NCM 410 dimensions regardless of diagnosis or

September 3, 2023 clinical setting;

GJCB 4. To use relevant and up-to-date
knowledge, caring attitude and
Critical Care Practice
clinical skills, supported by
- Critical care nursing is the specialty appropriate technology for the
within nursing that deals specifically prevention, early detection and
with human responses to life- treatment of complications to
threatening problems. These facilitate recovery.
problems deal dynamically with 5. To provide palliative care to the
human responses to actual or critically ill patients in situations
potential life-threatening illnesses. where their health status is
- The critical care nursing practice is progressing to unavoidable death, and
based on a scientific body of to help the patients and families go
knowledge and incorporates the through their painful sufferings.
professional competencies specific to 6. On the whole, critical care nursing
critical care nursing practice and is should be patient-centered, safe,
focused on restorative, curative, effective, and efficient. The nursing
rehabilitative, maintainable, or interventions are expected to be
palliative care, based on identified delivered in a timely and equitable
patient’s need. manner.

GOALS:
1. Critical or intensive care is a complex ELEVEN (11) MAJOR KEY
specialty developed to serve the RESPONSIBILITIES AREAS IN
diverse health care need of patients CRITICAL CARE NURSING
(and their families) with actual or
Key Responsibility Area I:
potential life-threatening conditions.
It is therefore important that a clear 1. Safe Quality Nursing Care
statement of what critical care nursing
Responsibilities:
wishes to achieve and provide should
be articulated. 1. Conducting nursing
2. To promote optimal delivery of safe assessment.
and quality care to the critically ill DESCRIPTION: The critical
patients and their families by care/ intensive care unit
providing highly individualized care (ICU) nurse performs patient
so that the physiological dysfunction health assessment accurately,
as well as the psychological stress in continuously,
the ICU are under control; comprehensively and
3. To care for the critically ill patients systematically. The critical
with a holistic approach, considering care nurse prioritizes the
the patient’s biological, health needs of the patient
psychological, cultural and spiritual from a holistic perspective.
Competent Behavior Clusters: Competent Behavior Clusters:
1. Obtains comprehensive The critical care nurse:
patient information from a
1. Utilizes collected data to
holistic perspective with
establish a list of actual and
the aid of advanced
potential patient
technologies and physical
problems/needs.
examination techniques,
2. Collaborates with the
paying particular attention
patient, if applicable, family
to the psychosocial impact
and other healthcare team
of the critical care
members in identifying
environment on patients
problems/needs and planning
and relatives.
of appropriate nursing actions
2. Prioritizes the health
accordingly.
needs of the patient based
3. Establishes and records the
on the assessment data and
priority of problem/needs
communicates this
according to the actual danger
information to the right
or potential threats to the
people in a correct and
patient.
timely manner.
4. Formulates an
3. Collects patient’s data in a
individualized care plan with
systematic, objective and
continuous review to match
continuous manner from
both the needs of the patient
clinical observation and
and family.
monitoring devices.
4. Ensures pertinent data are Responsibilities:
clearly documented and
accessible to all health 3. Implementing planned care.
care team members. DESCRIPTION: The critical
care nurse implements
Responsibilities: planned care to achieve
optimal health status or
2. Formulating care plans.
dignified death of the patient.
DESCRIPTION: The critical
care identifies patient’s Competent Behavior Clusters:
problems in relation to
patient’s needs /nurse The critical care nurse:
develops individualized, 1. Carries out planned patient
holistic and patient-centered care or immediate nursing
care plans that document actions in a safe,
nursing diagnoses. comprehensive, effective and
humanistic manner according
to patient’s response.
 2. Adopts evidence based-practice in hospice, palliative and end-of-life
