Critical Care Nursing


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What is critical care nursing? Patients in critical care have often undergone some sort of trauma where their immediate health is at serious risk. It could result in long term health complications or death. As well it can involve patients who have multiple health complications that are not a result from trauma, but their health is at serious risk as well. Critical care and trauma patients are the most critically ill patients in the hospital (Emergency Nurses Association (ENA), 2000). Critical care nursing can involve patients that are trauma victims from motor vehicle crashes, violence, burns, drowning and falls. As well patients could have multiple health complications from health ailments like myocardial infarctions, cerebrovascular accidents and congestive heart failure (ENA, 2000). Critical care nursing requires extensive empirical knowledge, ethics, aesthetics and personal ways of knowing. A critical care nurse needs to know all the symptoms a critical care patient may have with certain health complications/ injuries. Critical care nurses need to be able to observe both subjective and objective information (ENA, 2000). As well critical care nurses need to be able to use their knowledge to diagnosis and perform the appropriate interventions. Critical thinking is extremely important as a critical care nurse. As well critical care nurses need to be caring and competent to help their patients healing process (ENA, 2000). Critical care nursing is complex and consists of many standards, technologies, and often death.


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Video: The day in the Life of a Critical Care Nurse

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The Standards of the Critical Care Nursing Unit and Process

The Canadian Association of Critical Care Nurses has developed a document that outlines specific standards for critical care nursing practice (Canadian Association of Critical Nurses, 2004). This Document is called Standards for Critical Care Nursing Practice. This Document describes in detail the specific standards for critical care nursing specific to the structure of the unit and the nursing process (CACCN, 2004).

The standards for the structure of the critical care unit are established in six main ideas:

· Distinct physical area provided by the facility with separate entrances for public and professional persons (CACCN, 2004)
· Opportunities for the nurses of the unit to maintain their skills and knowledge should be provided by the facility (CACCN, 2004)
· The health care facility provides qualified staff (CACCN, 2004)
· The facility establishes a Critical Care Committee (CACCN, 2004)
· The unit is technologically enhanced and supplies a documentation system for patient care (CACCN, 2004)
· The unit displays an interdisciplinary health care team approach to patient care that supports a peaceful death or preserves an optimal level of functioning (CACCN, 2004)

The standards for the critical care nursing process are illustrated in seven key points:

· At admission and during the patients stay, data of the patients status (physical and psychosocial) are to be collected by the critical care nurse (CACCN,2004)
· Data is to be analyzed by the critical care nurse to construct diagnoses (CACCN, 2004)
· The critical care nurse and other persons of the health care team plan interventions and formulate an overall care plan collectively (CACCN, 2004)
· Using independent and dependent nursing functions, the critical care nurse applies the plan of care (CACCN, 2004)
· The critical care nurse assesses patient outcomes based on independent and dependent nursing functions (CACCN, 2004)
· The critical care nurse is to develop and uphold therapeutic relationships with the patients and their families (CACCN, 2004)
· Legal, ethical and professional standards are within the scope of the critical care nurses practice (CACCN, 2004)


The Canadian Association for Critical Care Nurses is "a non-profit, specialty organization dedicated to maintaining and enhancing the quality of patient and family centered care by meeting educational needs of critical care nurses," (CACCN, 2009). On the CACCN website you can find the detailed outline of the standards of critical care nursing as well as a lot of other interesting information.




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The ventilator has become a symbol of critical illness. It is a machine designed to mechanically move breathable air into and out of the lungs to provide the mechanism of breathing for a patient who is physically unable to breathe or is not breathing sufficiently (Crocker & Timmons, 2009). The ventilator is also often referred to as "life support" which is part of the socially developed image of intensive care. Often times, the degree of critical illness is measured by the amount of equipment being utilized for a particular patient (Walters, 1995). Weaning patients from their ventilators is recognized as a form of technology in critical care nursing (Crocker & Timmons, 2009). Weaning is the process of slowly taking a patient off of a ventilator and reducing the amount of work it does for a patient. For weaning to be most effective, it should be done when a patient is refreshed from a good night's sleep because activities such as washing, physiotherapy, and sitting out of bed cause fatigue. Nurses need to know as much as possible about the current technological advances so they can use it to their advantage when caring for patients (Crocker & Timmons, 2009).


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Critical Care Nursing and Death
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The American Journal of Critical Care (AJCC) discusses how death in the ICU environment can be complicated and is often unnatural (Beckstrand, Callister, & Kirchhoff, 2006). It has been shown that critical care nurses wish they had more say in the care of dying patients to make their death easier (Beckstrand et al., 2006). The critical care nurse works in collaboration with members of the health care team to provide the best holistic care in a timely manner in order to aid in the critically ill patient’s recovery or to support a peaceful death (CACCN, 2004). Often critical care nurses are responsible for caring for these dying patients, because about 20% of intensive care unit (ICU) patients die while hospitalized. (Beckstrand et al., 2006). Critical care nurses are constantly faced with death. Each nurse will handle the death of a patient, and the emotions that come with it, in a unique way. The constant presence of death and dying makes critical care nursing an extremely demanding and complex profession. The role of a critical care nurse is complex with specific standards, technology and unfortunately the face of death.




References


Beckstrand, R. L., Callister, L. C., & Kirchhoff, K. T. (2006). Providing a "good death": Critical care nurses’ suggestions for improving end-of-life care. American Journal of Critical Care, 15(1), 38-45. Retrieved from http://ajcc.aacnjournals.org/cgi/reprint/15/1/38

Canadian Association of Critical Care Nurses. (2004). Standards for critical care nursing practice. Retrieved from http://www.caccn.ca./en/files/standards_3rd_edition.pdf

Crocker, C. & Timmons, S. (2009). The role of technology in critical care nursing. Journal of Advanced Nursing. 65(1), 52-61. doi: 10.1111/j.1365-2648.2008.04838.x

Emergency Nurses Association (2000). Trauma nursing core course: Provider manual (5th ed.). United States: The Official Trauma Nursing Core Course of the Emergency Nurses Association.


Walters, A. (1995). Technology and the life-world of critical care nursing. Journal of Advanced Nursing. 22(2), 338-346.