Development and Evaluation of a Core Competence Inventory for Geriatric Transitional Care Nurses

Development and Evaluation of a Core Competence Inventory for Geriatric Transitional Care Nurses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and Evaluation of a Core Competence Inventory for Geriatric Transitional Care Nurses Weiling Xia, Pak Leng Cheong, Jiaxi Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6237283/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background China is experiencing a growing population of older people with a high prevalence of chronic diseases. While geriatric transitional care is essential for improving their health outcomes, its effectiveness is hindered by a shortage of skilled nurses and a core competency inventory to guide practice. This study aims to develop an inventory of core competencies for geriatric transitional care nurses in China, to provide an effective assessment tool to evaluate the competencies required in geriatric transitional care. Methods This study used a two-phase design. In phase one, a core competency inventory was developed from three Chinese theoretical frameworks for nurses and refined through a two-round Delphi consultation with 13 experts from China. In phase two, the reliability and validity of the inventory were evaluated through an Exploratory Factor Analysis in a cross-sectional study involving 320 nurses from 12 hospitals in Guangdong. The inventory’s validity was confirmed through the Content Validity Index, while its reliability was assessed using Cronbach’s α and split-half reliability. Results The final inventory comprises 61 items across five dimensions: Nursing Care and Education Guidance (18 items), Legal and Ethical Principles (9 items), Critical Thinking and Evidence-Based Practice (9 items), Leadership and Coordination (13 items), and Professional Autonomy (12 items). The five dimensions accounted for 76.90% of the variance, indicating a robust factor structure. The inventory demonstrated excellent internal consistency, with Cronbach’s α of 0.991 (p < 0.001) and a split-half reliability of 0.964 (p < 0.001). Additionally, the Scale Content Validity Index (S-CVI) was 0.98, and the Item Content Validity Index (I-CVI) was 0.8, confirming strong validity. Conclusions The inventory shows strong validity and reliability, making it an essential tool for developing competencies in geriatric transitional care nurses in China. It also provides valuable insights for implementing targeted training and assessment measures for nursing staff. Professional Competence Transitional Care Geriatric Nursing Nurses Inventory Background Population ageing has arisen as a major problem for most countries throughout the world, as well as a global research subject. China is suffering from the world's largest population of older adults and rapid population ageing [ 1 ]. Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12–22% [ 2 ]. By 2050, there will be 400 million Chinese over the age of 65, with 150 million of them over the age of 80 [ 3 ]. In 2050, 80% of older people will live in low- and middle-income countries [ 2 ]. In parallel with rapid population ageing, the topic of geriatric care demand in China has increasingly captured the attention of society by proposing strategies for improvement in several key areas [ 3 , 4 ]. A relatively high proportion of the country's ageing population also suffers from chronic illnesses or other health problems. It was shown that up to 75.8% of Chinese over the age of 60 had at least one chronic condition, three-quarters of the older adults have at least one chronic condition, and the burden of chronic diseases is growing [ 5 ]. This indicates that a large portion of the geriatric population is in poor health, leading to diverse and complex healthcare needs among older adults [ 3 , 4 ]. In that case, the Chinese government has investigated various forms of geriatric transitional care to adapt to the rapid process of ageing, raise their health status, and enhance their quality of life, such as community-embedded care, the aged-care consultant system, and the Internet + home care service (IHC) [ 3 , 4 ]. Transitions of care were defined by the World Health Organisation as times when a patient goes to or returns from a specified physical place or makes contact with a healthcare provider to receive health care [ 6 ]. Transitional care (also known as transitional care intervention) sprang to prominence in the 1980s, when it combined post-hospitalization home follow-up services with discharge planning during the patient's hospital stay [ 7 ]. It is frequently defined as utilizing pre-hospital to post-hospital support services, follow-up activities, and other interventions [ 8 – 10 ]. Quality transitional care needs to have several components: Communication between healthcare providers on the discharge assessment and plan, carer preparation for patients and care transition, medication reconciliation at transition, a follow-up plan, and patient education about self-care [ 9 , 11 ]. Therefore, transitional care is not completely as primary care, care coordination, making discharge plans, managing medical conditions, or individual care [ 12 ]. It strives to care for extremely patients who are fragile or have a chronic illness throughout the transitional care process, with a focus on teaching patients and family carers to prevent needless rehospitalizations and address the root causes of poor outcomes [ 12 ]. Many older adults experience re-hospitalizations due to poor communication between healthcare providers and families regarding discharge instructions [ 13 ]. Transitional care focuses on monitoring and assessing discharged patients between scheduled visits by nurses or other professionals [ 14 ]. High-intensity transitional care has been shown to reduce hospital readmissions, healthcare costs, and mortality rates while improving physical function. These benefits are especially significant for frail older adults with chronic or complex conditions, who often face inadequate care due to a lack of proper guidance [ 13 , 15 – 17 ]. The demand for transitional care is very high in Mainland China; however, it is still in its early stages of development and implementation [ 18 ]. Globally, nurses and Advanced Practice Nurses often perform various leadership roles in facilitating care transitions including those of case managers, communicators, liaisons, and coordinators [ 19 ]. In China, nursing specialists in Hong Kong and Taiwan began adapting primary transitional care planning for patient discharge in the 1990s, marking the early development of transitional care adoption [ 18 ]. Nurse-led, autonomous groups have demonstrated improved rehabilitation outcomes for older adults [ 14 ], underscoring the need for advanced skills among transitional care nurses. Several countries, including the UK [ 20 ] and Australia [ 21 ], have established comprehensive guidelines to support transitional care services. These guidelines outline best practices for healthcare professionals, including nurses, involved in transitional care. Core competency is a critical indicator for developing professionals, establishing industry certifications [ 22 ], and measuring nurses' knowledge and capabilities [ 23 ]. Previous studies have highlighted that, to achieve successful results, nurses must possess advanced knowledge, clinical competence, a deep understanding of health and social care systems, exceptional communication skills, and the ability to collaborate effectively [ 24 ]. A Delphi study in China developed a competencies framework for gerontological nursing staff, which includes competencies such as "providing gerontological care," "communication and collaboration," "organization of gerontological nursing care," "health promotion," "evidence-based nursing and lifelong learning," and "professional behaviour" [ 21 ]. However, in China, nurses involved in transitional care for older adults lack standardized guidelines and formal core competency inventories to guide their practice. Developing a unified core competency inventory for Chinese geriatric transitional care nurses would provide essential guidance in navigating the complexities of transitional care. This inventory would not only serve as a reference to improve the quality of geriatric transitional care but also aid in the professional development of nurses, ensuring better patient safety and quality of life. Thus, this study was conducted to evaluate a core competency inventory for geriatric transitional care nurses within the context of China. Methods Aim The objective of this study is to develop and verify an inventory of core competencies for geriatric transitional care nurses by a two-round Delphi consultation and performing an Exploratory Fact Analysis (EFA). Study Design This study utilized a two-phase research design. In the first phase, core competencies were identified through two rounds of Delphi expert consultation. In the second phase, the inventory evaluation was based on a cross-sectional survey. Phase 1: Inventory development To define a concept to be measured is the first step in developing a core competence. According to the theoretical frameworks of core competency for registered nurses in China [ 25 ], transitional care nurses [ 26 ], and geriatric nursing [ 27 ], the core competence of geriatric transitional care nurses was defined as 7 dimensions: geriatric transitional care practice, professional development, education and consultation competencies, leadership and management competencies, communication and coordination competencies, legal and ethical practice competencies, and research competencies. Regarding the item pool development, a comprehensive review of the scientific literature and policy documents to identify the international trends in geriatric transitional care. Through several rounds of the panel discussion, we constructed the first draft of the core competence inventory for geriatric transitional care nurses. Six senior nurses, each with over five years of work experience in geriatric transitional care were invited to the panel for discussion, a total of 7 dimensions and 79 items were determined. Subsequently, 13 experts were invited to evaluate the relevance and clarity of all the items. The expert inclusion criteria are as follows: employed in tertiary hospitals or geriatric medical education institutions; holds a bachelor's degree or higher; possesses a senior professional title; has over 10 years of experience in geriatric transitional care; and has been involved in teaching and training in fields related to geriatric transitional care. The 13 experts from six regions of mainland China are from pilot cities that were early adopters of the transitional nursing model. The years of experience range from 8–30, with an average of 19.69 years of experience, and were actively involved in geriatric transitional care or gerontology education. All experts were asked to rate each item for relevance and clarity by using a 4-point Likert scale (from 1 = not relevant/clear, 2 = somewhat relevant/clear, 3 = relevant/clear, 4 = highly relevant/clear. Experts were also asked to provide comments for modifications, such as adding, removing, or editing items. The positive coefficient of experts was 100%, the judgment coefficient was 0.84, the familiarity degree was 0.76, authority coefficient of Delphi experts was 0.80. At the end of each round consultation, the items were analyzed with the average, the standard deviation, and the quartile difference. After two rounds of consultation, the Interquartile Range (IQR) was tested to evaluate the level of expert consensus. IQR ranged from 0.00 to 1.00, indicating high content consistency. Finally, the opinions of the experts tended to be consistent. According to the results of the first round of consultation, five items were deleted due to items were not specific to geriatric transitional care (Items: 9, 31, 49, 63, 65). Two items were deleted due to insufficient importance (Items: 4, 51). Ten items were combined