Class Notes For Understanding the Essentials of Critical Care Nursing, 2nd Edition
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[Perrin 2e IRM]
Chapter 1 What Is Critical Care?
RESOURCE LIBRARY
COMPANION WEBSITE
Case Study: Critical Care Nursing
Nursing Care Plan
NCLEX Review Questions
Media Links
Media Link Applications
Learning Outcome 1
Define critical care.
Concepts for Lecture
1. Critical care is the direct delivery of medical care to a critically ill or injured
patient. The care is often delivered in a specialized unit with advanced technology
available. This care is provided by a specially trained team of professionals.
2. Critical care is defined by the Department of Health and Human Services (2001)
as the “direct delivery of medical care for a critically ill or injured patient. To be
considered critical an illness or injury must acutely impair one or more vital organ
Chapter 1 What Is Critical Care?
RESOURCE LIBRARY
COMPANION WEBSITE
Case Study: Critical Care Nursing
Nursing Care Plan
NCLEX Review Questions
Media Links
Media Link Applications
Learning Outcome 1
Define critical care.
Concepts for Lecture
1. Critical care is the direct delivery of medical care to a critically ill or injured
patient. The care is often delivered in a specialized unit with advanced technology
available. This care is provided by a specially trained team of professionals.
2. Critical care is defined by the Department of Health and Human Services (2001)
as the “direct delivery of medical care for a critically ill or injured patient. To be
considered critical an illness or injury must acutely impair one or more vital organ
[Perrin 2e IRM]
Chapter 1 What Is Critical Care?
RESOURCE LIBRARY
COMPANION WEBSITE
Case Study: Critical Care Nursing
Nursing Care Plan
NCLEX Review Questions
Media Links
Media Link Applications
Learning Outcome 1
Define critical care.
Concepts for Lecture
1. Critical care is the direct delivery of medical care to a critically ill or injured
patient. The care is often delivered in a specialized unit with advanced technology
available. This care is provided by a specially trained team of professionals.
2. Critical care is defined by the Department of Health and Human Services (2001)
as the “direct delivery of medical care for a critically ill or injured patient. To be
considered critical an illness or injury must acutely impair one or more vital organ
Chapter 1 What Is Critical Care?
RESOURCE LIBRARY
COMPANION WEBSITE
Case Study: Critical Care Nursing
Nursing Care Plan
NCLEX Review Questions
Media Links
Media Link Applications
Learning Outcome 1
Define critical care.
Concepts for Lecture
1. Critical care is the direct delivery of medical care to a critically ill or injured
patient. The care is often delivered in a specialized unit with advanced technology
available. This care is provided by a specially trained team of professionals.
2. Critical care is defined by the Department of Health and Human Services (2001)
as the “direct delivery of medical care for a critically ill or injured patient. To be
considered critical an illness or injury must acutely impair one or more vital organ
systems such that a patient’s survival is jeopardized. Critical care is usually but
not always given in a critical care area such as a coronary care unit, an intensive
care unit, a respiratory care unit, or an emergency care unit.”
PowerPoint Lecture Slides
1. Critical care—“direct delivery of medical care for a critically ill or injured patient. To
be considered critical an illness or injury must acutely impair one or more vital organ
systems so that a patient’s survival is jeopardized” (Department of Health and Human
Services, 2001).
2. Elements of critical illness or injury:
• Impairment of one or more vital organs
• Patient survival jeopardized
• Care given in specialty unit with specialized personnel and equipment
Suggested Strategies for Classroom Experience
Ask students to share examples of patient conditions that, according to the definition
provided, would require critical care.
Learning Outcome 2
State the three levels of care provided in critical care units.
not always given in a critical care area such as a coronary care unit, an intensive
care unit, a respiratory care unit, or an emergency care unit.”
PowerPoint Lecture Slides
1. Critical care—“direct delivery of medical care for a critically ill or injured patient. To
be considered critical an illness or injury must acutely impair one or more vital organ
systems so that a patient’s survival is jeopardized” (Department of Health and Human
Services, 2001).
2. Elements of critical illness or injury:
• Impairment of one or more vital organs
• Patient survival jeopardized
• Care given in specialty unit with specialized personnel and equipment
Suggested Strategies for Classroom Experience
Ask students to share examples of patient conditions that, according to the definition
provided, would require critical care.
Learning Outcome 2
State the three levels of care provided in critical care units.
Concepts for Lecture
1. In 2003, the Society of Critical Care Medicine (SCCM) endorsed guidelines for critical
care services based on three levels of care. These guidelines suggested that each hospital
provide a level of care appropriate to its mission and regional needs for critical care
services because not all hospitals are able to meet the needs of all types of patients and
severities of illness.
2. Level I critical care units possess sophisticated equipment. Specialized nurses and
physician specialists are continuously available. Care is comprehensive for a wide variety
of disorders. Support services are readily available. These ICUs are usually located in
teaching hospitals.
3. Level II units provide comprehensive care for most patients but may not be able to
care for more complex types of patients such as cardiothoracic surgical patients. These
ICUs must have transfer arrangements in place so that care can be made available for the
most complex patients if necessary.
4. Level III units provide initial stabilization of critically ill patients but have limited
ability to provide comprehensive critical care. Patients who require routine care may
remain at the facility but written transfer policies must be in place to provide options for
critical care for those patients who need it.
1. In 2003, the Society of Critical Care Medicine (SCCM) endorsed guidelines for critical
care services based on three levels of care. These guidelines suggested that each hospital
provide a level of care appropriate to its mission and regional needs for critical care
services because not all hospitals are able to meet the needs of all types of patients and
severities of illness.
2. Level I critical care units possess sophisticated equipment. Specialized nurses and
physician specialists are continuously available. Care is comprehensive for a wide variety
of disorders. Support services are readily available. These ICUs are usually located in
teaching hospitals.
3. Level II units provide comprehensive care for most patients but may not be able to
care for more complex types of patients such as cardiothoracic surgical patients. These
ICUs must have transfer arrangements in place so that care can be made available for the
most complex patients if necessary.
4. Level III units provide initial stabilization of critically ill patients but have limited
ability to provide comprehensive critical care. Patients who require routine care may
remain at the facility but written transfer policies must be in place to provide options for
critical care for those patients who need it.
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PowerPoint Lecture Slides
1. Three levels of care for critical care services are necessary.
Not all hospitals are equipped to meet the needs of all patient types and severities of
illness.
