【作者】 陶红；

【导师】 黄辉； 陈琦蓉；

【作者基本信息】 中南大学 ， 护理（专业学位）， 2025， 硕士

【摘要】 目的:(1)构建MNS(Master of Nursing Specialist,代指护理硕士专业学位研究生并简称为护理专硕)临床带教老师置信职业行为评价指标体系并确定各级评价指标权重。(2)初步验证该评价指标体系的信效度和可行性。方法:(1)MNS临床带教老师置信职业行为评价指标体系初稿的构建:基于文献分析法,对国内外关于MNS临床带教老师核心能力以及护理领域或医学教师领域的置信职业行为评价指标的相关文献进行归纳总结;采用目的抽样法对相关利益者进行一对一半结构化访谈,探究其对MNS临床带教老师置信职业行为评价指标的看法和内容建议;综合文献分析以及质性访谈结果,构建MNS临床带教老师置信职业行为评价指标体系初稿。(2)MNS临床带教老师置信职业行为评价指标体系终稿和各级评价指标权重的确定:采用德尔菲法对初稿进行专家函询,计算专家积极系数、专家权威系数、专家意见集中程度、每项评价指标的得分和变异系数,结合专家意见对评价指标体系进行修订并确定终稿。采用层次分析法,确定评价指标体系终稿的各级指标权重。(3)MNS临床带教老师置信职业行为评价指标体系的初步验证:信效度检验:采用多阶段和便利抽样法,选取来自我国六大地理区域中符合纳入标准的研究对象,进行问卷调查;使用一般资料问卷、MNS临床带教老师置信职业行为评价指标调查问卷、评价指标体系评价效果调查表开展调查;采用SPSS26.0软件进行统计分析,计数资料采取频数和百分比进行描述,计量资料使用均数、标准差进行描述;采用临界比值法、相关系数法和同质性检验进行项目分析;采用内部一致性(Cronbach’sα系数)和折半信度进行信度分析;采用内容效度和结构效度(探索性因子分析)进行效度分析。预调查:采用便利抽样法,选取湖南省长沙市某三甲医院符合纳入标准的研究对象进行问卷调查;使用预调查一般资料问卷、MNS临床带教老师置信职业行为评价指标应用预调查问卷;采用SPSS26.0软件进行统计分析,计数资料采取频数和百分比进行描述,计量资料使用均数、标准差进行描述;采用非参数检验比较评价结果是否存在统计学差异。结果:(1)MNS临床带教老师置信职业行为评价指标体系初稿的构建:基于文献分析法,(1)共纳入8篇相关文献进行分析,整合形成了适合本研究的MNS临床带教老师核心能力框架,其中包含8个一级指标,24个二级指标;(2)共纳入27篇相关文献进行分析,为构建MNS临床带教老师置信职业行为评价指标提供过程、方法和内容参考。基于资料饱和原则共纳入15例访谈对象。共提炼出4个主题(指导护理实践、实施护理教学、管理临床实习、协助护理科研)和15个亚主题。基于文献分析和质性访谈结果,形成包括4个一级指标、15个二级指标和43个具体观测内容的MNS临床带教老师置信职业行为评价指标体系初稿。(2)MNS临床带教老师置信职业行为评价指标体系终稿和各级评价指标权重的确定:共进行两轮德尔菲专家函询,专家权威系数分别为0.858和0.860;第二轮函询时,条目的变异系数为0～0.24;满分频率为42%～100%。根据专家意见修改完善后,形成包括6个一级指标、12个二级指标和44个具体观测内容的MNS临床带教老师置信职业行为评价指标体系终稿。6个一级指标的权重值分别为指导临床护理实践(0.352)、实施护理课堂教学(0.159)、管理临床护理实习(0.210)、指导临床护理科研(0.113)、关注心理健康(0.113)、协助职业规划(0.053)。各级指标CR值均小于0.1,表示判断矩阵的一致性良好。(3)MNS临床带教老师置信职业行为评价指标体系的初步验证:(1)信效度检验:问卷调查共纳入215名研究对象。在项目分析方面,临界比值法显示各指标的CR值均大于3.0,P小于0.05;在相关系数法和同质性检验中,各指标均满足预定标准,无需删除指标。在信度检验方面,评价指标体系总体和各一级指标的Cronbach’sα系数在0.789至0.969之间,折半信度在0.756至0.912之间。在效度检验方面,内容效度中各指标的I-CVI在0.89至1之间,总体的S-CVI/UA为0.932;结构效度中,累积方差贡献率均大于70%,各具体观测内容的因子载荷及共同度均大于0.6,在标准范围内。最终确定MNS临床带教老师置信职业行为评价指标体系包含6个一级指标、12个二级指标和44个具体观测内容,并且实现了评价指标与核心能力的相互映射。同时,基于各指标权重系数,确定了评价指标的评分标准。评价指标体系信效度良好。85%以上的研究对象认为该评价指标体系设计全面详细具体、具有实践意义和可行性。(2)预调查:问卷调查共纳入30名研究对象,包含MNS、MNS临床带教老师和护理管理者各10名。从总得分均数而言,MNS评价其临床带教老师(74.28±13.90分)低于临床带教老师自评(77.68±12.19分)及护理管理者评分(80.25±13.00分);三类评价主体两两比较的结果表明,自评和他评得分在统计学上无显著差异。结论:(1)构建了MNS临床带教老师置信职业行为评价指标体系,包含6个一级指标、12个二级指标以及44个具体观测内容;评价指标的权重分配合理。构建过程严谨、可靠,该评价指标体系具有全面性和科学性,为MNS临床带教老师的能力评价提供了客观可量化的有效工具。(2)初步验证了MNS临床带教老师置信职业行为评价指标体系具有良好的信效度和可行性,能够通过多主体(自评和他评)、多维度的综合评价,全面、客观地反映MNS临床带教老师的实际表现。图5幅,表52个,参考文献97篇更多还原

【Abstract】 Objective(1)To construct an evaluation index system for entrustable professional activities of MNS(Master of Nursing Specialist,refers to Master of Nursing Specialist postgraduates)clinical teachers and determine the weights of indicators at all levels.(2)To preliminarily validate the reliability,validity,and feasibility of this framework.Methods(1)Development of the draft entrustable professional activities evaluation index system for MNS clinical teachers:A literature review was conducted to summarize domestic and international frameworks for core competencies of MNS clinical teachers and entrustable professional activities evaluation indicators in nursing and medical education.Purposeful sampling was used to conduct one-on-one semi-structured interviews with stakeholders to gather opinions and advice on entrustable professional activities evaluation index system.The draft framework was constructed by integrating results from the literature reviews and qualitative interviews.