Content area
Background:
Training programs for cardiovascular specialist nurses in China lack standardized evaluation frameworks. This study developed a structured evaluation model based on the Workplace-Based Assessment (WPBA) guided by Miller's Pyramid of clinical competence.
Method:
A Delphi method was employed, involving 15 cardiovascular nursing education experts who participated in two consultation rounds. Initial evaluation items were derived from literature reviews and expert group discussions. Consensus and content validity were assessed using descriptive statistics and Kendall's coefficient of concordance.
Results:
Experts achieved strong consensus, validating a comprehensive evaluation model comprising four integrated assessment components: theoretical knowledge examination, Mini-Clinical Evaluation Exercise (Mini-CEX), Direct Observation of Procedural Skills (DOPS), and Case-Based Discussion (CBD). Each assessment aligns with one level of Miller's Pyramid, ensuring a comprehensive evaluation from theoretical knowledge to clinical performance. Consensus analysis demonstrated high expert agreement and consistency across assessment criteria and clinical sites.
Conclusion:
This structured assessment model addresses existing gaps in advanced nursing education, offering standardized and objective evaluations of trainee competencies. This evaluation framework contributes substantially to advancing nursing education and enhancing cardiovascular health care quality through better trained specialist nurses.
Full text
Cardiovascular diseases pose significant public health challenges globally and account for approximately 44% of all deaths in China, emphasizing the critical need for effective disease prevention and management strategies (Chinese Cardiovascular Health and Disease Report Writing Group, 2020). Cardiovascular specialist nurses play a pivotal role in these efforts, contributing substantially through patient education, risk factor management, and care coordination (Hayman et al., 2015).
Formalized training programs for cardiovascular specialist nurses have recently emerged in China. However, evaluation methods for assessing training outcomes remain inconsistent, lacking systematic, standardized models to confirm whether trainees achieve desired competencies (Mrayyan et al., 2023). Establishing a rigorous evaluation framework aligns with national objectives such as the National Nursing Development Plan (2016–2020), which emphasizes structured assessments to enhance clinical nursing quality (Sakuramoto et al., 2023; Zhang et al., 2023).
Workplace-Based Assessment (WPBA), a competency assessment conducted in clinical settings using tools such as the Mini-Clinical Evaluation Exercise (Mini-CEX), Direct Observation of Procedural Skills (DOPS), and Case-Based Discussion (CBD), offers a feasible approach for nursing education (Liu, 2012; Royal College of General Practitioners, 2024). WPBA effectively assesses real-world clinical skills, providing structured feedback that enhances learning. Its successful adaptation for nursing contexts internationally further justifies its integration into specialist nurse training programs (Swanwick & Chana, 2005). For example, since 2005 the United Kingdom's “Modernizing Medical Careers” initiative has emphasized WPBA as a key component of formative assessment for physicians, underlining its educational value (Hurreiz, 2019). This global trend supports the incorporation of WPBA into specialist nurse training programs.
Miller's Pyramid, which features ascending competence levels (knows, knows how, shows how, does), provides a structured model widely employed in medical and nursing education for evaluating theoretical knowledge and practical skills comprehensively (Bordage et al., 2009; Davis et al., 2009; Sethi & Badyal, 2019; Singh & Singh, 2021). Miller's theory emphasizes that progression through these levels is required to achieve true clinical proficiency (Davis et al., 2009; Ten Cate et al., 2021; Williams et al., 2016). By aligning assessment methods to Miller's levels, educators can ensure a comprehensive evaluation of both theoretical knowledge and practical skills.
In recent years, educators have increasingly integrated these methods to bridge the gap between academic knowledge and clinical practice in nursing education (Yousuf Guraya, 2015). To address the need for a standardized, competency-based evaluation of cardiovascular specialist nurses, we developed an evaluation model integrating WPBA tools within Miller's Pyramid. We hypothesized this model would systematically assess trainee performance, standardize evaluations across institutions, and enhance training outcomes. This study was conducted to achieve expert consensus on essential evaluation components and establish the model's content validity to inform future implementation.
Method
Study Design
This descriptive study developed an evaluation instrument through expert consensus using the Delphi method. Data were collected from November 2024 to March 2025. Miller's Pyramid served as the theoretical foundation, and WPBA tools provided the practical assessment framework. Corresponding to Miller's competence levels (“knows” to “does”), the evaluation model assessed theoretical knowledge, clinical reasoning, observed skills, and real clinical performance. Two Delphi rounds were conducted to achieve expert consensus, refine the evaluation content, and validate the model.
Instrument Development
The evaluation instrument was developed in three steps. First, a literature review of cardiovascular nursing competencies and assessment tools was conducted using national and international databases (CNKI, Wanfang, PubMed, Web of Science). This review identified core competency areas and standard evaluation criteria used in existing Mini-CEX, DOPS, and CBD assessments.
Second, a research team comprising six cardiovascular nursing experts (two nursing administrators, two clinical educators, and two senior nurses) was formed to draft the initial evaluation framework. Guided by the literature findings and clinical experience, the team generated preliminary evaluation items for each component (theoretical knowledge, Mini-CEX, DOPS, and CBD). Performance criteria and a 5-point Likert scale (1 = not important, 5 = very important) were developed to evaluate item importance and operability.
Third, these items formed the basis of the Round 1 Delphi questionnaire, structured into three sections: an introduction explaining the study purpose and instructions; a list of proposed evaluation items grouped by assessment domains (Mini-CEX, DOPS, CBD, and theoretical knowledge), with rating scales for item importance and feasibility; and a demographic section collecting experts' professional backgrounds, experience, and familiarity with the topic. Open-ended questions allowed experts to suggest modifications, ensuring iterative refinement of the evaluation instrument.
Validity and Reliability Testing
Content validity was established through a two-round Delphi expert consultation. Surveys were distributed via email, telephone, and online platforms to maximize expert participation. In Round 1, experts rated proposed evaluation items for importance and feasibility, provided comments, and suggested revisions. Items with a mean importance score of less than 3.5, a coefficient of variation (CV) of greater than 0.30, or less than 80% expert agreement (important or very important) were flagged for modification or removal. Feedback led to revisions such as adding a “professional theoretical knowledge” assessment component (addressing the foundational level of Miller's Pyramid) and refining the wording and organization of Mini-CEX, DOPS, and CBD items.
In Round 2, experts reassessed the revised items considering group feedback. Consensus was quantified using Kendall's coefficient of concordance (W), with higher values (approaching 1) indicating greater consensus. Additionally, an expert authority coefficient (Cr) was calculated based on experts' familiarity with the content and their knowledge sources; Cr values greater than 0.70 indicated reliable expert judgments.
Consensus was achieved on all items by the end of Round 2, confirming strong content validity. The finalized instrument, comprising evaluation items and performance criteria, was established with rigorous expert agreement. Although a separate field reliability test was not performed at this stage, reliability was supported by consistency in expert ratings (high Kendall's W values) and iterative refinement through the Delphi process, enhancing item clarity and reducing ambiguity.
Pilot and Main Study
To assess the practicality and effectiveness of the evaluation model, we initially conducted a pilot study followed by a larger multi-center validation study. The pilot study involved 20 cardiovascular nurse trainees from a tertiary hospital in Beijing, China, assessed using the Mini-CEX, DOPS, and CBD tools. Each trainee completed at least one evaluation per assessment category. Evaluators received standardized training to ensure scoring consistency. Assessments were performed during routine clinical care, and immediate feedback was provided. This pilot confirmed feasibility and led to minor wording and scoring revisions.
Subsequently, the main validation study involved 52 trainees across two hospitals in Beijing. Assessments were conducted midway and at training completion, with trainees undergoing multiple Mini-CEX assessments, DOPS evaluations of cardiovascular procedures, and CBD sessions based on real patient cases. Evaluators underwent standardized calibration training. Assessment scores and evaluator feedback were collected to determine trainee performance, instrument reliability, and consistency across clinical settings.
Participants
The Delphi panel consisted of 15 cardiovascular nursing experts purposively selected from 12 tertiary hospitals across China. Participants included 11 senior nursing managers (head nurse level or above) and 4 full-time cardiovascular nursing educators. Inclusion criteria were: bachelor's degree or higher in nursing; professional title of associate chief or supervisory nurse or higher; minimum of 10 years' cardiovascular nursing experience; and active involvement and high familiarity with cardiovascular nursing training and research, as self-assessed by each expert.
For context, cardiovascular specialist nurse trainees in China are typically registered nurses with more than 5 years of cardiovascular experience, a bachelor's degree or higher, and a professional title of nurse practitioner or above. They undergo a standardized 2-month training program (1 month online theory and 1 month clinical practice) and receive national specialist nurse certification on successful examination.
Ethical Considerations
Ethical approval was granted by the Research Ethics Committee of Peking University International Hospital (IRB no. 2024-KY-0079-01; approval date: 10/30/2024). All faculty members and trainees provided written informed consent after receiving study information and assurances of confidentiality.
