A Tiered Training Program for Emergency Nurses’ Core Competencies Based on Kolb’s Learning Cycle: A Delphi Study

A Tiered Training Program for Emergency Nurses’ Core Competencies Based on Kolb’s Learning Cycle: A Delphi Study | 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 A Tiered Training Program for Emergency Nurses’ Core Competencies Based on Kolb’s Learning Cycle: A Delphi Study Qian Wu, Wenjun Cai, Fang Cheng, Yan Jiang, Qiang Shi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8761414/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract Background: Emergency nursing requires advanced competencies, yet current training in China lacks theoretical grounding and career alignment. Based on Kolb’s experiential learning theory, this study develops a tiered core-competency program corresponding to nurses’ professional stages (N1–N4), aiming to foster systematic training and sustainable workforce development. Methods: A mixed-methods research design was employed. First, a preliminary draft of the training program was developed through systematic literature review and semi-structured interviews. Subsequently, from September to November 2025, 18 experts with over 10 years of emergency nursing experience from four provinces were invited to participate in two rounds of Delphi expert consultation. A Likert 5-point scale was used to evaluate the importance of program items, with consensus criteria set as follows: mean importance score ≥4.0, coefficient of variation ≤0.25, and agreement rate (score ≥4) ≥75%. The expert positivity, authority coefficient, and opinion coordination degree were evaluated through questionnaire recovery rate, authority coefficient (Cr), and Kendall's coefficient of concordance (Kendall's W), respectively. Results: The effective recovery rates of both rounds of expert consultation questionnaires were 100%, with expert authority coefficients of 0.913 and 0.917, indicating the credibility of the consultation results. After two rounds of revisions, a final training program was developed, comprising 5 first-level indicators, 15 second-level indicators, and 48 third-level indicators. All indicators achieved high consensus, and the program systematically integrated the learning cycle of Kolb's experiential learning theory with the competency advancement pathway for competency advancement from novice (N1) to expert (N4) levels. Conclusion: This study successfully established China's first emergency nursing core competency tiered training program based on Kolb's Learning Cycle theory, spanning the entire career trajectory of nurses. The program demonstrates both systematic design and operational feasibility, providing not only a scientific framework for standardized training, competency certification, and continuous professional development of emergency nurses, but also offering theoretical foundations and practical guidelines for sustainable workforce development in emergency nursing. Emergency Nurse Core competency Kolb's Learning Cycle Program Competency level Introduction The emergency department serves as the primary front-line unit of medical institutions in responding to sudden critical illnesses, characterized by complex and rapidly changing patient conditions, time-sensitive decision-making, and intensive interdisciplinary collaboration. This demands that nurses not only possess solid emergency skills but also have advanced competencies including rapid assessment under pressure, independent clinical judgment, effective coordination, and emotion regulation. Currently, China's nursing workforce faces dual structural challenges: the slow competency development among junior nurses and the increasing burnout and attrition of senior nurses [1-5]. Additionally, China's nursing practice confronts complex challenges such as nurse shortages, heavy workloads, and strained doctor-patient relationships [6]. This situation poses significant challenges to the continuity of care quality, patient safety, and the sustainable development of emergency medicine. In 2022, the National Health Commission of China issued the "National Nursing Development Plan (2021-2025)" [7], which explicitly proposed strengthening professional training in critical nursing fields, such as emergency nursing, to enhance technical expertise. This policy direction clearly indicates that establishing a systematic talent cultivation mechanism capable of simultaneously accelerating competency for junior nurses, deepening empowerment for senior nurses, and anchoring their career development has become an urgent strategic task. The concept of "core competencies" originated from the field of business management, emphasizing the comprehensive qualities formed through collective learning, experience transfer, and collaborative participation which support an organization's sustainable development [8]. In the field of nursing, core competence refers to a nurse's ability to integrate professional knowledge, skills, attitudes, and personal traits in specific clinical environments to deliver safe and effective nursing practice [9]. Currently, some studies in China have focused on cultivating emergency nurses' core competencies, including exploring core competency elements [10], designing training programs for specific positions like triage nurses [11], and investigating training models for subspecialty emergency nurses [12,13]. However, a fundamental gap remains in both research and practice. Existing efforts primarily focus on summarizing training content or developing skills for specific positions, yet they generally lack a comprehensive design framework that is grounded in established learning theories, encompasses the entire career development cycle of nurses, and achieves a closed-loop of "learning, practice, and evaluation." Specifically: (1) Weak theoretical guidance: Training designs are predominantly based on empirical summaries rather than systematically integrating pedagogical theories, resulting in a disconnect between the training process and the psychological mechanisms of competency internalization; (2) Lack of systematic closed-loop: Training often follows a linear or modular approach,failing to establish a continuous improvement cycle of "assessment-training-practice-reflection-reassessment," which hinders the solidification and transfer of training outcomes; and (3) Unclear developmental pathways: Training content inadequately aligns with the phased developmental needs of nurses at different competency levels, impeding the establishment of a talent pipeline and sustainable growth. Therefore, developing a theoretically driven, hierarchical, and closed-loop core competency training system for emergency nurses is urgently needed. The cultivation of nurses’ core competencies is essentially a spiral, ascending process that progresses from practical experience to reflective observation, then to conceptual internalization, and ultimately to active application. Kolb’s Experiential Learning Cycle [14] provides a crucial theoretical framework for this process. This study aims to construct a hierarchical training system for core competency in emergency nurses at varying proficiency levels, guided by Kolb's Learning Cycle theory and integrated with China's clinical emergency practice and nursing career development pathways, using the Delphi expert consultation method. The objectives include: (1) Designing a progressive training content framework aligned with the N1-N4 competency levels of emergency nurses based on Kolb's four-stage learning cycle model; (2) Systematically embedding an integrated mechanism of formative assessment-competency certification-continuous professional development within the program to ensure measurable, traceable, and sustainable training outcomes; and (3) Establishing expert consensus on the training content, methodologies, and evaluation indicators through Delphi consultation to ensure scientific validity and clinical applicability. Methods This study consists of two phases: (1) the construction of a training program aimed at developing the core competencies of emergency nurses across varying competency levels, utilizing methods such as literature reviews, semi-structured interviews, and expert panel meetings; and (2) achieving a consensus on the training content for the core competencies of emergency nurses through the execution of two rounds of the Delphi method. Establish a research group The research team is composed of four members, each possessing professional backgrounds in emergency nursing. One member serves as the head nurse of the emergency department, holding the position of deputy chief nurse with 15 years of experience in emergency nursing management. This individual is responsible for overseeing overall supervision and quality control. The other three members include: an emergency department supervisor nurse with 12 years of clinical experience, tasked with conducting literature reviews and qualitative interviews; another emergency department supervisor nurse with 10 years of clinical experience, responsible for expert liaison and questionnaire management; and an emergency department nurse with 8 years of clinical experience, who handles data analysis and report writing. Prior to the commencement of the study, the research team underwent training in qualitative research methods and Delphi techniques to ensure consistency and objectivity throughout the research process. Construction of the structure Literature analysis A comprehensive search was conducted across various databases, including PubMed, Web of Science, The Cochrane Library, Embase, CNKI, Wanfang Data Knowledge Service Platform, and VIP, to gather training materials pertaining to the core competencies of emergency nurses. The search strategy combines subject headings and free-text terms, including keywords such as "Emergency Nursing", "Emergency Room Nursing", "Clinical Competencies", "Clinical Skill", "Professional competence", "Competence", "Professional", "Expertise Development", "Core Competency", "Education", and "Curriculum". The literature search was conducted up to May 2025 (search strategies are detailed in supplementary material Table 1 and Figure 1). Inclusion criteria for literature were: (a) full-text availability; (b) relevance to this study, including guidelines, systematic reviews, meta-analyses, original research, and evidence summaries. Exclusion criteria for studies included: (a) duplicate studies; (b) flawed study designs; and (c) unavailability of full text. Initially, 1,529 articles were retrieved, with 292 remaining after duplicate removal via software. Following a review of titles and abstracts, 231 articles deemed irrelevant to the topic were excluded. After a thorough reading of the full texts, an additional 50 articles with inconsistent research subjects or themes were eliminated, resulting in a final inclusion of 11 articles [11, 15-24]. Semi-structured interviews Based on the aforementioned literature review, the research team conducted face-to-face semi-structured interviews with personnel in the emergency field from June to August 2025. The selection criteria for emergency nursing experts include: (a) registered clinical nurses with over 10 years of experience in the emergency department; (b) nursing management personnel or nursing educators; (c) individuals holding intermediate or higher professional titles; (d) a bachelor's degree or higher; (e) proficient language skills; and (f) willingness to participate in the research. The selection criteria for emergency nurses comprised: (a) possession of a nursing practice certificate and registration; (b) completion of two years of standardized training and current employment in the emergency field; (c) proficient language skills; and (d) willingness to participate in the research. A purposive sampling method was employed, with sampling ceasing once information reached saturation and no new insights emerged [25]. Ultimately, six emergency nursing experts and five emergency nurses from a tertiary comprehensive hospital in Anhui Province were interviewed. The topics of the interviews were as follows: For nursing experts: 1. If you want to design a training program to enhance the core competencies of emergency nurses, which core training modules do you think must be included? 2. How do you think the entire training process should be effectively organized and connected to ensure that the training effectiveness can be translated into practical work abilities? 3. What do you foresee as the biggest obstacles or challenges in implementing such a systematic training program in clinical practice? 4. To overcome these obstacles and ensure the implementation of the plan, which one or two key supports do hospitals or nursing departments need to provide in terms of policies or resources the most? 5. How to evaluate whether this training program has truly enhanced the core competencies of nurses? Besides regular assessments, which behaviors or changes in outcomes do you think should be the most important focus? 6. Based on your experience, what is the core principle or approach that needs to be adhered to the most to ensure the success of such a competency oriented training program? Regarding emergency nurses: 1. Reviewing your own growth experience, which specific experiences or events have helped you the most in enhancing your core competencies while working in the emergency department? Why? 2. Which learning format has left the deepest impression and gained the most from the various trainings or studies you have participated in? 3. After busy clinical work, do you have the opportunity or habit of systematically reviewing or reflecting on the work process? What form of reflection do you think is feasible and effective? 4. Besides first aid skills, what other areas do you think you would like to participate in in the future and do you need more training in? How do you hope to obtain it? 5. If we were to tailor an ideal training program that can truly help you sustain your growth, what would you like it to include and in what form would it be conducted? Before each interview, the researcher provides participants with a comprehensive explanation of the research purpose, process, and confidentiality principles, and obtains written informed consent. The interviews are conducted in a quiet and private conference room, with each lasting between 30 to 60 minutes. The entire process is recorded, and detailed notes are taken. A complete verbatim transcription is performed within 48 hours after the interview, followed by analysis using Colaizzi's seven-step method [26]: (a) Carefully read all interview records; (b) Extract meaningful statements; (c) Encode meaningful statements; (d) Summarize the coding into themes; (e) Describe the topic in detail and without omission; (f) Summarize the detailed topics into general descriptions; and (g) Ultimately form a structured description. Expert group meeting Based on a comprehensive literature review and semi-structured interviews, a preliminary training plan was developed. Guided by Kolb’s Experiential Learning Cycle [14] as the core theoretical framework, the program centers around four key learning stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. A closed-loop management system encompassing evaluation, certification, and continuous professional development was integrated into the framework. This approach resulted in the construction of a hierarchical and progressively structured core competency training program for emergency nurses, characterized by a cyclical learning progression. The final program comprises 5 first-level items (corresponding to Kolb’s four learning stages and the evaluation system), 15 second-level items, and 44 third-level items (The initial version of the plan). It clearly defines the alignment between each item and the nurse competency level (N1-N4), along with specifying corresponding training formats and frequencies. This design ensures the systematic, phased, and operational feasibility of the training program (supplementary material Figure 2). Expert inquiry Expert Information From September to November 2025, 18 experts were invited to participate in a Delphi study. All experts possessed over 10 years of experience in emergency nursing, nursing management, or nursing education. The inclusion criteria for the experts aligned with those used for the semi-structured interviews. Additionally, experts were required to commit to completing two rounds of consultation and to be available for clarification during the process. The experts were recruited from four provinces in China: Anhui, Zhejiang, Shandong, and Jiangxi. Their mean age was 45.78 ± 8.50 years. The cohort included males (6, 33.3%) and females (12, 66.7%). Detailed demographic and professional characteristics of the expert panel are presented in Table 1. Preparation of survey questionnaire The questionnaire comprised three sections: (a) a detailed introduction to the research objectives, background, and significance of the study; (b) a basic information survey and a self‑assessment form for evaluating expert authority; and (c) the consultation questionnaire itself. The preliminary training program, designed to enhance the core competencies of emergency nurses, was structured around four key stages: concrete experience, reflective observation, abstract conceptualization, and active practice. Experts were asked to rate the importance of each item using a 5-point Likert scale, ranging from "extremely unimportant" to "extremely important." The questionnaire also incorporated open‑ended sections for adding comments and for proposing modifications, deletions, or additions to the listed indicators. Data collection The questionnaire was distributed in either electronic or paper format, with a set collection period of 7 days. Experts who did not respond within this timeframe were reminded via follow‑up email or telephone. Following the first round of consultation, the