2. Level I Critical Care Units
Most comprehensive care available
Usually in teaching hospitals
Specialty physicians, nurses, and equipment continuously available
Comprehensive support services available
3. Level II Critical Care Units
Limited care for some specific patients (ex: cardiothoracic surgical patients)
Must have transfer plan to Level I facilities for patients with specific disorders for which
the unit does not provide care
4. Level III Critical Care Units
Provide initial stabilization of critically ill patients
Limited ability to provide comprehensive critical care
Should have written policies for patient transfer if required
1. Three levels of care for critical care services are necessary.
Not all hospitals are equipped to meet the needs of all patient types and severities of
illness.
2. Level I Critical Care Units
Most comprehensive care available
Usually in teaching hospitals
Specialty physicians, nurses, and equipment continuously available
Comprehensive support services available
3. Level II Critical Care Units
Limited care for some specific patients (ex: cardiothoracic surgical patients)
Must have transfer plan to Level I facilities for patients with specific disorders for which
the unit does not provide care
4. Level III Critical Care Units
Provide initial stabilization of critically ill patients
Limited ability to provide comprehensive critical care
Should have written policies for patient transfer if required
Loading page 5...
Suggested Strategies for Classroom Experience
Discuss clinical facilities in use by students in your program. What attributes are obvious
in the critical care units of these facilities? What level of care is provided at each?
Learning Outcome 3
Compare and contrast “open” and “closed” critical care units.
Concepts for Lecture
1. Critical care units may be “open” or “closed.”
2. In an open ICU, nurses, pharmacists, and respiratory therapists are based in the
ICU but the physicians directing patient care may have other obligations. These
physicians may or may not choose to consult an intensivist to assist with the
management of their ICU patients.
3. In a closed ICU, patient care is provided by a dedicated ICU team that includes a
critical care physician. The SCCM recommends that primary care physicians and
consultants collaborate and use an intensivist to intervene and direct care in urgent
and emergent situations.
PowerPoint Lecture Slides
1. “Open” Unit
• Nurses, pharmacists, and respiratory therapists are ICU-based
• Physicians are not ICU-based—have other responsibilities
• The primary physician may consult an intensivist to assist with patient
management
Discuss clinical facilities in use by students in your program. What attributes are obvious
in the critical care units of these facilities? What level of care is provided at each?
Learning Outcome 3
Compare and contrast “open” and “closed” critical care units.
Concepts for Lecture
1. Critical care units may be “open” or “closed.”
2. In an open ICU, nurses, pharmacists, and respiratory therapists are based in the
ICU but the physicians directing patient care may have other obligations. These
physicians may or may not choose to consult an intensivist to assist with the
management of their ICU patients.
3. In a closed ICU, patient care is provided by a dedicated ICU team that includes a
critical care physician. The SCCM recommends that primary care physicians and
consultants collaborate and use an intensivist to intervene and direct care in urgent
and emergent situations.
PowerPoint Lecture Slides
1. “Open” Unit
• Nurses, pharmacists, and respiratory therapists are ICU-based
• Physicians are not ICU-based—have other responsibilities
• The primary physician may consult an intensivist to assist with patient
management
Loading page 6...
2. “Closed” Unit
• ICU team with critical care physician
• Primary care physician and consultants collaborate
• Intensivist is given authority to manage patient’s care in urgent and
emergent situations
Suggested Strategies for Classroom Experience
Ask students to reflect upon the ICUs in the facilities in which they have clinical
experience. Are the units open or closed? What attributes, specifically, indicate this
status?
Learning Outcome 4
Explain why critical care units are one of the most common sites for health care errors.
Concepts for Lecture
1. Critically ill patients require complex, carefully coordinated care. When a care
pattern is complex, failure in one part of the system can unexpectedly affect
another. Therefore, if anything goes wrong, and an error is identified, it can be
difficult to prevent deterioration of the situation because of the extreme
complexity of care in critical care areas.
2. The Institute of Medicine (IOM) postulates that technology increases errors for
several reasons:
• ICU team with critical care physician
• Primary care physician and consultants collaborate
• Intensivist is given authority to manage patient’s care in urgent and
emergent situations
Suggested Strategies for Classroom Experience
Ask students to reflect upon the ICUs in the facilities in which they have clinical
experience. Are the units open or closed? What attributes, specifically, indicate this
status?
Learning Outcome 4
Explain why critical care units are one of the most common sites for health care errors.
Concepts for Lecture
1. Critically ill patients require complex, carefully coordinated care. When a care
pattern is complex, failure in one part of the system can unexpectedly affect
another. Therefore, if anything goes wrong, and an error is identified, it can be
difficult to prevent deterioration of the situation because of the extreme
complexity of care in critical care areas.
2. The Institute of Medicine (IOM) postulates that technology increases errors for
several reasons:
Loading page 7...
• Technology changes tasks by shifting the workload and eliminating
human decision making.
• Although technology decreases workload during nonpeak hours, it often
increases it during peak hours or during system failure (e.g., when the
computerized medication scanning device fails and documentation must
be done on paper and then entered electronically later when the system is
working).
• When technology controls performance of tasks automatically, users no
longer know how to perform functions without it (e.g., calculation of
mcg/kg/min for drug doses) when the system fails.
• Errors can occur when equipment is not standardized and demands
precision for use (e.g., ICU nurses use many different brands of IV pumps
or ventilators).
3. Safety of all patients is a concern, but safety for vulnerable, critically ill patients is
paramount. In one 24-hour examination of errors in ICUs worldwide, nearly 75%
reported errors, including:
• dislodgement of lines, catheters, and drains
• medication errors
• failure of infusion devices
• failure or dysfunction of a ventilator
• unplanned extubation while ventilator alarms were turned off
human decision making.
• Although technology decreases workload during nonpeak hours, it often
increases it during peak hours or during system failure (e.g., when the
computerized medication scanning device fails and documentation must
be done on paper and then entered electronically later when the system is
working).
• When technology controls performance of tasks automatically, users no
longer know how to perform functions without it (e.g., calculation of
mcg/kg/min for drug doses) when the system fails.
• Errors can occur when equipment is not standardized and demands
precision for use (e.g., ICU nurses use many different brands of IV pumps
or ventilators).
3. Safety of all patients is a concern, but safety for vulnerable, critically ill patients is
paramount. In one 24-hour examination of errors in ICUs worldwide, nearly 75%
reported errors, including:
• dislodgement of lines, catheters, and drains
• medication errors
• failure of infusion devices
• failure or dysfunction of a ventilator
• unplanned extubation while ventilator alarms were turned off
Loading page 8...