Statistical Analysis
Statistical analyses were performed using SPSS, version 26.0 (IBM), and Excel 2017 (Microsoft) software. For the Delphi rounds, descriptive statistics (mean, standard deviation) assessed item importance and feasibility. The CV measured dispersion among expert ratings, where lower CV indicated higher consistency. Expert consensus was quantified using Kendall's W for Mini-CEX, DOPS, and CBD domains, and overall model items; significance was set at p < .05, indicating non-random agreement. The expert authority coefficient (Cr) was calculated as Cr = (Ca + Cs)/2, where Ca represents self-assessed expert familiarity and Cs represents the evidence basis for expert judgments. These metrics guided model refinement.
In the pilot study, we evaluated feasibility and identified potential ceiling or floor effects through score distribution analysis, with qualitative review of evaluator feedback guiding further refinements. During the main study, paired t tests or Wilcoxon signed-rank tests compared mid- and post-training scores to assess trainee improvement. Inter-rater reliability was determined using intraclass correlation coefficients (ICCs), and internal consistency was assessed with Cronbach's alpha. Correlation analyses evaluated relationships among Mini-CEX, DOPS, and CBD scores, establishing construct validity. Statistical significance was set at p < .05 for all tests, examining model reliability, internal coherence, and sensitivity in detecting trainee competency improvements.
Results
Expert Panel Characteristics
All 15 invited experts completed Round 1 (100%), and 14 completed Round 2 (93.3%), indicating strong participation. Experts had extensive experience (average nursing career, 27.3 ± 6.8 years; average management experience, 14.0 ± 8.8 years) and were highly qualified (66.7% held senior roles as associate chief nurses or higher). Education levels included bachelor's degrees or higher for all experts; approximately half (46.7%) had master's degrees and one (6.7%) had a doctoral degree. The experts reported high familiarity with and enthusiasm for cardiovascular nursing training (mean familiarity score = 0.91), resulting in a robust expert authority coefficient (Cr = 0.93). The panel provided substantial written feedback in Round 1, with 73.3% contributing suggestions for improvement. Detailed expert characteristics are presented in Table A, available in the online version of this article.
Table A
Characteristics of Delphi Expert Panel (N = 15)
| Education level | Bachelor's | 15 (100) |
| Master's | 6 (40) | |
| Doctorate | 1 (6.7) | |
| Professional Title | Chief Nurse | 1 (6.7) |
| Deputy Chief Nurse | 9 (60) | |
| Head Nurse | 5 (33.3) | |
| Role/Position | Director of Nursing | 1 (6.7) |
| Deputy Director of Nursing | 2 (13.3) | |
| Section Chief Nurse | 2 (13.3) | |
| Ward Chief Nurse | 6 (40) | |
| Clinical Instructor | 4 (26.7) | |
| Clinical Base Hospital Level | Tertiary A (Top Tier) | 15 (100) |
(All experts had ≥10 years of cardiovascular nursing experience. Senior titles include associate chief nurse and above.)
Delphi Consultation Outcomes
Round 1 (Tables B–D, available in the online version of this article). The initial Delphi round yielded high mean importance scores (> 4 of 5) for most proposed items, indicating strong expert agreement on item relevance. However, a few items showed greater dispersion (CV > 0.30), suggesting inconsistent perceptions and necessitating further review. Experts provided extensive feedback (73.3%), highlighting areas needing clarification, combination, or removal. Notably, several experts recommended adding a formal theoretical knowledge assessment component, which was subsequently incorporated to address the foundational “knows” level of Miller's Pyramid. The instrument was thus refined based on this expert feedback, resulting in a revised Round 2 questionnaire with clearer item wording and fewer redundancies.
Table B
Results of the First Round of Expert Consultation (Mini-CEX)
| I-1 Interviewing Skills | Overall | 4.8 ± 0.52 | .11 | 4.88 ± 0.35 | .07 |
| I-1.1 Understand the patient's condition in detail before the consultation | 4.93 ± 0.26 | .50 | 5.00 ± 0.00 | 0 | |
| I-1.2 Address the patient correctly | 4.87 ± 0.35 | .07 | 4.93 ± 0.258 | .05 | |
| I-1.3 Introduce oneself to the patient | 4.80 ± 0.56 | .12 | 5.00 ± 0.00 | 0 | |
| I-1.4 Explain the purpose of the consultation | 4.93 ± 0.26 | .05 | 4.93 ± 0.26 | .05 | |
| I-1.5 Encourage the patient to express their feelings | 4.87 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-1.6 Guide the patient appropriately when deviating from the topic | 4.73 ± 0.59 | .13 | 4.73 ± 0.79 | .17 | |
| I-1.7 Use medical terminology | 4.47 ± 1.25 | .28 | 4.73 ± 0.79 | .17 | |
| I-2 Professional Attitude | Overall | 4.93 ± 0.22 | .04 | 4.74 ± 0.48 | .10 |
| I-2.1 Interview seriously and meticulously | 5 ± 0 | 0 | 4.73 ± 0.59 | .13 | |
| I-2.2 Respect and revere life | 4.933 ± 0.26 | .05 | 4.80 ± 0.41 | .09 | |
| I-2.3 Possess an inquisitive spirit | 4.87 ± 0.35 | .07 | 4.53 ± 0.64 | .14 | |
| I-2.4 Possess professional knowledge | 4.93 ± 0.26 | .05 | 4.80 ± 0.41 | .09 | |
| I-2.5 Possess professional qualities and empathy | 4.933 ± 0.26 | .05 | 4.86 ± 0.35 | .07 | |
| I-3 Nursing Assessment | 4.85 ± 0.37 | .08 | 4.85 ± 0.37 | .77 | |
| I-3.1 Collect information completely and accurately | 4.933 ± 0.26 | .05 | 4.86 ± 0.35 | .07 | |
| I-3.2 Conduct comprehensive nursing assessment without omissions | 4.933 ± 0.26 | .05 | 4.86 ± 0.35 | .07 | |
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| I-3.3 Assess according to the condition without redundant assessments | 4.87 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-3.4 Use gentle assessment techniques to avoid discomfort or pain for the patient | 4.87 ± 0.35 | .07 | 4.73 ± 0.59 | .13 | |
| I-3.5 Ensure assessment content is clear and organized | 4.73 ± 0.59 | .13 | 4.86 ± 0.35 | .07 | |
| I-3.6 Complete all five major prescription assessments | 4.8 ± 0.41 | .09 | 4.93 ± 0.25 | .05 | |
| I-4 Nursing Plan | Overall | 4.82 ± 0.45 | .09 | 4.78 ± 0.40 | .08 |
| I-4.1 Have a comprehensive understanding of the patient's condition | 4.8 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-4.2 Arrange nursing diagnoses in order of priority based on the patient's condition | 4.8 ± 0.41 | .09 | 4.86 ± 0.35 | .07 | |
| I-4.3 Able to list nursing diagnosis basis | 4.87 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-4.4 Based on nursing diagnosis, list correct nursing measures | 4.8 ± 0.41 | .09 | 4.80 ± 0.41 | .09 | |
| I-4.5 List nursing measures with evidence basis | 4.87 ± 0.35 | .07 | 4.66 ± 0.62 | .13 | |
| I-4.6 List nursing measures with strong implement ability | 4.73 ± 0.46 | .1 | 4.86 ± 0.35 | .07 | |
| I-5 Health Education | Overall | 4.84 ± 0.36 | .07 | 4.83 ± 0.40 | .08 |
| I-5.1 Through assessment, inform patients of methods to manage risk factors | 4.87 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-5.2 Inform patients of medication timing, pharmacological effects, and precautions | 4.87 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-5.3 Inform patients of existing positive physical signs and laboratory indicators | 4.73 ± 0.46 | .10 | 4.73 ± 0.59 | .13 | |
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| I-5.4 Inform the significance and precautions of various examinations | 4.87 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-5.5 Provide personalized health education for deficiencies identified during consultation | 4.87 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-5.6 Health education is easy to understand, and patients can master it proficiently | 4.87 ± 0.35 | .07 | 4.80 ± 0.41 | .09 | |
| I-6 Communication Skills | Overall | 4.78 ± 0.42 | .09 | 4.81 ± 0.39 | .08 |
| I-6.1 Communicate with a smile, make eye contact when necessary | 4.8 ± 0.41 | .09 | 4.86 ± 0.35 | .07 | |
| I-6.2 Understand patients' feelings, encourage them to express their concerns | 4.73 ± 0.46 | .10 | 4.86 ± 0.35 | .07 | |
| I-6.3 Have empathy, master questioning and interactive skills | 4.8 ± 0.41 | .09 | 4.80 ± 0.41 | .09 | |
| I-6.4 Provide correct answers to patients' questions, gain their trust | 4.87 ± 0.35 | .07 | 4.80 ± 0.41 | .09 | |
