Address of information system with evidences of research contribution and evidences of societal impact:




MICE-ICU online module https://lms.mice-icu.eu/

Evaluated unit

Institute of Health Sciences, College of Medical Sciences, University of Rzeszow

Scientific field

Health Sciences

Title of societal impact case study

MultIcultural Care in European Intensive Care Units - MICE ICU


1. Research contribution

Already in 2003 the Swiss Forum for Migration and Population Studies (2003) and lately scientists from London`s Global University (2011) noticed, that the cultural diversity will be one of the most important factor in health-care area. Due to this, it is important to equip medical personnel with proper cultural competencies. As an answer to the above needs, the MICE-ICU project aimed at improving the knowledge, skills and cultural competencies of nurses working in intensive care units (ICUs). The MICE-ICU project was developed to improve knowledge, skills and competencies of ICU nurses in cultural sensitive care by developing and providing online access to a specialist, multicultural course for ICU nurses. The partnership started from the initiative of Polish Society of Anesthesiology and Intensive Care Nurses (PTPAiIO). PTPAiIO and two higher education institutions: the College of Nursing in Celje from Slovenia and the University of Ostrava from Czech Republic engaged scientific experts in order to prepare proper methodological approach to achieve the objectives of the project. The high quality of the project results and the effectiveness of dissemination were ensured by the European federation of Critical Care Nursing associations (EfCCNa) - who is a European network and umbrella organisation for national associations of intensive/critical care nurses. EfCCNa consists of 28 national European critical care nursing associations, and represents more than 25 000 critical care nurses in Europe. The strategic partnership was supported by Danmar Computers Lld., who became the technical partner, responsible for preparing e-learning platform, MICE-ICU web site and other IT solutions. Finally the assist GmbH from Germany joined the partnership and offered expertise in training international soft skills as well as train-the-trainer training. All partners, except for Danmar Computers Lld. and assist GmbH acted as experts in the intensive nursing care. Despite the differences in the nature of main activities of the each partner, all of them contributed to the final outcomes of the MICE project. Main activities conducted during the project include: Literature review and ICU nurses training needs analysis - the systematic literature review was conducted by researchers from Poland, Slovenia and Czech Republic in order to identify nurses educational needs related to multicultural care in ICU in participating countries. Additionally the survey technique was used to identify actual cultural competences level of ICU nurses. The Healthcare Provider Cultural Competence Instrument (HPCCI) developed by Schwarz i in. (2015) was used for this purpose. In total 598 ICU nurses participated in this study including 155 nurses (25.92%) from Poland (PL), 218 (36.45%) from Czech Republic CZ), 97 (16.22%) from Slovenia (SI) and 128 (21.40%) from 20 European countries like Sweden, Izrael, Finland, Denmark. The results of literature review and training needs analysis formed the basis for developing the course curriculum and content.

  1. The course was developed in cooperation between all partners and implemented on-line as e-learning course. It was agreed that the course will consist of three modules: Module I: Cultural awareness and sensitivity, Module II: Culturally diverse patients in health care environment, Module III: Specifics when caring for culturally diverse patients on ICU. The course was translated into Polish, Czech and Slovenian languages. Danmar Computers Lld. implemented the course online and provided access to the testing platform.
  2. Testing phase involved nurses from PL, CZ, SI and a few European countries, who took the e-learning course and answered questionnaires regarding usability, effectiveness and provided other suggestion to improve course quality.
  3. The final version of the online course on multicultural care for ICU nurses was presented to EfCCNa council members and the join decision to recommend this course for ICU nurses all over the Europe was stated. The MICE-ICU project resulted in a specialized and accredited e-learning course on multicultural care dedicated to nurses working in intensive care environments. Besides main intellectual outputs, the multiplier events in all partner countries and the international Symposium on Multicultural Care were organized. The impact of MICE ICU project is expected on national and the European levels which assure long-term benefits in the shape of better qualified ICU nurses ready for caring for culturally dissimilar patients. If relevant, longer-term benefits. As the result, the ICU Nurses will increase their vocational competencies and receive a practical tool for work with patients from different cultures.

