In brief
A national eDelphi study updated Canada's 2010 home health nursing competencies, narrowing 359 preexisting competencies down to a final set of 79 through nurse-panel consensus and broad stakeholder consultation, adding trauma-informed care, data-driven decision-making, and culturally safe care as new priorities.
What this article is about
Quick Answer
A national eDelphi study updated Canada's 2010 home health nursing competencies, narrowing 359 preexisting competencies down to a final set of 79 through nurse-panel consensus and broad stakeholder consultation, adding trauma-informed care, data-driven decision-making, and culturally safe care as new priorities.
Student takeaways
Key Takeaways
- An environmental scan consolidated 359 preexisting home health nursing competency statements into 96 unique candidate competencies to seed the eDelphi process.
- In Round 1, a 43-member panel of home health nurses reached consensus (≥75% agreement) that 94 of 96 competencies were relevant to current practice and proposed 5 new competencies.
- Across the eDelphi rounds, 62 competencies reached the higher 'essential' consensus threshold (51 in Round 2 and 11 in Round 3); together with 31 competencies retained as 'important', a total of 93 were brought forward as both relevant and essential for current home health nursing practice.
- Broader consultations with 41 additional home health nurses, 12 interdisciplinary team members, and a 24-member advisory working group refined the list to a final set of 79 competencies.
- The updated competency set adds new concepts not prominent in the 2010 version, including trauma-informed care, data-driven decision-making, and provision of culturally safe care, alongside retained core concepts like evidence-informed practice and interdisciplinary collaboration.
Student summary
Why This Research Matters
Home health nursing looks very different today than it did in 2010, when Canada's first national set of home health nursing competencies was written. Since then, home care has taken on sicker clients, more complex technology, virtual care, and a much stronger focus on equity and culturally safe care. This study, published in BMC Nursing in 2025 by Margaret Saari, Chelsea Coumoundouros, John Tadeo, Barbara Chyzzy, Melissa Northwood, and Justine Giosa, set out to update Canada's home health nursing competencies so they reflect what nurses actually need to know and do today.
The researchers used a four-phase modified eDelphi study, a structured method for building expert consensus through repeated rounds of surveys and feedback, combined with consensus meetings and written feedback forms. They began with an environmental scan, reviewing existing competency documents and standards published since 2010, which produced 359 preexisting competency statements. These were consolidated into 96 unique home health nursing competencies to serve as the starting point for the eDelphi process.
A panel of 43 home health nurses from across Canada took part in three eDelphi rounds. In Round 1, the panel reached consensus (at least 75% agreement) that 94 of the 96 competencies were still relevant to current practice, and they proposed five brand-new competencies. Through Rounds 2 and 3, the panel refined this list further, ultimately confirming 93 competencies as both relevant and essential for current home health nursing practice. In Round 2, 51 competencies reached consensus; an additional 11 reached consensus in Round 3, while the rest continued to be rated important without reaching the higher "essential" threshold.
The researchers didn't stop with the nursing panel. They held broader consultations with 41 additional home health nurses and 12 interdisciplinary home care team members (drawn from nine different professional groups) to validate and pressure-test the eDelphi results. An advisory working group of 24 home health nursing leaders, representing eight provinces and territories, guided decisions throughout the study and helped finalize the recommendations. This layered, multi-group process narrowed the competencies down to a final set of 79.
What's new in this updated set? The competencies still anchor on foundational ideas like evidence-informed practice and interdisciplinary collaboration, but they now explicitly include trauma-informed care, data-driven decision-making, and the provision of culturally safe care, concepts that either didn't exist or weren't prioritized in the 2010 version. Participants who gave qualitative feedback said the update captured what matters most in current practice, including health equity and interprofessional teamwork, though some felt the wording of certain competencies could be clearer and less repetitive.
Feedback also surfaced real-world tension: some nurses worried that a good competency list means little if the home care system itself doesn't change. One participant described home care as feeling like "a sort of drive-through service" and cautioned that competencies "will never fully be adopted if systemic change does not occur," pointing to staffing shortages and resource constraints, especially in remote and northern areas, as ongoing barriers.
