Introduction to

Critical care
 Critical Care Nursing

 Specialty under 70 years old

 Separate units
 Support new technology
 Enable elaborate interventions
 Improve efficiency
 Specialized knowledge and practice
 Critical Care Nursing

 Patient age
 Neonatal
 Pediatric
 Adult
 Geriatric
 Medical versus surgical problems
 Special patient populations
 Cardiac
 Pulmonary
 Neurologic
 Critical Care Nursing Roles

 Multidisciplinary Team Approach to Care

 Expanded-role nursing positions
 Case managers
 Patient educators
 Cardiac rehabilitation specialists
 Administrative nurses
 Infection control specialists
 Advanced practice nurses (APNs)
 Clinical nurse specialist (CNS)
 Nurse practitioner (NP)
 Critical Care Professional
Accountability

 The Society of Critical Care Medicine (SCCM)

 Multidisciplinary, multispecialty, international
organization
 American Association of Critical-Care Nurses
(AACN)
 Certifications
 National organizations
 Awards
Evidence-Based Nursing Practice

 Research-based interventions
 Traditional practices to EBP
 Example-Trendelenberg

 Consistent, positive outcomes

 Strive for best practice
 Use valid and reliable data
 EPB and research utilization models
 Critical Care Nursing

 Practice Alerts (Evidence Based Practice

Summaries) Recent Examples
 Family Presence During Resuscitation
 Visitation in the Adult ICU
 Ongoing Feeding Tube Verification of Placement
 Prevention of Aspiration in Adults
 Critical Care Nursing Standards

 Established by AACN
 Provide a framework
 Authoritative statements
 Describe expected roles and responsibilities
 Describe standards of care and standards of
professional practice
 Holistic Critical Care Nursing

 Caring
 Merges psychosocial elements with technologic
environment
 Individualized care
 Patient’s preferences
 Patient- and family-centered care
 Cultural care
 Reflects society
 Incorporates individual differences
 Alternative and
Complementary Care

 Guided Imagery
 Decreased side effects
 Decreased length of stay
 Reduced hospital costs
 Enhanced sleep
 Increase in patient satisfaction
 Massage
 Reduction in anxiety
 Decrease respiratory rate, heart rate and pain
 Animal-Assisted
 Pet Visitation
 The Patient’s Experience

 Perception of Critical Illness

 Differing perceptions of ICU
 Stress
 Loss and Responses to Loss
 Shock and disbelief
 Development of awareness
 Restitution
 Impact of the Critical Care
Environment on the Patient

 Impact on Cognition and Perception

 Sensory Input
 Deprivation and Overload
 ICU Psychosis

 Orientation to Time and Place

 Need for Personal Space and Privacy
 Impact of the Critical Care
Environment on the Patient

 Impact on Body Clock (Chronobiology)

 Sleep-Wake Cycles
 Circadian Rhythm

 Delirium (Acute Confusion)

 Elderly especially prone
 Nursing Assessment
 Individualize care for better patient adaptation
 Nursing Interventions

 Allowing control
 Sensory Stimulation
 Sensory Input for the Unresponsive
 Reality Orientation
 Noise Control
 Rest and Sleep
 Personal Space Control
 Presencing and Reassurance
 Guided Imagery and Relaxation Training
 Spirituality & prayer
 Massage
 Deep Breathing
 Music
 Humor
 The Family’s Experience

 The Family in Crisis

 Threats to Homeostasis
 Coping Mechanisms
 Nursing Assessment
 Nursing Interventions
 Interprofessional Collaborative
Practice

 Increases quality of care and services

 Contains or decreases costs
 Core Competencies for Interprofessional
Collaborative Practice
 Assess competencies’ relevance
 Develop action plan
Interdisciplinary Planning for Care:
Care Management Models and
Tools

 Care management
 Enables, supports, and coordinates care
 Disease state management
 Case management
 Oversees care and organizes services
 Nurse, Primary care manager, allied health care
provider
 Care management tools
 Variance Tracking and Managing
Interdisciplinary Planning for Care:
Care Management Tools

 Algorithm
 Stepwise decision-making flowchart
 Practice guideline
 Created by expert panels and professional organizations
 Protocol
 Directive, useful tool for research studies
 Order set
 Preprinted/Preprogrammed Provider Orders
 Quality, Safety, and Regulatory
Issues in Critical Care: Quality and
Safety Issues

 Institute of Medicine (IOM) report

 The Joint Commission
 National Patient Safety Goals
 Healthcare Information and Management Systems Society (HIMSS)
 Safe Medical Devices Act
 National Quality Forum (NQF)
 National Database of Nursing Quality Indicators (NDNQI)
 Quality and Safety Education for Nurses (QSEN)
 Established standards for education for Bachelor and Master Degree
academic education
 Institute for Safe Medication Practices
 HIPAA
Quality, Safety, and Regulatory
Issues in Critical Care: Quality
and Safety Issues

 Communication Among Health Care Providers

 “Handoff”
 SBAR-Communication Tool
Healthy Work Environment

“Essential for established collaborative, trusting and safe

environments”