Construction of the course training system of infectious disease specialist nurses’ core competence: a Delphi study


 Aims

This study aimed to construct a set of course training system which was scientific, authentic and comprehensive to foster the infectious disease specialist nurses’ core competence.
Background

Nowadays, with the further spread of infectious diseases, it puts forward higher requirements for the improvement of the ability and quality of nurses, especially infectious disease specialist nurses. It is an urgent task to standardize and improve the core competence of infectious disease specialist nurses. There was no course training system of infectious disease specialist nurses’ core competence.
Design:

A two-round Delphi consultation survey were carried out to get feedback from experts on constructing the course training system of infectious disease specialist nurses’ core competence.
Methods

This study adopted a series of methods including group discussion, theoretical analysis and Delphi consultation to draft the course training system of infectious disease specialist nurses’ core competence. 21 Chinese experts from the fields of infectious disease health care, infectious disease nursing, and infectious disease nursing education were invited to participate in the Delphi consultation between November 2021 and December 2021.
Results

The experts were highly motivated in this study and they were regarded as leading authority on the subject. Besides, they reached a consensus on the results. The final course training system of infectious disease specialist nurses’ core competence focused on 5 competence modules and was composed of 12 course categories with 66 class contents and corresponding objectives.
Conclusions

The research methods were scientific and precise. The course system was comprehensive in content and reliable in result. It could be reference for course training of infectious disease specialist nurses.


Introduction
With the rapid development of medical treatment, especially in the era of knowledge explosion, medical personnel must continue to learn in order to meet the needs of professional development 1,2 . It is reported that continuing education and vocational learning are the main ways for nurses to obtain knowledge 3 . Systematic and scienti c training courses can help nurses learn more e ciently and master new knowledge and skills 4,5 . Specialist nurses refer to expert clinical nurses with high level and expertise in a special nursing eld, who can use their knowledge, expertise and technology to provide nursing services for patients and social groups 6,7 . As the backbone of the nursing team, specialist nurses play an important core role in the teamwork 8, 9 . Therefore, continuing education for this group is particularly important. In China, however, specialist nurse training is still at the initial stage, we need to improve and enhance the teaching arrangements, teaching methods and training process continually 10-12 .

1.1Background
Currently, with the development of transportation and subsequent economic and cultural exchanges helped speed up the spread of the COVID-19, the pandemic has seriously threatened the life and health of all mankind, and has brought extremely serious negative effects on countries around the world 13,14 . In the process of infectious disease prevention and control, infectious disease nursing staff have played critical roles in ghting against the pandemic 15,16 . Their ability is not only related to their own work safety, but also greatly affects the quality and e ciency of infectious disease nursing. As an important ways of talent transmission, nursing training ensures the sustainability of nursing team. Therefore, how to scienti cally train infectious disease specialist nurses who can adapt themselves to the needs of the times and better respond to the COVID-19 pandemic is of great importance and urgency 17 . At present, more and more studies focus on the ability of infectious disease nurses [18][19][20] . But there are no mature, systematic and scienti c training courses for infectious disease specialist nurses to take. As the core of the training, courses are of crucial signi cance for carrying out homogeneous training. The implementation of standardized curriculum can comprehensively improve the core competence of infectious disease nurses. Therefore, our study aims at constructing a set of scienti c and authentic training courses for infectious disease specialist nurses which can regulate the training of infectious disease specialist nurses in different hospitals, improve the training quality and push the development of infectious disease specialist nursing so as to better respond to the infectious diseases.

Delphi method
The Delphi method was a kind of technique to get feedback via several rounds of anonymous consultation until consensus was obtained 21 . The procedure included: rstly receiving the experts' assessment on the problem, secondly compiling the experts' responses and revised the questions, thirdly sending the revised questions to every expert anonymously and seeking their responses, again and again until consensus of opinion was obtained 22 . Delphi expert method can avoid some shortcomings of group decision-making. The person with the loudest voice or the highest status has no chance to control the will of the group. At the same time, Delphi method is to consult each expert by letter, and everyone's views will be collected. Managers can ensure that everyone's views are obtained when collecting opinions 23,24 .

