Resea ch A icle
Basic Compe ence o In ensi e Ca e Uni Nu ses:
C oss-Sec ional Su ey S udy
Rii a-Liisa Lakanmaa,1Ta ja Suominen,2Ma i a Ri mala-Cas én,3
Te o Vahlbe g,4and Helena Leino-Kilpi5,6
1Tu ku Uni e si y o Applied Sciences, 20720 Tu ku, Finland
2School o Heal h Sciences, Uni e si y o Tampe e and Uni e si y o Tu ku, 33014 Tampe e, Finland
3Depa men o Anes hesiology and In ensi e Ca e, Helsinki Uni e si y Hospi al, HUS, 00029 Helsinki, Finland
4Bios a is ics, Uni e si y o Tu ku, 20014 Tu ku, Finland
5Depa men o Nu sing Science, Uni e si y o Tu ku, 20014 Tu ku, Finland
6Tu ku Uni e si y Hospi al, 20521 Tu ku, Finland
Co espondence should be add essed o Rii a-Liisa Lakanmaa; ii a-liisa.lakanmaa@ u kuamk. i
Recei ed 28 Decembe 2014; Accep ed 23 Ap il 2015
Academic Edi o : Elizabe h Papa hanassoglou
Copy igh © 2015 Rii a-Liisa Lakanmaa e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion
License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly
ci ed.
C i ical ca e pa ien s bene i om he a en ion o nu sing pe sonnel wi h a high compe ence le el. The aim o he s udy was o
desc ibe and e alua e he sel -assessed basic compe ence o in ensi e ca e uni nu ses and ela ed ac o s. A c oss-sec ional su ey
design was used. A basic compe ence scale (In ensi e and C i ical Ca e Nu sing Compe ence Scale e sion 1, Like scale 1–5, 1
= poo and 5 = excellen ) was employed among Finnish in ensi e ca e uni nu ses (𝑛 = 431). In ensi e ca e uni nu ses’ sel -
assessed basic compe ence was good (mean 4.19, SD 0.40). The a i ude and alue base o basic compe ence was excellen whe eas
expe ience base was he poo es compa ed o he knowledge base and skill base o in ensi e and c i ical ca e nu sing. The s onges
ac o explaining nu ses’ basic compe ence was hei expe ience o au onomy in nu sing ca e (𝐹 alue 60.85, 𝛽0.11, SE 0.01, and
𝑃 ≤ 0.0001). Clinical compe ence was sel - a ed as good. Nu ses ga e hei highes compe ence sel - a ings o ICU pa ien ca e
acco ding o he p inciples o nu sing ca e. The ICU nu ses also sel - a ed hei p o essional compe ence as good. Collabo a ion was
sel - a ed as he bes compe ence. In basic and con inuing educa ion and p o essional sel -de elopmen discussions i is meaning ul
o conside and ind solu ions o how o imp o e nu ses’ expe ienced au onomy in nu sing.
1. In oduc ion
Wha is known abou his opic?
(i) Compe ence in in ensi e and c i ical ca e nu sing
(ICCN) is a mul idimensional concep .
(ii) The e a e, globally, de ini ions and desc ip ions o
compe ence in ICCN bu only a ew s udies o
in ensi eca euni nu ses’compe ence.
(iii) Compe ence e alua ion in ICCN educa ion and p ac-
ice is essen ial o he nu ses’ p o essional de elop-
men .
Wha does his pape add?
(i) In ensi e ca e uni (ICU) nu ses’ compe ence con-
ains ou bases: knowledge base, skill base, a i ude
and alue base, and expe ience base. ICU nu ses sel -
e alua ed hei expe ience base as he poo es . Expe-
ience o ICCN ca e is c ucial o he p o essional
de elopmen o he ICU nu ses.
(ii) ICU nu ses’ expe ience o au onomy in nu sing ca e
explains sel -e alua ed basic compe ence. Au onomy
in nu sing ca e is impo an o he p o essional
g ow h o he ICU nu ses.
Hindawi Publishing Co po a ion
BioMed Resea ch In e na ional
Volume 2015, A icle ID 536724, 12 pages
h p://dx.doi.o g/10.1155/2015/536724
2BioMed Resea ch In e na ional
(iii) Comp ehensi e compe ence o ICU nu ses should in
a ious ways be de eloped du ing ICCN educa ion
and o ien a ion p og ams. This should be conside ed
ca e ully when planning he con en s and educa ional
me hods o he p og ams.
The e a e app oxima ely 30 in ensi e ca e uni s (ICUs) in
Finland in which o e 28,000 pa ien s a e ca ed o annually
[1]. I is es ima ed ha by he yea 2030 he need o in ensi e
and c i ical ca e will g ow by 25%, o example, due o he ac
ha he Finnish popula ion is ge ing olde [2]. Mul i ac o ial
easons inc ease he need o c i ical ca e beds in Finland and
also in o he coun ies in Eu ope.
In ensi eca euni nu ses(ICUnu ses)a e hela ges
p o essional g oup wo king in he ICUs. Se e ely ill pa ien s
and amilies bene i om he a en ion o highly ained and
skilled pe sonnel [3, 4]. ICU nu ses con ibu e o pa ien
sa e y,suchasimp o edpa ien ou comes, educedmo bidi y
and mo ali y, and dec eased complica ions, e o s, and
o e all cos s [5–10]. Compe en ICU nu ses ha e a signi ican
impac on ICU pa ien ’s physiological and psychological
ou comes, o example, e idence based nu sing in e en ions
and e hical ac i i y.
