Context/Background The management of patients who are critically ill is changing due to increasing population age, increasing prevalence of co-morbid diseases and significant advances (and costs) associated with medical science. Increasing patient acuity means access to specialty training and high quality intensive care nursing (ICN) education is imperative. There is a need to raise the level of practice to more advanced nursing practice (ANP) roles in order to accommodate these changes. However not all countries have developed programs to do so and there is a lack of consistency of content among the existing programs. Our recent survey of intensive care units across Europe (n=24 countries) identified: considerable variation in eligibility requirements, how students were assessed/examined and duration of programmes (30 days to 24 months); challenges in providing ongoing education (n=22 countries); and lack of access to educational resources in 6 countries. This variation in baseline creates role confusion between countries, impeding mobility across Europe and career progression for the ICN workforce. Objectives 1. Use consensus methods to develop a set of competencies required of an advanced level intensive care nurse. 2. Map these competencies against country-specific and multi-country policies and evidence for advanced practice nursing. 3. Identify the feasibility and support the application of these competencies in a number of countries 4. Develop an outline curriculum based on the competencies, freely available online. 5. Map the competencies and curriculum against existing web-based curriculum resources. 6. Develop a prototype online educational resource to support the competencies and curriculum. Number and Profile of Participants Participants will be involved in four activities for the project: (i) A Delphi study (WP 2): n= 75 -100 drawn from VET & HE sectors, the nursing profession and patient representatives. (ii) validation of competencies (WP4): n= 72 patient representatives and n= 80 multi-professional team members, including VET educators (iii) pilot of the online educational resource (WP7): n= 150 ICU nurses and educators (iv) dissemination activities (WP8): (n= 250 minimum) Description of activities The INACTIC Project is a 2 year project and will be delivered through a series of Work Packages. In the central WP (WP2) competencies will be developed, using a three-round, online consensus process across 24 countries. At the same time a review of evidence and policy will be undertaken (WP3), the initial outcomes from which will feed into the second round of the WP2 consensus Delphi process. Following development of the competencies, these will be tested in WP4 to determine the applicability and feasibility of the competencies for individual countries. Content validity testing will also be undertaken during this WP, to ensure individual competency statements have wide acceptability. A curriculum will be developed (WP5), mapped against existing resources (WP6) to enable the competencies to be used on completion of the Project. A prototype online educational resource (WP7) will be developed from existing ESICM resources. WPs1 (Project management) and 8 (Dissemination and Exploitation) will underpin the whole project. Methodology This project applies established methods in new situations, across a culturally diverse group of professionals who share the same title. Specifically, we will: 1. Apply the principles of competency-based training in a new situation, developing a pan-Europe model of curriculum for advanced nursing practice in intensive care. 2. Seek feedback from patient representatives in the testing of competencies; this will give patients across countries a unique opportunity to engage as co-creators of the primary project output. 3. Develop a final set of agreed competencies that can be taught and assessed in the workplace. 4. Develop an outline curriculum, interactive map of educational resources and prototype educational resource to underpin the competencies. Results and Impact envisaged The expected impact is that the outputs will be used to underpin new education and training programmes, for validation in VET and HE settings as appropriate to the individual country. Some benefits will take time to be realised but will be captured by the Project Team after completion: 1. Uptake of the competencies to underpin local education and training programmes. 2. Citation of the outputs in policy guidance for workforce development. 3. Uptake of the on-line educational resource. 4. Acceptance of manuscripts in well-regarded journals, ensuring both wider dissemination and longevity. In those hospitals implementing advanced nursing practice for ICU, it will be important to analyse the wider impact on adverse events, workforce resilience (for example, avoidance of burnout and reduced attrition) and clinical decision-making. This stream of work will be developed on project completion.
