Diversity & Equality in Health and Care Open Access

Development of Clinical Practice Ability Evaluation Scale for New Nurses and its Reliability and Validity

Shan Weichao^*, Ning Yanjiao, Weiying Shan and Feng Yajing Department of Nursing, Chengde Nursing Vocational College, China
^*Correspondence: Shan Weichao, Department of Nursing, Chengde Nursing Vocational College, China, Email:

Received: 28-Nov-2022, Manuscript No. ipdehc-22-15274; Editor assigned: 30-Nov-2022, Pre QC No. ipdehc-22-15274 (PQ); Reviewed: 14-Dec-2022, QC No. ipdehc-22-15274; Revised: 19-Dec-2022, Manuscript No. ipdehc-22-15274 (R); Published: 26-Dec-2022, DOI: 10.21767/2049-5471.19.12.59

INTRODUCTION

The Outline of the “Healthy China 2030” Plan proposes that by 2030, China will have 4.7 registered nurses per 1000 permanent residents [1]. According to the Statistical Bulletin of National Economic and Social Development in 2021 released by the National Bureau of Statistics in February 2022, there are 5.02 million registered nurses in China, with 3.5 registered nurses per 1000 people, and 3 million more nurses are needed [2]. The supply of new nurses plays an important role in maintaining the stability of the nursing human resource team, and the quality of new nurses’ skills is related to the safety of patients, and also reflects the smooth transition from graduates to clinical nurses [3]. Therefore, it is of great significance to evaluate the clinical practice ability of newly recruited nurses and improve their pertinence. At present, the evaluation of clinical competence of nursing staff is mostly based on competency and core competence, and most of them are senior nursing staff. Most of the research focuses on emergency, operating room, newborn and other specialized fields [4,5]. For example, if the evaluation scale of core competence or competency that has been formed is used, it does not conform to the characteristics of new nurses, and it is unable to evaluate the real ability of new nurses [3]. Therefore, the purpose of this study is to build a scientific and practical evaluation scale for the clinical practice ability of new nurses, to achieve an all-round evaluation of new nurses, to provide a reference for the training and training of new nurses, to promote new nurses to better and faster adapt to the role of nurses, and to lay a foundation for the effective improvement of nursing service quality.

Materials and Methods

Preparation of the Scale

An item pool was formed to retrieve databases such as CNKI, Wanfang, PubMed, Web of Science, and CINAHL. The Chinese search terms are “newly recruited,” “nurse,” “clinical practice ability,” “core competence,” and “core competence;” In addition, drawing on the already formed scales “China Registered Nurse Core Competency Scale,” “Nurse Competency Scale” and “Admission Level Nurse Questionnaire,” forming the original item pool; Through two expert meetings, the original item pool was revised to form a draft scale with 6 dimensions and 57 items, and an expert consultation questionnaire was formed [6-8]. Delphi expert consultation selects experts in clinical nursing, nursing management, nursing education, social psychology, health statistics and other fields covering the eastern, central and western regions of China. Criteria for inclusion of experts:

• Education background: Bachelor degree or above;

• Professional title: Deputy Senior or above;

• Working years in the existing work field ≥ 10 years;

• Informed consent.

The experts use the Likert 5 level scoring method to score the importance of the items, and assign values from “very unimportant” to “very important” [9]. The index shall be selected according to the importance assigned value mean>4 and coefficient of variation (CV)<0.2. The final evaluation index shall be determined through discussion of the research group in combination with expert opinions. Pre survey In April 2021, Hebei Province, Jilin Province and Gansu Province were selected for the pre survey of small samples by the convenient sampling method, and 30 samples were selected from each province.

Inclusion criteria: Graduates of secondary vocational and higher vocational nursing major who passed the nursing qualification examination in 2020 and are employed in tertiary hospitals, secondary hospitals and primary medical institution. Those who have not interrupted their work in clinical nursing post since graduation.

Rejection criteria: Those who give up in the process of answering. All entries have the same answer. During the investigation, record whether the respondents question the items or have difficulties in understanding them, and revise them through the discussion of the expert meeting and the research group.

Reliability and Validity Test

From July to August 2021, according to the level of economic development and regional characteristics, 2 to 3 provinces (municipalities directly under the Central Government or autonomous regions) in the east, middle and west of China were randomly selected by multi-stage stratified random sampling method, including Jiangsu Province, Jilin Province, Gansu Province, Hubei Province, Hebei Province and Chongqing City. Inclusion criteria and exclusion criteria are the same as those of pre investigation. The calculation of sample size is based on 5-10 times of the items. There are 45 items in this scale. According to the 10% loss rate, at least 248 cases are included, and 578 cases are actually included.

