| OBJECTIVE:It was widely acknowledged that clinical nurse specialists (CNS) could provide advanced nursing practice and quality care. Education of CNS has become necessary not only for the need of health but also for the progress of nursing field. In china, some hospitals have developed CNS programs and lots of advanced nursing professionals have been trained. However, some problems cannot be ignored. Because of its late start and some other reasons, CNS evaluation is developing in research and practice at the beginning. To adapt to the trend of standardization, systematization and internationalization of CNS, it is imperative to lay emphasis on CNS evaluation. The aim of this study was to establish the evaluation index system of certificating CNS, so that the scientific standard can be offered to relative departments to evaluate CNS, which is in turn to enhance the development of the CNS evaluation. METHODS:Using the Delphi method, a total of 34 experts in different nursing field were consulted. And then using the analytic hierarchy process, relevant weights weredeveloped. These experts come from two medical universities, seven hospitals and health administration in Beijing and Guangzhou. Age range is from 33 to 59, average age is 43.7+5.81 (SD). Working years of these experts range from 13 to 40, the mean is 25.3 ±6.86 (SD). All the experts have high technical posts. The questionnaire of expert consultation, which was based on authorities consultation and retrospective literatures, was designed according to the result of the pilot study.The questionnaire of nurse self-survey was established by CNS evaluation index system. Its aim was to investigate the reliability and validity of the evaluation index system. A total of 120 nurses coming from 8 grade II &III hospitals in Guangzhou was selected by using stratified random sampling, which including 60 with primary technical post, 40 with secondary technical post and 20 with high technical post. Among 98 received questionnaires, 40 were selected by random sampling in order to be retested two weeks later.In the study, describing statistics was used to analyze demographic constitution of experts. Mean and coefficient of variance was used to describe the experts' opinion of the importance of the item; and coefficient of Kendall's W, percentage of questionnaire received and the authority degree of experts were used to examine the reliability and representation of expert consultation. In the self-survey, test-retest reliability was proved by correlation analysis; the internal consistency of questionnaire was examined by calculating Cronbach alpha; construct validity was evaluated by factor analysis and correlation analysis. Independent sample / test, test of homogeneity of variances and one-way ANOVA were used to analyze group differences in demographic characteristic of nurses. The data was analyzed by using statistical package for social sciences (SPSS) 10.0.RESULTS: 1. Reliability and Consistency of the Expert ConsultationAccording to demographic factors, the experts show higher education level, the percentage of experts working more than twenty years is 58.8%, more than thirty years is 29.4%. In addition, authority degree of experts is beyond 0.8. Therefore, based on practice and theory, the expert consultation had high reliability.The percentage of questionnaire received from the three rounds of expert consultation were more than 80.0%, furthermore answer rate in each one of three special fields of nursing study was more than 70.0%. In received questionnaire, the number of opinions and suggestions of experts was more than 100. It shows enthusiasm and support of experts. The coefficient of Kendall's W of three rounds were 0.251,0.298 and 0.307(P<0.001) respectively, which provides sufficient evidence of high consistency among expert opinions.2. Filtrate Index and Set Weight of ItemUsing Likert 5-scale method to describe the experts' opinion of the importance of the item, the mean beyond 3.5 and the coefficient of variance less than 0.25 were used to filtrate index. Conclusions could be drawn according to the statistics above. On the other hand, mean of item had been used to calculate the Saaty sign. According to the analytic hierarchy process, next step was to establish the multi-ranks judge matrix. And then the weight of item was identified. The value of RI showed that evaluation index system of certificating CNS had logical consistency. In conclusion, the weight of the first grade in which included individual index, special knowledge and skill, and assessment of CNS role and function, were 0.1007, 0.6738 and 0.2255 respectively. In the same way, the weight of the second grade and the third grade could be worked out. By using principle of probability multiplication, weight of each item could be set up. Based on the evaluation index system of certificating CNS and weight of item set up, we established the assessment model of certificating CNS.3. Examination of Evaluation Index System of Certificating CNSAccording to the general principles of measurement, self-survey in nurses was performed successfully. In the result, test-retest reliability of the index system is 0.668; Cronbach alpha of the evaluation index system of certificating CNS is 0.945. It was found that in correlation analysis value of items vs. its superior grade item had higher correlation coefficient than value of items vs. other grade item. The factor analysis result showed that four factors were picked up which proved the role and function of CNS. The cumulative extraction sum of squared loadings was 73.64%, after amended it was up to 75.30%. These data suggest that configuration of questionnaire was accordant to the result of factor analysis in the main. The questionnaire had a better reliability and construct validity. CONCLUSIONS:After three rounds of expert investigation and statistic analyses, a CNS evaluation index system was established and validated. Finally, we discussed the significance of establishing of the evaluation index system of certificating CNS. 1. Establishment of the Evaluation Index System of Certificating CNSBased on the theory and methodology of evaluation, and on the related authoritative literatures, the four elements were established, including the training foundation, the certificate institution, the attestation mode, and the evaluation index system. Nursing department of medical university and/or places entitled to grant master degree of nursing and hospital focused on the special field would be selected as training foundation. Nursing department of medical university empowered by government would become the certificate institution. The attestation mode was included individual application, hospital recommendation, and certificate institution evaluation. The evaluation index system included three grades and 55 items: 4 items in the first grade, 29 items in the second grade and 31 items in the third grade, the CNS evaluation index system was established and connotation definition of items was set up.2. Foundation and Examination of the Assessment Model of Certificating CNSBased on the Delphi method and analytic hierarchy process, weight of item of evaluation systems was calculated. And, the assessment model of certificating CNS was established. Using such two scientific methods, logicality and accuracy of the study would be enhanced. By using assessment model, we could certificate the competency of CNS and evaluate their role and function, which could help us to understand the behavior and contribution of CNS adequately. According to the nursing self-survey, we concluded that the evaluation index system had both rationality and feasibility, and the assessment model had a better reliability and validity, it provided a set of standard evaluation pattern for certificating CNS in the coming future.3. Significance of the establishment of the Evaluation Index System of CNSBased on theoretical research and practical examination, professional evaluation agencies and professional standard of the CNS evaluation had been set up. The criteria for CNS scientific evaluation reflected the characteristics of nursing profession and include all information of nurse. Quantification of evaluation index system made it comparable and objective in evaluating individual index, special knowledge and skill, and clinical role and function. In addition, the assessment model be calculated and operated more easily, which would provide quantificational and impersonal estimated ? method in certificating CNS.Besides, the significance of the foundation of CNS evaluation system was discussed as follows. First, it would promote training and using skillful nurses, inspiring their inventiveness and positivity. The CNS role could provide space for nursing career development, motivate experienced nurses who wish to remain clinically involved, to improve their care for patients and promote their career. Secondly, an authority and powerful result in evaluation could make nurses pay more attention to professional knowledge and clinical practice, and then they would study positively; in this way,nursing research and practice would be improved greatly, fulfilling continuously developing need of health. Therefore, skillful nurses would become clinical nurse specialists, who could find out questions in clinical nursing practice and solve it in time. Thirdly, CNS evaluation would promote specialization in nursing field. Because of the important role of CNS in advanced nurse professional model and nursing development, there is no doubt that nursing would be more scientific and specialized. With their much experience, high skill, prompt sense, and excellent humanity quality, CNS could provide individualized care targeting at every patient's needs, as well as the patient-centered high quality services.
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