1. Introduction
The demanding environment of the Intensive Care Unit (ICU) necessitates a nursing staff equipped with superior competence. Critically ill patients depend on the expertise of these professionals for their survival and recovery. Understanding and evaluating the competence of Intensive Care Unit nurses (ICU nurses) is therefore paramount to ensuring optimal patient outcomes. This article delves into the self-assessed basic competence of ICU nurses, exploring the factors that influence their perceived abilities and highlighting the significance of tools like the Basic Knowledge Assessment Tool For Critical Care Nursing in professional development.
What is known about this topic?
- Competence in intensive and critical care nursing (ICCN) is a complex, multi-faceted concept, encompassing various dimensions of knowledge, skills, and attitudes.
- While global definitions and frameworks for ICCN competence exist, empirical research specifically evaluating the competence of ICU nurses remains limited.
- Valid and reliable competence evaluation methods are crucial in ICCN education and practice to support nurses’ ongoing professional growth and improve patient care.
What does this paper add?
- This study identifies four key bases of ICU nurses’ competence: knowledge, skill, attitude and value, and experience. Notably, ICU nurses in this study self-assessed their experience base as the area needing most improvement, emphasizing the critical role of practical experience in professional development.
- The research demonstrates a significant link between ICU nurses’ perceived autonomy in nursing care and their self-evaluated basic competence. This highlights the importance of fostering autonomy to enhance professional growth and competence in ICU nursing.
- The findings underscore the need for comprehensive competence development strategies within ICCN education and orientation programs. Curriculum design and educational methodologies should carefully consider these factors to ensure well-rounded and highly competent ICU nurses.
The critical care landscape in regions like Finland, with approximately 30 ICUs caring for over 28,000 patients annually [1], is facing increasing demands. Projections estimate a 25% surge in the need for intensive care by 2030, driven by factors such as aging populations [2]. This escalating demand for critical care services is mirrored across Europe and globally, emphasizing the crucial role of competent ICU nurses.
ICU nurses, the largest professional group in these units, are pivotal in ensuring patient safety and positive outcomes [3, 4]. Their competence directly impacts patient outcomes, contributing to reduced morbidity and mortality, fewer complications, and lower healthcare costs [5–10]. Evidence-based interventions and ethical practice by competent ICU nurses significantly enhance patient well-being, both physiologically and psychologically.
Critical care nursing is recognized as a specialized nursing field [11], demanding a unique blend of technological proficiency, psychosocial sensitivity, and ethical decision-making skills to address the complexities of critical illness [12]. Advanced education in critical care nursing, often at a postqualification level, is typically required [13], aligning with level 6 of the European Qualifications Framework for Lifelong Learning [14, 15]. However, in some regions, like Finland at the time of this study, formal postqualification degree programs in intensive and critical care nursing were lacking.
The global demand for competent nurses is well-documented [16]. Nurses routinely demonstrate clinical competence and theoretical knowledge within recognized professional frameworks [4, 17, 18]. The need for specific and validated instruments for competence evaluation, particularly within specialized fields like critical care nursing, is evident. Competence assessment can utilize diverse methods, including self-assessment, knowledge tests (such as a basic knowledge assessment tool), peer reviews, observational evaluations, OSCEs (objective structured clinical examinations), and portfolios. A combination of these methods often provides the most comprehensive evaluation. Self-assessment, in particular, is a valuable skill that can be cultivated throughout nursing education and professional practice.
Research on Intensive and Critical Care Nursing Competence Scales remains limited. Nursing literature identifies only a few scales, notably the Basic Knowledge Assessment Tool (BKAT), the Intensive Care Hundred Item Test (I-HIT), and multilevel critical care competency statements [19]. Among these, BKAT and I-HIT are knowledge-based tests, while the latter relies on self-assessment and is still undergoing validation. The need for a reliable basic competence self-assessment tool in intensive and critical care nursing is therefore clear, particularly for undergraduate education and establishing practice standards for newly registered nurses. A systematic review of literature from PubMed and critical care nursing organizations over the past decade revealed 21 relevant studies and documents focusing on competence in intensive and critical care nursing (see Appendix).
