[HF6213, Intensive care, 1964, Length: 00:18:26, Color, Sound.

This Beta SP was duplicated from a 16mm answer print by Bono Film & Video, Inc. for the National Library Medicine, November 2010]

[Screen dark, countdown]

[Narrator:] This is one of the most important buildings in any community, its hospital. 

Within these walls a variety of medical services are performed.

Ever-expanding, ever-changing in application and scope. 

Responsible for care during so many phases of life. 

It's bringing forth, it's preservation, and continued good health into later years. 

The modern hospital faces many problems in caring for the population of a growing community and a growing nation.

To help foster better hospital facilities and better, more efficient care, 

many hospital authorities and members of the medical and nursing professions are applying a concept known as progressive patient care. 

In this film we shall explore a major element of this concept, the element of intensive care.

[Music]

[The U.S. Department of Health, Education, and Welfare, Public Health Service presents]

[A Public Health Service Audiovisual Facility Production]

[Intensive Care]

[Produced for Division of Hospital and Medical Facilities]

[John Shaffer:] Hello, I'm John Shaffer. As the administrator of a hospital which has established a program of progressive patient care, 

I've been asked to tell you something about it, particularly about one phase of it, intensive care.

I've asked Miss Carolyn Jones, who is head nurse of our 27-bed intensive care unit, to assist me.

We've chosen to discuss intensive care because in the planning and implementation of a complete, 

or even a partial program of progressive patient care, the setting up of an intensive care unit 

represents a major consideration and a logical first step.

To begin with, let's review briefly all the elements of progressive patient care 

to see where intensive care fits into the overall concept. 

Generally, progressive patient care, which groups patients according to their care needs, is composed of six elements.

For the critically or seriously ill patient who needs constant observation and highly skilled nursing care, there is intensive care.

For those patients who are moderately ill, on their way to recovery, 

or terminally ill and requiring palliative treatment, there are the services of intermediate care.

Ambulatory patients who are convalescing, and those requiring only diagnosis and therapy, can be treated in a self-care unit.

To care for those who may be hospitalized for prolonged periods, 

such as patients requiring extensive rehabilitation and physical therapy, there is long-term care.

Hospital-administered services are extended to a patient's own home,

with the help of other health organizations, by a home care unit.

And finally for those patients who visit the hospital only for diagnosis and treatment,

and do not require a bed, there is outpatient care. 

These are the basic elements of a complete progressive patient care program, 

and depending on the hospital and the individual community's resources and needs, 

a progressive patient care program can be composed of all these elements, or perhaps just two or three of them.

Now let's take a closer look at intensive care, in terms of the planning that must go into the setting up of such a unit, 

its physical requirements and its staffing and administration.

The purpose of intensive care is to place critically and seriously ill patients in an area where they can be under constant observation, 

where they can receive immediate attention for any emergency.

Patients here may include severe burns or multiple fractures,

major gastrointestinal hemorrhages,

major surgical cases just released from the recovery room will require continued observation after the post-anesthesia phase.

Patients with critical injuries

or acute coronaries.

In addition to the seriousness of the patient's condition, his clinical diagnosis, 

an important criterion for placing him under intensive care is the nature of the nursing care required. 

Those requiring the most constant attention would be placed here. 

How does a hospital interested in establishing an intensive care unit begin its planning? 

This is one way to do it. This is the way we did it.

A preliminary step was the designation of a patient evaluation team. 

This team included the hospital administrator and selected members of the medical and nursing staffs.

We had the responsibility of evaluating the care requirements of all the patients in the hospital. 

To do this we developed a checklist of patients' needs to use as a guide in determining care requirements. 

This checklist is based on the patient's need for observation, physical assistance, and special medical or nursing skills and equipment. 

Although this list is by no means exhaustive, it was possible for us to classify our patients fairly well.

For example, under need for observation, we included the frequency of checking temperature, pulse, respiration, 

blood pressure and degree of consciousness. 

The need for physical assistance included bathing, mobility, and need for assistance with meals.

Special medical or nursing skills and the use of special equipment is involved when oxygen therapy, transfusion or infusion are called for,

or when aspiration of a tracheostomy tube is needed.

With the help of this checklist, our patient evaluation team next determined criteria for patient classification, 

classification which allowed us to determine the most appropriate care unit for each patient.

Having established criteria for patient classification, the patient population was observed daily for three months, 

and an average census established in terms of care need. 

This census was the determining factor in estimating the average number of beds which our hospital would need for intensive care.

On some days the census indicated a need for 26 beds, and on other days the census was as low as 10. 

We decided from this that we would need a basic intensive care unit of 17 beds.

From the study estimating bed needs by the Public Health Service, we found that for our average daily census of 19, 

we would need about 10 additional beds to provide for our fluctuation in census.

This model shows the arrangement of our intermediate and intensive care units, 

and on it you can see how our intensive care unit provides for our census fluctuation. 

The intensive care unit consists of a larger intensive care rooms and several adjacent two-bed rooms.

These two-bed rooms are so equipped and located that with proper staffing 

they can be used for either intensive care or intermediate care patients. 

We refer to these rooms as our flexible zone.

Our intensive care rooms plus the additional beds form a patient care unit under the direction of a head nurse. 

Should our need for intensive care beds increase, additional beds can be provided, 

because our intensive care unit is adjacent to an intermediate care unit.

Having seen briefly how we establish the bed needs of our intensive care unit, 

let's look for a moment at an intensive care room. 

As I stated before, one of the purposes of intensive care is to place critically and seriously ill patients 

in an area where they can be under constant observation.

We found that a room layout was required in which the nurse or nurses on duty could see and hear 

all patients at all times, and in which they can reach each patient quickly when necessary.

