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Critical Care Across the Continuum:
Standards the Same for Progressive Care Nurses
By Ray Quintero, RN, MSN, CCRN
Progressive Care Task Force
Education, training and continuing education are
pivotal in providing a foundation for any practice. However, though progressive
care nurses care for critically ill patients, healthcare facilities,
professional organizations and educators are often challenged in trying to
provide them the education and training necessary to meet and maintain critical
care practice and education nursing standards.
AACN�s Education Standards for Acute and
Critical Care Nursing and Standards for Acute and Critical Care Nursing Practice
are applicable to acute and critical care nurses across the critical care
continuum.
After reviewing all aspects of the care
provided, the Progressive Care Task Force has concluded that, except for a few
highly technical differences and procedures, the core requirements are similar
in critical care and progressive care units. The intensity of care, vigilance,
critical thinking, collaboration, decision making, assessment and implementation
of the nursing process are the same.
Unfortunately, many progressive care units have
minimal bedside and ancillary support systems and may not have a critical care
unit with a continuous support system nearby. Therefore, educators must develop
education and training programs that address all aspects of care for progressive
care nurses. For example, because technological patient monitoring data may not
be readily available, these programs become vital in maintaining critical care
standards and providing quality patient care.
Educators must be creative in developing
programs that address both similar and unit-specific needs. Because progressive
care is rapidly developing as an alternative level of care, schools of nursing
must provide students with greater opportunities to be exposed to acute and
critical care clinical areas. These types of environments can assist students in
practicing critical thinking, problem solving and collaboration to begin honing
their acute care assessment skills.
Regardless of whether a nurse is experienced or
a new graduate, their training should be similar in design. Although the length
of orientation can be individualized, competencies, required introductory
courses, unit in-services, required certifications and clinical demonstrations
should be the same.
The basic critical care course (see description
below) is an example of how educators can be creative in meeting nurses� general
and specific unit requirements. Progressive care units, such as those where
organ transplant, cardiac, medicine, surgical and bone marrow transplant
patients are cared for, can use it to meet their educational program goals.
Continuing education and training is also an
important component for acute and critical care nurses. The AACN education
resource booklet, which includes numerous multimedia training materials,
continues to expand topics that support progressive care training. Additional
training needs and requirements can be met through CE articles, computer-based
training, video presentations, satellite-delivered programs and unit-based
training days. Being creative in developing unit-specific programs will ensure
that the standards of education and care are maintained.
As economic, workforce and healthcare reform
issues build, we will see a significant increase in the number of progressive
care units. We must therefore be ready to support healthcare organizations and
nurses in meeting change and additional demands on their practice. Innovative
educational programs, methods and materials will help prepare progressive care
nurses for present and future demands.
Critical Care Basics I
The overall objective of this course is to
provide the participant with vital information that sets the foundation for safe
beginning practice in the critical-acute care environment.
Content:
Dysrhythmia interpretation and management
Introduction to hemodynamic monitoring and
manipulation
Oxygenation and airway management
Critical Care Basics II
This course is targeted to nurses who are in
their eighth to 14th week of working in a critical care, step-down or telemetry
unit. It provides the application of critical care concepts and the development
of intermediate level skills. Presentations are interactive and based on case
studies.
Content:
Intermediate dysrhythmias
Intermediate hemodynamic monitoring
Multisystem complications
Acute renal failure
Gastrointestinal case studies
Infectious disease
Intermediate mechanical ventilation
ICP dynamics
Competencies that are evaluated:
Temporary pacers
Conscious sedation/train of 4 monitoring
Malignant hyperthermia
Join the Club! AJCC Feature Encourages
Discussion
A new feature designed to stimulate interest in
evidence-based practice and familiarize readers with the research process is
included in the September 2002 issue of the American Journal of Critical Care.
It�s called the AJCC Journal Club.
The idea is to gather a group of colleagues to
discuss the Journal Club article that will appear in each issue of AJCC.
Questions and discussion points accompany each article. The articles and
discussion points, as well as guidelines for critiquing research and a glossary
of research terms, are also available online at
http://www.ajcconline.org
> Journal Club. In addition, the guidelines (Document #4200) and glossary
(Document #4201) are available on Fax on Demand at (800) 222-6329.
