Development and Preliminary Application of an Entrustable Professional Activities-Based Evaluation Indicator System for Rehabilitation Nursing among Undergraduate Nursing Interns
This study successfully developed and preliminarily validated a seven-domain, 46-item Entrustable Professional Activities (EPA) evaluation indicator system for undergraduate nursing interns in rehabilitation, demonstrating strong expert consensus and clinical feasibility to inform future rehabilitation nursing education.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
As the world's population ages, the need for rehabilitation care grows steadily, yet the training of nurses who specialize in this field often lags behind. In modern medical education, there is a shift away from simply testing whether a student knows facts in a classroom. Instead, educators are increasingly focused on whether a student can actually perform specific, real-world tasks safely and effectively. This approach relies on the concept of "entrustable professional activities." Rather than asking a student to prove they are generally "competent," teachers observe them performing concrete duties, such as assessing a patient's ability to move or managing a complex medical order. The goal is to determine exactly how much supervision a student needs before they can be trusted to work independently. For undergraduate nursing students rotating through rehabilitation departments, defining these specific, observable tasks is crucial, but until now, there has been no standardized way to measure their progress in this specialized area.
A team of researchers from Shandong Provincial QianFoShan Hospital and Shandong First Medical University set out to build this missing measurement tool. They recognized that while general nursing skills are well-documented, the unique demands of rehabilitation nursing—such as helping patients regain movement or managing long-term recovery—require a tailored evaluation system. The team began by gathering a group of experienced nurses and therapists to brainstorm what a student should actually be able to do. They reviewed existing textbooks and medical literature, then held focused discussions with clinical instructors to identify the specific behaviors that matter most in a rehabilitation setting. This initial brainstorming produced a long list of potential tasks, which the team then refined using a quality checklist to ensure each task was clear, observable, and essential to the profession.
To finalize their list, the researchers turned to a group of eighteen experts, all senior nursing professionals with years of experience in rehabilitation. These experts participated in two rounds of careful review, rating the importance of each proposed task and suggesting changes. The team found that the experts agreed strongly on what mattered. They decided to keep some tasks, merge others that were too similar, and add new ones that had been overlooked, such as specific assessments for mental health and the ability to refer patients to community rehabilitation services. After this rigorous process, the team settled on a final system containing seven main categories of work, broken down into twenty specific areas of responsibility, and further detailed into forty-six distinct, observable actions. These categories cover everything from the initial health assessment and daily nursing care to handling medical orders, preventing infections, responding to emergencies, and educating patients and their families.
The researchers then tested this new system in a real-world setting. They selected fifty-seven undergraduate nursing students who were currently completing their internships in a rehabilitation department at a major hospital. Clinical instructors, acting as supervisors, used the new evaluation form to rate the students on each of the twenty specific tasks. The instructors assigned scores based on how much supervision the student needed, ranging from needing constant observation to being able to work independently. The results showed that the system worked well in practice. The students received an average total score of 83.07 out of a possible higher range, indicating that they were generally meeting the expected standards. The system revealed specific strengths and weaknesses: students performed exceptionally well in preventing cross-infections, a critical safety skill, but struggled more with identifying when a patient's condition was deteriorating or recognizing alarms on medical equipment. These lower scores in high-risk areas highlighted where future training needs to be more focused.
Beyond the scores, the students themselves were asked about their experience with this new way of being evaluated. They reported that they found the system very important and felt it had a positive effect on their learning. The clarity of the tasks helped them understand exactly what was expected of them, moving beyond vague ideas of "doing well" to concrete goals like "correctly assessing a patient's motor function" or "accurately documenting care." The researchers concluded that this new evaluation system is a practical and reliable tool. It successfully translates the abstract idea of nursing competence into a clear set of real-world activities that can be observed and measured. While the study was limited to one hospital and a relatively small group of students, the results suggest that this approach could serve as a valuable guide for teaching and assessing the next generation of rehabilitation nurses, ensuring they are truly ready to care for patients as they transition from the classroom to the bedside.
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