Sustainable Development in the Training and Professional

Competence of Nurses in Intensive Care Structures

Anushka N. Dimitrova

Faculty of Public Health, Medical University – Sofia, str. Byalo More 8, Sofia, Bulgaria

Keywords: Nurse, Intensive Care, Training, Professional Competence.

Abstract: Intensive care is a specific diagnostic and treatment process for patients with disruption of critical vital

functions and/or patients expected to have decompensation in vital functions in the immediate future. The

application of intensive treatment and care for life-saving situations is based on an orderly system, with its

diverse aspects regulated and developed. The objective of the completed study is discovering the need for

improving competence of nurses employed in intensive care structures. A documentary method, a sociological

method (questionnaire) and a graphic method for visual illustration of the deliverables have been employed

in the study. The object of the study is 246 nurses, employed in intensive care clinics/units. Results and

discussion. More than half of nurses (54.47%) are satisfied by their professional realization in intensive

treatment structures. For 84.55% of nurses, extra knowledge is important, 67.48% of nurses consider they

have the qualification necessary to work, almost half have never been part of a postgraduate training.

Conclusions. Nurses employed in intensive care structures have extensive length of service and experience.

More than half have high self-assessment marks for professional qualification. Only half of nurses have

completed post-graduate training to improve their professional qualification in the scope of intensive care.

1 INTRODUCTION

Intensive care is a specific diagnostic and treatment

process for patients with critical disruption of vital

functions and/or for patients expected to have

decompensation in those functions over a period in

the immediate future. Presently, the application of

intensive treatment and intensive care for life-saving

conditions is based on an orderly system, which is

regulated and developed in detail in all of its versatile

aspects. The regulated scope of professional

competence defines the particular professional

activities that people practicing regulated professions

can exercise in medical establishments.

The legal framework for training and operations

of healthcare professionals in Bulgaria includes a

series of laws and regulatory provisions that govern

the qualification and the professional realization of

nurses. Within the framework of the higher medical

education, the education process for the ‘Nurse’

specialty is directed toward establishing and

developing professional competencies, as a set of

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https://orcid.orig/0000-0002-5845-4190

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knowledge, skills, conduct and habits for the students

in that specialty. A multi-aspect and diverse training

is provided, which contains actions and handling

procedures, which are learned as part of their

theoretical and practical studies. The training

includes learning behavior algorithms for providing

first aid and applying resuscitation measures in case

of particular diseases and/or life-threatening

situations, consistent with the existing standards and

proven practices. Depending on adequate actions of

medical specialists, possible complications and

adverse outcomes for patients may be significantly

reduced or prevented.

Within the context of the European Qualification

Framework (EQF) for lifelong learning, knowledge is

detailed as theoretical and/or factual. Skills are

classified as cognitive (involving the use of logical,

intuitive and creative thinking) and practical

(involving manual dexterity and use of methods,

materials, tools and instruments). Competence is

defined as the proven ability to use knowledge, skills

and personal, social and/or methodological resources

in vocational situations, in the areas of professional

656

Dimitrova, A.

Sustainable Development in the Training and Professional Competence of Nurses in Intensive Care Structures.

DOI: 10.5220/0010595506560661

In Proceedings of the International Scientiﬁc and Practical Conference on Sustainable Development of Regional Infrastructure (ISSDRI 2021), pages 656-661

ISBN: 978-989-758-519-7

and personal development, and abilities are described

in view of the degree of taking responsibility and

independence (European Qualification Framework

for Lifelong Learning (EQF), 2009).

Intensive care is a set of care encompassing the

complete treatment and diagnostic area, consistent

with the pathology, condition, and personal needs of

the patient. The treatment of critically ill patients

requires a high level of professional preparation of

nurses, development of habits and skills for clinical

observation, analysis of the patient condition and

application of an individual approach in their

conduct. The organization and management of care in

intensive structures are extremely complex to

understand, analyze and model, due to the specifics

of the object and the subject of their activity, and are

dependent on the intensive scientific, information,

technological and practical progress of the specialty.

State-of-the-art methods to ensure good quality of

safe intensive care are based on proven rules for good

nurse practices in diagnostics and treatment. The

wide-ranging use of invasive procedures and multiple

treatment in intensive clinics/departments expose

patients to increased risk of complications (Bjork et

al., 2007). The efficiency of the conducted tests,

manipulations and procedures is directly dependent

on the qualification and professional skills of nurses

in specialized structures. Acquiring autonomous

functions in practice of intensive care is a long

process of uninterrupted training for development of

professional qualities.

The post-graduate training in the healthcare

system defines lifelong qualification after acquiring

rights to practice the profession, in the form of

courses, individual training, programs for obtaining

professional qualification to exercise certain legal

capacity, as well as remote training programs.

Healthcare professionals, who are employed in

specialized treatment structures, are given an

opportunity to gain clinical specialty in

Anesthesiology and Intensive Care, under Ordinance

1/22.01.2015 of the Ministry of Health. Training

consists of gaining theoretical knowledge and

practical skills in the respective sector of medical

science and practice. The professional training of

nurses employed in specialized intensive care

structures has to be properly conducted, in full

compliance with the regulatory requirements for

application of special resuscitation activities,

including procedures employed in cases of force

majeure, natural disasters, industrial accidents, traffic

accidents, instances of fire, or due to other reasons.

