A. General information 1.

Critical care nursing deals with human responses to life-threatening problems and includes the critically ill patient, the critical care nurse, and the critical care environment. 2. It is the field of nursing with a focus on the care of the critically ill or unstable patients. 3. Care is provided to patients of all ages with alterations in physical or emotional health. 4. The critical care nurse coordinates interventions aimed at resolving life-threatening problems. 5. Critical care nurses can be found working in a wide variety of environments and specialties, such as emergency departments and the intensive care units. B. Critically Ill Patient 1. Critically ill patients are defined as those patients who are at high risk for actual or potential life-threatening health problems. 2. The critically ill patient is at high risk for developing life-threatening problems and requires constant, intensive, multidisciplinary assessment and intervention to restore stability, prevent complications, and achieve and maintain optimal responses 3. 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. C. History of Critical Care Nursing 1. Critical care began as a component of recovery rooms before expanding into coronary care units in the 1960s 2. The American Association of Critical-Care Nurses (AACN) was organized in 1969 3. A competency-based examination was developed in 1975 to provide certification in critical care nursing; certification is valid for 3 years; available for adult, neonatal, and pediatric certification 4.The AACN developed Standards for Nursing Care of the Critically Ill in 1981 to explain the role of the critical care nurse in ensuring quality care for critically ill patients and their families C. Critical care environment 1. Units may be specially designated as medical, surgical, coronary, pediatric, neonatal, recovery, or postanesthesia or may encompass other areas in some institutions 2. Adequate resources (emergency equipment, supplies, and support systems) are necessary for safe care 3. A management and administrative structure is required to ensure effective care through all phases of the patients hospital stay, from emergency department to discharge 4. Legal, regulatory, social, economic, and political trends must be monitored to promote the early recognition of problems and a timely response 5. Specialized electronic technology and techniques are used to monitor patient status continuously; these may create safety hazards for patients, such as possible exposure to electric shock

D. Roles of the critical care nurse 1. Care provider: provides comprehensiveand at times highly technicaldirect care to the patient and family in response to life-threatening health problems 2. Educator: provides patient and family with education based on their learning needs and the severity of the situation and allows the patient to assume more responsibility for meeting healthcare needs as health condition stabilizes or improves 3. Manager: coordinates the care provided by various health care workers to achieve the specific goal of providing optimal nursing care to critically ill patients 4. Advocate: protects the patients rights E. Functions of the critical care nurse 1. Assesses and implements treatment for patient responses to life-threatening health problems 2. Provides direct measures to resuscitate, if necessary 3. Uses independent, dependent, and interdependent interventions to restore stability, prevent complications, and achieve and maintain optimal patient responses 4. Provides health education to the patient and family 5. Supervises patient care and ancillary personnel 6. Supports patient adaptation, restores health, and preserves the patients rights, including the right to refuse treatment F. Legal issues affecting the provision of critical care nursing 1. Negligence 2. MALPRACTICE 3. INFORMED CONSENT 4. Implied consent 5. Advanced directives, including DURABLE POWER OF ATTORNEY and living wills G. Qualifications of a Critical Care Nurse 1. To become a registered nurse (RN), an individual must earn a diploma in nursing, an associates degree in nursing (ADN) or a bachelors degree in nursing (BSN) and pass a national licensing exam. 2. Requirements vary and are dictated by each states Board of Nursing. Many nursing schools offer students exposure to critical care, but most of a critical care nurses specialty education and orientation is provided by the employer. Advanced practice nurses must earn a degree at the masters or doctoral level. 3. Although certification is not mandatory for practice in a specialty like critical care, many nurses choose to become certified. Some employers prefer to hire certified nurses because they have demonstrated acquisition of a specific high level of knowledge in their specialty through successful completion of a rigorous, psychometrically valid, job-related examination. 4. Certification examinations test critical care knowledge primarily at the application/analysis level, which indicates strong critical thinking abilities.

5. A required number of clinical hours in the specialty are also an examination prerequisite. Certified nurses validate their continuing knowledge of current practices in critical care nursing through a renewal process every three years, which includes meeting extensive continuing education and clinical experience requirements. 6. Certified critical care nurses (CCRN) must have been in critical care practice for a minimum of two years to be eligible for the examination.