HASHIM N. ALAWI JR.

,RN,MAN

Standards of Care for Acute & Critical Care Nursing

1. 2. 3. 4. 5. Assessment Diagnosis Outcome Identification Implementation Evaluation

Definition:
Critical:
Being in; or verging on a state of crisis or emergency Urgently needed Absolutely necessary

Definition:
Critical Care Nursing:
Attending to patients at high risk for life-threatening health problems.
Providing vigilant, around-the-clock care.

Assessment
Standard of Care I:

Assessment
Standard of Care I:
Measurement Criteria 1. Data collection involves the: Patient Family Other health care providers Purpose: Develop a Holistic picture of the patients needs

Assessment
Standard of Care I:
Measurement Criteria 2. The priority of data collection activities depends on: patients immediate condition and/or anticipated needs

Assessment
Standard of Care I:
Measurement Criteria

3.
4. 5.

Data are collected using appropriate assessment techniques and instruments Documents are retrievable Collection process is: systematic ongoing

Diagnosis
Standard of Care II:

Diagnosis
Standard of Care II:
Measurement Criteria 1. Diagnoses are derived from the assessment data. 2. Validated throughout the nursing interactions with the team consisting of the: Patient Family Other healthcare providers

Diagnosis
Standard of Care II:
Measurement Criteria 3. Prioritized and documented : To facilitate determining expected outcomes To develop a plan of care Documented in a retrievable form

4.

Outcome Identification
Standard of Care III:

Outcome Identification
Standard of Care III:
Measurement Criteria

1. Outcomes are derived from actual and potential diagnoses 2. Mutually formulated with: Patient Family Other health care providers

Outcome Identification
Standard of Care III:
Measurement Criteria

3. Individualized Culturally appropriate Realistic In relation to patients age Present and potential capabilities

Outcome Identification
Standard of Care III:
Measurement Criteria
4. Attainable in relation to resources available to the patient 5. Measurable, and should include a time estimate for attainment

Outcome Identification
Standard of Care III:
Measurement Criteria
6. Provide direction for continuity of care; Nurses competencies are matched with the patients needs 7. Documented in a retrievable form

Planning
Standard of Care IV:

Planning
Standard of Care IV:
Measurement Criteria
1. Individualized to reflect the patients characteristics and needs 2. Developed collaboratively with the team, consisting of: Patient Family Other health care providers promote each members contribution toward achieving expected outcomes

Planning
Standard of Care IV:
Measurement Criteria
3. Reflects current acute and critical care nursing practice 4. Provides for continuity of care 5. Prioritized 6. Documented to promote continuity of care

Implementation
Standard of Care V:

Implementation
Standard of Care V:
Measurement Criteria
1. Delivered in a manner that minimizes complications and life-threatening situations

Implementation
Standard of Care V:
Measurement Criteria
2. The patient and family participate in implementing plan of care based upon their : Ability to participate Decision making regarding care 3. Documented in a retrievable manner

Evaluation
Standard of Care VI:

Evaluation
Standard of Care VI:
Measurement Criteria 1. Systematic, ongoing, and Criterion - based 2. Consisting of : Patient Family Healthcare providers

Evaluation
Standard of Care VI:
Measurement Criteria
3. Occurs within appropriate time frame after interventions are initiated 4. Ongoing assessment data are used to - revise diagnoses, - Outcomes - Plan of care as needed

Evaluation
Standard of Care VI:
Measurement Criteria
4. Document revisions in diagnoses, outcomes, and plan of care 5. Evaluate effectiveness of interventions in relation to outcomes 6. Document patients response to interventions

Standards of Professional Practice

1. Quality of care 2. Individual practice evaluation 3. Education 4. Collegiality 5. Ethics 6. Collaboration 7. Resource utilization

Standard of Professional Practice I

I. Quality of Care

Standard of Professional Practice I

I. Quality of Care Measurement Criteria 1. Participate in quality of care activities 2. Use the results to initiate changes to improve practices and healthcare delivery system 3. Incorporate the patients and familys perspective as appropriate

