1. Scope of Critical Care Nursing
بسم الله الرحمن الرحيم
Scope of Critical Care Nursing
Dr. Abdul-Monim Batiha
Associate Professor
Critical Care Nursing

2. Scope of Critical Care Nursing

3. Introduction
Critical care nursing is subspecialties of medical surgical nursing. The reason of being of “Nursing” in any setting is the provision of holistic nursing care.
The adjective “Critical” is characterized by actual or potential crises for the recipients of nursing care –
Critical – is defined as pertaining to a crisis, involving danger or risk.

4. Critical care practice areas began to develop in the late 1960’s in response to
Developments in medical science and technology
Related changes in community values and attitudes.

5. Definition: The American Nurses’ Association defined Nursing as:
“The diagnosis and treatment of human response to actual or potential health problem.

6. In 1984, The American Association of Critical Care Nurses’ (AACN) defined Critical Care Nursing:
“Critical care Nursing is that specialty within nursing that deals specifically with human responses to life- threatening problems”

7. Analysis of these definitions reveals several important concepts.
The basis of the definition rests with the words human responses.
Critical care nurses deal with
- The total human being
- His or her response to actual and
potential health problems.

8. This suggests that the critical care nurse is involved with prevention as well as cure.
Additionally, human response can take the form of :-
- a physiological phenomenon.
- a psychological phenomenon.

9. Critical care nursing is specifically concerned with human responses to life-threatening problems. However, prevention can also be viewed as appropriate in this definition.
Ex: a critical care nurse can teach patient methods to lower blood cholesterol levels, which may prevent a life-threatening problem.

10. scope of critical care nursing practice
A scope of practice statement provides a framework within which an individual can provide a particular service.
The AACN’s Scope of Critical Care Nursing Practice statement provides a definition and description of the practice of critical care nursing.

11. The scope of critical care nursing practice is described as a dynamic process with three components:
1- The critically ill patients and their significant
social relationship.
2- The critical care nurse.
3- The environment where critical care nursing is
practiced.

12. Scope of Critical Care Nursing Practice

13. Central to the scope are nurse-patient interactions.
The goal of critical care nursing is :-
To ensure effective interaction of these three requisite elements to affect competent nursing practice and optimal patient outcomes

14. The critically ill patients

15. Critical care patients share one or more of a number of defining characteristics:
1- A significant health breakdown problem which is life threatening.
2- Biophysiological health breakdown problems of such acuity and / or chronicity that they may lead to extraordinary dependence on health care providers, and possibly technology for health maintenance or life support.

16. The American Association of Critical Care Nurses (AACN) described the critically ill patient as follows:
“The critically ill patient is characterized by the presence of actual and / or potential (being at risk for developing) life- threatening health problems.”
The needs of these patients require continuous assessment (observation) and intervention to restore health and prevent complications.

17. As man is biopsychosocial being the concept of the critically ill patient includes the family and / or significant others.
The needs of the critically ill are considerable. These needs may be categorized as physical or non-physical

18. 1- Physical needs:-
are equated with basic physiological or biological needs for ex, for air, nutrition, and elimination.
2- Non-physical needs:-
may include social, spiritual, and psychological needs. Social integrity (self-esteem), information, and communications are also included.

19. The comfort and support provided by social relationships can enhance effective coping. Therefore the concept of the critically ill patient includes the interaction and impact of the patients’ family and / or significant others.
The nature of critical care is such that physical needs are considered a priority and are almost always met. However, the critical care environment can actually obstruct the fulfillment of non-physical needs contributing to the stressful nature of critical illness.

20. “Identity(personality) and social integrity can be very difficult to maintain when a person is in a strange situation without their usual clothes, hair style, and when work and conversation or discussion goes on around and over them without including them as a person.”

21. The obstructed need for identity and social integrity may lead to the development of a range of negative emotional or psychological status for ex. Loss of self-esteem & confidence.
Obstruction of these non-physical needs increases the stress experienced by fragile, critically ill patients.

22. Obviously the needs of the patient’s family and significant others must also be considered and met as far as possible.
If all the needs of the critically ill are to be met, both physical and non-physical needs should be considered in planning holistic nursing care.

23. The Critical Care Nurse

24. The critical care nurse is a licensed professional, who is responsible for ensuring that all critically ill patients receive optimal care.
Nurses practicing in critical care areas have to make clinical judgments to prevent clinical deterioration in their patients.

25. Anticipation (expectation) and early prevention of patient problems are central requirements of critical care nursing practice, and these requirements mandate highly developed skills of :-
1- Assessment.
2- Clinical judgment.

26. Prediction of patient problems must be based on:-
1- A sound understanding of anatomy and
physiology
2- Smart assessment skills.

