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HEALTHCARE CAREER GUIDES

Critical Care Nurse Career

What is a critical care nurse.

If you’ve ever been seriously ill or visited someone in the hospital who was, you’ve likely encountered a critical care nurse. Often called ICU nurses because of the unit they commonly work in, critical care nurses are highly trained to understand and provide care for people of all ages who are recovering from life-threatening illnesses or injuries. 

Today, there are more than  half a million  critical care nurses working in the United States. But despite that number, critical care careers continues to be in high demand thanks to the recent registered nursing shortage.

If you’re thinking about getting into critical care nursing, you should know it’s both a demanding career and a rewarding one. From a patient’s first assessment to end-of-life care, you’ll be a vital part of lifesaving treatments and actions. You’re also caring for people who are at their very worst, physically. For this reason, it takes a special kind of nurse to work in critical care units.

RESPONSIBILITIES

What Does A Critical Care Nurse Do?

Critical care nursing involves working with doctors and specialists to assess, treat, and monitor critically ill patients while also providing their basic care.

A typical shift as an ICU nurse can include things like assessing a patient’s condition and starting treatment, taking vital signs, communicating with patients and their families, setting up IVs, and administering medication. Many times, patients in the ICU are ventilated or have multiple IV drips. For this reason, registered nurses in critical care unites (also known as intensive care units or ICUs) need more knowledge of equipment and charting than other registered nurses.

• Assessing and treating patients. It’s fairly common that a patient sees a nurse in the ICU before a doctor, so ICU nurses will be expected to assess a patient’s condition and start treatment. This could include everything from taking vital signs to dressing wounds. They'll also be in charge of monitoring a patient’s progress and reporting back to the physician. 
• Ordering diagnostic tests. Many of the critical care patients you will see on a day-to-day basis will be suffering from some kind of injury or illness, which means they’ll need diagnostic testing. It’s often up to the critical care nurse to send orders for x-rays, EKGs, or CT scans and then go over those results with the doctor to decide on a treatment plan. 
• Acting as a patient advocate. When critical care patients are physically at their worst, the nurse's role is to be there to provide support, education, and empathy. This is done in several different ways—from helping patients make informed decisions about their health, to translating complex medical terms, to acting as a liaison between patients and their doctor.  
• Monitoring medical equipment. Many critical care patients will be set up on cardiac monitors or ventilators, so their nurse will be the one in charge of setting up those machines and regularly monitoring and tracking a patient’s progress. 

EDUCATION & BEST DEGREES

How to become a critical care nurse.

Step One: Become a registered nurse.

The first step in becoming a critical care nurse is completing a  bachelor’s degree  in nursing. Most programs take four years for full-time students to complete. However, students who’ve already completed an associate nursing degree can apply to RN-to-BSN programs that let working nurses earn bachelor’s degrees in less time.

Step Two: Earn your critical care nursing licensure.  

After earning your degree, you’ll be required to pass the NCLEX-RN exam and meet your other  state’s other requirements  to be eligible for nursing licensure. This exam is a computer-generated test that’s offered by the American Association of Critical Care Nurses (AACN). The NCLEX-RN is divided up into four categories and six subcategories that cover the foundations of nursing practice and measure nursing competency.

Step Three: Get certified as a critical care nurse.

Nurses who want to establish their knowledge for nursing critically ill or injured patients should obtain the CCRN certification from the AACN. To be eligible for this exam, you’ll need to meet one of the following:

Practice as an RN or APRN (advanced practice registered nurse) for 1,750 hours in direct care of acutely or critically ill patients during the past two years. 875 of these hours must be accrued in the year preceding application.

Practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct care of acutely or critically ill patients. 144 of these hours must be accrued in the year preceding application.

Step Four: Explore additional certifications and education.

After working as a critical care nurse, you might decide to pursue a  master’s degree  or post-master's certificate in nursing. Or you may choose to earn specialty certifications depending on what type of patients you enjoy working with most. 

These additional certifications could include: 

CMC: providing care to critically ill cardiac patients

CSC: providing care to critically ill cardiac surgery patients

ACNPC-AG: providing care for very sick geriatric patients

Best Degrees for a Critical Care Nurse

Nursing (Prelicensure) – B.S.

A one-of-a-kind nursing program that prepares you to be an RN and a...

A one-of-a-kind nursing program that prepares you to be an RN and a baccalaureate-prepared nurse:

• Locations:  Due to in-person clinical requirements, students must be full time residents of Arkansas, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin to enroll in this program. The coursework in this program is offered online, but there are in-person requirements.
• Tuition:  $8,755 per 6-month term for the first 4 terms of pre-nursing coursework and $8,755 per 6-month term for the remaining 4 terms of clinical nursing coursework.
• Time:  This program has a set pace and an expected completion time of 4 years. Certain coursework may be accelerated to finish faster.
• WGU offers the prelicensure program in areas where we have partnerships with healthcare employers to provide practice sites and clinical coaches to help teach you and inspire you on your path to becoming a nurse.
• If you don't live in one of our prelicensure states or don't qualify to apply, consider getting our  Bachelor's in Health and Human Services  instead. This degree allows you to work inside the healthcare industry, while also working directly with patients who need help.

Skills for your résumé that you will learn in this program:

• Community Health
• Women's and Children's Nursing

Nursing – Leadership & Management (BSN-to-MSN) – M.S.

For registered nurses with a bachelor's degree who are ready for...

For registered nurses with a bachelor's degree who are ready for additional career opportunities.

• Time:  61% of grads finish within 23 months
• Tuition: $5,035 per 6-month term
• Courses : 15 total courses in this program

This program is ideal for current RNs who have a BSN and are ready for the next step in their education.

Skills for your résumé you will learn in this program:

• Quality Outcomes in a Culture of Value-Based Nursing Care
• Nursing Leadership and Management
• Advanced Pathopharmacological Foundations
• Informatics for Transforming Nursing Care

Compare degrees

This program is not the only degree WGU offers designed to create leaders in the field of healthcare. Compare our health leadership degrees.

Nursing (RN-to-BSN Online) – B.S.

An online BSN degree program for registered nurses (RNs) seeking the added...

An online BSN degree program for registered nurses (RNs) seeking the added theoretical depth, employability, and respect that a bachelor's degree brings:

• Time:  The program is designed to be completed in 1 year.
• Tuition:  $5,325 per 6-month term.
• Courses : 23 total courses in this program.
• Transfers: Students can transfer up to 90 credits.
• Healthcare Policy and Economics
• Information Technology in Nursing Practice
• Anatomy and Physiology
• Applied Healthcare Statistics

If you don't currently have an RN and don't qualify for your nursing prelicensure program, consider getting our Bachelor's in Health and Human Services  instead. This degree allows you to work inside the healthcare industry in a unique way.

Nursing Leadership and Management – Post-Master's Certificate

A certificate for registered nurses with a master's degree in nursing who...

A certificate for registered nurses with a master's degree in nursing who are ready for greater responsibility in a leadership and management role.

• Time:  Students typically finish this program in 12 months.
• Tuition:  $5,035 per 6-month term. The cost to sit for the NAHQ Certified Professional in Healthcare Quality (CPHQ) exam is included in tuition.
• Courses : 8 total courses in this program.
• Strategic Planning
• Resource Management
• Business Case Analysis
• Evaluating Healthcare Improvements

Nursing – Leadership & Management (RN-to-MSN) – M.S.

This program for RNs includes a BSN component and is a substantial leap...

This program for RNs includes a BSN component and is a substantial leap toward becoming a nurse leader.

• Time: 62% of RN-to-MSN grads finish within 37 months.
• Tuition:  $5,325 per 6-month term during undergraduate portion and $5,035 per 6-month term during graduate portion.
• Courses : 32 total courses in this program.

If you're driven to lead, this online nursing degree will provide you everything needed to make that career a reality. This program is ideal for current RNs who are interested in earning both their BSn and MSN in an accelerated program.

How Much Does a Critical Care Nurse Make?

Critical care nurses are often paid higher than other nurses because of their specialized training. The U.S. Bureau of Labor Statistics (BLS) reports that the median average salary for RNs was  $81,220  in 2022.

What Is the Projected Job Growth?

The BLS also predicts the demand for RNs, which includes critical care nurses, is expected to  grow by 6%  from 2022 to 2032, faster than the average for all occupations. This growth is fueled by increasing rates of chronic conditions such as diabetes and obesity, the aging population, and an increase in emerging diseases like COVID-19.

What Skills Does a Critical Care Nurse Need?

Being a nurse in an intensive care unit is a demanding position—both physically and mentally. The physical demands might include working on your feet for long shifts, transporting patients by pushing or pulling wheelchairs, and lifting patients as needed. You’ll also be constantly monitoring highly unstable and at-risk patients, so strong analytical skills and the ability to make quick decisions under pressure is a must. 

To be successful working in critical care you’ll need a mix of clinical and non-clinical skills. Some of these include:

• Understanding medical technology and equipment 
• Strong knowledge of anatomy and physiology 
• The ability to create and implement patient care plans
• Understanding how to use various medical devices, such as catheters and feeding tubes
• In-depth knowledge of medications, including side effects and dosing calculations
• Operating life support systems
• Understanding patient safety and privacy rules and regulations 
• Good communication skills and the ability to work well in a team environment 
• Strong organizational skills and the ability to prioritize 
• Comfortably handling end-of-life situations

Our Online University Degree Programs Start on the First of Every Month, All Year Long

No need to wait for spring or fall semester. It's back-to-school time at WGU year-round. Get started by talking to an Enrollment Counselor today, and you'll be on your way to realizing your dream of a bachelor's or master's degree—sooner than you might think!

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Interested in Becoming a Critical Care Nurse?

Learn more about degree programs that can prepare you for this meaningful career.

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‘The challenges facing nurse education must be tackled’

STEVE FORD, EDITOR

• You are here: Emergency And Critical Care

Essential critical care skills 1: what is critical care nursing?

18 October, 2021

Critical care nurses provide highly skilled, expert care for the most severely ill or injured patients. This introduction - part one of a six-part series – provides an overview of their role

In this first article of a six-part series on critical care nursing, we introduce the role and what it involves, as well as looking at how critical care nurses can support the whole patient, from a physical and psychosocial perspective. The importance of rehabilitation, assessment of risk of ongoing morbidity and delirium are also discussed. Part 2 describes the assessment of the critically ill patient.

Citation: Credland N et al (2021) Essential critical care skills 1: what is critical care nursing? Nursing Times [online]; 117: 11, 18-21.

Authors: Nicki Credland is reader in critical care, University of Hull; Louise Stayt is senior lecturer, Oxford Brookes University; Catherine Plowright is professional adviser, British Association of Critical Care Nurses; David Waters is associate professor, Birmingham City University.

• This article has been double-blind peer reviewed
• Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)
• Click here to see other articles in this series

Introduction

Critical care nurses provide expert, specialist care to the most severely ill or injured patients in intensive care units and the wider hospital. They are highly trained and skilled safety-critical professionals working as part of a multidisciplinary team. Critical care is classified using four levels of patient acuity, as outlined in Table 1. Updated guidelines for the provision of intensive care services (Faculty of Intensive Care Medicine, 2019) recommend that level-3 patients should have a minimum registered nurse–patient ratio of 1:1 and level-2 patients must have a minimum nurse–patient ratio of 1:2.

To deliver highly skilled care, critical care nurses undertake postgraduate study and ongoing training. The Step Competency Framework underpins critical care nurse education; it recognises that, to be able to deliver high-quality care to patients, staff need the knowledge and skills so they can work at the highest level, with standardisation across all critical care units. Step 1 for adult critical care begins when a nurse with no previous experience of the specialty starts working in intensive care medicine. Steps 2 and 3 should be incorporated into academic intensive care programmes.

