this chaprtr is

1. Building a Professional Practice
Model for Excellence in Critical
Care
Nursing
Lecturers:
Dr. Mathar
Dr. Jeneth

2. LEARNING OBJECTIVES
Based on the content in this chapter, the
student should be able to:
1. Discuss nursing professionalism and
nursing excellence.
2. Recognize characteristics of professional
development.
3. Explore personal and professional
attributes to build a professional practice
model of critical care nursing excellence.

3. • In today’s fast-paced critical care
environment, nurses respond to the needs of
patients and families who have entered a
chaotic and frightening world of illness,
trauma, and pain.
• Often, finding the time for professional growth
can be challenging. Building a professional
practice of excellence requires a “passion” to
profoundly affect the lives of patients and
families.
• At the same time, it requires advancing the
critical care nursing profession through
evidence-based practice, best practice

4. Defining the Critical Care Nurse
• Knowledgeable,” “highly skilled,” and “caring”
are a few of the professional attributes that
can be applied to critical care nurses.
• Critical care nurses know all too well that
responding to lethal dysrhythmias,
administering blood products, and weaning
patients from ventilators is more about having
a specialized body of knowledge, competent
skills, and clinical experience in holistic
nursing than about just “helping doctors.”

6. • CRITICAL CARE NURSING -It refers to
those comprehensive, specialized and
individualized nursing care services
which are rendered to patients with life
threatening conditions and their families.
DEFINITIONS

7. ANY PERSON WITH LIFE THREATENING
CONDITION PATIENTS WITH :
• Acute Renal Failure
• Acute Myocardial Infraction
• CARDIAC TAMPONATE
• Severe Shock
• Heart Block
• Acute Renal Failure Poly Trauma,
• Multiple Organ Failure And Organ
Dysfunction Severe Burns
What are the conditions considered
as Critical?

8. TYPES OF CRITICAL CARE UNIT
• NEONATAL INTENSIVE UNIT (NICU)
• SPECIAL CARE NURSERY (SCN)
• PAEDIATRIC INTENSIVE CARE UNIT (PICU)
• PSYCHIATRIC INTENSIVE UNIT (PICU)
• CORONARY CARE UNIT (CCU)
• CARDIAC SURGERY INTENSIVE CARE UNIT (CSICU)
• CARDIOVASCULAR INTENSIVE CARE UNIT (CVICU)
• MEDICAL INTENSIVE CARE UNIT (MICU)
• MEDICAL SURGICAL INTENSIVE CARE UNIT (MSICU)
• SURGICAL INTENSIVE CARE UNIT (SICU)
• TRAUMA INTENSIVE CARE UNIT (TICU)
• SHOCK TRAUMA INTENSIVE CARE UNIT (STICU)
• TRAUMA – NEURO CRITICAL CARE INTENSIVE CARE UNIT (TNCC)
• RESPIRATORY INTENSIVE CARE UNIT (RICU) GERIATRIC INTENSIVE
CARE UNIT (GICU)
TYPES OF CRITICAL CARE
UNIT:

9. • ANTICIPATION : One has to recognize the
high risk patients and anticipate the
requirements, complications and be
prepared to meet any emergency.
• EARLY DETECTION AND PROMPT
ACTION : The prognosis of the patient
depends on the early detection of
variation, prompt and appropriate action to
prevent or combat complication.
PRINCIPLES OF CRITICAL CARE
NURSING

10. • COMMUNICATION : Intra professional, inter
departmental and inter personal
communication has a significant importance
in the smooth running of unit.
• Prevention of Infection : Nosocomial infection
cost a lot in the health care services. Critically
ill patients requiring intensive care are at a
greater risk than other patients due to the
immunocompromised state with the antibiotic
usage and stress, invasive lines, mechanical
ventilators, prolonged stay and severity of
illness and environment of the critical unit
itself.

11. • Should be at a geographically distinct area
within the hospital, with controlled access.
• There should be a single entry and exit.
However, it is required to have emergency
exit points in case of emergency and
disaster.
• There should not be any through traffic of
goods or hospital staff.
• Supply and professional traffic should be
separated from public/visitor traffic.
ORGANIZATION OF ICU DESIGN
OF ICU

12. • Safe, easy, fast transport of a critically sick
pt should be a priority in planning its
location.
• Therefore, the ICU should be located in
close proximity or ER, OT, trauma ward
etc.
• Corridors, lifts and ramps should be
spacious enough to provide easy
movement of bed/trolley of a critically sick
patient. Close, easy proximity is also
desirable to diagnostic facilities, blood
bank, pharmacy etc.

13. Defining Nursing
Professionalism
• Flexner defines professionalism as a process by
which an occupation achieves professional status
• Margretta Styles, argued that the professionalism
of nursing can only be achieved through the
“professionhood” of its members.
• Kelly, Styles believes there must be a sense of
social significance, commitment to professional
performance, and appreciation of collegiality and
collectivity
• “Professionalists strive to build a solid foundation
for their calling—an ethical, academic, political,
and socioeconomic foundation to serve as the
underpinning for a strong profession to evolve and
serve”

14. Kelly’s Characteristics of a
Profession
• The services provided are vital to humanity and the
welfare of society.
• There is a special body of knowledge that is
continually enlarged through research.
• The services provided involve intellectual activities
where accountability is a strong feature.
• Practitioners are educated in institutions of higher
learning.
• Practitioners are motivated by service, and work is an
important component of their lives.
• There is a code of ethics to guide the decisions and
conduct of practitioners.
• There is an association that encourages and supports
standards of practice.

