Fundamentals of Critical Care E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Fundamentals
• Sprache: Englisch

Seitenzahl: 1441

Veröffentlichungsjahr: 2022

Beschreibung

Fundamentals of Critical Care

A Textbook for Nursing and Healthcare Students

In Fundamentals of Critical Care, a team of clinicians and health educators deliver an accessible, timely, and evidence-based introduction to the role of nurses and healthcare practitioners in critical care. The book explores fundamental concepts in critical care and their implications for practice. Each chapter outlines essential knowledge necessary to understand key concepts and includes high quality, full-colour artwork to enhance learning and recall.

Readers are also provided with clinical scenarios, practice questions, and red and orange flags to indicate physiological and psychological alerts respectively. Covering a range of common and specialised disease processes and treatments requiring critical care, the book provides:

• A thorough introduction to the critical care unit, including philosophies of care, ways of working, humanisation, and outreach
• Comprehensive exploration of organisational influences, including political, local, national, and international influences
• Practical discussion of legal, ethical, and professional issues, as well as evidence-based approaches to critical care
• In-depth examination of nursing care assessment tools, nursing communication, cognition, pharmacology, and more

Perfect for nursing students and trainee nursing associates, Fundamentals of Critical Care: A Textbook for Nursing and Healthcare Students will also earn a place in the libraries of healthcare students in physiotherapy, paramedicine, medicine, and those returning to practice.

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Leseprobe

Table of Contents

Cover

Title Page

Copyright Page

Contributors

Preface

References

Acknowledgements

How to use your textbook

Features contained within your textbook

About the companion website

Chapter 1: The critical care unit

Introduction

Levels of care

The critical care environment

Critical care patients

Level 1 care

Level 2 care

Level 3 care

Critical care competence

The interprofessional team

Communication

Ways of working

Understanding philosophies of care

Humanising critical care

Surviving critical care

Death in critical care

Resilience

Nursing considerations and recommendations for practice

Future challenges

Conclusion

References

Chapter 2: Organisational influences

Introduction

The four UK nations

Legislation

Professional Statutory Regulatory Bodies (PSRBs)

Shared decision making

Capacity for shared decision making

Confidentiality

Decisions relating to end‐of‐life care

Risk management

International influences

National influences

UK government organisations

Networks

National guidelines

Quality assurance

Local policies

Nursing considerations and recommendations for practice

Conclusion

References

Chapter 3: Legal and ethical issues

Introduction

Confidentiality

End‐of‐life care and best interest decisions

Ethical themes

Mental Capacity Act

Organ donation

Consent (authorisation in Scotland) for organ donation

First person consent

First person opt‐in

First person opt‐out

Appointed/nominated representative (not Scotland)

Deemed consent

The ethics of deemed consent

Consent from a person in the highest‐ranking relationship

Cadaveric organ donation

The organ donation process

Post organ retrieval

Organ allocation

Conclusion

References

Chapter 4: Professional issues in critical care

Introduction

Opportunities for learning

NMC Code in critical care units: journey to independent, safe practice

The core principles

UK National Competency Framework: critical care

Development of critical thinking in healthcare

The prioritising process

Support systems: the student

Conclusion

References

Chapter 5: Using an evidence‐based approach

Introduction

What is evidence‐based practice (EBP)?

Step 1: formulating a clinical question – the PICO method

Step 2: locating the evidence/research: performing a systematic literature review

Step 3: critical appraisal and the hierarchy of evidence

Step 4: extracting the most relevant and useful results

Step 5: implementing research into practice

Quality healthcare in critical care

Clinical audit and quality improvement

Research and development in critical care

Conclusion

References

Chapter 6: Nursing care

Introduction

Standards of care

Physical care

Mobility

Critical care bundles

Conclusion

References

Chapter 7: Skin integrity

Introduction

Anatomy and physiology of the skin

Impact of ageing on skin and tissue integrity

Pressure ulcers

Nursing assessment

Prevention of pressure ulcers

Management of pressure ulcers

Wound healing

Patient factors that affect wound healing

Nursing assessment

Recognising wound infection

Management of non‐healing wounds

Conclusion

References

Chapter 8: Shock

Introduction

Shock

Hypovolaemic shock

Blood analysis

Multiple organ dysfunction syndrome

Staging of hypovolaemic shock

Principles of managing hypovolaemic shock

Fluid resuscitation

Training and education for Registered Nurses

Cardiogenic shock

Obstructive shock

Altered pathophysiology

Tension pneumothorax

Cardiac tamponade

Pulmonary embolism (PE)

Distributive shock

Conclusion

References

Chapter 9: Communication

Introduction

Communicating effectively with patients

Communicating during a pandemic

Communication with families

Conclusion

References

Chapter 10: Electronic health records

Introduction

Digitisation within healthcare

Understanding your responsibilities and the law in relation to record keeping

Intensive Care Society Guidelines

Understanding the different types of EHRs in critical care and how they are used

Understanding what patient data is available within the critical care unit and how this is recorded in an electronic health record

Understanding how EHRs are used in critical care audit and research

Understanding the benefits and barriers to EHRs

Conclusion

References

Chapter 11: Pharmacology

Introduction

Principles of pharmacology and pharmacotherapy

The processes of drug therapy

Medication safety in critical care

Drugs and dialysis

Core drugs utilised within critical care

Respiratory drugs

Cardiovascular drugs

Haematological drugs

Renal drugs

Fluids and electrolytes

Gastrointestinal drugs

Insulin

H

2

‐histamine antagonists and proton pump inhibitors (PPIs)

Anti‐emetics

Laxatives and anti‐diarrhoeal drugs

Neurological drugs

Analgesics

Opioids

Non‐opioid analgesics

Epidural and regional anaesthesia

Sedatives and anxiolytics

Muscle relaxants

Anticonvulsants

Antideliriogenics

Immunomodulatory drugs

Antibacterial agents

Antifungals

Antiviral drugs

Corticosteroids

Immunoglobulins

Toxicology

Conclusion

References

Chapter 12: Anaesthesia and sedation

Introduction

Indications for sedation and anaesthesia

Anaesthetic and sedative medications

Sedative drugs

Neuromuscular blocking agents and reversal agents

Sedation management

Conclusion

References

Chapter 13: Medicines management and drug calculations

Introduction

Purpose of pharmacological interventions in the critically ill adult patient

Legal and professional issues

Collaborative multidisciplinary team working

Medication errors

Overview of routes and methods of administering medications in CCU

Rights of medication administration

Managing and reporting a medication error

Anaphylaxis

Pathophysiology and clinical manifestations of DIA

Management for DIA

Medication calculation formulae

Displacement

Conclusion

References

Chapter 14: Neurological critical care

Introduction

Neurological anatomy and physiology

Central nervous system

Neurological assessment

Signs and symptoms of increasing ICP

Primary and secondary brain injury

Management of raised ICP

Nursing care

Transfer

Conclusion

References

Chapter 15: Cognition

Introduction

Cognitive impairment

Causes of cognitive impairment

Signs of cognitive impairment

Delirium

Risk factors

Management of delirium

Sleep

Assessment of sleep in ICU

Conclusion

References

Chapter 16: Respiratory care: intubation and mechanical ventilation

Introduction

Respiratory failure

Hypoventilation

Ventilation/perfusion (V/Q) mismatch

Work of breathing

Arterial blood gases (ABGs)

