Caring for the critically ill cardiothoracic patient requires a multidisciplinary approach with nursing roles being pivotal. Nursing the critically ill cardiothoracic patient requires advanced skills and competence as well as in-depth knowledge of nursing practice, anatomy, physiology and pathophysiology, technology and pharmacology used in critical care. Integral to the nurses’ role is supporting patients and their families during and after critical illness.
Critical care areas are constantly adapting to the needs of the patient and now often extend beyond the physical unit itself. The concept of ‘critical care without walls’ is well established and ensures continuity of the patient pathway before, during and after the ICU admission. Many units now further defragment the care of the critically ill patient through advanced nurse practice, developing the role of the healthcare support worker, establishing new ways of working and offering nurse led services.
Most critical care area nursing teams include a dedicated education team, their role being primarily to ensure access to all nurses to appropriate education and to support the senior nursing team in sharing best practice.
Critical care is a complex specialty with the new nurse having to acquire many skills and competencies. The education team provides both a framework and support to meet these needs. Technology within critical care is constantly evolving and the education team has a vital role in ensuring all new equipment is introduced with a robust training programme to ensure patient safety.
It is important that all nurses are provided with the opportunity to develop throughout their careers. The education team is able to ensure all staff have access to appropriate educational opportunities.
Integral to the care of the patient is the bedside nurse. Their roles vary in different cardiac intensive care units and countries, but they are the person who has the most contact with the critically ill patient. The roles of the bedside nurse are summarised in Table 53.1. In critical care this is a registered practitioner who enhances the delivery of comprehensive patient centred care, for acutely ill patients, often on a 1:1 basis. Structured handover at the start of each shift ensures accurate transfer of clinical information ensuring continuity of safe care.