research team collated all expert feedback and revised the training program accordingly. The updated program, along with a summary of the first‑round comments and modifications, was then redistributed to the expert panel for the second round of consultation. The final version of the training program was determined after incorporating the feedback received in the second round. Statistical analysis SPSS Version 25.0 software was used for statistical analysis of the data. The general information of experts was analyzed through descriptive methods, and the results were expressed in frequency and percentage. Expert engagement was assessed by the questionnaire response rate and the proportion of experts providing suggestions [27]. The authority of the experts was quantified using the authority coefficient (Cr), which combined the judgment basis (Ca) and familiarity with the topic (Cs). Calculated as Cr = (Ca + Cs) / 2. A Cr ≥ 0.7 indicates high level of expert authority [28]. The degree of consensus among experts was assessed using the coefficient of variation (CV) and Kendall’s coefficient of concordance (Kendall’s W) [29]. Items were retained if they met the following criteria: a mean importance score ≥ 4.0, CV ≤ 0.25, and agreement from at least 75% of experts (score ≥ 4) [30]. Items not meeting one or more criteria were reviewed based on additional evaluation metrics, expert comments, and research team discussion. Statistical significance was set at P < 0.05. Ethics This study obtained ethical approval from the Medical Ethics Committee of a tertiary hospital in Anhui Province (Approval No. 2024‑Science‑94). Before participation, all experts were fully informed of the study’s purpose, procedures, and methodology, and written informed consent was obtained from each individual. All data were anonymized and handled with strict confidentiality throughout the research process. Results The level of enthusiasm and authority of experts A total of 18 questionnaires were distributed and collected in both consultation rounds, yielding a 100% response rate. In the first round, all 18 experts (100%) provided suggestions for revision; in the second round, 14 experts (83.33%) did so, reflecting a high level of engagement. The expert judgment coefficient (Ca) was 0.911 in the first round and 0.914 in the second. The familiarity coefficient (Cs) was 0.915 and 0.920, respectively. The resulting authority coefficient (Cr) was 0.913 in the first round and 0.917 in the second, indicating high expert authority and reliable consultation outcomes. Concentration of expert opinions In the first round, 64 items were evaluated. The mean importance scores ranged from 3.57 to 4.45, with standard deviations between 0.32 and 0.67. Following revisions, the second round included 68 items. Mean importance scores improved to a range of 3.78-4.83, while standard deviations increased to between 0.38 and 0.81. The rise in mean scores alongside the change in dispersion reflects a shift toward greater consensus among the expert panel. Coordination level of expert opinions In the first round of consultation, the coefficient of variation (CV) across all indicators ranged from 0.09 to 0.23. In the second round, the CV narrowed to 0.08-0.19, suggesting improved consensus among the experts. The Kendall’s coefficients of concordance for the three categories of indicators were 0.213-0.322 in the first round and 0.095-0.156 in the second round ( P < 0.01). These results indicate that the overall coordination of expert opinions reached statistical significance (Table 2). Expert modification suggestions During the first round of expert consultation, 18 reviewers evaluated the initial draft of the emergency nurses’ tiered core competency training program. A total of 13 specific revision suggestions were gathered, which included overlapping comments. The research team deliberated on each suggestion and integrated all of them into the revised draft, based on their relevance to the study objectives and the extent of expert agreement.The revisions encompassed the following adjustments: (1) the addition of one new item, namely "1.3.4 One-on-one mentorship throughout clinical teaching," to establish a formal clinical supervision mechanism; (2) the refinement of three items, such as redefining "complex case simulation" as "simulation of atypical critical cases (for example, atypical myocardial infarction or aortic dissection)" and underscoring the application of the SBAR structured model during post-simulation debriefing; (3) the clarification of wording or scope for six items, including specifying the roles of nurses in "quality improvement projects" according to their competency level, from N1 to N4, which ranges from participation to leadership of subtasks or cross-departmental projects, and renaming "Advanced First Aid Workshop" as "Advanced First Aid and Team-Based Comprehensive Simulation Training" to better convey its educational focus; (4) the removal of one item; and (5) the expansion of theoretical modules to cover "Emergency Mental and Behavioral Disorders" and "Differential Diagnosis of Emergency Symptoms" (see Table 3). Subsequently, a second round of consultation was held with 14 experts, whose feedback was consolidated into five thematic categories. Opinions in this round showed greater convergence, primarily affirming the earlier revisions and proposing only minor refinements. No items were added or deleted. The experts supported a clear distinction between "major positive event seminars" and "adverse event analysis meetings," and concurred that "simulation of atypical critical cases" should emphasize common emergency situations. The overarching framework of the training system, which integrates the four stage experiential learning cycle including concrete experience, reflective observation, abstract conceptualization, and active practice, with tiered nurse competency levels from N1 to N4, gained unanimous expert endorsement (Table 3). Following the two consultation rounds, a strong consensus was achieved. The final program is structured into 5 first-level, 15 second-level, and 48 third-level items, forming a scientifically grounded, systematic, and implementable training scheme (Table 4). Discussion The significance of constructing an emergency nurse training program This study developed a hierarchical training program for emergency nurses in China through a Delphi consensus process. This program addresses a critical need identified in China’s National Nursing Career Development Plan (2021–2025) [ 7 ], which calls for enhanced professional training in high-demand fields such as emergency care to strengthen the technical expertise of the nursing workforce. More broadly, this initiative aligns with the strategic goals of the “Healthy China 2030” blueprint, which prioritizes the development of a high-quality, efficient healthcare delivery system. Aligned with this policy direction, the present study adopted Kolb's experiential learning cycle as its theoretical foundation and referenced established core competency standards for emergency nursing. Using the Delphi expert consensus method, the research developed a hierarchical training program for emergency nurses in China, competency advancement from novice (N1) to expert (N4) levels. The program details level-specific training content, frequency, format, and evaluation criteria. It provides a theoretical basis for the systematic training, management, and assessment of emergency nurses and supports the ongoing development of the specialty. Reliability of Establishing an Emergency Nurse Training Program This study approached the development of the training program from multiple perspectives. Initially, the research team conducted a comprehensive review of domestic and international literature, policy documents, and existing training frameworks to understand the current state of emergency nursing education. These findings informed the preliminary design of the program.To ensure the program reflected both the actual conditions of emergency care training and current clinical needs, it was further refined through a structured expert consultation process. Experts with intermediate or senior professional titles were recruited from provinces including Anhui, Shandong, and Zhejiang. They represented fields such as emergency nursing, nursing management, and clinical education.These experts provided constructive feedback on the training plan. The response rate for both rounds of the questionnaire survey reached 100%, demonstrating a high level of engagement and commitment to emergency nursing practice and education. The authority coefficients of the expert panel were 0.913 in the first round and 0.917 in the second, indicating a high degree of expertise. Furthermore, a strong consensus was achieved on the proposed indicators, as evidenced by coefficients of variation all below 0.25 following the two consultation rounds. Therefore, the tiered training program for emergency nurses developed in this study demonstrates strong scientific rigor and reliability. Analysis of the Training Program for Emergency Nurses The internationally widely used core courses in trauma care (TNCC) [ 31 ], advanced trauma care (ATCN) [ 32 ], and advanced trauma life support (ATLS) [ 33 ] have achieved remarkable results in providing standardized first aid skills certification. However, these courses are essentially modular and summative, and do not cover the comprehensive roles of leadership, teaching, quality control, and cross departmental collaboration required by nurses in complex emergency environments. Building on the technical rigor of these courses, the present study introduces important conceptual and structural innovations. The training objectives extend beyond technical skill acquisition to encompass integrated professional competencies. Leadership, educational capability, evidence-based practice, and systems thinking are explicitly incorporated into the core framework.Furthermore, a clearly defined progression across four competency levels (N1-N4) ensures that training content and evaluation criteria align closely with nurses’ developmental pathway from novice to expert. Consequently, this program serves as both a necessary complement and an advanced extension of existing international standardized courses. It aims to systematically develop versatile nursing professionals who are proficient in clinical care, team leadership, and continuous quality improvement. Several studies in China have provided a reference basis for the training of emergency sub specialist nurses. For example, Hu et al. [ 13 ] designed a competency-based training program for emergency nurses in ophthalmology and otorhinolaryngology (EENT), with content modules closely focused on the specialized knowledge and skills relevant to EENT emergency care. Similarly, the emergency specialist nurse training program developed by Feng et al. [ 12 ] is organized around disease-system modules, such as trauma, poisoning, and cardiopulmonary resuscitation. A common feature of these programs is their content organization, which centers on specific diseases or specialty areas. In contrast, the present program does not target particular diseases or clinical topics. Instead, it aims to cultivate higher-order cognitive abilities that can be applied to the management of diverse critical conditions. This shift from a "disease-centered " to a "competency-centered " approach enhances the adaptability of training to the complex and unpredictable clinical environment of the emergency department, thereby improving the transferability and flexibility of nurses’ professional capabilities. Furthermore, this study is the first to systematically introduce Kolb’s experiential learning cycle into the design of emergency nurse training in China. This theoretical framework translates abstract core competency elements into operable, traceable learning-practice-reflection cycles. It not only operationalizes Benner’s "novice-to-expert" [ 34 ] developmental model but also provides clear developmental milestones and differentiated support for nurses at different career stages. This study aligns with the work of Munroe et al. [ 35 ] in developing the Emergency Department Clinical Emergency Response System (EDCERS), as both share the core objective of enhancing patient safety and care quality in emergency settings. The EDCERS framework establishes standardized operating procedures for identifying clinical deterioration and activating multidisciplinary team responses from organizational and workflow perspectives. The present training program offers a structured approach to systematically develop these competencies. For instance, the "Complex Case Simulation" module, which corresponds to the concrete experience stage, and the "Structured Review" module, aligned with reflective observation, can be designed around specific trigger scenarios outlined in the EDCERS protocol. This allows nurses to not only master procedural steps but also deepen their understanding of the underlying pathophysiology and refine their clinical reasoning skills. Thus, in future clinical practice, this training program can serve as an enabling tool for the effective implementation of rapid response systems such as EDCERS. Integrating such a system‑level protocol with a competency‑based training model may help address both process standardization and individual skill development, thereby offering a more comprehensive approach to reducing delays in recognizing and responding to clinical deterioration. The primary theoretical contribution of this program is its empirical demonstration of the applicability of Kolb’s Experiential Learning Cycle within structured nursing education. The four stages of the cycle are operationalized as follows (supplementary material Fig. 1): (a) Concrete experience: nurses engage in near‑real clinical situations through high‑fidelity simulation and exposure to complex cases; (b) Reflective observation: metacognition and critical thinking are systematically developed via structured debriefing and peer evaluation; (c) Abstract conceptualization: knowledge to support clinical decision‑making is constructed through study of current theories and pathophysiological mechanisms; and (d) Active practice: knowledge is translated into practice through leadership in quality‑improvement projects, clinical teaching, and related activities. On a practical level, the program offers a clear competency‑based pathway, incorporates varied instructional methods such as simulation, mentorship, and project‑based learning, and establishes an integrated system linking evaluation, certification, and professional development. This design allows the program to be flexibly embedded into existing frameworks, including orientation training for emergency nurses, annual continuing‑education schedules, specialized‑nurse training curricula, and unit‑based quality‑improvement initiatives. For instance, reflective‑observation activities can be incorporated into monthly nursing case discussions, while active‑practice projects can be aligned with annual departmental quality‑and‑safety priorities. Such integration helps shift training from an added task to a natural, ongoing component of daily nursing practice and professional growth. Limitation This study has several limitations. First, as this study established a program based on expert consensus, the effectiveness of the proposed program in improving nurse performance and patient outcomes requires empirical validation. Second, the participating experts were primarily recruited from tertiary hospitals. Consequently, the applicability of the program in secondary hospitals or community emergency centers, which often operate with different resource levels and staffing structures, needs further evaluation. Future research should address the following directions: (1) Effectiveness verification: implementing the program in multiple centers using a cluster‑randomized controlled or stepped‑wedge design to longitudinally assess its impact on nurses’core competency, team performance indicators, and patient safety outcomes; (2) Adaptation studies: exploring how the framework can be adapted and applied in specific emergency subspecialties, such as pediatric, stroke, or chest‑pain care; and (3) Implementation science inquiry: investigating organizational, contextual, and leadership factors that influence the successful implementation of this complex intervention, including necessary resource support and system‑level enablers. Conclusion Based on a systematic review of the literature and theoretical analysis, this study established a foundational framework for a training program. Guided by Kolb's Experiential Learning Cycle, the framework was refined through interviews with emergency nursing experts and clinical nurses. Subsequently, a Delphi expert consultation process was conducted to finalize the training program. The resulting program can serve as a practical reference for emergency nurse training. The next phase of this research will involve implementing the program among emergency department nurses. Feedback gathered from real‑world application will be used to further refine and optimize the training plan. Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Board of The Second People's Hospital of Hefei in accordance with the Declaration of Helsinki. All methods were carried out in accordance with relevant guidelines and regulations. Written informed consent was obtained from all individual patients included in the study. Consent for publication Not Applicable. Avalability of data and materials The datasets used or analysed during the current study are available from the corresponding author on reasonable request. Due to privacy and ethical restrictions regarding patient data, data sharing may require a formal data use agreement. Competing interests The authors declare no competing interests. Funding Key Project of Humanities and Social Sciences at Bengbu Medical University（2024byzd566sk） Authors' contributions Qian Wu: Conceptualization, Methodology, Project administration, Writing original draft. Wenjun Cai: Conceptualization, Validation, Writing review & editing, Supervision. Yan jiang: Investigation, Formal analysis, Data curation, Writing original draft. Qiang Shi: Investigation, Resources, Data curation. Fang Cheng: Methodology, Validation, Writing review & editing. 