Construction and Evaluation of a Nutrition Nurse Specialist Training Center Impact Statement

Background: To construct and evaluate the new Clinical Nutrition Nurse Practice Training Center in Guangdong Province. Methods: Seventy-four specialized nutrition nurses were trained from 2019-2020. Their core abilities and performance of duties were evaluated using the Clinical Nutrition Spe-cialty Nurses Core Competence Self-evaluation Scale. This study adhered to the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines. This study was approved by the Ethics Committee of “The Third Affiliated Hospital of Sun Yat-sen University”. Results: The nurses obtained higher results one year after graduation compared with before training. Except for the areas of writing and participation, all training dimension differences were statistically significant (p < 0.05) for working nutritional nurses. Conclusions: The results indicate that the training provided in the Clinical Nutrition Nurse Practice Training Center is effective in improving the quality of specialist nursing as a whole.


Methods
The

Design of Training Methods and Tools for Nutrition Specialist Nurses
Each rotating department develops a 1 -2 week "Clinical Nutrition Specialty Nurses' Homogeneous Teaching Path Table" according to the students' scheduled practical time. It is divided into a teacher and a student version. It utilizes a phased approach to teaching, so that students can gain clear and specific knowledge from their experiences. Goals, skills, and assessment items are employed to foster practical learning, and students are urged to complete the learning tasks on time with the goal-oriented nature of their training in mind. Specialized technical ability assessment: The clinical nurse trainer will select a test of one operational skill from the specialized technical skills specified in Table 1 for evaluation, which will be completed in the first practice stage. Acceptance assessment: complete case care ≥ 5 cases, one of them must be selected for PPT report, 1 nutrition nursing rounds, 1 patient education activity organized, 1 scientific research project designed, and specialty operation assessment completed.
Clinical practice: basic and practice of parenteral nutrition.
Clinical probation: parenteral nutrition solution configuration (venous configuration center).
Teaching activities: operation demonstration (intravenous infusion configuration, PICC maintenance technology, infusion pump operation technology), small nutrition lectures (common nutrition support approaches and methods), teaching rounds (nutrition support and nursing care of cancer patients).
Week 2, Weeks 3 -4 Clinical practice: basic and practice of enteral nutrition.
Teaching activities: operation demonstration (nasal feeding method, enteral nutrition pump infusion nursing operation, nasogastric/intestinal tube implantation technology and nursing, digestive juice reinfusion operation process), teaching rounds (nutrition support and nursing for patients with gastrointestinal diseases).
The second stage (rotating departments:) Week 3, Weeks 5 -6 Clinical practice: nutritional support and nursing for common diseases.
Teaching activities: operation demonstration (use of body composition analyzer, indirect energy measurement, grip strength measurement, nutrition configuration and recipe preparation), case discussion, patient education activities.
Assessment: nutrition case/review report, patient education.
Week 4, Weeks 7 -8 Clinical practice: nutritional support and specialty nursing practice and research.
Clinical probation: oral cleanliness assessment, food preparation plus feeding, homogenized meal configuration (rehabilitation department).
Teaching activities: nutritional nursing follow-up/home nutritional rehabilitation guidance (gastrointestinal surgery).
Assessment: report on the opening of special subject technology and scientific research.
Note. Adjust the teaching content and duration appropriately according to the practice plan, trainee training time, and manual content. "※" is the mastery content, Δ is the familiar content, and the trainee content is the understanding content.

Statistical Methods
Statistical analysis was performed using SPSS version 20.0. Descriptive measurement data were reported as mean ± standard deviation, comparison between groups was examined and evaluated with t-tests, and data counts were expressed as frequencies and percentages. Additional comparisons between groups were made using the chi-square test, Fisher's exact test, and analysis of variance (ANOVA). Differences were considered statistically significant at p < 0.05.

Results
Our

Training of Nurses Specialized in Clinical Nutrition in the Center
Seventy-four clinical nutrition specialist nurses with an average age of (33.35 points, evaluated on a one hundred-point system. The students reported high satisfaction program at the center (see Table 3).

The Core Competency Status of Trained Clinical Nutrition Nurses
The "Clinical Nutrition Specialty Nurses' Core Competence Self-evaluation  competence, leadership and management competence, professional development competence, the dimensional scores and mean values were significantly higher than those before the training. The difference was statistically significant (t = −13.959, −14.089, −9.994, −11.092, −9.850, p < 0.01). The occupational humanistic traits dimensional scores and mean values were higher before and after the training, but the difference was not statistically significant (t = −0.805, p = 0.422), as shown in Table 4. In the single-item ranking, the items with the lowest scores before and after the training were the scientific research ability evaluation items, with scores of (2.52 ± 0.551, 3.68 ± 0.653) points, but the difference between them was sufficiently large and achieved statistical significance (p < 0.001, t = −8.981).

The Job Performance of Trained Clinical Nutrition Nurses after Graduation
Our self-designed "Clinical Nutrition Specialty Nurses' Duty Performance Survey Form after Graduation" was used to investigate the professional work progress of trainees pre-and one year post-training. The trainees were carrying out clinical nutrition nursing, management, teaching, and scientific research work. The most categories of training program ratings increased. Except for the writing or participating in the editing of written work, where there were no significant differences, the ratings' differences for all other items were statistically significant (p < 0.05) The results are shown in Table 5.

