title: Developing a fidelity assessment instrument for nurse home visitors.
abstract: Fidelity monitoring is a core component for successful translation of evidence-based interventions, yet little guidance is available on developing tools to assess intervention fidelity that are valid and feasible for use in community settings. We partnered with nurses in the field to develop a fidelity monitoring instrument that would capture the essential elements of the nursing intervention that is the core of Nurse-Family Partnership, a prenatal and early childhood home visitation program. Using a grounded approach, we employed concept mapping to identify the salient behavioral characteristics associated with the program, and then, adapting Dreyfus' model of skill development, created a tool to assess nurse home visitors (NHVs) according to their stage of growth. In a pilot, the Nursing Practice Assessment (NPA) form was used to assess 188 NHVs. The average time to complete the tool was 1 hour, and skill development stage was concordant with years of NHV experience. According to surveys of supervisors and NHVs, the tool captured the essential elements of the program model. Articulating the essential elements of each skill development stage can provide a foundation for professional development for NHVs. In response to feedback, online training modules were developed prior to large-scale implementation in the field. The grounded methods used to develop the NPA enhanced its internal consistency and implementation feasibility and could be utilized by other public health nursing programs.
authors.affiliation: Colorado School of Public Health, Center for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Nighthorse Campbell Native Health Building, 13055 E. 17th Ave., Aurora, CO, 80045.
authors.forename: Kirsten J
authors.initials: KJ
authors.lastname: Black
authors.affiliation: Jefferson County Public Health, Lakewood, Colorado.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Wenger
authors.affiliation: Nurse-Family Partnership National Service Office, Denver, Colorado.
authors.forename: Molly
authors.initials: M
authors.lastname: O' Fallon
mesh_terms: D026683:Advisory Committees; D002983:Clinical Competence; D005190:Family / Q000523:psychology; D006801:Humans; D008960:Models, Psychological; D009723:Nurse-Patient Relations; D064691:Nurses, Community Health / Q000523:psychology* / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: instrument development; intervention fidelity; nurse home visiting; nurse-family partnership; quality improvement; translational research