Non‐invasive ventilation (NIV)

Continuous positive airway pressure (CPAP)

High flow nasal oxygen

Intubation

Mechanical ventilation

Artificial ventilation

Minute ventilation (Vm)

Fraction of inspired oxygen

Positive end‐expiratory pressure (PEEP)

Volume control

Pressure control

Inspiratory:Expiratory (I:E) ratio

Inverse ratio

Synchronisation

Humidification

Benefits of mechanical ventilation

Risks of mechanical ventilation

Ventilator care bundles

Prone positioning

Prone positioning in COVID‐19

Weaning from mechanical ventilation

Conclusion

References

Chapter 17: Lung function in critical care

Introduction

Anatomy and physiology

Composition of air

Alveolar gas

Expired air

Lung volumes

Pulmonary ventilation

External respiration

Ventilation/Perfusion

Transport of gases

Internal respiration

Assessment of lung function

Normal breath sounds (vesicular)

Absent Sounds

Wheeze

Crackles

The work of breathing

Compliance

Resistance

Emphysema

Asthma

Obstructive sleep apnoea

Prone positioning

Conclusion

References

Chapter 18: Cardiac physiology

Introduction

Functions of the cardiovascular system

Anatomy of the heart and great vessels

Pericardium

Layers of the heart

Chambers of the heart

Valves of the heart

Coronary circulation

Cardiac conduction system

The cardiac cycle

Cardiac output and blood pressure

Regulation of heart rate

Stroke volume

The microcirculation

Capillary exchange

Effects of ventilation on the cardiovascular system

Conclusion

References

Chapter 19: Cardiovascular critical care

Introduction

Cardiovascular assessment

Heart rate and rhythm

Atrial ectopic beats

Ventricular ectopic beats

Blood pressure

Invasive blood pressure monitoring

Central venous catheters (CVCs) and central venous pressure (CVP)

Markers of organ and tissue perfusion

Neurological status

Urine output

Blood results

Advanced haemodynamic monitoring

Cardiac pacing

Nursing considerations and recommendations for practice

Conclusion

References

Chapter 20: Fluids and electrolytes incritically ill patients

Introduction

The role of the critical care nurse

Intravenous fluids

Crystalloids versus colloids critical care

Fluid management

Third spacing

Assessment and monitoring

Training and education

Electrolyte replacement therapy

Management of hyperkalaemia

Oral sodium and water

Oral rehydration therapy (ORT)

Oral bicarbonate

Parenteral preparations for fluid and electrolyte imbalance

Plasma and plasma substitutes

Plasma substitutes

Fluid overload

The four Ds of fluid management

Hyponatraemia

Hypernatraemia

Hypokalaemia

Hyperkalaemia

Hypophosphataemia

Hypocalcaemia

Hypomagnesaemia

Conclusion

References

Chapter 21: Critical care emergencies

Introduction

A – Airway

B – Breathing

C – Circulation/Cardiovascular

D – Disability

E – Everything else (exposure, endocrine, electrolytes and environmental)

Care of the patient post return of spontaneous circulation (ROSC)

Critical care emergencies and human factors

Debriefing

Do‐not‐attempt‐cardiopulmonary‐resuscitation (DNACPR) and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT)

Conclusion

References

Chapter 22: Gastrointestinal critical care

Introduction

Anatomy and physiology

GI monitoring and investigation in the critically ill

Imaging and endoscopy

Bowel charts and abnormal GI motility

The acute abdomen in critical care

Common surgical procedures cared for in critical care

Post‐operative monitoring

Abdominal surgical drains

Anaesthetics

Post‐operative complications

Wound dehiscence

GI pharmacology

Conclusion

References

Chapter 23: Nutrition in critical care

Introduction

Pathophysiology

Fight or flight

Resistance

Exhaustion

Nutritional screening and assessment

Indirect calorimetry (IC)

Routes of administration

Nursing considerations and recommendations for practice

Care of people with feeding tubes

Glycaemic control

Refeeding syndrome

Discontinuing feed

Nutritional guidance

Conclusion

References

Chapter 24: Renal critical care

Introduction

Anatomy and physiology of the renal tract

Vascular supply

Renin‐angiotensin‐aldosterone system (RASS)

The nephrons

Control of plasma osmolality

Electrolyte balance

Acid‐base balance

Renal failure

Acute kidney injury

Classification of AKI

Pathophysiology

Organ cross‐talk

Risk factors for AKI

Clinical features and examination

Investigations

Specific disorders associated with AKI

Drug‐induced renal damage

Management of AKI

Clinical features and examination

Management

Chronic kidney disease

Management

Diabetic nephropathy

Continuous renal replacement therapy (CRRT)

Dosing of CRRT

Anticoagulation

Drug dosing and RRT

Kidney transplantation – critical care considerations

Conclusion

References

Chapter 25: Endocrine critical care

Introduction

Thyroid and parathyroid glands

Disorders of the thyroid gland

Thyroid crisis

Parathyroid glands

Disorders of the parathyroid glands

Hypocalcaemia

Pituitary gland

Disorders of the pituitary gland

Diabetes insipidus

Pathophysiology

Hyperglycaemia in the critically ill

Diabetic emergencies

Pathophysiology

Conclusion

References

Chapter 26: Haematological and immunological critical care

Introduction

Normal physiology

Blood components

Haematopoiesis

Disorders of erythrocytes

B12 vitamin deficiency

Sickle cell anaemia

Genetic haemochromatosis

Haemostasis

Lymphoma

Disseminated intravascular coagulation

Thrombocytopenia

Neutropenia and sepsis

Vasculitis

Blood transfusions in adults

Blood sample collections

Blood groups

Compatibility

Indications for blood transfusions

Platelets

Fresh frozen plasma (FFP)

Cryoprecipitate

Granulocytes

Procedural safety

Pre‐procedure and sampling

Administration of the blood product

Post‐procedural care

Traceability

Patient information

Alternatives to blood transfusions

Summary of SaBTO recommendations on consent

Conclusion

References

Chapter 27: Musculoskeletal considerations in critical care

Introduction

Trauma

Management of traumatic injury

Intensive care unit‐acquired weakness

Assessment of musculoskeletal impairment or injury

Management of musculoskeletal injury and impairment

Conclusion

References

Chapter 28: Burn care within a criticalcare setting

Introduction

Classification of burn wound depths

Pathological considerations

Burn size estimation

An ABCDE approach to burn care

Breathing

Cardiovascular

Disability (neurological assessment)

Exposure (and everything else)

Psychological support

Acknowledgement

References

Chapter 29: Maternal critical care

Introduction

Epidemiology

Adapted physiology

Recognising clinical deterioration

Nursing considerations and recommendations for practice

Conclusion

References

Chapter 30: Critical care transfers

Inter‐hospital and intra‐hospital patient transfers

Transfer of the critically ill adult

Critical care bed and repatriation

The risks of critical care transfer

Preparation for transfer

ABCDE process during critical care transfer

Conclusion

References

Chapter 31: Rehabilitation after critical illness

Introduction

The impact of critical illness – what do we mean by morbidity?