Literature reviews indicate that competence is a multidimensional concept, encompassing clinical practice (nursing process), ethics, collaboration, leadership, education, and professional development. It is influenced by factors like age, experience, and the frequency of utilizing specific competencies. Global research in Europe, Australia, New Zealand, USA, Canada, and Brazil highlights the need for systematic competence evaluation. Self-assessment [20–22] and knowledge tests [23] are commonly used evaluation methods. ICU nurses’ self-assessed competence generally ranges from moderate to excellent, varying with experience levels. European ICU nurses’ average knowledge score on assessments was 66% (SD 12), with experience being a significant factor in score variance. Respiration and ventilation were identified as knowledge areas with lower scores [23].
This empirical study aimed to describe and evaluate the self-assessed basic competence of ICU nurses and explore related factors, utilizing the Intensive and Critical Care Nursing Competence Scale version 1 (ICCN-CS-1) [11]. Related factors were categorized into: (i) demographics (age, gender), (ii) education, (iii) work experience, (iv) information retrieval habits, (v) knowledge test scores, and (vi) other factors like autonomy. The hypothesis was that these factors could explain basic competence levels. This study is part of a larger project focused on developing and validating the ICCN-CS-1 scale [24], aiming to establish its psychometric properties (reliability and construct validity). The overarching project sought to define ICCN competence, create a self-assessment scale for its evaluation, and establish baseline competence levels for graduating nursing students.
In this study, “ICU nurse” refers to registered nurses practicing in ICUs with a Bachelor of Health Care, specialist nurse, or nurse education. The analysis of ICU nurses’ basic competence included their experience base, unlike a prior study on graduating nursing students where experience was limited. This study uniquely emphasizes the multidimensional nature of competence, analyzing four bases: knowledge, skill, attitude and value, and experience [19].
ICCN-CS-1 assesses basic competence, representing the foundational abilities required for ICU practice. It aligns with step 1 competencies in frameworks like the National Competency Framework for Adult Critical Care Nurses [25] and Critical Care Nurse Education Practice Standards [26]. ICCN-CS-1 is valuable for planning supervision in preregistration clinical practice and orientation programs, aiding in identifying learning gaps, setting goals, and facilitating comprehensive competence discussions. The scale’s content aligns with postgraduate education and specialist-level competence standards, serving as a starting point for transitioning from preregistration to postgraduate education. Developed for intensive and critical care education, ICCN-CS-1 results can inform nursing education, particularly basic and continuing education, as well as professional performance appraisals in ICUs.
Alt Text: An ICU nurse attentively monitors a patient in an intensive care unit, showcasing the dedication and focused care required in critical care nursing.
2. Materials and Methods
2.1. Aim
This study aimed to describe and evaluate the self-assessed basic competence of ICU nurses and identify related factors. The findings are intended to support educators, clinicians, and researchers in refining basic nursing education and ICU orientation programs, potentially incorporating tools like a basic knowledge assessment tool for critical care nursing.
2.2. Research Questions
The study addressed the following research questions:
- What is the self-assessed basic competence level of ICU nurses?
- What factors are associated with this basic competence?
2.3. Design
A cross-sectional survey design was implemented, utilizing questionnaires distributed to Finnish ICU nurses in university hospitals.
2.4. Sample/Participants
Total sampling was employed across five Finnish university hospitals, resulting in 431 participants (54% response rate). In one hospital, a convenience sample of 82 ICU nurses (37% response rate) also completed a biological and physiological knowledge test. A pilot study in 2008 excluded that hospital from the 2010 data collection, resulting in four participating hospitals in the final study.
2.5. Data Collection
Data was gathered using questionnaires facilitated by contact persons in each ICU. The instruments included the Intensive and Critical Care Nursing Competence Scale (ICCN-CS-1) [24] and, for the convenience sample, the Basic Knowledge Assessment Tool version 7 (BKAT-7) [27] as a background factor. The questionnaire’s first page collected 12 background factors integral to the ICCN-CS-1.
The ICCN-CS-1 is a self-assessment tool comprising 144 items across six sum variables, measuring basic competence in intensive and critical care nursing. It conceptually divides basic competence into clinical and professional competence. Clinical competence includes principles of nursing care, clinical guidelines, and nursing interventions. Professional competence encompasses ethical activity and health care law familiarity, decision-making, development work, and collaboration. Competence is further categorized into knowledge, skill, attitude and value, and experience bases, each with seven subdomains. Items are rated on a Likert scale (1-5), yielding a total score range of 144-720. Score ranges correspond to competence levels: poor (144–288), moderate (289–432), good (433–576), and excellent (577–720) [24]. Mean score classifications are: poor (1–2.49), moderate (2.5–3.49), good (3.5–4.49), and excellent (4.5–5.0) (Table 1) [19].