due to repetitive content (Items: 44 and 45; 53 and 36; 52 and 37; 54 and 47; 59 and 60; 62 and 44; 68 and 70; 75 and 76; 79 and 74; 75 and 77). The remaining entries and dimensions remain the same. In the second round of consultation, we revised the content of three items according to the comments from experts. Therefore, the revised questionnaire contains 7 dimensions and 61 items. Phase 2: Inventory evaluation: a cross-sectional survey Pre-investigation A pre-survey was conducted by randomly selecting 30 geriatric transitional care nurses from the target group. Online questionnaires were distributed to examine whether there were any ambiguously worded or potentially misleading questions in the survey. If such questions were found, the causes were analyzed and revisions made. The logical sequence between the questions was reviewed for consistency, ensuring smooth transitions and the inclusion of any missing or unreasonable options. This pre-survey was designed to minimize response bias caused by unclear wording, and once validated, it was used for the formal survey [ 28 ]. Setting and participants We conducted a cross-sectional study by using online questionnaires from 12 healthcare facilities in Guangdong in March 2023. All the 12 healthcare institutions are located within Guangdong Province and were among the first to implement continuity of care services, with similar scale and qualifications. We invited a head nurse at each healthcare facility to coordinate the survey. They were trained by researchers. Convenience sampling was used in this survey. Inclusion criteria include: (1) registered nurses with a bachelor's degree or higher in nursing; (2) engaging in geriatric transitional care; (3) voluntarily participating in research. Nurses on sick leave, maternity leave, or otherwise unavailable during the survey period, as well as those who refused to participate, were excluded. Instrument The survey and questionnaires were developed for this study, and the questionnaires is shown in Appendix A. The clinical competence of registered nurses is significantly influenced by individual factors such as age, marital status, education level, and work experience [ 29 ]. Therefore, the demographic section of the questionnaire included relevant items: age, gender, marital status, educational background, and years of experience. Besides, the revised geriatric transitional care inventory contains 7 dimensions and 61 items. Each item was designed with a 5-level Likert scale, and the options were “strongly disagree,” “disagree,” “uncertainty,” “agree,” and “strongly agree.” Data Analysis Data were analyzed using SPSS 22.0 software. The validity and reliability of 61 items were evaluated. Validity includes the Content Validity Index (CVI) and Exploratory Factor Analysis (EFA). CVI was tested by Delphi experts’ scores which included the content validity index of the items (I-CVI) and the Content Validity Index of the Scale (S-CVI). Exploratory Factor Analysis was performed to extract factors, removing those with eigenvalues less than one, and retaining items with factor loadings of 0.3 or higher. The order of the scale's structural dimensions and items was adjusted based on factor loadings. Reliability was tested by Cronbach's α internal consistency coefficient and split-half reliability coefficient. Cronbach's α was calculated for the overall scale and each dimension, with values greater than 0.7 indicating high reliability [ 30 ]. Additionally, split-half reliability was assessed using the Spearman-Brown formula, after randomly dividing all items into two halves (odd and even). Ethical Considerations The study accordance with the Helsinki Declaration. All methods were performed in accordance with the relevant guidelines and regulations. The research was approved by the Ethical Committee of Kiage Wu Nursing College of Macao (Reference no: REC-2022.27). With approval from 12 participating healthcare institutions, electronic questionnaires were distributed to eligible nurses. Informed consent was obtained from all participants included in the study and they could withdraw from the study at any time for any reason. Moreover, they were assured that the questionnaires would only be used for research, with assurance that their identities would remain confidential in all reports and publications. Results Demographic characteristics of the participants Of the 340 distributed questionnaires, 20 were excluded due to identical responses and short completion times. The final sample included 320 valid questionnaires, yielding a 94.1% response rate. A majority of participants (68%) were over the age of 30, with 96% identifying as female. Most participants (74%) were unmarried, and 79% held a bachelor's degree or higher. Additionally, 62% had 10 or more years of work experience, while 34.4% had 6 or more years of experience in geriatric transitional care services. The sociodemographic characteristics of the participants are summarized in Table 1 . Table 1 Sociodemographic characteristics of the participants (N = 320) Variable Category Number Percentage/Rate* (%) Gender Male 14 4.4 Female 306 95.6 Age 30 years and below 102 31.9 31–40 years 156 48.8 41 years and above 62 19.4 Marital status Non-unmarried 237 74.1 Unmarried 83 25.9 Professional position Junior 119 37.2 Mid-level 165 51.6 Senior 36 11.3 Educational background Below Bachelor's degree 68 21.3 Bachelor's degree and above 252 78.8 Years of working 10 years and below 123 38.4 11–20 years 83 25.9 21 years and above 114 35.6 Years of participation in geriatric transitional care services 5 years and below 210 65.6 6–10 years 93 29.1 11 years and above 17 5.3 Reliability of the Geriatric Transitional Care Nurse Competency Inventory Reliability was deemed acceptable, as Cronbach's α exceeded 0.7 [ 31 ]. The overall Cronbach's α was 0.991 (P < 0.001), with a standardized Cronbach's α of 0.992. The inventory was randomly divided into two sections, with the split-half reliability yielding 0.964 (P < 0.001). Cronbach’s α for the first section (31 items) was 0.982, and for the second section (31 items) it was 0.985. After applying the Spearman-Brown correction, the adjusted Cronbach’s α was 0.978. Validity Analysis of the Geriatric Transitional Care Nurse Competency Inventory In the second round, results showed that the I-CVI ranged from 0.83 to 1.00, and the S-CVI was 0.98. To assess structural validity, factor analysis was performed. The Kaiser-Meyer-Olkin (KMO) value was 0.973, and Bartlett's Sphericity test was statistically significant (χ2 = 26650.219, P = 0.000), confirming the suitability of the 61 items for factor analysis. The total variance explained by the extracted factors was 76.90%, with eigenvalues ranging from 1.18 to 40.47 and factor loadings ranging from 0.32 to 0.74. Following group discussions and a review of relevant core competencies [ 25 – 27 ], five factors were identified and labelled: Nursing Care and Education Guidance, Legal and Ethical Principles, Critical Thinking and Evidence-Based Practice, Leadership and Coordination, and Professional Autonomy. The final inventory for geriatric transitional care nurses in China comprises 61 items across five dimensions: Nursing Care and Education Guidance (18 items), Legal and Ethical Principles (9 items), Critical Thinking and Evidence-Based Practice (9 items), Leadership and Coordination (13 items), and Professional Autonomy (12 items). The revised inventory and factor loadings are presented in Table 2 . Table 2 The revised inventory and factor loadings Item Category and Item Factor Loading Nursing Care and Education Guidance (18 items) Able to comprehensively assess the health status of the older people in physical, mental, social, and spiritual aspects. 0.75 Encourages the older people and their families to participate in the formulation and implementation of care plans. 0.75 Able to provide multicultural nursing services to the older people. 0.72 Able to dynamically observe and record the progress of the older people's condition. 0.71 Able to implement accurate, safe, and effective care according to the care plan. 0.69 Able to accurately analyse data collected directly and indirectly, and formulate nursing plans suitable for the older people based on the data. 0.69 Able to identify the most urgent needs of the older people and incorporate them into the care plan. 0.68 Able to provide holistic and individualized care for the older people. 0.66 Able to accurately assess the activity and self-care abilities of the older people. 0.61 Able to evaluate the effectiveness of nursing measures accurately. 0.61 Able to provide psychological care for the older people, family members, and caregivers. 0.58 Able to grasp the relevant knowledge of common geriatric diseases and provide corresponding nursing measures and health education. 0.57 Able to accurately assess the living environment and community environment of the older people. 0.54 Able to identify potential health risks and complications in the older people. 0.42 Able to assess the learning needs of the older people, family members, and caregivers for health maintenance and promotion. 0.38 Able to provide professional counselling and consultation for the older people, family members, and caregivers. 0.38 Able to provide appropriate health education for the older people, family members, and caregivers based on assessment results. 0.38 Able to evaluate the effectiveness of health education activities. 0.34 Legal and Ethical (9 items) Able to respect the privacy of the older people and maintain the confidentiality and security of medical and nursing data. 0.73 Respecting the older people's self-choice and decision-making rights in nursing practice. 0.71 Able to report mistakes and accidents that occur while working outside the hospital truthfully. 0.71 Taking personal responsibility for words and actions when working independently outside the hospital. 0.69 Protecting the rights of the older people in various aspects during work. 0.68 Able to comply with legal regulations and organizational requirements for conducting transitional nursing practice activities outside the hospital. 0.66 Recognizing the personal beliefs and cultural customs of the older people, family members, and caregivers. 0.46 To have enough patience to take care of the older people. 0.44 To objectively file complaints and advocate for older people whose rights have been violated. 0.40 Critical Thinking and Evidence-Based Practice (9 items) Capable of judging theories proposed by others based on personal practice experience and acquired knowledge. 0.74 Willingness to seek innovative and feasible research projects in the workplace. 0.74 Assisting and participating in relevant scientific research projects related to geriatric nursing. 0.73 Able to correctly apply evidence-based evidence to guide nursing practice and related work. 0.71 Capable of making evidence-based and accurate judgments in nursing clinical decision-making. 0.68 Able to use various methods to search for relevant research data and references. 0.62 Able to utilize various resources and information to find multiple solutions to problems encountered in work. 0.59 Establishing and managing health information archives for the older people and using them to guide nursing decisions. 0.37 Selecting appropriate new technologies and equipment for the older people to improve nursing services. 0.35 Leadership and Communication Coordination (13 items) Able to create a positive atmosphere of cooperation within the work team. 0.67 Able to demonstrate personal development direction. 0.65 Able to accept and adopt constructive criticism and suggestions. 0.63 Able to clarify the role of professional organizations (such as nursing associations, etc.) and actively participate. 0.63 Able to obtain collective consensus before important actions. 0.61 Able to recognize strengths and weaknesses in geriatric nursing profession. 0.56 Able to acknowledge the contributions of others and motivate and influence others. 