Introduction

to Critical
Care
NELL GRACE S. CABLINDA
Pre-Test

1. True or False
Critical Care Nursing is that specialty within nursing that deal
specifically with human responses to life-threatening problems.
Pre-Test

2. Choose the best answer

The focus of care for the critically ill patients is holistic.
I. Holistic means treatment of the whole person
II. Focusing of the symptoms of disease only
III.Taking into account the bio-psycho-social-spiritual nature
when taking care of patients
A. I is correct
B. I and II is correct
C. I and III is correct
D. Only III is correct
Pre-Test

3. What is the meaning of CCNAPI?

A. Critical Care Nurses Association of the Philippines,
Incorporated
B. Critical Care Nursing Association in the Philippines,
Incorporated
C. Critical Care Nurses Association of the Philippines
Incorporation
D. Critical Care Nursing Association in the Philippines
Incorporation
Pre-Test

4. Critical Care Nursing should be:

a. Patient-centered
b. Safe
c. Effective
d. Efficient
e. Timely
f. Equitable manner

A. All of the above

B. All except F
C. All except D
D. All except E
Pre-Test

5. The ICU nurses provide direct patient care and indirect

patient care. True or False
Pre-Test

6. Understanding the family needs and providing information to

allay fears and anxieties is part of:
A. Direct Patient Care
B. Indirect Patient Care
Pre-Test

7. Coordination with other healthcare provision of optimal care

to achieve best possible outcomes is part of:
A. Direct Patient Care
B. Indirect Patient Care
Pre-Test

8. Which of the following is considered as an extended role of

CCU nurses?
A. Weaning patient off ventilations
B. Performing and interpreting ECGs
C. All of the above
D. None of the above
Pre-Test

9. Which of the following is true about the difference or

similarities of Critical Care and Emergency Medicine?
A. Critical Care focuses on stabilizing the patient while Emergency
Medicine don’t
B. Both CC and EM require diagnosis to initiate care
C. For CC, care can continue for months; while for EM, care
continue for less than 24 hours.
Pre-Test

10. Select All that Apply

Which of the following best describes a Critical Care Patient?
1. High risk/ with life threatening illness
2. Unstable
3. Requires intense and constant care
4. Has massive disruption of Physiology

A. All of the above

B. All except 1
C. All except 4
 Learning Objectives

1. To be familiar with the definitions of critical care unit, critical care nursing and
critical care patient
2. To differentiate critical care and emergency nursing
3. To know how physiological compensation reacts from our body.
4. To participate in the development and improvement of policies and standards
regarding safe nursing practice and relevant to human resource management
5. To manage resources (human, physical, time) efficiently and effectively.
6. To maintain a positive practice environment
DEFINITION OF
CRITICAL CARE
A patient is
critically ill and
intubated
A hemodialysis
patient
A patient with
tracheostomy tube
and a NGT
A patient brought to
the ER because of
an accident
A patient with
traumatic brain
injury
CRITICAL CARE NURSING

▪ Deals specifically with human responses

to life threatening problems
▪ Is a licensed professional nurse who is
responsible for ensuring that accurately
and critically ill patients and their
families receive optimal care
 CRITICAL CARE PATIENT?

✔ highrisk/life threatening illness

✔ unstable
✔ requires intense and constant care
✔ has massive disruption of physiology
DIFFERENCE BETWEEN CRITICAL CARE AND
EMERGENCY MEDICINE
CRITICAL CARE
▪ Focuses on stabilizing an
unstable patient in critical stage
▪ Diagnosis is required to initiate
care
▪ Environment is controlled
▪ Care can continue for months
EMERGENCY MEDICINE
▪ Focuses on stabilizing an
unstable patient in crisis stage
▪ Diagnosis is not required to
initiate care
▪ Environment is less controlled
▪ Care continue for less than 24
hours
PHYSIOLOGIC COMPENSATION

The reaction to change by systems

within the body.
What are the examples?
✔ flight and fight response
 PHYSIOLOGIC RESERVE

Is the ability of the body’s to

compensate for change

What will happen if the physiologic

reserve is lower?
 PHYSIOLOGIC RESERVE

✔ AGING
✔ DISORDERS OF
SYSTEMS
GOAL OF CCU
❑ to provide therapeutic
support to the patient when
the patient’s physiological
reserves are decreased
Multiorgan dysfunction syndrome

▪ Is when the physiological reserves of an organ

cannot compensate for a change
▪ Leads to cascade effect
GOAL OF CCU
❑ to enlist a preemptive strategy
that uses therapeutic
interventions to assist an organ
to compensate before the
physiological reserve is depleted
 Development of Critical Nursing Practice Education and Professional Activities in the
Philippines