Context/Background The management of patients who are critically ill is changing due to increasing population age, increasing prevalence of co-morbid diseases and significant advances (and costs) associated with medical science. The increased complexity of critically ill patients in intensive care settings calls for highly specialised and high-quality intensive care nursing education. There is a need to raise the level of nursing practice to more advanced intensive care nursing practice roles in order to accommodate these changes. However, not all countries have developed advanced critical care nursing programmes and there is a lack of consistency of content among the existing programs. Our survey of intensive care units across 24 European countries identified: considerable variation in eligibility requirements, how students are assessed/examined, a variation in programme duration (30 days to 24 months), availability of post nursing degree critical care nursing education (n=22 countries), and lack of access to educational resources (n= 6 countries). This variation in baseline intensive care nursing education creates role confusion between countries, impeding mobility across Europe and career progression for the intensive care nursing workforce. Objectives 1. Use consensus methods to develop a set of competencies required of an advanced level intensive care nurse. 2. Map these competencies against country-specific and multi-country policies and evidence for advanced practice nursing. 3. Identify the feasibility and support for the application of these competencies in a number of countries 4. Develop an outline curriculum based on the competencies. 5. Map the competencies and curriculum against existing web-based curriculum resources. 6. Develop a prototype online educational resource to support the competencies and curriculum. Number and Profile of Participants Participants were involved in four activities for the project: (i) A Delphi study to develop competencies: We recruited 184 participants from 20 countries. To maximise opportunity for participation, the questionnaires were translated in 8 languages (English, Croatian, French, German, Greek, Polish, Spanish, Turkish). Participants in a number of countries preferred to complete the survey in English. (ii) validation of competencies: In the UK, we undertook two focus group consultations and recruited 12 former patients and family members who had spent time in an intensive care unit. Our Associate Partner in Greece also conducted a consultation with 5 participants. Our intention was to repeat this process in a number of countries but there was no mechanism, outside of the UK and the personal endeavours of our Associate Partner in Greece, to locate and invite former intensive care patients. This is a well-established practice in the UK and patients/family members have access to training and ongoing support to enable them to participate in consultation exercises and research studies. We recruited 16 members of multidisciplinary teams from 5 countries to provide feedback on the competencies. (iii) pilot of the online educational resource: A total of 615 health care professionals completed the online resource from 22 European countries and 18 countries outside of Europe. (iv) dissemination activities: Dissemination activities held throughout the project have recruited 170 participants. These activities include networking events for the Nursing and Allied Health Professionals section of the European Society of Intensive Care Medicine (ESICM) in October 2017 and September 2018; presentations to the ESICM Council (members from 24 European countries) in 2017, 2018 and 2019, and discussion of the project at the ESICM Academy committee. We have a further four events planned in 2020: Brussels (17th March), Copenhagen (June), Madrid (October) and England (September). Description of activities The INACTIC Project was a 2-year project with the goal of developing 6 intellectual outputs (IOs). The central output (IO1) was a set of detailed competencies for advanced intensive care nursing developed, using a three-round, online consensus process across 20 countries. A review of the evidence and policies related to skills and competencies required for advanced critical care nursing practice in European countries was undertaken (IO2). Following development of the competencies, we determined the applicability and feasibility of the competencies for different countries (IO3). Former patients and family members who had been in an intensive care unit reviewed the competencies in focus group interviews. Consultation took place with other professionals who work alongside advanced intensive care nurses (or would. if the role was created in their country). A curriculum was developed (IO4) to enable Vocational Education and Training (VET) and Higher Education (HE) stakeholders to subsequently develop education programmes to relevant to the competencies. The competencies were then mapped against existing online resources (IO5) to enable the competencies to be used on completion of the project by education providers across VET and HE sectors. A prototype online educational resource (IO6) was developed and delivered. Methodology This project applied established methods in new situations, across a culturally diverse group of professionals who share the same title. Specifically, we: 1. Applied the principles of competency-based training in a new situation, developing a pan-Europe model of curriculum for advanced nursing practice in intensive care. 2. Sought feedback from patient and family representatives in the testing of competencies; this gave patients a unique opportunity to engage as co-creators of the primary project output. 3. Developed a final set of agreed competencies that can be taught and assessed in the workplace. 4. Developed an outline curriculum, interactive map of educational resources and prototype educational resource to underpin the competencies. Results and Impact envisaged The expected impact is that the outputs will be used to underpin new education and training programmes, for validation in VET and HE settings as appropriate to the individual country. Our team of international pedagogic experts agree that the competencies achieve Level 6 on the European Qualifications Framework (EQF). This is evident in the language used in the competencies. The starting point for the competencies was responses to open-ended questions hence they reflect the language used by the participants in Round 1 of the consensus process. Given the lower status of nursing in some countries the need to map the competencies to the EQF is important. We have provided a brief summary of the process undertaken to achieve consensus for the competencies and included this detail regarding EQF mapping (summary uploaded to the European Project Results Platform (EPRP)). Some benefits will take time to be realised but will be captured by the Project Team after completion: 1. Uptake of the competencies to underpin local education and training programmes. 2. Citation of the outputs in policy guidance for workforce development. 3. Uptake of the on-line educational resource. 4. Acceptance of manuscripts in well-regarded journals, ensuring both wider dissemination and longevity. In those hospitals implementing advanced nursing practice for Intensive Care Units (ICU), it will be important to analyse the wider impact on adverse events, workforce resilience (for example, avoidance of burnout and reduced attrition) and clinical decision-making. This stream of work will be developed on project completion; some of the Project Team members are engaged in other studies linked to the European workforce research teams, for example, RN4cast, a Europe-wide study (Ball et al 2018) . In addition, the provision of a map of web-based educational resources (Intellectual Output 5), mapped to the competencies, will allow nurses to work at their own pace and without the need to travel outside their own country.