Page 128 - ACCCN's Critical Care Nursing

Essential Nursing Care of

the Critically Ill Patient 6

Bernadette Grealy
Wendy Chaboyer

important component of quality care; if patients are
Learning objectives assessed thoroughly and on a continuing basis then prob-
lems may be detected and treated early, preventing the
After reading this chapter, you should be able to: development of unnecessary complications. These prin-
● identify risks posed to critically ill patients relating to ciples underpin this chapter. Additionally, it is important
inadequate physical care and hygiene always to treat the patient as a person. Although this
● describe best practice in the provision of physical care and chapter focuses on the physical dimension of nursing care,
hygiene patients’ psychosocial care should not be ignored (see
● understand the key elements of safe transfer of critically ill Chapters 7 and 8). Further, while this chapter describes
patients within the hospital setting essential nursing care, care bundles, which encompass a
● understand the principles of infection-control risk number of these activities, are described in Chapter 3.
identification and management for critically ill patients

Practice tip

Make sure patients know your name when you are caring for
Key words them; introducing yourself is professionally appropriate and
reassuring to patients.
bowel management
eye care
infection control PERSONAL HYGIENE
intrahospital transport
oral care It is important to provide the critically ill patient with
patient positioning and mobility effective personal hygiene as poor hygiene may increase
the risk of bacterial colonisation and subsequent infec-
personal hygiene tion, or lead to surgical infection. Daily bed-baths are
1
2
urinary catheter care
usually provided for most critically ill patients, although
their effectiveness at reducing bacterial colonisation is
1
questionable. Personal hygiene is also closely related to
an individual’s esteem and sense of wellbeing. It may also
INTRODUCTION influence family members’ perception of the quality of
This chapter is about essential nursing care. Because it is care the patient is receiving and the confidence they have
often referred to as basic nursing, nurses may not always in the staff’s ability to care for their loved one.
perceive it as deserving of priority. Yet, how well patients Consideration of the patient’s specific condition may
are cared for has a direct effect on their sense of wellbeing influence the timing and way personal hygiene is per-
and their recovery. This chapter focuses on the physical formed. For example, the patient may have to be moved
care, infection control, preventative therapies and trans- slowly when changing bed linen because of their cardio-
port of critically ill patients. The first two areas are closely vascular instability, or they may require a blanket while
linked: poor-quality physical care increases the risk of bathing if they are hypothermic. Finally, providing essen-
infection. The final areas are essential features of critical tial care should be timed to promote optimal rest.
care nursing.
Comfort is a paramount concern in intensive care. The ASSESSMENT OF PERSONAL HYGIENE
two key areas of care – reducing risk and providing quality Assessment of critical care patients’ personal hygiene
care – are closely related and served by a series of princi- should be undertaken on two levels: first, determining
ples (see Table 6.1). Good risk management is an what patients are able to do for themselves and what they 105