1. Critical Care Nursing: Environment, Ethics, & the Patient Diane E. White RN MS CCRN PhD(c)

2. Critical Care Nursing A Team Approach to Care A Multidisciplinary Perspective A Holistic Approach to Care A Synergistic Approach to Care A Highly-Motivated Environment An Environment of Education

3. Professional Organizations The Society of Critical Care Medicine (SCCM) – a multidisciplinary, multi- specialty, international organization. American Association of Critical Care Nurses (AACN) – world’s largest specialty nursing organization

4. AACN Organization Founded in 1969 Purpose is to “promote the health and welfare of those experiencing critical illness or injury by advancing the art and science of critical care nursing and promoting environments that facilitate comprehensive professional nursing practice” (AACN fact sheet, home page)

5. AACN Standards of Care Assessment – relevant data Diagnosis – analyzes assessment data Outcome Identification- individualized Planning- plan of care that prescribes interventions Implementation Evaluation

6. Standards of Professional Practice (AACN) Quality of Care – evaluates quality Individual Practice Evaluation Education – maintains current knowledge Collegiality Ethics Collaboration

7. Standards of Professional Practice (cont’d) Research – practice based on research; inquiry approach to care Resource Utilization

8. Ethics/Legal Issues Autonomy – freedom to make decisions about one’s own body without the coercion or interference of others. Beneficence – doing good and preventing harm Nonmaleficence – prevent harm and correct harmful situations

9. Ethical Terms Veracity – truth-telling Fidelity – faithfulness and promise- keeping to patients Justice – allocation of scarce resources; access to care not a right guarenteed AACN’s Position Statements regarding ethical issues

10. Legal Issues Negligence – unintentional breach of duty or failure Malpractice – held liable for negligence Essential elements – duty and standard of care, breach of duty, causation, injury & damage Understaffing? What do you do?

11. Legal Issues California Nurse-patient ratio law Advance Directives for health care (1990. Cruzan vs. State of Missouri): Power of Attorney & Living Wills Withholding and Withdrawing treatment Do Not Resuscitate Orders

12. Critical Care Environment Psychosocial issues: self-esteem, body image, personal identity, & role performance Stressors in the ICU? Coping Mechanisms: regression, suppression, denial, trust, hope, hardiness & resilience, spiritual beliefs & practices, family support, & sharing

13. Sleep Alterations/Pain Control Somatostatin released in deep sleep which inhibits pain (prostaglandin release) Pain Control – “the 5 th vital sign” Sedation – Ramsey Scale and others Ramsey I – awake, II- cooperative and oriented, tranquil, III- responds to commands, IV- Asleep, V- sluggish response to light tap or loud auditory stimulus, VI – no response to light tap or loud auditory stimulus