Integrated measure for training transfer in nursing practice: Development and validation study

The persistent knowledge-practice gap in nursing, where competencies gained through continuing professional development fail to integrate into practice, remains a significant challenge. Effective transfer of acquired knowledge and skills to the workplace is essential for bridging this gap. However, there is a lack of comprehensive, validated instruments to assess factors influencing training transfer in nursing practice.

This study aims to develop a questionnaire capable of assessing training transfer as an integrated construct, encompassing all factors influencing this process in nursing practice.

The study followed a developmental, iterative approach guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN).

Eight tertiary teaching hospitals in the Netherlands.

Educational experts (n = 8) and nurses (n = 1588).

The questionnaire development consisted of three phases: Phase 1) content development, in which instruments were identified based on a literature study and translation of included instruments into Dutch, Phase 2) pilot phase: content validation and usability testing using Delphi studies with experts and nurses, Phase 3) psychometric validation: construct validation using exploratory and confirmatory factor analysis, composite reliability and discriminant validity. The phases were completed from January 2023 till June 2024.

The literature review led to the inclusion of two key instruments: the Learning Transfer System Inventory (LTSI) and the Learning Climate Questionnaire (LCQ). Following item reduction based on Delphi rounds, nurses completed the adapted instruments. Psychometric validation demonstrated a good fit for these instruments in nursing practice. The adapted LTSI showed loadings ranging from 0.37 to 0.99, with a Normed Χ2 of 1.996, TLI of 0.908, CFI of 0.920, and RMSEA of 0.050 [CI = 0.047-0.054]. The adapted LCQ exhibited loadings from 0.64 to 0.94, with a Normed Χ2 of 3.385, TLI of 0.963, CFI of 0.974, and RMSEA of 0.069 [CI = 0.061-0.078]. The combined model demonstrated a Normed Χ2 of 2.014, TLI of 0.900, CFI of 0.907, and RMSEA of 0.051 [CI = 0.048-0.054].

The adapted LTSI and LCQ, both separately and combined, are reliable and valid instruments for use in the Dutch nursing hospital context. Together, they provide a comprehensive assessment of factors influencing training transfer. They can also be used independently to examine specific components such as trainers (LCQ), context (LTSI), personal aspects (LTSI), or training (LTSI/LCQ). Furthermore, these instruments can facilitate discussions between nurses, managers, and educational experts to address barriers to training transfer in nursing practice.