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Medical-Surgical Nursing

Introduction

Medical-Surgical NursingIntroduction
Figure 35.1 A patient is cared for in an intensive care unit. The patient is intubated with multiple intravenous catheters. (credit: U.S. Navy, public domain)

Chapter Outline

Introduction

Critical care nursing is a specialty requiring astute assessment skills, clinical judgment, and critical thinking. Nurses who work in critical care settings are tasked with caring for extremely ill patients who are at high risk for death without life-saving medical intervention. Because of these patients’ high acuity, critical care nurses in the intensive care unit (ICU) are typically assigned to care for only one or two patients at a time. A typical patient in the ICU is intubated, receiving ventilatory support, and receiving several continuous intravenous (IV) medications (e.g., sedation, vasoactive drugs) that must be monitored and adjusted frequently by the nurse because of their systemic effects on the patient’s hemodynamics. In addition to managing the ventilator and medications, these patients also often have technological therapies in place, such as continuous renal replacement therapy or extracorporeal membrane oxygenation (ECMO), which the nurse is responsible for maintaining. Thus, critical care nurses must not only possess the technical skills to implement such complex therapies, they must also be able to think critically and make autonomous clinical decisions based on subtle changes in their patient’s conditions. The critical care nurse must be able to use all patient data—including assessments, medical histories, medications, and laboratory values—to determine real or potential complications the patient is currently experiencing or for which they are at risk.

Critical care is still a relatively new concept, with the first ICUs being established in the late 1950s to address the need for mechanical ventilation of patients with polio (Vincent, 2013). Over the next decade, ICUs were opened in many hospitals throughout the United States, Europe, and Australia. To assist with the education of nurses employed in these new intensive care settings, the American Association of Cardiovascular Nurses was established in 1960. The organization was renamed the American Association of Critical-Care Nurses (AACN) in 1970 to reflect the complex patient population more accurately (AACN, n.d.). As critical care units became more widespread in the 1970s, extensive research resulted in major advancements in medical technology. In present-day critical care units, these technological advancements are obvious. A wide variety of life-saving pharmacological and technological therapies have been developed and integrated into most ICUs worldwide. More recently, as telehealth has become more prevalent, electronic ICUs have been established in which critically ill patients are monitored remotely by critical care providers and nurses (Udeh et al., 2018).

The disease and financial burdens associated with critical care are already high, and several health-care trends continue to increase this burden. As patient life expectancy increases, so do the frequency of disease and resulting critical illness (Adhikari et al., 2010). Though technological advances have multiplied the available treatment options, they also bring an increased risk for treatment-associated complications, which can negatively affect the length of hospital stays and increase overall health-care costs. Additionally, incidence of burnout and post-traumatic stress disorder in bedside nurses and critical care providers has skyrocketed over recent years, largely related to the COVID-19 pandemic. This burnout has resulted in large-scale nursing and provider shortages that are likely to negatively affect critical care and health care in general for many years. According to the American Association of Colleges of Nursing (2022), there is a projected shortage of more than 200,000 nurses by the year 2031, and nursing school enrollments are not keeping up the pace to supply the workforce.

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