Volume 49, Issue 2 , Pages 127-128, February 2012
Post-registration ICU nurses education: Plea for a European curriculum
Article Outline
Keywords: Education, Knowledge, e-Learning
During the past decades, the nursing profession has succeeded in developing a substantial and distinctive body of knowledge, and in placing great emphasis on optimising the delivery of high quality patient care. Also, as healthcare has increased in complexity, various specialised areas of nursing practice have emerged, among which the provision of care to critically ill patients.
These past decades have also witnessed increasingly rapid progresses in the field of intensive care medicine. Due to fast evolving scientific and technological advances, today's intensive care unit (ICU) has become an area of extreme specialisation and, as a result, a complex and at times stressful work environment. To cope with the numerous job demands and to handle the intellectual, physical, psychological and ethical challenges inherent to the daily confrontation with critical illness, ICU nurses need to be adequately equipped, both practically and theoretically. Their equipment should, at the very least, contain a thorough and advanced knowledge of the numerous ICU-related topics and domains, as this is a crucial prerequisite to underpin daily nursing practice and, consequently, to deliver high quality patient care.
Until recently, however, the image of European ICU nurses’ level of knowledge depicted upon the results of a number of recent studies was disturbing. For in several specialised topics, such as respiratory care and infection prevention, their knowledge showed to be substantially inadequate (Blot et al., 2007, Cason et al., 2007, Labeau et al., 2008, Labeau et al., 2009, Pirret, 2007, Soh et al., 2007), and sometimes almost alarming (Labeau et al., 2010). Given these distressing data, it is quite encouraging to discover in the current issue of the Journal a more optimistic perspective (Fulbrook et al., 2012).
Fulbrook and colleagues submitted 1142 ICU nurses in 20 European countries to an online 100-item multiple choice knowledge test, pertaining to 11 subject categories. They found an overall mean score of 65.7% (standard deviation 11.9), and with 90% of the sample exceeding a 50% ‘pass’ mark. These test results can be considered to be rather satisfying as they clearly outweigh those reported in most previously published related papers (Cason et al., 2007, Labeau et al., 2008, Labeau et al., 2009, Labeau et al., 2010, Pirret, 2007, Soh et al., 2007). They might imply that ICU nurses have an adequate basic knowledge of a broad range of global ICU domains, but lack in-depth knowledge of more specialised topics. This suggestion is strengthened by the fact that the current sample's knowledge of respiration and ventilation showed to be relatively poor as compared to other, less specialised, areas examined. These findings have quite some practical implications as they are highly useful to help local and governmental bodies detect ICU nurses’ specific educational needs and to determine tailored initiatives for their continuing professional development.
In line with previous findings (Labeau et al., 2008, Labeau et al., 2009, Toth, 2003), Fulbrook et al., 2012 identified length of ICU experience as a predictor of better knowledge levels. A potential positive interpretation of this finding could be that the ICU is a stimulating work environment that encourages learning and promotes gathering of knowledge during the course of nurses’ careers. A more negative interpretation, however, could be that European institutes for nursing education do not succeed in satisfactorily preparing students to work in the complex ICU environment. Thereby, newly recruited nurses would struggle with a considerable lack of general knowledge when making their first steps in the job and would need at least a couple of years to catch up with their more experienced colleagues. The latter interpretation is rather distressing. It is nevertheless supported by the authors’ finding that having less than two years of ICU experience was identified as an independent predictor of lower test scores by multivariate regression analysis (Fulbrook et al., 2012).
Throughout Europe, there is indeed an enormous variety in the duration, level and content of the courses leading to a specialised degree in ICU nursing, as well as in the nature and level of the institutions providing this education (Baktoft et al., 2003, Labeau et al., 2008, Fulbrook et al., 2012). Although regrettable, this is not surprising given the fact that in Europe even for the preregistration, basic nursing education programs a myriad of arrangements is still available (Spitzer and Perrenoud, 2006). Back in 2004, the European federation of Critical Care Nursing associations (EfCCNa) launched a position statement on the post-registration ICU nursing education within Europe to overcome this issues and promote uniformity (European Federation of Critical Care Nursing Associations, 2004, Fulbrook et al., 2012). Seven years later, however, national and even local disparities still abound, while in today's globalising society the need for a pan-European high quality qualification for ICU nurses has only become more pressing.