Table 1. Structure and item amounts of ICCN-CS-1.
| Basic competence = clinical competence + professional competence | Knowledge base | Skill base | Attitude and value base | Experience base | Items |
|---|---|---|---|---|---|
| Clinical competence (80) | |||||
| Principles of nursing care | 4 | 4 | 4 | 4 | 16 |
| Clinical guidelines | 4 | 4 | 4 | 4 | 16 |
| Nursing interventions | 12 | 12 | 12 | 12 | 48 |
| Professional competence (64) | |||||
| Ethical activity and familiarity with health care laws | 4 | 4 | 4 | 4 | 16 |
| Decision-making | 4 | 4 | 4 | 4 | 16 |
| Development work | 4 | 4 | 4 | 4 | 16 |
| Collaboration | 4 | 4 | 4 | 4 | 16 |
| Items | 36 | 36 | 36 | 36 | 144 |
The 12 background factors were grouped into: (i) age and gender (2 questions), (ii) education (basic, continuing, conferences; 3 questions), (iii) work experience (ICU, other healthcare; 2 questions), (iv) information retrieval (independent, journals; 2 questions), and (v) others (autonomy and motivation on a 1-10 scale, special responsibilities – yes/no). Autonomy was assessed by asking nurses to rate their perceived autonomy in their nursing work. The convenience sample also completed BKAT-7, a biological and physiological basic knowledge assessment tool with 100 items across eight sum variables: cardiovascular, monitoring lines, pulmonary, neurology, endocrine, renal, gastrointestinal, and other [27]. Data collection spanned January to May 2010.
2.6. Ethical Considerations
The study adhered to ethical guidelines [28, 29], receiving ethics committee approval from university XXX [26.10.2009]. Permission to use BKAT-7 and its Finnish version was granted. Research permissions were secured from each hospital. Participation was voluntary and anonymous at all stages, with questionnaire return considered consent. Hospitals were not compared, and data was securely and anonymously stored.
2.7. Data Analysis
Data was analyzed using SAS for Windows (version 9.2). Sum variables were calculated if at least 80% of items were answered. Two-independent-sample t-tests compared basic competence across two-category factors. One-way ANOVA with Tukey’s adjustment tested differences across education groups. Linear regression analyzed associations between continuous factors and basic competence. ANCOVA, excluding age (due to multicollinearity with work experience, r = 0.76) and other work experience (due to missing data), was used to analyze factors associated with basic competence. Spearman correlations were calculated. Statistical significance was set at P < 0.05.
2.8. Validity and Reliability
ICCN-CS-1 reliability and validity were previously assessed as adequate in its early development phase. The scale’s content was rigorously defined in a theoretical phase [24]. In this study, ICCN-CS-1 internal consistency was 0.99 (sum variable range 0.88–0.98), indicating good reliability. Further development and testing are planned. BKAT-7 internal consistency was not assessed as it is a knowledge test.
3. Results
3.1. Participants
The majority of participants were female (84.6%), with a mean age of 38 years (range 22–62). Over half held a Bachelor of Health Care degree (52.9%), and their average ICU work experience was 9.1 years (range 0.02–36 years) (Table 2).
Table 2. Characteristics of nurses (n = 431).
| Background factors | Nurses |
|---|---|
| Mean | SD |
| n | % |
| Age (n = 430) | 38 |
| Gender (n = 421) | |
| Female/male | 356/65 |
| Education (n = 429) | |
| Nurse (Bachelor of Health Care) | 227 |
| Specialist nurse | 95 |
| Nurse | 82 |
| Others | 25 |
| Work experience (years) as a nurse in intensive and critical care (n = 425) | 9.1 |
| Other work experience as a nurse in health care (n = 328) | 5.4 |
| Continuing education in intensive care nursing (n = 423) | |
| Yes | 73 |
| No | 350 |
| Participation in intensive care conferences and education days (n = 428) | |
| Yes | 307 |
| No | 121 |
| Independent information retrieval of intensive and critical care nursing (n = 426) | |
| Yes | 400 |
| No | 26 |
| Use of nursing journals in information retrieval of intensive and critical care nursing (n = 429) | |
| Yes | 367 |
| (i) International scientific journals | 67 |
| (ii) National scientific journals | 141 |
| (iii) Professional journals | 352 |
| No | 62 |
| Work motivation (1–10) (n = 429) | 8.1 |
| Autonomy in nursing (1–10) (n = 430) | 8.1 |
| Special responsibility areas in the ICU (n = 428) | |
| Yes | 326 |
| No | 102 |
3.2. ICU Nurses’ Basic Competence
Nurses’ self-rated basic competence (n = 431) was predominantly excellent (67.5%) or good (32.3%), with a mean score of 4.19 (SD 0.40). Clinical competence, directly related to patient care, was rated higher than professional competence. The highest competence self-ratings were for “principles of nursing care,” emphasizing ethical standards and patient-centeredness. Collaboration was rated as the strongest professional competence, while development work received the lowest ratings. Among the competence bases, “attitude and value base” was rated excellent, while the “experience base” received the lowest, though still within the “good” range (Table 3).