Describing physical functioning and morbidity

Models of post‐critical care morbidity

Assessment

Goals

Key timepoints in RaCI

Treatment

National guidelines and standards

Conclusion

Disclaimer

References

Chapter 32: Dying and death

Introduction

End‐of‐life care

Palliative care

Dying

Recognising Dying

Advance care planning

Involve and support

Nursing the dying patient

The critical care environment

Symptom management

End‐of‐life care discharges from a critical care setting

Care after death

Conclusion

References

Index

End User License Agreement

List of Tables

Chapter 5

Table 5.1 The PICO Model and a critical care example.

Table 5.2 Boolean operators and their meaning.

Table 5.3 PICO model, synonyms and Boolean operators.

Table 5.4 Example truncations of chosen synonyms and Boolean operators appl...

Table 5.5 Rationale for inclusion and exclusion criteria.

Table 5.6 Example data extraction tool.

Table 5.7 Factors influencing the implementation of evidence‐based guidelin...

Chapter 6

Table 6.1 Glasgow Coma Scale.

Table 6.2 Richmond Agitation‐Sedation Scale (RASS).

Chapter 7

Table 7.1 Specialised cells and appendages involved in the skin’s functions...

Table 7.2 Patient factors associated with hard‐to‐heal and non‐healing woun...

Table 7.3 Wound assessment should include this information.

Chapter 8

Table 8.1 Complications.

Table 8.2 Clinical features of hypovolaemic shock.

Table 8.3 Investigations table.

Table 8.4 Causes of cardiogenic shock.

Table 8.5 Other causes of cardiogenic shock.

Table 8.6 Management of obstructive shock.

Chapter 10

Table 10.1 EHRs: benefits and barriers.

Chapter 11

Table 11.1 An overview of the four main processes of pharmacotherapy.

Table 11.2 Common respiratory dugs utilised within critical care.

Table 11.3 Physiological and clinical risks of hyperoxaemia.

Table 11.4 Receptors of the autonomic nervous system.

Table 11.5 Common renal drugs.

Table 11.6 Common gastrointestinal drugs.

Table 11.7 Common CNS drugs.

Table 11.8 Common immunomodulatory drugs.

Chapter 13

Table 13.1 Overview of implementing RPS safe administration of medicines gu...

Table 13.2 Quick guide to vascular access devices used for IV medications....

Table 13.3 Rights of medication administration in the CCU patient

Table 13.4 Known common medications causing anaphylaxis

Table 13.5 ABCDE approach.

Table 13.6 Suggested learning guidelines for a new RN in CCU to achieve acc...

Chapter 14

Table 14.1 Glasgow Coma Scale.

Table 14.2 Limb movement.

Table 14.3 Signs and symptoms of increasing ICP.

Table 14.4 Neuroprotective target ranges.

Table 14.5 Commonly used medications in the management of ABI.

Table 14.6 Richmond Agitation‐Sedation Scale.

Chapter 15

Table 15.1 Delirium risk factors.

Table 15.2 RASS.

Chapter 16

Table 16.1 The meaning of the ABG result.

Table 16.2 Normal arterial blood gas values.

Table 16.3 Positive end‐expiratory pressure (PEEP).

Chapter 17

Table 17.1 Partial pressures of gases.

Table 17.2 Inspired and expired air.

Table 17.3 Lung volumes.

Chapter 18

Table 18.1 An overview of the action of adrenoreceptors.

Table 18.2 Hormones involves in the regulation of blood pressure.

Chapter 19

Table 19.1 Characteristic components of common cardiac arrhythmias, possibl...

Table 19.2 Risks associated with arterial and central lines.

Table 19.3 Relevant blood tests as part of a cardiovascular assessment.

Table 19.4 Different methods of advanced haemodynamic monitoring.

Table 19.5 Advanced haemodynamic readings and normal values.

Chapter 20

Table 20.1 Crystalloid and colloids.

Table 20.2 A summary of the main characteristics of crystalloid and colloid...

Table 20.3 IV Fluid management strategies.

Table 20.4 Parameters for fluid resuscitation.

Table 20.5 The 5 Rs of IV fluid therapy.

Table 20.6 Electrolyte concentrations in intravenous fluids.

Chapter 21

Table 21.1 Airway emergencies that may be encountered within critical care....

Table 21.2 Breathing emergencies that may be encountered within critical ca...

Table 21.3 Circulatory emergencies that may be encountered within critical ...

Table 21.4 Neurological emergencies that may be encountered within critical...

Table 21.5 Emergencies concerning exposure, endocrine, electrolyte and envi...

Table 21.6 The SBAR tool.

Chapter 22

Table 22.1 Causes of diarrhoea.

Table 22.2 The Five Ws mnemonic for post‐operative fever.

Chapter 23

Table 23.1 Biochemistry Monitoring.

Chapter 24

Table 24.1 Summary of the functions of the kidney (Peate and Nair, 2017, Jo...

Table 24.2 Functions of the segments of the nephron.

Table 24.3 Pre‐renal, intrinsic and post‐renal causes of AKI.

Table 24.4 Risk factors for AKI.

Table 24.5 Biochemistry investigations.

Table 24.6 Clinical features and findings in AKI and how they may be interp...

Table 24.7 Fundamental principles of RRT in ICU.

Table 24.8 Anticoagulation options for CRRT.

Chapter 25

Table 25.1 Functionality of the pituitary gland.

Table 25.2 Saline and potassium replacement regime.

Table 25.3 Suggested rates of insulin infusion.

Table 25.4 Potassium replacement.

Table 25.5 Suggested rates of insulin.

Table 25.6 Signs and symptoms.

Table 25.7 Signs and symptoms of reduced aldosterone and cortisol levels.

Chapter 26

Table 26.1 The red blood cells.

Table 26.2 Haematological disorders.

Table 26.3 Examples of different types of shock.

Table 26.4 Some types of vasculitis

Table 26.5 Blood groups and compatibility in relation to red blood cells on...

Chapter 27

Table 27.1 The Abbreviated Injury Scale.