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Jeffries D, Ceci K, Graunke S, et al. The Game Is On and We're in the Ninth! Evolution of the Trauma Nursing Core Course, Ninth Edition[J]. Journal of emergency nursing, 2023,49(6):800-801. Glenn M A. Advanced Trauma Care for Nurses New International Collaboration: ATCN Sister Sites Program[J]. Journal of trauma nursing : the official journal of the Society of Trauma Nurses, 2024,31(4):181. Vassiliu P, Mavrogenis A, Theos C, et al. Advanced trauma life support course for medical students. A new era?[J]. Frontiers in surgery, 2022,9:1025920. Anderson J A, Willson P. Knowledge management: organizing nursing care knowledge[J]. Critical care nursing quarterly, 2009,32(1):1-9. Munroe B, Curtis K, Balzer S, et al. Translation of evidence into policy to improve clinical practice: the development of an emergency department rapid response system[J]. Australasian emergency care, 2021,24(3):197-209. Tables Table 1. Characteristics of the experts (n=18). Characteristics n （ %） Gender（%, n） Male 6(33.3) Female 12(66.6) Age (years, n) 30-40 5 (27.8) 41-50 8 (44.4) 51-60 5(27.8) Educational background (%, n) Bachelor's degree 2 (11.1) Master's degree 12 (66.6) Doctoral degree 4(22.2) Profession titles (%, n) intermediate 8 (44.4) Associate senior 7 (38.8) Senior 3 (16.6) Professional experience (years, n) 10-15 6 (33.3) 16-20 2 (11.1) ≥21 10 (55.6) Table 2. Expert coordination factor Categories Items Kendall's W Chi-square P Round 1 First-level indicators 5 0.322 14.86 ＜0.001 Second-level indicators 15 0.276 20.45 0.012 Third-level indicators 44 0.213 110.23 0.005 Round 2 First-level indicators 5 0.156 11.222 0.024 Second-level indicators 15 0.095 23.926 0.047 Third-level indicators 48 0.134 108.594 ＜0.001 Table3. Summary of opinions raised by two rounds of expert inquiries The first round of expert opinions. Items revision comments Reason and content for modification 1.1 revise The expression should be broad and closely correspond to the core emergency skills. It should be divided into 1.1 basic emergency skills operation and workshop and 1.2 advanced emergency and team comprehensive simulation training, with a clear list of skills. 1.1.1 revise Add ‘Team CPR’ at the top of the list and move ‘Chest Closed Drainage Coordination’ to the Advanced Skills module. 1.1.3 delete/merge The content is vague and overlaps with 1.1.1, so it is incorporated into 1.1.1. 1.2.3 revise Vague expression. The definition of‘complex' is unclear and prone to duplication with 1.2.1. Revision: Clarify as ‘rare case simulation’. 1.3.1 revise The intensity of ‘observation and participation' is insufficient, and it should be ‘led or collaboratively completed under supervision according to hierarchical levels’. 1.3.2 revise The correlation between occupational health and disaster recovery scenarios and emergency core competencies is slightly weak. Revision: Focus on ‘on-site response and collaborative practice of various emergency codes within the hospital’. 1.3.3 add Suggest adding contact with patients with ‘emergency mental and behavioral abnormalities’. 2.1.3 revise The merging of ‘reflection’and ‘stress management’ is illogical. Suggest splitting it into two sub items: ‘Structured Reflection Log’and ‘Stress Perception and Emotion Recording’. 2.3.1 revise Add an explanation of ‘following structured reporting models (such as SBAR)’. 2.3.2 revise The frequency and hosting mode of the discussion should be clearly defined (such as having nurses of different seniority take turns hosting). 3.1.1 add Suggest adding a module on ‘Pathophysiology and Differentiation of Common Symptoms in Emergency Care’. 3.2.2 divide Too much content. Suggest splitting it into two parts: ‘Nursing Ethics and Legal Regulations’ and ‘Emergency and Safety Management Policies’. 4.1.1 revise The term‘leading’puts pressure on junior nurses. It can be classified as ‘participating’or ‘dominant’according to energy levels. The second round of expert opinions. Items revision comments Reason and content for modification 1.2 revise The term ‘workshop’ is not sufficient to reflect its simulation and team characteristics, and is easily confused with 1.1. Adjust the name of the first level item to ‘1.2 Advanced First Aid and Team Comprehensive Simulation Training’. 1.2.3 revise Rare diseases are not the focus of emergency treatment. It is recommended to focus on the early identification and team management simulation of critical cases with atypical symptoms, such as atypical myocardial infarction and aortic dissection. 1.3 add Add ‘1.3.4 One on One Clinical Tutoring System’ as the core method for job rotation to implement the requirement of ‘under supervision’. 1.3.1 revise The expression ‘leading or collaborating to complete' is ambiguous, and for junior nurses,‘collaboration' is the main form. Suggest distinguishing by energy level. 2.3.3 revise It is suggested to define this as a ‘deep experience summary and promotion seminar for major positive events (such as successful rescue and application of new technologies)’ and distinguish it from ‘analysis of negative events based on their causes’. Table4. Results of the second round of expert consultation Items Applicable energy levels Training frequency Training format Mean ± SD CV Proportion scored ≥ 4 (%) concrete experience 4.17±0.52 0.12 94.44 1.1 Basic First Aid Skills Operation and Workshop Once every six months 4.00±0.511 0.17 77.78 1.1.1 Trauma and first aid skills: team cardiopulmonary resuscitation, hemostasis, bandaging, fixation, airway management, establishment of venous/arterial access, shock monitoring N1, N2 and above Annual review system Centralized Substation Workshop, Assessment and Certification 4.00±0.59 0.15 83.33 1.1.2 Equipment usage: AED, ventilator, monitor, infusion workstation, blood transfusion heating equipment, and understanding the role of key ultrasound assessment (eFAST) in trauma assessment and assisting doctors in positioning, etc N1, N2 and above Synchronize with the introduction of new equipment and conduct annual retraining Standardized training and departmental practical assessments provided by equipment suppliers 4.28±0.67 0.16 88.89 1.2 Advanced First Aid and Team Comprehensive Simulation Training 4.56±0.51 0.11 100 1.2.1 Emergency team simulation: cardiac arrest, severe trauma, acute poisoning, severe allergic reactions, and concomitant closed chest drainage, etc N2, N3, N4 (N3 and above require leadership roles) Once every 2 months High-fidelity cross-disciplinary team simulation with post-event debriefing 4.28±0.67 0.16 88.89 1.2.2 Group injury detection and classification simulation: strictly follow the START/JumpSTART process N2, N3, N4 At least once a year Scenario exercises or tabletop simulations 4.33±0.59 0.14 88.89 1.2.3 Simulation of critical cases with atypical symptoms: early identification of atypical myocardial infarction, aortic dissection, pulmonary embolism, etc N3, N4 (design or lead) At least once a year Case guided high fidelity simulation, focusing on training, evaluation, and identification thinking 4.06±0.73 0.18 94.44 1.3 Clinical Immersion and Practice 3.94±0.64 0.16 77.8 1.3.1 Clinical immersion and rotation practice: in emergency EICU、 Emergency ward rotation N1 (collaborative), N2 and above (leading/guiding) At least once a year, with each rotation lasting no less than 4 weeks On duty practice, supervised by a mentor 4.39±0.7 0.16 77.78 1.3.2 Specific scenario practice: on-site response and collaborative practice of various emergency codes within the hospital N1, N2 (participation), N3+(coordination) Participate in actual emergency code activation On site response and collaboration, a brief verbal review with the supervisor is required afterwards 4.39±0.7 0.16 88.89 1.3.3 Cross disciplinary contact: exposure to multiple specialized cases such as myocardial infarction, pediatric emergencies, and emergency mental and behavioral abnormalities [All energy levels] Arrange at least 1-2 times a year Planned participation in joint ward rounds and discussions on difficult cases in relevant departments 4.61±0.5 0.11 88.89 1.3.4 One on one mentorship system for integrated clinical teaching N3, N4 (serving as mentors) Synchronize with nurse rotation cycle Fixed mentor pairing, regular supervision meetings 4.28±0.67 0.16 100 reflective observation 4.28±0.67 0.16 88.89 2.1 Structured self-assessment and reflection 4.18±0.62 0.15 88.89 2.1.1 Self evaluation of Ability Checklist [All energy levels] Once every quarter Self evaluation of online scales 4.11±0.68 0.16 88.89 2.1.2 Write a structured clinical reflection log [All energy levels] At least one article per week, with important cases requiring reflection records to be completed within 24 hours Template based electronic logs submitted to the platform 4.28±0.67 0.16 83.33 2.1.3 Occupational stress awareness and emotional management records [All energy levels] Encourage continuous recording and formal review at least once a month Use standardized emotion self-assessment tools or free logging for recording 4.28±0.67 0.16 88.89 2.1.4 Analyzing multi-source feedback: comparative analysis of feedback based on self-evaluation, mentoring teacher, and at least one peer evaluation N2, N3, N4 Systematic analysis once every six months Based on the collected feedback (self-evaluation, mentor evaluation, peer evaluation), write a brief analysis report, clarify 1-2 core improvement goals, and discuss with the mentor 4.22±0.73 0.17 88.89 2.2 Peer evaluation and mentoring feedback 4.17±0.71 0.17 83.33 2.2.1 Peer operation mutual evaluation N1, N2 (peer evaluation), N3 and above (guidance) Once every six months Provide feedback through a structured skill observation checklist, write a brief report, and clarify 1-2 improvement goals 4.44±0.71 0.16 83.33 2.2.2 One on one clinical guidance [All energy levels] (N1-N2 as the recipient, N3 and above as the provider) At least one formal feedback per week Provide immediate feedback by the bedside and briefly record it 4.78±0.43 0.09 88.89 2.3 Case review and collective discussion 4.33±0.59 0.14 94.44 2.3.1 Post simulation report: Review the team's performance, decision-making, and communication during the simulation exercise according to SBAR [All energy levels] Immediately after each simulated training session Using structured modes such as SBAR for team reporting, led by a mentor, with a duration of approximately 15-30 minutes 4.39±0.61 0.14 100 2.3.2 Nursing Case Discussion Conference: Analyzing Successful and Insufficient Real Cases, Extracting Lessons [All levels] (N2 and above take turns hosting) Once a month Collective discussion within the department, with nurses taking turns to preside over 3.94±0.64 0.16 94.44 2.3.3 Deep Experience Summary and Promotion Seminar on Major Positive Events (such as Successful Rescue and Application of New Technologies) N3, N4 (dominant) Once every quarter Conduct seminars 4.11±0.68 0.16 83.33 2.3.4 Root cause analysis of adverse events or cases that did not achieve expected outcomes [All energy levels] (N3 and above leading analysis) A meeting must be held after a serious adverse event occurs; Organize at least one review and learning session per quarter for typical cases (which can be anonymized) Adhere to the non punitive principle and use tools such as root cause analysis for structured discussions 4.39±0.70 0.16 100 2.3.5 Security Review Meeting [All energy levels] Once a week (such as after morning meetings) 15-30 minutes, discussion on non accountability security issues 4.61±0.70 0.15 88.89 abstract conceptualization 4.78±0.43 0.09 94.44 3.1 Core Theory and Knowledge System Construction 4.11±0.68 0.16 83.33 3.1.1 Systematic Theory Teaching: The content covers the pathophysiology of trauma/critical illness, advanced pharmacology, pathophysiology and differential diagnosis of common emergency symptoms N1 (basic), N2 and above (deepening and updating) Each person is required to complete the prescribed class hours annually Blended online and offline teaching, with online quizzes at the end of each module 4.83±0.38 0.08 88.89 3.1.2 Nursing theories and models: learning crisis management models, clinical decision-making theories, and other theoretical frameworks N2, N3, N4 Special workshops held every six months or once a year Workshop combining theoretical explanation with clinical cases 4.83±0.38 0.08 100 3.1.3 Clinical judgment and critical thinking training N2, N3, N4 Once every quarter Adopting the format of "difficult case discussion" or "diagnostic reasoning workshop" 4.22±0.81 0.19 100 3.2 Professional Standards and Framework Learning 4.11±0.76 0.18 77.78 3.2.1 Interpretation of Capability Framework: Learn ICN disaster nursing core competencies, APN general competencies, and master Benner's "novice to expert" development model [All energy levels] Retraining is required before applying for promotion Lectures and workshops 4.17±0.71 0.17 77.78 3.2.2 Nursing Ethics and Legal Regulations [All energy levels] Update training at least once every 2 years A workshop or online learning module that analyzes typical medical dispute cases from that year and passes a test 4.22±0.73 0.17 83.33 3.2.3 Emergency and Safety Management Policy [All energy levels] Retraining and assessment once a year Policy interpretation, situational Q&A, or online exams 4.44±0.78 0.18 83.33 3.2.4 Study on Patient Safety Culture and Nursing Quality Indicator System [All energy levels] Quarterly thematic activities, monthly safety indicator disclosure and briefing Narrative medical writing sharing session, patient role-playing workshop, or discussion after watching related film and television works 4.56±0.51 0.11 83.33 3.2.5 Humanistic Care and Narrative Medicine Practice [All energy levels] Organize at least one special event every six months Narrative Medicine Writing and Sharing Session, Patient Role Experience Workshop, or Discussion of Care Ethics Cases 4.22±0.73 0.17 100 3.3 The Foundation of Evidence Based Practice and Research Methods 4.00±0.69 0.17 77.78 3.3.1 Evidence based guideline learning: Mastering the latest evidence-based nursing guidelines and research results N2 (compulsory), N1 (elective/understanding) At least one core guide for deep learning per year Workshop+Group Presentation 4.5±0.71 0.16 83.33 3.3.2 Research Methodology: Basic Steps of Evidence Based Practice Learning and Literature Retrieval Evaluation N3, N4 (mandatory), N2 (understanding) One centralized workshop per year for N3/N4; N2 level optional core modules Research and design workshop, covering the entire process from problem formulation to solution design, and completing a mini research proposal 4.56±0.51 0.11 88.89 active experimentation 4.33±0.49 0.11 100 4.1 Clinical Leadership and System Improvement Practice 4.11±0.76 0.18 77.78 4.1.1 Quality improvement project N1 (participation), N2 (leading sub projects), N3 and above (leading cross departmental projects) Project cycle 6-12 months Seminar and Conference 4.28±0.67 0.16 100 4.1.2 Scenario leadership exercise: Serve as a team leader in simulated or real rescue situations, coordinate decision-making N2, N3, N4 At least once per quarter High fidelity cross disciplinary team simulation, retrospective review afterwards 4.39±0.7 0.16 88.89 4.1.3 Process design and optimization: Analyze and pilot improvements to clinical processes such as triage and shift handover N2, N3, N4 At least once per quarter High fidelity cross disciplinary team simulation, retrospective review afterwards 4.22±0.65 0.15 88.89 4.2 Teaching guidance and health promotion practice 4.39±0.50 0.11 100 4.2.1 Clinical Teaching Ability Development System N2 (Teaching Practice), N3 and above (Course Development and Evaluation) Complete at least one round per year Clinical mentoring 4.06±0.64 0.16 88.89 4.2.2 Patient Education and Community Activities [All energy levels] At least twice a year Patient health education lectures or community emergency science popularization activities organized by the department 3.78±0.43 0.11 83.33 4.3 Evidence based exploration and research projects 4.61±0.50 0.11 100 4.3.1 Evidence based Practice Proposal: Retrieve evidence and develop change plans for clinical issues Nursing graduate students N3, N4 As the starting point of a research project, it is completed at the beginning of the project cycle (usually 6-12 months) Submit a written proposal, including PICO issues, summary of evidence, change plan, and pass the opening defense 4.11±0.68 0.16 100 4.3.2 Small research project: completing a nursing quality monitoring or clinical study under guidance Specialist nurses,N3, N4 The project cycle is usually 1-2 years Independently completed under the guidance of a research advisor, including ethics application, data collection and analysis, and writing a final report 4.56±0.51 0.11 83.33 4.3.3 Evidence based practice reform or clinical small research projects led by specialized nurses Specialist nurses,N3, N4 The project cycle is usually 1-3years Lead a full cycle project from evidence summary to practical change, effectiveness evaluation, and promotion, and the results should have promotional value within the department or hospital 4.50±0.71 0.16 100 Evaluation, Certification, and Sustainable Development 4.50±0.52 0.11 100 5.1 Comprehensive evaluation system 4.22±0.65 0.15 88.89 5.1.1 Process evaluation: Integrate learning portfolios, electronically integrate all outputs of 2.1-2.3 [All energy levels] Continuously ongoing, real-time summary Through a digital learning management platform 4.22±0.81 0.19 88.89 5.1.2 Final assessment: The content covers sections 3.1-3.2 and serves as the conclusion for projects 4.1.1 and 4.3 [All energy levels] Conduct a centralized assessment once a year Theoretical unified examination+multi station OSCE+project defense meeting 4.17±0.51 0.12 77.78 5.1.3 Multi source feedback integration: The system summarizes the evaluation information of self, peers, mentors, and patients to form a three-dimensional evaluation portrait [All energy levels] Systematically integrate, analyze, and provide feedback at least once a year Automatically generate multi-dimensional capability radar charts or reports by the system platform, and have the mentor interpret and interview them 4.06±0.73 0.18 94.44 5.2 Ability Certification and Advancement 4.50±0.51 0.11 100 5.2.1 Certification level standards: Establish clear competency standards corresponding to the nursing level (N1-N4) [All energy levels] Standard documents are reviewed and revised every 2-3 years Organize preaching sessions 4.28±0.75 0.18 77.78 5.2.2 Certification decision-making process: The certification committee conducts review and certification based on the comprehensive evaluation results [All energy levels] Certification review meeting once every six months or annually Nurses submit materials for committee review 4.17±0.71 0.17 83.33 5.2.3 Result application mechanism: The certification results are clearly linked to personal development paths such as job appointment, performance, and promotion [All energy levels] Institutional linkage, normalized implementation The human resources department directly calls the certification results during promotion, evaluation, and performance accounting 4.50±0.71 0.16 83.33 5.3 Continuous tracking and development 4.17±0.79 0.19 100 5.3.1 Effect tracking evaluation [All energy levels] Follow up at 6, 12, and 24 months after certification Questionnaire survey, skill test, interview 4.61±0.5 0.11 88.89 5.3.2 Personal Development Profile: Establish an electronic lifelong learning profile to continuously record career growth [All energy levels] Lifetime record, dynamically updated The electronic record system continuously collects all career trajectories such as training, evaluation, and certification achievements, and nurses and managers can view them according to their permissions 4.06±0.54 0.13 100 5.3.3 Continuous learning support: providing personalized learning advice based on records, and building a network of peer communication and mentors [All energy levels] normalized operation Seminar and Conference 4.16±0.44 0.11 88.89 Additional Declarations No competing interests reported. 