Construction of a pre-service training program for nursing assistants in China

Nursing assistants (NAs) are a key occupational group that provide daily living care and nursing support across medical and integrated healthcare settings. NAs have been introduced to alleviate nursing shortages and better meet patients' care needs. In many countries, mandatory pre-employment training programs are tailored to the NAs' role. However, China lacks a standardized pre-service training program, leading to fragmented content and variable training quality. In response to national policy priorities, this study aims to develop a standardized pre-service training program for NAs in China.

A modified Delphi method and the Analytic Hierarchy Process (AHP) were used to establish a competency-based pre-service training program, guided by the Competency Iceberg Model, from June to October 2022. An expert panel (n = 12) from nine tertiary hospitals across eight provinces participated in two rounds of Delphi consultations to reach consensus on program content. Expert agreement was evaluated using consensus levels and Kendall's W coefficient.

The final training program comprises a three-level framework with three first-level indicators, 25 s-level indicators, and 100 third-level indicators, encompassing both practical care competencies and latent professional competencies. Expert consensus was achieved across all hierarchical indicators. Kendall's W values for the second- and third-level indicators were 0.222 and 0.179, respectively, both of which were statistically significant (p < 0.001). The AHP results assigned the highest priority to skills (0.50), followed by professionalism (0.25) and knowledge (0.25). Within these domains, practical care skills, including mobility care, sputum management, and latent competencies, including emotional management and communication, received the highest priority weightings. These weightings can provide an evidence-informed rationale for prioritising training content, allocating instructional time, and further guiding practical implementation.

This study established a structured, competency-based pre-service training program for NAs by integrating expert consensus with quantitative prioritization. The program provides a holistic framework and evidence-informed basis for developing NAs training and standardizing pre-service training in Chinese healthcare settings. Future research should examine its feasibility, effectiveness, and implementation across diverse clinical contexts.