0.55 Knows how to delegate and refer appropriate geriatric nursing tasks based on colleagues' abilities. 0.53 Able to handle interpersonal conflicts effectively. 0.44 Able to objectively and correctly evaluate oneself. 0.36 Proficient in using modern media such as networks for communication and exchange. 0.35 Has good expression and presentation skills for effective communication. 0.34 Keeps promises, dares to take responsibility, and establishes mutual trust with the older people, family members, and caregivers. 0.32 Professional Autonomy (12 items) Able to analyse and confirm primary crises in emergency situations. 0.66 Able to provide end-of-life care for older people. 0.65 Able to effectively handle emergencies outside of the hospital, such as verbal violence, personal safety, and sudden cardiopulmonary arrest. 0.59 Able to use time effectively and schedule nursing work reasonably. 0.55 Able to utilize various resources (such as community, nursing homes, volunteers, etc.) to conduct diverse health promotion activities. 0.50 Possesses basic rehabilitation knowledge and skills to guide older people, family members, and caregivers in rehabilitation training. 0.56 Able to establish the concept of geriatric transitional care and apply it in practical work. 0.46 Able to effectively coordinate relationships between community health service personnel, the older people, family members, and caregivers and obtain their cooperation. 0.46 Able to maintain a positive and optimistic attitude in work, use stress reduction methods for self-guidance, and seek help from others when necessary. 0.46 Able to assist and advise other nurses and staff working in geriatric transitional care. 0.46 Able to identify their own learning needs in geriatric nursing and continuously learn new knowledge through various channels. 0.33 Able to pay attention to discipline dynamics and professional development trends. 0.32 Discussion The core competency inventory for geriatric transitional care nurses in China includes 61 items across five dimensions. The five core competencies include: Nursing Care and Education Guidance, Legal and Ethical, Critical Thinking and Evidence-Based Practice, Leadership and Communication Coordination, and Professional Autonomy . This inventory comprehensively covers the core competencies needed for geriatric transitional nurses, fulfilling the objective of providing an effective assessment tool to evaluate the competencies required in geriatric transitional care, in response to the growing population of older adults with a high prevalence of chronic diseases. This core competency inventory for geriatric transitional care nurses addresses a significant research gap by providing a standardized guide for geriatric transitional care nurses in Mainland China. Well-embedded in the Chinese context, it offers practical, concrete suggestions for the competencies and skills that nurses will need to succeed in current and future roles within gerontological nursing education and practice. We employed a two-phase design, consisting of a two-round Delphi expert consultation followed by a cross-sectional study for EFA. The purpose of the expert consultation was to provide comprehensive and valuable suggestions for exploring the research topic. The content validity reflects the degree of consistency between the objectives and the consultation results, ensuring the standardization and scientific rigour of the Delphi method [ 32 ]. The diversity of expert backgrounds and experiences is crucial for the effectiveness of the Delphi method [ 33 ]. Therefore, we made an effort to select expert members from a wide range of backgrounds, experiences, and categories [ 33 , 34 ]. Notably, more revision suggestions were proposed by experts from Hong Kong and Macau, likely due to differences in the development of geriatric transitional care between these regions and Mainland China. Moreover, experts believed that the service settings for geriatric transitional care were not in a medical institution but at home, so referring to the service recipients as "patients" was not appropriate. Therefore, the term "patients" in the inventory was changed to "older adults". Since family caregivers for older adults can be divided into family members and professional caregivers, it is not accurate to use the same term "family members". Therefore, based on expert suggestions and the actual work situation, "family members" in all items was changed to "family members and caregivers". Experts gave careful consideration to the dignity of older adults, emphasizing that valuing their dignity, feelings, and psychological well-being is a key aspect of improving their quality of life [ 35 ]. After revisions, the findings show that the experts reached a high level of consensus on the factors included in the inventory. The 18 items listed under the core competency Nursing Care and Education Guidance primarily focus on the holistic care of older adults in transitional nursing, including comprehensive assessments of their physical, mental, social, and spiritual health. The transitional care model is a patient-centred approach that promotes recovery and prevents disease deterioration [ 18 ], and it is a comprehensive discharge plan that integrates advanced nursing practices with family follow-ups [ 36 ]. Therefore, nurses are expected to be competent in mobilizing patients and families in care planning, providing culturally sensitive nursing services, and continuously monitoring patient progress. Moreover, nurses should assess and address health risks, provide psychological care, offer health education, and continuously evaluate the impact of these interventions, ensuring patient and caregiver education and care continuity. This aligns with the Patient and Caregiver Engagement, Patient Education and Care Continuity component of comprehensive and effective transitional care outlined by Naylor et al. [ 37 ]. Optimizing the engagement of both patients and caregivers through consistent efforts by healthcare professionals and systems to identify key outcomes is essential. The implementation of individualized care plans and ensuring continuous access to care are vital for building trust with patients and caregivers [ 37 ]. Additionally, Naylor et al. [ 37 ] emphasize the importance of continuous interactive teaching and learning processes involving both the healthcare team and the patient, as highlighted in this inventory. The nine items under the core competency Legal and Ethical focus on protecting the rights of older adults in transitional nursing practice. Research on the ethical aspects of transitional care is limited, and existing studies suggest there is still room to develop skills for balancing ethical principles [ 38 ]. Our inventory provides specific guidance for the professional training of geriatric transitional care nurses in Legal and Ethical competence: the core competency includes respecting privacy and confidentiality, honouring the self-choice and decision-making rights of older individuals, and ensuring the accurate reporting of errors and incidents. Nurses are expected to comply with legal regulations and organizational requirements in their practice, particularly when working outside the hospital. They must also recognize and respect the personal beliefs and cultural customs of older adults, their families, and caregivers, while demonstrating patience and care. Additionally, nurses are responsible for advocating for the rights of older adults, including filing complaints when necessary to protect those whose rights have been violated. The Critical Thinking and Evidence-Based Practice competency, comprising 9 items, focuses on developing the ability to critically assess theories and apply evidence-based practices in geriatric transitional nursing. It includes the ability to judge theories based on personal experience and knowledge, seek innovative research projects, and participate in geriatric nursing research. Nurses are expected to apply evidence-based knowledge in clinical decision-making, use various methods to find relevant research data, and find multiple solutions to work-related challenges. Additionally, nurses should establish and manage health information archives to guide nursing decisions and select appropriate technologies to improve nursing services for older adults. Both Evidence-Based Practice and Critical Thinking are a component of one key domain of the International Council of Nurses (ICN) Core Competencies for Registered Nurses [ 39 ]. Critical Thinking has been lauded as a vital prerequisite and a key element essential to evidence-based nursing practice [ 40 ] and is an essential mental process for ensuring, efficient and skilful nursing interventions [ 41 ]. Chinese health systems and academic nursing schools have been working to enhance the evidence-based practice and research competence of geriatric transitional nurses by integrating education on evidence-based thinking and research skills into their training. This approach aims to promote continued education, foster a strong research environment, and strengthen critical thinking and evidence-based practice skills [ 42 ]. The Leadership and Communication Coordination competency, consisting of 13 items, emphasizes the importance of effective leadership and communication in geriatric transitional nursing. Nurses are expected to foster a positive team atmosphere, demonstrate personal development, accept feedback, and clarify the role of professional organizations. They should ensure collective consensus before taking action, recognize strengths and weaknesses in geriatric nursing, motivate others, and acknowledge contributions. Nurses must delegate tasks based on colleagues' abilities, manage conflicts, and evaluate themselves objectively. Proficiency in modern media communication, presentation skills, and maintaining trust with patients and caregivers is also essential. This competency aligns with Team Accountability , a component of comprehensive and effective transitional care outlined by Naylor et al. [ 37 ], which emphasizes the responsibility of each healthcare professional to contribute expertise and collaborate for patient and caregiver health goals. The Professional Autonomy competency, consisting of 12 items, emphasizes the ability to make independent decisions and take responsibility in geriatric transitional care. Key areas of focus include assessing and addressing primary crises in emergency situations, providing end-of-life care, and managing external emergencies such as verbal violence and sudden medical events. Nurses must also effectively manage their time, schedule nursing tasks, and utilize resources such as community services and volunteers for health promotion activities. In addition, nurses are expected to have basic rehabilitation knowledge to guide patients and caregivers in rehabilitation training. Establishing and applying the concept of geriatric nursing continuity, coordinating relationships with community health personnel as an independent professional, and maintaining a positive, resilient attitude are critical components. Nurses should also assist and advise colleagues, identify their own learning needs, and stay updated on professional trends and advancements. Professional autonomy is closely linked to job satisfaction, as greater autonomy can enhance nurses' work fulfilment. However, promoting autonomy requires investment beyond the individual and unit levels; organizational and political support is essential to foster autonomy [ 43 ]. Moreover, the entire core competency in this inventory aims to introduce improvements in the nursing practice environment for geriatric transitional nurses, managers, researchers, and stakeholders. This approach encourages nurses to fully utilize their training in these core competencies, enhancing their ability to perform at their highest potential. Limitations Transitional care is still in its early stages of development and implementation in Mainland China, which has limited the scope of the inventory evaluation's cross-sectional survey, resulting in a relatively