NCM 81: Lecture Notes Ex.
Teaching patients on how to lower
8/26/2021 cholesterol levels – prevents the worsening
of life threating problem.
Critical Care Nursing
Subspeciality of MS Scope of Critical Care Nursing (CCN) Practice
Provides a framework within which an
The reason of provision of Nursing in any Setting: individual can provide a particular service
The Provision of holistic nursing care o Provides a definition and description
of the practice of CCN
Described as a dynamic process
Critical – actual or potential crises for the Has 3 Dynamic Components:
recipients of nursing care. o (C) Critically ill patients & their
significant social relationship
Defined as: pertaining to a crisis, involving danger o (C) Critical care nurse
or risk o (E) Environment – where CCN is
practiced
Late 1960’s Central to the scope: nurse-patient
Critical care practice areas were developed, in interactions
terms of: Goal of CCN: to ensure effective interaction
Medical Science and Technology of these 3 requisite elements to affect
Changes in community values and attitudes component nursing practice and optimal
patient outcomes
American Nurses’ Association
Definition: diagnosis and treatment of Characteristics of a Critical Care Patient
human response to actual or potential These patients share 1 or more of the
health problem. following:
1. Significant health breakdown problem (life
American Association of Critical Care Nursing (late threatening)
1984) 2. Biophysiological health breakdown
Critical Care Nursing (CCN): problems.
o a specialty in nursing. Acute or chronic
o deal with the total human being, may lead to extraordinary
his/her response to actual potential dependence on health care
health problems providers and possible technology
Analysis of the definition revealed: for health maintenance or life
Basis of the definition – human responses support.
CCN deals with:
o The total human being Note: as long as a patient has a problem in
o Patients’ response to actual and elimination, nutrition, oxygenation, and has non-
potential health problem physical problems – it qualifies as a CCN patient
Suggests that CCN – Involved with
prevention as well as cure. Can take the Triage – separate and prioritize patients according
form of: to their care.
o Physiological phenomenon
o Psychological phenomenon
CNN is concerned with – human responses
to life-threatening problems; prevention is
also viewed as appropriate.
American Association of Critical care Nurses Obstructed need for identity and social
(AACN) describes the critically ill patient as: integrity – lead to the development of a
range of negative emotional or
Presence of actual or potential life- psychological status
threatening health problems Obstruction of the non-physical needs
Needs of these patients to restore health increases the stress experience
and prevent complications requires: The needs of the family & SO must also be
o continuous assessment and met and considered
interventions If all needs are met, both physical and non-
physical needs should be considered in
Example:
planning holistic nursing care
Not CCNP
Note:
Pt admitted for 3 days due to fever.
Critical Care Nurse (CCN): Abroad
CNNP
Intensive Care Unit Nurse (ICU): Philippines
Pt is under comma base on GCS.
Critical Care Nurse
Biopsychosocial being the concept of the Should be a licensed nurse
critically ill patient includes the family & SO. Responsible for ensuring that all critically ill
o Assessment of the patient history patients receive optimal care
through family. Make clinical judgements to prevent clinical
o Needs cooperation for intervention. deterioration in their patients
Needs of the critically ill are considerable o This is achieved through clinical
and is categorized as physical or non- experience
physical Anticipation/expectation and early
o Physical – basic prevention of pt problems are central
physiological/biological needs requirements of critical care nursing
Air practice
Nutrition o Skills: assessment; clinical
Elimination judgement
o Non-physical – social, spiritual,
psychological needs; social integrity, Note: Early prevention is better than curing.
information, communication.
Comfort and support provided by social Prediction of patient problems must be based on:
relationships can enhance effective coping Sound understanding of anaphy
o Ex. interaction and impact of the Smart assessment skills
patient’s family & SO
Nature of critical care: physical needs Healthcare team for any single pt:
o considered a priority Various medical officers (doctors)
o almost always met Nurse
Critical care environment can obstruct the Pharmacist
fulfillment of non-physical needs Dietician
o Non-fulfillment of non-physical Physiotherapist
needs can contribute to stressful Radiographer
nature of a critical illness. Social worker – for family members
o Setting: well lighted and ventilated
Identity (personality) & social integrity
o Can be difficult to maintain when a
person is in a strange situation.