15. Defining Nursing Excellence
• The term excellence can be difficult to define, similar
to the expression best practice. No single definition
captures the essence of excellence for everyone.
• For some, excellence can be defined as a “sixth
sense”—for example, the way a critical care nurse
sees a patient going “bad” before laboratory values or
hemodynamic numbers are known may be evidence of
excellence.
• Excellence may also be demonstrated by the way a
critical care nurse hears an S3 or S4 heart sound
before a patient becomes symptomatic, or the way a
critical care nurse “feels” the pain of a postoperative
patient on neuromuscular blockade without analgesics

16. • Weston et al. define nursing excellence as a
dynamic process that is continually redefined
and reinforced.
• They further describe excellence as an
ongoing comparison with a standard that one
continuously tries to improve.
• Six attributes of advanced-practice nursing
excellence have been identified by Weston et
al as values, vision, mastery, passion, action,
and balance.

18. Values
• True excellence is seen when professionals
reflect their core values.
• The values of one’s profession, the values of
one’s employing organization, and one’s own
personal values are the behaviors that guide
professional practice for excellence.
• The unique contributions that critical care
nurses bring to the bedside are often a
reflection of an inner core value of caring. It is
this deep and personal connection to caring
that brings many into the nursing profession.

19. Vision
• A clear vision, based on core values, is essential
to building a professional practice model of critical
care nursing excellence.
• It requires envisioning the future’s possibilities and
then taking the challenge of making the vision a
reality
• Nursing has a long tradition of taking “bumpy”
roads to make a vision reality. No matter how
many times nurses fall down and get bruised on
the way to reach a vision, they maintain their
resilience by having the courage to listen, learn,
and act for themselves, their patients, and their
professional practice

20. Core Values: American Association
of Critical-Care Nurses (AACN)
• Ethical accountability and integrity in
relationships, organization decisions, and
stewardship of resources.
• Leadership to enable individuals to make
their optimal contribution through lifelong
learning, critical thinking, and inquiry.
• Excellence and innovation at every level of
the organization to advance the profession.
• Collaboration to ensure quality patient- and
family-focused care.

21. Mastery
• Studer, author of Hardwiring Excellence,
believes that excellence in health care occurs
when “employees feel valued, physicians feel
their patients are getting great care, and
patients feel the service and quality they
receive are extraordinary”
• To value lifelong learning and to have a vision
for personal mastery is essential to building a
professional practice model for critical care
nursing excellence

22. Passion
• Passion is the essential thread to link together all
the professional practice attributes for critical care
nursing excellence
• Passion involves enthusiastically striving for what
is best for ourselves and those we serve.
• Weston et al. stated that “passion involves
ardently striving for the best, even when repeated
efforts seem tedious or appear exceedingly
strenuous”
• The truly passionate critical care nurse is not
satisfied with providing less than the highest
quality care possible to patients and families.

23. Action
• Nightingale41 once said, “One’s feelings
waste themselves in words, they ought all to
be distilled into action which brings results”
• In other words, part of professionalism in
critical care nursing is “to walk the talk” for
excellence.
• As values, vision, mastery, and passion for
critical care nursing excellence build, the
attribute of action becomes another essential
pillar for the framework, and one that
resonates well for tangible results in critical
care.

24. Balance
• Balance is the final component of the
professional practice model for critical care
nursing excellence illustrated.
• Balance can bring renewal to the spirit and
allow for more moments of “full presence,”
which often breaks down in our busy
professional and personal lives.
• Taking the time to care for one’s self is
essential to keep the body and mind in
balance. Otherwise, it can be difficult to
maintain a clear perspective.

25. Conclusion
• Building a professional practice of excellence
requires a passion to profoundly affect the
lives of those who trust critical care nurses
most: complex, unstable, and vulnerable
patients and their families.
• At the same time, it requires advancing the
critical care nursing profession through a
healthy work environment that is patient
centered, collaborative, interdisciplinary, and
evidence based

26. • The desire for and commitment to critical
care nursing excellence requires self-
reflection about the values, vision,
mastery, passion, action, and balance in
one’s practice.
• Critically ill patients and their families
expect and deserve nothing but the best
care

27. • In the fast-paced critical care
environments of today, finding the time for
professional growth is challenging but, as
evidence demonstrates, essential.
• For the profession of critical care nursing
to advance, nurses must acquire the
necessary clinical experience and
competencies to provide best practice
models of care for critically ill patients and
their families.

28. Reference
Patricia G. Morton & Dorrie K. Fontaine (
2018 )
Critical Care Nursing: A Holistic
Approach 11th Edition, Wolters Kluwer
Health | Lippincott Williams & Wilkins.