4. Since release of the IOM report To Err Is Human (2000), there has been a focus
on identifying and correcting system problems that increase potential for errors so
that risk for errors can be reduced. Recommendations for error reduction include:
• utilizing constraints—an example of this is when the height, weight, and
allergies of a patient must be on file to obtain a medication for the patient
• installing forcing functions or system-level firewalls—for example,
concentrated potassium chloride (KCl) is no longer available on hospital
units
• avoiding reliance on vigilance—forcing use of checklists, protocols, and
rechecking with another professional (e.g., time-outs prior to surgery and
checking doses of insulin with another RN prior to administration)
• simplifying and standardizing key processes
5. Providers can enhance safe, effective care and limit risks to critically ill patients
by:
• developing a multidisciplinary approach to patient care—Care should
be delivered by a multidisciplinary team headed by a full-time critical-
care-trained physician and consisting of at least an ICU nurse, a
respiratory therapist, and a pharmacist. Outcomes for patients are better
when multidisciplinary teams collaborate and work well together.
• encouraging a culture of safety—This encompasses seven essential
properties: teamwork, evidence based practice, communication, patient-
centered care, leadership, learning, and justice. In a critical care unit that
on identifying and correcting system problems that increase potential for errors so
that risk for errors can be reduced. Recommendations for error reduction include:
• utilizing constraints—an example of this is when the height, weight, and
allergies of a patient must be on file to obtain a medication for the patient
• installing forcing functions or system-level firewalls—for example,
concentrated potassium chloride (KCl) is no longer available on hospital
units
• avoiding reliance on vigilance—forcing use of checklists, protocols, and
rechecking with another professional (e.g., time-outs prior to surgery and
checking doses of insulin with another RN prior to administration)
• simplifying and standardizing key processes
5. Providers can enhance safe, effective care and limit risks to critically ill patients
by:
• developing a multidisciplinary approach to patient care—Care should
be delivered by a multidisciplinary team headed by a full-time critical-
care-trained physician and consisting of at least an ICU nurse, a
respiratory therapist, and a pharmacist. Outcomes for patients are better
when multidisciplinary teams collaborate and work well together.
• encouraging a culture of safety—This encompasses seven essential
properties: teamwork, evidence based practice, communication, patient-
centered care, leadership, learning, and justice. In a critical care unit that
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has embraced a culture of safety, practitioners have a responsibility to
their patients to make their errors known, have them corrected, and share
them with the patient, his family, and other practitioners. With practice
improvement as the goal rather than punishment of the health care
provider who committed the error, the reporting of the error promotes
examination of factors that contributed to the error and changes in practice
for the future.
• instituting closed units—These are units in which only intensivists treat
patients.
• providing adequate staffing—This does not imply only looking at
numbers of patients/nurse, but also to assigning a nurse with appropriate
competencies to meet the needs of the assigned patients.
• limiting work hours—The IOM recommends that nurses work no more
than 60 hours per week and no more than 12 hours in any 24-hour period.
PowerPoint Lecture Slides
1. Technology increases errors because:
• It eliminates need for human decision making
• It increases workload when it fails or is inadequate
• Nurses forget how to calculate drips without technology
• Equipment is highly sophisticated, nonstandard, and demands precision for use
their patients to make their errors known, have them corrected, and share
them with the patient, his family, and other practitioners. With practice
improvement as the goal rather than punishment of the health care
provider who committed the error, the reporting of the error promotes
examination of factors that contributed to the error and changes in practice
for the future.
• instituting closed units—These are units in which only intensivists treat
patients.
• providing adequate staffing—This does not imply only looking at
numbers of patients/nurse, but also to assigning a nurse with appropriate
competencies to meet the needs of the assigned patients.
• limiting work hours—The IOM recommends that nurses work no more
than 60 hours per week and no more than 12 hours in any 24-hour period.
PowerPoint Lecture Slides
1. Technology increases errors because:
• It eliminates need for human decision making
• It increases workload when it fails or is inadequate
• Nurses forget how to calculate drips without technology
• Equipment is highly sophisticated, nonstandard, and demands precision for use
Loading page 10...
2. Technology can affect patient care
• Nurses may fail to touch patients
• Best assessment occurs when nurses assess in addition to what technology
provides
• Technology can predispose to errors in delivery of care
• Technology devices may fail and contribute to error (extubation, failure of
infusion devices, etc.)
3. Patient safety strategies for prevention and early detection of errors
• utilizing constraints—height, weight, and allergies required before a medication
can be obtained for the patient
• installing forcing functions or system-level firewalls—concentrated potassium
chloride (KCl) is no longer available on hospital units
• avoiding reliance on vigilance—forcing use of checklists, protocols, and
rechecking with another professional (e.g., time-outs prior to surgery and
checking doses of insulin with another RN prior to administration)
• simplifying and standardizing key processes
4. Providers can enhance safe, effective care and limit risks to critically ill patients
by:
• developing a multidisciplinary approach to patient care
• encouraging a culture of safety
• instituting a closed unit
• Nurses may fail to touch patients
• Best assessment occurs when nurses assess in addition to what technology
provides
• Technology can predispose to errors in delivery of care
• Technology devices may fail and contribute to error (extubation, failure of
infusion devices, etc.)
3. Patient safety strategies for prevention and early detection of errors
• utilizing constraints—height, weight, and allergies required before a medication
can be obtained for the patient
• installing forcing functions or system-level firewalls—concentrated potassium
chloride (KCl) is no longer available on hospital units
• avoiding reliance on vigilance—forcing use of checklists, protocols, and
rechecking with another professional (e.g., time-outs prior to surgery and
checking doses of insulin with another RN prior to administration)
• simplifying and standardizing key processes
4. Providers can enhance safe, effective care and limit risks to critically ill patients
by:
• developing a multidisciplinary approach to patient care
• encouraging a culture of safety
• instituting a closed unit
Loading page 11...
• providing adequate staffing
• limiting work hours
Suggested Strategies for Classroom Experience
Ask students why it is important to check insulin doses with another professional nurse
prior to administration of the drug. (If necessary, remind them that insulin is considered
a high-alert medication according to the Institute for Safe Medication Practices.)
Ask students why it is important not to have concentrated potassium chloride available on
the unit. What risks are involved with intravenous administration of this medication in
particular?
Learning Outcome 5
Describe the relationship between the patient and nurse in the AACN’s synergy model.