Analysis of Practical Training and Core Competence of Clinical Nutrition Specialist Nurses
With the rapid development and progress of nutritional preparation, infusion methods, and nutritional care, clinical demand for nutrition specialist nurses is increasing [8]. The results in Table 3 show that nutrition specialist training for nurses successfully helps cultivate trainees regardless of where the training takes place. The 74 trainees had excellent practice scores (>90 points) and relatively satisfactory job satisfaction. The results in Table 4 show that there was no statistical difference in the scores of the professional humanistic traits before and after training (t = −0.805, p = 0.422), but the scores after training (4.52 ± 1.181) were higher than the scores before training (4.44 ± 1.145). Moreover, the trainees reported good professional quality, healthy professional personality, three correct  outlooks, positive and optimistic, good self-adjustment ability and basic humanistic care ability, and the ability to quickly adapt to different working environments. The humanistic traits of nutritional support have improved. After training, the scores of nutritional nursing professional ability, guidance and collaboration ability, leadership and management ability, and professional development ability were significantly improved compared to pre-training (t = −13.959, −14.089, −9.994, −11.092, −9.850, p < 0.01). This indicates that specialist training can effectively help nurses improve many of their core abilities. With a solid base of professional knowledge and operational skills gained in specialist training, nurses can improve their interdisciplinary communication, team-building abilities, and continuous development.
In the single item score ranking, the item with the lowest score was the scientific research ability evaluation item. The score for this item was significantly higher after the training, which is similar to the situation among oncology nurses [9] and organ transplant nurses [10].
Analysis of the Job Performance of the Nutrition Specialist Nurses One Year after the Completion of the Training According to the survey results pertaining to trainee progress after graduation, the trainees' clinical nutrition nursing work, nutrition nursing management work, nutrition nursing teaching work, and nutrition nursing scientific research work have increased at a statistically significant level in most areas excluding writing or editing an academic or scientific thesis. These results indicate achievement of qualifying levels of skill and knowledge at graduation and continual improvement of trainees' competence as they work in professional specialist nursing positions. After graduation, all trainees can use their professional expertise in their original units, and, share their skills and nutrition nursing-related knowledge, broadening the practice scope of nutrition specialist nurses; in fact, 73.0% of the trainees had already done so in the hospital or department where they were employed. In the nutrition risk screening and intervention work, 25.7%, 71.6%, and 37.4% of the trainees had conducted nutrition nursing clinics, nursing consultations, and follow-up work, respectively, consistent with the reports of Jing et al. [11]. As the current training model focuses on the organization and management ability of specialist nurses and the cultivation of nursing research ability, 47.3% of the trainees can now participate in the formulation and revision of nutrition-related nursing systems, guidelines, procedures, and norms after graduation; furthermore, 46% have conducted specialist nursing research projects.
The application and writing of relevant professional and scientific papers have become an important support for the hospital's nutrition and nursing work. Additionally, specialized nurses have begun to pay attention to community nutrition, taken the initiative to manage or participate in programs designed to promote community nutrition and health work, and further the development of community nutrition care. This demonstrates that specialist nurses play an important role in providing professional nursing services and improving the quali- The training of specialist nurses in China is mainly conducted by hospitals alone or jointly by colleges and universities, where hospitals are used as practical skills training centers [13]. Clinical practice is critical in the training of clinical nutrition specialist nurses, and the quality of practical training is directly related to the success or failure of nurse nutrition training [14]. The hospital's clinical nutrition specialist nurse practice training center is high-quality in terms of equipment, technology, manpower, academic level, teachers' qualifications, and training programs.
Seventy-four qualified nurses have been trained as nutrition specialists inside and outside the province. Based on the current status of specialized nurse education in the province, the base has developed a thorough training program with the goal of cultivating core competency in the post, covering clinical nutritional nursing evaluation, decision-making, intervention, evaluation, management, teaching, research, and other practical content. Boldly innovated the training model of nutrition specialist nurses in Guangdong Province, combined internship and internship, rotated multiple departments, adopted the clinical path method to carry out practical training, designed the teacher version and the student version path table, set the mastery, familiarity and understanding goals, and expanded the recognition Know the scope and focus on key skills to make teaching and learning more active, targeted, standardized and purposeful [15].
Nursing research capabilities of specialist nurses are still insufficient and lack of confidence in nursing research [16]. In addition to theoretical courses, the training program also includes clinical practice. However, two months of practical training alone cannot achieve the goal of building core scientific research capabilities [17]. Therefore, after the students graduate, they must continue to take part in practical training. The qualification certificate of specialist nurses, to a certain extent, urges trainees to earnestly perform all of the duties of nutrition specialist nurses. The training program first establishes a core competency evaluation system for nutrition specialist nurses in China, and then conducts a multi-faceted and comprehensive evaluation of nutrition specialist nurses' specialized nursing, professional quality, guidance and collaboration, leadership and management, and self-development to promote further learning.

Limitations
The base has a systematic training system, but the teaching quality monitoring mechanism still needs to be improved. Only by monitoring and evaluating the teaching quality of the base, and continuously discovering the weaknesses and  [18]. In addition, the quality of base teachers plays a key role in the training of specialist nurses [19]. In addition to excellent specialist nursing skills, teachers also need systematic teaching ability training and advanced teaching methods. However, domestic specialist nurses. The construction of the faculty and the evaluation standards for teachers are few, so it is necessary to further establish and improve the qualification certification system of base teachers.

Conclusion
Clinical nutrition specialist nurse training should be based on a strong organizational management structure, a complete training system, and a homogeneous training program. Moreover, the training should consist of innovative training models and tools that meet the actual needs of the trainees so they can develop multi-faceted abilities.