Saint Paul University Philippines

Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences
COLLEGE OF NURSING
BSN 4A (CMTP)

CRITICAL NURSING CARE the need and desire for specialty nursing
• Specialty within nursing that deals specifically organizations like the Critical Care Nurses
with human responses to life-threatening Association of the Philippines, Inc (CCNAPI) to revisit
problems. the existing statements of its Standards of Nursing
• It utilizes the nursing process applying Practice to provide clear and updated statements
assessment, diagnosis, outcome identification, regarding the scopes of practice and standards of
planning implementation and evaluation. critical care nursing.
• The framework of critical care nursing is a ➢ The CCNAPI Standards of Practice of 1982 has been
complex, challenging area of nursing practice revisited and revised to be aligned with the 2005 BON
statements of the 11 Core Competencies for Entry
EVOLUTION OF CARE Level for Safe and Quality Nursing Care. The CCNAPI
Core Competencies of a Critical Care Nurse are stated
• Began with polio units(1950s), recovery rooms,
according to the levels of expected behavior defining
and coronary care units (1960s)
the actual knowledge, skills and abilities in the
• Patient outcomes improved
practice of critical care by a nursing professional.
• Intensive care units(1970s)
➢ The focus of care for the critically ill patient is holistic.
CRITCAL CARE IN THE 21ST
CENTURY However, to organize statements in this paper,
physiological focus has been categorized under
• Specialization
bodily functional system such as pulmonary system,
o Cardiovascular, neurological, trauma,
cardiovascular system, renal system, neurological
burn units
system and other system.
o Pediatric
o Neonatal PHILOSOPHY OF CRITICAL CARE NURSING
• Variety of settings ➢ Critical Care Nursing reflects a holistic approach
o Inpatient in caring of patients. It places great emphasis on
o Outpatient the caring of the bio-psycho-social-spiritual-
o Home care nature of human beings and their responses to
• Eicu illnesses rather than on the disease process.
➢ It helps maintain the individual patient’s identity
➢ The critical care nursing practice is based on a and dignity. The focus of caring includes
scientific body of knowledge and incorporates the preventive care, risk factor modification and
professional competencies specific to critical; care education to decrease future patient admissions
nursing practice and is focused on restorative, to acute care facilities.
curative, rehabilitative, maintainable, or palliative
care, based on identified patient’s need. THE CRITICAL CARE NURSES OF THE PHILIPPINES, INC
➢ It upholds multi and interdisciplinary collaboration (CCNAPI)
in initiating interventions to restore stability, prevent ➢ Is responsible for the promotion of man’s health and
complications, achieve and maintain optimal patient welfare for national development. It desires to
responses. support the professional and personal growth and
➢ In the Philippines, the Professional Regulation development of initial core nurses. CCNAPI has
Commission – Board of Nursing(PRC-BON) is organized itself into a national association
committed to provide need-driven, effective and committed to the ideals of service to the people,
efficient specialty nursing care services of high equality, justice and social progress.
standards and international level within the ➢ IntheCritical Care Units, each patient is viewed as a
obtainable resources. unique individual with dignity and worth. The
➢ To respond to this mission and commitment, a PRC- critically ill patient should receive comfort and
BON Working Group in Developing the Nursing provide privacy in a highly technological
Specialty Framework was formed in the 1996 to take environment. In collaboration with other health care
on the task of setting the process-based framework team members, critical care nurses provide high
and guidelines for specialty nursing services. The level of patient care which includes patient and
Working Group members are clinical nurse family education, health promotion and
practitioners, nurse educators and nurse managers. rehabilitation.
➢ To achieve this holistic care process, participation
CRITCAL CARE NURSES ASSOCIATION OF THE by the patient and his/her family is always
PHILIPPINES emphasized. At the forefront of critical care science
➢ The expanding healthcare and nursing knowledge and technology, critical care nurses maintain
together with new and evolving healthcare sites, professional competence based on a broad base of
structures, and technologies all have contributed to
 knowledge and experience through continues COMMUNICATION
education and evidence-based research. • Communicates with individual patient and/or groups
➢ With the advances in sophisticated biomedical and with other members of the health care team.
technology and knowledge, critical care nurses are
able to continuously monitor and observe patients HEALTH EDUCATION
for physiological changes to confront problems
• Provide appropriate health education based on
proactively and to assist patients achieve and
comprehensive learning needs of the patient and
maintain an optimum level of functioning or a
family.
peaceful death.