Critical care nurses also lead many outreach teams that identify, monitor and initiate timely treatment to prevent clinical deterioration, and support ward nurses (Department of Health, 2000). They offer advanced system assessment and rescue before irretrievable deterioration and cardiac arrest takes place.

This article is the first in a six-part series on essential critical care skills, which aims to explore essential critical care nursing competencies.

Managing organ dysfunction

Admission to a critical care unit is usually because of organ dysfunction or organ failure. Respiratory failure alone leads to around 100,000 annual admissions to critical care in the UK (FICM, 2019). The goal is to correct or provide support to these dysfunctional organs. Technological and medical advances over the past few decades have meant significant growth in treatments and interventions, and more-effective management of patients who need organ support.

The interventions most commonly used include mechanical ventilators, infusion devices and renal replacement therapy. Table 2 outlines the interventions used for different physiological systems.

Patient monitoring and documentation

It is crucial to gather accurate data on physiological parameters – such as oxygen saturation (SpO2), heart rate and fluid balance – at the bedside of the patient who is critically ill. Typically, each patient will have their own monitor that will display a range of clinical factors (Box 1) and provide real-time feedback to help evaluate critical care interventions, and detect any deterioration or emergency situations promptly.

Box 1. Clinical factors recorded by bedside monitors

• Heart rhythm
• Oxygen saturation
• Respiratory rate
• Exhaled carbon dioxide concentration/partial pressure
• Non-invasive blood pressure
• Arterial blood pressure
• Central venous pressure
• Temperature

Critical care nurses need technical skill and knowledge to effectively use and interpret bedside monitors. A further common technical resource is the clinical information system (CIS), which can record and process large amounts of data, such as:

• Patient physiological observations;
• Care or interventions delivered;
• Medication plans.

The FICM (2019) highlights how a CIS can not only improve efficiency, but also reduce errors and improve compliance with standards or guidelines.

Psychosocial care

Holistic patient-centred care – as outlined by Jasemi et al (2017) – is vital in critical care, with effective psychosocial care, and cultural, spiritual and family care being of particular significance. Immediately on admission to a critical care setting, patients are subjected to an onslaught of physical and psychosocial stressors including:

• Physical pain;
• An unfamiliar environment; equipment and treatments;
• Sensory disturbances;
• Isolation from family;
• Loss of autonomy;
• Impaired communication;
• Fear for their life (Kiekkas et al, 2010).

It can lead to severe emotional distress and the development of delirium, anxiety, depression and post-traumatic stress disorder (PTSD) (Hatch et al, 2018) – all of which may persist long after the patient’s physical recovery and discharge from hospital (Ewens et al, 2018).

Psychosocial care is often considered the touchstone to person-centred care and, in this setting, refers to supportive interventions that may mitigate the stressors associated with critical illness. Evidence-based measures that may all help include:

• Providing information and explanations;
• Regularly orientating the patient to date, time and place;
• Reassurance;
• Empathetic touch;
• Early mobilisation;
• Family visits;
• Maintaining clear night and day routines;
• Minimising noise (Bani Younis et al, 2021; Alaparthi et al, 2020; Parsons and Walters, 2019).

Delirium is of particular concern in patients who are critically ill, and has an incidence range of 45-87% (Cavallazzi et al, 2012). It is characterised by the acute onset of cerebral dysfunction, with a change or fluctuation in baseline mental status, inattention, disorganised thinking or an altered level of consciousness (NICE, 2019). Delirium is associated with significant increases in mortality, morbidity and hospital stay, as well as having long-term ramifications such as cognitive impairment, PTSD, anxiety and depression (Cavallazzi et al, 2012) so the prevention, early recognition and effective management of it is of paramount importance. The ABCDEF bundle of care may help:

• A ssessment, prevention and management of pain;
• Awakening the patient and doing a spontaneous B reathing trial;
• C hoice of sedation and analgesia;
• Assessment, prevention and management of D elirium;
• E arly mobilisation;
• F amily engagement (Marra et al, 2017) .

Cultural and spiritual care

A patient’s cultural and spiritual background influences many aspects of nursing in critical care, such as patient and family roles, communication, nutrition, values and beliefs towards health, care and treatments, and end-of-life care. Careful assessment of the patients’ health beliefs, communication needs, social networks and family dynamics, dietary requirements, religious practices and values, is essential to plan and deliver culturally sensitive and spiritual care that contributes to the quality of life, care and satisfaction of patients as well as their families (Willemse et al, 2020).

Family care

Family members of patients who are critically ill can play an important part – often acting as surrogate decision makers – and be essential in providing emotional and social support. However, relatives may experience extreme stress, fear and anxiety, both during and after the patient’s admission. Relatives are also vulnerable to ongoing psychological illnesses such as PTSD, anxiety and depression (Johnson et al, 2019). Nurses need to develop a collaborative relationship with them to effectively identify and address their immediate needs, as well as prepare them to cope with their loved one’s discharge and ongoing rehabilitation. Families need honest and timely information, assurance, proximity, comfort and support (Scott et al, 2019).

Rehabilitation

Critical illness can cause significant long-term physical and non-physical problems for patients, and rehabilitation is important to improve recovery. National guidelines, such as those by the FICM (2019) and the National Institute for Health and Care Excellence (2017), have supported this, with the aim of improving these patients’ physical, psychological and cognitive outcomes.

Patients should be assessed at the following key stages:

• Within four days of admission to a critical care unit, or earlier if being discharged;
• Just before discharge to ward-based care;
• When receiving ward-based care;
• Before discharge to their home or community care;
• Two to three months after discharge from the critical care unit.

Rehabilitation should be patient centred, involve the whole multidisciplinary team and occur throughout the patient pathway, with plans updated as the patient’s condition changes (FICM, 2019). Physiotherapists, occupational therapists, dieticians, speech and language therapists, critical care nurses and doctors, as well as patients and their families, all have a role.

Short clinical assessments should be done with all patients in critical care to identify their risk of physical and non- physical morbidity. A short clinical assessment is applicable for patients who are expected to recover quickly, despite requiring initial level-3 care, and should assess a range of factors (Box 2). If the patient is deemed at risk, a comprehensive clinical assessment should be undertaken; this will also assess physical and non-physical risk (Box 3).

Box 2. Short clinical assessment

The following may indicate that the patient is at risk of physical/non-physical morbidity and needs further assessment:

• Unable to get out of bed independently
• Anticipated long duration of critical care stay
• Obvious significant physical or neurological injury
• Lack of cognitive functioning to continue exercise independently
• Unable to self-ventilate on 35% of oxygen or less
• Presence of pre-morbid respiratory or mobility problems
• Unable to mobilise independently over short distances

Non-physical

• Recurrent nightmares, particularly if the patient reports trying to stay awake to avoid them
• Intrusive memories of traumatic events that occurred before admission (for example, road traffic accidents) or during their critical care stay (for example, delusion experiences or flashbacks)
• New or recurrent anxiety or panic attacks
• Expressing a wish not to talk about their illness or changing the subject quickly

Box 3. Comprehensive clinical assessment

This assessment should be undertaken for all patients identified as being at risk of physical or non-physical morbidity.

Physical issues

• Breathlessness
• Tracheostomy
• Artificial airway
• Swallowing issues
• Poor nutritional state
• Minor assistance needed
• Major assistance needed
• Full assistance needed
• Visual changes
• Hearing changes
• Altered sensations
• Sedated/pain
• Difficulties in speech
• Changes in voice quality
• Difficulty writing
• Poor wound healing

Non-physical issues

• Palpitations, irritability or sweating
• Hallucinations, delusions
• Flashbacks, withdrawal, traumatic memories of critical care
• Loss of memory
• Attention deficit
• Sequencing problems
• Lack of organisational skills
• Disinhibition
• Low self-esteem
• Low self-image
• Relationship difficulties
• Difficulty sleeping

During the assessment of these patients, a range of tools may be used including the following:

• Hospital Anxiety and Depression Score (Zigmond and Snaith, 1983);
• Barthel Activities of Daily Living Index (Wade and Colin, 1988);
• Chelsea Critical Care Physical Assessment Tool (Corner et al, 2013).

Many critical care units provide follow-up services for patients after discharge, giving them access to a range of health professionals, including critical care nurses, to assess physical and non-physical recovery (NICE, 2017). If these are not available, patients can be directed to ICU Steps (www.icusteps.org), which can help to support patients and families affected by critical illness.

This article aims to provide an overview of critical care and the critical care nurse role. The following articles in this series will explore in more detail key issues relating to the management of patients who are critically ill.

• Critical care nursing is highly skilled, and requires postgraduate study and training
• Critical care nurses provide outreach to support ward nurses who are caring for patients at risk of deterioration
• Care of patients on critical care units often involves organ system support and close monitoring is needed
• A holistic view of the patient – which takes into account physical and psychosocial matters – is vital, as is supporting families

Also in this series

• Essential critical care skills 2: assessing the patient
• Essential critical care skills 3: arterial line care
• Essential critical care skills 4: airway assessment and management
• Essential critical care skills 5: management of fluid balance
• Essential critical care skills 6: arterial blood gas analysis

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What does a critical care nurse do?

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What is a Critical Care nurse?

A critical care nurse is a registered nurse who has received specialized training in the care of patients with life-threatening medical conditions. These nurses work in intensive care units (ICUs) and other critical care settings, where they provide care for patients who require constant monitoring and intervention. They are responsible for assessing patient needs, administering medications and treatments, monitoring vital signs, and providing emotional support to patients and their families.

Critical care nurses may work with a variety of patients, including those who have suffered from traumatic injuries, heart attacks, strokes, or other serious medical conditions. They work closely with other healthcare professionals, including doctors, respiratory therapists, and pharmacists, to provide the best possible care for their patients. In addition to providing direct patient care, critical care nurses also educate patients and their families about their conditions and help them to make informed decisions about their healthcare.

What does a Critical Care nurse do?

The expertise and attention to detail that critical care nurses have are essential in helping patients recover and return to a healthy state. Without critical care nurses, the quality of care for critically ill patients would suffer, and their chances of survival would decrease significantly.

Duties and Responsibilities The duties and responsibilities of critical care nurses may include:

• Patient assessment: Critical care nurses are responsible for assessing patients' conditions to identify any changes or deterioration in their condition. This includes monitoring vital signs such as blood pressure, heart rate, and respiratory rate. They must also evaluate laboratory and diagnostic test results to determine appropriate interventions.
• Medication administration: Critical care nurses are responsible for administering medications, including intravenous medications, and monitoring the patient's response to the treatment. They must also be knowledgeable about medication interactions and side effects to ensure patient safety.
• Ventilator management: Critical care nurses are responsible for managing patients who require mechanical ventilation. This includes assessing the patient's response to the ventilator, monitoring the ventilator settings, and making adjustments as needed.
• Communication with the healthcare team: Critical care nurses must communicate effectively with physicians, respiratory therapists, and other healthcare professionals to ensure that patients receive optimal care. This includes providing updates on the patient's condition and collaborating to develop a comprehensive treatment plan.
• Patient education: Critical care nurses must provide patient education, including explaining treatments and procedures, and helping patients and their families understand the patient's condition. This includes teaching patients and families about their medications, equipment, and other aspects of their care.
• Documentation: Critical care nurses must keep accurate records of patient care, including vital signs, medications, and treatments provided. This documentation is critical for ensuring that patients receive appropriate care and for communicating with other healthcare professionals.
• Support for families: Critical care nurses may provide emotional support to patients' families, including explaining the patient's condition and answering questions. They may also help families navigate the healthcare system and connect them with resources and support services.
• Infection prevention and control: Critical care nurses are responsible for implementing infection control measures to prevent the spread of infections in the critical care unit. This includes ensuring that patients and staff follow appropriate hand hygiene protocols, wearing personal protective equipment when necessary, and implementing isolation precautions as needed.
• Crisis management: Critical care nurses must be able to respond quickly to medical emergencies, including performing cardiopulmonary resuscitation (CPR) and other life-saving interventions. They must also be able to identify and respond to signs of patient distress and rapidly escalate care as needed.
• Collaborative care: Critical care nurses work closely with other healthcare professionals to provide coordinated care to patients. This includes developing and implementing treatment plans, coordinating care transitions, and communicating with other members of the healthcare team. They may also participate in multidisciplinary rounds to review patient progress and make care decisions.