Table 27.2 Load‐bearing equivalent of common weight‐bearing terms.

Table 27.3 Differential conditions that can be the cause of weakness in cri...

Table 27.4 Clinical investigations: MRC scale.

Chapter 28

Table 28.1 Classification of burn depth

Chapter 29

Table 29.1

Physiological changes of pregnancy pertinent to critical care nur...

Table 29.2 Normal vital signs in pregnancy.

Chapter 30

Table 30.1 Commonly used transfer terms.

Table 30.2 The transfer process.

Table 30.3 Roles and responsibilities for critical care transfers.

Table 30.4 MINT mnemonic entails considerations for personnel, equipment, a...

Table 30.5 Oxygen cylinder capacities.

Table 30.6 A–E approach and considerations pre‐transfer.

Table 30.7 PERSONAL mnemonic.

Chapter 31

Table 31.1 Five conditions that impact on rehabilitation.

Chapter 32

Table 32.1 Priorities of care.

Table 32.2 Documentation to support advance care planning.

Table 32.3 Symptom management overview (FICM, 2019; Frew and Snell, 2019; P...

List of Illustrations

Chapter 1

Figure 1.1 Layout of a critical care bed space

Figure 1.2 The concept of resilience in nurses.

Figure 1.3 Examples of mechanisms to improve workplace stressors.

Chapter 2

Figure 2.1 Examples of local policies in critical care.

Chapter 4

Figure 4.1 The tripartite model.

Chapter 5

Figure 5.1 Evidence‐based practice: a triad of factors aiming to improve pat...

Figure 5.2 The hierarchy of evidence.

Figure 5.3 Barriers to adherence to evidence‐based practice guidelines in re...

Figure 5.4 The audit cycle.

Figure 5.5 The PDSA cycle.

Chapter 7

Figure 7.1 Anatomy of the skin.

Figure 7.2 Age‐related changes in the skin.

Figure 7.3 Categorises of pressure ulcers.

Figure 7.4 Common sites for pressure ulcers.

Figure 7.5 Presentation of pressure ulcers in different skin tones.

Figure 7.6 Pressure redistribution.

Figure 7.7 Recognising infection.

Figure 7.8 The Levine technique.

Figure 7.9 Integration of the TIMERS framework into wound management (Flanga...

Chapter 10

Figure 10.1 Smartcard and smartcard reader.

Figure 10.2 Critical care bedspace.

Chapter 11

Figure 11.1 Principles of drug actions.

Figure 11.2 The adverse effects of certain drugs upon the kidney.

Figure 11.3 Properties of inotropic drugs.

Figure 11.4 Arterial blood pressure monitoring.

Figure 11.5 Antihypertensive agents and their location of action.

Figure 11.6 Site of diuretic effects upon the nephron.

Chapter 13

Figure 13.1 Decimal place value chart.

Chapter 14

Figure 14.1 Example of a neurone.

Figure 14.2 Subdivision of the nervous system into PNS and CNS.

Figure 14.3 Division of the autonomic nervous system.

Figure 14.4 Anatomical regions of the brain.

Figure 14.5 (a) Lobes of the cerebrum. (b) Functional areas of the brain....

Figure 14.6 Brain herniation.

Figure 14.7 Neurological observation chart.

Chapter 15

Figure 15.1 Delirium.

Chapter 16

Figure 16.1 Respiratory failure and gas exchange.

Figure 16.2 Some useful definitions.

Figure 16.3 Problem identification using article blood gas analysis.

Figure 16.4 ABG analysis.

Figure 16.5 Mask options for CPAP and BIPAP; meeting the needs of the patien...

Figure 16.6 Cuffed endotracheal tube.

Chapter 17

Figure 17.1 Picture of the lung.

Figure 17.2 Picture of the alveoli.

Figure 17.3 Picture of the respiratory centre.

Figure 17.4 Picture of the peripheral chemoreceptors.

Figure 17.5 Auscultation.

Chapter 18

Figure 18.1 Position of the heart and associated structures.

Figure 18.2 Pericardium and heart wall.

Figure 18.3 Internal structures of the heart.

Figure 18.4 The heart valves.

Figure 18.5 The coronary circulation.

Figure 18.6 The cardiac conduction system.

Figure 18.7 The cardiac cycle.

Figure 18.8 Cardiac output.

Figure 18.9 Frank–Starling relationship.

Figure 18.10 Arterioles, capillaries and venules.

Figure 18.11 Capillary exchange.

Chapter 19

Figure 19.1 3‐ and 5‐lead ECG electrode placement.

Figure 19.2 Sinus bradycardia.

Figure 19.3 Sinus tachycardia.

Figure 19.4 Supraventricular tachycardia.

Figure 19.5 Atrial fibrillation.

Figure 19.6 Atrial flutter.

Figure 19.7 Complete heart block.

Figure 19.8 Ventricular fibrillation.

Figure 19.9 Ventricular tachycardia.

Figure 19.10 Asystole.

Figure 19.11 Radial pulse.

Figure 19.12 ECG demonstrating atrial fibrillation.

Figure 19.13 A transducer system.

Figure 19.14 Arterial waveform.

Figure 19.15 Central venous pressure waveform.

Chapter 20

Figure 20.1 The consequences of electrolyte imbalance.

Figure 20.2 The problems leading to fluid and electrolyte imbalance.

Chapter 21

Figure 21.1 Overview of emergencies The ABCDE approach.

Figure 21.2 The ABCDE approach to patient assessment.

Figure 21.3 Adult in‐hospital resuscitation algorithm.

Figure 21.4 Adult advanced life support algorithm.

Figure 21.5 Adult advanced life support algorithm for COVID19 positive patie...

Figure 21.6 Difficult airway tracheal intubation of critically ill adults....

Figure 21.7 Adult bradycardia algorithm.

Figure 21.8 Adult tachycardia algorithm.

Figure 21.9 12‐lead ECG Standard ECG electrode positions, a normal 12‐lead E...

Figure 21.10 Consensus‐based algorithm for the management of severe traumati...

Action Figure 5 Take a blood sample from the side of the finger using a lanc...

Action Figure 13 Insert the test strip into the blood glucose monitor and ap...

Action Figure 14 Read the result.

Figure 21.11 Post‐resuscitation care algorithm.

Chapter 22

Figure 22.1 The anatomy of the gastrointestinal system.

Figure 22.2 The layers of the gastrointestinal tract lining.

Figure 22.3 The anatomy of the hepatic system.

Figure 22.4 Paralytic ileus, showing both large and small bowel dilatation....

Figure 22.5 Erect chest film showing free gas in peritoneal cavity

Figure 22.6 Ultrasound appearances of an abdominal aortic aneurysm. The bloo...

Figure 22.7 Toxic megacolon demonstrated on CT abdomen.

Figure 22.8 Indications and contraindications for use of faecal management s...