C i ical ca e nu sing is an own nu sing speciali y [11]
whe eas echnologyisin eg a edwi hpsychosocialchal-
lenges and e hical con lic s associa ed wi h c i ical illness
[12]. Gene ally, c i ical ca e nu sing educa ion is a special
pos quali ica ion educa ion [13] and is desc ibed in he
Eu opean Quali ica ions F amewo k o Li elong Lea ning
asle el6(o eigh )[14,15].Cu en lynopos quali ica ion
educa ion in in ensi e and c i ical ca e nu sing leading o a
deg ee exis s in Finland.
We know ha he e is a wo ldwide need o compe en
nu ses [16]. In nu sing p ac ice, nu ses ge o demons a e
on a egula basis clinical compe ence as well as a sound
heo e ical knowledge base acco ding o na ionally ecog-
nized amewo ks[4,17,18].The eisaneed o alid
speci ic ins umen s (e.g., o in ensi e and c i ical ca e
nu sing) o compe ence e alua ion pu poses. Compe ence
e alua ion can be pe o med in a ious ways, o example,
using sel -assessmen , knowledge es s, pee e alua ion (col-
league), obse a ion (men o , supe iso ), OSCE (objec i e
s uc u ed clinical examina ion), o po olios. The bes way
o pe o m compe ence e alua ion is o combine di e en
e alua ion me hods. Sel -assessmen is an essen ial abili y
ha can be lea ned and de eloped du ing educa ion and
nu sing ca ee .
In ensi e and C i ical Ca e Nu sing Compe ence Scale
esea ch is sca ce. Only h ee scales (Basic Knowledge Assess-
men Tool [BKAT], In ensi e Ca e Hund ed I em Tes [I-
HIT], and mul ile elled c i ical ca e compe ency s a emen s)
o compe ence in in ensi e and c i ical ca e nu sing a e
epo ed in nu sing li e a u e [19]. O hese scales, wo a e
knowledge es s (BKAT + I-HIT) while he hi d one is based
on nu ses’ sel -assessmen ; howe e , we a e well awa e ha i
has no been p ope ly es ed o eliabili y and alidi y and
is s ill in i s ea ly phases. The need o a basic compe ence
sel -assessmen scale in in ensi e and c i ical ca e nu sing
is he e o e also e iden , o example, o unde g adua e
educa ion o beginning egis e ed nu ses p ac ice s anda ds.
The sys ema ic li e a u e e iew conduc ed o his s udy in
PubMed and sea ch om c i ical ca e nu sing o ganiza ions
o e he las en yea s ound 21 s udies o documen s o
compe ence in in ensi e and c i ical ca e nu sing (see he
appendix).
As a summa y o he li e a u e, compe ence concep is
e y mul idimensional (e.g., ocusing on clinical p ac ice
[nu sing p ocess], e hics, collabo a ion, leade ship, educa-
ion, and de elopmen wo k) and s ongly ela ed o, o
example, age, wo k expe ience, and equency o using
speci ic compe encies. Compe ence is s udied wo ldwide
(10 documen s om Eu ope, 7 documen s om Aus alia
and New Zealand, and 4 documen s om USA, Canada,
and B azil); hus, he e is lacking sys ema ic compe ence
e alua ion esea ch. E alua ion is o en pe o med by sel -
assessmen [20–22] o knowledge es [23]. ICU nu ses’ sel -
assessed compe ence was e alua ed as anging om mode -
a e o excellen : om mode a e o good (sample consis ing o
newly egis e ed ICU nu ses) [22], good (sample consis ing
o ICU nu ses wi h a ying wo k expe ience) [20], and om
good o excellen (sample consis ing o ICU nu ses wi h
a ying wo k expe ience) [21]. Eu opean ICU nu ses’ o e all
knowledge sco e was 66% o 100 poin s (min 22, max 91, and
SD12); hemain ac o ha con ibu ed o a ianceinsco es
is leng h o nu ses’ in ensi e ca e expe ience. The knowledge
ca ego y wi h he lowes sco e was espi a ion and en ila ion
[23].
The pu pose o his empi ical s udy was o desc ibe and
e alua e he sel -assessed basic compe ence o in ensi e ca e
uni nu ses and ela ed ac o s using a scale, In ensi e and
C i ical Ca e Nu sing Compe ence Scale e sion 1 (ICCN-
CS-1) [11]. The ela ed ac o s we e di ided in o he ollowing
a eas: (i) age and gende , (ii) educa ion, (iii) wo k expe i-
ence, (i ) in o ma ion e ie al, ( ) knowledge es , and ( i)
o he s. The hypo hesis was ha he basic compe ence can
be explained wi h hese. This empi ical s udy is pa o a
la ge p ojec whe e he scale was de eloped [19]. This s udy
was conduc ed o acili a e es ablishmen o he psychome ic
p ope ies ( eliabili y and cons uc alidi y) o he scale
beingused[24].Thep ojec omwhich hiss udyisapa
aimed o de ine compe ence in in ensi e and c i ical ca e
nu sing (ICCN), o de elop a basic sel -assessmen based
measu emen scale o compe ence e alua ion in ICCN, and
o desc ibe g adua ing nu sing s uden s’ basic compe ence in
ICCN by seeking e e ence basis om ICU nu ses.
ICU nu se is a egis e ed nu se who p ac ises in an
ICU and whose nu se educa ion is Bachelo o Heal h Ca e,
specialis nu se, o nu se. In his ICU nu ses basic compe-
ences udywasusedalso heexpe iencebaseo heICU
nu ses in da a analysis which we e no analysed in g adua ing
nu sing s uden s’ basic compe ence s udy. The s uden s had
no expe ience base enough in ICCN and he e o e in da a
analysis only h ee bases o ou we e analysed knowledge,
skill,anda i udeand aluebases.Ano elissuein hiss udy
is ha i highligh s he mul idimensionali y o he concep
o compe ence. Fou bases o compe ence in in ensi e and
c i ical ca e nu sing we e analysed in ICU nu ses’ da a:
knowledge base, skill base, a i ude and alue base, and
expe ience base [19].