Types of Critical Care Nurses There are several types of critical care nurses who specialize in different areas of critical care nursing. Here are some examples:

• Intensive Care Unit (ICU) Nurse: ICU nurses work in intensive care units and provide care to patients who are critically ill or injured. They may specialize in caring for patients with specific conditions, such as cardiac ICU nurses who care for patients with heart-related conditions, or neuro ICU nurses who care for patients with neurological conditions.
• Emergency Room (ER) Nurse : ER nurses work in emergency departments and provide care to patients who are experiencing a medical emergency or trauma. They must be able to respond quickly to emergencies and have knowledge of a wide range of medical conditions.
• Flight Nurse: Flight nurses provide care to critically ill or injured patients who require transportation by air. They may work in helicopters, fixed-wing aircraft, or air ambulances.
• Pediatric ICU Nurse: Pediatric ICU nurses specialize in providing care to critically ill or injured children. They may work in pediatric ICUs, neonatal ICUs, or pediatric emergency departments.
• Trauma Nurse: Trauma nurses specialize in caring for patients who have experienced severe trauma, such as from a car accident or gunshot wound. They work in trauma centers and emergency departments.
• Cardiac Catheterization Lab Nurse: Cardiac catheterization lab nurses specialize in providing care to patients undergoing cardiac catheterization procedures. They work in cardiac catheterization labs and must have a thorough understanding of cardiac anatomy and physiology.
• Perioperative Nurse: Perioperative nurses provide care to patients before, during, and after surgical procedures. They may work in operating rooms, preoperative areas, or post-anesthesia care units.

What is the workplace of a Critical Care nurse like?

The workplace of a critical care nurse can be demanding and fast-paced, as they are responsible for the care of critically ill patients in hospitals, intensive care units (ICUs), and other medical settings. Critical care nurses work alongside other healthcare professionals such as doctors, respiratory therapists, and pharmacists to ensure that patients receive the best possible care.

One of the key responsibilities of a critical care nurse is to closely monitor their patients' vital signs, such as heart rate, blood pressure, and oxygen saturation levels. They also administer medications, monitor intravenous lines and other medical equipment, and communicate with patients and their families about the patient's condition and treatment plan.

In addition to providing direct patient care, critical care nurses also collaborate with other members of the healthcare team to develop and implement treatment plans, participate in patient rounds and conferences, and ensure that medical orders and procedures are followed correctly.

Due to the unpredictable and often life-threatening nature of critical care nursing, nurses in this field must be able to think quickly on their feet, stay calm under pressure, and communicate effectively with both patients and other healthcare professionals. They may work long and irregular hours, and often have to adapt to changing patient needs and situations.

Frequently Asked Questions

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Critical Care Nurses are also known as: Critical Care Registered Nurse

• Adult Nursing

Critical Care Nursing

• Family Nursing
• Holistic Nursing
• Home Health Nursing – visiting nurse
• Neonatal Intensive Care Nursing
• Pediatric Nursing
• Perinatal Nursing
• Psychiatric and Mental Health Nursing
• Public Health or Community Nursing
• Rehabilitation Nursing
• Faye Abdellah
• Phil Barker
• Dr. Patricia Benner
• Helen C. Erickson
• Katie Eriksson
• Lydia E. Hall
• Virginia Henderson
• Dorothy E. Johnson
• Imogene King
• Katharine Kolcaba
• Madeleine Leininger
• Myra Estrine Levine
• Ramona Mercer
• Betty Neuman
• Margaret A. Newman
• Florence Nightingale
• Ida Jean Orlando
• Dorothea E. Orem
• Rosemarie Rizzo Parse
• Nola Pender
• Hildegard Peplau
• Isabel Hampton Robb
• Martha E. Rogers
• Nancy Roper
• Sister Callista Roy
• Henry Stack-Sullivan
• Joyce Travelbee
• Jean Watson
• Ernestine Wiedenbach
• Alfred Adler
• Lawrence Kohlberg
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• Albert Bandura
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Critical care nursing is a field of nursing that practices predominantly in intensive care and emergency units. Critical care nurses are equipped to handle critically ill patients, often specializing in a particular aspect of critical illness, such as cardiac care, to provide the best care for patients who are seriously ill or injured.

In addition to caring for the physical health of patients, critical care nurses must deal with the emotional health of patients as they cope with their conditions, as well as working with family members to make the best health care decisions for the patients. The nurses usually work with a team of health care professionals to develop a patient’s care plan. Communication is imperative in critical care nursing; in addition, a nurse must be prepared for adapting a patient’s care quickly based on the patient’s health.

Critical Care Nursing Theories and Models

• Erickson’s Modeling and Role Modeling Theory
• King’s Theory of Goal Attainment
• Neuman’s Systems Model
• Orem’s Self-Care Deficit Nursing Theory
• Orlando’s Nursing Process Discipline Theory
• Peplau’s Theory of Interpersonal Relations
• Parse’s Human Becoming Theory
• Rogers’ Theory of Unitary Human Beings
• Roy’s Adaptation Model of Nursing
• Kolcaba’s Theory of Comfort
• Watson’s Philosophy and Science of Caring
• Nightingale’s Environment Theory
• Pender’s Health Promotion Model
• Roper-Logan-Tierney’s Model for Nursing Based on a Model of Living
• Henderson’s Nursing Need Theory

For more information on Critical Care Nursing, try the following sources:

Nursing Schools

Critical Care Nurse

Critical Care Nurses are at the forefront of nursing, providing care for the most vulnerable patients who are facing life-threatening conditions. These dedicated professionals work in a high-stress environment where every decision can be a matter of life or death. Critical Care Nurses must possess a deep knowledge of complex technologies and treatment protocols, as well as the ability to make quick, informed decisions. Their role is pivotal in intensive care units ( ICU ), where they apply their specialized skills to support patients' recovery. Let's delve into the Critical Care Nurse specialty, explore their work environment, outline their duties, learn how to become a Critical Care Nurse, education requirements, annual salary, and advancement opportunities for this career in nursing .

What Is a Critical Care Nurse?

Critical Care Nurses, also known as Intensive Care Unit (ICU) Nurses, specialize in caring for patients with life-threatening illnesses or injuries. They work in a dynamic and technically complex environment, closely monitoring patients' conditions, administering treatments, and using advanced medical equipment. The role requires not only a high level of technical nursing skills but also strong emotional resilience and the ability to communicate effectively with patients and their families during difficult times. These nurses are trained to provide the highest level of care in critical situations, often coordinating with multidisciplinary teams to ensure comprehensive patient care.

Where Does a Critical Care Nurse Work?

Critical Care Nurses are primarily found in settings that provide intensive care services.

The most common workplaces for a Critical Care Nurse:

• Hospital Intensive Care Units (ICU)
• Cardiac Care Units (CCU)
• Emergency Departments
• Specialized units for burn care patients or neonatal intensive care
• Flight or transport services for critically ill patients

These environments are equipped with the advanced technology and resources necessary for treating critically ill patients, requiring nurses to be proficient in their use and vigilant in their care.

Duties of a Critical Care Nurse

The duties of a Critical Care Nurse are complex and varied, directly impacting the outcomes of critically ill patients.

The most common duties of a Critical Care Nurse:

• Monitoring patient vital signs and identifying changes in condition
• Administering medications and treatments
• Operating and troubleshooting critical care equipment
• Communicating with patients and their families about care plans
• Collaborating with healthcare professionals to coordinate patient care

This role demands a high level of expertise, continuous education, and the ability to work under pressure.

How To Become a Critical Care Nurse

Becoming a Critical Care Nurse requires specific education and training to handle the demands of the ICU.

Follow these steps to become a Critical Care Nurse:

• Earn a Bachelor of Science in Nursing (BSN) degree
• Pass the NCLEX-RN to become a registered nurse
• Gain experience in a general nursing role
• Obtain additional certifications in critical care nursing (e.g., CCRN)
• Pursue continuous education and training in critical care

This career path is challenging but rewarding, offering the opportunity to make a significant difference in the lives of patients facing critical conditions.

How long does it take to become a Critical Care Nurse?

The journey to becoming a Critical Care Nurse typically takes 6 to 8 years, including completing a BSN nursing school program, obtaining RN licensure, and gaining necessary clinical experience in critical care settings.

Education Requirements for a Critical Care Nurse

A Bachelor of Science in Nursing ( BSN ) is generally required to become a Critical Care Nurse, followed by RN licensure and specialized training or certification in critical care nursing, such as the CCRN certification offered by the American Association of Critical-Care Nurses.

How Much Does a Critical Care Nurse Make?

The salary of a Critical Care Nurse varies based on experience, location, and the type of facility. On average, they can expect to earn between $60,000 and $100,000 annually.

Annual salary for a Critical Care Nurse:

• Entry-level positions: $60,000 - $70,000
• Experienced nurses: $70,000 - $85,000
• Advanced roles and specialized units: $85,000 - $100,000 or more

Salaries can increase with additional certifications, experience, and taking on leadership roles.

Critical Care Nurse Career Advancement Opportunities

There are numerous advancement opportunities for Critical Care Nurses, including leadership positions such as Charge Nurse , Nurse Manager, or Clinical Nurse Specialist . Many also pursue further education to become nurse practitioners or nurse anesthetists, specializing in critical care or anesthesia.

The Future of Critical Care Nursing

The demand for Critical Care Nurses is expected to grow, driven by an aging population and advances in medical treatments that increase survival rates for critically ill patients. The role will continue to evolve, incorporating new technologies and treatments to improve patient care and outcomes.

Critical Care Nursing is a highly specialized and rewarding field that demands a combination of advanced clinical skills, emotional strength, and a commitment to patient care. Those who choose this career path are essential to the healthcare team, providing life-saving care to patients in their most vulnerable moments. With ongoing advancements in medical care, the importance and demand for skilled Critical Care Nurses will only continue to rise.

Last updated: February 19, 2024

Nursing Careers

References:

• Initial Certifications . American Association of Critical-Care Nurses, Certification. Retrieved February 19, 2024.
• How to Become a Critical Care Nurse . Colorado Technical University, Nursing Degrees. Retrieved February 19, 2024.
• Career Spotlight: Critical Care Nurse . Excelsior University, Life at Excelsior. Retrieved February 19, 2024.
• Registered Nurses . Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook. Retrieved February 19, 2024.
• Critical Care Nurse . Johnson & Johnson, Nursing Careers. Retrieved February 19, 2024.
• What Is a Critical Care Nurse . Indeed, Career Guide. Retrieved February 19, 2024.
• Critical Care Nurse . PayScale, Browse Jobs by Industry. Retrieved February 19, 2024.

Critical Care Nurse Career Overview

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Job outlook, average earning potential, what does a critical care nurse do.

