title: Measuring nursing competencies in the operating theatre: instrument development and psychometric analysis using Item Response Theory.
abstract: BACKGROUND
  Concern about the process of identifying underlying competencies that contribute to effective nursing performance has been debated with a lack of consensus surrounding an approved measurement instrument for assessing clinical performance. Although a number of methodologies are noted in the development of competency-based assessment measures, these studies are not without criticism.
  
  
  OBJECTIVE
  The primary aim of the study was to develop and validate a Performance Based Scoring Rubric, which included both analytical and holistic scales. The aim included examining the validity and reliability of the rubric, which was designed to measure clinical competencies in the operating theatre.
  
  
  METHODS
  The fieldwork observations of 32 nurse educators and preceptors assessing the performance of 95 instrument nurses in the operating theatre were used in the calibration of the rubric. The Rasch model, a particular model among Item Response Models, was used in the calibration of each item in the rubric in an attempt at improving the measurement properties of the scale. This is done by establishing the 'fit' of the data to the conditions demanded by the Rasch model.
  
  
  RESULTS
  Acceptable reliability estimates, specifically a high Cronbach's alpha reliability coefficient (0.940), as well as empirical support for construct and criterion validity for the rubric were achieved. Calibration of the Performance Based Scoring Rubric using Rasch model revealed that the fit statistics for most items were acceptable.
  
  
  CONCLUSIONS
  The use of the Rasch model offers a number of features in developing and refining healthcare competency-based assessments, improving confidence in measuring clinical performance. The Rasch model was shown to be useful in developing and validating a competency-based assessment for measuring the competence of the instrument nurse in the operating theatre with implications for use in other areas of nursing practice.
authors.affiliation: Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Australia. pfnich@unimelb.edu.au.
authors.forename: Patricia
authors.initials: P
authors.lastname: Nicholson
authors.forename: Patrick
authors.initials: P
authors.lastname: Griffin
authors.forename: Shelley
authors.initials: S
authors.lastname: Gillis
authors.forename: Margaret
authors.initials: M
authors.lastname: Wu
authors.forename: Trisha
authors.initials: T
authors.lastname: Dunning
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement; D006801:Humans; D008962:Models, Theoretical; D009871:Operating Room Nursing / Q000592:standards*; D011594:Psychometrics / Q000379:methods*; D015203:Reproducibility of Results