We, as nurses, need to take the time to renew and revisit what makes us happy'

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We, as nurses, need to take the time to renew and
revisit what makes us happy.
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Integration and Inclusion of Progressive Care
Into Mainstream AACN

• Juan (Ray) Quintero, RN, MSN, CCRN
• Critical Care Services Manager
• Sentara CarePlex Hospital

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Whenever we Serve,It should bring a smile!
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Presentation Objectives

• Define critical care delivery on a continuum of
  care.
• Discuss opportunities that we face within this
  new critical care environment.
• Identify three major areas where there are
  limited information on Progressive Care

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Presentation Objectives

• List three initiatives that AACN is presently
  involved to support Progressive Care
• Describe four methods and ways which AACN
  chapters support Progressive Care, PC nurses and
  the AACN PC initiatives

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Bold Voices Fearless and EssentialLets start
taking risks!!!!
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Progressive CareTask Force Purpose

• In 2000, AACN called a task force to analyze and
  propose a plan of action to gain understanding
  regarding Progressive Care.

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Actions taken at the National Level

• AACN takes the CHALLENGE of addressing
  Progressive Care
• AACN constructs the National Task on Progressive
  Care
• In 2000, the 1st Task Force meeting takes place
  in San Antonio, Tx

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Progressive CareAACNs Position

• AACN recognizes the emergence of progressive
  care and has established a task force to discuss
  the impact of this expanding component of patient
  care. The task force quickly determined that
  progressive care is still evolving.
• Mary O. Palazzo, RN,
  MS, CCRN

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The Impetus for Change!

• Multiple economic, workforce, and health care
  reform issues have pressed the health care
  industry to meet such demand with innovative care
  management strategies. One creative,
  cost-effective approach thats emerged and
  continues to develop is the progressive care
  unit.
• Ray Quintero, RN, MSN,
  CCRN

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Progressive Care How did we get here?

• The traditional four walls of the critical care
  unit has fallen
• The vision of healthcare must be driven by the
  patient and family needs
• Healthcare is going upstream

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Progressive CareHow did we get here?

• Hospitals are shrinking and even disappearing.
• The future is here!
• Great expansion of progressive care units occur
• The expansion of critical care is here.
• Joe Flowers

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Progressive CareTask Force Goals

• Evaluation of AACNs programs, products and
  services to raise awareness which clearly defined
  PC as part of the Continuum of Critical Care
• Propose the development and distribution methods
  for nursing resources to specifically target
  education for PC units and nurses

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Progressive CareTask Force Goals

• Identify areas of key integration of shared needs
  of PC nurses and other initiatives in the
  association
• Discuss descriptors which identify progressive
  care
• List core competencies

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Progressive Care Definition

• Care delivered to patients whose needs fall
  within the continuum of critical care
• Generally at the less acute end of the continuum
• Care is supported by lower nurse to patient
  ratios based on acuity

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Progressive Care Definition

• Care provided to progressive care patients is not
  bound by geographic location
• It is based on the care and interventional needs
  of the patient
• Patients require the same standard of care as
  those requiring critical care

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Progressive Care Definition

• The care is reflective of the unique needs of
  these patients
• Patients transfer from critical care to
  progressive care when the degree of vigilance
  changes
• Vigilance changes from continuous to intermittent

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Progressive Care Patients Experience

• A decreased risk of a life-threatening event
• A decreased need for invasive monitoring
• Increased stability in their condition
• An increased ability to participate in their care

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Progressive CareStandards of Care

• The Standards for Acute and Critical Care
  Nursing Practice describe the practice of the
  nurse who cares for an acutely or critically ill
  patient no matter where that patient is cared for
  within the healthcare environment.
• AACN Standards for Acute and Critical Care
  Nursing Practice

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Progressive CareEducation and Training

• We need to ensure staff education and
  competency. Providing care for higher-acuity
  patients often necessitates enhanced education
  requirements for the staff in progressive care.
• Wendy J. Berke, RN,
  BSN, MHA
• Margaret M. Ecklund, RN, MS, CCRN, APRN-BC

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Progressive Care Core Competencies

• Basic Life Support
• Advanced Cardiac Life Support
• Advanced physical and psychosocial assessment
• Basic Dysrhythmia monitoring interpretation and
  treatment

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Progressive CareCore Competencies

• Medication Administration
• Calculate dosages
• Administer continuous medication infusions
• Monitor patient effects to infusions
• Not limited to vasoactive agents, platelet
  inhibitors, insulin and anti-arrhythmic agents

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Progressive CareCore Competencies

• Preassessment and Monitoring
• Use of Standardized protocols for pre, intra,
  post procedural care
• Cardioversion, TEE, Cardiac Cath, bronch, EGD,
  PEG placement, Chest Tube insertion

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Progressive CareCore Competencies

• Hemodynamic Monitoring
• Troubleshoot hemodynamic monitoring to assess
  patient status
• Recognize signs and symptoms of hemodynamic
  instability

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Progressive CareCore Competencies

• Emergency Management
• Recognize signs and symptoms of clinical
  emergencies
• Initiate standardized interventions
• Stabilize patient while awaiting transfer to
  critical care

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Progressive Care Core Competences

• Respiratory Management
• Interpret ABGs and report findings
• Manage patients requiring non-invasive O2
  delivery systems
• Oral airways, bipap, nasal CPAP
• Assess ventilator for correct delivery of
  prescribed treatment
• Liberate patient from Mech. ventilation

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Progressive CareCore Competencies

• Indications and complications of enteral and
  parenteral nutrition
• Monitor/manage patients requiring renal
  therapeutic interventions
• Hemodialysis, Peritoneal Dialysis, Stents,
  Continuous bladder irrigation and Urostomies

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Progressive CareHow is staffing determined?