Table 3. The domains and bases of basic competence and the self-assessment scores.
| Domains and bases of basic competence | Self-assessment scores (1–5) |
|---|---|
| (n = 428–431) | |
| Mean | SD |
| Basic competence | 4.19 |
| Clinical competence | 4.33 |
| Principles of nursing care | 4.47 |
| Clinical guidelines | 4.36 |
| Nursing interventions | 4.27 |
| Professional competence | 4.02 |
| Collaboration | 4.28 |
| Decision-making | 4.24 |
| Ethical activity and familiarity with health care laws | 3.90 |
| Development work | 3.65 |
| Attitude and value base of competence | 4.68 |
| Knowledge base of competence | 4.05 |
| Skill base of competence | 4.02 |
| Experience base of competence | 3.82 |
3.3. Background Factors in relation to Basic Competence
Ten of twelve background factors showed positive associations with basic competence (Table 4). In ANCOVA modeling, autonomy in nursing care, special responsibility areas, ICU work experience, independent information retrieval, and participation in conferences remained significant. Higher education levels and journal use correlated positively with competence. Work motivation and gender did not show a positive association.
Table 4. Statistically significant background factors in relation to basic competence.
| Background factor | P value | Regression coefficient β | Standard error | Mean of ICCN-CS-1 | SD |
|---|---|---|---|---|---|
| Age (n = 430) | 1 | 0.02 | 0.002 | ||
| Education (n = 429) | 2 | ||||
| Nurse (Bachelor of Health Care) | 4.07 | 0.38 | |||
| Specialist nurse | 4.39 | 0.32 | |||
| Nurse | 4.35 | 0.36 | |||
| Others | 4.04 | 0.43 | |||
| Work experience (years) as a nurse in intensive and critical care (n = 425) | 3 | 0.02 | 0.002 | ||
| Other work experience as a nurse in health care (n = 328) | 0.00041 | 0.01 | 0.003 | ||
| Continuing education in intensive care nursing (n = 423) | 3 | ||||
| Yes | 4.35 | 0.40 | |||
| No | 4.15 | 0.39 | |||
| Participation in intensive care conferences and education days (n = 428) | 3 | ||||
| Yes | 4.30 | 0.35 | |||
| No | 3.92 | 0.39 | |||
| Independent information retrieval of intensive and critical care nursing (n = 426) | 0.00013 | ||||
| Yes | 4.21 | 0.39 | |||
| No | 3.90 | 0.43 | |||
| Use of nursing journals (n = 429) | 3 | ||||
| Yes | 4.23 | 0.38 | |||
| No | 4.00 | 0.43 | |||
| Autonomy in nursing care (1–10) (n = 429) | 1 | 0.16 | 0.01 | ||
| Special responsibility areas in the ICU (n = 428) | 3 | ||||
| Yes | 4.28 | 0.36 | |||
| No | 3.90 | 0.39 |
1Linear regression.
2One-way analysis of variance; Tukey’s adjusted P values; nurse (BHC) versus specialist nurse (P < 0.05); nurse versus nurse (P < 0.05); specialist nurse versus others (P < 0.05); nurse versus others (P = 0.001).
3Two-independent-sample t-test.
The basic knowledge assessment tool, BKAT-7, administered to a convenience sample, showed a mean score of 68.26 (SD 10.27). The ICCN-CS-1 mean score in this sample was 4.13 (SD 0.42). No significant correlation was found between BKAT-7 scores and ICCN-CS-1 self-assessment scores (r = 0.098).
