SCOPE OF CRITICAL CARE PRACTICE RULES FOR 21ST CENT HEALTH SYS
CCN- (Critical Care Nursing) 1. Care is based on continuous healing
DEF. deals w/ human responses to life-threatening relationships.
probs. 2. Care is customized according to patient needs
FW. Utilizes nursing process applying ADOPIE. and
COMP. Restorative, Curative, Rehabilitative, 1. values.
Maintainable, Palliative care. 2. The patient is the source of control.
OBJ. Upholds multi and interdisciplinary collab in 3. Knowledge is shared, and information flows
initiating interventions to restore stability, prevent freely.
complications, achieve and maintain optimal pt 4. Decision making is evidence-based.
responses. 5. Safety is a system property.
CCNURSES. Maintain prof comp based on a broad base 6. Transparency is necessary.
of knowledge and experience. 7. Needs are anticipated.
8. Waste is continuously decreased.
RIGHTS OF CRITICALLY ILL PT. 9. Cooperation among clinicians is a priority.
- Decline care
- Right to accept/refuse treatment/nourishment CORE COMP.
- informed consent 1. Provide pt-centered care
- confidentiality and dignity 2. Employ evidenced-based practice
- right to die w/ dignity 3. Apply quality improvement
GOALS OF CCN 4. Work in interdisciplinary teams
- pt-centered 5. Utilize informatics
- safe
- effective LEADERSHIP IN CRITICAL CARE
- efficient 1. STANDARDS OF PRACTICE
- nurs interventions delivered timely & equitable - To provide a framework for evaluation of
nursing practice within the specialty of critical
CATEGORIES OF CCN care.
AGE GROUP - To provide a basis for the assessment of staff
- Neonatal development needs in the critical care nursing.
- Pediatric - To guide the development of collaborative
- Adult relationship with other members of the health
SPECIALTY care team.
- Medical
- Surg 2. CLINICAL LEADERSHIP
- Cardio-thoracic - Perform management and leadership skills in
- Cardiac providing safe and quality care
- Respi - Accountability for safe critical care nursing
- Neurosurg practice
- Trauma - Delivery of effective health programs and
services to critically-ill patients in the acute
COMPETENCIES FOR CCN setting
- Safe and quality nurs care - Management of the critical care nursing unit or
- Management of resources acute care setting
- Legal responsibilities - Take lead and supervision among nursing
- Ethico-moral responsibilities support staff
- Collab and teamwork - Utilize appropriate mechanism for
- Personal and prof development collaboration, networking, linkage –building and
- Communication referrals.
- Health educ
- Quality improvement
- Research
- Record management
, MANAGEMENT SYSTEMS AND RESOURCES Types of Care Bundles:
- Resources and Supports in the Governance and - WHO Surgery Safety Checklist
Management of a Critical Care Unit - Urinary Catheter cb
- Physical Design and Equipment, Requirements - Clostridium difficile cb
of a CCU - Ventilator assisted Pneumonia cb
- Human Resources Requirements, Supports and - Sepsis
Training of the Workforce. - PVC cb
- Leadership and Management Principles - Ventilator-associated Pneumonia (VAP) Bundle
Influencing Quality, Efficacy and - DVT Prophy
Appropriateness of a CCU - GI Prophy
- Risk Management - Head of bed elevated to 30-45 deg
- Daily sedation vacation
QUALITY AND SAFETY - Daily spontaneous breathing trial
1. EBN (Evidence-based nursing)- prob-solving
approach to the delivery of healthcare that CHECKLISTS- algorithmic listing of actions to be perform
integrates the best evidence from studies. The Benefits: - create memory recall
integration of clinical expertise, patient value. - create a culture of accountability
- standardize care
STEPS IN EBN PROCESS - reduce pt harm
1. Asking a question - improve consistency of care
PICO- Pt/Prob, Intervention, Comparison, Outcome - help avoid medical errors
CATEGORIES OF CLINICAL QUESTIONS:
a. Diagnosis- which diagnostic test CONTINUOUS QUALITY IMPROVEMENT (CQI)
b. Theraphy- which therapy will be most beneficial - Is a deliberate, defined process, continuous and
c. Prognosis- how to predict likelihood of ongoing effort to achieve measurable
outcomes improvements in the efficiency, effectiveness,
d. Etiology- how to determine cause of disease performance, accountability, outcomes.
2. Acquiring evidence- know databases Tools & strategies for CQI and pt safety
3. Appraising evidence- examining article PDCA CYCLE:
4. Applying results- how to utilize infos PLAN- recognize an opportunity and plan a change
5. Assessing outcome- monitor and evaluate DO- test the change, carry out a small-scale study
changes CHECK- review the test, analyze the results, identify
SPIDER TOOL- can be used when dealing w/ quali what you’ve learned.
research questions. ACT- taking action
Sample
Phenomenon of
Interest
Design
Evaluation
Research type
2. CLINICAL PRACTICE GUIDELINES (CPG)
- Evidence-based recommendations used to
optimize pt care
3. CARE BUNDLES- collection of interventions
Benefits: - Maintain consistency in pt care
- set pt care standards
- improve overall quality of nursing care
- establish best clinical practices
- improve clinical effectiveness
- reduce morbidity and mortality
CCN- (Critical Care Nursing) 1. Care is based on continuous healing
DEF. deals w/ human responses to life-threatening relationships.
probs. 2. Care is customized according to patient needs
FW. Utilizes nursing process applying ADOPIE. and
COMP. Restorative, Curative, Rehabilitative, 1. values.
