Page 27 - ACCCN's Critical Care Nursing

4 S C O P E O F C R I T I C A L C A R E

primarily of coronary care units for the care of cardiology Critical care nursing education developed in unison with
patients, cardiothoracic units for the care of postoperative the advent of specialist critical care units. Initially, this
patients, and general intensive care units for the care of consisted of ad-hoc training developed and delivered in
patients with respiratory compromise. Later develop- the work setting, with nurses and medical officers learn-
ments in renal, metabolic and neurological management ing together. For example, medical staff brought expertise
led to the principles and context of critical care that exist in physiology, pathophysiology and interpretation of
today. electrocardiographic rhythm strips, while nurses brought
expertise in patient care and how patients behaved and
Development of critical care nursing was characterised by 12,17
4
a number of features, including: responded to treatment. Training was, however, frag-
mented and ‘fitted in’ around ward staffing needs. Post-
● the development of a new, comprehensive partnership registration critical care nursing courses were subsequently
between nursing and medical clinicians developed from the early 1960s in both Australasia and
4,8
● the collective experience of a steep learning curve for the UK. Courses ranged in length from 6 to 12 months
nursing and medical staff and generally incorporated employment as well as spe-
● the courage to work in an unfamiliar setting, caring cific days for lectures and class work. Given the local
for patients who were extremely sick – a role that nature of these courses developed for the local needs of
required development of higher levels of competence individual hospitals and regions, differences in content
and practice and practice therefore developed between hospitals,
● a high demand for education specific to critical care regions and countries. 18-20
practice, which was initially difficult to meet owing to
the absence of experienced nurses in the specialty During the 1990s the majority of these hospital-based
● the development of technology such as mechanical courses in Australasia were discontinued as universities
ventilators, cardiac monitors, pacemakers defibrilla- developed postgraduate curricula to extend the knowl-
tors, dialysers, intra-aortic balloon pumps and cardiac edge and skills gained in pre-registration undergraduate
assist devices, which prompted development of addi- courses. A significant proportion of critical care nurses
tional knowledge and skills. now undertake specialty education in the tertiary sector,
often in a collaborative relationship with one or more
There was also recognition that improving patient out- hospitals. One early study of students enrolled in
4
comes through optimal use of this technology was linked university-based critical care courses in Australia identi-
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to nurses’ skills and staffing levels. The role of ade- fied a number of burdens (workload, financial, study–
12
quately educated and experienced nurses in these units work conflicts), but also a number of benefits (e.g. better
was recognised as essential from an early stage, and led job prospects, job security).
8
to the development of the nursing specialty of critical care.
Although not initially accepted, nursing expertise, ability Within Australia and New Zealand, most tertiary institu-
to observe patients and appropriate nursing intensity are tions currently offer postgraduate critical care nursing
now considered essential elements of critical care. 12 education at a Graduate Certificate or Graduate Diploma
level as preparation for specialty practice, although this
As the practice of critical care nursing evolved, so did is often provided as a Master’s degree. In the UK, similar
22
the associated areas of critical care nursing education provisions for postgraduate critical care nursing edu-
and specialty professional organisations such as the cation at multiple levels are available, although some
Australian College of Critical Care Nurses (ACCCN). The universities also offer critical care specialisation at the
combination of adequate nurse staffing, observation of undergraduate level (for example, King’s College,
the patient and the expertise of nurses to consider the London). Education throughout Europe has undergone
complete needs of patients and their families is essential significant change in the past 10 years as the framework
to optimise the outcomes of critical care. As critical care articulated under the Bologna Process has been imple-
continues to evolve, the challenge remains to combine mented. In relation to critical care nursing, this has led
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excellence in nursing care with judicious use of techno- to the expansion of programs, primarily at the postgradu-
logy to optimise patient and family outcomes. ate level, for specialist nursing education. Critical care
nursing education in the USA maintains a slightly differ-
CRITICAL CARE NURSING EDUCATION ent focus, with most postgraduate studies being generic
Appropriate preparation of specialist critical care nurses in nature, including a focus on advanced practice roles
such as clinical nurse specialists and nurse practitioners,
is a vital component in providing quality care to patients while specialty education for critical care nurses is under-
5
and their families. A central tenet within this framework taken as continuing education. Employment in critical
24
of preparation is the formalised education of nurses care, with associated assessment of clinical competence,
13
to practise in critical care areas. Formal education – remains an essential component of many university-
in conjunction with experiential learning, continuing based critical care nursing courses. 22,25
professional development and training, and reflective
clinical practice – is required to develop competence in Both the impact of post-registration education on prac-
critical care nursing. The knowledge, skills and attitude tice and the most appropriate level of education that is
necessary for quality critical care nursing practice have required to underpin specialty practice remain controver-
been articulated in competency statements in many sial, with no universal acceptance internationally. 26-29
countries. 14-16 Globally, the Declaration of Madrid, which was endorsed