BioMed Resea ch In e na ional 3
Table 1: S uc u e and i em amoun s o ICCN-CS-1.
Basic compe ence = clinical compe ence + p o essional
compe ence
Knowledge
base
Skill
base
A i ude and
alue base
Expe ience
base I ems
Clinical compe ence (80)
P inciples o nu sing ca e 4 4 4 4 16
Clinical guidelines 4 4 4 4 16
Nu sing in e en ions 12 12 12 12 48
P o essional compe ence (64)
E hical ac i i y and amilia i y wi h heal h ca e laws 4 4 4 4 16
Decision-making 4 4 4 4 16
De elopmen wo k 4 4 4 4 16
Collabo a ion 4 4 4 4 16
I ems 36 36 36 36 144
ICCN-CS-1 measu es basic compe ence and i e e s o
p elimina y compe ence o p ac ice in an ICU. I is com-
pa able o s ep 1 compe encies o he Na ional Compe ency
F amewo k o Adul C i ical Ca e Nu ses [25] and C i i-
cal Ca e Nu se Educa ion P ac ice S anda ds [26]. ICCN-
CS-1 is use ul in planning supe ision in p e egis a ion
nu sing s uden s’ clinical p ac ice and du ing o ien a ion
p og ammes, o example, o iden i y lea ning gaps, de ine
lea ning goals, and discuss compe ence in a comp ehensi e
manne . The con en o he scale is in line wi h pos g adua e
educa ion s anda ds and he compe ence s anda ds o c i ical
ca enu ses,alsoa specialis le el.Thescalemeasu es he
basic compe ence in in ensi e and c i ical ca e nu sing and
can be used as a s a ing poin o he ansi ion p ocess om
p e egis a ion educa ion o pos g adua ion educa ion. The
scale was de eloped o in ensi e and c i ical ca e educa ion
pu poses, o example, o p e egis a ion educa ion and in
o ien a ion p og ammes. The esul s o his s udy can be
use ul in nu sing educa ion, especially in basic educa ion
and when planning con inuous educa ion. In clinical p ac ice
he esul s can also be help ul in p o essional pe o mance
app aisals in ICUs.
2. Ma e ials and Me hods
2.1. Aim. The aim o he s udy was o desc ibe and e alua e
he sel -assessed basic compe ence o in ensi e ca e uni
nu ses and ela ed ac o s. The esul s o his s udy will
help educa o s, clinicians, and esea che s o de elop basic
nu sing educa ion and o ien a ion in he ICUs.
2.2. Resea ch Ques ions. The esea ch ques ions o his s udy
we e as ollows:
(1)Wha is hele elo in ensi eca euni nu ses’sel -
assessed basic compe ence?
(2) Wha a e ac o s ela ed o he basic compe ence?
2.3. Design. A c oss-sec ional su ey design was employed
using ques ionnai es among Finnish ICU nu ses in uni e si y
hospi als.
2.4. Sample/Pa icipan s. To alsamplingwasused o ICU
nu ses in i e Finnish uni e si y hospi als (𝑛 = 431 pa -
icipan s, esponse a e 54%). In one o he i e uni e si y
hospi als, a con enience sample o ICU nu ses (𝑛=82
pa icipan s, esponse a e 37%) also comple ed a biological
and physiological knowledge es . In 2008, a pilo s udy had
been conduc ed in one uni e si y hospi al; his o ganiza ion
was he e o e no included in his da a ga he ing in 2010. The
inal numbe o hospi als aking pa in his s udy was hus
ou .
2.5. Da a Collec ion. Da a we e collec ed using a ques ion-
nai e wi h he suppo o con ac pe sons in he ICUs.
Theins umen susedin hiss udywe e heIn ensi eand
C i ical Ca e Nu sing Compe ence Scale (ICCN-CS-1) [24]
and a knowledge es , he Basic Knowledge Assessmen Tool
e sion 7 (=BKAT-7) [27], which was used as he backg ound
ac o in he con enience sample. Backg ound ac o s (12)
in eg al o he ICCN-CS-1 we e asked and hey o med he
i s page o he ques ionnai e.
ICCN-CS-1 is a sel -assessmen ool consis ing o 144
i ems (six sum a iables). The scale measu es basic com-
pe enceinin ensi eandc i icalca enu sing.Theo e ically,
basic compe ence is di ided in o clinical compe ence and
p o essional compe ence. Clinical compe ence consis s o
h ee subdomains: p inciples o nu sing ca e, clinical guide-
lines, and nu sing in e en ions. P o essional compe ence
consis s o ou subdomains: e hical ac i i y and amilia i y
wi h heal h ca e laws, decision-making, de elopmen wo k,
and collabo a ion. In addi ion, basic compe ence comp ises
ou bases: knowledge, skill, a i ude and alue, and expe i-
ence bases. Each o hem has se en subdomains. E e y i em
is measu ed wi h he Like scale 1–5, gi ing he ange sco e
144–720. Sum o sco es on he ICCN-CS-1 can be classi ied
as poo compe ence (144–288), mode a e compe ence (289–
432), good compe ence (433–576), o excellen compe ence
(577–720) [24]. Mean sco e can be classi ied as ollows: 1–2.49,
poo ; 2.5–3.49, mode a e; 3.5–4.49, good; o 4.5–5.0, excellen
(Table 1) [19].
