Page 28 - ACCCN's Critical Care Nursing

Scope of Critical Care Practice 5

‘beginner’ ‘competent’ ‘specialist’ ‘expert’

continuing experience/experiential learning Practice
Induction/
orientation
to critical short courses/skills updates/in-service education Training
care
nursing
initial competencies increasing complexity of competencies Education
Postgraduate Graduate Graduate Masters
education Certificate Diploma
FIGURE 1.1 Critical care nursing practice: training and education continuum.

by the World Federation of Critical Care Nurses, provides Appendix B). The validity of this structure of six domains
a baseline for critical care nursing education (see Appen- has been questioned, however, as a number of compe-
35
dix A for the position statement). 5 tency statements are linked to several domains. Further
research is therefore required to refine the structure of a
A range of factors continue to influence critical care 35
nursing education provision, including government poli- competency model with improved construct validity.
cies at national and state levels, funding mechanisms and Other competency domains and assessment tools have
25
resource implications for organisations and individual also been developed. Although articulated slightly dif-
students, education provider and healthcare sector part- ferently, the American Association of Critical-Care Nurses
nership arrangements, and tensions between workforce (AACN) provides ‘Standards of Practice and Performance
36
and professional development needs. Recruitment, ori- for the Acute and Critical Care Clinical Nurse Specialist’,
13
entation, training and education of critical care nurses which outlines six standards of practice (assessment,
can be viewed as a continuum of learning, experience and diagnosis, outcome identification, planning, implemen-
professional development. The relationships between tation and evaluation) and eight standards of profes-
5
the various components related to practice, training and sional performance (quality of care, individual practice
education are illustrated in Figure 1.1, on a continuum evaluation, education, collegiality, ethics, collaboration,
from ‘beginner’ to ‘expert’ and incorporating increasing research and resource utilisation) (see Online resources).
complexities of competency. All elements are equally
important in promoting quality critical care nursing CRITICAL CARE NURSING PROFESSIONAL
practice. Practice- or skills-based continuing education ORGANISATIONS
sessions support clinical practice at the unit level. Professional leadership of critical care nursing has under-
30
(Orientation and continuing education issues are dis- gone considerable development in the past three decades.
cussed further in the context of staffing levels and skills Within Australia, the ACCCN (formerly the Confedera-
mix in Chapter 2.) tion of Australian Critical Care Nurses) was formed from
Many countries now incorporate requirements for con- a number of preceding state-based specialty nursing
tinuing professional development into their annual bodies (e.g. Australian Society of Critical Care Nurses,
licensing processes. Specific requirements include ele- Clinical Nurse Specialists Association) that provided pro-
ments such as minimum hours of required professional fessional leadership for critical care nurses since the early
development and/or ongoing demonstration of compe- 1970s. In New Zealand, the professional interests of criti-
tence against predefined competency standards. 31,32 cal care nurses are represented by the New Zealand Nurses
Organisation, Critical Care Nurses Section, as well as
SPECIALIST CRITICAL CARE COMPETENCIES affiliation with the ACCCN. The ACCCN has strong pro-
Critical care nursing involves a range of skills, classified fessional relationships with other national peak nursing
bodies, the Australian and New Zealand Intensive Care
as psychomotor (or technical), cognitive or interpersonal. Society (ANZICS), government agencies and individuals,
Performance of specific skills requires special training and and healthcare companies.
practice to enable proficiency. Clinical competence is
a combination of skills, behaviours and knowledge, Professional organisations representing critical care
demonstrated by performance within a practice situa- nurses were formed as early as the 1960s in the USA with
33
tion and specific to the context in which it is demon- the formation of the American Association of Critical
37
34
strated. A nurse who learns a skill and is assessed as Care Nurses (AACN). Other organisations have devel-
performing that skill within the clinical environment is oped around the world, with critical care nursing bodies
deemed competent. As noted above, a set of competency now operating in countries from Australasia, Asia, North
statements for specialist critical care practice comprises America, South America, Africa and Europe. In 2001 the
20 competency standards grouped into six domains: inaugural meeting of the World Federation of Critical
professional practice, reflective practice, enabling, clinical Care Nurses (WFCCN) was formed to provide profes-
14
problem solving, teamwork and leadership (see sional leadership at an international level. 38,39 The ACCCN