small sample size. Additionally, future studies will require larger sample sizes and participants from more regions and healthcare centres nationwide to enable confirmatory factor analysis. Conclusions This study developed and validated an inventory for measuring the core competence of geriatric transitional care nurses through a Delphi method. The inventory consists of 61 items and five dimensions: nursing care and education guidance, legal ethics, critical thinking and evidence-based practice, leadership and coordination, and professional autonomy. The inventory comprehensively covers the core competencies that geriatric transitional care nurses should possess. These competencies are well embedded in a Chinese context. Abbreviations IHC Internet+ Home Care Service EFA Exploratory Fact Analysis IQR Interquartile Range CVI Content Validity Index I-CVI Content Validity Index of the Items S-CVI Content Validity Index of the Scale Declarations Ethics approval and consent to participate The study accordance with the Helsinki Declaration. All methods were performed in accordance with the relevant guidelines and regulations. The research was approved by the Ethical Committee of Kiage Wu Nursing College of Macao (Reference no: REC-2022.27). With approval from the heads of the 12 participating healthcare institutions, electronic questionnaires were distributed to eligible nurses. Informed consent was obtained from all participants included in the study and they could withdraw from the study at any time for any reason. Moreover, they were assured that the questionnaires would only be used for research, with assurance that their identities would remain confidential in all reports and publications. Clinical trial number: not applicable. Consent for publication Not applicable Data availability The author confirms that all data generated or analyzed during this study are included in this published article. Furthermore, the data supporting the findings of this study are available upon reasonable request from the corresponding author. Competing interests Not applicable. Funding Not applicable. Authors’ contributions W . L.X. contributed to conceptualization, data curation, formal analysis, investigation, methodology, software development, validation, and writing—original draft preparation, as well as reviewing and editing the manuscript. P.L.C. contributed to conceptualization, data curation, methodology, software development, validation, and writing—original draft preparation, as well as reviewing and editing the manuscript. J.X.X. contributed to conceptualization, methodology, writing—original draft preparation, and reviewing and editing the manuscript. All authors reviewed and approved the final version of the manuscript. Acknowledgements We extend our gratitude to all the institutions and participants involved for their support and cooperation. References Wu L, Huang Z, Pan Z. The spatiality and driving forces of population ageing in China. PLoS ONE. 2021;16(1):e0243559. World Health Organization. Ageing and health. Geneva: World Health Organization; 2021. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health . Fang EF, Scheibye-Knudsen M, Jahn HJ, Li J, Ling L, Guo H, et al. A research agenda for aging in China in the 21st century. Ageing Res Rev. 2015;24(Pt B):197–205. Bao J, Zhou L, Liu G, Tang J, Lu X, Cheng C, et al. Current state of care for the elderly in China in the context of an aging population. Biosci Trends. 2022;16(2):107–18. Wang LM, Chen ZH, Zhang M, Zhao ZP, Huang ZJ, Zhang X, et al. [Study of the prevalence and disease burden of chronic disease in the elderly in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2019;40(3):277–83. World Health Organization. Transitions of care: technical series on safer primary care [online]. 2016. https://www.who.int/publications/i/item/9789241511599 Brooten D, Brown LP, Munro BH, York R, Cohen SM, Roncoli M, Hollingsworth A. Early Discharge and Specialist Transitional Care. Image: J Nurs Scholarsh. 1988;20(2):64–8. Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc. 2003;51(4):549–55. Coleman EA, Boult C. Improving the Quality of Transitional Care for Persons with Complex Care Needs. J Am Geriatr Soc. 2003;51(4):556–7. Holland DE, Harris MR, Discharge Planning T, Care. Coordination of Care, and Continuity of Care: Clarifying Concepts and Terms from the Hospital Perspective. Home Health Care Serv Q. 2007;26(4):3–19. Allen J, Hutchinson AM, Brown R, Livingston PM. Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Serv Res. 2014;14(1):346. Mary D, Naylor LHA, Ellen T, Kurtzman DM, Olds, Karen B. Hirschman. The Importance Of Transitional Care In Achieving Health Reform. Health Aff. 2011;30(4):746–54. Menezes TMO, ALBd O, Santos LB, Freitas RAd, Pedreira LC, Veras SMCB. Hospital transition care for the elderly: an integrative review. Revista Brasileira de Enfermagem. 2019;72:294–301. Aljohani M, Basher Alazimi M, Saied Ayoub N. The home healthcare nursing services provided to the elderly patients: a systematic review. Nurs Commun. 2022;6:e2022034. Facchinetti G, D’Angelo D, Piredda M, Petitti T, Matarese M, Oliveti A, De Marinis MG. Continuity of care interventions for preventing hospital readmission of older people with chronic diseases: A meta-analysis. Int J Nurs Stud. 2020;101:103396. Joo JY, Liu MF. Transitional care interventions for supporting frail older adults discharged from hospitals: An umbrella review. Geriatr Nurs. 2023;50:80–9. Lisa Fønss R, Louise Bang G, Jeppe L, Ishay B, Merete G. Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review. BMJ Open. 2021;11(1):e040057. Ye Z-J, Liu M-L, Cai R-Q, Zhong M-X, Huang H, Liang M-Z, et al. Development of the Transitional Care Model for nursing care in Mainland China: A literature review. Int J Nurs Sci. 2016;3(1):113–30. Albert NM, Barnason S, Deswal A, Hernandez A, Kociol R, Lee E, et al. Transitions Care Heart Fail Circulation: Heart Fail. 2015;8(2):384–409. British Association of Perinatal Medicine. Neonatal transitional care: a framework for practice. London: British Association of Perinatal Medicine; 2017. https://www.bapm.org/resources/24-neonatal-transitional-care-a-framework-for-practice-2017 . Australian Government Department of Health. Transition Care Programme guidelines. Canberra: Australian Government Department of Health. 2022. Available from: https://www.health.gov.au/resources/publications/transition-care-programme-guidelines?language=en Hafeez K, Zhang Y, Malak N. Core competence for sustainable competitive advantage: a structured methodology for identifying core competence. IEEE Trans Eng Manage. 2002;49:28–35. Cowin LS, Hengstberger-Sims C, Eagar SC, Gregory L, Andrew S, Rolley J. Competency measurements: testing convergent validity for two measures. J Adv Nurs. 2008;64(3):272–7. Coffey A, Mulcahy H, Savage E, Fitzgerald S, Bradley C, Benefield L, Leahy-Warren P. Transitional care interventions: Relevance for nursing in the community. Public Health Nurs. 2017;34(5):454–60. Liu M, Kunaiktikul W, Senaratana W, Tonmukayakul O, Eriksen L. Development of competency inventory for registered nurses in the People's Republic of China: scale development. Int J Nurs Stud. 2007;44(5):805–13. Xu YL, Li SL, Wang D et al. Primary construction of continuity of care nurses’ core competency evaluation indexes. Nurs Res 2016;30(6B). http://hlyj.suo1.cn/site/showzz.php?id=47564 Wang Z. A qualitative research on the development of geriatric nursing competency inventory. Chin J Nurs. 2012. Choi BC, Pak AW. A catalog of biases in questionnaires. Prev Chronic Dis. 2005;2(1):A13. Gunawan J, Aungsuroch Y, Fisher ML, Marzilli C, Liu Y. Factors Related to the Clinical Competence of Registered Nurses: Systematic Review and Meta-Analysis. J Nurs Scholarsh. 2020;52(6):623–33. Shi Y, Pu S, Peng H, Luo Y. Development and validation of the patient-reported outcome scale for chronic kidney disease. Int Urol Nephrol. 2023. Chair SY, Wong FKY, Bryant-Lukosius D, Liu T, Jokiniemi K. Construct validity of advanced practice nurse core competence scale: an exploratory factor analysis. BMC Nurs. 2023;22(1):57. Spranger J, Homberg A, Sonnberger M, Niederberger M. Reporting guidelines for Delphi techniques in health sciences: A methodological review. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2022;172:1–11. Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and Reporting the Delphi Method for Selecting Healthcare Quality Indicators: A Systematic Review. PLoS ONE. 2011;6(6):e20476. Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol. 2021;11(4):116–29. Alexopoulos GS. Depression in the elderly. Lancet. 2005;365(9475):1961–70. Brooten D, Naylor MD, York R, Brown LP, Munro BH, Hollingsworth AO, et al. Lessons learned from testing the quality cost model of advanced practice nursing (APN) transitional care. J Nurs Scholarsh. 2002;34(4):369–75. Naylor MD, Shaid EC, Carpenter D, Gass B, Levine C, Li J, et al. Components of Comprehensive and Effective Transitional Care. J Am Geriatr Soc. 2017;65(6):1119–25. Paul M, O’Hara L, Tah P, Street C, Maras A, Ouakil DP, et al. A systematic review of the literature on ethical aspects of transitional care between child- and adult-orientated health services. BMC Med Ethics. 2018;19(1):73. International Council of Nurses. ICN Framework for competencies for the Nurse Specialist. Geneva, Switzerland; 2009. Canada AN. Probing the Relationship Between Evidence-Based Practice Implementation Models and Critical Thinking in Applied Nursing Practice. J Contin Educ Nurs. 2016;47(4):161-8; quiz 9–70. Papathanasiou IV, Kleisiaris CF, Fradelos EC, Kakou K, Kourkouta L. Critical thinking: the development of an essential skill for nursing students. Acta Inf Med. 2014;22(4):283–6. Zhang J, Yan QY, Yue S. Nursing research capacity and its management in China: A systematic review. J Nurs Manag. 2020;28(2):199–208. Pursio K, Kankkunen P, Mikkonen S, Kvist T. Organizational characteristics of nursing practice environments related to registered nurses’ professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study. BMC Nurs. 2024;23(1):100. Additional Declarations No competing interests reported. Supplementary Files AppendixA.SurveyQuestionnaireonCoreCompetencie.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 30 Apr, 2025 Editor assigned by journal 18 Apr, 2025 Editor invited by journal 31 Mar, 2025 Submission checks completed at journal 29 Mar, 2025 First submitted to journal 29 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6237283","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452250084,"identity":"5d972367-e416-403f-898d-779b73bc4101","order_by":0,"name":"Weiling Xia","email":"","orcid":"","institution":"Kiang Wu Nursing College of Macau","correspondingAuthor":false,"prefix":"","firstName":"Weiling","middleName":"","lastName":"Xia","suffix":""},{"id":452250086,"identity":"22c13cbe-181a-474e-93a0-6a747e6da6ad","order_by":1,"name":"Pak Leng Cheong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYBACxgYGBmYwi70NKnSAaC08x4jUAgIQLRJpRGphbm8++LmgwiZPPvJZmnRBDYMc340E1g0f8Dms51iy9IwzacWGt9OOSc84xmAseSOB7eYMfFpm5Jgx87YdTtw4O73tNm8DQ+IGoJbbPHi15H9j5v0H1DLzOFhLPRFactiYeRsOJ86XYDsG0pJgQFBLzzFjaZ5jaYkbeNLSf/MckzCceeZhG16/GLY3P/zMU2OTOL/9mLExkCHPdzz52A18IWbYAGUYHABTEgyQ6MUD5OEM/OpGwSgYBaNgJAMA911Q9egWL/IAAAAASUVORK5CYII=","orcid":"","institution":"Kiang Wu Nursing College of Macau","correspondingAuthor":true,"prefix":"","firstName":"Pak","middleName":"Leng","lastName":"Cheong","suffix":""},{"id":452250088,"identity":"98267af3-cbe7-4155-a24d-d6c756bf3faf","order_by":2,"name":"Jiaxi Xu","email":"","orcid":"","institution":"Kiang Wu Nursing College of Macau","correspondingAuthor":false,"prefix":"","firstName":"Jiaxi","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2025-03-16 11:38:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6237283/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6237283/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82104323,"identity":"2b3a7293-ab0c-49ba-bd65-326a8a558de2","added_by":"auto","created_at":"2025-05-06 20:04:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":756020,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6237283/v1/ff55f380-4b62-42b4-8581-90089f8690fc.pdf"},{"id":82103714,"identity":"2e3d5403-bf71-4028-b03c-5e060f5974b1","added_by":"auto","created_at":"2025-05-06 19:48:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":29751,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.SurveyQuestionnaireonCoreCompetencie.docx","url":"https://assets-eu.researchsquare.com/files/rs-6237283/v1/c9181ca18c599e296a9942db.