Concepts for Lecture
1. The AACN believes that critical care nursing should be defined more by the
needs of the patients and those of their families than by the environment in which
care is delivered or the diagnoses of the patients. An underlying assumption of the
synergy model is that optimal patient outcomes occur when patient and family
needs are aligned with nurse competencies.
• limiting work hours
Suggested Strategies for Classroom Experience
Ask students why it is important to check insulin doses with another professional nurse
prior to administration of the drug. (If necessary, remind them that insulin is considered
a high-alert medication according to the Institute for Safe Medication Practices.)
Ask students why it is important not to have concentrated potassium chloride available on
the unit. What risks are involved with intravenous administration of this medication in
particular?
Learning Outcome 5
Describe the relationship between the patient and nurse in the AACN’s synergy model.
Concepts for Lecture
1. The AACN believes that critical care nursing should be defined more by the
needs of the patients and those of their families than by the environment in which
care is delivered or the diagnoses of the patients. An underlying assumption of the
synergy model is that optimal patient outcomes occur when patient and family
needs are aligned with nurse competencies.
Loading page 12...
PowerPoint Lecture Slides
1. Critical care nursing practice should be defined more by the needs of patients and
those of their families than by the environment in which care is delivered or the
diagnosis of the patients.
Patient/Family Needs + Nurse Competencies = Optimal Patient Outcomes
Suggested Strategies for Classroom Experience
Ask students to think about why it would be preferable to have an expert critical care
nurse care for a 78-year-old fresh cardiothoracic surgical patient with a history of
diabetes and chronic lung disease, whereas a competent critical care nurse might be
assigned to a chronic postoperative cardiothoracic surgical patient.
Learning Outcome 6
Discuss the competencies of critical care nurses as defined by the synergy model.
Concepts for Lecture
1. According to the synergy model, critical care nurse competencies can be
described along a continuum from competent to expert. These competencies
include the following:
• clinical inquiry—The critical care nurse should provide care based on the
best available evidence rather than tradition.
• clinical judgment—The nurse should engage in clinical reasoning according
to his or her level of expertise. For example, a competent critical care nurse is
1. Critical care nursing practice should be defined more by the needs of patients and
those of their families than by the environment in which care is delivered or the
diagnosis of the patients.
Patient/Family Needs + Nurse Competencies = Optimal Patient Outcomes
Suggested Strategies for Classroom Experience
Ask students to think about why it would be preferable to have an expert critical care
nurse care for a 78-year-old fresh cardiothoracic surgical patient with a history of
diabetes and chronic lung disease, whereas a competent critical care nurse might be
assigned to a chronic postoperative cardiothoracic surgical patient.
Learning Outcome 6
Discuss the competencies of critical care nurses as defined by the synergy model.
Concepts for Lecture
1. According to the synergy model, critical care nurse competencies can be
described along a continuum from competent to expert. These competencies
include the following:
• clinical inquiry—The critical care nurse should provide care based on the
best available evidence rather than tradition.
• clinical judgment—The nurse should engage in clinical reasoning according
to his or her level of expertise. For example, a competent critical care nurse is
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able to collect and interpret basic information and then follow algorithms
when providing care, whereas an expert nurse can see the “big picture” and
anticipate patient needs.
• caring—According to the AACN, this encompasses “nursing activities that
create a compassionate, supportive, and therapeutic environment for patients
and staff, with the aim of promoting comfort and preventing unnecessary
suffering.”
• advocacy—This refers to the nurse’s respect and support for the rights and
beliefs of the critically ill patient (AACN).
• systems thinking—The critical care nurse manages the existing environment
and resources for the benefit of patients and their families.
• facilitator of learning—The nurse should facilitate both informal and formal
learning for patients, families, and members of the health care team.
• response to diversity—The nurse should be sensitive to diversity among
patients and providers and incorporate appropriate cultural and spiritual values
into care.
• collaboration—The nurse will work with others in order to achieve optimal
and realistic patient goals.
PowerPoint Lecture Slides
1. According to the synergy model, critical care nurse competencies include the
following:
clinical inquiry
clinical judgment
when providing care, whereas an expert nurse can see the “big picture” and
anticipate patient needs.
• caring—According to the AACN, this encompasses “nursing activities that
create a compassionate, supportive, and therapeutic environment for patients
and staff, with the aim of promoting comfort and preventing unnecessary
suffering.”
• advocacy—This refers to the nurse’s respect and support for the rights and
beliefs of the critically ill patient (AACN).
• systems thinking—The critical care nurse manages the existing environment
and resources for the benefit of patients and their families.
• facilitator of learning—The nurse should facilitate both informal and formal
learning for patients, families, and members of the health care team.
• response to diversity—The nurse should be sensitive to diversity among
patients and providers and incorporate appropriate cultural and spiritual values
into care.
• collaboration—The nurse will work with others in order to achieve optimal
and realistic patient goals.
PowerPoint Lecture Slides
1. According to the synergy model, critical care nurse competencies include the
following:
clinical inquiry
clinical judgment
Loading page 14...
caring
advocacy
systems thinking
facilitator of learning
response to diversity
collaboration
Suggested Strategies for Classroom Experience
Divide the class into groups and assign each group one of the critical care nurse
competencies from the synergy model. Ask each group to identify levels of function
likely for the competent nurse and the expert nurse for the assigned competency.
Learning Outcome 7
Describe ways to enhance communication and collaboration among members of the
health care team.
Concepts for Lecture
1. Optimum patient outcomes require communication and collaboration by a
multidisciplinary team. Skilled communication includes determining appropriate
content for the message and delivery of the content. One method of skilled
communication advocated by the Institute for Healthcare Improvement (IHI) is
the SBAR technique (situation, background, assessment, recommendation).
o S: Situation
advocacy
systems thinking
facilitator of learning
response to diversity
collaboration
Suggested Strategies for Classroom Experience
Divide the class into groups and assign each group one of the critical care nurse
competencies from the synergy model. Ask each group to identify levels of function
likely for the competent nurse and the expert nurse for the assigned competency.
Learning Outcome 7
Describe ways to enhance communication and collaboration among members of the
health care team.
Concepts for Lecture
1. Optimum patient outcomes require communication and collaboration by a
multidisciplinary team. Skilled communication includes determining appropriate
content for the message and delivery of the content. One method of skilled
communication advocated by the Institute for Healthcare Improvement (IHI) is
the SBAR technique (situation, background, assessment, recommendation).
o S: Situation
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• I am calling about [patient, name, location].
• The problem I am calling about is [the nurse states specifics].
• I have assessed the patient personally.
• Vital signs are _____.
