Study On The Evaluation System Of The Clinical Competence Of Graduates In Master Of Nursing Specialist

BackgroundIt is necessary to adapt to the structural transformation of postgraduate education with the current social-economic situation.In January2010, the Academic Degrees Committee of the State Council approved the setting of Master of Nursing Specialist (MNS). It is a new professional degree of medicine after Master of Medicine (M.M.), Master of Stomatological Medicine (S.M.M), and Master of Public Health (MPH). So, in China, the training model of nursing graduate education has changed from a single academic degree for teachers and researchers to both professional degree for high-level, application-type, specialist nursing experts and academic degree diversely. This also shows that China has begun with international standards, and turned to develop advanced practice nurses(APN). As a new thing,the Master of Nursing Specialist still is in a stage of exploration. Based on the concept of Competency-based education, the level of clinical competence of postgraduates of MNS is the key to reflect their quality of education. Moreover, the clinical competence evaluation for postgraduates of MNS is a necessary means to protect the quality. At present, the evaluation of clinical competence in nursing education in China are more concentrated in the undergraduate of nursing students, lack of research on nursing graduates.The education of M.M. started relatively early. The document about "the content and requirements of clinical competency assessment for M.M." was issued by the Science and Technology Education Department of the Ministry of Health and the Academic Degrees Committee of the State Council. Many researchers have conducted research on clinical competency evaluation of M.M. through referring to this document. These can provide an important reference for building China’s national conditions, scientific, standardized clinical competency evaluation system of MNS.ObjectiveThis study was designed to use Delphi expert consultation and the Analytic Hierarchy Process (AHP) to build the evaluation system of the clinical competence of MNS and indexes weight, and measured the quality of the indicator system for small samples, and analysed situation of nursing graduate clinical competence by the small-scale survey. This is hope that provides a scientific, standardized, objective and fair measurement tool for clinical competency assessment of MNS, and affords a scientific basis for the evaluation of postgraduates’ training quality, and promotes the continuous improvement of nursing graduate education level.Study Subjects and Methods1. The primary construction of evaluation system for clinical competence of masters of nursing specialist.The advanced works included exporting to build the basic principles, the theoretical and practical basis of the index system, and protocolling framework of competencies for MNS through literature review, theoretical analysis, and expert interviews. Then, we applied the Delphi method to two screening of the indicators. In this study, we selected29experts from Guangzhou, Beijing, Shanghai, Changsha, and Chengdu of nursing education, nursing management, and clinical nurse specialist as the studied objects. Experts in the inclusion criteria:①The Bachelor degree or above;②The intermediate technical titles or above;③The nursing profession for more than10years experience.④In this study, are interested and willing participants. The survey data was processed by the statistics software of SPSS13.0, analyzing general condition of experts by descriptive statistics; experts with positive coefficient by questionnaire recovery; experts’authority by the coefficient of authority; experts’ concentration by mean, full marks rate of indicators of the importance scores; experts coordination by coefficients of variation and the Kendall coefficient of concordance (Kendall’s W) and its significance test.2. The determination of evaluation indicator weights of clinical competence for masters of nursing specialist. Material from the first part of the second round of expert consultation was statistical processing with excel2003software. The application of Analytical hierarchy process (AHP):Fisrtly, compared the means of indicators to determine saaty scale,and constructed judgment matrix; Secondly, the square root method is used to determine the weight and the maximum eigenvalue. Sorted single level and whole system and its consistency inspection; Finally, determined the index system of the combination of index weight at all levels.3. The testing application and analysis of evaluation system for clinical competence of masters of nursing specialist.Fewer to have entered the clinical practice phase of MNS, so this part will have entered or completed the clinical practice of master graduate student of academic degree also included in the survey objects. Survey inclusion criteria:①Postgraduate students of nursing in school;②has entered the postgraduate clinical practice or have completed the clinical internship. Convenience sampling to select the six medical colleges and33full-time nursing graduate students to conduct the investigation with the clinical competence of nursing graduate students self-assessment scale that was based on three indicators of the first two parts constructed index system. Then, we evaluated the quality of the index system through the evaluation of the reliability and validity of this scale.Result1.The