NCM 118 Mod 1 Introduction to Critical Care Nursing

What is Critical Care Nursing?

A nursing specialty that deals with human responses to actual or potentially life-threatening illnesses, requiring clinical expertise, critical care knowledge, and caring practices.

What is the scope of Critical Care Nursing?

It applies the nursing process (assessment, diagnosis, outcome identification, planning, implementation, evaluation), is based on a scientific body of knowledge, and focuses on restorative, curative, rehabilitative, maintainable, or palliative care based on patient needs.

How does Critical Care Nursing uphold collaboration?

It emphasizes multi- and interdisciplinary collaboration to restore stability, prevent complications, and achieve optimal patient responses.

What did Florence Nightingale advocate in the 1800s?

Placing patients recovering from surgery in a separate area of the hospital for better care.

When and where was the first three-bed postoperative neurosurgical ICU opened?

Early 1900s at John Hopkins Hospital, Baltimore.

How did World War II influence critical care?

Shock wards were established to care for critically injured patients, highlighting the need for specialized care.

What role did nursing shortages post-WWII play?

Forced grouping of postoperative patients into designated recovery areas for proper monitoring and care.

How did 20th-century technology and combat experiences impact critical care?

Provided impetus for specialized medical and nursing care in the civilian setting.

What advancement in the 1950s influenced ICU development?

Introduction of mechanical ventilation, necessitating grouping patients receiving this therapy in one location.

When was critical care nursing organized as a specialty?

Less than 60 years ago; before that, it was practiced wherever critically ill patients were found.

How did nurses consolidate knowledge in the 1960s?

Focused on specialized areas such as coronary care, nephrology, and intensive care, within hospital units for specialized patients.

What is the role of the Philippines PRC Board of Nursing (PRC BON)

Provide need-driven, effective, efficient specialty nursing care of high standards at an international level.

What specialty nursing organization exists in the Philippines

Critical Care Nurses Association of the Philippines, Inc. (CCNAPI), supporting specialty nursing knowledge and care.

What is the CCNAPI?

The Critical Care Nurses Association of the Philippines, Inc., a specialty nursing organization supporting critical care nursing practice in the Philippines.

What is the purpose of the CCNAPI Standard of Practice?

To align with the 2005 BON statements of the 11 Core Competencies for entry-level safe and quality nursing care, defining the knowledge, skills, and abilities expected of critical care nurses.

How does CCNAPI define Core Competencies?

According to the level of expected behavior, covering roles of:

• Nursing Clinician 1

• Nursing Clinician 2

• Nurse Specialist
  These serve as the basis for assessing competence in critical care practice.

What approach does Critical Care Nursing reflect according to CCNAPI?

A holistic approach in caring for patients.

What is the responsibility of critical care nurses in the Philippines?

Promote health and welfare of individuals for national development.

How are patients viewed in critical care units?

Each patient is a unique individual with dignity and worth.

How do advances in biomedical technology impact critical care nursing?

They allow nurses to continuously monitor and observe physiological changes, proactively confront problems, and help patients achieve optimal functioning or a peaceful death.

How does the International Council of Nurses (ICN) view health care?

As a right of every individual, regardless of financial, political, geographical, racial, or religious considerations.

What is the stance of the World Federation of Critical Care Nurses (WFCCN)?

The rights of critically ill patients are supported, and the ICN statement on patient rights forms the basis for their position statement.

How does CCNAPI support patient rights?

As a founding member of WFCCN, CCNAPI supports the ICN position statement on nurses and human rights.

What are the primary goals of Critical Care Nursing?

Promote safe and quality care for critically ill patients and their families.

Care holistically, considering biological, psychological, cultural, and spiritual dimensions.

Apply up-to-date knowledge, skills, and technology for prevention, early detection, and treatment of complications.

Provide palliative care for patients with unavoidable death, supporting patients and families through painful suffering.

Who stratified critical care provisions in the Philippines and why?

In 2003, the Philippines Society of Critical Care Medicine, along with Society of Pediatric Critical Care Medicine and CCNAPI, stratified care to align with international standards and ensure effective utilization and organization of resources.

What determines the level of care provision in a critical care unit?

The role of a unit depends on:

• Staffing

• Facilities

• Support services

• Type and number of patients it must manage

What defines Level 1 Critical Care?

Provides immediate resuscitation and short-term cardio-respiratory support for patients at risk of deterioration.

Focus on monitoring and preventing complications in “at-risk” patients.

Nurse in charge and some staff have post-registration critical care qualifications.

• Nurse-patient ratio: 1:1 for all critically ill patients.

What defines Level 2 Critical Care?

Provides high-standard general critical care for patients stepping down or requiring single-organ support/post-operative care.

Capable of mechanical ventilation, renal replacement therapy, invasive hemodynamic monitoring, and care for various specialties.

Medical director with intensive care qualification and duty specialist available exclusively to the unit.

Significant number of nursing staff have critical care certification.

• Nurse-patient ratio: 1:1 for all critically ill patients.

