[Developing a Clinical Nurse Specialist System in Taiwan: A Mixed-Methods Study]

Population aging and increasing disease complexity have increased the demand for specialized care provided by clinical nurse specialists (CNSs). However, Taiwan still lacks a comprehensive institutional framework, highlighting an urgent need to establish a structured CNS system to enhance the quality of care.

This study was designed to develop a CNS system to strengthen the nursing profession and improve the overall quality of healthcare delivery.

A mixed-methods approach combining a literature review, the modified Delphi technique, focus group interviews, and expert consensus forums was used to develop a locally adapted CNS framework for Taiwan.

The CNS framework was developed through a rigorous and systematic process. Initially, three rounds of expert focus group discussions were conducted to identify core components and inform the development of a structured questionnaire. Subsequently, 30 expert panelists participated in two rounds of Delphi surveys to evaluate and refine the proposed framework. The finalized framework comprised 19 articles organized into six chapters and demonstrated a high level of consensus, with convergence rates of 94.0%-94.3% for feasibility and 93.6%-95.8% for appropriateness. The resulting CNS system structure consists of: general principles (3 articles), appointment (6 articles), core competencies and responsibilities (4 articles), selection (2 articles), continuing education (2 articles), and performance evaluation (2 articles).

The CNS system developed in this study contributes substantively to expanding nursing roles and enhancing care quality in Taiwan. Future implementation should focus on strengthening interprofessional support to improve system feasibility in practice. Also, an appropriately funded and supported CNS certification system should be established. Finally, CNS contents must be incorporated into graduate-level nursing education to ensure the quality of CNS practice.