(2)Finalization of the framework and determination of indicator weights:The Delphi method was employed for expert consultation.Expert engagement was quantified by calculating the expert response rate,expert authority coefficient,degree of expert consensus,mean scores and coefficients of variation(CV)for each indicator.The draft framework was iteratively revised based on expert feedback to finalize the structure.Subsequently,the Analytic Hierarchy Process(AHP)was applied to determine the weights of indicators at all levels in the finalized framework.(3)Preliminary validation of the evaluation index system:(1)Reliability and validity testing:Participants meeting inclusion criteria were selected using stratified sampling and convenience sampling from six major geographic regions in China.Data were collected through three instruments:different demographic questionnaires,the entrustable professional activities evaluation questionnaire,and a framework effectiveness survey.Statistical analyses were conducted using SPSS 26.0,with categorical variables described by frequency and percentage and continuous variables by mean and standard deviation.Item analysis included the critical ratio method,correlation coefficient method and homogeneity testing.Reliability was assessed via internal consistency(Cronbach’sαcoefficient)and split-half reliability,while validity was evaluated through content validity and construct validity(exploratory factor analysis).(2)Pilot survey:Participants meeting inclusion criteria were selected using convenience sampling from a third-class hospital in Changsha,Hunan Province.Data were collected through two instruments:pilot survey different demographic questionnaires and the entrustable professional activities evaluation questionnaire for the application.Statistical analyses were conducted using SPSS 26.0,with categorical variables described by frequency and percentage and continuous variables by mean and standard deviation.Nonparametric tests were applied to compare statistical differences in evaluation outcomes.Results(1)Development of the Draft entrustable professional activities evaluation index system for MNS clinical teachers:Literature analysis integrated findings from 8 studies to establish a core competency framework with 8 first-level indicators and 24 second-level indicators,supplemented by 27 additional studies to guide the structure,methodology,and content of the entrustable professional activities evaluation index system.Qualitative interviews with 15 participants based on data saturation principles identified four key themes(guiding nursing practice,delivering nursing education,managing clinical training,and supporting nursing research)with 15 subthemes,leading to a preliminary framework comprising 4 first-level indicators,15second-level indicators,and 43 observable items.(2)Finalization of the entrustable professional activities evaluation index system and weight allocation:The finalized framework was refined through two rounds of Delphi expert consultation,demonstrating high expert authority coefficients(0.858 and 0.860)and acceptable variability in Round 2(coefficients of variation:0～0.24;full-score frequencies:42%～100%).The final version includes 6 first-level indicators:guiding clinical nursing practice(0.352),delivering nursing classroom teaching(0.159),managing clinical nursing training(0.210),mentoring clinical nursing research(0.113),addressing mental health needs(0.113),and supporting career development(0.053),12 second-level indicators,and44 observable items,with all hierarchical consistency ratios(CR)<0.1,confirming strong consistency across judgment matrices.