Intensive care nursing unit one week one

Education

1. INTENSIVE CARE NURSING
INSTRUCTOR
THADDEUS. C. UGWUIBE

2. COURSE DESCRIPTION
Thiscoursewillpreparethestudentwithbasicknowledgeandskillsinordertoappraise,assessand
managecriticallyillpatients.
Criticallyanalyzetheoryandknowledgeinordertoinformandinfluenceclinicalpractice,and
supportthephysicalandpsychosocialwell-beingofcriticallyillpatients.Thisinvolvesintensivecare
unitportrayal,patientassessmentandmonitoring,commonpatientneeds,theirgeneralmanagement.
Thestudentwilllearnhowtocommunicatewithcriticallyillpatientsandtheirfamilies,howto
documentandreportpatientdata.Theywillalsogainpracticalexperienceondifferentmonitoring
techniquesandbasicpatientmanagement

3. INTRODUCTION
Intensivecareunits(ICU)arethemostexpensive,technologicallyadvancedandresource-intensive
areaofmedicalcare.Becausetheyprovidepotentialbenefitatgreatpersonalandpubliccost,the
intensivecareunitandtheinterventionsrenderedthereinhavebecomesymbolsofboththe
promiseandthelimitationsofmedicaltechnology.
ICUisusuallyonlyofferedtothosepatientswhoseconditionsispotentiallyreversibleandwhohave
agoodchanceofsurvivingwithintensivecaresupport.Itinvolvesclose,constantattentionbya
teamofspeciallytrained–trainedhealthprofessionals.Theconceptofintensivecareunitsevolved
fromthehistoricalrecognitionthattheneedsofpatientswithacute,lifethreateningillnessorinjury
couldbebettermetiftheyweregroupedintospecificareasofthehospital.

4. HistoricalPerspective
Thereisunprecedenteddemandforcriticalcareservicesglobally.Inourregion,thereare
approximately119,000admissionsto141generalintensivecareunits(ICUs)inAustraliaperyear;
thisincludes5500patientreadmissionsduringthesamehospitalepisode.InNewZealand,thereare
18,000admissionsperyearto26ICUs,including500re-admissions.1Patientsadmittedtocoronary
care,pediatricorotherspecialtyunitsnotclassifiedasageneralICUarenotincludedinthese
figures,sotheoverallclinicalactivityfor‘criticalcare’ismuchhigher(e.g.therewerealso5500
pediatricadmissionstoPICUs).Importantly,criticalcaretreatmentisahighexpensecomponentof
hospitalcare;oneconservativeestimateofcostexceeded$A2600perday,withmorethantwo-
thirdsgoingtostaffcosts,onefifthtoclinicalconsumablesandtheresttoclinicalsupportand
capitalexpenditure. (“ACCN’sCriticalCareNursing2
nd
Edition”)

5. IntheUnitedStatesandotherEuropeandevelopedcountriesforapproximately50yearsnow,ICU
hasexisted.Theyevolvedfrompostoperativerecoveryunit,thefirstofwhichwasestablishedfor
neurosurgicalpatientsattheJohnsHopkinsHospitalinBaltimorein1923.
ThedemandforrecoveryunitsincreasedduringWorldWar11,withthedevelopmentoffield
hospitalsandnewsurgicaltechniquesthatkeptpatientsalivebutrequireprolongedrecovery.The
OchsnerClinicinNewOrleansopenedarecoveryunitin1947sothatpatientsundergoing
complicatedprocedures,suchaspneumonectomyandesophagogastrostomy,couldbemaintained
aftersurgery.Thisandotherrecoveryunitsweretheforerunnersoftoday’ssurgicalICUs.

6. ThefirstmedicalICUswerecreatedprimarilytocareforpatientswithrespiratoryfailurecaused
bypoliomyelitisandotherneuromusculardiseases.Thefirstcoronarycareunits(CCUs)were
establishedin1962atTorontoGeneralHospital,BethanyHospitalinKansascityandpresbyterian
hospitalinPhiladelphia.Theseandtheotherunitsthatfollowedwerebasedinlargeparton
advancesinelectrocardiographicmonitoring,whichrevealedthatpotentiallytreatmentarrhythmias
oftencausedbydeathinpatientswithmyocardialinfractionsandonresuscitativetechniquesthat
couldbestbeusedinsuchpatientsiftheywerecloselymonitored.Specializedunitsforneonataland
pediatricspatients,patientswithburnsandneurosurgicalproblemsandpatientsrecoveringfrom
heartsurgeryweredevelopedaftertheSICUs,MICUs,CCUswereestablished.

7. DEFINITION
Intensivecare/Criticalcareasaspecialtyinnursinghasdevelopedoverthelast30years.Importantly,
developmentofitsspecialtyhasbeeninconcertwithdevelopmentofintensivecaremedicineasadefined
clinicalspecialty.CriticalcarenursingisdefinedbytheWorldFederationofCriticalCareNursesas:
Specializednursingcareofcriticallyillpatientswhohavemanifestorpotentialdisturbancesofvitalorganfunctions.
Criticalcarenursingmeansassisting,supportingandrestoringthepatienttowardshealth,ortoeasethepatient’s
painandtopreparethemforadignifieddeath.
IntensiveCareNursing(alsocalledCriticalCareNursing)isaspecializedareaofnursingthatfocuseson
providingcontinuousandcomprehensivecaretopatientswhoarecriticallyillorunstableandrequire
closemonitoring,advancedmedicalinterventions,andlifesupportsystems.