The 12 backg ound ac o s o all ICU nu ses we e
di ided in o i e a eas: (i) age and gende (2 ques ions),
(ii) educa ion (basic, con inuing educa ion, and pa icipa ion
4BioMed Resea ch In e na ional
in con e ences; 3 ques ions), (iii) wo k expe ience (ICU,
o he heal h ca e; 2 ques ions), (i ) in o ma ion e ie al
(independen , use o nu sing jou nals; 2 ques ions), and ( )
o he s (au onomy in nu sing and wo k mo i a ion, on scale
1–10, 1 = poo and 10 = excellen , and special esponsibili y
a eas in ICU, scale yes/no). The esponden s’ expe ience
o au onomy in nu sing was asked by eques ing hem o
assess how au onomous hey el hei wo k as a nu se. The
con enience sample o ICU nu ses (𝑛=82)comple ed he
BKAT-7 as an ex a backg ound ac o a ea ( i). BKAT-7 is
a biological and physiological knowledge es comp ising 100
i ems. Each co ec answe gi es one poin , yielding he ange
0–100. The BKAT has eigh sum a iables: ca dio ascula ,
moni o ing lines, pulmona y, neu ology, endoc ine, enal,
gas oin es inal, and o he a iables [27]. The da a we e
ga he ed be ween Janua y 2010 and May 2010.
2.6. E hical Conside a ions. The esea ch was conduc ed
acco ding o e hical guidelines [28, 29]. E hics commi ee
app o al was ob ained om a uni e si y XXX [26.10.2009].
Thepe mission ouseBKAT-7wasgi enbyD .JeanTo h
and ouse heFinnish e sionbyMNScMa i aRi mala-
Cas ´
en. Resea ch pe mission was ob ained sepa a ely om
each pa icipa ing hospi al. Pa icipa ion was olun a y and
based on anonymi y in e e y phase. I was assumed ha by
e u ning he ques ionnai e pa icipan s ga e hei consen
o ake pa in he s udy. The hospi als we e no compa ed
wi h each o he . The da a we e s o ed acco ding o e hical
guidelines (in sa e s o age and anonymously).
2.7. Da a Analysis. The da a we e s a is ically analysed using
SAS o Windows ( e sion 9.2, SAS Ins i u e Inc., Ca y,
NC). The sum a iables we e calcula ed by di iding he sum
sco e by he numbe o i ems answe ed. To calcula e he
sum a iables and o al sum o he ICCN-CS-1 and BKAT-
7, 80% o he i ems should be answe ed. Two-independen -
sample 𝑡- es was used o es he di e ences in basic compe-
ence be ween ac o s ha consis ed o wo ca ego ies. The
di e ence in basic compe ence be ween educa ion g oups
was es ed wi h one-way analysis o a iance using Tukey’s
adjus men in pai wise compa isons. Linea associa ions
be ween con inuous backg ound ac o s and basic compe-
ence we e analysed using linea eg ession analysis. Fac o s
associa ed wi h basic compe ence we e included in analysis
o co a iance, excep o age which was excluded o a oid
mul icollinea i y p oblems (age e sus wo k expe ience, 𝑟=
0.76), while o he wo k expe ience was excluded due o he
high numbe o missing alues (𝑛 = 103). Co ela ions we e
calcula ed using he Spea man co ela ion coe icien s. The
le el o s a is ical signi icance was de ined as 𝑃 < 0.05.
2.8. Validi y and Reliabili y. Reliabili y and alidi y o he
ICCN-CS-1 ha e been es ed and we e shown o be adequa e
o hescalea i sea lys age.Thescaleisbasedonan
ex ensi e heo e ical phase whe e he con en o compe ence
was de ined [24]. In his s udy he in e nal consis ency o
ICCN-CS-1 was 0.99 ( ange o sum a iables 0.88–0.98),
whichshowedadequa e eliabili y.The eliabili yand alidi y
o he scale need u he de eloping and es ing. As he BKAT
is a knowledge es , i s in e nal consis ency was no e alua ed.
3. Resul s
3.1. Pa icipan s. Mos pa icipan s we e emale (84.6%) and
hei mean age was 38 yea s ( ange 22–62). Mos o he nu ses
had a Bachelo o Heal h Ca e deg ee (52.9%) and hei mean
leng h o wo k expe ience in ICU was 9.1 yea s (0.02–36
yea s) (Table 2).
3.2. ICU Nu ses’ Basic Compe ence. The nu ses’ (𝑛 = 431)
sel - a ed basic compe ence was 67.5% excellen , 32.3% good,
and 0.2% mode a e. The mean sco e was 4.19 (2.79–5.00, SD
0.40). Clinical compe ence (di ec ly ela ed o pa ien ca e)
was sel - a ed as good. Nu ses ga e hei highes compe ence
sel - a ings o ICU pa ien ca e acco ding o he p inciples
o nu sing ca e ( his e e s o e hical s anda ds such as sa e y,
jus ness, pa ien cen e edness, ecogni ion o abno mal i al
signs, need o pain ca e, changes in skin condi ion, and need
o luid he apy). The ICU nu ses sel - a ed hei p o essional
compe ence ( ela ed o he p o ession in gene al) as good.
Collabo a ion was sel - a ed as he bes compe ence and
de elopmen wo k as he poo es . Clinical compe ence was
a ed as be e han p o essional compe ence. The nu ses sel -
a ed hei knowledge base, skill base, and expe ience base
as good. A i ude and alue base was a ed as excellen . The
nu ses ga e he poo es a ings o he expe ience base o
compe ence (Table 3).