The first Journal Club article, by Kathleen A.
Puntillo, RN, DNSc, Lorie Rietman Wild, RN, PhD, Ann Bonham Morris, RN, MSN,
CPNP, Julie Stanik-Hutt, RN, PhD, ACNP, Carol Lynn Thompson, RN, PhD, CCRN, ACNP,
CCNS, and Cheri White, RN, PhD, CCRN, is titled �Practices and Predictors of
Analgesic Interventions.�
Subscriptions to the American Journal of
Critical Care are included in AACN membership dues.
Nurse Practitioner Publications Added as
Benefit for Members
Advanced practice members of AACN will soon be
receiving two new publications geared to nurse practitioners. Starting in
October, they will receive the American Journal for Nurse Practitioners and
Nurse Practitioner World News. AJNP is the official peer-reviewed, clinical
journal of the American College of Nurse Practitioners. NPWN is ACNP�s official
news publication. Both are published 10 times per year, with combined issues for
July and August and for November and December. AACN is a national affiliate
member of ACNP.
Latest ACLS and PALS Recommendations
Available as Pocket References
The latest strategies and recommendations
sanctioned by the American Heart Association are available on handy ACLS pocket
references, developed by AACN in conjunction with AHA. All are priced at $5
each, plus shipping and handling. To order, call (800) 899-2226 or visit the
AACN online bookstore at
http://www.ajcconline.org
> Bookstore > Clinical Practice > Pocket Reference.
� ACLS Coronary Syndromes and Stroke Strategies
(Item #400859)
� ACLS Arrhythmias and Their Treatment (Item
#400860)
� ACLS Cardiac Arrest Algorithms (Item #400861)
In addition, a PALS (pediatric advanced life
support) pocket reference is available for the same price (Item #400858).
Puntillo to Deliver 2003 Distinguished
Research Lecture at NTI
Kathleen A. Puntillo, RN, MS, DNSc, FAAN, has
been selected as the Distinguished Research Lecturer for 2003. Puntillo, a
professor at the University of California, San Francisco, will present the
Distinguished Research Lecture at AACN�s National Teaching Institute and
Critical Care Exposition, May 17 through 22, 2003, in San Antonio, Texas. Her
topic will be �Pain Assessment and Management in the Critically Ill: Wizardry or
Science?�
The lecture will again be sponsored by Philips
Medical Systems.
The award honors a nationally known researcher
who has made significant contributions to acute and critical care research. In
addition, the recipient is known for publications, presentations and mentorship
relevant to acute and critical care and is viewed as a consultant in his or her
area of expertise.
Puntillo chaired AACN�s Thunder Project II,
which studied the pain perceptions and responses of critically ill patients to
commonly performed clinical procedures: tracheal suctioning, nonburn wound care,
drain removal, turning, femoral sheath removal and central line placement. A
total of 161 sites participated in the research, with data collected from more
than 6,000 patients.
In 1998, Puntillo was presented the Distinction
in Teaching Award by the Academic Senate at UCSF. She was selected for the
Harvard Palliative Care Education Program in 1999 and is a Soros Faculty Scholar
of the Open Society Institute, Project on Death in America.
In addition, she received the NTI 2001
Outstanding Research Abstract Award and the Nursing section Research Poster
Award at the 2002 Society of Critical Care Medicine Scientific Meeting.
Dec. 1 Is Deadline to Apply for 2004 Award
Dec. 1 is the deadline to apply for the 2004
AACN Distinguished Research Lecture Award. The recipient will present the
Distinguished Research Lecture at the NTI scheduled for May 15 through 20, 2004,
in Orlando, Fla.
The Distinguished Research Lecture awardee
receives a $1,000 honorarium and $1,000 toward NTI expenses.
For more information, contact Research Associate
Dolores Curry at (800) 394-5995, ext. 377; e-mail,
dolores.curry@aacn.org.
Practice Resource Network: Seek Out
Experienced Researchers
Q:I
am a master�s-prepared nurse who is interested in becoming involved in a
research project that will help me learn processes such as study design and data
collection. I hope to conduct my own studies and eventually be published. Do you
have advice on how I could get involved with experienced researchers?