Maintainable, Palliative care. 2. The patient is the source of control.
OBJ. Upholds multi and interdisciplinary collab in 3. Knowledge is shared, and information flows
initiating interventions to restore stability, prevent freely.
complications, achieve and maintain optimal pt 4. Decision making is evidence-based.
responses. 5. Safety is a system property.
CCNURSES. Maintain prof comp based on a broad base 6. Transparency is necessary.
of knowledge and experience. 7. Needs are anticipated.
8. Waste is continuously decreased.
RIGHTS OF CRITICALLY ILL PT. 9. Cooperation among clinicians is a priority.
- Decline care
- Right to accept/refuse treatment/nourishment CORE COMP.
- informed consent 1. Provide pt-centered care
- confidentiality and dignity 2. Employ evidenced-based practice
- right to die w/ dignity 3. Apply quality improvement
GOALS OF CCN 4. Work in interdisciplinary teams
- pt-centered 5. Utilize informatics
- safe
- effective LEADERSHIP IN CRITICAL CARE
- efficient 1. STANDARDS OF PRACTICE
- nurs interventions delivered timely & equitable - To provide a framework for evaluation of
nursing practice within the specialty of critical
CATEGORIES OF CCN care.
AGE GROUP - To provide a basis for the assessment of staff
- Neonatal development needs in the critical care nursing.
- Pediatric - To guide the development of collaborative
- Adult relationship with other members of the health
SPECIALTY care team.
- Medical
- Surg 2. CLINICAL LEADERSHIP
- Cardio-thoracic - Perform management and leadership skills in
- Cardiac providing safe and quality care
- Respi - Accountability for safe critical care nursing
- Neurosurg practice
- Trauma - Delivery of effective health programs and
services to critically-ill patients in the acute
COMPETENCIES FOR CCN setting
- Safe and quality nurs care - Management of the critical care nursing unit or
- Management of resources acute care setting
- Legal responsibilities - Take lead and supervision among nursing
- Ethico-moral responsibilities support staff
- Collab and teamwork - Utilize appropriate mechanism for
- Personal and prof development collaboration, networking, linkage –building and
- Communication referrals.
- Health educ
- Quality improvement
- Research
- Record management
, MANAGEMENT SYSTEMS AND RESOURCES Types of Care Bundles:
- Resources and Supports in the Governance and - WHO Surgery Safety Checklist
Management of a Critical Care Unit - Urinary Catheter cb
- Physical Design and Equipment, Requirements - Clostridium difficile cb
of a CCU - Ventilator assisted Pneumonia cb
- Human Resources Requirements, Supports and - Sepsis
Training of the Workforce. - PVC cb
- Leadership and Management Principles - Ventilator-associated Pneumonia (VAP) Bundle
Influencing Quality, Efficacy and - DVT Prophy
Appropriateness of a CCU - GI Prophy
- Risk Management - Head of bed elevated to 30-45 deg
- Daily sedation vacation
QUALITY AND SAFETY - Daily spontaneous breathing trial
1. EBN (Evidence-based nursing)- prob-solving
approach to the delivery of healthcare that CHECKLISTS- algorithmic listing of actions to be perform
integrates the best evidence from studies. The Benefits: - create memory recall
integration of clinical expertise, patient value. - create a culture of accountability
- standardize care
STEPS IN EBN PROCESS - reduce pt harm
1. Asking a question - improve consistency of care
PICO- Pt/Prob, Intervention, Comparison, Outcome - help avoid medical errors
CATEGORIES OF CLINICAL QUESTIONS:
a. Diagnosis- which diagnostic test CONTINUOUS QUALITY IMPROVEMENT (CQI)
b. Theraphy- which therapy will be most beneficial - Is a deliberate, defined process, continuous and
c. Prognosis- how to predict likelihood of ongoing effort to achieve measurable
outcomes improvements in the efficiency, effectiveness,
d. Etiology- how to determine cause of disease performance, accountability, outcomes.
2. Acquiring evidence- know databases Tools & strategies for CQI and pt safety
3. Appraising evidence- examining article PDCA CYCLE:
4. Applying results- how to utilize infos PLAN- recognize an opportunity and plan a change
5. Assessing outcome- monitor and evaluate DO- test the change, carry out a small-scale study
changes CHECK- review the test, analyze the results, identify
SPIDER TOOL- can be used when dealing w/ quali what you’ve learned.
research questions. ACT- taking action
Sample
Phenomenon of
Interest
Design
Evaluation
Research type
2. CLINICAL PRACTICE GUIDELINES (CPG)
- Evidence-based recommendations used to
optimize pt care
3. CARE BUNDLES- collection of interventions
Benefits: - Maintain consistency in pt care
- set pt care standards
- improve overall quality of nursing care
- establish best clinical practices
- improve clinical effectiveness
- reduce morbidity and mortality