Method
This study adopted the Delphi method for research. Our research group drafted the course training system of infectious disease specialist nurses' core competence on October 2021 and complied the Delphi consultation questionnaire. Two rounds of Delphi consultation were carried out during November and December of 2021. In this process, the training courses were re ned and revised until the nal version of the course training system of infectious disease specialist nurses' core competence was constructed.

Setting up research group
The research group was set up before the research. And it was composed of one professor, one associate professor, two lecturers, one nurse-in-charge and one postgraduate. Based on the index system of core competence assessment for infectious disease specialist nurse constructed in early stage, the research group drafted the course training system of infectious disease specialist nurses' core competence after group discussion and experts interviews. At the same time, the research group compiled the experts consultation questionnaires, sent out the questionnaires and analyzed the feedback.

Selection of the expert panel
Generally speaking, the number of consultation experts was between 15 to 50 25 . And the more experts there was, the more reliable the result would be. This study adopted random sampling method and 21 experts were selected to get involved in the consultation. The expert panel contained three types of people and the inclusion criterion were as follows: (a) for experts on infectious disease health care: they should be engaged in infectious disease health care or infectious disease medical supervision for more than 15 years, obtain the intermedium or advanced level of certi cate, acquire a bachelor degree or above, sign the informed consent for and voluntarily participate in this study; (b) for experts on infectious disease nursing: they should be engaged in infectious disease nursing or infectious disease nursing supervision for more than 15 years, obtain the intermedium or advanced level of certi cate, acquire a bachelor degree or above, sign the informed consent for and voluntarily participate in this study; (c) for experts on infectious disease nursing education, they should be engaged in the teaching of infectious disease nursing in the training class of infectious disease specialist nurses for more than 3 years or in institution of higher education for more than 15 years, obtain the intermedium or advanced level of certi cate, acquire a bachelor degree or above, sign the informed consent form and voluntarily participate in this study.

Constructing expert consultation questionnaire
The expert consultation questionnaire was composed of three parts: (a) basic information of the experts involved, namely name, age, professional title, years of engaging in infectious disease specialist nurse training and working unit, etc.; (b) the rst draft of the course training system of infectious disease specialist nurses' core competence, namely 5 competence modules, 12 course categories, 46 class contents and their corresponding objectives. The importance of course system was evaluated by way of Likert 5-level scoring method, 5 = very important, 4 = important, 3 = general, 2 = unimportant, 1 = completely unimportant, and the column for suggestions and supplements was provided; (c) expert familiarity with content of the survey and judgement.

Questionnaire collection and classi cation
The consultation questionnaires were sent via e-mail. To ensure the quality of the consultation questionnaire, the experts had two weeks to ll in the questionnaire. We revised the questionnaire as per the result of the rst round consultation and issued the revised questionnaire to the experts for the second round.
The statistical software SPSS24.0 was applied in the process of data analysis. Data measurement and data calculation were expressed in the form of mean ± standard deviation and frequency, percentage respectively. The enthusiasm of the experts was also expressed in the form of questionnaire recovery rate. The authority degree of the expert opinion was expressed by the authority coe cient. The coordination degree of expert opinion was expressed by variable coe cient and Kendall harmony coe cient. P<0.05 indicated that the difference was statistically signi cant.

Quality control
To ensure the research quality, the research group selected experts from 5 different provinces and cities to participate in the consultation. Besides, the experts were from three different elds, namely infectious disease health care or medical supervision, infectious disease nursing or nursing supervision and infectious disease nursing education, which assured the authority and quality of consultation.

Ethical consideration
This study complied with the Declaration of Helsinki 26,27 . Before formal consultation, the purpose and signi cance of the study was elaborated to the experts and informed consent of experts was obtained. During the investigation, the experts could terminate and withdraw from the consultation at any time. And their personal information was completely con dential and and none of the participants were provided with details of the other participants in the study. The inquiry data was only used for this study and not open for other purposes.

