The document defines critical care units and intensive care units as specialized hospital sections that provide comprehensive care for critically ill patients. It discusses the goals, organization, staffing, and principles of critical care nursing. The levels of ICU are described from level 1 to level 3 with increasing complexity of care. Ethical principles like beneficence, non-maleficence, autonomy and justice govern critical care. Staffing includes intensive care doctors, resident doctors, intensive care nurses, and allied health professionals like respiratory therapists and physiotherapists.

1. CRITICAL CARE UNIT

2. Content
• Introduction to CCU
• Organizational set up
• Policies
• Staffing norms
• Principles of critical care nursing

3. Definition of ICU
• An intensive care unit (ICU) or critical care unit
(CCU) is a specialized section of a hospital that
provides comprehensive and continuous care for
persons who are critically ill and who can benefit
from treatment.

4. DEFINITION of critical care nursing
Critical care nursing is a comprehensive, specialized
and individualized nursing care services which are
rendered to patients, with life threatening
conditions and their families.

5. GOALS OF CRITICAL CARE
1. Towards the survival of the critically ill
patients and restoring quality of life
2. Restoring optimal physiological,
psychological, social and spiritual potential
3. Helping the families of the critically ill patient
in coping with crisis

6. ORGANIZATION AND PHYSICAL SETUP OF CCU
DESIGN OF INTENSIVE CARE UNIT
1.The Design Team:
Multidisciplinary team consist of ICU
medical director, ICU nurse manager, the
chief architect, hospital administration and
the operating engineering staff.
2.Location /Entry/ Exit Points of ICU in Hospital
There should be a single entry and exit
point to ICU. However, it is required to have
emergency exit points
3. ICU Bed Designing and Space Issues:
Space per bed from 125 to 150 sq ft
area

7. ORGANIZATION AND PHYSICAL SETUP OF CCU
4. Floor and Wall Coverings:
Should be easy to clean, non slippery
5. Patient Areas:
Patients must be situated so that direct or indirect
visualization by healthcare providers is possible at all
times.

8. ORGANIZATION AND PHYSICAL SETUP OF CCU
6. Central Nursing Station:
This is the nerve centre of ICU
7.Work Areas and Storage:
Work areas and storage for critical supplies
should located within or immediately adjacent
to each ICU.
8. Special Procedures Room
If a special procedures room is desired, it
should be located within or immediately
adjacent to the ICU.
9.Clean and Dirty Utility Rooms
Clean and dirty utility rooms must be separate
room

9. ORGANIZATION AND PHYSICAL
SETUP OF CCU
10. Equipment Storage:
An area must be provided for the storage and
securing of large patient care equipment items not
in active use,
11. Nourishment Preparation Area:
12. Staff lounge
13. Receptionist Area
14. Visitors lounge
15. Conference room
16. Administrative office

10. Levels of ICU
LEVEL 1
• It is recommended for small district hospital, small private nursing
homes, rural centers
• Ideally 6 to 8 beds
• Provides resuscitation, mechanical ventilation and short-term cardio
respiratory support including defibrillation.
• It should be able to ventilate a patient for at least 24 to 48 hrs and
non invasive
• Monitoring like - SPO2, H R and ECG, temperature etc
• Able to have arrangements for safe transport of the patients to
secondary or tertiary centers

11. Levels of ICU
LEVEL 2
• Recommended for larger general hospitals
• Provide complex, multisystem life support
• Bed strength 6 to 12
• Monitoring for a period of at least several days or for longer periods

12. Levels of ICU
• Director be a trained/qualified intensivist
• Multisystem life support
• Invasive and non invasive ventilation
• Invasive monitoring
• Long term ventilation ability
• Access to ABG, electrolytes and other routine diagnostic support 24
hrs

13. Levels of ICU
Level 3
• Recommended for tertiary level hospitals
• Bed strength 10 to 16,care given for indefinite periods
• Headed by intensivist
• Have all recent methods of monitoring, invasive and non invasive
• Long term acute care of highest standards and multisystem care
• Bedside x-ray, USG, 2d-echo available
• Own or outsourced CT scan and MRI facilities should be there

14. Levels of ICU
Level 3
• Bedside broncoscopy
• Bedside dialysis and other forms RRT available
• optimum patient/nurse ratio is maintained with 1/1 pt /nurse ratio
in ventilated patient.
• Doctors, nurses and other support staff be continuously updated in
newer technologies and knowledge in critical care

15. Principles of critical care
nursing
 ANTICIPATION
 EARLY DETECTION & PROMPT ACTION
 COLLABORATIVE PRACTICE
 COMMUNICATION
 PREVENTION OF INFECTION
 CRISIS INTERVENTION AND STRESS REDUCTION

16. Principles
1. Anticipation:
Recognize the high risk patients and anticipate the
requirements
2. Early Detection and Prompt Action: The prognosis of the
patient depends on the early detection of variation,
prompt and appropriate action to prevent complication.

17. Principles
3. Collaborative Practice: Collaborative practice fosters a
partnerships for decision making and ensures quality and
compassionate patientcare.
4. Communication: Intraprofessional, interdepartmental and
interpersonal communication has a significant importance in
the smooth running of unit.

18. Principles
5. Prevention of Infection: Critically ill patients requiring
intensive care are at a greater risk than other patients
6 Crisis Intervention and Stress Reduction: As patient
advocates, nurses assist the patient to express fear and
identify their grieving pattern and provide avenues for positive
coping.

19. Ethical principles governing critical
care
• BENEFICENCE AND NONMALEFICENCE
• Do good
• Do no harm
• AUTONOMY
• Right to self determination
• JUSTICE
• Distinguish right from wrong in patient care

20. STAFFING NORMS
• Critical care unit consists of many
different, highly trained staff,
working together, caring for
seriously ill patients.

21. INTENSIVE CARE DOCTORS
 Termed as intensivist or ICU consultant
 Responsible for co-ordination of patient care in ICU and
will consult with other specialists
 Skilled in diagnosing and treating critical illnesses and
injuries

22. RESIDENT DOCTORS
 PGs from anaesthesia, medicine, respiratory medicine
 One PG resident with one graduate resident for an ICU
with 10-14 beds

23. INTENSIVE CARE NURSES
 Responsible for co-ordination and implementation of treatment and
care of critically ill patients
 Undergo special training and education and have experience in caring
critically ill patients
 Capable of providing constant and continuous bed side care
 Ratio:
 1:1 in ventilated or MODS patients
 1:2 or1:3 N-P ratio for less seriously ill

24. ALLIED HEALTH
PROFESSIONALS
ICU team cannot care for the patient without help of other
health care professionals
• Respiratory therapist
• Physiotherapist
• Pharmacist
• Technician
• Occupational therapist
• Nutritionist

25. ALLIED HEALTH
PROFESSIONALS CONTD….
• Biomedical engineer
• Cleaning staff
• Computer operator
• Counsellor

26. Vancouver style of writing reference

27. REFERENCES
• Linda D.Urden, Kathleen M Stacy ;Critical care nursing
Diagnosis and management; Mosby Publication. 5 th
ed; Missuri
• Javed Ansari, a text book of medical surgical nursing-II
, pee vee publications
• Lewis, bucher, heitkemper, harding, kwong, roberts.
Lewi’s medical surgical nursing.3rd south asia edition.
Vol 2. New delhi: elseiver publications;
• Https://icuconsultants.Com/criticalcare.Html