Standard of Professional Practice II

II. Individual Practice Evaluation

Standard of Professional Practice II

II. Individual Practice Evaluation Measurement Criteria 1. Evaluate the nursing practice vs. the professional practice standards

Standard of Professional Practice II

II. Individual Practice Evaluation Measurement Criteria 2. Engage in self-assessment &/or a formal performance appraisal identifying: Areas of strength Areas where professional development would be of benefit

Standard of Professional Practice II

II. Individual Practice Evaluation Measurement Criteria 3. Seek and reflect constructive feedback from the team consisting of: The patient Family Healthcare providers

Standard of Professional Practice II

II. Individual Practice Evaluation Measurement Criteria

4. Take action to achieve performance goals

Standard of Professional Practice III

III. Education

Standard of Professional Practice III

III. Education Measurement Criteria 1. Participate in ongoing educational activities to acquire knowledge and skills

Standard of Professional Practice III

III. Education Measurement Criteria 2. Seek experiences that reflect current clinical practice

Standard of Professional Practice III

III. Education Measurement Criteria 3. Participate in ongoing educational activities related to professional issues.

Standard of Professional Practice IV

IV. Collegiality

Standard of Professional Practice IV

IV. Collegiality Measurement Criteria 1. Share knowledge, Skills, and experiences with colleagues

Standard of Professional Practice IV

IV. Collegiality Measurement Criteria 2. Provide peers & other healthcare providers with constructive feedback regarding their practice, as appropriate to their level of expertise

Standard of Professional Practice IV

IV. Collegiality Measurement Criteria 3. Interact with colleagues to enhance own professional nursing practice

Standard of Professional Practice IV

IV. Collegiality Measurement Criteria 4. Contribute to the learning environment that is conducive to healthcare education

Standard of Professional Practice IV

IV. Collegiality Measurement Criteria 5. Contribute to an effective team environment by working with others in a way that promotes & encourages each persons contribution.

Standard of Professional Practice V

V. Ethics

Standard of Professional Practice V

V. Ethics Measurement Criteria 1. The nurses practice is guided by the : PRC-BON Code for Nurses Critical Care Nurses Association of the Philippines Ethics of Care and Ethical Principles

Standard of Professional Practice V

V. Ethics Measurement Criteria 2. Maintain patient confidentiality within legal and regulatory parameters

Standard of Professional Practice V

V. Ethics Measurement Criteria 3. Act as a patient advocate and assist others in developing skills so they can advocate for themselves

Standard of Professional Practice V

V. Ethics Measurement Criteria 4. Deliver care in a: Non judgmental Non discriminatory manner that is sensitive to patient diversity

Standard of Professional Practice V

V. Ethics Measurement Criteria 5. Deliver care in a manner that: meets the diverse needs and strengths of the patient and preserves patients autonomy, dignity, and rights

Standard of Professional Practice V

V. Ethics Measurement Criteria 6. Use available resources in formulating ethical decisions

Standard of Professional Practice VI

VI. Collaboration

Standard of Professional Practice VI

VI. Collaboration Measurement Criteria 1. Communicate with the team regarding: Patient care Nurses role in providing care

Standard of Professional Practice VI

VI. Collaboration Measurement Criteria 2. Work with the team to: formulate the plan of care and to make decisions related to the care and delivery of services

Standard of Professional Practice VI

VI. Collaboration Measurement Criteria 3. Consult with other healthcare providers and initiates referrals as appropriate to promote continuity of care

Standard of Professional Practice VII

VII. Research

Standard of Professional Practice V

VII. Research Measurement Criteria 1. Continually question and evaluate practice Use best available evidence or research findings to develop appropriate plans of care

Standard of Professional Practice V

VII. Research Measurement Criteria 2. Participate in activities to support clinical inquiry appropriate to the nurses level of expertise

