The Construction and Implementation of a Clinical Nursing Experts-Oriented Retraining Program for Peritoneal Dialysis Specialist Nurses

The Construction and Implementation of a Clinical Nursing Experts-Oriented Retraining Program for Peritoneal Dialysis Specialist Nurses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Construction and Implementation of a Clinical Nursing Experts-Oriented Retraining Program for Peritoneal Dialysis Specialist Nurses Peipei He, Xiaohong Yin, Ying Xu, Tingjun Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8535587/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Peritoneal dialysis specialist nurses are the main force in peritoneal dialysis care in China, but most have not yet reached the core competencies of clinical nursing experts. This study aims to develop a retraining program for peritoneal dialysis nurses based on the ADDIE model (Analysis, Design, Development, Implementation, Evaluation), focusing on clinical nursing expert orientation and job competency, to accelerate their progression into clinical nursing experts. Methods From May 1, 2023, to September 31, 2025, based on the five stages of the ADDIE model, the research team investigated the needs, characteristics, and existing resources for the retraining of peritoneal dialysis specialist nurses. We analyzed the training modules, content, format, and assessment plans, and developed a draft training program. Twenty-two experts in the field of peritoneal dialysis were invited to participate in two rounds of Delphi expert consultations to finalize the training program. The program was then implemented and evaluated with 36 nurses who had obtained the Zhejiang Province Peritoneal Dialysis Nursing Specialist Certificate. Results The retraining program developed consisted of 11 learning modules and 38 learning topics (28 theoretical courses and 10 practical projects). In the formative evaluation phase, the satisfaction of peritoneal dialysis specialist nurses was 4.74 (4.61, 5.00). In the summative evaluation phase, the overall satisfaction of peritoneal dialysis specialist nurses was 5.00 (4.00, 5.00), with content satisfaction at 5.00 (5.00, 5.00), method satisfaction at 4.64 (4.51, 5.00), and satisfaction with the training duration and course schedule at 5.00 (4.25, 5.00). By September 2025, 88.89% of peritoneal dialysis specialist nurses had advanced to clinical nursing experts. Conclusions The retraining and utilization program for peritoneal dialysis specialist nurses developed in this study is scientific, reliable, and innovative. It focuses on enhancing nurses' practical abilities and intrinsic qualities, aligning with clinical needs while also boosting nurses' intrinsic motivation. ADDIE model specialized nurse training Delphi technique clinical nursing expert Background Specialist nurses (SN) are those who possess a high level of theoretical knowledge and practical skills in a specific specialty field and are engaged in specialized nursing work [ 1 ] . Clinical nursing experts are senior registered nurses with advanced knowledge, skills, and clinical experience in a particular field [2] . They perform functions such as nursing practice, education, consultancy, research, and management, acting as leaders, researchers, supervisors, and advisors throughout the entire nursing process. SN is not synonymous with a clinical nursing expert but refers to professional nurses working in specialized positions, marking the beginning of nursing specialization. In many countries, clinical nursing experts are developed through further training based on the foundation of SN [3–4] . Currently, most SNs have not reached the core competencies of clinical nursing experts. Compared to other countries, the practice and research of clinical nursing experts in China are still in the early stages. Therefore, how to develop the clinical nursing expert system, practice, and training research in line with the characteristics of nursing talent, training models, and management mechanisms in China remains an ongoing process. Peritoneal dialysis SNs are the main workforce in peritoneal dialysis nursing in China. While the initial training of peritoneal dialysis SNs in Zhejiang Province has achieved some scale and effectiveness, most post-graduation retraining and deployment are handled by the hospitals where they work. However, differences in hospital scale, specialized nursing levels, and retraining programs hinder the standardization and improvement of specialized skills for all peritoneal dialysis SNs in the province. Thus, there is an urgent need to build and improve a retraining and utilization program for peritoneal dialysis SNs post-graduation, aiming to transform these nurses into true clinical nursing experts. The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) [5–6] is a well-established and widely applied training model. It designs and develops programs based on training needs, evaluates each phase promptly, and avoids one-sidedness and blind spots, ensuring both flexibility and high-quality training. This study constructed a retraining and utilization program for peritoneal dialysis SNs based on the ADDIE model, with a focus on clinical nursing expert orientation and job competency. The BOPPPS teaching model (Bridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment, and Summary) [7–8] was applied during the implementation of the program to improve teaching standards and quality. Methods Establishing a Research Team The research team consists of 1 chief physician, 2 deputy chief nurses, 1 charge nurse, and 1 nurse, with a doctoral degree holder, 2 master's degree holders, and 2 bachelor's degree holders. All team members are engaged in peritoneal dialysis medical and nursing education and have extensive teaching experience. Construction of the Peritoneal Dialysis SN Retraining and Utilization Program (1)Analysis The main task of this phase was to understand the needs for retraining peritoneal dialysis SNs and identified the professional gaps and challenges encountered in clinical practice. This was mainly achieved through literature review and semi-structured interviews. Literature Review. From May 1, 2023, to May 31, 2023, a systematic search was conducted on China National Knowledge Infrastructure, Wanfang Database, VIP Database, PubMed, CINAHL, Cochrane Library, Web of Science, Embase, and EBSCO. The search terms were "Specialist Nurse; Clinical Nurse Specialist; Advanced Practice Nurses; Cultivation; Training; Curriculum; Program; Post Competency," to clearly define relevant concepts and gather indicators related to the core competencies of clinical nursing experts in peritoneal dialysis. Semi-structured Interviews. Based on the results of the literature review and the Competency Iceberg Model [9] , an interview questionnaire was developed for this study, as detailed in Appendix 1 . Cluster sampling was used to select peritoneal dialysis SNs and senior peritoneal dialysis SN instructors from different hospitals in Zhejiang Province for semi-structured in-depth interviews. The inclusion criteria for the interviewed SNs were: (a) Having held the Zhejiang Province peritoneal dialysis SN training certificate for at least 3 years; (b) Holding at least a bachelor's degree; (c) Having independently managed at least 100 long-term follow-up peritoneal dialysis patients; (d) Providing informed consent and signing an informed consent form. The inclusion criteria for the interviewed SN instructors were: (a) Having engaged in peritoneal dialysis SN instructor work in Zhejiang Province for at least 3 years; (b) Holding a senior or higher professional title; (c) Having trained at least 10 peritoneal dialysis SNs. Before the interviews, the researchers provided the interviewees with informed consent forms, informed them of the study's purpose, methods, and content, ensured privacy protection, and established trust. The interviews were conducted in the head nurse's office, with each interview lasting between 30 to 90 minutes. Within 48 hours of the interviews, two team members transcribed the data and analyzed the competencies of peritoneal dialysis clinical nursing experts and the retraining needs of peritoneal dialysis SNs. The sample size was considered saturated when no new themes emerged. (2)Design Based on the analysis phase, the initial draft of the peritoneal dialysis SN retraining and utilization program was designed, followed by two rounds of Delphi expert consultation to revise the program. The expert consultants for this study were selected from professionals in the fields of peritoneal dialysis nursing and nursing education, based on the following criteria: an associate senior title or higher, at least 10 years of experience in peritoneal dialysis or nursing education, enthusiasm for the study, and willingness to participate in two rounds of expert consultation within the project timeline. The expert consultation questionnaire consisted of four sections: consultation instructions, expert basic information, consultation content, and the expert’s familiarity with the content and judgment basis. The consultation focused on the retraining modules, content, and assessment cycles for peritoneal dialysis SNs, using a Likert 5-point scale (5 points for "very satisfied" and 1 point for "very dissatisfied") to rate the importance of each module and content, and included options for different training cycles (from 1 to 5 years or other). Two rounds of consultation were conducted between September 1 and October 31, 2023, through email, WeChat, DingTalk, or in person, with a one-month interval between rounds. The results of the first round were analyzed, and revisions were made based on expert feedback before the second round. The project was considered for inclusion if the mean importance score exceeded 3.50 and the coefficient of variation was less than 25%. (3)Development Building on the previous stages, the research team developed the content, methods, and timeline for the retraining program. We held multiple meetings, both online and offline, to discuss key points such as the knowledge, skills, emotional, and ideological goals of the course content, reaching a consensus. Difficult and critical teaching points were analyzed based on the latest guidelines and industry standards, while also clarifying the needs of the learners. We integrated the concepts of active teaching and active learning to enhance the learning outcomes. Regarding lesson plan writing, PowerPoint (PPT) creation, and video production, a three-tier responsibility system was implemented. Detailed lesson plans were written first, covering teaching objectives, target audience, content, methods, and expected outcomes. Once the lesson plan was approved, the teaching PPT and videos were produced. Both the lesson plans and the teaching materials (PPT and videos) were reviewed by a three-tier system: the course expert, peer experts, and the project leader, ensuring the quality of the materials and the effectiveness of the teaching. (4)Implementation From May 1, 2024, to September 30, 2025, the retraining program was implemented for peritoneal dialysis SNs in Zhejiang Province who had already graduated and obtained the SN certificate. Before the training, a DingTalk learning group was organized, where all notifications were posted. Online learning, assessments, and evaluations were completed on the online platform, while offline learning was based on continuing education courses organized by the Peritoneal Dialysis Nursing Group of the Zhejiang Nursing Association and grassroots training programs (or nursing salons). During the implementation process, the BOPPPS teaching model was applied to each course: Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment, and Summary. (5)Evaluation Satisfaction of Peritoneal Dialysis SNs with the