| I-6.5 Speak clearly, use a kind tone, listen attentively, be enthusiastic and patient | 4.73 ± 0.46 | .10 | 4.73 ± 0.45 | .10 | |
| I-7 Organizational Effectiveness | Overall | 4.84 ± 0.37 | .08 | 4.84 ± 0.37 | .08 |
| I-7.1 Knowledge mastery and consultation efficiency | 4.87 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-7.2 Clear goals | 4.87 ± 0.35 | .07 | 4.80 ± 0.41 | .09 | |
| I-7.3 Clear organization, smooth information flow | 4.87 ± 0.35 | .07 | 4.80 ± 0.41 | .09 | |
| I-7.4 Gain patient recognition | 4.73 ± 0.46 | .10 | 4.86 ± 0.35 | .07 | |
| I-7.5 Emphasize cooperative atmosphere | 4.87 ± 0.35 | .07 | 4.86 ± 0.352 | .07 | |
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| I-8 Humanistic Care | Overall | 4.88 ± 0.33 | .06 | 4.61 ± 0.59 | .13 |
| I-8.1 Protect patient privacy | 4.93 ± 0.26 | .05 | 4.86 ± 0.352 | .07 | |
| I-8.2 Respect patients' wishes, choose a suitable time for consultation as determined by the patient | 4.87 ± 0.35 | .07 | 4.80 ± 0.41 | .09 | |
| I-8.3 Throughout the process, care for and love the patient, able to timely detect patient discomfort | 4.87 ± 0.35 | .07 | 4.86 ± 0.35 | .07 | |
| I-8.4 Learn to think from others' perspectives, possess diverse nursing skills | 4.87 ± 0.35 | .07 | 4.66 ± 0.48 | .11 | |
| I-9 Overall Clinical Competence | Overall | 4.73 ± 0.45 | .09 | 4.65 ± 0.6 | .13 |
| I-9.1 Possess basic medical knowledge and cardiovascular disease knowledge | 4.8 ± 0.41 | .09 | 4.73 ± 0.45 | .10 | |
| I-9.2 Possess observation and assessment skills | 4.73 ± 0.46 | .10 | 4.66 ± 0.61 | .13 | |
| I-9.3 Possess specialized rescue and emergency response capabilities | 4.73 ± 0.46 | .10 | 4.60 ± 0.63 | .14 | |
| I-9.4 Possess certain specialized operational skills | 4.73 ± 0.46 | .10 | 4.60 ± 0.63 | .14 | |
| I-9.5 Possess certain assistance capabilities | 4.67 ± 0.49 | .10 | 4.46 ± 0.640 | .14 | |
| Additional Item I-9 | Possess the ability to solve and handle problems in a timely manner |
Table C
Results of the First Round of Expert Consultation (DOPs)
| I-10 Operation Preparation | Overall | 4.98 ± 0.06 | .01 | 4.98 ± 0.06 | 0.01 |
| I-10.1 Operator Preparation: Appearance and attire comply with standards | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-10.2 Item Preparation: Resuscitation cart, defibrillator, conductive gel, gauze | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-10.3 Environmental preparation: Spacious, bright, suitable for operation | 5 ±0 | 0 | 5 ± 0 | 0 | |
| I-10.4 Check defibrillator performance | 4.93 ± 0.26 | .05 | 4.93 ± 0.26 | 0.05 | |
| I-11 Operation Assessment | Overall | 4.97 ± 0.08 | .01 | 5 ± 0 | 0 |
| I-11.1 Assess operational environmental safety | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| I-11.2 Assess patient consciousness | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| I-11.3 Assess ECG monitoring waveform | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-11.4 Assess whether electrode pads are properly attached | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-11.5 Assess whether lead wires are properly connected | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-11.6 Assess whether there is any electrode interference | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-12 Pre-defibrillation Preparation | Overall | 4.89 ± 0.06 | .01 | 4.98 ± 0.04 | .01 |
| I-12.1 Call other medical staff | 4.73 ± 0.12 | .02 | 5 ± 0 | 0 | |
| I-12.2 Record resuscitation time | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-12.3 Defibrillator in the resuscitation cart is in place | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-12.4 Positioning for defibrillation, left arm extended | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-12.5 Move electrode pads to a non-defibrillation position | 5 ± 0 | 0 | 5 ± 0 | 0 | |
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| I-12.6 Check for skin moisture, wipe with gauze if necessary | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-12.7 Check if hair in the defibrillation area is too long | 4.8 ± 0.41 | .08 | 4.87 ± 0.35 | .07 | |
| I-12.8 Check if the patient has a pacemaker in the left clavicular area | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-13 Correct Implementation of Defibrillation | Overall | 4.98 ± 0.03 | .01 | 4.95 ± 0.1 | .02 |
| I-13.1 Correct positioning for defibrillation | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-13.2 Apply conductive gel evenly and correctly | 5 ± 0 | 0 | 4.87 ± 0.35 | .07 | |
| I-13.3 Defibrillation electrode pads are placed correctly | 5 ± 0 | 0 | 4.93 ± 0.26 | .05 | |
| I-13.4 Observe the ECG waveform again to confirm ventricular fibrillation | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-13.5 Are the electrode pads firmly attached to the patient's skin | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-13.6 Are the electrode pads vertically pressed with 4-11 kg of force | 4.87 ± 0.36 | .07 | 4.8 ± 0.41 | .08 | |
| I-13.7 Warn and confirm that others are away from the bed | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-13.8 Observe the ECG waveform and the patient's condition | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-13.9 Perform 5 cycles of CPR | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-13.10 Correctly evaluate the defibrillation effect | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-14 Post-operation Handling and Precautions | Overall | 4.87 ± 0.35 | .07 | 4.17 ± 0.27 | .06 |
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| I-14.1 Clean and assess the defibrillation site skin | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| I-14.2 Wipe the electrode pads and defibrillator | 4.87 ± 0.35 | .07 | 4.87 ± 0.52 | .10 | |
| I-14.3 Place the electrode pads correctly on the defibrillator | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| I-14.4 Defibrillator is charged and ready for use | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-14.5 Health education | 4.47 ± 1.06 | .23 | 4.6 ± 0.82 | .17 | |
| I-14.6 Hand hygiene is performed at the correct time | 4.67 ± 0.61 | .13 | 4.73 ± 0.6 | .12 | |
| I-14.7 Record correctly | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| I-15 Resuscitation Capability | Overall | 4.87 ± 0.35 | .07 | 4.87 ± 0.38 | .07 |
| I-15.1 Possess the ability to assess medical conditions | 4.93 ± 0.26 | .05 | 4.87 ± 0.35 | .07 | |
| I-15.2 The resuscitation process is orderly and calm | 4.93 ± 0.26 | .05 | 4.87 ± 0.35 | .07 | |
| I-15.3 Quick actions and proper positioning | 4.73 ± 0.45 | .09 | 4.73 ± 0.45 | .07 | |
| I-15.4 Observation and judgment of the patient's condition | 4.93 ± 0.26 | .05 | 4.87 ± 0.35 | .07 | |
| I-15.5 Use of emergency equipment and troubleshooting skills | 4.86 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
| I-15.6 Documentation and writing skills | 4.86 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
| I-15.7 Communication skills after resuscitation | 4.66 ± 0.48 | .10 | 4.67 ± 0.49 | .10 | |
| I-16 Critical Thinking Ability | Overall | 4.93 ± 0.26 | .05 | 4.66 ± 0.62 | .13 |
| I-16.1 Make independent and correct judgments and decisions | 5 ± 0 | 0 | 4.67 ± 0.49 | .10 | |
| I-16.2 Possess a rigorous and independent attitude and analytical ability | 4.93 ± 0.26 | .05 | 4.67 ± 0.49 | .10 | |
| I-16.3 Possess the ability to solve patient problems | 4.93 ± 0.26 | .05 | 4.67 ± 0.49 | .10 | |
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| I-16.4 Make rational judgments and correct choices through thinking and reasoning | 4.87 ± 0.35 | .07 | 4.67 ± 0.49 | .10 | |
| Additional Items | None | - | - | - | - |
Table D
Results of the First Round of Expert Consultation (CBD)
| I-17 Topic Selection with Specialized Features | Overall | 4.53 ± 0.74 | 0.16 | 4.88 ± 0.28 | .06 |
| I-17.1 Topic scope is heart disease or heart failure patients | 4.53 ± 0.74 | 0.16 | 4.73 ± 0.46 | .10 | |
| I-17.2 The topic is scientific | 4.87 ± 0.35 | 0.10 | 4.87 ± 0.35 | .10 | |
| I-17.3 Able to list epidemiological status related to the disease | 4.47 ± 0.92 | 0.20 | 4.93 ± 0.26 | .20 | |
| I-17.4 Reflect the significance of cardiac rehabilitation | 4.87 ± 0.35 | 0.10 | 5 ± 0 | 0 | |
| I-17.5 Clear objectives, novel content | 4.8 ± 0.41 | 0.09 | 4.87 ± 0.35 | .07 | |
