ST. MARY’S COLLEGE OF TAGUM, INC.

NURSING PROGRAM

LEARNING
NCM 118 - CARE OF CLIENTS WITH LIFE-THREATENING CONDITIONS,
ACUTELY ILL/MULTI-ORGAN PROBLEMS, HIGH ACUITY AND EMERGENCY

MODULE
SITUATION
BSN4

Lesson 1:Introduction to Critical

Care

Prepared by:
JOSEFINA S. BALOTE,RN,MN
 Module 1 – Lesson 1

Timothy 5:8 “Then your light

will break forth like the
dawn, and your healing will
quickly appear; then your
righteousness will go before
you and the glory of the Lord
will be your rear guard.”

2
Module 1 – Lesson 1

Ignacian Core/ Related

Values:,
Excellence; service, Faith

3
 Module 1 – Lesson 1

Learning Outcomes
At the end of the lesson the students can:

1. Integrate relevant principles of social, physical, natural

and health sciences and humanities in a given critical
health situations in critical care nursing.
 
2. Apply appropriate nursing concepts and actions
holistically and comprehensively.

4
 Introduction

This unit introduces basic concepts of critical care

nursing. This include the scope of critical care
practice and competencies expected from a critical
care nurse.

5
 What
do you
see on
the To what
picture extent is
? your action
being the
nurse?

6
 Learning Contents

Introduction to Critical Care

1.Scope of Critical Care Practice

2. Development of Critical Care Nursing Practice,

Education and Professional Activities in the
Philippines

3. Critical Care Body of Knowledge

Critical Care Competencies
Professional Organizations

7
 Scope of Critical Care
Practice

Critical care is medical care for people who have life-

threatening injuries and illnesses.
• It usually takes place in an intensive care unit (ICU).
• A team of specially-trained health care providers,
including critical care nurse, gives the 24-hour care to
the patient. This includes using machines to constantly
monitor the vital signs.

Examples of patients who need critical care:

•those who undergo very invasive surgery or who have
poor outcomes after surgery,
•those who are severely injured in an accident,
• people with serious infections, or
•people who have trouble breathing on their own and
require a ventilator to breathe for them

8
 Scope of Critical Care
Practice

Critical Care Unit

• refers to Intensive Care Units or Critical Care Units or
Intensive Therapy/Treatment Units of the hospital
where seriously ill patients receive specialized care
such as intensive monitoring and advanced life
support.

Critical care nursing is the field of nursing with a focus

on the utmost care of the critically ill or unstable
patients following extensive injury, surgery or life
threatening diseases.

Critical Care Nurses are trained to identify sudden or

subtle changes in a patient's condition and to
immediately provide emergency care.

•Patients who are critically ill require more frequent

nursing assessments and round-the-clock monitoring
because their condition can change rapidly without
warning.

9
 Scope of Critical Care
Practice

The scope of practice for critical care nursing covers

the different roles of the critical care nurse who is
committed to using specific and safe interventions
designed to restore, rehabilitate, cure, maintain, or
palliate for adult patients in critical care settings across
their lifespan.

Critical Care Nursing is one of the 4 scope of nursing

practice which includes operating room, critical care
and emergency departments, women's health and
mental health. There are many sub-specialty areas
such as sports injury nursing, cancer nursing, cardiac
care, newborn intensive care. (ANA)

Scope of practice defines the boundaries of the

practitioner’s license, to apply the procedures, nursing
actions, and processes for which the practitioner has
received the education, training, licensure and,
certification to practice in the state where he works

10
 Scope of Critical Care
Practice

The scope of practice for critical care nursing

according to the Association of Critical Care Nurses in
the Philippines 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
(competence) in an environment conducive to the
provision of this highly specialized care.

Work of a Critical Care Nurse in a Critical Care Unit.

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
(ACCNP).