Retraining Program . This included formative and summative assessments. The formative assessment was conducted after each training session, where the trainer distributed a Quick Response code (QR code) for the trainees to scan and provide feedback on the spot. The questionnaire consisted of a single question: "Are you satisfied with this training?" The summative assessment was conducted after the entire retraining phase had been completed. The project leader distributed a QR code for the trainees to scan and provide feedback. This questionnaire included five questions: (a) What is your overall satisfaction with this training program? (b) How satisfied are you with the content of this training program? (c) How satisfied are you with the duration and course schedule of this training program? (d) How satisfied are you with the delivery method of this training program? (e) Do you have any suggestions for improving the training program? The assessments used the Likert 5-point scale. Peritoneal Dialysis SNs Meeting the Standards to Become Clinical Nursing Experts . The rate of peritoneal dialysis SNs progressing to clinical nursing experts was calculated as: Rate of Progression = Number of nurses meeting the progression standards/Total number of trained nurses. The progression standards are listed in Table 1 . These standards were discussed by the research team, taking into account the promotion criteria for senior practice nurses at our hospital and the training goals and content of this project. A pre-experiment was conducted with 23 SNs, and the Cronbach's α coefficient for the pre-experiment was 0.749. Table 1 Standards for the Advancement of Peritoneal Dialysis SN to Clinical Nursing Expert Module Entry Note Knowledge (1)All tests during the period were ≥ 90 points Mandatory Skills (2)Ability to Lead and Organize a Nursing Case Analysis of Difficult Peritoneal Dialysis Cases at the Hospital Level or Lead an Interdisciplinary Collaborative Nursing Round Related to Peritoneal Dialysis Mandatory (3)Ability to Create a Patient Education Video or Brochure and Distribute It to At Least 100 Patients or Their Families Mandatory (4)Undertake at least 2 hours of teaching tasks within the hospital or externally Mandatory Publish one nursing research or quality award-winning paper as the first author, with at least one of the following (choose one): ① Case study, review, article, etc., published in a core Chinese scientific and technological journal; ② Patent conversion or granted invention patent; ③ Project approved at the municipal level or higher; ④ Paper or project awarded third prize or above at the provincial level or higher. Mandatory (5)Organize an offline peritoneal dialysis kidney patient meeting, with no fewer than 100 patients and family members participating Mandatory (6)Increase in the Peritoneal Dialysis Quality Control Indicator Compliance Rate at the Institution Mandatory Traits (1)High patient satisfaction, with no nursing-related complaints or disputes Mandatory (2)Complete at least 3 hours of volunteer service at a hospital or in the community Choose one from four options (3)Rated as an advanced worker or excellent nurse at the hospital level or above (4)Participate in public emergencies at the hospital level or above (5)Won second prize or above in a hospital-level nursing competition, and third prize or above in a regional-level or higher nursing competition Motivation (1)Nurses with a bachelor's degree or higher and at least 10 years of work experience, or nurses with a master's degree or higher and at least 8 years of work experience Mandatory (2)Have obtained a specialist nurse certificate at the provincial level or above Mandatory Social Role (1)Participated in at least one interdisciplinary nursing consultation at the hospital level or above Mandatory (2)Participated in at least one free clinic, community activity, or grassroots project Mandatory Self-concept (1)Without any violations of laws or regulations Mandatory (2)Without any issues related to research integrity Mandatory Statistical Methods . All data were entered into Statistical Product and Service Solutions (SPSS) 27.0 statistical software. For normally distributed quantitative data, the mean and standard deviation were used for description. For data that did not meet the assumptions of normality and homogeneity of variance, as well as ordinal data, the median and percentage were used. The questionnaire response rate reflected the experts' level of engagement, while the authority coefficient was used to describe the experts' authority. Kendall's coefficient of concordance was used to reflect the degree of consensus among expert opinions. A difference was considered statistically significant if P Value < 0.05. Results Analysis Phase From June 1, 2023, to July 15, 2023, interviews were conducted with 10 peritoneal dialysis SNs and 6 peritoneal dialysis SN preceptors from Zhejiang Province. All participants were female, with an average age of (42.81 ± 1.31) years. The interviews resulted in the identification of 4 core themes, with specific details and characteristics of each theme presented in Table 2 . The initial draft of the retraining program was formed, as shown in Appendix 2 . Table 2 Results of Semi-Structured Interviews Topic Sub-topic Specific content and characteristics Topic 1: Peritoneal Dialysis Specialist Nurse and Clinical Nursing Expert Role Differentiation Progression Relationship Thirteen interviewees believed that nursing experts are the advanced form of SNs, with the core difference lying in the ability dimension—nursing experts possess stronger research capabilities and the ability to solve complex cases. Years of Experience Difference Two interviewees focused on the duration of experience, believing that only those with longer work tenure can become nursing experts, without mentioning differences in the ability dimension. Conceptual ambiguity One interviewee made no distinction between the two roles and did not form a clear understanding of the differences. Topic 2: Core Work Responsibilities of Clinical Nursing Experts in Peritoneal Dialysis The results were highly consistent, forming five core modules Patient management is the foundational work, covering daily follow-ups of peritoneal dialysis patients, monitoring dialysis effectiveness, and preventing and managing complications. Nursing research is key to improving work quality, including conducting clinical studies related to peritoneal dialysis care, summarizing nursing experiences, and forming academic achievements. Nursing education and nurse mentoring are central to the transmission of specialized knowledge, involving theoretical training, procedural guidance, and the cultivation of clinical thinking in junior nurses (such as SNs). Leading peritoneal dialysis nursing work in the department is an important responsibility that requires coordinating and formulating departmental peritoneal dialysis nursing standards, promoting nursing technological innovation, and addressing common issues in nursing work. These five modules together form the complete work system of a nursing expert. Topic 3: Priority Competencies for Clinical Nursing Experts in Peritoneal Dialysis Core competencies / Professional qualities / Supporting skills Twelve interviewees believe that core abilities (research capabilities and the ability to solve clinical complex cases) are the most important qualities, and are the key distinguishing factors between nursing experts and SNs. The second priority is professional qualities (such as a passion for specialized nursing and compassion for patients), which are considered the foundation supporting the effective application of core abilities. Lastly, auxiliary abilities (such as communication skills and teaching abilities) are recognized as important, but their priority is considered lower than the first two categories. Four interviewees placed professional qualities (passion for the specialty and compassion for patients) at the top, believing that professional qualities are the prerequisite for engaging in specialized nursing. Without passion and compassion, it would be difficult to deeply develop core abilities. The second priority is core abilities (research and solving complex cases), followed by auxiliary abilities. Topic 4: Training Needs for Specialist Nurses Advancing to Clinical Nursing Experts in Peritoneal Dialysis SN advancement requires a dual-track training model based on 'continuous learning + long-term practice On one hand, there is a need for "periodic retraining," which includes regularly attending peritoneal dialysis specialized training, academic seminars, new technology workshops, etc., to ensure that knowledge stays up to date with clinical developments and avoids becoming outdated. On the other hand, "long-term clinical practice" is necessary to accumulate experience, such as managing a more diverse range of patients, participating in complex case consultations, and following senior nursing experts for clinical mentorship, in order to improve the ability to solve practical problems through hands-on practice. Both are indispensable and together form the essential training path for an SN to progress to a nursing expert. Authority and Reliability of Expert Consultation. Questionnaires were distributed to all 22 experts in both rounds of consultation, with effective response rates of 100% and 95.45%, respectively. In the first round, 5 experts provided 5 suggestions. No suggestions were made in the second round. The expert judgment coefficients for the two rounds were 0.93 and 0.92, respectively. The familiarity of the experts with the indicators was 0.86, and the expert authority coefficients were 0.90 and 0.89. For the importance ratings of the learning modules, the mean scores in the two rounds ranged from 4.36 to 5.00 and from 4.43 to 5.00, with coefficients of variation from 0% to 13.08% and 0% to 13.17%, respectively. The Kendall’s W coefficients were 0.273 (P < 0.001) and 0.249 (P < 0.001). For the importance ratings of the learning directory, the mean scores ranged from 3.77 to 4.86 and from 3.81 to 4.90, with coefficients of variation from 7.06% to 23.02% and 5.98% to 22.73%, respectively. The Kendall’s W coefficients were 0.269 (P < 0.001) and 0.258 (P < 0.001). Expert Consultation Results . The initial draft of the retraining content covered 9 learning modules and 38 learning directories (29 theoretical courses and 9 practical projects). The final version of the retraining plan, after two rounds of expert consultation, covered 11 learning modules and 38 learning directories (28 theoretical courses and 10 practical projects). The 11 learning modules included ideological and political courses and practices, knowledge (in the fields of profession, teaching, research, and management), and skills (in the fields of profession, teaching, research, and management). After considering clinical practice and group discussions, the research team decided to revise the content. In the first round of expert consultation, the learning module "Ideological and Political Education" was revised to "Ideological and Political Courses and Practices." In the learning directory, the practical project "Participate in free clinics, community activities, or grassroots training projects at least once" was modified to "Participate in free clinics, community activities, or grassroots projects at least once and report on peritoneal dialysis outcomes or share professional insights," and "The peritoneal dialysis quality control index of the institution rises" was changed to "Lead peritoneal dialysis-related continuous quality improvement projects and the peritoneal dialysis quality control index of the institution rises." No modifications were suggested in the second round of expert consultation. After two rounds of expert consultation, 