Learning Enviroment

The care of critically ill patients is dependent on the use of complex medical equipment. Equipment includes patient bedside monitoring, respiratory and cardiac support, emergency resuscitation devices, infusion pump and et cetera. Operating with these equipment which is so critical to the health and wellbeing of patients, yet gain practitioner to be skill and knowledgeable. According to Bunch (2002) that positive outcomes from equipment use should not make critical care nurses overlook ethical dilemmas and decision making challenges. Particularly in critical care settings, Barnard (2000) argues that a large percentage of daily practice has to do with equipment, checking, preparing, manipulating or maintaining it. However Anderson et al (2008) also fostered that our challenge is to use not only the available technology, but also the knowledge, theory and collective clinical experience that enhance the ability of practitioner to use forward reasoning and reflective practice to advance their expertise, finally improve the outcomes of their patients.

Respiratory lab as linked with ICU is functioned to help and guide nurses in handled of respiratory equipment, in that reasons too hospital support service that close alliance with the hospital played roles to obtain user training to upgrade nurse's competence in utilize medical devices. From Linderman (2000) sight agrees that, since there have been dramatic advances in technology; clinical education has to change in order to respond to them.

Learning is a continuous, lifelong process enhanced the behavioural, cognitive and humanistic theories of learning; with the rapid changes in technology nurses are required to up-to-date their knowledge needs for efficient care. Similarly with nursing unit philosophy, nursing goals, mission, and vision and nursing objective (Appendix 1).

However Haskell (2001) found that individuals who are presented with new knowledge for application, thought to change individuals' awareness, receptivity and motivation to store and apply the new knowledge. Supported by Huggins (2004) that critical care nurses need to acquire knowledge and skills through a lifelong learning process to maintain competence. The Nursing Unit committee committed on adult learning development of practitioners and has focused learning activity for instance Nursing Audit, continuous Nursing Education (CNE), encourage In-house training or courses and to ensure the protocol or guidelines as revision tools are available in nursing practice.

The Nursing Audit responsible to assess the nursing practice in accordance with the Code of Professional Conduct and to rule out medical error. Nurses required to achieve thirty-six credit points for accreditation and to issue the annual practicing license enforced by Malaysian Nursing Board. Jones et al (2005) found that the analysis and results of the audit process are very positive.