An educational intervention to enhance critical care nurses’ mentoring competence – a mixed-methods feasibility study

Technical Summary: An Educational Intervention to Enhance Critical Care Nurses' Mentoring Competence

Problem Statement
Critical care nursing (CCN) globally faces persistent staffing shortages, exacerbated by the COVID-19 pandemic, leading to increased burnout and turnover. Concurrently, nursing students' retention in the profession is heavily influenced by their clinical placement experiences, where inadequate support or strained relationships with mentors are primary risk factors for discontinuation. While mentors are central to student learning, few Norwegian critical care nurses possess formal mentoring education. Although general mentoring programs exist, research specific to the high-complexity context of intensive care units (ICUs) remains limited. There is a recognized need for targeted educational interventions to enhance the mentoring competence of CCNs, yet the feasibility of implementing such interventions in the Norwegian healthcare context had not been previously evaluated.

Methodology
This study employed a convergent parallel mixed-methods feasibility design, aligned with the UK Medical Research Council (MRC) framework for complex interventions. The primary objective was to evaluate the acceptability (satisfaction, perceived workload, willingness to recommend) and feasibility (recruitment, retention, adherence, resource use) of a tailored educational intervention.

• Participants: Fourteen critical care nurses (CCNs) from four Norwegian ICUs (two general, one medical, one post-operative) participated. The sample included nurses with varying levels of experience and mentoring backgrounds.
• Intervention: The program consisted of two components totaling approximately 10 hours:
  1. A self-paced online module (approx. 6 hours) built on the Open edX platform, featuring texts, videos, and six written reflective assignments.
  2. An in-person session (approx. 4 hours, though completed in 3 hours) involving simulated student-mentor conversations and group discussions.
• Data Collection: Data were gathered via pre- and post-intervention questionnaires, including the Mentors' Competence Instrument (MCI) (a 43-item self-evaluation tool across seven dimensions), a course evaluation questionnaire (5-point Likert scales and open-text fields), and field notes from facilitators.
• Analysis: Quantitative data were analyzed using descriptive statistics and Hedges' g for preliminary effect size estimation. Qualitative data (open-text feedback and field notes) underwent directed content analysis. Results were merged in the discussion phase.

Key Contributions

• Context-Specific Intervention: The study developed and tested an educational intervention specifically adapted for the Norwegian critical care context, addressing a gap in literature regarding mentoring in high-acuity settings.
• Feasibility Framework Application: It provides a structured evaluation of a complex intervention using the MRC framework, offering specific metrics on recruitment challenges, retention, and resource allocation in a real-world clinical setting.
• Instrument Validation: The study utilized the MCI to assess responsiveness and acceptability, providing preliminary data on its suitability for future definitive effect studies in this population.

Results

• Acceptability: The intervention was highly acceptable. Participants reported high satisfaction (mean scores >4.0/5.0) with the digital platform, course content, and specifically the practical exercises (mean 4.93). All participants rated the workload as "just right" and expressed willingness to recommend the course to colleagues. Qualitative feedback highlighted the course as relevant, engaging, and pedagogically well-structured, though some instructions for written assignments required clarification.
• Feasibility (Retention & Adherence): Retention was 100% (14/14 participants completed the intervention and all surveys). Adherence was excellent, with only one missed assignment across the entire cohort.
• Feasibility (Recruitment): Recruitment was the primary barrier. Only 4 out of 20 contacted ICUs (20%) participated, and the process took over 12 months. Many units withdrew when asked to allocate work time for participation, indicating a lack of organizational support despite individual interest.
• Resource Use: The total time investment was approximately 10–11 hours per participant. Facilitator time averaged 3.5 hours per participant. The in-person modules were the most resource-intensive component.
• Competence Outcomes: Preliminary analysis of the MCI indicated positive changes in self-reported mentoring competence across all dimensions, with effect sizes ranging from medium to large, though the study was not powered to determine definitive efficacy.

Significance and Claims
The paper concludes that the educational intervention is acceptable, relevant, and practical for Norwegian critical care nurses, demonstrating high satisfaction and excellent adherence among participants. The high retention rate and positive qualitative feedback suggest the content and delivery method are well-suited to the target audience.

However, the authors modestly claim that the study cannot yet support a larger-scale evaluation due to significant recruitment challenges. The low participation rate of units (4/20) and the prolonged recruitment timeline highlight that organizational barriers, specifically the lack of managerial support and protected work time, are critical obstacles. The authors assert that before a main study can be conducted, the recruitment strategy must be revised to secure stronger organizational backing and potentially broaden the target group to other nursing specialties. The intervention itself requires only minor refinements (e.g., clarifying assignment instructions) but needs substantial changes in implementation logistics to be scalable.