The Ins and Outs of the Critical Care Nursing Field

Whenever the term critical care is mentioned – most people immediately think about severely sick patients in intensive care units or ICUs. They are not mistaken. Intensive Care Units and Critical Care specialized areas in the hospital that care for patients in need of intense and one on one attention. These are the areas where a critical care nurse Practices.

What is a Critical Care Nurse

A Critical Care Nurse or a CCN is a highly specialized nurse that has been trained to work in Intensive Care areas. They are nurses that care for patients who are severely ill and in need of individualized care. A CCN cares for patients of all diagnoses and gender. Patients may vary depending on this category. Critical care nurses also deal with complex technology that helps sustain patients.

The History

This type of nursing is a relatively new nursing specialty. It wasn’t until the 1950′s that the very first Intensive Care Units appeared in the Western world. These units were created to deal with gravely ill patients. They were considered to need a more intensive form of care compared to the patients in the regular wards. The notion of an intensive care unit quickly spread. Today, most hospitals are required to have these specialized areas and in turn specialized nurses and physicians to run them.

Back then, nurses assigned in CCUs and ICUs were not seen as different from regular ward RNs. It was only a few years later that CCN was considered as a specialized nursing field.

Roles of a CCN

Like any other registered nurse, the roles of the critical care nurse are very complex. These nurses have to deal with severely ill patients. They also need to be familiar with complex technologies that are continually present in a critical care setting. The critical care nurse also has to know basic and advance life support. Such skills may be called upon at any point during his/her service.

The critical care nurse must also be skilled in the art of diagnosis. He/she must be able to diagnose and identify a patient’s immediate needs. This part of nursing is important as it may be the difference between life and death for a patient. Nonetheless, the nurse must remember that despite being skilled at diagnosis, one must not overstep her boundaries and perform roles reserved for a physician alone.

Aside from dealing with patients and their needs, the CCN also has to deal with the patient’s family. The CCN often works as a counselor that helps the family get through the crisis at hand. He/she may have to deal with questions and concerns from the patient’s immediate family and significant others.

Qualifications and Requirements

IN THE PHILIPPINES – Locally, any registered nurse can become a critical care nurse. It is only a matter of area assignment. Most of the time, nurses who are assigned in critical care units are those who have shown promise in their previous areas of exposure. They are also the ones who have worked in similar areas such as medical/surgical or pediatric units.

ABROAD – Abroad, in the US specifically, there are no specialized requirement to be a critical care nurse other than an RN License. However, there are bodies of authority that certify CCNs.

Although, certification is not required, most CCNs abroad are choosing to go for it because it increases their credibility. Employers also often require their CCNs to be certified in the field. Certification is achieved post graduation. It is not something taught in school. Some schools may expose their students to ICUs, but this is not considered enough for certification. The RNs get their CCN certificates while they are on the job. It is also often sponsored by the employer.

Work Opportunities in the Philippine Nursing Scene

There are a lot of opportunities to become a critical care nurse in the Philippines. But, nurses have to understand that these critical care units are often hard to get into. These units only require a limited number of nurses. Most of the time there are only a total of 12 nurses that work in a typical ICU with 8-10 beds.

Those who do get into these areas are considered lucky because their position opens great opportunities to work abroad. In most settings, CCNs have a lesser work load compared to nurses in large wards. Patients in ICUs need more attention but the numbers are much smaller compared to wards. A typical government hospital ward may hold 50-70 patients and with only a nurse or two to manage it.

Work Abroad

There are a lot of work opportunities for a critical care nurse abroad. The CCN can work in any area where there is an intensive care unit. Certification is often an option provided by employers to deserving and promising nurses. The employers are often the ones who fund certification seminars and the likes.

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Disparities in US Healthcare System

Healthcare disparities pose a major challenge to the diverse 21st century America. Demographic trends indicate that the number of Americans who are vulnerable to suffering the effects of healthcare disparities will rise over the next half century. These trends pose a daunting challenge for policymakers and the healthcare system. Wide disparities exist among groups on the basis of race/ethnicity, socioeconomic status, and geography. Healthcare disparities have occurred across different regional populations, economic cohorts, and racial/ethnic groups as well as between men and women. Education and income related disparities have also been seen. Social, cultural and economic factors are responsible for inequalities in the healthcare system.

The issue of racial and ethnic disparities in healthcare have exploded onto the public stage. The causes of these disparities have been divided into health system factors and patient-provider factors. Health system factors include language and cultural barriers, the tendency for racial minorities to have lower-end health plans, and the lack of community resources, such as adequately stocked pharmacies in minority neighborhoods. Patient-provider factors include provider bias against minority patients, greater clinical uncertainty when treating minority patients, stereotypes about minority health behaviors and compliance, and mistrust and refusal of care by minority patients themselves who have had previous negative experiences with the healthcare system.

The explanation for the racial and ethnic disparities is that minorities tend to be poor and less educated, with less access to care and they tend to live in places where doctors and hospitals provide lower quality care than elsewhere. Cultural or biological differences also play a role, and there is a long-running debate on how subtle racism infects the healthcare system. Inadequate transportation or the lack of knowledge among minorities about hospital quality could also be factors of inadequate care. Racial disparities are most likely a shared responsibility of plans, providers and patients. There’s probably not one factor that explains all of the disparity, but health plans do play an important role. Racial and ethnic disparities in healthcare do not occur in isolation. They are a part of the broader social and economic inequality experienced by minorities in many sectors. Many parts of the system including health plans, health care providers and patients may contribute to racial and ethnic disparities in health care.

