Structures, processes and outcomes of specialist critical care nurse education: an integrative review

Objectives: The objective of this study was to review and synthesise international literature to reveal thecontemporary structures, processes, and outcomes of critical care nurse (CCN) education.Method: An integrative review on specialist critical care education was guided by Whittemore andKnafl's integrative review steps: problem identification; literature search; and data evaluation, analysis,and presentation. Donabedian's Quality Framework (Structure-Process-Outcome) provided a usefulanalytical lens and structure for the reporting of findings.Results: (1) Structures for CCN education incorporated transition-to-practice and ongoing educationprograms typically offered by hospitals and health services and university-level graduate certificate,diploma, and masters programs. Structural expectations included a standard core curriculum, clinically credible academic staff, and courses compliant with a higher education framework. Published workforcestandards and policies were important structures for the practice learning environment. (2) Processesincluded incremental exposure to increasing patient acuity; consistent and appropriately supported andcompetent hospital-based preceptors/assessors; courses delivered with a flexible, modular approach;curricula that support nontechnical skills and patient- and family-centred care; stakeholder engagementbetween the education provider and the clinical setting to guide course planning, evaluation andrevalidation; and evidence-based measurement of clinical capabilities/competence. (3) Outcomesincluded articulation of the scope and levels of graduate attributes and professional activities associatedwith each level. The role of higher degree research programs for knowledge creation and critical careacademic leadership was noted.Conclusions: Provision of high-quality critical care education is multifaceted and complex. These findingsprovide information for healthcare organisations and education providers. This may enable best practicestructures and processes for critical care specialist training that meets the needs of industry and safelysupports developing CCN expertise. There is an acknowledged tension between the expectations ofgoverning bodies for policies, standards, and position statements to enhance quality and reduce carevariance and the availability of high-quality evidence to underpin these across international contexts