INTRODUCTION TO CRITICAL CARE

Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients following extensive injury, surgery or life threatening diseases. The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues.

Critical Care

• Critical care (medicine) is the multidisciplinary healthcare specialty that cares for patients with acute, life-threatening illness or injury.
• Critical care (Intensive Care) is a healthcare specialty that cares for patients with acute, life-threatening illness or injury and involves multiple skills and specialties.

Critical Illness

• Critical illness is a condition where life cannot be sustained without invasive therapeutic interventions.

Critically Ill Patient

• Critically ill patient is defined as those patients who are at high risk for actual or potential life-threatening health problems and they are highly vulnerable, unstable and complex, thereby requiring intense and vigilant nursing care.

The Aim of the Critical Care

• The aim of the critical care is to see that one provides a care such that patient improves and survives the acute illness or tides over the acute exacerbation of the chronic illness.

CRITICAL CARE NURSING

• Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients.
• Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems.
• Critical care nursing is a branch of nursing practice that deals patients with the life-threatening problems and being supported with life saving measures.

Principles of Critical Care Nursing

• Efficacy: The extent to which care, and nursing interventions have achieved the project or desired patient outcome.

• Appropriateness: This Indicates the extent to which care, and intervention rendered are relevant to the clinical needs of the patient.

• Availability: It refers to the degree of appropriate care and intervention to meet the needs of the patient and family, i.e., the critical care units are properly staffed and equipped.
• Timeliness: The extent to which care, and intervention is provided to the patient, family. This requires your adequate knowledge and in-depth observation of the patient's progress during the different stages of the disease and the diagnoses, deviations, and readiness to act during the different stages of the disease. For example, if CPR is not performed within five minutes of the arrest, a patient with cardiac arrest can lose his life.
• Effectiveness: The degree of care and interventions are rendered in correct manner to achieve the desired or predicted patient outcome. It refers to the nurse's knowledge and skills for proper nursing diagnosis of the patient and efficient operation of machine/gadgets, administration of treatment therapies, carrying out diagnostic procedure, continuous monitoring, documentation, detection of deviations and taking necessary action.
• Safety: The extent to which the risk of interruption of the care-environment can be eliminated for patient and others including health care providers. This indicates that you should adhere to the protocol standards of critical care, which have been established and modified based on research conducted or available research into various aspects of safety such as the physical care environment, therapies, and procedure, etc.
• Efficiency: Depends on the relationship between outcomes and resources used for care, e.g., the level of competence of care providers, availability of technology needed to rescue/treat the patient, availability of needed equipment, supplies, medications, appropriate communication channels and effective communication skills. In other words, a well-established critical care system that provides collaborative, dedicated, and compassionate care.
• Respect and care: It refer to the degree to which patients and family members are involved in making decisions about care and its implementation; we must listen carefully to the customer's concerns with sensitivity and respect individual differences in their expression. Our objective as a critical care nurse is to promote quality of life rather than just survival. we can ensure this by helping the patient to gain control of his or her care through self-care decisions and gradual involvement in care activities.

CRITICAL CARE NURSE

Critical care nurse is a licensed professional nurse who is responsible for providing total nursing care of seriously acute and chronically ill patients experiencing life-threatening problems requiring complex assessment, high intensity therapies and interventions, and continuous nursing vigilance.

Ratio

• ICU nurse-patient ratio 1:1 for ventilated cases and 1:2 for other cases.
• 1:2 to 1:3 nurse patient ratios is acceptable for less seriously sick patients.

Qualifications

• Should be a registered nurse (RN)
• Should preferably have critical-care training course or orientation that includes essential information on the care of the critically ill patient.

Roles

• Care provider : help the client to obtain necessary care and supporting the basic needs and comprehensive direct care to the patient and family
• Educator: based on patient's needs and severity of the condition
• Manager: coordinates the care provided by various health care
• Advocate: protects the patient's rights

Responsibility / Functions

• Critical-care nurse will perform actions listed below:
• Assesses and implements treatment for patient responses to life-threatening health problems
• Provides direct measures to resuscitate, if necessary
• Uses independent, dependent, and interdependent interventions to restore stability, prevent complications, and achieve and maintain optimal patient responses
• Critical Care Nurse
• Provides health education to the patient and family
• Supervises patient care and ancillary personnel
• Supports patient adaptation, restores health, and preserves the patient's rights, including the right to refuse treatment

Skill

• Admission, Transfer and Discharge of patient
• Bedside Safety
• Bedside and Patient Care Planning
• Patient Care Issues –
  • Essential patient care
  • Skin Care
  • Safe Moving and handling
  • Monitoring of vital signs
• Documentation
  • Observation chart,
  • Fluid balance chart,
  • Care plan
• Respiratory Care (Airway and Breathing)
  • Airway management,
  • Manual Ventilation,
  • Care of Endotracheal/ Tracheostomy Tube
  • Respiratory Support,
  • Ventilation
  • Extubation
• Cardiovascular Care (Circulation)
  • Arterial lines
  • Central lines
  • Fluid management
  • Emergency clinical situations (shock, cardiac arrest)
• Neurological Care (Disability)
  • Level of consciousness (AVPU / GCS)
  • Sedation and analgesia
• Nutritional Care
  • Enteral nutrition
  • Glycaemia control
• Psychosocial / Spiritual Care
• Infection Control
• Laboratory Investigations