ABOUT CRITICAL CARE NURSING

Definition of Critical Care Nursing Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. A critical care nurse is a licensed professional nurse who is responsible for ensuring that acutely and critically ill patients and their families receive optimal care. Definition of a Critically Ill Patient Critically ill patients are defined as those patients who are at high risk for actual or potential lifethreatening 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. Number of Critical Care Nurses in the United States According to "The Registered Nurse Population" study conducted in March 2004 by the Department of Health and Human Services, there are 503,124 nurses in the U.S. who care for critically ill patients in a hospital setting. Of these, 229,914 spend at least half their time in an intensive care unit (ICU); 92,826 spend at least half their time in step-down or transitional care units; 117,637 spend at least half their time in emergency departments; and 62,747 spend at least half their time in post-operative recovery. Critical care nurses account for an estimated 37% of the total number of nurses who work in a hospital setting. Where Critical Care Nurses Work According to "The Registered Nurse Population" study, 56.2% of all nurses work in a hospital setting, and critical care nurses work wherever critically ill patients are found — intensive care units, pediatric ICUs, neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units, progressive care units, emergency departments and recovery rooms. Increasingly, critical care nurses work in home healthcare, managed care organizations, nursing schools, outpatient surgery centers and clinics. What Critical Care Nurses Do Critical care nurses practice in settings where patients require complex assessment, highintensity therapies and interventions, and continuous nursing vigilance. Critical care nurses rely upon a specialized body of knowledge, skills and experience to provide care to patients and families and create environments that are healing, humane and caring. Foremost, the critical care nurse is a patient advocate. AACN defines advocacy as respecting and supporting the basic values, rights and beliefs of the critically ill patient. In this role, critical care nurses:

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Respect and support the right of the patient or the patient's designated surrogate to autonomous informed decision making. Intervene when the best interest of the patient is in question. Help the patient obtain necessary care. Respect the values, beliefs and rights of the patient. Provide education and support to help the patient or the patient's designated surrogate make decisions. Represent the patient in accordance with the patient's choices. Support the decisions of the patient or designated surrogate, or transfer care to an equally qualified critical care nurse. Intercede for patients who cannot speak for themselves in situations that require immediate action. Monitor and safeguard the quality of care the patient receives.

Managed care has also fueled a growing demand for advanced practice nurses in the acute care setting. such as the Web-based Essentials of Critical Care Orientation (ECCO) program.S. Nursing Shortage More Pronounced for Critical Care Nurses The nursing shortage is especially acute in the specialty areas of nursing. Some employers prefer to hire certified nurses because they have demonstrated acquisition of a specific high level of knowledge in their specialty through successful completion of a rigorous. an individual must earn a diploma in nursing. many nurses choose to become certified. but most of a critical care nurse's specialty education and orientation is provided by the employer. They provide direct patient care. critical care nurses are caring for patients who are more ill than ever before. Their activities include risk appraisal. interpretation of diagnostic tests and providing treatment. Act as a liaison between the patient. they are most frequently clinical nurse specialists (CNS) or acute care nurse practitioners (ACNP). as noted in the skyrocketing number of requests for temporary and traveling critical care nurses to fill staffing gaps in every part of the U. Because of the availability of Medicare and managed care reimbursement to clinical nurse specialists. planning and prescribing pharmacological and nonpharmacological treatment of health problems. Certified nurses validate their continuing knowledge of current practices in acute/critical care nursing through a renewal process that includes meeting continuing education and clinical experience requirements. Critical Care Nurse Certification Although certification is not mandatory for practice in a specialty like critical care. The CNS is responsible for the identification. psychometrically valid. as state boards of nursing attain statutory authority to issue advanced practice nursing licenses. especially in the annual Career Guide. job-related examination. In addition. Hospitals are offering critical care nurses ever more attractive incentives. and reimbursement for continuing education and certification. ACNPs in the critical care setting focus on making clinical decisions related to complex patient care. a growing number of employers are requiring advanced practice certification. With the onset of managed care and the resulting migration of patients to alternative settings. which may include prescribing medication. including sign-on bonuses. Advanced practice nurses are those who have received advanced education at the master's or doctoral level. nurse researchers. Requirements vary as dictated by each state's Board of Nursing. Recruitment advertising for critical care nurses in AACN's publications continues to grow. an associate's degree in nursing (ADN) or a bachelor's degree in nursing (BSN) and pass a national licensing exam. one of many credentials the association offers. Many nursing schools offer students exposure to critical care. Level of Education for Critical Care Nurses To become a registered nurse (RN). pediatric and neonatal ICUs and emergency departments. clinical nurse specialists and nurse practitioners. Advanced practice nurses must earn a degree at the master's or doctoral level. many hospitals are launching critical care orientation and internship programs. In the critical care setting. nurses are often being required to pass a nationally recognized certification examination. A CNS is an expert clinician in a particular specialty — critical care in this case. Additionally. nurse educators. The Roles of Critical Care Nurses Critical care nurses work in a wide variety of settings. including assessing. filling many roles including bedside clinicians. the patient's family and other healthcare professionals. These requests are most pronounced for adult critical care units. diagnosing. intervention and management of clinical problems to improve care for patients and families. a critical care nurse must care for critically ill patients for a minimum of two years to be eligible for the CCRN certification exam offered by AACN. to attract and prepare . relocation bonuses. nurse managers. For example.