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and Evaluation of a Core Competence Inventory for Geriatric Transitional Care Nurses","fulltext":[{"header":"Background","content":"\u003cp\u003ePopulation ageing has arisen as a major problem for most countries throughout the world, as well as a global research subject. China is suffering from the world's largest population of older adults and rapid population ageing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12\u0026ndash;22% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. By 2050, there will be 400\u0026nbsp;million Chinese over the age of 65, with 150\u0026nbsp;million of them over the age of 80 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In 2050, 80% of older people will live in low- and middle-income countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In parallel with rapid population ageing, the topic of geriatric care demand in China has increasingly captured the attention of society by proposing strategies for improvement in several key areas [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A relatively high proportion of the country's ageing population also suffers from chronic illnesses or other health problems. It was shown that up to 75.8% of Chinese over the age of 60 had at least one chronic condition, three-quarters of the older adults have at least one chronic condition, and the burden of chronic diseases is growing [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This indicates that a large portion of the geriatric population is in poor health, leading to diverse and complex healthcare needs among older adults [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In that case, the Chinese government has investigated various forms of geriatric transitional care to adapt to the rapid process of ageing, raise their health status, and enhance their quality of life, such as community-embedded care, the aged-care consultant system, and the Internet\u0026thinsp;+\u0026thinsp;home care service (IHC) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTransitions of care were defined by the World Health Organisation as times when a patient goes to or returns from a specified physical place or makes contact with a healthcare provider to receive health care [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Transitional care (also known as transitional care intervention) sprang to prominence in the 1980s, when it combined post-hospitalization home follow-up services with discharge planning during the patient's hospital stay [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It is frequently defined as utilizing pre-hospital to post-hospital support services, follow-up activities, and other interventions [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Quality transitional care needs to have several components: Communication between healthcare providers on the discharge assessment and plan, carer preparation for patients and care transition, medication reconciliation at transition, a follow-up plan, and patient education about self-care [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, transitional care is not completely as primary care, care coordination, making discharge plans, managing medical conditions, or individual care [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It strives to care for extremely patients who are fragile or have a chronic illness throughout the transitional care process, with a focus on teaching patients and family carers to prevent needless rehospitalizations and address the root causes of poor outcomes [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Many older adults experience re-hospitalizations due to poor communication between healthcare providers and families regarding discharge instructions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Transitional care focuses on monitoring and assessing discharged patients between scheduled visits by nurses or other professionals [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. High-intensity transitional care has been shown to reduce hospital readmissions, healthcare costs, and mortality rates while improving physical function. These benefits are especially significant for frail older adults with chronic or complex conditions, who often face inadequate care due to a lack of proper guidance [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The demand for transitional care is very high in Mainland China; however, it is still in its early stages of development and implementation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobally, nurses and Advanced Practice Nurses often perform various leadership roles in facilitating care transitions including those of case managers, communicators, liaisons, and coordinators [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In China, nursing specialists in Hong Kong and Taiwan began adapting primary transitional care planning for patient discharge in the 1990s, marking the early development of transitional care adoption [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Nurse-led, autonomous groups have demonstrated improved rehabilitation outcomes for older adults [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], underscoring the need for advanced skills among transitional care nurses. Several countries, including the UK [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and Australia [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], have established comprehensive guidelines to support transitional care services. These guidelines outline best practices for healthcare professionals, including nurses, involved in transitional care.\u003c/p\u003e \u003cp\u003eCore competency is a critical indicator for developing professionals, establishing industry certifications [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and measuring nurses' knowledge and capabilities [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Previous studies have highlighted that, to achieve successful results, nurses must possess advanced knowledge, clinical competence, a deep understanding of health and social care systems, exceptional communication skills, and the ability to collaborate effectively [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. A Delphi study in China developed a competencies framework for gerontological nursing staff, which includes competencies such as \"providing gerontological care,\" \"communication and collaboration,\" \"organization of gerontological nursing care,\" \"health promotion,\" \"evidence-based nursing and lifelong learning,\" and \"professional behaviour\" [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, in China, nurses involved in transitional care for older adults lack standardized guidelines and formal core competency inventories to guide their practice. Developing a unified core competency inventory for Chinese geriatric transitional care nurses would provide essential guidance in navigating the complexities of transitional care. This inventory would not only serve as a reference to improve the quality of geriatric transitional care but also aid in the professional development of nurses, ensuring better patient safety and quality of life. Thus, this study was conducted to evaluate a core competency inventory for geriatric transitional care nurses within the context of China.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAim\u003c/p\u003e \u003cp\u003eThe objective of this study is to develop and verify an inventory of core competencies for geriatric transitional care nurses by a two-round Delphi consultation and performing an Exploratory Fact Analysis (EFA).\u003c/p\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eThis study utilized a two-phase research design. In the first phase, core competencies were identified through two rounds of Delphi expert consultation. In the second phase, the inventory evaluation was based on a cross-sectional survey.\u003c/p\u003e \u003cp\u003ePhase 1: Inventory development\u003c/p\u003e \u003cp\u003eTo define a concept to be measured is the first step in developing a core competence. According to the theoretical frameworks of core competency for registered nurses in China [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], transitional care nurses [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and geriatric nursing [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], the core competence of geriatric transitional care nurses was defined as 7 dimensions: geriatric transitional care practice, professional development, education and consultation competencies, leadership and management competencies, communication and coordination competencies, legal and ethical practice competencies, and research competencies. Regarding the item pool development, a comprehensive review of the scientific literature and policy documents to identify the international trends in geriatric transitional care. Through several rounds of the panel discussion, we constructed the first draft of the core competence inventory for geriatric transitional care nurses. Six senior nurses, each with over five years of work experience in geriatric transitional care were invited to the panel for discussion, a total of 7 dimensions and 79 items were determined.\u003c/p\u003e \u003cp\u003eSubsequently, 13 experts were invited to evaluate the relevance and clarity of all the items. The expert inclusion criteria are as follows: employed in tertiary hospitals or geriatric medical education institutions; holds a bachelor's degree or higher; possesses a senior professional title; has over 10 years of experience in geriatric transitional care; and has been involved in teaching and training in fields related to geriatric transitional care.\u003c/p\u003e \u003cp\u003eThe 13 experts from six regions of mainland China are from pilot cities that were early adopters of the transitional nursing model. The years of experience range from 8\u0026ndash;30, with an average of 19.69 years of experience, and were actively involved in geriatric transitional care or gerontology education. All experts were asked to rate each item for relevance and clarity by using a 4-point Likert scale (from 1\u0026thinsp;=\u0026thinsp;not relevant/clear, 2\u0026thinsp;=\u0026thinsp;somewhat relevant/clear, 3\u0026thinsp;=\u0026thinsp;relevant/clear, 4\u0026thinsp;=\u0026thinsp;highly relevant/clear. Experts were also asked to provide comments for modifications, such as adding, removing, or editing items.\u003c/p\u003e \u003cp\u003eThe positive coefficient of experts was 100%, the judgment coefficient was 0.84, the familiarity degree was 0.76, authority coefficient of Delphi experts was 0.80. At the end of each round consultation, the items were analyzed with the average, the standard deviation, and the quartile difference. After two rounds of consultation, the Interquartile Range (IQR) was tested to evaluate the level of expert consensus. IQR ranged from 0.00 to 1.00, indicating high content consistency. Finally, the opinions of the experts tended to be consistent.\u003c/p\u003e \u003cp\u003eAccording to the results of the first round of consultation, five items were deleted due to items were not specific to geriatric transitional care (Items: 9, 31, 49, 63, 65). Two items were deleted due to insufficient importance (Items: 4, 51). Ten items were combined due to repetitive content (Items: 44 and 45; 53 and 36; 52 and 37; 54 and 47; 59 and 60; 62 and 44; 68 and 70; 75 and 76; 79 and 74; 75 and 77). The remaining entries and dimensions remain the same. In the second round of consultation, we revised the content of three items according to the comments from experts. Therefore, the revised questionnaire contains 7 dimensions and 61 items.