Caring for the Critically Ill Patient Chapter 1 Caring for the Critically Ill Patient Copyright © 2012, 2008, 2004, 2000, 1996, 1992 by Mosby, an imprint of Elsevier Inc.

Objectives Describe critical care nursing roles. Discuss the importance of holistic care for the critically ill patient and family. Compare and contrast interdisciplinary critical care management models and tools. Explain the safety issues in the critical care environment. Discuss the six standards of a healthy work environment. Add copyright line

Critical Care Nursing Roles Expanded-role nursing positions Case managers Patient educators Cardiac rehabilitation specialists Office nurses Advanced practice nurses Clinical nurse specialist (CNS) Nurse practitioner (NP) or acute care nurse practitioner (ACNP) Add copyright line 3

Question What is the purpose of critical care nursing standards? Standards provide recommendations to care providers. Standards are stepwise decision-making tools for specific processes. Standards are guidelines for research. Standards serve as descriptors of expected nursing roles and responsibilities. Add copyright line

Answer Standards serve as descriptors of expected nursing roles and responsibilities. The standards are authoritative statements that describe the level of care and performance by which the quality of nursing care can be judged. Standards serve as descriptors of expected nursing roles and responsibilities. Add copyright line

Critical Care Nursing Standards American Association of Critical-Care Nurses (AACN) has established nursing standards to provide a framework for critical care nurses. These standards serve as descriptions of expected nursing roles and responsibilities. These standards are prescriptive of a competent level of nursing practice. Add copyright line

Evidence-Based Nursing Practice Research-based interventions Early practice based on traditions Shift to use of best data available Consistent, positive outcomes Strive for best practice Use valid and reliable data Add copyright line

Holistic Nursing Caring Individualized care Cultural care Spirituality Incorporate psychosocial elements with technological environment Individualized care Recognize uniqueness of patient’s preferences Patient- and family-centered care Cultural care Accounts for cultural diversity of society Ensures that individual differences are incorporated Spirituality

Nursing’s Unique Role in Health Care Facilitating communication among health care providers, patients, and families Need to be confident and assertive Advocating for patients Ensuring appropriate actions and interventions are done Knowledgeable about latest evidence Support practice Mentor others Formulating patient care goals Add copyright line

Interdisciplinary Critical Care Management Case management Overseeing patient care and organizing services Collaboration Outcomes management Model aimed at managing the outcomes of care by the use of various tools, quality improvement processes, and interdisciplinary team involvement and action Add copyright line

Care Management Tools Algorithm Practice guideline Protocol Stepwise decision-making flowchart Practice guideline Created by expert panels and developed by professional organizations Protocol Directive, useful tool for research studies Add copyright line

Quality, Safety, and Regulatory Issues in Critical Care Institute of Medicine report Safety as an ethical imperative AACN “Practice Alert” Evidence-based Reference for safe, quality care (continued)

2011 The Joint Commission (TJC) National Patient Safety Goals Identify patients correctly Improve staff communication Use medications safely Prevent infections Identify patient safety risks Prevent mistakes in surgery

Question Which of the following behaviors are considered intimidating and disruptive? Verbal outbursts Physical threats Refusing to carry out a task All of the above Add copyright line

Answer All of the above It has been shown that intimidating and disruptive clinician behaviors can lead to errors and preventable adverse patient outcomes. Verbal outbursts, physical threats, and more passive behaviors such as refusing to carry out a task or procedure are all under this category. Unfortunately, these types of behavior are not rare in health care organizations, with as many as 40 % of clinicians having said that they were involved in such interactions. Add copyright line

Quality, Safety, and Regulatory Issues in Critical Care (continued) Safe Medical Device Act (SMDA) of 1990 Requires hospitals to report: Serious or potentially serious device-related injuries or illness of patients and/or employees to the manufacturer of the device If death is involved must also report to the FDA Implantable devices must be documented and tracked Add copyright line

Privacy and Confidentiality Health Insurance Portability and Accountability Act of 1996 (HIPAA) Protection of health care data Add copyright line

Healthy Work Environment Stressful environment Need to support health care providers Unhealthy environments increase errors Creating a healthy work environment Mentoring new staff Role modeling positive behaviors Leading interdisciplinary teams Add copyright line

Healthy Work Environment Standards Standard I: Skilled Communication Nurses must be as proficient in communication skills as they are in clinical skills. Standard II: True Collaboration Nurses must be relentless in pursuing and fostering true collaboration. Standard III: Effective Decision Making Nurses must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations. (continued) Add copyright line

Healthy Work Environment Standards (continued) Standard IV: Appropriate Staffing Staffing must ensure the effective match between patient needs and nurse competencies. Standard V: Meaningful Recognition Nurses must be recognized and must recognize others for the value each brings to the work of the organization. Standard VI: Authentic Leadership Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement. Add copyright line

Healthy Work Environment, Clinical Outcomes, and Patient Outcomes FIGURE 1-1 Interdependence of Healthy Work Environment, Clinical Excellence and Optimal Patient Outcomes. (From American Association of Critical-Care Nurses (AACN): Standards for establishing and sustaining healthy work environments, Aliso Viejo, Calif., 2005, AACN.) Add copyright line

Healthy Work Environment Model for becoming a skilled communicator: Becoming aware of self-deception Becoming authentic Becoming candid Becoming mindful Becoming reflective Thus creating a healthy work environment Add copyright line