3.3. Backg ound Fac o s in ela ion o Basic Compe ence. O
he wel e backg ound ac o s en we e posi i ely associa ed
wi h basic compe ence (Table 4). The alues ob ained om
uni a iable models, ANCOVAs, when o ming ANCOVA
model (𝑛 = 405) whe e age and o he wo k expe ience we e
excluded (age and wo k expe ience we e highly co ela ed,
𝑟 = 0.76, and o he wo k expe ience had 103 missing alues),
au onomy in nu sing ca e (𝐹 alue 60.85, 𝛽0.11, SE 0.01,
𝑃 ≤ 0.0001), special esponsibili y a eas in he ICU (𝐹 alue
9.33, 𝛽0.13, SE 0.04, and 𝑃 = 0.0024), wo k expe ience
in ICU (𝐹 alue 7.73, 𝛽0.008, SE 0.003, and 𝑃 = 0.0057),
independen in o ma ion e ie al o in ensi e and c i ical
ca e nu sing (𝐹 alue 7.07, 𝛽0.17, SE 0.07, and 𝑃 = 0.0082),
and pa icipa ion in in ensi e ca e con e ences and educa ion
days (𝐹 alue 5.78, 𝛽0.10, SE 0.04, and 𝑃 = 0.0167) emained
signi ican . Mo e educa ion (basic and con inuing educa ion)
and in o ma ion e ie al (use o nu sing jou nals) we e pos-
i i ely ela ed o basic compe ence, whe eas wo k mo i a ion
o gende had a nega i e associa ion wi h i .
Aknowledge es ,BKAT-7,wasusedas hebackg ound
ac o in his s udy in a con enience sample o ICU nu ses.
The ICU nu ses’ mean sco e o BKAT-7 was (𝑛=82)
68.26 (SD 10.27, ange 32–86) and he ICCN-CS-1 mean
sco e was 4.13 (SD 0.42, ange 3.02–5.00). No co ela ion was
de ec ed be ween knowledge es and sel -assessmen basic
compe ence scale (𝑟 = 0.098).
BioMed Resea ch In e na ional 5
Table 2: Cha ac e is ics o nu ses (𝑛 = 431).
Backg ound ac o s
Nu ses
Mean SD Min Max
𝑛%
Age (𝑛 = 430)38 9.9 22 62
Gende (𝑛 = 421)
Female/male 356/65 84.6/15.4
Educa ion (𝑛 = 429)
Nu se (Bachelo o Heal h Ca e) 227 52.9
Specialis nu se 95 22.1
Nu se 82 19.1
O he s 25 5.8
Wo k expe ience (yea s) as a nu se in in ensi e
andc i icalca e(𝑛 = 425)9.1 8.1 0.02 36
O he wo k expe ience as a nu se in heal h ca e
(𝑛 = 328)5.4 7.2 0 37
Con inuing educa ion in in ensi e ca e nu sing
(𝑛 = 423)
Yes 73 17.3
No 350 82.7
Pa icipa ion in in ensi e ca e con e ences and
educa ion days (𝑛 = 428)
Yes 307 71.7
No 121 28.3
Independen in o ma ion e ie al o in ensi e
andc i icalca enu sing(𝑛 = 426)
Yes 400 93.9
No 26 6.1
Use o nu sing jou nals in in o ma ion e ie al o
in ensi e and c i ical ca e nu sing (𝑛 = 429)
Yes 367 86.0
(i) In e na ional scien i ic jou nals 67 18.3
(ii) Na ional scien i ic jou nals 141 38.4
(iii) P o essional jou nals 352 95.9
No 62 14.0
Wo k mo i a ion (1–10) (𝑛 = 429)8.1 1.5 2 10
Au onomy in nu sing (1–10) (𝑛 = 430)8.1 1.2 2 10
Special esponsibili y a eas in he ICU (𝑛 = 428)
Yes 326 76.2
No 102 23.8
4. Discussion
This s udy used a sel -assessmen based compe ence scale
which is de eloped di ec ly o in ensi e and c i ical ca e
nu sing. I is clinically impo an ha nu sing compe ence in
speci ic a eas o nu sing is e alua ed wi h he help o speci ic
compe ence scales.
ICU nu ses’ sel -assessed basic compe ence was in gene al
good and was ela ed o wo k expe ience as ound in p e ious
s udies [20–22]. They a ed hei clinical compe ence highe
han p o essional compe ence. The eason o his may be
he high echnical and clinical skill equi emen s in he
ICUs. Also e hics was highligh ed in many ways: ICU nu ses
sel -assessed hei a i ude and alue base as excellen . In
clinical compe ence, “p inciples o nu sing ca e” was a ed as
highwhileinp o essionalcompe ence“e hicalac i i yand
amilia i y wi h heal h ca e laws” was a ed as low. This can be
explained by he ac ha ICU nu ses a bed-side nu sing ca e

6BioMed Resea ch In e na ional
Table 3: The domains and bases o basic compe ence and he sel -assessmen sco es.
Domains and bases o basic compe ence
Sel -assessmen sco es (1–5)
(𝑛=428–431)
Mean SD
Basic compe ence 4.19 0.40
Clinical compe ence 4.33 0.39
P inciples o nu sing ca e 4.47 0.41
Clinical guidelines 4.36 0.38
Nu sing in e en ions 4.27 0.44
P o essional compe ence 4.02 0.45
Collabo a ion 4.28 0.45
Decision-making 4.24 0.48
E hical ac i i y and amilia i y wi h heal h ca e laws 3.90 0.55
De elopmen wo k 3.65 0.59
A i ude and alue base o compe ence 4.68 0.32
Knowledge base o compe ence 4.05 0.45
Skill base o compe ence 4.02 0.46
Expe ience base o compe ence 3.82 0.68
a e mo e amilia wi h sa e, di ec pa ien -cen ed ca e (when
using in p ac ice hese compe encies equen ly in daily ca e)
han wi h adhe ence o e hical codes, gene al heal h ca e
legisla ion, and ansplan a ion legisla ion (li e ally) [20–22].