| I-18 Comprehensive Medical History Introduction | Overall | 4.87 ± 0.35 | 0.07 | 4.96 ± 0.14 | .03 |
| I-18.1 Comprehensive introduction, highlighting key points | 4.87 ± 0.35 | 0.07 | 5 ± 0 | 0 | |
| I-18.2 Use of standard terminology, clear and organized | 4.87 ± 0.52 | 0.10 | 5 ± 0 | 0 | |
| I-18.3 Clearly describe chief complaints, current medical history, past medical history, auxiliary examinations, etc. | 4.99 ± 0.05 | 0.01 | 5 ± 0 | 0 | |
| I-18.4 Reflect the entire treatment process and disease progression of the patient | 4.87 ± 0.35 | 0.07 | 4.93 ± 0.26 | .05 | |
| I-18.5 No omissions in positive laboratory indicators and physical signs | 4.7 ± 0.59 | 0.12 | 4.93 ± 0.26 | .05 | |
| I-18.6 Reflect the trend of treatment for positive results | 4.8 ± 0.41 | 0.09 | 4.87 ± 0.35 | .07 | |
| I-19 Comprehensive Risk Factor Assessment | Overall | 4.93 ± 0.26 | 0.20 | 4.95 ± 0.17 | .03 |
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| I-19.1 Assessment is comprehensive, no omissions | 4.85 ± 0.35 | .07 | 4.93 ± 0.26 | .05 | |
| I-19.2 Assessment is professional, using specialized terminology | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| I-19.3 Assessment demonstrates continuity | 4.87 ± 0.35 | .07 | 5 ± 0 | 0 | |
| I-19.4 Identify patient issues through assessment | 4.93 ± 0.26 | .05 | 4.93 ± 0.26 | .05 | |
| I-19.5 Assess whether smoking cessation patients are at risk of relapse | 4.67 ± 0.49 | .10 | 4.87 ± 0.35 | .07 | |
| I-20 Highlight Key Nursing Points and Difficulties | Overall | 4.8 ± 0.41 | .09 | 4.81 ± 0.38 | .08 |
| I-20.1 Correctly distinguish between nursing difficulties and priorities | 4.8 ± 0.41 | .09 | 4.73 ± 0.46 | .10 | |
| I-20.2 Nursing issues are supported by diagnostic evidence | 4.93 ± 0.26 | .05 | 4.87 ± 0.35 | .07 | |
| I-20.3 Whether combined with medical records and five major treatments | 4.8 ± 0.41 | .09 | 4.73 ± 0.46 | .10 | |
| I-20.4 Nursing priorities are issues existing in the patient's disease progression | 4.93 ± 0.26 | .05 | 4.93 ± 0.26 | .05 | |
| I-20.5 Whether clearly identify behaviors that patients need to change but are difficult to change | 4.93 ± 0.26 | .05 | 4.87 ± 0.35 | .07 | |
| I-20.6 Clearly identify comorbidities and complications | 4.6 ± 0.63 | .13 | 4.73 ± 0.46 | .10 | |
| I-21 Comprehensive Assessment of Inpatient Rehabilitation Five Prescriptions | Overall | 4.73 ± 0.46 | .10 | 4.79 ± 0.44 | .09 |
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| I-21.1 Assess intervention content based on the patient's current condition | 4.87 ± 0.35 | .07 | 4.93 ± 0.26 | .05 | |
| I-21.2 Detailed assessment content, no omissions | 4.8 ± 0.41 | .09 | 4.93 ± 0.26 | .05 | |
| I-21.3 Correct use of assessment scales | 4.93 ± 0.26 | .05 | 4.93 ± 0.26 | .05 | |
| I-21.4 Correct calculation method and scoring for SF-36 | 4.53 ± 0.74 | .16 | 4.73 ± 0.59 | .13 | |
| I-21.5 Patients can accurately recall past situations and record them precisely | 4.6 ± 0.51 | .11 | 4.6 ± 0.63 | .14 | |
| I-21.6 For patients at high risk for anxiety and depression, guide them to express their true feelings correctly | 4.6 ± 0.63 | .14 | 4.6 ± 0.63 | .14 | |
| I-22 Inpatient Rehabilitation Prescription Objectives | Overall | 4.87 ± 0.35 | .10 | 4.88 ± 0.33 | .07 |
| I-22.1 Use of assessment tools, setting goals reasonably | 4.87 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
| I-22.2 Whether combined with evidence-based information | 4.87 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
| I-22.3 Whether the goals are feasible | 4.87 ± 0.35 | .07 | 4.93 ± 0.26 | .05 | |
| I-22.4 Setting goals that are easy for patients to implement | 4.93 ± 0.26 | .05 | 4.93 ± 0.26 | .05 | |
| I-22.5 Whether set in collaboration with patients to increase their motivation | 4.8 ± 0.41 | .09 | 4.8 ± 0.41 | .09 | |
| I-23 Inpatient Rehabilitation Prescription Development | Overall | 4.67 ± 1.04 | .22 | 4.85 ± 0.46 | .09 |
| I-23 Inpatient Rehabilitation Prescription Development | I-23.1 Prescription development is based on prescription objectives | 4.87 ± 0.35 | .07 | 4.8 ± 0.41 | .09 |
| I-23.2 Need to combine with patients' habits | 4.87 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
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| I-23.3 When developing exercise prescriptions, are various data calculations accurate | 4.87 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
| I-23.4 Are all measures practical and feasible for patients | 4.93 ± 0.26 | .05 | 4.8 ± 0.41 | .09 | |
| I-23.5 Whether the dietary prescription's calorie conversion is correct | 4.87 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
| I-23.6 Whether the dietary prescription for obese patients shows a gradual decrease in calories | 4.87 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
| I-23.7 Whether the prescription development measures are comprehensive | 4.73 ± 0.46 | .09 | 4.67 ± 0.62 | .13 | |
| I-24 Inpatient Rehabilitation Prescription Implementation | Overall | 4.67 ± 0.62 | .02 | 4.71 ± 0.53 | .11 |
| I-24.1 Supervise the patient's implementation effectiveness | 4.93 ± 0.26 | .05 | 4.54 ± 0.64 | .14 | |
| I-24.2 Teach patients how to monitor during exercise | 4.8 ± 0.56 | .11 | 4.8 ± 0.41 | .09 | |
| I-24.3 Teach patients the appropriate timing to stop exercising | 4.87 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
| I-24.4 Teach patients dietary substitution methods in the prescription | 4.87 ± 0.35 | .07 | 4.8 ± 0.41 | .09 | |
| I-24.5 Teach patients the principles of prescription development | 4.67 ± 0.49 | .10 | 4.53 ± 0.83 | .18 | |
| I-25 Personalization of Inpatient Prescriptions | Overall | 4.87 ± 0.35 | .07 | 4.87 ± 0.34 | .07 |
| 1-25.1 Prescriptions are based on the patient's disease itself | 4.93 ± 0.26 | .05 | 4.87 ± 0.35 | .07 | |
| 1-25.2 Patients need improvement and benefit from it | 4.87 ± 0.35 | .07 | 4.93 ± 0.26 | .05 | |
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| 1-25.3 When evaluating patients' psychological issues, use critical thinking | 4.73 ± 0.46 | .09 | 4.84 ± 0.41 | .09 | |
| I-26 Deep Impressions from Experience | Overall | 4.93 ± 0.26 | .20 | 4.9 ± 0.32 | .06 |
| I-26.1 Clarify viewpoints, sufficient evidence | 4.87 ± 0.35 | .07 | 4.93 ± 0.26 | .05 | |
| I-26.2 Whether the prescription formulated in response to issues in the case | 4.87 ± 0.35 | .07 | 4.93 ± 0.26 | .05 | |
| I-26.3 Gains made during the completion of the case | 4.73 ± 0.46 | .09 | 4.93 ± 0.26 | .05 | |
| I-26.4 Whether it promotes the resolution of medical and nursing issues | 4.73 ± 0.46 | .09 | 4.93 ± 0.26 | .05 | |
| I-26.5 Whether it demonstrates multi-team collaboration and meets patient needs | 4.87 ± 0.35 | .07 | 4.87 ± 0.35 | .07 | |
| I-26.6 Insights and future development directions gained from completing a case | 4.87 ± 0.26 | .05 | 4.84 ± 0.56 | .12 | |
| I-27 Critical Thinking Ability | Overall | 4.73 ± 0.46 | .10 | 4.8 ± 0.61 | .12 |
| I-27.1 Ability to flexibly use existing knowledge and experience | 4.93 ± 0.26 | .05 | 4.93 ± 0.26 | .07 | |
| I-27.2 Ability to make choices regarding problems and solutions | 4.67 ± 1.05 | .20 | 4.67 ± 0.62 | .22 | |
| I-27.3 Ability to think critically, make rational judgments, and correct choices | 4.87 ± 0.35 | .07 | 4.8 ± 0.56 | .12 | |
| I-27.4 Ability to value one's own judgment and critical thinking skills, and take appropriate nursing actions | 4.93 ± 0.26 | .05 | 4.8 ± 0.56 | .21 |
Round 2 (Tables E–G, available in the online version of this article). In Round 2, experts re-rated the revised items, achieving improved consensus. Mean importance scores remained high (> 3.5) with significantly reduced variability (CV < 0.20), reflecting greater expert alignment. Kendall's W values indicated substantial overall consensus (W = 0.78, p < .001), with similarly high domain-specific agreement (Mini-CEX, W = 0.80; DOPS, W = 0.70; CBD, W = 0.65; all p < .05). The expert authority coefficient (Cr = 0.94) further confirmed reliability of the consensus. No additional major revisions were recommended. Thus, the Delphi process successfully established a consensus-based evaluation model comprising four assessment components aligned with Miller's Pyramid, including 35 evaluation items and 105 sub-item criteria. The finalized evaluation framework structure is depicted in Figure 1.
