Overview of Critical Care Nursing: Fundamentals and Practices

University of Basrah College of Nursing Fundamentals of Nursing Department 4th stage Critical care Nursing 4thStage Lecture (Theory) Introduction in critical care nursing Assist lecturer Sukaina Hafedh 2024\9\23

Learning objective Learn about Critical care nurses, critical care unit, a critical illness, critical ill patient . Describe Healthy Work Environments. Describe the value of evidence-based practice (EBP) in caring for critically ill patients. Learn about nursing diagnosis and nursing intervention in critical care unit.

The American Association of Critical-Care Nurses The American Association of Critical-Care Nurses is the specialty organization that supports and represents critical care nurses. The vision of the AACN is a healthcare system driven by achieving Effectively meeting the needs of critically ill patients and families. The AACN Standards delineate the nursing process as applied to critically ill patients: collect data, determine diagnoses, identify expected outcomes, develop a plan of care, implement interventions, and evaluate care.

Critical care nurses Nurses that provide specialized care to patients experiencing a life threatening or potentially life- threatening illness. Must have an adequate understanding of the practice of critical care nursing that is embodied in different standards of care competencies as well as an affiliate and continuously adheres to professional organizations in critical care nursing.

critical care unit is a special department of a hospital or health care facility that provides intensive care medicine to patients with severe or life-threatening illnesses and injuries, which require constant care, close supervision from life support equipment and medication in order to ensure normal bodily functions.

A critical illness is a sudden, unexpected, and often life-threatening occurrence for both the patient and the family that threatens the steady state of internal equilibrium usually maintained in the family unit. It can be an acute illness or trauma, an acute exacerbation of a chronic illness, or an acute episode of a previously unknown problem.

Critically ill patients are defined as those patients who are at high risk for actual or potential life threatening health problems

critical care nurse role American Association of Critical-Care Nurses (AACN) critical care nurse role responsibilities include: Respecting the values, beliefs, and rights of the patient. Intervening when the best interest of the patient is in question. Helping the patient obtain necessary care. Monitoring and safeguarding the quality of care the patient receives. The nurse is not to make decisions for the patient or the patient's family but should support their decisions. The nurse should act as a liaison, not a gatekeeper, for the patient and the patient's family and other health care professionals.

Levels of ICU 1) as high dependency ICU. Resuscitation, short term mechanical ventilation and simple invasive cardiovascular monitoring for less than 24 hours. Level I: These ICUs are referred to 2) Level II: These ICUs are located in general hospital and undertake more prolonged ventilation. They usually provide a high standard of general intensive care including complex multi-system life support. 3) Level III: These are tertiary referral unit for intensive care patients that provides comprehensive critical care including complex multi-system life support for an indefinite period.

Critical Care Practice Patterns in the ICU 1) Open Units: In this type of pattern, Any attending physician with hospital admitting privileges can be the physician of record and direct ICU care. 2) Closed Model : Management is coordinated by a qualified Critical Care Specialist. 3) Transitional / Hybrid Model: This combines aspects of open and closed modes by staffing the ICU with attending physician and/or team to work in association with primary physicians.

Healthy Work Environments A healthy work environment (HWE) can lead to positive patient outcomes. In addition, nurses gravitate to facilities that have optimal work conditions. Conversely, unhealthy work environments play a role in: 1. health care errors. 2. result ineffective care. 3. waste scarce resources leading to increased costs associated with health care. 4. contribute to moral distress and adverse outcomes.

Essential Elements of a Healthy Work Environment (HWE) 1. Skilled Communication. 2. True Collaboration. 3. Effective Decision Making. 4. Appropriate Staffing. 5. Meaningful Recognition. 6. Authentic Leadership..

Evidence-based practice (EBP) (EBP) is the process of shared decision making between practitioner, patient, and others significant to them based on research evidence, the patient s experiences and preferences, clinical expertise or know-how, and other available robust sources of information. The ANCC, acknowledge EBP as a crucial step in improving healthcare quality.

Critical care nurses working a wide variety of settings, filling many roles including: Bedside clinicians. Nurse educators. Nurse researchers. Nurse Managers. Clinical nurse specialists and nurse practitioners. Managed care has also fueled a growing demand for advanced practice nurses in the acute care setting. Advanced practice nurses are those who have received advanced education at the master's or doctoral level

Eight Characteristics of Critically Ill Patients: Resiliency Vulnerability Stability Complexity Resource Availability Participation in Care Participation in Decision Making Predictability

Eight Nurse Competencies of Concern to Patients, Clinical Units, and Systems 1. Clinical Judgment 2. Advocacy and Moral Agency 3. Caring Practices 4. Collaboration 5. Systems Thinking 6. Response to Diversity 7. Facilitation of Learning 8. Clinical Inquiry (Innovator/Evaluator)

Examples of nursing diagnoses For the Patient With Critical Illness or Injury Grieving Anxiety Disturbed Body Image Impaired Verbal Communication Ineffective Coping Ineffective Denial Fear Hopelessness Risk for Loneliness Powerlessness Situational Low Self-Esteem Sleep Deprivation Spiritual Distress Readiness for Enhanced Spiritual Well-Being

Nursing Interventions Creating a Healing Environment Promoting Rest and Sleep Fostering Trust Providing Information Allowing Control Practicing Cultural Sensitivity Presencing and Reassurance Cognitive Techniques Guided Imagery and Relaxation Training Deep Breathing Music Therapy Massage, Aromatherapy, and Therapeutic Touch Fostering Spirituality and Healing

Question 1. Which of the following professional organizations best supports critical care nursing practice? a. American Association of Critical-Care Nurses b. American Heart Association c. American Nurses Association d. Society of Critical Care Medicine 2. Which of the following assists the critical care nurse in ensuring that care is appropriate and based on research? a. Clinical practice guidelines b. Computerized physician order entry c. Consulting with advanced practice nurses d. Implementing Joint Commission National Patient Safety Goals

References Critical Care Nursing by Patricia.