Alt Text: A focused ICU nurse carefully reviews a patient’s medical chart, emphasizing the importance of meticulous documentation and attention to detail in critical care.
4. Discussion
This study uniquely utilized a self-assessment competence scale specifically designed for intensive and critical care nursing, addressing the critical need for specialized evaluation tools in nursing. Evaluating competence in specific nursing areas with tailored scales, like a basic knowledge assessment tool for critical care nursing, is clinically essential.
The findings indicated that ICU nurses generally self-assessed their basic competence as good, aligning with previous research highlighting the positive correlation between competence and work experience [20–22]. The higher rating for clinical competence over professional competence may reflect the technically demanding nature of ICU environments. The excellent rating for attitude and value base underscores the strong ethical orientation in ICU nursing. However, within professional competence, “ethical activity and familiarity with health care laws” received a lower rating than “principles of nursing care,” possibly due to ICU nurses’ greater familiarity with direct patient care ethics than broader legal and ethical frameworks [20–22].
Collaboration was recognized as a strength, while development work was identified as the weakest area of professional competence, consistent with prior studies [20–22]. This may stem from limited education, experience, and resources for development work, or potentially negative attitudes towards nurses’ roles in development activities.
The critical self-evaluation of the “experience base” suggests that ICU nurses associate specialized competence with extensive practical experience. The strong correlation between perceived autonomy and basic competence reinforces autonomy’s crucial role in professional identity and development [30].
The lack of correlation between BKAT-7 knowledge test scores and self-assessed competence underscores that competence is a holistic, multidimensional concept beyond just knowledge. While foundational knowledge, as assessed by a basic knowledge assessment tool, is crucial, skills, attitudes, values, and experience are equally vital [11]. This highlights the importance of comprehensive competence evaluation and development in nursing education.
Most ICU nurses actively seek information and engage in professional development. However, the range in work motivation and autonomy scores suggests variability in these factors. While work motivation did not correlate with self-assessed competence in this study, autonomy was strongly linked. Further research into the interplay between “safety culture,” “basic competence,” and factors like intent to leave nursing, job satisfaction, and patient safety is warranted [31].
4.1. Strengths and Limitations
Limitations include the national sample from university hospitals and a moderate response rate. The novelty of the ICCN-CS-1 scale presents challenges, similar to other holistic competence scales [32], with high Cronbach’s alpha values and potential unidimensionality. Self-assessment, while valuable, has inherent limitations and should be complemented by other assessment methods. Respondent bias is also a potential factor. However, the scale’s rigorous development by experts, targeted sampling of high-competence ICUs, and a reasonable response rate strengthen the study’s findings.
5. Conclusions
This study concludes that ICU nurses’ perceived autonomy significantly influences their self-assessed basic competence. Specific responsibilities and ICU work experience also contribute positively. Enhancing nurses’ autonomy and fostering specific interest areas are crucial for professional development and retention in critical care nursing. Work experience, both in length and quality, is integral to basic competence. Areas like “experience base,” “development work,” and “ethical activity and familiarity with health care laws” require focused attention in education and training. Future research could explore the development and integration of basic knowledge assessment tools for critical care nursing within comprehensive competence development programs.
Acknowledgments
The authors gratefully acknowledge all participating ICU nurses and contact persons from Finnish university hospitals, as well as Mrs. Anna Vuolteenaho for her English language expertise. The Finnish Post-Graduate School in Nursing Science provided funding for this project.
Appendix
See Table 5.
Table 5. Summary of competence literature in intensive and critical care nursing 2004–2014.