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This demands that nurses not only possess solid emergency skills but also have advanced competencies including rapid assessment under pressure, independent clinical judgment, effective coordination, and emotion regulation. Currently, China\u0026apos;s nursing workforce faces dual structural challenges: the slow competency development among junior nurses and the increasing burnout and attrition of senior nurses [1-5]. Additionally, China\u0026apos;s nursing practice confronts complex challenges such as nurse shortages, heavy workloads, and strained doctor-patient relationships [6]. This situation poses significant challenges to the continuity of care quality, patient safety, and the sustainable development of emergency medicine.\u003c/p\u003e\n\u003cp\u003eIn 2022, the National Health Commission of China issued the \u0026quot;National Nursing Development Plan (2021-2025)\u0026quot; [7], which explicitly proposed strengthening professional training in critical nursing fields, such as emergency nursing, to enhance technical expertise. This policy direction clearly indicates that establishing a systematic talent cultivation mechanism capable of simultaneously accelerating competency for junior nurses, deepening empowerment for senior nurses, and anchoring their career development has become an urgent strategic task. The concept of \u0026quot;core competencies\u0026quot; originated from the field of business management, emphasizing the comprehensive qualities formed through collective learning, experience transfer, and collaborative participation which support an organization\u0026apos;s sustainable development [8]. In the field of nursing, core competence refers to a nurse\u0026apos;s ability to integrate professional knowledge, skills, attitudes, and personal traits in specific clinical environments to deliver safe and effective nursing practice [9]. Currently, some studies in China have focused on cultivating emergency nurses\u0026apos; core competencies, including exploring core competency elements [10], designing training programs for specific positions like triage nurses [11], and investigating training models for subspecialty emergency nurses [12,13]. However, a fundamental gap remains in both research and practice. Existing efforts primarily focus on summarizing training content or developing skills for specific positions, yet they generally lack a comprehensive design framework that is grounded in established learning theories, encompasses the entire career development cycle of nurses, and achieves a closed-loop of \u0026quot;learning, practice, and evaluation.\u0026quot; Specifically: (1) Weak theoretical guidance: Training designs are predominantly based on empirical summaries rather than systematically integrating pedagogical theories, resulting in a disconnect between the training process and the psychological mechanisms of competency internalization; (2) Lack of systematic closed-loop: Training often follows a linear or modular approach,failing to establish a continuous improvement cycle of \u0026quot;assessment-training-practice-reflection-reassessment,\u0026quot; which hinders the solidification and transfer of training outcomes; and (3) Unclear developmental pathways: Training content inadequately aligns with the phased developmental needs of nurses at different competency levels, impeding the establishment of a talent pipeline and sustainable growth. Therefore, developing a theoretically driven, hierarchical, and closed-loop core competency training system for emergency nurses is urgently needed.\u003c/p\u003e\n\u003cp\u003eThe cultivation of nurses\u0026rsquo; core competencies is essentially a spiral, ascending process that progresses from practical experience to reflective observation, then to conceptual internalization, and ultimately to active application. Kolb\u0026rsquo;s Experiential Learning Cycle [14] provides a crucial theoretical framework for this process. This study aims to construct a hierarchical training system for core competency in emergency nurses at varying proficiency levels, guided by Kolb\u0026apos;s Learning Cycle theory and integrated with China\u0026apos;s clinical emergency practice and nursing career development pathways, using the Delphi expert consultation method. The objectives include: (1) Designing a progressive training content framework aligned with the N1-N4 competency levels of emergency nurses based on Kolb\u0026apos;s four-stage learning cycle model; (2) Systematically embedding an integrated mechanism of formative assessment-competency certification-continuous professional development within the program to ensure measurable, traceable, and sustainable training outcomes; and (3) Establishing expert consensus on the training content, methodologies, and evaluation indicators through Delphi consultation to ensure scientific validity and clinical applicability.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study consists of two phases: (1) the construction of a training program aimed at developing the core competencies of emergency nurses across varying competency levels, utilizing methods such as literature reviews, semi-structured interviews, and expert panel meetings; and (2) achieving a consensus on the training content for the core competencies of emergency nurses through the execution of two rounds of the Delphi method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEstablish a research group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research team is composed of four members, each possessing professional backgrounds in emergency nursing. One member serves as the head nurse of the emergency department, holding the position of deputy chief nurse with 15 years of experience in emergency nursing management. This individual is responsible for overseeing overall supervision and quality control. The other three members include: an emergency department supervisor nurse with 12 years of clinical experience, tasked with conducting literature reviews and qualitative interviews; another emergency department supervisor nurse with 10 years of clinical experience, responsible for expert liaison and questionnaire management; and an emergency department nurse with 8 years of clinical experience, who handles data analysis and report writing. Prior to the commencement of the study, the research team underwent training in qualitative research methods and Delphi techniques to ensure consistency and objectivity throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConstruction of the structure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLiterature analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive search was conducted across various databases, including PubMed, Web of Science, The Cochrane Library, Embase, CNKI, Wanfang Data Knowledge Service Platform, and VIP, to gather training materials pertaining to the core competencies of emergency nurses. The search strategy combines subject headings and free-text terms, including keywords such as \u0026quot;Emergency Nursing\u0026quot;, \u0026quot;Emergency Room Nursing\u0026quot;, \u0026quot;Clinical Competencies\u0026quot;, \u0026quot;Clinical Skill\u0026quot;, \u0026quot;Professional competence\u0026quot;, \u0026quot;Competence\u0026quot;, \u0026quot;Professional\u0026quot;, \u0026quot;Expertise Development\u0026quot;, \u0026quot;Core Competency\u0026quot;, \u0026quot;Education\u0026quot;, and \u0026quot;Curriculum\u0026quot;. The literature search was conducted up to May 2025 (search strategies are detailed in supplementary material Table 1 and Figure 1). Inclusion criteria for literature were: (a) full-text availability; (b) relevance to this study, including guidelines, systematic reviews, meta-analyses, original research, and evidence summaries. Exclusion criteria for studies included: (a) duplicate studies; (b) flawed study designs; and (c) unavailability of full text. Initially, 1,529 articles were retrieved, with 292 remaining after duplicate removal via software. Following a review of titles and abstracts, 231 articles deemed irrelevant to the topic were excluded. After a thorough reading of the full texts, an additional 50 articles with inconsistent research subjects or themes were eliminated, resulting in a final inclusion of 11 articles [11, 15-24].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSemi-structured interviews\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the aforementioned literature review, the research team conducted face-to-face semi-structured interviews with personnel in the emergency field from June to August 2025. The selection criteria for emergency nursing experts include: (a) registered clinical nurses with over 10 years of experience in the emergency department; (b) nursing management personnel or nursing educators; (c) individuals holding intermediate or higher professional titles; (d) a bachelor\u0026apos;s degree or higher; (e) proficient language skills; and (f) willingness to participate in the research. The selection criteria for emergency nurses comprised: (a) possession of a nursing practice certificate and registration; (b) completion of two years of standardized training and current employment in the emergency field; (c) proficient language skills; and (d) willingness to participate in the research. A purposive sampling method was employed, with sampling ceasing once information reached saturation and no new insights emerged [25]. Ultimately, six emergency nursing experts and five emergency nurses from a tertiary comprehensive hospital in Anhui Province were interviewed. The topics of the interviews were as follows:\u003c/p\u003e\n\u003cp\u003eFor nursing experts: 1. If you want to design a training program to enhance the core competencies of emergency nurses, which core training modules do you think must be included? 2. How do you think the entire training process should be effectively organized and connected to ensure that the training effectiveness can be translated into practical work abilities? 3. What do you foresee as the biggest obstacles or challenges in implementing such a systematic training program in clinical practice? 4. To overcome these obstacles and ensure the implementation of the plan, which one or two key supports do hospitals or nursing departments need to provide in terms of policies or resources the most? 5. How to evaluate whether this training program has truly enhanced the core competencies of nurses? Besides regular assessments, which behaviors or changes in outcomes do you think should be the most important focus? 6. Based on your experience, what is the core principle or approach that needs to be adhered to the most to ensure the success of such a competency oriented training program?\u003c/p\u003e\n\u003cp\u003eRegarding emergency nurses: 1. Reviewing your own growth experience, which specific experiences or events have helped you the most in enhancing your core competencies while working in the emergency department? Why? 2. Which learning format has left the deepest impression and gained the most from the various trainings or studies you have participated in? 3. After busy clinical work, do you have the opportunity or habit of systematically reviewing or reflecting on the work process? What form of reflection do you think is feasible and effective? 4. Besides first aid skills, what other areas do you think you would like to participate in in the future and do you need more training in? How do you hope to obtain it? 5. If we were to tailor an ideal training program that can truly help you sustain your growth, what would you like it to include and in what form would it be conducted?\u003c/p\u003e\n\u003cp\u003eBefore each interview, the researcher provides participants with a comprehensive explanation of the research purpose, process, and confidentiality principles, and obtains written informed consent. The interviews are conducted in a quiet and private conference room, with each lasting between 30 to 60 minutes. The entire process is recorded, and detailed notes are taken. A complete verbatim transcription is performed within 48 hours after the interview, followed by analysis using Colaizzi\u0026apos;s seven-step method [26]: (a) Carefully read all interview records; (b) Extract meaningful statements; (c) Encode meaningful statements; (d) Summarize the coding into themes; (e) Describe the topic in detail and without omission; (f) Summarize the detailed topics into general descriptions; and (g) Ultimately form a structured description.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExpert group meeting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on a comprehensive literature review and semi-structured interviews, a preliminary training plan was developed. Guided by Kolb\u0026rsquo;s Experiential Learning Cycle [14] as the core theoretical framework, the program centers around four key learning stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. A closed-loop management system encompassing evaluation, certification, and continuous professional development was integrated into the framework. This approach resulted in the construction of a hierarchical and progressively structured core competency training program for emergency nurses, characterized by a cyclical learning progression. The final program comprises 5 first-level items (corresponding to Kolb\u0026rsquo;s four learning stages and the evaluation system), 15 second-level items, and 44 third-level items (The initial version of the plan). It clearly defines the alignment between each item and the nurse competency level (N1-N4), along with specifying corresponding training formats and frequencies. This design ensures the systematic, phased, and operational feasibility of the training program (supplementary material Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExpert inquiry\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExpert Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom September to November 2025, 18 experts were invited to participate in a Delphi study. All experts possessed over 10 years of experience in emergency nursing, nursing management, or nursing education. The inclusion criteria for the experts aligned with those used for the semi-structured interviews. Additionally, experts were required to commit to completing two rounds of consultation and to be available for clarification during the process. The experts were recruited from four provinces in China: Anhui, Zhejiang, Shandong, and Jiangxi. Their mean age was 45.78 \u0026plusmn; 8.50 years. The cohort included males (6, 33.3%) and females (12, 66.7%). Detailed demographic and professional characteristics of the expert panel are presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreparation of survey questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire comprised three sections: (a) a detailed introduction to the research objectives, background, and significance of the study; (b) a basic information survey and a self‑assessment form for evaluating expert authority; and (c) the consultation questionnaire itself. The preliminary training program, designed to enhance the core competencies of emergency nurses, was structured around four key stages: concrete experience, reflective observation, abstract conceptualization, and active practice. Experts were asked to rate the importance of each item using a 5-point Likert scale, ranging from \u0026quot;extremely unimportant\u0026quot; to \u0026quot;extremely important.