In house Continuing Nursing Education (CNE) on “Shaping Excellence in Critical Care Nursing” at Kauvery Hospital, Cantonment
Cecily Ruba, Mahalakskmi
Department of Nursing, Kauvery Hospital, Cantonment
Background
The Continuing Nursing Education (CNE) Program, “Shaping Excellence in Critical Care Nursing” was conducted on October 29th 2024. This important program was initiated by our honourable Nursing Superintendent Mrs. Maha Lakshmi in collaboration with Cecily Ruba Nurse Educator Cantonment. The total members who attended the event is 50 and that includes
Organizing Chairperson: 1
Organizing Secretary: 1
Doctors: 2
Phamacist: 1
Speakers (Nurses): 11
Dietician :1
Delegates-36 (Thennur -5, Maa Kauvery-3,
Heartcity-5 Cantonment-26)
Objective
The Primary objective of this CNE Program was to enhance the proficiency and competence of critical care nurses through advanced educational and training. This will be fostering excellence in patient care, clinical decision making and professional development in the high stakes environment of critical care.
Program overview
CN program covered 10 pivotal topics delivered by esteemed speakers
Pretest: Ms. Christine Rajathi, Nursing in charge initiated the program with pretest utilizing QR codes .
Session 1: “Integrative Approaches to Hemodynamic Monitoring and ABG Analysis” By Ms. Deep, Nursing Supervisor Kauvery Hospital
She highlighted the importance of hemodynamic monitoring in critical care, noting that it provides vital information about cardiovascular function and organ perfusion. She discussed both non-invasive methods, such as arterial pressure waveform analysis, and invasive techniques. Ms. Deepa emphasized hemodynamic data to guide patient treatment and improve outcomes.
She focused on ABG analysis, explaining its significance in assessing oxygenation, ventilation, and acid-base balance in critically ill patients. She broke down key ABG components, such as pH, PaO₂, PaCO₂, bicarbonate (HCO₃), and oxygen saturation (SaO₂), explaining their clinical relevance. Deepa demonstrated how ABG results should be interpreted in light of the patient’s condition, guiding interventions like ventilator adjustments and fluid management. She also shared case studies to help nurses practice interpreting ABGs alongside hemodynamic data, reinforcing the integration of both tools in decision-making.
Session 2: Ms. Merina, Senior Safety Nurse, delivered an insightful session on the “Effective utilization of critical nursing tools” in improving patient care during the CNE program.
She emphasized the importance of using evidence-based tools to assess and manage patient risks in the critical care setting. One of the key tools discussed was the CPOT (Critical Care Pain Observation Tool), which helps assess pain in non-verbal or critically ill patients, ensuring timely pain management.
She also presented the Braden-Wells Scale, a well-established tool for assessing pressure injury risk.
She discussed the Morse Fall Risk Scale, a tool used to assess the risk of patient falls, which are common in the ICU. By evaluating factors like history of falls, mobility, and mental status, the Morse scale helps nurses implement fall prevention strategies, enhancing patient safety
Session 3: Dr. Thaddeu, Registrar at the CCU, led an in-depth session on “Managing patient care on Mechanical ventilation and respiratory care”.
He began by explaining the basics of respiration, highlighting how the lungs and respiratory muscles work together to facilitate gas exchange and maintain oxygenation. He emphasized the importance of understanding ventilator mechanics to effectively manage patients on mechanical ventilation. He explained how ventilators assist in controlling inhalation and exhalation, ensuring that both the tidal volume and respiratory rate are adjusted to meet the patient’s needs.
He outlined the different ventilator modes, including assist-control, synchronized intermittent mandatory ventilation (SIMV), and pressure support, explaining when and why each mode would be used based on the patient’s condition. He discussed how positive pressure ventilation helps overcome the work of breathing in patients with respiratory failure, while also preventing atelectasis and improving oxygenation. The session also covered the common diseases that affect inspiration and expiration, such as chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), and pneumonia. He highlighted how these conditions influence ventilator settings and the need for careful monitoring and adjustment.