Critical Care Nurse Factors that influence the provision of care to the
Knowledge base in critical care nursing critically ill:
practice is highly specialized and constantly Legal
subjected to revision and development, due Regulatory
to: Social
o Research activity Economic
o Technological innovation Political factors
Preparations for practice of critical care
must emphasize the importance of a holistic Presence and Application of Technology – another
approach to nursing care key feature of critical care nursing practice
o such approach might meet the
needs of the critically ill person Critical Care Nurse – needs to be competent in the
wide range of technical devices for life support.
Critical Care Environment
Cardiac Monitor Bed/ stretcher Patricia Benner – what stage is competent
Infusion Pumps Side rails 1. novice
Ventilator Bedside table 2. advanced beginner
Bulbs Emergency-cart 3. competent
Vital Signs Equipment 4. proficient
-Built in 5. expert
Technology Increases Errors:
Critical Care Environment – should be intact; Can eliminate human decision-making
everything should be within reach. Can increase workload if it fails or is
Designed and organized to give the best inadequate
possible patient care where significant Nurses may not know how to calculate
change can occur in patient rapidly. drips/ perform a function without
Safety of both pt and staff is a primary technological monitoring devices.
consideration. Some are not standardized or demands
precision which can be new for others who
Note: Isolation Ward: Many isolation rooms become familiar with old equipment.
Critical Care Environment is Viewed from 3 Technology can Affect Patient Assessment and
Perspectives: Interaction
1. Conditions and circumstances surrounding Nurse may fail to use human touch
the direct interaction between the critical Patient assessment is essential along with
care nurse and critically ill pt technical devices
a. environment must contain resources Technology can predispose to errors in
that constantly support this delivery of care
interaction Technology may fail or contribute to error
2. Setting within which critically ill pt receive o Extubating
care; effective care delivery thru provision o Failure of infusion device.
of:
a. adequate human and financial Nurses in CCN should be good with technology.
resources Needs to be able to understand and use the
b. quality control system & technologies inside ICU
maintenance of standard nursing
care
Facilitator of Learning – nurse facilitates
Patient Safety Strategies for Prevention and Early informal and formal learning for pt, families
Detection of Errors and health team members
1.5 serious errors/day in 10-bed unit Collaboration – work with others to achieve
(according to research) optimal and realistic pt/family goals
o 12-15 beds in ICU Communication – optimal pt care requires
o Idealy: 1 ICU room:1 PT proficient communication skill
Utilize patient constraints: height, weight,
allergies for patient medication profile 3 Components of Informed Consent
Forcing functions: not doing responsibilities decision to permit the treatment or
or pointing fingers at who is at fault. procedure must be made voluntarily
Avoid reliance on vigilance- doubly check o if pt is in coma = ask somebody else
with 2 other nurses for any procedure to do it
Time-outs before surgical procedures – o if pt has no SO = under emergency
double check with two RNs care (legal)
Simplify and standardize key processes decision to permit the treatment or
procedure must be made by a competent
Code red in admission process – full admission adult
o parent, wife/husband
Identify, Evaluate, and Minimize Hazards in the o age: 21 yrs old (competent adult
Environment under the law)
Assure adequate staffing o should be in a legal
o Effective staffing realizes that the partnership/immediate family
needs of critically ill patients pt must understand his condition and the
fluctuate possible treatments
Staffing policies should support the o if pt is in coma = talk to the pt
provision of quality care o talk to SO/family
Effectiveness of staffing decisions should be
evaluated. Note: Loss of capacity may be temporary
Support care services should be available to
help with nursing care delivery To Determine Capacity, ask:
Limited work hours – no more than 60 Does the pt understand the medical
hrs/week or 12 hrs/24-hr period condition?
o You only have to watch over 1 pt but Does the patient understand the options
over minutes. and consequences of the decision?
Extended work shifts should be eliminated If the patient refuse treatment, is refusal
Teamwork and collaboration among staff based on rational reasons?
members
Note: Patient can withdraw consent any time as we
Nurse’s goal are patient-centered.
Restore the pt to an optimal level of
wellness that is defined by the pt and family if pt refuses the treatment
Caring – compassionate, therapeutic and 1. Ask why
supportive environment to promote 2. Acknowledge and reinforce
comfort and prevent unnecessary suffering 3. Sign waiver/refusal form
Advocacy – promotes, advocates for and 4. inform the doctor
strives to protect the health safety and
rights of the pt
