Background
Sleep plays an important role in regulating physiological functions such as energy metabolism, immune regulation, and endocrine and brain function activities of the organism, and good sleep helps to promote the recovery of physical strength and energy, improve memory, and enhance resistance, which is the basis for the survival and development of the individual [1]. With the accelerated pace of modern life and changes in lifestyle, the sleep time of residents has gradually decreased, the incidence of sleep problems has gradually increased, and sleep disorders have increasingly become a prominent medical and public health problem [2]. The causes of sleep disorders are complex, and they are often the result of the combined effects of multiple factors, such as biological, psychological, familial, environmental, and even socioeconomic status [3‐5]. The outbreak of novel coronavirus pneumonia has further exacerbated sleep problems, and a meta-analysis that included nearly half a million people noted that the global prevalence of sleep problems in the general population during the COVID-19 pneumonia epidemic was as high as 40.5% [6]. Therefore, sleep medicine research is a critical issue for the health of the population.
According to the China Big Data Report, more than 500 million people in China face sleep disorders and related problems [7], including insomnia, sleep apnea syndrome (SAS), restless legs syndrome (RLS), periodic limb movement disorder (PLMD), rapid-eye-movement sleep behavior disorder (RBD), etc. Among them, 32.2% of primary school students have less than 8 h of sleep; 59.4% of secondary school students have less than 7 h of sleep; and the prevalence of sleep disorders in adults is as high as 38.2%. The prevalence of sleep disorders in adults is as high as 38.2%, and the prevalence of sleep disorders in the elderly group reaches 46%. In addition to anxiety, depression, and other psychiatric disorders [8], sleep disorders also increase the risk of heart disease, diabetes, hypertension, and other physical diseases or aggravate their conditions [9‐11]. In 2021, the American Academy of Sleep Medicine (AASM) published Guidelines for the Behavioural and Psychological Treatment of Adult Patients with Chronic Insomnia, focusing on the behavioral and psychological treatment of adult patients with chronic insomnia, and proposed six guiding recommendations related to the behavioral and psychological treatment of adult patients with chronic insomnia [12]. In the same year, the Italian Society of Hypertension (SIIA, Italian Society of Hypertension) published the Consensus on Diagnostic and Therapeutic Approaches to Sleep Disorders, Hypertension, and Cardiovascular Disease [13]. This document summarizes the updated evidence linking sleep disorders to hypertension and cardiovascular diseases, the major underlying mechanisms, and the possible management strategies.
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China’s sleep medicine research started late and did not develop gradually until 1994 when the China Sleep Research Society was officially established [14]. In 2017, the China Sleep Research Society released the China Insomnia Diagnosis and Treatment Guidelines, and at the end of 2021, the nation’s first Guidelines for the Standardised Construction of China’s Sleep Medicine Centers were released [15], which provided the basis for the standardized construction and development of China’s sleep medicine centers and the reference. At present, China has initially formed a multiregional collaborative innovation network and built a national clinical research platform related to sleep disorders, which has strongly promoted the development of sleep medicine research [16], and sleep health has been included in the Action for a Healthy China (2019 ~ 2030) [17]. However, there are many problems in sleep medicine nursing: weak theoretical knowledge of nursing staff, uneven skill levels, insufficient relevant education, and poor training quality [18, 19], and the talent training system and talent echelon construction are still in the initial exploration stage. Core competence refers to the special knowledge, skills, judgment, and personal attributes that nurses need to provide safe and ethical care and is an important indicator of the professionalization level of specialist nurses [20]. Therefore, this study constructed a core competency evaluation system for sleep medicine specialist nurses through a literature review, Delphi expert consultation method, and hierarchical analysis method to provide a reference for the cultivation and development of high-quality sleep medicine nursing talents in China in the future and to provide a basis for the development of training programs and assessment standards for sleep medicine specialist nurses.
Methods
We used a literature review and expert meetings to construct an evaluation index system. We used the Delphi method to investigate the attitudes of 27 specialists toward the core competency evaluation index system. This study is based on the conducting and reporting of Delphi Studies (CREDES) [21].