the care of the critically ill patients care needs.
where applicable.
Responsibilities:
3. Assists the patient towards end-of-
5. Maintaining effective
life attaining peaceful and dignified
communication.
death.
DESCRIPTION: The critical
Responsibilities: care nurse communicates
relevant, accurate and
4. Evaluating patient’s health
comprehensive information,
progress and outcome.
both verbal and written, about
DESCRIPTION: The critical
the patient’s health status to
care nurse evaluates the
related health care team
outcomes of nursing care in an
members and family
explicit, systematic and
members.
ongoing manner.
Competent Behavior Clusters:
Competent Behavior Clusters:
The critical care nurse:
The critical care nurse:
1. Reports instantly key changes of
1. Maximizes clinical skills with
patient’s health condition in an
monitoring devices to evaluate the
emergency situation.
care process and compares the
patient’s response with expected 2. Monitors and documents relevant
outcome. information objectively and
systematically.
2. Identifies the cause for any
significant difference between the 3. Maintains information in an
patient’s response and the expected accessible and retrievable form.
outcome.
4. Conducts effective patients and
3. Identifies potential risk of patients, family health education.
such as but not limited to Deep Venus
Responsibilities:
Thrombosis (DVT), aspiration,
pressures, infection, fall risk, 6. Acting in emergency
malnutrition / starvation, patient situations such as rapid
abuse, iatrogenic etiologies. deterioration, life-
threatening, unstable, and
4. Revises the care plan to ensure
critical events.
patient centered and quality of care to
DESCRIPTION: The critical
patient.
care nurse responds swiftly in
5. Implements appropriate and a calm and proficient manner
effective nursing interventions to help when faced with an
patients and significant others address unexpected or rapidly
 changing situation related to h) Trauma
the patient or environment. i) Burn
j) Organ Transplantation
Competent Behavior Clusters:
k) Control of Infection
The critical care nurse: l) Psychosocial and
Spiritual Care
1. Demonstrates knowledge of ICU
emergencies such as medical Competent Behavior Clusters:
emergencies, civil disasters and
A. Pulmonary care
contingency plan for hospital
emergencies. The critical care nurse:
2. Anticipates possible changes / 1. Has an understanding of the
complications associated with applied respiratory physiology.
particular diseases and/or treatment
2. Demonstrates nursing
procedures.
competencies in:
3. Implements prompt and
▪ Respiratory assessment
appropriate resuscitative
▪ Respiratory monitoring such
interventions.
as clinical observation,
4. Keeps the medical team informed arterial blood gases, SpO2,
of patient’s deteriorating condition in ETCO2.
a timely manner. ▪ Airway management such as
suctioning, chest
5. Fulfills the specific team role
physiotherapy, oral care, use
during large-scale crisis to provide
of airway gadgets and others
safe, effective and efficient care of the
Respiratory investigation and
patient.
therapy such as
Responsibilities: bronchoscopy, tracheostomy,
chest physiotherapy
7. Demonstrating specific
knowledge and skills in the 3. Provides holistic care to patients in
critical care setting. the following conditions:
DESCRIPTION: The critical
Before and after thoracic
care nurse provides quality
surgery.
and effective care to patient in
With acute or chronic
the following aspects:
respiratory disorders.
a) Pulmonary
On ventilator support
b) Cardiovascular
Being weaned from
c) Neurological
mechanical ventilator.
d) Renal
On oxygen therapy
e) Gastrointestinal
Initiates and assists in the
f) Endocrine
emergency and resuscitative
g) Peri-operative
procedures such as
 endotracheal intubation, D. Renal care.
tracheostomy and chest drain
The critical care nurse:
insertion.
Educates and supervises Has an understanding of the applied
patients and families on home renal physiology.
oxygen therapy. Demonstrates nursing competencies
in:
B. Cardiovascular care
➢ Renal assessment
The critical care nurse: ➢ Renal investigation
➢ Interpretation of blood
Has an understanding of the applied
biochemistry
cardiac physiology.
Provides holistic care to patients with
Demonstrates nursing competencies
renal failure by:
in:
➢ Peritoneal dialysis
➢ Cardiovascular assessment
➢ Hemodialysis
➢ Cardiovascular investigation
➢ Continuous renal replacement
➢ Interpretation of
therapy (CRRT)
electrocardiogram.
➢ Hemodynamic monitoring such E. Gastrointestinal care
as non-invasive, arterial pressure,
The critical care nurse:
pulmonary artery pressure, CVP.
➢ Administration of cardiac Has an understanding of the applied
medication. gastrointestinal physiology.
Provides holistic care to patient:
C. Neurological care
➢ With gastrointestinal disorder
The critical care nurse: such as acute pancreatitis, hepatic
failure.
Has an understanding of the applied
➢ Before and after gastrointestinal
neurological physiology.
operation.
Demonstrates nursing competencies
➢ With gastrointestinal emergencies
in:
such as gastrointestinal bleeding,
➢ Neurological assessment
esophageal varices bleeding.
➢ Neurological investigation
➢ Undergoing different procedures
Provides holistic care to patient:
such as peritoneal lavage.
➢ Before and after neurological
➢ Early access and early feeding
operation.
using appropriate gadgets.
➢ Suffering from neuro-medical
disorders. F. Endocrine care
➢ On intracranial pressure
The critical care nurse:
monitoring.
Has an understanding of the applied
endocrine physiology.
Provides holistic care to patients with
the following conditions:
 ➢ Diabetic emergencies such as I. Burn care
diabetic ketoacidosis,
The critical care nurse:
hyperglycemia, hypoglycemia.
➢ Thyroid storm Has an understanding of the:
➢ Other endocrine emergencies ➢ Applied skin physiology
➢ Mechanism of injury associated
G. Peri-operative care
with burn and inhalation injury.
The critical care nurse: Demonstrates nursing competencies
in:
Equips oneself with knowledge and
➢ Burn assessment
skills for implementation of safe,
➢ Burn resuscitation such as airway,
adequate evidence-based care of
breathing and circulation.
clients during the pre-, intra- and
➢ Burn wound care
post-operative procedures.
Provides holistic care to patients with
Provides holistic care to patients with
burn.
the following conditions:
Educates patient on long term skin
➢ Before and after different
care.
types of operations.
➢ With wounds and drains. J. Organ transplantation care
Demonstrates nursing competencies
The critical care nurse:
in pain assessment and pain
management. Demonstrates knowledge in brain
stem death test.
H. Trauma care
Identifies potential organ donor.
The critical care nurse: Provides holistic care to:
➢ Potential donor
Has an understanding on the
➢ Perioperative transplant patient
mechanism of different types of
Identifies potential risk associated
injury.
with organ transplant and takes
Demonstrates nursing competencies
appropriate actions.
in:
➢ Primary and secondary K. Pain Management
assessment
The critical care nurse:
➢ Stabilization, transfer and
transport of trauma patients. 1. Applies evidence-based practices
➢ Emergency and resuscitative on pain prevention.
procedures.
Provides holistic care to patients with 2. Selects appropriate assessment and
different types of traumas. intervention tools and techniques in
collaboration and consultation with
other team members (such as WHO
Pain Ladder or other similar
framework).
 3. Demonstrate management N. Miscellaneous
capabilities of clients using
The critical care nurse provides holistic care
pharmacological and non-
to patients with the following problems:
pharmacological interventions.
➢ Drug overdose
L. Prevention and Control of Infection
➢ Hematological failure
The critical care nurse: ➢ Obstetrical emergencies
➢ Pediatric emergencies
1. Has an understanding of the
➢ Near drowning
principles of prevention of infection.
➢ Thermal injuries – heat stroke,
2. Complies with infection prevention hypothermia
and control guidelines.
M. Psychosocial and spiritual care
3. Demonstrates competency in
The critical care nurse:
handling and preventing infection.
1. Identifies the psychosocial and
4. Monitors patient’s treatment
spiritual needs of ICU patent and
compliance and the related outcome.
his/her families.
5. Provides health education on
2. Demonstrates nursing competence
infection control to the patients and
in communication and counseling
relatives.
skills.
M. Psychosocial and spiritual care
3. Supports the family during the loss,
The critical care nurse: grieving and bereavement process.

