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Critical care unitK. HEMA ANANDHYM.Sc NURSINGPONDICHERRYHistory of Critical Care NursingAlthough there have always been very ill and severely injured patients, the concept of critical care is relatively modern. As advances have been made in medicine and technology, patient care has become more complex. To provide appropriate care, nurses needed specialized knowledge and skills, and the care delivery mechanisms needed to evolve to support the patients' needs for continuous monitoring and treatment. The first intensive care units emerged in the 1950s to provide care to very ill patients who needed one-to-one care from a nurse. From this environment the specialty of critical care nursing emerged.

CONCEPTFLORENCE NIGHTINGALEIN 1970 THE TERM CLINIAL CARE UNIT CAME INTO PRATICE WHICH COVERED ALL TYPES OF SPECIAL ARE UNITSdefinitionCritical care unit is defined as the unit in comprehensive care of a critically ill patients who is deemed recoverable is carried out.Critical care unit is a specially designed & equipped facility staffed by skilled personnel to provide effective & safe care for dependent patients with life threatening or potentially life threatening problems .definitionCritical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. A critical care nurse is a licensed professional nurse who is responsible for ensuring that acutely and critically ill patients and their families receive optimal care. Definition of a Critically Ill PatientCritically ill patients are defined as those patients who are at high risk for actual or potential life-threatening health problems. The more critically ill the patient is, the more likely he or she is to be highly vulnerable, unstable and complex, thereby requiring intense and vigilant nursing care. Principles of critical nursingREVERSIBLE STAGE OF CRITICAL ILLNESS

IRREVERSIBLE STAGE OF CRITICAL ILLNESS

PATHOPHYSIOLOGICAL CHANES IN THIS STAGELungs , multiple organ failer, surgery, shock, burns.Principles of critical careANTICIPATIONEARLY DETECTION & PROMPT ACTIONCOLLABORATIVE CARECOMMUNICATIONPREVENTION INFECTIONCRISIS INTERVENTIONSTREES REDUCTION

SCOPETHE NURING PRATICE IN CRITICAL CARE UNIT IS HIGHLY CHALLENGING & COMPLEX. CRITICAL CARE NURSING IS FAST EVOLVING AS SPECIALTYTO MEET ALL THESE CHANLLENGES. POLICYPOLICY IS A COURSE OF ACTION FOR DEALING WITH A PARTICULAR MATTER SITUATIION BY A POLITICAL PARTY, GOVERNMENT OR ORGNATZATION.

PROCEDURE ;IS A SET ACTIONS NECESSARY FOR DOING SOMETHING .PROTOCALSTHE CEREMONIAL SYSTEM OF FIXED RULES & ACCEPTED BEHAVIOURS .LEVELS OF CRITICAL CARELEVEL I ;High dependency care Nurse patient ratio 1;3Level ii;Capable to provide prolonged mechanical care N;p I;2Level iiiComprehensive careNp 1;1

Planning critical careLocationNumber of beds Space 3 feets head of the bed & the wallDesignLightingTempreature & humiditityNurses stationHand washingWork room

Washing roomDrug distribution roomClean linen storage roomPantryEmergency equipments roomDuty doctor roomlaboratoryElectrical system BedEquipment monitoring equipment resuscitative equipment supportive equipment

Admission criteriaNursing charts or flow sheets

Flow sheet ; is a monitoring aid that record data chronologically to allow rapid review in a form, which easily interpreatble.

Vital signs , cvs , cns, fluid balance parametersStaffingManagement policesRecommendations for infection controlHand washingSpacingIsolationVisitingCleaningTerminal cleaningEnvironmental sampling

Risk proceduresIv thearpyInfusion pumpsTpnWound careInvasive pressure monitorTracheotomy careCathterizationCollecting specimens