| Organisation/author, year, country | Document/title of the study/method | Aim | Main findings/results |
|---|---|---|---|
| Gill et al. 2015, Australia [26] | “Development of Australian Clinical Practice Outcome Standards for Graduates of Critical Care Nurse Education”Delphi technique | To develop critical care nurse education practice standards | The process resulted in the development of 98 practice standards, categorized into three levels |
| Lakanmaa et al. 2014, Finland [24] | “Basic Competence in Intensive and Critical Care Nursing: Development and Psychometric Testing of a Competence Scale”Questionnaire survey | To develop a scale to assess basic competence in intensive and critical care nursing | The Intensive and Critical Care Nursing Competence Scale is a self-assessment test consisting of 144 items. Basic competence is divided into patient-related clinical competence and general professional competence. Basic competence consists of knowledge base, skill base, attitude and value base, and experience base |
| EfCCNa 2013, Europe [4] | “EfCCNa Competencies forEuropean Critical Care Nurses” | To develop a European Critical Care Nursing competency framework | Four main domains: clinical domain, professional domain, managerial domain, and education and development domain. These are divided into 14 different subdomains |
| Camelo 2012, Brazil [33] | “Professional Competences of Nurse to Work in Intensive Care Units: An Integrative Review”Literature review | To identify and analyse nurses’ competences to work at intensive care units | Eight themes of competence were found: nursing care management, high-complexity nursing care delivery, decision-making, leadership, communication, continuing/permanent education, human resource management, and material resource management |
| Gill et al. 2012, Australia [34] | “A Review of Critical Care Nursing Staffing Education and Practice Standards”Review | To review the differences and similarities in critical care nursing staffing, education, and practice standards in the US, Canada, UK, New Zealand, and Australia | There is a general consensus about the importance of optimum staffing by registered nurses with proportion of those holding relevant postregistration qualifications; there is no consistency in defining the educational preparation for qualified critical care nurse |
| Hadjibalassi et al. 2012, Cyprus [35] | “Development of an Instrument to Determine Competencies of Postgraduate ICU Nurses in CyprusCombination of Qualitative and Quantitative Approach” | To report the development of an instrument to determine what competencies are expected of postgraduate critical care nurses | The final questionnaire includes 72 items and has a four-dimensional structure; the dimensions are (i) leadership/management and professional development, (ii) decision-making and management of emergencies, (iii) provision of care and professional practice, and (iv) ethical practice |
| Fullbrook et al. 2012, Australia [23] | “A Survey of European Intensive Care Nurses’ Knowledge Levels”Questionnaire survey | To examine the knowledge levels of European intensive care nurses | The overall mean knowledge score was 66% (SD 12); the main factor that contributed to variance in scores was nurses’ length of intensive care experience; the knowledge category which scored lowest was respiration and ventilation |
| Lakanmaa et al. 2012, Finland [11] | “Competence Requirements in Intensive and Critical Care Nursing-Still in Need of Definition? A Delphi Study” Qualitative Delphi study | To identify competence requirements | Competence requirements can be divided into five main domains: knowledge base, skill base, attitude and value base, nursing experience base, and personal base of the nurse |
| Critical Care Networks-National Nurse Leads 2012, UK [25] | “National Competency Framework for Adult Critical Care Nurses” | The framework is a collection of the core clinical competencies that have been identified as basic to the effective performance of adult critical care nursing | Step 1 competencies should be commenced when a nurse begins in critical care or when he/she has no previous experience of the specialityStep 2 and 3 competencies should be completed during the period of an academic critical care programmeThe Critical Care Competency Framework Content includes several system and additional areas |
| O’Leary 2012, USA [21] | “Comparison of Self-Assessed Competence and Experience among Critical Care Nurses”Questionnaire survey | To determine the level of self-assessed nursing competence and the relationship with age and experience in nursing | The nurses “self-assessed level of competence ranged from good to excellent along with an increased frequency of using competencies. The longer the nurses” experience, the greater their self-assessed level of competence |
| Stewart and Rae 2013, UK [36] | “Critical Care Nurses’ Understanding of the NHS Knowledge and Skills Framework. An Interpretative Phenomenological Analysis”Qualitative study | To explore critical care nurses’ understanding of the National Health Service (NHS) Knowledge and Skills Framework (KSF) | Two superordinate themes of “engagement” and “theory-practice gap” were identified; six subthemes of “fluency,” “transparency,” “self-assessment,” “achieving for whom,” “reflection,” and “the nursing role” further explained the superordinate themes Challenges identified were primarily concerned with complex language, an unclear process, and the use of reflective and self-assessment skills |
