CRITICAL
CARE
DEFINITION OF CRITICAL CARE
• Critical or intensive care is a complex specialty developed
to serve the diverse health care need of patients (and their
families) with actual or potential life-threatening conditions.
It is therefore important that a clear statement of what
critical care nursing wish to achieve and provide should be
articulated.
GOALS OF CRITICAL CARE
To promote optimal delivery of safe and quality care to the critically ill
patients and their families by providing highly individualized care so
that the physiological dysfunction as well as the psychological stress
in the ICU are under control.
To care for the critically ill patients with a holistic approach,
considering the patient’s biological, psychological, cultural and
spiritual dimensions regardless of diagnosis or clinical setting.
To use appropriate and up-to-date knowledge, caring attitude and
clinical skills, supported by advanced technology for prevention, early
detection and treatment of complications in order to facilitate
recovery.
To provide palliative care to the critically ill patients in
situations where their health status is progressing to
unavoidable death, and to help the patients and families to
go through the painful sufferings.
On the whole, critical care nursing should be patient-
centered, safe, effective, and efficient. The nursing
interventions are expected to be delivered in a timely and
equitable manner.
SCOPE OF CRITICAL CARE
The scope of critical care nursing is defined by the dynamic
interaction of the critically ill patient, the critical care nurse and the
critical care environment in order to bring about optimal patient
outcomes through nursing proficiency within an environment
conducive to the provision of this highly specialized care.
Constant intensive assessment, timely critical care interventions and
continuous evaluation of management through multidisciplinary
efforts are required to restore stability, prevent complications and
achieve optimal health. Palliative care should be instituted to alleviate
pain and sufferings of the patient and family in situations where death
is imminent.
SCOPE OF CRITICAL CARE
Critical Care Nurses are registered nurses, who are trained and qualified to
practice critical care nursing. They possess the standard critical care nursing
competencies in assuming specialized and expanded roles in caring for the
critically ill patients and their family. Likewise, the critical care nurse is personally
responsible and committed to continues learning and updating of knowledge and
skills. The critical care nurses carry out interventions and collaborates patient care
activities to address life-threatening situations that will meet patient’s biological,
psychological, cultural and spiritual needs.
The critical care environment constantly supports the interaction between the
critically ill patients, their family and the critical care nurses to achieve desired
patient outcomes. It entails readily available and accessible emergency equipment,
sufficient supplies and effective supporting system to ensure quality patient care as
well as staff safety and productivity.
EDUCATION AND PROFESSIONAL
ACTIVITIES IN THE PHILIPPINES
CCNAPI recommends that all practicing CCN shall ensure that they continuously
update their knowledge, skills and behavior through active participation in related critical care
nursing education. This shall include but not limited to the following adult and pediatric
concepts on:
Advanced Cardiac Life Support
Basic Critical Care Course (BCCC)
Cardiac Assessment
Neurological Assessment
Respiratory Assessment
Continuous Renal Replacement Therapy
Advanced Pharmacology h. Advanced Intravenous Therapy
Others as may be deemed necessary to enhance critical care practice.
LEVELS AND CATEGORIES OF CRITICAL
CARE PROVISIONS WITHIN THE
PHILIPPINES
A. Levels
Level 1
Should be capable of providing immediate resuscitation for the critically ill and short-term cardio-
respiratory support because the patients are at risk of deterioration;
Has a major role in monitoring and preventing complications in “at risk” medical and surgical
patients;
Must be capable of providing mechanical ventilation and simple invasive cardiovascular monitoring.
Has a formal organization of medical staff and at least one registered medical officer available to
the unit at all times;
A certain number of nurses including the nurse in-charge of the unit should possess post-
registration qualification in critical care or in the related clinical specialties; and
Has a nurse: patient ratio of 1:1 for all critically ill patients.
LEVELS AND CATEGORIES OF CRITICAL
CARE PROVISIONS WITHIN THE
PHILIPPINES
Level 2
Should be capable of providing a high standard of general critical care for patients who are stepping
down from higher levels of care or requiring single organ support/support post-operatively;
Capable of providing sustainable support for mechanical ventilation, renal replacement therapy,
invasive hemodynamic monitoring and equipment for critically ill patients of various specialties such
as medicine, surgery, trauma, neurosurgery, vascular surgery;
Has a designated medical director with appropriate intensive care qualification and a duty specialist
available exclusively to the unit at all times;
The nurse in-charge and a significant number of nursing staff in the unit have critical care certification;
and
A nurse: patient ratio is 1:1 for all critically ill patients.