What defines Level 3 Critical Care?

Tertiary referral unit, managing all aspects of critical care medicine.

Medical director with specialist critical care qualification, duty specialist, and experienced medical staff present at all times.

Majority of nursing staff have intensive care certification.

• Nurse-patient ratio: at least 1:1 for all patients at all times.

How are Critical Care Units categorized?

According to patients’ age group or medical specialty.

What are the age group categories for critical care units?

Neonatal

Pediatric

Adult

What are the specialty categories for critical care units?

• General ICU: serves patients of various specialties.

• Dedicated ICUs: for specific groups such as:

  1. Medical

  2. Surgical

  3. Cardiothoracic

  4. Cardiac

  5. Respiratory

  6. Neurosurgical

  7. Trauma

How can the operation of critical care units be classified?

Into Open System and Closed System.

Open System:

The primary physician retains overall responsibility for the patient.

• Consulting intensivists provide recommendations but do not have full authority.

Closed System:

Intensivists or critical care team assume full responsibility for the patient’s care.

• Primary physician acts as a consultant, and the critical care team directs management.

What defines a Critical Care Nurse?

A licensed professional nurse responsible for ensuring optimal care for critically ill patients and their families.

What are the requirements to work in critical care areas?

Requirements vary by institution and may include specialized training, certification, or qualifications.

What position statement does CCNAPI follow regarding the critical care workforce?

CCNAPI adopts the World Federation of Critical Care Nurses’ (WFCCN) position, called the “Declaration of Buenos Aires.”

• It sets global standards for qualifications, staffing, and professional requirements in critical care nursing.

Care provider role of a Critical Care Nurse?

Delivers direct and indirect patient care and family support.

Extended Practitioner Roles of a Critical Care Nurse?

Performs advanced procedures like arterial blood gas analysis, ventilator weaning, ECGs, IV titration, defibrillation, and removal of pacer wires or chest tubes following clinical protocols

What are the Educator Roles of a Critical Care Nurse?

• Provides health education to patients and families

• Participates in training and coaching of novice healthcare team members

What are the Patient Advocate Roles of a Critical Care Nurse?

Acts in the best interests of the patient

• Monitors and safeguards the quality of care received by the patient

What are the Management and Leadership Roles of a Critical Care Nurse?

Leads and manages the critical care unit, ensures safe, quality care, supervises staff, delivers effective health programs, and fosters collaboration and networking.

What is the Research Role of a Critical Care Nurse?

• Engage in nursing or health-related research, with or under experienced supervision

• Use guidelines to evaluate research studies or reports

• Apply the research process to improve patient care and integrate quality improvement with the healthcare team

What is the Advanced Practice Level of a Critical Care Nurse?

Represents the future direction of critical care nursing in the Philippines, benchmarked internationally

• Requires advanced knowledge and skills to meet the demands of the global healthcare environment

Clinical Nurse Specialist in critical care requires?

Education and preparation through graduate or master’s degree programs

• Registered nurse with >3 years uninterrupted ICU experience

• Builds and develops nursing competencies in the ICU

What is the role of an Acute Care Nurse Practitioner (ACNP)?

Leads in evidence-based practice and facilitates patient care processes across teams

• Requires post-registration experience in critical care

• Holder of a clinical master’s degree in a nursing specialty or related discipline with critical care training

What is the role of an Outcome Specialist?

Develops and implements patient outcomes management

• Acts as a qualified nurse expert in monitoring and improving patient care results

What are the challenges faced by Critical Care Nurses

Maintain knowledge of patient norms, values, beliefs, illness patterns, and care needs

• Analyze and evaluate specialty skills and evolving roles

• Apply evidence-based practice, integrating research, cultural, and contextual factors

• Exercise professional judgment in critical care settings

How are Critical Care Nurses trained?

Hospitals provide training opportunities for competency development

• Includes: orientation, preceptorship, mentoring, postgraduate critical care programs, and specialized critical care training

• Prepares nurses to manage complex and changing patient needs

What is included in Orientation, Preceptorship, and Mentoring Programs for Critical Care Nurses?

Orientation: New recruits learn unit policies, procedures, and patient care protocols

• Preceptorship & Mentoring: Work under senior staff supervision, with experienced staff available for consultation

• In-service Training:

  • Hospital-based courses, workshops, seminars

  • On-the-job training and bedside supervision

What are the components of Critical Care Nursing education and training

• Postgraduate Specialty Programs

  • Advanced education after bachelor’s degree, accredited by CHED/PRC BON

  • Reviewed/endorsed by CCNAPI

  • Follows WFCCN policy framework

• Certification Courses

  • Recognition after completing specialized training

  • Accredited by PRC BON

  • Examples: ACLS, PALS, NRP, CRRT, Advanced IV therapy, Stroke nursing

• Continuing Professional Education (CPE)

  • Practicing CCNs must earn ≥20 credit units/year

  • Updates in critical assessment, critical care practice, end-of-life/palliative care