Development of Competency Indexes to Assess Nursing Postgraduate's Tutor

The aim of this study was to develop competency indexes assessing nursingpostgraduate's tutor in China. Based on Iceberg competency theory, a Delphisurvey was carried out. 30 nursing experts in 16 provinces of China wereinvited to rate the importance of indexes and give some comments on thecontent. There were 22 experts taking part in two rounds Delphi study. AKendall's W test also demonstrated experts were well coordinated. Duringthe first round, overall mean scores were high, except for 1 tertiary index.We also added and moved some indexes building on the experts'suggestions. After two rounds, we developed competency indexesappropriate to assess tutots' competencies, consisting of 5 preliminaryindexes, 13 secondary indexes and 68 tertiary indexes. The competencyindexes were validated and scientific, it can be used to assess tutors in China.


INTRODUCTION
Now, nursing has been the first level discipline in 2011 in China, and there is an increasing needs for nursing service, demonstrating an increasing demands for high quality nurse. So higher education is significant, and postgraduate nursing education, as the highest level of nursing education, is the main way to cultivate high quality nursing personel. Recently, nursing postgraduates' education has been developing vigorously, there is a sharp increase in universities with nursing postgraduates' enrollment qualification, and so is tutor of nursing postgraduates in China. However, each university had its own tutor assessment criterion [1]- [3], and tutors' level was irregular [4]- [5]. Tutor, as main performer of postgraduates' training program and instructor of scientific research, played a key role in ensuring quality of postgraduate education. Competency, which was proposed by MeClelland D in 1973 [6], was widely used on management, education and medicinel in foreign countries [7]- [10]. In China, researches about competency focused on human resource management, also on education and medicine [11]- [12]. And tutor competency was one of the key factors guaranting quality of postgraduate education and promoting the development of nursing discipline.
Teacher competency included professional knowledge, professional skills and professional value in which teachers possessed [13]. Nevertheless, study on evaluation of nursing postgraduates' tutor has not yet been widely carried out. Developing valid competency indexes to assess nursing postgraduates' tutor had great significance in enhancing quality of tutor, as well as the education. So we adopted a Delphi survey to develop competency indexes to provide a reference basis for assessing tutors.

RESEARCH METHOD 2.1. Design
We carried out a Delphi-survey on e-mail to collect opinions from a wide range of experts for developing a consensus about the assessment indexes. Delphi survey were supposed to offer quantitative estimates through qualitative methods, characterized by anonymity, iteration, controlled feedback, and statistical group response [14]. The competency indexes were presented to an expert panel.

Delphi Expert Panel
Expert selection was built on the following criteria: at least bacholar 's degree in nursing; at least senior professional titles; at least ten-year working experience in nursing, participating in the education/ management of nursing postgraduates and active support for our research. 30 experts in 16 provinces of China were selected to participate in the study. And we carried out two rounds of Delphi survey by E-mail.

Delphi Procedure
Two researchers designed the Delphi questionnaire based on competency framework-'Competence iceberg theory'. Among them, skill and knowledge are threshold competency, motives and traits are differentiating competence, which are key to distinguish achievers from mediocrity; self-concept is inbetween. Beisdes, we searched PubMed, EBSCO, CNKI, Wanfang Database, as well as educational web sites about tutors' competency by the following search terms: "nursing mentor/nursing supersivor/nursing teacher/nursing educator", "competency/competency evaluation", On the basis of group discussion, we developed competency indexes preliminarily, including 5 preliminary indexes, 13 secondary indexes and 64 tertiary indexes. In two consecutive Delphi rounds, experts were asked to comment on the content by giving ratings, building on a likert-5 scale (1=least important, 5=most important).

Delphi Data Analysis
Data were recorded with Excel by two persons and re-checked , then, they were imported into IBM SPSS Statistics for Windows (version 19.0) for analysis. The mean, standard deviation, coefficient of variation for overall indexes were calculated. Index selection were based on mean scores greater than 3.5, coefficient of variation not greater than 0.25 as well as expert suggestions. Descriptive statistic were used to summarise sample characteristics. Besides, a kendall "w test were used to demenstrate experts" coordinated degree.

