2.9. Critical Care Nursing
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Transcript of 2.9. Critical Care Nursing
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HASHIM N. ALAWI JR.,RN,MAN
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Standards of Care for Acute &Critical Care Nursing
1. Assessment
2. Diagnosis
3. Outcome Identification4. Implementation5. Evaluation
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Definition:
Critical:
Being in; or verging on a state
of crisis or emergency
Urgently needed
Absolutely necessary
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Definition:Critical Care Nursing:
Attending to patients
at high risk
for life-threateninghealth problems.
Providing vigilant,around-the-clock care.
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AssessmentStandard of Care I:
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AssessmentStandard of Care I:
1. Data collection involves the:
Patient Family Other health care providersPurpose:
Develop a Holistic picture of thepatients needs
Measurement Criteria
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AssessmentStandard of Care I:
Measurement Criteria
2. The priority of data collection activitiesdepends on: patients immediate condition and/or anticipated needs
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AssessmentStandard of Care I:
Measurement Criteria
3. Data are collected using appropriate assessment
techniques and instruments4. Documents are retrievable5. Collection process is:
systematic ongoing
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DiagnosisStandard of Care II:
Measurement Criteria
1. Diagnoses are derived from the assessmentdata.
2. Validated throughout the nursing interactionswith the team consisting of the:
Patient Family Other healthcare providers
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DiagnosisStandard of Care II:
Measurement Criteria
3. Prioritized and documented :
To facilitate determining expectedoutcomes
To develop a plan of care
4. Documented in a retrievable form
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Outcome IdentificationStandard of Care III:
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Outcome IdentificationStandard of Care III:
Measurement Criteria
1. Outcomes are derived from actual and potentialdiagnoses
2. Mutually formulated with:
Patient
Family
Other health care providers
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Outcome IdentificationStandard of Care III:
Measurement Criteria
3. Individualized
Culturally appropriate
Realistic
In relation to patients age
Present and potential capabilities
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Outcome IdentificationStandard of Care III:
Measurement Criteria
4. Attainable in relation to resources available to
the patient5. Measurable, and should include a
time estimate for attainment
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Outcome IdentificationStandard of Care III:
Measurement Criteria
6. Provide direction for continuity of care;
Nurses competencies are matched with thepatients needs
7. Documented in a retrievable form
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PlanningStandard of Care IV:
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PlanningStandard of Care IV:
Measurement Criteria
1. Individualized to reflect the patientscharacteristics and needs
2. Developed collaboratively with the team,consisting of:
Patient Family
Other health care providerspromote each members contributiontoward achieving expected outcomes
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PlanningStandard of Care IV:
Measurement Criteria
3. Reflects current acute and critical care nursingpractice
4. Provides for continuity of care
5. Prioritized
6. Documented to promote continuity of care
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ImplementationStandard of Care V:
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ImplementationStandard of Care V:
Measurement Criteria
1. Delivered in a manner that
minimizes complications and
life-threatening situations
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ImplementationStandard of Care V:
Measurement Criteria
2. The patient and family participate inimplementing plan of care based upon their :
Ability to participate
Decision making regarding care
3. Documented in a retrievable manner
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Evaluation
Standard of Care VI:
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EvaluationStandard of Care VI:
Measurement Criteria
1. Systematic,
ongoing, andCriterion - based
2. Consisting of :
Patient
Family
Healthcare providers
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EvaluationStandard of Care VI:
Measurement Criteria
3. Occurs within appropriate time frame afterinterventions are initiated
4. Ongoing assessment data are used to
- revise diagnoses,
- Outcomes
- Plan of care as needed
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EvaluationStandard of Care VI:
Measurement Criteria
4. Document revisions in diagnoses, outcomes,
and plan of care
5. Evaluate effectiveness of interventions inrelation to outcomes
6. Document patients response to interventions
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St d d f
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Standards ofProfessional Practice
1. Quality of care2. Individual practice evaluation
3. Education
4. Collegiality5. Ethics6.Collaboration
7. Resource utilization
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Standard of Professional Practice I
I. Quality of Care
St d d f P f i l P ti I
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Measurement Criteria
Standard of Professional Practice I
I. Quality of Care
1. Participate in quality of care activities
2. Use the results to initiate changes to improvepractices and healthcare delivery system
3. Incorporate the patients and familys perspective
as appropriate
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Standard of Professional Practice II
II. Individual Practice Evaluation
St d d f P f i l P ti II
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Measurement Criteria
Standard of Professional Practice II
II. Individual Practice Evaluation
1. Evaluate the nursing practice vs. the
professional practice standards
St d d f P f i l P ti II
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Measurement Criteria
Standard of Professional Practice II
II. Individual Practice Evaluation
2. Engage in self-assessment &/or a formal
performance appraisal identifying: Areas of strength
Areas where professional development
would be of benefit
St d d f P f i l P ti II
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Measurement Criteria
Standard of Professional Practice II
II. Individual Practice Evaluation
3. Seek and reflect constructive feedback from the
team consisting of: The patient
Family
Healthcare providers
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i i
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Standard of Professional Practice III
III. Education
Standard of Professional Practice III
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Measurement Criteria
Standard of Professional Practice III
III. Education
1. Participate in ongoing educational activities to
acquire knowledge and skills
Standard of Professional Practice III
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Measurement Criteria
Standard of Professional Practice III
III. Education
2. Seek experiences that reflect
current clinical practice
Standard of Professional Practice III
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Measurement Criteria
Standard of Professional Practice III
III. Education
3. Participate in ongoing
educational activities related to
professional issues.