1. Identifies the psychosocial and 4. Provides psychosocial care such as

spiritual needs of ICU patent and music therapy, therapeutic touch and
his/her families. relaxation therapy to patient and
his/her family according to their need.
2. Demonstrates nursing competence
in communication and counseling
skills.
Key Responsibility Area II:
3. Supports the family during the loss
2. Management of Resource
grieving and bereavement process.
Responsibilities:
4. Provides psychosocial care such as
music therapy, therapeutic touch and 1. Managing within the
relaxation therapy to patient and organization.
his/her family according to their
DESCRIPTION: The critical care
needs.
nurse understands the vision, mission
and core values of the organization
and facilitates the achievement of the
organizational goals.
Competent Behavior Clusters: 3. Encourages subordinates to
participate in specialty activities, and
1. Demonstrates specialty knowledge
stimulates their innovation in critical
in managing within the organization.
care nursing development.
2. Uses organizational core values
Responsibilities:
and objectives in line with daily work.
3. Assisting in maintaining a safe and
3. Follows organizational policies,
healthy working environment.
procedures and protocols.
DESCRIPTION: The critical care nurse
4. Participates in organizational
carries out activities to assist in maintaining a
initiatives by contributing
favorable working environment.
constructive proposals for
improvement. Competent Behavior Clusters:
5. Strengthens and develops critical The critical care nurse:
care delivery in paced with rapid
1. Creates a favorable working
advanced technologies.
environment that maximizes the
6. Maximizes effective resource production of high-quality critical
utilization. care delivery.
Responsibilities: 2. Establishes effective feedback loop
between health care teams, patients
2. Empowering subordinate.
and relatives.
DESCRIPTION: The critical care nurse
3. Contributes to the maintenance of
achieves targets through subordinates using
occupational health and safety, and
the processes and techniques associated with
prevention of occupational hazard
motivating, coaching, delegating and
ensuring positive practice
supervising.
environment.
Competent Behavior Clusters:
4. Establishes effective linkages
1. Motivates subordinates to achieve between inter and intra departments
assignments and goals by providing and hospitals to share updated
them with the rationale for specialty information and different
performing the task; considering and experiences, thus preparing the
accepting their suggestions when organization to cope with continuous
appropriate; and reinforcing good external changes more efficiently.
practice.
5. Reports any unfavorable
2. Collaborates tasks and deploys environment which may have a
subordinates according to their negative impact on the patient’s
capabilities and job experiences, to physical, psychological and social
allow immediate delivery of critical well-being as well as the process of
care services in crisis management. rehabilitation.
Key Responsibility Area III: empower them to make responsible
choice.
3. Legal Responsibilities
6. Maintains legible, dated signed
Responsibilities:
and accurate nursing records to fulfill
1. Fulfilling legal responsibilities legal responsibilities.
and acting as patients advocate.
7. Is aware of self-limitation and
DESCRIPTION: The critical care seeks advice and supervision from
nurse functions in accordance with senior if a delegated task or
common law, ordinance and responsibility is felt to be beyond
regulations influencing nursing current training or ability, (e.g.,
practice. informs seniors that he/she has no
experience and training in caring
Competent Behavior Clusters: patient undergoing continuous renal
The critical care nurse: replacement therapy).

1. Demonstrates awareness of the 8. Reports any unfavorable

relevant ordinances and environment which may have a
organizational regulations that have negative impact on the patient’s
legal regulations such as Code of physical, psychological and social
Professional Conduct for Nurses and well-being as well as the process of
the Philippines Nursing Law of 2002 rehabilitation.
(RA 9173).
2. Acts based on ethical principles Key Responsibility Area IV:
and ensures that no action or omission
is detrimental to the safety of patients. 4. Ethico-Moral Practice