The discussion included the role of PEEP (Positive End-Expiratory Pressure) in preventing alveolar collapse, particularly in ARDS patients, and how it aids in improving oxygenation. Additionally, Dr. Thaddeus discussed how to wean patients off ventilation when they show signs of improved respiratory function, emphasizing the need for a gradual reduction in support to avoid respiratory distress.
Session 4: Ms. Surya Prabha, Assistant Manager of Clinical Research, delivered a session on “Safe medication practices “and the importance of “standardized drug dilution”.
Ms. Surya Prabha highlighted the importance of understanding drug properties, including concentration, dosage, and administration routes, to prevent errors. She stressed that standardized drug dilution protocols help reduce variability and ensure consistency in drug preparation. The session focused on the need for accurate calculations in dilution to avoid overdose or under dose, which can lead to serious complications.
She explained that ongoing staff education is key to maintaining high standards of medication safety
She advocated for a culture of safety, where staff feel comfortable reporting errors without fear of reprimand, allowing for continuous improvement
Finally, she stressed that collaborative communication among health care teams is critical when managing complex medication regimens, particularly in critical care settings.
Session 5: Ms. Sneka Priya, Dietician, delivered an informative session on “Essential nutritional support for patients in critical conditions”
She explained that nutrition plays a pivotal role in the recovery of critically ill patients, as it supports healing, immune function, and overall organ performance. Ms. Sneha emphasized that malnutrition is a common problem in critically ill patients, leading to delayed recovery and increased complications. She outlined the key principles of nutritional assessment, including evaluating the patient’s nutritional status, medical condition, and caloric needs.
She emphasized on parenteral, Enteral nutrition specially for wound healing, muscle maintenance, and immune function. The session also covered the need to monitor electrolyte levels and glucose control closely when providing nutritional support, especially in critically ill patients.
Session 6: Ms. Subathra Devi, Nursing Supervisor, led an important session on” Nursing Best Practices in the Critical Care Unit (CCU)”.
She began by emphasizing that critical care nursing requires specialized skills, knowledge, and a holistic approach to manage life-threatening conditions. Subathra Devi discussed the importance of patient-centered care, stressing that nurses must focus on both the physical and emotional needs of critically ill patients and their families.
She highlighted the best practices which we do day to day nursing like FAST HUG BID, Bundle care check list, Alarm Settings, follow up of the patient, one the patient moved toward from critical care. Quality indicator, Cuff pressure monitoring, o2 cut off, Taking care of Personal belongings of critically ill patient.
Session 6: Ms. Flora, Nursing Supervisor explain about “Nurses role in infection prevention and control in critical care unit”
She emphasized the vital role nurses play in infection prevention and control (IPC) in critical care units (CCUs). Healthcare-associated infections (HAIs) are a significant concern in CCUs due to the high-risk nature of patients in these areas. Insisting mainly on including hand hygiene, the use of personal protective equipment (PPE), and maintaining a clean environment. She also discussed the importance of following a bundle care checklist, which ensures comprehensive adherence to IPC protocols, especially when managing invasive devices like central lines, catheters, and ventilators.
Ms. Flora also highlighted the importance of collaboration with the hospital’s infection control team to track and address any potential out breaks
In addition to clinical practices, nurses advocate for continuous education, ensuring they are updated on the latest guidelines and protocols.
Session 7: Dr. Santra, MBBS MD Anesthesiology, provided an insightful session on the “management of sepsis and septic shock.”
Sepsis is a life-threatening condition resulting from an infection that causes widespread inflammation and can lead to organ failure. Septic shock is a more severe form, characterized by persistent hypo tension despite adequate fluid resuscitation. Dr. Santra emphasized the importance of early recognition and prompt treatment to improve patient outcomes.
The initial management of sepsis involves early goal-directed therapy, including rapid administration of intravenous fluids to address hypovolemia and restore circulatory volume. She highlighted the significance of starting broad-spectrum antibiotics within the first hour of recognizing sepsis to combat the underlying infection. Once the pathogen is identified, antibiotics should be tailored based on sensitivity. Vasopressor therapy, such as nor epinephrine, is often required to maintain blood pressure in septic shock, with a target mean arterial pressure (MAP) of 65 mmHg or higher.
