A new approach to critical care education

This article describes the development of a new degree programme in critical care nursing. The underlying principle, berzhind the degree, is that there are more similarities between the various 'critical care' areas than there are differences. Thus, the skills and knowledge base also share similarities. The focus of this programme is on educating nurses for practice within critical care as a whole - producing a practitioner who is able to nurse throughout the spectrum of critical care. The concept of a generic critical care nurse is fundamental to the philosophy of the programme, which has evolved from discussion exploring the provision of critical care required for the 21st century, and the nature of nursing that will be required to provide this service.     

A regional approach to entry-level critical care education

The education and training of the novice critical care nurse place a constant financial demand on many Puget Sound area hospitals. Critical care educators from this area, committed to cost-effective, high-quality education, enhanced through precepted clinical experience, assessed the need for a collaborative approach among institutions. Jointly we have successfully planned, implemented, and evaluated a cooperative educational program. To date, the program has served to reduce the costs of preparing the RN entering critical care in the Puget Sound area. Application of principles of adult education, timely application of theory to practice, and expansion of the professional role of critical care clinical nurse specialists and educators have also been recognized as outcomes of the CCEC.     

The Tele-ICU: a new dimension in critical care nursing education and practice

As health care reform pushes for improved patient care outcomes and reduced costs, tele-intensive care units are increasingly included in the discussion of critical care delivery. Nursing must be involved in the implementation of and education for this transformative initiative.     

Match critical care situations with savvy devices. High-tech solutions give a new twist to familiar procedures

Advances in cardiac resynchronization therapy, stents, robotics, and monitoring offer patients new treatment options.     

New treatment strategies for COPD. Pairing the new with the tried and true

Knowledge about COPD has increased substantially in recent years. Smoking cessation campaigns have significantly decreased smoking prevalence in the United States, and similar efforts in the rest of the world will likely have the same impact. The consequence should be a drop in incidence of COPD in the years to come. The use of LTOT for hypoxemic patients has resulted in increased survival, and expanded drug therapy options have effectively improved dyspnea and quality of life. Recent studies have documented the benefits of pulmonary rehabilitation. In addition, noninvasive mechanical ventilation offers new alternatives for patients with acute or chronic failure. Furthermore, the revival of surgery for emphysema may serve as an alternative to lung transplantation for patients with severe COPD who remain symptomatic despite maximal medical therapy. With all of these options, a nihilistic attitude toward management of COPD is not justified.     

Implementing a multidisciplinary approach to comprehensive critical care

Following recent government recommendations on critical care services, the skills and training opportunities within the critical care environment should be shared with staff on the general wards. This article discusses a one-day study course offered at one NHS trust that was developed to address the educational needs of staff working on general wards.     

Comprehensive critical care education is critical to success.

Intensive and high-dependency care is currently receiving considerable attention, not least since the Department of Health review of adult critical care nursing and subsequent proposals for the development of a consistent and comprehensive critical care service (DoH 2000). The report highlights the need for policy changes at all levels and across all disciplines and makes several recommendations that are deemed essential for the future organization and delivery of critical care. Central to the proposed reforms is the availability of a skilled workforce, adequately prepared and appropriately trained to provide specialist care in a variety of settings where acutely ill patients are found. This paper considers the implications of 'comprehensive critical care' for pre- and post-registration nurse education and offers insight into programmes of learning that are tailored to meet the needs of the service and individuals. The paper draws upon three influential and timely publications, namely the Audit Commission report into critical care services, the English National Board (ENB) review of adult intensive/critical and high-dependency care programmes and the United Kingdom Central Council (UKCC) Commission for Education recommendations regarding 'fitness for practice'.     

Critical care education: experience with a community-based consortium approach

A continuous cycle of new orientees, cost-containment issues related to orientation, and conflicting job priorities prove to be challenging adversaries for critical care educators. The San Diego Chapter of the American Association of Critical Care Nurses (AACN) has met some of these educational challenges by providing a community-wide, consortium-based Critical Care Nursing Internship Program (CCIP) for novice critical care nurses. Over the last 15 years this CCIP has been instrumental in providing comprehensive education for more than 2,200 novice critical care nurses in San Diego County. This article discusses the background, rewards, and current challenges of the program. It also addresses a comparison between consortium-based education and the National AACN Essentials of Critical Care Orientation (ECCO) Program.     

Exploring critical thinking in critical care nursing education: a pilot study

BACKGROUND: Critical care nurses process vast amounts of information and require well developed critical-thinking skills to make clinical decisions. METHOD: Using a pretest posttest design, the critical-thinking skills of 31 postgraduate nurses were evaluated using the California Critical Thinking Skills Test (CCTST). RESULTS: For the total group, mean critical-thinking scores improved slightly over time. The CCTST revealed a mean pretest score of 18.5 and a mean posttest score of 19.7, both of which were higher than the established norms for the test. Overall, no significant difference was observed between pretest and posttest. However, statistical significance was observed posttest for nurses whose critical-thinking scores improved (p < .000). CONCLUSION: Despite the small sample, the majority of the postgraduate nurses improved their critical-thinking skills during the course of their study.     

Kitwood's approach to dementia and dementia care: a critical but appreciative review

This paper critically examines the recent work of Tom Kitwood and his colleagues at the Bradford Dementia Group After initial details relating to Kitwood's early work and the development of the research group, the paper sets out Kitwood's ideas regarding the nature of dementia and dementia care Four areas of contribution made by Kitwood are outlined Problems relating to Kitwood's research methods are then put forward In conclusion, it is suggested that while Kitwood's work will undoubtedly help enhance the care given to elderly demented people, more work needs to be done to ensure the validity of his methods