1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1: Critical Care Nursing Practice: Promoting Excellence Through Caring, Competence, and Commitment

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Various Certifications Available for Critical Care Nurses CCRN: Critical Care Registered Nurse PCCN: Progressive Care Certified Nurse CCNS: Certified Clinical Nurse Specialist ACNPC: Acute Care Nurse Practitioner Certification CMC: Cardiac Medicine Certification CSC: Cardiac Surgery Certification

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Value of Certification in Critical Care Nursing Value to the consumers Value to the employer Value to the nurse

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following best describes certification in critical care? A.Ensures that medical errors will not occur B.Serves as the license once obtained C.Certifies adequate knowledge base of critical care nursing expertise D.Certifies ability to perform critical care skills in the clinical setting

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Certifies adequate knowledge base of critical care nursing expertise Rationale: Licensure ensures that an RN has basic entry- level competency. Critical care certification ensures an expert level of competency for the RN who practices in critical care. The certification test does not assess the nurse’s ability to perform skills. The certification test does not replace the license. Even with certification or licensure, a nurse can still make a medical error.

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins What Is Evidence-Based Practice? Evidence-based practice (EBP) is the use of the best available research data from well-designed studies coupled with experiential knowledge and patient preferences in clinical practice in order to support clinical decision making.

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is the best source of evidence to use when developing EBP guidelines? A. Nursing textbooks B. Cochrane Library C. A descriptive research study using 30 subjects D. A nursing procedure manual revised 5 years ago

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Cochrane Library Rationale: Cochrane reviews provide the highest level of evidence to use when developing EBP guidelines. Nursing textbooks may or may not contain evidence-based practice guidelines based on the strongest research. Textbooks can be 5 or more years behind recent research findings. One small descriptive study or a nursing procedure manual would not provide sufficient evidence for developing EBP guidelines.

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Essential Elements of a Healthy Work Environment (HWE)

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins HWE Scenario 1 During your 0400 assessment of a client admitted from the ED earlier with a diagnosis of syncope R/O sick sinus syndrome you note that the client’s pupils are now unequal in size, and the right pupil is more sluggish than the left pupil. The client is slurring his words. You call the admitting physician, who tells you in a condescending voice that you could have waited until he makes rounds at 0800 to tell him about the change and that you should have ordered a CT scan without contrast on your own and called a neurosurgeon to evaluate the patient. How do you respond?

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins HWE Scenario 2 While listening to the taped report about the patient you are assigned to care for in the ICU, you realize that you have never learned how to do continuous renal replacement therapy. You immediately contact the charge nurse, who tells you that she will go over how the equipment works and how to complete the forms involved. To maintain a HWE, what should you do?

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins HWE Scenario 3 Your patient, admitted with the diagnosis of alcoholism experiencing delirium tremors, has not responded to the ordered protocol. Based on your experience of caring for this patient population in a large university hospital, you recognize there is a more effective protocol. You call the physician and give your experience-based suggestions. The physician ignores you and tells you to continue with what was already ordered. Other nurses tell you that the physician ignores whatever the nurse has to say and does what he wants. What steps should you take to create a HWE?

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins HWE Scenario 4 You were scheduled to work 12 hours in the ICU. The nursing supervisor mandates that you work another shift on another unit. You state that your contract prohibits mandatory overtime, and you have a sick child at home who needs your attention. The nursing supervisor begins to curse and belittle you in front of visitors, coworkers, and the unit clerk. The supervisor states that if you don’t work the shift, then that is abandonment of your duty, and she will report it to the state board of nursing. What should you do to establish a HWE?

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

15. Characteristics of Patients, Clinical Units, and Systems of Concern to Nurses See Box 1-8.

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurse Competencies of Concern to Patients, Clinical Units, and Systems See Box 1-9.

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Future Challenges Facing Critical Care Nursing Practice Culture and language barriers New and emerging infections Natural and manmade disasters Actual or potential bioterrorism Technological challenges to improve healthcare communication

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question When making assignments for the ICU, which principle should the charge nurse use first? A.Consider the nurse’s skill and expertise level and match it with the client’s needs. B.Provide the nurse with the same client assignment to promote continuity of care. C.Provide learning opportunities for the nurse who recently completed critical care classes. D.Consider the nurse’s need for a variety of experiences.

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A.Consider the nurse’s skill and expertise level and match it with the client’s needs. Rationale: Although the other three choices have merit to improve satisfaction among nurses, the client’s needs should take precedence. The Synergy Model recommends matching the nurse’s skill and expertise level with the needs of the client.