Where Critical Care Nurses WorkAccording to "The Registered Nurse Population" study, 56.2% of all nurses work in a hospital setting, and critical care nurses work wherever critically ill patients are found intensive care units, pediatric ICUs, neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units, progressive care units, emergency departments and recovery rooms. Increasingly, critical care nurses work in home healthcare, managed care organizations, nursing schools, outpatient surgery centers and clinics. Critical care nurses practice in settings where patients require complex assessment, high-intensity therapies and interventions, and continuous nursing vigilance. Critical care nurses rely upon a specialized body of knowledge, skills and experience to provide care to patients and families and create environments that are healing, humane and caring. Foremost, the critical care nurse is a patient advocate. AACN defines advocacy as respecting and supporting the basic values, rights and beliefs of the critically ill patient. In this role, critical care nurses:

Respect and support the right of the patient or the patient's designated surrogate to autonomous informed decision making.Intervene when the best interest of the patient is in question.Help the patient obtain necessary care.Respect the values, beliefs and rights of the patient.Provide education and support to help the patient or the patient's designated surrogate make decisions.Represent the patient in accordance with the patient's choices..

Support the decisions of the patient or designated surrogate, or transfer care to an equally qualified critical care nurse.Intercede for patients who cannot speak for themselves in situations that require immediate action.Monitor and safeguard the quality of care the patient receives.Act as a liaison between the patient, the patient's family and other healthcare professionalsThe Roles of Critical Care Nurses

Critical care nurses work in a wide variety of settings, filling many roles including bedside clinicians, nurse educators, nurse researchers, nurse managers, clinical nurse specialists and nurse practitionersFuture of Critical Care Nursing

Rapid advances in healthcare and technology have contributed to keeping more people out of the hospital. However, patients in critical care units are more ill than ever. Many patients who would have been cared for in a critical care unit five years ago are now being cared for on medical floors or at homeMany patients in today's critical care units would not have survived in the past. It has been proposed that hospitals of the future will be large critical care units, and other types of care will be provided in alternative locations or at home. Critical care nurses will need to keep pace with the latest information and develop skills to manage new treatment methods and technologies. As issues relating to patient care become increasingly complex and new technologies and treatments are introduced, critical care nurses will need to become ever more knowledgeable.

Transitional careTransitional care refers to the actions of healthcare providers designed to ensure the coordination and continuity of health care during the movement, called care transition, between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness. Older adults who suffer from a variety of health conditions often need health care services in different settings to meet their many needs. For young people the focus is on moving successfully from child to adult health services.A recent position statement from the American Geriatrics Society defines transitional care as follows[1]: For the purpose of this position statement, transitional care is defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location. Representative locations include (but are not limited to) hospitals, sub-acute and post-acute nursing homes, the patients home, primary and specialty care offices, and long-term care facilities. Transitional care is based on a comprehensive plan of care and the availability of health care practitioners who are well-trained in chronic care and have current information about the patients goals, preferences, and clinical status. It includes logistical arrangements, education of the patient and family, and coordination among the health professionals involved in the transition. Transitional care, which encompasses both the sending and the receiving aspects of the transfer, is essential for persons with complex care needs.

Care Transitions InterventionThe Care Transitions Intervention (CTI)[8] is a coaching intervention to assist patients in resuming self-care following a change in health status. It uses coaching techniques to ensure that patients are comfortable in managing their own medications and their own health information, understand the signs and symptoms that should lead them to contact a healthcare provider, and have assertion skills to ask important questions of providers. Although the coaching intervention occurs for the first 30 days following the transition, this approach has been shown to significantly reduce hospital readmission as far out as 6 months.[9]

TurfingTurfing is where a healthcare provider transfers a patient they could have taken care of to another provider in order to reduce their own patient load.[10] According to one study in the US, 9 percent of physicians admitted that they had transferred a patient in such manner.[11]

Continuity of health careContinuity of health care (also called continuum of care[2]) is to what degree the care is coherent and linked, in turn depending on the quality of information flow, interpersonal skills, and coordination of care.[3] Continuity of health care means different things to different types of caregivers, and can be of several types:

Continuity of information. It includes that information on prior events is used to give care that is appropriate to the patient's current circumstance.[3]Continuity of personal relationships, recognizing that an ongoing relationship between patients and providers is the undergirding that connects care over time and bridges discontinuous events.[3]Continuity of clinical management.[3]To avoid misinterpretation, the type of continuity should be agreed to before any related discussions or planning begin.[3] Seamless care refers to an optimal situation where there is continuity in the healthcare even in the presence of many transitions.[2]Analysis of medical errors usually reveals the presence of many gaps in health continuity, yet only rarely do gaps produce accidents.[4] Patient safety is increased by understanding and reinforcing health care providers' normal ability to bridge gaps.[4]meaning N orms are standards that guide, control, and regulate individuals and communities. For planning nursing Manpower we have to follow some norms. The nursing norms are recommended by various committees, such as; the Nursing Man Power Committee, the High-power Committee, Dr. Bajaj Committee, and the staff inspection committee, TNAI and INC.INDIAN NURSING COUNCIL :INDIAN NURSING COUNCIL ownership of the hospital, resources of the hospital, type of the hospital and level of care it provides, size of the hospital and community it serves, hours and pattern of work, type of building and premises plan, and other variables like level of technology, automation and researchStaffing Norms For Nursing Staff And Nursing Supervisors :Staffing Norms For Nursing Staff And Nursing Supervisors Nursing Superintendent 1:1per hospital Dy. Nursing Supdt . 1 upto 400 beds Asstt . Nursing Supdt . 1 for every 200 beds Ward Sisters 1 for 100-150 bedsCont..:Cont.. Staff Nurse 1 nurse for 3 beds Teaching hospital1 nurse for 5 beds Non-teaching hospital1 nurse for 3 beds For ICU/CCU 1 nurse for 1 beds

Accurate Pressure Meter Air Cleaner Alternating Pressure Bed Ambulatory Infusion Pump Apnea Alarm Apnea Monitor Aspiration Pump Aspirator, Emergency Aspirator, Surgical Automatic Chest Compressor BBed, Pediatric Bilirubinometer Blood Gas Analyzer Blood Gas Monitor Blood Pressure Monitor Blood Warmer Breathing Monitor Bronchoscope CC-Arm Cardiac Output Computer CO2 Monitor CPAP DData Management System, Anesthesia EEar Thermometer ECG ECG Holter ECG R-Wave Trigger ECG Scanner EEG Monitor Electrolyte Analyzer Emergency Cart Endoscope Light Source ESR Measurement Device Exam Light External Automated Defibrillator External Defibrillator External Pacemaker External Pacemaker Tester

FFeeding Pump Fractional Flow Reserve Information System GGlucose Monitor HHemodialysis Machine High Resolution Medical Video Monitor Human Anatomy Model Hyperbaric Chamber Hypothermia Unit IIce Maker & Storage ICP Monitor Infant Scale Infant Warmer Infusion Pump Injector for Measuring Cardiac Output Intermittent Compression Unit Intra Aortic Balloon Pump LLaboratory Glucose Analyzer Laparoscope Laryngeal Mask

MManual Wheelchair Mediastinoscope Medical Gas Monitor Medication Management System Medicine Cart Mist Tent Mobile X-ray Motorized Wheelchair Motorized X-ray View-box NNebulizer OOperating Room Monitor Ophthalmic Viewer Osmometer Oxygen Mixer Oxygen Monitor PPassive Motion Exerciser, Limbs Patient Hoist Patient Monitor Patient Monitor Module Patient Scale Patient Warmer pH Meter Phototherapy Unit Portable ECG Powered Wheelchair Practice Management System Pulse Oximeter Pump IV RRespiratory Volume Calibration Syringe Resuscitators and Emergency Kits

RRespiratory Volume Calibration Syringe Resuscitators and Emergency Kits SScale, Chair Single Channel ECG Sphygmomanometer Spirometer Stretcher Suction Regulator Syringe Pump TTelemedicine System Telemetry Monitor Temperature Monitor Temperature Regulation System Test Lung Thermometer Tourniquet Training Manikin Transport Ventilator UUltrasonic Blood Flow Detector Ultrasound, Cardiac Ultrasound, Portable VVentilator, Intensive Care Ventilator, Pediatric Ventilator, Portable Ventricular Assist Device Video Conferencing Equipment Warming Cabinet

Ethical & legal aspectscommunicationVerbal

nonverbalIntensive care recordsThank you