Adult Health Study Guide
Introduction:
oPatient education in critical care is ongoing and frequently reinforced
Use layman terms and stop/explain what you’re doing to family/patient
Patient can be scared when transitioning to independence = help the know this is a good thing oPurpose of the Code of Ethics
Prevention of malpractice or maltreatment of patient
Protects patients and possible healthcare providers Autonomy = independence
Beneficience = do good
Nonmaleficence = do no harm
Justice = be fair
Fidelity – be failthful, truth
oPalliative care – see below
oAdvanced directives – see below Test 1 Chapter 1: Critical Care Nursing Practice
oContemporary Critical Care
Critical care uses a multidisciplinary team
Includes nurses, physicians, clergy, OT, PT, etc.
Each have in depth knowledge
Wide range of discipline = should take advantage of lots of specialties. Diabetes specialties, heart doctor, respiratory, etc. High risk patients
Specialized units
There is now a continuum of care with critical care
Critical care goes to progressive care
oIn between medical/surgical floor and critical care There are units that are specialized and based on the pts. (age, etc._
oNeonatal (nicu), pediatric (picu), adult, (icu), geriatric etc.
oNot every hospital will have all these designation areas, if a hospital doesn’t have picu, and have a child who is really sick they will transfer them to another hospital. Medical vs. surgical problems
oMedical icu from what’s coming in vs. surgical icu which deals with pts. in critical care after surgery
Special pt. populations
oCardiac, pulmonary, neurologic etc. oCritical care nursing roles
Expanded role nursing positions Case managers Patient educators – diabetes nurse, hand hygiene etc.
Cardiac rehabilitation specialties Office nurses
Infection control specialists
Advanced practice nurse (APNs)
Clinical nurse specialists (CNS) – in charge of leadership type stuff
Nurse practitioner (NP) or acute care nurse practitioner (ACNP) - like a doctor, orders tests, labs, meds
Certified registered nurse anesthetist (CRNA)
The most widespread role of nursing is in direct care for the patient
Our care is also seen in caring with the family of the patient as well. oCritical care professional accountability
The society of critical care medicine (SCCM)
Multidisciplinary, multispecialty, international organization
American association of critical care nurses AACN
Certifications
oHave certifications for different specialties of intensive care such as pediatric, nicu, etc. oHospitals are pushing for nurses to be certified because EBP shows it creates better care
National organizations
Awards
oEvidenced based nursing practice
Research based interventions
Early practice based on traditions
oWe used to do what felt right and what has worked in the past, but this was not always scientific
oNow we focus on evidenced based practice, what research shows work
There is now a shift to use of best data available
oUse science as a base and is able to explain reason for interventions
oCreates more positive outcomes oStrive for best practice
oExample: catheter care – removing quickly, etc
oHolistic critical care nursing
Care
Merges psychological elements with technologic environment Holistic care It can be difficult to give a pt/family more attention because of how fast paced nursing can be Need to make sure they understand we care and promote that. Individualized care
Patient preferences
oBehaviors that indicate we don’t care = rushing, not telling people what/why we are doing things. oYou should focus on the patient, not whats outside the room. Don’t show the pt. you’re stressing out
Patient and family centered care
oInvolving the pt. in care is super important oMake sure they know whats going on. Cultural care
oReflects society
oIncorporates individual differences
oMake sure to include ethnic values in care oComplementary and alternative therapy
Alternative- using specific therapy INSTEAD of traditional treatment
Complementary – ADDING the therapy to the traditional treatment
Examples
Spiritual/prayer – finding meaning and feeling guided
Guided imagery – low cost, decrease stress/pain/anxiety
Massage – promote relaxation, reduce pain Animals – provide positive pt. outcomes with orientation, mobility, communication, and moods oNursing’s unique role in health care Both independent and dependent nursing roles Interdependence with all health care professionals We must be the eyes and ears for the provider
oIs what they are hearing from the pt. what’s actually going on. oExplain, intervene, create best plan of action
oWe need to be professional
oClarify orders We must be exceptional at communication skills Facilitate communication between health workers, family, patiet
Need to communicate with lots of different people in different ways
Assertive in communication
oCritical care nursing practice
Research
Studies link between clinical judgement and interventions Identifies two major categories of thought and action
oNursing thought/action
Clinical grasp
Clinical inquiry
Problem identification
Problem solving
Clinical forethought – preventing problems in the future
oClinical practice Diagnosing/managing functions
Managing a crisis
Providing comfort measures
Caring for families
Prevent hazards
Facing death and end of life care
Communicating/negotiating
Monitoring/managing quality of care
Clinical leadership
oInterprofessional Collaborative practice
Increases quality of care and services
Contains or decreases costs
Core competencies for interprofessional collaborative practice
Assess competencies relevance
Develop plan of action This involves a collaboration between disciplines (doctors, dieticians, therapy, speech
Decrease costs, increase care, better results
Improve communication/accuracy Different departments are experts on different things oPharmacist – meds, dietician etc.
oCare management methods
Care management Enables, supports, and coordinates care
Seen in many settings
Pt. focused, continuum driven, and team approach is goal driven Care manager
oFacilitate care services as a pt. moves through places
Case management Oversees care and organizes services
Collaboration
Case management tools
Clinical algorithm
oDisease population management
Manage the populations’ health over a lifetime
Diabetes, heart failure, etc. oThis is a stepwise decision making flowchart
Helps to guide clinicians through the decision making process
Identify treatments
Ex
Plan for diabetes, first try lifestyle management, then oral diabetics, then insulin
Practice guideline
oResources to help form algorithms oCreated by expert panels and professional organizations Protocol oDirective, useful tool for research studies oDirect plan of action
oDon’t vary
oIf you see a high potassium, don’t give potassium, oRigid guidelines to follow based on what’s going on with the pt. oDo not vary from protocol Order set oPreprinted orders from the provider Helps the order process oExamples
Standard orders for this type of patient which are validated through evidenced based practice Get meds, diagnostics, studies, for certain type of pts. oQuality, safety, and regulatory issues in critical care
Institute of medicine (IOM) report
Publicized a book that reported healthcare harms more people and fails to deliver In healthcare errors happen
oIdentify ways to decrease errors
oCulture of safety, not blame oLook at the big picture, pharmacy sent wrong med, and I gave the wrong med, how can we prevent this from happening Safety as an ethical imperative
Medication administration challenges
oDistraction – distracted by pt., family, phones etc.
oIntentional to prevent distractions oMake sure you do your double checks Important to report errors oExplain what happened, what you are looking for, how to prevent errors again, oNo intimidation
Blameless culture
Intimidating/disruptive clinician Technology
The joint commission
oNational patient safety goals oEnsure high levels of care oEstablishes safety goals in health care organizations
safe medical device act
oserious/potential device injuries should be reported the FDA
oif death is involved = FDA
oimplantable devices = reported and tracked so FDA can learn about issues
privacy and confidentiality
HIPPA
oLaw that allows consumers to have greater access, standardization, and protects information for the pts.
oIncreased regulations and requirements
ICU is an hippa issue
oMany family members, family could overhear, family overhears about other pts., lots of people, tight spaces etc.
oDon’t want family members in the hall way Healthy work environment
Stressful
oThings happen at anytime, it can be hard to work in
oNeed to have support and self-care
Support health care providers
oEBP – unhealthy work increases errors, conflicts, ineffective communication, oIdentify roles we play in healthy work environment
Patient and Family response to the Critical Care experience
oIntroduction
Nurses play a unique role in addressing the needs of patients and families in a busy and complex environment