68.18% of the experts agreed that the retraining and assessment cycle should be 3 years. Development Phase Based on the results of the design phase, the peritoneal dialysis SN retraining and usage plan was developed, along with the corresponding training materials, such as PPTs, videos, and a case library, as detailed in Table 3 . Table 3 Final Draft of Peritoneal Dialysis SN Retraining and Utilization Plan Module Number Content Time Method Political Education Courses and Practice Provincial and Hospital Ⅰ-1 *The Nightingale Pledge and Real-life Stories One hour for each course Provincial-level offline continuing education class Ⅰ-2 *The Nursing Vision of Zhejiang Nursing Association and the Organizing Institutions Ⅰ-3 *"Nurturing Growth, Encountering the Future" — A Brief Discussion on the Career Development Path of Nurses Ⅰ-4 *Igniting the Light of Profession—From Core Competencies to Compassionate Care Specialized Ⅰ-5 *Patient-Centered Full-Course Case Management in Peritoneal Dialysis Specialized Nursing Practice One hour for each course Provincial-level offline continuing education class Ⅰ-6 *The Key Role of Specialist Nurses in Peritoneal Dialysis Patients' Discharge Preparation and Adaptation to Home Dialysis Ⅰ-7 *The Role of Peritoneal Dialysis Specialist Nurses in Improving Patient Outcomes Ⅰ-8 *Love on the Left, Care on the Right — Narrative Nursing Illuminates the Light of Hope Ⅰ-9 *Participate in at least one free clinic, community activity, or grassroots program, and deliver a report on the outcomes of peritoneal dialysis promotion or share reflections on its professional value Same as Skill Module Individual Ⅰ-10 *Cultivating 360° Communication Competence One hour for each course Provincial-level offline continuing education class Ⅰ-11 *Tips for Time and Stress Management Ⅰ-12 *Research Integrity and Literacy Ⅰ-13 *Back to the Essentials: Nursing Clinical Thinking Ⅰ-14 *Participate in at least one interdisciplinary nursing consultation at the hospital level or above Same as Skill Module Ⅰ-15 *Complete at least 3 hours of volunteer service at a hospital or in the community Knowledge Professional Ⅱ-1 Strategies and Practices to Improve Long-term Peritoneal Dialysis Patient Compliance Once every two weeks, with each session lasting 1 hour Online delivery + test assessment Ⅱ-2 Progress in the Prevention and Management of Complications in Long-term Peritoneal Dialysis Patients Ⅱ-3 Progress in the Application of Automated Peritoneal Dialysis Technology in Critically Ill Patients with Renal Failure Ⅱ-4 *Development of a Peritoneal Dialysis Patient Retraining Program Based on the ADDIE Model Ⅱ-5 Exploration and Practice of Peritoneal Dialysis Patient Management in the Digital Age Ⅱ-6 Exploration and Practice of Home Peritoneal Dialysis Nursing under the "Internet Plus" Model Ⅱ-7 *Application of Traditional Chinese Medicine Techniques in Alleviating Severe Symptoms in Peritoneal Dialysis Patients Ⅱ-8 *The Application Prospects of Artificial Intelligence in the Field of Peritoneal Dialysis Teaching Ⅱ-9 Development of Teaching Competencies for Peritoneal Dialysis Specialist Nurses Ⅱ-10 How to Teach a Good Class One hour for each course Provincial-level offline continuing education class + test assessment Research Ⅱ-11 Writing of Nursing Research Proposals Ⅱ-12 Writing and Submission of Nursing Academic Papers Ⅱ-13 *The Development and Practice of Patient-Reported Outcomes in the Field of Peritoneal Dialysis Management Ⅱ-14 Thinking and Practice in the Application of Specialist Nurses Ⅱ-15 *Exploration and Practice of Core Competencies for Peritoneal Dialysis Nursing Experts Ⅱ-16 *Development of Nursing Leadership Skills Professional Ⅲ-1 *Ability to Lead and Organize a Nursing Case Analysis of Difficult Peritoneal Dialysis Cases at the Hospital Level or Above within one training cycle Submit proof materials and wait for review Ⅲ-2 *Ability to Create a Patient Education Video or Brochure and Distribute It to At Least 100 Patients or Their Families Teaching Ⅲ-3 Write a Lesson Plan Ⅲ-4 *Ability to Lead an Interdisciplinary Collaborative Nursing Round Related to Peritoneal Dialysis Research Ⅲ-5 Ability to Write and Submit One Nursing Paper Management Ⅲ-6 *Organize an Offline Peritoneal Dialysis Kidney Patient Support Meeting Ⅲ-7 *Increase in the Peritoneal Dialysis Quality Control Indicator Compliance Rate at the Institution Note: * The italicized items are not covered in the first training. The usage standards: at least half of the nurse's working hours are dedicated to peritoneal dialysis-related specialized nursing, teaching, research, and management, and they have been doing so for at least 3 years. Implementation Phase A total of 36 nurses who graduated in 2021 and obtained the peritoneal dialysis nursing SN certificate in Zhejiang Province were selected. All participants were female, with an average age of (39.25 ± 3.53) years. During the implementation process, the BOPPPS teaching model was applied to each course. An example of the teaching process, using The Nightingale Pledge and True Stories , is provided in Appendix 3. Evaluation Phase In the formative evaluation phase, the satisfaction of peritoneal dialysis SNs was 4.74 (4.61, 5.00). In the summative evaluation phase, the overall satisfaction of peritoneal dialysis SNs was 5.00 (4.00, 5.00), with content satisfaction at 5.00 (5.00, 5.00), method satisfaction at 4.64 (4.51, 5.00), and satisfaction with the training duration and course schedule at 5.00 (4.25, 5.00). By September 2025, 88.89% of peritoneal dialysis specialist nurses had advanced to clinical nursing experts. Discussion The ADDIE model, developed in 1975 by the Educational Center at Florida State University with the help of renowned educationalist Robert Gagné, is the most fundamental and widely applied training method. It designs and develops projects based on training needs and conducts timely evaluations of each phase to avoid one-sidedness and blindness. It is flexible while ensuring training quality [8] . The BOPPPS teaching model was originally created by the Canadian Teacher Skills Training Workshop based on the teacher certification requirements in British Columbia, Canada. Initially used for teacher skills training, it is now widely applied in universities and training institutions. The BOPPPS model modularizes and standardizes the entire teaching process, making it highly operational. It breaks down the teaching course into introduction, learning objectives, pre-assessment, participatory learning, post-assessment, and summary [7–8] . The retraining program developed in this study is based on the ADDIE model, combined with literature analysis, semi-structured interviews, and two rounds of expert consultations. The BOPPPS teaching model was applied during the program's implementation, ensuring strong operability, repeatability, and scientific rigor. The two rounds of expert consultation had a questionnaire response rate of over 90%, indicating high expert engagement. The expert authority coefficient was greater than 0.7, showing the experts’ strong authority. The coefficient of variation for the project was less than 25%, indicating consensus among the experts. The coordination coefficient for the learning modules and projects, tested by chi-square, was P < 0.001, indicating a high level of coordination among the experts on the indicators [5,10] . Therefore, the retraining program developed in this study is reliable. While most domestic programs focus on the initial training of SNs, with few addressing retraining, this study is one of the first in China to develop and implement a retraining and usage program for specialist nurses, making it innovative. As an expert nursing professional, it is not enough to possess only specialized skills and knowledge. This brings up the question: What are the core competencies for peritoneal dialysis clinical nursing experts? The competency iceberg model divides competencies into the "visible" part above the iceberg and the "hidden" part below the iceberg. The "visible" part above the iceberg includes knowledge (specialized knowledge required for the position, such as technical and industry knowledge) and skills (specific abilities required to perform the job, such as operating tools and communication skills). These competencies can be quickly improved through training. The "hidden" part below the iceberg includes traits (personal stable behavioral characteristics, such as responsibility and stress tolerance), motivation (intrinsic factors driving personal behavior, such as achievement motivation and power motivation), social roles (behavioral styles and patterns based on attitudes and values, such as teamwork spirit), and self-concept (personal perceptions of one’s role and abilities, such as self-confidence and values). These hidden traits are more difficult to change but have a profound impact on job performance [11–12] . Therefore, how to cultivate the "hidden traits" of peritoneal dialysis SNs is crucial. The retraining program developed in this study is clinical expert-oriented, focusing on improving nurses' practical abilities and intrinsic qualities. While aligning with clinical needs, it also enhances nurses' intrinsic motivation, which is one of the key features of this program. The initial training program focuses on training SNs, while the retraining program is oriented towards developing clinical nursing experts. The former emphasizes knowledge and skills, while the latter highlights practical skills (such as interdisciplinary nursing rounds) and the development of the hidden traits, motivation, and intrinsic qualities (such as volunteer activities). In Xi Jinping’s speech at the 2016 National Conference on Ideological and Political Work in Universities, he emphasized, "We must insist on taking the cultivation of virtue and talent as the central link, integrating ideological and political work into the entire educational process, and achieving all-round education and all-encompassing cultivation of people" [13] . The Central Committee of the Communist Party of China and the State Council, in the 2017 document Opinions on Strengthening and Improving Ideological and Political Work in Universities in the New Situation, pointed out that "We must promote the outstanding traditional Chinese culture, revolutionary culture, and advanced socialist culture, implement the Chinese cultural inheritance project, and integrate traditional Chinese culture into education and teaching" [14–15] . While ideological and political education has made certain achievements in nursing student education and the standardized training of new nurses [16–18] , its application in retraining in-service nurses is less common. Given the importance of ideological education to the long-term stability of the nursing workforce, it is urgent to apply ideological education in the training of in-service nurses, such as specialist nurses. This will deepen their work attitude in adhering to regulations and strengthen their legal awareness, fostering moral qualities such as "thinking from the patient's perspective and acting according to the patient's wishes," thereby better serving clinical practice. In this program, the 15 items in Modules 1–3 are all related to ideological and political courses and practices, and their content aligns well with the "hidden traits" of competency in the workplace. Conclusions The peritoneal dialysis SN retraining and usage program developed in this study is scientific, reliable, and innovative, with a focus on enhancing nurses' practical abilities and intrinsic qualities. It aligns with clinical needs while boosting nurses' intrinsic motivation. This training program integrates ideological and political education throughout the entire retraining process, reflecting the shift from "explicit ideological education" to "implicit ideological education." It avoids stereotyped ideological content and achieves the goal of "educating all, throughout the process, and in all aspects." However, the implementation phase of this program was limited to Zhejiang Province. Further expansion of the sample size is needed to apply this study more broadly, allowing for real-time revisions and updates to the retraining program. Abbreviations ADDIE Analysis, Design, Development, Implementation, and Evaluation SN specialist nurse BPPPS Bridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment, and Summary PPT PowerPoint QR code Quick Response code SPSS Statistical Product and Service Solutions Declarations Ethics approval and consent to participate This study has been approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine, with the ethical approval number [2025B]1502. The informed consent to participate was obtained from all of the participants in the study. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. This manuscript does not contain any personal data. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests We have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding This work was supported by Medical Science and Technology Project of Zhejiang Province, China (2023KY096), Nursing Research Project of the First Affiliated Hospital, Zhejiang University School of Medicine (2025ZYHL06). Authors' contributions PP H conducted semi-structured interviews, issuing expert consultation letters, and wrote the original manuscript. XH Y provided supervision and overall coordination of the research. Y X provided methodological guidance. TJ Y performed the literature review and data organization. All authors have read and approved the final version of the manuscript. Acknowledgements In addition to expressing our gratitude to the above-mentioned funds and authors for their assistance with the article, we also thank the anonymous reviewers for their constructive feedback, which greatly improved the quality of this paper References Shi R, Weng L, Wu H. Bibliometric analysis of domestic specialist nurse research literature using CiteSpace visualization software. Nursing Practice and Research, 2022, 19 (22): 3363-3368. Guo H, Li J. Research status of advanced practice nurse roles in China. Chinese Journal of Modern Nursing, 2023, 29 (6): 827-834. Tian J, Su L, Zhang J, et al. Development and reflection on 20 years of specialist nurse training in China. Chinese Nursing Education, 2024, 21 (7): 773-779. Feng J, Xu J, Zhu X, et al. Organization and practice of multi-disciplinary nursing collaborative rounds for critically ill patients. Chinese Nursing Education, 2025, 22 (1): 78-84. He P, Chen L, Sun M, et al. Construction and application of a retraining program for peritoneal dialysis patients based on a systematic teaching model. Chinese Nursing Journal, 2024, 59 (02): 149-155. Kong W, Huang Y, Lu Y, et al. Development, implementation, and evaluation of consultation case-based learning courses to improve interdisciplinary clinical reasoning ability—a pilot study from nephrology. BMC Medical Education, 2025, 25 (1). Bi J, Na J. Exploration of BOPPPS-based blended teaching methods in obstetrics and gynecology ideological and political courses. Chinese Continuing Medical Education, 2025, 17 (1): 66-70. Liang T. Quick Reference Handbook of Clinical Teaching Methods . Beijing: People's Medical Publishing House, 2021. He J, Li J, Feng, L, et al. Oncology nurse competency in chimeric antigen receptor T-cell therapy: A qualitative study. Nurse Educ Today, 2024, 132 : 106040. Luo J, Gong W, Dong S, et al. Construction of a comprehensive evaluation index system for outpatient specialist nursing workshops. Chinese Nursing Journal, 2023, 58 (3): 325-333. Connor D M, Narayana S, Dhaliwal G. A clinical reasoning curriculum for medical students: An interim analysis. Diagnosis, 2022, 9 (2): 265-273. Gong F, Li H, Chen C, et al. Constructing a competency evaluation index system for community nurses in elderly common chronic disease care based on the iceberg model. Evidence-Based Nursing, 2025, 11 (03): 507-513. Xi Jinping emphasized at the National Conference on Ideological and Political Work in Colleges and Universities: To integrate ideological and political work throughout the education and teaching process and create a new development phase for China's higher education. People's Daily , 2016, December 9. Ministry of Education of the People's Republic of China. Opinions on Strengthening the Construction of “Situation and Policy” Courses in New Era Colleges and Universities. [EB/OL]. [2018-04-13]. [2025-04-21]. http://www.moe.gov.cn/srcsite/A13/moe_772/201804/t20180424_334097.html. General Office of the State Council, General Office of the CPC Central Committee. Opinions on Deepening Education System and Mechanism Reform. [EB/OL]. [2017-09-25]. [2025-04-21]. http://www.moe.gov.cn/jyb_xwfb/s6052/moe_838/201709/t20170925_315201.html. Ma X, Yu D, Yang X, et al. (2023). Design and practice of ideological and political education in nursing courses based on the competency perspective. Chinese Continuing Medical Education, 2023, 15(15): 116-119. Ji H, Li F, Zhang M, et al. Research on the impact of ideological and political education reform in the "Basic Nursing Techniques" course on vocational nursing education. Medical Theory and Practice, 2023, 36 (08): 1429-1431. Luo H, Chen Q. Research on the impact of ideological and political education on the stress sources of newly hired nurses in traditional Chinese medicine hospitals. Chinese Modern Distance Education in Traditional Chinese Medicine, 2023, 21 (10): 58-59, 80. Additional Declarations No competing interests reported. Supplementary Files Appendix1.docx Appendix2.docx Appendix3.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 24 Feb, 2026 Reviews received at journal 15 Feb, 2026 Reviews received at journal 13 Feb, 2026 Reviews received at journal 10 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers invited by journal 04 Feb, 2026 Editor assigned by journal 03 Feb, 2026 Editor invited by journal 13 Jan, 2026 Submission checks completed at journal 13 Jan, 2026 First submitted to journal 13 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Clinical nursing experts are senior registered nurses with advanced knowledge, skills, and clinical experience in a particular field \u003csup\u003e[2]\u003c/sup\u003e. They perform functions such as nursing practice, education, consultancy, research, and management, acting as leaders, researchers, supervisors, and advisors throughout the entire nursing process. SN is not synonymous with a clinical nursing expert but refers to professional nurses working in specialized positions, marking the beginning of nursing specialization. In many countries, clinical nursing experts are developed through further training based on the foundation of SN \u003csup\u003e[3\u0026ndash;4]\u003c/sup\u003e. Currently, most SNs have not reached the core competencies of clinical nursing experts. Compared to other countries, the practice and research of clinical nursing experts in China are still in the early stages. Therefore, how to develop the clinical nursing expert system, practice, and training research in line with the characteristics of nursing talent, training models, and management mechanisms in China remains an ongoing process.\u003c/p\u003e \u003cp\u003ePeritoneal dialysis SNs are the main workforce in peritoneal dialysis nursing in China. While the initial training of peritoneal dialysis SNs in Zhejiang Province has achieved some scale and effectiveness, most post-graduation retraining and deployment are handled by the hospitals where they work. However, differences in hospital scale, specialized nursing levels, and retraining programs hinder the standardization and improvement of specialized skills for all peritoneal dialysis SNs in the province. Thus, there is an urgent need to build and improve a retraining and utilization program for peritoneal dialysis SNs post-graduation, aiming to transform these nurses into true clinical nursing experts.\u003c/p\u003e \u003cp\u003eThe ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) \u003csup\u003e[5\u0026ndash;6]\u003c/sup\u003e is a well-established and widely applied training model. It designs and develops programs based on training needs, evaluates each phase promptly, and avoids one-sidedness and blind spots, ensuring both flexibility and high-quality training. This study constructed a retraining and utilization program for peritoneal dialysis SNs based on the ADDIE model, with a focus on clinical nursing expert orientation and job competency. The BOPPPS teaching model (Bridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment, and Summary) \u003csup\u003e[7\u0026ndash;8]\u003c/sup\u003e was applied during the implementation of the program to improve teaching standards and quality.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEstablishing a Research Team\u003c/h2\u003e \u003cp\u003eThe research team consists of 1 chief physician, 2 deputy chief nurses, 1 charge nurse, and 1 nurse, with a doctoral degree holder, 2 master's degree holders, and 2 bachelor's degree holders. All team members are engaged in peritoneal dialysis medical and nursing education and have extensive teaching experience.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eConstruction of the Peritoneal Dialysis SN Retraining and Utilization Program\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e(1)Analysis\u003c/h2\u003e \u003cp\u003eThe main task of this phase was to understand the needs for retraining peritoneal dialysis SNs and identified the professional gaps and challenges encountered in clinical practice. This was mainly achieved through literature review and semi-structured interviews.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLiterature Review.\u003c/b\u003e From May 1, 2023, to May 31, 2023, a systematic search was conducted on China National Knowledge Infrastructure, Wanfang Database, VIP Database, PubMed, CINAHL, Cochrane Library, Web of Science, Embase, and EBSCO. The search terms were \"Specialist Nurse; Clinical Nurse Specialist; Advanced Practice Nurses; Cultivation; Training; Curriculum; Program; Post Competency,\" to clearly define relevant concepts and gather indicators related to the core competencies of clinical nursing experts in peritoneal dialysis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSemi-structured Interviews.\u003c/b\u003e Based on the results of the literature review and the Competency Iceberg Model \u003csup\u003e[9]\u003c/sup\u003e, an interview questionnaire was developed for this study, as detailed in \u003cb\u003eAppendix 1\u003c/b\u003e. Cluster sampling was used to select peritoneal dialysis SNs and senior peritoneal dialysis SN instructors from different hospitals in Zhejiang Province for semi-structured in-depth interviews. The inclusion criteria for the interviewed SNs were: (a) Having held the Zhejiang Province peritoneal dialysis SN training certificate for at least 3 years; (b) Holding at least a bachelor's degree; (c) Having independently managed at least 100 long-term follow-up peritoneal dialysis patients; (d) Providing informed consent and signing an informed consent form. The inclusion criteria for the interviewed SN instructors were: (a) Having engaged in peritoneal dialysis SN instructor work in Zhejiang Province for at least 3 years; (b) Holding a senior or higher professional title; (c) Having trained at least 10 peritoneal dialysis SNs. Before the interviews, the researchers provided the interviewees with informed consent forms, informed them of the study's purpose, methods, and content, ensured privacy protection, and established trust. The interviews were conducted in the head nurse's office, with each interview lasting between 30 to 90 minutes. Within 48 hours of the interviews, two team members transcribed the data and analyzed the competencies of peritoneal dialysis clinical nursing experts and the retraining needs of peritoneal dialysis SNs. The sample size was considered saturated when no new themes emerged.