For nursing students, this study is a useful reminder that professional competency frameworks are living documents, not one-time checklists. They get revisited as care settings, technology, and population needs evolve. If you're heading into community or home care nursing, this updated framework gives you a much clearer picture of what you'll actually be expected to know, from trauma-informed approaches to using data to guide clinical decisions to delivering culturally safe care for Indigenous and other underserved populations. The study's authors intend for these 79 competencies to shape prelicensure nursing curricula and ongoing professional development, so the ideas here may eventually shape what you're taught and tested on in home and community care courses. As you read this kind of consensus-based research, it's worth asking whose voices were represented, and whose weren't, in shaping the final list.
Source abstract
Study Overview
Abstract Background Home health nursing competencies outline the knowledge, skills and attributes home health nurses need for safe and ethical practice. Since the Canadian Home Health Nursing Competencies were first developed in 2010, several important contextual changes have occurred. To ensure competencies reflect current practice contexts, this study aimed to update Canada’s home health nursing competencies. Methods A four-phase modified eDelphi study was conducted using online surveys, consensus meetings and feedback forms. An environmental scan was conducted to identify home health competencies emerging since 2010, to create a comprehensive set of preexisting competencies to serve as the starting point for a 3-round modified eDelphi process. The eDelphi was conducted with a panel of home health nurses (n = 43) to identify core competencies relevant to current home health nursing practice environments. Broader consultations with home health nurses (n = 41) and interdisciplinary home care team members (n = 12) were held to validate eDelphi findings. An advisory working group (n = 24) of home health nursing leaders provided guidance on study decision-making and final recommendations. Results Three hundred fifty-nine preexisting competencies were consolidated into 96 unique home health nursing competencies. In Round 1 of the eDelphi, home health nurses reached consensus (agreement ≥ 75%) that 94 competencies were relevant to current practice environments and suggested five new competencies. Subsequent eDelphi rounds resulted in 93 competencies being brought forward as both relevant and essential for current home health nursing practice. Further consultations refined recommendations, resulting in a final set of 79 competencies. Qualitative feedback provided insights into the relevance and importance of competencies, opportunities for comprehension improvements, and implementation considerations. Conclusions The home health nursing competency set generated through this study incorporates core concepts in home health nursing practice, such as evidence-informed practice and interdisciplinary collaboration, along with several new concepts, such as trauma-informed care, data-driven decision-making, and provision of culturally safe care. This updated competency set can be used to inform prelicensure education and professional development opportunities to enhance home health workforce capacity. Future work exploring strategies to support competency uptake in education and home and community care organizations is needed.
Evidence appraisal
Main Findings
- An environmental scan consolidated 359 preexisting home health nursing competency statements into 96 unique candidate competencies to seed the eDelphi process.
- In Round 1, a 43-member panel of home health nurses reached consensus (≥75% agreement) that 94 of 96 competencies were relevant to current practice and proposed 5 new competencies.
- Across the eDelphi rounds, 62 competencies reached the higher 'essential' consensus threshold (51 in Round 2 and 11 in Round 3); together with 31 competencies retained as 'important', a total of 93 were brought forward as both relevant and essential for current home health nursing practice.
- Broader consultations with 41 additional home health nurses, 12 interdisciplinary team members, and a 24-member advisory working group refined the list to a final set of 79 competencies.
- The updated competency set adds new concepts not prominent in the 2010 version, including trauma-informed care, data-driven decision-making, and provision of culturally safe care, alongside retained core concepts like evidence-informed practice and interdisciplinary collaboration.
Practice transfer
Clinical Relevance
- Home health nurses can expect updated national expectations that explicitly include trauma-informed approaches, meaning training and workplace supports for recognizing and responding to trauma should be prioritized in home care settings.
- Data-driven decision-making is now framed as a core home health nursing competency, suggesting nurses may need stronger skills in using client data and documentation systems to guide clinical judgment.
- The explicit inclusion of culturally safe care as a named competency supports embedding cultural safety and Indigenous ways of knowing into home care practice and orientation, not treating it as optional add-on content.
- Because participants flagged staffing shortages and resource constraints as barriers, organizations adopting these competencies should pair rollout with realistic staffing and infrastructure planning, especially in remote and northern communities.
- Nurse educators and professional development leads can use the finalized 79 competencies as a structured framework for prelicensure curricula and continuing education targeting home and community care practice.