• I am concerned about [the nurse states what the specific concern is].
o B: Background
• The patient’s immediate history is_______.
• The patient’s other physical findings are [e.g., mental status].
• The patient’s treatments are [e.g., oxygen therapy].
o A: Assessment
▪ This is what I think the problem is: _____________.
▪ Or, I’m not sure what the problem is but the patient is deteriorating.
o R: Recommendation
▪ I suggest [or request] that you [the nurse states the desired course of
action].
2. Two-Challenge Rule—Another method of skilled communication adopted from
the airline industry. This rule can be used for managing situations in which
members of the health care team do not listen even when information has been
presented in an appropriate format. When following the two-challenge rule, a
• The problem I am calling about is [the nurse states specifics].
• I have assessed the patient personally.
• Vital signs are _____.
• I am concerned about [the nurse states what the specific concern is].
o B: Background
• The patient’s immediate history is_______.
• The patient’s other physical findings are [e.g., mental status].
• The patient’s treatments are [e.g., oxygen therapy].
o A: Assessment
▪ This is what I think the problem is: _____________.
▪ Or, I’m not sure what the problem is but the patient is deteriorating.
o R: Recommendation
▪ I suggest [or request] that you [the nurse states the desired course of
action].
2. Two-Challenge Rule—Another method of skilled communication adopted from
the airline industry. This rule can be used for managing situations in which
members of the health care team do not listen even when information has been
presented in an appropriate format. When following the two-challenge rule, a
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nurse who disagrees with another health care provider’s proposed intervention
would respectfully state his concerns about the intervention twice then would seek
a superior as soon as possible and explain his concerns.
3. Collaboration—This is the link between teamwork and patient outcomes in ICU.
Collaboration is a process of sharing knowledge and responsibility for patient care.
Many characteristics influence collaboration.
PowerPoint Lecture Slides
1. Communication—Optimal patient care is not possible without skilled
communication.
2. Skilled communication has two components—appropriate content for the message
and delivery of the content.
3. SBAR Technique—provides process for determining what information is
appropriate and delivering it in specific manner
Situation—who you are calling about (patient name, location); state specific
problem, patient assessment, and specific concern
Background—patient’s immediate history, physical findings, and treatments
Assessment—what you think the problem is; if unsure, state that patient is
deteriorating
Recommendation—state or request desired course of action
would respectfully state his concerns about the intervention twice then would seek
a superior as soon as possible and explain his concerns.
3. Collaboration—This is the link between teamwork and patient outcomes in ICU.
Collaboration is a process of sharing knowledge and responsibility for patient care.
Many characteristics influence collaboration.
PowerPoint Lecture Slides
1. Communication—Optimal patient care is not possible without skilled
communication.
2. Skilled communication has two components—appropriate content for the message
and delivery of the content.
3. SBAR Technique—provides process for determining what information is
appropriate and delivering it in specific manner
Situation—who you are calling about (patient name, location); state specific
problem, patient assessment, and specific concern
Background—patient’s immediate history, physical findings, and treatments
Assessment—what you think the problem is; if unsure, state that patient is
deteriorating
Recommendation—state or request desired course of action
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4. Two-Challenge Rule—a rule for disagreement about the proposed course of
action
• Respectfully state concerns about the intervention twice; then seek help
from supervisor.
• Assertive communication—nurse should state disagreement and present
concerns respectfully; speak with a bold voice.
5. Collaboration—this is the link between teamwork and patient outcomes in ICU.
• Collaboration is a process, not a single event.
• Characteristics that influence collaboration:
o Emotional maturity
o Understanding the perspectives of others
o Team goal is patient well-being
o Negotiate respectfully
o Manage conflict wisely—watch emotional responses
Suggested Strategies for Classroom Experience
Given a patient scenario, ask students to demonstrate use of SBAR communication to a
health care provider.
Ask students to describe what it means to them to “collaborate” on a project.
action
• Respectfully state concerns about the intervention twice; then seek help
from supervisor.
• Assertive communication—nurse should state disagreement and present
concerns respectfully; speak with a bold voice.
5. Collaboration—this is the link between teamwork and patient outcomes in ICU.
• Collaboration is a process, not a single event.
• Characteristics that influence collaboration:
o Emotional maturity
o Understanding the perspectives of others
o Team goal is patient well-being
o Negotiate respectfully
o Manage conflict wisely—watch emotional responses
Suggested Strategies for Classroom Experience
Given a patient scenario, ask students to demonstrate use of SBAR communication to a
health care provider.
Ask students to describe what it means to them to “collaborate” on a project.
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Learning Outcome 8
Explain why some health care providers believe that critically ill patients cannot give
informed consent.
Concepts for Lecture
1. Obtaining informed consent has legal and ethical ramifications. When a patient
gives consent, he agrees to the suggested treatment or procedure. Legally, if a
nurse treats or touches a patient without consent, it is considered battery, even if
the treatment is appropriate and has no negative effects. Consent is usually
implied rather than written for “routine” procedures such as turning, dressing
changes, and most medication administration.
2. There are three components of informed consent:
• The decision must be made voluntarily.
• The decision must be made by a competent adult.
• The decision must be made by a competent adult who understands his
condition and the possible treatments.
This means that the patient’s decision must be an autonomous choice. The patient
must be capable of rational thought and be able to recognize what the treatment
involves.
3. Are critically ill patients able to make decisions? This is sometimes difficult to
determine because the patient may be in severe pain, may be intubated, or may be
very depressed. Determination of the patient’s capacity to give informed consent
Explain why some health care providers believe that critically ill patients cannot give
informed consent.
Concepts for Lecture
1. Obtaining informed consent has legal and ethical ramifications. When a patient
gives consent, he agrees to the suggested treatment or procedure. Legally, if a
nurse treats or touches a patient without consent, it is considered battery, even if
the treatment is appropriate and has no negative effects. Consent is usually
implied rather than written for “routine” procedures such as turning, dressing
changes, and most medication administration.
2. There are three components of informed consent:
• The decision must be made voluntarily.
• The decision must be made by a competent adult.
• The decision must be made by a competent adult who understands his
condition and the possible treatments.
This means that the patient’s decision must be an autonomous choice. The patient
must be capable of rational thought and be able to recognize what the treatment
involves.
3. Are critically ill patients able to make decisions? This is sometimes difficult to
determine because the patient may be in severe pain, may be intubated, or may be
very depressed. Determination of the patient’s capacity to give informed consent
Loading page 19...
does not require a legal proceeding. It is a clinical judgment. To determine
capacity, the nurse may ask:
• Does the patient understand the medical condition?
