Beyond information delivery: Candidate competencies for ICU nurses navigating prognostic uncertainty with patients...

Prognostic uncertainty is intrinsic to critical illness, yet communication education often treats the clinician's task as accurate information transfer. This Discussion Paper presents and critically examines author-derived candidate competencies for intensive care unit (ICU) nurses supporting adult patients and families when prognosis remains uncertain.

A four-step, author-led narrative synthesis integrated uncertainty theory, adult patient and family evidence, ICU communication literature, and nursing role constraints. Recurrent nursing functions were compared, grouped, and cross-checked against reported needs, harms, and role boundaries. The resulting domains are: align roles and messages; map patient participation, uncertainty, and preferences; name what is known, unknown, and next; respond to emotion and verify understanding; and revisit uncertainty across time and transitions. Their enactment depends on trust, interdisciplinary coherence, staffing, continuity, interpreter access, family-centred policies, and a suitable communication environment. The process was interpretive rather than systematic and did not include independent coding or patient and family partners.

The domains are a transparent conceptual proposal for education and debate, not a disclosure protocol or validated standard. Patient and family co-design, content validation, context-sensitive behavioral assessment, and testing of learner, relational, and system outcomes are required before implementation.