Basic information of the experts
According the inclusion criterion of this study, 21 experts from 5 provinces and cities including Shaanxi, Hubei, Zhejiang, Chongqing and Beijing were selected. The age of the experts involved ranged from 34 to 51 years old, with an average of 42.48 (SD 4.63) years old. Their working year varied from 3 to 24, with an average of 14.05 (SD 6.36) years. The details were shown in Table  1.

Experts' enthusiasm
The enthusiasm of the experts was assessed on the basis of the recovery of the questionnaires. In this study, during the two rounds of consultation, 21 questionnaires were distributed and 21 valid questionnaires were returned, with a recovery rate of 100%, and 18 and 4 experts respectively put forward their suggestions on the revision of the course items, indicating that the experts attached great importance to this study and had a good enthusiasm. The details were shown in table 2.

Expert authority coe cient
The authority degree of the expert opinion was expressed by the authority coe cient. It was the arithmetic average of the judgement coe cient and familiarity coe cient. Generally speaking, if the authority coe cient was over 0.7, it meant the result of consultation was reliable. The experts' judgement was based on four aspects, namely practical experience, theoretical analysis, domestic and foreign reference materials and intuitive perception. The degree of expert familiarity were very familiar, relatively familiar, familiar, not quite familiar and completely not familiar. Each item was referred to a different value and the details were shown in table 3 and table 4.
In this study, the judgement coe cient of the experts was 0.952, the degree of expert familiarity was 0.962 and the authority coe cient of the experts was 0.957, indicating that the degree of expert authority was relative high and the result of the study was reliable, as shown in table 5 and table 6.

Experts' opinion coordination degree
The experts' opinion coordination degree was used to evaluate whether the experts had disagreements on the importance of the items. It was normally expressed by Kendall's coe cient of concordance (Kendall's W). The Kendall's W ranged from 0 to 1. The closer it was to 1, the higher the expert's opinion coordination degree was.
For this study, in the rst round of consultation, the Kendall's W of competence module, course category and class content were 0.280, 0.292 and 0.303 respectively while in the second of consultation, they were 0.301, 0.350 and 0.253 respectively. So the Kendall's W test had statistical signi cance (P 0.05), indicating that the experts' opinion coordination degree in the two rounds of consultation was preferable, as shown in table 7.

Results of the Delphi consultation
In the rst round of questionnaire consultation, 18 experts put forward their suggestions on the revision of the course system. After group discussion, we made modi cations on the course system: revising 2 course categories, deleting 1 class content, revising 10 class content, adding 10 class contents, splitting 1 class content into 2 parts, revising 12 class objectives and adding 22 class objectives.
In the second round of questionnaire consultation, 4 expert put forward their suggestions on the revision of the course system: revising 1 class content and 4 class objectives.
Finally, core competence training courses for infectious diseases specialist nurses were focused on 5 competence modules (professional development abilities, responsiveness to infectious diseases, nursing abilities for infectious diseases, professionalism and humanistic accomplishment, and infection prevention and control abilities). The courses were divided into 12 categories and composed of 66 classes, as shown in table 8.

