Construction of an evaluation index system for nurse-led discharge planning competence in patients with chronic heart failure based on the iceberg model

Abstract

To construct an iceberg model-based competency evaluation index system for nurse-led discharge planning in patients with chronic heart failure (CHF), providing a scientific foundation for the cultivation and management of nurses’ discharge planning competencies. A preliminary item pool was established through a literature review. The Delphi method was employed to conduct three rounds of expert consultation with 17 experts. Following the three Delphi rounds, the same 17 experts were invited to complete pairwise comparison questionnaires based on the Saaty 1–9 scale, independently evaluating the relative importance of indicators at each hierarchical level. The research team aggregated all pairwise comparison matrices and computed indicator weights using the Analytic Hierarchy Process (AHP). The effective response rates for all three rounds were 100%. The rates of experts proposing modifications were 64.70%, 29.41%, and 11.76%, respectively. The authority coefficient (Cr) was 0.93. Kendall's W coefficients for the first-, second-, and third-level indicators across the three rounds were 0.430, 0.308, and 0.158; 0.431, 0.321, and 0.292; and 0.365, 0.204, and 0.203, respectively. Moderate coordination was observed for first- and second-level indicators, while third-level indicators showed relatively weaker coordination; all differences were statistically significant (all P  < 0.001). The final system comprised 5 first-level, 16 s-level, and 52 third-level indicators. The competency evaluation index system demonstrates strong scientific rigor, reliability, and practical utility. It provides a reference for the training, evaluation, and instructional design of nurse-led CHF discharge planning competencies, and offers an evidence-based foundation for healthcare institutions to develop relevant training programs and assessment criteria.