\u0026quot; The questionnaire also incorporated open‑ended sections for adding comments and for proposing modifications, deletions, or additions to the listed indicators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire was distributed in either electronic or paper format, with a set collection period of 7 days. Experts who did not respond within this timeframe were reminded via follow‑up email or telephone. Following the first round of consultation, the research team collated all expert feedback and revised the training program accordingly. The updated program, along with a summary of the first‑round comments and modifications, was then redistributed to the expert panel for the second round of consultation. The final version of the training program was determined after incorporating the feedback received in the second round.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS Version 25.0 software was used for statistical analysis of the data. The general information of experts was analyzed through descriptive methods, and the results were expressed in frequency and percentage. Expert engagement was assessed by the questionnaire response rate and the proportion of experts providing suggestions [27]. The authority of the experts was quantified using the authority coefficient (Cr), which combined the judgment basis (Ca) and familiarity with the topic (Cs). Calculated as Cr = (Ca + Cs) / 2. A Cr \u0026ge; 0.7 indicates high level of expert authority [28]. The degree of consensus among experts was assessed using the coefficient of variation (CV) and Kendall\u0026rsquo;s coefficient of concordance (Kendall\u0026rsquo;s W) [29]. Items were retained if they met the following criteria: a mean importance score \u0026ge; 4.0, CV \u0026le; 0.25, and agreement from at least 75% of experts (score \u0026ge; 4) [30]. Items not meeting one or more criteria were reviewed based on additional evaluation metrics, expert comments, and research team discussion. Statistical significance was set at \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study obtained ethical approval from the Medical Ethics Committee of a tertiary hospital in Anhui Province (Approval No. 2024‑Science‑94). Before participation, all experts were fully informed of the study\u0026rsquo;s purpose, procedures, and methodology, and written informed consent was obtained from each individual. All data were anonymized and handled with strict confidentiality throughout the research process.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eThe level of enthusiasm and authority of experts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 18 questionnaires were distributed and collected in both consultation rounds, yielding a 100% response rate. In the first round, all 18 experts (100%) provided suggestions for revision; in the second round, 14 experts (83.33%) did so, reflecting a high level of engagement. The expert judgment coefficient (Ca) was 0.911 in the first round and 0.914 in the second. The familiarity coefficient (Cs) was 0.915 and 0.920, respectively. The resulting authority coefficient (Cr) was 0.913 in the first round and 0.917 in the second, indicating high expert authority and reliable consultation outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcentration of expert opinions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the first round, 64 items were evaluated. The mean importance scores ranged from 3.57 to 4.45, with standard deviations between 0.32 and 0.67. Following revisions, the second round included 68 items. Mean importance scores improved to a range of 3.78-4.83, while standard deviations increased to between 0.38 and 0.81. The rise in mean scores alongside the change in dispersion reflects a shift toward greater consensus among the expert panel.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCoordination level of expert opinions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the first round of consultation, the coefficient of variation (CV) across all indicators ranged from 0.09 to 0.23. In the second round, the CV narrowed to 0.08-0.19, suggesting improved consensus among the experts. The Kendall\u0026rsquo;s coefficients of concordance for the three categories of indicators were 0.213-0.322 in the first round and 0.095-0.156 in the second round (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e \u0026lt; 0.01). These results indicate that the overall coordination of expert opinions reached statistical significance (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExpert modification suggestions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the first round of expert consultation, 18 reviewers evaluated the initial draft of the emergency nurses\u0026rsquo; tiered core competency training program. A total of 13 specific revision suggestions were gathered, which included overlapping comments. The research team deliberated on each suggestion and integrated all of them into the revised draft, based on their relevance to the study objectives and the extent of expert agreement.The revisions encompassed the following adjustments: (1) the addition of one new item, namely \u0026quot;1.3.4 One-on-one mentorship throughout clinical teaching,\u0026quot; to establish a formal clinical supervision mechanism; (2) the refinement of three items, such as redefining \u0026quot;complex case simulation\u0026quot; as \u0026quot;simulation of atypical critical cases (for example, atypical myocardial infarction or aortic dissection)\u0026quot; and underscoring the application of the SBAR structured model during post-simulation debriefing; (3) the clarification of wording or scope for six items, including specifying the roles of nurses in \u0026quot;quality improvement projects\u0026quot; according to their competency level, from N1 to N4, which ranges from participation to leadership of subtasks or cross-departmental projects, and renaming \u0026quot;Advanced First Aid Workshop\u0026quot; as \u0026quot;Advanced First Aid and Team-Based Comprehensive Simulation Training\u0026quot; to better convey its educational focus; (4) the removal of one item; and (5) the expansion of theoretical modules to cover \u0026quot;Emergency Mental and Behavioral Disorders\u0026quot; and \u0026quot;Differential Diagnosis of Emergency Symptoms\u0026quot; (see Table 3). Subsequently, a second round of consultation was held with 14 experts, whose feedback was consolidated into five thematic categories. Opinions in this round showed greater convergence, primarily affirming the earlier revisions and proposing only minor refinements. No items were added or deleted. The experts supported a clear distinction between \u0026quot;major positive event seminars\u0026quot; and \u0026quot;adverse event analysis meetings,\u0026quot; and concurred that \u0026quot;simulation of atypical critical cases\u0026quot; should emphasize common emergency situations.\u003c/p\u003e\n\u003cp\u003eThe overarching framework of the training system, which integrates the four stage experiential learning cycle including concrete experience, reflective observation, abstract conceptualization, and active practice, with tiered nurse competency levels from N1 to N4, gained unanimous expert endorsement (Table 3). Following the two consultation rounds, a strong consensus was achieved. The final program is structured into 5 first-level, 15 second-level, and 48 third-level items, forming a scientifically grounded, systematic, and implementable training scheme (Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eThe significance of constructing an emergency nurse training program\u003c/h2\u003e \u003cp\u003eThis study developed a hierarchical training program for emergency nurses in China through a Delphi consensus process. This program addresses a critical need identified in China\u0026rsquo;s National Nursing Career Development Plan (2021\u0026ndash;2025) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], which calls for enhanced professional training in high-demand fields such as emergency care to strengthen the technical expertise of the nursing workforce. More broadly, this initiative aligns with the strategic goals of the \u0026ldquo;Healthy China 2030\u0026rdquo; blueprint, which prioritizes the development of a high-quality, efficient healthcare delivery system. Aligned with this policy direction, the present study adopted Kolb's experiential learning cycle as its theoretical foundation and referenced established core competency standards for emergency nursing. Using the Delphi expert consensus method, the research developed a hierarchical training program for emergency nurses in China, competency advancement from novice (N1) to expert (N4) levels. The program details level-specific training content, frequency, format, and evaluation criteria. It provides a theoretical basis for the systematic training, management, and assessment of emergency nurses and supports the ongoing development of the specialty.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eReliability of Establishing an Emergency Nurse Training Program\u003c/h2\u003e \u003cp\u003eThis study approached the development of the training program from multiple perspectives. Initially, the research team conducted a comprehensive review of domestic and international literature, policy documents, and existing training frameworks to understand the current state of emergency nursing education. These findings informed the preliminary design of the program.To ensure the program reflected both the actual conditions of emergency care training and current clinical needs, it was further refined through a structured expert consultation process. Experts with intermediate or senior professional titles were recruited from provinces including Anhui, Shandong, and Zhejiang. They represented fields such as emergency nursing, nursing management, and clinical education.These experts provided constructive feedback on the training plan. The response rate for both rounds of the questionnaire survey reached 100%, demonstrating a high level of engagement and commitment to emergency nursing practice and education. The authority coefficients of the expert panel were 0.913 in the first round and 0.917 in the second, indicating a high degree of expertise. Furthermore, a strong consensus was achieved on the proposed indicators, as evidenced by coefficients of variation all below 0.25 following the two consultation rounds. Therefore, the tiered training program for emergency nurses developed in this study demonstrates strong scientific rigor and reliability.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnalysis of the Training Program for Emergency Nurses\u003c/h3\u003e\n\u003cp\u003eThe internationally widely used core courses in trauma care (TNCC) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], advanced trauma care (ATCN) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], and advanced trauma life support (ATLS) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] have achieved remarkable results in providing standardized first aid skills certification. However, these courses are essentially modular and summative, and do not cover the comprehensive roles of leadership, teaching, quality control, and cross departmental collaboration required by nurses in complex emergency environments. Building on the technical rigor of these courses, the present study introduces important conceptual and structural innovations. The training objectives extend beyond technical skill acquisition to encompass integrated professional competencies. Leadership, educational capability, evidence-based practice, and systems thinking are explicitly incorporated into the core framework.Furthermore, a clearly defined progression across four competency levels (N1-N4) ensures that training content and evaluation criteria align closely with nurses\u0026rsquo; developmental pathway from novice to expert. Consequently, this program serves as both a necessary complement and an advanced extension of existing international standardized courses. It aims to systematically develop versatile nursing professionals who are proficient in clinical care, team leadership, and continuous quality improvement.\u003c/p\u003e \u003cp\u003eSeveral studies in China have provided a reference basis for the training of emergency sub specialist nurses. For example, Hu et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] designed a competency-based training program for emergency nurses in ophthalmology and otorhinolaryngology (EENT), with content modules closely focused on the specialized knowledge and skills relevant to EENT emergency care. Similarly, the emergency specialist nurse training program developed by Feng et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] is organized around disease-system modules, such as trauma, poisoning, and cardiopulmonary resuscitation. A common feature of these programs is their content organization, which centers on specific diseases or specialty areas. In contrast, the present program does not target particular diseases or clinical topics. Instead, it aims to cultivate higher-order cognitive abilities that can be applied to the management of diverse critical conditions. This shift from a \"disease-centered \" to a \"competency-centered \" approach enhances the adaptability of training to the complex and unpredictable clinical environment of the emergency department, thereby improving the transferability and flexibility of nurses\u0026rsquo; professional capabilities. Furthermore, this study is the first to systematically introduce Kolb\u0026rsquo;s experiential learning cycle into the design of emergency nurse training in China. This theoretical framework translates abstract core competency elements into operable, traceable learning-practice-reflection cycles. It not only operationalizes Benner\u0026rsquo;s \"novice-to-expert\" [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] developmental model but also provides clear developmental milestones and differentiated support for nurses at different career stages.\u003c/p\u003e \u003cp\u003eThis study aligns with the work of Munroe et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] in developing the Emergency Department Clinical Emergency Response System (EDCERS), as both share the core objective of enhancing patient safety and care quality in emergency settings. The EDCERS framework establishes standardized operating procedures for identifying clinical deterioration and activating multidisciplinary team responses from organizational and workflow perspectives. The present training program offers a structured approach to systematically develop these competencies. For instance, the \"Complex Case Simulation\" module, which corresponds to the concrete experience stage, and the \"Structured Review\" module, aligned with reflective observation, can be designed around specific trigger scenarios outlined in the EDCERS protocol. This allows nurses to not only master procedural steps but also deepen their understanding of the underlying pathophysiology and refine their clinical reasoning skills. Thus, in future clinical practice, this training program can serve as an enabling tool for the effective implementation of rapid response systems such as EDCERS. Integrating such a system‑level protocol with a competency‑based training model may help address both process standardization and individual skill development, thereby offering a more comprehensive approach to reducing delays in recognizing and responding to clinical deterioration.\u003c/p\u003e \u003cp\u003eThe primary theoretical contribution of this program is its empirical demonstration of the applicability of Kolb\u0026rsquo;s Experiential Learning Cycle within structured nursing education. The four stages of the cycle are operationalized as follows (supplementary material Fig.\u0026nbsp;1): (a) Concrete experience: nurses engage in near‑real clinical situations through high‑fidelity simulation and exposure to complex cases; (b) Reflective observation: metacognition and critical thinking are systematically developed via structured debriefing and peer evaluation; (c) Abstract conceptualization: knowledge to support clinical decision‑making is constructed through study of current theories and pathophysiological mechanisms; and (d) Active practice: knowledge is translated into practice through leadership in quality‑improvement projects, clinical teaching, and related activities. On a practical level, the program offers a clear competency‑based pathway, incorporates varied instructional methods such as simulation, mentorship, and project‑based learning, and establishes an integrated system linking evaluation, certification, and professional development. This design allows the program to be flexibly embedded into existing frameworks, including orientation training for emergency nurses, annual continuing‑education schedules, specialized‑nurse training curricula, and unit‑based quality‑improvement initiatives. For instance, reflective‑observation activities can be incorporated into monthly nursing case discussions, while active‑practice projects can be aligned with annual departmental quality‑and‑safety priorities. Such integration helps shift training from an added task to a natural, ongoing component of daily nursing practice and professional growth.