In p o essional compe ence, collabo a ion was sel -
assessed as he bes and de elopmen wo k ( e e ing o
sel -de elopmen , eam de elopmen , nu sing de elopmen ,
and subo dina e skill de elopmen ) as he poo es dimension
o compe ence. This inding sha es simila i ies wi h se e al
p e ious s udies [20–22]. One eason may be ha nu ses lack
educa ion, expe ience, and esou ces o de elopmen wo k
in hei p o ession. In addi ion, nu ses’ a i udes owa ds
e idence based nu sing and de elopmen wo k may be
nega i e because hey do no see hemsel es as “de elope s,”
me ely as “clinical wo ke s.” They migh also hink ha hese
kinds o jobs a e no o hem, o hey may no ha e enough
knowledge o hem.
In expe ience base he nu ses we e guided o e alua e how
su icien hey assess he quali y o hei expe ience in speci ic
issues in in ensi e and c i ical ca e nu sing (“Do he nu ses
ha e enough expe ience in e e y aspec o compe ence?”)
The nu ses ega ded his wi h suspicion. They e alua ed
he quali y and su iciency o hei expe ience base e y
c i ically. The esea che s in e p e ed his as deno ing ha
special compe ence in nu sing is associa ed wi h ex ensi e
expe ience. The au onomy in nu sing expe ienced by nu ses
was he s onges ac o ela ed o basic compe ence. This
indingislogicalandna u albecauseau onomyisanessen ial
elemen o p o essional s a us as s a ed by Va jus e al. in hei
e iew [30].
The basic biological and physiological knowledge did no
co ela e wi h sel -assessed basic compe ence. In his s udy
heICUnu ses’meano BKAT-7knowledge es was68o
100 (SD 10), which co ela es o a p e ious s udy by Fulb ook
e al. [23] (Finnish nu ses’ mean sco e was 64 o 100, SD
9; in his Eu opean ICU nu ses s udy, he I-HIT knowledge
es was used). Compe ence as a concep is holis ic and
mul idimensional, wi h knowledge only a pa o he whole.
This gi es an idea o compe ence e alua ion and planning
in nu sing educa ion. “Knowledge base comes i s ,” bu also
o he ields o compe ence such as skill base, a i ude and
alue base, and expe ience base as well as pe sonal base o
heICUnu sea eimpo an [11].
Mos o he ICU nu ses sea ch o in o ma ion indepen-
den ly and pa icipa e in con e ences and educa ion days.
The a iance in wo k mo i a ion and au onomy in nu sing
was 2–10, which means ha some nu ses ha e e y low
mo i a ion and do no eel au onomy in hei wo k. In his
s udy, wo k mo i a ion was no associa ed wi h sel -assessed
basic compe ence whe eas au onomy was s ongly associa ed
wi h i . I is impo an ha he ela ionship be ween “sa e y
cul u e” and “basic compe ence” is examined oge he and
a ended o in ICUs. Nu ses’ compe ence is ela ed o in en o
lea e nu sing p o ession, job sa is ac ion, pa ien sa e y, and
quali y o nu sing in ICUs [31].
4.1. S eng hs and Limi a ions. The e a e limi a ions in his
s udy. They a e ela ed o he na ional sample, sampling which
co e ed only uni e si y hospi als and he somewha low
esponse a e. The basic compe ence scale ICCN-CS-1 was a
newscaleandi sha es hesamedi icul ieswi hap e ious
holis ic compe ence scale de eloped o c i ical ca e nu sing
[32].TheC onbachalpha alueswe esomewha highand he
na u e o he compe ence scale is unidimensional, and he
i ems co ela e s ongly wi h each o he [19]. Fu he mo e,
he me hod o sel -assessmen is ques ionable: how eliable
is sel -assessmen as a me hod? Sel -assessmen as a skill is
impo an o nu ses; howe e , i should no be used alone
bu in combina ion wi h o he assessmen me hods. I is
also impo an o ecognize he bias ela ed o esponden s.
BioMed Resea ch In e na ional 7
Table 4: S a is ically signi ican backg ound ac o s in ela ion o basic compe ence.
Backg ound ac o 𝑃 alue Reg ession coe icien 𝛽S anda d e o Mean o ICCN-CS-1 SD
Age (𝑛 = 430)<0.000110.02 0.002
Educa ion (𝑛 = 429)<0.00012
Nu se (Bachelo o Heal h Ca e) 4.07 0.38
Specialis nu se 4.39 0.32
Nu se 4.35 0.36
O he s 4.04 0.43
Wo k expe ience (yea s) as a nu se in
in ensi e and c i ical ca e (𝑛 = 425)<0.000130.02 0.002
O he wo k expe ience as a nu se in
heal h ca e (𝑛 = 328)0.000410.01 0.003
Con inuing educa ion in in ensi e ca e
nu sing (𝑛 = 423)<0.00013
Yes 4.35 0.40
No 4.15 0.39
Pa icipa ion in in ensi e ca e
con e ences and educa ion days (𝑛 = 428)<0.00013
Yes 4.30 0.35
No 3.92 0.39
Independen in o ma ion e ie al o
in ensi e and c i ical ca e nu sing
(𝑛 = 426)
0.00013
Yes 4.21 0.39
No 3.90 0.43
Use o nu sing jou nals (𝑛 = 429)<0.00013
Yes 4.23 0.38
No 4.00 0.43
Au onomy in nu sing ca e (1–10)
(𝑛 = 429)<0.000110.16 0.01
Special esponsibili y a eas in he ICU
(𝑛 = 428)<0.00013
Yes 4.28 0.36
No 3.90 0.39
1Linea eg ession.
