Week 1: Overview of Critical Care Nursing Flashcards
Exam 1
What is Critical Care Nursing?
AACN defines progressive or critical care nursing as the speciality that manages the human responses to actually or potentially life threatening problems.
Evolution of Critical Care:
How did it begin?
Began with polio units (1950s), recovery rooms, and coronary care units (1960s)
Evolution of Critical Care:
How did patient outcomes improve?
Patient outcomes improved with specialty care
Evolution of Critical Care:
When were ICUs made?
Intensive Care Units (1970s)
Critical Care in the 21st Century
What are examples of specialization?
Cardiovascular,
neurological,
trauma,
burn units
Pediatric
Neonatal
Critical Care in the 21st Century
Variety of settings like?
Inpatient
Outpatient
Home care
EICU
Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…
- Promote
- Intervene
- Ensure
- Serve
Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…
Promote: What should nurses promote amongst patients?
Autonomous decision making
Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…
Promote: What should nurses respect?
Respect & represent patient and family wishes
Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…
INTERVENE: What should they intervene in? What should they provide education for?
in patient/family best interests
intercede for those who cannot advocate for themselves
educate patients access care resources
Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…
Ensure: What should nurses ensure?
safe, competent, & high-quality care
Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…
Serve: Who should nurses serve?
as liaison between patient, family & providers
The Synergy Model
The underlying premises of the Synergy Model are:
What are a concern to the nurses?
Patients’ characteristics are of concern to nurses.
The Synergy Model
The underlying premises of the Synergy Model are:
What is important to patients?
Nurses’ competencies are important to patients.
The Synergy Model
The underlying premises of the Synergy Model are:
What drives nurses competencies?
Patients’ characteristics drive nurses’ competencies.
(How stable a patient is and the complexities of their illness). The ability of the patient to participate in their care matters to the nurse?
The Synergy Model
The underlying premises of the Synergy Model are:
When patients’ characteristics and nurses’ competencies match and synergize,
What happens?
When patients’ characteristics and nurses’ competencies match and synergize, outcomes for the patient are optimal.
The Synergy Model: What is it?
A framework that can be used as a basis for work to be done by facilities seeking Magnet designation.
What is synergy?
Synergy- collaboration, cooperation, working hand in hand. Things work better together then working separate.
Magnet Hospital?
Patient Characteristics include?
Resiliency
Vulnerability
Stability
Complexity
Participation in care
Participation in decision making
Slide 9
Standards of Practice: What does it do?
Guide evidence-based clinical practice
Establish goals for patient care
Provide assessment of outcomes
AACN Standards for Acute and Critical Care Nursing Practice:
Describe level of performance
Describe expected roles and responsibilities of critical care nurses
Value of Certification
(examples: CCRN, CNRN, SCRN, ACLS)
Value to the patient and family
Value to employers and nurses
Value of Certification
Value to the patient and family: What does it validate to people? What does it demonstrate to people?
Validation of experience and knowledge
Make decisions with greater confidence
Demonstrates commitment to continual learning
Value of Certification:
Value to employers and nurses
Knowledge and expertise to promote optimal patient outcomes
Commitment to quality
Workplace empowerment
Enhanced communication and coordination of care
Remain employed in an area where they can apply the knowledge
Sense of professional pride and achievement
Evidence-Based Practice in Critical Care Nursing
What is it?
“The process of shared decision making between practitioner, patient, and others significant to them based on research evidence, the patient’s experiences and preferences, clinical expertise or know-how, and other available robust sources of information”
Evidence-Based Practice in Critical Care Nursing
What does it do?
EBP takes what is known and uses it to guide patient care to achieve the best possible outcomes.
Importance of Evidence-Based Practice
Evaluate research
Hierarchy of evidence
Implement practice based on evidence
Barriers to Implementation of EBP:
How long does it take to translate research findings into clinical practice?
17 to 20 years to translate research findings into clinical practice
Barriers to Implementation of EBP:
Lack of knowledge of the research process
Limited access to literature
Lack of confidence in ability to critique research
Limited interest in scientific inquiry
Limited power to change practice
Time factors
Lack of organizational support and commitment
Future Challenges in Critical Care Nursing
Having to do with cultures?
Increase ability to deliver evidence-based care
that is culturally congruent and relevant
Have a multilingual, culturally diverse workforce
Recruit and retain diverse professionals
Future Challenges in Critical Care Nursing
What are other challenges?
Expand the skill set of today’s already experienced critical care nurses
Critical care nurses must be prepared to identify, manage, and treat unknown threats.
Prepare to handle an actual or potential bioterrorism threat
Continued expansion of skills and evidence-based interventions
Focus on Quality & Safety
What must be prevented?
Errors and harm must be prevented
Focus on Quality & Safety
What are nurses challenged to do?
Nurses are challenged to reduce errors and promote a safe environment
Focus on Quality & Safety
What are several initiatives?
- Joint Commission National Patient Safety Goals
- Institute for Healthcare Improvement
- Quality and Safety Education for Nurses (QSEN)
Harms Targeted for Reduction include:
Adverse drug events
Infections
Injuries from falls and immobility
Prevention of venous thromboembolism (VTE)
Harms Targeted for Reduction include:
Infections: What are examples?
Catheter-associated urinary tract infections (CAUTI)
Central line-associated bloodstream infections (CLABSI)
Surgical site infections
Ventilator-associated pneumonia (VAP)
Trends and Issues:
What is important to reduce errors?
Communication important to reduce errors
Trends and Issues:
What is a communication strategy?
SBAR communication strategy
Situation
Background
Assessment
Recommendation
Trends and Issues:
What should be done to reduce issues?
Handoff at bedside
Rapid response team (RRT)
Trends and IssuesInterprofessional Collaboration
Daily rounds with multidisciplinary team
Implementation of “bundles” of care to promote evidence-based practices and prevent complications
Trends and IssuesInterprofessional Collaboration
Culture of collaboration includes what?
Mutual respect
Mutual recognition
Bundled CareA “bundle“: What are they?
group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually.
Institute for Health Care Improvement (IHI)
Bundled CareA “bundle“: What does it include?
- Head of the Bed 30O
- Daily sedative interruption and daily assessment of
readiness to extubate - PUD Prophylaxis
- DVT Prophylaxis
- Daily Oral Care
with chlorhexidine
Other Trends and Issues include:
Reducing hospital readmission rates
Increasing use of technology
Ethical issues associated with prolonging life and futile treatment
Telemedicine and eICU
