| Background The National Nutrition Plan(2017-2030)points out that the clinical nutrition work system should be established and improved to comprehensively promote the clinical nutrition work.However,the effect of clinical nurses in the implementation of nutrition care is not ideal.Because there is no current clinical nutrition care competence evaluation tools,it is unclear whether the clinical nutrition care competence level and unable to carry out targeted training,strictly follow scale establishment process,this study aims to prepare the self-assessment lists of clinical nutrition care competence,in order to provide reference for the evaluation of clinical nutrition care competence.Objective(1)To explore the cognition of clinical medical staff to the nutrition care work scope and competence evaluation of clinical nurses and construct the evaluation index system of nutrition care competence of clinical nurses.(2)To develop a self-evaluation scale for nutrition care competence of clinical nurses that conforms to China’s cultural and medical background,and test the reliability and validity of the scale.Methods(1)Qualitative interviews: Select 15 medical staffs from grade III hospital as object of interview by purposive sampling method in Anhui province from 2019 May to October and conduct semi-structured interviews.Using Colaizzi phenomenological data 7 steps analysis method to analyze the data of interviews and extract the theme,in order to provide reference for the dimensions and indicators of clinical nutrition care competence evaluation index system.(2)Build the draft of evaluation index system:Draft evaluation index system was established through literature review,theoretical analysis and qualitative interview.(3)Delphi method expert consultation: Sixteen experts in nutrition care related fields from 7 tertiary first-class general hospitals and 5medical colleges in 6 provinces and cities were invited to evaluate the importance of all levels of indicators through two rounds of expert consultation.The final three-level indicators were used as the scale item pool.(4)Scale preliminary investigation: Using convenient sampling method and selected 367 clinical nurses from 8 hospitals in Anhui province in 2021 January and screen items through item analysis.(5)Scale formal investigation: Using convenient sampling method and selected 762 clinical nurses from4 hospitals in Anhui province in January 2021,using content validity,structure validity,criterion-related validity,Cronbach’s alpha coefficient,split-half reliability and test-retest reliability to examine the reliability and validity of self-evaluation scale of nutrition care competence for clinical nurses.Results(1)A total of ten clinical nurses,four clinicians and one dietician were interviewed.In this study,seven topics were put forward in terms of nutrition care competence needs of clinical nurses,which were nutrition professional knowledge,nutrition assessment,nutrition support care,health education competence,communication cooperation competence,learning competence and professional quality.(2)The recovery rates of the two rounds of Delphi expert consultation were 81.82% and88.89% respectively,with both effective rates of 100%.The degree of expert authority in the two rounds was 0.845 and 0.810,respectively.The Kendall W coefficients of the three-level evaluation indexes were 0.264,0.108 and 0.087 respectively.After two rounds of expert consultation,the final evaluation index system includes 5 first-level indicators,18 second-level indicators and 63 third-level indicators.The weight coefficients of the five first-level indicators were 0.2576,0.2576,0.1513,0.2576,0.0759,the weight coefficients of the second-level indicators was 0.0082～0.1288,and the weight coefficients of the third-level indicators was 0.0020～0.0859.Finally,an initial scale of 63 items was formed.(3)The results of item analysis in the initial test of the scale showed that each item had good discrimination and high correlation with the whole,and no item was deleted.The final formal scale included 5 dimensions and 63items: nutritional professional knowledge(items 1～7),clinical nutrition assessment competence(items 8～17),nutrition and health education competence(items 18～30),nutrition support care competence(items 31～ 48),nutrition care related quality(items49～63).(4)Formal investigation and analysis results showed that the overall Cronbach’sα coefficient of the scale was 0.991,the Cronbach’s α coefficient of each item was0.952～0.981,and the split and half reliability were 0.926,with statistically significant differences.The results of confirmatory factor analysis showed that the fitting index values of each dimension met the requirements,and the structural validity of the scale was good.The content validity index(I-CVI)of each item level was 0.833～1,and the content validity index(S-CVI)of the scale level was 0.968,indicating that the content validity of 63 items was high,and the consensus degree of the participating experts was high.Criterion-related validity test results showed that the correlation between each dimension and the criterion indicators was 0.582～0.809,and the correlation coefficient between the whole scale and the criterion indicators was 0.788,the differences were statistically significant.(5)Single factor analysis results showed there was statistical significance in the scores of nutrition care competence of clinical nurses in the following factors such as age,working years,degree,with or without children,professional title,level,position,in the department,whether for teaching teachers,whether to have the related certificate,monthly income,professional satisfaction,whether have the superior hospital study expierience,whether the department or the hospital managers to supervise the patient’s nutritional status on a regular basis,whether participated in nutrition classes,study frequency of the nutritional study in department,whether have taken nutrition classes during the school.Conclusions(1)Through the qualitative interview,it can be concluded that the work contents of nutrition care work mainly include clinical nutrition assessment,nutrition and health education,and nutrition support care.(2)The evaluation index system of nutrition care competence of clinical nurses constructed in this study is rigorous and scientific in construction process,and the results are true and reliable.By calculating the weight of each index,it provides a reference for the standardized training of nutrition care competence of clinical nurses.(3)This study completed the preparation of the self-evaluation scale of nutrition care competence of clinical nurses,which finally included 5 dimensions and 63 items.The scale compiled has good reliability and validity,and the contents of the items are comprehensive,specific and practical,which can be used as an evaluation tool to evaluate the level of nutrition care competence of clinical nurses in China. |
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