PhD, RN, NP, Professor, College of Nursing and Health Sciences, Da-Yeh University, Taiwan.
MA, Lecturer, Academic Writing Education Center, National Taiwan University, Taiwan.
J Nurs Res. 2023 Jun 1;31(3):e276. doi: 10.1097/jnr.0000000000000551.
Nurse practitioners (NPs) play a vital role in healthcare, particularly in acute care settings in Taiwan. The professional competencies of NPs are essential for providing safe and effective care to patients. To date, no measurement tool is available for assessing the clinical competencies of NPs in acute care practices.
The aim of this study was to develop and investigate the psychometric properties of the Acute Care Nurse Practitioner Competencies Scale (ACNPCS).
Mixed-method research was employed using samples of experienced NPs. First, we used a focus group of seven experienced NPs who worked for medical centers, community hospitals, and regional hospitals to identify clinical competencies content. Second, we implemented consensus validation using two rounds of the Delphi study and revised it to a 39-item ACNPCS. Third, we conducted content validity with nine NP experts and modified the competency content to 36 items. Finally, we conducted a national survey of 390 NPs from 125 hospitals to determine the extent to which the NP competency content relates to their clinical practice. To examine the reliability of the tool, we tested the internal consistency reliability and test-retest reliability. Exploratory factor analysis, confirmatory factor analysis, and known-group validity were used to test the construct validity of the ACNPCS.
The Cronbach's alpha coefficient for the overall scale was .92, with subscale coefficients ranging from .71 to .89. Test-retest reliability showed the two scores of the ACNPCS on the two occasions tested to be highly correlated ( r = .85, p < .001). Exploratory factor analysis revealed that the scale had six factors: providing healthcare, evaluating care, collaboration, education, care quality/research, and leadership/professionalism. Factor loadings for each factor item ranged from .50 to .80 and explained 72.53% of the total variance in the NPs' competencies. Confirmatory factor analysis indicated that the six-factor model showed satisfactory model fit (χ 2 = 780.54, p < .01), and the fit indices met the standards for adequate fit (goodness-of-fit index = .90, comparative fit index = .98, Tucker-Lewis index = .97, root mean square error of approximation = .04, and standardized root mean residual = .04). Known-group validity revealed that the total scores for novice NPs differed significantly from those of expert NPs in terms of the competencies ( t = 3.26, p < .001). These results validated the psychometric soundness of the newly developed ACNPCS.
The newly developed ACNPCS exhibited satisfactory reliability and validity, supporting the use of the ACNPCS as a tool to assess the clinical competencies of NPs in acute care settings.
护士从业者（NPs）在医疗保健中发挥着至关重要的作用，特别是在台湾的急性护理环境中。NPs 的专业能力对于为患者提供安全有效的护理至关重要。迄今为止，尚无评估急性护理实践中 NPs 临床能力的测量工具。
本研究旨在开发和研究急性护理护士从业者能力量表（ACNPCS）的心理测量特性。
采用经验丰富的 NPs 样本的混合方法研究。首先，我们使用了一个由七名在医疗中心、社区医院和区域医院工作的经验丰富的 NPs 组成的焦点小组，以确定临床能力的内容。其次，我们使用两轮 Delphi 研究进行了共识验证，并对其进行了修订，形成了一个 39 项的 ACNPCS。第三，我们对 9 名 NP 专家进行了内容有效性测试，并对胜任力内容进行了修改，使其达到 36 项。最后，我们对来自 125 家医院的 390 名 NP 进行了全国性调查，以确定 NP 胜任力内容与他们的临床实践之间的关联程度。为了检验工具的可靠性，我们测试了内部一致性信度和重测信度。探索性因素分析、验证性因素分析和已知组有效性用于检验 ACNPCS 的结构有效性。
总体量表的 Cronbach's alpha 系数为.92，子量表系数范围为.71 至.89。两次测试的 ACNPCS 测试的重测信度表明两个分数高度相关（r =.85，p <.001）。探索性因素分析表明，该量表有六个因素：提供医疗保健、评估护理、协作、教育、护理质量/研究和领导力/专业精神。每个因素项目的因子负荷从.50 到.80 不等，解释了 NPs 能力的总方差的 72.53%。验证性因素分析表明，六因素模型表现出良好的模型拟合（χ 2 = 780.54，p <.01），拟合指数符合良好拟合标准（拟合指数=.90，比较拟合指数=.98，Tucker-Lewis 指数=.97，均方根误差近似值=.04，标准化均方根残差=.04）。已知组有效性表明，新手 NPs 的总分与专家 NPs 在能力方面存在显著差异（t = 3.26，p <.001）。这些结果验证了新开发的 ACNPCS 的心理测量学的合理性。
新开发的 ACNPCS 表现出令人满意的可靠性和有效性，支持使用 ACNPCS 作为评估急性护理环境中 NPs 临床能力的工具。