St d d f P f i l P ti IV
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Standard of Professional Practice IV
IV. Collegiality
Standard of Professional Practice IV
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Measurement Criteria
Standard of Professional Practice IV
IV. Collegiality
1. Share knowledge,Skills, and
experiences with colleagues
Standard of Professional Practice IV
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Measurement Criteria
Standard of Professional Practice IV
IV. Collegiality
2. Provide peers &
other healthcare providers withconstructive feedback
regarding their practice,
as appropriateto their level of expertise
Standard of Professional Practice IV
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Measurement Criteria
Standard of Professional Practice IV
IV. Collegiality
3. Interact with colleagues to
enhance ownprofessional nursing practice
Standard of Professional Practice IV
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Measurement Criteria
Standard of Professional Practice IV
IV. Collegiality
4. Contribute to the
learning environment that isconducive to healthcare education
Standard of Professional Practice IV
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Measurement Criteria
Standard of Professional Practice IV
IV. Collegiality
5. Contribute to an effective
team environment byworking with others in a way that
promotes & encourages each
persons contribution.
St d d f P f i l P ti V
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Standard of Professional Practice V
V. Ethics
Standard of Professional Practice V
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Measurement Criteria
Standard of Professional Practice V
V. Ethics
1. The nurses practice is guided by the :
PRC-BON Code for Nurses
Critical Care Nurses Association of thePhilippines
Ethics of Care and Ethical Principles
Standard of Professional Practice V
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Measurement Criteria
Standard of Professional Practice V
V. Ethics
2. Maintain patient confidentiality
within legal andregulatory parameters
Standard of Professional Practice V
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Measurement Criteria
Standard of Professional Practice V
V. Ethics
3. Act as a patient advocate and
assist others indeveloping skills
so they can
advocate for themselves
Standard of Professional Practice V
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Measurement Criteria
Standard of Professional Practice V
V. Ethics
4. Deliver care in a:
Non judgmental Non discriminatory manner
that is sensitive to
patient diversity
Standard of Professional Practice V
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Measurement Criteria
Standard of Professional Practice V
V. Ethics
5. Deliver care in a manner that:
meets the diverse needs andstrengths of the patient and
preserves patients
autonomy,
dignity, and
rights
Standard of Professional Practice V
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Measurement Criteria
Standard of Professional Practice V
V. Ethics
6. Use available resources in
formulating
ethical decisions
Standard of Professional Practice VI
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Standard of Professional Practice VI
VI. Collaboration
Standard of Professional Practice VI
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VI. Collaboration
1. Communicate with the team regarding: Patient care
Nurses role in providing care
Measurement Criteria
Standard of Professional Practice VI
Standard of Professional Practice VI
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VI. Collaboration
2. Work with the team to:
formulate the plan of care and to make decisions related to the
care and delivery of services
Measurement Criteria
Standard of Professional Practice VI
Standard of Professional Practice VI
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Measurement Criteria
Standard of Professional Practice VI
VI. Collaboration
3. Consult with other healthcare providers and
initiates referrals as appropriate to
promote continuity of care
Standard of Professional Practice VII
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Standard of Professional Practice VII
VII. Research
Standard of Professional Practice V
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Measurement Criteria
Standard of Professional Practice V
VII. Research
1. Continually question and evaluate practice
Use best available evidence or
research findings to
develop appropriate
plans of care
Standard of Professional Practice V
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Measurement Criteria
Standard of Professional Practice V
VII. Research
2. Participate in activities
to support clinical inquiry
appropriate to
the nurses level of expertise
Standard of Professional Practice VIII
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Standard of Professional Practice VIII
VIII. Resource Utilization
Standard of Professional Practice VIII
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Measurement Criteria
Standard of Professional Practice VIII
VIII. Resource Utilization
1. Evaluate factors related to:
Safety Effectiveness &
Cost when choosing between two (2) or morepractice options that would result in the sameexpected outcome
Standard of Professional Practice VIII
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Measurement Criteria
Standard of Professional Practice VIII
VIII. Resource Utilization
2. Assist the patient & family in:
Identifying & Securing appropriate & available services to
address health-related needs
Standard of Professional Practice VIII