Standard of Professional Practice VIII

VIII. Resource Utilization

Standard of Professional Practice VIII

VIII. Resource Utilization Measurement Criteria 1. Evaluate factors related to: Safety Effectiveness & Cost when choosing between two (2) or more practice options that would result in the same expected outcome

Standard of Professional Practice VIII

VIII. Resource Utilization Measurement Criteria 2. Assist the patient & family in: Identifying & Securing appropriate & available services to address health-related needs

Standard of Professional Practice VIII

VIII. Resource Utilization
Measurement Criteria 3. Assign or delegate aspects of care as defined by the nurse practice acts

Standard of Professional Practice VIII

VIII. Resource Utilization
Measurement Criteria

4. Assist the patient & family in becoming informed consumers about: Costs Risks & Benefits of treatment & care

Critical Thinking in Critical Care Nursing

Critical Thinking :

A multidimensional skill
A cognitive or mental process Set of procedures

Critical Thinking in Critical Care Nursing

Critical Thinking : involves;

Reasoning Purposeful Systematic Reflective Rational Outcome directed thinking

Critical Thinking in Critical Care Nursing

Critical Thinking : involves;

Outcome directed thinking based on: A body of knowledge Examination Analysis of all available information and ideas

Components of Critical Thinking

1. Ask questions: To determine the reason why certain developments have occurred 2. Gather as much relevant information presented 3. Analyze the information 4. Draw on past clinical experience and knowledge

Components of Critical Thinking

5. Maintain flexible attitude 6. Consider available options 7. Formulate decisions that reflect: Creativity Independent decision making

Critical Thinking In Nursing Practice

Predominant Thinking Strategies Used by Nurses; Regardless of their area of Clinical Practice

Thinking Strategies
1. 2. 3. 4. 5. 6. Recognize a pattern Set priorities Search for information Generate hypotheses Make predictions Form relationships

Thinking Strategies
7. State the proposition (if then) 8. Make choices (alternative actions) 9. Judge the value 10. Draw conclusions 11. Provide explanations

The Inquiring Mind: Critical thinking in Action

Some guide questions:

1. What relevant assessment information do I need,

How do I interpret this information? What does this information tell me?

The Inquiring Mind: Critical thinking in Action

Some guide questions:

2. To what problems does this information point? Have I identified the most important one? Does the information point to any other problems that I should consider?

The Inquiring Mind: Critical thinking in Action

Some guide questions: 3. Have I gathered all the information I need?

Signs / symptoms Laboratory values Emotional factors Mental status Is anything missing?

The Inquiring Mind: Critical thinking in Action

Some guide questions:
4. Is there anything that needs to be reported immediately? Do I need to seek additional assistance?

The Inquiring Mind: Critical thinking in Action

Some guide questions:

5. Does this patient have any special risk factors?

Which ones are most significant? What must I do to minimize these risks?

The Inquiring Mind: Critical thinking in Action

Some guide questions:
6. What are the possible complications?

The Inquiring Mind: Critical thinking in Action

Some guide questions: 7. What are the desired outcomes for this patient? Which have the highest priority? Does the patient agree with me on these points?

The Inquiring Mind: Critical thinking in Action

Some guide questions:
8. What will be my first intervention in this situation? 9. How can I construct a Plan of Care to achieve the goals?

The Inquiring Mind: Critical thinking in Action

Some guide questions: 10. Are there any age related factors involved?

Will they require special approach? Will I need to make some changes in the plan of care to make them effective?

The Inquiring Mind: Critical thinking in Action

Some guide questions:

11. How do the family dynamics affect this situation? Will this affect my plan of care?
12. Are there cultural factors that I must address and consider?

The Inquiring Mind: Critical thinking in Action

Some guide questions: 13. Am I dealing with an ethical problem here? If yes, how am I going to resolve it? 14. Has any nursing research been conducted on this subject?

1. Standards of care 2. Standards of professional practice 3. Critical thinking defined 4. Thinking strategies

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.

Leo Buscaglia

AJ ALAWI