\u003c/p\u003e \u003cp\u003ePhase 2: Inventory evaluation: a cross-sectional survey\u003c/p\u003e \u003cp\u003ePre-investigation\u003c/p\u003e \u003cp\u003eA pre-survey was conducted by randomly selecting 30 geriatric transitional care nurses from the target group. Online questionnaires were distributed to examine whether there were any ambiguously worded or potentially misleading questions in the survey. If such questions were found, the causes were analyzed and revisions made. The logical sequence between the questions was reviewed for consistency, ensuring smooth transitions and the inclusion of any missing or unreasonable options. This pre-survey was designed to minimize response bias caused by unclear wording, and once validated, it was used for the formal survey [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSetting and participants\u003c/p\u003e \u003cp\u003eWe conducted a cross-sectional study by using online questionnaires from 12 healthcare facilities in Guangdong in March 2023. All the 12 healthcare institutions are located within Guangdong Province and were among the first to implement continuity of care services, with similar scale and qualifications. We invited a head nurse at each healthcare facility to coordinate the survey. They were trained by researchers. Convenience sampling was used in this survey. Inclusion criteria include: (1) registered nurses with a bachelor's degree or higher in nursing; (2) engaging in geriatric transitional care; (3) voluntarily participating in research. Nurses on sick leave, maternity leave, or otherwise unavailable during the survey period, as well as those who refused to participate, were excluded.\u003c/p\u003e \u003cp\u003eInstrument\u003c/p\u003e \u003cp\u003eThe survey and questionnaires were developed for this study, and the questionnaires is shown in Appendix A. The clinical competence of registered nurses is significantly influenced by individual factors such as age, marital status, education level, and work experience [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Therefore, the demographic section of the questionnaire included relevant items: age, gender, marital status, educational background, and years of experience. Besides, the revised geriatric transitional care inventory contains 7 dimensions and 61 items. Each item was designed with a 5-level Likert scale, and the options were \u0026ldquo;strongly disagree,\u0026rdquo; \u0026ldquo;disagree,\u0026rdquo; \u0026ldquo;uncertainty,\u0026rdquo; \u0026ldquo;agree,\u0026rdquo; and \u0026ldquo;strongly agree.\u0026rdquo;\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS 22.0 software. The validity and reliability of 61 items were evaluated. Validity includes the Content Validity Index (CVI) and Exploratory Factor Analysis (EFA). CVI was tested by Delphi experts\u0026rsquo; scores which included the content validity index of the items (I-CVI) and the Content Validity Index of the Scale (S-CVI). Exploratory Factor Analysis was performed to extract factors, removing those with eigenvalues less than one, and retaining items with factor loadings of 0.3 or higher. The order of the scale's structural dimensions and items was adjusted based on factor loadings.\u003c/p\u003e \u003cp\u003eReliability was tested by Cronbach's α internal consistency coefficient and split-half reliability coefficient. Cronbach's α was calculated for the overall scale and each dimension, with values greater than 0.7 indicating high reliability [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Additionally, split-half reliability was assessed using the Spearman-Brown formula, after randomly dividing all items into two halves (odd and even).\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003e The study accordance with the Helsinki Declaration. All methods were performed in accordance with the relevant guidelines and regulations. The research was approved by the Ethical Committee of Kiage Wu Nursing College of Macao (Reference no: REC-2022.27). With approval from 12 participating healthcare institutions, electronic questionnaires were distributed to eligible nurses. Informed consent was obtained from all participants included in the study and they could withdraw from the study at any time for any reason. Moreover, they were assured that the questionnaires would only be used for research, with assurance that their identities would remain confidential in all reports and publications.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic characteristics of the participants\u003c/p\u003e \u003cp\u003eOf the 340 distributed questionnaires, 20 were excluded due to identical responses and short completion times. The final sample included 320 valid questionnaires, yielding a 94.1% response rate. A majority of participants (68%) were over the age of 30, with 96% identifying as female. Most participants (74%) were unmarried, and 79% held a bachelor's degree or higher. Additionally, 62% had 10 or more years of work experience, while 34.4% had 6 or more years of experience in geriatric transitional care services. The sociodemographic characteristics of the participants are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of the participants (N\u0026thinsp;=\u0026thinsp;320)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage/Rate* (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 years and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-unmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eProfessional position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMid-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducational background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelow Bachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eYears of working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 years and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eYears of participation in geriatric transitional care services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 years and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eReliability of the Geriatric Transitional Care Nurse Competency Inventory\u003c/p\u003e \u003cp\u003eReliability was deemed acceptable, as Cronbach's α exceeded 0.7 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The overall Cronbach's α was 0.991 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a standardized Cronbach's α of 0.992. The inventory was randomly divided into two sections, with the split-half reliability yielding 0.964 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Cronbach\u0026rsquo;s α for the first section (31 items) was 0.982, and for the second section (31 items) it was 0.985. After applying the Spearman-Brown correction, the adjusted Cronbach\u0026rsquo;s α was 0.978.\u003c/p\u003e \u003cp\u003eValidity Analysis of the Geriatric Transitional Care Nurse Competency Inventory\u003c/p\u003e \u003cp\u003eIn the second round, results showed that the I-CVI ranged from 0.83 to 1.00, and the S-CVI was 0.98. To assess structural validity, factor analysis was performed. The Kaiser-Meyer-Olkin (KMO) value was 0.973, and Bartlett's Sphericity test was statistically significant (χ2\u0026thinsp;=\u0026thinsp;26650.219, P\u0026thinsp;=\u0026thinsp;0.000), confirming the suitability of the 61 items for factor analysis. The total variance explained by the extracted factors was 76.90%, with eigenvalues ranging from 1.18 to 40.47 and factor loadings ranging from 0.32 to 0.74. Following group discussions and a review of relevant core competencies [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], five factors were identified and labelled: Nursing Care and Education Guidance, Legal and Ethical Principles, Critical Thinking and Evidence-Based Practice, Leadership and Coordination, and Professional Autonomy. The final inventory for geriatric transitional care nurses in China comprises 61 items across five dimensions: Nursing Care and Education Guidance (18 items), Legal and Ethical Principles (9 items), Critical Thinking and Evidence-Based Practice (9 items), Leadership and Coordination (13 items), and Professional Autonomy (12 items). The revised inventory and factor loadings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe revised inventory and factor loadings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem Category and Item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor Loading\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNursing Care and Education Guidance (18 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to comprehensively assess the health status of the older people in physical, mental, social, and spiritual aspects.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEncourages the older people and their families to participate in the formulation and implementation of care plans.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to provide multicultural nursing services to the older people.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to dynamically observe and record the progress of the older people's condition.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to implement accurate, safe, and effective care according to the care plan.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to accurately analyse data collected directly and indirectly, and formulate nursing plans suitable for the older people based on the data.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to identify the most urgent needs of the older people and incorporate them into the care plan.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to provide holistic and individualized care for the older people.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to accurately assess the activity and self-care abilities of the older people.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to evaluate the effectiveness of nursing measures accurately.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to provide psychological care for the older people, family members, and caregivers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to grasp the relevant knowledge of common geriatric diseases and provide corresponding nursing measures and health education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to accurately assess the living environment and community environment of the older people.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to identify potential health risks and complications in the older people.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to assess the learning needs of the older people, family members, and caregivers for health maintenance and promotion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to provide professional counselling and consultation for the older people, family members, and caregivers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to provide appropriate health education for the older people, family members, and caregivers based on assessment results.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to evaluate the effectiveness of health education activities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLegal and Ethical (9 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to respect the privacy of the older people and maintain the confidentiality and security of medical and nursing data.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespecting the older people's self-choice and decision-making rights in nursing practice.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to report mistakes and accidents that occur while working outside the hospital truthfully.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaking personal responsibility for words and actions when working independently outside the hospital.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtecting the rights of the older people in various aspects during work.