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e(2)Design\u003c/h3\u003e\n\u003cp\u003eBased on the analysis phase, the initial draft of the peritoneal dialysis SN retraining and utilization program was designed, followed by two rounds of Delphi expert consultation to revise the program. The expert consultants for this study were selected from professionals in the fields of peritoneal dialysis nursing and nursing education, based on the following criteria: an associate senior title or higher, at least 10 years of experience in peritoneal dialysis or nursing education, enthusiasm for the study, and willingness to participate in two rounds of expert consultation within the project timeline. The expert consultation questionnaire consisted of four sections: consultation instructions, expert basic information, consultation content, and the expert\u0026rsquo;s familiarity with the content and judgment basis. The consultation focused on the retraining modules, content, and assessment cycles for peritoneal dialysis SNs, using a Likert 5-point scale (5 points for \"very satisfied\" and 1 point for \"very dissatisfied\") to rate the importance of each module and content, and included options for different training cycles (from 1 to 5 years or other). Two rounds of consultation were conducted between September 1 and October 31, 2023, through email, WeChat, DingTalk, or in person, with a one-month interval between rounds. The results of the first round were analyzed, and revisions were made based on expert feedback before the second round. The project was considered for inclusion if the mean importance score exceeded 3.50 and the coefficient of variation was less than 25%.\u003c/p\u003e\n\u003ch3\u003e(3)Development\u003c/h3\u003e\n\u003cp\u003eBuilding on the previous stages, the research team developed the content, methods, and timeline for the retraining program. We held multiple meetings, both online and offline, to discuss key points such as the knowledge, skills, emotional, and ideological goals of the course content, reaching a consensus. Difficult and critical teaching points were analyzed based on the latest guidelines and industry standards, while also clarifying the needs of the learners. We integrated the concepts of active teaching and active learning to enhance the learning outcomes. Regarding lesson plan writing, PowerPoint (PPT) creation, and video production, a three-tier responsibility system was implemented. Detailed lesson plans were written first, covering teaching objectives, target audience, content, methods, and expected outcomes. Once the lesson plan was approved, the teaching PPT and videos were produced. Both the lesson plans and the teaching materials (PPT and videos) were reviewed by a three-tier system: the course expert, peer experts, and the project leader, ensuring the quality of the materials and the effectiveness of the teaching.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e(4)Implementation\u003c/h2\u003e \u003cp\u003eFrom May 1, 2024, to September 30, 2025, the retraining program was implemented for peritoneal dialysis SNs in Zhejiang Province who had already graduated and obtained the SN certificate. Before the training, a DingTalk learning group was organized, where all notifications were posted. Online learning, assessments, and evaluations were completed on the online platform, while offline learning was based on continuing education courses organized by the Peritoneal Dialysis Nursing Group of the Zhejiang Nursing Association and grassroots training programs (or nursing salons). During the implementation process, the BOPPPS teaching model was applied to each course: Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment, and Summary.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e(5)Evaluation\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eSatisfaction of Peritoneal Dialysis SNs with the Retraining Program\u003c/b\u003e. This included formative and summative assessments. The formative assessment was conducted after each training session, where the trainer distributed a Quick Response code (QR code) for the trainees to scan and provide feedback on the spot. The questionnaire consisted of a single question: \"Are you satisfied with this training?\" The summative assessment was conducted after the entire retraining phase had been completed. The project leader distributed a QR code for the trainees to scan and provide feedback. This questionnaire included five questions: (a) What is your overall satisfaction with this training program? (b) How satisfied are you with the content of this training program? (c) How satisfied are you with the duration and course schedule of this training program? (d) How satisfied are you with the delivery method of this training program? (e) Do you have any suggestions for improving the training program? The assessments used the Likert 5-point scale.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePeritoneal Dialysis SNs Meeting the Standards to Become Clinical Nursing Experts\u003c/b\u003e. The rate of peritoneal dialysis SNs progressing to clinical nursing experts was calculated as: Rate of Progression\u0026thinsp;=\u0026thinsp;Number of nurses meeting the progression standards/Total number of trained nurses. The progression standards are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. These standards were discussed by the research team, taking into account the promotion criteria for senior practice nurses at our hospital and the training goals and content of this project. A pre-experiment was conducted with 23 SNs, and the Cronbach's α coefficient for the pre-experiment was 0.749.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStandards for the Advancement of Peritoneal Dialysis SN to Clinical Nursing Expert\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModule\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEntry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNote\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)All tests during the period were \u0026ge;\u0026thinsp;90 points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eSkills\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(2)Ability to Lead and Organize a Nursing Case Analysis of Difficult Peritoneal Dialysis Cases at the Hospital Level or Lead an Interdisciplinary Collaborative Nursing Round Related to Peritoneal Dialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(3)Ability to Create a Patient Education Video or Brochure and Distribute It to At Least 100 Patients or Their Families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(4)Undertake at least 2 hours of teaching tasks within the hospital or externally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublish one nursing research or quality award-winning paper as the first author, with at least one of the following (choose one):\u003c/p\u003e \u003cp\u003e① Case study, review, article, etc., published in a core Chinese scientific and technological journal;\u003c/p\u003e \u003cp\u003e② Patent conversion or granted invention patent;\u003c/p\u003e \u003cp\u003e③ Project approved at the municipal level or higher;\u003c/p\u003e \u003cp\u003e④ Paper or project awarded third prize or above at the provincial level or higher.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(5)Organize an offline peritoneal dialysis kidney patient meeting, with no fewer than 100 patients and family members participating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(6)Increase in the Peritoneal Dialysis Quality Control Indicator Compliance Rate at the Institution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eTraits\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)High patient satisfaction, with no nursing-related complaints or disputes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(2)Complete at least 3 hours of volunteer service at a hospital or in the community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eChoose one from four options\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(3)Rated as an advanced worker or excellent nurse at the hospital level or above\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(4)Participate in public emergencies at the hospital level or above\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(5)Won second prize or above in a hospital-level nursing competition, and third prize or above in a regional-level or higher nursing competition\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMotivation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)Nurses with a bachelor's degree or higher and at least 10 years of work experience, or nurses with a master's degree or higher and at least 8 years of work experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(2)Have obtained a specialist nurse certificate at the provincial level or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSocial Role\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)Participated in at least one interdisciplinary nursing consultation at the hospital level or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(2)Participated in at least one free clinic, community activity, or grassroots project\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSelf-concept\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)Without any violations of laws or regulations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(2)Without any issues related to research integrity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandatory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical Methods\u003c/b\u003e. All data were entered into Statistical Product and Service Solutions (SPSS) 27.0 statistical software. For normally distributed quantitative data, the mean and standard deviation were used for description. For data that did not meet the assumptions of normality and homogeneity of variance, as well as ordinal data, the median and percentage were used. The questionnaire response rate reflected the experts' level of engagement, while the authority coefficient was used to describe the experts' authority. Kendall's coefficient of concordance was used to reflect the degree of consensus among expert opinions. A difference was considered statistically significant if P Value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis Phase\u003c/h2\u003e \u003cp\u003eFrom June 1, 2023, to July 15, 2023, interviews were conducted with 10 peritoneal dialysis SNs and 6 peritoneal dialysis SN preceptors from Zhejiang Province. All participants were female, with an average age of (42.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31) years. The interviews resulted in the identification of 4 core themes, with specific details and characteristics of each theme presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The initial draft of the retraining program was formed, as shown in \u003cb\u003eAppendix 2\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of Semi-Structured Interviews\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTopic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-topic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpecific content and characteristics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTopic 1: Peritoneal Dialysis Specialist Nurse and Clinical Nursing Expert Role Differentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProgression Relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThirteen interviewees believed that nursing experts are the advanced form of SNs, with the core difference lying in the ability dimension\u0026mdash;nursing experts possess stronger research capabilities and the ability to solve complex cases.