Construction of an evaluation index system
The research team consisted of seven members, including one head nurse of the sleep medicine department, one chief physician of the sleep medicine department, three head nurses engaged in sleep medicine nursing, and two graduate nursing students. The research team first identified the research questions and objectives and conducted a literature search, screening the literature that met the research topics and criteria and paying attention to the publication date, source, and quality of the literature. Databases such as China National Knowledge Infrastructure, Wanfang Database, Joanna Briggs Institute, China Biomedical Literature Database, PubMed, Embase, and Web of Science were searched. The search period was from database establishment to October 2023. The search terms in Chinese were sleep medicine center/specialist nurses/core competencies/job competencies/skills, and the search terms in English were sleep disorders clinic/specialist nurses/core competencies/job competencies/technical skills. Health policies, laws, and regulations related to sleep medicine were searched. Concerning the essentials of core competencies for sleep medicine physicians, the essentials of core competencies for general practitioners in China, and the essentials of core competencies for army sleep medicine nurses, the index items of core competencies for sleep medicine nurses were compiled and extracted. The research methods, data sources, and quality of the literature were also analyzed. Understand the key nursing skills, theories, methods, and attributes of the specialist nurse within the field of sleep medicine. Categorize the literature according to topic, methodology, or theory. The logic of the literature review was established, and a framework of indicators for evaluating the core competencies of nurses in sleep medicine was developed. An expert consultation form was created, consultants were selected, the consultation form was distributed and received, and the results of the two rounds of expert consultation were collated and analyzed.
Identification of the advisory experts
The number of Delphi consultants should be controlled at 15–30 to avoid homogeneity of research objects [22]. From December 2023 to January 2024, the group distributed questionnaires to experts in the fields of nursing management, sleep nursing, and sleep medicine for expert consultation. The inclusion criteria were as follows: (1) engaged in sleep medicine, neurology, clinical nursing, nursing management, nursing education, and other related field; (2) acquired a bachelor’s degree or above; (3) engaged in work > 10 years; (4) had a professional title intermediate or above; and (5) voluntarily participated in the investigation and promised to participate in consultations.
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The first draft of the expert consultation questionnaire
Based on the results of previous literature reviews and expert meetings, we initially constructed a library of articles on the core competency evaluation system for sleep medicine nurses and prepared an expert consultation form. The consultation form consisted of three parts: (1) Questionnaire completion instructions, including the research purpose, significance, method, and filling requirements. (2) The preliminary evaluation index system for the core competence of nurses in sleep medicine specialties includes 5 first-level indicators, 15 s-level indicators, and 59 third-level indicators. The 5-point Likert scoring method was adopted, with 1 point for unimportant and 5 points for very important. Meanwhile, the expert opinion column is set, and experts can add, delete, and modify the items. (3) The basic information of the expert, including the general information questionnaire of the expert (name, gender, age, education, title, field of work, years of work), the expert’s familiarity with the content of the consultation (Cs), and the basis of judgment (Ca), was collected. Expert familiarity consisted of five levels—very familiar, familiar, familiar, less familiar, and unfamiliar—with scores of 1.0, 0.8, 0.6, 0.4, and 0.2 points, respectively. The judgments of experts on the research content include theoretical analysis, practical experience, reference to domestic and international literature, and subjective feeling. Each aspect was divided into three levels—large, medium, and small—and the scores were quantified: theoretical analysis (0.3, 0.2, 0.1), practical experience (0.5, 0.4, 0.3), reference to domestic and foreign literature (0.1, 0.1, 0.1), and subjective feeling (0.1, 0.1, 0.1). Based on the results of the analysis of the first round of correspondence and the relevant opinions of the experts, the questionnaire for the second round of correspondence was revised.
Consulting and feedback cycle
Two rounds of expert consultation will be conducted from December 2023 to January 2024, and expert consultation questionnaires will be distributed and collected via email and WeChat. After the first round of consultation, we sorted and analyzed the expert scores and suggestions and formed a second round of expert consultation questionnaires based on the indicator screening criteria, which were discussed by team members. After the second round of consultation, the experts’ scores and suggestions were sorted, summarized, and analyzed again. The screening criteria for two rounds of indicators were an importance score ≥ 4.0 and a coefficient of variation < 0.25.