| Critical Care Nurses’ Section 2010, New Zealand [37] | “New Zealand Standards in Critical Care Nursing Education” | The standards provide the framework for curriculum development and student evaluation | There are six standards: (i) nursing education is provided and managed by appropriately qualified staff, (ii) entry requirements for nursing programmes are explicit, fair, and equitable, (iii) the curriculum is developed collaboratively and directed towards providing clinical, educational, and professional preparation to be a qualified nurse, (iv) the opportunity to gain clinical competence in the areas covered by the programme is also provided, (v) nurses are assessed throughout and on completion of the programme, and (vi) theoretical content is offered to provide the nurse with knowledge to assess, plan, manage, document, and analyse the care of the critically ill patient and family |
| CACCN 2009, Canada [38] | “Standards for Critical CareNursing Practice” | To provide an essential resource to all nursing professionals in their pursuit of best practice in the critical care environment | Seven standards are provided related to patient monitoring and management for the promotion of optimal physiological balance, comfort, and well-being of the patient, patient and family centeredness care, end-of-life care, patient safety and best practice, collaboration practice, and leadership |
| AACN 2008, USA [39] | “AACN Scope and Standards for Acute and Critical Care Nursing Practice” | To describe a competent level of behaviour in the professional role. The measurement criteriadescribe how the standards are met | The nursing process is used as the framework. Nine standards include activities related to quality of professional practice, professional practice evaluation, education, collegiality, ethics, collaboration, research, resource utilization, and leadership |
| Ääri et al. 2008, Finland [40] | “Competence in Intensive and Critical Care Nursing: A Literature Review”Literature review | To define and describe the concept of competencein adult intensive care nursing | Clinical and professional competence in intensive and critical care nursing can be defined as a specific knowledge base, skill base, attitude and value base, and experience base of intensive and critical care nursing |
| Salonen et al. 2007, Finland [22] | “Competence Profiles of Recently Registered Nurses Working in Intensive and Emergency Settings” | To describe recently registered nurses’ perceptions of their competence level and to identify factors influencing these perceptions | Nurses’ self-assessed competence level ranged from moderate to good; a statistically significant association was seen between competence level and age, length of current work experience, and the frequency of using competencies |
| ACCCN 2006, Australia [41] | “ACCCN Position Statement (2006) on the Provision of Critical Care Nursing Education” | To outline the recommendations regarding the provision of critical care nursing education | The recommendations are based on evidence from research in critical care nursing or allied fieldsIn areas where current research-based evidence is not available, the recommendations (16, 16 subject areas) are based on the opinion of expert nurses |
| Lindberg 2006, Sweden [42] | “Competence in Critical Care: What It Is and How to Gain It: A Qualitative Study from the Staff’s Point of View”Qualitative interview study | To contribute to the body of knowledge relating to the concept of competence | Five different ways of understanding competence in intensive care were described: ability to cooperate, being able to perceive the situation correctly, being aware of abilities and limitations, being able to act, and being able to disregard the technology when needed |
| Fisher et al. 2005, Australia [32] | “Competency Standards for Critical Care Nurses: Do They Measure Up?”Questionnaire survey | To determine the construct validity of the Australian College of Critical Care Nurses (ACCCN) competency standards as a tool for assessing the clinical practice of specialist level critical care nurses | There was no support for the structure for the ACCCN competencies; the elements did not fit statistically uniquely to a single competency. Competency statements also loaded across several domains |
| WFCCN 2005 [43] | “Position Statement on the Provision of Critical Care Nursing Education-Declaration of Madrid, 2005” | To inform critical care nursing associations, health care providers, and educational facilities of the development and provision of critical care nursing education | Five central principles and 14 recommendation guidelines providing critical care nursing education: health services, educational facilities, and critical care nursing organisations |
| Meretoja et al. 2004, Finland [20] | “Comparison of Nurse Competence in Different Hospital Work Environments”Questionnaire survey | To examine nurses’ perceptions of competence in different university hospital work environments | Nurses reported their overall level of competence as good; they felt most competent in the categories of managing situations, diagnostic functions, andhelping role and least competent in ensuring quality categoryThe greater the self-assessed level of competence, the higher the frequency of using of competencies; correlations between both age and length of work experience and the self-assessed overall level of competence were positive |
Conflict of Interests
The authors declare no conflict of interests.
Authors’ Contribution
(1) R.-L. Lakanmaa, M. Ritmala-Castrén, T. Suominen, H. Leino-Kilpi, and T. Vahlberg contributed to the conception and design of the study, data acquisition, and data analysis and interpretation. (2) R.-L. Lakanmaa, M. Ritmala-Castrén, T. Suominen, H. Leino-Kilpi, and T. Vahlberg drafted and critically revised the paper for important intellectual content. (3) R.-L. Lakanmaa, M. Ritmala-Castrén, T. Suominen, H. Leino-Kilpi, and T. Vahlberg provided final approval of the submitted version. All authors have approved the final paper and confirm that all individuals entitled to authorship are included.
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