Introduction

Nursing the critically ill cardiothoracic patient requires advanced skills in assessment as well as in-depth knowledge of nursing practice, cardiovascular physiology, technology and pharmacology used in critical care. The nurse's role is essential to helping patients and their families cope with life-threatening illness and its treatment.

The cardiothoracic critical care unit has evolved alongside rapid advances in diagnostic modalities and therapeutic intervention in the fields of clinical cardiology and cardiac surgery. These changes have led to a progressive and aggressive specialist field in which very sick patients receive often complex care that is usually delivered and managed by the nurse at the bedside.

The workforce

The most notable difference between critical care and a general ward is that the former has a much higher nurse-to-patient ratio, which reflects the dependency of patients in this setting. Historically, this ratio has been one to one, but tight adherence to this principle is being challenged. The pivotal role in delivering critical care is that of the bedside registered nurse. In this, the bedside nurse is supported by health care support workers, supervised by a senior nurse and guided by an education team.

The bedside critical care nurse

In addition to basic education, such nurses have been specifically trained in critical care and most have completed a specialized critical care course. The primary role of the nurse is to provide continuous nursing vigilance of vital signs, assess change, adjust medication as appropriate and communicate with the nurse in charge and the rest of the multidisciplinary team when necessary.