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Progressive Care Nuring

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Jennifer McEachin

on 14 October 2012

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Transcript of Progressive Care Nuring

Progressive Care Nursing Exploring Our Roots Presented by: Jennifer McEachin, RN What is progressive care?
Continuum of critical care.
Transitional Care Unit
Step-down Unit
Intermediate Care Unit
Telemetry Unit 1982 Maggie White, RN, BSN, remembers 1982 as the year that surgeons at Methodist Dallas Medical Center requested a separate area staffed with skilled surgical nurses to monitor patients with cardiac arrhythmias. Nursing colleagues recruited, educated, and got the group up to speed. So began the hospital's surgical telemetry unit. 1970’s The way this unit developed parallels the birth of progressive care units (PCUs) and nursing in the early ‘70s across the country. The “NEED” for PCU Critical Care beds had become a premium, both financially and logistically.
Step-down units embraced patients as they progressed out of the traditional ICU.
"Patients’ need for a new level of care pushed open progressive care doors,’’ says Juan (Ray) Quintero, RN, CCRN, at the VCU Medical Center in Richmond, Va. Needs of the patients Needs fall along the less-acute end of the continuum.
Moderately stable condition with less complexity
Require moderate resources
Require intermittent nursing vigilance or are in stable condition with a high potential for becoming unstable
Require increased intensity of care and vigilance. Nurses’
Competencies Patients’ Characteristics Evolution of Progressive Care Nursing Practice In 2001, the American Association of Critical-Care Nurses (AACN) recognized the need to define and identify the distinct needs of the progressive care nurses, and to delineate the core competencies and basic knowledge and skill requirements of PCU nursing. PCU’s became extremely specialized for whatever need there was to fill, whether the patient care focused on a specific system, such as cardiac, or broader based, such as in a medical intermediate care unit.
‘’A high turnover of patients and a faster pace than med/surg are the facts of life in PCUs,’’ says Kathleen Dooney, RN, MSN, director of nursing education at Winthrop-University Hospital in Minneola, N.Y. ICU Shortage Continues References Core Curriculum for Progressive Care Nursing
http://www.nurseweek.com/news/Features/04-10/ProgressiveCare.asp
http://www.nursezone.com/student-nurses/specialty-spotlight/specialty-spotlight-all-about-progressive-care/telemetry-nursing_18216.aspx AACN Synergy Model Defines nursing practice according to the needs of the patient and the characteristics of the nurse so that optimal patient outcomes can be achieved. Decreased risk for life-threatening events
Decreased need for invasive monitoring
Increased stability
Increased ability to participate in their care more than those in ICU
Some examples are those with low-probability MI, hemodynamically stable MI, dysrhythmia or pacemaker, mild to moderate heart failure, and hypertensive urgency with no evidence of end organ damage, we care for cardiac patients, some with comorbidities.
What makes the difference in our telemetry patients is their need for high-frequency monitoring for cardiac changes and interventions often the result of medications not administered on medical/surgical floors. New Role, New Skills Basic cardiac rhythm monitoring techniques, interpretation and treatment
Basic and advanced life support
Drug dosage, calculations, administration of continuous medication infusions for drugs such as agents that affect cardiac function and blood pressure, anti-arrhythmic agents and platelet inhibitors
Patient monitoring for patients before, during and after some invasive procedures such as cardiac catheterization.
Recognition of the signs and symptoms of cardiopulmonary and respiratory emergencies and initiation of standardized interventions to stabilize the patient awaiting transfer to a critical care unit
Recognition of and evaluation of the patient and family's need for enhanced involvement in the care of the patient to facilitate the transition from hospital to home . one foot in progressive care and one foot in critical care. PCU nurses perform interventions more frequently than on med/surg floors but less often than in the ICU, that care is a direct reflection of the patient's condition.

"Though PCU patients are stable, they are also acutely and critically ill and at risk for rapid status change,’’ Salipante says. "There’s a revolving door for patients whose degree of need for vigilance escalates from intermittent to continuous.’’

In 2001, AACN set out to create the “vision to give progressive care nurses a sense of who they are and the required skills they use when caring for high-acuity patients outside ICUs,’’ says Quintero, an AACN task force member. Financial sense ‘’Hospitals are cost constrained,’’ Quintero says.
‘’Since costs drop by about 50% with each decrease in a level of patient care, progressive care offers a significant savings over critical care.’’
Quintero maintains that patient outcomes are improved when a patient is cared for at the most appropriate level of care.
Discharging patients from the ICU to the PCU instead of to a general floor lower mortality rates because patients receive the appropriate care level for their acuity. Feelings and Great Outcomes Moving patients to PCUs offers a morale boost.
Patients who progress to a step-down unit see themselves as getting better, a real gain psychologically. Next step is discharge home.
Rules for visitation are less restrictive than in ICUs, families have more opportunities to be with patients and participate in their care.
Within patients’ short stay, nurses educate them as they focus on health and wellness.
Nurses connect patients with rehabilitation and home care visits that will keep them healthy and at home.’’ Today, the AACN recognizes progressive care as part of the continuum of critical care. According to the AACN-developed Synergy Model, a framework for practice, patient needs drive nurse competencies, and when characteristics and competencies synergize, outcomes for the patient, the nurse, and the system are optimal. Progressive care nurses practice the same standard of nursing as critical care nurses and require the same level of education as nurses who work in the ICU, except with respect to invasive technologies Moving toward the mainstream ‘’The story of progressive care is one of inclusion into the mainstream, recognition, and acceptance,’’ says Quintero, who encourages progressive care nurses to be active spokespeople about the care they provide. We need to acquire a voice here at Prince William hospital. We need to champion PROGRESSIVE CARE care to help it grow. AACN Synergy Model Defines nursing practice according to the needs of the patient and the characteristics of the nurse so that optimal patient outcomes can be achieved. Needs of our patients -2- Decreased risk for life-threatening events
Decreased need for invasive monitoring
Increased stability
Increased ability to participate in their care more than those in ICU
Need for high-frequency monitoring for cardiac changes and interventions often the result of medications not administered on medical/surgical floors.
Examples are low-probability MI, hemodynamically stable MI, dysrhythmia or pacemaker, mild to moderate heart failure, and hypertensive urgency with no evidence of end organ damage, cardiac patients with comorbidities. PATIENT’S CHARACTERISTICS 1 RESILENCY
2 VULNERABILITY
3 STABILITY
4 COMPLEXITY
5 PREDICTABILITY
6 RESOURCE AVAILABILTY
7 PARTICIPATION IN CARE
8 PARTICIPATION IN DECISION MAKING NURSE’S COMPETENCIES 1 CLINICAL JUDGEMENT
2 ADVOCACY/MORAL AGENT
3 CARING PRACTICE
4 COLLABORATION
5 SYSTEMS THINKING
6 RESPONSE TO DIVERITY
7 CLINICAL INQUIRY
8 FACILITATION OF LEARNING
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