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Measurement Criteria
Standard of Professional Practice VIII
VIII. Resource Utilization
3. Assign or delegate aspects of care as
defined by the
nurse practice acts
Standard of Professional Practice VIII
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Measurement Criteria
Standard of Professional Practice VIII
VIII. Resource Utilization
4. Assist the patient & family in becominginformed consumers about:
Costs
Risks &
Benefits of treatment & care
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Critical Thinking in
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Critical Thinking :
A multidimensional skill
A cognitive or mental process
Set of procedures
gCritical Care Nursing
Critical Thinking in
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Critical Thinking : involves;
Reasoning Purposeful
Systematic Reflective
Rational
Outcome directed thinking
gCritical Care Nursing
Critical Thinking in
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Critical Thinking : involves;
Outcome directed thinking based on: A body of knowledge
Examination Analysis of all available information
and ideas
gCritical Care Nursing
Components of Critical Thinking
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1. Ask questions: To determine the reason why certain
developments have occurred2. Gather as much relevant information presented3. Analyze the information4. Draw on past clinical experience and knowledge
Components of Critical Thinking
Components of Critical Thinking
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5. Maintain flexible attitude6. Consider available options
7. Formulate decisions that reflect: Creativity Independent decision making
Components of Critical Thinking
Critical Thinking
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gIn
Nursing Practice
Predominant
Thinking StrategiesUsed by Nurses;
Regardless of their area of
Clinical Practice
Thinking Strategies
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1. Recognize a pattern2. Set priorities3. Search for information4. Generate hypotheses
5. Make predictions6. Form relationships
Thinking Strategies
Thinking Strategies
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7. State the proposition (if then)8. Make choices (alternative actions)9. Judge the value10. Draw conclusions
11. Provide explanations
Thinking Strategies
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The Inquiring Mind:
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Some guide questions:
1. What relevant assessmentinformation do I need,
How do I interpret thisinformation?
What does thisinformation tell me?
q gCritical thinking in Action
The Inquiring Mind:
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Some guide questions:
2. To what problems does thisinformation point? Have I identified the most
important one? Does the information
point to any otherproblems that I shouldconsider?
q gCritical thinking in Action
The Inquiring Mind:
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Some guide questions:3. Have I gathered all the
information I need?
Signs / symptoms Laboratory values Emotional factors
Mental status Is anything missing?
q gCritical thinking in Action
The Inquiring Mind:
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Some guide questions:
4. Is there anything that
needs to be reportedimmediately?
Do I need to seek
additionalassistance?
Critical thinking in Action
The Inquiring Mind:
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Some guide questions:
5. Does this patient haveany special risk factors?
Which ones are mostsignificant?
What must I do tominimize theserisks?
Critical thinking in Action
The Inquiring Mind:
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Some guide questions:
6. What are the possiblecomplications?
Critical thinking in Action
The Inquiring Mind:
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Some guide questions:7. What are the desired
outcomes for thispatient?
Which have thehighest priority?
Does the patientagree with me onthese points?
Critical thinking in Action
The Inquiring Mind:
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Some guide questions:
8. What will be my
first intervention inthis situation?
9. How can I construct
a Plan of Care toachieve the goals?
Critical thinking in Action
The Inquiring Mind:
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Some guide questions:
10. Are there any age relatedfactors involved?
Will they requirespecial approach?
Will I need to make
some changes in theplan of care to makethem effective?
Critical thinking in Action
The Inquiring Mind:
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Some guide questions:
11. How do the familydynamics affect this
situation? Will this affect my
plan of care?
12. Are there culturalfactors that I mustaddress and consider?
Critical thinking in Action
The Inquiring Mind:
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Some guide questions:
13. Am I dealing with anethical problem here?
If yes, how am Igoing to resolve it?
14. Has any nursing
research beenconductedon this subject?
Critical thinking in Action
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1. Standards of care
2. Standards ofprofessionalpractice
3. Criticalthinking defined
4. Thinkingstrategies
Too often we
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underestimate
the power of a touch,
a smile,a kind word,
a listening ear,
an honest compliment,
or thesmallest act of caring,
all of which
have the potential
to turn a life around.
Leo Buscaglia
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