11
 Scope of Critical Care
Practice

The scope of practice for critical care nursing

covers registered and licensed nurses, who are trained
and qualified to practice critical care nursing.

Critical Care Nurses possess the standard critical care

nursing competencies in assuming specialized and
expanded roles in caring for the critically ill patients and
their family.

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.

Likewise,  each critical care nurse is personally

responsible and committed to continuous learning and
updating of his/her knowledge and skills.

12
 Scope of Critical Care
Practice

The critical care environment constantly support 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.

In the nursing schools, the exposure of the student

nurses may not be enough to prepare  them for the
complexity of critical care nursing practice once
they 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
.
The Framework for the Nursing Career by the BON
and CHED emphasizes that the advanced practice
nurses in the critical care, must earn an advanced
degree either at the master’s or doctorate level in
nursing.

13
 Development of Critical
Care Nursing in the
Philippines

The health care industry all over the world has been
undergoing great changes over the past two decades
and the Philippines has been part of these
transformational events having great impact on the
quality of nursing practice. New expectations in the
way nurses and the nursing practices are to be
delivered particularly now that there are many
challenges that besiege the present time as a
consequence of the complexities of globalization.

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

14
 Development of Critical
Care Nursing in the
Philippines

Critical Care Nursing Practice 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 attributes guidelines and nursing
practice standards in guiding the critical care nursing
practice to fulfill this purpose.

15
 Development of Critical
Care Nursing in the
Philippines

In the Philippines, the Professional Regulation

Commission – Board of Nursing (PRC-BON) is
committed to provide:
 need-driven and
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 manage.
(ACCP)

16
 Development of Critical
Care Nursing in the
Philippines

ROLES OF THE CRITICAL CARE

NURSES

In response to changes and expansion within and

outside the healthcare environment, critical care
nurses have broadened their roles at both practice
and advanced practice levels.

PRACTIONER ROLE
ICU nurses execute their practice roles 24-hours a day
to provide high quality care to the critically ill patient.

17
 Development of Critical
Care Nursing in the
Philippines

ROLES OF THE CRITICAL CARE

NURSES

CARE PROVIDER
Direct patient care
•Detects and interprets indicators that signify the
varying conditions of the critically ill with the
assistance of advanced technology and knowledge.
•Plans and initiates nursing process to its full capacity
in a need-driven and proactive manner.
•Acts promptly and judiciously to prevent or halt
deterioration when conditions warrant.
•Coordinates with other healthcare providers in the
provision of optimal care to achieve the best possible
outcomes.
Indirect patient care – Care of the Family
•Understands family needs and provide information to
allay fears and anxieties.
•Assists family to cope with the life-threatening
situation and/or patient's impending death.

18
 Development of Critical
Care Nursing in the
Philippines

ROLES OF THE CRITICAL CARE

NURSES

EXTENDED ROLES AS CRITICAL CARE NURSES

Critical care nurses have roles beyond their professional
boundary. With proper training and 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:

•Sampling and analyzing arterial blood gases;

•Weaning patients off ventilations;
•Adjusting intravenous analgesia / sedations;
•Performing and interpreting ECGs;
•Titrating intravenous and central line medicated infusion
and nutrition support; and
•Initiating defibrillation to patient with ventricular
fibrillation or lethal ventricular tachycardia.
•Removal of pacer wire, femoral sheaths and chest tubes
•Other procedures deemed necessary by their respective
institution under a clinical protocol.

19
 Development of Critical
Care Nursing in the
Philippines

ROLES OF THE CRITICAL CARE

NURSES

EDUCATOR
Provides health education to patient and family to promote
understanding and acceptance of the disease process and
to facilitate recovery.
Participates in the training and coaching of novice
healthcare team members to achieve cohesiveness in the
delivery of patient care.

PATIENT ADVOCATE
Acts in the best interest of the patient.
Monitors and safeguards the quality of care which the
patient receives.