Survey tool: General information survey scale: Including department, gender, education background, specialty, independent duty, etc. Investigation scale of clinical practice ability of newly recruited nurses: This scale is a self-assessment scale with 5 dimensions and 45 entries. It adopts Likert 5-grade scoring method, and 1 point=cannot be completed; 2=completed under the guidance of teachers; 3=completed with the help of colleagues; 4=can be completed independently; 5=can guide junior nurses to complete. The total score of the questionnaire is 45-225. The higher the score, the stronger the clinical practice ability.

Data Collection Method

Questionnaire stars were used to complete the questionnaire survey. In order to ensure the quality of the questionnaire recovery, members of the research team set up quality control related settings in the background of the questionnaire stars, such as: Set up unified guidelines in the questionnaire; The minimum submission time is set for each questionnaire; The questionnaire must be completed, otherwise it cannot be submitted.

Statistical Methods

SPSS21.0 and AMO21.0 software were used for analysis. Quantitative data were expressed by mean ± standard deviation; Qualitative data are expressed in frequency and percentage. The items were screened by correlation coefficient method, internal consistency analysis and factor analysis. Exploratory factor analysis, confirmatory factor analysis and content validity index were used to evaluate the validity; Cronbach’s α coefficient and Spearman Brown coefficient were used to evaluate the reliability. P<0.05 indicates that the difference is statistically significant.

Results

Delphi Expert Consultation Results

A total of 19 experts, aged 41-60 years, were included; 16 (84%) with more than 20 years of service; Education background: 3 undergraduates (16%), 10 masters (53%), 6 doctors (31%); 16 (84%) of them are senior leaders and 3 (16%) are deputy senior leaders; There were 3 clinical nursing workers (16%), 7 nursing educators (37%), 5 nursing managers (26%), 3 social psychologists (16%), and 1 health statistician (5%). The positive coefficients of the two rounds of expert consultation are 100% and 95%, the authoritative coefficients are 0.888 and 0.892, and the Kendall coordination coefficients are 0.238 and 0.265. After two rounds of expert consultation, 1 primary indicator and 12 secondary indicators were deleted; Modify 2 primary indicators and 28 secondary indicators; Consolidate 6 secondary indicators; Add 3 secondary indicators. The final scale consists of 5 dimensions and 45 items.

Pre Survey Results

The pre survey did not delete dimensions and items, but only revised the description of items. “Have professional quality, love your job and be dedicated to your work” is revised to “be able to be cautious and independent in your work, love your job and be dedicated to your work.”

Formal Findings

Project differentiation analysis: All items in this study are not binary scoring questions, so the Pearson product difference correlation coefficient between the score of each item and the total score of the scale is used as the index to evaluate the project differentiation (Table 1).

Table 1: Project differentiation

Construct Validity Analysis

Exploratory factor analysis: Exploratory factor analysis showed that the KMO value was 0.963, the Bartlett spherical test value was 15219.956, the degree of freedom (df)=990, P<0.001, which was suitable for factor analysis. According to the five dimensions of clinical practice ability and the judgment of lithotripsy chart (Figure 1), 5 factors with characteristic roots>1 were selected, and the cumulative variance contribution rate was 60.959% (Table 2).

Figure 1: Five dimensions of clinical practice ability and the judgment of lithotripsy chart

Table 2: Results of exploratory factor analysis

Confirmatory factor analysis: The maximum likelihood method is used to verify the consistency of the model. The results showed that the ratio of chi square of goodness of fit to degrees of freedom (c2/df)=1.035, root mean square of approximation error (RMSEA)=0.008, goodness of fit index (GFI)=0.932, adjusted goodness of fit index (AGFI)=0.925, comparative fit index (CFI)=0.998, irregular quasi fit index (TLI)=0.998, and standardized root mean square residual (SRMR)=0.028.

Calibration related validity: Calibration related validity is to use the existing authoritative scale as the criterion to measure its correlation with the newly prepared scale. The greater the correlation, the better the validity of the new scale [10]. At present, there is no authoritative clinical practice ability evaluation scale for new nurses. Therefore, this study takes the self-evaluation of the research object as the calibration standard, and the statistical results show that the correlation validity of the calibration standard is 0.831.

Content validity: According to the expert evaluation results, there are 42 items with all expert scores ≥ 3, S-CVI=42/45=0.93; the content validity index (I-CVI) of each item level was 0.833~1.000.

Internal consistency of the scale: The correlation coefficient between the total score of each dimension and the total score of the scale is 0.583~0.861, and the correlation coefficient between the dimensions of the scale is 0.262~0.362, which is statistically significant (Table 3).