Statistical analysis
Data were entered and analyzed using Excel 2021 and SPSS 27.0, with measurement information expressed as mean and standard deviation and count information expressed as frequency and percentage. The questionnaire return rate reflects the enthusiasm of the experts. The arithmetic mean of the coefficient of judgment (Ca) and the coefficient of familiarity (Cs) indicated the coefficient of expert authority (Cr), i.e., Cr = (Ca + Cs)/2. It is generally accepted that a questionnaire return rate of ≥ 70% indicates a high degree of enthusiasm and ≥ 0.7 indicates a high degree of expert authority. The degree of unity of expert opinion is expressed by the coefficient of variation and Kendall’s coefficient of agreement. The coefficient of variation and Kendall’s coefficient of agreement indicate the degree of harmonization of expert opinions. The mean, coefficient of variation, and percentage of the full score of the importance distribution indicate the degree of concentration of expert opinions. The hierarchical analysis method (AHP) was used to calculate the weights of the indicators at each level, and P < 0.05 was considered to indicate statistical significance.
Results
General information of the experts
The experts in the two rounds were the same; 27 were from hospitals and colleges and universities in Beijing, Inner Mongolia, Guangdong, Jiangsu, and Jiangxi provinces, with ages ranging from 37 to 58 (47.81 ± 6.15) years and working years ranging from 13 to 36 (28.18 ± 7.91) years. The general characteristics are shown in Table 1.
Table 1
The basic information of the consulting experts (n = 27)
Variables | Classification | Number of people | Percentage |
|---|---|---|---|
Age (years) | 30~ | 3 | 11.11 |
40~ | 13 | 48.15 | |
50 ~ 58 | 11 | 40.74 | |
Education background | Bachelor’s degree | 7 | 25.93 |
Master’s degree | 18 | 66.67 | |
Doctorate | 2 | 7.40 | |
Professional title | Intermediate title | 3 | 11.11 |
Associate senior | 16 | 59.26 | |
Senior | 8 | 29.63 | |
Work Field | Sleep Medicine | 18 | 66.67 |
Neurology | 3 | 11.11 | |
Clinical Nursing | 3 | 11.11 | |
Nursing Administration | 2 | 7.40 | |
Nursing Education | 1 | 3.70 | |
Working years | 10~ | 4 | 14.81 |
21~ | 13 | 48.15 | |
31 ~ 36 | 10 | 37.04 |
Table 2
The results of the degree of coordination of expert opinions
Item | The number of indexes | Kendall’s W | X² | Degree of freedom | P |
|---|---|---|---|---|---|
First round of consultation | |||||
First-level index | 5 | 0.314 | 42.356 | 4 | 0.000 |
Second-level index | 15 | 0.337 | 127.251 | 14 | 0.000 |
Third-level index | 59 | 0.261 | 408.576 | 58 | 0.000 |
Second round of consultation | |||||
First-level index | 6 | 0.373 | 50.368 | 5 | 0.000 |
Second-level index | 16 | 0.346 | 140.132 | 15 | 0.000 |
Third-level index | 64 | 0.223 | 379.191 | 63 | 0.000 |
Experts’ enthusiasm
The return rate of the questionnaire reflects the positive attitude of the experts. We sent out a total of 27 questionnaires for the two rounds of expert consultation and returned 27 valid questionnaires; the positive coefficients of the experts in the two rounds of consultation were both 100%, with 14 (51.85%) experts proposing modifications in the first round and 5 (18.5%) experts proposing modifications in the second, which indicates that the experts are more active in their participation.
Expert authority coefficient and opinion coordination degree
The coefficients of expert authority, familiarity, and judgment in the first round were 0.878, 0.907, and 0.849, respectively, and the coefficients of expert authority, familiarity, and judgment in the second round were 0.865, 0.893, and 0.837, respectively. The degree of confidence is considered high when the coefficients of authority are > 0.7. In the first round of expert consultation, Kendall’s W values for the first-, second-, and third-level indicators were 0.314, 0.337, and 0.177, respectively. In the second round of expert consultation, Kendall’s W values for the first-, second-, and third-level indicators were 0.373, 0.346, and 0.223, respectively. Kendall’s test was statistically significant (P < 0.05). The Kendall harmony coefficient of all indexes in the second round of consultation is greater than that in the first round of consultation, which shows that the expert opinions in the two rounds of consultation tend to be unified. These findings are shown in Table 2.