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYears of Experience Difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTwo interviewees focused on the duration of experience, believing that only those with longer work tenure can become nursing experts, without mentioning differences in the ability dimension.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConceptual ambiguity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOne interviewee made no distinction between the two roles and did not form a clear understanding of the differences.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTopic 2: Core Work Responsibilities of Clinical Nursing Experts in Peritoneal Dialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe results were highly consistent, forming five core modules\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePatient management\u003c/b\u003e is the foundational work, covering daily follow-ups of peritoneal dialysis patients, monitoring dialysis effectiveness, and preventing and managing complications.\u003c/p\u003e \u003cp\u003e\u003cb\u003eNursing research\u003c/b\u003e is key to improving work quality, including conducting clinical studies related to peritoneal dialysis care, summarizing nursing experiences, and forming academic achievements.\u003c/p\u003e \u003cp\u003e\u003cb\u003eNursing education and nurse mentoring\u003c/b\u003e are central to the transmission of specialized knowledge, involving theoretical training, procedural guidance, and the cultivation of clinical thinking in junior nurses (such as SNs).\u003c/p\u003e \u003cp\u003e\u003cb\u003eLeading peritoneal dialysis nursing work\u003c/b\u003e in the department is an important responsibility that requires coordinating and formulating departmental peritoneal dialysis nursing standards, promoting nursing technological innovation, and addressing common issues in nursing work. These five modules together form the complete work system of a nursing expert.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTopic 3: Priority Competencies for Clinical Nursing Experts in Peritoneal Dialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCore competencies / Professional qualities / Supporting skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTwelve interviewees believe that core abilities (research capabilities and the ability to solve clinical complex cases) are the most important qualities, and are the key distinguishing factors between nursing experts and SNs. The second priority is professional qualities (such as a passion for specialized nursing and compassion for patients), which are considered the foundation supporting the effective application of core abilities. Lastly, auxiliary abilities (such as communication skills and teaching abilities) are recognized as important, but their priority is considered lower than the first two categories.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFour interviewees placed professional qualities (passion for the specialty and compassion for patients) at the top, believing that professional qualities are the prerequisite for engaging in specialized nursing. Without passion and compassion, it would be difficult to deeply develop core abilities. The second priority is core abilities (research and solving complex cases), followed by auxiliary abilities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTopic 4: Training Needs for Specialist Nurses Advancing to Clinical Nursing Experts in Peritoneal Dialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSN advancement requires a dual-track training model based on 'continuous learning\u0026thinsp;+\u0026thinsp;long-term practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOn one hand, there is a need for \"periodic retraining,\" which includes regularly attending peritoneal dialysis specialized training, academic seminars, new technology workshops, etc., to ensure that knowledge stays up to date with clinical developments and avoids becoming outdated. On the other hand, \"long-term clinical practice\" is necessary to accumulate experience, such as managing a more diverse range of patients, participating in complex case consultations, and following senior nursing experts for clinical mentorship, in order to improve the ability to solve practical problems through hands-on practice. Both are indispensable and together form the essential training path for an SN to progress to a nursing expert.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAuthority and Reliability of Expert Consultation.\u003c/b\u003e Questionnaires were distributed to all 22 experts in both rounds of consultation, with effective response rates of 100% and 95.45%, respectively. In the first round, 5 experts provided 5 suggestions. No suggestions were made in the second round. The expert judgment coefficients for the two rounds were 0.93 and 0.92, respectively. The familiarity of the experts with the indicators was 0.86, and the expert authority coefficients were 0.90 and 0.89. For the importance ratings of the learning modules, the mean scores in the two rounds ranged from 4.36 to 5.00 and from 4.43 to 5.00, with coefficients of variation from 0% to 13.08% and 0% to 13.17%, respectively. The Kendall\u0026rsquo;s W coefficients were 0.273 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 0.249 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For the importance ratings of the learning directory, the mean scores ranged from 3.77 to 4.86 and from 3.81 to 4.90, with coefficients of variation from 7.06% to 23.02% and 5.98% to 22.73%, respectively. The Kendall\u0026rsquo;s W coefficients were 0.269 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 0.258 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e\u003cb\u003eExpert Consultation Results\u003c/b\u003e. The initial draft of the retraining content covered 9 learning modules and 38 learning directories (29 theoretical courses and 9 practical projects). The final version of the retraining plan, after two rounds of expert consultation, covered 11 learning modules and 38 learning directories (28 theoretical courses and 10 practical projects). The 11 learning modules included ideological and political courses and practices, knowledge (in the fields of profession, teaching, research, and management), and skills (in the fields of profession, teaching, research, and management). After considering clinical practice and group discussions, the research team decided to revise the content. In the first round of expert consultation, the learning module \"Ideological and Political Education\" was revised to \"Ideological and Political Courses and Practices.\" In the learning directory, the practical project \"Participate in free clinics, community activities, or grassroots training projects at least once\" was modified to \"Participate in free clinics, community activities, or grassroots projects at least once and report on peritoneal dialysis outcomes or share professional insights,\" and \"The peritoneal dialysis quality control index of the institution rises\" was changed to \"Lead peritoneal dialysis-related continuous quality improvement projects and the peritoneal dialysis quality control index of the institution rises.\" No modifications were suggested in the second round of expert consultation. After two rounds of expert consultation, 68.18% of the experts agreed that the retraining and assessment cycle should be 3 years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDevelopment Phase\u003c/h2\u003e \u003cp\u003eBased on the results of the design phase, the peritoneal dialysis SN retraining and usage plan was developed, along with the corresponding training materials, such as PPTs, videos, and a case library, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal Draft of Peritoneal Dialysis SN Retraining and Utilization Plan\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eModule\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMethod\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e \u003cp\u003ePolitical Education Courses and Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eProvincial and Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*The Nightingale Pledge and Real-life Stories\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOne hour for each course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eProvincial-level offline continuing education class\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*The Nursing Vision of Zhejiang Nursing Association and the Organizing Institutions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*\"Nurturing Growth, Encountering the Future\" \u0026mdash; A Brief Discussion on the Career Development Path of Nurses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Igniting the Light of Profession\u0026mdash;From Core Competencies to Compassionate Care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Patient-Centered Full-Course Case Management in Peritoneal Dialysis Specialized Nursing Practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOne hour for each course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eProvincial-level offline continuing education class\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*The Key Role of Specialist Nurses in Peritoneal Dialysis Patients' Discharge Preparation and Adaptation to Home Dialysis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*The Role of Peritoneal Dialysis Specialist Nurses in Improving Patient Outcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Love on the Left, Care on the Right \u0026mdash; Narrative Nursing Illuminates the Light of Hope\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Participate in at least one free clinic, community activity, or grassroots program, and deliver a report on the outcomes of peritoneal dialysis promotion or share reflections on its professional value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eSame as Skill Module\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eIndividual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Cultivating 360\u0026deg; Communication Competence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOne hour for each course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eProvincial-level offline continuing education class\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Tips for Time and Stress Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Research Integrity and Literacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Back to the Essentials: Nursing Clinical Thinking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Participate in at least one interdisciplinary nursing consultation at the hospital level or above\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003eSame as Skill Module\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅠ-15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Complete at least 3 hours of volunteer service at a hospital or in the community\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"15\" rowspan=\"16\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eProfessional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStrategies and Practices to Improve Long-term Peritoneal Dialysis Patient Compliance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eOnce every two weeks, with each session lasting 1 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eOnline delivery\u0026thinsp;+\u0026thinsp;test assessment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProgress in the Prevention and Management of Complications in Long-term Peritoneal Dialysis Patients\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProgress