Development And Validation Of A Competency Evaluation Index System For Nurses In Stroke Centers

Objectives:To understand the work responsibilities of nurses in stroke centers and the competent elements of stroke nursing based on literature review,competency theory exploration and qualitative interview.The competency evaluation index system of nurses in stroke center was constructed by Delphi method.On this basis,the self-assessment questionnaire of nurses’ competence in stroke centers was developed and its reliability and validity was tested.Methods:Part 1:A qualitative study on the competency evaluation index of nurses in stroke centers.A total of 18 nurses and nursing experts from 2 stroke centers certified by Stroke Prevention and Treatment Project of the National Health Commission were selected by the objective sampling method to conduct semi-structured interviews.Colaizzi’s phenomenological research method was used to analyze the data and extract the competencies of nurses in stroke centers.Part 2:Construction of competency evaluation index system for nurses in stroke centers.Based on the competency theory,literature analysis,semi-structured interviews and group discussions,the evaluation index entry pool for nurses in stroke center was set up,and the content of the index system was finally determined after two rounds of Delphi expert consultation.By Delphi method,15 experts in clinical nursing,nursing management,clinical medicine,nursing education and rehabilitation medicine were selected from tertiary class A hospitals and medical colleges and universities in different provinces.After two rounds of expert consultation,evaluation indexes were selected and revised to determine the competency evaluation index system of nurses in stroke centers.Part 3:Verification of competency evaluation index system for nurses in stroke centers.On the basis of the evaluation index system,the self-assessment questionnaire of nurses’ competence in stroke center was developed.By convenient sampling,1083 nurses from 17 provincial/national certified stroke centers in 13 regional administrative region in Yunnan province were selected from September to November of 2020 to conducting a questionnaire survey and 946 valid questionnaires were collected.The evaluation index items were further screened through item analysis,and the reliability and validity of the index system were tested.Results:Part 1:By collating and analyzing the interview data,The competencies of nurses in stroke centers were summarized into 4 themes:theoretical knowledge,operational skills,comprehensive competence,and personal traits and motivations,which included 13 sub-themes.Part 2:The expert consultation questionnaire was developed with 4 first-level indicators,17 second-level indicators and 85 third-level indicators.The effective recovery rates of the two rounds of expert consultation were 93.8%and 100%,the opinion raising rates were 66.7%and 33.3%,the expert authority coefficients were 0.873 and 0.927,and the coefficients of concordance were 0.196 and 0.149(P<0.01),respectively.The coefficient of variation of evaluation indicators in the second round of expert consultation ranged from 0.00 to 0.25.The competency evaluation index system for nurses in stroke center consisted of 4 first-level indicator(theoretical knowledge,operational skills,comprehensive abilities,personal traits and motivations),14 second-level indicators and 79 third-level indicators.Part 3:The critical ratio of each index item was 10.470～20.893(P<0.001),and the correlation coefficient r between each item and the overall index was>0.40;Exploratory factor analysis was carried out for the four dimensions of theoretical knowledge,operational skills,comprehensive ability,and personal traits and motivations of the self-assessment questionnaire for nurses in stroke centers,and 1,6,2,and 1 common factor were extracted respectively.The cumulative variance contribution rates were above 60%.Two three-level index entries with duplicate content have been removed.The total Cronbach’s a coefficient of the evaluation index system was 0.988,and the total split-half reliability coefficient is 0.925.The content validity index S-CVI/UA was 0.936,S-CVI/AVE was 0.989,and the content validity index I-CVI of each item was 0.833～1.000.The correlation coefficient between the first-level index and the overall index was 0.765～0.984(all P<0.05).Finally,a competency evaluation index system for nurses in stroke centers was formed,including 4 first-level indicators,10 second-level indicators and 77 third-level indicators.Conclusions:A competency evaluation index system for nurses in stroke centers was established by combining qualitative and quantitative research methods,including 4 first-level indicators(theoretical knowledge,operational skills,comprehensive ability,personal traits and motivations),10 second-level indicators and 77 third-level indicators.And a large sample size data survey showed that the competency evaluation index system had good reliability and validity,which could guide nurses’ own clinical practice to improve stroke nursing comprehensive ability.It can also provide basic support for hospital nursing managers in the admittance,evaluation,training and assessment of nurses in stroke centers.