Indeed, the past decades have increased openness and transparency across borders. Through the ongoing process of globalisation there has been an increasing recognition of the need for a globally aware workforce in healthcare, but also one which can meet the needs of all patients in an equitable and highly professional way. Workforce issues, including shortages of nursing in some countries with excesses in others are recognised as a major concern, and are raised in the recent EU Green paper on healthcare workforce (Commission of the European Communities, 2008). It is consequently an imperative that this modern nursing workforce is most effectively prepared to deliver high quality care in any European ICU setting.
Therefore, together with Fulbrook et al., we argue in favour of a pan-European curriculum for post-registration ICU nurses. The time has come for European bodies with authority in matters of nursing education to enact an overarching regulation in this area and to recognise the urgent need of devising a unified educational programme that is in line with today's societies profile, needs and expectancies. This curriculum should also reflect the extraordinary challenges and opportunities available to the nursing profession to act as fully-fledged members of the multi-professional ICU team. Therefore, the design of such a curriculum should be supported, or even guided, by a professional organisation such as the European Society of Intensive Care Medicine (ESICM), that brings together all ICU team members: nurses, physicians, physiotherapists and other allied health professionals. A curriculum that aims to direct the next generation of ICU nurses towards a holistic and patient-centered care will best be accomplished by adding to the specific professional issues unique to nursing a broader, multidisciplinary viewpoint.
In conclusion, we recognize the importance of the research done by Fulbrook et al. Together with the authors, we emphasise the need for a pan-European curriculum for post-registration ICU nurses in order to ensure a high quality care across contemporary Europe.
Conflict of interest: None declared.
References
- . A survey of critical care nursing education in Europe. Connect: The World of Critical Care Nursing. 2003;2(3):85–87
- . Evidence-based guidelines for the prevention of ventilator-associated pneumonia. Results of a knowledge test among intensive care nurses. Intensive Care Medicine. 2007;33(8):1463–1467
- . Nurses’ implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention. American Journal of Critical Care. 2007;16(1):28–36
- Commission of the European Communities, 2008. Green Paper on the Workforce for Health. Brussels, 10.12.2008 COM(2008) 725. Available from: http://ec.europa.eu/health/ph_systems/docs/workforce_gp_en.pdf (accessed February 2009).
- European Federation of Critical Care Nursing Associations, 2004. Position statement on post-registration critical care nurse education within the European Community. September 2004. Available from: http://www.efccna.org/downloads/Position%20statement%20on%20education%20EfCCNa.pdf (accessed December 2010).
- . A survey of European intensive care nurses’ knowledge levels. International Journal of Nursing Studies. 2012;49(2):191–200
- . Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among European intensive care nurses. Journal of Hospital Infection. 2008;70(2):180–185
- . Nurses’ knowledge of evidence-based guidelines for the prevention of surgical site infection. Worldviews on Evidence-Based Nursing. 2010;7(1):16–24
- . Centers for disease control and prevention guidelines for preventing central venous catheter-related infection: results of a knowledge test among 3405 European intensive care nurses. Critical Care Medicine. 2009;37(1):320–323
- . The level of knowledge of respiratory physiology articulated by intensive care nurses to provide rationale for their clinical decision-making. Intensive and Critical Care Nursing. 2007;23(3):145–155
- . Critical care nurses’ knowledge in preventing nosocomial pneumonia. Australian Journal of Advanced Nursing. 2007;24(3):19–25
- . Reforms in nursing education across Western Europe: implementation processes and current status. Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing. 2006;22(3):162–171
- . Comparing basic knowledge in critical care nursing between USA and foreign nurses: an international study. American Journal of Critical Care. 2003;12(1):41–46
PII: S0020-7489(11)00300-2
doi:10.1016/j.ijnurstu.2011.07.014
© 2011 Elsevier Ltd. All rights reserved.
Volume 49, Issue 2 , Pages 127-128, February 2012
