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