Diseño y validación de un instrumento para la evaluación de competencias en enfermeras de práctica avanzada (IECEPA)

Resumo

The ongoing spread and implementing of Advanced Practice Nursing (APN)'s roles worldwide has resulted in a wide range of approaches to origin and development of these nurses, which involves controversy and conceptual ambiguity. One of the essential elements of this process, which is the drawing up of competency maps and standards of practice, has proved also to be markedly dissimilar. In order to address this issue, it was decided to review the literature including specific competency maps to APN recognized roles, being developed by each country's or healthcare services' regulating institutions and bodies, among which 119 scientific literature documents as well as 92 grey literature and corporate documents were selected. After performing a first analysis of the mentioned documents' contents, a group of 17 transversal competency domains at an international level as well as a professional skills' initial set encompassing 211 items emerged. On this basis, a research was conducted by consensus using the Delphi technique, that has been frequently used to the development of measurement scales and instruments by an iterative multi-stage process, where successive rounds are based on achieved previous results, in order to reach an agreement on those domains (related competencies' clusters) and competencies, relevant to the scope of advanced practice according to the opinion of an experts panel being selected on purpose. The outcome of this consensus step comes into being as a proto-instrument including 12 domains and 54 competencies, which was subjected to a further clinimetric validation process, through an analysis process consisting of a three-steps sequence based on a combination of Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). In the first round, the main components were analyzed by using the Varimax orthogonal rotation. The process contained a preliminary test to substantiate the analysis, with the help of the determinant of the correlation matrix as well as the Bartlett's test and KMO index. Kaiser criterion was used in order to extract the factors. From the confirmatory analysis that the factor construct underwent after exploratory analysis, it transpired that univariate and multivariate normality tests did not find any abnormality challenges, and the results of multivariate Kurtosis delivered a proper value of 1,216. The results showed a good fit value to the eight-factors model, which comprehended a final tally of 44 competencies. This research has resulted in the Instrument for Competence Assessment in Advanced Practice Nurses (known by its Spanish acronym IECEPA), which has proved to be useful to specific competences' assessment in Advanced Practice Nursing and susceptible to being applied in any area of the Spanish healthcare system, regardless of APN levels of development or implementation.