Critical care nurses possess the same skills as a registered nurse and may undergo additional training to care for acute or critical illnesses. An average workday includes monitoring critical medical support equipment and tending to patients with life-threatening injuries. Critical care nurses require clear communication to interact with other nurses and interdisciplinary teams to stabilize emergency situations. Nurses also work with healthcare providers to administer medical treatments, and keep the patient’s family informed.

• Ability to access and treat patients swiftly and accurately
• Critical thinker in a fast-paced environment
• Good communicator between patients and families
• Physically fit for long, intensive shifts

Where Do Critical Care Nurses Work?

Critical care nurses apply their advanced training and expertise to various healthcare settings.

They typically work in intensive care units (ICU) but provide care in other healthcare facilities related to emergency injuries or long-term illness. Step-down units look after patients who don’t need as much immediate care as a patient in the ICU but aren’t stable enough to be sent to a medical floor or home. Some critical care nurses can even work from home by supporting other nurses from a teleICU.

• Stabilize patients’ health by assessing their condition, administering medicine, and monitoring life support machines
• Adapt and stay calm under high-stress situations where critical thinking is crucial
• Coordinate with the interdisciplinary team and the patient’s family on the best course of action for the patient

Step-down Units

• Help lower the number of patients in the ICU by providing an intermediate place for more stable patients to go
• Provide care for patients who have just gone through major surgery or continue to need medical support
• Comfort patients and families
• Quickly be able to respond to any changes in a patient’s condition
• Create a treatment plan for a patient with other nurses and specialists through videoconferencing
• Have an open mind to new ideas and ways to treat patients with teleICUs being a new development in healthcare
• Technologically capable
• Analytically minded

Why Become a Critical Care Nurse?

Critical care nurses bear high-risk, high-reward careers because of the incredible amount of responsibility they carry when caring for patients in life-threatening situations. Nurses have to assume the job of advocate for unconscious patients and form bonds with the patient’s family throughout the patient’s admission. These situations add emotional weight to nurses’ professional lives and can take a toll on their mental health.

Although they carry this heavy burden, there are many benefits to critical care nursing . When working at an ICU or other healthcare facilities, the critical care nurses have access to the most up-to-date medical equipment and get to work alongside veteran professionals. A critical care nurse also has many opportunities to specialize and gain a higher salary or seek higher-level positions.

Advantages to Becoming a Critical Care Nurse

Disadvantages to becoming a critical care nurse, how to become a critical care nurse, earn a bsn or adn ., pass the nclex-rn to receive rn licensure., gain experience in critical care nursing., consider earning a specialty certification in critical care nursing., critical care nurse certifications and specialty areas, pediatric critical care nurse (ccrn-p), neonatal critical care nurse (ccrn-p), how much do critical care nurses make.

A critical care nurse’s salary varies from geographical location, but they receive a national annual median pay of $74,991 . Los Angeles, California, boasts the highest salaries for critical care nurses, with nurses earning more than 51.7% above the national average. The more experience a nurse has plays a large part in their earnings with PayScale reporting that critical care nurses with 20 years of experience earn over $40 an hour.

The BLS projects that all registered nurses positions, including critical care nurse jobs, will grow by 7% from 2019 to 2029.

Frequently Asked Questions

How long does it take to become a critical care nurse.

A critical care nurse requires an associate or bachelor’s degree in nursing, which typically takes 2-4 years to complete. Along with this, a nurse needs to pass the NCLEX-RN exam to get their registered nurse license. Depending on the state or employer, healthcare facilities may also require certification from the AACN, which calls for a minimum of two years of professional experience.

Is a graduate degree required to become a critical care nurse?

A critical care nurse with a graduate degree has the ability to pick from a larger pool of job opportunities, but a graduate degree isn’t required to be a critical care nurse. A graduate degree, such as an MSN prepares nurses by providing them with additional education and training before starting their career.

What career advancement opportunities are available for critical care nurses?

More career opportunities open up for critical care nurses when they pursue higher education. Critical care nurses can specialize in specific fields like cardiac or neonatal. Critical care nurses who possess a master’s degree or doctorate have the option of working as a critical care nurse practitioner .

Resources for Critical Care Nurses

American association of critical-care nurses (aacn), aacn online courses, society of critical care medicine (sccm), world federation of critical care nurses (wfccn), related pages.

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Reviewed by:

Nicole Galan is a registered nurse who earned a master’s degree in nursing education from Capella University and currently works as a full-time freelance writer. Throughout her nursing career, Galan worked in a general medical/surgical care unit and then in infertility care. She has also worked for over 13 years as a freelance writer specializing in consumer health sites and educational materials for nursing students.

Galan is a paid member of our Healthcare Review Partner Network. Learn more about our review partners .

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The Vital Role of Critical Care Nursing

In the vast and ever-evolving landscape of healthcare, one crucial aspect that often goes unnoticed by the public eye is critical care nursing. These unsung heroes play a pivotal role in ensuring the health and well-being of patients requiring a higher level of care.

Table of contents:

• What is critical care nursing

The role of critical care nurses

• How to become a critical care nurse

What is critical care nursing?

Critical care nursing refers to a specialized area of nursing that focuses on managing and coordinating  the care of severely ill patients suffering from complicated medical or surgical illnesses. Critical care nurses work in emergency rooms, intensive care units (ICUs), post-anesthesia care units (PACUs), and other acute care departments.

These highly skilled nursing professionals are adept at assessing patients quickly and administering rapid interventions to stabilize and treat patients in critical conditions. Their competence and quick decision-making abilities are essential in ensuring positive patient outcomes.

• Rapid Response and Emergency Care: Emergency departments are where patients will encounter their first line of critical care nurses. They are rapid critical thinkers who respond swiftly and efficiently to patients' emergent needs. Their ability to remain calm under pressure and prioritize critical interventions can be the difference between life and death.
• Monitoring and Assessment: Critical care nurses closely monitor patients' vital signs, diagnostics, and overall condition to detect any changes or complications. Their ability to assess subtle and minute changes in a patient's condition promotes rapid intervention for the best possible patient outcomes.
• Collaborative Care: These nurses work closely with physicians, specialists, and other members of the interdisciplinary healthcare team to develop comprehensive plans of care individualized to a patient's specific needs. Effective communication and teamwork are vital in acute care settings, where time is of the essence.
• Medication Administration: Critical care nurses administer and titrate medications based on physician orders and a patient's condition, ensuring prompt treatment and a high quality of care.
• Patient Advocacy: Advocacy is a core principle of nursing, and critical care nurses are strong advocates for their patients. They ensure patients and their families are given every opportunity to make informed decisions even when the patient cannot speak for themselves.
• Emotional Support: Nurses in this role also provide emotional support to families. Critical care nurses comfort, educate, and care for patients and their families during some of the worst times in their lives.

What does it take to become a critical care nurse?

Becoming a critical care nurse requires a comprehensive blend of education, skills, and dedication. 

• Education: Aspiring nurses must first complete a registered nursing (RN) program, which involves obtaining a bachelor's degree in Nursing (BSN) or an associate degree in nursing (ADN) from an accredited institution. 
• Licensure: After successfully completing their nursing education, individuals need to pass the National Council Licensure Examination for Registered Nurses ( NCLEX-RN ) to become licensed RNs . 
• Further Training & Skills Development: Specializing in critical care will require additional training, experience, and in some situations, certifications. Critical care nurses must have advanced critical thinking and communication skills, work calmly and efficiently under pressure.
• Certifications & Specialization: They often pursue critical care nurse certifications such as the CCRN credential from the American Association of Critical-Care Nurses, which validates their high proficiency in providing direct care to acutely ill patients.
• Finding Work: Finding critical care nurse jobs can vary in ease depending on factors such as location, experience, and current demand within the healthcare industry. There are numerous critical care specific specialties available for RNs working in acute care - including ICU RN, NICU RN, flight nurse, and critical care transport nurse.

Critical care nursing plays a vital role in the healthcare ecosystem by providing comprehensive, rapid, life saving care to patients in critical conditions. Critical care nurses are the backbone of emergency departments and critical care units, demonstrating unwavering dedication, compassion, and expertise in their field.

As we acknowledge the significance of critical care nursing, let us also show our appreciation for this group of skilled professionals and the difference they make to patients and their families every day. Their commitment and resilience truly exemplify the essence of nursing care in its most critical form.

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Critical Care Nurse

What Is a Critical Care Nurse?

• Western Governors University. Critical Care Nurse Career .
• Maryville University. How to Become a Critical Care Nurse .
• CareRev. The Vital Role of Critical Care Nursing .
• Lippincott NursingCenter. Critical Care Nursing . 

What Does a Critical Care Nurse Do?

Critical Care Nurses work in high-stress environments where patients require constant attention and complex care. They must be able to make quick decisions, handle emergencies calmly, and provide compassionate care to critically ill patients and their families.

Key Responsibilities

• Perform comprehensive patient assessments, including physical examinations and evaluation of vital signs
• Monitor and interpret complex physiological data from various medical devices and equipment
• Administer medications, including intravenous drugs, and manage drug therapies
• Operate and troubleshoot life support equipment such as ventilators, cardiac monitors, and dialysis machines
• Respond quickly to changes in patient condition and initiate appropriate interventions
• Assist with or perform invasive procedures like intubation, central line placement, and arterial line insertion
• Provide advanced cardiac life support (ACLS) during emergencies and participate in code blue situations
• Manage pain and sedation levels for critically ill patients
• Assess and manage wounds, including complex dressings and wound vacs
• Implement infection control measures to prevent hospital-acquired infections
• Collaborate with physicians and multidisciplinary teams to develop and adjust patient care plans
• Coordinate patient care across various hospital departments and specialties
• Provide emotional support and education to patients and their families
• Advocate for patients’ needs and preferences within the healthcare team
• Document patient care, including assessments, interventions, and responses to treatment

How to Become a Critical Care Nurse

Becoming a Critical Care Nurse requires dedication, advanced training, and a strong commitment to patient care. The journey involves earning a nursing degree, gaining experience, and obtaining specialized certifications. The following steps outline the path to becoming a Critical Care Nurse.

1. Earn a Bachelor of Science in Nursing (BSN)

Begin your journey to becoming a critical care nurse by obtaining a Bachelor of Science in Nursing (BSN) degree from an accredited nursing program. This four-year degree provides a comprehensive education in nursing theory, practice, and clinical skills essential for critical care. While an Associate Degree in Nursing (ADN) can lead to RN licensure, a BSN is increasingly preferred or required by employers in critical care settings due to the complex nature of the work.

2. Obtain RN Licensure

3. gain general nursing experience, 4. acquire specialized certifications, 5. pursue critical care nursing education, 6. gain experience in critical care, 7. obtain critical care nursing certification.

After gaining experience, pursue professional certification in critical care nursing. The American Association of Critical-Care Nurses (AACN) offers the CCRN certification, which validates your expertise in critical care nursing. This certification can enhance your career prospects and demonstrate your commitment to excellence in the field.

8. Continue Professional Development

Commit to lifelong learning and stay updated on the latest advancements in critical care nursing. Attend conferences, participate in research, and pursue advanced degrees such as a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) to further your career and potentially move into leadership roles in critical care.

Benefits of Becoming a CCN

Opportunity for specialized skills and knowledge, lower nurse-to-patient ratios, career advancement and specialization opportunities, collaborative and dynamic work environment, critical care nurse salary.

Critical Care Nurses in the United States earn competitive salaries, with an average annual income of approximately $94,610, though estimates vary slightly between sources. The typical salary range falls between $74,000 and $101,500, with top earners potentially making up to $119,500 annually. Factors influencing salary include location, experience, education, and specialized certifications.