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to comply with legal regulations and organizational requirements for conducting transitional nursing practice activities outside the hospital.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecognizing the personal beliefs and cultural customs of the older people, family members, and caregivers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo have enough patience to take care of the older people.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo objectively file complaints and advocate for older people whose rights have been violated.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCritical Thinking and Evidence-Based Practice (9 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapable of judging theories proposed by others based on personal practice experience and acquired knowledge.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWillingness to seek innovative and feasible research projects in the workplace.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssisting and participating in relevant scientific research projects related to geriatric nursing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to correctly apply evidence-based evidence to guide nursing practice and related work.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapable of making evidence-based and accurate judgments in nursing clinical decision-making.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to use various methods to search for relevant research data and references.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to utilize various resources and information to find multiple solutions to problems encountered in work.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEstablishing and managing health information archives for the older people and using them to guide nursing decisions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelecting appropriate new technologies and equipment for the older people to improve nursing services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeadership and Communication Coordination (13 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to create a positive atmosphere of cooperation within the work team.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to demonstrate personal development direction.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to accept and adopt constructive criticism and suggestions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to clarify the role of professional organizations (such as nursing associations, etc.) and actively participate.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to obtain collective consensus before important actions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to recognize strengths and weaknesses in geriatric nursing profession.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to acknowledge the contributions of others and motivate and influence others.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnows how to delegate and refer appropriate geriatric nursing tasks based on colleagues' abilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to handle interpersonal conflicts effectively.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to objectively and correctly evaluate oneself.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProficient in using modern media such as networks for communication and exchange.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas good expression and presentation skills for effective communication.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKeeps promises, dares to take responsibility, and establishes mutual trust with the older people, family members, and caregivers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfessional Autonomy (12 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to analyse and confirm primary crises in emergency situations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to provide end-of-life care for older people.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to effectively handle emergencies outside of the hospital, such as verbal violence, personal safety, and sudden cardiopulmonary arrest.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to use time effectively and schedule nursing work reasonably.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to utilize various resources (such as community, nursing homes, volunteers, etc.) to conduct diverse health promotion activities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePossesses basic rehabilitation knowledge and skills to guide older people, family members, and caregivers in rehabilitation training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to establish the concept of geriatric transitional care and apply it in practical work.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to effectively coordinate relationships between community health service personnel, the older people, family members, and caregivers and obtain their cooperation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to maintain a positive and optimistic attitude in work, use stress reduction methods for self-guidance, and seek help from others when necessary.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to assist and advise other nurses and staff working in geriatric transitional care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to identify their own learning needs in geriatric nursing and continuously learn new knowledge through various channels.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to pay attention to discipline dynamics and professional development trends.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe core competency inventory for geriatric transitional care nurses in China includes 61 items across five dimensions. The five core competencies include: \u003cem\u003eNursing Care and Education Guidance, Legal and Ethical, Critical Thinking and Evidence-Based Practice, Leadership and Communication Coordination, and Professional Autonomy\u003c/em\u003e. This inventory comprehensively covers the core competencies needed for geriatric transitional nurses, fulfilling the objective of providing an effective assessment tool to evaluate the competencies required in geriatric transitional care, in response to the growing population of older adults with a high prevalence of chronic diseases. This core competency inventory for geriatric transitional care nurses addresses a significant research gap by providing a standardized guide for geriatric transitional care nurses in Mainland China. Well-embedded in the Chinese context, it offers practical, concrete suggestions for the competencies and skills that nurses will need to succeed in current and future roles within gerontological nursing education and practice.\u003c/p\u003e \u003cp\u003e We employed a two-phase design, consisting of a two-round Delphi expert consultation followed by a cross-sectional study for EFA. The purpose of the expert consultation was to provide comprehensive and valuable suggestions for exploring the research topic. The content validity reflects the degree of consistency between the objectives and the consultation results, ensuring the standardization and scientific rigour of the Delphi method [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The diversity of expert backgrounds and experiences is crucial for the effectiveness of the Delphi method [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Therefore, we made an effort to select expert members from a wide range of backgrounds, experiences, and categories [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Notably, more revision suggestions were proposed by experts from Hong Kong and Macau, likely due to differences in the development of geriatric transitional care between these regions and Mainland China. Moreover, experts believed that the service settings for geriatric transitional care were not in a medical institution but at home, so referring to the service recipients as \"patients\" was not appropriate. Therefore, the term \"patients\" in the inventory was changed to \"older adults\". Since family caregivers for older adults can be divided into family members and professional caregivers, it is not accurate to use the same term \"family members\". Therefore, based on expert suggestions and the actual work situation, \"family members\" in all items was changed to \"family members and caregivers\". Experts gave careful consideration to the dignity of older adults, emphasizing that valuing their dignity, feelings, and psychological well-being is a key aspect of improving their quality of life [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. After revisions, the findings show that the experts reached a high level of consensus on the factors included in the inventory.\u003c/p\u003e \u003cp\u003eThe 18 items listed under the core competency \u003cem\u003eNursing Care and Education Guidance\u003c/em\u003e primarily focus on the holistic care of older adults in transitional nursing, including comprehensive assessments of their physical, mental, social, and spiritual health. The transitional care model is a patient-centred approach that promotes recovery and prevents disease deterioration [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and it is a comprehensive discharge plan that integrates advanced nursing practices with family follow-ups [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, nurses are expected to be competent in mobilizing patients and families in care planning, providing culturally sensitive nursing services, and continuously monitoring patient progress. Moreover, nurses should assess and address health risks, provide psychological care, offer health education, and continuously evaluate the impact of these interventions, ensuring patient and caregiver education and care continuity. This aligns with the Patient and Caregiver Engagement, Patient Education and Care Continuity component of comprehensive and effective transitional care outlined by Naylor et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Optimizing the engagement of both patients and caregivers through consistent efforts by healthcare professionals and systems to identify key outcomes is essential. The implementation of individualized care plans and ensuring continuous access to care are vital for building trust with patients and caregivers [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Additionally, Naylor et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] emphasize the importance of continuous interactive teaching and learning processes involving both the healthcare team and the patient, as highlighted in this inventory.\u003c/p\u003e \u003cp\u003eThe nine items under the core competency \u003cem\u003eLegal and Ethical\u003c/em\u003e focus on protecting the rights of older adults in transitional nursing practice. Research on the ethical aspects of transitional care is limited, and existing studies suggest there is still room to develop skills for balancing ethical principles [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Our inventory provides specific guidance for the professional training of geriatric transitional care nurses in \u003cem\u003eLegal and Ethical\u003c/em\u003e competence: the core competency includes respecting privacy and confidentiality, honouring the self-choice and decision-making rights of older individuals, and ensuring the accurate reporting of errors and incidents. Nurses are expected to comply with legal regulations and organizational requirements in their practice, particularly when working outside the hospital. They must also recognize and respect the personal beliefs and cultural customs of older adults, their families, and caregivers, while demonstrating patience and care. Additionally, nurses are responsible for advocating for the rights of older adults, including filing complaints when necessary to protect those whose rights have been violated.