All About Adult-Gerontology Acute Care Nursing

Acute care is the timely administration of short-term care in cases of serious illness, injury, aggravated chronic conditions, or other health conditions, such as recovery from a surgical procedure. Unlike primary care, which treats long-term illness, acute care is often administered in emergency situations where a lack of intervention can mean loss of life or permanent disablement.

Definition of Acute Care

In an attempt to accurately define acute care, the National Library for Medicine (NLM) states: “A proposed definition of acute care includes the health system components, or care delivery platforms, used to treat sudden, often unexpected, urgent or emergent episodes of injury and illness that, without rapid intervention, can lead to death or disability.”

Acute care is the treatment of a patient when time is of the essence. This is not to be confused with chronic care, which is the long-term care of patients with lasting chronic conditions, for example, dementia or asthma. There will be times when a patient with a chronic disease such as asthma needs acute care, and at this point, the patient will be handed over to the acute care practitioner. A severe asthma attack can lead to death if not treated as an emergency.

Acute care is not just a reliance on technology, nor is it restricted to an efficient ambulance or ER service. It is about responding to incidents that threaten life or limb, requiring resources to minimize the risk of death or disability. It, therefore, needs to integrate with a healthcare system that incorporates acute care, primary care, and prevention.

The NLM advocates a need for establishing guidelines regarding acute care, focusing on the importance of acting timeously: lines of responsibility and metrics for the evaluation of successful acute care administration. Many simple but effective interventions can save lives when administered promptly. Examples of this are trauma management in surgery wards, dealing with pregnancy complications, and administering medicines to prevent infection.

Where and when is Acute Care necessary?

Acute care settings in hospitals include emergency rooms, intensive care units, coronary care units, cardiology sections, and neonatal intensive care units.

In non-hospital environments, acute care facilities include specialized clinics, rehabilitation hospitals, long-term critical care facilities, ambulatory centers, end-stage renal disease facilities, and hospices. Home-based acute care is also available through organizations that offer support under the direction of registered nurses.

Acute care plays a role in critical medical situations where the loss of life, or permanent disability is a risk. Primary carers are often unable to assume this role as they do not have the necessary qualifications.

Types of Acute Care

Trauma and emergency care: treating patients with life-threatening conditions, such as a stroke or heart attack, and evaluating patients with extreme head, chest, or abdominal pains.

Acute care surgery: treating patients with life-threatening injuries or emergency surgical needs such as acute appendicitis or a strangulated hernia.

Urgent care: ambulatory care in a center other than a hospital, treating mainly walk-in patients. For example, a fractured limb or a child with a high fever.

Short-term stabilization: treatment of a patient with acute needs before administering definitive treatment, such as administering intravenous fluids to a critically injured patient before transfer to an operating room.

Pre-hospital care: care provided in the community until the patient is able to reach a hospital, for example, treatment by ambulance personnel or local healthcare providers.

Critical care: special care provided to patients with life-threatening conditions and those who require constant monitoring, often administered in intensive care units. Examples are patients with severe respiratory problems or needing post-operative stabilization and monitoring.

As the population grows and people age, there is an increasing demand for acute, responsive care for life-threatening cases, chronic illnesses, and routine health problems that require prompt action.

Acute Care strategies, with a focus on time-sensitive, rapid intervention

• Preventative strategies reduce the probability of incident cases through interventions that decrease the risk of developing a disease. Situations that come to mind are equipment sanitation to avoid infection, fall prevention, prevention of bedsores, and musculoskeletal issues when patients are immobile.
• Curative strategies reduce the probability of death or disability among existing cases. It is imperative to get the patient to the right place, in the right amount of time, for the correct treatment. Failure to consider the time factor results in failure. For example, delayed treatment of sepsis with antibiotics can result in death or disability.
• Rehabilitative strategies include the assessment of patients to determine their rehabilitation needs: when and where to send them for therapy and rehabilitation. For example, bedridden patients may need therapy in hospital to prevent or cure ‘muscle wasting’, a muscular-skeletal condition that results from a lack of movement; patients who are discharged may need referrals for transfer to a suitable rehabilitative facility with physiotherapy services.

The World Health Organization defines palliative care as: “an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness.” Thus, palliative care is primarily concerned with controlling pain and relieving other debilitating symptoms, such as severe nausea, to help make the patient as comfortable as possible. The psychological, spiritual, and social needs involving patients and family members are just as important. 

What are the differences between primary care and acute care NPs?

It’s important to note that the difference between primary care and acute care NPs is not determined by their work environments, but by their educational training and subsequent certification.

The primary care NP: education of the primary care NP typically involves comprehensive chronic disease management and continuous care for long-term, stable patients. The primary care NP administers medication, manages long-term and chronic ailments, and plays a role in patient education, assisting them to lead healthier lifestyles.

Acute care NP: the acute care NP learns to treat patients with possible life-threatening conditions or patients at risk of permanent disability if treatment is not administered timeously. The focus is on restorative care in rapidly changing, time-critical clinical conditions. Their training involves various methods of restoring the patient to a state where they can return to the primary care unit for further treatment and observation. This involves patients with unstable, critical, chronic, acute, and complex conditions.

Sometimes the duties of the NP and the AGACNP may overlap, for example, in the case of diabetes. A primary care nurse practitioner can manage the long-term treatment of diabetes, but in the case of a life-threatening diabetic coma, that same patient will need urgent, acute care to see them through the crisis. Therefore, it is important for the medical facility to have a system in place that encompasses all essential aspects of healthcare delivery, and the acute care and primary care NPs should be able to work well in a collaborative environment.

An NP educational program focuses either on primary or acute care. However, there is sometimes a dual-track preparation to cover both acute and primary care. But when it comes to certification, one certificate for both disciplines is only permissible if the NP has qualified in both acute and primary care.

