TABLE 3.

Skills of ECMO nurses

Domains	Subcompetencies	Items in subcompetencies
Skills	Skills of critical care	Being able to comprehensively evaluate the physiological and psychological conditions in critically ill patients to complete the taking of medical histories and systematically and comprehensively observe their conditions according to changes in the respiratory system, circulatory system, digestive system, etc., and carry out critical care assignments in an organized manner.
		Being able to correctly and effectively carry out all critical care techniques, including basic nursing techniques such as oral nursing and nasal feeding and specialized nursing techniques such as closed suction and deep vein indwelling and nursing, and master the implementation and nursing essentials of usual basic and advanced life support techniques such as CPR, PP, CRRT, IABP and mechanical ventilation.
		Being able to accurately implement liquid management strategies.
		Being able to collect test specimens correctly and normatively.
		Being able to write medical documents accurately, timely and truthfully.
	Skills of ECMO care	Completing the preparation independently, quickly and accurately before establishing ECMO, including materials preparation, patient preparation, environment preparation and team preparation.
		Completing ECMO pipes pre‐flush independently, accurately and quickly.
		Completing nursing cooperation of ECMO establishment, pipe fixation, pipe maintenance, membrane replacement and programmed weaning procedures under different modes independently.
		Being able to check the safety of ECMO patients and ECMO circuit accurately, including checking the connection and fixation status of each pipe and parameter values and pressure monitoring of pre‐membrane and postmembrane timely.
		Being able to effectively observe patients' vital signs, the dryness of the puncture site dressing, the recovery level of each system, the operation status of each ECMO pipe and the effectiveness of the ECMO membrane during treatment with different ECMO modes.
		Being able to use various assessment tools for critically ill patients correctly, such as the ability to assess patients' level of sedation and analgesia and then properly restrain ECMO patients.
		Being able to evaluate and monitor the cardiopulmonary function of ECMO patients correctly, use anticoagulant drugs and implement anticoagulant monitoring and management correctly, and reasonably interpret the results of usual laboratory tests such as blood gas analysis, infection indicators and coagulation indicators.
		Being able to formulate individualized rehabilitation training programmes covering the early, middle and long‐term stages of ECMO treatment for ECMO patients according to their conditions and assist them in carrying out progressive rehabilitation training in various forms, such as active training and passive training.
		Mastering transport procedures of ECMO patients and completing the inter and intra‐hospital transport quickly, safely and effectively.
		Being able to take corresponding nursing measures to prevent and treat ECMO‐associated complications and strengthen infection prevention and control, anticoagulant and haemorrhage monitoring, and ventilator‐associated pneumonia prevention and management for long‐term ECMO.
		Being able to implement aseptic techniques and other infection control relevant preventive measures strictly during delivering ECMO care.
		Being able to make plans for long‐term follow‐up and implement them.
		Being able to charge correctly according to ECMO‐related charging standards.
	Holistic nursing skill	Being able to view critically ill patients and applications of ECMO as a complex holistic, provide care effectively for patients treated with both ECMO and other conventional therapeutic techniques and instruments such as PP, CRRT, IABP and mechanical ventilation.
	Emergency rescue skill	Mastering first aid techniques and being able to quickly and calmly implement the necessary emergency rescue measures, such as CPR, when faced with an emergency ECMO patient treatment scenario.
	Teaching skill	Being able to develop systematic teaching plans, carry out various ECMO‐related training activities such as lectures and workshops for low‐level nurses, complete the teaching and assessment tasks for new trainees, and guide and assist low‐level nurses on ECMO care to help cultivate ECMO nursing talents and improve the overall quality of the ECMO team.
	Health education skill	Providing health education and counselling to ECMO patients and their family members based on principles and methods of health education.
Skills
	Clinical thinking skill	Being able to apply knowledge such as nursing, anatomy, pathology, physiology, pharmacology and psychology making a health assessment to analysis, analogy, integrate, conjecture, evidence‐based confirm or exclude, inductive, and then develop individualized care plans and implement them critically, and constantly revise the thought process and thought activity.
	Evidence‐based practice	Being able to integrate evidence from domestic and foreign advanced research such as the latest guidelines and guide ECMO nursing practice based on evidence‐based concepts to explore suitable nursing methods for national conditions.
	Risk warning and prevention skill	Being able to evaluate predictively and early warning about the potential risk factors that may induce ECMO‐associated complications such as coagulation dysfunction, haemorrhage, thrombosis, lower limb ischemia, infection, air embolism and adverse events like inadvertent decannulation and pressure ulcers, and implement corresponding nursing interventions to prevent the occurrence of accidents.
	Emergency handling skill	Mastering relevant ECMO emergency plans such as circuit disruption, inadvertent decannulation, raceway rupture, system or component alarm elimination, air embolus, intracranial and other haemorrhage and so on.
		Being able to respond quickly and flexibly in the above emergencies.
Interpersonal communication	Communicate with ECMO multidisciplinary teams, patients and family members timely, accurately and effectively.