Introduction to

Critical Care Nursing

Topic Outline
• Critical Care Nursing Scope and Standards
a. Development Of Critical Care Nursing Practice, Education And Professional Activities In The Philippines
b. philosophy Of Critical Care Nursing According to the CCNAPI
c. The Right Of The Critically Ill Patient
d. Goals Of Critical Care Nursing
e. Levels & Categories Of Critical Care Provisions within Philippines
f. Categories of Critical Care Unit
g. System Operation Of Critical Care Units
h. Scope Of Critical Care Nursing (CCNAPI)
i. Critical Care Nurse Qualifications
j. Roles of the Critical Care Nurse
k. Challenges of Critical care Nurses
l. Standards of Critical care Nursing Practice (CCNAPI)
m. Critical Care Nursing Practice

• Critical Care Body of Knowledge Critical Care Competencies Professional Nursing Care of Clients with
Life-Threatening Conditions, Acutely III / Multi-Organ Problem, High Acuity and Emergency Situation
Learning Objectives
• After going through this topic, you will be able to:
• Identify Critical Care Nursing its Scope and Standards as a patient care specialization.
• Explain the Development of Critical Care Nursing Practice, Education and Professional
Activities in the Philippines and the world.
• Recognize competencies required for the delivery of nursing care in the critical care.
• Discuss the importance of a consistent and systematic approach to assessment of
critically ill patients and their families.
• Identify the assessment priorities for different stages of a critical illness:
• Prearrival assessment
• Admission quick check
• Comprehensive admission assessment
• Ongoing assessment

• Describe how the assessment is altered based on the patient’s clinical status.
Introduction
• The health care industry all over the world has been evolving
and the Philippines has been part of these changes that
greatly impact the quality of nursing practice. There is an
evolution in the delivery of nursing care particularly now that
there are many new challenges that surround the nursing
profession and the healthcare field as a consequence of the
complexities of globalization, transcultural issues, emerging
illness and advancements in technology.
Critical Care Nursing
• Did you know that:
• Critical care nursing is the specialty within nursing profession
that deals specifically with human responses to life-
threatening problems.
• These problems deal dynamically with human responses to
actual or potentially life-threatening illnesses.
• Critical care nursing is a complex, challenging area of nursing
practice, where clinical expertise is developed overtime by
integrating critical care knowledge, clinical skills, and caring
practices.
CRITICAL CARE NURSING SCOPE AND
STANDARDS
• The health care industry all over the world has been evolving and the
Philippines has been part of these changes that greatly impact the quality
of nursing practice. There is an evolution in the delivery of nursing care
particularly now that there are many new challenges that surround the
nursing profession and the healthcare field because of the complexities of
globalization, transcultural issues, emerging illness and advancements in
technology
• Critical care nursing is the specialty within nursing profession that deals
specifically with human responses to life threatening problems These
problems deal dynamically with human responses to actual or potentially
life-threatening illnesses
CRITICAL CARE NURSING SCOPE AND
STANDARDS
• The framework of critical care nursing is a complex, challenging area of nursing
practice
• It utilizes the nursing process applying assessment, diagnosis, outcome identification, planning,
implementation, and evaluation
• The critical care nursing practice is based on a scientific body of knowledge and incorporates
the professional competencies specific to critical care nursing practice and is focused on
restorative, curative, rehabilitative, maintainable, or palliative care, based on identified
patient’s need
• It upholds multi and interdisciplinary collaboration in initiating interventions to restore stability,
prevent complications, achieve and maintain optimal patient responses
• The critical care nursing profession requires a clear description of the attribute’s guidelines and
nursing practice standards in guiding the critical care nursing practice to fulfill this purpose
CRITICAL CARE NURSING SCOPE AND
STANDARDS
• Health care is undergoing dramatic change at a speed that makes it almost
impossible to remain current and be proactive The chaos and many
challenges facing health care providers and consumers are evident in critical
care, in which new treatment modalities and technology interface with the
continuing effort to strive for quality care and positive outcomes Efficiency
and cost effectiveness in relation to health care services are frequently
discussed and are emphasized to all health care providers To some, it appears
that quality patient care has taken a back seat to the emphasis on cost
containment and that quality and cost effectiveness are not congruent It is
incumbent on all critical care health care providers to face these challenges
from their individual discipline’s scope of practice and collectively from
collaborative and interdisciplinary approaches
CRITICAL CARE NURSING SCOPE AND
STANDARDS
• The ever-changing health care environment creates many challenges
for providers and consumers of care Sensitivity to the appropriate time
to eliminate or modify practices and adopt innovations is key to
maintaining quality, cost effective care delivery
• Willingness to step outside of traditional structures and roles is the first
step in making necessary changes Change is constant Flexibility and
adaptation to change are essential to maintaining personal and
organizational balance and to surviving in today’s health care
environment
History of Critical Care
• Critical care evolved from the recognition that the needs of patients with acute, life threatening illness or
injury could be better met if the patients were organized in distinct areas of the hospital.