(3)Preliminary verification of the evaluation index system:(1)Reliability and validity testing:The questionnaire survey included 215participants.In item analysis,the Critical Ratio(CR)method indicated that all items had CR values greater than 3.0(P<0.05).Both correlation analysis and homogeneity tests confirmed that all items satisfied the predefined thresholds,with no items requiring deletion.For reliability testing,the overall evaluation index system and its first-level indicators demonstrated Cronbach’sαcoefficients ranging from 0.789 to 0.969,and split-half reliability values between 0.756 and 0.912.For content validity,the item-level content validity indices(I-CVI)ranged from 0.89 to 1 and scale-level content validity index/universal agreement(S-CVI/UA)was0.932.For construct validity,the cumulative variance contribution rate exceeded 70%,with factor loadings and communalities of all observed items falling within standard ranges.The finalized version of the entrustable professional activities evaluation index system for MNS clinical teachers consists of 6 first-level indicators,12 second-level indicators,and 44 specific observable items,while establishing a bidirectional mapping relationship between the evaluation indicators and core competencies.Meanwhile,the scoring criteria for the evaluation indicators were established based on the weight coefficients of each indicator.The evaluation index system demonstrated good reliability and validity.Over 85%of participants agreed that the evaluation index system was comprehensive,practical,and highly feasible.(2)Pilot survey:The questionnaire included 30 participants:10 MNS postgraduates,10 clinical teachers and 10 nursing administrators.Overall mean scores revealed that MNS postgraduates rated their clinical teachers lower(74.29±13.90points)compared to teachers’self-evaluations(77.68±12.19 points)and nursing administrators’evaluations(80.25±13.00 points).Pairwise comparisons among the three groups showed no statistically significant differences between self-and peer-assessment scores.Conclusion(1)A framework for evaluating entrustable professional activities of clinical teachers for Master of Nursing Specialist postgraduates was developed,comprising 6 first-level indicators,12 second-level indicators,and 44 observable items with rational weight allocation.The framework was constructed through a rigorous and reliable process,demonstrating comprehensiveness and scientific validity,thereby providing an objective and quantifiable tool for assessing the competencies of MNS clinical teachers.(2)Preliminary validation confirmed that the entrustable professional activities evaluation index system for MNS clinical teachers exhibits strong reliability,validity,and feasibility.By integrating multi-source assessments(self-evaluations and peer-evaluations)and multi-dimensional criteria,the framework comprehensively and objectively reflects the actual performance of clinical nurse teachers in specialized nursing graduate programs.The full text has 5 figures,52 tables and 97 references.更多还原