Table E
Results of the Second Round of Expert Consultation (Mini-CEX)
| I-1 Interviewing Skills | Overall | 5.0 ± 0 | 0 | 4.98 ± 0.05 | .01 |
| II-1.1 Introduce oneself to the patient | 4.92 ± 0.17 | 0.03 | 5.00 ± 0.00 | 0 | |
| II-1.2 Explain the purpose of the consultation | 5 ± 0 | 0 | 4.86 ± 0.35 | .07 | |
| II-1.3 Encourage patients to express their feelings | 4.85 ± 0.36 | 0.74 | 4.78 ± 0.58 | .12 | |
| II-1.4 Appropriately guide the patient when off-topic | 4.85 ± 0.36 | 0.74 | 4.70 ± 0.46 | .10 | |
| I-2 Professional Attitude | Overall | 4.91 ± 0.26 | 0.05 | 4.91 ± 0.27 | .55 |
| II-2.1 Be serious and meticulous in the consultation | 4.93 ± 0.26 | 0.07 | 4.78 ± 0.58 | .12 | |
| II-2.2 Respect and revere life | 4.93 ± 0.26 | 0.05 | 4.84 ± 0.36 | .18 | |
| II-2.3 Have an inquisitive spirit | 4.78 ± 0.42 | 0.09 | 4.6 ± 0.63 | .14 | |
| II-2.4 Possess professional qualities and empathy | 5 ± 0 | 0 | 4.7 ± 0.46 | .10 | |
| I-3 Nursing Assessment | Overall | 4.92 ± 0.27 | 0.05 | 4.92 ± 0.27 | .05 |
| II-3.1 Collect complete and accurate information | 5 ± 0 | 0 | 4.85 ± 0.36 | .74 | |
| II-3.2 Comprehensive nursing assessment, no omissions | 5 ± 0 | 0 | 4.78 ± 0.58 | .12 | |
| II-3.3 Assessment technique is accurate and gentle, causing no discomfort or pain to the patient | 4.93 ± 0.26 | 0.05 | 4.68 ± 0.6 | .13 | |
| I-4 Nursing Plan | Overall | 4.92 ± 0.27 | 0.05 | 5 ± 0 | 0 |
| II-4.1 Comprehensive understanding of the patient's condition | 5 ± 0 | 0 | 4.92 ± 0.27 | .05 | |
| II-4.2 Prioritize nursing diagnoses in order | 4.93 ± 0.26 | 0.05 | 4.91 ± 0.26 | .05 | |
| II-4.3 List nursing measures with evidence-based support | 4.85 ± 0.36 | 0.74 | 4.86 ± 0.35 | .07 | |
| I-5 Health Education | Overall | 4.87 ± 0.28 | 0.57 | 4.74 ± 0.36 | .01 |
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| II-5.1 Inform patients of methods to manage risk factors through assessment | 5 ± 0 | 0 | 4.77 ± 0.42 | .09 | |
| II-5.2 Inform patients of medication timing, pharmacological effects, and precautions | 5 ± 0 | 0 | 4.89 ± 0.29 | .06 | |
| II-5.3 Inform patients of the significance and precautions of various examinations | 5 ± 0 | 0 | 4.91 ± 0.27 | .06 | |
| II-5.4 Provide personalized health education for issues identified during consultation | 4.93 ± 0.26 | 0.05 | 4.82 ± 0.37 | .08 | |
| II-5.5 Health education is easy to understand, and patients can master it proficiently | 5 ± 0 | 0 | 4.91 ± 0.28 | .05 | |
| I-6 Communication Skills | Overall | 4.86 ± 0.29 | 0.01 | 4.76 ± 0.3 | .06 |
| II-6.1 Understand patient feelings, encourage patients to express their troubles | 4.8 ± 0.41 | 0.09 | 4.7 ± 0.46 | .10 | |
| II-6.2 Have empathy, master questioning and interactive skills | 4.87 ± 0.35 | 0.07 | 4.8 ± 0.37 | .08 | |
| II-6.3 Provide correct answers to patients' questions, gain their trust | 4.8 ± 0.41 | 0.09 | 4.89 ± 0.29 | .06 | |
| I-7 Organizational Effectiveness | Overall | 4.77 ± 0.37 | 0.08 | 4.62 ± 0.4 | .09 |
| II-7.1 Mastery of consultation knowledge and consultation efficiency | 4.98 ± 0.53 | 0.11 | 4.84 ± 0.36 | .18 | |
| II-7.2 Clear objectives | 4.98 ± 0.53 | 0.11 | 4.84 ± 0.36 | .18 | |
| II-7.3 Clear organization, smooth information flow | 4.91 ± 0.26 | 0.05 | 4.82 ± 0.37 | .08 | |
| I-8 Humanistic Care | Overall | 4.93 ± 0.13 | 0.26 | 4.81 ± 0.37 | .08 |
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| II-8.1 Protect patient privacy | 4.93 ± 0.26 | 0.05 | 4.86 ± 0.36 | .07 | |
| II-8.2 Respect patient wishes, choose a suitable time for consultation | 4.907 ± 0.27 | 0.06 | 4.9 ± 0.28 | .06 | |
| II-8.3 Care and love for patients, able to timely detect patient discomfort | 4.97 ± 0.106 | 0.02 | 4.78 ± 0.43 | .09 | |
| II-8.4 Think from the patient's perspective, possess diverse nursing skills | 4.86 ± 0.36 | 0.07 | 4.84 ± 0.36 | .18 | |
| I-9 Overall Clinical Competence | Overall | 4.73 ± 0.45 | 0.09 | 4.72 ± 0.41 | .09 |
| II-9.1 Possess medical and cardiovascular disease basic knowledge | 4.86 ± 0.35 | 0.07 | 4.84 ± 0.36 | .18 | |
| II-9.2 Possess observation and assessment ability | 4.78 ± 0.58 | 0.12 | 4.84 ± 0.36 | .18 | |
| II-9.3 Possess specialized rescue and emergency response capability | 4.93 ± 0.27 | 0.06 | 4.77 ± 0.42 | .09 | |
| II-9.4 Possess specialized operational skills | 4.93 ± 0.09 | 0.09 | 4.84 ± 0.36 | .18 | |
| II-9.5 Possess collaborative ability | 4.84 ± 0.36 | 0.07 | 4.84 ± 0.36 | .02 | |
| II-9.6 Possess the ability to solve and handle problems in a timely manner | 5 ± 0 | 0 | 4.96 ± 0.13 | .03 |
Table F
Results of the Second Round of Expert Consultation (DOPs)
| I-10 Operation Preparation | Overall | 4.8 ± 0.8 | .55 | 4.80 ± 0.41 | .09 |
| II-10.1 Operator preparation: Appearance and attire comply with standards | 4.8 ± 0.8 | .17 | 4.86 ± 0.53 | .11 | |
| II-10.2 Item preparation: Resuscitation cart, defibrillator, conductive gel, gauze | 4.93 ± 0.27 | .27 | 4.86 ± 0.36 | .07 | |
| II-10.3 Environmental preparation: Spacious and bright, suitable for operation | 4.79 ± 0.58 | .12 | 4.86 ± 0.53 | .11 | |
| II-10.4 Check defibrillator performance | 5 ± 0 | 0 | 4.93 ± 0.27 | .27 | |
| I-11 Operation Assessment | Overall | 4.93 ± 0.27 | .55 | 4.86 ± 0.35 | .07 |
| II-11.1 Assess operational environment safety | 4.86 ± 0.36 | .11 | 4.93 ± 0.27 | .27 | |
| II-11.2 Assess patient consciousness | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| II-11.3 Assess ECG monitoring waveform | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| II-11.4 Assess whether electrode pads are properly attached | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| II-11.5 Assess whether lead wires are properly connected | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| II-11.6 Assess whether there is any electrode interference | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| I-12 Pre-defibrillation Preparation | Overall | 5 ± 0 | 0 | 4.86 ± 0.35 | .07 |
| II-12.1 Call other medical staff | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| II-12.2 Record resuscitation time | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| II-12.3 Defibrillator in the resuscitation cart is in place | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| II-12.4 Position the defibrillation body position, left arm extended | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
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| II-12.5 Move the electrode pads to a non-defibrillation position | 4.86 ± 0.36 | .11 | 5 ± 0 | 0 | |
| II-12.6 Check for skin moisture, wipe with gauze if necessary | 4.93 ± 0.26 | .05 | 5 ± 0 | .30 | |
| II-12.7 Check if hair in the defibrillation area is too long | 4.86 ± 0.36 | .11 | 5 ± 0 | 0 | |
| II-12.8 Check if the patient has a pacemaker in the left clavicular area | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| I-13 Correct Implementation of Defibrillation | Overall | 5 ± 0 | 0 | 4.86 ± 0.352 | .07 |
| II-13.1 Correctly position the defibrillation body position | 5 ± 0 | 0 | 4.93 ± 0.27 | .27 | |
| II-13.2 Correctly apply conductive gel | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| II-13.3 Place the defibrillation electrode pads correctly | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| II-13.4 Observe the ECG waveform again to confirm ventricular fibrillation | 5 ± 0 | 0 | 4.93 ± 0.27 | .27 | |