2One-way analysis o a iance; Tukey’s adjus ed 𝑃 alues; nu se (BHC) e sus specialis nu se (𝑃 < 0.0001); nu se (BHC) e sus nu se (𝑃 < 0.0001); specialis
nu se e sus o he s (𝑃 = 0.0001); nu se e sus o he s (𝑃 = 0.001).
3Two-independen -sample 𝑡- es .
D opou analysis was no pe o med. Howe e , he scale was
de eloped e y ca e ully by expe s in an academic se ing
and he sampling was planned o co e he mos compe ence-
demanding ICUs in Finland. The esponse a e was also qui e
good o a ques ionnai e s udy.
5. Conclusions
Fi s ly, ICU nu ses’ expe ienced au onomy in nu sing ca e
is highly ela ed o sel -assessed basic compe ence. Sec-
ondly, speci ic esponsibili y a eas in ICUs (such as medical
eme gency eam membe , s uden supe iso ) and, hi dly,
wo k expe ience in he ICU a e ela ed o sel -assessed
basic compe ence. In basic and con inuing educa ion and
p o essional sel -de elopmen discussions i is meaning ul
o conside and ind solu ions o how o imp o e nu ses’
expe ienced au onomy in nu sing and how o ind speci ic
in e es a eas o e e y ICU nu se and mo i a e as well as
e ain hem in in ensi e and c i ical ca e nu sing. Fou hly,
wo k expe ience in yea s as well as he quali y o wo k expe-
ience (su iciency) is an essen ial pa o basic compe ence in
in ensi e and c i ical ca e nu sing. Fi hly, he e a e domains
in ICU nu ses’ basic compe ence ha sco e lowe han o he
domains and bases, such as “expe ience base o compe ence,”
“de elopmen wo k,”and“e hicalac i i yand amilia i ywi h
heal h ca e laws,” which can be highligh ed in educa ion
planning.
Appendix
See Table 5.
8BioMed Resea ch In e na ional
Table 5: Summa y o compe ence li e a u e in in ensi e and c i ical ca e nu sing 2004–2014.
O ganisa ion/au ho ,
yea , coun y
Documen / i le o he
s udy/me hod Aim Main indings/ esul s
Gill e al. 2015,
Aus alia [26]
“De elopmen o
Aus alian Clinical P ac ice
Ou come S anda ds o
G adua es o C i ical Ca e
Nu se Educa ion”
Delphi echnique
To de elop c i ical ca e
nu se educa ion p ac ice
s anda ds
The p ocess esul ed in he de elopmen o
98 p ac ice s anda ds, ca ego ized in o h ee
le els
Lakanmaa e al. 2014,
Finland [24]
“Basic Compe ence in
In ensi e and C i ical Ca e
Nu sing: De elopmen and
Psychome ic Tes ing o a
Compe ence Scale”
Ques ionnai e su ey
To de elop a scale o assess
basic compe ence in
in ensi e and c i ical ca e
nu sing
The In ensi e and C i ical Ca e Nu sing
Compe ence Scale is a sel -assessmen es
consis ing o 144 i ems. Basic compe ence is
di ided in o pa ien - ela ed clinical
compe ence and gene al p o essional
compe ence. Basic compe ence consis s o
knowledge base, skill base, a i ude and
aluebase,andexpe iencebase
E CCNa 2013,
Eu ope [4]
“E CCNa Compe encies o
Eu opean C i ical Ca e
Nu ses”
To de elop a Eu opean
C i ical Ca e Nu sing
compe ency amewo k
Fou main domains: clinical domain,
p o essional domain, manage ial domain,
and educa ion and de elopmen domain.
These a e di ided in o 14 di e en
subdomains
Camelo 2012, B azil
[33]
“P o essional Compe ences
o Nu se o Wo k in
In ensi e Ca e Uni s: An
In eg a i e Re iew”
Li e a u e e iew
To iden i y and analyse
nu ses’ compe ences o
wo k a in ensi e ca e uni s
Eigh hemes o compe ence we e ound:
nu sing ca e managemen , high-complexi y
nu sing ca e deli e y, decision-making,
leade ship, communica ion,
con inuing/pe manen educa ion, human
esou ce managemen , and ma e ial
esou ce managemen
Gill e al. 2012,
Aus alia [34]
“A Re iew o C i ical Ca e
Nu sing S a ing Educa ion
and P ac ice S anda ds”
Re iew
To e iew he di e ences
and simila i ies in c i ical
ca e nu sing s a ing,
educa ion, and p ac ice
s anda ds in he US,
Canada, UK, New Zealand,
and Aus alia
The e is a gene al consensus abou he
impo ance o op imum s a ing by
egis e ed nu ses wi h p opo ion o hose
holding ele an pos egis a ion
quali ica ions; he e is no consis ency in
de ining he educa ional p epa a ion o
quali ied c i ical ca e nu se
Hadjibalassi e al.
