Page 40 - ACCCN's Critical Care Nursing

Resourcing Critical Care 2

Denise Harris
Ged Williams

INTRODUCTION
Learning objectives
In 1966 Dr B Galbally, a hospital resuscitation officer at
St Vincent’s Hospital, Melbourne, published the first
After reading this chapter, you should be able to: article on the planning and organisation of an intensive
● describe historical influences on the development of critical care unit (ICU) in Australia. He identified that critically
1
care and the way this resource is currently viewed and used ill patients who have a reasonable chance of recovery
● explain the organisational arrangements and interfaces that require life-saving treatments and constant nursing and
may be established to govern a critical care unit medical care, but this intensity of service delivery ‘does
● identify external resources and supports that assist in the not necessarily continue until the patient dies, and it
governance and management of a critical care unit should not continue after the patient is considered no
● describe considerations in planning for the physical design longer recoverable’. 1
and equipment requirements of a critical care unit
● describe the human resource requirements, supports and The need for prudent and rational allocation of limited
training necessary to ensure a safe and appropriate financial and human resources was as important for
workforce Australia’s first ICU (St Vincent’s, Melbourne, 1961) as it
● explain common risks and the appropriate strategies, is for the 200 or more now scattered across Australia and
policies and contingencies necessary to support staff and New Zealand. This chapter explores the influences on the
patient safety development of critical care and the way this resource is
● discuss leadership and management principles that currently viewed and used; describes various organisa-
tional, staffing and training arrangements that need to be
influence the quality, efficacy and appropriateness of the in place; considers the planning, design and equipment
critical care unit needs of a critical care unit; covers other aspects of
● discuss common considerations from a critical care resource management including the budget; and finishes
perspective in responding to the threat of a pandemic.
with a description of how critical care staff may respond
to a pandemic. First, however, important ethical decisions
in managing the resources of a critical care unit, which
are just as important as the ethical resources that govern
the care decisions for an individual patient (see Chapter
6), are discussed below.
Key words
ETHICAL ALLOCATION AND
critical care UTILISATION OF RESOURCES
resource management In management, as in clinical practice, careful consider-
business case ation of the pros and cons of various decisions must be
staff made on a daily basis. The interests of the individual
competence patient, extended family, treating team, bureaucracy and
credentialling the broader community are rarely congruent, nor are they
governance usually consistent. Decisions surrounding the provision
skill mix of critical care services are often governed by a compro-
budget mise between conflicting interests and ethical theories.
risk management Two main perspectives on ethical decision making,
pandemic deontological and utilitarian, are explored briefly.
patient dependency The deontological principle suggests that a person has a
fundamental duty to act in a certain way – for example, 17