NCM 81: Lecture Notes
Teaching patients on how to lower
8/26/2021
Critical Care Nursing
 Subspeciality of MS
The reason of provision of Nursing in any Setting:
 The Provision of holistic nursing care
Critical – actual or potential crises for the
recipients of nursing care.
Defined as: pertaining to a crisis, involving danger
or risk
Late 1960’s
Critical care practice areas were developed, in
terms of:
 Medical Science and Technology
 Changes in community values and attitudes
American Nurses’ Association
 Definition: diagnosis and treatment of
human response to actual or potential
health problem.
American Association of Critical Care Nursing (late
1984)
 Critical Care Nursing (CCN):
o a specialty in nursing.
o deal with the total human being,
his/her response to actual potential
health problems
Analysis of the definition revealed:
 Basis of the definition – human responses
 CCN deals with:
o The total human being
o Patients’ response to actual and
potential health problem
 Suggests that CCN – Involved with
prevention as well as cure. Can take the
form of:
o Physiological phenomenon
o Psychological phenomenon
 CNN is concerned with – human responses
to life-threatening problems; prevention is
also viewed as appropriate.
 Ex.
cholesterol levels – prevents the worsening
of life threating problem.
Scope of Critical Care Nursing (CCN) Practice
 Provides a framework within which an
individual can provide a particular service
o Provides a definition and description
of the practice of CCN
 Described as a dynamic process
 Has 3 Dynamic Components:
o (C) Critically ill patients & their
significant social relationship
o (C) Critical care nurse
o (E) Environment – where CCN is
practiced
 Central to the scope: nurse-patient
interactions
 Goal of CCN: to ensure effective interaction
of these 3 requisite elements to affect
component nursing practice and optimal
patient outcomes
Characteristics of a Critical Care Patient
These patients share 1 or more of the
following:
1. Significant health breakdown problem (life
threatening)
2. Biophysiological health breakdown
problems.
 Acute or chronic
 may lead to extraordinary
dependence on health care
providers and possible technology
for health maintenance or life
support.
Note: as long as a patient has a problem in
elimination, nutrition, oxygenation, and has non-
physical problems – it qualifies as a CCN patient
Triage – separate and prioritize patients according
to their care.
American Association of Critical care Nurses
(AACN) describes the critically ill patient as:
 Presence of actual or potential life-
threatening health problems
 Needs of these patients to restore health
and prevent complications requires:
o continuous assessment and
interventions
Example:
Not CCNP
 Pt admitted for 3 days due to fever.
CNNP
 Pt is under comma base on GCS.
 Biopsychosocial being the concept of the
critically ill patient includes the family & SO.
o Assessment of the patient history
through family.
o Needs cooperation for intervention.
 Needs of the critically ill are considerable
and is categorized as physical or non-
physical
o Physical – basic
physiological/biological needs
 Air
 Nutrition
 Elimination
o Non-physical – social, spiritual,
psychological needs; social integrity,
information, communication.
 Comfort and support provided by social
relationships can enhance effective coping
o Ex. interaction and impact of the
patient’s family & SO
 Nature of critical care: physical needs
o considered a priority
o almost always met
 Critical care environment can obstruct the
fulfillment of non-physical needs
o Non-fulfillment of non-physical
needs can contribute to stressful
nature of a critical illness.
o Setting: well lighted and ventilated
 Identity (personality) & social integrity
o Can be difficult to maintain when a
person is in a strange situation.
 Obstructed need for identity and social
integrity – lead to the development of a
range of negative emotional or
psychological status
 Obstruction of the non-physical needs
increases the stress experience
 The needs of the family & SO must also be
met and considered
 If all needs are met, both physical and non-
physical needs should be considered in
planning holistic nursing care
Note:
Critical Care Nurse (CCN): Abroad
Intensive Care Unit Nurse (ICU): Philippines
Critical Care Nurse
 Should be a licensed nurse
 Responsible for ensuring that all critically ill
patients receive optimal care
 Make clinical judgements to prevent clinical
deterioration in their patients
o This is achieved through clinical
experience
 Anticipation/expectation and early
prevention of pt problems are central
requirements of critical care nursing
practice
o Skills: assessment; clinical
judgement
Note: Early prevention is better than curing.
