Study On Establishing The Evaluation Index System Of Clinical Competence Of Nursing Undergraduate Interns

Objective:The study aimed at establishing a evaluation index system of clinical competence of nursing undergraduate interns,which is more scientific,clearly guidable, comparative and convenient in order to provide the theoretical foundations to enhance the standardization, objectivity and fairness of the evaluation of clinical competence of nursing undergraduate interns.Methods:Based on the methods of theory analysis, document research, Delphi expert consultation and etc., the items of evaluation system was selected, the standards with 4 different levels for each item and the weight for each item were set,thus the evaluation index system of clinical competence of nursing undergraduate interns was initially established. The Enthusiasm Coefficient of experts, the Authority Coefficient of experts , the Coefficients of Variation and the Harmonization Coefficient W were used to examine the reliability and representation of expert consultation. A small sample test of the index system in a total of 52 nursing interns from a nursing school was implemented to analyze the quality of the evaluation index system. The Cronbach alpha was used to examine the Internal Consistency Reliability of the system. The logical analysis and correlation analysis were used to analyze the content validity of the system. The Discrimination Index was used to examine the discrimination of the system.Results:1. Construction of the evaluation index systemThe evaluation index system of clinical competence of nursing undergraduate interns was constructed,which was composed of 23 items from 5 domains including professional value, clinical nursing competence, communication and collaboration competence, teaching and management competence and professinonal development competence. Four different levels of evaluation standards was set for each item to diferenciate differert levels of clinical competence . The Enthusiasm Coefficient of experts was 96.2%( >60% ), the average Authority Coefficient of experts was 0.9128 (>0.70) . After 3 rounds of expert concultation , the Coefficients of Variation of the 5 domains in the first grade index ranged from 0.0773 to 0.1896, and those of the 23 items in the second grade index ranged from 0.0679 to 0.2385 (<0. 3) . The Harmonization Coefficient W of the 5 domains in the first grade index was 0.9262 and those of 23 items in the second grade index was 0.9127. The test of Harmonization Coefficient showed P <0.05.The weights of the 5 domains in the first grade index and 23 items in the second grade index were set up .The weights of the 5 domains (including professional value, clinical nursing competence , communication and collaboration competence, teaching and management competence and professinonal development competence) were 0.1891, 0.3671, 0.1858, 0.1330 and 0.1250 respectively.2. Small sample test on the evaluation index systemThe Cronbach alpha of the total evaluation index system was 0.9698 and that of each domain in the first grade index ranged from 0.8316 to 0.9423( >0. 8 ). The Content Validity was proved to be good by logical analysis. The Correlation Coefficient between the total index system and each domain ranged from 0.8451 to 0.9582. The Correlation Coefficient between each domain and their items in the second grade index ranged from 0.3008 to 0.9525 (P <0.05) .The Discrimination Index of the system was 0.5183 (> 0.4) .Conclusions:1. Construction of the evaluation index systemThough 3 rounds of expert consultation, a set of evaluation index system was established,which was composed of 23 items from 5 domains and 4 different levels of evaluation standards and the weights were set for each item. The reliability analysis of the 3 rounds expert consultation showed that the expert consultations had good reliability and representation.The weight of clinical nursing competence was 0.3671, which was the highest among the 5 domains in the first grade index. The weights of another 4 domains in the first grade index in turn (from high to low )were: professional value (0.1891) , communication and collaboration competence (0.1858), teaching and management competence(0.1330)and professional development competence (0.1250) .2. Small sample test on the evaluation index systemThe results of a small sample test proved that the system had good quality. The total system and each domain had good internal consistency reliability. The results of logical analysis and Correlation analysis proved that the system had good content validity. The discrimination of the system was good.3. Significance of the construction of the evaluation index system(1)Facilitate to achieve the training objectives of nursing undergraduates; (2)Provide a direction for clinical teaching management and cultivation of nursing undergraduates;(3)Provide the theoretical foundation and reference for the evaluation of clinical competence of nursing undergraduates and other nursing staff.4. Suggestions for further study :(1) Though the evaluation standards of 4 different levels for each item had been revised by 2 rounds of expert consultation, there are still some shortcomings which need to be improved in the further research. (2) The reliability and representation of the small sample test were inadequate, which need to be further proved, revised and perfected though carrying out big sample survey in the future. (3) The study should further analyze and compare the different results between different evaluators and the different level of clinical competence of nursing interns at different stage of clinical practice.