2. Evidence of research contribution

Dobrowolska B, Gutysz -Wojnicka A, Ozga D et al. European ICU nurses’ cultural competency: an international cross-sectional survey. Intensive and Critical Care Nursing. 2020 (accepted for publication).

3. Characteristic of societal impact

The project allows to promote the results which have already been achieved and those that are yet planned in a given institution, an organization of nurses in Europe. It brings opportunities to build networks with both the institution as well as individual participants who may be interested in implementing the findings. The project is an essential trigger in developing our Institution on an international stage. It influences the process of improving ICU nurses’ qualifications (cultural competence as an aspect of Knowledge, Skills and Social Competence), builds up their self-esteem in target groups and helps break language barriers among the project participants. Moreover the project gives their participants and their organizations appropriate certification which will confirm their qualifications and the implementation of the new tool, the specialist course. There will be a detailed program for the certified specialist course with a specific number of schooling hours and a rapport describing international studies, which will be published in prestigious international magazines available in databases such as PubMed. There will also be a long-term impact, scientific publications which may be quoted by institutions outside the project and researchers all around the world dealing with the topic. The measurement of publication’s value is Hirsch coefficient or index, h coefficient, h index. The measurement was introduced in 2005 by Jorge Hirsch to indicate the significance of all scientific publications. The project will contribute to boosting motivation for education in the target group and among other participants (nurses from other communities, doctors, midwives, physiotherapists, dietitians, paramedics, clinical psychologists). It will help promote foreign language learning, encourage self-education not only in case of the project participants but also immediate participants such as hospital staff. After the Amsterdam Symposium there were some inquiries from critical care colleagues who work in the field of clinical education. They asked for the permission to receive and use specific information they have got to know at the Amsterdam Symposium in their critical care teaching institution, also. In Sweden a couple of nursing colleagues and universities have shown interest to include the E-learning course in the curriculum for the Critical Care Specialist nursing course. One German delegate of the symposium in Amsterdam, currently in her post-graduate education for pediatric and neonatal intensive care nursing, felt so inspired that she decided to dedicate her scientific term paper to the topic of multicultural nursing care in ICU. Additionally, UR was approached by nurses from different countries of the possibility to come and present the MICE-ICU project at their national Intensive Care conferences.

The project has been promoted in specific countries that are represented in EfCCNa. For example during the annual Israeli cardiac and intensive care conference MICE online course and symposium were presented. During the conference a question and answer session took place in which conference participants openly discussed cultural challenges they face in their daily workplace. - Increased awareness about the needs for intercultural education in various fields of nursing, also in the intensive care field: Symposium on ICU. Dissemination conference ( SL -50, PL- 60, D-35, CZ-60 , EFCCNA). Professional seminar of the Section of Nurses and Medical Technicians for Anesthesiology, Intensive Care and transfusion medicine. The publication of an article in the bulletin Utrip - SL(15.360 nursing care providers). PTPAiIO organized in Karpacz the 10th International Congress of the Polish Society of Anaesthesiology and Intensive Care Nurses in 2017, in cooperation UR in the program of which was the inaugural session of the MICE-ICU project. Number of participants - 700 people. The e-learning course on Multicultural care will be provided for the next three years via the MICE-ICU and EfCCNa, PTPAiIO, The College of Nursing in Celje, University of Ostrava website. Regular promotional actions will be arranged. Apart from the electronic promotion (websites, social media), a hard cover card will be delivered to European critical care nurses via their national congresses. The next EfCCNa congress, which in going to be held in February 2019, 20021,2023 will provide a workshop on multi-cultural nursing care. Additionally, the federation thought about establishing a paper on this issue, as well EfCCNa has been invited to give an update of the project this year at Word Federation of Critical Care Nurses conference in Belgrade. This invitation is the second one in a two years’ time which shows an interest of the project not only in Europe but also in the rest of the world. All ICU nurses in Europe will have access to the E-learning program in English through the projects web site, EfCCNa website and also from a link on their national organizations website. There are some plans of translating the course to the other countries’ languages as there is a language barrier sometimes with nurses.

