Development and Validation of an Entrustable Professional Activity-Based Assessment Scale for Nurse Practitioners in Taiwan

Competency-based education is essential for training nurse practitioners (NPs). Although entrustable professional activities (EPAs) have been widely used to assess competency in health professionals, a valid EPA-based assessment scale is required to assess the clinical competencies of NPs in acute care settings. The aim of this study was to develop and examine the reliability and validity of an EPA-based assessment scale for NPs. A psychometric study with a cross-sectional survey was used in this study. The participants included NP instructors as evaluators and novice NPs currently in clinical practice as test takers. Convenience sampling was used to recruit participants from among members of the Taiwan Association of Nurse Practitioners. First, five EPA focus groups were used to develop five EPAs using a template and following the suggested steps. Second, a consensus validation was conducted using the Delphi study. Third, content validity was performed through a national study involving 218 novice NPs as test takers and 57 certified clinical NP educators serving as observers to test the EPAs. The Cronbach's alpha and intraclass correlation coefficient were calculated to examine EPA-based assessment scale reliability, and exploratory factor analysis, concurrent validity, and discriminant validity were applied to assess the validity of the EPAs. Finally, the EPA-based assessment scale of NP care for patients with fever was used in data analysis. The final version of the EPA-based assessment scale included a 22-item observable checklist scale designed to evaluate the clinically independent performance (1-5) of nine key NP competencies. The Cronbach's alpha coefficient for the overall scale was .95. The results revealed that the EPA-based assessment scale addressed two key factors of direct patient-centered care and communication/time management. Factor loadings for each item ranged from .58 to .83, accounting for 70.83% of the total variance in the EPA-based assessment scale. Concurrent validity indicated a high correlation between the developed EPA-based assessment scale and the Ottawa Clinic Assessment Tool (r = .96, p < .001). The results of the discriminant validity analysis indicated a statistically significant difference between novice and expert NPs (F = 7.84, p < .001). The novel EPA-based assessment scale developed in this study demonstrated satisfactory reliability and validity, thereby supporting its application in evaluating the clinical competencies of NPs.