20
 Development of Critical
Care Nursing in the
Philippines

ROLES OF THE CRITICAL CARE

NURSES

MANAGEMENT AND LEADERSHIP ROLE

The critical care nurse in her management and leadership
role will be able to render the following responsibilities:
Perform management and leadership skills in providing
safe and quality care
Accountability for safe critical care nursing practice
Delivery of effective health programs and services to
critically-ill patients in the acute setting
Management of the critical care nursing unit or acute care
setting
Take lead and supervision among nursing support staff
Utilize appropriate mechanism for collaboration,
networking, linkage –building and referrals.

21
 Development of Critical
Care Nursing in the
Philippines

ROLES OF THE CRITICAL CARE

NURSES

RESEARCHER ROLE
The critical care nurse in her researcher role will be
able to render the following responsibilities:
•Engage self in nursing or other health –related
research with or under supervision of an experienced
researcher.
Utilize guidelines in the evaluation of research study or
report
•Apply the research process in improving patient care
infusing concepts of quality improvement and in
partnership with other team-players

22
 Development of Critical
Care Nursing in the
Philippines

ADVANCED PRACTICE LEVEL

This is the future direction in the Philippines and to be
benched marked with other countries. For now, a
thorough study of Advanced Practice Nursing in critical
care will be pursued to align with the BON initiative on
specialization framework.
The current healthcare environment demands
intensive care nurses to have advanced knowledge
and skills to provide the highest possible level of care
to the critically ill patients

23
 Development of Critical
Care Nursing in the
Philippines

COMPETENCIES FOR CRITICAL CARE NURSES (PRC-BON)

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:

1. Safe and Quality Nursing Care

2.Management of Resources
3.Legal Responsibilities
4.Ethico-Moral Responsibilities
5.Collaboration and Teamwork
6.Personal and Professional Development
7.Communication
8.Health Education
9.Quality Improvement
10.Research
11.Record Management

24
 Development of Critical
Care Nursing in the
Philippines

COMPETENCIES FOR CRITICAL CARE NURSES (PRC-BON)

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:

1. Safe and Quality Nursing Care

2.Management of Resources
3.Legal Responsibilities
4.Ethico-Moral Responsibilities
5.Collaboration and Teamwork
6.Personal and Professional Development
7.Communication
8.Health Education
9.Quality Improvement
10.Research
11.Record Management

25
STANDARDS OF
CRITICAL CARE
NURSING PRACTICE

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 (ICU).

In order to achieve this, standards should be

developed to serve as a guide for monitoring and
enhancing the quality of intensive care nursing
practice.

26
STANDARDS OF
CRITICAL 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 step-by-step guidelines in
guiding nurses to carry out the day-to-day
nursing procedure in the most appropriate
manner.

27
STANDARDS OF
CRITICAL CARE
NURSING PRACTICE

The following 11 Standards are intended to furnish

nurses with direction in providing quality care and
excellence in Critical Care Nursing.
1.The critical care nurse functions by 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.

28
STANDARDS OF
CRITICAL CARE
NURSING PRACTICE

5. The critical care nurse demonstrates accountability

for his/her professional judgment and actions.
6. The critical care nurse creates and maintains an
environment that promotes the 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 the immediate care of patients.
8. The critical care nurse protects patients from
developing an environmental induced infection.

29
STANDARDS OF
CRITICAL CARE
NURSING PRACTICE

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.

30
 Reference

Guidelines for Critical Care Nursing

Drafted FEBRUARY 24,2012

31
 APPLICATION

Activity 1

You have been given information about the

physical, social, natural/health sciences and
humanities in your early years in nursing
study. Earlier you are able to learn basic
information about Critical Care Nursing. How
will you merge these knowledge and
information in order for you to perform your
task as a Critical Care Nurse in during your
RLE 118?
•Find your group mates. Discuss on what is
asked in number 2 item. Present your output
after.
• Good Luck!

32
Synthesis

33