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Results of the expert consultation
Delphi round 1
In the first round of expert consultation, the average value assigned to the first-level indicators was 4.59 ~ 5.00, and the coefficient of variation was 0.000 ~ 0.109. The mean value of the importance assignment for the secondary indexes ranged from 4.00 to 5.00, and the coefficient of variation ranged from 0.000 to 0.178. The mean value of importance assignment for the three indexes ranged from 4.00 to 4.85, and the coefficient of variation ranged from 0.000 to 0.222.
Experts believe that communication and management are two concepts, so we split the level 1 indicator “communication and management” into “communication and coordination” and “nursing management.” Increased indicators include one secondary indicator, “sleep promotion-related therapy”; five tertiary indicators, “Ability to create a suitable sleep environment and control stimuli (temperature, humidity, light, volume, etc.); “Knowledge of relevant exercise instruction to improve sleep (aerobic, yoga, Tai Chi, Baduanjin, etc.)”; “Ability to construct a sleep-promoting diet program”; “Ability to rationalize patient treatment time; and Ability to apply relevant research findings to clinical practice based on evidence-based d thinking.” Revised indicators include two secondary indicators: “operational skills” and “use of equipment.” The revisions to “specialized nursing operational skills” and “use of equipment”. We revised the meanings and word order of some of the tertiary indicators and developed the questionnaire for the second round of expert consultation.
Delphi round 2
The second round of the expert consultation questionnaire was formed. In the second round of expert consultation, the average value assigned to the first-level indicators was 4.30 ~ 5.00, and the coefficient of variation was 0.000 ~ 0.141. The mean value of the importance assignment for the secondary indexes ranged from 4.04 to 5.00, and the coefficient of variation ranged from 0.000 to 0.144. The mean value of importance assignment for the three indexes ranged from 4.04 to 5.00, and the coefficient of variation ranged from 0.000 to 0.222. Further filtering, restructuring, deletion, merging of indexes, and simplification of textual presentation were performed. Finally, an evaluation system for the core competence of nurses in the sleep medicine specialty was developed, which included six primary indexes, 16 secondary indexes, and 64 tertiary indexes. We used hierarchical analysis to calculate the weights of the indicators and constructed a judgment matrix based on the average of the importance assignments. All CR values are < 0.1, and the judgment matrix in this study meets the consistency test (Table 3).
Table 3
Consultation results of indicators at all levels of the evaluation index system for sleep medicine specialist nurses
Index level 1st, 2nd, and 3rd | Mean ± SD | Coefficient of variation | Weight |
|---|---|---|---|
I Practical ability | 5.00 | 0.000 | 0.283 |
I−1 Professional nursing operations skills | 5.00 | 0.000 | 0.148 |
I−1−1 Master the method of physical examination | 4.93 ± 0.27 | 0.054 | 0.154 |
I−1−2 Mastery of the method of psychotherapy | 4.74 ± 0.45 | 0.094 | 0.057 |
I−1−3 Master the method of light therapy | 4.74 ± 0.45 | 0.094 | 0.048 |
I−1−4 Master the method of traditional Chinese medicine, including ear point pressure bean, Chinese medicine foot bath, and five-tone therapy | 4.70 ± 0.47 | 0.099 | 0.058 |
I−1−5 Master the method of sleep diary writing | 5.00 | 0.000 | 0.250 |
I−1−6 Master the method of sleep diary writing | 4.93 ± 0.27 | 0.054 | 0.178 |
I−1−7 Master the method of the sleep-related scale questionnaire | 4.85 ± 0.36 | 0.075 | 0.165 |
I−1−8 Master the method of electronic record management | 4.78 ± 0.42 | 0.089 | 0.091 |
I−2 Instrument and equipment use techniques | 5.00 | 0.000 | 0.138 |
I−2−1 Master and use the transcranial electrical stimulator | 4.89 ± 0.32 | 0.065 | 0.117 |
I−2−2 Master and use the insomnia treatment instrument | 4.81 ± 0.40 | 0.082 | 0.117 |
I−2−3 Master and use the brain-controlled sleep sensor chair | 4.41 ± 0.50 | 0.114 | 0.117 |
I−2−4 Master and use the sleep monitoring equipment | 4.74 ± 0.45 | 0.094 | 0.117 |
I−2−5 Master and use the Functional Brain Status Instrument | 4.11 ± 0.75 | 0.183 | 0.117 |