Figure 22.9 The ligament of Treitz.

Figure 22.10 An intra‐abdominal pressure monitoring transducer set.

Chapter 23

Figure 23.1 Methods of enteral feeding.

Figure 23.2 Feeding tubes.

Figure 23.3 Confirmation of tube placement.

Chapter 24

Figure 24.1 Factors influencing renal function and renal‐organ cross talk. ...

Figure 24.2 The structure of the vascular supply to the kidney and nephron. ...

Figure 24.3 The Renin‐angiotensin‐aldosterone system – the hormones and thei...

Figure 24.4 The internal structure of the kidney and the nephron.

Figure 24.5 The physiological mechanisms of plasma osmolality and plasma vol...

Figure 24.6 The sites of electrolyte and water exchange within the nephron i...

Figure 24.7 Acid base balance, disorders and compensation.

Figure 24.8 Clinical features and findings in acute kidney injury.

Figure 24.9 The adverse effects of certain drugs upon the kidney.

Figure 24.10 Treatment algorithm for hyperkalaemia.

Figure 24.11 KDIGO classification of CKD (2012).

Figure 24.12 Clinical manifestations of CKD.

Figure 24.13 Renal replacement therapy and absolute indications.

Chapter 25

Figure 25.1 Regulation of the secretion of aldosterone by renin‐angiotensin....

Figure 25.2 Adrenal glands.

Chapter 26

Figure 26.1 Components of blood.

Figure 26.2 Change in RBCs.

Figure 26.3 Signs of Vitamin B12 deficiency.

Figure 26.4 Components of haemostasis.

Figure 26.5 Blood coagulation pathways.

Figure 26.6 The process of DIC.

Chapter 27

Figure 27.1 Post‐operative photographs of the ankle after stabilisation via ...

Figure 27.2 Pathophysiological processes and risk factors in ICUAW.

Figure 27.3 Manual muscle testing algorithm.

Figure 27.4 Critical care. Expert consensus and recommendations on safety cr...

Figure 27.5 The ICU Mobility Scale.

Chapter 28

Figure 28.1 Erythema (Lee, 2020).

Figure 28.2 Superficial dermal injury (Wollinger, 2022).

Figure 28.3 Deep dermal injury (London and South East Burn Network, 2015).

Figure 28.4 Full thickness injury (Wollinger, 2022).

Figure 28.5 Burns response (Lee, 2021).

Figure 28.6 Lund and Browder.

Figure 28.7 Wallace Rule of Nines.

Figure 28.8 Mersey burns app (Mersey Burns app, 2020).

Figure 28.9 Burns patients warming management strategies (Lee, 2020).

Figure 28.10 Facial dressing concealing a facial burn injury (Lee, 2020).

Figure 28.11 Smriti’s burns coverage.

Figure 28.12 Bobs Burn Injury coverage.

Chapter 29

Figure 29.1 Involution of the uterus.

Chapter 30

Figure 30.1 Example of CC transfer trolley.

Figure 30.2 A consensus to determine the ideal critical care transfer bag.

Figure 30.3 Oxygen calculations for the spontaneously breathing patient.

Figure 30.4 Minute volume calculation.

Figure 30.5 Oxygen calculation for the ventilated patient.

Figure 30.6 Critical care transfer flow chart.

Figure 30.7 Transfer checklist handover.

Chapter 31

Figure 31.1 The WHO ICF.

Figure 31.2 The biopsychosocial model.

Figure 31.3 Conceptual model of factors that are included in the World Healt...

Figure 31.4 Conceptual framework of PICS.

Figure 31.5 Clinical Investigation – IPAT.

Figure 31.6 NICE CG83 – key principles of care timepoints.

Chapter 32

Figure 32.1 Structures of the mouth.

Guide

Cover Page

Title Page

Copyright Page

Contributors

Preface

Acknowledgements

How to use your textbook

About the companion website

Table of Contents

Begin Reading

Index

WILEY END USER LICENSE AGREEMENT

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Fundamentals of Critical Care

A Textbook for Nursing and Healthcare Students

EDITED BY

IAN PEATE

Senior Lecturer, Roehampton University; Visiting Professor of Nursing, St George’s University of London and Kingston University London; Visiting Professor, Northumbria University; Visiting Senior Clinical Fellow, University of Hertfordshire, and Editor‐in‐Chief of the British Journal of Nursing

AND

BARRY HILL

Director of Education (Employability) and Assistant Professor, Northumbria University; Clinical Series and Commisoning Editor of the British Journal of Nursing

This edition first published 2023© 2023 John Wiley & Sons Ltd

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Ian Peate and Barry Hill to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

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Library of Congress Cataloging‐in‐Publication Data applied for

Names: Peate, Ian, editor. | Hill, Barry (Lecturer in nursing) editor.Title: Fundamentals of critical care : a textbook for nursing and healthcare students / edited by Ian Peate and Barry Hill.Description: Hoboken, NJ : Wiley-Blackwell, 2023. | Includes bibliographical references and index.Identifiers: LCCN 2022035756 (print) | LCCN 2022035757 (ebook) | ISBN 9781119783251 (paperback) | ISBN 9781119783275 (adobe pdf) | ISBN 9781119783282 (epub)Subjects: MESH: Critical Care NursingClassification: LCC RC86.8 (print) | LCC RC86.8 (ebook) | NLM WY 154 | DDC 616.02/8–dc23/eng/20220822LC record available at https://lccn.loc.gov/2022035756LC ebook record available at https://lccn.loc.gov/2022035757

Cover Design: WileyCover Image: © Grafton Marshall Smith/Getty Images

Contributors

Aileen Aherne, RN, Dip HE (Nursing), BHSc Nursing, MSc Nursing Studies, MSc Advanced Clinical Practice, V300Central Manchester University Hospitals NHS Foundation Trust

Aileen’s interests lie in hepatology, nursing Science and Oncology Aileen has skills and expertise in nursing, palliative medicine, and clinical nursing. She works in the Department of General Surgery at Manchester Royal Infirmary.

Pamela Arasen, RN, FHEA, BScN in Cardiorespiratory Care, MSc in Advanced Practice in Critical care, PGCESenior Lecturer in Critical Care Nursing, University of West London (UWL).

Pamela started her career as a registered nurse after completing a Diploma in Nursing at St Bartholomew School of Nursing, City University in 2005. She spent a few years working in Acute Medical/Surgical wards and A&E, continued her education pathway in a BSc in Cardiorespiratory Care, before moving to Critical Care at West Middlesex University Hospital. She specialised in the Critical Care Outreach Team at King’s College Hospital, after completing her MSc in Advanced Practice in Critical Care in 2015. In 2018, she was appointed as a Lecturer Practitioner in Intensive Care at UWL teaching on the ITU course. She had a joint appointment at the London Northwest Healthcare Trust as the Lead in Education in Intensive Care Nursing, where she introduced the inhouse Intensive Care Adult course with UWL partnership during the COVID 19 pandemic. After the completion of the Academic Professional Apprenticeship, she works as a Senior Lecturer in Critical Care at the UWL, teaching in the Continuous Professional Development modules. Pamela’s special interests are Critical Care, Education and Career Development in Nursing.