Availability of the E-learning program for the training via platform MICE-ICU (accreditation at the National Agencies in the field of ICU). The curriculum for the optional subject Intercultural competences in healthcare and nursing care Publication of textbook “Intercultural nursing care” including general contents from the modules I and II were prepared. Presentation of the E-learning platform at the National Congress of Nursing and Midwifery in the following countries PL, NL, SI and CZ. Promotion of the E-learning platform at the meeting of professional section. Presentation of the E-learning platform in the information bulletin. Publication of an original scientific article for professional public in PL, NL, SI and CZ. based on the research, conducted among nursing care providers in ICUs. Since 1.10.2018 on 20/11/2018, people from outside the partner group logged on to the platform with the course ( Macedonia -Skopje -2, United States- New York City- 1, United Kingdom- London -5, Bristol - 2, Ireland- Rathfarnham-1, Slovakia- Trnava -1, Ružomberok-1, Burundi- Mairie de Bujumbura(Republic of Burundi - Africa)-3, Poland - Lublin- 1, Gdańsk-1, Rzeszów-1 Warszawa -3, Norway- Narvik -4, Netherlands- Enschede -1, Lithuania-Kaunas-1. In addition, it is scheduled for the next congresses WFCCN , World Congress in Melbourne, Australia 2019, World Congress Dubaj -2020 et al. This gives us a guarantee of the durability of the project on a global scale. MICE-ICU online module https://lms.mice-icu.eu/

4. Evidence of societal impact

One of the main challenges for the future of critical care is to provide respect and dignity: while unconscious patients find it difficult to make themselves and their humanity is mainly preserved by considering their individual will, values and priorities. As a coordinator, we tried to look globally at the problem of multiculturalism and thus reach the widest possible audience, not only employees, employers but also other health care workers. At the first stage of the implementation, we set goals that were implemented. Our mission was to reach a wide audience in each partner country and beyond. Cooperation with various external stakeholders allowed to achieve the assumed goal. The partner organizations mentioned above took part in the research phase, which concerned the assessment of cultural competences and educational needs of ICU nurses, external evaluators / reviewers were asked to evaluate the research report (reviews attached). Members of the organization from outside the project took part in testing the e-learning platform with the same course, giving valuable feedback to the evaluation of the course, which was improved after the end of the project (October 2018), participated in questionnaire, dissemination workshop. WFCCN (World Federation of Critical Care Nurses) is an international federation consisting of national associations of ICU nurses from over 40 countries. Starting cooperation allowed for reaching a wide audience, project promotion. The realization of the project was monitored according to the project’s application and discussed by the partners during the transnational meetings, as well as on Skype’s chats. The tangible effect of the monitoring are the questionnaires researches’ results. From the beginning to the end of the project the following were conducted:

1) Questionnaire for Project Progress Evaluation - Period 1 (October 2016 - March 2017)

2) Questionnaire for Project Progress Evaluation - Period 2 (April 2017 - September 2017)

3) Questionnaire for Project Progress Evaluation - Period 3 (October 2017 - March 2018)

4) Questionnaire for Project Progress Evaluation - Period 4 (April 2018 - September 2018)

5) 1st partnership meeting in Rzeszów, Poland, 3rd-4th November, 2016

6) 2nd partnership meeting in Celje, Slovenia, 24-25th April, 2017

7) 3rd partnership meeting in Paderborn, Germany, 04-05th October, 2017

8) 4th partnership meeting in Ostrava, Czech Republic, 23rd -24th April, 2018

9) 5th partnership meeting in Amsterdam, Netherlands, 14-15th September 2018

The project management and implementation was carried out in a good conditions and with respect to the deadlines. The work was based on creation of groups within the consortium. These groups were responsible for specific areas. Partners contributed to the project according to their expertise and the plans in the application. In particular: PTPAiIO, UR, as coordinator, overlooked overall project implementation, assuring that the outputs were achieved on time, within the budget and high quality. Besides that PTPAiIO and UR contributed with experience in critical care practice. It led IO1, coordinated research and prepared the report. In particular, the association did literature review and needs analysis in Poland, led development of the curriculum and prepared part of content of the course, testing in Poland and prepared report. PTPAiIO and UR did intensive dissemination writing articles in branch magazines, presenting the project at various events, organising conference. PTPAiIO and UR  has prepared and submitted the documentation for accreditation of the course in Poland.

