Instruments for assessing geriatric nursing competence among nursing personnel: protocol for a COSMIN-based systematic review

Abstract

Introduction

Accelerated population ageing has resulted in increasingly diverse and complex care needs among older people, posing a major challenge to healthcare systems worldwide. Nursing personnel represent a core workforce in the delivery of healthcare and nursing services for older people, and their geriatric nursing competence (GNC) is closely associated with the quality of care provided, care outcomes and older people’s quality of life. Therefore, accurate assessment of GNC is essential for nursing education, workforce development and quality improvement. Although several instruments have been developed to assess GNC, no systematic review has yet comprehensively evaluated their measurement properties.

Methods and analysis

This protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. A comprehensive search will be conducted from 1 October 2026 to 1 December 2026 in seven English-language databases and two Chinese-language databases to identify studies reporting the development or evaluation of instruments assessing geriatric nursing competence among nursing personnel. Two reviewers will independently perform study selection, data extraction and methodological quality appraisal. Any disagreements will be resolved through discussion or, if necessary, consultation with a third reviewer. The measurement properties of included instruments will be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

Ethics and dissemination

As this review will include only published or publicly available studies, ethical approval is not required. The findings will be submitted for publication in a peer-reviewed journal and presented at relevant academic conferences.

PROSPERO registration number

CRD420261356885.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This protocol was reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement, and the completed review will be reported following the PRISMA 2020 statement to ensure transparency and reproducibility.

• The methodological quality, measurement property results and certainty of evidence will be systematically evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

• Database restrictions may lead to the omission of relevant studies, representing a potential limitation.

Introduction

Population ageing has become a major structural challenge for health systems worldwide. According to the WHO, the global population aged 60 years or older will surpass 2 billion by 2050.¹ As populations age, older adults increasingly experience multimorbidity, functional decline, cognitive impairment and geriatric syndromes, resulting in care needs that are long term, complex and multidimensional.^2–4 At the same time, persistent shortages and maldistribution of the global nursing workforce continue to constrain the capacity of health systems to respond effectively to the growing demand for older adult care.^{5 6} In this context, the ability to assess geriatric nursing competence in a scientifically robust manner is increasingly important for informing workforce development, service planning and quality improvement.

Geriatric nursing competence (GNC) is a multidimensional and context-specific professional competence.⁷ It includes knowledge, skills and attitudes, as well as the ability to integrate and apply them in complex care situations.⁸ Although care for older people is inherently interprofessional, the nursing-sensitive components of GNC are reflected mainly in ongoing assessment, direct care, risk identification, functional maintenance, care coordination and continuity of care.⁹ The competencies required also vary across care settings. In hospitals, greater emphasis is placed on recognising clinical deterioration, preventing hospital-associated functional decline and treatment-related risks and supporting safe discharge and care transitions.¹⁰ Community care focuses on assessing intrinsic capacity, promoting health, managing chronic conditions, supporting self-management and coordinating health and social care services.¹¹ Nursing homes and other long-term care settings place greater emphasis on sustained person-centred care, dementia and palliative care, collaboration with family caregivers and the maintenance of daily functioning.^{12 13} Accordingly, this review will not be restricted to hospital settings and will also include community, nursing home and other long-term care contexts.

The populations considered in this review include nursing students, nurses and nursing assistants. Together, these groups represent the continuum of GNC from professional education and clinical practice to the delivery of long-term care. The competence of nursing students reflects the foundational geriatric nursing knowledge and educational preparedness expected before graduation or entry into clinical practice.¹⁴ Nurses are required to integrate geriatric knowledge, clinical skills and professional judgement within specific care contexts.⁷ Nursing assistants undertake daily care, observe changes in residents’ conditions and provide supportive care in nursing homes and other long-term care settings.¹⁵ Including these populations will allow the review to examine available instruments and evidence gaps across different stages of nursing education and practice.

Accurate assessment of GNC is important for identifying competence gaps, designing educational interventions and supporting improvements in care quality. Several assessment instruments have been developed for this purpose. Bing-Jonsson et al developed the Nursing Older People–Competence Evaluation Tool, which was designed primarily to assess professional competence in community-based care for older people.¹⁶ Purfarzad et al developed and validated the Farsi version of the Gerontological Nursing Competence Questionnaire for hospital nurses in Iran.¹⁷ Catalão et al developed the Geriatric Gerontology Competency Scale for newly registered nurses.¹⁸ However, evidence on the measurement properties of these instruments has not been systematically synthesised. Studies also differ in their methodological quality and the certainty of the available evidence. This uncertainty makes it difficult for researchers, nursing educators and clinical managers to select instruments suited to particular populations and care settings.

