Competency Assessment in Nursing Using Simulation: A Generalizability Study and Scenario Validation Process

The measurement of competency in nursing is critical to ensure safe and effective care of patients. This study had two purposes. First, the psychometric characteristics of the Nursing Performance Profile (NPP), an instrument used to measure nursing competency, were evaluated using generalizability theory and a sample of 18 nurses in the Measuring Competency with Simulation (MCWS) Phase I dataset. The relative magnitudes of various error sources and their interactions were estimated in a generalizability study involving a fully crossed, three-facet random design with nurse participants as the object of measurement and scenarios, raters, and items as the three facets. A design corresponding to that of the MCWS Phase I data--involving three scenarios, three raters, and 41 items--showed nurse participants contributed the greatest proportion to total variance (50.00%), followed, in decreasing magnitude, by: rater (19.40%), the two-way participant x scenario interaction (12.93%), and the two-way participant x rater interaction (8.62%). The generalizability (G) coefficient was .65 and the dependability coefficient was .50. In decision study designs minimizing number of scenarios, the desired generalizability coefficients of .70 and .80 were reached at three scenarios with five raters, and five scenarios with nine raters, respectively. In designs minimizing number of raters, G coefficients of .72 and .80 were reached at three raters and five scenarios and four raters and nine scenarios, respectively. A dependability coefficient of .71 was attained with six scenarios and nine raters or seven raters and nine scenarios. Achieving high reliability with designs involving fewer raters may be possible with enhanced rater training to decrease variance components for rater main and interaction effects. The second part of this study involved the design and implementation of a validation process for evidence-based human patient simulation scenarios in assessment of nursing competency. A team of experts validated the new scenario using a modified Delphi technique, involving three rounds of iterative feedback and revisions. In tandem, the psychometric study of the NPP and the development of a validation process for human patient simulation scenarios both advance and encourage best practices for studying the validity of simulation-based assessments.