Critical Care Nurses generally earn more than general RNs but less than advanced practice nurses. The field offers opportunities for salary growth through career advancement, such as moving into administrative roles or pursuing advanced degrees.

Job Outlook

The job outlook for critical care nurses is very positive. According to the U.S. Bureau of Labor Statistics, employment of registered nurses, including those in critical care, is projected to grow 6% from 2022 to 2032. This growth is driven by several factors, including an aging population requiring more healthcare services, increased demand for critical care services due to complex health conditions, and a shortage of critical care physicians leading to expanded roles for nurses.

The COVID-19 pandemic has further highlighted the essential role of critical care nurses, intensifying the demand. Additionally, with up to 27% of critical care nurses estimated to be planning to exit the profession in the near future, there will likely be numerous job openings to fill these vacancies.

• Salary.com. Critical Care Nurse Salary in the United States . 
• Host Healthcare. 8 Factors That Play Into ICU Nurse Salary .
• ShiftMed. How Much Do Critical Care Nurse (ICU Nurse) Make?

Frequently Asked Questions

Caring for acutely or critically ill patients requires an advanced skill set. The complexity and demands of the job mean that nurses working in ICUs must have the education and clinical experience to qualify for their position. The minimum education for patient care roles in ICUs varies by location, but most states and employers require nurses to have a Bachelor of Science in Nursing degree with additional training in advanced nursing practices.

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Critical Care Nursing

• Reference work entry
• First Online: 01 January 2022
• pp 1219–1225
• Cite this reference work entry

• Rick Yiu Cho Kwan 3 ,
• Vico Chiang 4 &
• Kitty Chan 3  

48 Accesses

Emergency care nursing ; High-acuity care nursing ; Intensive care nursing

Critical care is defined by the US Department of Health and Human Services as the direct delivery of care for people who are critically ill, which means that an illness or injury has acutely impaired one or more vital organ system to a degree that there is a high probability of life-threatening deterioration (Duke 2006 ). According to the Association of American Critical Care Nurses, critical care nursing is a specialty that deals specifically with human responses to life-threatening problems; a critical care nurse is a licensed professional nurse who is responsible for ensuring that critically ill patients and their families receive optimal care (Burns 2014 ).

Critical care nursing emerged from the early 1950s. At that time, the use of mechanical ventilation and cardiopulmonary resuscitation began, and there was a great demand for providing efficient care to gravely ill patients (Perrin...

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Abella Alvarez A, Torrejon Perez I, Enciso Calderon V, Hermosa Gelbard C, Sicilia Urban JJ, Ruiz Grinspan M, … Gordo Vidal F (2013) ICU without walls project. Effect of the early detection of patients at risk. Med Intensiva 37(1):12–18. https://doi.org/10.1016/j.medin.2012.08.006

Akgun KM, Kapo JM, Siegel MD (2015) Critical care at the end of life. Semin Respir Crit Care Med 36(6):921–933. https://doi.org/10.1055/s-0035-1565254

Article   Google Scholar  

Bell L (2015) AACN scope and standards for acute and critical care nursing practice. Retrieved from http://www.dphu.org/uploads/attachements/books/books_5310_0.pdf

Biel M, Eastwood J-A, Muenzen P, Greenberg S (1999) Evolving trends in critical care nursing practice: results of a certification role delineation study. Am J Crit Care 8(5):285

Google Scholar  

Burns SM (2014) AACN essentials of critical care nursing. McGraw-Hill Education, Chicago, IL

Burns KE, Misak C, Herridge M, Meade MO, Oczkowski S (2018) Patient and family engagement in the ICU. Untapped opportunities and underrecognized challenges. Am J Respir Crit Care Med 198(3):310–319

Calhoun A (2018) ECMO: nursing care of adult patients on ECMO. Crit Care Nurs Q 41(4):394–398. https://doi.org/10.1097/CNQ.0000000000000226

Chamberlain D, Pollock W, Fulbrook P (2018) ACCCN workforce standards for intensive care nursing: systematic and evidence review, development, and appraisal. Aust Crit Care 31(5):292–302. https://doi.org/10.1016/j.aucc.2017.08.007

Chaudhuri D, Tanuseputro P, Herritt B, D’Egidio G, Chalifoux M, Kyeremanteng K (2017) Critical care at the end of life: a population-level cohort study of cost and outcomes. Crit Care 21(1):124. https://doi.org/10.1186/s13054-017-1711-4

Critical care services Ontario (2012) Standards for critical care nursing in Ontario. Critical Care Services Ontario, Ontario

Duke EM (2006) The critical care workforce: a study of the supply and demand for critical care physicians. US Department of Health and Human Services, Rockville, p 34

European Federation of Critical Care Nursing associations. Clinical Practice. Retrieved from http://www.efccna.org/clinical-practice

Fairman J, Lynaugh J, Lewensgn SB (2000) Critical care nursing: a history. University of Pennsylvania Press, Philadelphia

Flannery L, Ramjan LM, Peters K (2016) End-of-life decisions in the Intensive Care Unit (ICU) – exploring the experiences of ICU nurses and doctors – a critical literature review. Aust Crit Care 29(2):97–103. https://doi.org/10.1016/j.aucc.2015.07.004

Foreman MD, Milisen K, Fulmer TT (2010) Critical care nursing of older adults best practices, 3rd edn. Springer, New York

Gordo F, Abella A (2014) Intensive care unit without walls: seeking patient safety by improving the efficiency of the system. Med Intensiva 38(7):438–443. https://doi.org/10.1016/j.medin.2014.02.001

Hardin, S. R. (2005). Introduction to the AACN synergy model for patient care. In S. R. Hardin & R. Kaplow, Synergy for clinical excellence: the AACN synergy model for patient care (pp 3–10). Burlington, MA: Jones & Bartlett Learning.

Kelly D, Kutney-Lee A, Lake ET, Aiken LH (2013) The critical care work environment and nurse-reported health care-associated infections. Am J Crit Care 22(6):482. https://doi.org/10.4037/ajcc2013298

Kelly DM, Kutney-Lee A, McHugh MD, Sloane DM, Aiken LH (2014) Impact of critical care nursing on 30-day mortality of mechanically ventilated older adults. Crit Care Med 42(5):1089

Kleinpell R, Heyland DK, Lipman J, Sprung CL, Levy M, Mer M, … Curtis JR (2018) Patient and family engagement in the ICU: report from the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 48:251–256. https://doi.org/10.1016/j.jcrc.2018.09.006

Laporte L, Hermetet C, Jouan Y, Gaborit C, Rouve E, Shea KM, … Guillon A (2018) Ten-year trends in intensive care admissions for respiratory infections in the elderly. Ann Intensive Care 8(1):84

Lavallee JF, Gray TA, Dumville J, Russell W, Cullum N (2017) The effects of care bundles on patient outcomes: a systematic review and meta-analysis. Implement Sci 12(1):142. https://doi.org/10.1186/s13012-017-0670-0

Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, Danis M (2008) Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med 148(11):801–809

Lilly CM, Swami S, Liu X, Riker RR, Badawi O (2017) Five-year trends of critical care practice and outcomes. Chest 152(4):723–735

Mick DJ, Ackerman MH (2004) Critical care nursing for older adults: pathophysiological and functional considerations. Nurs Clin N Am 39(3):473–493. https://doi.org/10.1016/j.cnur.2004.02.007

Minton C, Batten L, Huntington A (2019) A multicase study of prolonged critical illness in the intensive care unit: families’ experiences. Intensive Crit Care Nurs 50:21–27. https://doi.org/10.1016/j.iccn.2018.08.010

Montgomery H, Grocott M, Mythen M (2017) Critical care at the end of life: balancing technology with compassion and agreeing when to stop. Br J Anaesth 119(Suppl 1):i85–i89. https://doi.org/10.1093/bja/aex324

Murphy P, Kreling B, Kathryn E, Stevens M, Lynn J, Dulac J (2000) Description of the SUPPORT intervention. Study to understand prognoses and preferences for outcomes and risks of treatments. J Am Geriatr Soc 48(5 Suppl):S154

Nurses AA o C-C, Corporation AC (2003) Safeguarding the patient and the profession: the value of critical care nurse certification. Am J Crit Care 12(2):154–164

Perrin KO, MacLeod CE (2012) Understanding the essentials of critical care nursing. Pearson Higher Ed, London

Saito S, Nakatani T, Kobayashi J, Tagusari O, Bando K, Niwaya K, … Kitamura S (2007) Is extracorporeal life support contraindicated in elderly patients? Ann Thorac Surg 83(1):140–145

Schofield-Robinson OJ, Lewis SR, Smith AF, McPeake J, Alderson P (2018) Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database Syst Rev 11:Cd012701. https://doi.org/10.1002/14651858.CD012701.pub2

The Canadian Association of Critical Care Nurses (2009) Standards for critical care nursing practice: Canadian Association of Critical Care Nurses. Retrieved from https://www.caccn.ca/pdfs/CACCN%20STND%20CRIT%20CARE%202009.pdf

Ward NS, Chong DH (2015) Critical care beds and resource utilization: current trends and controversies. Semin Respir Crit Care Med 36(6):914–920. https://doi.org/10.1055/s-0035-1564876

World Federation of Critical Care Nurses (2017) WFCCN resources for clinical guidelines. Retrieved from http://wfccn.org/clinical-guidelines/

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Kwan, R.Y.C., Chiang, V., Chan, K. (2021). Critical Care Nursing. In: Gu, D., Dupre, M.E. (eds) Encyclopedia of Gerontology and Population Aging. Springer, Cham. https://doi.org/10.1007/978-3-030-22009-9_844

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Critical care: A concept analysis

Martin christensen.

a School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China

b The Interdisciplinary Centre for Qualitative Research, The Hong Kong Polytechnic University, Hong Kong, China

Mining Liang

Associated data.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

The terms critical care and the Intensive Care Unit (ICU) are often used interchangeably to describe a place of care. Defining critical care becomes challenging because of the colloquial use of the term. Using concept analysis allows for the development of definition and meaning. The aim of this concept analysis is to distinguish the use of the term critical care to develop an operational definition which describes what constitutes critical care.

Walker and Avant’s eight-step approach to concept analysis guided this study. Five databases (CINAHL, Scopus, PubMed, ProQuest Dissertation Abstracts and Medline in EBSCO) were searched for studies related to critical care. The search included both qualitative and quantitative studies written in English and published between 1990 and 2022.

Of the 439 papers retrieved, 47 met the inclusion criteria. The defining attributes of critical care included 1) a maladaptive response to illness/injury, 2) admission modelling criteria, 3) advanced medical technologies, and 4) specialised health professionals. Antecedents were associated with illness/injury that progressed to a level of criticality with a significant decline in both physical and psychological functioning. Consequences were identified as either death or survival with/without experiencing post-ICU syndrome.

Describing critical care is often challenging because of the highly technical nature of the environment. This conceptual understanding and operational definition will inform future research as to the scope of critical care and allow for the design of robust evaluative instruments to better understand the nature of care in the intensive care environment.

What is known?

• • Critical care is often associated with the use of advanced medical technologies focused around a medical model of care.
• • While well known, critical care is often widely discussed in general terms, yet is poorly defined within what could be described as the essence or nature of care.
• • Critical care is often referred to as a ‘process’ of looking after the seriously ill or injured.

What is new?

• • This paper provides a detailed conceptual definition of critical care.
• • The formation of a model case provides information for practitioners and researchers that will support future work to better understanding of basis of critical care across the health professions.
• • The results of this conceptual analysis provide a different view of what constitutes care from the perspective of the different health care groups that work in the intensive care space.