critical care nurses will need to become ever more knowledgeable. resuscitation and life support equipment are available and used. nurses needed specialized knowledge and skills. As advances have been made in medicine and technology. The first intensive care units emerged in the 1950s to provide care to very ill patients who needed one-to-one care from a nurse. However. intensive care unit a hospital unit in which are concentrated special equipment and skilled personnel for the care of seriously ill patients requiring immediate and continuous attention. patients in critical care units are more ill than ever. a specially equipped hospital area designed for the treatment of patients with sudden life-threatening conditions. Angström unit angstrom. and other types of care will be provided in alternative locations or at home. As issues relating to patient care become increasingly complex and new technologies and treatments are introduced. 2. Future of Critical Care Nursing Rapid advances in healthcare and technology have contributed to keeping more people out of the hospital. To provide appropriate care. atomic mass unit (u) (amu) the unit mass equal to 112 the mass of the nuclide of carbon-12.experienced and newly licensed nurses to work in critical care and the Essentials of Nurse Manager Orientation program. unit (u´nit) 1. CCUs contain resuscitation and monitoring equipment and are staffed by personnel specially trained and skilled in recognizing and immediately responding to cardiac and other emergencies. and the care delivery mechanisms needed to evolve to support the patients' needs for continuous monitoring and treatment. critical care care of a patient in a life-threatening situation of an illness. including ECG. Includes artificial life support system. From this environment the specialty of critical care nursing emerged. Called also dalton. Symbol U. critical care unit a unit in a hospital in which special patient care staff and units. blood gas analysis apparatus. Critical care nurses will need to keep pace with the latest information and develop skills to manage new treatment methods and technologies. It has been proposed that hospitals of the future will be large critical care units. patient care has become more complex. . Many patients who would have been cared for in a critical care unit five years ago are now being cared for on medical floors or at home. critical care unit (CCU). Many patients in today's critical care units would not have survived in the past. abbreviated ICU. a single thing. See also intensive care unit. a quantity assumed as a standard of measurement. History of Critical Care Nursing Although there have always been very ill and severely injured patients. the concept of critical care is relatively modern.

medical and nursing staff. 2004 by Houghton Mifflin Company. Dorland's Medical Dictionary for Health Consumers. including a respiratory bronchiole. alveolar ducts and sacs. vitamins. hormones. SI unit any of the units of the Système International d'Unités (International System of Units) adopted in 1960 at the Eleventh General Conference of Weights and Measures. intensive care unit a hospital unit in which are concentrated special equipment and skilled personnel for the care of seriously ill patients requiring immediate and continuous attention. equal to the amount of inhibitor in patient plasma that will inactivate 50 per cent of factor VIII in an equal volume of normal plasma following a 2-hour incubation period. an imprint of Elsevier. toxin unit the smallest dose of a toxin which will kill a guinea pig weighing about 250 gm in three to four days. International unit (IU) a unit of biological material. CGS unit any unit in the centimeter-gram-second system. All rights reserved. coronary care unit a specially designed and equipped hospital area containing a small number of private rooms. usually from 39°F to 40°F. The American Heritage® Medical Dictionary Copyright © 2007. USP unit one used in the United States Pharmacopeia in expressing potency of drugs and other preparations. British thermal unit (BTU) the amount of heat necessary to raise the temperature of one pound of water one degree Fahrenheit. Also called critical care unit. Inc. intensive care unit n. © 2007 by Saunders. abbreviated ICU. Somogyi unit that amount of amylase which will liberate reducing equivalents equal to 1 mg of glucose per 30 minutes under defined conditions. and monitoring devices necessary to provide intensive care. Svedberg unit (S) a unit equal to 10−13 second used for expressing sedimentation coefficients of macromolecules. and alveoli. etc. CH50 unit the amount of complement that will lyse 50 per cent of a standard preparation of sheep red blood cells coated with antisheep erythrocyte antibody. terminal respiratory unit the anatomical and functional unit of the lung.Bethesda unit a measure of the level of inhibitor to coagulation factor VIII.. motor unit the unit of motor activity formed by a motor nerve cell and its many innervated muscle fibers. . Published by Houghton Mifflin Company. All rights reserved. toxic unit . ICU A specialized section of a hospital containing the equipment. established by the International Conference for the Unification of Formulas. as of enzymes. Bodansky unit the quantity of alkaline phosphatase that liberates 1 mg of phosphate ion from glycerol 2phosphate in 1 hour under standard conditions. Abbr. with all facilities necessary for constant observation and possible emergency treatment of patients with severe heart disease.

A large tertiary care facility usually has separate units specifically designed for the intensive care of adults. INTERIOR DESIGNERS. intensive care unit (ICU) a hospital unit in which is concentrated special equipment and specially trained personnel for the care of seriously ill patients requiring immediate and continuous attention (intensive CARE).intensive care unit (ICU). Bioengineering. 10. STAFF NURSES.NURSING E. OBSERVATION AND SHORT TERM VENTILATION.MEDICATION STORAGE 11. An ICU contains highly technical and sophisticated monitoring devices and equipment and is staffed by personnel trained to deliver critical care. Setting up an Intensive Care unit — Presentation Transcript     1. Civil. See also coronary care unit. a hospital unit in which patients requiring close monitoring and intensive care are kept.EATING (Clean area for food preparation & delivery) U. infants. 7. Elsevier. LEVELS OF ICU CARE LEVEL I – PROVIDES MONITORING. LEVEL II – PROVIDES OBSERVATION.V P – PATIENT CARE N. 3. 8th edition. ENVIRONMENTAL ENGINEERS. VELLORE 2. MONITORING & LONG TERM VENTILATION WITH RESIDENT DOCTORS. LEVEL III – PROVIDES ALL ASPECTS OF INTENSIVE CARE INCLUDING INVASIVE HAEMO DYNAMIC MONITORING & DIALYSIS. PHYSICIANS. 6. © 2009. PATIENTS AND FAMILIES MAY BE ASKED FOR COMMENTS. OBJECTIVE TO PROVIDE A FUNCTIONAL AND USER. SETTING UP AN INTENSIVE CARE UNIT Leah Macaden COLLEGE OF NURSING CMC. AN ARCHITECT ENGINEERS (Electrical. A – ADMINISTRATION (CLERKING & STATIONARY) T – TEACHING I – INFECTION CONTROL & ELIMINATION (STERILIZATION & DISINFECTION) C – CLEAN AREA . CORE COMPONENTS OF AN ICU CONSTANT MONITORING RAPID SKILLED INTERVENTION MULTI DISCIPLINARY TEAM WORK 4. children. DESIGNING AN ICU THE TEAM SHOULD CONSIST OF AN INTENSIVE CARE DIRECTOR NURSING ADMINISTRATORS & SUPERVISORS HOSPITAL ADMINISTRATORS 8. FACTORS TO CONSIDER SOURCES OF PATIENTS ADMISSION AND DISCHARGE CRITERIA EXPECTED RATE OF OCCUPANCY ECONOMIC INVESTMENT FINANCIAL VIABILITY PERSONNEL REQUIRED TECHNOLOGICAL RESOURCES        5.FRIENDLY ENVIRONMENT .UNCLEAN (Dirty linen & equipment) M. or newborns or for other groups of patients requiring a certain kind of treatment. Mosby's Medical Dictionary. Called also critical care unit. DESIGN PNEUMATICS . Electronics etc) ALL POTENTIAL USERS 9.