| II-13.5 Whether the electrode pads are firmly attached to the patient's skin | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| II-13.6 Ensure electrode pads are vertically pressed | 4.93 ± 0.05 | .05 | 5 ± 0 | 0 | |
| II-13.7 Remind and confirm that others are away from the bed | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| II-13.8 Observe ECG waveform and patient's condition | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| II-13.9 Perform 5 cycles of CPR | 4.86 ± 0.36 | .11 | 5 ± 0 | 0 | |
| II-13.10 Correctly evaluate the defibrillation effect | 5 ± 0 | 0 | 5 ± 0 | 0 | |
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| I-14 Post-operation Handling and Precautions | Overall | 5 ± 0 | 0 | 4.80 ± 0.41 | .09 |
| II-14.1 Clean and assess the defibrillation site skin | 4.93 ± 0.26 | .05 | 5 ± 0 | 0 | |
| II-14.2 Wipe the electrode pads and defibrillator | 5 ± 0 | 0 | 4.86 ± 0.53 | .11 | |
| II-14.3 Place the electrode pads correctly on the defibrillator | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| II-14.4 Charge the defibrillator in standby mode | 4.93 ± 0.27 | .27 | 5 ± 0 | 0 | |
| II-14.5 Health education | 4.86 ± 0.36 | .07 | 4.75 ± 0.43 | .09 | |
| I-15 Resuscitation Capability | Overall | 4.93 ± 0.27 | .55 | 4.86 ± 0.35 | .07 |
| II-15.1 Possess condition assessment capability | 4.93 ± 0.27 | .27 | 4.88 ± 0.31 | .06 | |
| II-15.2 Rescue process is orderly and calm | 4.86 ± 0.36 | .07 | 4.86 ± 0.35 | .07 | |
| II-15.4 Observation and judgment of medical conditions | 4.93 ± 0.27 | .27 | 4.75 ± 0.43 | .90 | |
| II-15.5 Use and troubleshooting of emergency equipment | 5 ± 0 | 0 | 4.82 ± 0.37 | .77 | |
| II-15.6 Documentation and writing skills | 4.93 ± 0.27 | .27 | 4.82 ± 0.37 | .77 | |
| II-15.1 Possess condition assessment capability | 4.93 ± 0.27 | .27 | 4.88 ± 0.31 | .06 | |
| I-16 Critical Thinking Ability | Overall | 4.93 ± 0.26 | .05 | 4.66 ± 0.62 | .13 |
| II-16.1 Make independent and correct judgments and decisions | 4.93 ± 0.27 | .27 | 4.82 ± 0.37 | .77 | |
| II-16.2 Possess rigorous and independent attitude and analytical ability | 4.93 ± 0.27 | .27 | 4.82 ± 0.37 | .77 |
Table G
Results of the Second Round of Expert Consultation (CBD)
| I-17 Topic Selection with Specialized Features | Overall | 5 ± 0 | 0 | 4.9 ± 0.07 | .01 |
| I-17.1 Topic scope is heart disease or heart failure patients | 4.53 ± 0.74 | .16 | 4.73 ± 0.46 | .10 | |
| I-17.2 The topic is scientific | 4.87 ± 0.35 | .10 | 4.87 ± 0.35 | .10 | |
| I-17.3 Able to list epidemiological status related to the disease | 4.47 ± 0.92 | .20 | 4.93 ± 0.26 | .20 | |
| I-17.4 Reflect the significance of cardiac rehabilitation | 4.87 ± 0.35 | .10 | 5 ± 0 | 0 | |
| I-17.5 Clear objectives, novel content | 4.8 ± 0.41 | .09 | 4.87 ± 0.35 | .07 | |
| I-18 Comprehensive Medical History Introduction | Overall | 4.93 ± 0.26 | .05 | 4.9 ± 0.07 | .01 |
| I-18.1 Comprehensive introduction, highlighting key points | 4.87 ± 0.35 | .07 | 5 ± 0 | 0 | |
| I-18.2 Use of standard terminology, clear and organized | 4.87 ± 0.52 | .10 | 5 ± 0 | 0 | |
| I-18.3 Clearly describe chief complaints, current medical history, past medical history, auxiliary examinations, etc. | 4.99 ± 0.05 | .01 | 5 ± 0 | 0 | |
| I-18.4 Reflect the entire treatment process and disease progression of the patient | 4.87 ± 0.35 | .07 | 4.93 ± 0.26 | .05 | |
| I-18.5 No omissions in positive laboratory indicators and physical signs | 4.7 ± 0.59 | .12 | 4.93 ± 0.26 | .05 | |
| I-18.6 Reflect the trend of treatment for positive results | 4.8 ± 0.41 | .09 | 4.87 ± 0.35 | .07 | |
| II-19 Medical History Introduction | 5 ± 0 | 0 | 4.9 ± 0.07 | .01 | |
| II-19.1 Content is comprehensive, highlights key points | 4.86 ± 0.36 | .07 | 4.96 ± 0.035 | .01 | |
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| II-19.2 Use of standard terminology, clear and organized | 4.86 ± 0.36 | .07 | 4.9 ± 0.07 | .01 | |
| II-20 Risk Factor Assessment | 5 ± 0 | 0 | 5 ± 0 | 0 | |
| II-20.1 Assessment content is comprehensive | 4.93 ± 0.26 | .05 | 4.9 ± 0.07 | .01 | |
| II-20.2 Assessment has professional quality | 4.93 ± 0.26 | .05 | 4.9 ± 0.07 | .01 | |
| II-20.3 Assessment reflects continuity | 5 ± 0 | 0 | 4.98 ± 0.014 | 0 | |
| II-20.4 Through assessment, identify existing issues | 5 ± 0 | 0 | 4.84 ± 0.14 | .03 | |
| II-21 Key Nursing Points and Difficulties Highlighted | 5 ± 0 | 0 | 4.9 ± 0.07 | .01 | |
| II-21.1 Correctly distinguish nursing difficulties and key points | 4.93 ± 0.26 | .05 | 4.77 ± 0.11 | .02 | |
| II-21.2 Nursing issues raised have diagnostic support | 4.86 ± 0.36 | .07 | 4.9 ± 0.07 | .01 | |
| II-22.1 Assessment content is comprehensive and detailed | 4.86 ± 0.36 | .07 | 4.84 ± 0.14 | .03 | |
| I-22 Inpatient Rehabilitation Prescription Objectives | Overall | 4.87 ± 0.35 | .10 | 4.88 ± 0.33 | .07 |
| II-22.2 Correct use of assessment scales | 4.86 ± 0.36 | .07 | 4.77 ± 0.11 | .02 | |
| II-22.3 Correctly identify existing issues | 4.93 ± 0.26 | .05 | 4.89 ± 0.07 | .01 | |
| II-22.4 Formulating Prescriptions Based on Reliable Data, Strong Operability | 4.93 ± 0.26 | .05 | 4.84 ± 0.096 | .02 | |
| II-22.5 Health Education is Feasible | 4.93 ± 0.26 | .05 | 4.77 ± 0.11 | .02 | |
| II-22.2 Correct use of assessment scales | 4.86 ± 0.36 | .07 | 4.77 ± 0.11 | .02 | |
| I-23 Discharge Follow-up | Overall | 4.86 ± 0.36 | .07 | 4.9 ± 0.07 | .01 |
| II-23.1 Complete Follow-up Medical Records | 5 ± 0 | 0 | 4.89 ± 0.07 | .01 | |
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| II-23.2 Adjust Prescriptions Dynamically Based on Existing Problems | 4.92 ± 0.27 | .05 | 4.77 ± 0.11 | .02 | |
| II-23.3 Detailed Measures, Highlighting Specialized Features | 4.93 ± 0.26 | .05 | 4.84 ± 0.096 | .02 | |
| I-24 Outcome Evaluation | Overall | 4.93 ± 0.26 | .05 | 4.64 ± 0.13 | .03 |
| II-24.4 Objective Evaluation of Implementation Effects | 4.93 ± 0.26 | .05 | 4.64 ± 0.13 | .03 | |
| II-25 Experience Sharing | Overall | 4.93 ± 0.26 | .05 | 4.9 ± 0.07 | .01 |
| II-25.1 Clearly State Opinions, Sufficient Evidence | 4.86 ± 0.36 | .07 | 4.9 ± 0.07 | .01 | |
| II-25.2 Gains from the Case Process | 4.86 ± 0.36 | .07 | 4.9 ± 0.07 | .01 | |
| II-25.3 Experience and Suggestions, Deep Impression | 4.93 ± 0.26 | .05 | 4.9 ± 0.07 | .01 | |
| II-25.4 Evidence Support | 4.93 ± 0.26 | .05 | 4.9 ± 0.07 | .01 | |
| II-26 Critical Thinking Ability | Overall | 4.91 ± 0.27 | .05 | 4.3 ± 0.1 | .02 |
| II-26.1 Ability to Flexibly Apply Specialized Knowledge | 4.86 ± 0.36 | .07 | 4.9 ± 0.07 | .01 | |
| II-26.2 Ability to Assess Existing Problems | 4.86 ± 0.36 | .07 | 4.9 ± 0.07 | .01 | |
| II-26.3 Ability to Reason, Make Rational Judgments, and Correct Choices Through Thinking | 4.86 ± 0.36 | .07 | 4.77 ± 0.11 | .02 | |
| II-26.4 Ability to Take Appropriate Nursing Measures | 5 ± 0 | 0 | 4.9 ± 0.07 | .01 |
Figure 1. - Construction process of training evaluation model for Workplace-Based Assessment (WPBA) cardiovascular specialist nurses. CBD, Case-Based Discussion; DOPS, Direct Observation of Procedural Skills; Mini-CEX, Mini-Clinical Evaluation Exercise.
