard of Professional Practice VII: Research
The nurse caring for acute and critically ill patients uses
clinical inquiry in practice.
Standard of Professional Practice VIII: Resource Utilization
The nurse caring for acute and critically ill patients considers
factors related to safety, effectiveness, and cost in planning
and delivering patient care.
13. CRITICAL CARE NURSE -
CHANGING ROLES
The Critical Care Nurses’ role & responsibility
includes:
Respect and support the right of the patient
or patient’s designated surrogate to autonomy and
informed decision making.
Intervene when the best interest of the
patient is in question
Help the patient to obtain necessary care.
Respect the values, beliefs, and rights of the
patient.
Provide education and support to the patient
or patient’s designated surrogate to make
decisions.
14. Represent the patient in accordance with the patient’s
choices
Support the decisions of the patient or patient’s designated
surrogate or transfer care to an equally qualified critical
care nurse.
Intercede for patients who cannot speak for themselves in
situations that require immediate attention.
Monitor and safeguard the quality of care that the patient
receives.
Act as a liaison between the patient, the patient’s family
and other health care professionals.
15. The various capacities in which a critical care nurse
may function includes:
Staff Nurse
The staff nurse functions as a primary care giver by
independently making assessments, planning and
implementing patient care.
Nurse Educator
The nurse assess patients’ and family members’
learning needs, plans and implements teaching strategies to
meet those needs, and evaluates the effectiveness of
teaching.
16. Nurse Manager
The Nurse Manager ensures that the effective and quality
nursing care is provided in a timely and fiscally managed
environment.
Case Manager
This expanded capacity enables the nurse to manage
comprehensive care of an individual patient. It includes the
patient’s entire illness episode, crosses all care settings, and
involves the collaboration of all personnel who provide care.
The case manager is involved in discharge planning, making
referrals, identifying community and personal resources, and
arranging for equipment and supplies needed by the patient on
discharge.
17. Clinical Nurse Specialist
The clinical nurse specialist provides evidence-based
nursing care by participating in education and direct patient care,
consulting the patient and family members, and collaborating
with other nurses and health care team members to deliver high-
quality care.
Nurse Practitioner
Nurse Practitioners provide primary health care to patients
and families and can function independently. The Nurse
Practitioner may obtain histories and conduct physical
examinations, order laboratory and diagnostic tests and interpret
their results, diagnose disorders, treat patients, counsel and
educate patients and family members, and provide continuous
follow-up care after patients are discharged from the CCU.
18. Nurse Researcher
Nurse Researchers promote the science of nursing by
investigating problems related to nursing.
The goal is to develop and refine nursing knowledge and
practice. Staff nurses participate in nursing research by
reading current nursing literature, applying the information in
practice, and collecting data.
Advanced practice nurses (Clinical nurse specialist and
Nurse Practitioner) can assist staff nurses by conducting the
research study and by serving as a consultant to the nurses
during implementation of a research study.
19. HOLISTIC CRITICAL CARE NURSING
Holistic care addresses all dimensions of a person,
including: physical, emotional, social and spiritual.
Caring
Holistic care focuses on human integrity and stresses
that the body, the mind, and the spirit are interdependent
and inseparable.
The critical care nurse must be able to deliver high
quality care skillfully, using all appropriate technologies,
while also incorporating psychosocial and other holistic
approaches as appropriate to the time and condition of the
patient.
20. Individualized Caring
Special consideration must be given to determine the
unique interventions that will positively impact each
individual patient and help their progress toward desired
outcomes.
An important aspect in the care delivery and recovery
of critically ill patients is the personal support of family
members and significant others.
The value of both patient-and family-centered care
should not be underestimated. It is important for families to
be included in care decisions and to be encouraged to
participate in the care of the patient as appropriate.
21. Cultural Care
Diversity includes not only ethnic sensitivity and
openness to differences in lifestyles, opinions, values and
beliefs. Unless cultural differences are taken into account,
optimal health care cannot be provided. Cultural competence
is one way to ensure that individual differences related to
culture are incorporated into the plan of care.
Complementary and Alternative Therapies
Complementary therapies offer patients, families and
health care providers additional options to assist with
healing and recovery. Some of the complementary therapies
that have been used in critical care areas include spirituality
and prayer, guided imagery and massage.
22. RECENT PROFESSIONAL AND TECHNOLOGICAL
ADVANCES AND THEIR IMPACT ON CRITICAL CARE
NURSING
The general public believes that technology will improve
health care efficiency, quality, safety and cost. However, few
people consider that these same technologies may also
introduce errors and adverse events.
Patient care technology has become increasingly complex;
transforming the way nursing care is conceptualized and
delivered.
While technology has the potential to improve care, it is not
without risks. Technology has been described as both part of
the problem and part of the solution for safer health care.
