Page 26 - ACCCN's Critical Care Nursing

Scope of Critical Care Practice 1

Leanne Aitken
Wendy Chaboyer
Doug Elliott

consumables and the rest to clinical support and capital
Learning objectives expenditure. 2
Critical care as a specialty in nursing has developed over
After reading this chapter, you should be able to: the last 30 years. Importantly, development of our spe-
3,4
● describe the history and development of critical care cialty in Australia and New Zealand has been in concert
nursing practice, education and professional activities with development of intensive care medicine as a defined
● discuss the influences on the development of critical care clinical specialty. Critical care nursing is defined by the
nursing as a discipline and the professional development of World Federation of Critical Care Nurses as:
individual nurses
● outline the various roles available to nurses within critical Specialised nursing care of critically ill patients who have mani-
care areas or in outreach services fest or potential disturbances of vital organ functions. Critical
● discuss the potential impact of clinical decision-making care nursing means assisting, supporting and restoring the
processes on patient outcomes patient towards health, or to ease the patient’s pain and to
● consider processes in the work and professional prepare them for a dignified death. The aim of critical care
nursing is to establish a therapeutic relationship with patients
environment that are influenced by local leadership styles.
and their relatives and to empower the individuals’ physical,
psychological, sociological, cultural and spiritual capabilities by
preventive, curative and rehabilitative interventions. 5
Critically ill patients are those at high risk of actual or
Key words potential life-threatening health problems. Care of the
6
critically ill can occur in a number of different locations
critical care nursing in hospitals. In Australia and New Zealand, critical care
roles of critical care nurses is generally considered a broad term, incorporating
clinical decision making subspecialty areas of emergency, coronary care, high-
clinical leadership dependency, cardiothoracic, paediatric and general inten-
sive care units. 7
This chapter provides a context for subsequent chapters,
INTRODUCTION outlining some key principles and concepts for studying
and practising nursing in a range of critical care areas. The
There is unprecedented demand for critical care services scope of critical care nursing is described in the Australian
globally. In our region, there are approximately 119,000 and New Zealand contexts, which in turn have some
admissions to 141 general intensive care units (ICUs) influence on clinical practice in Southeast Asia and the
in Australia per year; this includes 5500 patient re- Pacific. Development of the specialty is discussed, along
admissions during the same hospital episode. In New with the professional development and evolving roles of
Zealand, there are 18,000 admissions per year to 26 ICUs, critical care nurses in contemporary health care, including
1
including 500 re-admissions. Patients admitted to coro- clinical decision making and leadership.
nary care, paediatric or other specialty units not classified
as a general ICU are not included in these figures, so the
overall clinical activity for ‘critical care’ is much higher DEVELOPMENT OF CRITICAL
(e.g. there were also 5500 paediatric admissions to CARE NURSING
1
PICUs). Importantly, critical care treatment is a high-
expense component of hospital care; one conservative Critical care as a specialty emerged in the 1950s and
estimate of cost exceeded $A2600 per day, with more 1960s in Australasia, North America, Europe and South
than two-thirds going to staff costs, one fifth to clinical Africa. 4,8-11 During these early stages, critical care consisted 3