\u003c/p\u003e \u003cp\u003eThe \u003cem\u003eCritical Thinking and Evidence-Based Practice\u003c/em\u003e competency, comprising 9 items, focuses on developing the ability to critically assess theories and apply evidence-based practices in geriatric transitional nursing. It includes the ability to judge theories based on personal experience and knowledge, seek innovative research projects, and participate in geriatric nursing research. Nurses are expected to apply evidence-based knowledge in clinical decision-making, use various methods to find relevant research data, and find multiple solutions to work-related challenges. Additionally, nurses should establish and manage health information archives to guide nursing decisions and select appropriate technologies to improve nursing services for older adults. Both Evidence-Based Practice and Critical Thinking are a component of one key domain of the International Council of Nurses (ICN) Core Competencies for Registered Nurses [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Critical Thinking has been lauded as a vital prerequisite and a key element essential to evidence-based nursing practice [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] and is an essential mental process for ensuring, efficient and skilful nursing interventions [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Chinese health systems and academic nursing schools have been working to enhance the evidence-based practice and research competence of geriatric transitional nurses by integrating education on evidence-based thinking and research skills into their training. This approach aims to promote continued education, foster a strong research environment, and strengthen critical thinking and evidence-based practice skills [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe \u003cem\u003eLeadership and Communication Coordination\u003c/em\u003e competency, consisting of 13 items, emphasizes the importance of effective leadership and communication in geriatric transitional nursing. Nurses are expected to foster a positive team atmosphere, demonstrate personal development, accept feedback, and clarify the role of professional organizations. They should ensure collective consensus before taking action, recognize strengths and weaknesses in geriatric nursing, motivate others, and acknowledge contributions. Nurses must delegate tasks based on colleagues' abilities, manage conflicts, and evaluate themselves objectively. Proficiency in modern media communication, presentation skills, and maintaining trust with patients and caregivers is also essential. This competency aligns with \u003cem\u003eTeam Accountability\u003c/em\u003e, a component of comprehensive and effective transitional care outlined by Naylor et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], which emphasizes the responsibility of each healthcare professional to contribute expertise and collaborate for patient and caregiver health goals.\u003c/p\u003e \u003cp\u003eThe \u003cem\u003eProfessional Autonomy\u003c/em\u003e competency, consisting of 12 items, emphasizes the ability to make independent decisions and take responsibility in geriatric transitional care. Key areas of focus include assessing and addressing primary crises in emergency situations, providing end-of-life care, and managing external emergencies such as verbal violence and sudden medical events. Nurses must also effectively manage their time, schedule nursing tasks, and utilize resources such as community services and volunteers for health promotion activities. In addition, nurses are expected to have basic rehabilitation knowledge to guide patients and caregivers in rehabilitation training. Establishing and applying the concept of geriatric nursing continuity, coordinating relationships with community health personnel as an independent professional, and maintaining a positive, resilient attitude are critical components. Nurses should also assist and advise colleagues, identify their own learning needs, and stay updated on professional trends and advancements. Professional autonomy is closely linked to job satisfaction, as greater autonomy can enhance nurses' work fulfilment. However, promoting autonomy requires investment beyond the individual and unit levels; organizational and political support is essential to foster autonomy [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, the entire core competency in this inventory aims to introduce improvements in the nursing practice environment for geriatric transitional nurses, managers, researchers, and stakeholders. This approach encourages nurses to fully utilize their training in these core competencies, enhancing their ability to perform at their highest potential.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eTransitional care is still in its early stages of development and implementation in Mainland China, which has limited the scope of the inventory evaluation's cross-sectional survey, resulting in a relatively small sample size. Additionally, future studies will require larger sample sizes and participants from more regions and healthcare centres nationwide to enable confirmatory factor analysis.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e This study developed and validated an inventory for measuring the core competence of geriatric transitional care nurses through a Delphi method. The inventory consists of 61 items and five dimensions: nursing care and education guidance, legal ethics, critical thinking and evidence-based practice, leadership and coordination, and professional autonomy. The inventory comprehensively covers the core competencies that geriatric transitional care nurses should possess. These competencies are well embedded in a Chinese context.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIHC Internet+ Home Care Service\u003c/p\u003e\n\u003cp\u003eEFA Exploratory Fact Analysis\u003c/p\u003e\n\u003cp\u003eIQR Interquartile Range\u003c/p\u003e\n\u003cp\u003eCVI Content Validity Index\u003c/p\u003e\n\u003cp\u003eI-CVI Content Validity Index of the Items\u003c/p\u003e\n\u003cp\u003eS-CVI Content Validity Index of the Scale\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 accordance with the Helsinki Declaration. All methods were performed in accordance with the relevant guidelines and regulations.\u0026nbsp;The research was approved by the Ethical Committee of Kiage Wu Nursing College of Macao (Reference no: REC-2022.27). With approval from the heads of the 12 participating healthcare institutions, electronic questionnaires were distributed to eligible nurses. Informed consent was obtained from all participants included in the study and they could withdraw from the study at any time for any reason. Moreover, they were assured that the questionnaires would only be used\u0026nbsp;for research, with assurance that their identities would remain confidential in all reports and publications.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\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\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The author confirms that all data generated or analyzed during this study are included in this published article. Furthermore, the data supporting the findings of this study are available upon reasonable request from the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eW\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003cstrong\u003eL.X.\u003c/strong\u003e contributed to conceptualization, data curation, formal analysis, investigation, methodology, software development, validation, and writing—original draft preparation, as well as reviewing and editing the manuscript. \u003cstrong\u003eP.L.C.\u003c/strong\u003e contributed to conceptualization, data curation, methodology, software development, validation, and writing—original draft preparation, as well as reviewing and editing the manuscript. \u003cstrong\u003eJ.X.X.\u003c/strong\u003e contributed to conceptualization, methodology, writing—original draft preparation, and reviewing and editing the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our gratitude to all the institutions and participants involved for their support and cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWu L, Huang Z, Pan Z. The spatiality and driving forces of population ageing in China. PLoS ONE. 2021;16(1):e0243559.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Ageing and health. 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BMC Nurs. 2024;23(1):100.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"Professional Competence, Transitional Care, Geriatric Nursing, Nurses, Inventory","lastPublishedDoi":"10.21203/rs.3.rs-6237283/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6237283/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChina is experiencing a growing population of older people with a high prevalence of chronic diseases. While geriatric transitional care is essential for improving their health outcomes, its effectiveness is hindered by a shortage of skilled nurses and a core competency inventory to guide practice. This study aims to develop an inventory of core competencies for geriatric transitional care nurses in China, to provide an effective assessment tool to evaluate the competencies required in geriatric transitional care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study used a two-phase design. In phase one, a core competency inventory was developed from three Chinese theoretical frameworks for nurses and refined through a two-round Delphi consultation with 13 experts from China. In phase two, the reliability and validity of the inventory were evaluated through an Exploratory Factor Analysis in a cross-sectional study involving 320 nurses from 12 hospitals in Guangdong. The inventory\u0026rsquo;s validity was confirmed through the Content Validity Index, while its reliability was assessed using Cronbach\u0026rsquo;s α and split-half reliability.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e The final inventory comprises 61 items across five dimensions: Nursing Care and Education Guidance (18 items), Legal and Ethical Principles (9 items), Critical Thinking and Evidence-Based Practice (9 items), Leadership and Coordination (13 items), and Professional Autonomy (12 items). The five dimensions accounted for 76.90% of the variance, indicating a robust factor structure. The inventory demonstrated excellent internal consistency, with Cronbach\u0026rsquo;s α of 0.991 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a split-half reliability of 0.964 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the Scale Content Validity Index (S-CVI) was 0.98, and the Item Content Validity Index (I-CVI) was 0.8, confirming strong validity.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe inventory shows strong validity and reliability, making it an essential tool for developing competencies in geriatric transitional care nurses in China. It also provides valuable insights for implementing targeted training and assessment measures for nursing staff.\u003c/p\u003e","manuscriptTitle":"Development and Evaluation of a Core Competence Inventory for Geriatric Transitional Care Nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 19:48:31","doi":"10.21203/rs.3.rs-6237283/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-04-30T15:01:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-18T08:20:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-31T07:45:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-30T02:48:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-03-30T02:47:34+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":"258d5aa8-2e0c-41f0-bf84-0b6bb391a86d","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-06T19:48:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-06 19:48:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6237283","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6237283","identity":"rs-6237283","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}