Final Evaluation of the Model Structure
The cardiovascular specialist nurse training evaluation model integrates four assessment components aligned with Miller's Pyramid to comprehensively assess trainee competencies.
Theoretical Knowledge Assessment. This foundational (“knows”) component consists of a written assessment covering essential cardiovascular nursing knowledge, including cardiac pathophysiology, emergency management, pharmacology, and national clinical guidelines. Expert consensus emphasized this as crucial but descriptive, without numerical ratings.
Mini-CEX (Table H, available in the online version of this article). The Mini-CEX evaluates real clinical practice (“does”), comprising nine nursing-specific domains: interviewing skills, professional attitude, nursing assessment, care planning, health education, communication, organizational efficiency, humanistic care, and overall clinical competence. Each domain includes explicit evaluation criteria (35 in total) for observable behaviors, adapted from traditional Mini-CEX frameworks by focusing specifically on nursing roles and removing physician-centric items.
Table H
Mini-CEX Evaluation Form
| Assessment Focus | □Data Collection | □Nursing Assessment | □Nursing Plan | □Health Education | □Communication Skills | □Humanistic Care | □Other | |
| 1. Interviewing Skills | ||||||||||
| 2. Professional Attitude | ||||||||||
| 3. Nursing Assessment | ||||||||||
| 4. Nursing Plan | ||||||||||
| 5. Health Education | ||||||||||
| 6. Communication Skills | ||||||||||
| 7. Organizational Effectiveness | ||||||||||
| 8. Humanistic Care | ||||||||||
| 9. Overall Clinical Competence |
DOPS (Table I, available in the online version of this article). The DOPS component assesses practical clinical skills (“shows how/does”). It includes seven cardiovascular nursing procedures (e.g., cardiac examinations, defibrillation, intravenous medication management, emergency response), each subdivided into clearly defined steps (40 checkpoints). This structure ensures consistent evaluation and detailed feedback on trainees' procedural performance.
Table I
DOPS Operation Scoring Form
| Assessment Focus | □Data Collection | □Nursing Assessment | □Nursing Plan | □Health Education | □Communication Skills | □Humanistic Care | □Other | |
| 1. Preparation of Procedure | ||||||||||
| 2. Procedure Evaluation | ||||||||||
| 3. Pre-resuscitation Preparation | ||||||||||
| 4. Correct Implementation of Resuscitation | ||||||||||
| 5. Post-procedure Handling and Precautions | ||||||||||
| 6. Resuscitation Ability | ||||||||||
| 7. Critical Thinking Ability |
CBD (Table J, available in the online version of this article). The CBD assesses clinical reasoning and knowledge application (“knows how”) through in-depth discussions of real patient cases. Nine evaluation items (with 30 detailed sub-items) address case presentation quality, patient-problem identification, rationale for clinical decisions, interpretation of diagnostic findings, multidisciplinary collaboration, and reflection. Expert input refined this section, emphasizing diverse cardiac conditions and standardized evaluation rubrics.
Table J
CBD Case Evaluation Form
| Assessment Focus | □Data Collection | □Nursing Assessment | □Nursing Plan | □Health Education | □Communication Skills | □Humanistic Care | □Other | |
| 1. Topic Selection | ||||||||||
| 2. Introduction | ||||||||||
| 3. Medical History Introduction | ||||||||||
| 4. Risk Factor Assessment | ||||||||||
| 5. Nursing Key Points and Challenges | ||||||||||
| 6. Inpatient Rehabilitation Prescription | ||||||||||
| 7. Discharge Follow-up | ||||||||||
| 8. Outcome Evaluation | ||||||||||
| 9. Experience Summary | ||||||||||
| 10. Critical Thinking Ability |
The Round 2 Delphi consensus demonstrated strong agreement across components, with Kendall's W values ranging from 0.55 to 0.92 for importance ratings and 0.133 to 0.979 for feasibility ratings (Tables 1–3). Figure 1 summarizes the final model structure and development process clearly and succinctly.
Table 1
Significance Analysis of Expert Opinion Consensus (MINI-CEX)
| 1 | Evaluation item | .95 | 54.10 | .121 | 0.10 | 11.68 | .166 |
| Evaluation criteria | .88 | 63.30 | .072 | 0.12 | 89.15 | < .001 | |
| 2 | Evaluation item | .92 | 32.65 | < .001 | 0.16 | 18.95 | .015 |
| Evaluation criteria | .93 | 74.10 | .022 | 0.11 | 67.66 | .010 |
Note. The degree of coordination among experts was quantified by Kendall's W.
The expert authority coefficient (Cr) was calculated using the formula Cr = (Ca + Cs)/2, where Ca is the experts' average self-assessed familiarity with the content and Cs is the average judgment basis score (reflecting how informed their judgments were by theory, practical experience, or literature).
Abbreviation: Mini-CEX = Mini-Clinical Evaluation Exercise.
p < .05 for Kendall's W was considered statistically significant, indicating non-random agreement.
Table 2
Significance Analysis of Expert Opinion Coordination Degree (DOPS)
| 1 | Evaluation item | .84 | 7.09 | .313 | .98 | 8.77 | .187 |
| Evaluation criteria | .55 | 36.98 | .070 | .13 | 77.91 | .002 | |
| 2 | Evaluation item | .61 | 14.47 | .025 | .15 | 85.15 | < .001 |
| Evaluation criteria | .73 | 116.61 | < .001 | .19 | 124.90 | < .001 |
Note. The degree of coordination among experts was quantified by Kendall's W.
The expert authority coefficient (Cr) was calculated using the formula Cr = (Ca + Cs)/2, where Ca is the experts' average self-assessed familiarity with the content and Cs is the average judgment basis score (reflecting how informed their judgments were by theory, practical experience, or literature).
Abbreviation: DOPS = Direct Observation of Procedural Skills.
p < .05 for Kendall's W was considered statistically significant, indicating non-random agreement.
Table 3
Significance Analysis of Expert Opinion Coordination Degree (CBD)
| 1 | Evaluation item | .72 | 9.66 | .379 | .73 | 9.18 | .421 |
| Evaluation criteria | .84 | 71.63 | .092 | .97 | 83.29 | .013 | |
| 2 | Evaluation item | .71 | 9.01 | .043 | .13 | 17.34 | .027 |
| Evaluation criteria | .77 | 23.79 | .013 | .84 | 71.63 | .009 |
Note. The degree of coordination among experts was quantified by Kendall's W.
The expert authority coefficient (Cr) was calculated using the formula Cr = (Ca + Cs)/2, where Ca is the experts' average self-assessed familiarity with the content and Cs is the average judgment basis score (reflecting how informed their judgments were by theory, practical experience, or literature).
Abbreviation: CBD = Case-Based Discussion.
p < .05 for Kendall's W was considered statistically significant, indicating non-random agreement.
Pilot and Main Study
In the pilot study, 20 trainees completed Mini-CEX, DOPS, and CBD assessments. Trainees generally met expectations, scoring higher in professionalism and communication but lower in physical examination and technical skills. Evaluator feedback indicated good feasibility and practicality, leading to minor wording adjustments before the main study (Table 4).
