Focus of nursing in critical and acute care settings: prevention or cure?

The fluidity of the boundaries of critical and acute care can lead to challenges for nurses working on acute general wards when caring for post-critical care patients and for those in whom a critical care situation arises during a period of acute care. The development and use of critical care skills pose special difficulties for acute care nurses, because of the acuteness and infrequency of such incidents and the diversity of skills the nurses need to possess. Nonetheless, critical care is an important component of an acute ward nurse's repertoire, particularly in relation to preventing episodes of critical illness. It might be expected that the increased provision of high dependency units and the formation of postoperative care teams would relieve some of this pressure, but such developments are, in fact, more likely to create an increase in overall patient acuity. They may, in addition, lead to an over-reliance on the use of such facilities and must be implemented carefully in order to bridge, rather than widen, the gap between acute and critical care. Critical care is used in this paper as a global term, to encompass all settings where patients are usually more highly dependent and critically ill than patients on general wards. It includes intensive therapy, high-dependency, coronary care and other specialist critical care units.