Keperawatan Kritis

Capaian Pembelajaran
• Mahasiswa mampu menerapkan filosofi, konsep
holistik, dan proses keperawatan kritis
• Bahan kajian :
• Konsep keperawatan kritis
• Peran & fungsi perawat keperawatan kritis
• Proses keperawatan pada area keperawatan kritis
• Efek kondisi kritis pada pasien dan keluarga
• Isu end of life keperawatan kritis
• Aspek psikososial keperawatan kritis
 Konsep Keperawatan Kritis
• Pengertian Keperawatan Kritis
• Acute and critical care nursing as the specialty that
manages human responses to actual or potential life-
threatening problems (AACN, 2015).
• Critical care nursing is aspecialty which exists to care
for patients who are experiencing life-threatening
health crises within a patient/family centred model
of care ( CACN, 2009).
• Critical care service meet the needs of patients facing
immediate life-threatening health condition
specifically, that in which vital system organs are at
risk of falling (CCSO, 2012)
 KONSEP KEPERAWATAN KRITIS
• Keperawatan kritis adalah keahlian khusus di dalam
ilmu perawatan yang dihadapkan secara rinci dengan
manusia (pasien) dan bertanggung jawab atas
masalah yang mengancam jiwa.
• Perawat kritis adalah perawat profesional yang resmi
yang bertanggung jawab untuk memastikan pasien
dengan sakit kritis dan keluarga pasien mendapatkan
kepedulian optimal (AACN, 2006)
 Pelayanan Kritis
• Pelayanan pasien kondisi kritis diperlukan pada pasien dengan kegagalan
organ yang terjadi akibat komplikasi akut penyakitnya atau akibat sekuele
dari regimen terapi yang diberikan (Permenkes Nomor :
519/MENKES/PER/III/2011).
 Role & Responsibilities of CCN
• Nursing in the ICU is unique as the nurses are
expected to initiate and control the care given to
their patients.
• It also has collaborative elements in that the patients
themselves and their family members are involved
and will participate in the care given.
 Role of Critical Care Nurse
• The following are the roles of critical care nurses in fulfilling
goals of care in the ICU:
• Nurses play an essential role in facilitating communication
between critically ill patients and their families.
• Nurses must be proficient in communication skills in
addition to clinical skills.
• Nurses can use evidence-based knowledge related to
disease processes and prognosis to advocate effectively for
patients and families.
• Nurses have an essential role as team members in
establishing the goals of care in the ICU.
 Role of Critical Care Nurse
• Critical care nursing is aspecialty which exists to
care for patients who are experiencing life-
threatening health crises within a patient/family
centred model of care ( CACN, 2009)
• Nursing the critically ill patient is continuous and
intensive, aided by technology.
• Critical care nurses require advanced problem-
solving abilities using specialized knowledge
regarding the human response to critical illness.
 Scope
• The scope of practice for nursing care of
acutely and critically ill patients of all ages
encompasses the dynamic interaction of the
patient and his or her family, the nurse, and
the environment where care is being provided
with a goal of ensuring optimal patient
outcomes.
 Standar (CACCN)
• Critical care nurses use advanced skills and specialized
knowledge to continuously assess, monitor and manage
patients for the promotion of optimal physiological balance
• Critical care nurses promote and facilitate optimal comfort
and well-being in highly technological environment that is
often unfamiliar to patients and families
• Critical care nurses foster mutually beneficial partnerships
with patients and families based on trust, dignity, respect,
communication and collaboration. Family is defined by the
patient.
• When providing care in a high risk environment, critical care
nurses participate in safety initiatives and adhere to best
practice
 Standar (CACCN)
• When life sustaining technologies are no longer beneficial,
critical care nurses support patients and families through the
transition from active treatment to a peaceful death.
• The critical care nurse promote collaborative practice in
which the contribution of the patient, family and each
health care provider is solicited, acknowledged and valued in
a non-hierarchical manner
• Critical care nurse provide leadership by fostering a critical
care culture conductive to collaboration, quality
improvement, safety, professional growth and responsible
resource utilization
 Standar
• The Standards for Critical Care Nursing in Ontario
• Professional Behaviour/Ethics
• Continuing Competence and Research
• Client and Nurse Safety/Risk Prevention
• Therapeutic and Professional Relationships/Caring
• Clinical Skills, Knowledge, Integration and Critical
Thinking
Proses Keperawatan
 Pengkajian
• Prearrival and admissionquick check assessment
• Comprehensive admission assessment requirement
• Suggest questions for review of past history category by body system
• Ongoing assessment
• Identification of symptom characteristics
• Chest pain assessment
• Pain assessment tools commonly used in critical ill patients
• Glasgow coma scale
• Sensory dermatoms
• Edema rating scale
• Peripheral pulse rating scale
• Physiologic effects of aging
 Abstract
• Aims
To describe the nursing diagnoses, outcomes and interventions for patients admitted to intensive care units and to assess
their possible relation with classical outcomes like length of stay and mortality.
• Background
The analysis of nursing diagnosis frequencies may help to estimate the patients’ complexity and the need for nursing
interventions and can predict hospital outcomes. Nonetheless, few studies were conducted on critical patients.
• Design
Prospective cohort observational study.
• Methods
Between 15 July–31 October 2013 we collected the above‐described nursing parameters of 100 subjects throughout their
stay in intensive care. We classified the parameters according to established taxonomies. The independent association
between the number of nursing diagnoses and length of stay/mortality was investigated with multiple regressions.
• Results
We found an average of 19 diagnoses, 24 outcomes and 60 interventions per patient. Most frequently, the plans of care
involved support for self‐care deficits or interrupted family processes. They also included strategies to prevent infection,
disuse syndrome and impairment of skin integrity. Nineteen nursing diagnoses were significantly related with mortality or
length of stay in bivariate analyses. In regression models, the number of such diagnoses explained 29·7% of the variance in
length of stay and was an independent predictor of mortality.
• Conclusion
In critically ill patients, the analysis of nursing diagnoses, outcomes and interventions confirmed an intense activity in
response to a broad spectrum of patient needs. The number of nursing diagnoses allowed to predict patient outcomes.
Physiological Assessment
Environment Assessment
Emotional Assessment
 Aspek Psikososial
• Common psychologic stressors for critically ill
patients and their families :
(a) Powerlessness (lack of control)
(b) Sleep deprivation
(c) Grief and loss
(d) Sensory overload or deprivation
(e) Pain
 Psikososial
• Experiencing illnesses which require intensive care :
• frightening
• stressful experience for patients.
• highly technological invasive and non-invasive
procedures
• unfamiliar environment
• totally dependent on nurses to care for them
Feeling involved in an emotional assessment of patient in the ICU
 Critical Care : the future
• Critical care: the future
• In 2010 Halpern and Pastores published a review of the
evolution in critical care medicine in the United States
between 2000 and 2005. During this time period there was a
4% decrease in the total number of hospital beds, but the
number of ICU beds increased by 7%.
• Hospital non-ICU inpatient days increased by 5%, but ICU
inpatient days increased by 10%. Annual critical care medicine
costs increased by 44%, but the proportion of hospital costs
and national health expenditures allocated to critical care
medicine decreased by 1.6% and 1.8%, respectively, over this
time period.
End-of Life