Page 57 - ACCCN's Critical Care Nursing

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

in scalable, flexible plans that are underpinned by the
normal management structure and ensure effective lines Case study
of communication.
St Mary MacKillop’s Hospital is a 500-bed, metropolitan, general
teaching public hospital that is planning to build a new 20-bed
SUMMARY intensive care unit. The planners have asked you to act as the
new nurse unit manager for the ICU. Your task is to plan for what
The management of all resources in the critical care is required to make this a functional unit when it is open. The
unit is key to meeting the needs of the patients in a hospital planners inform you that you will ultimately need
safe, timely and cost-effective manner. Many factors influ- 16 ICU beds and 4 HDU beds, but in the first instance they want
ence not only the resources available but also how these you to open half this amount (i.e. 8 ICU and 2 HDU beds).
are allocated. Managers of critical care units are required
to be knowledgeable in the design and equipping of Among other things you must consider the following tasks
units; human resource management, including the and make recommendations to the director of nursing of St
make-up of the nursing workforce; and the fundamentals Mary MacKillop’s Hospital (see Learning activities 1–4). Utilise
of the budget: how it is determined, monitored and information contained in this chapter to inform your work and
managed. recommendations.

Research vignette

Leen T, Williams T, Campbell L, Chamberlain J, Gould A, study period and those admitted during the same time period in
McEntaggart G, Leslie G. Early experience with influenza A H1N1 the previous year. Data sources were identified and included
09 in an Australian intensive care unit. Intensive Critical Care APACHE II and III, and sepsis-related/sequential organ failure
2010; 26(4):207–14. assessment (SOFA), as well as demographic and specific clinical
Abstract data with regard to length of ventilation and length of stay (LOS).
A total of 343 patients were admitted during the period of the
Influenza is a common seasonal viral infection that affects large study. Testing procedures and processes to confirm H1N1 were
numbers of people. In early 2009, many people were admitted to described. The study found that the study population was younger
hospitals in Mexico with severe respiratory failure following an (P = 0.018), with a higher percentage of patients being female
influenza-like illness, subtyped as H1N1. An increased mortality (61%), and that the LOS for the H1N1 population was significantly
rate was observed. By June 2009, H1N1 was upgraded to pandemic longer (P < 0.001) than for the non-H1N1 patients in the same or
status. In June–July, Australian ICUs were experiencing increased the previous year.
activity due to the influenza pandemic. While hospitals imple-
mented plans for the pandemic, the particularly heavy demand to The paper goes on to describe the issues that arose during the
provide critical care facilities to accommodate an influx of people study period and the mechanisms and processes that were devel-
with severe respiratory failure became evident and placed a great oped and implemented to manage them. These issues were similar
burden on provision of these services. This paper describes the to those identified in other studies. There is clear evidence that this
initial experience (June to mid-September) of the pandemic from unit had a surge plan in place, and the discussion identifies how
the nursing perspective in a single Australian ICU. Patients were these experiences will be used to guide planning and clinical prac-
noted to be younger, with a higher proportion of women, two of tices in the future.
whom were pregnant. Two patients had APACHE III comorbidity. Of Descriptive research studies have a clear purpose to allow us to
the 31 patients admitted during this period, three patients died in observe, describe and document naturally occurring situations.
ICU and one patient died in hospital. Aerosol precautions were Their aim is to describe relationships between or among variables
initiated for all patients. The requirement for single room accom- rather than to infer a causal relationship. This research methodo-
modation placed enormous demands for bed management in ICU. logy does not always fit completely into the definition of quali-
Specific infection control procedures were developed to deal with tative or quantitative, but allows us to use elements of each
this new pandemic influenza.
methodology to appropriately and fully describe a situation. This
Critique form of research can afford insights that we may not have previ-
The study initially introduces the H1N1 pandemic and its origins in ously had and also provides us with the basis to identify future
Mexico, describes the unit within which the study was conducted areas of practice development, practice change and research.
and identifies the research methodology as descriptive. The paper
also defines the inclusion and exclusion criteria for the study and This paper clearly described the experiences of this hospital in
data collection. response to the increased demand for critical care services during
the H1N1 pandemic of 2009 and how it responded. The lessons
Descriptive statistics (measures of central tendency such as mean, learnt are not only valuable to the unit in question, but also provide
median and deviance from mean) were appropriately used to valuable information for other units to use in examining their own
compare the two patient populations: those admitted during the response to a similar situation.