• Does the patient understand the options and the consequences of her
decision?
• If the patient refuses to give consent for the recommended treatment, is the
refusal based on rational reasons?
4. Surrogate decisions: Occasionally, loss of capacity may be temporary, such as
when a patient has been heavily medicated. When a patient is incapacitated, a
surrogate health decision maker may be asked to consent for treatment of the
patient.
PowerPoint Lecture Slides
1. Three components of informed consent:
• The decision to permit the treatment or procedure must be made voluntarily.
• The decision to permit the treatment or procedure must be made by a
competent adult.
• The patient must understand his condition and the possible treatments.
2. An ICU patient may lack the capacity to give informed consent.
Determination does not require legal proceeding—it is a clinical judgment.
Loss of capacity may be temporary (pain medication).
capacity, the nurse may ask:
• Does the patient understand the medical condition?
• Does the patient understand the options and the consequences of her
decision?
• If the patient refuses to give consent for the recommended treatment, is the
refusal based on rational reasons?
4. Surrogate decisions: Occasionally, loss of capacity may be temporary, such as
when a patient has been heavily medicated. When a patient is incapacitated, a
surrogate health decision maker may be asked to consent for treatment of the
patient.
PowerPoint Lecture Slides
1. Three components of informed consent:
• The decision to permit the treatment or procedure must be made voluntarily.
• The decision to permit the treatment or procedure must be made by a
competent adult.
• The patient must understand his condition and the possible treatments.
2. An ICU patient may lack the capacity to give informed consent.
Determination does not require legal proceeding—it is a clinical judgment.
Loss of capacity may be temporary (pain medication).
Loading page 20...
3. To determine capacity, the health care provider may ask:
• Does the patient understand the medical condition?
• Does the patient understand the options and consequences of the decision?
• If the patient refuses treatment, is refusal based on rational reasons?
4. Surrogate decisions:
• Some states allow next of kin to make decision.
• Some states require health care proxy or durable power of attorney—advance
directive or court appointed.
• Two ethical modes for surrogate decisions:
• Best interest standard—decision maker decides what he or she
believes is in the best interest of the patient
• Substituted judgment—surrogate decides what he or she thinks
patient would have decided if able to make the decision
Suggested Strategies for Classroom Experience
Ask students to consider a situation in which they may be asked to be a surrogate
decision maker for someone. Ask them to discuss their feelings and concerns about using
the “best interest standard” versus the “substituted judgment” standard. Which seems
more comfortable to them? Why?
• Does the patient understand the medical condition?
• Does the patient understand the options and consequences of the decision?
• If the patient refuses treatment, is refusal based on rational reasons?
4. Surrogate decisions:
• Some states allow next of kin to make decision.
• Some states require health care proxy or durable power of attorney—advance
directive or court appointed.
• Two ethical modes for surrogate decisions:
• Best interest standard—decision maker decides what he or she
believes is in the best interest of the patient
• Substituted judgment—surrogate decides what he or she thinks
patient would have decided if able to make the decision
Suggested Strategies for Classroom Experience
Ask students to consider a situation in which they may be asked to be a surrogate
decision maker for someone. Ask them to discuss their feelings and concerns about using
the “best interest standard” versus the “substituted judgment” standard. Which seems
more comfortable to them? Why?
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Learning Outcome 9
Analyze why moral distress might be a significant concern for critical care nurses.
Concepts for Lecture
1. Critical care nurses have the potential to develop moral distress or compassion
fatigue as a result of being placed continually in situations with high levels of
complexity, uncertainty, and decisional authority.
2. Moral distress has been defined as when a nurse would know the right thing to
do, but would not do it because of institutional constraints or personal authority.
Critical care nurses are often in situations associated with high levels of moral
distress—such as when nurses are required to provide aggressive care to patients
whom they do not believe will benefit from the care.
3. Moral distress impacts health care. Nurses leave ICUs, they lose the capacity to
care for patients, and they experience physiological and psychological problems.
4. The AACN developed a public policy statement in which the 4 A’s to rise above
moral distress (ask, affirm, assess, act) are described.
5. Conscientious refusal of an assignment is an option if the nurse believes he
cannot ethically perform an action he is being asked to perform. The nurse,
however, should consider administrative repercussions for his refusal. It is
possible that administration will fully support the decision; however, it is also
Analyze why moral distress might be a significant concern for critical care nurses.
Concepts for Lecture
1. Critical care nurses have the potential to develop moral distress or compassion
fatigue as a result of being placed continually in situations with high levels of
complexity, uncertainty, and decisional authority.
2. Moral distress has been defined as when a nurse would know the right thing to
do, but would not do it because of institutional constraints or personal authority.
Critical care nurses are often in situations associated with high levels of moral
distress—such as when nurses are required to provide aggressive care to patients
whom they do not believe will benefit from the care.
3. Moral distress impacts health care. Nurses leave ICUs, they lose the capacity to
care for patients, and they experience physiological and psychological problems.
4. The AACN developed a public policy statement in which the 4 A’s to rise above
moral distress (ask, affirm, assess, act) are described.
5. Conscientious refusal of an assignment is an option if the nurse believes he
cannot ethically perform an action he is being asked to perform. The nurse,
however, should consider administrative repercussions for his refusal. It is
possible that administration will fully support the decision; however, it is also
Loading page 22...
possible that the nurse may be dismissed from the nursing position. Therefore,
this option should be taken only after careful consideration of influence on the
patient/family, the nurse, and the institution.
6. Compassion fatigue is a response to caring for people who are suffering. It can
be traumatizing for the care provider. Symptoms may include:
• Intrusive thoughts or images of patients’ situations or traumas
• Difficulty separating work life from personal life
• Lowered tolerance for frustration and/or outbursts of anger or rage
• Dread of working with certain patients
• Depression
• Increase in ineffective and/or self-destructive self-soothing behaviors
• Hypervigilance
• Decreased functioning in nonprofessional situations
• Loss of hope
7. Standards for self-care to establish and maintain wellness for care providers:
• Make a commitment to self-care
• Develop strategies to let go of work
• Develop strategies for rest and relaxation
• Plan strategies for daily stress reduction
this option should be taken only after careful consideration of influence on the
patient/family, the nurse, and the institution.