• In the 1800s, Florence Nightingale described the advantages of placing patients recovering from surgery in a
separate area of the hospital.
• A three-bed postoperative neurosurgical intensive care unit was opened in the early 1900 s at Johns Hopkins
Hospital in Baltimore.
• This was soon followed by a premature infant unit in Chicago.
• 1 Major societal issues have affected the development of intensive care as a specialty During World War II,
shock wards were established to care for critically injured patients.
• The nursing shortage after the war forced the grouping of postoperative patients into designated recovery
areas so that appropriate monitoring and care could be provided.
• The technologies and combat experiences of health care providers during the wars of the 20th century also
provided an impetus for specialized medical and nursing care in the civilian setting .
• The 1950 s brought the new technology of mechanical ventilation and the need to group patients receiving
this new therapy in one location
History of Critical Care
• Critical care nursing was organized as a specialty less than 60 years ago before that time, critical care nursing was
practiced wherever there were critically ill patients The development of new medical interventions and technology
prompted recognition that nursing was important in the monitoring and observation of critically ill patients Physicians
depended on nurses to watch for critical changes in the condition of patients in the physicians’ absence, and they
sometimes depended on the nurses to initiate emergency medical treatment
• As sophisticated technology began to support more elaborate medical interventions, hospitals began to organize
separate units to make more efficient use of equipment and specially trained staff.
• Postoperative care, once provided by private duty nurses on general nursing wards throughout the hospital, was moved
into recovery rooms, where nurses with specialized knowledge regarding anesthesia recovery provided the patient care.
• Medical and surgical intensive care units segregated the most critically ill patients in locations where they could be
cared for by nurses with specialized knowledge in those areas of care.
• By the 1960 s, nurses had begun to consolidate their knowledge and practice into focused areas such as coronary care,
nephrology, and intensive care In the hospital units established for patients needing such specialized care, nurses
assumed many functions and responsibilities formerly reserved for physicians, and they assumed a new authority by
virtue of their knowledge and expertise
 History of Critical Care
• In the Philippines, the Professional Regulation Commission Board of Nursing (PRC BON) is committed to provide need driven,
effective and efficient specialty nursing care services of high standard and at international level within the obtainable
resources To respond to this mission and commitment, a PRC BON Working Group in Developing the Nursing Specialty
Framework was formed in the 1996 to take on the task of setting the process based framework and guidelines for specialty
nursing services The Working Group members are clinical nurse practitioners, nurse educators and nurse managers.
• The expanding healthcare and nursing knowledge together with new and evolving healthcare sites, structures, and
technologies all have contributed to the need and desire for specialty nursing organizations like the Critical Care Nurses
Association of the Philippines, Inc ..( to revisit the existing statements of its Standards of Nursing Practice to provide clear and
updated statements regarding the scopes of practice and standards of critical care nursing This will ensure continued
understanding and acknowledgment of nursing’s varied specialty professional contributions in today’s healthcare
environment.
• The CCNAPI Standards of Practice of 1982 has been revisited and revised to be aligned with the 2005 BON statements of the
11 Core Competencies for Entry Level for Safe and Quality Nursing Care The CCNAPI Core Competencies of a Critical Care
Nurse are stated according to the levels of expected behavior defining the actual knowledge, skills and abilities in the practice
of critical care by a nursing professional These statements cover expected behavior of a Nurse Clinician I, Nurse Clinician II and
Nurse Specialist that will serve as the basis for assessing competence in critical care practice
• The focus of care for the critically ill patient is holistic However, within Critical Care Nursing there are also specialized areas of
focus of care Physiologically each focus is categorized under bodily functional systems such as pulmonary system,
cardiovascular system, renal system, neurological system and other system all belonging to the specialty of critical care
nursing
PHILOSOPHY OF CRITICAL CARE NURSING
according to the CCNAPI
• Critical Care Nursing reflects a holistic approach in caring of patients. It places great emphasis on the caring of the bio-
psycho-social-spiritual nature of human beings and their responses to illnesses rather than salary on the disease process. It
helps maintain the individual patient’s identity and dignity. The focus of caring includes preventive care, risk factor
modification and education to decrease future patient admissions to acute care facilities.