➢ In other words, this nursing philosophy of the QUALITY IMPROVEMENT
CCNAPI is accomplished by looking after critically ill
• Proactive in the implementation of changes as a
patient in an environment with specially trained
consequence of quality improvement initiatives
nurses, appropriate equipment, adequate medical
supplies and other members of health care RESEARCH
personnel.

COMPETENCIES FRO CRITICAL CARE NURSES

RECORD MANAGEMENT
➢ The competence of critical care nurses together with
established nursing standards and the identified • Ensures that written information conforms to legal
core competencies for registered nursing will result and ethical framework
to excellence in critical care nursing practice. This PROFESSIONAL ORGANIZATIONS
three-pronged holistic framework ensures quality
performance through an adherence to nursing • Support critical care nurse and practice
standards, the demonstration of competencies, and • Key organizations
the integration of appropriate nursing model/s into o American Association of Critical-Care Nurse
the health care delivery process. o Society of Critical Care Medicine
➢ To achieve safe and quality client-centered care,
nurses working in the critical care units are AMERICAN ASSOCIATION OF CRITICAL-CARE NURSES
envisioned to adopt not only the stated core (AACN)
competencies of registered nurses but also the • Founded in 1969
specific competencies stipulated in the following • Largest specialty organization in world
eleven major key responsibility areas: • Mission: Assist acute and critical care nurses to
attain knowledge and influence to deliver
MANAGEMENT OF RESOURCES excellent care
• Empowering subordinates • Values: An ethic of care that focuses on
• Assisting in maintaining a healthy working compassion, collaboration, accountability, and
environment trust
• Web site: www.accn.org
SAFE AND QUALITY NURSING CARE
• Conduct Nursing Assessment SOCIETY OF CRITICAL CARE MEDICINE (SCCM)
• Formulating Care Plans • Founded in 1970
• Implementing Planned Care • Multiprofessional membership
• Evaluating Health Progress • Web site: www.sccm.org
• Demonstrating Specific Knowledge and Skills • Journal: Critical Care Medicine

LEGAL RESPONSIBILITIES CRITICAL CARE CERTIFICATION

• Purpose:
• Fulfilling legal responsibilities and acting as patient
o Validate knowledge
advocate
o Promote professional excellence
ETHICO-MORAL RESPONSIBILITIES o Help nurses to maintain up-to-date
knowledge
• Practicing ethico-moral standards of the nursing
profession STANDARDS
COLLABORATION AND TEAMWORK • Guide clinical practice
• Establish goals for patient care
• Provide assessment of outcomes
PERSONAL AND PROFESSIONAL DEVELOPMENT • AACN Standards for Acute and Critical Care Nursing
Practice
• Facilitating the development of nursing knowledge
o Nursing Process
in clinical setting
o Expectation of the nurses
• Promoting the professional image of ICU nurse
• Evaluating own nursing practice and knowledge to STANDARDS OF PRACTICE (BELL, 2008)
enhance personal skills. • Evaluate quality of nursing practice
• Evaluate own practice
 • Acquire knowledge and maintain competency of these resources is an important factor in
• Contribute to professional development of peers controlling hospital costs.
• Act ethically
ORGANIZATION AND MANAGEMENT OF CCU
• Used skilled communication
• Use clinical inquiry and integrate research findings The organization and management of critical care
• Consider factors related to safety, effectiveness, and services are key components that contribute to ICU
cost performance and may impact patient outcomes and
• Provide leadership in clinical setting health care costs. The guidelines for critical care delivery,
clinical roles, and best practice model in the ICU from the
TRENDS AND ISSUES Society of Critical Care Medicine published in 2001 and
• Critical care patients more complex updated in 2015 are excellent resources for how ICUs
• Multisystem organ dysfunction should be administered.