1996,
Responds to a Working
mission and In the Group in
commitment to Philippines, Developing
the in Nursing Critical Care
provide need- Expanding Nurse
driven, Professional Specialty
Regulation Framework. Healthcare Association
effective and and of the
efficient Commission It comprises
– Board of clinical Nursing Philippines,
nursing care Knowledge Inc.
services of Nursing nurse
(PRC-BON) practitioners (CCNAPI)
high standard
and , nurse
international educators
level and nurse
managers
CRITICAL CARE NURSE ASSOCIATION OF
THE PHILIPPINES, INC.(CCNAPI)

❑ to provide clear and updated statements

regarding the scopes of practice and standards of
critical care nursing
❑ will ensure continued understanding and
acknowledgment of nursing’s varied specialty
professional contributions in today’s healthcare
environment.
Development of Critical Nursing Practice Education
and Professional Activities in the Philippines

❑ framework of critical care nursing is a complex, challenging area of

nursing practice which utilizes the nursing process applying assessment,
diagnosis, outcome identification, planning, implementation, and evaluation
❑based on a scientific body of knowledge and incorporates the professional
competencies specific to critical care nursing practice and is focused on
restorative, curative, rehabilitative, maintainable, or palliative care, based
on identified patient need
❑It upholds multi and interdisciplinary disciplinary collaboration in initiating
interventions to restore stability, prevent complications, achieve and
maintain optimal patient responses
SCOPE OF CRITICAL NURSING

❑ Constant intensive assessment

❑ the critical care nurse is personally responsible and
committed to continues learning and updating of
knowledge and skills.
❑ The critical care environment constantly supports the
interaction between the critically ill patients, their family
and the critical care nurses to achieve desired patient
outcomes
ROLES OF A CRITICAL NURSE

❑ PRACTITIONAL ROLE
✔ CARE PROVIDER (DIRECT AND INDIRECT)
❑ EXTENDED ROLES AS CRITICAL CARE
NURSES
❑ EDUCATOR
❑ PATIENT ADVOCATE
Management and Leadership Role
The critical care nurse in her management and leadership role will be able to render the
following
responsibilities:
a. Perform management and leadership skills in providing safe and quality care
b. Accountability for safe critical care nursing practice
c. Delivery of effective health programs and services to critically-ill patients in the acute
setting
d. Management of the critical care nursing unit or acute care setting
e. Take lead and supervision among nursing support staff
f. Utilize appropriate mechanism for collaboration, networking, linkage –building and referrals.
TRAINING OF NURSES FOR CRITICAL
CARE SERVICES
❑ Orientation program / Preceptorship and
mentoring program
❑ In-service training program
❑ Critical Care Nursing Program (Post-
Graduate specialty program)
❑ Continuing Nursing Education
LEVELS & CATEGORIES OF CRITICAL CARE
PROVISIONS WITHIN PHILIPPINES
❑ With respect to the physical set-up and supporting
facilities of critical care units in the Philippines, the
Department of Health (DOH) Standards requires
the critical care units / intensive care unit to be a
self-contained area, with the provisions for
resources that will support critical care practice.
LEVELS OF CRITICAL CARE PROVISIONS
❑ LEVEL 1
✔Capable of providing immediate resuscitation for the critically ill and short term cardio-respiratory
support of deterioration;
✔Has a major role in monitoring and preventing complications in “at risk” medical and surgical
patients;
✔Must be capable of providing mechanical ventilation and simple invasive cardiovascular
monitoring;
✔Has a formal organization of medical staff and at least one registered medical officer available to
the unit at all times;
✔A certain number of nurses including the nurse in-charge of the unit should possess post-
registration qualification in critical care or in the related clinical specialties; and
✔Has a nurse: patient ratio of 1:1 for all critically ill patients
 LEVELS OF CRITICAL CARE PROVISIONS
❑ LEVEL 2
✔ Should be capable of providing a high standard of general critical care for patients
✔Capable of providing sustainable support for mechanical ventilation, renal replacement
therapy, invasive hemodynamic monitoring and equipment for critically ill patients of
various specialties such as medicine, surgery, trauma, neurosurgery, vascular surgery;
✔Has a designated medical director with appropriate intensive care qualification and a
duty specialist available exclusively to the unit at all times;
✔The nurse in-charge and a significant number of nursing staff in the unit have critical
care certification; and
✔A nurse: patient ratio is 1:1 for all critically ill patients.
LEVELS OF CRITICAL CARE PROVISIONS
❑ LEVEL 3
✔Is a tertiary referral unit, capable of managing all aspects of critical care
medicine (This does not only include the management of patients requiring
advanced respiratory support but also patients with multi-organ failure);
✔Has a medical director with specialist critical / intensive care qualification and
a duty specialist available exclusively to the unit and medical staff with an
appropriate level of experience present in the unit at all times;
✔A nurse in-charge and the majority of nursing staff have intensive care
certification; and
✔A nurse: patient ratio is at least 1:1 for all patients at all times.
Categories of Critical Care Unit

