Assessing Structural Competency in Professional Nursing: Enhancing Learning Through Observable Behaviors

As nursing education transitions toward competency-based models, the ability to assess structural competency remains underdeveloped. Observable indicators are needed to guide instruction and evaluation. This study aimed to identify observable behaviors and associated levels of mastery that demonstrate structural competency in professional nursing.

Using a two-round Delphi design, experts rated and refined proposed behaviors and mastery levels. Round 1 focused on observable behaviors; Round 2 addressed clarity, relevance, and level appropriateness of associated mastery statements.

Five domains and 15 observable behaviors were identified, each with three levels of mastery. Identified domains included: (1) recognition of structural factors; (2) patient advocacy and policy engagement; (3) cultural humility and reflexivity; (4) collaboration for social justice; and (5) effective communication. Ratings and qualitative feedback established expert consensus.

These results provide educators with a set of practical competencies to measure prelicensure student knowledge, skills, and attributes, thereby advancing health equity education.