1. Introduction

The terms critical care and Intensive Care Unit (ICU) are often used interchangeably to describe a place of care. Yet, one is the function of a dedicated, specialist team of health professionals to support and care for the critically ill person during a medical emergency or crisis, while the other is a dedicated location where this focused care is undertaken. As a place of critical care, it is the technology that separates it from other areas of the hospital [ 1 ]. When used, the notion of intensive care often conjures up images of a specific place in the hospital where the seriously or critically ill are cared for. In many respects, the concept of critical care may not have a different array of meanings or be elusive and this is possibly because of the normal or ordinary day language that is used to describe this concept. Yet, the term intensive or critical care has a variety of different names and perhaps meanings to signify the essence of critical care, for example, the critical care unit, the intensive care unit or the intensive therapy unit [ 2 , 3 ]. Moreover, the term critical care has now become a more standardised term because of the inclusion of other areas in the hospital that effectively treat and care for the seriously ill or injured such as the accident and emergency department or the coronary care unit [ 4 ]. The intensive care unit differs significantly from other areas because its major focus is on invasive mechanical ventilation. What is potentially missing is what is encompassed in ‘critical care’. For this review the term critical care will be used to exemplify and describe the ‘inter-professional care’ that is undertaken in the intensive care unit (Step 1). Therefore, the aims of this concept analysis are to 1) distinguish the use of the term in developing an operational definition, 2) to explore the concept of critical care as a possible space for care, cure and function and 3) develop a conceptual/theoretical model of critical care (Step 2). Furthermore, it may be possible to describe, define and discuss the relationship between critical illness and critical care undertaken in an intensive care unit. Using Walker and Avant's [ 5 ] eight-step approach to concept analysis may aid in seeking conceptual clarity, therefore the analysis may make it possible to promote a single vocabulary for discussion, whilst allowing an understanding of what signifies the parameters of critical care to be. It will achieve this by providing background literature in the form of a scoping review to identify uses and meanings of the concept, explore the nature of critical care in the form of fictional model cases, determine the antecedents and consequences associated with critical care and finally ascertain the empirical referents that are conducive to this concept.

Concept analysis, as described by Walker and Avant [ 5 ] is a strategy that allows for an examination and exploration to define and evaluate the concept of critical care. In particular, it distinguishes between those critical characteristics and attributes of critical care that allowed for clarity of meaning [ 5 ] and is therefore fundamental to the formation of nursing knowledge. The result of which is a precise operational definition that meets the requirements of construct validity.

The basis of Walker and Avant’s [ 5 ] eight-step concept analysis approach to concept analysis guided this project. It is an iterative framework, which encompasses an entity based structural analytical approach. The central focus is the identification of the wider ranges of intentions coupled with the ability to distinguish between the defining attributes and the relevant attributes, which allows for the formation of distinct analytical goals.

2.1. Search strategy

A scoping review was undertaken using the Joanna Briggs Institute (JBI) System for the Unified Management of the Assessment and Review of Information (SUMARI) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR) [ 6 ]. The pneumonic PCC (population, concept and context) for scoping reviews was considered for developing the search strategy – ‘what is care in terms of critical care’ in the intensive care unit, P = critically ill, C = critical care, and C = intensive care unit. Five databases were accessed for published works which stipulated intensive care, critical care, care and caring within their title between 1990 and 2022 (CINAHL, Scopus, PubMed, ProQuest Dissertation Abstracts and Medline in EBSCO). Additional searches were undertaken within the grey literature, discursive papers, conference papers, editorials and unpublished commentaries were also included. Search terms related to definition∗, car∗ AND intensive care OR critical care were paired with intensive care unit OR ICU OR intensive therapy unit OR ITU OR cardiac ICU OR neuro ICU. Additional searches were undertaken using wild card terms using ‘?’ and truncated terms ending with ∗ to elicit further combinations associated with intensive and/or critical care. Hand searching of reference lists along with the content pages of intensive and/or critical care specific journals was also undertaken. Papers were included if they discussed the nature of care and what constituted care within an intensive care environment. Papers were excluded if they did not adequately describe the ‘essence of care’ fully. The study design was inclusive of both qualitative and quantitative methods. This resulted in 47 documents that met the criteria for identifying the concepts use ( Fig. 1 ) [ 7 ].

Study selection flow chart.

After the search was completed, all identified citations were collated and uploaded into EndNote, and from there, all duplicates were removed. Using JBI SUMARI, all eligible titles and abstracts were screened by two independent reviewers and assessed for relevance against the inclusion criteria. Those studies that were potentially relevant were retrieved in full text. The full-text papers selected were then evaluated against the inclusion criteria by two independent reviewers. Reasons for exclusion were recorded as part of the PRISMA-ScR reporting [ 6 ]. Disagreements arising between the reviewers at each stage of the study selection process were resolved through discussion ( Fig. 1 ).

2.2. Identify uses of the concept: critical care (Step 3)

Identifying the uses of the concept is an important first step in establishing how the concept is defined/used in everyday parlance. This may include implicit and explicit uses of the concept so that a fully rounded view of the concept is initially established. This may include a search of the relevant literature, commonly used definitions, lay language or other narrative forms that may be relevant to the concept.

The Concise Oxford Dictionary [ 8 ] defines critical care as “ the continuous care and attention, often using special equipment, for people in hospital who are seriously ill or injured”. Likewise, the Cambridge Dictionary [ 9 ], describes critical care “as the continuous treatment for patients who are seriously ill, very badly injured or have just had an operation or the department of a hospital that provides this care” . The notion of critical care was first observed by Florence Nightingale, during the Crimean War of 1854, where she first used the concept of triage to identify the seriously injured and set them apart from the others to receive more critical care from a specialist team of nurses [ 10 ]. Other examples, though not typically referred to as critical care appeared in the late nineteenth century where the unstable and critically ill patients were moved to a more observable vantage point for the nurses charged with their care. An example of this is in the exert from Louisa May Alcott’s [ 11 ] Hospital Sketches where she reflects :

“My ward was now divided into three rooms … I had managed to sort out the patients in such a way that I had what I called my “duty room”, my pleasure room and my pathetic room” and worked for each in a different way. One I visited, armed with a dressing tray, full of rollers, plasters and pins; another with books, flowers, games and gossip; a third with teapots, lullabies, consolation and sometimes a shroud … wherever the sickest or most helpless man chanced to be, there I held my watch …” (p47)

It is implied in this anecdote that the duty room (perhaps the nineteenth century ICU equivalent) was where the sickest and infirm were nursed and the pathetic room was similar in some respects to a hospice or palliative care unit. The notion of increased vigilance and observation eventually became the precursor to what is now known as critical care. For example, in the mid 40’s where the physiological instability of the post-operative patient and the dangers of anaesthesia meant that collective organisation of these patients into one specific area, the recovery room, occurred. With the continued hypervigilance of patient monitoring led directly to the birth of the ICU [ 4 , 12 , 13 ]. Jackson and Cairns ([ 14 ], p2) describe critical care as the “ process of looking after patients who either suffer from life threatening conditions or at risk of developing them ”. Equally they describe the intensive care unit as a “ distinct geographical entity in which high staffing ratios, advanced monitoring and organ support can be offered to improve patient morbidity and mortality ”. This is not too dissimilar to those definitions/descriptions identified by internationally recognised intensive care societies or organisations ( Table 1 ). However, the difference is that these definitions or more aptly descriptions of critical/intensive care are offered as lay comments specifically for patients and or families. It could be suggested, therefore, that healthcare professionals, whether they work in this environment or not, may be fully conversant with what critical care and what the intensive care unit are ( Table 1 ). Moreover, a recent concept analysis attempted to define critical care as the “ identification, monitoring and treatment of patients with critical illness through the sustained support of vital organ functions ” [15, p9], yet fails to distinguish between the different health professional roles in the delivery of critical care and therefore conforms to the technical-rational medical model of care [ 16 ]. Importantly, when attributing this definition of critical care to the fictional model case, it is difficult to distinguish the actual ‘care’ involved and what is deemed critical except to identify the geographical place the patient is admitted to and the administration of oxygen along with regular monitoring. Whilst this is valuable in finding a definition of critical care, the authors also make the important distinction of what critical illness might entail in order for critical care to be implemented – “ a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility.” ([15], p 8)

Table 1

Consensus definitions of critical care and ICUs.

3.1. Determining the defining attributes (Step 4)

Determining the defining attributes of the concept is attempting to identify those attributes frequently associated with the concept, in this case, critical care. Moreover, the specific phenomenon in question is reduced to those key features that differentiate the concept from other similar or related concepts, such as intensive care. To assist in this step of the concept analysis, an inductive content analysis described by Krippendorf [ 17 ] was undertaken with 47 papers identified from the literature search to ascertain uses of the concept critical care [ 1 , 12 , 13 , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] ]. This resulted in the development of five categories ( Table 2 ). The defining attributes associated with critical care can be divided into three main categories – critical illness, supportive and treatment therapies, and critical care based around a technical-rational medical model of care [ 16 ]. Nursing and allied health play supportive and facilitative roles in the delivery of this care in conjunction with their individual scopes of practice. Therefore, in determining the defining attributes of critical care those distinctive features that emerged which are associated with the concept include ( Table 2 ):

• ⁃ The patient’s maladaptive response to illness/injury that results in a systemic inflammatory reaction (critical illness);
• ⁃ The patient must present with intensive care unit admission modelling criteria that denote critical illness;
• ⁃ The application and administration of advanced medical technologies to support and treat ongoing failing organ systems;
• ⁃ The application of specialised allied health, medical and nursing care that considers the micro and macro levels of care associated with critical illness;
• ⁃ That critical care is not to be confused with the intensive care unit, which is a geographical location within the hospital setting.

Table 2

Defining attributes of critical care.

Note: SAPS = Simplified Acute Physiological Score. SOFA = Sequential Organ Failure Assessment Score. TISS-28 = Therapeutic Intervention Scoring System. APACHE = Acute Physiological and Chronic Health Evaluation.

In order to identify the key components of the concept critical care, the development of a model, borderline and contrary case is useful in recognising and refining the defining attributes. It is often seen as a form of constant comparative examination so that the internal structure of the phenomenon has meaning and clarity.

3.2. Model case (Step 5)

The fictional model case contains all of the constituents identified in the defining attributes as well as the working definition of critical care from the diagnosis of critical illness and subsequent admission to an ICU along with the initiation of advanced medical technologies to support and treat the underlying condition. It also includes those activities associated with a macro level of care such as those undertaken by nursing and physiotherapy.

Mr. Melvin Jones, a 72-year-old widower who resides in a residential aged care facility, has a body mass index of 38 and was transported by ambulance to the Accident and Emergency department (A&E) after experiencing a chest infection for six days. He has a medical history of hypertension, peripheral vascular disease, insulin-controlled type 2 diabetes, and chronic bronchitis. Additionally, he smokes twenty roll-up cigarettes a day. As a result of worsening respiratory indices (oxygen saturations, arterial blood gas analysis and respiratory rate), he is electively intubated in the A&E and transferred to the ICU. Once in the ICU he is placed on continuous cardiac monitoring, a quadruple lumen right internal jugular central venous line (CVL) is placed for drug administration along with the monitoring of right atrial filling pressures (CVP). An intra-arterial line is placed in his right radial artery to continuously monitor his blood pressure while also allowing access for blood sampling in particular samples for arterial blood gas analysis (ABG). His vital signs showed marked hypotension (↓ mean arterial & central venous pressures), pyrexia, tachycardia and peripheral cyanosis. His ABG showed marked acute-on-chronic hypoxia and hypercarbia. Mr Jones is immediately given a fluid challenge as a result of his hypotension and started on an inotropic infusion. Blood samples taken in the A&E show elevated serum urea and creatinine indicative of renal insufficiency as a result of his hypotension. A sputum sample is taken for culture and sensitivity to identify the bacterium responsible for his chest infection, but in the mean while he is started on intravenous broad-spectrum antibiotics. Mr Jones’ chest x-ray reveals not only correct placement of his CVL and endotracheal tube, but increased opacity in the right lower and middle lobes consistent with pneumonia.