• Complicated by aging population • The 2001 recommendations were based on 6 tenets
• Increasing costs for care • (1) Medical interventions should be provided by
• Challenged to reduce costs and length of stay Intensivists leading multidisciplinary groups
• Transfer of higher acuity patient from the critical care • (2) Patient care should be directed by ICU teams
unit to other units or home using a "closed" format in which dedicated critical
care teams take ownership o all aspects of cate in the
CRITICAL CARE NURSE CHARACTERISTICS
ICU
- Technical Competence
• (3) ICU physicians should be available for medical
- Relationship Building
and administrative tasks without competing clinical
- Ability to multitask and set priorities
responsibilities
NATIONAL PATIENT SAFETY GOALS • (4) ICU physicians and nurses should have critical
- The Joint Commission National Patient Safety care credentials
Goals • (5) Care teams should include critical care
o Examples relative to critical care nursing pharmacists and full- time respiratory care
▪ Communication practitioners as well as ICU physicians and nursing
▪ Medication safety staff, and
▪ Reduce infections • (6) ICU governance should be conducted by
▪ Reconcile medications multidisciplinary

OTHER TRENDS AND ISSUES - Within the past several years, critical care
- Reduce hospital readmission rates leaders at academic medical centers and large
- Increasing use of technology community hospitals have increasingly
o Electronic medical records examined their ICU infrastructure and clinical
o Physician order entry staff and take on "battles to pull the ICUs away
- Ethical issues associated with prolonging life and from departments and place them into a hospital-
futile treatment based environment and political and
- Telemedicine and Eicu administrative infrastructure. From the
hospital's perspective, a critical care
MANAGEMENT SYSTEMS AND RESOURCES organization (CCO) offers an excellent
(REPORTING AND DOCUMENTATION OF CARE) opportunity to bring together all ICUs under one
leadership with defined accountability.
Resources and Supports in the Governance and - Added advantages include improved
Management of Critical Care Unit opportunities to contain costs; implementation
of local and national patient safety and quality
initiatives through protocols, standardization of
INTENSIVE CARE UNITS/CRITICAL CARE UNITS
technologies across ICUs with resultant savings
(ICU/CCU)
from volume based equipment and supply
- Is a specialized area equipped with monitoring, purchases, warranties, and staff training;
diagnostics and therapeutic devices designed to enhanced critical care research; and improved
provide intensive observation, continuous recruitment or retention of faculty through a
monitoring and care for cardiac and non-cardiac more stable environment.
medical, surgical, obstetric and pediatric patients
who are in an unstable vital condition or who TOOLS FOR CRITICAL CARE GOVERNANCE
may urgently require treatment on life support - Among the most powerful tools that may be useful to
systems. new leaders of critical care in their hospitals are the
- Intensive Care Units (ICUs) consume a large outreach programs of having Intensivists responding
proportion of hospital resources and they are rapidly to medical and surgical emergencies outside
focused places in the hospital with well-defined of the ICU. In addition to expert resuscitation and
boundaries. Medical resources such as drugs, stabilization, the intensivist controlling the
supplies and equipment constitute a high admission to a higher level of care has the ability to
proportion of costs in this unit. The management
 select patients who would derive the highest benefit compromised patients. These rooms may have 20%
from a trial of ICU management extra space than other rooms.
- In conclusion, critical care leaders are increasingly
faced with the rising patient demand for critical care FACILITIES
services at a time of intensivist workforce shortage - Nursing Station
and mandates from external organizations to - Clean Utility Area
improve on the efficiency and quality of care. These - Equipment Room
leaders must also respond to the need to educate new
generations of ICU physicians and nonphysician care EQUIPMENT IN ICU
providers (nurse practitioners and physician GENERAL CRITICAL CARE EQUIPMENT
assistants); standardize care and technologies in
hospitals with many ICUs; optimize ICU integration - Anesthesia Machine
within the hospital; and participate in cost control, - Respiratory Ventilator
research, and fundraising initiatives. Movement - ICU Bed
toward unification of governance starts with the - Medical Stretcher
education of Intensivists during their fellowship - Patient Monitor
training. - Syringe Pump
- The creation of more advanced governance CCOs in - Infusion Pump
acute care hospitals led by effective and successful - Ultrasound Machine
leaders can ensure not only the delivery of high- - EKG Machine
quality safe patient care but also more effective use of - Vital Signs Monitor
resources and assistance in organizational and
development. EQUIPMENTS IN CCU
AIRWAY MANAGEMENT AND VENTILATOR
PHYSICAL SET UP
ACCESSORIES
General
- Video Laryngoscope
- Principle - 2 to 5 percent total medical and surgical - Laryngoscope Blades
beds in a hospital should be Critical Care beds. - Laryngoscope Handles
Minimum 4, maximum 12 bed per Critical Care unit. - Endotracheal Tubes
- Number of beds -5% of the total hospital bed - Intubating Stylets
strength. - Laryngeal Mask Airways
- ICUs having less than 6 beds are not cost effective and - Nasopharyngeal/Oropharyngeal/Guedel Airways
also do not provide enough clinical experience and - Anesthesia Masks
exposure to skilled HR of the ICU. At the same time, - Cannulas
ICU with bed strength of greater than 24 are difficult - Breathing Circuits
to manage.
MONITORING ACCESSORIES
LOCATION
- Patient cables
- In close proximity of emergency and accident - Modules
department, Operating rooms, trauma ward, - Batteries
diagnostic facilities, blood bank, pharmacy etc. (for
Safe, easy, fast transport of a critically sick patient).