The study conducted has an objective of

establishing the need of improving the professional

competence of nurses working in intensive care

structures.

2 MATERIAL AND METHODS

A documentary method, a sociological method

(questionnaire) and a graphic method to provide

visual illustration of the results have been employed

in the study. The objects of the study are 246 nurses

employed in clinics/intensive care units (CCU/ICU)

of University and Multi-Profile Hospitals for Active

Treatment in the territory of the country ‒ Sofia,

Yambol, Smolyan, Lom, Montana, Varna. The study

has been conducted over the period between February

and April in 2020.

3 RESULTS

The age characteristics of the interviewed nurses

shows that the highest relative share (40.21%) is the

group of nurses between 51 and 60 years of age, with

the nurses age 41-50 years of age ranked second,

followed by the interviewed nurses between 31 and

40 years of age (21.65%). The lowest relative share

of 2.06% is the share of nurses between 20 and 30

years of age.

For length of service of nurses in specialized

treatment structures, results show a high level of

diversity. The largest relative share (31.71%) is the

share of interviewed nurses with length of service

ranging between 11 and 20 years, 20.73% with length

of service between 6 and 10 years, and 19.92% of

nurses with a period between 1 and 5 years of length

of service (table 1). With the long-standing

experience in the nurse vocation, the standard

approaches, and practices for good quality of care in

the intensive care process are affirmed, and the

control over their application diminishes the risk of

additional patient complications.

Sustainable Development in the Training and Professional Competence of Nurses in Intensive Care Structures

657

Table 1: General labor and professional experience in intensive care structures.

Total duration of employment Professional employment in ICUs

years Number Relative share in % Number Relative share in %

1-5 years 17 6.91 49 19.92

6-10 years 14 5.69 51 20.73

11-20 years 54 21.95 78 31.71

21-30

ears 89 36.18 43 17.48

31-40

ears 62 25.20 24 9.76

More than 40

ears 10 4.07 1 0.41

Total 246 100 246 100

Regarding the education and qualification level

(EQL) of medical specialists, results show almost half

(44.31%) have college education, 15.04% of them

hold the degree “specialist”, 12.20% of them have a

bachelor’s degree in Healthcare. 11.79% of the

respondents have a bachelor’s degree in Healthcare

Management, and 8.54% of the respondents have a

master’s degree in Healthcare Management. This

high level of diversity as regards to EQL of education

is consistent with the duration of employment and age

characteristics of the examined individuals (figure 1).

Figure 1: Allocation according to the education and

qualification degree of training.

The specialty “Healthcare Management” with EQL

Bachelor and Master is a requirement for the

individuals in a managerial role – Head or Senior

Nurse. Although nurses with other higher education

degrees (8.13%) of the respondents exist, they

continue to exercise their profession, possibly due to

various incentives.

The success of a particular activity depends on a

series of subjective and objective factors (Tsvetkova

et al., 2011). Some people are satisfied with certain

factors and not satisfied with others, which shows that

measuring job satisfaction of the workers cannot be

unambiguous (Vasilev, 2010). The results show that

54.47% of the respondent nurses are fully satisfied

with their professional realization, 37.80% are only

partially satisfied with their professional realization,

and 7.72% remain unsatisfied with work in intensive

structures. Professional satisfaction is not only a

result, but also a factor, which impacts the efficiency

of the completed work and a prerequisite for turnover

of nurse staff (figure 2).

Figure 2: Level of satisfaction with the professional

realization in intensive structures.

We have examined the self-assessment of the

respondent specialists as regards to their professional

qualification for operation in intensive structures. A

significant relative share (67.48%) of the respondents

consider that they have the qualification required to

work, 26.83% of them indicate that they “only

partially” have the qualification required to work, and

5.69% answer negatively. The results of the answers

received can be attributed to the age characteristics of

experts and the indicated professional experience in

specialized treatment structures.

Nurses in intensive care units need to be trained in

specific techniques of cardiopulmonary resuscitation

and how to deal with emergency conditions related to

disruptions in vital organs and systems in the

treatment process. A significant portion (84.55%) of

the respondents indicate that the work in intensive

structures require additional knowledge and expensed

scope of professional skills, and the smaller relative

portion (0.81%) are the ones, for which this is not

necessary (figure 3).

College

Specialis

Bachelor in Healthcare

Bachelor in HCM

Master in HCM

other higher education

44,31%

15,04%

12,20%

11,79%

8,54%

8,13%

54%

38%

Yes, completely Partially No

ISSDRI 2021 - International Scientiﬁc and Practical Conference on Sustainable Development of Regional Infrastructure

658

Figure 3: Need of acquiring additional knowledge and skills.