BULLETIN BOARD.  22. DISPOSABLE PAPER TOWELS / HAND DRIER. 3 SUCTION OUTLETS (GASTRIC. HANDWASHING AREAS – UNINTERRUPTED WATER SUPPLY.  25. Supply and professional traffic should be separated from public/visitor traffic. BED SPACE & BEDS 150 – 200 SQUARE FEET PER OPEN BED WITH 8 FEET IN BETWEEN BEDS. 14. SHELVING & CABINETS OFF THE GROUND FOR STORAGE.WINDOWS ARE AN IMPORTANT ASPECT OF SENSORY ORIENTATION. 43 HDU beds) 1 ISOLATION BED FOR EVERY 10 ICU BEDS  17. or within direct elevator travel to and from. DUTY DOCTOR’S ROOM. Intermediate care units. OFFICE ROOMS. 20. AIRCONDITIONING (SPLIT / CENTRAL) – 25 + OR – 2 DEGREES CENTIGRADE.  18.   27. No through traffic to other departments should occur. GOWNING etc BEDS . DOORWAYS – OFFSET TO MINIMISE SOUND TRANSMISSION. 225 – 250 SQUARE FEET PER BED IF IN A SINGLE ROOM. Operating Room. NATURAL ILLUMINATION AND VIEW .    19. LIGHTING – FOCUSSED & CENTRAL LIGHTING. STORAGE BY EACH BEDSIDE (BUILT IN / ALCOVE). NEED TO BE MODULATED. INFUSION PUMPS TO BE MOUNTED ON STANDS / POLES. THE PREFERRED DESIGN IS TO ALLOW A DIRECT LINE OF VISION BETWEEN THE PATIENT AND THE CENTRAL NURSING STATION.     12. CLEANING – VACUUM CLEANING & WET MOPPING OF THE FLOOR. BEVERAGE FACILITIES etc. SIDE RAILS AND WITH WHEELS. the Emergency Department. BED STRENGTH IDEALLY 8 TO 12 BEDS LARGER AREAS – DIFFICULT TO ADMINISTER AND SMALLER AREAS NOT BEING COST EFFECTIVE 3 TO 5 BEDS PER 100 HOSPITAL BEDS FOR A LEVEL III ICU / 2 TO 20% OF THE TOTAL NUMBER OF HOSPITAL BEDS (In CMC – 68 ICU Beds. 16.G. LIBRARY etc). Location should be chosen so that the unit is adjacent to. STORAGE VISITORS (OTHERS. MODULAR DESIGN – SLIDING GLASS DOORS & PARTITIONS TO FACILITATE VISIBILITY. HOOKS & DEVICES TO HANG INFUSIONS / BLOOD BAGS – SUSPENDED FROM THE CEILING WITH A SLIDING RAIL TO POSITION.  24. LOCATION Should be a geographically distinct area within the hospital. 28. GENERATOR SUPPLY & BATTERY BACK UP. AND A SCHEDULE FOR THEIR CLEANING MUST BE ESTABLISHED. (NO CLOTH TOWELS PLEASE) TELEPHONES & COMPUTERS FOR COMMUNICATION. ENVIRONMENT SIGNALS & ALARMS – ADD TO THE SENSORY OVERLOAD. TECHNICAL SPACE FOR A LAB. RELATIVES’ WAITING ROOM WITH A TELEPHONE. INFRASTRUCTURE PATIENTS MUST BE SITUATED SO THAT DIRECT OR INDIRECT (E.  23. TWO COMPRESSED AIR OUTLETS AND 16 POWER OUTLETS PER BED. BY VIDEO MONITOR) VISUALIZATION BY HEALTHCARE PROVIDERS IS POSSIBLE AT ALL TIMES. and the Radiology Department. STERILISING AREA – LARGE WATER BOILER / GEYSER & EXHAUST FANS. WINDOW TREATMENTS SHOULD BE DURABLE AND EASY TO CLEAN. TRACHEAL & UNDERWATER SEAL). FUMIGATION IS NO LONGER RECOMMENDED. WASTE & SHARPS DISPOSAL. WATER FROM A CERTIFIED SOURCE ESPECIALLY IF USED FOR HAEMODIALYSIS. AND/OR PILLOW SPEAKER CONNECTED TO RADIO AND TELEVISION. EQUIPMENT SHELF AT THE HEAD END (MIND THE HEIGHT OF THE CARE GIVER).  26. HELPS TO REINFORCE DAY/NIGHT ORIENTATION. ADDITIONAL APPROACHES TO IMPROVING SENSORY ORIENTATION FOR PATIENTS MAY INCLUDE THE PROVISION OF A CLOCK. ACCESSORIES 3 OXYGEN OUTLETS. UTILITIES ELECTRICAL – ADEQUATE SOCKETS (5AMPS & 15 AMPS). CALENDAR. .ADJUSTABLE. STAFF LOUNGE. 15. 60 Nursery beds. LIGHT & SOFT MUSIC (EXCEPT 10 PM TO 6 AM). TV. with controlled access. FLOOR COVERINGS AND CEILING WITH SOUND ABSORPTION PROPERTIES. 13. HAND RINSE SOLUTION BY EACH BEDSIDE.BEREAVEMENT / QUIET ROOM. BLOOD GAS ANALYSER etc. 21. NO HEAD BOARD. MEDICAL GAS & VACUUM PIPELINE – COLOUR CODED AND NOT INTERCHANGEABLE. SINGLE ROOM – WITH AN ANTEROOM (20 FEET) FOR HAND WASHING. CLEAN AND A DIRTY UTILITY WITH NO INTERCONNECTION.