- Equipped with central suction and medical gases, HUMAN RESPOURCES REQUIREMENTS, SUPPORTS AND
uninterrupted electric supply, heating, ventilation, TRAINING OF THE WORKFORCE
central air conditioning and efficient life services. - Human resource management is also a strategic and
- Corridors, lifts & ramps spacious enough to provide comprehensive approach to managing people and the
easy movement of bed/trolley. workplace culture and environment. Done well, it
- There should be single entry/exit point enables employees to contribute effectively and
- It is required to have emergency exit points in case of productively to the overall company direction and
emergencies and disaster. the accomplishment of the organization's goals and
objectives.
DESIGNING AND SPACE
REQUIREMENTS FOR ENTERING HUMAN RESOURCE
- 125 to 150 sq ft area per bed in the patient care area MANAGEMENT
or the room of the patient. In addition there should be
100 to 150% extra space to accommodate nursing - Those wishing to enter the field of HRML usually need
station, storage, patient movement area, equipment at least a bachelor's degree in human resource
area, doctors and nurses rooms and toilet. management or a related neid, such as business
- One or two bigger rooms or area which may be management. Some employers may also require
utilized for patients to undergo bedside procedures candidates to a master's degree in business
with support Gadgets attached to them administration, human resources, or labor relations
- 10% (one to two) rooms or beds may be designated Special certification isn't always necessary to get a
to use exclusively as isolation rooms for cases like for job in HRM, but it can help candidates stand out, and
burns, severely infected patients or immune
 some employers may require it. Several professional to about 32 clinical measurements per day per
associations offer these types of certifications patient in a general ward.
- The Society for Human Resource Management • Without a CIS, clinicians must collect most of these
(SHRM) offers the SHRM Certified Professional and measurements and record them on paper-based 24-
SHRM Senior Certified Professional programs. hour 'ICU flowcharts.
- The HR Certification Institute (HRC)) offers several • With a CIS, all such measurements can be captured,
certifications, including Associate Professional in recorded and collated electronically.
Human Resources, Professional in Human Resources, • This reduces the need for many different paper-based
Senior Professional in Human Resources, and Global forms, saves time and reduces the risk of error.
Professional in Human Resources. HRCI also offers
micro-credential programs on several topics. B. COMPUTERIZED PROVIDER ORDER ENTRY
- WorldatWork also offers, several certifications in the (CPOE)
categories of Compensation, Executive
Compensation, Sales Compensation, and Benefits. • "the process where a medical professional entering
International Foundation of Employee Benefit Plans orders or Instructions electronically"
offers certificates in many areas as well, including • Computer Physician Order Entry is software that
benefits and health and welfare plans. allows physicians to directly enter their medical
orders into a hospital information system. (Reider,
WHERE TO START WITH HUMAN RESOURCES 2003)
TRAINING? • Offers access to patient records
- Becoming an HR Business Partner. At the top of the • Offers clinical decision support
HR org chart, there are business partners responsible
MEDICAL ORDERS INCLUDE:
for driving operational and strategic change across
the organization. This set of courses focuses on - Medication
building onboarding programs, setting up pay - Laboratory tests
systems, and managing a diverse workforce. - Radiological procedures
- Finding and Retaining Talent Talent - Surgical procedures
recruitment/management is one of the most - Dietary orders
important roles of human resources, But it's also one - Ancillary Support
of the most challenging. There's more competition - Nursing Orders
than ever vying for limited talent. This learning path - Involves electronic communication of orders
discusses how to attract new talent, develop its - Consultation
potential, and effectively manage performance along
FEATURES OF CPOE
the way.
• Ordering
A. CLINICAL INFORMATION SYSTEM • Patient-centered decision support
• Patients safety features
- A clinical information system (CIS) is an information
• Intuitive human interface
system designed specifically for use in the critical care
environment, such as in an intensive care unit (ICU). It can • Security
network with the many computer systems in a modern • Portability
hospital, such as pathology and radiology. It draws • Management
information from all these systems into an electronic • Billing
patient record, which clinicians can see at the patient's
BENEFITS
bedside.
1. Reduce errors and Patient Safety
A cis can benefit both patients and clinicians by: a. Ensuring providers produce standardize
legible, and complete orders
• Improving communication between the many b. Built-in support tools in CPOE technology
health professionals caring for each patient automatically check for:
• Providing all the information clinicians need to i. Drug interactions
make good decision ii. Medication allergies
• Making it easier for patients to have x-rays and iii. Other potential problems
scans when needed 2. Improve efficiency
• Encouraging quality improvement 3. Improve reimbursement.