Reliability and scienti city of Delphi expert consultation results
Under the guidance of the previous index system of core competence assessment for infectious disease specialist nurses 19 and on the basis of fully reviewing the core competence training course of specialist nurses in and out of China, after rigorous Delphi expert consultation, this study constructed the training system for infectious disease specialist nurse. The system contained 4 aspects, namely the training competence modules, course categories, class contents and class objectives. In this study, the course was developed in a gradual and orderly manner and the research contents were comprehensive. Before class contents were formulated, the research group held group meeting, consulted the infectious disease health care experts, nursing supervision experts and nursing education experts, drew feedback from the experts, and invited relevant experts to assess the feasibility of the rst draft of the course system so as to ensure the practicability of the class contents. Since there was no uni ed course training system of infectious disease specialist nurses' core competence, our study scienti cally constructed a comprehensive course training system through combined methods of literature review and expert questionnaire consultation. Besides, the effective recovery rate of the two rounds of expert consultation questionnaire were 100% in this study, and most experts put forward scienti c and reasonable opinions, indicating that the experts were enthusiastic in the research. The experts involved in the research came from level-A tertiary hospital, infectious disease specialist hospital and School of Nursing in high educational institutions in 5 provinces and cities around China. They all had rich clinical and nursing education experience of infectious diseases. The selection of the experts were very strict, assuring the expert authority. The Kendall's coe cient of concordance of the two rounds of Delphi expert consultation after signi cance testing (P<0.05) indicated that the experts' opinion coordination degree was preferable and the result of the study was reliable.

Analysis of course system contents
The course training system of infectious disease specialist nurses' core competence in this study focused on 5 competence modules and was divided into 12 course categories which involved 66 class contents and corresponding objectives. The system covered all the aspects related to core competence, such as infectious disease specialist nurses' scienti c researches, management and response to epidemic.

Competence module of professional development
The competence module of professional development was the key point of this course training system. Scienti c researches on nursing was the biggest problem that had always plagued the clinical nurses 28, 29 . Compared with ordinary nurses, the specialist nurses should have a more systematic and comprehensive scienti c research knowledge system and capability 30 . Besides, a good level of scienti c research could improve e ciency and quality of nursing work 31 . Therefore, this study concentrated on the weakness of clinical nurses and problems that were urgently needed to be solved. Scienti c researches on nursing was regarded as the priority of the course training system. The system not only covered contents such as scienti c research selection and design, literature review and statistical analysis, paper writing and etc, but also extended to related contents such as research project application and achievement declaration, clinical issues and patent transformation so that the system could effectively provide guarantee for the improvement of the specialist nurses' core competence. In the competence module of professional development, the weighting target of classes of nursing management accounted for the largest proportion, around 0.082. It covered the contents of management of nursing quality, management of re ned nursing and so on, aiming to improve the nursing management capabilities of the infectious disease specialist nurses through comprehensive management training classes so that the specialist nurses could play the role of nursing managers in clinical work and improve the quality of infectious disease nursing. Specialist nurses not only needed to play important roles such as nursing staff and nursing managers, but also needed to be nursing educators who could deliver lectures on infectious diseases to ordinary nurses, nurse students and nursing staff in other departments 32,33 . In response to the COVID-19 pandemic, nurses in infectious disease department provided great help for nurses in other departments in quickly responding to the pandemic 34 .

Competence module of response to infectious disease
The classes under the competence module of response to infectious disease were set in accordance with the current global pandemic background. Countries were closely linked and no country could be immune to the global pandemic [35][36][37] . Therefore, the training course system should also keep pace with the times and meet the needs. The infectious disease specialist nurses should not only be pro cient in infectious disease nursing, but also have the ability to respond to infectious diseases. Considering that the infectious disease specialist nurses were lack of the ability of response to infectious diseases, the competence module of response to infectious disease was regarded as a relative important part of this training course system. Started with two course categories, namely prediction and emergency drills and response to infection disease epidemic, this module elaborated the distribution of the current key global infectious diseases and analysis of their development trend, prediction and recognition of the public health emergencies, interpretation of laws and regulations related to major infectious diseases, and the China's experience in responding to major outbreaks of infectious diseases in the past ten years. The contents of this module ranged from theories to practices, from macro analysis to speci c operations. This kind of setting aimed to provide effective measures and meet the needs in responding to future infectious disease emergencies.