Prediction of patient problems must be based on:
 Sound understanding of anaphy
 Smart assessment skills
Healthcare team for any single pt:
 Various medical officers (doctors)
 Nurse
 Pharmacist
 Dietician
 Physiotherapist
 Radiographer
 Social worker – for family members
Critical Care Nurse
 Knowledge base in critical care nursing
practice is highly specialized and constantly
subjected to revision and development, due
to:
o Research activity
o Technological innovation
 Preparations for practice of critical care
must emphasize the importance of a holistic
approach to nursing care
o such approach might meet the
needs of the critically ill person
Critical Care Environment
Cardiac Monitor Bed/ stretcher
Infusion Pumps Side rails
Ventilator Bedside table
Bulbs Emergency-cart
Vital Signs Equipment
-Built in
Critical Care Environment – should be intact;
everything should be within reach.
 Designed and organized to give the best
possible patient care where significant
change can occur in patient rapidly.
 Safety of both pt and staff is a primary
consideration.
Note: Isolation Ward: Many isolation rooms
Critical Care Environment is Viewed from 3
Perspectives:
1. Conditions and circumstances surrounding
the direct interaction between the critical
care nurse and critically ill pt
a. environment must contain resources
that constantly support this
interaction
2. Setting within which critically ill pt receive
care; effective care delivery thru provision
of:
a. adequate human and financial
resources
b. quality control system &
maintenance of standard nursing
care
Factors that influence the provision of care to the
critically ill:
 Legal
 Regulatory
 Social
 Economic
 Political factors
Presence and Application of Technology – another
key feature of critical care nursing practice
Critical Care Nurse – needs to be competent in the
wide range of technical devices for life support.
Patricia Benner – what stage is competent
1. novice
2. advanced beginner
3. competent
4. proficient
5. expert
Technology Increases Errors:
 Can eliminate human decision-making
 Can increase workload if it fails or is
inadequate
 Nurses may not know how to calculate
drips/ perform a function without
technological monitoring devices.
 Some are not standardized or demands
precision which can be new for others who
become familiar with old equipment.
Technology can Affect Patient Assessment and
Interaction
 Nurse may fail to use human touch
 Patient assessment is essential along with
technical devices
 Technology can predispose to errors in
delivery of care
 Technology may fail or contribute to error
o Extubating
o Failure of infusion device.
Nurses in CCN should be good with technology.
Needs to be able to understand and use the
technologies inside ICU

Patient Safety Strategies for Prevention and Early
Detection of Errors
 1.5 serious errors/day in 10-bed unit
(according to research)
o 12-15 beds in ICU
o Idealy: 1 ICU room:1 PT
 Utilize patient constraints: height, weight,
allergies for patient medication profile
 Forcing functions: not doing responsibilities
or pointing fingers at who is at fault.
 Avoid reliance on vigilance- doubly check
with 2 other nurses for any procedure
 Time-outs before surgical procedures –
double check with two RNs
 Simplify and standardize key processes
Code red in admission process – full admission
Identify, Evaluate, and Minimize Hazards in the
Environment
 Assure adequate staffing
o 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.
 Support care services should be available to
help with nursing care delivery
 Limited work hours – no more than 60
hrs/week or 12 hrs/24-hr period
o You only have to watch over 1 pt but
over minutes.
 Extended work shifts should be eliminated
 Teamwork and collaboration among staff
members
Nurse’s goal
 Restore the pt to an optimal level of
wellness that is defined by the pt and family
 Caring – compassionate, therapeutic and
supportive environment to promote
comfort and prevent unnecessary suffering
 Advocacy – promotes, advocates for and
strives to protect the health safety and
rights of the pt
 Facilitator of Learning – nurse facilitates
informal and formal learning for pt, families
and health team members
 Collaboration – work with others to achieve
optimal and realistic pt/family goals
 Communication – optimal pt care requires
proficient communication skill
3 Components of Informed Consent
 decision to permit the treatment or
procedure must be made voluntarily
o if pt is in coma = ask somebody else
to do it
o if pt has no SO = under emergency
care (legal)
 decision to permit the treatment or
procedure must be made by a competent
adult
o parent, wife/husband
o age: 21 yrs old (competent adult
under the law)
o should be in a legal
partnership/immediate family
 pt must understand his condition and the
possible treatments
o if pt is in coma = talk to the pt
o talk to SO/family
Note: Loss of capacity may be temporary
To Determine Capacity, ask:
 Does the pt understand the medical
condition?
 Does the patient understand the options
and consequences of the decision?
 If the patient refuse treatment, is refusal
based on rational reasons?
Note: Patient can withdraw consent any time as we
are patient-centered.
if pt refuses the treatment
1. Ask why
2. Acknowledge and reinforce
3. Sign waiver/refusal form
4. inform the doctor