\u003c/p\u003e\n\u003ch3\u003eLimitation\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, as this study established a program based on expert consensus, the effectiveness of the proposed program in improving nurse performance and patient outcomes requires empirical validation. Second, the participating experts were primarily recruited from tertiary hospitals. Consequently, the applicability of the program in secondary hospitals or community emergency centers, which often operate with different resource levels and staffing structures, needs further evaluation. Future research should address the following directions: (1) Effectiveness verification: implementing the program in multiple centers using a cluster‑randomized controlled or stepped‑wedge design to longitudinally assess its impact on nurses\u0026rsquo;core competency, team performance indicators, and patient safety outcomes; (2) Adaptation studies: exploring how the framework can be adapted and applied in specific emergency subspecialties, such as pediatric, stroke, or chest‑pain care; and (3) Implementation science inquiry: investigating organizational, contextual, and leadership factors that influence the successful implementation of this complex intervention, including necessary resource support and system‑level enablers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on a systematic review of the literature and theoretical analysis, this study established a foundational framework for a training program. Guided by Kolb's Experiential Learning Cycle, the framework was refined through interviews with emergency nursing experts and clinical nurses. Subsequently, a Delphi expert consultation process was conducted to finalize the training program. The resulting program can serve as a practical reference for emergency nurse training. The next phase of this research will involve implementing the program among emergency department nurses. Feedback gathered from real‑world application will be used to further refine and optimize the training plan.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board of The Second People\u0026apos;s Hospital of Hefei in accordance with the Declaration of Helsinki. All methods were carried out in accordance with relevant guidelines and regulations. Written informed consent was obtained from all individual patients included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvalability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used or analysed during the current study are available from the corresponding author on reasonable request. Due to privacy and ethical restrictions regarding patient data, data sharing may require a formal data use agreement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKey Project of Humanities and Social Sciences at Bengbu Medical University（2024byzd566sk）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQian Wu: Conceptualization, Methodology, Project administration, Writing original draft. Wenjun Cai: Conceptualization, Validation, Writing review \u0026amp; editing, Supervision. Yan jiang: Investigation, Formal analysis, Data curation, Writing original draft. Qiang Shi: Investigation, Resources, Data curation. Fang Cheng: Methodology, Validation, Writing review \u0026amp; editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the respondents who completed the questionnaire in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHuang L, Zhang X, Wang F, et al. The relationship between reflective ability and professional identity: the mediating effect of self-directed learning and self-efficacy for junior clinical nurses[J]. BMC nursing, 2024,23(1):858.\u003c/li\u003e\n \u003cli\u003eZhang M, Wu J, Yang Y, et al. Mediating role of emotional intelligence in the relationship between dual work stress and reflective ability among junior nurses[J]. BMC nursing, 2025,24(1):547.\u003c/li\u003e\n \u003cli\u003eMurray M, Sundin D, Cope V. New graduate nurses\u0026apos; understanding and attitudes about patient safety upon transition to practice[J]. Journal of clinical nursing, 2019,28(13-14):2543-2552.\u003c/li\u003e\n \u003cli\u003eBleich M R, Cleary B L, Davis K, et al. Mitigating knowledge loss: a strategic imperative for nurse leaders[J]. The Journal of nursing administration, 2009,39(4):160-164.\u003c/li\u003e\n \u003cli\u003eXiao J, Zhu JH, Ye WX, et al. Research progress on human resource management of senior nurses. Chin Nurs Manag. 2021;21(10):1539-42.\u003c/li\u003e\n \u003cli\u003eZhou J, Yang Y, Qiu X, et al. Serial multiple mediation of organizational commitment and job burnout in the relationship between psychological capital and anxiety in Chinese female nurses: A cross-sectional questionnaire survey[J]. International journal of nursing studies, 2018,83:75-82.\u003c/li\u003e\n \u003cli\u003eLi Z, Wang J, Yuan Y, et al. Association analysis of obesity and hypertension and research on ethnic heterogeneity: a cross-sectional study based on different populations in Northwest China[J]. BMC public health, 2025:10-1186.\u003c/li\u003e\n \u003cli\u003eCaterinicchio M J. Redefining nursing according to patients\u0026apos; and families\u0026apos; needs: an evolving concept. AACN Certification Corporation[J]. AACN clinical issues, 1995,6(1):153-156.\u003c/li\u003e\n \u003cli\u003eXia RX, Jin LH, Chen YY, et al. Conceptual analysis of core competencies for specialized nurses. Chin J Evid Based Nurs. 2025;11(11):2125-31.\u003c/li\u003e\n \u003cli\u003eFan L, Xi SH. Construction of a core competency evaluation index system for emergency specialist nurses. Chin J Nurs. 2011;46(02):144-7.\u003c/li\u003e\n \u003cli\u003eZhang L, Gao B, He F, et al. Construction of learning objectives and content for emergency triage nurses in tertiary general hospitals: A Delphi study[J]. Nurse education in practice, 2024,80:104145.\u003c/li\u003e\n \u003cli\u003eFeng LL. Construction of a Core Competency-Oriented Training Program for Emergency Specialist Nurses [D]. Lanzhou University; 2021.\u003c/li\u003e\n \u003cli\u003eHu Y, Wang F, Cao W, et al. Development of training program for the Eye, Ear, Nose, and Throat emergency nurses in China based on core competency: a Delphi study[J]. BMC emergency medicine, 2024,24(1):112.\u003c/li\u003e\n \u003cli\u003eChen L, Jiang W, Zhao R. Application effect of Kolb\u0026apos;s experiential learning theory in clinical nursing teaching of traditional Chinese medicine[J]. Digital health, 2022,8:579782025.\u003c/li\u003e\n \u003cli\u003eXu L, Tan J, Chen Q, et al. Development and validation of an instrument for measuring junior nurses\u0026apos; recognition and response abilities to clinical deterioration (RRCD)[J]. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 2023,36(5):754-761.\u003c/li\u003e\n \u003cli\u003eLoke A Y, Li S, Guo C. Mapping a postgraduate curriculum in disaster nursing with the International Council of Nursing\u0026apos;s Core Competencies in Disaster Nursing V2.0: The extent of the program in addressing the core competencies[J]. Nurse education today, 2021,106:105063.\u003c/li\u003e\n \u003cli\u003eLjungbeck B, Sj Gren Forss K, Finnbogad\u0026oacute;ttir H, et al. Content in nurse practitioner education - A scoping review[J]. Nurse education today, 2021,98:104650.\u003c/li\u003e\n \u003cli\u003eUnhasuta K, Robinson M V, Magilvy K. Research plan for developing trauma core competencies for nurses in Thailand[J]. International emergency nursing, 2010,18(1):3-7.\u003c/li\u003e\n \u003cli\u003eZhang X, Meng K, Chen S. Competency framework for specialist critical care nurses: A modified Delphi study[J]. Nursing in critical care, 2020,25(1):45-52.\u003c/li\u003e\n \u003cli\u003eSastre-Fullana P, De Pedro-G\u0026oacute;mez J E, Bennasar-Veny M, et al.\u0026nbsp;Competency frameworks for advanced practice nursing: a literature review[J]. International nursing review, 2014,61(4):534-542.\u003c/li\u003e\n \u003cli\u003eXie L, Feng M, Cheng J, et al. Developing a core competency training curriculum system for emergency trauma nurses in China: a modified Delphi method study[J]. BMJ open, 2023,13(5):e66540.\u003c/li\u003e\n \u003cli\u003eKim H S. Effectiveness of Disaster Nursing Education Programs: A Meta-Analysis Focused on Knowledge, Attitude, and Skill Domains[J]. Disaster medicine and public health preparedness, 2025,19:e275.\u003c/li\u003e\n \u003cli\u003eYamaguchi Y, Matsunaga-Myoji Y, Fujita K. Advanced practice nurse competencies to practice in emergency and critical care settings: A scoping review[J]. International journal of nursing practice, 2024,30(4):e13205.\u003c/li\u003e\n \u003cli\u003eLalloo D, Demou E, Kiran S, et al. Core competencies for UK occupational health nurses: a Delphi study[J]. Occupational medicine (Oxford, England), 2016,66(8):649-655.\u003c/li\u003e\n \u003cli\u003eZhou N, Yang L, Pan J, et al. Perspectives of clinical nurse educators on competency-based nursing teaching in blended learning environments during nursing internship: A descriptive qualitative study[J]. Nurse education in practice, 2024,79:104027.\u003c/li\u003e\n \u003cli\u003eVignato J, Inman M, Patsais M, et al. Computer-Assisted Qualitative Data Analysis Software, Phenomenology, and Colaizzi\u0026apos;s Method[J]. Western journal of nursing research, 2022,44(12):1117-1123.\u003c/li\u003e\n \u003cli\u003eBabbie E. The practice of social research (10the) Farmington Mound, Michigan, USA: Thompson Wadsworth (2007).\u003c/li\u003e\n \u003cli\u003eZeng G, Hui L. SAS statistical analysis course. Beijing, China: Pecking Union Medical College Union Press (1994).\u003c/li\u003e\n \u003cli\u003eLiao Q, Gui JY. Progress of Delphi method in nursing. Nurs Res. 2015;29(03):269\u0026ndash;71.\u003c/li\u003e\n \u003cli\u003eCai X, Zheng S, Huang J, et al. Establishing Performance Evaluation for Quality Inspection of Specialty Nurses[J]. Clinical nurse specialist CNS, 2021,35(4):180-187.\u003c/li\u003e\n \u003cli\u003eJeffries D, Ceci K, Graunke S, et al. The Game Is On and We\u0026apos;re in the Ninth! Evolution of the Trauma Nursing Core Course, Ninth Edition[J]. Journal of emergency nursing, 2023,49(6):800-801.\u003c/li\u003e\n \u003cli\u003eGlenn M A. Advanced Trauma Care for Nurses New International Collaboration: ATCN Sister Sites Program[J]. Journal of trauma nursing : the official journal of the Society of Trauma Nurses, 2024,31(4):181.\u003c/li\u003e\n \u003cli\u003eVassiliu P, Mavrogenis A, Theos C, et al. Advanced trauma life support course for medical students. A new era?[J]. Frontiers in surgery, 2022,9:1025920.\u003c/li\u003e\n \u003cli\u003eAnderson J A, Willson P. Knowledge management: organizing nursing care knowledge[J]. Critical care nursing quarterly, 2009,32(1):1-9.\u003c/li\u003e\n \u003cli\u003eMunroe B, Curtis K, Balzer S, et al. Translation of evidence into policy to improve clinical practice: the development of an emergency department rapid response system[J]. Australasian emergency care, 2021,24(3):197-209.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Characteristics of the experts (n=18).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e%）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eGender（%, n）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e6(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e12(66.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eAge (years, n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e30-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e5 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e41-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e8 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e51-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e5(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eEducational background (%, n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eBachelor\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e2 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eMaster\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e12 (66.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eDoctoral degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e4(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eProfession titles (%, n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eintermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e8 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eAssociate senior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e7 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eSenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e3 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eProfessional experience (years, n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e10-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e6 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e16-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e2 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026ge;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e10 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2. Expert coordination factor\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKendall\u0026apos;s W\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-square\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 11px;\"\u003e\n \u003cp\u003eRound 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eFirst-level indicators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e14.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eSecond-level indicators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e20.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eThird-level indicators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e110.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 11px;\"\u003e\n \u003cp\u003eRound 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eFirst-level indicators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e11.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eSecond-level indicators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e23.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eThird-level indicators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e108.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable3. Summary of opinions raised by two rounds of expert inquiries\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first round of expert opinions.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"905\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevision comments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eReason and content for modification\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e1.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eThe expression should be broad and closely correspond to the core emergency skills. It should be divided into 1.1 basic emergency skills operation and workshop and 1.2 advanced emergency and team comprehensive simulation training, with a clear list of skills.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e1.1.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eAdd \u0026lsquo;Team CPR\u0026rsquo; at the top of the list and move \u0026lsquo;Chest Closed Drainage Coordination\u0026rsquo; to the Advanced Skills module.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e1.1.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003edelete/merge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eThe content is vague and overlaps with 1.1.1, so it is incorporated into 1.1.1.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e1.2.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eVague expression. The definition of\u0026lsquo;complex\u0026apos; is unclear and prone to duplication with 1.2.1. Revision: Clarify as \u0026lsquo;rare case simulation\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e1.3.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eThe intensity of \u0026lsquo;observation and participation\u0026apos; is insufficient, and it should be \u0026lsquo;led or collaboratively completed under supervision according to hierarchical levels\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e1.3.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eThe correlation between occupational health and disaster recovery scenarios and emergency core competencies is slightly weak. Revision: Focus on \u0026lsquo;on-site response and collaborative practice of various emergency codes within the hospital\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e1.3.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eadd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eSuggest adding contact with patients with \u0026lsquo;emergency mental and behavioral abnormalities\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e2.1.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eThe merging of \u0026lsquo;reflection\u0026rsquo;and \u0026lsquo;stress management\u0026rsquo; is illogical. Suggest splitting it into two sub items: \u0026lsquo;Structured Reflection Log\u0026rsquo;and \u0026lsquo;Stress Perception and Emotion Recording\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e2.3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eAdd an explanation of \u0026lsquo;following structured reporting models (such as SBAR)\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e2.3.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eThe frequency and hosting mode of the discussion should be clearly defined (such as having nurses of different seniority take turns hosting).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e3.1.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eadd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eSuggest adding a module on \u0026lsquo;Pathophysiology and Differentiation of Common Symptoms in Emergency Care\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e3.2.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003edivide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eToo much content. Suggest splitting it into two parts: \u0026lsquo;Nursing Ethics and Legal Regulations\u0026rsquo; and \u0026lsquo;Emergency and Safety Management Policies\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e4.1.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 654px;\"\u003e\n \u003cp\u003eThe term\u0026lsquo;leading\u0026rsquo;puts pressure on junior nurses. It can be classified as \u0026lsquo;participating\u0026rsquo;or \u0026lsquo;dominant\u0026rsquo;according to energy levels.