23. Technology Commonly Used by Nurses
Direct Nursing Care Delivery Technology
• Barcode medication administration
• Intravenous (IV) tubing
• IV pumps
• Feeding pumps
• Nasogastric tubes
• Endotrachial tube
• Tracheostomy tubes
• Syringes
• Needles
• Urinary catheters and drainage bags
• Ostomy appliances
• Wound drainage tubes
• Chest tubes
• Suction equipment
• Oxygen and air regulators, tubing, and face masks
• Oxygen tanks and regulators
• Nebulizers
• Dressings (from gauze to specialized materials)
• Traction systems
• Code carts
24. Indirect Nursing Care Delivery Technology
• Robotics
• Radio frequency identification
• Electronic inventory systems
• Computerized staffing systems
Nurse Protective Devices
• Face masks
• Gloves
• Gowns
• Hand sanitizer dispensers
• Mechanical lifts
• Patient transfer devices
Remote Patient Monitoring
• Telemedicine and telehealth
25. Patient Protective Devices
• Floor mats
• Beds
• Elopement/wandering alarms
• Fall alarms
• Hip protectors
• Specialized mattresses (e.g., low air loss)
• Specialized lighting
• Hand rails in patient rooms, hallways, and bathrooms
• Specialized seating cushions
• Limb compression devices
28. Continuous Learning
• Distance learning
• Video conferencing
• Online training
Pattern Identification
• Electronic medical records
Communication With People Distanced by Place and
Time
• Electronic medical records
• Electronic ordering systems
• Communication devices (cell phones, PDAs, paging
systems)
• Call systems, including emergency call bell staffing data
systems
29. Tips for Nurses to Influence Technology at the Bedside
Organize equipment fairs to gain input from key users and
stakeholders before purchases.
Examine performance of technology on challenging scenarios
in a simulated setting with a small number (three to five) of
untrained, representative users
Mentor and oversee temporary nurses and other personnel
(e.g., resident physicians) during first-time use of
sophisticated technology
Become critical users of technology by identifying problems
early and communicating them to vendors and in-house
biomedical engineering staff.
30. Tips for Nurses to Influence Technology at the
Bedside (cont..)
Report adverse events associated with medical
devices to the Food and Drug Administration
reporting system
Serve as a resource person on your unit for new
technologies by getting training early,
communicating with vendors, training others on
your unit.
31. FUTURE OF CRITICAL CARE NURSING
Rapid advances in healthcare and technology have
contributed to keeping more people out of the hospital.
Many patients in today's critical care units would not have
survived in the past.
It has been proposed that hospitals of the future will be large
critical care units, and other types of care will be provided in
alternative locations or at home.
32. FUTURE OF CRITICAL CARE NURSING (Cont…)
Critical care nurses will need to keep pace with the latest
information and develop skills to manage new treatment
methods and technologies. As issues relating to patient care
become increasingly complex and new technologies and
treatments are introduced, critical care nurses will need to
become ever more knowledgeable.
33. EVIDENCE- BASED NURSING PRACTICE
♪ Much of early medical and nursing practices were based on
nonscientific traditions that resulted in various and haphazard
patient outcomes.
♪ Examples of non-scientific-based critical care nursing practice
include suctioning artificial airways every 2 hours; using iced saline
when measuring a cardiac output, always using lead II for cardiac
monitoring; stripping chest tubes every 2 hours; and limiting
visiting hours for all patients.
♪ The dramatic and multiple changes in health care have placed greater
emphasis on demonstrating the effectiveness of treatments and
practices on outcomes.
34. EVIDENCE- BASED NURSING PRACTICE (cont..)
♪ Greater importance is placed on efficiency, cost-effectiveness,
quality of life, and patient satisfaction ratings.
♪ By means of scientific basis, with its ability to explain and predict,
nurses are able to provide research based interventions with
consistent, positive outcomes.
♪ Not only must appropriate research studies be designed to answer
clinical questions, but also research findings must be used to make
necessary changes for implementation in practice.
35. EVIDENCE- BASED NURSING PRACTICE
(cont..)
♪ Multiple evidence-based practice and research utilization
models exist to guide the critical care nurse in the use of
existing research findings. One such model is Iowa Model of
evidence-based practice to promote quality care that
incorporates both evidence and research as the basis for
practice.
36. BECOMING A CRITICAL CARE NURSE
To become a Critical Care Nurse,
♪ An individual should be a registered nurse (RN)
♪ He/She must earn at least a diploma in nursing or
a bachelor's degree in nursing.
♪ Much of the training required to become a critical
care nurse is learned on the job.
37. BECOMING A CRITICAL CARE NURSE
(cont..)
♪ A competency –based orientation period allows the
nurse to acquire knowledge and the technical skills
needed to work in the critical care environment.
♪ Such technical skills include working with equipment,
such as cardiac monitoring systems, mechanical
ventilators, hemodynamic monitoring devices, and intra
cranial pressure monitoring devices.
38. CONCLUSION
Critical Care Nursing has reached an all time height
in its advances in technology and in caring based on
scientific basis during the last two decades. Critical Care
Nurses provide care to restore health, alleviate pain and
suffering, preserve and uphold the rights and dignity of
the individuals.
Finally, the critical care nurses at all time must strive
for updating their knowledge continuously through all the
resources available to make themselves capable of
meeting diversified challenges which they come across in
their day-today practice.
![TRENDS IN CRITICAL
CARE NURSING
JOHNY WILBERT, M.Sc[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL
MANAGEMENT AND ALLIED SCIENCE](https://image.slidesharecdn.com/trendsincriticalcarenursing-180419183610/85/trends-in-critical-care-nursing-1-320.jpg)