• Allowing better clinical research.
DISADVANTAGES
CLINICAL INFORMATION SYSTEMS IN THE ICU
1. Too much information/over-alerting
• In ICUs, many medical devices are used to continually 2. Physician non-acceptance
monitor extremely sick patients Vast amounts of 3. Integration/staff training
information are produced. 4. Installation costs
• This information allows clinicians to make the right 5. Intrusion of physician decision-making
decisions.
• It is estimated that ICU clinicians manage about 1,700 ADVANTAGES
clinical measurements per day per patient, compared 1. Provides drug screening information
2. Helps prevent adverse drug effects REMOTE MONITORING
3. Improves quality of patient care Many technologies allow your provider or health care
4. Reduces drug expenses team to check your health remotely. These technologies
5. Provides predefined orders include:
6. Speeds up medication ordering
7. Easy accessibility to patient's medical orders - Web-based or mobile apps for uploading data to your
8. Eliminates handwriting/transcription errors provider or health care team. For example, if you have
9. Increases productivity and workflow diabetes, you may upload food logs, blood sugar
10. Provides decision support levels and drugs that a nurse checks.
- Devices that measures and wirelessly send data, such
NURSING COMPETENCIES as blood pressure, blood sugar and oxygen levels.
a. Use the database applications to enter and retrieve
patient data/orders PATIETN PORTAL
b. Demonstrate basic technology skills (typing & Your primary care clinic may have an online patient
printing) portal. These portals offers a safer way of contacting your
c. Use applications for structured data entry provider instead of email. A portal provides a safe online
d. Use the application to plan care for patients tool to do the following:
e. Use networks to navigate systems
f. Operate peripheral devices (PDAS) - Message your provider or a nurse
- Ask for prescription refills
NURSING FUNCTIONS/RESPONSIBILITIES - Review test results and summaries of earlier visits
1. Enter admission/discharge orders - Schedule visits or ask for appointment reminders for
2. Place medication and non-medication orders preventive care.
3. Place order sets PERSONAL HEALTH APPS
4. Update allergy information
5. Resolve orders conflicts Many apps have been made to help people better organize
6. Discontinue orders their medical information in one secure place. These
digital tools may help you:
C. HAND-HELD TECHNOLOGIES
- Store personal health information
• Commonly known s personal digital assistants - Record vital signs
(PDAs) - Calculate and tract your calories
• The rapid acceptance and ongoing swift - Schedule reminders for taking drugs
development of handheld computing technology is - Record physical activity such as daily step count.
leading to an evolution in the way clinical data and
PERSONAL HEALTH RECORDS
information move to and from the bedside and into
the patient record. An electronic personal health record system (PHR
system) is a collection of information about your health
BENEFITS that you control and maintain. A PHR app is easy for you
Allows providers to access to: to see anytime via a web-enabled device, such as your
computer, laptop, tablet or smartphone. A PHR also
- Patient’s vitals allows you to review your lab results, X-rays and notes
- Active meds from your provider. Your provider may give this to other
- Lab works and x-rays providers with permission.
- Medical studies
- Drug databases In an emergency, a personal health record can quickly
give emergency staff vital information. For example, it
USEFULNESS OF A HANDHELD DEVICE IN CLINICAL can show your current conditions, drug, drug allergies
CARE and your provider's contact details.
- Goal: to allow the practitioners to create efficient
GOALS OF TELEHEALTH
workflow that will allow for nurses to spend more
time nursing - Make health care easier to get for people who live in
- Ultimate Goal: to improve the delivery of healthcare communities that are remote or in the country
- Keep you and others safe if you have an infectious
D. TELEHEALTH disease such as COVD-19
- Offer primary care for many conditions.
What is Telehealth? - Make services more easily offered or handy for
- Telehealth is the use of communication technologies people who have limited ability to move, time, or
to provide health care form a distance. It can include transportation
everything from conducting medical visits over the - Offer access to medical specialist
computer, to monitoring patients’ vital signs - Improve communication and coordination of care
remotely. among health care team members and a person
getting care.
- Offer advice for self-management of health care.
POTENTIAL OF TELEHEALTH
Technology has the potential to improve the quality of
health care. And technology can make it easier for more
people to get health care
Telehealth may offer ways to make health care more
efficient, better coordinated and closer to home. You can
go to a virtual visit anywhere – such as at home or in
your car. And you don’t need to travel to go to a virtual
visit.