LEVELS AND CATEGORIES OF CRITICAL
CARE PROVISIONS WITHIN THE
PHILIPPINES
Level 3
Is a tertiary referral unit, capable of managing all aspects of critical care medicine (This does
not only include the management of patients requiring advanced respiratory support but also
patients with multi-organ failure);
Has a medical director with specialist critical / intensive care qualification and a duty
specialist available exclusively to the unit and medical staff with an appropriate level of
experience present in the unit at all times;
A nurse in-charge and the majority of nursing staff have intensive care certification; and
A nurse: patient ratio is at least 1:1 for all patients at all times.
LEVELS AND CATEGORIES OF CRITICAL
CARE PROVISIONS WITHIN THE
PHILIPPINES
B. Categories
Age Group Specialty
a. Neonatal a. Medical
b. Pediatric b. Surgical
c. Cardio-thoracic
c. Adult
d. Cardiac v. Respiratory
e. Neurosurgical
f. Trauma
ROLES OF CRITICAL CARE NURSES
A. Practitioner – ICU nurses execute their practice roles 24-hours a day to provide high quality
care to the critically ill patient.
B. Care Provider
Direct Patient Care
- Detects and interprets indicators that signify the varying conditions of the critically ill with the assistance of
advanced technology and knowledge.
- Plans and initiates nursing process to its full capacity in a need-driven and proactive manner.
- Acts promptly and judiciously to prevent or halt deterioration when conditions warrant.
- Co-ordinates with other healthcare providers in the provision of optimal care to achieve the best possible
outcomes.
Indirect Patient Care
- Understands family needs and provide information to allay fears and anxieties.
- Assists family to cope with the life-threatening situation and/or patient’s impending death.
ROLES OF CRITICAL CARE NURSES
C. Extended Roles as Critical Care Nurses – Critical care nurses have roles beyond their professional
boundary. With proper training and established guidelines, algorithms, and protocols that are continuously
reviewed and updated, critical care nurses also perform procedures and therapies that are otherwise
done by doctors. Such procedures and therapies are:
Sampling and analyzing arterial blood gases;
Weaning patients off ventilations;
Adjusting intravenous analgesia / sedations;
Performing and interpreting ECGs;
Titrating intravenous and central line medicated infusion and nutrition support; and
Initiating defibrillation to patient with ventricular fibrillation or lethal ventricular tachycardia.
Removal of pacer wire, femoral sheaths and chest tubes
ROLES OF CRITICAL CARE NURSES
D. Educator
Provides health education to patient and family to promote understanding and acceptance of
the disease process and to facilitate recovery.
Participates in the training and coaching of novice healthcare team members to achieve
cohesiveness in the delivery of patient care.
E. Patient Advocate
Acts in the best interest of the patient.
Monitors and safeguards the quality of care which the patient receives.
ROLES OF CRITICAL CARE NURSES
F. Management and Leadership Role
Perform management and leadership skills in providing safe and quality care Accountability for safe
critical care nursing practice
Delivery of effective health programs and services to critically-ill patients in the acute setting
Management of the critical care nursing unit or acute care setting e. Take lead and supervision
among nursing support staff
Utilize appropriate mechanism for collaboration, networking, linkage –building and referrals.
G. Researcher Role
Engage self in nursing or other health-related research with or under supervision of an experienced
researcher
Utilize guidelines in the evaluation of research study or report
Apply the research process in improving patient care infusing concepts of quality improvement and in
partnership with other team-players.
COMPETENCIES FOR CRITICAL CARE
NURSES
• The competence of critical care nurses together with established nursing standards and the
identified core competencies for registered nurses will result to excellence in critical care nursing
practice. To achieve safe and quality client-centered care, nurses working in the critical care units
are envisioned to adopt not only the stated core competencies of registered nurses but also the
specific competencies stipulated in the following eleven major key responsibility areas:
6. Personal and Professional Development
1. Safe and Quality Nursing Care
7. Communication
2. Management of Resources
8. Health Education
3. Legal Responsibilities 11
9. Quality Improvement
4. Ethico-Moral Responsibilities
10.Research
5. Collaboration and Teamwork
11.Record Management
CRITICAL CARE PROFESSIONAL
ORGANIZATION
Critical Care Nurses Association of the Philippines (CCNAPI)
CCNAPI is a specialty Nursing Organization that caters and continuing uplifting
the standards of Filipino Critical Care Nurses by providing updated and Evidence-
Based training, workshops, and seminars.
The organization was founded in February 1977 with approved
SEC registration (CN 200813601), a founding member of the World Federation of Critical
Care Nurses (2001) and accredited as a Continuing Professional Development (CPD)
Provider by the Professional Regulation Commission (Provider Number 2009-019).
As its mission, CCNAPI is committed to the promotion and protection of man’s health
and welfare for national development. It also supports the professional and personal growth
and development of its members; and committed to the ideals of service to the people, for
equality, justice, and social progress.
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