Faculty notes
Educational Relevance
This is a health-workforce and curriculum-relevant study for programs teaching home and community care nursing. Saari and colleagues (BMC Nursing, 2025, open access) used a four-phase modified eDelphi design to update the Canadian Home Health Nursing Competencies originally published in 2010. The design combined an environmental scan, a three-round eDelphi survey with a 43-member nurse panel, broader validation consultations (41 additional home health nurses and 12 interdisciplinary team members across nine professional groups), and oversight from a 24-member advisory working group spanning eight provinces/territories. This is a strong example of structured consensus methodology applied to competency development, worth discussing as a model for curriculum-relevant research design.
Methodologically, the environmental scan consolidated 359 preexisting competency statements from five source documents (including mapping to the Canadian Community Health Nursing Standards of Practice) into 96 unique candidate competencies. Round 1 used a 75% agreement threshold for relevance and yielded 94 retained competencies plus 5 newly proposed ones. Rounds 2 and 3 raised the bar to require both 75% agreement and a modal rating of "essential" (versus merely "important"), which is a meaningful methodological detail for teaching students about consensus thresholds and how they shape which items survive a Delphi process. Round 2 produced 51 competencies reaching consensus; Round 3 added 11 more, while 31 competencies remained rated important but did not clear the essential threshold. The multi-stage validation (nurse panel to broader nurse/interdisciplinary consultation to advisory group sign-off) narrowed the field to a final 79 competencies.
Substantively, the updated set retains core domains such as evidence-informed practice and interdisciplinary collaboration while adding or elevating trauma-informed care, data-driven decision-making, and culturally safe care, reflecting shifts in population health needs and practice context since 2010. This offers a natural discussion anchor: what changed in home care between 2010 and 2025 (acuity, virtual care, equity focus, aging in place policy) that would drive these additions?
Qualitative feedback strengthens the study's credibility as a source of real-world context: participants praised the comprehensiveness of the revised competencies but flagged wording redundancy and inconsistent terminology as barriers to comprehension, useful for a discussion of knowledge-translation challenges in competency frameworks. Participants also raised implementation concerns, describing systemic constraints, staffing shortages, and resource limitations, especially in remote and northern settings, that could blunt uptake regardless of how well-designed the competencies are. This is a good prompt for discussing the gap between competency statements and practice-environment readiness.
A notable limitation, acknowledged by the authors, is representation: perspectives of some groups, including nurses identifying as Indigenous or as members of visible minorities, and nurses from the territories and some provinces, were not adequately represented in the consultation process. This is directly relevant to a class discussion on equity in research recruitment and whose expertise counts in consensus-building exercises meant to apply nationally. Other limitations include the inherent subjectivity of Delphi consensus thresholds, the exploratory/qualitative nature of the feedback data, and the fact that competency adoption in curricula and workplaces was outside this study's scope.
For faculty, this paper is well suited to seminars on competency-based education, curriculum mapping for community/home care rotations, and critical appraisal of consensus methodology (Delphi/eDelphi design, threshold-setting, and stakeholder representation). It also supports conversations about how national competency frameworks translate, or fail to translate, into frontline practice given systemic resourcing constraints.
Critical appraisal
Limitations
- The authors acknowledge that perspectives of some groups, including nurses identifying as Indigenous or as members of visible minorities, and nurses from the territories and some provinces, were not adequately represented in the study.
- Delphi/eDelphi consensus methods rely on subjective agreement thresholds (75% agreement and modal ratings), which shape which competencies are retained and can vary with panel composition.
- Panel attrition occurred across rounds (43 participants in Round 1, fewer completing later rounds), which can affect the stability and representativeness of later-round consensus.
Classroom use
Discussion Questions
- Why might home health nursing competencies need updating roughly every decade, and what changes in care delivery since 2010 most plausibly drove the need for this revision?
- How does a modified eDelphi process differ from a single expert survey, and what advantages does a multi-round consensus process offer for competency development?
- What is the significance of raising the consensus bar between Round 1 (relevance, 75% agreement) and Rounds 2/3 (75% agreement plus a modal rating of essential)?
- Why might trauma-informed care, data-driven decision-making, and culturally safe care have emerged as new priority competencies since 2010?
- What are the risks of underrepresentation of Indigenous nurses, nurses from visible minority backgrounds, and nurses from the territories in a study meant to produce a national competency framework?
- How should nursing programs balance teaching a growing list of competencies (79 in this case) without overwhelming students or diluting depth of learning?
- One participant described home care as feeling like a 'drive-through service.' How might systemic constraints undermine adoption of even a well-designed competency framework?
- What role should interdisciplinary team members (not just nurses) play in validating nursing-specific competency frameworks, as was done in this study's broader consultation phase?