8. Theaimofcriticalcarenursingistoestablishatherapeuticrelationshipwithpatientsandtheir
relativesandtoempowertheindividuals’physical,psychological,sociological,culturalandspiritual
capabilitiesbypreventive,curativeandrehabilitativeinterventions.Therewasalsorecognitionthat
improvingpatientoutcomesthroughoptimaluseofthistechnologywaslinkedtonurses’skillsand
staffinglevels.Theroleofadequatelyeducatedandexperiencednursesintheseunitswasrecognized
asessentialfromanearlystage,andledtothedevelopmentofthenursingspecialtyofcriticalcare.
Criticallyillpatientsarethoseathighriskofactualorpotentiallife-threateninghealthproblems.
Careofthecriticallyillcanoccurinanumberofdifferentlocationsinhospitals.criticalcareis
generallyconsideredabroadterm,incorporatingsubspecialtyareasofemergency,coronarycare,
highdependency,cardiothoracic,pediatricandgeneralintensivecareunits.

9. DEVELOPMENTOFINTENSIVECARENURSING
DevelopmentofIntensivecarenursingwascharacterizedbyanumberoffeatures,including:
●thedevelopmentofanew,comprehensivepartnershipbetweennursingandmedicalclinicians
●thecollectiveexperienceofasteeplearningcurvefornursingandmedicalstaff
●thecouragetoworkinanunfamiliarsetting,caringforpatientswhowereextremelysick–arolethat
requireddevelopmentofhigherlevelsofcompetenceandpractice
●ahighdemandforeducationspecifictocriticalcarepractice,whichwasinitiallydifficulttomeetowingto
theabsenceofexperiencednursesinthespecialty
●thedevelopmentoftechnologysuchasmechanicalventilators,cardiacmonitors,pacemakersdefibrillators,
dialysers,intra-aorticballoonpumpsandcardiacassistdevices,whichprompteddevelopmentofadditional
knowledgeandskills.

10. Objectives of Intensive Care Nursing
•Provide continuous and specialized nursing care to critically ill patients.
•Monitor and maintain vital functions (cardiac, respiratory, renal, and neurological).
•Assist in the use of life-support equipment such as ventilators and cardiac monitors.
•Prevent and manage complications through early recognition and intervention.
•Collaborate effectively with the multidisciplinary ICU team (doctors, respiratory therapists,
physiotherapists).
•Support patients’ families through clear communication and emotional guidance.

11. ScopeofIntensiveCareNursing
Intensivecarenursingcoversawiderangeofclinicalareas,including:
•MedicalICU(MICU)
•SurgicalICU(SICU)
•CoronaryCareUnit(CCU)
•NeonatalICU(NICU)
•PediatricICU(PICU)
•NeuroandTraumaICUs
Each area requires specialized knowledge, technical skills, and
emotional resilience. As the practice of critical care nursing evolved,
so did the associated areas of critical care nursing education and
specialty professional organisations such as the Australian College of
Critical Care Nurses (ACCCN). The combination of adequate nurse
staffing, observation of the patient and the expertise of nurses to
consider the complete needs of patients and their families is essential
to optimize the outcomes of critical care. As critical care continues
to evolve, the challenge remains to combine excellence in nursing
care with judicious use of technology to optimize patient and family
outcomes.

12. Characteristics of Intensive Care Nursing
•High level of vigilance and observation
•Advanced assessment and technical skills
•Quick and accurate decision-making
•Ability to work under stress
•Strong communication and teamwork skills
•Ethical sensitivity and emotional stability

13. Roles and Responsibilities of an ICU Nurse
As the discipline of critical care has developed, so too has the range of roles performed by specialty critical
care nurses.
•Patient Assessment and Monitoring
•Continuous observation of vital signs and clinical parameters.
•Recognizing early signs of deterioration.
•Implementation of Medical Orders and Interventions
•Administering IV medications, blood transfusions, and managing infusions.
•Operating and maintaining advanced life-support equipment.
•Maintaining Infection Control and Patient Safety
•Strict adherence to aseptic techniques.
•Preventing hospital-acquired infections.
•.

14. •Documentation and Communication
•Accurate charting of patient data.
•Reporting promptly to physicians and team members.
•Family Support and Education
•Providing updates, emotional support, and education to family members.
•Ethical and Legal Accountability
•Maintaining patient confidentiality and informed consent.
•Participating in end-of-life care and decision-making discussions

15. CRITICAL CARE NURSING PROFESSIONAL ORGANISATIONS
Professional leadership of critical care nursing has undergone considerable development
in the past three decades. Within Australia, the ACCCN (formerly the Confederation of
Australian Critical Care Nurses) was formed from a number of preceding state-based
specialty nursing bodies (e.g. Australian Society of Critical Care Nurses, Clinical Nurse
Specialists Association) that provided professional leadership for critical care nurses since
the early 1970s. In New Zealand, the professional interests of critical care nurses are
represented by the New Zealand Nurses Organization, Critical Care Nurses Section, as
well as affiliation with the ACCCN. The ACCCN has strong professional relationships
with other national peak nursing bodies, the Australian and New Zealand Intensive Care
Society (ANZICS), government agencies and individuals, and healthcare companies.

16. Professional organizations representing critical care nurses were formed as
early as the 1960s in the USA with the formation of the American
Association of Critical Care Nurses (AACN). Other organizations have
developed around the world, with critical care nursing bodies now operating
in countries from Australasia, Asia, North America, South America, Africa and
Europe. In 2001 the inaugural meeting of the World Federation of Critical
Care Nurses (WFCCN) was formed to provide professional leadership at
an international level.3