Delphi Round 1
Mean scores and coefficient of variation reflected that all indexes were perceived as important and feasible for assessing tutor (mean scores ＞3.5, coefficient of variation≤0.25)After the first Delphi survey, 1 tertiary index: emotional persistence, was removed, due to its variation coefficient was 0.26.
Interesting, many suggestions were presented. Some experts raised concerns about different competency indexes assessing two types of nursing postgraduates' tutor: academic nursing postgraduates and master of nursing specialist (MNS). Some experts thought many tutors lacked communication with students and did not help them plan career.
Based on the comments, the researchers decided to remove 1 tertiary index: emotional persistence, added 7 tertiary indexes: ability to acquire expertise in depth, breadth and new progress, ability to innovate, the evaluation of employer to postgraduates, postgraduates' score of professional courses, ability to acquire information, showing ethics, serving in various academic societies and academic journals; adjusted the way of expression for 19 indexes and moved 3 indexes among tertiary index.

Delphi Round 2
During the second round, all indexes resulting from the first round were presented again to the panel. The experts were invited to give some suggestions. They were additionally informed about the changes based on the results from the first round. In this final Delphi-round, all assessment indexes turned out to be validated and consensus was obtained. A Kendall's W test demonstrated the results were statistically significant (p<0.01), meaning that experts were well coordinated after two rounds.
Building on the two rounds, the final validated competency indexes assessing nursing postgraduates' tutor consists of 5 preliminary indexes, 13 secondary indexes and 68 tertiary indexes (

Disscussion
The present study aimed to develop the competency-based indexes assessing tutors' competencies in China, we adopted a Delphi-survey to collect expert opinions. In total, two rounds of consultation were needed to validate the competency-based indexes. It demonstrated that all competency indexes, except 1 tertiary index, were already considered important in the first round (mean scores >3.5, coefficient of variation ≤0.25), Besides, after two round, there was an increasing consensus among experts. We dealt with a large amount of comments related to the competency indexes by deleting, adding and moving some indexes during the two rounds.
Building on the comments, we develop 5 preliminary indexes. Firstly, Nursing professional level was the basic competency for tutor, its mean scores was 5.00, and coefficient of variation is 0.00, demonstrating the index was considered most important. Nursing was an applied subject, and hospital was the main place for practice. So nursing professional level was signifcant. Besides, research ability was core, so mean score was the same as nursing professional level, scored highest, and coefficient of variation is 0.00. The big difference between undergraduate and postgraduate nursing education is research, tutor is instructor of scientific research for nursing postgraduates. And scientific research was the significant way of promoting development of nursing profession and improving the level of clinical care, so it could not be emphasized no longer for postgraduates' education [15], the result meaned experts' high expectations for it. Tutor should focus on their research ability, use their own rich resources to create a good scientific environment for nursing postgraduates, and give some guidances on project declaration, implementation and thesis writing [16]. Then, teaching and guiding ability was important, its mean scores was 4.95, and coefficient of variation was 0.04. it was stressed by nursing educators in foreign countries [17]. In deed, teaching and guiding were tutors' duty. so they should treat nursing postgraduates as individuals, besides, teaching activities should be learner-centered [18], proper teaching methods should be used, such as interaction teaching [19]. Except theoretical study, postgraduates' life and social pratice were all changed in the tutor's words and deeds, so tutor's guidance should be comprehensive [16]. Next, motivation as tutor could not be ignored, its mean scores was 4.27, and coefficient of variation is 0.16. Compared with Shang Linping's research, we added it on delphi survey [20], motivation was a psychological tendency or impetus which triggered and maintained individuals' activities, and instructed individuals make efforts for a goal, including internal motivation and external motivation. Motivation can differentiate out standing performer and average one, and measure a tutor's competence. It also can stimulate tutor to work better, determine tutor's participation and continuity of cultivating nursing postgraduates directly, determine effort level of cultivating postgraduates, and affect the quality of postgraduates in the end. Although work motivation was hard to change, it can be influenced by environment [21], so we can not ignore function of internal and external motivation, and make great efforts to create good external environment to improve tutor's enthusiasm of cultivating postgraduates. Finally, personality trait was prerequisites for tutor. Its mean score was not low, tutor not only setted us an example of scientific research, but also inflenced our behaivors. As a tutor, morality and personality trait were basic. So they should pay more attention to moral trait, responsibility and dedication; besides, they should take good care of postgraduates, communicate more with them, respect them and treat them equally to develop harmonious relationship with nursing postgraduates [22]- [23].