etc.  33. RECEPTIONIST. OTHER FACILITIES BEREAVEMENT & AFTER CARE SERVICES COUNSELLING LAST OFFICE SUPPORT SYSTEMS FOR PATIENT RELATIVES & STAFF 42. CONCEPT OF CRITICAL CARE PRESENTED BY:. Worthley. EXPERIENCE WITH HEALTH INFORMATION SYSTEMS. Concept Of Critical Care — Presentation Transcript      1. ABILITY TO ENSURE THAT CRITICAL CARE NURSING PRACTICE MEETS APPROPRIATE STANDARDS. THE INTENSIVE CARE TEAM. TECHNICIANS. Remote data transmission capabilities (to offices.  34. 4. AND HEALTHCARE ECONOMICS.  30. etc. Essentials of Critical Care. EQUIPMENT MONITORING EQUIPMENT THERAPEUTIC EQUIPMENT DIGITAL & ANALOGUE DISPLAY AUDIO & VISUAL ALARMS BATTERY BACK UP & CHARGING 32. The Australasian Academy of Critical Care Mediicne.I.FINAL YEAR 2. PERSONNEL DEVELOPMENT IN SERVICE EDUCATION PROGRAMMES DEBRIEF SESSIONS – TO BURN OUT TEAM BUILDING EXERCISES INVOLVEMENT IN POLICY DEVELOPMENT 38. PERSONNEL NURSE PATIENT RATIO – 1: 1.  35. INFECTION CONTROL SURVEILLANCE STERILIZATION & DISINFECTION QUALITY CONTROL & AUDITING 40. ALCOVES SHOULD PROVIDE FOR THE STORAGE AND RAPID RETRIEVAL OF CRASH CARTS AND PORTABLE MONITOR/DEFIBRILLATORS. 3. on-call rooms. (2000). LEGAL & ETHICAL GUIDELINES & MLC POLICIES STANDING ORDERS. QUALITY IMPROVEMENT/RISK MANAGEMENT ACTIVITIES. it is the home of an organization : the intensive care team. 23(3):582. PREPARATION TO PARTICIPATE IN THE ON-SITE EDUCATION OF CRITICAL CARE UNIT NURSING STAFF. Shakti Prints.JASPREET KAUR SODHI MSc. POLICIES & PROTOCOLS ADMISSION. ABILITY TO FOSTER A COOPERATIVE ATMOSPHERE WITH REGARD TO THE MULTIDISCIPLINARY TRAINING PERSONNEL INVOLVED IN THE CARE OF CRITICAL CARE UNIT PATIENTS.). 29. John. A DOUBLE LOCKING SAFE FOR CONTROLLED SUBSTANCES. South Australia. (2003). CRITICAL CARE NURSING Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. Clinical Examination of the Critically Ill Patient. x-ray reports.G. L. DOCUMENTATION CONVENTIONAL ELECTRONIC MEDICAL RECORDS (EMR) Bedside terminals Interfaced with existing hospital data Systems. 39. builds an environment for healing or dying. KNOWLEDGE ABOUT CURRENT ADVANCES IN THE FIELD OF CRITICAL CARE NURSING. CHAPLAIN / COUNSELLOR.   31. PARTICIPATION IN STRATEGIC PLANNING AND REDESIGN EFFORTS  36. Vellore. ICU NURSE MANAGER AN RN (REGISTERED NURSE) WITH A BSN OR PREFERABLY AN MSN DEGREE.     37. MEDICAL STAFFING – COVER FOR EVERY SHIFT WITH COMPETENCE TO HANDLE ANY EMERGENCY. ANCILLARY STAFF – THERAPISTS. DISCHARGE & WITHDRAWAL OF SUPPORT. 5. WORK AREAS AND STORAGE FOR CRITICAL SUPPLIES SHOULD BE LOCATED IMMEDIATELY ADJACENT TO EACH ICU. . Edition IV.588. G. AND A TABLE TOP FOR PREPARATION OF DRUGS AND INFUSIONS. THERE SHOULD BE A SEPARATE MEDICATION AREA OF AT LEAST 50 SQUARE FEET CONTAINING A REFRIGERATOR FOR PHARMACEUTICALS. RADIOGRAPHERS etc. CRITICAL CARE NURSING Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. data retrieval (laboratory Results. This team – Doctor Nurses Therapists Nutritionists Chaplains and other support staff. ORGAN DONATION. REGULAR PARTICIPATION IN ONGOING CONTINUING NURSING EDUCATION. Edition II.)   41. REFERENCES Guidelines for Intensive Care Unit Design – Crit Care Med 1995 Mar. CERTIFICATION IN CRITICAL CARE OR EQUIVALENT GRADUATE EDUCATION WITH AT LEAST 2 YRS EXPERIENCE WORKING IN A CRITICAL CARE UNIT. INTRODUCTION The intensive care unit is not merely a room or series of room filled with patients attached to interventional technology.

