Lesson 1 :

Scope of Critical Care

1. Development of Critical Practice,
Education and Professional Activities in
the Philippines
2. Critical Care Body of Knowledge
Critical Care Competencies Professional
Organizations

Prof. Dodie A. Dichoso

 SCOPE OF CRITICAL CARE NURSING
A critical care nurse is a licensed professional nurse who
is responsible for ensuring that all critically ill patients and their
families receive optimal care.
To be able to work in a critical care area other
requirements are necessary and may vary depending on the
institution. In the nursing schools, critical care nursing is
considered an elective subject and the exposure of students to
critical care practice may not be enough to prepare them for the
complexity of critical care nursing practice once these student
nurses become licensed professional nurses. Therefore, it is
necessary that the health institution as employer provide newly
hired nurses with a basic critical care nurse specialty education
and orientation prior to the deployment in the critical care areas.
In the Advanced Practice Nursing level, the advanced practice
nurses in the critical care, must earn an advanced degree either
at the master’s or doctorate level in nursing.
1. Development of Critical Care Nursing Practice Education
and Professional Activities in the Philippines

Critical care nursing is the specialty within nursing

that deals specifically with human responses to life-
threatening problems1.These problems deal dynamically
with human responses to actual or potential life-
threatening illnesses.

The Critical Care Nurses of the Philippines, Inc.

(CCNAPI) is responsible for the promotion of man’s
health and welfare for national development. It desires to
support the professional and personal growth and
development of initial core nurses. CCNAPI has
organized itself into a national association committed to
the ideals of service to the people, equality, justice and
social progress.
 Critical Care Body of Knowledge Critical Care
Competencies Professional Organizations
1. To promote optimal delivery of safe and quality care to
the critically ill patients and their families by providing
highly individualized care so that the physiological
dysfunction as well as the psychological stress in the
ICU are under control;

2. To care for the critically ill patients with a holistic

approach, considering the patient’s biological,
psychological, cultural and spiritual dimensions
regardless of diagnosis or clinical setting;

3.To use relevant and up-to-date knowledge, caring

attitude and clinical skills, supported by appropriate
technology for the prevention, early detection and
treatment of complications to facilitate recovery.
Critical Care Body of Knowledge Critical Care
Competencies Professional Organizations

4.To provide palliative care to the critically

ill patients in situations where their health
status is progressing to unavoidable death,
and to help the patients and families go
through their painful sufferings.

On the whole, critical care nursing

should be patient-centered, safe,
effective, and efficient. The nursing
interventions are expected to be
delivered in a timely and equitable
manner.
 Nursing Care of Clients with Life
Threatening Conditions , Acutely ill /
Multi – Organ Problems , High Acuity and
Emergency Situation

Prof. Dodie A. Dichoso

Nursing Diagnosis Components
 Planning
1. Planning for Health Promotion
2. Planning for Health Restoration and Maintenance

The planning stage is where goals and outcomes are

formulated that directly impact patient care based on EDP
guidelines. These patient-specific goals and the attainment of
such assist in ensuring a positive outcome. Nursing care plans
are essential in this phase of goal setting

Nurses are the catalysts for healthier

lifestyles through encouragement and teaching,
helping patients to potentially receive
preventative services such as counseling,
screenings, and precautionary procedures or
medications.

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Planning
1. Planning for Health Promotion
2. Planning for Health Restoration and Maintenance

Rehabilitation and Health Restoration

Rehabilitation is a process of restoring ill or injured people to
maximum and functional levels of wellness.

Essential points for Maintenance of Health

So just what are the most important factors for
establishing optimum health. Studies indicate that the
following five factors make the biggest difference in
overall health and wellness: 1) diet; 2) rest; 3) exercise;
4) posture; and 5) avoiding the use of alcohol, drugs
and tobacco.
Planning
 Implementation

Implementation is the step that involves action or

doing and the actual carrying out of nursing
interventions outlined in the plan of care.

Implementation is when you put the

treatment plan into effect. This typically begins
with the medical staff performing any needed
medical interventions. Then, the patient follows
the plan for optimum recovery. As a nurse, you
will be expected to monitor the implementation
to ensure the patient is following through.

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 Nursing Implementation
Providing physical treatments, emotional support, and
patient education are all examples of nursing interventions. Nurses
typically perform these actions as part of a nursing care plan to monitor
and improve their patient's comfort and health.

Is nursing intervention and implementation

the same?
The terms resemble one another yet can be considered
discrete; while 'intervention' indicates involving, in order
to improve or help a situation, 'implementation' implies
carrying something out, or putting (something) into
action.
 A. Independent Nursing Care
1. Physiologic Care
2. Psychosocial Care
3. Spiritual Care
Independent nursing Care are the tasks that a
nurse can perform without input from another
discipline, particularly without a physician's order.
These interventions include many basic comfort care
actions such as providing water, repositioning a
patient, providing toileting assistance, and bathing.

Independent nursing Care are activities that

nurses are licensed to initiate based on their
sound judgement and skills. Includes: ongoing
assessment, emotional support, providing comfort,
teaching, physical care, and making referrals to other
health care professionals.
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 B. Interdependent Care
1. Pharmacological Therapeutic
2. Complementary and Alternative Therapies
3. Nutritional and Diet Therapy
4. Surgical intervention
5. Immunologic Therapy

Pertaining to actions or activities

that require one individual to work with
another. Interdependent nursing actions
are those that are performed by the
nurse after mutual determination by the
nurse and the physician.

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Interdependent Nursing Care

Are those that nurses perform as part of

a collaborative team of medical professionals
working together to care for a patient.

An example of an interdependent
intervention could include a patient
recovering from knee surgery who is
prescribed pain medication by a physician,
administered medication by a nurse and
given physical therapy exercises by a
specialist.
 Patient Education can be defined as the
process of influencing patient behavior and
producing the changes in knowledge, attitudes
and skills necessary to maintain or improve
health.

Patient Education include:

•Delegate more responsibilities to support
staff and be more focused on patient
education.
•Begin educating patients with every
encounter from admission.
•Find out what the patient already knows.
...
•Feed patients information in layman's
terms.
 Evaluation of the Outcome of Care
Evaluation: Monitoring (and documenting) the
patient's status and progress towards goals, and
modifying the care plan as needed.
Outcome Evaluation The fifth step of the
process, outcome evaluation, attempts to interpret
the results and evaluate the outcomes of the
applied evidence (intervention).

Expected outcomes are statements of measurable

action for the patient within a specific time frame
that are responsive to nursing interventions. Nurses
may create expected outcomes independently or refer
to classification systems for assistance.
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 Reporting and Documentation of Care

Documentation is anything written or printed that is

relied on as a record of proof for authorized persons.
Documentation and reporting in nursing are needed for
continuity of care it is also a legal requirement showing the
nursing care performed or not performed by a nurse.

Nursing documentation is essential for good

clinical communication. Appropriate documentation
provides an accurate reflection of nursing
assessments, changes in clinical state, care provided
and pertinent patient information to support the
multidisciplinary team to deliver great care.
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 1. Admission nursing assessment
2. Nursing Care plan
3. Kardexes
4. Pertinent
5.Medication with date of order & time of
administration
6. Daily treatment & procedures
7. Flow chart
8. Graphic record(TPRBP)
9. Fluid balance record
10. Medication
11. Skin assessment record
12. Progress notes
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