Improving professional competencies is a

prerequisite for achieving high standards of intensive

care, but this also requires providing opportunities

and easy access to continuing education. Regarding

completed courses for post-graduate training in the

area of intensive care, the results show that 50.41% of

the respondents have participated once for the last

five years, 45.93% of them have not participated at

all, and only 3.66% of the nurses have indicated that

they have participated twice (figure 4).

Figure 4: Participation in post-graduate education for

professional competence.

The professional development of high-quality

staff potential creates a serious requirement for nurses

to constantly update their knowledge and skills, in

order to respond to novelties in medical practice. This

process has to be supported by easy access to life-long

learning opportunities (Aleksandrova, 2010). The

results show that a significant portion (89.43%) of the

studied individuals do not have clinical or non-

clinical specialties in the direction “Healthcare”

under the Ordinance for Acquiring a Specialty in the

Healthcare System. Only 10.57% of the respondents

give a positive response, and 8.54% of them indicate

a specialty in Anesthesiology and Intensive Care,

1.63% of them indicate specialty in Hospital Hygiene,

and only 0.41% of them “Surgical and wound-

dressing techniques”.

4 DISCUSSION

The age characteristics of the respondent nurses

(n=246) is in a wide range. The highest relative share

(40.21%) is the group of individuals from 51 to 60

years of age, followed by the group between 41 and

50 years of age (36.08%). Data shows aging

contingent of personnel that works in specialized

treatment structures. Regarding the length of service

of the respondent nurses, 39.24% are individuals with

a length of service from 21 to 30 years, followed by

individuals with length of service from 31 to 40 years

(27.85%). The established length of employment and

professional experience provides grounds to assume

that the respondent specialists are familiar with the

organization of work, the standard approaches and

practices for high-quality care in the process of

intensive care.

The analysis of the results as regards to education

shows a high level of diversity in education and

qualification degree of respondents, which is the

result of the conducted reforms in the area of

professional and university education of nurses over

the years. The highest relative share of 44.31% are

nurses with college education, which matches the age

characteristics and length of service of the

respondents.

Measuring the employment-related satisfaction

levels of employed individuals cannot be

unambiguous and depends on a series of subjective

and objective factors of the work environment.

Professional satisfaction is not only a result, but also

0,00%

20,00%

40,00%

60,00%

80,00%

100,00%

Yes, completely Partially No

84,55%

6…

0,81%

54%

38%

Yes, completely Partially No

Sustainable Development in the Training and Professional Competence of Nurses in Intensive Care Structures

659

a factor, which impacts the efficiency of the exercised

work and a prerequisite for turnover of nurse staff.

The analysis of the results shows that a little more

than a half (54.47%) of the respondent nurses are

fully satisfied with their professional realization in

intensive treatment structures.

Given the market economy conditions and a shift

in social and economic attitudes in the health system,

the role and personal contribution of nurses are

factors for the storage, life and health of patients in

the treatment process. This is a reference to both the

levels of professional qualification with the available

knowledge and skills and the personal properties,

reflected in the communication process and

dedication in the performance of obligations in their

official capacity. It is established that the operation in

intensive structures requires additional knowledge

and an expanded scope of professional skills for a

significant portion (84.55%) of nurses, and 67.48% of

them have indicated that they have the requisite

qualification to work in intensive care units. The

long-standing length of service and experience of

nurses is the prerequisite for their self-assessment

regarding their professional qualification.

The specifics of the medical activity in the

intensive care structures requires an overall and

consistent quality policy, which encompasses the

technology, organization of work, labor conditions

and the training of all employees, at various levels in

the work process. This shall necessitate provision of

the necessary organization, staff and financial

resources for implementation of the staff training

programs. The analysis of the results indicates that

over the course of the last five years, only about half

(50.41%) of the respondent nurses have participated

at once in a post-graduate training on the topic, and

45.93% of them have not participated in such training

at all. Only 8.54% of the respondent nurses have

acquired a degree in Anesthesiology and Intensive

Care. The results confirm the existing need of training

and improving the professional qualification of

nurses in sync with the updated and state-of-the-art

setting for the work environment in intensive care

units

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5 FINDINGS

1. Nurses working in intensive care units have a long

length of service and experience, which is a

prerequisite for their high level of self-assessment as

regards to their professional qualification.

2. More than fifty percent of nurses (54.47%) are

fully satisfied by their professional realization in

intensive treatment structures.

3. A significant share (84.55%) of nurses assesses

the importance of the additional training and

acquiring a larger volume of knowledge in the area of

intensive care.

4. Only half the nurses have completed post-

graduate training, and only 8.54% of them have

completed a major in Anesthesiology and Intensive

Care.

6 CONCLUSION

Current prerequisites for development of healthcare

on a global scale creates a high requirement threshold

toward the professional conduct of medical

professionals and quality of healthcare. Nurses

acquiring and improving professional competence

depends on multiple factors ‒ education, professional

experience, and interests, and also the legal

framework in the context of a nurse’s practice.

Determining the roles in the treatment process and the

scope of the nurse vocation shall reflect what

distinguishes and puts an emphasis on the multi-

disciplinary nature of intensive care.

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