Construction of an index system of core competence assessment for infectious disease specialist nurse in China: a Delphi study

Delphi survey is a feedback anonymous inquiry method, during the process the experts do not know each other and can’t exchange opinions. Multiple rounds of consultation are conducted by questionnaires which contain the questions to be asked to obtain the opinions of experts until a consensus is reached [24]. This way of independent consultation can ensure that the experts won’t discuss or exchange views [25]. Therefore, it is regarded as an effective method to set goals, items, etc. Besides, we set up a research group which is composed of one professor, one associate professor, two lecturers, one supervisor nurse and one postgraduate. They are responsible for literature review, theoretical analysis, selection inquiry experts, compilation and distribution of inquiry questionnaires, sorting out and analyzing suggestions and data.

The inclusion criteria of consultation experts were as follows: (a) they should be engaged in clinical nursing or medical work of infectious diseases, and their working years in this field are no less than 15 years; (b) they should obtain the intermedium or advanced level certificate; (c) they should acquire a bachelor degree or above; (d) they should voluntarily participate in the investigation, and promise to participate in two rounds of consultation.

We consulted the literature about specialist nurses, infectious diseases, core competence and other related aspects [26‐28] and the core competence theory as well [29]. On the basis of the above literature review, after discussion, our research group carried out qualitative face-to-face interviews with the infectious disease experts, specialist nurses and patients with infectious diseases. The inclusion criteria were the same as mentioned above. We conducted profound interviews based on the Grounded theory, according to which, the principle of sample size is information saturation [30, 31]. We carried out interviews with 21 subjects composed of 7 infectious disease experts, 10 infectious disease specialist nurses and 4 patients with infectious diseases from 5 hospitals in Shaanxi Province from June 2020 to August 2020. During the interviews, a lot of questions were included, such as: According to your experience, in the practices of clinical work, what kinds of work should the infectious disease specialist nurses undertake? What kinds of qualities should the infectious disease specialist nurses possess? During the period of hospitalization, what kinds of nursing services do you expect to be provided by the nurses? et al. With the consent of the interviewees, the researchers made records of the content of the interview. The researchers then transformed the recorded content into words one by one within 48 h, and used the Colaizzi’s 7-step phenomenological analysis method to sort out the interview data. Through Colaizzi’s method, we refined the content of the interview and finally set up 6 primary indicators (namely, Nursing Abilities for Infectious Diseases, Infection Prevention and Control Abilities, Responsiveness to Infectious Diseases, Professional Development Abilities, Communication and Management Abilities, and Professionalism and Humanistic Accomplishment), 17 secondary indicators and 48 tertiary indicators.

The questionnaire was composed of three parts: (a) general information of the experts: age, working years, education background, professional title, etc.; (b) evaluation index system of core competence of infectious disease specialist nurses expert consultation form: the importance of the index was evaluated by way of Likert 5-level scoring method, 5 = very important, 4 = important, 3 = general, 2 = unimportant, 1 = completely unimportant, and the column for suggestions was provided; (c) expert familiarity with the content of the survey and index judgment.

Firstly, after introducing the subject to experts and obtaining informed consent, we sent the questionnaire to experts in the field of infectious diseases by email. Experts scored and modified the index items, and then returned their feedback by email. The Delphi method was adopted to ensure the independence of opinions. We sorted out and summarized the experts’ opinions and redesigned the questionnaire for the second round. The index inclusion criterion: Mean value assignment > 4.5; coefficient of variation< 3. If the importance score was between 3.5 and 4.5, the research team needed to discuss and decide whether the indicator items needed to be retained or deleted [32]. In the second round of Delphi expert consultation, the opinions of all experts turned out to be the same, the evaluation index system was confirmed.

Our research was approved by the ethics committee and was conducted under ethical guidelines described in the Helsinki Declaration (World Medical Association [33]). The purpose was elaborated to the experts before the investigation and verbal consent had been obtained from the experts before the survey. During the investigation, participants could terminate and withdraw from the investigation at any time.

In order to make sure that the research results were representative and reliable, we had proposed some basic requirements in selecting appraisal experts. As a result, 30 infectious disease experts from 8 provinces and cities including Shaanxi, Chongqing, Beijing, Zhejiang, Yunnan, Shandong, Hubei and Shanxi were selected. The research group collated and summarized the experts’ opinions. In the process of data analysis, we made use of Kendall coordination coefficient and chi square value to test the significance of the expert’s opinions, which assured the reliability of the results.

