Chapter_01.pptx.critical care in nursing

Chapter 1
Overview of Critical Care Nursing
Copyright © 2013, 2009, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Critical Care Nursing
 Deals with human responses to critical illness or
injury
 Physiological
 Psychological
 Focus on both the patient’s and family’s
responses
Copyright © 2013, 2009, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2

Critical Thinking Challenge
What comes to your mind when you hear the
following terms?
 Intensive care
 Critical care
 ICU and CCU
 Trauma

Evolution of Critical Care
 Began with E/R units, recovery rooms, and
coronary care units
 Patient outcomes improved

Critical Care in the 21st Century
 Specialization
 Variety of settings
 Inpatient
 Outpatient
 Home care
 eICU

Competencies for Acute and
Critical Care Nurses

Professional Organizations
 Support critical care nurses and practice
 Key organizations
 American Association of Critical-Care Nurses
 Society of Critical Care Medicine

American Association of
Critical-Care Nurses (AACN)
 Founded in 1969
 Largest specialty organization in world
 Mission
 Assist nurses to attain knowledge and influence
 Healthy work environment initiative
 Web site: www.aacn.org

AACN’s Vision
Create a healthcare system driven by patient’s and family’s needs in
which critical care nurses make their optimum contributions
Figure 1-3. The American Association of Critical-Care Nurses Synergy
Model for Patient Care. (From Curley M. Patient-nurse synergy: optimizing
patients’ outcomes. American Journal of Critical Care. 1998;7:69.)

AACN Membership Benefits
 Professional journals and continuing education
offerings
 Critical Care Nurse
 American Journal of Critical Care
 AACN Advanced Critical Care (reduced rate)
 Practice Alerts
 Evidence-based interventions

AACN Membership Benefits
(continued)
 Continuing education
 National Teaching Institute (NTI)
 Support from local chapters
 Scholarships
 Research grants
 Student rate for membership
 Discounted rate for certification exams

Society of Critical Care Medicine
(SCCM)
 Founded in 1970
 Multiprofessional membership
 Physicians
 Nursing section
 Other critical care team members
 Web site: www.sccm.org
 Journal: Critical Care Medicine

SCCM Vision
 Healthcare system in which all critically ill and
injured persons receive care
 Multiprofessional healthcare team
 Directed by physician specializing in critical care—
intensivist

Quick Quiz!
The charge nurse assigns patients based on their
acuity and the level of experience of the critical
care nurses on duty. This is an example of
implementation of:
A. SBAR communication
B. Healthy work environment
C. National patient safety goals
D. Synergy model

Critical Care Certification
 Purpose
 Validate knowledge
 Promote professional excellence
 Help nurses to maintain up-to-date knowledge
 AACN Certification Corporation oversees
process
 Based on AACN synergy model for patient care
 Needs of patients and families drive practice

AACN Critical Care Certification
 Bedside practice
 CCRN: Adult, Neonatal, and Pediatric
 PCCN for those working in step-down units
 Advanced practice
 CCNS Critical Care Clinical Nurse Specialist
 ACNPC Acute Care Nurse Practitioner
 Subspecialty certification
 Cardiac medicine
 Cardiac surgery

Standards
 Guide clinical practice
 Establish goals for patient care
 Provide assessment of outcomes
 AACN Standards for Acute and Critical Care
Nursing Practice
 Process of nursing practice
 Expectation of the nurse

Standards of Practice (Bell, 2008)
 Evaluate quality of nursing practice
 Evaluate own practice
 Acquire knowledge and maintain competency
 Contribute to professional development of peers
 Act ethically
 Use skilled communication
 Use clinical inquiry
 Consider factors related to safety, effectiveness, and
cost
 Provide leadership in clinical setting

Trends and Issues
 Critical care patients more complex
 Multisystem organ dysfunction
 Complicated by aging population
 Increasing costs for care
 Challenged to reduce costs and length of stay
 Transfer of higher acuity patient from the critical care
unit to other units or home

Critical Care Nurse Characteristics
 Technical competence
 Relationship building
 Ability to multitask and set priorities

Critical Thinking Challenge
 Discuss strategies for reducing or preventing
stress and burnout in critical care nurses.

Focus on Quality and Safety
 Errors and harm must be prevented
 Nurses are challenged to reduce errors and
promote a safe environment
 Several initiatives
 Joint Commission National Patient Safety Goals
 Institute for Healthcare Improvement
 Quality and Safety Education for Nurses (QSEN)

National Patient Safety Goals
 The Joint Commission National Patient Safety
Goals
 Examples relative to critical care nursing
• Communication
• Medication safety
• Reduce infections
• Reconcile medications

Harms Targeted for Reduction
 Adverse drug events
 Infections
 Catheter-associated urinary tract infections (CAUTI)
 Central line–associated bloodstream infections
(CLABSI)
 Surgical site infections
 Ventilator-associated pneumonia (VAP)
 Injuries from falls and immobility
 Obstetric adverse events
 Pressure ulcers
 Venous thromboembolism (VTE)

Importance of Evidence-Based
Practice
 Implement practice based on evidence
 Evaluate research
 Hierarchy of evidence

AACN Hierarchy of Evidence

Quick Quiz!
During report using SBAR, the nurse states, “Since
we have just initiated a potassium replacement
protocol, the patient will need a potassium level
drawn at 1300.” This depicts:
A. Situation
B. Background
C. Assessment
D. Recommendation

Communication
 Communication important for safe care
 Much information derived from airlines
 Crew resource management
 Standardized approaches
 SBAR and SBAP
• Situation
• Background
• Assessment
• Recommendation (Plan)

Collaboration
 Create a culture of safety where everyone works
together
 Mutual respect
 Mutual recognition
 Aim during multiprofessional daily rounds
 Briefings are another approach

Quick Quiz!
Which of the following is a component of a healthy
work environment?
A. Collaboration
B. Use of many agency nurses
C. Crew-resource training
D. Evidence-based practice

Other Trends and Issues
 Reducing hospital readmission rates
 Increasing use of technology
 Electronic medical records
 Physician order entry
 Ethical issues associated with prolonging life
and futile treatment
 Telemedicine and eICU

Trends and Issues
 Aging population
 Transfer of patients from the critical care unit
while still acute
 Aging workforce

Trends and Issues
 Shortage of critical care nurses
 Importance of recruitment, orientation, and retention
 Ongoing debate about hiring new graduates to work
in critical care units

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