Table 4
Summary of Competency Assessment Results from the Pilot and Main Studies
| Mini-CEX | Interviewing skills | 6.2 ± 0.9 | 6.1 ± 1.0 | 7.0 ± 0.9 | .012 |
| Professional attitude | 6.8 ± 0.7 | 6.6 ± 0.7 | 7.5 ± 0.6 | .004 | |
| Nursing assessment | 6.4 ± 1.0 | 6.2 ± 0.7 | 7.1 ± 0.8 | < .001 | |
| Nursing plan | 6.0 ± 1.1 | 5.9 ± 1.1 | 6.8 ± 0.8 | .009 | |
| Health education | 6.3 ± 0.8 | 6.1 ± 0.7 | 7.1 ± 0.9 | .002 | |
| Communication skills | 7.2 ± 0.6 | 7.0 ± 0.8 | 7.6 ± 0.5 | .031 | |
| Organizational effectiveness | 5.8 ± 1.3 | 5.5 ± 1.3 | 6.4 ± 1.1 | .018 | |
| Humanistic care | 6.4 ± 0.9 | 6.2 ± 0.9 | 7.1 ± 0.8 | < .001 | |
| Overall clinical competence | 6.4 ± 0.9 | 6.2 ± 0.8 | 7.2 ± 0.8 | .001 | |
| DOPS | Preparation of procedure | 6.7 ± 0.6 | 6.5 ± 0.7 | 7.4 ± 0.7 | < .001 |
| Procedure evaluation | 6.5 ± 1.0 | 6.2 ± 0.9 | 7.2 ± 0.9 | .001 | |
| Pre-resuscitation preparation | 6.4 ± 0.7 | 6.2 ± 0.8 | 7.1 ± 0.8 | < .001 | |
| Correct implementation of resuscitation | 6.3 ± 0.8 | 6.1 ± 0.7 | 7.2 ± 0.8 | < .001 | |
| Post-procedure handling and precautions | 6.7 ± 0.7 | 6.5 ± 0.5 | 7.4 ± 0.7 | < .001 | |
| Resuscitation ability | 6.4 ± 0.8 | 6.1 ± 0.7 | 7.2 ± 0.7 | .002 | |
| Critical thinking ability | 5.8 ± 1.3 | 5.6 ± 1.2 | 6.4 ± 1.1 | .097 | |
| CBD | Topic selection | 6.4 ± 0.8 | 6.1 ± 0.9 | 7.3 ± 0.9 | < .001 |
| Introduction | 6.7 ± 0.6 | 6.5 ± 0.7 | 7.4 ± 0.8 | .047 | |
| Medical history introduction | 6.5 ± 0.8 | 6.2 ± 0.8 | 7.1 ± 1.0 | < .001 | |
| Risk factor assessment | 6.7 ± 0.8 | 6.4 ± 0.7 | 7.4 ± 0.8 | .001 | |
| Nursing key points and challenges | 7.2 ± 0.8 | 7.0 ± 0.8 | 7.6 ± 0.9 | .011 | |
| Inpatient rehabilitation prescription | 6.2 ± 0.9 | 6.1 ± 1.0 | 7.0 ± 1.0 | .017 | |
| Discharge follow-up | 6.8 ± 1.0 | 6.5 ± 0.8 | 7.2 ± 0.8 | .004 | |
| Outcome evaluation | 6.4 ± 0.9 | 6.2 ± 0.8 | 7.1 ± 0.8 | .008 | |
| Experience summary | 6.7 ± 0.7 | 6.4 ± 0.8 | 7.4 ± 0.7 | < .001 | |
| Critical thinking ability | 6.5 ± 1.0 | 6.2 ± 0.9 | 7.2 ± 0.9 | .245 |
Note. All data are presented as mean ± standard deviation.
Abbreviations: CBD = Case-Based Discussion; DOPS = Direct Observation of Procedural Skills; Mini-CEX = Mini-Clinical Evaluation Exercise.
In the subsequent main study involving 52 trainees from two hospitals, scores improved significantly from mid-program to completion, notably in clinical reasoning and procedural skills (Mini-CEX, from 6.2 ± 0.8 to 7.2 ± 0.8). DOPS and CBD scores similarly increased over time (Table 4). Reliability metrics were robust: ICC for inter-rater reliability was 0.74, Cronbach's alpha was .86 for internal consistency, and Kendall's W value was 0.69, indicating strong rater agreement.
Discussion
This study developed a structured, competency-based evaluation model for cardiovascular specialist nurse training, successfully integrating WPBA tools within Miller's Pyramid. Using a rigorous Delphi method, we achieved strong expert consensus (Kendall's W = 0.78; Cr = 0.94) (Liu et al., 2019), underscoring the validity and relevance of the developed model. To our knowledge, this study is among the first to systematically combine WPBA methods (Mini-CEX, DOPS, and CBD) specifically tailored for cardiovascular nursing education in China. The high consensus among expert panelists highlights the model's practicality and alignment with national nursing education priorities and global best practices (Zhang et al., 2023).
Our study extends existing evidence supporting WPBA as effective for nursing education. Previous studies have demonstrated the utility of the Mini-CEX in enhancing clinical competencies among junior nurses (Motefakker et al., 2022), and the DOPS has similarly been shown to effectively develop procedural skills (Yousuf Guraya, 2015). Our findings align with these reports, affirming that WPBA tools, traditionally physician oriented, can be effectively adapted to nursing contexts. Specifically, our nursing-specific Mini-CEX emphasized core competencies such as communication, professional attitudes, and patient-centered care, whereas our adapted DOPS and standardized CBD provided structured frameworks for procedural skills and clinical decision-making, respectively. This aligns with previous research supporting multidimensional assessments to better capture nursing competencies (Liu et al., 2019).
Statistically, our results demonstrated significant improvements from mid-program to completion across Mini-CEX, DOPS, and CBD assessments (all p < .05). Notably, Mini-CEX scores increased from 6.2 ± 0.8 to 7.2 ± 0.8, with similar improvements observed in clinical reasoning and procedural skill evaluations. Reliability analyses supported these findings: inter-rater reliability (ICC = 0.74), internal consistency (Cronbach's alpha = 0.86), and inter-rater agreement (Kendall's W = 0.69) were robust. These results affirm both the clinical and statistical significance of our model in consistently improving trainee competencies and reliably assessing these improvements across multiple evaluators and settings (Ying Ying, 2021).
Implications for Nursing and Professional Development
Our evaluation model provides several practical advantages for nursing education and professional development. By standardizing training assessments across institutions, this framework addresses existing inconsistencies and contributes directly to improved nursing practice and patient outcomes. The structured, continuous assessment facilitates targeted feedback at every competency level, promoting trainee self-reflection and instructor clarity in identifying developmental needs. Such a formative approach aligns with contemporary educational principles that advocate continuous competency development and improvement of clinical skills. Further, adopting this comprehensive evaluation model may enhance patient safety and quality of care by ensuring that cardiovascular specialist nurses achieve demonstrable clinical proficiency across theoretical knowledge, technical skills, and clinical reasoning. Clearly defined, standardized competencies also strengthen communication and shared expectations among stakeholders, including nursing educators, administrators, and trainees, ultimately benefiting overall nursing practice quality.
Implications for Continuing Education
The WPBA-based training and evaluation model proposed in this study has strong potential for application beyond initial specialist nurse preparation. It offers a structured framework for continuing education by emphasizing competency assessment, feedback, and reflective practice. Incorporating diverse instructional methods (e.g., scenario-based simulation, case discussion, and emergency response drills) can further enhance learning engagement and clinical readiness. Although most certified cardiovascular specialist nurses in China currently work in inpatient settings, integrating this model into continuing education may broaden their roles in outpatient cardiovascular clinics, follow-up programs, and multidisciplinary management of hypertension, diabetes, and dyslipidemia. In this way, the model supports not only clinical proficiency but also sustained professional growth and lifelong learning in cardiovascular nursing.
Limitations
Several limitations must be acknowledged. First, the expert panel predominantly included representatives from specific regions, potentially introducing geographic bias. Although the consensus achieved was strong, it may reflect regional practices rather than national or international applicability. Future research involving broader geographic representation will strengthen the generalizability of the model. Second, the Delphi method inherently relies on expert opinion rather than direct empirical observations of clinical performance. Although this approach ensures content validity, it does not guarantee direct clinical effectiveness. Additionally, inter-rater reliability, although assessed, may vary with broader implementation because of differences in evaluator experiences. Feasibility concerns such as required time and resources also merit further examination. Finally, although the model was built on established frameworks (WPBA and Miller's Pyramid) and supported by literature (Berendonk et al., 2018; Chang et al., 2020), continuous improvement is important. As clinical practice and training evolve, the content should be periodically reviewed and updated, potentially through further Delphi rounds or pilot testing feedback, to ensure it remains current and evidence based.
Future studies should focus on broader implementation across diverse institutions to further validate the generalizability and inter-rater reliability of the model. Longitudinal research is also recommended to evaluate the model's long-term impact on trainee performance and patient outcomes. Periodic reviews and updates of the evaluation criteria, informed by ongoing research and clinical practice changes, will ensure the continued relevance and effectiveness of the evaluation model.
Conclusion
We developed a novel competency-based evaluation model for cardiovascular specialist nurse training by integrating theoretical knowledge assessment and workplace-based tools (Mini-CEX, DOPS, and CBD) within Miller's Pyramid framework. A rigorous Delphi approach achieved strong expert consensus, resulting in a highly valid, comprehensive evaluation tool. This structured assessment model addresses existing gaps in advanced nursing education, offering standardized and objective evaluations of trainee competencies. This evaluation framework contributes substantially to advancing nursing education and enhancing cardiovascular health care quality through better trained specialist nurses.
From Heart Failure & Cardiovascular Intensive Care Unit (XL, MZ), Cardiovascular Medicine Department (LW, JY), Cardiac Surgery Intensive Care Unit (HF), and Nursing Department (HL), Peking University International Hospital, Beijing, People's Republic of China.
Funding: This work was supported by the Institutional Research Fund of Peking University International Hospital (YN2021HL02).
Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.
Address correspondence to Hong Lu, MD, Nursing Department, Peking University International Hospital, Life Park Road, Life Science Park, Changping District, Beijing, 102218, P.R. China; email: [email protected].
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