• POINT STAFFING STANDARDS PROPOSED
  CALIFORNIA FIRST TO MANDATE RATIOS
• The important link between nurse staffing and
  positive patient outcomes is becoming clearly
  delineated in nursing and medical literature.
• AACN NEWS March 2002

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Progressive CareNational Initiatives

• The task force published eight articles on PC and
  has a QA on care of PC patients in each of the
  AACN News.
• The Nursing Management Journal worked with AACN
  and published six articles addressing key aspects
  of PC and critical care management of those
  units.

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Progressive Care National Initiatives

• These articles will be also published in Critical
  Care Nurse.
• The 2002 NTI activities of the PC roundtable
• The sunrise session was a great success.

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Progressive CareNational Initiatives

• Key educational resources were developed by the
  task force and are now available in the practice
  section of the AACN web site.
• The task force was invited to facilitate a
  discussion group regarding PC at the 2002
  Management Congress, in Dallas, TX
• A data bank of progressive care articles was
  developed

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Progressive CareNTI 2003

• Formulated a definition and core competencies
• Presented a creative solutions poster
• Presented a sunrise session
• This Presentation on the Integration of
  progressive care into mainstream AACN
• The possibility of certification in progressive
  care

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Progressive CareWho is responsible ?

• The individual chapters
• The leadership group of each chapter
• The members of each chapter

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Progressive CareChapter Involvement
The story of inclusion, recognition and
acceptance.
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Progressive CareChapter Involvement

• All chapter literature should include words which
  notate progressive care
• Critical Care Symposium
• Initially omitted from brochure
• The brochure included a specialty designation of
  progressive care

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Progressive CareChapter Involvement

• Use of the Newsletter
• Writing articles on progressive care
• THE FLOWSHEET
• Write a small article with each newsletter
• Extract from the many articles that AACN New and
  Nursing Management has published

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Greater Richmond Chapter NewsletterThe Flow
Sheet

• Articles
• The Wonderful World of Progressive Care
  Critical Care Nurse Supplement
• Critical Thinking on the Continuum of Care
  AACN News
• Stopping the Bottleneck Admission and
  Discharge Criteria Nursing Management Journal

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Progressive CareChapter Involvement

• The Use of the Website
• This is a powerful tool we should be using
• Placing the Chapter Newsletter on the website
• Articles on progressive care can be placed on the
  website

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Progressive CareChapter Involvement

• Speaking engagements
• Incorporate them in your monthly meetings
• Incorporate them in your conferences
• Submit abstracts to speak on progressive care
• Speak at local hospitals open house

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Progressive Care Chapter Involvement

• Rewards and Recognition
• GRAC Chapter has an annual Nursing Extravaganza
• Progressive Nurses are nominated
• Designated awards can be focused on progressive
  care
• Hospital and Units awards

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Progressive CareBold Voices in Numbers

• We speak about infusing new energy and blood into
  our chapters
• The more voices we have the more bold we can be
• Diversity of all kinds only strengthens the group
• Have a membership drive specific to progressive
  care nurses

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The Greater Richmond AACN Chapter2004 Theme

• New Directions
• Community Schools, organizations, etc
• Schools of Nursing
• All hospitals
• Alliances with other organizations
• Target Progressive Care Nurses

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Progressive CareChapter Involvement

• The Multitude of Chapters
• The Magnitude of Members
• The World of Creativity
• We certainly can think and do many more
  activities to integrate progressive care into
  AACN, local chapters, hospitals, and units.

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Progressive Care is Critical CareProgressive
Care Nurses are CC Nurses

There is enough room for all of us!
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Progressive CareCritical Care Nurses Mindset

• Critical Care Nurses are having a difficult
  time accepting progressive care as critical care
  and see themselves separate from progressive care
  nurses.
• Ray
  Quintero, RN

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The Mindset A Bold Challenge!

• Our CHALLENGE is to help them cross over this
  bridge through our national organization
  initiatives and local chapter work.

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AACN Progressive Care National Task Force Team

• Leann Ash, RN, BSN, CCRN
• Melissa Fitzpatrick, RN, MSN
• Susan Helms, RN, MSN, CCRN
• Maddie Burke, RN, BSN, CCRN
• Diane Salipante, RN,CS,MS
• Terry Palazzo, RN, MS, CCRN
• Ray Quintero, RN, MSN, CCRN
• Katie Schatz, RN, MSN

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Bridging the Gap BetweenCritical Care and
Progressive Care