Objectives:
1. Discuss the various health care environments in which high-acuity patients receive care.
2. Identify the need for resource allocation and staffing strategies for high-acuity patients.
3. Examine the use of technology in high-acuity environments.
4. Identify the components of a healthy work environment.
5. Discuss the importance of patient safety in the high-acuity environment.
I. High-Acuity Environment
A. Historical perspective
1. Intensive care units (ICUs) were developed in the 1960s. Medical advances resulted in the
initiation of these units.
a) The implementation of CPR
b) Improved management of patients experiencing hypovolemia and shock
c) The implementation of emergency medical services
d) Technological advances
e) The advancement of renal transplant services
B. Determining the level of care needed
1. Systematic triage approach for high-acuity patients aids in giving the most efficient and
cost-effective care.
a) ICU
b) Intermediate-care unit (IMC)
(1) Developed to manage those patients who did not require life-saving, critical-care functions
(2) Ability to manage the potentially serious health care needs of the patient whose condition
is too complex for the traditional medical-surgical floor
c) Medical-surgical acute care unit.
2. Nurses should use a prioritization model to triage and determine the level of care needed by
acutely ill patients. The model divides patient needs into four categories:
a) Priority 1: The patient is acutely ill, requiring intensive treatments not available outside of the
intensive care unit.
b) Priority 2: The patient is seriously ill and has the potential to require immediate medical
interventions to prevent complications.
, c) Priority 3: The patient is critically ill but has a limited chance for recovery. There might be
limits placed on the amount of life-saving interventions that may be implemented.
d) Priority 4: This is a large category of patients. Their inclusion into the ICU will depend on an
individualized decision based on the appropriate use of resources and current patient status.
C. Levels of intensive care units
1. The American College of Critical Care Medicine has identified three levels of ICUs as deter-
mined by resources available to the hospital:
a) Level I: Hospitals with ICUs that provide comprehensive care for patients with a wide range
of disorders. Sophisticated equipment, specialized nurses and comprehensive support ser-
vices.
b) Level II: Hospitals with ICUs that provide comprehensive care to most critically ill patients.
c) Level III: Hospitals with ICUs that provide initial stabilization of critically ill patients.
D. Profile of the high-acuity nurse
1. Able to analyze clinical situations.
2. Make decisions based on analysis.
3. Rapidly intervene to ensure optimal patient outcomes.
4. Competent in detecting early signs of an impending complication.
5. Role of the nurse in the management of the high-acuity environment:
a) Review the patient’s clinical condition and implement a plan of care.
(1) Studies show that constant surveillance of patients by nurses reduces mortality and
complications.
PowerPoint Slides
1. Intensive Care Units (ICU)
• Developed in 1960
• Why initiated
2. Intermediate Medical Care (IMC) Units
• Intended for patients needing close observation but not in need of life-saving, critical
interventions
• Able to manage those patients too complex for the traditional medical surgical unit
3. Triage Prioritization Model
• Priority 1: acutely ill patients requiring life-saving, critical interventions
• Priority 2: seriously ill patients possibly in need of immediate medical interventions
• Priority 3: critically ill patients who will not likely recover from their disorders
• Priority 4: patients who might be terminally ill
4. The Registered Nurse in High-Acuity Settings
• Continual assessment of the patient’s status
• Implementation of the plan of care
, • Studies link to reduced mortality and complications
II. Resource Allocation
A. Nurse staffing
1. Nurse-patient ratios
a) Many interrelated factors have led to a shortage of nurses able and willing to work with
acutely ill patients. Factors linked to the nursing shortage include:
(1) Reduced job satisfaction, resulting in nurses leaving the workforce
(2) Aging of the registered nurse workforce
(3) Limited number of young adults choosing nursing as a career
(4) Increasing number of aging persons, resulting in an increase in persons requiring acute
care health services
b) The reduction in the number of professional nurses has resulted in an increase in the nurse–
patient ratio.
c) The Academy of Medical Surgical Nurses (AMSN) does not support the development of
exact patient–nurse ratios.
2. Magnet Status: Recruiting and Retaining Nurses
a) Magnet designation is a status awarded to hospitals that demonstrate success in recruiting and
retaining professional nurses.
b) Magnet hospitals promote environments that are attractive to the retention of professional
nurses.
3. Unlicensed assistive personnel (UAP) can be used to provide direct care.
a) The UAP provides care under the direction of the professional nurse.
B. Decreasing resources, increasing care needs
1. Who Belongs in an ICU?
a) The health care needs of the patient and the skill mix available must be the deciding factors.
b) The assignment of patients to units requires a close review of available resources.
c) A goal is to ensure that those patients requiring the greatest level of care will be cared for in
the intensive care unit.
d) Age and seriousness of illness can be controversial variables in the assignment of intensive
care beds. Severity scales are models used to determine which patients will benefit most from
intensive care services.
e) Additional considerations must be given to ethical, economic, and legal concerns.
PowerPoint Slides
1. Nursing Shortage
• The nursing shortage has resulted in a scarcity of nurses available to work with acutely ill
patients. Factors linked to the nursing shortage include:
• Reduced job satisfaction
• Aging of the nursing workforce
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