Caccn STND Crit Care 2009
Caccn STND Crit Care 2009
Caccn STND Crit Care 2009
Standards for
Critical Care
Nursing Practice
4th edition
We gratefully acknowledge the dedication and contribution of the CACCN members who participated
in this project:
Acknowledgement
The Standards Revision Committee would like to thank the contributors to the previous three editions
of the Standards for Critical Care Nursing Practice. Their work and dedication to critical care nursing
in Canada have provided the foundation on which this edition is built.
The Committee would also like to recognize the invaluable support of the CACCN Board of
Directors, Chapter Presidents and members throughout the completion of this document.
Special thanks to Steve B. Gagn, BSN, CNCC(C), for providing French translation of the Standards.
And further thanks to those who provided expert review:
Patricia Benner, RN, PhD, FAAN, FRCN
Franco Carnevale, RN, PhD
Donalda Dyjur, RN, BScN
Mary Lou King, RN, PhD
Gail Liggett, RN, MN, CNCC(C)
Brenda Lynn Morgan RN, BScN, MSc CNCC(C)
Major Andrea Schmaltz, RN, BScN, Canadian Forces
And Paula Price, RN, PhD for her editorial skills.
The publication of the CACCN Standards for Critical Care Nursing Practice would not be possible
without the generous support of our corporate sponsors:
Baxter Medical
Edwards Lifesciences
Table of Contents
Standards for Critical Care Nursing Practice and Philosophical Statement of Critical Care Nursing ....1
Standard 1 ........................................................................................................3
Standard 2 ........................................................................................................4
Standard 3 ........................................................................................................5
Standard 4 ........................................................................................................6
Standard 5 ........................................................................................................7
Standard 6 ........................................................................................................8
Standard 7 ........................................................................................................9
Bibliography ..........................................................................................................................................11
Philosophical Statement
of Critical Care Nursing
Critical care nursing is a specialty which exists to care for patients who are experiencing life-threatening
health crises within a patient/family centred model of care. Nursing the critically ill patient is continuous
and intensive, aided by technology. Critical care nurses require advanced problem-solving abilities using
specialized knowledge regarding the human response to critical illness.
The critical care nurse, works collaboratively within the interprofessional team, and is responsible for
coordinating patient care using each members unique talents and scope of practice to meet patient and
family needs. Each patient has the right to receive care based on his/her personal preferences. The
critically ill patient must be cared for with an appreciation of his or her wholeness, integrity, and relation
to family and environment. Critical care nurses plan, coordinate and implement care with the health care
team to meet the physical, psychosocial, cultural and spiritual needs of the patient and family. The
critical care nurse must balance the need for the highly technological environment with the need for
safety, privacy, dignity and comfort.
Critical care nurses are at the forefront of critical care science and technology. Lifelong learning and the
spirit of enquiry are essential for the critical care nurse to enhance professional competencies and to
advance nursing practice. The critical care nurses ability to make sound clinical nursing judgments is
based on a solid foundation of knowledge and experience.
The terms nurse and critical care nurse throughout the document refer specifically to registered
nurses. The following are standards for critical care nursing in Canada.
Standard 1
Critical care nurses use advanced skills and specialized knowledge to continuously assess,
monitor and manage patients for the promotion of optimal physiological balance.
Criteria:
The critical care nurse:
1.1 Gathers physiological, psychosocial, cultural, developmental and spiritual data
based on the patients condition using all available and appropriate resources.
1.2 Analyzes and validates data from multiple sources to inform decisions about
patient/family needs.
1.3 Makes decisions about priorities of care in life-threatening and non life-threatening
situations.
1.4 Integrates all findings from the assessment to identify a collaborative and/or an
independent plan of care.
1.5 Coordinates and implements the plan of care within the individuals scope of
practice.
1.6 Anticipates, prevents, prepares for, recognizes, and intervenes in life-threatening
situations.
1.7 Manages multiple therapies in the context of ever-changing patient needs.
1.8 Monitors and evaluates the effectiveness of interventions within an appropriate
time frame, revising therapies as necessary to achieve expected outcomes.
Standard 2
Critical care nurses promote and facilitate optimal comfort and well-being in a highly
technological environment that is often unfamiliar to patients and families.