TYPES OF ICUs There are two types of ICUs.   17. and short term ventilation <24hrs has to be performed. there were 20 units in USA and In 1958. D. Level III : Located in a major tertiary hospital. D. 6. Bennett. which is a referral hospital. medicine and chest who have clinical Commitment elsewhere. BMJ 1999. John Hopkins University Hospital developed a special care unit for neurosurgical patients . with refinements in intraoperative membrane oxygen techniques.  24. STAFFING Large hospital requires bigger team. et al. Bennett. treat and discharge and A closed: in this type. SEVEN Cs OF CRITICAL CARE Compassion Communication (with patient and family). nurses. Modern medicines boomed to its higher ladder after world war 2      12. 22. 8. At the same time came about newer horizons in cardiothoracic surgery. Junior staff are intensive care trainees and trainees on deputation from other disciplines. D. the epidemic of poliomyelitis necessitated thousands of patients requiring respiratory assist devices and intensive nursing care. HISTORICAL PRESPECTIVES Florence nightingale recognized the need to consider the severity of illness in bed allocation of patients and placed the seriously ill patients near the nurses’ station. Architectural. The number of trained nurses should be also worked out by the type of ICU. CONTEXTUAL FORCES The expansion of American hospital system and hospital insurance. BMJ 1999. Reallocations for direct patient care responsibility and creations of new forms of care. Critical care units have evolved over the last four decades in response to medical advances . 13. Level II : Can be located in general hospital. HISTORICAL PRESPECTIVES In 1953.     7. et al. In 1950. It should provide all aspects of intensive care required. From Anaesthesia. access to pathology. Consideration (to patients.318:1468-1470 14. An open :-. radiology. THE EVOLUTION OF CRITICAL CARE Forty years of development in critical care and critical care nursing has given rise to a recognized speciality in nursing practice . Bennett. 9. During 1970’s.  11. Comfort: prevention of suffering Carefulness (avoidance of injury) Consistency Closure (ethics and withdrawal of care ). Time and commitment to maintain active and regular involvement in the care of patients in the unit. discharge and referral policies are under the control of intensivists. etc. THE AIM OF THE CRITICAL CARE:. physicians admit. UNIT DIRECTOR:. It may be ideal to have an in house training programme for critical Care nursing.  23. 1923.Specific requirements for the unit director include the following: Training. and time availability to give clinical. et al.318:1468-1470 16. interest.the number increased to 150. 18. relatives and colleagues) and avoidance of Conflict. HISTORICAL PRESPECTIVES As surgical techniques advanced it became necessary that post operative patient required careful monitoring and this came about the recovery room. ICUS CAN BE CLASSIFIED AS: Level I : This can be referred as high dependency is where close monitoring. He/she will be the director. the admission. and educational direction to the ICU. 10. In complex situations they may require two nurses per patient. NURSING STAFF The major teaching tertiary care ICU will require trained nurses in critical care.   21. Board certification in critical care medicine. Manchester Memorial Hospital opened a four bedded unit at Philadelphia was started. Must have resident doctors. The number of nurses ideally required for such units is 1:1 ratio.318:1468-1470 15. By 1957. undertake more prolonged ventilation. Less preferred are other specialists viz. . resuscitation. hospital changes towards private and semi private accommodations. administrative. CRITICAL CARE UNIT Critical care unit is a specially designed and equipped facility staffed by skilled personnel to provide effective and safe care for dependent patients with a life threatening problem. 20. BMJ 1999. In this type.the term critical care unit came into existence which covered all types of special care   19. the workload and work statistics and type of patient load. CRITICAL CARE NURSE A critical care nurse is a licensed professional nurse who is responsible for ensuring that acutely and critically ill patients and their families receive optimal care .is to see that one provides a care such that patient improves and survives the acute illness or tides over the acute exacerbation of the chronic illness. Medical staff Carrier intensivists are the best senior medical Staff to be appointed to the ICU.

Preparation to participate in the on-site education of critical care unit nursing staff  28. and safety considerations. ventilators. complexity. assist mobilization. and blood gas analysers Medical physics technicians 5. using objective measures whenever possible. An appropriate number of respiratory therapists with specialized training must be available to the unit at all times. and intracranial pressure monitoring. 26. PHYSICIAN SUBSPECIALISTS General surgeon or trauma surgeon Neurosurgeon Cardiovascular surgeon Obstetric-gynecologic surgeon Urologist Thoracic surgeon Vascular surgeon Anesthesiologist Cardiologist with interventional capabilities Pulmonologist  35. Therapists must undergo orientation to the unit before providing care to ICU patients. haemofiltration machines. FUNCTION THERAPIST S. and drug dosing in patients with liver or renal dysfunction Pharmacists 2.  31. An appropriate number of nurses should be trained in highly specialized techniques such as renal replacement therapy. Active participation in the review of the appropriate use of ICU resources in the hospital. Unit orientation is required before assuming responsibility for patient care. quality improvement/risk management activities. Maintain equipment. prevents and treat chest problems. Ideal intensivist-to-patient ratios vary from ICU to ICU depending on the hospital’s unique patient population. PHYSICIAN SUBSPECIALISTS Gastroenterologist Hematologist Infectious disease specialist Nephrologist Neuroradiologist (with interventional capability) Pathologist Radiologist (with interventional capability) Neurologist Orthopedic surgeon  36. . RESPIRATORY CARE PERSONNEL REQUIREMENTS The therapist must have expertise in the use of mechanical ventilators. and other personnel involved in the care of critical care unit patients Regular participation in ongoing continuing nursing education Knowledge about current advances in the field of critical care nursing Participation in strategic planning and redesign efforts  29. Hospitals should have guidelines for these ratios based on acuity.  30. physicians. Availability (either the director or a similarly qualified surrogate) to the unit 24 hrs a day. RESPIRATORY CARE PERSONNEL REQUIREMENTS Respiratory care services should be available 24 hrs a day. NURSE MANAGER An RN (registered nurse) with a BSN (bachelor of science in nursing) or preferably an MSN (master of science in nursing) degree Certification in critical care or equivalent graduate education At least 2 yrs experience working in a critical care unit Experience with health information systems. Participation in continuing education programs in the field of critical care medicine. and healthcare economics Ability to ensure that critical care nursing practice meets appropriate standards . 7 days a week. Ideal levels of staffing should be based on acuity. Hospital privileges to perform relevant invasive procedures. Nurse-to-patient ratios should be based on patient acuity according to written hospital policies. pharmacists. NURSE MANAGER Ability to foster a cooperative atmosphere with regard to the training of nurses. Critical Care Unit nursing requirements:. including patient monitors. Active involvement in local and/or national critical care societies. All nurses should be familiar with the indications for and complications of renal replacement therapy. A advise on potential drug interactions and side effects. and prevent contractures in immobilized patients Physiotherapists 1. The following physician subspecialists should be available and be able to provide bedside patient care within 30 mins:  34. All nurses working in critical care should complete a clinical/didactic critical care course before assuming full responsibility for patient care. 24-hr in-house coverage should be provided by intensivists who are dedicated to the care of ICU patients and do not have conflicting responsibilities.  27. Active participation in the education of unit staff. Advise on nutritional requirements and feeds Dietitians 3.All critical care nurses must participate in continuing education. including the various ventilatory modes. Proficiency in the transport of critically ill patients is required. Active involvement as an advisor and participant in organizing care of the critically ill patient in the community as a whole. Advise on treatment and infection control Microbiologists 4. Critical Care Unit nursing requirements :.  32. intra-aortic balloon pump monitoring.NO. Respiratory therapists should participate in continuing education and quality improvement related to their unit activ ities. Ideally.  33.All patient care is carried out directly by or under supervision of a trained critical care nurse.  25. respiratory therapists. 7 days a week for both clinical and administrative matters.

