Introduction to Critical

Care Nursing

Acknowledgment:
Presented by :
Mr. Tanzeel ul Rehman Umar Hayat
Mr. Ghani Ullah Nursing Instructor SNC

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 Learning Objectives
At the end of this session students will be able to:
 Define Critical care nursing
 Enlist 7 C’s of Critical Care nursing
 Describe the value of certification in critical care nursing.
 Define critical care nurse and critical care units.
 Differentiate Various levels of ICU’s
 Describe the value of evidence-based practice (EBP) in
caring for critically ill patients.

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 Learning Objectives
At the end of this session students will be able to:
 List the six standards for a healthy work environment and
describe how the work environment can affect patient
outcomes and employee well-being.
 Describe the critical care nurse’s role in promoting a healthy
work environment.
 Explain the underlying premises of the synergy model.

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 Critical Care Nursing
 Critical care nursing is the delivery of specialized care to
critically ill patients, that is, ones who have life-threatening
illnesses or injuries.
 Such patients may be unstable, have complex needs, and
require intensive and vigilant nursing care.
 Illnesses and injuries commonly seen in patients include:
 Gunshot wounds
 Traumatic injuries from such events as automotive
collisions and falls
 Cardiovascular disorders, such as heart failure and acute
coronary syndromes (unstable angina and myocardial
infarction [MI])

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 Seven Cs Of Critical Care

 Compassion
 Communication (with patient and family).
 Consideration (to patients, relatives and colleagues) and
avoidance of Conflict.
 Comfort: prevention of suffering
 Carefulness (avoidance of injury)
 Consistency
 Closure (ethics).

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 Critical Care Nurse
A critical care nurse is a certified licensed professional nurse
who is responsible for ensuring that acutely and critically ill
patients and their families receive optimal care.

Value of Certification
American Association of Critical-Care Nurses (AACN) promotes
excellence in the critical care nursing profession by helping
nurses achieve and maintain an up-to-date knowledge base

Certification has value for :

 Patients and families
 Employers
 Nurses themselves

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 Value of Certification
Value to the patient and family
 Certification validates to patients and families that the
nurses caring for them have experience and knowledge.
 Experience and knowledge enable nurses to recognize and
respond to clinical situations more quickly.
 Research has shown that nurses who have had their
knowledge validated through a certification examination
make decisions with greater confidence, promoting optimal
outcomes.
 In addition, nurses who are certified have demonstrated
commitment to continual learning, needed to care for
patients with complex multisystem problems.

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 Value of Certification
Value to Employers.
 It validates to employers that the nurse working, has the
knowledge and experience to work efficiently to promote
optimal patient outcomes.
 Organizations that support and recognize the value of
certification may experience decreased turnover and
improved retention rates.
 In addition, employing nurses who have achieved
certification demonstrates :
 To the public (healthcare consumers)
 To credentialing organizations (JCI, ANCC) that the facility has
recruited and retained knowledge-validated nurses.

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 Value of Certification
Value to Nurses.
 Certification provides nurses with a sense of professional
pride and achievement.
 Confidence that comes with certification may give the nurse
a competitive edge when seeking a promotion or new
career opportunities.
 In addition, certified nurses can anticipate increased
recognition from peers and employers.
 Certification may have monetary benefits as well.
 e.g. some employers recognize certification with a salary
differential.

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 Critical Care Unit
Critical care unit is a specially designed and equipped facility
staffed by skilled personnel to provide effective and safe care
for dependent patients with a life threatening problem.

ICUs can be classified as:

Level I: This can be referred as high dependency is where close
monitoring resuscitation, and short term ventilation <24hrs has
to be performed.
Level II: Can be located in general hospital, undertake more
prolonged ventilation. Must have resident doctors, nurses,
access to pathology, radiology, etc.
Level III: Located in a major tertiary hospital, which is a referral
hospital. It should provide all aspects of intensive care required

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 Historical Perspectives
 Florence Nightingale recognized the need to consider the
severity of illness in bed allocation of Patients and placed the
seriously ill patients near the nurses’ station.