• 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.
• In the Critical Care Units, each patient is viewed as a unique individual with dignity and worth. The critically ill patient
should receive comfort and provided privacy in a highly technological environment. In collaboration with other health care
team members, critical care nurses provide high level of patient care which includes patient and family education, health
promotion and rehabilitation. To achieve this holistic care process, participation by the patient and his/her family is always
emphasized. At the forefront of critical care science and technology, critical care nurses maintain professional competence
based on a broad base of knowledge and experience through continuous education and evidence-based research.
PHILOSOPHY OF CRITICAL CARE NURSING
according to the CCNAPI
• With the advances in sophisticated biomedical technology and
knowledge, critical care nurses are able to continuously monitor and
observations for physiological changes to confront problems
proactively and to assist patients achieve and maintain an optimum
level of functioning or a peaceful death.
• In other words, these nursing philosophy off the CCNAPI he's
accomplished by looking after critically ill patients in an environment
with specially trained nurses, appropriate equipment, adequate
medical supplies and other members of the health care personnel.
• https://www.ccnapi.org/news-and-events/critical-care-nursing-guidelines-standards-and-competencies/
THE RIGHTS OF THE CRITICALLY ILL PATIENT
• The International Council of nurses ( views health care as the rights of
every individual regardless of financial political, geographical, racial and
religious consideration This right includes the right to choose or decline
care, including the right to accept or refuse treatment or nourishment
informed consent confidentiality and dignity, including the right to die with
dignity It involves both the right of those seeking care and the providers
• The World Federation of Critical Care Nurses ( has considered the rights of
the critically ill patients, WFCCN has agreed that the statement of the
patient’s right from the ICN covers the requirement for position statement
on the rights of the critically ill patients
• CCNAPI being a founding member of WFCCN likewise supports the ICN
position statement on Nurses and Human Rights
GOALS OF CRITICAL CARE NURSING
• Critical or intensive care is a complex specialty developed to serve the diverse health care need of
patients (and their families) with actual or potential life-threatening conditions. It is therefore
important that a clear statement of what critical care nursing wishes to achieve and provide
should be articulated
• Goals of Critical Care Nursing include the following
• 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
• 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
• 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
• 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
LEVELS & CATEGORIES OF CRITICAL CARE
PROVISIONS WITHIN PHILIPPINES
• With respect to the physical set up and supporting facilities of critical care units in
the Philippines, the Department of Health ( Standards requires the critical care
units intensive care unit to be a self-contained area, with the provisions for
resources that will support critical care practice Currently, the DOH is reviewing
these standards to come up with updated requirement
• In 2003 the Philippine Society of Critical Care Medicine ( Society of Pediatric Critical
Care Medicine (and the CCNAPI stratified the care provisions in critical care
practice into different levels and categories to make it similar to its counterparts
overseas with the goal of having effective utilization and organization of resources
Hence, as a guide, CCNAPI will incorporate these standards into this guideline
LEVELS & CATEGORIES OF CRITICAL CARE
PROVISIONS WITHIN PHILIPPINES
• Levels of Care Provision
• The role of a particular critical care unit will vary, depending on the
staffing, facilities and support services as well as the type and
number of patients it must manage.