A:Although
AACN does not currently offer research activities that allow for member
participation, we do have a variety of resources and recommendations to support
your efforts.
For a short, easy-to-read overview of the basics
of research, check out the �AACN Nursing Research Series: Discovery to Practice,
Module I,� which is available online as a CE offering under the �What�s New�
heading at
http://www.ajcconline.org.
This first in a series of five modules on using and conducting research is
geared to practicing nurses and beginning researchers.
Another excellent way to increase your research
knowledge and practice critiquing research studies is to form a journal club
where you can review and critique current nursing research articles with your
colleagues. In fact, the American Journal of Critical Care has established a
journal club, which will focus on an article that will be published in each
issue. The first AJCC Journal Club article appears in the September 2002 issue.
Participating in a journal club will help you to
not only update your practice, but also better understand the research process
as you look objectively at a study�s strengths and weaknesses. Review forms can
be found in most nursing research texts. A clinical specialist may be able to
link you with researchers in your area.
To obtain practical experience in research, you
might ask if any members of your local AACN chapter are currently conducting
research and need volunteers to help with data collection. (To find a chapter
near you, call (800) 899-2226 or visit the AACN Web site at www.aacn.org >
Chapters > Find a Chapter.) You might even find an experienced researcher who is
willing to include you in his or her project or to begin a joint venture with
you as a co-investigator. In addition, your hospital�s nursing department may
know of someone conducting research in your facility who needs help with data
collection.
Your facility�s quality assurance department may
also be a source for contacts. Even if it cannot link you to nursing research
contacts, there may be opportunities to become involved in a performance
improvement project. Although this research is not formal, it does offer an
opportunity to learn about problem identification, cause delineation, solution
implementation and outcomes evaluation. This early step along the research
continuum could provide you with an opportunity to submit a Creative Solutions
abstract for a future National Teaching Institute and Critical Care Exposition.
Check also with a nursing school in your area,
especially if it has a doctoral program. This is where much nursing research
occurs and volunteers are often sought to join research teams. For an online
list of nursing programs in the United States, visit
http://iiswinprd03.petersons.com/nursing/code/AlphaSearchResult.asp?sponsor=.
If you still are unable to find good nursing
research contacts, consider linking with a physician-driven study. Drug and
device studies are frequently conducted in large teaching or community
hospitals. Although they may not address nursing issues, this type of research
will provide insight into how research is done. The study director usually is a
physician, but an RN is often the study coordinator and may be willing to form a
mentor relationship with you.
Do you have a question related to your practice?
Contact AACN�s Practice Resource Network at (800) 394-5995, ext. 217, or visit
http://www.ajcconline.org.
Philips Grant Offers $100,000 for Outcomes
Research
A new grant, funded by Philips Medical Systems,
will support studies that center on improved outcomes or system efficiencies in
the care of acute or critically ill patients. The Philips Medical Systems-AACN
Outcomes for Clinical Excellence Research Grant will award up to $100,000 every
three years.
This award replaces the Critical Care Nursing
Research Grant that Agilent Technologies (now Philips) funded since 1991. The
grant will be awarded for the first time at AACN�s 2003 National Teaching
Institute and Critical Care Exposition, May 17 through 22 in San Antonio, Texas.
Applications are due Jan 15.
Research conducted with this grant may apply to
any age patient in any clinical environment, but must relate directly to at
least one of AACN�s research priorities.
Other Grants
Oct. 1 is the deadline to apply for three other
nursing research grants that are available through AACN:
AACN Clinical Practice Grant�This grant awards
up to $6,000 to support research focused on one or more of AACN�s research
priorities.
AACN-Sigma Theta Tau Critical Care
Grant�Cosponsored by Sigma Theta Tau, this grant awards up to $10,000.
Recipients may be members of either AACN or Sigma Theta Tau.
Evidence-Based Clinical Practice Grant�This
grant awards up to $1,000 for research that includes research utilization
studies, CQI projects or outcome evaluation studies. Collaborative research
teams are encouraged.
To find out more about AACN�s research
priorities and grant opportunities, visit the AACN Web site at
http://www.ajcconline.org.
The grants handbook is also available from AACN Fax-on-Demand at (800) 222-6329
(Canada call 949-448-7315), Request Document #1013.
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