Course Rationale and Philosophy
Rationale
Background to the course, its essence and special characteristics
The Department of Health (DH) carried out an extensive review of adult critical care services within the United Kingdom. Comprehensive Critical Care – a review of adult critical care services (DH, 2000) developed the philosophy of 'Critical Care without Walls' – recognising that critically ill patients were receiving care from a variety of practitioners within a range of healthcare settings, not just the intensive care unit (ICU). To support this the DH (2000) devised a patient dependency system whereby patients with one organ failure were defined as dependency Level Two and those with two or more organ failure were defined as dependency Level Three. Level Two and Level Three dependent patients are both defined as critically ill patients. The review also demonstrated that through such diversity of care settings, critically ill patients were sometimes cared for by practitioners often lacking the skill and knowledge base for this dependency of patient. The Response to Comprehensive Critical Care (DH, 2001) recommended that critical care education needed to extend to a variety of acute practitioners beyond the environment historically associated with caring for the critically sick- the Intensive Care Unit. A subsequent report by National Confidential Enquiry into Patient Outcome and Death (2005) indicated that despite the recommendations and developments from the Department of Health, there is a still a high proportion of avoidable admissions to critical care areas. Consequently, this Programme aims to support development of practitioners in this area.
Another aspect of critical care education currently regarded to be lacking was the absence of any measurable critical care competencies throughout the current Programmes of study on offer. Again, in light of the recommendations in the Nursing Response to Comprehensive Critical Care (DH, 2001), this needed to be urgently addressed. The National Institute for Health and Clinical Excellence (2007) published 'Acutely Ill Patients in Hospital' comprising a set of recommendations for the recognition of and response to acute illness. An integral component of this document is the recommendation that staff should have competencies, appropriate to the level of care they provide in four distinct areas:
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Monitoring
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Measurement
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Interpretation
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Prompt response
Finally, the emergence of the Personal Development Review with Agenda for Change (DH 2004) has demonstrated that a greater number of practitioners are now wishing to be supported in gaining a degree. This has also been driven by the Knowledge and Skills Framework inherent with Agenda for Change (DH, 2004). Within acute and critical care, the majority of practitioners are already at or near to diploma level, but in many cases are using practical skills which evidence Honours academic thinking. They now require an educational Programme to support this.
Philosophy
Driven by national policies and audits including Critical to Success (Audit Commission, 1999), Comprehensive Critical Care (DH, 2000), National Confidential Enquiry into Patient Outcome and Death (2005) and Acutely Ill Patients in Hospital (NICE 2007) the vision encapsulated in this Programme is to support the development of intelligent, articulate and respected acute and critical care practitioners up to and including the level of Specialist Practice.
The Programme will develop autonomous practitioners able to work within the inter-professional team in a variety of settings caring for acute and critically ill patients, within both the primary and secondary care settings. By equipping practitioners with a diverse range of knowledge, skills and attitudes, the Programme will enable greater use of staff to work within a variety of settings as the needs of society and government policies change. Advances in medical care and technology, coupled with the shifting demographic demands of an increasingly elderly population, are resulting in patients within primary, secondary and tertiary care being sicker with a diversity of chronic and acute conditions. Consequently, practitioners must be able to respond to such increasing demands.
However, another important aspect of this Programme is the aim to nurture a patient centred approach which fosters inter-professional working and embraces an holistic approach to patient care. Such an approach will break down professional barriers in the best interests of the patients and their families. The psychosocial aspects of acute and critical care for the patients and their relatives are recognised as well as the physical aspects of care. Ostensibly, the Programme aims to explore the real essence of acute and critical care practice.
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