A Delphi study to identify competencies of registered nurses in Kenyan intensive care units.

backgroundNurses form the largest professional group in the Intensive Care Unit (ICU) workforce. Their competency in care delivery contributes to improved patient outcomes, reduced morbidity and mortality, and overall reduced cost of care. Many countries have established frameworks to support a set of core competencies that all qualified ICU nurses are expected to possess. Kenya has yet to embark on a unifying competency framework, leading to ICU nurses' poor transfer of knowledge, skills, and attitudes because of differences in the scope and depth of competencies learned. Unification of competencies may best be achieved through stakeholders' agreement on the required set of competencies.

aimThe aim of this study was to establish consensus on the initial set of competencies required by registered nurses working in Kenyan ICUs.

methodsThe study adopted a mixed-method design with a multistage approach. This involved two stages: an integrative review, and two rounds of e-Delphi. The integrative review of competencies and competency frameworks for ICU nurses informed the development of an initial set of 91 competencies. These competencies were subsequently subjected to expert evaluation by a heterogeneous panel of experts in a two-round e-Delphi process. However, All the competencies in the two rounds achieved consensus by attaining a priori mean of ≥ 4. This manuscript reports findings from the integrative review and the first round of the e-Delphi process. Findings from subsequent Delphi rounds are reported separately. Notably, despite ICU competencies being universal, some competencies are culturally specific and may require contextual tweaking for their acceptability. These include competencies touching on palliative and end-of-life care, involvement of patients and their families in pain management, and competencies that require autonomous practice of nurses, like performance of invasive procedures. CONCLUSIONS/IMPLICATION: This study identified and synthesised competencies for registered nurses in Kenyan ICUs through an integrative review and further evaluated their relevance through the first round of a Delphi process. The findings provide an initial, evidence-informed set of competencies that can inform curriculum development, clinical practice, and policy discussions. Further Delphi round will build on these findings to establish final consensus on the competency framework. CLINICAL TRIAL NUMBER: Not applicable.