Chapter 1 - Critical Care Nursing Practice: Promoting Excellence

Through Caring, Collaboration, and Evidence

I.

II.

Value to Certification
A. Value to the patient and family
Validation of experience & knowledge increased knowledge
base
Make decisions with greater confidence
Demonstrates commitment to continual learning
B. Value to employers and nurses
Knowledge & expertise to promote optimal patient outcomes
Commitment to quality
Workplace empowerment
Enhanced communication & coordination of care
Remain employed in an area where they can apply the
knowledge
Sense of professional pride & achievement
Evidenced-Based Practice in Critical Care Nursing
A. Levels of Evidence
Lowest to highest
1. Opinions of authorities or expert committees
2. Single, descriptive, qualitative, or physiologic study
3. Systemic review of descriptive, qualitative, or physiologic
studies
4. A single correlational or observational studies
5. Systemic review of correlational or observational studies
6. Single RCT, and non-randomized control trial (quasiexperimental)
7. Systematic review of RCTs or meta-analysis
B. Barriers to implementation of EBP
17-20 years to translate research findings into clinical practice
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 & commitment
C. Strategies to promote implementation
Use of protocols, clinical pathways, algorithms
Educational interventions
Increasing awareness of available resources
Accountability & role modeling

III.

IV.
V.

Databases
Professional nursing organizations research-based practice
recommendations
Websites & publications
Elements of a Healthy Work Environments (page 4)
A. Skilled communication
B. True collaboration
C. Effective decision making
D. Appropriate staffing
E. Meaningful recognition
F. Authentic Leadership
The Synergy Model
Future Challenges in Critical Care Nursing
Increase ability to deliver evidence-based care that is culturally
congruent & relevant
Have a multilingual, culturally, diverse workforce
Recruit & retain diverse professionals
Expand the skill set of todays already experienced critical care
nurses
Critical care nurses must be prepared to identify, manage, & treat
unknown threats
Prepare to handle an actual or potential bioterrorism threat
Continued expansion of skill & evidence-based interventions