NCM 118 Lecture 1st Sem

CARE OF CLIENTS WITH LIFE-THREATENING
CONDITIONS, ACUTELY ILL/MULTI-ORGAN

PROBLEMS, HIGH ACUITY AND EMERGENCY
SITUATIONS, ACUTE AND CHRONIC
NCM 118
INTRODUCTION TO CRITICAL CARE
 A. Scope of Critical Care Practice
 Critical care nursing is subspecialties of medical surgical

nursing. The reason of being of “Nursing” in any
setting is the provision of holistic nursing care.
 Actual or future emergencies for nursing care recipients

are described by the word "Critical" -
 Critical – is defined as pertaining to a crisis, involving
danger or risk.
 Critical care practice areas began to develop in the late

1960’s in response to:
 A. Developments in medical science and technology

 B. Related changes in community values and attitudes.
DEFINITION
 The American Nurses Association defined Critical Care Nursing as:
 “The diagnosis and treatment of human response to actual

or potential health
problem.”
 In 1984 the American Association of Critical Care Nurses
(AACN) defined Critical Care Nursing'-
 “Critical care Nursing is that specialty within nursing that

deals specifically with human responses to life- threatening
problems”
 Analysis of these definitions reveals several important concepts.
 The basis of the definition rests with the words human responses
CRITICAL CARE NURSING THEORY
 Critical care nurses deal with;
 a- The total human being
 b- His or her response to actual and potential health problems.
 - This suggests that the critical care nurse is involved with prevention as
well as cure.
 - Additionally, human response can take the form of ;


a- a physiological phenomenon.
 b- a psychological phenomenon.
 Example, a critical care nurse can teach patient methods to lower blood
cholesterol level, which may prevent a life-threatening problem.

SCOPE OF CRITICAL CARE NURSING PRACTICE
 A scope of practice statement provides a

framework within which an individual can
provide a particular service.
 The AACN’s Scope of Critical Care Nursing

Practice statement provides a definition and description
of the practice of critical care nursing.
 The scope of critical care nursing practice is described as

a dynamic process with three components:
3 COMPONENTS:
 1- The critically ill patients and their significant
social relationship.
 2- The critical care nurse.
 3- The environment 0here critical care nursing is practiced
 Central to the scope are nurse-patient interactions.

THE GOAL OF CRITICAL CARE NURSING
IS;
 To ensure effective interaction of these three

requisite elements to affect competent nursing practice
and optimal patient outcomes.
1. Critical Ill Patient

Critical care patients share one or more of a number of
defining characteristics:
A,- A significant health breakdown problem which is life
threatening.
 B- Biophysiological health breakdown problems of such
acuity and or chronicity that they may lead to
extraordinary dependence on health
care providers, and possibly technology for healthmainte
nance or life support.
 The American Association of Critical Care Nurses

(AACN) described the critically ill patient as follows:
 “The critically ill patient is characterized by the presence of
actual and or potential (being at risk for developing) life-
threatening health problems.”
 - The needs of these patients require continuous assessment
(observation) and intervention to restore health and prevent
complications.
 - As man is bio-psychosocial being the concept of the critically
ill patient includes the family and or significant others.
 - The needs of the critically ill are considerable. These needs
may be categorized as physical or non-physical.
1. PHYSICAL NEEDS
are equated with basic physiological or biological needs for example,
air , nutrition and elimination.
2. NON -PHYSICAL NEEDS
may include social, spiritual, and psychological needs. Social integrity

(self-esteem), information and communications are also included.
- The comfort and support provided by social relationships can

enhance effective coping. Therefore the concept of the critically ill
patient includes the interaction and impact of the patients & family
and or significant others
 Because of the nature of critical care, physical requirements
are prioritized and virtually always addressed. The stressful
nature of critical illness is exacerbated by the fact that the
critical care environment can actually prevent the
satisfaction of non-physical needs.
 “Identity and social integrity can be very challenging to
maintain when a person is in a strange situation without their
regular clothes, hairstyle, and talk or conversation revolves
around them without mentioning them specifically as a
person.
 A variety of detrimental emotional or psychological
conditions may arise as a result of the unmet demand for
identity and social integrity. It is obvious that the needs of
the patient's family and significant others must also be
taken into account and met to the greatest extent possible.
However, if all of the critically ill patient's needs are to be
met, both physical and non-physical needs should be taken
into consideration in planning holistic nursing care.
2. CRITICAL CARE NURSE
 The critical care nurse is a licensed professional, who is
responsible for ensuring that all critically ill patients
receive optimal care.
 Nurses practicing in critical care areas have to make

clinical judgments to prevent clinical deterioration in
their patients.
Anticipation and early prevention of patient problems
are central requirements of critical care nursing practice, and
these requirements mandate highly developed skills of:
1. Assessment.
2. Clinical judgment.
The very essence of critical care nursing is anticipation and

early intervention in problems besetting the critically ill.
CRITICAL CARE NURSING PRACTICE IS BASED
ON THE FOLLOWING
 1. Individual professional accountability.

 2- A thorough knowledge of biophysical and
social sciences.
 The application of this knowledge requires:
 a- Skills in clinical assessment
 b- Appropriate nursing and technological intervention.
 3. Recognition and appreciation of the holistic basis for

nursing practice.
 This includes recognizing:
 a- The individual’s uniqueness. wholeness
 b Significant social and environmental
relationships.
 Acknowledgment of the interaction and collaborative roles

of all members of the health team
(Coordination of the care delivered by various health

care providers)
 Since the clinical requirements of the critically ill are such
that the team caring for any single patient may consist of :

Various medical officers
 A nurse
 A pharmacist
 A dietician
 A physiotherapist
 A radiographer
 A social worker
 The knowledge base, which underlines critical care nursing
practice, is highly specialized and it is constantly subject to
revision and development as a consequence of‘:
 a- Research activity
 b- Technological innovation.
Preparations for practice in critical care must emphasize the

importance of a holistic approach to nursing care. Such an approach
is most likely to meet the needs of the critically ill person.
EMERGENCY NURSING

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CARE OF CLIENTS WITH LIFE-THREATENING

CONDITIONS, ACUTELY ILL/MULTI-ORGAN

 Critical care nursing is subspecialties of medical surgical

 Actual or future emergencies for nursing care recipients

 Critical care practice areas began to develop in the late

 A. Developments in medical science and technology

 “The diagnosis and treatment of human response to actual

 “Critical care Nursing is that specialty within nursing that

 Analysis of these definitions reveals several important concepts.

 b- His or her response to actual and potential health problems.

 - Additionally, human response can take the form of ;

cholesterol level, which may prevent a life-threatening problem.

 A scope of practice statement provides a

 The AACN’s Scope of Critical Care Nursing

 The scope of critical care nursing practice is described as

 2- The critical care nurse.

 3- The environment 0here critical care nursing is practiced

 Central to the scope are nurse-patient interactions.

 To ensure effective interaction of these three

1. Critical Ill Patient

 The American Association of Critical Care Nurses

2. NON -PHYSICAL NEEDS

may include social, spiritual, and psychological needs. Social integrity

- The comfort and support provided by social relationships can

 Nurses practicing in critical care areas have to make

The very essence of critical care nursing is anticipation and

 1. Individual professional accountability.

 3. Recognition and appreciation of the holistic basis for

 Acknowledgment of the interaction and collaborative roles

(Coordination of the care delivered by various health

Preparations for practice in critical care must emphasize the

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