International competencies of nurses with advanced practice in anesthesia nursing: An integrative review.

Background: Internationally, nurse anesthetists play a pivotal role in the highly specialized field of anesthesia care, which requires advanced knowledge. In Austria, advanced nursing practice in anesthesia care lacks a model that allows for an expanded role. Thus, there is a need to explore the scope of practice, advanced competencies, and skills of nurse anesthetists to address the challenges in the provision of healthcare. Objective: The aim of this review was to explore the competencies and skills of advanced practice nurses in anesthesia care at the international level. Design: An integrative literature review was conducted using Whittemore and Knafl's five-step methodology. Methods: A systematic literature search was performed in the databases PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Web of Science. Keywords such as 'nurse anesthetist', 'nurse practitioner', 'advanced nursing', 'advanced practice', 'professional competence', 'role ', 'clinical competence' and related terms in American and British spelling were used. In addition, references in the included publications, databases for doctoral theses, and non-listed international journals on anesthesia care, as well as studies from websites of professional societies were searched. The quality of included publications was assessed using critical appraisal tools and a qualitative content analysis approach was used to synthesize the data. Results: In total, 26 publications from 13 different countries were included. Eight qualitative, ten quantitative, and one mixed methods study, as well as seven scientific reports could be identified. The seven main themes - professional competencies, communication competencies, coordination and management competencies, scholarship competencies, advocacy competencies, collaboration competencies, and clinical competencies - could be extracted from the literature. These were supplemented by eleven inductive sub-themes. Conclusions: Nurse anesthetists demonstrate a comprehensive set of competencies that encompass technical as well as non-technical skills, enabling them to provide high-quality and advanced anesthesia care. There are variations in the scope of practice, roles, and skills of nurse anesthetists across different countries. In some countries, nurse anesthetists practice within a broad scope, while in other countries, often due to policy considerations, their responsibilities and skills are limited. Registration: PROSPERO CRD42022351430, registered 15/08/2022. Social media abstract: Nurse anesthetists' scope of practice varies internationally due to policies but covers a comprehensive range of competencies @GlarcherManela @KathrinPann.