Revising the Canadian Standards of Critical Care Nursing Practice 6th Edition: Part 2 – A Modified Delphi Process

Abstract

Background: The Canadian Association of Critical Care Nurses (CACCN) establishes the national standards of practice, to guide safe, competent, and evidence-informed critical care nursing practice, which are reviewed regularly to ensure they remain current and responsive to emerging evidence. Previous revisions lacked a standardized methodology, prompting this study to employ a Modified Delphi process to revise the Standards for Critical Care Nursing Practice (6th edition). Methods: An expert panel of Canadian critical care nurses (≥5 years’ experience) was recruited to ensure representation across provinces, care settings, and patient populations. Three Delphi rounds, with a fourth for peer review, were conducted using secure online surveys. The overarching standard of practice statements along with sub-standard statements included were generated from a previously conducted scoping review. Standards and sub-statements were rated on a 5-point Likert scale, with consensus defined a priori as ≥75%. Results: Attrition occurred across rounds, but consensus was achieved on eight overarching standards and 42 sub-statements, emphasizing accountability, evidence-informed practice, ethical care, leadership, collaboration, specialized education, and high-quality care across the illness trajectory. Protocol deviations, including stricter inclusion criteria for later rounds, were implemented to maintain rigour. Conclusion: This structured, reproducible approach strengthens the validity of the revised standards and provides a framework for future updates. The findings underscore the importance of systematic, collaborative processes in defining national practice standards for critical care nursing in Canada.