2012, Cyp us [35]
“De elopmen o an
Ins umen o De e mine
Compe encies o
Pos g adua e ICU Nu ses
in Cyp us
Combina ion o Quali a i e
and Quan i a i e
App oach”
To epo he de elopmen
o an ins umen o
de e mine wha
compe encies a e expec ed
o pos g adua e c i ical ca e
nu ses
The inal ques ionnai e includes 72 i ems
and has a ou -dimensional s uc u e; he
dimensions a e (i) leade ship/managemen
and p o essional de elopmen , (ii)
decision-making and managemen o
eme gencies, (iii) p o ision o ca e and
p o essional p ac ice, and (i ) e hical
p ac ice
Fullb ook e al. 2012,
Aus alia [23]
“A Su ey o Eu opean
In ensi e Ca e Nu ses’
Knowledge Le els”
Ques ionnai e su ey
To examine he knowledge
le els o Eu opean in ensi e
ca e nu ses
The o e all mean knowledge sco e was 66%
(SD 12); he main ac o ha con ibu ed o
a iance in sco es was nu ses’ leng h o
in ensi eca eexpe ience; heknowledge
ca ego y which sco ed lowes was
espi a ion and en ila ion
Lakanmaa e al. 2012,
Finland [11]
“Compe ence
Requi emen s in In ensi e
andC i icalCa e
Nu sing-S ill in Need o
De ini ion? A Delphi
S udy” Quali a i e Delphi
s udy
To iden i y compe ence
equi emen s
Compe ence equi emen s can be di ided
in o i e main domains: knowledge base,
skill base, a i ude and alue base, nu sing
expe ience base, and pe sonal base o he
nu se
BioMed Resea ch In e na ional 9
Table 5: Con inued.
O ganisa ion/au ho ,
yea , coun y
Documen / i le o he
s udy/me hod Aim Main indings/ esul s
C i ical Ca e
Ne wo ks-Na ional
Nu se Leads 2012,
UK [25]
“Na ional Compe ency
F amewo k o Adul
C i ical Ca e Nu ses”
The amewo k is a
collec ion o he co e
clinical compe encies ha
ha e been iden i ied as
basic o he e ec i e
pe o mance o adul
c i ical ca e nu sing
S ep 1compe encies should be commenced
when a nu se begins in c i ical ca e o when
he/she has no p e ious expe ience o he
speciali y
S ep 2and 3compe encies should be
comple ed du ing he pe iod o an academic
c i ical ca e p og amme
The C i ical Ca e Compe ency F amewo k
Con en includes se e al sys em and
addi ional a eas
O’Lea y 2012, USA
[21]
“Compa ison o
Sel -Assessed Compe ence
and Expe ience among
C i ical Ca e Nu ses”
Ques ionnai e su ey
To de e mine he le el o
sel -assessed nu sing
compe ence and he
ela ionship wi h age and
expe ience in nu sing
The nu ses “sel -assessed le el o
compe ence anged om good o excellen
along wi h an inc eased equency o using
compe encies. The longe he nu ses”
expe ience, he g ea e hei sel -assessed
le el o compe ence
S ewa and Rae
2013, UK [36]
“C i ical Ca e Nu ses’
Unde s anding o he NHS
Knowledge and Skills
F amewo k. An
In e p e a i e
Phenomenological
Analysis”
Quali a i e s udy
To explo e c i ical ca e
nu ses’ unde s anding o
he Na ional Heal h Se ice
(NHS) Knowledge and
Skills F amewo k (KSF)
Two supe o dina e hemes o “engagemen ”
and “ heo y-p ac ice gap” we e iden i ied;
six sub hemes o “ luency,” “ anspa ency,”
“sel -assessmen ,” “achie ing o whom,”
“ e lec ion,” and “ he nu sing ole” u he
explained he supe o dina e hemes
Challenges iden i ied we e p ima ily
conce ned wi h complex language, an
unclea p ocess, and he use o e lec i e and
sel -assessmen skills
C i ical Ca e Nu ses’
Sec ion 2010, New
Zealand [37]
“New Zealand S anda ds in
C i ical Ca e Nu sing
Educa ion”
The s anda ds p o ide he
amewo k o cu iculum
de elopmen and s uden
e alua ion
The e a e six s anda ds: (i) nu sing
educa ion is p o ided and managed by
app op ia ely quali ied s a , (ii) en y
equi emen s o nu sing p og ammes a e
explici , ai , and equi able, (iii) he
cu iculum is de eloped collabo a i ely and
di ec ed owa ds p o iding clinical,
educa ional, and p o essional p epa a ion o
be a quali ied nu se, (i ) he oppo uni y o
gain clinical compe ence in he a eas
co e ed by he p og amme is also p o ided,
( ) nu ses a e assessed h oughou and on
comple ion o he p og amme, and ( i)
heo e ical con en is o e ed o p o ide he
nu se wi h knowledge o assess, plan,
manage, documen , and analyse he ca e o
he c i ically ill pa ien and amily
CACCN 2009,
Canada [38]
“S anda ds o C i ical Ca e
Nu sing P ac ice”
To p o ide an essen ial
esou ce o all nu sing
p o essionals in hei
pu sui o bes p ac ice in
he c i ical ca e
en i onmen
Se en s anda ds a e p o ided ela ed o
pa ien moni o ing and managemen o he
p omo ion o op imal physiological balance,
com o , and well-being o he pa ien ,
pa ien and amily cen e edness ca e,
end-o -li e ca e, pa ien sa e y and bes
p ac ice, collabo a ion p ac ice, and
leade ship
AACN 2008, USA
[39]
“AACN Scope and
S anda ds o Acu e and
C i ical Ca e Nu sing
P ac ice”
To desc ibe a compe en
le el o beha iou in he
p o essional ole. The
measu emen c i e ia
desc ibe how he s anda ds
a e me
Thenu singp ocessisusedas he
amewo k. Nine s anda ds include ac i i ies
ela ed o quali y o p o essional p ac ice,
p o essional p ac ice e alua ion, educa ion,
collegiali y, e hics, collabo a ion, esea ch,
esou ce u iliza ion, and leade ship