27. Since the clinical requirements of the critically ill are such that the team caring for any single patient may consist of :-
- Various medical officers,
- A nurse,
- A pharmacist,
- A dietician,
- A physiotherapist,
- A radiographer,
- A social worker.

28. The knowledge base, which underlines critical care nursing practice, is highly specialized and it is constantly subject to revision and development as a consequence of:-
a- Research activity
b-Technological innovation.
Preparations for practice in critical care must emphasize the importance of a holistic approach to nursing care. Such an approach is most likely to meet the needs of the critically ill person.

29. The Critical Care Environment

30. Critical care nursing takes place in a specialized environments that are designed and organized to give the best possible patient care in an area where significant change in patient morbidity can occur rapidly.
The safety of both patients and staff in the CCU is a primary consideration in designing the environment in which critical care nursing is carried out.

31. The critical care environment is viewed from three prospective:
1-The conditions and circumstances surrounding the direct interaction between the critical care nurse and the critically ill patient.
The environment must contain resources that constantly support this interaction. e.g. emergency equipment and supplies.

32. 2-The setting within which critically ill patient receive care
2-The setting within which critically ill patient receive care. Here critical care management and administrative structure ensure effective care delivery through provision of:-
- adequate human and financial resources,
- quality control systems, and maintenance
of standard of nursing care.

33. Factors that influence the provision of care to the critically ill
Factors that influence the provision of care to the critically ill. These include:-
- legal,
- regulatory,
- social,
- economic,
- political factors.

34. The presence and application of technology as a common component of patient management is another key feature of critical care nursing practice.
Critical care nurses are required to be competent in the use of a wide range of technological devices, many of which are necessary for life support.

35. Technology Increases Errors
Technology can eliminate human decision-making—use of monitoring equipment, IV pumps for critical care drips
Technology can increase workload if it fails or is inadequate
Nurses may not know how to calculate drips or perform a function without the technological monitoring device

36. Technology Increases Errors (cont.)
Technology that is not standardized or demands precision to use may be difficult for ICU nurses who become comfortable with familiar equipment

37. Technology Can Affect Patient Assessment and Interaction
Nurse may fail to use human touch
Patient assessment by nurse is essential along with technology devices
Technology can predispose to errors in delivery of care
Technology devices may fail and contribute to error (extubation, failure of infusion devices, etc.)

38. Patient Safety Strategies for Prevention and Early Detection of Errors
Research concludes serious errors common in ICU—1.5 serious errors/day in 10-bed unit
Utilize patient constraints—height, weight, allergies for patient medication profile
Forcing functions—such as not supplying KCL on ICU unit—make pharmacy responsibility to decrease error

39. Patient Safety Strategies for Prevention and Early Detection of Errors (cont.)
Avoid reliance on vigilanceيقظة —double-check with two RNs insulin—major procedures—other potentially dangerous medications or procedures
Timeouts before surgical procedures—double-check with two RNs
Simplify and standardize key processes

40. Identify, Evaluate, and Minimize Hazards in the Environment
Assure adequate staffing
Effective staffing realizes that the needs of critically ill patients fluctuate
Staffing policies should support the provision of quality care
Effectiveness of staffing decisions should be evaluated

41. Identify, Evaluate, and Minimize Hazards in the Environment (cont.)
Support care services should be available to help with nursing care delivery
Limited work hours—no more than 60 hours/week or 12 hours/24-hour period
Extended work shifts should be eliminated
Teamwork and collaboration among staff members

42. Nurse’s goal
Restore the patient to an optimal level of wellness that is defined by the patient and family
Caring—nurse behaviors that create a compassionate, therapeutic, and supportive environment to promote comfort and prevent unnecessary suffering

43. Nurse’s goal (cont.)
Advocacy —nurse promotes, advocates for, and strives to protect the health safety and rights of the patient Facilitator of Learning—nurses facilitate informal and formal learning for patients, families, and health team members

44. Nurse’s goal (cont.)
Collaboration—work with others to achieve optimal and realistic patient/family goals
Communication—optimal patient care requires proficient communication skills

45. Three Components of Informed Consent
The decision to permit the treatment or procedure must be made voluntarily
The decision to permit the treatment or procedure must be made by a competent adult
The patient must understand his condition and the possible treatments

46. An ICU Patient May Lack the Capacity to Give Informed Consent
Determination does not require legal proceeding—it is a clinical judgment
Loss of capacity may be temporary (pain medication)

47. To Determine Capacity Ask
Does the patient understand the medical condition?
Does the patient understand the options and consequences of the decision?
If patient refuses treatment, is refusal based on rational reasons?

48. Good Luck