Skip to main content


You are viewing the new article page. Let us know what you think. Return to old version

Volume 3 Supplement 1


A collaborative approach to training ward nurses in acute care skills in resource limited settings: the nursing intensive care skills training (nicts) project


Early recognition and prevention of deterioration of ward patients can improve patient outcomes and reduce critical care admissions [1]. In low and middle income countries (LMICs), with often minimal access to critical care therapies, the benefit may be even greater. However training to assist ward nurses develop acute care skills remains limited in such settings. As part of the NICST portfolio of acute care training, the Sri Lankan nursing faculty sought assistance to deliver a 2 day course for ward nurses [2].


To design a clinically relevant short course for ward nurses in a LMIC to be delivered by local nursing tutors and facilitators.

To assess whether such a clinically focused programme would increase ward nurses' knowledge and skills in identifying and managing deteriorating patients.


A multi-modal 2 day acute care course for ward nurses was co-designed and delivered by specialist overseas trainers in partnership with national tutors. The courses were sponsored by the Ministry of Health, Sri Lanka. Based upon the NICST model of collaborative course design, local faculty were up skilled in delivery and content through a pre course Train the Trainer programme [3].

Candidates were invited to undertake on-line pre course e-learning. Core clinical guidelines were delivered using mini lectures. Facilitator-led skills stations and structured scenarios were used to develop clinical skills.

Short term knowledge acquisition was tested by a pre and post course Multi-Choice Questionnaire (MCQ). Newly acquired skills and their application was assessed through a post course Objective Clinical Skills Assessment (OSCA) station.


122 ward nurses were trained over 6 courses in 2 locations. Post MCQ scores were significantly higher for each course compared to pre MCQ (Wilcoxon sign rank test P < 0.0001).

Over 71% passed the OSCA (pass mark of 60). Feedback reveals high candidate satisfaction.


Our short course results demonstrate an increase in relevant knowledge and clinical skills of the participants. Our NICST model demonstrates the feasibility of a local nursing faculty in a LMIC co-designing and effectively delivering a setting adapted acute care training programme integrated into the local nurse training system.

Table 1 Ward course pre and post course results.
Table 2 Selected course candidate feedback.


  1. 1.

    Spearpoint KG, Gruber PC, Brett SJ: Impact of the Immediate Life Support course on the incidence and outcome of in-hospital cardiac arrest calls: an observational study over 6 years. Resuscitation. 2009, 80 (6): 638-643. 10.1016/j.resuscitation.2009.03.002.

  2. 2.

    Acute care training from Sri Lanka to the developing world. NICS Training [Online] Available from: [Accessed 01:04:15]

  3. 3.

    De Silva AP, Stephens T, Welch J, Sigera C, De Alwis S, Athapattu P, et al: Nursing intensive care skills training: a nurse led, short, structured, and practical training program developed and tested in a resource-limited setting. J Crit Care. 2015, 30 (2): 438.e7-11. 10.1016/j.jcrc.2014.10.024.

Download references

Author information

Correspondence to A Beane.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark


  • Acute Care
  • Clinical Skill
  • Resource Limited Setting
  • Pass Mark
  • Ward Nurse