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe second round of expert opinions.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003erevision comments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 657px;\"\u003e\n \u003cp\u003eReason and content for modification\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e1.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 657px;\"\u003e\n \u003cp\u003eThe term \u0026lsquo;workshop\u0026rsquo; is not sufficient to reflect its simulation and team characteristics, and is easily confused with 1.1. Adjust the name of the first level item to \u0026lsquo;1.2 Advanced First Aid and Team Comprehensive Simulation Training\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e1.2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 657px;\"\u003e\n \u003cp\u003eRare diseases are not the focus of emergency treatment. It is recommended to focus on the early identification and team management simulation of critical cases with atypical symptoms, such as atypical myocardial infarction and aortic dissection.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e1.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eadd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 657px;\"\u003e\n \u003cp\u003eAdd \u0026lsquo;1.3.4 One on One Clinical Tutoring System\u0026rsquo; as the core method for job rotation to implement the requirement of \u0026lsquo;under supervision\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e1.3.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 657px;\"\u003e\n \u003cp\u003eThe expression \u0026lsquo;leading or collaborating to complete\u0026apos; is ambiguous, and for junior nurses,\u0026lsquo;collaboration\u0026apos; is the main form. Suggest distinguishing by energy level.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e2.3.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003erevise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 657px;\"\u003e\n \u003cp\u003eIt is suggested to define this as a \u0026lsquo;deep experience summary and promotion seminar for major positive events (such as successful rescue and application of new technologies)\u0026rsquo; and distinguish it from \u0026lsquo;analysis of negative events based on their causes\u0026rsquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable4.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eResults of the second round of expert consultation\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApplicable energy levels\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraining frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraining format\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProportion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003escored \u0026ge; 4 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003col\u003e\n \u003cli\u003econcrete experience\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.17\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e94.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.1\u0026nbsp;Basic First Aid Skills Operation and Workshop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eOnce every six months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.00\u0026plusmn;0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e77.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.1.1\u0026nbsp;Trauma and first aid skills: team cardiopulmonary resuscitation, hemostasis, bandaging, fixation, airway management, establishment of venous/arterial access, shock monitoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN1, N2 and above\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnnual review system\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eCentralized Substation Workshop, Assessment and Certification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.00\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.1.2\u0026nbsp;Equipment usage: AED, ventilator, monitor, infusion workstation, blood transfusion heating equipment, and understanding the role of key ultrasound assessment (eFAST) in trauma assessment and assisting doctors in positioning, etc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN1, N2 and above\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSynchronize with the introduction of new equipment and conduct annual retraining\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eStandardized training and departmental practical assessments provided by equipment suppliers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.28\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.2 Advanced First Aid and Team Comprehensive Simulation Training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.56\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.2.1\u0026nbsp;Emergency team simulation: cardiac arrest, severe trauma, acute poisoning, severe allergic reactions, and concomitant closed chest drainage, etc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2, N3, N4 (N3 and above require leadership roles)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnce every 2 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eHigh-fidelity cross-disciplinary team simulation with post-event debriefing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.28\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.2.2 Group injury detection and classification simulation: strictly follow the START/JumpSTART process\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2, N3, N4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt least once a year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eScenario exercises or tabletop simulations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.33\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.2.3\u0026nbsp;Simulation of critical cases with atypical symptoms: early identification of atypical myocardial infarction, aortic dissection, pulmonary embolism, etc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN3, N4 (design or lead)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eAt least once a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eCase guided high fidelity simulation, focusing on training, evaluation, and identification thinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.06\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e94.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.3 Clinical Immersion and Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3.94\u0026plusmn;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e77.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.3.1\u0026nbsp;Clinical immersion and rotation practice: in emergency EICU、\u0026nbsp;Emergency ward rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN1 (collaborative), N2 and above (leading/guiding)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt least once a year, with each rotation lasting no less than 4 weeks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eOn duty practice, supervised by a mentor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.39\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e77.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.3.2\u0026nbsp;Specific scenario practice: on-site response and collaborative practice of various emergency codes within the hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN1, N2 (participation), N3+(coordination)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eParticipate in actual emergency code activation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eOn site response and collaboration, a brief verbal review with the supervisor is required afterwards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.39\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.3.3\u0026nbsp;Cross disciplinary contact: exposure to multiple specialized cases such as myocardial infarction, pediatric emergencies, and emergency mental and behavioral abnormalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eArrange at least 1-2 times a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003ePlanned participation in joint ward rounds and discussions on difficult cases in relevant departments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.61\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1.3.4 One on one mentorship system for integrated clinical teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN3, N4 (serving as mentors)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSynchronize with nurse rotation cycle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eFixed mentor pairing, regular supervision meetings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.28\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003col start=\"2\"\u003e\n \u003cli\u003ereflective observation\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.28\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.1 Structured self-assessment and reflection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.18\u0026plusmn;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.1.1\u0026nbsp;Self evaluation of Ability Checklist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnce every quarter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eSelf evaluation of online scales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.11\u0026plusmn;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.1.2\u0026nbsp;Write a structured clinical reflection log\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt least one article per week, with important cases requiring reflection records to be completed within 24 hours\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eTemplate based electronic logs submitted to the platform\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.28\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.1.3\u0026nbsp;Occupational stress awareness and emotional management records\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEncourage continuous recording and formal review at least once a month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eUse standardized emotion self-assessment tools or free logging for recording\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.28\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.1.4\u0026nbsp;Analyzing multi-source feedback: comparative analysis of feedback based on self-evaluation, mentoring teacher, and at least one peer evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2, N3, N4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystematic analysis once every six months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBased on the collected feedback (self-evaluation, mentor evaluation, peer evaluation), write a brief analysis report, clarify 1-2 core improvement goals, and discuss with the mentor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.22\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.2\u0026nbsp;Peer evaluation and mentoring feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.17\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.2.1\u0026nbsp;Peer operation mutual evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN1, N2 (peer evaluation), N3 and above (guidance)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eOnce every six months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eProvide feedback through a structured skill observation checklist, write a brief report, and clarify 1-2 improvement goals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.44\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.2.2\u0026nbsp;One on one clinical guidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels] (N1-N2 as the recipient, N3 and above as the provider)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt least one formal feedback per week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eProvide immediate feedback by the bedside and briefly record it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.78\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.3 Case review and collective discussion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.33\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e94.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.3.1\u0026nbsp;Post simulation report: Review the team\u0026apos;s performance, decision-making, and communication during the simulation exercise according to SBAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmediately after each simulated training session\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsing structured modes such as SBAR for team reporting, led by a mentor, with a duration of approximately 15-30 minutes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.39\u0026plusmn;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.3.2\u0026nbsp;Nursing Case Discussion Conference: Analyzing Successful and Insufficient Real Cases, Extracting Lessons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All levels] (N2 and above take turns hosting)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnce a month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eCollective discussion within the department, with nurses taking turns to preside over\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3.94\u0026plusmn;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e94.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.3.3\u0026nbsp;Deep Experience Summary and Promotion Seminar on Major Positive Events (such as Successful Rescue and Application of New Technologies)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN3, N4 (dominant)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eOnce every quarter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eConduct seminars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.11\u0026plusmn;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.3.4\u0026nbsp;Root cause analysis of adverse events or cases that did not achieve expected outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N3 and above leading analysis)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eA meeting must be held after a serious adverse event occurs; Organize at least one review and learning session per quarter for typical cases (which can be anonymized)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eAdhere to the non punitive principle and use tools such as root cause analysis for structured discussions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.39\u0026plusmn;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2.3.5\u0026nbsp;Security Review Meeting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnce a week (such as after morning meetings)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15-30 minutes, discussion on non accountability security issues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.61\u0026plusmn;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003col start=\"3\"\u003e\n \u003cli\u003eabstract conceptualization\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.78\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e94.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.1\u0026nbsp;Core Theory and Knowledge System Construction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.11\u0026plusmn;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.1.1\u0026nbsp;Systematic Theory Teaching: The content covers the pathophysiology of trauma/critical illness, advanced pharmacology, pathophysiology and differential diagnosis of common emergency symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN1 (basic), N2 and above (deepening and updating)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEach person is required to complete the prescribed class hours annually\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eBlended online and offline teaching, with online quizzes at the end of each module\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.83\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.1.2\u0026nbsp;Nursing theories and models: learning crisis management models, clinical decision-making theories, and other theoretical frameworks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2, N3, N4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eSpecial workshops held every six months or once a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eWorkshop combining theoretical explanation with clinical cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.83\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.1.3 Clinical judgment and critical thinking training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2, N3, N4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eOnce every quarter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eAdopting the format of \u0026quot;difficult case discussion\u0026quot; or \u0026quot;diagnostic reasoning workshop\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.22\u0026plusmn;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.2 Professional Standards and Framework Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.11\u0026plusmn;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e77.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.2.1\u0026nbsp;Interpretation of Capability Framework: Learn ICN disaster nursing core competencies, APN general competencies, and master Benner\u0026apos;s \u0026quot;novice to expert\u0026quot; development model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eRetraining is required before applying for promotion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eLectures and workshops\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.17\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e77.