6. Compassion fatigue is a response to caring for people who are suffering. It can
be traumatizing for the care provider. Symptoms may include:
• Intrusive thoughts or images of patients’ situations or traumas
• Difficulty separating work life from personal life
• Lowered tolerance for frustration and/or outbursts of anger or rage
• Dread of working with certain patients
• Depression
• Increase in ineffective and/or self-destructive self-soothing behaviors
• Hypervigilance
• Decreased functioning in nonprofessional situations
• Loss of hope
7. Standards for self-care to establish and maintain wellness for care providers:
• Make a commitment to self-care
• Develop strategies to let go of work
• Develop strategies for rest and relaxation
• Plan strategies for daily stress reduction
Loading page 23...
PowerPoint Lecture Slides
1. Moral distress—distress suffered by nurses from being involved in patient
situations that they perceive to be morally wrong
2. Situations contributing to moral distress:
• Aggressive care to patients whom nurses perceive would not benefit from the
care
• Feelings of powerlessness
• Nurse unable to find meaning in patient or family suffering
3. Moral distress has impact on health care
• Nurses leave ICUs
• Nurses lose the capacity to care for patients
• Nurses experience physiological and psychological problems
4. Compassion fatigue—a “state of tension and preoccupation with the suffering of
those being helped that is traumatizing for the helper” (Figley, 2005)
5. Symptoms of compassion fatigue:
• Difficulty separating work from personal life
• Intrusive thoughts/images of patient situations/trauma
• Lowered frustration tolerance—outbursts of anger
1. Moral distress—distress suffered by nurses from being involved in patient
situations that they perceive to be morally wrong
2. Situations contributing to moral distress:
• Aggressive care to patients whom nurses perceive would not benefit from the
care
• Feelings of powerlessness
• Nurse unable to find meaning in patient or family suffering
3. Moral distress has impact on health care
• Nurses leave ICUs
• Nurses lose the capacity to care for patients
• Nurses experience physiological and psychological problems
4. Compassion fatigue—a “state of tension and preoccupation with the suffering of
those being helped that is traumatizing for the helper” (Figley, 2005)
5. Symptoms of compassion fatigue:
• Difficulty separating work from personal life
• Intrusive thoughts/images of patient situations/trauma
• Lowered frustration tolerance—outbursts of anger
Loading page 24...
• Dread working with certain patients—depression
• Increase in ineffective and self-destructive behaviors
• Hypervigilance
• Decreased functioning in nonprofessional situations
• Loss of hope
6. Standards for self-care to establish and maintain wellness:
• Make a commitment to self-care
• Develop strategies to let go of work
• Develop strategies for rest and relaxation
• Plan strategies for daily stress reduction
Suggested Strategies for Classroom Experience
Ask students if they have ever interacted with a staff nurse who may have been suffering
from compassion fatigue. What attributes made the students believe this to be the case?
Ask students to develop a plan for avoidance of compassion fatigue and maintaining
wellness for a critical care nurse. List the suggestions on the board for discussion.
Learning Objective 10
Prioritize measures a nurse might utilize to prevent compassion fatigue.
• Increase in ineffective and self-destructive behaviors
• Hypervigilance
• Decreased functioning in nonprofessional situations
• Loss of hope
6. Standards for self-care to establish and maintain wellness:
• Make a commitment to self-care
• Develop strategies to let go of work
• Develop strategies for rest and relaxation
• Plan strategies for daily stress reduction
Suggested Strategies for Classroom Experience
Ask students if they have ever interacted with a staff nurse who may have been suffering
from compassion fatigue. What attributes made the students believe this to be the case?
Ask students to develop a plan for avoidance of compassion fatigue and maintaining
wellness for a critical care nurse. List the suggestions on the board for discussion.
Learning Objective 10
Prioritize measures a nurse might utilize to prevent compassion fatigue.
Loading page 25...
Concepts for Lecture
1. The American Nurses Association (ANA) Code of Ethics indicates that “The
nurse owes the same duties to self as others, including the responsibility to
preserve integrity and safety, to maintain competence, and to continue personal
and professional growth.”
2. The standards of self-care for caregivers were developed to ensure that care
providers do no harm to themselves when helping to treat others and to encourage
providers to attend to their own physical, emotional, and spiritual needs so that
they can ensure high-quality services to those who rely on them.
3. Strategies to prevent compassion fatigue:
• Enhance physical well-being (tension, sleep, food and drink intake)
• Enhance psychological well-being (relaxation methods, balance between
work and play, use stress reduction methods)
• Enhance social/interpersonal well-being (identify five supportive people
at work to call on, know when to get personal and professional help)
• Enhance professional well-being (establish boundaries and set limits,
balance home and work responsibilities, generate a feeling of self-
satisfaction from work achievements)
PowerPoint Lecture Slides
1. Standards of self-care for caregivers
1. The American Nurses Association (ANA) Code of Ethics indicates that “The
nurse owes the same duties to self as others, including the responsibility to
preserve integrity and safety, to maintain competence, and to continue personal
and professional growth.”
2. The standards of self-care for caregivers were developed to ensure that care
providers do no harm to themselves when helping to treat others and to encourage
providers to attend to their own physical, emotional, and spiritual needs so that
they can ensure high-quality services to those who rely on them.
3. Strategies to prevent compassion fatigue:
• Enhance physical well-being (tension, sleep, food and drink intake)
• Enhance psychological well-being (relaxation methods, balance between
work and play, use stress reduction methods)
• Enhance social/interpersonal well-being (identify five supportive people
at work to call on, know when to get personal and professional help)
• Enhance professional well-being (establish boundaries and set limits,
balance home and work responsibilities, generate a feeling of self-
satisfaction from work achievements)
PowerPoint Lecture Slides
1. Standards of self-care for caregivers
Loading page 26...
• To ensure that care providers do no harm to themselves when helping to
treat others
• To encourage providers to attend to their own physical, emotional, and
spiritual needs so that they can ensure high-quality services to those who
rely on them
2. Strategies to prevent compassion fatigue:
• Enhance physical well-being
• Enhance psychological well-being
• Enhance social/interpersonal well-being
• Enhance professional well-being
Suggested Strategies for Classroom Experience
Ask class members to develop a plan for self-care for a critical care nurse. Encourage
them to think about physical, psychological, social/interpersonal, and professional aspects
of self-care.
treat others
• To encourage providers to attend to their own physical, emotional, and
spiritual needs so that they can ensure high-quality services to those who
rely on them
2. Strategies to prevent compassion fatigue:
• Enhance physical well-being
• Enhance psychological well-being
• Enhance social/interpersonal well-being
• Enhance professional well-being
Suggested Strategies for Classroom Experience
Ask class members to develop a plan for self-care for a critical care nurse. Encourage
them to think about physical, psychological, social/interpersonal, and professional aspects
of self-care.