Once Mr. Jones is stabilised, the nursing team starts to document his baseline vital signs, ventilatory parameters, drug infusion rates, sedation score, pain assessment, and urine output hourly and often converse with the medical team as to current orders and results of blood and ABG tests, adjusting infusion rates to maintain prescribed physiological parameters. As part of their physical health assessment, Mr Jones’ nurse identifies him as a high risk of pressure injury and therefore institute positioning guidelines not only to reduce the risk of tissue injury but to also aid in secretion removal. When assessing his chest, his nurse notices decreased expansion on the right side along with coarse inspiratory crackles and bronchial breath sounds on auscultation consistent excess secretions and alveolar consolidation. In addition to positioning, they place Mr Jones on a pressure relieving mattress. They also implement other nursing activities like regular mouth, indwelling catheter, bowel and eye care. This information is documented in the nursing notes. When Mr Jones’ two daughters arrive, his nurse sits with them and explains the current situation and what they might expect to see in the ICU before showing them to their father’s bed-space. His nurse also explains what the ‘machinery’ is and how it is supporting and monitoring their father’s progress. They are invited to ask questions and stay as long as they feel able. The nurse asks the hospital chaplain assigned to the ICU to talk with them as well so as to offer another person to talk with while Mr. Jones is being cared for. As the daughters have arrived from other areas of the country, his nurse helps organise emergency accommodation.

When reviewed by the ICU physiotherapist, the nurse conveys their findings from their initial physical assessment in particular those associated with his chest infection. The physio also finds on auscultation those reported by his nurse and the findings from the chest x-ray. They implement chest physiotherapy which includes chest percussion, hyperinflation and suctioning to aide in mobilizing and removing the secretions as well as re-inflating collapsed areas of lung. The physio also starts range of movement (ROM) exercises. They also document their findings and treatment and develop a chest physiotherapy plan for the nurses to follow during out-of-hours.

3.3. Borderline case (Step 6)

The fictional borderline case in this instance possesses some of the defining attributes identified in the definition especially that of needing advanced medical technologies. In this case, Mrs. Smith required continued ventilatory support because of the failure of anaesthetic reversal and was therefore experiencing acute respiratory failure. Though potentially dangerous, Mrs. Smith was not critically ill.

Mrs. Jean Smith is a 49-year-old married woman who has undergone elective surgery for the laparoscopic removal of her gallbladder. The operation was uneventful, with very little blood loss. However, Mrs. Smith failed a reversal of anaesthesia and therefore remained intubated and ventilated whereupon she was transferred to the ICU until such time that she could be extubated. On arrival into the ICU she was placed on continuous cardiac monitoring. Her baseline vital signs were recorded which showed a systolic blood pressure (BP) of 95 mmHg, heart rate (HR) of 110 beats/min an axilla temperature of 37.6 °C, transcutaneous oxygen saturations (SaO 2 ) of 98% on an FiO 2 of 40% via the ventilator and a sedation score of −5 (unarousable to physical stimuli) on the Richmond Agitation and Sedation Scale (RASS). She was given a fluid challenge as a result of her lowered BP and rising temperature. She is receiving intravenous fluids at 120 ml/h, and regular morphine pain relief via a patient-controlled analgesia pump with a background infusion rate of 1 mg/h. Mrs. Smith is what would be affectionately known as a ‘warm, wake and wean’ patient. As the anaesthesia begins to wear off, Mrs. Smith’s RASS score improves, and she is able to respond to verbal commands. A trial of weaning is commenced where upon she is successfully extubated and placed on 6ltrs/hour of oxygen via a face mask. Mrs. Smith is monitored for 24 h and then discharged back to her admitting ward.

3.4. Contrary case (Step 6)

The fictional contrary case contains none of the defining attributes that would signify critical illness nor would require an intensive care unit admission for critical care.

Mr. Brian Koenig is a 35-year-old man with chronic gastritis and was admitted to the day case surgical unit for routine gastroscopy. Mr. Koenig, is given a mild sedative, placed on continuous cardiac monitoring (BP, HR, SaO 2 , RR) and receiving oxygen at 6 L/h via a face mask. The gastroscopy was uneventful, his vital signs remained stable, and Mr Koenig was transferred back to the day-case ward, monitored for 4 h and discharged home with a follow-up appointment for outpatients two weeks later.

3.5. Antecedents (Step 7)

Antecedents are those factors that must occur prior to an occurrence of the concept [ 5 ]. From the perspective of critical care, the antecedents are those factors attributable to illness, which over time progresses to a level of criticality and therefore would influence an admission to an intensive care unit. In this respect, critical illness can be considered along a spectrum of adaptation to complete organ failure with maladaptation being the demarcation necessitating immediate intervention ( Fig. 2 ). As in the example of the model case, the individual has underlying chronic disease which makes them more susceptible to illness because of a depressed or ineffective immune response. What then results is the transition from a simple chest infection (adaptive) to pneumonia (maladaptive) and then systemic inflammatory response syndrome (SIRS)/sepsis (overwhelming).

The antecedents of critical illness.

3.6. Consequences (Step 7)

Unlike antecedents, which occur before the concept, the consequences are those events that transpire as a result of the occurrence or the outcomes of the concept [ 5 ]. The consequences associated with critical care are concerned with the decline in both physical and psychological functioning, ranging from sarcopenia, depression, cognitive decline and post-traumatic stress disorder (PTSD) [ [18] , [19] , [20] ]. These result in a condition commonly known as post-ICU syndrome [ 62 , 63 ]. The effects are a combination of both critical illness and the treatment modalities being used. For example, positive pressure ventilation along with critical illness has been shown to cause respiratory muscle dysfunction as a result of mitochondrial dysregulation, muscle inactivity and metabolic oversupply [ 64 , 65 ]. Likewise, psychological impairment is related to both pre-ICU cognitive functioning and the incidence of delirious episodes each of which can lead to post-ICU PTSD, depression and worsening or new cases of dementia [ [66] , [67] , [68] ].

Moreover, while critical care is reliant on the patient being critically ill, there is also the nature of the ICU itself especially in terms of what level of critical care can be delivered. This is often dependent on the size of the hospital and the availability of resources, both human and physical. The human resource is very much dependent on patient acuity, which often necessitates an inter-professional team approach with advanced qualifications and experience to provide an immediate and critical level of care. Based on Marshall et al.’s [ 69 ] classification system of ICU’s from Level 1 to 3 denotes the level of care that can be provided safely and competently. A Level 1 ICU, for example, has many basic elements of critical care in terms of monitoring capacity and physiologic stabilisation, the level of invasive support and personnel expertise. A Level 2 ICU can provide basic support for failing organs such mechanical ventilation, inotropic support and renal dialysis, invasive monitoring and personnel often have additional critical care training and education. A Level 3 ICU provides critical care for more complex patients. This often involves more complex forms of haemodynamic monitoring and advanced modes of mechanical ventilation such as prone ventilation or extra-corporeal membrane oxygenation. It is evident that the level of medical (micro) care differs between the subsequent ICUs, the macro level care invariably remains unchanged. Both nursing and allied health practices remain relatively stable.

3.7. Empirical referents (Step 8)

The empirical referents are described as phenomenal categories that empirically demonstrate the actual occurrence of the concept in question. They are not, however, tools used to measure the concept, instead are used to measure the defining characteristics [ 5 ]. However, the difficulty with defining the empirical referents is that critical care is often associated with the ICU, which are two separate entities. One is a physical location while the other is deemed to be an advanced level of care required to support and treat a patient who is critically ill. The literature is resplendent with examples of the quality of the care experienced in the ICU [ 29 , 30 ], but less about measuring the actual care. Perhaps this is based on mortality and survival rates, suggesting that if the patient survived the ICU, care must have been appropriate and importantly evidenced based. As yet there are few valid tools to measure critical care apart from self-reported satisfaction scales [ [31] , [32] , [33] ], illness severity scores [ 34 , 70 ] or survival data [ 36 ].

3.8. Operational definition

Based on these defining attributes, it might be possible to form a working theoretical definition of critical care as well as construct a possible conceptual model of critical care.

Critical care is the application of advanced medical technologies administered by specialist health care professionals to alleviate the inherent physiopsychosocial complications associated with critical illness while treating the underlying disease process.

From this definition, the characteristics of critical care encompass the three health professions based on their respective expertise in supporting critical illness ( Fig. 3 ). Medicine as supporting and treating the underlying pathophysiology – the person as a disease process. Nursing as the administrators of care cooperating and supporting respective treatment options as well as applying their own specialised nursing care – the patient as a person. Allied health as the ‘rebuilders’– the patient as structurally dysfunctional.

Characteristics of Intensive Care incorporating the Antecedents, Attributes and Consequences.

4. Discussion

These early definitions refer to critical care as a service for those individuals with recoverable life-threatening illness or injury where more intense observation and treatment are available than on the general wards [ 37 ]. Referring to two separate criteria associated with the meaning of critical care, Lynaugh and Fairman [ [ 71 ], p20] suggest that first, the individual is at risk of dying as a result of serious physiological instability and secondly, “intensive care is usually given in the expectation or hope, however slim, of the person's survival”. More recently, Marshall et al. [ 69 ] defines critical care as:

“… a multidisciplinary and interprofessional specialty dedicated to the comprehensive management of patients having, or at risk of developing, acute, life-threatening organ dysfunction.” (p271)

However, the contemporary critical care medical and nursing literature also refers to intensive care or critical care as a physical space, geographically placed to enable easy access for patient admissions from a variety of places such as the operating theatres, the clinical wards or the emergency department [ 13 , 18 , 72 ]. Alcott’s [ 11 ] early description of an ICU room has changed considerably over time. The ICU as a space is mentioned as early as 1923 with the opening of a three-bedded ICU to monitor and treat post-operative neurosurgical patients [ 4 ]. It wasn’t until the early 1950s that the precursor to the modern ICU came into being as a result of polio epidemic [ 12 , 13 ]). Prior to this, what would be termed intensive care units appears to be simply recovery rooms [ 3 ]. What is significant in this initial identification of the concept in use, is that critical care is used to denote an interdisciplinary specialty [ 69 ], a critical level of illness and the congregation of the critically ill into one specialist place for care and treatment.

4.1. Critical care: a process of care, cure and function

The nature of critical care is perhaps dichotomous and symbiotic at the same time because of the inter-play between the pathology of disease processes and how care is delivered and perceived [ 1 , 40 ]. First, it has often been described as the application of technology to support and measure failing organ systems to determine appropriate treatment options, which would sit easily with the medical model of diagnosis, treatment and cure [ 12 , 41 , 42 ]. Second, critical care is also viewed from a psychosociospiritual aspect that is seen as the basis of holistic nursing care and practice and last, critical care is seen as the restoration of physical function which is more applicable to the work of allied health in particular physiotherapy. The centre of what is deemed critical care is the technological application associated with care. McClure [ 73 ], for example, defines technology as:

“… any means of delivering care using objects that are not part of a patient’s own body. This means that it includes not only the vast array of machinery we have come to take for granted, but also the pharmaceuticals that are prescribed and administered.” (p144)

Or more aptly, “… the substitution of machine labour in the performance of a given task ([ 74 ], p74) and “ … as a collection of technological acts within the technological environment” ([ 75 ], p438), in this case the intensive care unit.

