Critical Care Nursing: Environment, Ethics, & the Patient

Diane E. White RN MS CCRN PhD(c)

Critical Care Nursing

A Team Approach to Care A Multidisciplinary Perspective A Holistic Approach to Care A Synergistic Approach to Care A Highly-Motivated Environment An Environment of Education

Professional Organizations

The Society of Critical Care Medicine (SCCM) – a multidisciplinary, multi- specialty, international organization.

American Association of Critical Care Nurses (AACN) – world’s largest specialty nursing organization

AACN Organization

Founded in 1969 Purpose is to “promote the health and

welfare of those experiencing critical illness or injury by advancing the art and science of critical care nursing and promoting environments that facilitate comprehensive professional nursing practice” (AACN fact sheet, home page)

AACN Standards of Care

Assessment – relevant data Diagnosis – analyzes assessment data Outcome Identification- individualized Planning- plan of care that prescribes

interventions Implementation Evaluation

Standards of Professional Practice (AACN)

Quality of Care – evaluates quality Individual Practice Evaluation Education – maintains current

knowledge Collegiality Ethics Collaboration

Standards of Professional Practice (cont’d)

Research – practice based on research; inquiry approach to care

Resource Utilization

Ethics/Legal Issues

Autonomy – freedom to make decisions about one’s own body without the coercion or interference of others.

Beneficence – doing good and preventing harm

Nonmaleficence – prevent harm and correct harmful situations

Ethical Terms

Veracity – truth-telling Fidelity – faithfulness and promise-

keeping to patients Justice – allocation of scarce

resources; access to care not a right guarenteed

AACN’s Position Statements regarding ethical issues

Legal Issues

Negligence – unintentional breach of duty or failure

Malpractice – held liable for negligence

Essential elements – duty and standard of care, breach of duty, causation, injury & damage

Understaffing? What do you do?

Legal Issues

California Nurse-patient ratio law Advance Directives for health care

(1990. Cruzan vs. State of Missouri): Power of Attorney & Living Wills

Withholding and Withdrawing treatment

Do Not Resuscitate Orders

Critical Care Environment Psychosocial issues: self-esteem,

body image, personal identity, & role performance

Stressors in the ICU? Coping Mechanisms: regression,

suppression, denial, trust, hope, hardiness & resilience, spiritual beliefs & practices, family support, & sharing

Sleep Alterations/Pain Control

Somatostatin released in deep sleep which inhibits pain (prostaglandin release)

Pain Control – “the 5th vital sign” Sedation – Ramsey Scale and others Ramsey I – awake, II- cooperative and

oriented, tranquil, III- responds to commands, IV- Asleep, V- sluggish response to light tap or loud auditory stimulus, VI – no response to light tap or loud auditory stimulus