Crisis situations are common in the care of acutely and critically ill patients. A psychiatric crisis calls for de-escalation strategies, security personnel, sedation, and restraints. During a crisis, in addition to providing direct care in response to the patient’s urgent physiological needs for intervention, the nurse must also prepare, orchestrate, and coordinate multiple aspects of the environment. Acute and critical care environments are generally set up at all times for a possible emergency. Experiential leadership is seeing what needs to or must be done before or during a crisis and doing it, even though a physician is present. Recognizing clinical talent and marshaling skilled clinicians requires astute clinical judgment and skill and is a pervasive aspect of caring for critically ill patients in crisis. An aspect of skilled know-how required for smooth management of a crisis is modulating one’s emotional responses to assist others in their ability to function well.

This chapter presents some of the educational strategies and implications of integrative teaching and learning. It describes two major types of integrative strategies that follow the logic of practice. First, multiple examples of how to coach situated learning in actual practice that have proven successful in developing embodied knowledge and skillful, intelligent performance, are detailed. Second, a Thinking-In-Action approach to integrating classroom with clinical teaching exemplifies how to teach learners to use extensive scientific, technological, and theoretical knowledge in the context of an unfolding patient situation that changes over time, while imaginatively responding to the patient’s multiple needs and other demands in the situation. In order to be effective clinicians, the student and developing nurse must progress to grasping the nature of whole clinical situations, developing an experience-based sense of salience and using multiple frames of reference that encompass patient and family-focused care.

Spirituality is essential to the holistic health of patients, their families, and health care providers. It addresses the “inner reality of human beings”, and provides a deeper understanding of our life’s purpose. It cannot be easily defined, yet it is evident in the values and ethics of all individuals. Spirituality has an important role in patient care and impacts nursing theory, research, and education. Often the role religion plays in an individual’s personal sense of spirituality can obstruct maintaining an open and unbiased view of the spiritual needs of others. Spiritual patient care needs could be greatly compromised if holistic support remains based on religiosity. The strengths of the research can be found in the large number of studies, long periods of observation, different cultural groups studied, and the consistent results confirming the health benefits of religious and spiritual beliefs.

Admission of a child to the pediatric intensive care unit is a highly stressful event for families. When guided by the American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care, nursing practice places the patient’s and the family’s needs as its central or driving force. When nursing competencies are based on these needs, optimal patient outcomes result. This chapter describes the AACN Synergy Model for Patient Care and presents a case study illustrating the use of the Synergy Model for Patient Care in practice. It also describes general childhood developmental concepts. Erikson’s stages of psychosocial development, Freud’s theory of personality development, and Piaget’s stages of cognitive development are summarized. The chapter discusses developmentally appropriate assessment of children, stress responses and coping behaviors, and issues related to hospitalization and critical care units. It also explores developmentally appropriate interventions, psychosocial needs of families, and interventions for dying children.

The needs and expectations of the family of critically ill patients are replete in the literature. A family-centered care concept views a patient’s family as a unit to be cared for and organizes care delivery around the patient’s family, as opposed to the more traditional patient centered model. Partnership with family serves to promote a holistic approach to the care of patients with critical illness. The American Association of Critical Care Nurses (AACN) reconceptualized the synergy model to form their AACN Synergy Model for Patient Care to address the needs of critically ill patients. An ongoing and proactive approach to the family ensures attention to patient care and may prevent conflict or crisis during periods of high family stress. As family presence becomes a more accepted practice, health care providers will need to accommodate families at the bedside and address unit and system specific barriers.

The radiology environment is diverse and changes quickly. The variability of the patient population leaves a great deal of unknown factors that difficult to plan for. Each patient brings unique identifiers that may add challenges to the nurse's goal of providing patient- and family-focused imaging care. The nurse must recognize the unique needs of each individual patient and work to meet those needs with the ultimate outcome of safe, quality patient care. This chapter discusses the care of a pediatric patient and the care of a geriatric patient, describing techniques for the care of high-risk/fragile patients.

This chapter discusses the purpose of electronic medical records (EMRs). It describes the integration of patient care with electronic documentation and terminology associated with electronic documentation. Because of federal legislation and regulatory requirements, most documentation done in patient care settings is now electronic. EMRs are designed so that documentation is easier, focused, inclusive, and more standardized. EMR documentation also provides valuable tools for reporting data and improving care. Clinicians can access patient data across a variety of care settings such as the ED, inpatient, and ambulatory care settings. As EMR vendors make improvements, there is the potential to have a completely integrated chart as well as the functionality to view care given at another facility.

Central venous catheters and implantable devices are placed to allow access to large veins for therapeutic treatment and diagnostic evaluation. Image guidance available in interventional radiology (IR) allows for safer placement of these catheters. This chapter discusses central venous catheters and implantable devices. It focuses on electrocardiography monitoring during procedure and maintenance of the central venous catheters and implantable devices. It covers the stages of chronic kidney disease, pulse assessments pre and post procedure, and procedural complications.

Allergic or adverse reactions can occur at any time and to any type of contrast. A known history of an adverse reaction needs to be fully investigated, and a careful plan of care must be created for the patient prior to the administration of contrast. If patient experiences a reaction to contrast, the imaging team must be able to react quickly to provide appropriate care to the patient. This chapter helps the reader to identify the types of reactions. It discusses the emergency treatment of reactions and treatment of extravasation, as well as pretreatment for prior contrast reactions.

Procedural sedation and patient monitoring are central to the role of the radiology nurse. Safe patient care in radiology requires radiology nurses to be knowledgeable in the care of the patient from the intrahospital transport of acutely ill patients to radiology and the care of the patient from presedation through postsedation patient monitoring and medication administration. Additionally, the radiology nurse provides important interventions when adverse events occur and patients are at risk of harm. This chapter discusses the types of monitoring equipment and purposes and the types of procedural sedation and analgesia (PSA), and presents the recovery process and interventions. PSA provides a means for patients to tolerate painful procedures or procedures requiring them not to move without undergoing the risks of general anesthesia. The rapid response system provides critical care expertise when intensive care unit (ICU) level care is needed for compromised patients outside of the ICU, including radiology.