The transition from active treatment to initiation of end-of-life care within the intensive care unit: A clinician's perspective

Abstract

Introduction: To achieve optimal patient outcomes, nurses working in critical care should hold a specialty qualification. Currently no uniform practice outcomes for critical care programs exist. Varying interpretations of a “critical care qualification” have been used as there are no agreed practice standards to measure outcomes. Additionally there have been no reported attempts to include health service consumer input into the development of practice standards. Study objectives: To develop national practice standards for graduates of critical care nurse education and a clinical assessment tool (SPECT) to measure practice. Methods:Amulti-step,mixedmethod design including a literature review, analysisof existingprograms (n=22)and identification of health consumer views via individual and group interviews (n=17). The findings informed a Delphi study of 105 nurse stakeholders to determine critical care graduate practice standards. The SPECT was based upon the Delphi results and pilot-tested. Results: The literature review, analysis of courses and health consumers viewswere used to develop 99 draft practice standards. The Delphi study resulted in 98 agreed standards (organised in 6 domains) that describe newly graduated critical care nurses should be able to manage the care of critically ill patients in most complex situations. They should not be expected to perform leadership roles. The standards were further arranged into a practical tool to measure graduate practice. This involved elimination of some duplication and re-grouping of some statements as elements. The SPECT contained 86 statements – initial testing revealed strong content validity, good internal consistency, test–retest and intrarater agreement, with at least moderate agreement for 94% of statements. The majority of panel responses (66%) were ranked as clinically feasible. Conclusion: For the first time health consumers have contributed to the components of critical care nurse graduate practice. The standards and SPECT provide the means to clearly define the expected practice level for graduates of critical care education programs. Acknowledgements: Thank you to: Australian College of Critical Care Nurses, Department of Health Western Australia, Helen Bailey Scholarship 2011, the participants for each phase of the study.