The Critical Care Unit can be categorized according

to patients’ age group or medical specialties.
a. Age group
i. Neonatal
ii. Pediatric
iii. Adult
 Categories of Critical Care Unit
In the existing environment, majority of the Critical Care Units in the Philippines provide service
for patients of various specialties. They are labelled as General ICUs. In certain hospitals, the
critical care unit / service is dedicated to the following specific groups:
i. Medical
ii. Surgical
iii. Cardio-thoracic
iv. Cardiac
v. Respiratory
vi. Neurosurgical
vii. Trauma
System operation of Critical Care Units

Open System Closed System

▪ The admitting and other ▪ Management is coordinated by a
qualified Critical Care Specialist.
attending doctors dictate The critical / intensive care
management, change specialist has clinical and
management or perform administrative responsibility.
procedures without ▪ There is a multi-disciplinary team of
consultation or specially trained critical care staff.
The “intensivist” is the final common
communication with a pathway for all medical decision-
Critical Care Specialist. making including the decision to
admit or discharge.
COMPETENCIES FOR CRITICAL CARE NURSES

The competence of critical care nurses together with established nursing standards
and the identified core competencies for registered nurses will result to excellence in
critical care nursing practice.
1. Safe and Quality Nursing Care
2. Management of Resources
3. Legal Responsibilities
4. Ethico-Moral Responsibilities
5. Collaboration and Teamwork
COMPETENCIES FOR CRITICAL CARE NURSES

The competence of critical care nurses together with established nursing standards
and the identified core competencies for registered nurses will result to excellence in
critical care nursing practice.
6. Personal and Professional Development
7. Communication
8. Health Education
9. Quality Improvement
10. Research
11. Record Management
STANDARDS OF CRITICAL CARE NURSING
PRACTICE

The following 11 are Standards are intended to furnish nurses with direction in providing
quality care and excellence in Critical Care Nursing.
1. The critical care nurse functions in accordance with legislation, common laws,
organizational regulations and by-laws, which affect nursing practice.
2. The critical care nurse provides care to meet individual patient needs on a 24-hour basis.
3. The critical care nurse practices current critical care nursing competently.
4. The critical care nurse delivers nursing care in a way that can be ethically justified.
5. The critical care nurse demonstrates accountability for his/her professional judgment and
actions.
6. The critical care nurse creates and maintains an environment which promotes safety and
security of patients, visitors and staff.
STANDARDS OF CRITICAL CARE NURSING
PRACTICE

The following 11 are Standards are intended to furnish nurses with direction in providing
quality care and excellence in Critical Care Nursing.
7. The critical care nurse masters the use of all essential equipment, available services and
supplies for immediate care of patients.
8. The critical care nurse protects patients from developing environmental induced infection.
9. The critical care nurse utilizes the nursing process in an explicit systematic manner to
achieve the goals of care.
10. The critical care nurse carries out health education for promotion and maintenance of
health.
11. The critical care nurse acts to enhance the professional development of self and others.
What are the
procedures that you
can identify with this
picture?
Video
Presentation
CCU Physical
Set-up and
Equipments
 Measuring Patient Risk Factors

❑ Acute Physiology and Chronic Health Evaluation (APACHE) – uses database of

more than 18,000 medical records to predict a patient’s risk of dying in a hospital
❑ Simplified Acute Physiology Score (SAPS) – predicts mortality of patients in CCU’s
according to severity of disease
❑ Mortality Probability Model (MPM) – is a system that predicts mortality of a patient
in the ICU by 15 factors that include cardiac function, liver function, renal function
and age
❑ Multiple Organ Failure (MOF) – patient’s mortality based on the number of organs
❑ Sequential Organ failure Assessment Score (SOFA) – monitor status while in the
CCU
References

1. Keogh, J. (2013). Critical Nursing Care. McGraw-Hill Education

LLC.
2. Critical Care Nurses Association, Inc. Guidelines for Critical
Care Nursing. Retrieved from http://www.ccnapi.org/
3. Nursing Law. Republic Act No. 9173. Retrieved from http://
www.prc.gov.ph/