in the Application of Automated Peritoneal Dialysis Technology in Critically Ill Patients with Renal Failure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Development of a Peritoneal Dialysis Patient Retraining Program Based on the ADDIE Model\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExploration and Practice of Peritoneal Dialysis Patient Management in the Digital Age\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExploration and Practice of Home Peritoneal Dialysis Nursing under the \"Internet Plus\" Model\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Application of Traditional Chinese Medicine Techniques in Alleviating Severe Symptoms in Peritoneal Dialysis Patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*The Application Prospects of Artificial Intelligence in the Field of Peritoneal Dialysis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTeaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDevelopment of Teaching Competencies for Peritoneal Dialysis Specialist Nurses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHow to Teach a Good Class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eOne hour for each course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eProvincial-level offline continuing education class\u0026thinsp;+\u0026thinsp;test assessment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eResearch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWriting of Nursing Research Proposals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWriting and Submission of Nursing Academic Papers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*The Development and Practice of Patient-Reported Outcomes in the Field of Peritoneal Dialysis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThinking and Practice in the Application of Specialist Nurses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Exploration and Practice of Core Competencies for Peritoneal Dialysis Nursing Experts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅡ-16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Development of Nursing Leadership\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eSkills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProfessional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅢ-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Ability to Lead and Organize a Nursing Case Analysis of Difficult Peritoneal Dialysis Cases at the Hospital Level or Above\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003ewithin one training cycle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eSubmit proof materials and wait for review\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅢ-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Ability to Create a Patient Education Video or Brochure and Distribute It to At Least 100 Patients or Their Families\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTeaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅢ-3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWrite a Lesson Plan\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅢ-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Ability to Lead an Interdisciplinary Collaborative Nursing Round Related to Peritoneal Dialysis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResearch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅢ-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAbility to Write and Submit One Nursing Paper\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅢ-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Organize an Offline Peritoneal Dialysis Kidney Patient Support Meeting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eⅢ-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e*Increase in the Peritoneal Dialysis Quality Control Indicator Compliance Rate at the Institution\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: * The italicized items are not covered in the first training. The usage standards: at least half of the nurse's working hours are dedicated to peritoneal dialysis-related specialized nursing, teaching, research, and management, and they have been doing so for at least 3 years.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImplementation Phase\u003c/h2\u003e \u003cp\u003e A total of 36 nurses who graduated in 2021 and obtained the peritoneal dialysis nursing SN certificate in Zhejiang Province were selected. All participants were female, with an average age of (39.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53) years. During the implementation process, the BOPPPS teaching model was applied to each course. An example of the teaching process, using \u003cem\u003eThe Nightingale Pledge and True Stories\u003c/em\u003e, is provided in \u003cb\u003eAppendix 3.\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation Phase\u003c/h2\u003e \u003cp\u003eIn the formative evaluation phase, the satisfaction of peritoneal dialysis SNs was 4.74 (4.61, 5.00). In the summative evaluation phase, the overall satisfaction of peritoneal dialysis SNs was 5.00 (4.00, 5.00), with content satisfaction at 5.00 (5.00, 5.00), method satisfaction at 4.64 (4.51, 5.00), and satisfaction with the training duration and course schedule at 5.00 (4.25, 5.00). By September 2025, 88.89% of peritoneal dialysis specialist nurses had advanced to clinical nursing experts.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe ADDIE model, developed in 1975 by the Educational Center at Florida State University with the help of renowned educationalist Robert Gagn\u0026eacute;, is the most fundamental and widely applied training method. It designs and develops projects based on training needs and conducts timely evaluations of each phase to avoid one-sidedness and blindness. It is flexible while ensuring training quality \u003csup\u003e[8]\u003c/sup\u003e. The BOPPPS teaching model was originally created by the Canadian Teacher Skills Training Workshop based on the teacher certification requirements in British Columbia, Canada. Initially used for teacher skills training, it is now widely applied in universities and training institutions. The BOPPPS model modularizes and standardizes the entire teaching process, making it highly operational. It breaks down the teaching course into introduction, learning objectives, pre-assessment, participatory learning, post-assessment, and summary \u003csup\u003e[7\u0026ndash;8]\u003c/sup\u003e. The retraining program developed in this study is based on the ADDIE model, combined with literature analysis, semi-structured interviews, and two rounds of expert consultations. The BOPPPS teaching model was applied during the program's implementation, ensuring strong operability, repeatability, and scientific rigor. The two rounds of expert consultation had a questionnaire response rate of over 90%, indicating high expert engagement. The expert authority coefficient was greater than 0.7, showing the experts\u0026rsquo; strong authority. The coefficient of variation for the project was less than 25%, indicating consensus among the experts. The coordination coefficient for the learning modules and projects, tested by chi-square, was P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, indicating a high level of coordination among the experts on the indicators \u003csup\u003e[5,10]\u003c/sup\u003e. Therefore, the retraining program developed in this study is reliable. While most domestic programs focus on the initial training of SNs, with few addressing retraining, this study is one of the first in China to develop and implement a retraining and usage program for specialist nurses, making it innovative.\u003c/p\u003e \u003cp\u003eAs an expert nursing professional, it is not enough to possess only specialized skills and knowledge. This brings up the question: What are the core competencies for peritoneal dialysis clinical nursing experts? The competency iceberg model divides competencies into the \"visible\" part above the iceberg and the \"hidden\" part below the iceberg. The \"visible\" part above the iceberg includes knowledge (specialized knowledge required for the position, such as technical and industry knowledge) and skills (specific abilities required to perform the job, such as operating tools and communication skills). These competencies can be quickly improved through training. The \"hidden\" part below the iceberg includes traits (personal stable behavioral characteristics, such as responsibility and stress tolerance), motivation (intrinsic factors driving personal behavior, such as achievement motivation and power motivation), social roles (behavioral styles and patterns based on attitudes and values, such as teamwork spirit), and self-concept (personal perceptions of one\u0026rsquo;s role and abilities, such as self-confidence and values). These hidden traits are more difficult to change but have a profound impact on job performance \u003csup\u003e[11\u0026ndash;12]\u003c/sup\u003e. Therefore, how to cultivate the \"hidden traits\" of peritoneal dialysis SNs is crucial. The retraining program developed in this study is clinical expert-oriented, focusing on improving nurses' practical abilities and intrinsic qualities. While aligning with clinical needs, it also enhances nurses' intrinsic motivation, which is one of the key features of this program. The initial training program focuses on training SNs, while the retraining program is oriented towards developing clinical nursing experts. The former emphasizes knowledge and skills, while the latter highlights practical skills (such as interdisciplinary nursing rounds) and the development of the hidden traits, motivation, and intrinsic qualities (such as volunteer activities).\u003c/p\u003e \u003cp\u003eIn Xi Jinping\u0026rsquo;s speech at the 2016 National Conference on Ideological and Political Work in Universities, he emphasized, \"We must insist on taking the cultivation of virtue and talent as the central link, integrating ideological and political work into the entire educational process, and achieving all-round education and all-encompassing cultivation of people\" \u003csup\u003e[13]\u003c/sup\u003e. The Central Committee of the Communist Party of China and the State Council, in the 2017 document Opinions on Strengthening and Improving Ideological and Political Work in Universities in the New Situation, pointed out that \"We must promote the outstanding traditional Chinese culture, revolutionary culture, and advanced socialist culture, implement the Chinese cultural inheritance project, and integrate traditional Chinese culture into education and teaching\" \u003csup\u003e[14\u0026ndash;15]\u003c/sup\u003e. While ideological and political education has made certain achievements in nursing student education and the standardized training of new nurses \u003csup\u003e[16\u0026ndash;18]\u003c/sup\u003e, its application in retraining in-service nurses is less common. Given the importance of ideological education to the long-term stability of the nursing workforce, it is urgent to apply ideological education in the training of in-service nurses, such as specialist nurses. This will deepen their work attitude in adhering to regulations and strengthen their legal awareness, fostering moral qualities such as \"thinking from the patient's perspective and acting according to the patient's wishes,\" thereby better serving clinical practice. In this program, the 15 items in Modules 1\u0026ndash;3 are all related to ideological and political courses and practices, and their content aligns well with the \"hidden traits\" of competency in the workplace.