1. 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.

2. 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.
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3. 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)
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4. 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.
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5. 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.
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6. 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.
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7. 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
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8. 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

9. 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
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10. 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
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11. 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
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12. 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)

13. 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

14. 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
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15. 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.
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16. 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
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17. Privacy and Confidentiality
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Protection of health care data
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18. 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
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19. 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)
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20. 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.
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21. 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.)
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22. 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
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