Knowledge

Common symptomatology following critical illness
Criteria for admission to, and discharge from ICU - factors influencing intensity and site of care (ward, high dependency unit (HDU), intensive care unit (ICU))
Causes and methods of minimising distress in patients
The role of patient's relatives and their contribution to care
Physiological effects of pain and anxiety
Stress responses
Recognition and assessment of anxiety
Recognition and methods of assessment of pain
Potential psychological impact of inter-hospital transfer and family dislocation
Principles of acute pain management
Indications, contra-indications, methods and complications of regional analgesia in critical illness
Patient-controlled analgesia
Sleep deprivation and its consequences
Methods of measuring depth of sedation; effects of over-sedation and strategies to avoid this
Causes and management of acute confusional states
Sensory deprivation / sensory overload
Environmental and drug-related psychopathology associated with critical illness (e.g. anxiety, sleep disorders, hallucinations, drug withdrawal)
Supportive services integral to the long term rehabilitation of critically ill patients (physiotherapy, occupational therapy, orthotics, social services).
Impact of staff-patient contact and environmental factors on patient stress
Post-traumatic stress disorders
Relevance and methods to care for skin, mouth, eyes and bowels, and to maintain mobility and muscle strength in critically ill patients
Methods of communicating with patients who are unable to speak
Fluid & caloric requirements in the critically ill patient including electrolytes, vitamins, trace elements and principles of immunonutrition
Methods to assess nutritional status and basal energy expenditure
Methods for assessing or measuring quality of life
Causes, prevention and management of critical illness polyneuropathy, motor neuropathy, and myopathy
Consequences of immobilisation and mobilisation techniques (including disuse atrophy, foot-drop, ectopic calcification)
Management of tracheostomy care and avoidance of complications outside the ICU
Prevention & management of pressure sores
Long-term ventilation outside the ICU environment (eg. home ventilation)
Principles of rehabilitation: physical and psychological
Persistent vegetative state
Resources available to patients and relatives for education and support (eg societies, local groups, publications, referral to allied health care professionals)
Methods to minimise potential psychological trauma to the patient and their family of transfer from the ICU (especially with regard to long term ICU patients)
Common risk factors for post-ICU mortality or re-admission and their minimisation
The implications for relatives of adopting a role as a carer at home
Impact of chronic illness post-ICU on socialisation and employment

Skills & Behaviours

Lead, delegate and supervise others appropriately according to experience and role
Identify discharge criteria for individual patients
Interpret data from scoring or scaling systems to assess pain and sedation
Select & determine adequacy and route of administration of analgesia
Minimise complications associated with opioid and non-opioid analgesics
Obtain and interpret data from a nerve stimulator to monitor the degree of neuromuscular blockade
Change a tracheostomy tube electively
Ensure effective information exchange before patient discharge from ICU
Liaise with medical and nursing staff in other departments to ensure optimal communication and continuing care after ICU discharge
Identify complications associated with critical illness
Work with colleagues and relatives to minimise patient distress
Anticipate the development of pain and/or anxiety and adopt strategies for its prevention or minimisation
Use analgesic, hypnotic and neuromuscular blocking drugs appropriately and safely
Propose and implement a plan to provide adequate sleep and rest in ICU patients
Communicate effectively with relatives who may be anxious, angry, confused, or litigious
Participate in the education of patients/families
Appropriate and timely referral to specialists / allied health professionals
Take decisions to admit, discharge or transfer patients
Follow-up patients after discharge to the ward
Participate in follow-up clinics / services where available

Attitudes

Appreciates that physical and psychological consequences of critical illness can have a significant and long lasting effect for both patients and their relatives
Desire to minimise patient distress
Establishes trusting relationships with and demonstrates compassionate care of patients and their relatives
Seeks to modify the stresses which the intensive care environment places upon patients, their relatives and members of staff
Acknowledges the consequences of the language used to impart information
Regards each patient as an individual
Respects the religious beliefs of the patient and is willing to liaise with a religious representative if requested by patient or family
Willingness to communicate with and support families / significant others
Early planning for rehabilitation
Recognises that intensive care is a continuum throughout the 'patient journey'
Promotes appropriate and timely discharge from ICU
Fosters effective communication and relationships with medical and nursing staff in other wards / departments
Recognises personal limitations, seeks and accepts assistance or supervision (knows how, when and who to ask)

Basic Sciences also underpin the competencies within this domain. These are presented in full in the Basic Sciences Syllabus.