 1923, John Hopkins University Hospital developed a special

care unit for neurosurgical patients.

 Modern medicines boomed to its higher ladder after world

war 2.

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 Nursing Staff
 The major teaching tertiary care ICU will require trained
nurses in critical care.
 It may be ideal to have an in house training programme for
critical Care nursing.
 The number of nurses ideally required for such units is 1:1
ratio.
 In complex situations they may require two nurses per
patient.
 The number of trained nurses should be also worked out by
the type of ICU, the workload and work statistics and type of
patient load.

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 Evidence-Based Practice in
Critical Care Nursing
 Evidence-based practice (EBP) is the use of the best available
research data from well-designed studies coupled/associate
with experiential knowledge and characteristics, values, and
patient preferences in clinical practice to support clinical
decision making.
 Essential to promote optimal outcomes effectiveness.
 Practice based on intuition or information that does not have
a scientific basis is not in the best interest of patients and
families.

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 Strategies to incorporate
evidence into clinical practice
 Use of protocols, clinical pathways, and algorithms
 Increase awareness of available resources (eg, databases such
as PubMed, CINAHL and MEDLINE; Web sites such as
UpToDate, which offers real-time evidence-based
recommendation for patient care and professional nursing
organizations, such as the AACN (American Association of
Colleges of Nursing), which publishes research-based Practice
Alerts)
 Creating an organizational culture that support EBP (eg,
identifying EBP champions, incorporating EBP activities into
nurses’ roles, allocating time and money to the process,
promoting multidisciplinary collaboration among researchers
and practitioners)

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 Healthy Work Environments
 A healthy work environment (HWE) optimizes collaboration ,
nursing practice and promotes employee satisfaction.
 Contrary harmful healthcare working environments result in
medical errors, poor healthcare delivery, and dissatisfaction
among healthcare providers.
 The AACN helped develop the HWE initiative.
 Focuses on barriers to patient safety and employee
satisfaction.

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 Healthy Work Environments
They identifies six essential standards for promoting a HWE:
 Skilled communication
 True collaboration
 Effective decision making
 Appropriate staffing
 Meaningful recognition(recognition encourages productivity)
 Authentic leadership

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 Healthy Work Environments
Skilled communication:
Skilled communication is essential to prevent errors as well as
to recruit and retain healthcare providers.
Almost 70% of sentinel events reported to the Joint
Commission in 2005 were related to communication issues.
Nurses must be as proficient in communication skills as they
are in clinical skills.

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 Healthy Work Environments
True collaboration:
Nurses must be relentless/Persistence in pursuing and fostering
true collaboration. Collaboration is a multifaceted concept,
which has been defined as working together to accomplish a
common goal.
Some investigators have suggested that collaboration is defined
through five concepts:
 Sharing
 Partnership
 Power
 Interdependency
 Process

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 Healthy Work Environments
True collaboration:
Other researchers has identified 10 lessons in collaboration:
(1) Know thyself
(2) Learn to value and manage diversity
(3) Develop constructive conflict resolution skills
(4) Create win–win situations
(5) Master interpersonal and process skills
(6) Recognize that collaboration is a journey
(7) Leverage/Hold all multidisciplinary forums
(8) Appreciate that collaboration can occur spontaneously
(9) Balance autonomy and unity in collaborative relationships
(10)remember that collaboration is not required for all decisions.

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 Healthy Work Environments
Effective Decision Making:
Healthcare environment mandates that nurses be accountable
for their practice, they must be able to participate in effective
decision making.
A high degree of responsibility and autonomy is necessary.
An environment that consistently and successfully encourages
nurses to participate in decision making promotes quality
patient outcomes and improved employee satisfaction.