First of all: no one of the project members has expected the immense workload which appears for each of them in the course of the project. Nevertheless, working together with the colleagues from three other European countries and learning about their specific health care situations was enriching in all aspects of cooperation. In EfCCNa with its 30 European critical care member organizations, represented by national council members, the project was able to sharpen the sensitivity for multicultural care issues in ICU not only by them but also in their national societies. EfCCNa enrolled ICU nurses from all over Europe to participate in the research and testing of the e-learning program. The awareness of the need of cultural competences in critical care nurses to meet the needs of patients from another cultural background than the hosting country is the main and most important learning outcome of this project. All member organizations of EfCCNa, representing more than 25.000 critical care nurses in Europe have been regularly updated with information on the project. Additionally, interested critical care nurses were targeted via social media channels like Face book and Twitter. At the end of September 2018 the MICE-ICU Facebook account has got more than 200 followers. Just to demonstrate the potential of social media in distributing news within a certain target group see the following examples: the announcement of the analysis report ‘Nurses Intercultural Training Needs and Competencies’ and the ‘Final Programme’ for the Amsterdam Symposium.

The huge amount of international delegates (representing 23 different countries) at the Amsterdam Symposium on Multicultural Care in ICU showed that we reached our goal: to inform and to wake interest of our European colleagues on multicultural care issues in health care. The EfCCNa federation and PTPAiIO, UR  has a close network together with the World federation of Critical Care Nurses (WFCCN). The coordinator of the EfCCNa group was invited to speak and present the project at the joint conference WFCCN and the World Congress of Intensive and Critical Care Medicine in Rio de Janeiro 2017. This has been a great opportunity to talk about the project and emphasize awareness and knowledge of multi-culture care to ICU nurses and intensivists from different parts of the world. The Report of the Testing Phase of the ICU online course among nursing care providers in MICE-ICU been read by 21 persons in Research Gate and have achieved two comments from readers: “Good, good” and “Excellent work”. In August 2017, EfCCNa together with members from the Polish team published an editorial with the title “The migrant crisis and the importance of developing cultural competence in the intensive care units”. The article has 112 reads so far. Nursing care providers were informed about the project through the information bulletin of the Nurses Association (number of copies + e-access via national websites of the Nurses and Midwives Association). Nurses have for the first time taken part in the training through an online educational platform. We encouraged the regulatory authorities to draw up a methodology for the evaluation of e-education, which will enable the nurses to acquire credit points for renewing their nursing licenses. We obtained useful educational contents, which will benefit not only the ICU nurses, but nurses in all areas of nursing care (Educational modules I and II). All partner project representatives have been continuously updated through emails and during council meetings on the development and the progress of the project. They have informed their national association boards and promoted the MICE-ICU project through their communication channels. The impact of this activity is difficult to estimate and assess. The project have been mentioned and described at least twice in the Swedish journal ‘Aniva Ventilen’ and since 2016 in two editions of the ‘Journal of Pediatric Intensive Care Nursing’ (ISSN 1819-7566), http://www.mcgill.ca,





5. Justification of interdisciplinarity and breakhrough of the research

Cooperation for innovation and exchange of good practices: KA2

KA202 - Strategic partnerships for vocational education and training

"This project has been funded with support from the European Commission. This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein."

The aim of the project is to increase the level of knowledge, skills and social competence of nurses working at the ICU in the field of culturally different patient care. The project was international, in Poland it was implemented by the Polish Society of Anaesthesiological Nurses and Intensive Care (PTPAiIO) as the main coordinator, beneficiary of the program in partnership with the Department of Teaching in Intensive Care and Emergency Medical Services, Medical Faculty, University of Rzeszów (UR). In addition, project partners were: OSTRAVSKA UNIVERZITA- Czech Republic, Visoka zdravstvena skola v Celju- Slovenia, European Federation of Critical Care Nursing associations (EfCCNa) -Netherlands, Danmar Computers sp z oo- Polska, assist Gesellschaft für Unternehmensberatung und Personalentwicklung m - Personal Germany. The project was implemented from 01/10/2016 to 30/09/2018. The project manager, the main contractor was Dr. Dorota Ozga, head of the Department of Didactics in Intensive Care and Emergency Medical Services. Woźniak Krystyna and Niemczyk Edyta also participated in the project team.