Loading page 27...
[Perrin 2e IRM]
Chapter 2 Care of the Critically Ill Patient
RESOURCE LIBRARY
COMPANION WEBSITE
NCLEX Review Questions
Media Links
Media Link Applications
IMAGE LIBRARY
Table 2-1 Description of the Critical Care Pain Observation Tool
Table 2-2 American Association of Critical Care Nurses Sedation Assessment
Scale
Table 2-3 Ventilator Adjusted Motor Assessment Scoring Scale (VAMASS)
Table 2-4 CAM-ICU Worksheet
Table 2-5 Body Mass Index (BMI) Calculation
Table 2-6 Harris-Benedict Equations for Calculating Basal Energy Expenditure
(BEE)
Learning Outcome 1
Explain the characteristics of the critically ill patient described in the AACN synergy
model.
Concepts for Lecture
1. Critically ill patients are at high risk for life-threatening problems, and nurses
must often focus on specific life-sustaining treatments. However, critically ill
Chapter 2 Care of the Critically Ill Patient
RESOURCE LIBRARY
COMPANION WEBSITE
NCLEX Review Questions
Media Links
Media Link Applications
IMAGE LIBRARY
Table 2-1 Description of the Critical Care Pain Observation Tool
Table 2-2 American Association of Critical Care Nurses Sedation Assessment
Scale
Table 2-3 Ventilator Adjusted Motor Assessment Scoring Scale (VAMASS)
Table 2-4 CAM-ICU Worksheet
Table 2-5 Body Mass Index (BMI) Calculation
Table 2-6 Harris-Benedict Equations for Calculating Basal Energy Expenditure
(BEE)
Learning Outcome 1
Explain the characteristics of the critically ill patient described in the AACN synergy
model.
Concepts for Lecture
1. Critically ill patients are at high risk for life-threatening problems, and nurses
must often focus on specific life-sustaining treatments. However, critically ill
Loading page 28...
patients have basic needs as well.
2. The American Association of Critical Care Nurses (AACN) defines critically ill
patients as “those who are at high risk for actual or potential life threatening
health problems. 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.”
3. According to the synergy model (Figure 2-1), the AACN postulates that when the
needs of the patient and family drive the competencies required by the nurse,
optimal patient outcomes can be achieved. Further, the model identifies eight
patient characteristics that can be scored along the health-illness continuum:
• Resiliency: “The ability to bounce back quickly after insult.”
• Vulnerability: “Susceptibility to actual or potential stressors.”
• Stability: “The ability to maintain a steady state equilibrium.”
• Complexity: “The intricate entanglement of two or more systems (e.g., body,
family).”
• Predictability: “A characteristic that allows one to predict a certain course of
events or course of illness.”
• Resource availability: “Extent of resources the patient, family, and community
bring to the situation.”
• Participation in care: “Extent to which patient and/or family engage in care.”
• Participation in decision making: “Extent to which patient and/or family
2. The American Association of Critical Care Nurses (AACN) defines critically ill
patients as “those who are at high risk for actual or potential life threatening
health problems. 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.”
3. According to the synergy model (Figure 2-1), the AACN postulates that when the
needs of the patient and family drive the competencies required by the nurse,
optimal patient outcomes can be achieved. Further, the model identifies eight
patient characteristics that can be scored along the health-illness continuum:
• Resiliency: “The ability to bounce back quickly after insult.”
• Vulnerability: “Susceptibility to actual or potential stressors.”
• Stability: “The ability to maintain a steady state equilibrium.”
• Complexity: “The intricate entanglement of two or more systems (e.g., body,
family).”
• Predictability: “A characteristic that allows one to predict a certain course of
events or course of illness.”
• Resource availability: “Extent of resources the patient, family, and community
bring to the situation.”
• Participation in care: “Extent to which patient and/or family engage in care.”
• Participation in decision making: “Extent to which patient and/or family
Loading page 29...
engage in decision making.”
PowerPoint Lecture Slides
1. Characteristics of critically ill patients (synergy model)
• Resiliency
• Vulnerability
• Stability
• Complexity
• Predictability
• Resource availability
• Participation in care
• Participation in decision making
Suggested Strategies for Classroom Learning
Considering each of the characteristics of critically ill patients, ask students to think about
and describe patients they have encountered who exhibit these characteristics at both ends
of the continuum. Discuss implications for care based on possession of these
characteristics.
Learning Outcome 2
Discuss the concerns expressed by critically ill patients.
PowerPoint Lecture Slides
1. Characteristics of critically ill patients (synergy model)
• Resiliency
• Vulnerability
• Stability
• Complexity
• Predictability
• Resource availability
• Participation in care
• Participation in decision making
Suggested Strategies for Classroom Learning
Considering each of the characteristics of critically ill patients, ask students to think about
and describe patients they have encountered who exhibit these characteristics at both ends
of the continuum. Discuss implications for care based on possession of these
characteristics.
Learning Outcome 2
Discuss the concerns expressed by critically ill patients.
Loading page 30...
Concepts for Lecture
1. Critical care nurses have long focused on creating environments conducive to the
comfort and healing of their patients. To that end, nurses have tried to limit
stressors for their patients. However, research has indicated that what nurses
thought would be stressful for patients varied considerably from what patients
reported to be stressful to them.
2. Patients described as the most stressful to them:
• being thirsty
• having tubes in the mouth and nose
• not being able to communicate
• being restricted by tubes/lines
• being unable to sleep
• not being able to control themselves
PowerPoint Lecture Slides
1. Stressors reported by critically ill patients
• being thirsty
• having tubes in the mouth and nose
• not being able to communicate
• being restricted by tubes/lines
• being unable to sleep
• not being able to control themselves
1. Critical care nurses have long focused on creating environments conducive to the
comfort and healing of their patients. To that end, nurses have tried to limit
stressors for their patients. However, research has indicated that what nurses
thought would be stressful for patients varied considerably from what patients
reported to be stressful to them.
2. Patients described as the most stressful to them:
• being thirsty
• having tubes in the mouth and nose
• not being able to communicate
• being restricted by tubes/lines
• being unable to sleep
• not being able to control themselves
PowerPoint Lecture Slides
1. Stressors reported by critically ill patients
• being thirsty
• having tubes in the mouth and nose
• not being able to communicate
• being restricted by tubes/lines
• being unable to sleep
• not being able to control themselves
Loading page 31...
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Subject
Nursing