Technology in the sense of critical care involves two distinct processes – monitoring/measurement and supportive treatment. First, the monitoring/measurement capabilities are used to analyse and display indirect and/or direct physiological functions, for example electrocardiography, intra-arterial blood pressure, central venous pressure and transcutaneous oxygen saturation. Second, supportive treatment includes equipment used to support compromised or failing organ systems such as a mechanical ventilator either invasive or non-invasive, extra-corporeal membrane oxygenator, dialysis machine, intra-aortic balloon pump, all used within the context of the patient condition. Included in this array of equipment are volumetric and syringe driver pumps used for drug and/or intravenous fluid administration and an enteral feeding pump to support the nutritional needs of the patient [ 46 ]. In terms of ICU personnel, the equipment when employed in this fashion is used to primarily aide decision making regardless of the how or what equipment is being used [ 47 ]. For example, an increase in airway pressures (monitoring/measurement) would necessitate a change in ventilatory parameters (supportive treatment) to reduce these while optimising oxygenation and carbon dioxide elimination or a change in mean arterial pressure might mean a change in inotropic support or an intravenous fluid challenge.

When described in this manner, it is easy to attribute this as the technical-rationale [ 16 ] medical model of care and as mentioned earlier fits within the domain of medicine. Nursing, however, can also be ascribed this process of care because of the technological environment that is encompassed in the ICU. This has been articulated by a number of authors who have concluded that nurses can and do become unwittingly machine-like in their approach to patient care especially in this environment as a means of supporting, to a large part, medical decision-making [ 1 , 48 ]. However, ICU nursing is also focused on the psychosociospiritual aspect of care especially in supporting the family members in the early stages of the ICU admission and then in the latter rehabilitative stages to both the patient and family. This is a unique position for the ICU nurse when compared to medicine and allied health for one specific reason – nursing offers 24-h care whereas medicine and allied health tend to provide care as ‘snap-shots of activity’, for example, medical ward rounds or chest physiotherapy sessions. In Price’s [ 47 ] ethnographic study, she found that, in contrast to those behaviours of care which might be easily attributable to technological care (monitoring/measurement), ‘being present’ and compassionate was distinctive to nursing. Likewise, the work of Bishop et al. [ 49 ], Jones et al. [ 50 ], Jakimowicz et al. [ 51 ] and Efstathiou and Ives [ 52 ] discuss that compassionate care is a hallmark of nursing practice in the ICU. They all describe compassionate care as encompassing those elements of humanness that responds to individual suffering. For example:

“Compassion asks us to go where it hurts, to enter into places of pain, to share in brokenness, fear, confusion, and anguish. Compassion means full immersion into the condition of being human .” ([ 53 ], p52)

Structural dysfunction in critical illness can be considered both at the macro and micro levels ( Fig. 2 ). At the micro level, this is often seen as supporting organ systems affected by mitochondrial or cellular dysfunction [ 54 ], for example, adrenal insufficiency [ 55 ], diaphragmatic ineffectiveness [ 56 ], gastro-intestinal dysfunction [ 57 ] and neurocognitive dysfunction [ 76 ]. At the macro level, restoring structural dysfunction entails reversing the effects of illness-induced sarcopenia and aiding in normal physiological processes, sometimes complicated by supportive therapies such as mechanical ventilation. These may include early enteral nutrition to reduce gut mucosal degradation, therefore reducing the incidence of bacterial translocation [ 59 , 60 ], ROM exercises to reduce joint contractures, early mobilisation to reduce muscle wasting [ 21 , 61 ] and chest physiotherapy to improve secretion removal and reduce the incidence of ventilator-induced alveolar collapse [ 22 , 23 ]. Medicines’ role at the micro level is focused on those supportive therapies, for example, the inception of mechanical ventilation and the prescribing of drug therapy. Their role at the macro level is minimal except perhaps the placing of invasive lines and prescribing care that will normally be undertaken by either nursing or allied health ( Fig. 2 ). While equally conversant and responsible with the macro level of care, nursing as the administrator of the medical model will naturally adopt a supportive, facilitative and cooperative role with both medicine and allied health. Alternatively, allied health will generally provide and direct the functional recovery such as mobility and ROM exercises as well as chest physiotherapy and as such facilitates in reducing the overall effects of critical illness [ 22 , 24 , 61 ].

4.2. Critical illness

The natural progression to critical illness is seen as a fine inter-play between pathophysiological adaptation and maladaptation. This is generally seen as a result of disruption to oxygen supply and demand at the micro-circulatory level in response to a potentially life-threatening insult [ [24] , [25] , [26] , [27] , [28] ] ( Fig. 3 ). During the adaptive phase, the normal processes associated with acute inflammation come into play involving both the innate immune and haemopoietic systems in an attempt to contain the injury or infection locally. However, if these systems become overwhelmed, a systemic inflammatory response then ensues causing organ dysfunction (maladaptive). If there is no reversal to the maladaptive stage multi-organ failure follows leading to death. The criteria which decides when adaptation becomes maladaptive is generally governed genetically and by co-morbid conditions present in the individual [ 25 ]. Therefore, the basis of diagnosing critical illness is often dependent on a number of pathophysiological processes [ 35 , 38 , 39 ] seen through the presenting disease symptomology for example, pyrexia, tachycardia and hypotension.

However, describing and defining critical illness based on diagnosis alone is often difficult and typically critically ill patients fall between two separate categories – too well to benefit (low risk of death) or too sick to benefit (high risk of death) [ 77 ]. Therefore, what determines critical illness is generally based on admission criteria often involving a significant decline in physiological functioning [ 39 ] in some form and the application of illness severity classification systems such as SAPS (Simplified Acute Physiological Score) [ 34 , 70 ] or SOFA (Sequential Organ Failure Assessment Score) [ 43 ] or TISS-28 (Therapeutic Intervention Scoring System) [ 44 , 45 ]. At present, there are three distinct models of ICU admission – prioritisation, diagnosis and physiological function (objective parameters) each of which serves as the basis, singularly or collectively, of defining and describing illness severity [ 77 ]. The prioritisation model determines patient characteristics based on benefit and need – those who will benefit versus those that won’t. The diagnosis model determines illness severity based on survivable outcomes, similar in some respects to the prioritisation model, but instead focused on an admission diagnosis such as myocardial infarction or traumatic brain injury. Finally, the objective parameter model uses physiological and investigative information to determine illness severity. However, there are also ethical and economic factors, which may influence an admission to ICU.

While these criteria provide some assistance for the clinician in determining who gets an ICU admission, there is perhaps a ‘loose’ connection as to defining or indeed describing critical illness. As mentioned previously illness severity classification systems such as SAPS or APACHE (Acute Physiological and Chronic Health Evaluation) scores are used to classify patients within specific groups of illness severity, the difference being that this is a mortality risk predicative tool as opposed to a decision-making tool [ 78 ]. There was an attempt to define illness severity in palliative care patients undergoing elective surgery. Using a Delphi method and a current evidence base of care, Lee et al. [ 58 ] were able to define illness severity based on ASA (American Society of Anaesthetists) risk and age (a subjective physiological based tool designed to predict perioperative risk, the higher the number the higher the risk of mortality). However, like the use of criteria modelling and severity classification scores, the definition identified here is also based on a classification system, which considers not only those mentioned above such as comorbid states, age, gender and cognitive function but also frailty. Therefore, building on the definition described by Kayambankadzanja et al. [ 15 ] it might be possible to find a single definition of critical illness which might consider the following:

Critical illness is a process in which normal or optimal physiological functioning has been severely compromised where advanced medical treatment is a necessity to preserve life.

5. Implications for practice and potential future research

Therefore, the implications for future research could encompass studies that accurately reflect the ‘care’ of the intensive care environment. In addition, describing critical care is challenging because each health professional group defines the concept based on their specific expertise. In other words, what is defined and described as critical care as opposed to the current medical model of care. As a result, nursing care associated with the critically ill, for example, can be considered universal across the spectrum of nursing, the major difference being the acuity of the patient. Therefore, further evidence of what constitutes critical care is required so that the defining attributes clearly articulate what is critical care is and is not, for example: adherence to nursing guidelines, implementation of new concepts for monitoring/documentation of wellbeing and satisfaction, and perhaps defining suitable nurse-patient ratios.

6. Limitations

The idea of concept analysis is to get a broader, deeper understanding and clarification of a concept. The limitations of this analysis lie in that it only considered published work reported in English and those from within a western context. Therefore, this may limit the depth and breadth of work reported elsewhere because of issues related to translation and interpretation. In addition, the nebulous nature of what defines and describes critical care means that the care provided in this area could equally be transposed into other clinical areas; the difficulty is that the subjectiveness of the term critical care means many different things to many different people. Yet, in saying that it is the patient acuity that may truly define what ‘critical care’ is.

7. Conclusion

When the term critical care is used, it invariably conjures up images of a physical space – ‘ the patient is being transferred to intensive care’ or ‘ the patient is in intensive care’ or ‘I work in intensive care’ . It is often taken for granted that the patient is receiving critical care, as such describing or defining the nature of the care provided is often challenging and consumed within the medical model of care. This concept analysis of what constitutes critical care has identified key defining attributes of what comprises ‘critical care’, namely micro and macro levels of care. Additionally, in providing a working definition of critical care, it has used hypothetical clinical cases to highlight what is deemed critical care and what is not. Therefore, given that care is multi-dimensional and multi-factorial, providing a conceptual framework of what denotes critical care may give rise to more focused research in addition to that already undertaken.

Nothing to declare.

Data availability statement

Credit authorship contribution statement.

Martin Christensen: Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing. Mining Liang: Conceptualization, Writing – original draft, Writing – review & editing.

Declaration of competing interest

There are no conflicts of interest.

Peer review under responsibility of Chinese Nursing Association.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.ijnss.2023.06.020 .

Appendix A. Supplementary data

The following is the Supplementary data to this article:

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Krasnodar , kray (territory), southwestern Russia , extending northward from the crest line of the Caucasus Mountains across the plains east of the Black Sea and the Sea of Azov as far as the Gulf of Taganrog. The plains, crossed by the Kuban and other rivers flowing to the Sea of Azov, form two-thirds of the region. Their steppe-grass vegetation on rich soils has been almost entirely plowed under. Widespread salt marshes and lagoons line the Azov coast. The southern third of the region is occupied by the western Caucasus, which reach 12,434 feet (3,790 metres) at Mount Psysh (in the neighbouring Karachay-Cherkessia republic) and fall gradually in height westward as they run parallel to the Black Sea, from which they are separated by a narrow coastal plain. The mountains’ lower slopes are covered by deciduous forest; higher up are conifers and alpine meadows.

The kray was established in 1937 with its headquarters at Krasnodar city in an area originally occupied by Kuban Cossacks. The population is overwhelmingly Russian but also includes some Adygey, Ukrainians, Armenians, Belarusians, and Tatars.

The northern plains form a major agricultural region that produces grains, especially winter wheat and, in the south, winter barley. Along the lower Kuban River, much swamp has been reclaimed for rice growing. Industrial crops, notably sunflowers, tobacco, and sugar beets, are important, as are vegetables along the Kuban and fruit and vines on the Caucasus foothills. Large numbers of cattle, pigs, and poultry are kept. Petroleum and natural gas are exploited on the Taman Peninsula and in the north. Novorossiysk and Tuapse are major oil-exporting ports. There are oil refineries at Krasnodar and Tuapse and a chemical complex at Belorechensk. Area 29,300 square miles (76,000 square km). Pop. (2006 est.) 5,096,572.