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Acute Care Chapter 20
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Acute Care
Chapter 20
20-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Acute Care
A type of nursing, as well as the place for the delivery of nursing care.
20-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Acute Care
Most expensive of health care settings Includes the full range of physical and
mental alterations afflicting individuals Saving life, prolonging life, palliative care
20-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Focus of Acute Care Nursing
Management of crisis Detection of disease in a pre-
symptomatic stage (secondary prevention)
Management of chronic disease
20-5Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Arenas of Acute Care
Proprietary or not-for-profit General or specialized
20-6Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Arenas of Acute Care
ICU Long-term acute care (LTAC) facilities
(for survivors of acute ICU interventions) Post-acute rehabilitation (subacute
services)
20-7Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Providers of Acute Care Nursing
Registered Nurses Licensed Practical Nurses Nursing Assistants Unlicensed Clinical Assistants
20-8Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Providers of Acute Care Nursing
Registered Nurses• Associate, diploma, baccalaureate• Certification• Master’s and doctoral level• Advanced Practice Nurses
20-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Providers of Acute Care Nursing
Advanced Practice Nurses• Nurse Practitioner• Nurse Midwife• Nurse Anesthetist• Clinical Nurse Specialist
20-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Importance of Critical Thinking in Acute Care Nursing
Use the nursing process with respect to specific acute problems.
Master the facts and concepts concerning commonly encountered problems.
20-11Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Importance of Critical Thinking in Acute Care Nursing
Apply principles of critical and ethical decision making in a complex environment.
Understand aggregates of clients.• Specialty populations with special needs
20-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Regulatory Organizations for Acute Care Nursing Practice
American Nursing Association (ANA) Canadian Nurses Association (CNA) American Association of Critical Care
Nurses (AACN) Intravenous Nurses Society (INS) American Association of Neuroscience
Nurses (AANN)
20-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Regulatory Organizations for Acute Care Nursing Practice
Allied Disciplines and Acute Care Nursing• Medical Technologists• American Heart Association• The American Occupational Therapy
Association (AOTA)• The American Physical Therapy Association
(APTA)
20-14Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Regulatory Organizations for Acute Care Nursing Practice
Standards for Care in Acute Care Nursing• Organized, and explicit expectations for
providers and clients • Scientific rigor applied to common diagnoses• Development of critical pathways (care
maps)
20-15Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Quality Control Agencies for Acute Care
Hospitals• Occupational Safety and Health
Administration (OSHA)• Clinical Laboratory Improvement
Amendments (CLIA)• Centers for Medicare and Medicaid Services
(CMS)
20-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Quality Control Agencies for Acute Care
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)• Monitors and evaluates appropriateness of
care• Evaluates quality of service• Resolves existing problems• Educational and supportive
20-17Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Quality Control Agencies for Acute Care
State and Federal Agencies• National Committee for Quality Assurance
(NCQA)• The California Department of Managed
Health Care• Ombudsman for the Managed Care
Consumer Advisory Board (Massachusetts)
20-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Quality Control Agencies for Acute Care
Institute of Medicine of the National Academy of Sciences Report • Error incidence, detection, analysis and
prevention• Four-tiered approach to improve safety in
health care
20-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Evidence-Based Practice in Acute Care Nursing
Conscientious, explicit, and judicious use of current best evidence in making decisions about individual client care
20-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Evidence-Based Practice in Acute Care Nursing
Outcomes Research in Acute Care Practice• Links care delivered to individuals to the
outcomes achieved• Means of monitoring and improving quality
of care in the acute care setting
20-21Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Evidence-Based Practice in Acute Care Nursing
Mastery of Knowledge in Acute Care Nursing• Wide range of pathologies• Broad range of assessment skills• Different laboratory and radiologic correlates• Multiple drug classes, and agents to manage
possible treatment complications
20-22Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Evidence-Based Practice in Acute Care Nursing
Mastery of Knowledge in Acute Care Nursing• Technical demands• Cultural and age-related concepts• Common diagnostic and complication-
related signs and symptoms• Collaboration with other members of the
health care team
20-23Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Value Orientation and Acute Care Nursing
An essential component of acute care nursing• Making difficult ethical decisions that are
accompanied by potentially serious consequences
• Justifying how resource expenditure decisions are made
20-24Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Capitalism and Acute Care Nursing
Philosophy of Capitalism and Health Care• American health care is considered and
treated as a market commodity to be bought and sold rather than as a right.
• There is infinite demand for finite resources.
20-25Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Capitalism and Acute Care Nursing
Managed Care Concepts in Acute Care• Health care financing and delivery
arrangement designed to provide appropriate, effective, efficient health care
20-26Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Managed Care Concepts in Acute Care
Many managed care institutions are strong allies with other groups interested in quality health care.
20-27Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Social Influences Influencing Acute Care Nursing
Culture and ethnicity Human genome mapping Aging trends Third-party payment systems of
insurance
20-28Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Social Influences Influencing Acute Care Nursing
Human Genome Mapping• Sequencing of DNA in the human genome• Focus of diagnostics and therapeutics is
shifting to genetic and molecular levels.
20-29Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Human Genome Mapping
Fundamental issues include:• How will the knowledge affect the acutely ill?• Will insurance cover illness in client’s with a
predisposition for a particular disease?
20-30Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Aging and Acute Care
Appropriate use of technology and other healthcare resources
Treatment and resuscitation decisions
20-31Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Social Influences Influencing Acute Care Nursing
Insurance and Acute Care• The uninsured often experience major
decompensation as a result of lack of attention to originally manageable problems.
20-32Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Insurance and Acute Care
Preventive services can be far less expensive to provide than emergency acute care services.
20-33Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Current Issues in Nursing and Effect on Acute Care Nursing
Entry into practice Use of variably trained caregivers Critical thinking in the acute care setting
20-34Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Entry Into Practice Issues and Acute Care
Who should bear the cost of continuing education?
Qualification profile of practicing nurses Debate concerning highest nursing
credential Is education adequate to address the
complexity of care demands?
20-35Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Current Issues in Nursing and Effect on Acute Care Nursing
Nonstandardized Care Providers in Acute Care• Challenge is to provide quality care in an
acute care environment with fewer nurses.- Education is not standardized.- Roles are not clearly defined.- Nursing professionals are ultimately responsible
for defining their capabilities.