patient monitoring life support and emergency resuscitation devices diagnostic devices 46. and other life support equipment designed to care for patients who are seriously injured. chemistry.  56. which combines aspects of open and closed models by staffing the ICU with an attending physician and/or team to work in tandem with primary physicians. or it may be designed and equipped to provide specialized care to patients with specific conditions 45.318:1468-1470 50. . lower blood pressure and lower pain medication needs.bedside&quot. There should be sufficient number of lifts available to carry these critically ill patients to different areas. THERAPEUTIC ELEMENTS IN ICU ENVIORNMENT Providng a measure of privacy and personal control through adjustable curtains and blinds . blood gas. trauma ICU. acute wards. 55. Portable chest radiographs affect decision making in critically ill patients. image logy. THERAPEUTIC ELEMENTS IN ICU ENVIORNMENT Window and art that provides natural views. Laboratory tests must be obtained in a timely manner. et al. CCU. and the hybrid model. ICU should be sited in close proximity to relevant areas viz.Intensive care unit (ICU) equipment includes patient monitoring. PHYSICAL SET UP OF 5 BEDDED ICU 54.accessible bed controls . These include:. or &quot. 40. Multidisciplinary requires more beds than single speciality. etc. One ICU may not cater to all needs.  38.including facilities for overnight stay and comfortable waiting rooms. have a critical or life-threatening illness. 24 hrs per day. immediately in some instances. hasten recovery.VCR and CD players.and TV . ORGANIZATIONAL MODELS FOR ICUs: the open model allows many different members of the medical staff to manage patients in the ICU.318:1468-1470 48. LIFE SUPPORT & RESUSCITATIVE EQUIPMENTS VENTILATOR INFUSION PUMP CRASH CART INTRAAORTIC BALOON PUMP 49. Noise reduction through computerized pagers and silent alarms.   39.Unit clerks physical therapists occupational therapists Advanced practice nurses Physician assistants Dietary specialists. or have undergone a major surgical procedure. et al.  57. ORGANIZATION OF ICU The number of ICU beds in a hospital ranges from 1 to 10 per 100 total hospital beds. DIAGNOSTIC EQUIPMENTS MOBILE X-RAYS PORTABLE CLINICAL LAB. DEFINITION OF INTENSIVE CARE UNIT EQUIPMENTS:. An institute may plan beds into multiple units under separate management by single discipline specialist viz. surgical ICU. the closed model is limited to ICU-certified physicians managing the care of all patients. One must keep the need of the hospital and its location. 53. medical ICU. Medical team continuity that allows one team to follow the patient through his or her entire stay. and Biomedical engineers. burns ICU. views of nature can reduce stress.  42. and toxicology analysis. emergency resuscitation devices. emergency department. DEVICES BLOOD ANALYZER 51. PURPOSE An ICU may be designed and equipped to provide care to patients with a range of conditions. BMJ 1999. pain management. 37. operating rooms.  41. Radiology and imaging services: The diagnostic and therapeutic radiologic procedures should be immediately available to ICU patients. thereby requiring 24-hour care and monitoring.  43. D. &quot. LABORATORY SERVICES A clinical laboratory should be available on a 24-hr basis to provide basic hematologic. ORGANIZATION OF ICU It requires intelligent planning. OTHER PERSONNEL : A variety of other personnel may contribute significantly to the efficient operation of the ICU. Family participation .STAT&quot. DESCRIPTION Intensive care unit equipment includes:. Bennett. laboratories adjacent to the ICU or rapid transport systems. PATIENT MONITORING EQUIPMENTS Acute care physiologic monitoring system Pulse oximeter Intracranial pressure monitor Apnea monitor 47.             44. Bennett. D. ICUs with fewer than 4 beds are not cost effective and over 20 beds are unmanageable. respiratory and cardiac support. BMJ 1999. DESIGN OF ICU 52.