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.2.2\u0026nbsp;Nursing Ethics and Legal Regulations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpdate training at least once every 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA workshop or online learning module that analyzes typical medical dispute cases from that year and passes a test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.22\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.2.3 Emergency and Safety Management Policy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eRetraining and assessment once a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePolicy interpretation, situational Q\u0026amp;A, or online exams\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.44\u0026plusmn;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.2.4 Study on Patient Safety Culture and Nursing Quality Indicator System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eQuarterly thematic activities, monthly safety indicator disclosure and briefing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNarrative medical writing sharing session, patient role-playing workshop, or discussion after watching related film and television works\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.56\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.2.5 Humanistic Care and Narrative Medicine Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eOrganize at least one special event every six months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNarrative Medicine Writing and Sharing Session, Patient Role Experience Workshop, or Discussion of Care Ethics Cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.22\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.3 The Foundation of Evidence Based Practice and Research Methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.00\u0026plusmn;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e77.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.3.1\u0026nbsp;Evidence based guideline learning: Mastering the latest evidence-based nursing guidelines and research results\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2 (compulsory), N1 (elective/understanding)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt least one core guide for deep learning per year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eWorkshop+Group Presentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3.3.2\u0026nbsp;Research Methodology: Basic Steps of Evidence Based Practice Learning and Literature Retrieval Evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN3, N4 (mandatory), N2 (understanding)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne centralized workshop per year for N3/N4; N2 level optional core modules\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResearch and design workshop, covering the entire process from problem formulation to solution design, and completing a mini research proposal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.56\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003col start=\"4\"\u003e\n \u003cli\u003eactive experimentation\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.33\u0026plusmn;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e4.1 Clinical Leadership and System Improvement Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.11\u0026plusmn;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e77.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.1.1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eQuality improvement project\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN1 (participation), N2 (leading sub projects), N3 and above (leading cross departmental projects)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProject cycle 6-12 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eSeminar and Conference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.28\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.1.2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eScenario leadership exercise: Serve as a team leader in simulated or real rescue situations, coordinate decision-making\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2, N3, N4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt least once per quarter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eHigh fidelity cross disciplinary team simulation, retrospective review afterwards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.39\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.1.3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eProcess design and optimization: Analyze and pilot improvements to clinical processes such as triage and shift handover\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2, N3, N4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt least once per quarter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eHigh fidelity cross disciplinary team simulation, retrospective review afterwards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.22\u0026plusmn;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e4.2 Teaching guidance and health promotion practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.39\u0026plusmn;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.2.1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eClinical Teaching Ability Development System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2 (Teaching Practice), N3 and above (Course Development and Evaluation)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplete at least one round per year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical mentoring\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.06\u0026plusmn;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.2.2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePatient Education and Community Activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eAt least twice a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003ePatient health education lectures or community emergency science popularization activities organized by the department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3.78\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e4.3\u0026nbsp;Evidence based exploration and research projects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.61\u0026plusmn;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.3.1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEvidence based Practice Proposal: Retrieve evidence and develop change plans for clinical issues\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNursing graduate students N3, N4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eAs the starting point of a research project, it is completed at the beginning of the project cycle (usually 6-12 months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eSubmit a written proposal, including PICO issues, summary of evidence, change plan, and pass the opening defense\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.11\u0026plusmn;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.3.2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSmall research project: completing a nursing quality monitoring or clinical study under guidance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecialist nurses,N3, N4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eThe project cycle is usually 1-2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eIndependently completed under the guidance of a research advisor, including ethics application, data collection and analysis, and writing a final report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.56\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.3.3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eEvidence based practice reform or clinical small research projects led by specialized nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecialist nurses,N3, N4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eThe project cycle is usually 1-3years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eLead a full cycle project from evidence summary to practical change, effectiveness evaluation, and promotion, and the results should have promotional value within the department or hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.50\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003col start=\"5\"\u003e\n \u003cli\u003eEvaluation, Certification, and Sustainable Development\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.50\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e5.1 Comprehensive evaluation system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.22\u0026plusmn;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.1.1 Process evaluation: Integrate learning portfolios, electronically integrate all outputs of 2.1-2.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eContinuously ongoing, real-time summary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eThrough a digital learning management platform\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.22\u0026plusmn;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.1.2 Final assessment: The content covers sections 3.1-3.2 and serves as the conclusion for projects 4.1.1 and 4.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eConduct a centralized assessment once a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eTheoretical unified examination+multi station OSCE+project defense meeting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.17\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e77.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.1.3 Multi source feedback integration: The system summarizes the evaluation information of self, peers, mentors, and patients to form a three-dimensional evaluation portrait\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eSystematically integrate, analyze, and provide feedback at least once a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eAutomatically generate multi-dimensional capability radar charts or reports by the system platform, and have the mentor interpret and interview them\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.06\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e94.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e5.2 Ability Certification and Advancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.50\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.2.1\u0026nbsp;\u003c/strong\u003eCertification level standards: Establish clear competency standards corresponding to the nursing level (N1-N4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eStandard documents are reviewed and revised every 2-3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eOrganize preaching sessions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.28\u0026plusmn;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e77.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.2.2 Certification decision-making process: The certification committee conducts review and certification based on the comprehensive evaluation results\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eCertification review meeting once every six months or annually\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eNurses submit materials for committee review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.17\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.2.3 Result application mechanism: The certification results are clearly linked to personal development paths such as job appointment, performance, and promotion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eInstitutional linkage, normalized implementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eThe human resources department directly calls the certification results during promotion, evaluation, and performance accounting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.50\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e5.3 Continuous tracking and development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.17\u0026plusmn;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.3.1 Effect tracking evaluation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eFollow up at 6, 12, and 24 months after certification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eQuestionnaire survey, skill test, interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.61\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.3.2 Personal Development Profile: Establish an electronic lifelong learning profile to continuously record career growth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eLifetime record, dynamically updated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eThe electronic record system continuously collects all career trajectories such as training, evaluation, and certification achievements, and nurses and managers can view them according to their permissions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.06\u0026plusmn;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.3.3 Continuous learning support: providing personalized learning advice based on records, and building a network of peer communication and mentors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[All energy levels]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003enormalized operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eSeminar and Conference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.16\u0026plusmn;0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.11\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emergency, Nurse, Core competency, Kolb's Learning Cycle, Program, Competency level","lastPublishedDoi":"10.21203/rs.3.rs-8761414/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8761414/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Emergency nursing requires advanced competencies, yet current training in China lacks theoretical grounding and career alignment. Based on Kolb’s experiential learning theory, this study develops a tiered core-competency program corresponding to nurses’ professional stages (N1–N4), aiming to foster systematic training and sustainable workforce development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA mixed-methods research design was employed. First, a preliminary draft of the training program was developed through systematic literature review and semi-structured interviews. Subsequently, from September to November 2025, 18 experts with over 10 years of emergency nursing experience from four provinces were invited to participate in two rounds of Delphi expert consultation. A Likert 5-point scale was used to evaluate the importance of program items, with consensus criteria set as follows: mean importance score ≥4.0, coefficient of variation ≤0.25, and agreement rate (score ≥4) ≥75%. The expert positivity, authority coefficient, and opinion coordination degree were evaluated through questionnaire recovery rate, authority coefficient (Cr), and Kendall's coefficient of concordance (Kendall's W), respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe effective recovery rates of both rounds of expert consultation questionnaires were 100%, with expert authority coefficients of 0.913 and 0.917, indicating the credibility of the consultation results. After two rounds of revisions, a final training program was developed, comprising 5 first-level indicators, 15 second-level indicators, and 48 third-level indicators. All indicators achieved high consensus, and the program systematically integrated the learning cycle of Kolb's experiential learning theory with the competency advancement pathway for competency advancement from novice (N1) to expert (N4) levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study successfully established China's first emergency nursing core competency tiered training program based on Kolb's Learning Cycle theory, spanning the entire career trajectory of nurses. The program demonstrates both systematic design and operational feasibility, providing not only a scientific framework for standardized training, competency certification, and continuous professional development of emergency nurses, but also offering theoretical foundations and practical guidelines for sustainable workforce development in emergency nursing.\u003c/p\u003e","manuscriptTitle":"A Tiered Training Program for Emergency Nurses’ Core Competencies Based on Kolb’s Learning Cycle: A Delphi Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-23 15:31:06","doi":"10.21203/rs.3.rs-8761414/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-24T04:35:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-23T10:30:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-22T17:31:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213592854329536567245756571871219235130","date":"2026-02-22T16:45:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T04:24:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109137003016833637815397329451740367460","date":"2026-02-20T04:21:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4086147312920158107757275472835115265","date":"2026-02-18T17:21:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316717974316567058132565160621459513897","date":"2026-02-17T17:45:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-17T11:30:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-17T05:09:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-04T11:43:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-04T11:40:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-02-02T06:39:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b9570626-9802-4e0e-97e7-358f40e4cd88","owner":[],"postedDate":"February 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T10:09:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-23 15:31:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8761414","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8761414","identity":"rs-8761414","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}