3. Familiarizes with the legal Responsibilities:

procedures for organ transplantation
1. Practicing ethico-moral
and be sensitive to organ preservation
standards of the nursing
management and family support.
profession.
4. Ensures that informed consent has
DESCRIPTION: The critical care
been obtained prior to carrying out
nurse demonstrates the appropriate
invasive and non-invasive procedures
application of knowledge in nursing
and medical treatment, particularly
practice, which complies with the
when patient or/and family does not
code of professional conduct,
have complete information to make
principles of autonomy, beneficence
an informed decision.
and justice. She / He also accepts
5. Facilitates delivery of personal responsibility for one’s own
comprehensive explanation to professional judgments and actions as
patient/family if indicated to well as consequence of one’s
behavior.
Competent Behavior Clusters: Competent Behavior Clusters:
The critical care nurse: The critical care nurse:
1. Has respect for patient / family 1. Contributes in various clinical
rights including confidentiality. meetings to provide professional
input in patient care management
2. Conducts intensive care nursing
such as case conference and risk
practice and makes sound
management meeting.
independent clinical judgment in a
way that can be ethically justified. 2. Values team members’
participation and joint decision-
3. Aware of the importance of open
making.
discussion with others about his/her
own views on ethical dilemmas. 3. Seeks opportunities to participate
in cross-functional, multi-disciplinary
4. Reports all perceived unethical
quality improvement initiatives.
incidents to responsible person such
as but not limited to, responsible use Responsibilities:
of technology (clinical or
2. Maintaining a cohesive nursing team.
administrative); use of
DESCRIPTION: The critical care nurse
communication devices not related to
establishes and maintains harmonious
clinical practice.
working relationships with nursing
5. Maintains professional decorum in colleague.
dealings with patient, family and co-
Competent Behavior Clusters:
workers.
The critical care nurse:
1.Demonstrates knowledge of team
Key Responsibility Area V:
concepts (e.g., discuss the dynamic of
5. Collaboration and Teamwork teams, participates in various stages
of team growth: forming,
Responsibilities:
brainstorming, and performing).
1. Maintaining collaborative
2. Demonstrates understanding of the
relationships in the multi-
structure, functions and purposes of
disciplinary team.
the team.
DESCRIPTION: The critical care
3. Demonstrates understanding of the
nurse maintains collaborative
role of different team members and
relationships within the ICU team.
the agreed goals.
This relationship contributes towards
the achievement of smooth and 4. Takes initiatives to participate in
effective team performance in team discussion and to achieve team
accomplishing common goals. goals and objectives.
 5. Shows willingness to share 5. Assimilates the evidence-based
workload when needed. research findings to further improve
clinical practice.
6. Participates in various intensive
care related activities such as CQI 6. Supports or participates in nursing
projects, research activities, infection research.
prevention and control survey.
7. Shares and disseminates evidence-
based findings.
Key Responsibility Area VI: 8. Shares clinical experience and
knowledge with colleague.
6. Professional and Personal Development
10. Applies theoretical knowledge to
Responsibilities:
practice.
1. Facilitating the development of
12. Identifies areas for enhancement
nursing knowledge in clinical
of nursing knowledge such as
setting.
counseling and communication skills
DESCRIPTION: The critical care in all areas of critical care practice
nurse takes initiative to support or including bereavement process.
conduct activities, which promote the
Responsibilities:
advancement of nursing knowledge.
2. Evaluating own nursing practice and
Competent Behavior Clusters:
knowledge to enhance personal skills.
The critical care nurse: DESCRIPTION: The critical care nurse
assesses self-awareness of his/her own
1. Develops the necessary skills and professional competence continuously and
initiates efforts to improve efficiency independently; maintains up-to-date nursing
and effectiveness of service; seeks knowledge to keep abreast of nursing trends
opportunities for further development and nursing standards in specialty practice.
within the organization and
contributes to the training and Competent Behavior Clusters:
development needs.
The critical care nurse:
2. Facilitates learners to achieve their
1. Uses professionally acceptable
training and development needs.
standards or practice to assess self-
3. Conducts coaching and actively performance.
participates in the preceptor ship and
2. Demonstrates proficiency in
mentorship program.
providing care to patients receiving
4. Assists in ward different modes of treatment in acute
orientation/induction for new nurses settings to achieve intended outcomes
and alerts them to the specific and prevent or minimize adverse
requirements in caring of ICU outcomes.
patients.
 3. Demonstrates awareness of Competent Behavior Clusters:
individual strength and limitations
The ICU nurse:
and the importance of enhancing
nursing knowledge. 1. Develops the necessary skills and
initiates efforts to improve efficiency
4. Seeks additional
and effectiveness of communication;
information/opportunities to polish
personal skills and qualities e.g., 2. Uses a range of appropriate
attending courses/seminars or reading communication strategies which will
books on relevant subjects when have effective outcome such as but
unfamiliar clinical situations with no not limited to Hand-off
precedents are encountered. communication, use of SBAR on
referral, use of ICU flow sheet.
5. Develops own personal
development plans that include 3. Encourages the use of non-verbal /
attending in-service ICU courses, alternative communication
ICU scientific meetings, overseas techniques including information
ICU conferences, tertiary educational technologies where appropriate to
programs and reading ICU specialty elicit appropriate communication.
journals/literature, etc.
4. Responds rapidly and appropriately
6. Shares up-to-date ICU nursing to the needs of the critically ill
knowledge and current practice with patients, their significant others and
nursing colleagues. the members of the health team.

