Identifying and establishing consensus on competencies required by registered nurses working in Kenyan intensive care units: a modified Delphi study

Waweru, Beth

Abstract

Background
Nurses form the largest professional group in the Intensive Care Unit (ICU) workforce. Their
proficiency 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 held by all qualified ICU nurses. Kenya has yet to embark
on a unifying competency framework, leading to ICU nurses' poor transferability of
knowledge, skills, and attitudes because of differences in the scope and depth of competencies
learned. Literature on the barriers and enablers for implementing a competency framework in
Kenya is scant. How unification of competencies may best be achieved requires stakeholders'
agreement on the required set of competencies and a procedural pathway to guide the
implementation.
Aim
The primary aim of this study was to identify and establish consensus on competencies required
by registered nurses working in Kenyan ICUs. The study also explored potential barriers,
facilitators and strategies for implementing these competencies. This study is the first of its
kind in the Kenyan context.
Methods
The study adopted a mixed-method design with a multistage approach. This involved three
stages: an integrative review, two rounds of e-Delphi, and a virtual focus group consensus
meeting. The integrative literature review on competencies/competency frameworks for ICU
nurses aided in the generation of 91 competencies. Two rounds of Delphi were held; round two
had an additional 12 competencies generated from the participant’s feedback; all the
competencies gained consensus. Following the Delphi rounds, a virtual consensus meeting was
held with a subset of participants as key stakeholders to agree on implementation strategies.
The study included a heterogeneous group of experts, justifying generalisability in applying
the competencies nationwide.
Findings
All the competencies in both rounds achieved consensus by attaining a priori mean of ≥4.
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. The key barriers and facilitators towards implementing the
competencies that stood out spun around three key themes: resources, lack of stakeholders’
involvement, and political influence. The key implementation strategies included clustering the
competencies and establishing competencies champions in the clinical practice.
Conclusions and Recommendations
This study offers great insight into policy, practice, education, and future research. The
competencies could be used to inform the Kenyan ICU curricula, orientation programs for
nurses transitioning into ICU, and continuous development of ICU nurses.

Citation

Waweru, B. (2024). Identifying and establishing consensus on competencies required by registered nurses working in Kenyan intensive care units: a modified Delphi study. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Feb 7, 2024
• Publicly Available Date: Apr 27, 2024
• Award Date: Mar 26, 2024