• Taking into consideration the recommendation of the Guidelines
on Critical Care Personnel and Services published in 2003 by the
Critical Care Medicine, the critical care service provision in the
Philippines can adapt these guidelines and apply the 3 levels of
classifications accordingly:
Levels of Care Provision
Level 1
• Should be capable of providing immediate resuscitation for the
critically ill and short-term cardio-respiratory support because the
patients are at risk of deterioration
• Has a major role in monitoring and preventing complications in “at
risk” medical and surgical patients Must be capable of providing
mechanical ventilation and simple invasive cardiovascular monitoring
Has a formal organization of medical staff and at least one registered
nurse
• A certain number of nurses including the nurse in charge of the unit
should possess post registration qualification in critical care or in the
related clinical specialties and
• Has a nurse patient ratio of 1:1 for all critically ill patients
Levels of Care Provision
Level 2
• Should be capable of providing a high standard of general critical care for
patients who are stepping down from higher levels of care or requiring single
organ support/support post-operatively;
• Capable of providing sustainable support for mechanical ventilation, renal
replacement therapy, invasive hemodynamic monitoring and equipment for
critically ill patients of various specialties such as medicine, surgery, trauma,
neurosurgery, vascular surgery;
• Has a designated medical director with appropriate intensive care qualification
and a duty specialist available exclusively to the unit at all times;
• The nurse in-charge and a significant number of nursing staff in the unit have
critical care certification; and
• A nurse: patient ratio is 1:1 for all critically ill patients.
Levels of Care Provision
Level 3
• Is a tertiary referral unit, capable of managing all aspects of critical
care medicine (This does not only include the management of
patients requiring advanced respiratory support but also patients
with multi-organ failure);
• Has a medical director with specialist critical / intensive care
qualification and a duty specialist available exclusively to the unit
and medical staff with an appropriate level of experience present in
the unit at all times;
• A nurse in-charge and the majority of nursing staff have intensive
care certification; and
• A nurse: patient ratio is at least 1:1 for all patients at all times
Categories of Critical Care Unit
The Critical Care Unit can be categorized according to patients’ age group or
medical specialties
A. Age Group
1. Neonatal
2. Pediatric
3. Adult
B. Specialty
In the existing environment, majority of the Critical Care Units in the Philippines
provide service for patients of various specialties They are labeled as General ICUs
In certain hospitals, the critical care unit service is dedicated to the following
specific groups
1. Medical
2. Surgical
3. Cardio thoracic
4. Cardiac
5. Respiratory
6. Neurosurgical
7. Trauma
SYSTEM OPERATION OF CRITICAL CARE
UNITS
The operation of critical care units can be classified into Open System and Closed System
A. Open System
• The admitting and other attending doctors dictate management, change management or
perform procedures without consultation or communication with a Critical Care Specialist
A Critical Care Specialist may be available for advice or be consulted to provide
interventional skills (No designated person who assumes the “gate keeper“ role.
B. Closed System
• Management is coordinated by a qualified Critical Care Specialist The critical intensive care
specialist has clinical and administrative responsibility There is a multi disciplinary team of
specially trained critical care staff The “ is the final common pathway for all medical
decision making including the decision to admit or discharge patients
• Irrespective of the ICU “ Operations, i e open system or closed system, or a mixture of the
two, there should be a designated group of registered nurses under unique management
to provide highly specialized care to the critically ill patients The nurse in charge and the
majority of nursing staff in each unit should have the relevant qualification in the specialty
of the respective Unit
 SCOPE OF CRITICAL CARE NURSING (CCNAPI)
• The scope of critical care nursing is defined by the dynamic interactions of the critically ill patient/family the critical care
nurse and the critical care environment to bring about optimal patient outcomes through nursing proficiency in an
environment conducive to the provision of this highly specialized care.

• Constant intensive assessment, timely critical care interventions and continuous evaluation of management through
multidisciplinary efforts are required to restore stability, prevent complications and achieve optimal health Palliative care
should be instituted to alleviate pain and sufferings of the patient and family in situations where death is imminent

• Critical Care Nurses are registered nurses, who are trained and qualified to practice critical care nursing They possess the
standard critical care nursing competencies in assuming specialized and expanded roles in caring for the critically ill
patients and their family Likewise, each critical care nurse is personally responsible and committed to continuous
learning and updating of his/her knowledge and skills The critical care nurses carry out interventions and collaborates
patient care activities to address life threatening situations that will meet patient’s biological, psychological, cultural and
spiritual needs

• The critical care environment constantly supports the interactions between the critically ill patients, their family and the
critical care nurses to achieve desired patient outcomes It entails readily available and accessible emergency equipment,
sufficient supplies and effective support system to ensure quality patient care as well as staff safety and productivity
CRITICAL CARE NURSE QUALIFICATION
• 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 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.
• The CCNAPI adopt the Position Statement of the World Federation of Critical Care Nurses on the Provisions of
Critical Care Nursing Workforce also called” the Declaration of Buenos Aires” ratified in the full council meeting last
August 27, 2011, at the Sheraton Hotel, Buenos Aires, Argentina.