I−2−6 Master and use the ventilator | 4.56 ± 0.51 | 0.111 | 0.117 |
I−2−7 Master and use the operation of a digital sleep psychology assessment system | 4.52 ± 0.51 | 0.113 | 0.064 |
I−2−8 Proficiency in the classification of instruments, their mechanisms of action, and their indications and contraindications | 4.74 ± 0.45 | 0.094 | 0.197 |
I−2−9 Mastering the maintenance of various instruments in sleep medicine | 4.67 ± 0.48 | 0.103 | 0.038 |
I−3 Sleep promotion-related therapy | 4.81 ± 0.40 | 0.083 | 0.042 |
I−3−1 Ability to create a suitable sleep environment and control stimuli (temperature, humidity, light, volume, etc.) | 4.81 ± 0.40 | 0.082 | 0.426 |
I−3−2 Knowledge of relevant exercise instruction to improve sleep (aerobic, yoga, Tai Chi, Baduanjin, etc.) | 4.63 ± 0.57 | 0.122 | 0.403 |
I−3−3 Ability to construct a sleep-promoting diet program | 4.56 ± 0.70 | 0.153 | 0.171 |
II Theoretical knowledge | 5.00 | 0.000 | 0.283 |
II−1 Basic knowledge | 5.00 | 0.000 | 0.114 |
II−1−1 Knowledge of basic concepts and classification of sleep disorders | 4.67 ± 0.48 | 0.103 | 0.074 |
II−1−2 Knowledge of the etiology and pathogenesis of sleep disorders | 4.37 ± 0.49 | 0.113 | 0.050 |
II−1−3 Knowledge of the clinical manifestations, diagnosis, and treatment of sleep disorders | 4.19 ± 0.74 | 0.176 | 0.066 |
II−1−4 Knowledge of common nursing diagnoses of sleep disorders | 4.63 ± 0.49 | 0.106 | 0.138 |
II−1−5 Mastering the interpretation of test reports for sleep disorders | 4.56 ± 0.51 | 0.111 | 0.108 |
II−1−6 Mastering the use of sleep disorder assessment tools | 4.56 ± 0.51 | 0.111 | 0.107 |
II−1−7 Knowledge of nonpharmacological treatments | 4.52 ± 0.58 | 0.128 | 0.118 |
II−1−8 Knowledge of the effects of therapeutic drugs on the body | 4.41 ± 0.50 | 0.114 | 0.153 |
II−1−9 Knowledge of adverse reactions to therapeutic drugs and preventive measures | 4.56 ± 0.51 | 0.114 | 0.153 |
II−1−10 Familiarity with epidemiologic features of sleep disorders | 4.04 ± 0.52 | 0.128 | 0.034 |
II−2 Other knowledge of the specialty | 4.74 ± 0.48 | 0.094 | 0.019 |
II−2−1 Familiarity with medical ethics and its application to sleep medicine | 4.15 ± 0.53 | 0.129 | 0.490 |
II−2−2 Familiarity with sleep medicine and legal issues | 4.04 ± 0.51 | 0.128 | 0.312 |
II−2−3 Learn about the history of sleep medicine and the history of sleep nursing | 4.11 ± 0.51 | 0.123 | 0.198 |
III Critical thinking | 4.85 ± 0.36 | 0.075 | 0.175 |
III−1 Assessment capacity | 4.96 ± 0.19 | 0.039 | 0.049 |
III−1−1 Ability to assess and identify the patient’s major sleep problems and associated risk factors (e.g., comorbid symptoms, risk factors, fatigue, anxiety-depressive conditions, somatic and psychological comorbidities, etc.) | 4.96 ± 0.19 | 0.039 | 0.556 |
III−1−2 Ability to consistently assess and identify the sleep care needs of patients at different stages of life | 4.78 ± 0.42 | 0.089 | 0.444 |
III−2 Decision-making ability | 4.74 ± 0.45 | 0.094 | 0.017 |
III−2−1 Ability to choose the best care plan for patients with different types of sleep disorders | 4.67 ± 0.48 | 0.103 | 0.571 |
III−2−2 Ability to develop a sleep health education program | 4.59 ± 0.50 | 0.109 | 0.429 |
III−3 Evaluation ability | 4.70 ± 0.47 | 0.099 | 0.041 |
III−3−1 Ability to evaluate and revise care programs when appropriate | 4.63 ± 0.49 | 0.106 | 0.636 |
III−3−2 Ability to evaluate and revise sleep health education programs when appropriate | 4.52 ± 0.58 | 0.128 | 0.364 |
IV Communication and coordination | 4.78 ± 0.42 | 0.089 | 0.140 |
IV−1 Communication skills | 4.81 ± 0.40 | 0.082 | 0.081 |
IV−1−1 Ability to communicate effectively with patients and families, quickly gather relevant information about patients, and provide support | 4.48 ± 0.58 | 0.129 | 0.600 |
IV−1−2 Ability to communicate effectively with departmental staff about medical conditions | 4.22 ± 0.85 | 0.201 | 0.400 |
IV−2 Coordination and cooperation ability | 4.67 ± 0.48 | 0.144 | 0.055 |
IV−2−1 Ability to effectively coordinate collaboration across departments based on patient profile | 4.07 ± 0.47 | 0.116 | 0.224 |
IV−2−2 Ability to effectively deploy manpower and materials in emergencies | 4.11 ± 0.70 | 0.170 | 0.405 |
IV−2−3 Ability to effectively handle complaint incidents | 4.04 ± 0.76 | 0.188 | 0.371 |
V Nursing management | 4.41 ± 0.64 | 0.094 | 0.094 |