Leonie Armstrong, RGN, NMP, Ma Ethics in Cancer and Palliative Care

Leonie qualified as a registered general nurse in 1994. She has worked in the speciality of palliative care for over 25 years in hospices and hospital palliative care services in the North East. Her current role is clinical lead nurse for hospital palliative care at Northumbria specialised emergency care hospital.

Joe Box, RN, BSc, MSc (Advanced Clinical Practice), V300

Joe has worked in emergency surgical admissions for 15 years, initially in Liverpool and Melbourne, before settling in Manchester. Whilst a ward‐based nurse, he facilitated the student nurse programme and received multiple award nominations for mentor of the year and then placement provider of the year. Going back to university to complete a MSc in Advanced Clinical Practice after 10 years of experience, he now works in a Nursing Times award winning team of emergency general surgical Advanced Nurse Practitioners and retains his passion for educating existing staff and the next generation of nurses.

Mark Cannan, MSc, BSc (Hons), Dip HEAdvanced Critical Care Practitioner, Intensive Care, North Cumbria University Hospitals Foundation Trust, UK

Mark entered the health care profession as an Operating Department Practitioner (ODP) in 2013 with the University of Central Lancashire (UCLan), having witnessed the work of an ODP first hand in the theatres of Camp Bastion, Afghanistan. On qualification, he rotated through anaesthetic and scrub practice, in both elective and emergency surgical procedures in two busy district general hospitals. Whilst qualifying with a diploma, he continued in education by completing an Honours Degree in Acute and Critical Care at the University of Cumbria, which is where he discovered the Advanced Critical Care Practitioner (ACCP) role. Having excluded career progression in managerial or educational roles, the ACCP role seemed to best fit his aspirations by being retained at the bedside, performing clinical duties. Mark started his ACCP training with Northumbria University in 2017 and qualified in 2019 with a Post Graduate Diploma and works across two general intensive care units, which increased to four during the COVID‐19 pandemic. Mark has since completed his Master’s Degree and has specialist interests in advanced airway management, regional anaesthesia and transfer of the critically ill patient. He is also on the national working group for legislation change in allowing ODPs who have progressed into advanced practice the ability to undertake non‐medical prescribing.

Tracey Carrott, MA, RGN

Tracey qualified as a Registered General Nurse some 40 years ago (1982) and she has worked in the Northeast of England the entire time. Tracey have witnessed many changes to the provision of health care during this time, however, she is still as passionate about the role as a nurse as she was and when she began nurse training. Tracey’s nursing background and clinical expertise is that of scientific paradigm having predominantly worked within the biomedical domain of critical care. Her current role is that of a Specialist Nurse in Organ Donation (SNOD). This niche role involves promoting and raising awareness about the value of organ and tissue donation. Fundamentally, she has the opportunity to be able to empower a family and to support them should their loved one become an organ and tissue donor. She has been in this role for 12 years although now work part‐time. Prior to becoming a SNOD she worked as a nurse in Cardio‐thoracic critical care and as a nurse practitioner in an accident and emergency department. She also managed a Coronary Care Unit for several years. Tracy has always had an avid interest in education and posess an MA in Advanced Practice. She is also a Registered NMC Lecturer Practitioner, having achieved a Post Graduate Diploma with Commendation in Health and Social Care Practice, Education and Development.

Iain Carstairs, MBBS, BSc (Hons) Pharmacology and NeuroscienceSpecialist Grade Doctor in Anaesthetics.

Iain studied medicine at Newcastle University and practiced his early career in the speciality of Emergency Medicine at Edinburgh Royal Infirmary. In 2009 he transferred to the speciality of anaesthesia within the Northern Deanery and currently works as a Specialty Grade Anaesthetist at Northumbria Healthcare NHS Foundation Trust. In his current role Iain provides planned and emergency care across a range of clinical settings that includes theatres, obstetrics, pre‐assessment and CPEX, and critical care to patients of all age ranges. He supports the clinical education and development of many members of the multidisciplinary team including trainee doctors, ODPs and Physician Associates. Iain is a member of the Association of Anaesthetists of Great Britain and Ireland and an SAS member of the Royal College of Anaesthetists.

Victoria Clemett, PhD, RN (adult), BNurs, FHEA

Victoria began her nursing a career as a healthcare assistant before completed her registered nurse (RN) training at The University of Birmingham, UK in 2005. Following her junior staff nurse rotations at The University Hospital Birmingham, she specialised in burns and reconstructive practice surgery. Victoria relocated to the southeast and moved into research and education. Victoria is an NMC registered teacher and has several years’ experience in nurse education. Special interests include wound care, clinical decision making, translational research and simulated learning.

Sarah Crowe, MN, PMD‐NP(F), CNCC(C), NPCritical Care Nurse Practitioner, Surrey Memorial Hospital, Fraser HealthAdjunct Professor, School of Nursing, University of British ColumbiaInstructor, Critical Care Speciality Nursing Program, British Columbia Institute of TechnologyPresident, Canadian Association of Critical Care Nurses Adjunct Professor, UBC School of NursingSarah began her nursing career at Surrey Memorial Hospital in 2000 in the Emergency department before transitioning to critical care in 2004. She completed dual specialty certification in both Emergency and Critical Care Nursing. She went on to complete a Master’s of Nursing in 2010, and a post‐Master’s graduate diploma in Nurse Practitioner in 2018. Her key areas of research and interest are in ICU survivorship, chronically critically ill patients, and supporting the mental health and practice of critical care nurses. She has received several research grants for her work. Sarah is currently the Vice President of the Canadian Association of Critical Care Nurses.

Stuart Cox, BSc (Hons), MSc (ACCP), mFICMAdvanced Critical Care Practitioner, University Hospitals Southampton NHS & Dorset and Somerset Air Ambulance.Stuart works as an Advanced Critical Care Practitioner (ACCP) at University Hospitals Southampton NHS & Dorset and Somerset Air Ambulance. Prior to this he was employed as a Senior Charge Nurse ICU at Southampton and Senior Nurse CEGA Air Ambulance. He graduated with a BSc (Hons) in Nursing Science and completed his MSc in ACCP in 2018. Stuart is a Registered Nurse with the Nursing and Midwifery Council (NMC), and an ACCP with membership with the faculty of intensive care medicine (FICM).

