CRITICAL CARE

NURSING
 CRITICAL CARE UNIT
Critical care unit is not merely a room or series
of rooms filled with patients attached with
interventional technology , it is the home of an
organization : the critical care team
 CRITICAL CARE NURSING
Critical care nursing is that specialty with in
nursing that deals specifically with human
responses with life threatening problems.
 7 C”s OF CRITICAL CARE
• Compassion
• Communication
• Consideration of(patients , relatives and
colleagues) and avoidance of conflict
• Comfort: protection of patient from suffering
 7 C”s OF CRITICAL CARE
• Carefulness : Avoidance of injury
• Consistency (of observation and care)
• Closure (Ethics and withdrawal of treatment)
 CRITICAL CARE NURSE

Critical care nurse is a Licensed professional

nurse who is responsible for ensuring that
acutely and critically ill patients and their family
receive optimal care.
 CRITICAL CARE UNIT
Critical care unit is a specially designed and
equipped facility staffed by skilled personnel to
provide effective and safe care for patients with
a life – threatening problems that is potentially
Reversible.
EVOLUTION OF CRITICAL CARE NURSING

Critical care units evolved over the last many

decades in response to medical advances
 HISTORICAL PERSPECTIVE
 Florence Nightingale recognized the need to
consider the severity of illness for bed
allocation of patients and she placed the
seriously ill patients near the nurses station.
 In 1923,John Hopkins university hospital
developed a special care unit for
neurosurgical patients.
 After world war II: Modern medicines ,
concept of triage and specialty nursing came
into existence.
 HISTORICAL PERSPECTIVE
 As surgical technique advanced , it became
necessary that post-operative patients
required careful monitoring and this brought
about the recovery room.
 In 1950,the epidemic of poliomyelitis
necessitated thousands of patients requiring
respiratory assist devices and intensive
nursing care.
 At the same time came about new horizons
in cardiothoracic surgery, with refinements in
intraoperative membrane oxygen techniques.
 HISTORICAL PERSPECTIVE
 Late 1950 s-beginning of critical care units
 1961- Ist specialized ICU- The coronary care
unit
 Emergence of specialized ICUs
LEVELS OF ICU
 LEVEL I ICU
• Referred to as high dependency
• Resuscitation , short term mechanical
ventilation and simple invasive cardiovascular
monitoring for < 24hrs
 LEVEL II ICU
• Located in general hospital undertake more
prolonged ventilation
• Provide a high standard of general intensive
care , including complex multi-system life
support
 LEVEL III ICU
• Tertiary referral units for Intensive care
patients
• Provides comprehensive critical care including
complex multi-system life support for an
indefinite period
• Demonstrated commitment to academic
education and research
ROLES AND RESPONSIBILITIES OF CRITICAL
CARE NURSE
• Assessing a patients condition and planning
and implementing patient care plans
• Provides direct comprehensive bedside care to
patients
• Treating wounds and providing advanced life
support
• Assisting physicians in performing procedures
 Able to attach equipments on patients as
ordered and interprets the data , graphs on
monitors etc.
 Observing and recording patients vital signs
 Ensuring that ventilators , monitors and other
types of medical equipment function properly
 Administering intravenous fluids and
medications
 Collaborating with fellow members of the
critical care team
 Responding to life-saving situations ,using
nursing standards and protocols for treatment
 Acting as patient advocate
 Documents appropriately
 Ensures patient safety
 Follows the policies and procedures of the
unit and the institution
 Is an expert in nursing
knowledge and practice
 Promotes quality assurance in nursing
 Providing education and support to families
 PRINCIPLES OF CRITICAL CARE NURSING

Anticipating nursing care

Early detection and prompt treatment
Expertise
Supportive care
Communication
Collaborative practice
Preservation of patients physiological defenses
Prevention of Infection
Crisis intervention
Stress reduction
Ethical principles
ORGANIZATIONAL MODELS OF ICU
STAFFING
 STAFFING
• Medical staffing ,including an ICU Director/
Intensivist , with sufficient experience to
provide for patient care , Administration ,
teaching , research , Audits etc.
• Trained nursing staff: 1:1 for ventilated
patients and 1:2 for other patients , Nurse in
charge with ICU qualification
 Allied health and ancillary staff : Respiratory
services , physiotherapist ,dietician , bio-
medical Engineer , technicians , computer
programmer, social worker ,counselor , House
keeping staff etc.
ICU EQUIPMENTS
ORGANIZATION/DESIGN OF ICU
 ORGANIZATION OF CCU
• It requires intelligent planning
• One must keep the need of the hospital and
its location
• One ICU may not cater to all needs
• An institute may plan beds into multiple units
under separate management by single
discipline specialized such as medical ICU ,
surgical ICU , CCU , Burns ICU , Trauma ICU etc.
 The number of beds in a hospital ranges from
2 to 20% of the total number of the hospital
beds . ICUs with fewer than the recommended
number of beds are not cost effective and excess
beds are unmanageable.10% of total ICU beds
are allotted towards Isolation room.
 ORGANIZATION OF ICU

