Interactive questioning in critical care during handovers: a transcript analysis of communication behaviours by physicians, nurses and nurse practitioners

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

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Organization and Structure of the Cardiothoracic Intensive Care Unit

Oncology ◽

10.4018/978-1-5225-0549-5.ch027 ◽

2017 ◽

pp. 709-727

Author(s):

Michael H. Wall

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Patient Outcomes ◽

Nurse Practitioners ◽

Physician Assistants ◽

Cost Of Care ◽

Team Members ◽

Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

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Critical care nurse practitioners

American Journal of Critical Care ◽

10.4037/ajcc1994.3.5.404-a ◽

1994 ◽

Vol 3 (5) ◽

pp. 404-404

Author(s):

SL Zorb

Keyword(s):

Critical Care ◽

Nurse Practitioners ◽

Care Nurse ◽

Critical Care Nurse

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Activities Performed by Acute and Critical Care Advanced Practice Nurses: American Association of Critical-Care Nurses Study of Practice

American Journal of Critical Care ◽

10.4037/ajcc2006.15.2.130 ◽

2006 ◽

Vol 15 (2) ◽

pp. 130-148 ◽

Cited By ~ 24

Author(s):

Deborah Becker ◽

Roberta Kaplow ◽

Patricia M. Muenzen ◽

Carol Hartigan

Keyword(s):

Critical Care ◽

Acute Care ◽

Nurse Practitioners ◽

Clinical Judgment ◽

American Association ◽

Critical Care Nurses ◽

Advanced Practice ◽

Clinical Nurse ◽

Care Nurse ◽

Clinical Nurse Specialists

• Background Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline. • Objectives To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners. • Methods A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients’ outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners. • Results Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment. • Conclusions Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.

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Perceptions of Physicians, Nurses, and Respiratory Therapists About the Role of Acute Care Nurse Practitioners

American Journal of Critical Care ◽

10.4037/ajcc2004.13.6.480 ◽

2004 ◽

Vol 13 (6) ◽

pp. 480-488 ◽

Cited By ~ 30

Author(s):

Leslie A. Hoffman ◽

Mary Beth Happ ◽

Carmella Scharfenberg ◽

Dana DiVirgilio-Thomas ◽

Frederick J. Tasota

Keyword(s):

Critical Care ◽

Acute Care ◽

Nurse Practitioners ◽

Medical Management ◽

Management Teams ◽

Care Nurse ◽

Respiratory Therapists ◽

Attending Physicians ◽

Weaning Protocols ◽

Family Focus

• Background Information about the contributions of acute care nurse practitioners to medical management teams in critical care settings is limited.• Objective To examine contributions of acute care nurse practitioners to medical management of critically ill patients from the perspectives of 3 disciplines: medicine, respiratory care, and nursing.• Methods Attending physicians, respiratory therapists, and nurses in 2 intensive care units were asked to list 3 advantages and 3 disadvantages of collaborative care provided by acute care nurse practitioners. Qualitative methods (coding/constant comparative analysis) were used to identify common themes and subthemes. Overall response rate was 35% (from 69% for attending physicians to 26% for nurses).• Results Responses were grouped into 4 main themes: accessibility, competence/knowledge, care coordination/communication, and system issues. Acute care nurse practitioners were valued for their accessibility, expertise in routine daily management of patients, and ability to meet patient/family needs, especially for “long-stay” patients. Also, they were respected for their commitment to providing quality care and for their communication skills, exemplified through teaching of nursing staff, patient/family involvement, and fluency in weaning protocols. Physicians valued acute care nurse practitioners’ continuity of care, patient/family focus, and commitment. Nurses valued their accessibility, commitment, and patient/family focus. Respiratory therapists valued their accessibility, commitment, and consistency in implementing weaning protocols.• Conclusion Responses reflected unique advantages of acute care nurse practitioners as members of medical management teams in critical care settings. Despite perceptions of the acute care nurse practitioner’s role as medically oriented, the themes reflect a clear nursing focus.

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A collaborative program for advanced practice in trauma/critical care nursing

Critical Care Nurse ◽

10.4037/ccn1996.16.2.120 ◽

1996 ◽

Vol 16 (2) ◽

pp. 120-127 ◽

Cited By ~ 3

Author(s):

V Keough ◽

J Jennrich ◽

K Holm ◽

W Marshall

Keyword(s):

Critical Care ◽

Acute Care ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

Practice Nurse ◽

Tertiary Care ◽

Standards Of Care ◽

Advanced Practice ◽

Advanced Practice Nurse ◽

Care Nurse

The students and faculty enrolled in the first TNP class have set a standard for future TNPs: a rigorous course of education with advanced practice and scholarship within an advanced practice collaborative model. Because of the increasingly number of trauma victims and the highly specialized care they require, nurses must come forward and provide quality care. The TNPs and their faculty must promote further recognition of the TNP role, become leaders in the field of acute care, and continue to develop and maintain collaborative relationship with physicians in support of advanced practice nursing in many areas of tertiary care. The first three graduates of the trauma/critical care practitioner class are now employed in advanced practice roles and are applying their education within trauma/critical care settings. Two of the students are trauma nurse practitioners in a community hospital, and one is a critical care nurse practitioner in a university hospital. Currently, there is an acute care nurse practitioner certification examination that is appropriate for nurses in the field of trauma/critical care. Co-sponsored by the AACN Certification Corporation and the American Nurses Credentialing Center, this examination is offered twice a year, in June and October. AACN is active in supporting and promoting the TNP role and, in conjunction with the American Nurses Association, has developed new standards of care and scope of practice to include this expanded role for the advanced practice nurse. The future for this exciting and demanding role looks bright for the advanced practice nurse interested in the care of the acutely ill patient. The time is right for this collaboration between nurses and physicians.

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