Sadie Diamond‐Fox, MCP ACCP (mFICM), BSc (Hons) RN, PGCAHP, NMP (V300), FHEA

Sadie Diamond‐Fox graduated from Northampton University in 2008 with a BSc (Hons) Adult Nursing and immediately began her critical care career, initially working at Papworth and Cambridge Hospitals. In 2012 she moved to Newcastle upon Tyne Hospitals to commence training as an Advanced Critical Care Practitioner, completing a Masters of Clinical Practice in Advanced Critical Care Practice (ACCP) in 2015 and was awarded ACCP membership to the Faculty of Intensive Care Medicine in 2016. Sadie has since continued to work clinically as an ACCP alongside developing an extensive teaching portfolio with Northumbria University, and is currently studying a PhD (The ‘ImpACCPt’ study). Sadie has several national roles in the fields of advanced practice and critical care, including her more recent appointments with Health Education England (HEE) as Regional Advancing Practice Supervision and Assessment Lead for North East & Yorkshire, the Intensive Care Society as Council Member, Education Committee Member and Chair of the Professional Advisory Group for Advanced Practitioners in Critical Care (APCC PAG). Sadie also co‐chairs the Advanced Clinical Practitioners Academic Network (ACPAN).

Rana Din, RGN BSc (Hons) Nursing (Manchester Metropolitan University), MSc Advance Clinical Nursing Skills (University of Huddersfield), PGCELecturer, University of Salford

Rana began his nursing career at Birch Hill Hospital in Rochdale working within Medicine/Surgery and ICU. The majority of his career has been based in Critical Care in the North West of England in various roles as Practice Educator, Charge Nurse and Matron. Also he has had extensive experience of working in nurse education at the University of Chester, University of Bolton and currently at the University of Salford.

Alexandra Gatehouse

Alexandra Gatehouse graduated from Nottingham University in 2000 with a BSc (Hons) Physiotherapy. Following Junior Rotations in the Newcastle Trust she specialised in Respiratory Physiotherapy in Adult Critical Care, also working within New Zealand. In 2012 she trained as an Advanced Critical Care Practitioner, completing a Masters in Clinical Practice in Critical Care and qualifying in 2014. Alex subsequently completed her non‐medical prescribing qualification and continues to rotate within all of the Critical Care Units in Newcastle Upon Tyne, also enjoying teaching on the regional transfer course. She is a co‐founder of the Advanced Critical Care Practitioner Northern Region Group and is a committee member of the North East Intensive Care Society. Alex has presented abstracts at the European Society of Intensive Care Medicine and the North East Intensive Care Society conferences.

Kirstin Geer, BSc (Hons) MSc (Advanced Clinical Practice) PGDip (Advanced Critical Care Practice) mFICM. Advanced Critical Care Practitioner, North Cumbria Integrated Care, UK

Kirstin qualified as a nurse in 2005 and has worked in Emergency Admissions, Critical Care Outreach and qualified as an Advanced Critical Care Practitioner in 2016.

Special interests include Critical Care Transfer and Simulation.

Jan Guerin, Dip General Nursing (RSA), BSc Nursing Education (RSA), PGD ANP(UK), Diploma General Adult Critical Care (RSA), Diploma Trauma and Emergency Nursing Science (RSA). Certified Lifestyle Medicine Practitioner (UK)

Jan is currently in a role as a General Manager of a residential adult care home, working for Signature Senior Lifestyle in the UK. Jan qualified as a General Registered Nurse in South Africa in 1992. She gained 12 years of accumulative experience working in acute care settings within the field of adult emergency and critical care including 4 years as a lead lecturer for Trauma and Emergency Nursing. Jan moved to the UK in 2006 and joined Hammersmith Hospitals NHS Trust as a Senior Staff Nurse in adult General ITU which included a year of secondment experience in Critical Care Outreach at Charing Cross Hospital. In 2017, Jan worked for the Hillingdon Hospitals NHS Trust and in the roles as an ITU Nurse Educator and Practice Nurse Educator as lead for Clinical skills. Jan moved to adult social care nursing in 2020, and is in a role as a Quality Business Partner with Sunrise‐Gracewell Senior Living. Jan has a special interest in health promotion and prevention of chronic disease and is a certified Lifestyle Medicine Practitioner.

Barry Hill, MSc, ANP, PGCAP, PGCE, BSc (Hons), DipHE, O.A. Dip, Fellow (FHEA), NMC RN & TCH & V300

Barry completed his Registered Nurse (RN) training at Northumbria University and Buckinghamshire Chilterns University College (BCUC). Barry’s clinical experience is within critical care nursing which has been gained at Imperial College NHS Trust, London, UK. Barry is critical care certified, has a clinical master’s in advanced practice (clinical), and has a PGC in Academic Practice. Barry is registered with the NMC as a Registered Nurse, independent and supplementary prescriber (V300), and Registered Teacher (TCH). Barry is currently the Director of Education (Employability) and Assistant Professor at Northumbria University. He teaches undergraduate and postgraduate students from all clinical healthcare disciplines. His key areas of interest are clinical education, acute and critical care, clinical skills, prescribing and pharmacology, and advanced‐level practice. Barry has published books, book chapters, and peer‐reviewed journal articles. He is a Senior Fellow with the Higher Education Academy (SFHEA) and Clinical Series and Commissioning Editor of the British Journal of Nursing.

Paul Jebb, OStJ MA, BSc(Hons), DipHE RN

Paul qualified as a nurse in 1996 and worked in numerous posts within nursing, operational management and a national role within NHS England.

In December 2016 Paul returned to an NHS Trust and is now Associate Chief Nurse Experience, Engagement & Safeguarding at Lancashire & South Cumbria NHS FT.

Paul has been involved and led on numerous quality improvement initiatives throughout his career, and has gained several awards and accolades.

Paul is also a member of an NMC Professional Standards advisory panel, and has represented the Royal College of Nursing at local, regional, national and international levels, and is currently a member of the RCN Nurses in Leadership & Management Forum steering group as well as a member of RCNi Editorial Advisory Board.

Paul also holds an Honorary Senior Lecturer post at the University of Central Lancashire.

Paul is also chair of the board of Trustees at Blackpool Carers Centre, and a passionate supporter of Cavell Nurses Trust.

Timothy Kuhn, RN, MSc, PgDip, BSc (Hons), Senior Lead Nurse Critical Care and Critical Care Outreach, Advanced Critical Care Practitioner

Timothy is a Registered Nurse educated to Master’s level. He has extensive experience in critical care nursing with both senior clinical and senior management skills and experience. Timothy is also a Faculty of Intensive Care Medicine (FICM) accredited Advanced Critical Care Practitioner. In addition to his professional experience, he has a wealth of experience in the voluntary sector. Some of his interests include ‐ nurse development and education, management, team development, clinical governance, vascular access, extracorporeal organ support, first aid teaching/training and voluntary sector work.

