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 for European 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 Cyprus Combination 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 speciality Step 2 and 3 competencies should be completed during the period of an academic critical care programme The 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 Care Nursing 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 criteria describe 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 competence in 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 fields In 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, and helping role and least competent in ensuring quality category The 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