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Development and Clinical Validation of an Entrustable Professional Activities Framework for Respiratory Nurses: A
Yufei He1, Kouying Liu2, Jiaxuan Li1
1School of Nursing, Nanjing Medical University, Nanjing 211166, China.
Healthcare (Basel, Switzerland)
|August 13, 2026
Summary
This study developed and validated a respiratory nursing Entrustable Professional Activities (EPA) framework. The EPA-based workplace-based assessment (WBA) system effectively captures learning trajectories and ensures reliable competency evaluation for nurses.
Area of Science:
- Nursing Education
- Competency-Based Assessment
- Workplace-Based Assessment (WBA)
Background:
- Limited evidence exists for nursing workplace-based assessment (WBA) systems utilizing Entrustable Professional Activities (EPAs) to track learning trajectories and ensure reliable programmatic decisions.
- Existing WBA systems need enhancement to capture developmental progression and provide defensible reliability in nursing education.
Purpose of the Study:
- To develop a respiratory nursing EPA framework.
- To clinically validate core EPAs using longitudinal WBA data, assessing performance progression, attainment patterns, and reliability via generalizability (G) and decision (D) studies.
Main Methods:
- EPA framework development through evidence synthesis and a two-round Delphi consultation with experts.
- Longitudinal clinical validation of four core EPAs with 30 respiratory nurses assessed by five raters over 12 weeks using a 1-5 entrustment scale.
- Reliability analysis using G-study (person × rater × occasion) and D-studies to determine optimal assessment configurations.
Main Results:
- A 13-item respiratory nursing EPA framework was established with high expert consensus (Cr = 0.841, 0.843; Kendall's W = 0.504, 0.532).
- Longitudinal WBA data (1392 assessments) showed heterogeneous learning speeds (β0 = 0.038-0.156) and attainment from 72.5% to 89.1%.
- Acceptable reliability (G = 0.792; EP² = 0.712) was achieved under feasible sampling (5 raters, ~4 ratings/week), with minimal configurations identified for EP² ≥ 0.70 (1 rater × 11 ratings/week) and EP² ≥ 0.80 (2 raters × 12 ratings/week).
Conclusions:
- The respiratory nursing EPA framework is supported by expert consensus and clinical validation.
- EPA-based WBA demonstrates developmental sensitivity and acceptable dependability for respiratory nursing training.
- This approach supports structured competency assessment and monitoring of progression in respiratory nursing education.
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