Also important is ample space between beds to allow the nursing team to work comfortably with any equipment necessary at the bedside. 

One such layout is this six-bed room which we adopted. 

In this arrangement, the nurse can observe all patients from the desk or any other point in the room.

An alternative to the six-bed room is our five-bed arrangement.

In this room the beds are separated by partitions, with glass from 40 inches above the floor to the ceiling. 

The partitions provide some degree of privacy but still do not obstruct the nurses' view of all patients.

Rooms with fewer beds have been adapted to intensive care use in some hospitals, 

but the principle that a nurse be on duty in the room at all times must be adhered to. 

We have found the five and six-bed rooms to be the most economical and efficient arrangements for intensive care rooms, 

particularly from the standpoint of the nurse-to-patient ratio. 

These are some room layouts and bed arrangements for intensive care.

Equally important to the size and type of room is the equipment. 

Intensive care calls for the availability of much special equipment and a highly skilled nursing staff to use it.

Miss Jones, you helped plan and set up our intensive care unit. 

Would you tell us a little more about it? 

[Carolyn Jones:] First, let's take a look at the equipment in one of our intensive care rooms. 

In this six-bed room much of the equipment is immediately accessible at each bedside.

For example, at every bedside there is an oxygen needle valve outlet with flowmeter and humidifier attached. 

Suction outlets with a regulator, pressure gauge, and vacuum bottle are all at hand.

Sufficient electrical outlets with the proper voltages are present to handle portable equipment. 

Also available over each bed are intravenous rods.

Wall-mounted sphygmomanometers are at each bedside and a call outlet for the nurses' use in an emergency. 

Medications and emergency drugs are kept in the medication cabinet.

Equipment and supplies not at bedsides are readily available in the room.

Necessary supplies are on mobile carts and include such equipment as might be needed to perform emergency procedures. 

Clean linens are kept on a cart in the storage room.

Special equipment such as a pacemaker and a defibrillator may also be kept in the intensive care room.

Any needed items which are not at hand can be ordered quickly by telephone or intercom from the nurses' station or the supply area,

but most important to intensive care patients is a well-trained, highly skilled nursing staff.

We had a two-week orientation for our staff on the policies and procedures for the intensive care unit, 

and have a continuing in-service program on special procedures, use of new equipment, new medications,

and care of patients with special problems.

Nurses responsible for intensive care must have the technical skills to provide a variety of special nursing services. 

They must also be suited in temperament and personality to work efficiently under pressure in dealing with many emergency situations.

Adequate staffing 24 hours a day is necessary in an intensive care unit. 

The size of the staff may vary according to the number of patients, 

but at least one professional nurse is present in our intensive care room at all times.

A graduate nurse and a practical nurse or a nurse's aide are usually required in a five- or six-bed room, 

which compares with a nurse and an aide to 12 to 14 patients on intermediate care.

Sometimes one or more additional nurses may be needed to care for the very sick patients requiring full-time attention.

The nurses in our unit ask to work there and have found the work quite rewarding. 

We have several other nurses who are prepared to work in the unit 

and are called on to fill in during vacations, illnesses, or as permanent replacements.

We come now to the operations aspect of an intensive care unit. 

Our intensive care unit admits both medical and surgical patients, some directly from the recovery room, 

some from the emergency room and some from other patient units.

In many respects, its administration is similar to other units, but there are some exceptions. 

In the case of admissions, while many patients will be admitted to intensive care through standard procedure, 

a system for direct admission of emergency cases has been arranged in this hospital.

This is accomplished by allowing the physician to call directly to the head nurse of the intensive care unit 

to see whether a bed is available. If not, we have a special procedure to follow in arranging for a bed.

Through his call, the doctor then arranges for a bed, orders medications, intravenous fluids if necessary, 

and equipment to be available immediately upon the patient's arrival.

The time saved by this direct admissions procedure has been vital to several critically ill patients.

Another procedure useful in our intensive care is the keeping of a special record form for each patient. 

The form covers a 24-hour period and includes temperature, pulse, respiration and blood pressure 

taken every two hours or as often as ordered, as well as measurements of fluid intake and output.

Although intensive care patients are allowed visitors, we limit visits to about five minutes on the hour. 

This has proved satisfactory to our patients and most visitors.

A family waiting room is located near the unit to permit relatives to be close to the patient without interfering with his treatment. 

Since the dietary needs of patients in intensive care vary greatly and change frequently, 

a flexible dietary service is especially necessary.

In order to give the intensive care nurse every opportunity to devote her full attention to her patients, 

certain services are made available to her.

Soiled and used equipment is collected by an aide or orderly at frequent intervals.

Supplies are replaced and replenished regularly according to a prearranged schedule. 

This relieves the nurse of having to check inventory and prepare requisitions.

[John Shaffer:] Thank you, Miss Jones. 

We have shown you some of the requirements and the kinds of services which add to the efficient operation of the intensive care unit, 

a major element of progressive patient care.

The setting-up of such a unit has many requirements. 

Careful planning and teamwork are required at the outset.

A thorough evaluation of the hospital's needs should be made. 

Flexibility should be provided for in all plans.

A highly skilled staff must be oriented to new methods, trained in new procedures. 

Definite administrative policies must be established, and patients and public informed about the operations of the unit.

We have found that our intensive care unit meets the needs of our critically ill patients, 

assures the doctor of close and careful observation of his patients and makes better use of personnel. 

This unit was our first step toward a more complete program of progressive patient care.

[Music]

[Technical Advisors: Charles F. Wagner, Josephine Strachan]

[Directed by: Jack C. Kirkland]

[THE END]