Table 3: Correlation analysis between dimensions and total amount table (r value)

Reliability analysis of the scale: The overall Cronbach’s α of the scale was 0.946, and the split half reliability was 0.682; Cronbach′s α of clinical nursing practice ability was 0.958, and the half reliability was 0.960; Cronbach’s α of health education ability was 0.883, and the half reliability was 0.881; Cronbach’s α of communication and cooperation ability is 0.857, and the split half reliability is 0.851; Cronbach' s α was 0.893, and the half reliability was 0.895; The Cronbach’s α of professional quality is 0.919, and the half reliability is 0.918.

Discussion

The clinical practice ability evaluation scale of new nurses meets the needs of the times. The knowledge and skills of newly recruited nurses cannot fully meet the actual clinical work needs, and they often face problems such as “insufficient professional knowledge reserves, unskilled skill operation, lack of disease observation ability and emergency response ability, poor interpersonal communication ability, and occupational identity problems” [11-13]. To improve the clinical ability of newly recruited nurses and successfully complete the transition from nursing students to licensed nurses is an important topic of current nursing talent training. An effective training program should be based on a comprehensive, in-depth and objective evaluation. The evaluation scale formed in this study provides an objective quantitative tool for the evaluation of new nurses’ clinical practice ability [14,15]. Moreover, in the process of constructing the scale, the practicability and measurability of the items are emphasized, and the following aspects are considered:

• The items are comprehensive and specific, covering clinical work;

• Meet the characteristics and ability needs of new nurses;

• In combination with the Training Program for New Nurses issued by the General Office of the National Health and Family Planning Commission, the scale is divided into five dimensions: Clinical nurses’ practical ability, health education ability, communication and cooperation ability, patient safety assurance ability, and professional quality, which meet the job needs of nursing staff in the new era P [16]. Through effective evaluation, it can provide a theoretical basis for medical colleges and universities to deepen education and teaching reform and develop a student training model based on post competency; it will lay a foundation for the hospital to develop a training system for new nurses based on evaluation, demand orientation and job competency [17].

The development of clinical practice ability evaluation scale for new nurses. The first draft of this scale is based on a large number of literature researches, drawing on the mature scale and two expert meetings. The experts selected in Delphi expert consultation cover the east, middle and west regions of China, which are respectively clinical nursing, nursing management, nursing education, social psychology, health statistics and other fields. They are familiar with the content of this study and have strong theoretical basis and practical experience. The expert consultation has high enthusiasm, strong authority and good coordination. At the same time, multiple item analysis method is adopted to screen indicators, and the data analysis is reasonable to effectively ensure the scientificity and preciseness of the scale. The reliability and validity of the clinical practice ability evaluation scale for new nurses are good. This study shows that the scale has good discrimination, and the correlation between each item and the total score of the scale is 0.437~0.697, which indicates that the scale has strong discrimination ability and can accurately measure the clinical practice ability of new nurses; In this study, exploratory factor analysis was used to test the construct validity of the scale. The results showed that the cumulative variance contribution rate of the 5 factors was 60.959%. On this basis, the model was verified by confirmatory factor analysis, and each fitting index was within the standard range, which showed that the factor structure model of the scale was well matched with the data, and the model was more reasonable. Moreover, the correlation coefficient between the total score of each dimension and the total score of the scale is 0.583~0.861, indicating that the internal consistency of the questionnaire is ideal [18]. The results showed that the content validity index of each item was 0.833~1.000, indicating that the content validity of the scale was good, and the dimensions and items of the scale could effectively reflect the clinical practice ability of new nurses; In this study, Cronbach’s α coefficient and split half reliability were used to evaluate the reliability of the scale. The Cronbach’s α coefficient and split half reliability of the scale as a whole and each dimension were at a high level, indicating that the internal consistency of the scale was good and it had certain stability.

Declarations

Ethical Approval

This study is the construction of the evaluation scale, which was approved by the Ethics Committee of Chengde Nursing Vocational College when conducting a large sample survey.

Competing Interests

This study does not involve the issue of competitive advantage.

Author's Contributions

Shan Weiying designed the whole research and drafted the first draft of the paper; Ning Yanjiao was responsible for data collection and writing the paper; Feng Yajing was responsible for data analysis; Shan Weichao guided the research design and implementation. All authors agree with the conclusion of the paper and agree to submit to Health and Quality of Life Outcomes.

Funding

The supporting fund for this research is: Youth Fund Program for Humanities and Social Sciences Research of Hebei University, SQ2022185, with a fund of 10000 yuan; Chengdu National Sustainable Development Agency Innovation Demonstration Area Construction Science and Technology Special Project Research on Chengdu Medical and Health Care Industry Construction, 202008F005, with a fund of 20000 yuan.

Availability of Data and Materials

The data of this study are collected by the researchers themselves, which are true and reliable.

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