V−1 Organizational leadership | 4.59 ± 0.50 | 0.109 | 0.035 |
V−1−1 Ability to improve the management system and quality management process related to sleep care | 4.63 ± 0.49 | 0.106 | 0.225 |
V−1−2 Ability to effectively manage the ward and maintain a normal working order | 4.04 ± 0.90 | 0.222 | 0.141 |
V−1−3 Ability to maintain and manage a sleep specialty care team | 4.59 ± 0.50 | 0.109 | 0.207 |
V−1−4 Ability to provide technical support for clinical care | 5.00 | 0.000 | 0.427 |
V−2 Supervision management | 4.74 ± 0.45 | 0.094 | 0.058 |
V−2−1 Ability to perform quality control through quality management tools such as the quality control circle | 4.56 ± 0.51 | 0.111 | 0.438 |
V−2−2 Ability to identify and improve deficiencies in the sleep care management process promptly | 4.22 ± 0.80 | 0.190 | 0.330 |
V−2−3 Ability to identify and deal with instrument and equipment malfunctions promptly | 4.07 ± 0.68 | 0.166 | 0.232 |
V−3 Time management ability | 4.04 ± 0.19 | 0.048 | 0.016 |
V−3−1 Ability to master time management methods and strategies to optimize processes | 4.37 ± 0.57 | 0.129 | 0.400 |
V−3−2 Ability to rationalize patient treatment time | 4.59 ± 0.57 | 0.125 | 0.600 |
VI Professional development | 4.30 ± 0.61 | 0.141 | 0.055 |
VI−1 Nursing research ability | 4.96 ± 0.19 | 0.039 | 0.108 |
VI−1−1 Ability to keenly identify scientific issues in the sleep management process and research design | 4.74 ± 0.45 | 0.094 | 0.288 |
VI−1−2 Ability to conduct research with scientific rigor and to write and communicate the results of research papers | 4.48 ± 0.64 | 0.143 | 0.150 |
VI−1−3 Ability to improve and patent existing sleep management-related tools | 4.59 ± 0.57 | 0.125 | 0.145 |
VI−1−4 Ability to apply relevant research findings to clinical practice based on evidence-based thinking | 5.00 | 0.000 | 0.354 |
VI−1−5 Ability to continue to develop new areas of practice in the direction of sleep medicine nursing | 4.33 ± 0.73 | 0.170 | 0.064 |
VI−2 Nursing education ability | 4.93 ± 0.27 | 0.054 | 0.067 |
VI−2−1 Ability to lead clinical teaching and supervise the clinical learning of interns, trainees, and junior nurses | 4.56 ± 0.51 | 0.111 | 0.416 |
VI−2−2 Ability to teach, plan, teach, and evaluate teaching results according to teaching objectives | 4.41 ± 0.57 | 0.130 | 0.321 |
VI−2−3 Ability to make the rounds of the wards and organize and learn the treatment and care of difficult cases of sleep disorders | 4.11 ± 0.58 | 0.140 | 0.263 |
VI−3 Independent learning ability | 4.74 ± 0.45 | 0.094 | 0.054 |
VI−3−1 Able to learn about sleep medicine through various means | 4.48 ± 0.51 | 0.114 | 0.381 |
VI−3−2 Ability to keep abreast of new technologies and developments in the field of sleep medicine | 4.19 ± 0.68 | 0.163 | 0.368 |
VI−3−3 Ability to identify their strengths and seek out learning methods and content that are appropriate to the developmental needs of the specialty | 4.04 ± 0.81 | 0.200 | 0.251 |
Discussion
The core competence index of sleep medicine nurses is reliable and scientific. The prerequisite for the effective implementation of the Delphi method is the representativeness, enthusiasm, and authority of the selected experts. The 27 experts selected were from 13 geographically representative cities (5 provinces and cities). The main work fields of the experts include sleep medicine, nursing management, nursing education, etc., and the professional fields are more targeted. In terms of the professional title structure, there were 24 experts with senior professional titles, accounting for 88.89%. A total of 85.19% of the experts who had worked for more than 20 years had rich working experience in this field. The positive coefficient of the experts in the two rounds of this study is 100%, and 14 and 5 of the experts provided forward modification opinions in the two rounds of consultation, indicating that the experts have a high degree of enthusiasm and concern. The mean of the authority coefficient of the two rounds of expert consultation was 0.859, and the coefficient of variation was 0.108, indicating that the selected experts had a high degree of authority and a small degree of variation and that the consultation results were reliable.
