Overview of Critical Care Nursing

Chapter 1
Overview of Critical Care Nursing
Copyright © 2013, 2009, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Critical Thinking Challenge
What comes to your mind when you hear the
following terms?
 Intensive care
 Critical care
 ICU and CCU
 Trauma
Copyright © 2013, 2009, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2
Introduction
 Nurses play a unique role in addressing the
needs of patients and families in a busy and
complex environment
 Nursing, like other applied medical disciplines, is

complex; the clinician must make critical
decisions in response to changes in the patient’s
status and the nature of their clinical condition
over time (Benner, Tanner &Chesla,2009).
 Patients in Critical Care Units represent some of
the most complex cases and complicated
medical situations (Galvin, 2010).
Critical Care Nursing
 Deals with human responses to critical illness or
injury
 Physiological
 Psychological
 Focus on both the patient’s and family’s
responses
Competencies for Acute and
Critical Care Nurses
Critical Thinking Challenge
 Think about the critical care environment:
 How would you describe the ICU?
 What sights and sounds do you experience?
 What sensations might you experience?
 How would your family react to the situation?
How would you feel if this were
your family member?
Figure 2-1. If you were the family member and your loved one was this patient,
how would you feel when you saw this situation? (Reprinted with permission,
Cleveland Clinic Center for Medical Art & Photography © 2011-2012. All rights
reserved.)
Critical Care Environment
 Designed for efficient, lifesaving interventions
 Patients and families often have little advance
preparation for the environment
 Stress
 Anxiety
Sensory Overload
 Light
 Noise
 Loss of privacy
 Multiple caregivers
 Multiple people in and out of unit and room
Patient and Family Response to the
Critical Care Experience
Copyright © 2013, 2009, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
The Critically Ill Patient
 Patient responses vary according to:
 Age
 Prior illness or hospitalization experience
 Family relationships and social support
 Coping mechanisms
 Beliefs about life and death
 Spirituality
 Cultural considerations
Patients’ Recall About Critical Care
 Difficult  Fear
communication  Lack of family
 Pain  Discomfort
 Thirst  Difficulty sleeping
 Difficulty swallowing  Loneliness
 Anxiety  Thoughts of dying
 Lack of control  Physical restraint
 Depression
Geriatric Concerns
 Diminished ability to adapt to, or cope with,
stressors of critical illness
 At greater risk for negative outcomes
Psychosocial Support
 Ensure safety
 Reduce sleep deprivation
 Reduce noxious sensory overload
 Increase pleasant sensory input
 Provide reorientation
Family Members
 Critical illness/injury affects the whole family
 Uncertainty
 Loss of control
Family Needs
 Receiving assurance
 Remaining near the patient
 Receiving information
 Being comfortable
 Having support available
Family Assessment
 Structural
 Who comprises family
 Decision makers/spokesperson
 Race, ethnicity, cultural factors
 Developmental
 Stages, tasks, and attachments
 Functional
 How family members interact with each other
Family Interventions
 Facilitate visitation
 Provide information
 Encourage family involvement in patient care
 Consider family presence during procedures
Evidence-Based Recommendations
to Support Family Members
 Review Box 2-2 and discuss evidence-based
strategies identified by the Society of Critical
Care Medicine
Unique Approach
Figure 2-2. EPICS family bundle. (From Knapp S. Effects of an Evidence-based

Intervention on Stress and Coping of Family Members of Critically Ill Trauma Patients.
Unpublished Dissertation, University of Central Florida, Orlando, Florida; 2009.)
Quality of Life After Critical Care
 Discharge from critical care can be difficult for
patients and families
 Relocation stress
 Fear of abandonment (neglect)
 Learn new routines
 Learn new staff
 New roommates
 Prepare patients and family members for
transfer from the unit
Quality of Life After Critical Care
 Post–critical care symptoms

 Fatigue, sleep disturbance
 Pain, muscle weakness
 Poor concentration, impaired memory
 Poor appetite
 Posttraumatic stress disorder may develop in
patients or families

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Chapter 1

Overview of Critical Care Nursing

 Nursing, like other applied medical disciplines, is

Figure 2-2. EPICS family bundle. (From Knapp S. Effects of an Evidence-based

 Post–critical care symptoms

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