Nicole Lee, RN, BSc, PGCE

Nicole Lee, Burns Matron Chelsea and Westminster hospital, Lead Nurse London and South East Burns Network and Co course Lead Advanced Burns Module, University East Anglia. My Burns History takes me back to starting within the burns speciality in 2008 in St Andrews (Chelmsford) Burns ITU, where I worked for 15 Years from band 5 up to band 7 clinical facilitator looking after the large burns that required burns ITU multi organ support. I took on the burns lead nurse role for the network in 2019 where I am able to support regional and national change to our specialist burns services. In 2020 I took on the Burns Matron role at Queen Victoria Hospital for one year and moved on to Burns Matron at Chelsea and Westminster in 2021. Additional Specialist interests are Simulation training, Burns education, Burns prevention and supporting burns and critical care charities.

Emma Long, BSc (Hons) Nursing, Msc Advanced Nursing.Practice Development Sister, Intensive Care, Chelsea & Westminster Hospital, London

Emma qualified in 1997. She started her Critical Care Nursing Career in 1998. She has worked not only in the UK (in London and Belfast) but also within the field in Australia. Emma has an interest in nursing education and is currently studying to become one the first Professional Nurse Advocates.

Fiona McLeod, RN, BScN, BSc, CNCC (C)Manager of Clinical Operations, Critical Care and Biocontainment, Surrey Memorial Hospital.

Fiona began her nursing career at Surrey Memorial Hospital in 2007 in the ICU after graduating with a BScN from British Columbia Institute of Technology with Honours and winning the Associate Dean’s Prize for Excellence in Clinical Nursing. Shortly after graduation she went on to complete her specialty certification in Critical Care. Fiona has spend her entire career in Critical Care starting as a bedside nurse and transitioning into many leadership roles throughout her time at Surrey Memorial Hospital. Fiona is also a member of the Canadian Association of Critical Care Nurses.

Aurora Medonica, PG Cert, BSc (Hons), MSc, NMC V300, mFICMAdvanced Critical Care Practitioner, Oxford University Hospitals Foundation Trust

Aurora began her nursing career in Italy with a BSc in Adult Nursing. She then moved to Oxford (UK), where she worked as registered intensive care nurse, deputy sister and advanced critical care practitioner in the cardiac and thoracic intensive care unit.

She also collaborated with Oxford Brookes University as a Specialist Lecturer and with the British Association of Critical Care Nurses, where she presented her MSc dissertation findings at the latest conference.

Her key areas of interest are intensive care and advanced practice.

Helen Merlane, MSC, BA (Hons), PGCE, PGDip HE, FHEA

Helen began her nursing a career at St James University Hospital, Leeds working on a medical and surgical ward, before becoming a Macmillan Clinical Nurse Specialist in Palliative Care in 1994. She worked as a Macmillan Nurse for 21 years at St James’s University Hospital Leeds & the Freeman Hospital, Newcastle upon Tyne. Helen took up the role of a senior lecturer at Northumbria University in 2015, and teaches on the preregistration, apprenticeship and master’s adult nursing programmes. She is currently undertaking a PhD, looking at what factors prepare student nurses to care for dying patients. Her key interests are palliative and end of life care.

Gerri Mortimore, PhD, MSc Advanced Practice; PgCert (IPPE); Ba(Hons) Health Studies; iLM, RGN, NMP, FHEA

Gerri is a RGN, with over 40 years’ experience, spanning both acute medical and surgical nursing, within the UK and abroad. This nursing expertise, especially within the field of liver disease has enabled her to be selected as an expert advisor on three National Institute of Health and Care Excellence (NICE) Clinical Guidelines and two Quality Standards and be a specialist member of an Advisory Committee in patients with suspected alcohol related liver disease. In 2015, in recognition of her contribution to NICE, Gerri was awarded the title, Nurse Expert Advisor.

In 2020, along with her co‐authors Gerri successfully authored the Venesection Best Practice Guidelines, endorsed by the Royal College of Nursing. This publication has assisted in standardising the care of thousands of UK patients undergoing venesection every year and culminated in Gerri winning the prestigious British Journal of Nursing, Nurse of the Year Award in 2021, nominated by the NMC.

Currently, Gerri is employed as an Associate Professor in Advanced Clinical Practice at the University of Derby and is also a Government Commissioner for the Commission of Human Medicines.

Lorraine Mutrie, Ma, PGC, BSc (Hons), DipHE, RN, FHEAAssistant Professor and Programme Leader for Adult Critical Care Nursing and Advanced Practice.

Lorraine completed her registered nurse training at Leeds University and her early career was in surgical nursing. In 2005 she returned to the Northeast and continued her nursing career in critical care roles.

Since 2015 Lorraine has worked at Northumbria University leading on post registration programmes and modules in acute and critical illness and advanced practice. She also contributes to teaching on pre‐registration healthcare programmes. Lorraine has published on topics related to critical care in textbooks and peer reviewed journal articles. Her research interests include the critical care workforce, and she is currently undertaking a PhD on this topic.

Lorraine was former chair of the Northern Region BACCN committee, is a current member of the NoECCN Education Group, and contributed to the development of the NoRF Level 1 Competence Framework.

Jacqueline Newby, BA

Jacqueline Newby is a specialist nurse in organ donation for NHS Blood and Transplant. She has been a nurse for 32 years working in intensive care or organ donation where she has been involved in developing and managing change in the dynamic field of donation and transplant.

Geraldine Fitzgerald O’Connor, BA (Hons)Practice Development Sister, Intensive Care, Chelsea & Westminster Hospital, London

Geraldine began her nursing career studying at both Oxford Brookes University and at the University of Pennsylvania, Philadelphia. She followed a Specialist Nursing rotation following graduation and has continued working within Intensive Care since.

Geraldine has an interest in nursing education and is one of the first Professional Nurse Advocates.

Samantha O’Driscoll, RN (Adult), PGDip, BSc (Hons)Senior Clinical Educator, Critical Care, Imperial College NHS Trust

Samantha studied Physiological Sciences at Bristol University. Whilst undertaking this degree she worked as an HCA at the Bristol Royal Infirmary, sparking a desire to pursue a career in nursing. She achieved a Post Graduate Diploma in Nursing from King’s College, London. During her nursing training she developed a love for critical care nursing, blending her human sciences background with compassionate care. She worked as a Staff Nurse in Adult Intensive Care at St Mary’s Hospital, Paddington, before moving into Emergency Department nursing and working as an Outreach Practitioner. She holds a postgraduate certificate in critical care and is an ALS instructor. Throughout her career she developed her skills in practice‐based coaching and teaching. She now works in clinical education, with an interest in clinical development and the use of simulated practice to support learning.

Dr Vikki Park, PhD, PG Dip., PG Cert., BSc (Hons), FHEA, HEA Mentor, RN, RNTAssistant Professor in Nursing & IPECP (Interprofessional Education & Collaborative Practice), Northumbria University, UK