• The declaration presents guidelines universally accepted by critical care professionals, which should be adopted to
meet the critical care nursing workforce and the system requirements of a particular country or jurisdiction. The
declaration states the specific central principles governing the provision and provides for specific recommended
critical care nursing workforce requirement. The complete declaration is attached as Annex II to this guideline.
ROLES OF THE CRITICAL CARE NURSES
• In response to the changes and expansions within and
outside the healthcare environment, critical care
nurses have broadened their roles in the practice
levels.
• Competencies of critical care nurses are honed and
developed to achieve their roles in practice,
management / leadership and research.
Practitioner Role
• The critical care nurses execute their practice roles 24 hours a day to provide high
quality care to the critically ill patient
• 1. Care Provider
• A. Direct patient care
1. Detects and interprets indicators that signify the varying conditions of the critically ill with
the assistance of advanced technology and knowledge
2. Plans and initiates nursing process to its full capacity in a need driven and proactive
manner
3. Acts promptly and judiciously to prevent or halt deterioration of patients’ condition when
conditions warrant, and
4. Co ordinates with other healthcare providers in the provision of optimal care to achieve
the best possible outcomes
• B. Indirect patient care Care of the Family
1. Understands family needs and provide information to allay fears and anxieties and
2. Assists family to cope with the life-threatening situation and/or patient’s impending death
Practitioner Role
2 Extended roles as critical care nurses
Critical care nurses have roles beyond their professional boundary With proper
training and in accordance with established guidelines, algorithms, and protocols
that are continuously reviewed and updated, critical care nurses also perform
procedures and therapies that are otherwise done by doctors Such procedures and
therapies are
a. Sampling and analyzing arterial blood gases
b. Weaning patients off ventilators
c. Adjusting intravenous analgesia sedations
d. Performing and interpreting ECGs
e. Titrating intravenous and central line medicated infusion and nutrition support
f. Initiating defibrillation to patient with ventricular fibrillation or lethal ventricular tachycardia
g. Removal of pacer wire, femoral sheaths and chest tubes, and
h. Other procedures deemed necessary in their respective institutions under a clinical protocol
Practitioner Role
Educator
As an educator, the critical care nurse must be able to:
a.Provides health education to patient and family to promote
understanding and acceptance of the disease process thus facilitate
recovery and
b.Participates in the training and coaching of novice healthcare team
members to achieve cohesiveness in the delivery of patient care.
Practitioner Role
Patient Advocate
• The critical care nurses’ role includes being an advocate someone who acts or intercedes on
behalf or another Typically, the critical care nurse may be in the best position to act as the liaison
between patient and family and other team members and departments because they are the
healthcare professionals with the most interpersonal contact with the patients. To perform this
function adequately, the nurse must be knowledgeable about the involved in all aspects of the
patient’s care and have a positive working relationship with other team members. The critical care
nurses are expected to
a. Acts in the best interests of the patient and
b. Monitors and safeguards the quality of care which the patient receives
Management and Leadership Role
The critical care nurse in her management and leadership role will be able to
assume the following responsibilities:
1. Performance of management and leadership skills in providing safe and quality
care.
2. Accountability for safe critical care nursing practice.
3. Delivery of effective health programs and services to critically ill patients in the
acute setting;
4. Management of the critical care nursing unit or acute care setting.
5. Taking the lead and supervision of nursing support staff, and
6. Utilization of appropriate mechanism for collaboration, networking, linkage–
building and referrals.
ROLE IN RESEARCH
The critical care nurse’s role in research will entail the
following responsibilities
a. Engage self in nursing or other health related research with
or under the supervision of an experienced researcher
b.Utilization of guidelines in the evaluation of research study
or report
c. Application of the research process in improving patient
care infusing concepts of quality improvement in
partnership with other team players
ADVANCED PRACTICE LEVEL
• The development of the Advanced Practice Nursing is the future direction in the
Philippines and to be bench marked with other countries For now, a thorough
study of Advanced Practice in critical care is being undertaken to align with the
PRC BON initiative on specialization framework

• The current global healthcare environment demands critical care nurses to have
advanced knowledge and skills to provide the highest possible level of care to
the critically ill patients CCNAPI supports the following descriptions of advanced
practice roles
EXPANDED ROLES
Nurse Specialist Clinical Nurse Specialist
• The education and preparation of the critical care nurse practitioner is provided by the
respective hospitals CCNAPI recommends that a graduate study or a master’s degree program
should support the development of critical care nursing specialization goes beyond the basic
baccalaureate nursing degree. Advanced educational preparation refers to the critical care
nursing educational program run by the university offering Advanced Nursing Studies or other
recognized advanced critical care program offered in the Philippines and overseas
• A registered nurse who is a nursing degree holder, should have more than 3 years of
uninterrupted practice experience in the critical care field He/she can function as a critical care
nurse specialist when he/she has attained advanced education and expertise in caring patients
with critical problems He/she is also eligible to be certified by the PRC Board of Nursing as a
Clinical Nurse Specialist.
