2.9. Critical Care Nursing

7/27/2019 2.9. Critical Care Nursing

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HASHIM N. ALAWI JR.,RN,MAN


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Standards of Care for Acute &Critical Care Nursing

1. Assessment

2. Diagnosis

3. Outcome Identification4. Implementation5. Evaluation


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Definition:

Critical:

Being in; or verging on a state

of crisis or emergency

Urgently needed

Absolutely necessary


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Definition:Critical Care Nursing:

Attending to patients

at high risk

for life-threateninghealth problems.

Providing vigilant,around-the-clock care.


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AssessmentStandard of Care I:


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1. Data collection involves the:

Patient Family Other health care providersPurpose:

Develop a Holistic picture of thepatients needs

Measurement Criteria


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2. The priority of data collection activitiesdepends on: patients immediate condition and/or anticipated needs


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3. Data are collected using appropriate assessment

techniques and instruments4. Documents are retrievable5. Collection process is:

systematic ongoing


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DiagnosisStandard of Care II:


1. Diagnoses are derived from the assessmentdata.

2. Validated throughout the nursing interactionswith the team consisting of the:

Patient Family Other healthcare providers


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DiagnosisStandard of Care II:


3. Prioritized and documented :

To facilitate determining expectedoutcomes

To develop a plan of care

4. Documented in a retrievable form


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Outcome IdentificationStandard of Care III:


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1. Outcomes are derived from actual and potentialdiagnoses

2. Mutually formulated with:

Patient

Family

Other health care providers


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3. Individualized

Culturally appropriate

Realistic

In relation to patients age

Present and potential capabilities


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4. Attainable in relation to resources available to

the patient5. Measurable, and should include a

time estimate for attainment


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6. Provide direction for continuity of care;

Nurses competencies are matched with thepatients needs

7. Documented in a retrievable form


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PlanningStandard of Care IV:


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1. Individualized to reflect the patientscharacteristics and needs

2. Developed collaboratively with the team,consisting of:

Patient Family

Other health care providerspromote each members contributiontoward achieving expected outcomes


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3. Reflects current acute and critical care nursingpractice

4. Provides for continuity of care

5. Prioritized

6. Documented to promote continuity of care


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ImplementationStandard of Care V:


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1. Delivered in a manner that

minimizes complications and

life-threatening situations


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2. The patient and family participate inimplementing plan of care based upon their :

Ability to participate

Decision making regarding care

3. Documented in a retrievable manner


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Evaluation

Standard of Care VI:


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EvaluationStandard of Care VI:


1. Systematic,

ongoing, andCriterion - based

2. Consisting of :

Patient

Family

Healthcare providers


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3. Occurs within appropriate time frame afterinterventions are initiated

4. Ongoing assessment data are used to

- revise diagnoses,

- Outcomes

- Plan of care as needed


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4. Document revisions in diagnoses, outcomes,

and plan of care

5. Evaluate effectiveness of interventions inrelation to outcomes

6. Document patients response to interventions


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St d d f


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Standards ofProfessional Practice

1. Quality of care2. Individual practice evaluation

3. Education

4. Collegiality5. Ethics6.Collaboration

7. Resource utilization


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Standard of Professional Practice I

I. Quality of Care

St d d f P f i l P ti I


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Standard of Professional Practice I

I. Quality of Care

1. Participate in quality of care activities

2. Use the results to initiate changes to improvepractices and healthcare delivery system

3. Incorporate the patients and familys perspective

as appropriate


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Standard of Professional Practice II

II. Individual Practice Evaluation

St d d f P f i l P ti II


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1. Evaluate the nursing practice vs. the

professional practice standards



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2. Engage in self-assessment &/or a formal

performance appraisal identifying: Areas of strength

Areas where professional development

would be of benefit



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3. Seek and reflect constructive feedback from the

team consisting of: The patient

Family

Healthcare providers


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i i


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Standard of Professional Practice III

III. Education



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III. Education

1. Participate in ongoing educational activities to

acquire knowledge and skills



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III. Education

2. Seek experiences that reflect

current clinical practice



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III. Education

3. Participate in ongoing

educational activities related to

professional issues.

St d d f P f i l P ti IV


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Standard of Professional Practice IV

IV. Collegiality



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IV. Collegiality

1. Share knowledge,Skills, and

experiences with colleagues



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IV. Collegiality

2. Provide peers &

other healthcare providers withconstructive feedback

regarding their practice,

as appropriateto their level of expertise



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IV. Collegiality

3. Interact with colleagues to

enhance ownprofessional nursing practice



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IV. Collegiality

4. Contribute to the

learning environment that isconducive to healthcare education



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IV. Collegiality

5. Contribute to an effective

team environment byworking with others in a way that

promotes & encourages each

persons contribution.

