Categorising Critically Ill Patients by Critical Care Nurses

Critical care nursing is the delivery of specialised care to critically ill patients or patients with the potential to become critically ill – that is, those who have or are susceptible to life-threatening illnesses or injuries. Such patients may be unstable, have complex needs and require intensive and vigilant critical care nursing. The Department of Health categorises acute hospital patient care into levels from 0 to 3:

Level 0 is normal acute ward care.
Level 1 is acute ward care with the input of critical care specialists, e.g. outreach. This may be required because of recent discharge from a critical care unit or because the patient’s condition or therapy/equipment used in their care means increased intervention is needed.
Level 2 is high dependency care for patients requiring an increased level of monitoring owing to their condition or potential for deterioration or patients with single organ failure/support. Nurse to patient ratios for this level of care are usually one nurse to two patients.
Level 3 is intensive care for patients with two or more organ failure/support or requiring mechanical ventilation. Nurse to patient ratios for this level of care are usually one nurse to one patient.

Illnesses and injuries commonly seen in patients on critical care units, either separate level 2 and 3 facilities or combined units, include:

traumatic injuries from such events as road traffic accidents, falls and assaults
cardiovascular disorders, such as heart failure and acute coronary syndromes (unstable angina and myocardial infarction [MI])
elective surgeries, such as abdominal aortic aneurysm repair and carotid endarterectomy
emergency surgeries, such as bowel perforation and neurosurgery
neurological disorders, such as hypoxic brain damage and subarachnoid haemorrhage
respiratory disorders, such as acute respiratory failure and pulmonary embolism
GI and hepatic disorders, such as acute pancreatitis, acute upper GI bleeding and acute liver failure
renal disorders, such as acute and chronic renal failure
cancers, such as lung, oesophageal and gastric cancer
shock caused by hypovolaemia, sepsis and cardiogenic events (such as after MI)

Meet the critical care nurse

They are responsible for making sure that critically ill patients and members of their families receive close attention and the best care possible.

What do you do?

Fill many roles in the hospital setting, such as staff nurses, sisters, charge nurses, nurse-educators, nurse-managers, clinical nurse specialists, advanced nurse practitioners (ANPs), nurse consultants and outreach nurses.

Where do you work?

Wherever critically ill patients are found, including:

adult, paediatric and neonatal intensive care units (ICUs) and high dependency units (HDUs), or combined critical care units caring for both level 2 and level 3 patients
coronary care units
cardiothoracic/neurosurgical/burns/liver units
accident and emergency departments
postanaesthesia/postoperative care units
general wards as part of an ‘outreach’ team (providing care to patients and education to staff caring for patients with complex care needs, potential to deteriorate or recently discharged from a critical care unit).

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Critical Care Insurance – Is it Right For You?

While it is true that the quirky Aflac duck has brought awareness to consumers about supplemental insurance, many individuals are not clear what it is and if they need to have it. Supplemental insurance, put simply, is insurance that provides additional financial benefits to the policyholder that traditionally fall outside the realm of a typical health insurance policy. Aflac’s “specified health event protection” plan, also packaged by other companies as a “critical care” plan, is an insurance plan that pays the insured for benefits such as hospital and intensive care confinement; major organ transplantation; ambulance costs; waiver of premium benefits and transportation and lodging compensation as needed during the treatment of a critical illness. If the medical facility is within a certain mile radius of a policyholder’s home, often the insurance company will pay a small per mile fee to the policyholder for traveling expenses for extended treatment. Each company’s policy varies so it is important to ask questions and read the brochures thoroughly to see what benefits are actually covered in the plan you are considering.

Anyone that already has a health insurance policy will already have coverage for the medical expenses incurred from a debilitating accident or illness. But the health insurance policy, of course, does not include the various expenses associated with a patient’s long-term care. So, who needs a critical care policy? Let’s take a closer look to see if a critical care policy would be advantageous for you.

First of all, a critical care policy provides a layer of financial protection beyond the conventional health insurance policy much like a savings account protects an individual’s checking account balance. If an individual inadvertently overdraws the checking account, then the bank uses funds from his/her savings account to protect the consumer’s buying power. Likewise, when medical bills are mounting due to a serious medical condition, the insurance company releases funds directly to the consumer rather than to the hospital so that the insured is free to pay incoming medical bills or other expenses related to the medical condition. An insured could actually take the funds released to him/her from the supplemental insurance plan to help pay the mortgage or to buy meals at the hospital. In this way, the supplemental plan bridges the gap between a traditional health insurance policy and actual expenses occurred.

Secondly, unlike a conventional health insurance policy, an individual’s “critical care” policy is guaranteed renewable each year. Therefore, once diagnosed with a condition, such as end-stage renal failure, at policy renewal time, the insurance company guarantees to renew the individual’s policy in spite of the mounting medical bills.

To determine if a critical care insurance policy is right for you, take a personal inventory. Is there a history of chronic health problems, such as heart failure, stroke or cancer? (Please note that some policies do not include cancer as a covered peril. Aflac, for instance, sells a cancer policy separately that provides benefits that are specifically geared toward the medical procedures related to cancer treatment.) A history of chronic illness is a good indicator that critical care insurance may be an excellent option for you.

Next of all, consider your personal finances. Do you have the discipline to set aside money monthly to cover long-term medical care due to critical illness? And do you have an adequate income to prepare for such an event? Costs for a year of nursing home care can range from $50,000 and higher. A part-time aide can cost as much as $10,000 per year. That is a year’s salary for many individuals.

And finally, get at least three quotes before you purchase a policy. Compare the policies to be sure that the premium you will pay covers your greatest medical and financial needs. Don’t forget to factor your age into the equation when deciding if the monthly premiums will eventually pay off to your benefit.