• The critical care nurse specialist is responsible for building up nursing competencies in the ICU
entity He She contributes to continuous improvement in critical care nursing through staff and
client’s education and uphold quality nursing guidelines on patient care through clinical research
and refinement of ICU Standards
EXPANDED ROLES
Acute Care Nurse Practitioner
• Acute Care Nurse Practitioner (in the critical care unit takes lead in developing evidence-
based practices to meet changing clinical needs and facilitates patient care processes
across professional and organizational boundaries. The qualification of Acute Care Nurse
Practitioner (includes should have the recommended number of post registration
(licensed experience) nursing experience which are spent in the critical field, exhibiting
in depth professional knowledge and skills An Acute Care Nurse Practitioner (is a holder
of a) clinical master’s degree in a clinical nursing specialty (Medical Surgical) such as
Critical Care Nursing or b) master’s degree in nursing or related discipline such as
management together with recognized critical care training qualifications. The Acute
Care Nurse Practitioner executes the nursing team leader’s responsibilities as
designated in the position of Advanced Nurse Practitioner.
EXPANDED ROLES
Outcome Specialist
• Outcome management has been introduced into the healthcare
system to ensure achievement of quality and cost effectiveness in
the delivery of patient care Some critical care units have adopted
clinical pathways (e g Critical Pathways, Protocols, Algorithms and
Orders) in the management of specific diseases such as Acute
Myocardial Infarction and Cardio thoracic Surgeries Qualified nurse
experts are involved in the development and implementation of
patient outcomes management
CHALLENGES OF CRITICAL CARE NURSES
The challenging needs that the advanced critical care practitioner will
face from the critical care nursing service and its environments demand
for them to consider the following objectives
1. To develop, foster and maintain a level of knowledge about the norms,
values, beliefs, patterns of illness, health and care needs of the people
2. To analyze and evaluate critical care nurses’ specialty skills and their
evolving roles
3. To review current studies and research and to examine contextual issues
that will enable evaluation and synthesis of new knowledge, traditional
techniques, religious and cultural influences to be applied in nursing
practice, particularly evidence-based nursing practice, and
4. To exercise professional judgments expected of them in the critical care
clinical setting.
TRAINING OF NURSES FOR CRITICAL CARE
SERVICES
• The institution hospital should provide training
opportunities to ensure staff competencies This will enable
the nurses working in the critical care units to cope with the
complexities and demands of the changing needs of the
critically ill patients. The following training activities should
be supported by the higher level of management to
maintain a high standard of care:
Orientation Program Preceptorship and
Mentoring Program
• New recruits to the critical care units shall attend an orientation
program and be given opportunities to work under senior staff
supervision Experienced staff in the unit should be readily available
for consultation
• In Service Training Program
a. Unit hospital-based training courses workshop seminar at hospital
level
b. On the job training and bedside supervision
CRITICAL CARE NURSING PROGRAM (POST
GRADUATE SPECIALTY PROGRAM)
• Critical Care Nurses Association of the Philippines, Inc recommends that all practicing CCN shall
continuously update their knowledge, skills and behavior through active participation in Critical Care
Nursing Education or its related field.
• The following are categorization of critical care nursing education

POST GRADUATE COURSES

• Post graduate courses are part of higher education taken after a Bachelor’s Degree that are accredited from
the Commission on Higher Education (or the Professional Regulation Commission Board of Nursing (PRC
BON)
• It is recommended that this course has been reviewed, evaluated and endorsed to the accrediting body by
the Critical Care Nurses Association of the Philippines, Inc.
