8.

11 - Introduction to Critical Care • “Critical care nursing is the specialty

• A hospital unit where 24-hour medical care • These problems deal dynamically
is rendered to patients with life-threatening with human responses to actual or
injuries and illnesses potential life-threatening illnesses”
(CCNAPI, 2014)
• A distinct organizational & geographic
section for clinical activity & care, operating 5. The CCU Nurse
in coordination with other departments
• A licensed professional nurse who is
integrated in a hospital
responsible for ensuring that all acutely and
2. The Functions critically ill patients receive optimal care
• Basic to the provision of optimal care is
Critical Care Unit / Intensive Care Unit: individual professional accountability
• To monitor & support threatened or failing through:
vital functions in critically ill patients,  Adherence to the standards of
nursing care of acutely ill and
 with illnesses that can endanger life, critically ill patients
&  Commitment to act in accordance
 that adequate diagnostic measures with ethical principles
& medical or surgical therapies are • Essential Elements of CCN:
performed to improve their outcome  Nursing expertise
 Ability to observe patients
3. The Men and Women  Appropriate nursing intensity
Critical Care Unit / Intensive Care Unit 6. The CCU Patients:
• A team of specially-trained health care Acutely and Critically Ill Patients
providers are involved in rendering
specialized treatments with the use of • Patients who are at high risk for
machines to constantly monitor vital signs mortality due to present health
problems (AACN, 2015)
• With dedicated medical, nursing, & allied
health staff that operates with defined • At high risk of actual or life-
policies & procedures, with its own quality threatening health problems (Aitken,
improvement, continuing education, & Chaboyer, Elliot, 2019)
research programs Development of Critical Care Units (CCU)
4. CCU Nursing Discipling
Acute and Critical Care Nursing
• The specialty within nursing that
specifically deals with human
responses to actual or potential life-
threatening health symptoms and
diagnosis (AACN, 2015)
• Assisting, supporting, and restoring
History of Critical Care
the patient toward health, or to ease
the patient’s pain, or to prepare them • 1800 - Florence Nightingale :
for dignified death (World Federation ⇒ advantages of separating
of Critical Nurses) recovering surgical patients
 ⇒ needs of acute, life-threatening education & expertise in the specialty field
illness or injury could be better met if of critical care
the patients were organized in
⇒ physicians intensivist / specialty
distinct areas of the hospital
physicians
• WW2 – shock wards were set to care for
critically injured patients ⇒ nurses (advanced practice nurses –
• 1900 – John Hopkins Hospital APNs)
• 3-bed post-op neurosurgical CC ⇒ pharmacists
(Baltimore) ⇒ respiratory therapists / other
• premature infants unit (Chicago) specialized therapists
• 1950s – mechanical ventilation was ⇒ social workers
introduced – establishing the first ICU ⇒ clergy / other religious sect
(respiratory) • Critical care is provided in specialized units,
• 1970s – the Society of Critical Care with emphasis on the continuum of care,
Medicine (SCCM) was established and with an efficient & seamless transition of
became the driving force behind: care from one setting to another
• critical care guidelines • Settings:
• education  adult / pediatric / neonatal
• interdisciplinary collaborative  step-down / telemetry / progressive
initiatives or transitional care units
 intentional radiology departments
• WW2 :  post-op recovery units
⇒ provided for the impetus for Scope of Practice
specialized MS Nursing care in the • Describers the; Who, What, Where, When,
civilian setting. Why & How the nurse functions when
⇒ the most critically ill patients were caring for acutely & critically ill patients
segregated in areas where they can • Should allow for an exchange, expansion,
be cared for by nurses with and flexibility of the profession to meet the
specialized knowledge. changing needs of patients, organizations,
• Organized as a specialty less than 60 years and society
ago (1960s) • Boundaries of the practitioner’s license:
• 1960s  procedures
⇒ physicians depended on nurses to  nursing actions
assess for critical changes in  processes
their patients • For which the practitioner has received:
⇒ nurses would initiate emergency  education
medical treatment  training
⇒ nurses began consolidating their  licensure
knowledge & practice into focused  certification
areas (coronary care, nephrology,
intensive care) Scope of Critical Care Practice
⇒ nurses assumed many functions & • Activities that the CCN is permitted to
responsibilities formerly reserved for perform
physicians, & assumed a new • Scope of practice is established by the ACT
authority by virtue of their knowledge of the specific practitioner's board, and the
& expertise rules adopted pursuant to the act (AACN,
2015)
Contemporary Critical Care Critical Illness:
• Provided by a multidisciplinary • Any disease process which causes
(multiprofessionals) team of health care physiological INSTABILITY leading to:
professionals equipped with an extensive  disability or death within minutes or
hours
 • Disturbance of these systems generally has
the most immediate life-threatening effects
 neurological
 respiratory
 cardiovascular
Critical Illness: Common Observations
• Hypotension
• Tachycardia
• Tachypnea
• Reduced level of urine output
• Altered consciousness
NOTE: The presence of 2 or more of these signs
strongly suggests that the patient is critically ill and
at risk of death