Ch. 1 Reading Flashcards
Sensitivity to the appropriate time to eliminate or modify practices and adopt innovations is key to maintaining quality, cost-effective care delivery
Willingness to step outside of traditional structures and roles is the first step in making necessary changes
Flexibility and adaptation to change are essential to maintaining personal and organizational balance and to surviving in today’s health care environment
Overview
Critical care evolved from the recognition that the needs of patients with acute, life-threatening illness or injury could be better met if the patients were organized in distinct areas of the hospital
first specialty ICU: respiratory
From the 1990s to the present, critical care has consistently demonstrated signifi cantly decreased hospital lengths of stay, overall hospital costs, and better patient outcomes
Hx of critical care
In the hospital units established for patients needing such specialized care, nurses assumed many functions and responsibilities formerly reserved for physicians, and they assumed a new authority by virtue of their knowledge and expertise.
Critical care nursing
importance is placed on the continuum of care, with an efficient and as seamless as possible transition of care from one setting to another
PCU: considered the best environment for patients who do not need intensive monitoring with highly technologic monitoring. The patients are less complex, are more stable, have a decreased need for physiologic monitoring, and have more self-care capabilities.
Contemporary critical care
Expanded-role nursing positions
Advanced practice nurses
Critical care nursing roles
Nurse care coor-dinators work closely with the care providers to ensure appropriate, timely care and services and to promote continuity of care from one setting to another.
The specific types of expanded-role nursing positions are determined by patient needs and individual organizational resources.
Expanded-role nursing positions
CNSs serve in specialty roles that use their clinical, teaching, research, leadership, and consultative abilities. They work in direct clinical roles and systems or administrative roles and in various other settings in the health care system. CNSs work closely with all members of the health care team, mentor staff, lead quality teams, and consult on complex patients. They are instrumental in ensuring that care is evidence based and that safety programs are in place. CNSs may be organized by specialty or by function,
NPs and ACNPs manage direct clinical care of a group of patients and have various levels of prescriptive authority, depending on the state and practice area in which they work. They also provide care consistency, interact with families, plan for patient discharge, and provide teaching to patients, families, and other members of the health care team.
Advanced practice nurses
Professional organizations support critical care practitioners by providing numerous resources and networks.
Critical care professional accountability
The increasingly complex and changing health care system presents many challenges to creating an EBP.
When there is not research evidence to support a practice, nursing uses critical thinking and clinical judgment on which to base a practice decision.
Dx and patient care management
Concept maps
Evidence-based nursing practice
It is crucial that nurses document their observations, diagnosis of patient conditions, and interventions that they carry out to address these issues. Nurses use their knowledge, critical thinking, and ability to link physiologic data with patient symptomology to diagnose actual or potential health problems.
International Classification for Nursing Practice (ICNP): “provides a structured and defined vocabulary as well as classification for nursing and a framework into which existing vocabularies and classifications can be cross-mapped to enable comparison of nursing data.” 3 elements: (1) nursing phenomena, sometimes referred to as nursing diagnosis; (2) nursing interventions; and (3) nursing outcomes.
Dx and patient care management
It is an excellent tool for knowledge management and synthesis to make clinical decisions.
Concept maps
Caring
Patient-centered critical care
Cultural care
Holistic critical care nursing
For this reason, the priority for care is using technology and treatments necessary for maintaining stability in the physiologic functioning of the patient.
The critical care nurse must be able to deliver high-quality care skillfully, using all appropriate technologies, while incorporating psychosocial and other holistic approaches as appropriate to the patient and his or her condition.
Holistic care focuses on human integrity and stresses that the body, the mind, and the spirit are interdependent and inseparable. All aspects need to be considered in planning and delivering care.
Caring
importance of establishing individualized care that recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status.
special consideration must be given to determining the unique interventions that can positively affect each person and help the patient progress toward the desired outcomes.
It is incumbent on health care professionals to ensure that these issues are minimized and that patients and families are well informed and feel safe and included in all aspects required decisions about their treatments and care. Humanizing the critical care unit is an imperative.
Patient-centered critical care
Cultural diversity is defined as “the awareness of the presence of differences among members of a social group or units.”
Cultural and linguistic competency is defined as “the capacity for individuals and organizations to work and communicate effectively in cross-cultural situations” and must be supported with policies, procedures, and dedicated resources. If this competency is not present, miscommunication, lack of understanding regarding health information, and treatments may negatively affect outcomes.
Cultural competence is one way to ensure that individual differences related to culture are incorporated into the plan of care.
Cultural care