Each Intensive care unit should be a

geographically distinct area within the hospital
with controlled access
 No through traffic to other departments should
occur
 Supply and professional traffic should be
separated from public/visitor traffic
 ORGANIZATION OF ICU
Location should be chosen so that the unit is
adjacent to, or within direct elevator travel to
and from , the Emergency department ,
Operating room , Intermediate care units and
Radiology department
 Corridors , lifts and ramps should be spacious
enough to provide easy movement of bed trolley
of a critically sick patient.
 ORGANIZATION OF ICU
Bed space:
 [Link]. area per open bed with
8ft. Between beds
 225-250 [Link]. area per bed if in a
single room . Beds should be adjustable
with side rails and wheels, no head board
should be there
ORGANIZATION OF ICU
Isolation Room 250 [Link]
 PATIENT AREAS
 3 oxygen outlets,3 suction outlets(gastric ,
tracheal and under water seal), 2 compressed
air outlets and 16 power outlets per bed
 Bed side storage , hand rinse solution ,
equipment shelf on head end
 Storage must be provided for each patients
personal belongings , patient care supplies ,
linen and toiletries
• Locking drawers and cabinets must be used if
syringes and pharmaceuticals are stored at the
bedside.
• Hooks and devices to hang infusions /blood
bags extended from the ceiling with a sliding
rail to position
 PATIENT AREAS
 Multi- channel invasive monitors , ventilators ,
infusion pumps , portable x-ray unit , fluid and
bed warmers , portable light , defibrillators ,
Anesthesia machines and difficult airway
management equipment's are necessary
 A cardiac arrest /emergency alarm button
must be present at every bed side within the
ICU.
 The alarm should be automatically sound in
the hospital telecommunications center , central
nursing station , ICU conference room , staff
lounge, and any on-call rooms.
 THERAPEUTIC ELEMENTS IN ICU
ENVIRONMENT
 Window and art that provide natural views,
views of nature can reduce stress , hasten
recovery , lower blood pressure and lower
pain medication needs
 Family participation, including facilities for
overnight stay and comfortable waiting rooms
 Providing a measure of privacy and personal
Control through adjustable curtains and blinds
, accessible bed controls
Noise reduction through computerized pagers
and silent alarms
Medical team continuity that allows one team
to follow the patient through his or her entire
stay
CENTRAL NURSING STATION
 CENTRAL NURSING STATION
 Patients must be situated so that direct or
indirect ([Link] video monitor) visualization by
health care providers is possible at all times .
This permits the monitoring of patient status
under both routine and emergency
circumstances .The preferred design is to allow
a direct line of vision between the patient and
the central nursing station.
 CENTRAL NURSING STATION
• In ICUs with a modular design, patients should
be visible from their respective nursing
substation.
 CENTRAL NURSING STATION
Sliding glass doors and partitions facilitate this
arrangement, and increase access to the room in
emergency situations
X-RAY VIEWING AREA
WORK AREAS AND STORAGE
EQUIPMENT STORAGE
SPECIAL PROCEDURE ROOM
RECEPTION AREA
CLEAN UTILITY ROOM
DIRTY UTILITY ROOM
PANTRY
STAFF LOUNGE
CONFERENCE ROOM
PATIENT TRANSPORTATION
VISITORS LOUNGE OR WAITING AREA
SUPPLY AND SERVICE CORRIDORS
PATIENT MODULES
EACH INTENSIVE CARE UNIT MUST HAVE

• Electric power
• Water supply
• Oxygen, Compressed air, Vacuum
• Lighting
• Environmental control systems
ELECTRIC SUPPLY
WATER SUPPLY
ENVIRONMENTAL CONTROL SYSTEMS
COMPUTERIZED CHARTING
OTHER FACILITIES