Development and Evaluation of the "Advanced Heart Failure Clinical Competence Survey": a Tool to Assess Knowledge of Heart Failure Care and Self-assessed Competence

Objective: We developed a tool to identify self-assessment of skills for advanced HF assessment and management and knowledge of HF care.

Methods: A framework for nursing competency in HF care was developed and its face validity confirmed through expert review. An initial instrument was pilot tested and revised. The survey tool was validated via administration to nurses expert in HF care and nurses novice in HF care. Descriptive statistics were used to identify sample characteristics; t-tests and Chi-square analysis were used to compare the novice and expert groups. An Analysis of Variance (ANOVA) was performed to test whether expert scores differed from novice scores.

Results: Thirty-six HF "expert" nurses and 85 hospice "novice" nurses completed the survey. The survey took 19.6 min on average (mean) with a mode of 15 min to complete. Self assessment of competence resulted in generally lower ratings by novice nurses (mean=69.6; S.D.=10.5) than by expert nurses (mean=81.9; S.D.=6.7), t (119)=6.47, p<0.001. HF nurse experts scored themselves less comfortable than did the hospice nurses in the three questions that dealt with coping, bereavement, and communication about dying and prognosis. The mean knowledge scores for experts (30.3; S.D.=2.5) were significantly higher than for novices (22.1; S.D.=4.0), t (119)=11.47, p<0.001. The standardized alpha coefficient of the survey was 0.78 for the questions about knowledge, indicating acceptable reliability of the survey as a tool to discriminate knowledge. Many novice nurses over-estimated their competence in HF assessment and prognostication compared to their performance on the knowledge portion of the survey.

Conclusion: The Advanced Heart Failure Clinical Competence Survey adequately distinguishes between novice nurses' self-assessment of skills and their demonstrated knowledge of HF assessment and management and those of HF nurse experts.

Practice Implications: The Advanced Heart Failure Clinical Competence Survey can identify hospice nurses' confidence and knowledge or the need for education to enable patient and family education and counseling regarding self-care, medications, distressing symptoms and approaching the end of life.