Location should be chosen so that the unit is adjacent to. An illuminated viewing box or carousel of appropriate size should be present to allow for the simultaneous viewing of serial radiographs.Storage. with controlled access. X-RAY VIEWING AREA.  69. clerical space. There must be adequate overhead and task lighting. Sliding glass doors and partitions facilitate this arrangement. 68. PATIENT AREAS. noise levels in most hospitals are between 50-70 dB(A) with occasional episodes above this range   67. Patient records should be readily accessible . Services that are unique to the individual institution. 20 dB(A) at night.Patient admission pattern Staff & visitor traffic patterns Need for support facilities such a nursing station . FLOOR PLAN AND DESIGN Eight to twelve beds per unit is considered best from a functional perspective . intermediate care units. This permits the monitoring of patient status under both routine . and increase access to the room in emergency situations. Administrative & educational requirements. each nursing substation should be capable of providing most if not all functions of a central station. it should be easily accessible as well   70. No through traffic to other departments should occur. Countertops must be provided for medication preparation.   61. a double locking safe for controlled substances. the Emergency Department. file cabinets and other storage for medical record forms must be located so that they are readily accessible by all personnel requiring their use. A &quot. When an ICU is of a modular design. 71. Supply and professional traffic should be separated from public/visitor traffic. Operating Room.bright light&quot. and a wall mounted clock should be present. 40 dB(A) in the evening. In ICUs with a modular design. and a sink with hot and cold running water. This need will depend mainly upon patient population and State Department of Public Health requirements. A separate room or distinct area near each ICU or ICU cluster should be designated for the viewing and storage of patient radiographs. when possible. 62. and cabinets should be available for the storage of medications and supplies .  64. ☻ Notably.especially critical care unit.  73.  63. ICU TEAM ICU deign should be approached by multidisciplinary team consisting of :.He must be experienced in hospital space programming and hospital functional planning. RECOMMENDED NOISE RANGES Signals from patient call systems. The International Noise Council has recommended that noise levels in hospital acute care areas not exceed 45 dB(A) in the daytime.:. alarms from monitoring equipment.g. and Radiology Department  65.  72. and telephones add to the sensory overload in critical care units.and negative pressure isolation rooms within the ICU. The preferred design is to allow a direct line of vision between the patient and the central nursing station. Adequate space for computer terminals and printers is essential when automated systems are in use. WORK AREAS AND STORAGE Work areas and storage for critical supplies should be located within or immediately adjacent to each ICU. FLOOR PLAN AND DESIGN IT SHOULD BE BASED ON:. CENTRAL STATION A central nursing station should provide a comfortable area of sufficient size to accommodate all necessary staff functions. FLOOR PLAN AND DESIGN Each intensive care unit should be a geographically distinct area within the hospital.Patients must be situated so that direct or indirect (e. Each healthcare facility should consider the need for positive. . should also be available. OTHER ADDITIONAL MEMBERS ENVIORNMENTAL ENGINEER INTERIOR DESIGNERS STAFF NURSES PHYSICIANS PATIENTS FAMILIES 60.ICU MEDICAL DIRECTORS ICU NURSE MANAGER THE CHIEF ARCHITECT THE OPERATING ENGINEERING STAFF 59. ENGINEER – He should be experienced in the design of mechanical and electrical systems For hopitals. CENTRAL STATION Adequate surface space and seating for medical record charting by both physicians and nurses should be provided.and emergency circumstances . THE CHIEF ARCHITECT . There should be a separate medication area of at least 50 square feet containing a refrigerator for pharmaceuticals. Shelving.  66. by video monitor) visualization by healthcare providers is possible at all times.   58. Although a secretarial area may be located separately from the central station. patients should be visible from their respective nursing substations. or within direct elevator travel to and from.

a countertop stove and/or microwave oven. and easy retrieval. Separate covered containers must be provided for soiled linen and waste materials. Monitoring capabilities. or multidisciplinary patient care conferences. house staff education. Work surfaces and storage areas must be adequate enough to maintain all necessary supplies and permit the performance of all desired procedures without the need for healthcare personnel to leave the room  78. support services. Staff Lounge. Public toilet facilities and a drinking fountain should be located within the lounge area or immediately adjacent. the ICU.  81. and the air supply from the dirty utility room must be exhausted. and a refrigerator. RECEPTIONIST AREA Each ICU or ICU cluster should have a receptionist area to control visitor access. Public telephones (preferably with privacy enclosures) and dining facilities must be available to visitors. and emergency cardiac arrest alarms should be audible in the room. Equipment Storage An area must be provided for the storage and securing of large patient care equipment items not in active use. This room must be linked to each relevant ICU by telephone or other intercommunication system. equipment. Secured locker facilities.  83.  76. A hand washing facility should be located in or near the area. Visitors&apos. an ice-making machine. Clean and dirty utility rooms must be separate rooms that lack interconnection. lounge or waiting area should be provided near each ICU or ICU cluster. and computerized interactive and self-paced learning equipment. Special containers should be provided for the disposal of needles and other sharp objects. It is desirable to have a visitors&apos. Consideration should be given to ease of access for patients transported from areas outside the ICU. The lounge must be linked to the ICU by telephone or intercommunication system. One special procedures room may serve several ICUs in close proximity.  74. entrance should be securable if the need arises. One and one-half to two seats per critical care bed are recommended. and emergency cardiac arrest alarms should be audible within. The area should include comfortable seating and adequate nourishment storage and preparation facilities. Special Procedures Room. . A staff lounge must be available on or near each ICU or ICU cluster to provide a private. The dirty utility room must contain a clinical sink and a hopper both with hot and cold mixing faucets. They must be adequately temperature controlled. it should be located within. Television and/or music should be provided. A visitors&apos. VCRs. Grounded electrical outlets should be provided within the storage area in sufficient numbers to permit recharging of battery operated items. Clean and Dirty Utility Rooms . a classroom should also be provided nearby. and relaxing environment. If a special procedures room is desired. entrance separate from that used by healthcare professionals. Room size should be sufficient to accommodate necessary equipment and personnel. RECEPTION AREA 75. Floors should be covered with materials without seams to facilitate cleaning. The receptionist should be linked with the ICU(s) by telephone and/or other intercommunication system. Lounge/Waiting Room . or immediately adjacent to. comfortable.  82. Ideally.  80. The refrigerator should not be used for the storage of laboratory specimens. Shelving and cabinets for storage must be located high enough off the floor to allow easy access to the floor underneath for cleaning. a countertop stove and/or microwave oven. Visitor access should be controlled from the receptionist area. The conference room may have multiple purposes including continuing education. a sink with hot and cold running water. Clean and Dirty Utility Rooms .  77. If the conference room is not large enough for educational activities. The clean utility room should be used for the storage of all clean and sterile supplies. including a refrigerator. There should be designated mechanisms for the disposal of items contaminated by body substances and fluids. it should be located so that all visitors must pass by this area before entering. The visitors&apos. Nourishment Preparation Area A patient nourishment preparation area should be identified and equipped with food preparation surfaces. Conference Room . and safety considerations must be consistent with those provided in the ICU proper. easy location of desired equipment. Special Procedures Room. showers and toilets should be present. A conference room should be conveniently located for ICU physician and staff use.  84. and may also be used for the storage of clean linen. Space should be adequate enough to provide easy access. A conference room is ideal for the storage of medical and nursing reference materials and resources.  79.