• Primary care and acute care NPs can serve as the contact point of entry into a healthcare facility and collaborate when managing patients.
• Both primary and acute NPs can evaluate a patient, but the extent of the illness or injury will determine where the patient is treated and by whom.
• Certification must match the formal education: an NP should only sit for certification that applies to their particular training.

NPs who practice outside their scope of education and certification are placing the patient’s wellbeing in jeopardy, and employers willing to allow this scenario are in contravention of state legislation.

Furthering your studies in Adult-Gerontology and Acute Care Nursing

If kindness and compassion are in your nature and you find caring for adults and elderly people particularly rewarding, perhaps you should consider the Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) qualification. Acute care involves working in a fast-paced, engaging, and often demanding environment, where the decisions you make affect people’s wellbeing. The AGACNP becomes proficient in a fair amount of technology involving monitors, ventilators, and diagnostic tools, as well as the analysis of statistics and test results.

If you are just starting your nursing career, the first step is to become a registered nurse. You will need the following:

• A bachelor’s degree in nursing from an accredited nursing institution or, alternatively, a diploma from an approved training facility.
• A license to work as a registered nurse from the relevant state authority.

The next step is a Master’s Degree in Nursing Science (MDNS). As an aspiring nurse practitioner (NP), you should ideally have some experience as a registered nurse before taking the next step to becoming a nurse practitioner. The knowledge and experience you build up as a registered nurse make further studies easier and more enjoyable. You can further your studies part-time while practicing as a registered nurse.

With a master’s degree in nursing, the NP can now take on the following responsibilities:

• Assess the symptoms of illness by taking the full patient history into account.
• Conduct physical examinations.
• Order diagnostic testing and interpret the results to arrive at a diagnosis.
• Prescribe medication for the treatment of illness.
• Patient education on managing illness.

It is important to note that regulations regarding the authority of NPs differ from state to state.

Generally, three different levels of practice authority exist:

• NP Full practice authority: more than half the states in the US embrace full practice authority, and this figure is gradually increasing as the shortage of healthcare providers becomes more serious.

An NP residing in a state with full practice authority may run their own private clinic and provide direct patient care within the regulations set by the state board of nursing. This enables the state to allocate much-needed healthcare resources to communities that have been previously underserved.

• NP Reduced practice authority: these states require the NP to enter into a collaborative practice with a physician.
• NP Restricted practice authority: the certified NP must comply with additional conditions such as prescription limitations, supervision requirements, and restrictions regarding practice setups.

It is advisable to research the regulations in the state you currently reside in or are planning to practice in.

Once qualified as an NP, you can specialize in several fields by completing a post-master’s certificate. Here is how to further your studies and become a specialized AGACNP.

Where to study

By now, you have decided that being in an acute care role is where you see your career heading, combined with caring for adults who face many health-related challenges as they age.

What is the next step?

Options exist to study online through an accredited university. As such, a post-master’s agacnp certificate from Rockhurst University provides online tuition with the flexibility to study full- or part-time. In addition, they facilitate a clinical placement service that arranges practical tuition at an approved clinical institution within your location.

It is a comprehensive course. Here are some of the topics covered:

• Ethical and legal parameters; quality and patient safety; social, cultural, political, and economic influences.
• Advanced acute care topics in the pharmacological and pathophysiology areas, as well as diagnostic test interpretation in critically ill patients.
• Comprehensive assessment, diagnosis, and management of patients with acute and chronic medical conditions, focusing on risk factors, diagnostic tests, and management, prevention, and follow-up care of patients.
• Understanding the use of statistics in research, statistical methods of designing studies, and analyzing data from research studies. Students will gain a foundation for evaluating research outcomes and a more critical view of research literature with a view to whether the statistics should be incorporated into nursing practices, or not.

There is immense scope for employment as an AGACNP. With modern science and technology advancing in leaps and bounds, people are living longer. For the first few years of retirement, they generally experience a good quality of life, provided there is reasonable access to medical facilities. Gradually, however, chronic conditions develop, with many people over 75 having to deal with two or more chronic conditions at the same time. It is at this stage that the aging population begins to add considerable pressure to the already overloaded medical facilities.

Added to this is the fact that the birth rate is dropping in many countries worldwide, including America. We are currently dealing with a shortage of physicians in most sectors, and these figures are predicted to rise exponentially, according to the Association of American Medical Colleges (AAMC). They predict the following:

• Primary care physicians: a shortage of between 17,800 and 48,000 by 2034
• Specialized physicians: a shortage of between 21,000 and 77,100 by 2034.

The role of the NP will help to alleviate these shortages in years to come as NPs take on many of the daily functions of primary care and specialized physicians, leaving them to do the more specialized work in their area of training.

The population sector of people over 65 years is predicted to grow at a rate of 45.1% in the next decade, placing even more strain on the medical fraternity. The good news is that there will always be a demand for nurse practitioners, especially in the AGACNP line of work.

The working environment of an AGACNP

There is plenty of scope for the AGANCP when seeking employment. Hospitals and clinics, outpatient facilities, long-term facilities, and larger homes all employ the services of acute care specialists.

Because of the age factor, the AGACNP often manages patients with two or more chronic medical conditions. In this case, the side effects or counter-effects of medicines must be considered.

Formulating a personal healthcare plan to handle the medication and possible side effects is part of the job, as is monitoring such a plan to ensure success. A specialist physician handles chronic health issues affecting the cardiovascular or pulmonary systems. However, acute care NPs can further their training in these specialties as an addition to the AGACNP certification.

Conclusion

For an active and responsible job that is often challenging and hugely gratifying, a career in AGACNP is likely to add interest and meaning to your life. The opportunity to get involved and make a difference in many lives, yours included, is just one step away.