Criteria:
The critical care nurse:
2.1 Manages the environment to mitigate the effects of noxious stimuli.
2.2 Discerns among pain, anxiety and delirium as the source of discomfort and implements
individualized therapies (pharmacological and non-pharmacological) to prevent and/or
alleviate suffering.
2.3 Preserves the dignity of each individual by respecting his/her personal privacy and
individual diversity including age, ethnicity, spiritual beliefs, gender, marital status,
sexual orientation, lifestyle and socio-economic status.
2.4 Communicates information in a manner that maintains realistic hope and that is
appropriate to the patients/familys needs, stage of development and level of
understanding.
Standard 3
Critical care nurses foster mutually beneficial partnerships with patients and families based on
trust, dignity, respect, communication and collaboration. Family is defined by the patient.
Criteria:
The critical care nurse:
3.1 Gathers data concerning patient/families needs and responses to the critical care
experience and accesses appropriate resources to address identified concerns.
3.2 Shares information with patients/families in an open, accurate, honest manner to
establish a plan of care and assist in decision-making.
3.3 Seeks out, listens to, and honours patient and family perspectives when planning
and delivering care.
3.4 Advocates for patients and families to address their expectations and needs.
3.5 Provides family members with open access to the patient, respecting the need
for privacy as the environment and situation allows.
Standard 4
When providing care in a high risk environment, critical care nurses participate in safety
initiatives and adhere to best practice.
Criteria:
The critical care nurse:
4.1 Integrates data to anticipate, prevent, and recognize injury or dysfunction that may
contribute to a life-threatening health crisis or long term alteration in health.
4.2 Documents patient care and its ongoing evaluation in a clear, concise, accurate
and timely manner while respecting the privacy and confidentiality of health and
personal information.
4.3 Seeks out and incorporates patient and family feedback into quality improvement
activities.
4.4 Uses quality improvement findings to inform change for nursing practice and
health care delivery.
4.5 Advocates for adequate numbers of knowledgeable and skilled critical care nursing
staff to ensure safe and humane care for patients based on the complexity of care
required.
Standard 5
When life sustaining technologies are no longer beneficial, critical care nurses support patients
and families through the transition from active treatment to a peaceful death.
Criteria:
The critical care nurse:
5.1 Promotes the discussion of advanced care directives with the patient and/or the family.
5.2 Collaborates with the patient and family to identify available resources that will
provide support during end of life care.
5.3 Identifies potential candidates for tissue and organ donation.
5.4 Accesses appropriate resources to guide ethically complex situations and foster
effective coping strategies and possible resolutions.
5.5 Maintains ongoing communication with the family and health care team about the
end of life plan of care.
Standard 6
The critical care nurse promotes collaborative practice in which the contribution of the
patient, family and each health care provider is solicited, acknowledged and valued in a
non-hierarchical manner.
Criteria:
The critical care nurse:
6.1 Explains and promotes his/her roles and responsibilities to patients, families and
other health care providers.
6.2 Demonstrates effective interpersonal communication, negotiation and conflict
resolution skills to promote positive collegial relationships.
6.3 Accepts accountability for his/her autonomous professional contributions and
collaborates to determine the best care provider based on respect for the unique roles,
responsibilities and shared competencies.
6.4 Emphasizes the value of shared responsibility in decision making and supports
the use of shared leadership and coordinating roles.
6.5 Consults with appropriate individuals to establish/review the plan of care and
promote continuity of care.
Standard 7
Critical care nurses provide leadership by fostering a critical care culture conducive to
collaboration, quality improvement, safety, professional growth and responsible resource
utilization.
Criteria:
The critical care nurse:
7.1 Incorporates professional, legal, ethical and critical care standards into practice.
7.2 Maintains critical care and professional competency by engaging in reflective practice,
by self-assessment of learning needs, and by participating in educational activities.
7.3 Promotes research, evidence informed practice and dissemination of nursing
knowledge.
7.4 Acts as a resource person, educator, role model, advocate and/or mentor for
students, peers and health care providers.
7.5 Contributes to and supports initiatives that enhance the critical care environment
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