The evaluation indexes of the core competence of sleep medicine nurses are comprehensive and professional. The evaluation indexes of the core competence of nurses in sleep medicine specialties include 6 first-level indexes, 16 s-level indexes, and 64 third-level indexes, which comprehensively cover the core competence of nurses in sleep medicine specialties. (1) Practical ability: With the highest weight of 0.283, experts agree that this index is the most critical core competence of nurses in sleep medicine specialties. Nurses’ clinical practice ability is a critical indicator of the quality of nursing education and the effect of clinical teaching, and it is also a critical factor that directly affects nursing quality and patient safety, which is consistent with research on the core competence of nurses in domestic and foreign specialties [22‐24]. The importance scores of the secondary indexes were all high, which is the most critical work content of sleep medicine nurses and the most specific part of core competence compared with that of other specialized nurses. Physical examination, cognitive behavioral therapy, and equipment use were the three critical indicators of practical ability, which were consistent with the conventional treatment of the patient’s disease. Practical ability is a feature that distinguishes specialist nurses from other nurses [25]. Nurses specializing in sleep medicine must master different operating techniques and coordination points to complete nursing work with high standards, which is also in line with the training objectives and requirements of specialist nurses issued by the National Health Commission. (2) Theoretical knowledge has a weight of 0.245, which is second only to practical ability. Sleep medicine is a clinical specialty involving all kinds of sleep-wake disorders. Common sleep disorders include insomnia disorder, restless leg syndrome, narcolepsy, and periodic sleepiness [26]. The pathogenesis and treatment of these diseases are relatively complex. As a specialist nurse, it is necessary to master various types of professional knowledge, such as disease nursing, instrument management, physiology, and psychology [27]. To be able to quickly and accurately judge the condition and take corresponding nursing measures in practical work, the quality of nursing should be improved, and the rehabilitation of patients should be promoted. (3) Critical thinking: the weight is 0.175, and the concentration of expert opinions is generally high. Critical thinking ability can persist throughout the treatment of patients [28]. The cause of sleep disorders is complex, covers a wide range of knowledge, and involves many disciplines. In clinical work, in the face of patients with different conditions, nurses should learn to use their existing sleep knowledge and experience to think dialectically about the patient’s sleep condition and make reasonable judgments. This study lays a solid foundation for nurses to carry out effective sleep diagnosis and treatment and targeted sleep care, thus improving the quality of sleep care and effectively relieving patients’ sleep problems [29]. Therefore, the skilled use of critical thinking by sleep medicine nurses is conducive to improving the ability to analyze and solve problems, which is highly important for improving the quality of nursing. (4) Communication and coordination: weight 0.140 and sleep Specialist nurses should properly handle relationships with medical staff, patients, and their families, and improving personal and teamwork efficiency, friendly communication skills, and coordination can reduce conflicts and increase patients’ satisfaction with the medical experience [30]. Studies have shown that in the current clinical nursing work, specialist nurses have good communication ability, and it is especially critical to develop good relationships with patients and to work with other healthcare professionals to ensure quality and safety of care [31]. (5) Nursing management: weight 0.094. This study pointed out that sleep medicine is a professional field focusing on the diagnosis, evaluation, and management of sleep disorders, and nursing management ability plays a key role in the overall management of a hospital [32]. High-quality organizational leadership and disease management can improve patient outcomes. Therefore, sleep medicine nurses are the backbone and authoritative experts in this field. As such, sleep medicine nurses are the backbone and leading experts in this field. (6) Professional development: weights of 0.055. Experts believe that sleep medicine nurses need to have good learning ability, scientific research and innovation ability, teaching ability, and continuous self-development to promote the development of the sleep nursing profession [33]. However, professional development ability ranked last, which may be related to the different positioning of sleep medicine specialist nurses by the selected experts or the lack of clarity about the responsibilities and scope of work of sleep medicine specialist nurses at this stage.