- How could data-driven decision-making be taught and assessed as a nursing competency in prelicensure or continuing education programs?
- What further research would you recommend to test whether adopting these updated competencies actually improves home health nursing practice or client outcomes?
Knowledge check
Quiz
1. What was the primary aim of this study?
- To evaluate client satisfaction with home health nursing services
- To update Canada's home health nursing competencies to reflect current practice contexts
- To compare home health nursing to hospital-based nursing
- To design a new national nursing licensure exam
Rationale: The abstract states the study 'aimed to update Canada's home health nursing competencies' because 'several important contextual changes have occurred' since 2010.
2. What research design was used to update the competencies?
- A randomized controlled trial
- A four-phase modified eDelphi study using surveys, consensus meetings, and feedback forms
- A single cross-sectional survey
- A systematic review with meta-analysis
Rationale: The abstract describes 'a four-phase modified eDelphi study...conducted using online surveys, consensus meetings and feedback forms.'
3. How many preexisting competencies were identified through the environmental scan, and how many unique competencies were consolidated from them?
- 359 preexisting competencies consolidated into 96 unique competencies
- 96 preexisting competencies consolidated into 359 unique competencies
- 79 preexisting competencies consolidated into 43 unique competencies
- 43 preexisting competencies consolidated into 12 unique competencies
Rationale: The abstract states 'Three hundred fifty-nine preexisting competencies were consolidated into 96 unique home health nursing competencies.'
4. In Round 1 of the eDelphi, how many competencies did the nursing panel agree were relevant to current practice, and how many new competencies did they suggest?
- 94 competencies relevant; 5 new competencies suggested
- 79 competencies relevant; 12 new competencies suggested
- 96 competencies relevant; 0 new competencies suggested
- 51 competencies relevant; 11 new competencies suggested
Rationale: The abstract states that in Round 1, 'home health nurses reached consensus...that 94 competencies were relevant to current practice environments and suggested five new competencies.'
5. What was the final number of competencies included in the recommended set after all consultation phases?
- 43
- 93
- 79
- 96
Rationale: The abstract and full text state that further consultations refined recommendations, 'resulting in a final set of 79 competencies.'
6. How many home health nurses made up the eDelphi panel, and how many interdisciplinary home care team members took part in the broader consultation?
- 43 home health nurses on the eDelphi panel; 12 interdisciplinary team members in broader consultation
- 24 home health nurses on the eDelphi panel; 41 interdisciplinary team members in broader consultation
- 12 home health nurses on the eDelphi panel; 43 interdisciplinary team members in broader consultation
- 79 home health nurses on the eDelphi panel; 96 interdisciplinary team members in broader consultation
Rationale: The abstract states the eDelphi 'was conducted with a panel of home health nurses (n = 43)' and broader consultations included 'interdisciplinary home care team members (n = 12).'
7. Which of the following is named in the abstract as a new concept added to the updated competency set?
- Trauma-informed care
- Basic vital sign measurement
- Medication dosage calculation
- Hand hygiene technique
Rationale: The abstract states the conclusion incorporates 'several new concepts, such as trauma-informed care, data-driven decision-making, and provision of culturally safe care.'
8. According to the full-text findings, what consensus threshold was required in Rounds 2 and 3 for a competency to be confirmed as 'essential', beyond simple relevance?
- 75% or more agreement with a mode of 7-Essential
- A simple majority vote of over 50%
- Unanimous agreement from all panelists
- Approval solely from the advisory working group
Rationale: The full text states Rounds 2-3 required consensus of '75% or more...with a mode of 7-Essential,' a higher bar than Round 1's relevance-only threshold.
9. What key limitation did the study authors themselves acknowledge regarding representation?
- Perspectives of some groups, including Indigenous nurses, nurses from visible minorities, and nurses from the territories and some provinces, were not adequately represented
- No nurses from Ontario participated in any round
- The study excluded all interdisciplinary team members from consultation
- Only physicians were consulted instead of nurses
Rationale: The full text states that 'perspectives of some groups (e.g., those identifying as Indigenous or as a member of a visible minority, home health nurses from the territories and some provinces) have not been adequately represented.'
