53 – Cardiothoracic Critical Care Nursing, Outreach and Follow-up




53 Cardiothoracic Critical Care Nursing, Outreach and Follow-up



Jo-anne Fowles



Introduction


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.



The Nursing Team



Education Team


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.



Bedside Nurse


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.




Table 53.1 Duties of the bedside nurse










  • The bedside nurse’s plan of care on a daily basis will include the following



  • Basic needs:




    • Assess all needs and provide general hygiene including eye care, mouth care, bathing



    • Prevent self harm when patients are agitated



    • Bowel care



  • Skin care:




    • Regular repositioning to prevent pressure sore development



    • Correct positioning of invasive devices to avoid skin damage



    • Assessing skin integrity and use of appropriate dressings and creams



    • Ensuring correct pressure relieving mattress utilised



    • Cleanliness to avoid development of moisture lesions



    • Assessing wounds and ensuring correct dressings used



  • Infection control:




    • Ensure local infection control policies are adhered to



    • Recognise early signs of infection



  • Psychological support:




    • Allay patients’ fears and concerns by ensuring they are comfortable, reassured and fully informed



  • Family care:




    • Ensure good communication and support family members



  • Monitoring:




    • Documenting and interpreting monitored parameters and communicating concerns early to prevent further deterioration



    • Medications:




      • Administering all prescribed medications



      • Titrate infusions within defined parameters (e.g. sedative infusions)



    • MDT:




      • Participate in MDT discussions acting as the patient’s advocate



    • Rehabilitation:




      • Be involved in the planning of rehabilitation



      • Assist with mobilising patients whenever possible



    • Advanced support:




      • Assisting with intubation



      • Regular bronchial toilet in ventilated patients



      • Care of tracheostomies including decannulation



      • Monitoring and managing CVVH, plasmapheresis, IABP



      • Measuring cardiac output studies, documenting and interpreting results and communicating concerns



      • Assisting with the insertion of invasive lines



      • Monitoring the patients supported with ECMO and VADs

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Jan 9, 2021 | Posted by in CARDIOLOGY | Comments Off on 53 – Cardiothoracic Critical Care Nursing, Outreach and Follow-up
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