SPSS 24.0 statistical software was applied in the process of data analysis. Data measurement and data calculation were expressed in the form of mean ± standard deviation and frequency, percentage respectively. The enthusiasm of the experts was also expressed in the form of questionnaire recovery rate. The expert authority coefficient (Cr) was the average value of expert familiarity with the indicators (Cs) and judgment criteria for the indicators [34]. The coordination degree of expert opinions was presented by Kendall harmony coefficient.

Among the experts participating in the consultation, 23 (76.67%) were infectious disease nursing experts, and 7 (23.33%) were infectious disease medical experts. Their age ranged from 36 to 56 years old, with an average age of 46.27 (SD 5.99). Their working years varied from 15 to 38 years, with an average of 25.27 (SD 5.92) years. Their educational background was different, 8 (26.67%) with bachelor’s degree, 16 (53.33%) with master’s degree and 6 (20%) with doctor’s degree (Table 1).

The enthusiasm of the experts was assessed on the basis of the recovery of the questionnaires. In the first round, 32 questionnaires were distributed and 30 effective questionnaires were returned, with a recovery rate of 93.75%; in the second round, 30 questionnaires were distributed and all of them were returned, with a recovery rate of 100% (Table 2).

The judgment coefficient, familiarity coefficient and authority coefficient are 0.933, 0.913 and 0.923 respectively, which meet the standard of expert consultation authority coefficient > 0.7. In the first round of expert consultation, the Kendall’s concordance coefficients of the first, second and third level indicators were 0.156, 0.262 and 0.318 respectively. While in the second round of expert consultation, the Kendall’s concordance coefficients of the first, second and third level indicators were 0.177, 0.236 and 0.324 respectively. The results of the Kendall’s concordance coefficients were on medium level and the Kendall’s test had statistical significance (all p < 0.01) (Table 3).

In this study, we conducted two rounds of consultation and made use of the Delphi method. In round 1, the research team modified 12 indexes, deleted 3 indexes, merged 3 indexes, added 2 indexes, adjusted 2 indexes based on the exclusion criterion and experts’ opinions. In round 2, the research team modified 2 indexes. Finally, the index system of core competence assessment for infectious disease specialist nurses was established and it included 6 first level indexes, 16 s level indexes and 47 third level indexes. The first level indicators referred to Nursing Abilities for Infectious Diseases, Infection Prevention and Control Abilities, Responsiveness to Infectious Diseases, Professional Development Abilities, Communication and Management Abilities, and Professionalism and Humanistic Accomplishment. Index weight was referred to the relative importance of a certain index in the overall evaluation system. And the Delphi method was applied to determine the index weight. The weight index was determined by dividing the sum of the scores of each item of the index into the score that represented the importance of the corresponding index according to the experts’ opinion. In the terms of weight, Infection Prevention and Control Abilities showed the highest value (0.172), followed by Nursing Abilities for infectious diseases (0.169), while Professionalism and Humanistic Accomplishment showed the smallest value (0.161). Among the secondary indicators, Safety Protection Abilities and Humanistic Care showed the highest value (0.065), while Prediction and Reporting showed the smallest value (0.058) (Table 4).

In this study, the experts who participated in the Delphi consultation came from 8 different provinces and cities in China, which ensured that the results were objective and would not be affected by the region. The consulting experts had been engaged in the work relevant to infectious diseases for more than 15 years, so they had rich experience in clinical infectious diseases and were familiar with the research. The authority coefficient of this research was 0.923, which proved that the authority of the research was assured. The response rates of the two rounds of expert consultation were 93.75 and 100% respectively, indicating that the experts were enthusiastic in the research. The Kendall’s concordance coefficient of the two rounds of consultation were statistically significant, so it proved that the results of the evaluation index system of core competence of infectious disease specialist nurses were reliable.

Infectious disease specialist nurses are the backbone of infectious disease nursing. Their core competence is related to the work quality, service level and team development of infectious disease nursing. At present, there is no research on the core competence index system of infectious disease specialist nurses, so the definition of the core competence of infectious disease specialist nurses is not clear. In the context of the novel Coronavirus disease and the increasing number of new infectious diseases [35, 36], speeding up the training of infectious disease specialist nurses and clarifying their core competencies will help standardize the work of infectious disease nursing, improve the quality of nursing services, and prevent the spread of infectious diseases. Therefore, it is of great practical significance to construct the evaluation index system of core competence of infectious disease specialist nurses.