results of the Delphi method for constructing evaluation system for clinical competence of masters of nursing specialist.The29experts of two rounds of the consultation come from Guangdong, Shanghai, Beijing, hunan, Sichuan, and hainan six provinces and cities6medical colleges and15teaching hospital. Experts age from37to59(46.45±6.60) years; The work experience fromr14to43(27.10±7.21) years; One professor nursing eight, associate professor five; Nursing doctoral3, the tutors10; Undergraduate course13patients (44.8%), master’s13patients (44.8%), dr three (10.3%),of whom, nursing professors8, associate professor5;Ph.D. supervisor3, Master Instructor10; Undergraduate13(44.8%), master13(44.8%), and Dr.3(10.3%).The two questionnaires were issued for35,29, recycled29,24respectively. The valid questionnaires are25,24respectively. Effective recovery ratings are71.4%,82.8%. In the first round,15experts (60.0%) had proposed37amendments and recommendations. In the second round,9experts (37.5%) had proposed29comments or suggestions that experts’enthusiasm was higher. Two rounds of consulting experts average authority degree are0.87and0.89. After two rounds of consultation, the coefficients of variation of the first-class indexes were between0.08-0.20, and the second-class indexes of the coefficient of variation in0.06-0.21. In the second round, the coefficients of concordance of all levels of indexes (except the third-class indexes) have increased that compared with the first round (P<0.001), indicating that experts’ advices on the coordination. Combined with boundary value method, expert’s opinion, and group discussion, this complete assessment index system includes the six contents of evaluation (ideological and moral qualities, the level of theoretical knowledge, clinical ability of practice, clinical research capacity, clinical teaching ability, organization and management capacity),23indicators of evaluation, and68criteria of evaluation.2.The results of the AHP method for determining of weight of evaluation system for clinical competence of masters of nursing specialist.The study results show that the weight of the first-class indexs of evaluation system for clinical competence of masters of nursing specialist from big to small are clinical ability of practice (0.332), the level of theoretical knowledge (0.246), ideological and moral qualities (0.180), clinical research capacity (0.133), clinical teaching ability (0.065), organization and management capacity (0.065).in the second-class indexs, the weight of Professional knowledge (0.138) is highest, followed by the professional attitude (0.090), and the lowest for ward management (0.005).In the third-class indexes,these three,""master theoretical knowledge of the specialist care (0.092)","master the basic medical and nursing theory based on knowledge (0.063)","familiar with are engaged in academic nursing research new developments and new trends (0.046)",are the top three. The results of single-sort, and whole-sort of indexes by the test has satisfactory consistency.3. The present situation investigation of clinical practice of nursing postgraduates and the result of quality inspection of the evaluation system for clinical competence of masters of nursing specialist.The questionnaire survey was40copies, recycling of36, recovery is90.0%, and the effective questionnaire was33of the recovery82.5%effective. The age of22-33(25.03±2.10years; Women of32, the male one; Academic degree of21, professional degree of12; The clinical practice time average5.65±4.24months.54.6%of the people with teaching approaches was not satisfied or general;51.5%of students showed not satisfied with or general for their internship performance;72.7%of the students’ clinical competence self-assessment scores of60-79points. The correlation coefficient of total score and6first-class indexes between0.692to0.903,of firs-class and their second-class indexes between0.540to0.950,and showed a significant positive correlation(P<0.01). The Cronbacha coefficient of the index system for0.976, six of firs-class indexes Cronbach a coefficient in0.793-0.957between, showed internal consistency reliability is higher. Structural validity analysis showed that, the Cronbach a coefficients for each factor were greater than the correlation coefficients of the factors and other factors, indicating that higher construct validity.Conclusion1. The evaluation system for clinical competence of masters of nursing specialist was built based on the Delphi method and its results are reliable, have a certain scientific and effective.2. The weight of evaluation system for clinical competence of masters of nursing specialist was determined by AHP and has scientific and accurate, can be used as a evaluation tool to measure the clinical competence of MNS. Meantime, the results suggest that the clinical ability of practice is the primary ability of the clinical competency of MNS. Adequate, high quality professional practice is an important guarantee of the quality of graduate education in professional degree.3. The results of testing application and analysis indicated that the index system has good reliability and validity,and can be used for measuring the clinical ability level of MNS. At the same time, according to the results of the survey, the clinical ability of the master graduate student of nursing in China is in the lower-middle level. Students’the satisfaction of clinical teaching ways and internship performance is low.