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 Healthy Work Environments
Appropriate Staffing:
There is a significant relationship between inadequate nurse
staffing and adverse patient events.
According to the Joint Commission (1995 to 2004) staffing levels
were a root cause of nearly a quarter of the sentinel events that
resulted in death, injury, or permanent loss of function.
Appropriate staffing must also consider the competencies of the
staff assigned in relation to the needs of the patient and family
during that shift.
When the needs of patients and families are matched with the
competencies of the assigned nurse, optimal outcomes may be
achieved.

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 Healthy Work Environments
Meaningful Recognition:
Employee recognition can have a significant effect on job
satisfaction, and can help to retain high- performing nurses and
ensure an adequate workforce in the future.
The recognition may be modest in scale but must represent
genuine caring and appreciation.
In addition to monetary rewards when possible recognition can
take the form of verbal or written praise, appreciation, and
acknowledgment of excellent performance.

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 Healthy Work Environments
Authentic Leadership:
Attributes of an authentic leader that are essential for
establishing and maintaining a HWE include genuineness,
trustworthiness, reliability, compassion, and believability.
An effective leader seeks to
(1) Balance the tension between production and efficiency
(2) Create and sustain trust throughout the organization
(3) Actively manage the process of change
(4) Involve workers in decision making pertaining/concern to
work design and work flow
(5) Use knowledge management to establish the organization
as a learning organization.

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 The Synergy Model
Synergy is a word that originated from the Greek word synergos,
which means working together.
conceptual model used in a variety of clinical settings as the
basis for job descriptions, performance appraisals, and career
advancement.
The underlying premises of the synergy model are:
(1) Patients’ characteristics are of concern to nurses
(2) Nurses’ competencies are important to patients
(3) Patients’ characteristics drive nurses’ competencies
(4) When patients’ characteristics and nurses’ competencies
match and synergize, outcomes for the patient are optimal.
 Eight characteristics (of patients, units, or systems)
 Eight nurse competencies that constitute nursing practice
form, the basis of the model
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 The Synergy Model
Patient/unit/system characteristics range depending on the
situation and are expressed as:
level 1, 3, or 5
 1 being “low”
 5 being “high.”
Similarly, nurse competencies range depending on the nurse’s
level of expertise, and are expressed as :
level 1, 3, or 5.
 1 being “competent”
 5 being “expert.”

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The Synergy Model

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The Synergy Model

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The Synergy Model

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• A nurse with lower competence in an area can learn and
go through training in order to increase their competence.
Nurses with strong abilities in the fields can act as a
mentor to help other nurses that are not as strong.

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• Every patient and nurse will be evaluated and have different rankings for
their features and ability. The following are examples of the Synergy
Model in nursing. Here is a patient:

• Vulnerability (2)
• Resiliency (3)
• Stability (3)
• Complexity (3)
• Resource availability (4)
• Participation in care (3)
• Involvement in decision-making (2)
• Predictability (3)
• For a patient, a 1 indicates the poorest condition, while a 5 indicates the
best patient state.
• In this case, this patient is likely able to communicate with the nurse, as
they have a 3 in participation. This patient may need special care to
avoid stresses or factors that can worsen their situation, as they have a
2 in vulnerability.

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 The Synergy Model
The synergy model is used to evaluate the relationship between
clinical practice and outcomes.
Patient-derived outcomes may include functional change,
behavioral change, trust, satisfaction, comfort, and quality of
life.
Nurse-derived outcomes may include physiological changes,
absence of complications, and the extent to which care or
treatment objectives are attained.
Healthcare system–derived outcomes may include, reduced
costs, and enhanced resource utilization.

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 References:

 Morton, P. G., & Fontaine, D. K. (2013). Essentials of Critical

Care Nursing A Holistic Approach. Wolters Kluwer Health|
Lippincott Williams & Wilkins.

 Sole, M. L., Klein, D. G., Moseley, M. J., Brenner, Z. R., &

Powers, J. (2009). Introduction to critical care nursing. 5th
Edition St. Louis, Mo.: Saunders, c2009.

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Any Question???

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