Competence module of nursing for infectious disease
Nursing abilities for infectious disease were the basic abilities that infectious disease specialist nurses should acquire. The weighting targets of this competence module was 0.204, ranking second. This competence module of nursing for infection disease included three categories, namely nursing capabilities, commonly used diagnosis and treatment technology in infectious disease department and critical thinking capabilities, with nursing capabilities accounting for the largest proportion of 0.086. Infectious disease patients were different from patients in specialist wards with a single type of disease, which placed high demands on the nurses' nursing ability in infectious disease department. Infectious disease specialist nurses should be pro cient in the symptoms and sign of different types of infectious diseases patients and corresponding nursing techniques, and take targeted nursing measures so as to provide patients with high-quality nursing service 20 . They also should be pro cient in commonly used diagnosis and treatment techniques in infectious disease nursing process. By attending training courses, they should further clarify and consolidate the main points and precautions of the operation techniques in diagnosis and treatment so as to promote more improvement of operational techniques. At the same time, in the process of training course, they should develop their critical thinking capability 38 . It was important in nursing work because it could help effectively avoid nursing errors and bad nursing accidents and improve work e ciency. The classes of critical thinking aimed to strengthen the specialist nurses' critical thinking abilities in the nursing of clinical infectious disease.

Competence module of professionalism and humanistic accomplishment
The competence module of professionalism and humanistic accomplishment included two categories, professionalism and humanistic care, their weighting targets were 0.080 and 0.082 respectively. The classes of professionalism aimed at improving the infectious disease specialist nurses' professionalism through the study of career planning and vocational stress coping in infectious disease nursing. The classes of humanistic accomplishment were composed of humanistic care in nursing, health education and health promotion, and application of hospice among infectious disease patients. The classes re ected the humanistic feelings in infectious disease nursing, including the care to infectious disease patients and the health education to the public, as well as the hospice care to infectious disease patients at terminal stage. The humanistic spirits of the nursing staff were integrated into all aspects of the classes.

Competence module of infection prevention and control
Competence module of infection prevention and control occupied the largest proportion of the expert questionnaire consultation in this training course system. Infection prevention and control ability was the most important ability which was the guarantee for the continuation of the combat effectiveness of nursing staff. The competence module of infection prevention and control included two categories, disinfection &quarantine and vocational protection, their weighting targets accounting for the same proportion, about 0.090. The contents of disinfection & quarantine classes and vocational protection classes were arranged from two aspects, both theoretical and practical, so as to provide comprehensive lectures on infectious disease disinfection and quarantine, improvement and standardization of infectious disease specialist nurses' vocational protection ability.

Practical signi cance of the construction of the course training system
At present, there are differences in training contents, training objectives, teaching resources, teaching management and so on for the training of infectious disease specialist nurses in and out of China so there is no uniform training standard for the training of infectious disease specialist nurses. Combing with the characteristics and competence requirements of the post, this study establishes a comprehensive, scienti c and standardized training course system of infectious disease specialist nurses. The training course system covers both the competence requirements that general nurses need to meet and the contents that infectious disease specialist nurses should learn. The study has important practical signi cance for the training specialist nurses, improving both the overall training quality and core competence of infectious disease specialist nurses.

Conclusion
Since the COVID-19 pandemic is still spreading nowadays, training high-quality infectious disease specialist nurses with comprehensive competence is an effective way to respond to the pandemic development and to ght against the pandemic 39 . In this study, through two rounds of Delphi expert questionnaire consultation, we construct the course training system of infectious disease specialist nurses' core competence which focus on 5 competence modules and is divided into 12 course categories with 66 class contents and corresponding objectives. The research methods are scienti c and rigorous, contents of the training course system are comprehensive and the research results are reasonable and reliable. In this way, the training course system could be reference for the training of infectious disease specialist nurses. This study was conducted in compliance with the ethical standards in the Declaration of Helsinki and those followed at Air Force Medical University. The study was part of the project to improve the core competence of infectious disease specialist nurses which received approval from the Institutional Review Board of Air Force Medical University. The panelists provided written informed consent before they took part in the study. They have the right to withdraw at any stage of the study.

Consent for publication
Not applicable.