10. What do the study authors recommend as a next step after finalizing the updated competencies?
- Using the competencies to inform prelicensure education and professional development, with future work on strategies to support competency uptake
- Immediately replacing all provincial nursing licensure exams with a new national test
- Discontinuing home health nursing competency frameworks altogether
- Reverting to the original 2010 competency set without changes
Rationale: The abstract states the competency set 'can be used to inform prelicensure education and professional development' and that 'future work exploring strategies to support competency uptake...is needed.'
Study cards
Flashcards
What is the main purpose of the Canadian Home Health Nursing Competencies?
They outline the knowledge, skills, and attributes home health nurses need for safe and ethical practice.
When were the Canadian Home Health Nursing Competencies first developed?
In 2010.
Why did researchers update the 2010 competencies?
Because several important contextual changes have occurred in home health practice since 2010, and the competencies needed to reflect current care environments and population health needs.
What research design was used in this study?
A four-phase modified eDelphi study using online surveys, consensus meetings, and feedback forms.
What is an environmental scan in this study's context?
A review conducted to identify home health competencies that had emerged since 2010, used to build a comprehensive starting set of preexisting competencies.
How many preexisting competencies did the environmental scan identify?
359 preexisting competencies.
How many unique competencies were these consolidated into before the eDelphi process began?
96 unique home health nursing competencies.
How many home health nurses formed the eDelphi panel?
43 home health nurses.
What consensus threshold was used to determine relevance in Round 1?
Agreement of 75% or more.
How many competencies did the panel agree were relevant in Round 1, and how many new ones were suggested?
94 competencies were agreed relevant, and 5 new competencies were suggested.
What higher threshold was applied in Rounds 2 and 3 beyond Round 1's relevance check?
75% or more agreement combined with a modal rating of 'essential' (not just relevant).
How many competencies reached consensus in Round 2?
51 competencies (52%).
How many additional competencies reached consensus in Round 3?
11 additional competencies.
How many home health nurses and interdisciplinary team members took part in the broader validation consultations?
41 additional home health nurses and 12 interdisciplinary home care team members.
What role did the 24-member advisory working group play?
They provided guidance on study decision-making and helped shape the final recommendations.
What was the final number of competencies in the recommended set?
79 competencies.
Name three new concepts added to the updated competency set.
Trauma-informed care, data-driven decision-making, and provision of culturally safe care.
What core concepts from the original competencies were retained?
Evidence-informed practice and interdisciplinary collaboration, among other core concepts.
What key limitation regarding representation did the authors acknowledge?
Perspectives of some groups, including Indigenous nurses, nurses from visible minorities, and nurses from the territories and some provinces, were not adequately represented.
What future work do the authors say is still needed?
Exploring strategies to support uptake of the updated competencies in prelicensure education and in home and community care organizations.
Search-ready answers
Frequently asked questions
What are the Canadian Home Health Nursing Competencies?
They are a national framework outlining the knowledge, skills, and attributes home health nurses need for safe and ethical practice, first developed in 2010 and updated in this 2025 study to reflect current care environments.
Why were the 2010 home health nursing competencies updated?
Because home health nursing practice has changed significantly since 2010, and the original competencies no longer fully reflected current care environments and complex population health needs.
How many competencies are in the updated Canadian home health nursing competency set?
The final updated set includes 79 competencies.
What method was used to update the competencies?
A four-phase modified eDelphi study combining an environmental scan, three rounds of expert surveys, consensus meetings, and feedback forms.
How many nurses and other professionals were involved in developing the updated competencies?
A 43-nurse eDelphi panel, a further 41 home health nurses and 12 interdisciplinary team members in broader consultation, and a 24-member advisory working group of home health nursing leaders.
What new competencies were added in the 2025 update?
New concepts include trauma-informed care, data-driven decision-making, and the provision of culturally safe care.
What is an eDelphi study?
It is a structured method for building expert consensus using repeated rounds of online surveys, where participants rate items and see aggregated group feedback between rounds, refining agreement over time.
Did the study find any limitations in who was consulted?
Yes. The authors acknowledged that perspectives of some groups, including Indigenous nurses, nurses from visible minorities, and nurses from the territories and some provinces, were not adequately represented.
How can these updated competencies be used in nursing education?
The authors state the competency set can inform prelicensure nursing education and professional development opportunities to strengthen the home health nursing workforce.
Where was this study published and who conducted it?
It was published in BMC Nursing in 2025 (open access) by Margaret Saari, Chelsea Coumoundouros, John Tadeo, Barbara Chyzzy, Melissa Northwood, and Justine Giosa.