Lounge/Waiting Room .  89.s contact with his/her surroundings. and passages into each ICU must be a minimum of 36 inches in width to allow easy and unobstructed movement of equipment and supplies. Shades. Televisions must be out of reach of patients and operated by remote control. gowning. If a toilet is provided. Water. oxygen. This helps to minimize any disruption of patient care activities and minimizes unnecessary noise. If possible. Patient Modules Ward-type icus should allow at least 225 square feet of clear floor area per bed. Rather. Educational materials and lists of hospital and community-based support and resource services should be displayed. Patient Modules Isolation rooms should each contain at least 250 square feet of floor space plus an anteroom. Icus with individual patient modules should allow at least 250 square feet per room (assuming one patient per room). openings. graphic design or picture . one or more walls within patient view may be selected for an accent color. including upright. When elevator transport is required. carpeting. Each anteroom should contain at least 20 square feet to accommodate hand-washing. staff lounge.  97.  93. Compressed air. Patient Modules Windows are an important aspect of sensory orientation. An additional comfort consideration is the choice of color scheme for the room. Advice from environmental engineers and designers should be sought to deinstitutionalize patient care areas as much as possible. Space and surfaces for computer terminals and patient charting should be incorporated into the design of each patient module as indicated. Warm colours. Patient privacy should be preserved and patient transportation should be rapid and unobstructed. excluding ancillary spaces (anteroom. central nursing station. Locking drawers and cabinets must be used if syringes and pharmaceuticals are stored at the bedside.Electrical power. lighting.  95. these should be held by Hospital Security until patient discharge. which should promote rest and have a calming effect. Visitors&apos. and reclining chairs. Removal of soiled items and waste should also be accomplished through this corridor. Drapes or shades of fireproof fabric can make attractive window coverings and serve to absorb sound. Doorways. an oversized keyed elevator. and these must meet or exceed regulatory and accreditation agency codes and standards . linen and toiletries.  90. Therefore. patient care supplies. blinds. Personal valuables should not be kept in the ICU.  96. Supply and Service Corridors A perimeter corridor with easy entrance and exit should be provided for supplying and servicing each ICU. should be provided. lounge. is also desirable. The origin of these alarms must be discernable.  86. texture. Every effort should be made to provide an environment that minimizes stress to patients and staff.  87. and any on-call rooms. Patient Transportation Routes Patients transported to and from an ICU should be transported through corridors separate from those used by the visiting public. To provide for visual interest. Comfort considerations should include methods for establishing privacy for the patient. and as many rooms as possible should have windows to reinforce day/night orientation . separate from public access. Patient Modules A cardiac arrest/emergency alarm button must be present at every bedside within the ICU. pillow speaker connected to radio and television.  91. Provide a minimum width of 15 feet. and doors should control the patient&apos. Floor coverings should be chosen to withstand heavy use and allow heavy wheeled equipment to be moved without difficulty . A separate family consultation room is strongly recommended. bulletin board.the provision of a clock. . Supply and Service Corridors The corridor should be at least 8 feet in width. and windows are desirable . it must be private.  88. indirect soft lighting. Patient Modules Storage must be provided for each patient&apos. design should consider natural illumination and view. A variety of seating. telephone service should be provided in each room. curtains. toilet. storage). Vacuum. A supply of portable or folding chairs should be available to allow for family visits at the bedside. Utilities Each intensive care unit must have :. Window treatments should be durable and easy to clean. and a schedule for their cleaning must be established  94. 85. and storage. IMPROVING SENSORY ORIENTATION Additional approaches to improving sensory orientation for patients may include :.  92. And environmental control systems that support the needs of the patients and critical care team under normal and emergency situations. The alarm should automatically sound in the hospital telecommunications center.s personal belongings. ICU conference room. calendar.

Sixteen outlets per bed are desirable. or between every two patients in ward-type units. data management. Environmental Control Systems . Hand-washing sinks deep and wide enough to prevent splashing. OTHER FACILITIES Voice Intercommunication Systems Satellite Laboratory Physician On-Call Rooms Administrative Offices . A minimum of six total air changes per room per hour are required. If and when a decision is made to utilize this technology.5 fc for continuous use or 19 fc for short periods.s bed . knee-. or sonar-operated faucets. For rooms having toilets. Outlets at the head of the bed should be placed approximately 36 inches above the floor to facilitate connection. Outlets at the sides and foot of the bed should be placed close to the floor to avoid tripping over electrical cords. 103. To discourage disconnection by pulling the power cord rather than the plug.   102. order entry.  100. Zone stop valves must be installed on pipes entering each ICU to allow service to be turned off should line breaks occur. and should be mounted  101. The water supply must be from a certified source. and nurse and physician charting. the temperature should be adjustable within each module. Air-conditioning and heating should be provided with an emphasis on patient comfort.  104. 98. Night lighting should not exceed 6. ELECTRIC SUPPLY Grounded 110 volt electrical outlets with 30 amp circuit breakers should be located within a few feet of each patient&apos.paperless&quot. It is preferable to place lighting controls on variablecontrol dimmers located just outside of the room. Water Supply . especially if hemodialysis is to be performed. Computerized Charting These systems provide for &quot. Lightning Total luminance should not exceed 30 foot-candles . For critical care units having enclosed patient modules. it is important to integrate such a system fully with all ICU activities. Separate lighting for emergencies and procedures should be located in the ceiling directly above the patient and should fully illuminate the patient with at least 150 fc shadow-free A patient reading light is desirable. Bedside terminals facilitate patient management by permitting nurses and physicians to remain at the bedside during the charting process.  99. with two air changes per hour composed of outside air. must be available near the entrances to patient modules. the required toilet exhaust of 75 cubic feet per minute should be composed of outside air. preferably equipped with elbow-. foot-. Central air-conditioning systems and recirculated air must pass through appropriate filters.