Acute Care Chapter 20

20-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Acute Care  A type of nursing, as well as the place for the delivery of nursing care.

20-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Acute Care  Most expensive of health care settings  Includes the full range of physical and mental alterations afflicting individuals  Saving life, prolonging life, palliative care

20-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Focus of Acute Care Nursing  Management of crisis  Detection of disease in a pre- symptomatic stage (secondary prevention)  Management of chronic disease

20-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Arenas of Acute Care  Proprietary or not-for-profit  General or specialized

20-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Arenas of Acute Care  ICU  Long-term acute care (LTAC) facilities (for survivors of acute ICU interventions)  Post-acute rehabilitation (subacute services)

20-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Providers of Acute Care Nursing  Registered Nurses  Licensed Practical Nurses  Nursing Assistants  Unlicensed Clinical Assistants

20-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Providers of Acute Care Nursing  Registered Nurses Associate, diploma, baccalaureate Certification Master’s and doctoral level Advanced Practice Nurses

20-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Providers of Acute Care Nursing  Advanced Practice Nurses Nurse Practitioner Nurse Midwife Nurse Anesthetist Clinical Nurse Specialist

20-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Importance of Critical Thinking in Acute Care Nursing  Use the nursing process with respect to specific acute problems.  Master the facts and concepts concerning commonly encountered problems.

20-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Importance of Critical Thinking in Acute Care Nursing  Apply principles of critical and ethical decision making in a complex environment.  Understand aggregates of clients. Specialty populations with special needs

20-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Regulatory Organizations for Acute Care Nursing Practice  American Nursing Association (ANA)  Canadian Nurses Association (CNA)  American Association of Critical Care Nurses (AACN)  Intravenous Nurses Society (INS)  American Association of Neuroscience Nurses (AANN)

20-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Regulatory Organizations for Acute Care Nursing Practice  Allied Disciplines and Acute Care Nursing Medical Technologists American Heart Association The American Occupational Therapy Association (AOTA) The American Physical Therapy Association (APTA)

20-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Regulatory Organizations for Acute Care Nursing Practice  Standards for Care in Acute Care Nursing Organized, and explicit expectations for providers and clients Scientific rigor applied to common diagnoses Development of critical pathways (care maps)

20-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Control Agencies for Acute Care  Hospitals Occupational Safety and Health Administration (OSHA) Clinical Laboratory Improvement Amendments (CLIA) Centers for Medicare and Medicaid Services (CMS)

20-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Control Agencies for Acute Care  Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Monitors and evaluates appropriateness of care Evaluates quality of service Resolves existing problems Educational and supportive

20-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Control Agencies for Acute Care  State and Federal Agencies National Committee for Quality Assurance (NCQA) The California Department of Managed Health Care Ombudsman for the Managed Care Consumer Advisory Board (Massachusetts)

20-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Control Agencies for Acute Care  Institute of Medicine of the National Academy of Sciences Report Error incidence, detection, analysis and prevention Four-tiered approach to improve safety in health care

20-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evidence-Based Practice in Acute Care Nursing  Conscientious, explicit, and judicious use of current best evidence in making decisions about individual client care

20-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evidence-Based Practice in Acute Care Nursing  Outcomes Research in Acute Care Practice Links care delivered to individuals to the outcomes achieved Means of monitoring and improving quality of care in the acute care setting

20-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evidence-Based Practice in Acute Care Nursing  Mastery of Knowledge in Acute Care Nursing Wide range of pathologies Broad range of assessment skills Different laboratory and radiologic correlates Multiple drug classes, and agents to manage possible treatment complications

20-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evidence-Based Practice in Acute Care Nursing  Mastery of Knowledge in Acute Care Nursing Technical demands Cultural and age-related concepts Common diagnostic and complication- related signs and symptoms Collaboration with other members of the health care team

20-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Value Orientation and Acute Care Nursing  An essential component of acute care nursing Making difficult ethical decisions that are accompanied by potentially serious consequences Justifying how resource expenditure decisions are made

20-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Capitalism and Acute Care Nursing  Philosophy of Capitalism and Health Care American health care is considered and treated as a market commodity to be bought and sold rather than as a right. There is infinite demand for finite resources.

20-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Capitalism and Acute Care Nursing  Managed Care Concepts in Acute Care Health care financing and delivery arrangement designed to provide appropriate, effective, efficient health care

20-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Managed Care Concepts in Acute Care  Many managed care institutions are strong allies with other groups interested in quality health care.

20-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Influences Influencing Acute Care Nursing  Culture and ethnicity  Human genome mapping  Aging trends  Third-party payment systems of insurance

20-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Influences Influencing Acute Care Nursing  Human Genome Mapping Sequencing of DNA in the human genome Focus of diagnostics and therapeutics is shifting to genetic and molecular levels.

20-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Human Genome Mapping  Fundamental issues include: How will the knowledge affect the acutely ill? Will insurance cover illness in client’s with a predisposition for a particular disease?

20-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Aging and Acute Care  Appropriate use of technology and other healthcare resources  Treatment and resuscitation decisions

20-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Influences Influencing Acute Care Nursing  Insurance and Acute Care The uninsured often experience major decompensation as a result of lack of attention to originally manageable problems.

20-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Insurance and Acute Care  Preventive services can be far less expensive to provide than emergency acute care services.

20-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Current Issues in Nursing and Effect on Acute Care Nursing  Entry into practice  Use of variably trained caregivers  Critical thinking in the acute care setting

20-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Entry Into Practice Issues and Acute Care  Who should bear the cost of continuing education?  Qualification profile of practicing nurses  Debate concerning highest nursing credential  Is education adequate to address the complexity of care demands?

20-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Current Issues in Nursing and Effect on Acute Care Nursing  Nonstandardized Care Providers in Acute Care Challenge is to provide quality care in an acute care environment with fewer nurses. -Education is not standardized. -Roles are not clearly defined. -Nursing professionals are ultimately responsible for defining their capabilities.