Dr. Santra discussed the role of monitoring lactate levels as an indicator of tissue perfusion and severity of sepsis. A lactate level greater than 2 mmol/L can be a marker for inadequate tissue oxygenation and may guide further resuscitation efforts. Source control—identifying and treating the source of infection—is another critical component of managing sepsis, whether through drainage of abscesses or removal of infected devices.
In addition, she stressed the importance of sedation and pain management in the ICU, as septic patients often require mechanical ventilation and may be in significant distress. Nurses, in particular, play a key role in monitoring vital signs, administering medications, and ensuring adherence to sepsis protocols.
Session 8: Ms. Jenma Rakkini, Nursing Supervisor, discussed the critical topic of “ICU delirium and sedation management.” ICU delirium is a common and serious condition in critically ill patients, often characterized by confusion, agitation, and altered consciousness. It is associated with longer ICU stays, increased risk of mortality, and long-term cognitive dysfunction. She emphasized the importance of early identification and prevention, as delirium is often preventable with appropriate management strategies.
She explained that sedation management plays a significant role in preventing and treating ICU delirium. Over-sedation can contribute to delirium, while inadequate sedation may lead to agitation and discomfort. She recommended sedation protocols, which involve using the minimal effective dose of sedatives and regularly assessing sedation levels using scales like the Richmond Agitation-Sedation Scale (RASS). The goal is to maintain a balance; ensuring patients are comfortable without being excessively sedated.
A key approach in delirium management is non-pharmacological interventions, such as promoting sleep hygiene, reducing noise levels, and maintaining normal day-night cycles in the ICU. She also highlighted the role of early mobilization and cognitive stimulation to reduce the risk of delirium. Pharmacological treatments, such as anti-psychotics, may be used to manage symptoms, but they should be prescribed with caution and only when necessary.
Ms. Jenma stressed that delirium screening tools, such as the Confusion Assessment Method for the ICU (CAM-ICU), should be used regularly to detect early signs of delirium.
She concluded by emphasizing the importance of individualized care, as each patient’s risk factors and response to sedation may differ. By adopting evidence-based practices and maintaining a proactive approach, ICU teams can minimize the incidence of delirium and improve recovery outcomes for critically ill patients.
Session 9: In the final session of the Continuing Nursing Education (CNE) program, Ms. Uma Periya Samy conducted a “hands-on training on ventilator settings for critical care nurses”. She began by emphasizing the importance of understanding ventilator settings in managing critically ill patients, especially those requiring mechanical ventilation due to respiratory failure. She explained the basic principles of mechanical ventilation, including invasive versus non-invasive ventilation, and highlighted the need for individualized settings based on the patient’s condition.
She demonstrated key parameters such as tidal volume (VT), respiratory rate (RR), and inspiratory pressure—each of which plays a crucial role in optimizing patient oxygenation and ventilation. She stressed the significance of setting an appropriate PEEP (positive end-expiatory pressure) to maintain alveolar recruitment and prevent atelectasis. The goal of ventilator settings is to ensure adequate oxygenation and carbon dioxide elimination, while minimizing ventilator-induced lung injury.
The hands-on training allowed nurses to practice adjusting ventilator settings on a simulation model, under Ms. Uma guidance.
Session 10: As a concluding session Ms. Jencia The nursing In charge conducted a Posttest with QR codes
To motivate and encourage active participation, we introduced a reward system where nurses with the highest test scores were selected for recognition and given prizes. This not only fostered a spirit of friendly competition but also emphasized the importance of continuous learning and professional excellence in nursing.
Conclusion
The Continuing Nursing Education (CNE) program on critical care nursing has played a pivotal role in shaping excellence within our nursing team. By enhancing knowledge, honing skills, and fostering a culture of continuous learning, the session empowered nurses to elevate the quality of patient care in critical settings. The engagement and enthusiasm demonstrated by participants highlighted the importance of ongoing professional development in a fast-evolving health care environment. With the support of targeted educational initiatives, we are confident that our nurses will continue to meet the complex demands of critical care with confidence and competence. Moving forward, we remain committed to advancing the standards of critical care nursing through continuous learning and excellence.
Ms. Cecily Ruba
Nurse Educator
B. Mahalakshmi
Nursing Superintendent
