英国icu护士培训指南

RCNCriticalCareForumCriticalCareForum
NewsandIssuesGuidancefornursestaffingincriticalcareABSTRACTEverypatient,nurseandcarefacilityisdifferent.Soprovidingtherightnursingcareforcriticallyillpatientsisnotsimplyamatterofapplyingstandardnurse-to-patientratios.Theskillofthenurse,thecomplexityofthepatient’sneedsandthephysicalenvironmentofcarewillallinfluencenursingrequirements.Unitandwardmanagersneedtorecogniseallthevariablesbeforetheydecideonappropriatestaffing.Thebestpeopletodecideonnursingstaffinglevelsareseniorcriticalcarenursesthemselves,whohavetheskillsandexperienceinassessingpatientneed.Aswellasmeasuringindividualpatientdependency,otheraspectsofnursingcaremustbetakenintoaccountindeterminingnursingrequirements—forexample,theskillmixofnursesandotherstaff,theneedsofpatients’relativesandfriends,thenumberofpatienttransferstakingnursesawayfromtheward,riskmanagementandpatientsafety.Managersofclinicalareasshouldworkcloselywiththeprovidersofpre-andpost-registrationeducation.Thiswillensurethecurrentandfutureworkforceiseducatedinresponsetotheneedsofthecriticalcareservice.Educationprovisionshouldincludeappropriatesupportandassessmentinclinicalareas,andlinklecturersandpracticeeducatorstofacilitatebettersupportfornursingstudents.Fornewstaffincriticalcare,we
ThisdocumentwaspublishedinFebruary2003bytheRCN(Publicationcode001976)andcanbeobtainedviaRCNDIRECTat—andnotwherethemainpurposeistoreducethelevelofskilledcareavailabletosavecosts.Registerednursesremainresponsiblefortheassessment,planningandevaluationofpatientcare.Theeffectiveuseofexperiencedcriticalcarenursescangreatlyimprovepatientcare,andreducetheincidenceofcomplicationsforpatients.Theirobservationalskillscanreducetheimpactofsuddenpatientdecline,forexample,andtheirholisticapproachtocarecanchangetheexperienceofcareforbothpatientsandtheirfamilies.INTRODUCTIONInFebruaryofthisyear,DrBeverleyMalone,RCNGeneralSecretary,attendedthelaunchoftheCriticalCareForum’sGuidanceforNursingStaffinginCriticalCaredocument.Theaimofthepublicationistoexplorethefactorsthataffectstaffingincriticalcareandtohighlightthelimitationsthatcanbeperceivedacrosstheworkforceatfixednurse-to-patientratios.Thedocumentemphasisesthatstaffingestablishmentsshouldbebasedupontheneedsofthepatient.ThedocumentcanbeIntensiveandCriticalCareNursing(2003)19,257–266257doi:10.1016/S0964-3397(03)00077-6RCNCriticalCareForumIntensiveandCriticalCareNursingobtainedfromRCNDirect08457726100(publicationcode:001976)orthroughfinednurse-to-patientratiosshouldbereplacedbyamoreflexiblesystem.ThiswasechoedinTheNursingContributiontotheProvisionofComprehensiveCriticalCareforAdults:AStrategicProgrammeofAction(DepartmentofHealth2001)andbytheScottishExecutiveHealthDepartment’spublicationBetterCriticalCare(2000).Thesedocumentsaimforalevelofstaffingandskillmixthatisdeterminedbypatientneedandlevelofdependencytoensurethatpatients’needsaremet.Therefore,effectiveworkforceplanningisessential.Criticallyillpatientsarenursedinavarietyoflocations.ComprehensiveCriticalCaredefinedlevelsofcare(Levels0,1,2,3)thatapatientrequiresratherthandefiningthefacilityinwhichthepatient’sneedsaremet.Wherethepatient’sneedsarebestmet,encompassesavarietyoflocations,suchaswards,highdependencyunitsandintensivecareunits(seeAppendixA).Theselevelsofpatientneedsaredefinedintermsoftheseverityandcomplexityoftheircriticalillnesses.LevelsaresimilarlydefinedinScotland.Inthisguidance,wedefineacriticalcarenurseasaregisterednursewhohastherightknowledge,skillsandcompetenciestomeettheneedsofacriticallyillpatientwithoutdirectsupervision.Theknowledge,skillsandcompetenciestheyrequiretonursecriticallyillpatientsshouldreflectthelevelofpatientneed,ratherthanbeingdeterminedbythepatientcareenvironment(forexample,ahighdependencyorintensivecareunit).Thisdefinitionrecognisesthatnursesworkinginotherareas,suchasmedicalandsurgicalwards,whohaveregularresponsibilityforLevel1patientswillneedtheappropriateknowledge,skillsandcompetenciestocareforthosepatients.Eachcriticalcarelocationisuniqueinitsfunctions,structureandorganisation—andeachstaffmemberhasdifferentskillsandlevelsofexperience.Whenassessingstaffingrequirementsforacriticalcarearea,orforanindividualpatient,thefollowingfactorsshouldbetakenintoaccount:•workloadandskillrequiredtomeetpatientneeds(includingpatientdependency);•theroleofcriticalcarenurses;•staffinglevelsandskillmixofthemulti-professionalteam;•contributionofhealthcareassistants;•pr