Construction of an evaluation index system for undergraduate nursing teachers’ curriculum humanistic competence: a Delphi study in China

This study adhered to the tenets of the Declaration of Helsinki. This study was approved by the Ethic Committee of Southern Medical University (approval number: NFYKDX003). Informed consent was provided and obtained from all participants before the study commenced.

The number of Delphi consultants should be controlled at 15–30 to avoid homogeneity of research objects [19]. From September 2022 to December 2022, the research group distributed questionnaires to 20 experts in nursing education, humanistic nursing, nursing teaching management and other fields for expert consultation. The inclusion criteria were the following: (1) Bachelor’s degree or above; (2) Title of deputy high or above; (3) Engaged in undergraduate nursing education, humanistic nursing, nursing teaching management and other related fields for more than 10 years; (4) Have certain research achievements in humanistic nursing, nursing education or nursing teaching management and other related fields and can objectively and comprehensively give suggestions and guidance; (5) Interest in this topic and willingness to participate. The exclusion criteria were the following: (1) Failing to complete the questionnaire according to the content of the questionnaire; (2) Failing to fill in and return the questionnaire within the specified time.

In the early stage of this study, a systematic literature review was conducted, and content analysis was used to extract elements in the literature related to undergraduate nursing teachers’ curriculum humanistic competence [8, 9, 20‐23]. Firstly, as the minimum unit of analysis, sentences were selected based on the following principles: (1) Include a specific concept for undergraduate nursing teachers’ competence; (2) Describe the humanistic competence of undergraduate nursing teachers clearly; (3) Provide specific explanations of the methods of undergraduate nursing teachers possess in curriculum humanistic teaching. A category system was subsequently conducted based on the onion model. The first-level indicators were initially determined according to the division of competences in the onion model. The selected analysis units were coded and summarized using content analysis and were put into the corresponding first-level indicators as the second-level and third-level indicators. At this stage, we formed 5 first-level indicators, 11 second-level indicators and 36 third-level indicators. Then, we conducted semi-structured interviews with 19 experts (5 part-time clinical nursing teachers, 9 full-time college nursing teachers and 5 experts in humanities-related fields) who taught medical undergraduates to enrich the content of the index system. Some of the main questions they were asked were as follows: Have you heard of “curriculum humanities” and how do you understand it? Have you conducted curriculum humanistic teaching? Would you show us specific examples? Would you please share with us any good experience or practices you have had during curriculum humanistic teaching? What are the problems and challenges you have encountered during the process of curriculum humanistic teaching? What support do you need? Do you have suggestions for improving nursing teachers’ curriculum humanistic competence? After the interviews, we converted the recordings to texts within 24 h. The grounded theoretical methods of Strauss and Corbin were used to analyze the texts [24]. Finally, we formed 5 first-level indicators (knowledge base, skills level, professional attitudes, personality traits and intrinsic motivations), 11 second-level indicators and 40 third-level indicators.

The questionnaire consisted of three parts: (1) Guidance to clarify the content of the questionnaire and purpose of the study. (2) Inviting experts to evaluate the text content of the indicators of the questionnaire. In this part, a 5-level Likert scale was used to evaluate the indicators. Five points means very important, 4 points means important, 3 points means neutral, 2 points means unimportant, and 1 point means very unimportant. Experts could put forward their views in the corresponding position of the questionnaire. (3) Obtaining information from experts, including their ages, education background, professional title, research field, working years, judgment basis for indicator importance (Ca) and familiarity with indicator content (Cs).

The research group distributed the questionnaire to the experts in the form of e-mail and reminded them to reply within 10 days. After the first round of consultation, the research group analyzed the questionnaires. In combination with screening criteria, expert opinions and group discussion results, the indicator system was supplemented, deleted and modified to form the second round of the expert consultation questionnaire. According to the score of each indicator, we calculated the mean value, full score rate and coefficient of variation in its importance assignment. The elements could be included when the coefficient of variation was < 0.25 and the mean value of importance assignment was > 4.00 [5]. If the above requirements were not met at the same time, the final selection of structural elements was determined based on the expert’s modification suggestions and the discussion of the research group. When the experts’ approval rate of the curriculum humanistic competence evaluation framework of undergraduate nursing educators was > 70%, the consultation was over [25].

SPSS26.0 was used for descriptive statistical analysis of the data. The continuous data were expressed by means ± standard deviations, and the categorical data were expressed by frequencies and percentages [26]. The reliability of the experts was tested by the authoritative coefficient (Cr) [27] and the expert coordination coefficient (Kendall’s W) [28]. The experts’ evaluation of items was expressed by the coefficient of variation (CV), mean of importance assignment, and full score rate (CLV) [28]. The difference was statistically significant at P < 0.05.

We used the analytic hierarchy process to calculate the importance of each item of the 2round Delphi consultation. YAHP12.9 software (Shanxi Yuan Decision Software Technology Co., Ltd., Shanxi, China) was used to establish a judgment matrix and calculate the weights of the indicators.

The experts for the first round of Delphi consultation were from 12 undergraduate colleges and 4 Grade A tertiary hospitals in 10 provinces and municipalities directly under the Central Government. In round 2, we distributed questionnaires to 18 experts who responded in the first round, and 16 responded (the response rate of experts reached 88.89%); they were from 10 undergraduate colleges and 4 Grade A tertiary hospitals in 9 different provinces and municipalities directly under the Central Government. The characteristics of the experts are shown in Table 1.

Authoritative coefficient (Cr) = (Ca + Cs)/2. In this study, the Cr of round 1 is 0.929, and the Cr of round 2 is 0.923. The scores showed that the results were highly credible [27]. For the two rounds of consultation, the scores of Kendall’s W are shown in Table 2, which suggested that the expert opinions had great consistency.