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe peritoneal dialysis SN retraining and usage program developed in this study is scientific, reliable, and innovative, with a focus on enhancing nurses' practical abilities and intrinsic qualities. It aligns with clinical needs while boosting nurses' intrinsic motivation. This training program integrates ideological and political education throughout the entire retraining process, reflecting the shift from \"explicit ideological education\" to \"implicit ideological education.\" It avoids stereotyped ideological content and achieves the goal of \"educating all, throughout the process, and in all aspects.\" However, the implementation phase of this program was limited to Zhejiang Province. Further expansion of the sample size is needed to apply this study more broadly, allowing for real-time revisions and updates to the retraining program.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eADDIE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 431px;\"\u003e\n \u003cp\u003eAnalysis, Design, Development, Implementation, and Evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eSN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 431px;\"\u003e\n \u003cp\u003especialist nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eBPPPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 431px;\"\u003e\n \u003cp\u003eBridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment, and Summary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ePPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 431px;\"\u003e\n \u003cp\u003ePowerPoint\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eQR code\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 431px;\"\u003e\n \u003cp\u003eQuick Response code\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eSPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 431px;\"\u003e\n \u003cp\u003eStatistical Product and Service Solutions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSchool of Medicine, with the ethical approval number [2025B]1502.\u0026nbsp;The informed consent to participate was obtained from all of the participants in the study.\u0026nbsp;The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any personal data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Medical Science and Technology Project of Zhejiang Province, China (2023KY096), Nursing Research Project of the First Affiliated Hospital, Zhejiang University School of Medicine (2025ZYHL06).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePP H conducted semi-structured interviews, issuing expert consultation letters, and wrote the original manuscript. XH Y provided supervision and overall coordination of the research. Y X\u0026nbsp;provided methodological guidance.\u0026nbsp;TJ Y performed the literature review and data organization. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn addition to expressing our gratitude to the above-mentioned funds and authors for their assistance with the article, we also thank the anonymous reviewers for their constructive feedback, which greatly improved the quality of this paper\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShi R, Weng L, Wu H. Bibliometric analysis of domestic specialist nurse research literature using CiteSpace visualization software. \u003cem\u003eNursing Practice and Research, 2022, 19\u003c/em\u003e(22): 3363-3368.\u003c/li\u003e\n\u003cli\u003eGuo H, Li J. Research status of advanced practice nurse roles in China. \u003cem\u003eChinese Journal of Modern Nursing, 2023, 29\u003c/em\u003e(6): 827-834.\u003c/li\u003e\n\u003cli\u003eTian J, Su L, Zhang J, et al. Development and reflection on 20 years of specialist nurse training in China. \u003cem\u003eChinese Nursing Education, 2024, 21\u003c/em\u003e(7): 773-779.\u003c/li\u003e\n\u003cli\u003eFeng J, Xu J, Zhu X, et al. Organization and practice of multi-disciplinary nursing collaborative rounds for critically ill patients. \u003cem\u003eChinese Nursing Education, 2025, 22\u003c/em\u003e(1): 78-84.\u003c/li\u003e\n\u003cli\u003eHe P, Chen L, Sun M, et al. Construction and application of a retraining program for peritoneal dialysis patients based on a systematic teaching model. \u003cem\u003eChinese Nursing Journal, 2024, 59\u003c/em\u003e(02): 149-155.\u003c/li\u003e\n\u003cli\u003eKong W, Huang Y, Lu Y, et al. Development, implementation, and evaluation of consultation case-based learning courses to improve interdisciplinary clinical reasoning ability\u0026mdash;a pilot study from nephrology. \u003cem\u003eBMC Medical Education, 2025, 25\u003c/em\u003e(1).\u003c/li\u003e\n\u003cli\u003eBi J, Na J. Exploration of BOPPPS-based blended teaching methods in obstetrics and gynecology ideological and political courses. \u003cem\u003eChinese Continuing Medical Education, 2025, 17\u003c/em\u003e(1): 66-70.\u003c/li\u003e\n\u003cli\u003eLiang T. \u003cem\u003eQuick Reference Handbook of Clinical Teaching Methods\u003c/em\u003e\u003cem\u003e. \u003c/em\u003eBeijing: People\u0026apos;s Medical Publishing House, 2021.\u003c/li\u003e\n\u003cli\u003eHe J, Li J, Feng, L, et al. Oncology nurse competency in chimeric antigen receptor T-cell therapy: A qualitative study. \u003cem\u003eNurse Educ Today, 2024, 132\u003c/em\u003e: 106040.\u003c/li\u003e\n\u003cli\u003eLuo J, Gong W, Dong S, et al. Construction of a comprehensive evaluation index system for outpatient specialist nursing workshops. \u003cem\u003eChinese Nursing Journal, 2023, 58\u003c/em\u003e(3): 325-333.\u003c/li\u003e\n\u003cli\u003eConnor D M, Narayana S, Dhaliwal G. A clinical reasoning curriculum for medical students: An interim analysis. \u003cem\u003eDiagnosis, 2022, 9\u003c/em\u003e(2): 265-273.\u003c/li\u003e\n\u003cli\u003eGong F, Li H, Chen C, et al. Constructing a competency evaluation index system for community nurses in elderly common chronic disease care based on the iceberg model. \u003cem\u003eEvidence-Based Nursing, 2025, 11\u003c/em\u003e(03): 507-513.\u003c/li\u003e\n\u003cli\u003eXi Jinping emphasized at the National Conference on Ideological and Political Work in Colleges and Universities: To integrate ideological and political work throughout the education and teaching process and create a new development phase for China\u0026apos;s higher education. \u003cem\u003ePeople\u0026apos;s Daily\u003c/em\u003e\u003cem\u003e, \u003c/em\u003e2016, December 9.\u003c/li\u003e\n\u003cli\u003eMinistry of Education of the People\u0026apos;s Republic of China. Opinions on Strengthening the Construction of \u0026ldquo;Situation and Policy\u0026rdquo; Courses in New Era Colleges and Universities. [EB/OL]. [2018-04-13]. [2025-04-21]. http://www.moe.gov.cn/srcsite/A13/moe_772/201804/t20180424_334097.html.\u003c/li\u003e\n\u003cli\u003eGeneral Office of the State Council, General Office of the CPC Central Committee. Opinions on Deepening Education System and Mechanism Reform. [EB/OL]. [2017-09-25]. [2025-04-21]. http://www.moe.gov.cn/jyb_xwfb/s6052/moe_838/201709/t20170925_315201.html.\u003c/li\u003e\n\u003cli\u003eMa X, Yu D, Yang X, et al. (2023). Design and practice of ideological and political education in nursing courses based on the competency perspective. \u003cem\u003eChinese Continuing Medical Education, 2023, \u003c/em\u003e15(15): 116-119.\u003c/li\u003e\n\u003cli\u003eJi H, Li F, Zhang M, et al. Research on the impact of ideological and political education reform in the \u0026quot;Basic Nursing Techniques\u0026quot; course on vocational nursing education. \u003cem\u003eMedical Theory and Practice, 2023, 36\u003c/em\u003e(08): 1429-1431.\u003c/li\u003e\n\u003cli\u003eLuo H, Chen Q. Research on the impact of ideological and political education on the stress sources of newly hired nurses in traditional Chinese medicine hospitals. \u003cem\u003eChinese Modern Distance Education in Traditional Chinese Medicine, 2023, 21\u003c/em\u003e(10): 58-59, 80.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ADDIE model, specialized nurse, training, Delphi technique, clinical nursing expert","lastPublishedDoi":"10.21203/rs.3.rs-8535587/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8535587/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePeritoneal dialysis specialist nurses are the main force in peritoneal dialysis care in China, but most have not yet reached the core competencies of clinical nursing experts. This study aims to develop a retraining program for peritoneal dialysis nurses based on the ADDIE model (Analysis, Design, Development, Implementation, Evaluation), focusing on clinical nursing expert orientation and job competency, to accelerate their progression into clinical nursing experts.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFrom May 1, 2023, to September 31, 2025, based on the five stages of the ADDIE model, the research team investigated the needs, characteristics, and existing resources for the retraining of peritoneal dialysis specialist nurses. We analyzed the training modules, content, format, and assessment plans, and developed a draft training program. Twenty-two experts in the field of peritoneal dialysis were invited to participate in two rounds of Delphi expert consultations to finalize the training program. The program was then implemented and evaluated with 36 nurses who had obtained the Zhejiang Province Peritoneal Dialysis Nursing Specialist Certificate.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe retraining program developed consisted of 11 learning modules and 38 learning topics (28 theoretical courses and 10 practical projects). In the formative evaluation phase, the satisfaction of peritoneal dialysis specialist nurses was 4.74 (4.61, 5.00). In the summative evaluation phase, the overall satisfaction of peritoneal dialysis specialist nurses was 5.00 (4.00, 5.00), with content satisfaction at 5.00 (5.00, 5.00), method satisfaction at 4.64 (4.51, 5.00), and satisfaction with the training duration and course schedule at 5.00 (4.25, 5.00). By September 2025, 88.89% of peritoneal dialysis specialist nurses had advanced to clinical nursing experts.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe retraining and utilization program for peritoneal dialysis specialist nurses developed in this study is scientific, reliable, and innovative. It focuses on enhancing nurses' practical abilities and intrinsic qualities, aligning with clinical needs while also boosting nurses' intrinsic motivation.\u003c/p\u003e","manuscriptTitle":"The Construction and Implementation of a Clinical Nursing Experts-Oriented Retraining Program for Peritoneal Dialysis Specialist Nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-07 01:16:21","doi":"10.21203/rs.3.rs-8535587/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-24T12:36:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T10:21:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T07:11:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T11:17:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277676939637327409441617768896873391295","date":"2026-02-10T11:12:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62740556068037760291220454741179525240","date":"2026-02-06T00:59:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310812541955709930813876462552979939854","date":"2026-02-06T00:54:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T11:38:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-03T06:49:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-13T11:10:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-13T07:30:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-01-13T07:24:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"72717a36-3130-4197-aa6b-d6995ea0d90f","owner":[],"postedDate":"February 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T05:39:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-07 01:16:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8535587","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8535587","identity":"rs-8535587","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}