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Evaluation indicators of the core competence of nurses in sleep medicine have clinical practicability. According to the China Sleep Research Report 2022 [34], the per capita sleep of Chinese residents has decreased by nearly 1.5 h in the past ten years, and the sleep environment and sleep quality have significantly decreased compared with before. To reduce the impact of sleep disorders on people, it is urgent to pay attention to and develop sleep medicine. Meanwhile, the National Nursing Career Development Plan (2021–2025) emphasizes the establishment of a nurse training system oriented by job demand and with postcompetency as the core, combining the nursing needs of the masses with the development of nursing disciplines. To carry out targeted training of nursing nurses in short supply. As a newly developed discipline, the clinical development of sleep medicine urgently needs the guidance and intervention of full-time personnel, so it is very urgent to strengthen the construction of the professional nurse team of sleep medicine.
In China, specialized nurses in the stomatology, emergency, and operating room training systems are relatively mature [35‐37]. Although there are many training institutions for specialized nurses in sleep medicine, the teaching quality is different, the training level is uneven in different places, and there is a lack of standards for identifying the core competence of specialized nurses in sleep medicine and research on their work roles. Therefore, it is of great clinical significance to construct a uniform, standardized core competency evaluation system for sleep medicine nurses. This evaluation index system can provide a reference for the training curriculum setting, training assessment, and qualification certification of sleep medicine nurses and provide a scientific tool for nursing managers to manage, appoint, and evaluate clinical sleep medicine nurses. At the same time, improving the core competence of sleep medicine nurses can improve the quality of sleep nursing work and improve patient satisfaction.
Limitations
The experts came from 13 cities (5 provinces), and there may be regional differences and limitations. Whether this index system can ultimately be applied in the clinical field of sleep care still needs to be continuously adjusted and improved through empirical tests. The next step of this study will be to expand the sample size and target cities with a high prevalence of sleep disorders to strengthen the empirical research.
Conclusions
This study conforms to the national health policy, combines the current situation of the development of sleep nursing practice in China and the development goals of specialist nurses, and adopts Delphi expert consultation and other methods to construct a core competence evaluation index system for sleep specialist nurses. The system is scientific, reasonable, and comprehensive, with outstanding professional characteristics, and can provide a reference for the training of sleep medicine nursing talents.
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Acknowledgements
The authors would like to thank all the experts involved in the Delphi consultation.
Declarations
Ethics approval and consent to participate
The study protocol was approved by the ethics committee of the Affiliated Rehabilitation Hospital of Nanchang University by the Declaration of Helsinki (No. SFYLL-KY-PJ-2024-003). All methods were performed according to relevant guidelines and regulations. Informed consent was obtained from all the participants and/or legal guardians for the study.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
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