Key Responsibility Area VII: Key Responsibility Area VIII:

7. Communication 8. Health Education
Responsibilities: Responsibilities:
1. Communicates with individual 1. Provides appropriate health
patient and/or groups and with education based on comprehensive
other members of the health care learning needs of the patient and
team. family.
DESCRIPTION: The critical care DESCRIPTION: The critical care
nurse takes initiative to communicate nurse makes thorough assessment of
with individual and / or groups and the learning needs of the patient and
with other members of the health family for the provision of health
team to facilitate care and education to assist the patient and
management of the patient. family towards a productive life.
Competent Behavior Clusters: DESCRIPTION: The critical care
nurse demonstrates positive attitudes
The critical care nurse:
towards change for improvement.
1. Assesses comprehensively the
Competent Behavior Clusters:
needs and learning barriers of
critically-ill clients, family and their The critical care nurse:
significant others.
1. Demonstrates in-depth
2. Provides refined health education understanding and facilitates the
plan which is individualized and achievement of the organization’s
comprehensive based on the client’s mission, vision and goals through
needs. quality improvement.
3. Demonstrates ability to develop 2. Identifies areas for quality
and use appropriate learning tools for improvement initiatives.
health education.
3. Establishes effective feedback
4. Conducts health education to loops between the organizations,
significant others of the critically-ill health teams, patients and significant
clients with emphasis on basic others pertaining to quality
concepts of the disease process improvement.
5. Facilitates the thorough 4. Facilitates the implementation of
understanding of the critically ill new policies, changes in
client’s significant others regarding implementing rules and regulations
the disease process and course of for quality improvement.
management to enable them to
5. Utilizes available and existing data
participate in the care process.
to support quality improvement
6. Demonstrates ability to appraise initiatives.
outcome of the health education.
7. Integrates the helping and coaching
Key Responsibility Area X:
role of a nurse during expressed need
of the client, his family and 10. Research
significant others.
Responsibilities:
1. Supports a positive climate for
Key Responsibility Area IX: research within the practice setting.
DESCRIPTION: The critical care
9. Quality Improvement
nurse maintains currency of
Responsibilities: knowledge and practice based on
relevant research finding.
1. Proactive in the implementation
of changes as a consequence of
quality improvement initiative.
Competent Behavior Clusters: 3. Demonstrates effective and
appropriate methods of documenting
The critical care nurse:
information.
1.Demonstrates active involvement in
4. Analyzes variances in the data
research activities.
recorded for improvement of client
2. Incorporates evidence-based and care.
research findings into nursing
practice.
3. Identifies areas of practice for
which further research is indicated.
4. Seeks continuous improvement of
professional practice through
research activities.

Key Responsibility Area XI:

11. Record Management
Responsibilities:
1. Ensures that written information
conforms to legal and ethical
framework.
DESCRIPTION: The critical care
nurse maintains accurate and updated
documentation of the care for the
critically ill patient.
Competent Behavior Clusters:
The ICU nurse:
1. Demonstrates ability to document
information in a comprehensive and
clear manner within the legal and
ethical framework.
2. Protects and safe guards the
document conforming legal and
ethical framework and institutional
policies.