It is seen that there are significant disparities in the quality of care delivered to racial and ethnic minorities. There is a need to combat the root causes of discrimination within our healthcare system. Racial or ethnic differences in the quality of healthcare needs to be taken care of. This can be done by understanding multilevel determinants of healthcare disparities, including individual belief and preferences, effective patient-provider communication and the organizational culture of the health care system.

To build a healthier America, a much-needed framework for a broad national effort is required to research the reasons behind healthcare disparities and to develop workable solutions. If these inequalities grow in access, they can contribute to and exacerbate existing disparities in health and quality of life, creating barriers to a strong and productive life.

There is a need to form possible strategies and interventions that may be able to lessen and perhaps even eliminate these differences. It is largely determined by assumptions about the etiology of a given disparity. Some disparities may be driven, for example, by gaps in access and insurance coverage, and the appropriate strategy will directly address these shortcomings. The elimination of disparities will help to ensure that all patients receive evidence-based care for their condition. Such an approach will help establish quality improvement in the healthcare industry.

Reducing disparities is increasingly seen as part of improving quality overall. The focus should be to understand their underlying causes and design interventions to reduce or eliminate them. The strategy of tackling disparities as part of quality improvement programs has gained significant attraction nationally. National leadership is needed to push for innovations in quality improvement, and to take actions that reduce disparities in clinical practice, health professional education, and research.

The programs and polices to reduce and potentially eliminate disparities should be informed by research that identifies and targets the underlying causes of lower performance in hospitals. By eliminating disparities, the hospitals will become even more committed to the community. This will help to provide culturally competent care and also improve community connections. It will stimulate substantial progress in the quality of service that hospitals offer to its diverse patient community. Ongoing work to eliminate health disparities will help the healthcare departments to continually evaluate the patient satisfaction with services and achieve equality in healthcare services.

It is important to use some interventions to reduce healthcare disparities. Successful features of interventions include the use of multifaceted, intense approaches, culturally and linguistically appropriate methods, improved access to care, tailoring, the establishment of partnerships with stakeholders, and community involvement. This will help in ensuring community commitment and serve the health needs of the community.

There is the need to address these disparities on six fronts: increasing access to quality health care, patient care, provider issues, systems that deliver health care, societal concerns, and continued research. A well-functioning system would have minimal differences among groups in terms of access to and quality of healthcare services. This will help to bring single standard of care for people of all walks of life.

Elimination of health care disparities will help to build a healthier America. Improving population health and reducing healthcare disparities would go hand in hand. In the health field, organizations exist to meet human needs. It is important to analyze rationally as to what actions would contribute to eliminate the disparities in the healthcare field, so that human needs are fulfilled in a conducive way.

Meenu Arora has contributed her articles for both online and hard copy magazines. Her articles have also been published in international magazines. Presently working in the healthcare industry, she has also written and edited Health Q-A columns for international magazine for 5 years.

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Healthcare Systems and Their Structure

Constantly under review and scrutiny, the issues on healthcare Systems have become international.

Made up mainly of organizations and individuals, these healthcare structural systems are designed to meet a target population’s need for health care. On an international level, there is a diverse variety of health care systems. In some countries the planning of the health care systems are market driven and participated in by the private sector. In other countries the systems are composed of government and non-government entities such as religious groups, trade unions charities and or other coordinative bodies that are centrally run and planned, to enable the delivery of healthcare services to the populations they target. In other words, health care planning has evolved.

According to a World Health Organization report in 2000, the main goals of health systems are the ability to provide a responsive health service alongside considerations of fair financial contributions. In order to appraise overall health care systems, a proposed two-dimensional approach was conceived. The first dimension consists of equity and the second is composed of efficiency, quality and acceptability.

Several proposals have come from the Senate in the United States and the White House. Health care system issues according to President Obama are issues that should be addressed immediately and placed them on a top priority list. A universal health care system does not exist or is practiced in the United States. Some countries subsidize their universal healthcare directly from government coffers. This kind of universal healthcare is called socialized medicine, which is a combination of private and public delivery systems, with most countries spending public funds for this service delivery. Government taxes plays the role of funding this system supplemented and strengthened with private payments.

The World Health Organization (WHO) report of 2000 ranks each member country’s health care system. Discussions on the positive and negative aspects of replacing health care systems with insurance systems use this report’s quotation. However, the WHO has remarked that as ranking healthcare systems is a complex task, these ranking tables will no longer be produced. Infant mortality and life expectancy are two main variables that are used in the ranking. Out of 198 countries, Canada ranks thirtieth and the US ranks thirty seventh. The World Health Organization ranks France, San Marino, Italy, Andorra, Singapore, Malta, Spain, Austria, Oman and Japan as the world’s top ten.

With the founding of the UN (United Nations), there was planning and discussion on the need for a single entity to serve, observe and assess global health care system trends. Thus the World Health Organization was formed in 1948 on April 7th with headquarters based in Geneva, Switzerland. Annually the WHO is recognized by the celebration of a World Health Day. The WHO is the coordinative and directive authority for United Nations’ member countries individual health systems. Member countries of the United Nations are allowed WHO membership through the acceptance of the WHO constitution. To date there are a total of 198 member nations participating in WHO programs.

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