Overview of CC
Critical Care Nursing
• Deals with human responses to critical illness or injury
o Physiological
o Psychological
• Focus on both the patient’s and family’s responses
• Critical Care Overview
• Not always centered in an “ICU setting”
o Inpatient
o Outpatient
o Home Care
o eICU
o Tele-stepdown
o Post anesthesia
o Flight nursing-transport
• Professional Organizations
o American Association of Critical-Care Nurses
o Society of Critical Care Medicine
Trends and Issues
• Critical care patients more complex
• Increasing costs for care
• Facilities for long term ventilators
• Reduces stays in hospitals: more risk for infection
• Better for patient to be at home
Focus on Quality and Safety
• Errors and harm must be prevented
o Communication is a big error
o On record where to find items
o Medication errors
o Documentation errors
o Handwashing
o Falls
• Nurses are challenged to reduce errors and promote a safe environment
• Several initiatives
o Joint Commission National Patient Safety Goals
o Institute for Healthcare Improvement
o Quality and Safety Education for Nurses (QSEN)
National Patient Safety Goals
• The Joint Commission National Patient Safety Goals
• Examples relative to critical care nursing
o Communication
,NR 340 Week 3 Exam 1 Studyguide
o Medication safety
o Reduce infections
o Reconcile medications
o Telephone orders- SAY BACK
o TALL letters for similar drug names
Harms Targeted for Reduction
• Adverse drug events
• Infections
o Catheter-associated urinary tract infections (CAUTI)
o Central line–associated bloodstream infections (CLABSI)
o Surgical site infections
o Ventilator-associated pneumonia (VAP)
• Injuries from falls and immobility
• Obstetric adverse events
• Pressure ulcers
• Venous thromboembolism (VTE)
Communication
• Communication important for safe care
• Standardized approaches
o SBAR and SBAP
▪ Situation
▪ Background
▪ Assessment
▪ Recommendation (Plan)
• Collaboration
o Nurse/ doctor
o Debreifing
Other Trends and Issues
• Reducing hospital readmission rates
o Chronic illness (HF)
• Increasing use of technology
o Electronic medical records
o Physician order entry
• Ethical issues associated with prolonging life and futile treatment
• Telemedicine and eICU
• Aging population and workforce
• Shortage of CC nurses
The Critical Care Environment
• Stressful
• Noisy
• Sleep Deprivation
• Concerns of the Critically Ill Patient
o Patients responses do vary
• Loss of control (even breathing)
• ↓ Communication (d/t vent)
• ↓Mobility, ↓Comfort
Psychosocial Support (HIGHEST CONCERN)
• Provide reorientation
o Strategies
▪ Mimic night/ day
▪ Calendar/ clock
▪ Tell them what you are doing
▪ Talk to the patient
▪ Allow for rest periods
▪ Provide pleasant area
Geriatric Concerns
• Diminished ability to adapt to, or cope with, stressors of critical illness
• At greater risk for negative outcomes
• May not bounce back
Ethical Issues
• Critical care nurses confront in everyday practice
o Informed consent and confidentiality
o Withholding or withdrawal of treatment
o Organ and tissue transplantation
o Distribution of healthcare resources
o Appropriate use of technology
• Greater frequency in critical care
Ethical Principles
• Autonomy
o Body
o Ability to make decisions for self
• Beneficence
o To do good
o To benefit the patient
• Nonmalificence
o To do no harm
• Justice
o People getting what they deserve/ need
• Veracity
o Be truthful
• Fidelity
o Be faithful
• Confidentiality
Nurse Involvement in Ethical Decision Making
• Advocacy
o Open communication of patient’s wishes and ethical concerns
o True collaboration with healthcare team members
• Dilemmas can result in moral distress
• Formal mechanisms (The Joint Commission)
o Bioethics committees
, NR 340 Week 3 Exam 1 Studyguide
o Ethics consultation
• Opportunities for critical care nurses
o Ethics forums and rounds
o Peer review
o Institutional review boards (research)
Selected Issues
• Informed Consent
o Have to insure that patient is actually informed
o No remaining questions about procedure/outcome
• Advanced Directives
• Organ and tissue donation
o Call gift of hope – Nurses only responsibility
• Life-sustaining treatment
Forum to Resolve Issues
• Bioethics Committees
• Ethics Consultation
Concerns of the Critically Ill
• Pain
o Physiology
o Predisposing Factors
▪ Disease process can cause pain
▪ Changing dressing, movement, etc.
▪ Ischemia
o Assessment
▪ Subjective
Pain is what the patient says it is
▪ Objective
Vital signs
Non-verbal
▶ Facial expressions
▶ Moaning/Groaning
▶ Grimiacing
▶ Guarding
▶ Body Movement
• Pain Management (acute pain)
o Nonpharmacologic
▪ Heat, cold, massage, breathing, guided imagery, etc.
o Prevention
▪ Opioids
Fentanyl
Dilaudid
Morphine
▪ Concern is respiratory depression
▪ Antidote is narcan
o Epidural
o NSAIDS
o PCA
• Anxiety
o Prolonged stated of apprehension in response to fear
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