St d d f P f i l P ti V


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Standard of Professional Practice V

V. Ethics



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V. Ethics

1. The nurses practice is guided by the :

PRC-BON Code for Nurses

Critical Care Nurses Association of thePhilippines

Ethics of Care and Ethical Principles



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V. Ethics

2. Maintain patient confidentiality

within legal andregulatory parameters



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V. Ethics

3. Act as a patient advocate and

assist others indeveloping skills

so they can

advocate for themselves



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V. Ethics

4. Deliver care in a:

Non judgmental Non discriminatory manner

that is sensitive to

patient diversity



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V. Ethics

5. Deliver care in a manner that:

meets the diverse needs andstrengths of the patient and

preserves patients

autonomy,

dignity, and

rights



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V. Ethics

6. Use available resources in

formulating

ethical decisions

Standard of Professional Practice VI


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VI. Collaboration



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VI. Collaboration

1. Communicate with the team regarding: Patient care

Nurses role in providing care





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VI. Collaboration

2. Work with the team to:

formulate the plan of care and to make decisions related to the

care and delivery of services





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VI. Collaboration

3. Consult with other healthcare providers and

initiates referrals as appropriate to

promote continuity of care

Standard of Professional Practice VII


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Standard of Professional Practice VII

VII. Research



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VII. Research

1. Continually question and evaluate practice

Use best available evidence or

research findings to

develop appropriate

plans of care



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VII. Research

2. Participate in activities

to support clinical inquiry

appropriate to

the nurses level of expertise

Standard of Professional Practice VIII


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VIII. Resource Utilization



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1. Evaluate factors related to:

Safety Effectiveness &

Cost when choosing between two (2) or morepractice options that would result in the sameexpected outcome



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2. Assist the patient & family in:

Identifying & Securing appropriate & available services to

address health-related needs



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3. Assign or delegate aspects of care as

defined by the

nurse practice acts



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4. Assist the patient & family in becominginformed consumers about:

Costs

Risks &

Benefits of treatment & care


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Critical Thinking in


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Critical Thinking :

A multidimensional skill

A cognitive or mental process

Set of procedures

gCritical Care Nursing



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Critical Thinking : involves;

Reasoning Purposeful

Systematic Reflective

Rational

Outcome directed thinking




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Critical Thinking : involves;

Outcome directed thinking based on: A body of knowledge

Examination Analysis of all available information

and ideas


Components of Critical Thinking


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1. Ask questions: To determine the reason why certain

developments have occurred2. Gather as much relevant information presented3. Analyze the information4. Draw on past clinical experience and knowledge




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5. Maintain flexible attitude6. Consider available options

7. Formulate decisions that reflect: Creativity Independent decision making


Critical Thinking


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gIn

Nursing Practice

Predominant

Thinking StrategiesUsed by Nurses;

Regardless of their area of

Clinical Practice

Thinking Strategies


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1. Recognize a pattern2. Set priorities3. Search for information4. Generate hypotheses

5. Make predictions6. Form relationships

Thinking Strategies

Thinking Strategies


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7. State the proposition (if then)8. Make choices (alternative actions)9. Judge the value10. Draw conclusions

11. Provide explanations

Thinking Strategies


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The Inquiring Mind:


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Some guide questions:

1. What relevant assessmentinformation do I need,

How do I interpret thisinformation?

What does thisinformation tell me?

q gCritical thinking in Action

The Inquiring Mind:


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2. To what problems does thisinformation point? Have I identified the most

important one? Does the information

point to any otherproblems that I shouldconsider?


The Inquiring Mind:


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Some guide questions:3. Have I gathered all the

information I need?

Signs / symptoms Laboratory values Emotional factors

Mental status Is anything missing?


The Inquiring Mind:


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4. Is there anything that

needs to be reportedimmediately?

Do I need to seek

additionalassistance?

Critical thinking in Action

The Inquiring Mind:


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5. Does this patient haveany special risk factors?

Which ones are mostsignificant?

What must I do tominimize theserisks?


The Inquiring Mind:


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6. What are the possiblecomplications?


The Inquiring Mind:


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Some guide questions:7. What are the desired

outcomes for thispatient?

Which have thehighest priority?

Does the patientagree with me onthese points?


The Inquiring Mind:


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8. What will be my

first intervention inthis situation?

9. How can I construct

a Plan of Care toachieve the goals?


The Inquiring Mind:


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10. Are there any age relatedfactors involved?

Will they requirespecial approach?

Will I need to make

some changes in theplan of care to makethem effective?


The Inquiring Mind:


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11. How do the familydynamics affect this

situation? Will this affect my

plan of care?

12. Are there culturalfactors that I mustaddress and consider?


The Inquiring Mind:


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13. Am I dealing with anethical problem here?

If yes, how am Igoing to resolve it?

14. Has any nursing

research beenconductedon this subject?



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1. Standards of care

2. Standards ofprofessionalpractice

3. Criticalthinking defined

4. Thinkingstrategies

Too often we


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underestimate

the power of a touch,

a smile,a kind word,

a listening ear,

an honest compliment,

or thesmallest act of caring,

all of which

have the potential

to turn a life around.

Leo Buscaglia


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