Week 1: Overview of Critical Care Nursing

Question 1

What is Critical Care Nursing?

Answer 1

AACN defines progressive or critical care nursing as the speciality that manages the human responses to actually or potentially life threatening problems.

Question 2

Evolution of Critical Care:

How did it begin?

Answer 2

Began with polio units (1950s), recovery rooms, and coronary care units (1960s)

Question 3

Evolution of Critical Care:

How did patient outcomes improve?

Answer 3

Patient outcomes improved with specialty care

Question 4

Evolution of Critical Care:

When were ICUs made?

Answer 4

Intensive Care Units (1970s)

Question 5

Critical Care in the 21st Century

What are examples of specialization?

Answer 5

Cardiovascular,

neurological,

trauma,

burn units

Pediatric

Neonatal

Question 6

Critical Care in the 21st Century

Variety of settings like?

Answer 6

Inpatient
Outpatient
Home care

EICU

Question 7

Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…

Answer 7

1. Promote
2. Intervene
3. Ensure
4. Serve

Question 8

Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…

Promote: What should nurses promote amongst patients?

Answer 8

Autonomous decision making

Question 9

Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…

Promote: What should nurses respect?

Answer 9

Respect & represent patient and family wishes

Question 10

Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…

INTERVENE: What should they intervene in? What should they provide education for?

Answer 10

in patient/family best interests

intercede for those who cannot advocate for themselves

educate patients access care resources

Question 11

Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…

Ensure: What should nurses ensure?

Answer 11

safe, competent, & high-quality care

Question 12

Nurse as Patient AdvocateAt the bedside 24 hours a day, so we can…

Serve: Who should nurses serve?

Answer 12

as liaison between patient, family & providers

Question 13

The Synergy Model

The underlying premises of the Synergy Model are:

What are a concern to the nurses?

Answer 13

Patients’ characteristics are of concern to nurses.

Question 14

The Synergy Model

The underlying premises of the Synergy Model are:

What is important to patients?

Answer 14

Nurses’ competencies are important to patients.

Question 15

The Synergy Model

The underlying premises of the Synergy Model are:

What drives nurses competencies?

Answer 15

Patients’ characteristics drive nurses’ competencies.

(How stable a patient is and the complexities of their illness). The ability of the patient to participate in their care matters to the nurse?

Question 16

The Synergy Model

The underlying premises of the Synergy Model are:

When patients’ characteristics and nurses’ competencies match and synergize,
What happens?

Answer 16

When patients’ characteristics and nurses’ competencies match and synergize, outcomes for the patient are optimal.

Question 17

The Synergy Model: What is it?

Answer 17

A framework that can be used as a basis for work to be done by facilities seeking Magnet designation.

Question 18

What is synergy?

Answer 18

Synergy- collaboration, cooperation, working hand in hand. Things work better together then working separate.

Question 19

Magnet Hospital?

Question 20

Patient Characteristics include?

Answer 20

Resiliency

Vulnerability

Stability

Complexity

Participation in care

Participation in decision making

Question 21

Slide 9

Question 22

Standards of Practice: What does it do?

Answer 22

Guide evidence-based clinical practice

Establish goals for patient care

Provide assessment of outcomes

Question 23

AACN Standards for Acute and Critical Care Nursing Practice:

Answer 23

Describe level of performance

Describe expected roles and responsibilities of critical care nurses

Question 24

Value of Certification

(examples: CCRN, CNRN, SCRN, ACLS)

Answer 24

Value to the patient and family

Value to employers and nurses

Question 25

Value of Certification Value to the patient and family: What does it validate to people? What does it demonstrate to people?

Answer 25

Validation of experience and knowledge Make decisions with greater confidence Demonstrates commitment to continual learning

Question 26

Value of Certification: Value to employers and nurses

Answer 26

Knowledge and expertise to promote optimal patient outcomes Commitment to quality Workplace empowerment Enhanced communication and coordination of care Remain employed in an area where they can apply the knowledge Sense of professional pride and achievement

Question 27

Evidence-Based Practice in Critical Care Nursing What is it?

Answer 27

“The process of shared decision making between practitioner, patient, and others significant to them based on research evidence, the patient’s experiences and preferences, clinical expertise or know-how, and other available robust sources of information”

Question 28

Evidence-Based Practice in Critical Care Nursing What does it do?

Answer 28

EBP takes what is known and uses it to guide patient care to achieve the best possible outcomes.

Question 29

Importance of Evidence-Based Practice

Answer 29

Evaluate research Hierarchy of evidence Implement practice based on evidence

Question 30

Barriers to Implementation of EBP: How long does it take to translate research findings into clinical practice?

Answer 30

17 to 20 years to translate research findings into clinical practice

Question 31

Barriers to Implementation of EBP:

Answer 31

Lack of knowledge of the research process Limited access to literature Lack of confidence in ability to critique research Limited interest in scientific inquiry Limited power to change practice Time factors Lack of organizational support and commitment

Question 32

Future Challenges in Critical Care Nursing Having to do with cultures?

Answer 32

Increase ability to deliver evidence-based care that is culturally congruent and relevant Have a multilingual, culturally diverse workforce Recruit and retain diverse professionals

Question 33

Future Challenges in Critical Care Nursing What are other challenges?

Answer 33

Expand the skill set of today’s already experienced critical care nurses Critical care nurses must be prepared to identify, manage, and treat unknown threats. Prepare to handle an actual or potential bioterrorism threat Continued expansion of skills and evidence-based interventions

Question 34

Focus on Quality & Safety What must be prevented?

Answer 34

Errors and harm must be prevented

Question 35

Focus on Quality & Safety What are nurses challenged to do?

Answer 35

Nurses are challenged to reduce errors and promote a safe environment

Question 36

Focus on Quality & Safety What are several initiatives?

Answer 36

1. Joint Commission National Patient Safety Goals 2. Institute for Healthcare Improvement 3. Quality and Safety Education for Nurses (QSEN)

Question 37

Harms Targeted for Reduction include:

Answer 37

Adverse drug events Infections Injuries from falls and immobility Prevention of venous thromboembolism (VTE)

Question 38

Harms Targeted for Reduction include: Infections: What are examples?

Answer 38

Catheter-associated urinary tract infections (CAUTI) Central line-associated bloodstream infections (CLABSI) Surgical site infections Ventilator-associated pneumonia (VAP)

Question 39

Trends and Issues: What is important to reduce errors?

Answer 39

Communication important to reduce errors

Question 40

Trends and Issues: What is a communication strategy?

Answer 40

SBAR communication strategy Situation Background Assessment Recommendation

Question 41

Trends and Issues: What should be done to reduce issues?

Answer 41

Handoff at bedside Rapid response team (RRT)

Question 42

Trends and IssuesInterprofessional Collaboration

Answer 42

Daily rounds with multidisciplinary team Implementation of “bundles” of care to promote evidence-based practices and prevent complications

Question 43

Trends and IssuesInterprofessional Collaboration Culture of collaboration includes what?

Answer 43

Mutual respect Mutual recognition

Question 44

Bundled CareA "bundle“: What are they?

Answer 44

group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. Institute for Health Care Improvement (IHI)

Question 45

Bundled CareA "bundle“: What does it include?

Answer 45

1. Head of the Bed 30O       2. Daily sedative interruption       and daily assessment of readiness to extubate 3. PUD Prophylaxis         4. DVT Prophylaxis         5. Daily Oral Care       with chlorhexidine

Question 46

Other Trends and Issues include:

Answer 46

Reducing hospital readmission rates Increasing use of technology Ethical issues associated with prolonging life and futile treatment Telemedicine and eICU