• Likewise, it is further recommended that the World Federation of Critical Care Nurses policy statement of
education shall be used as a framework for designing a critical care nursing program. (Please see
Declaration of Madrid, 2005 Annex I)
CRITICAL CARE NURSING PROGRAM (POST
GRADUATE SPECIALTY PROGRAM)
CERTIFICATION COURSE
• Certification courses provides recognition and designation earned by a professional nurse after
completing with satisfaction the requirements of the course and has earned qualification to
perform a job or task
• The certification courses should be recognized and accredited by the Professional Regulation
Commission Board of Nursing (PRC BON) or other authorized accrediting body
• This shall include but not limited to the following:
o Advanced Cardiac Life Support
o Pediatric Advanced Cardiac Life Support
o Newborn Resuscitation
o Continuous Renal Replacement Certification
o Advanced Intravenous therapy
o Stroke Nursing
TRAINING FOR CRITICAL CARE SERVICES
Continuing Professional Education (CPE)
• Continuing Professional Education Programs is a type of education that consist of updated
knowledge and other pertinent information that will help the Critical Care Nurse to attain
broader understanding of critical care practice and its related field. The goal includes Critical
Care Nurses development of skill, behavior that will help them view the critically ill person in a
holistic dimension.
• CCNAPI recommends that all practicing CCN shall ensure that they continuously update their
knowledge, skills and behavior through active participation in related critical care nursing
education and must earn at least 20 credit units per year
• The updated educational component includes but not limited to the following
o Advanced/Comprehensive Critical Assessment
o Critical Care Practitioner
o End of Life and Palliative Care
STANDARDS OF CRITICAL CARE NURSING
PRACTICE (see CCNAPI)
• Critical care specialty addresses the management and support of patients with severe or
life threatening illness The goal of critical care nursing is to promote optimal adaptation
of critically ill patients and their families by providing highly individualized care, so that
the critically ill patients adapt to their physiological dysfunction as well as the
psychological stress in the Critical Care Unit or Intensive Care Unit (To achieve this,
standards should be developed to serve as a guide for monitoring and enhancing the
quality of intensive care nursing practice
• Care standards for critical care nursing provide measures for determining the quality of
care delivered, and also serve as means for recognizing the competencies of nurses in
intensive care specialty
• Procedures standards for critical care nursing practice provide a step-by-step guideline
for nurses to carry out day to day nursing procedure in a most appropriate manner.
STANDARDS OF CRITICAL CARE NURSING
PRACTICE (see CCNAPI)
The following 11 Standards are intended to furnish nurses with directions in providing quality care and excellence in
Critical Care Nursing
1. The critical care nurse functions in accordance with legislation, common laws, organizational regulations and by
laws, which affect nursing practice
2. The critical care nurse provides care to meet individual patient needs on a 24-hour basis
3. The critical care nurse practices current critical care nursing competently
4. The critical care nurse delivers nursing care in a way that can be ethically justified
5. The critical care nurse demonstrates accountability for his/her professional judgment and actions
6. The critical care nurse creates and maintains an environment which promotes safety and security of patients,
visitors and staff
7. The critical care nurse masters the use of all essential equipment, available services and supplies for immediate care
of patients
8. The critical care nurse protects the patients from developing environmental induced infection
9. The critical care nurse utilizes the nursing process in an explicit systematic manner to achieve the goals of care
10. The critical care nurse carries out health education for promotion and maintenance of health
11. The critical care nurse acts to enhance the professional development of self and others.
• The Structure Process Outcome model is used Emphasis is put on management systems, nursing activities and
interactions between the nurse and the care recipients, as well as the outcomes of nursing care provided.
COMPETENCIES FOR CRITICAL CARE NURSES
• The competence of critical care nurses together with established nursing standards and the identified core
competencies for registered nurses will result to excellence in critical care nursing practice. This three-pronged
holistic framework ensures quality performance through an adherence to nursing standards, the demonstration of
competencies, and the integration of appropriate nursing model/s into the health care delivery process.
• To achieve safe and quality client centered care, nurses working in the critical care units are envisioned to adopt
not only the stated core competencies of registered nurses but also the specific competencies stipulated in the
following eleven major key responsibility areas:
o Safe and Quality Nursing Care
o Management of Resources
o Legal Responsibilities
o Ethico Moral Responsibilities
o Collaboration and Teamwork
o Personal and Professional Development
o Communication
o Health Education
o Quality Improvement
o Research
o Records Management