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) provides a widely used methodological framework for systematic reviews of measurement instruments.¹⁹ Although COSMIN was originally developed for patient-reported outcome measures (PROMs), adapted guidance has extended its application to other types of outcome measurement instruments.²⁰ It therefore provides a standardised approach for evaluating study quality, rating measurement properties and grading the certainty of evidence for the competence assessment instruments included in this review. COSMIN is primarily intended to compare and rate the measurement properties of different instruments. This differs from the Standards for Educational and Psychological Testing and Messick’s framework, which focus on developing validity arguments for the interpretation and use of scores generated by a particular instrument.^{21 22} Accordingly, this study will apply the COSMIN methodology to systematically evaluate the psychometric properties of existing instruments for assessing GNC among nursing personnel. Specifically, the objectives of this systematic review are to: (1) systematically identify all instruments used to assess GNC among nursing personnel; (2) critically evaluate the psychometric properties of existing instruments by assessing both the methodological quality of studies on measurement properties and the measurement properties themselves; (3) provide recommendations regarding the appropriate contexts of use and future application of these instruments and (4) identify current research gaps in the field of GNC assessment tools for nursing personnel.

Methods

Study design

This systematic review will be conducted in accordance with the COSMIN methodology for systematic reviews of PROMs.²⁰ This protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement (see online supplemental file 1), and the completed systematic review will be reported in accordance with the PRISMA 2020 statement.^{23 24} The study is scheduled to commence in October 2026 and is expected to be completed by December 2026. This protocol has been prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO).

Inclusion and exclusion criteria

The eligibility criteria were developed around four elements specified in the COSMIN guidance, namely the target construct, target population, instrument type and measurement properties.²⁰

1. Population. Eligible studies must include nursing personnel, defined as nurses, nursing students or nursing assistants. Studies involving several groups of healthcare professionals will be included only when nursing personnel account for at least 50% of the sample or when data for nursing personnel can be extracted separately.

2. Target construct. The instrument must be explicitly intended to assess geriatric nursing competence. Instruments that assess only a single construct, such as knowledge, attitudes, self-efficacy, satisfaction or training experience, will not be eligible. However, an instrument may be included when one of these constructs forms a dimension of a multidimensional measure of geriatric nursing competence.

3. Instrument type. Eligible studies must examine a standardised instrument for assessing geriatric nursing competence. Self-report instruments, observer-reported instruments and performance-based assessment instruments will be considered.

4. Measurement properties. The study must report at least one measurement property defined by COSMIN. These may include content validity, structural validity, internal consistency, reliability, measurement error, cross-cultural validity or measurement invariance, hypothesis testing for construct validity, criterion validity or responsiveness.

Studies meeting any of the following criteria will be excluded: (1) non-original publications, such as narrative reviews, systematic reviews, scoping reviews, editorials, commentaries, opinion articles, book chapters, conference abstracts and study protocols; (2) studies that use an instrument solely as an outcome measure without developing the instrument or evaluating any of its measurement properties; (3) unavailability of the full text and (4) duplicate publication.

Search strategy

A systematic search will be conducted in seven English-language databases (PubMed, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO and Scopus) and two Chinese databases China National Knowledge Infrastructure (CNKI) and Wanfang). Both English and Chinese databases will be included because studies on the development and validation of relevant assessment instruments have been conducted across multiple countries and linguistic contexts.^16–18 Restricting the search to English-language databases alone may lead to the omission of Chinese-language studies and locally developed instruments, thereby compromising the comprehensiveness of the evidence base. The search period will cover from database inception to 1 October 2026.

The search strategy will be developed in accordance with the COSMIN guidelines, incorporating four key components: construct, target population, instrument type and measurement properties.²⁰ The initial search strategy will be developed by the research team in collaboration with an experienced medical information specialist, using a combination of controlled vocabulary and free-text terms. Relevant search terms will be identified based on existing systematic reviews. In addition, the COSMIN search filter for measurement properties will be applied, and the search strategy will be adapted to the indexing systems of each database.²⁵ Furthermore, reference list screening and citation tracking of included studies will be conducted to identify additional relevant studies. The detailed search strategy for PubMed and CNKI are provided in online supplemental material 2.

Study selection

All retrieved records will first be imported into EndNote to identify and remove duplicate references. Two reviewers will then independently perform title and abstract screening, followed by full-text review. Inter-rater agreement between the two reviewers will be assessed using Cohen’s kappa coefficient, with κ values interpreted as follows: <0.20, poor agreement; 0.21–0.40, fair agreement; 0.41–0.60, moderate agreement; 0.61–0.80, substantial agreement and >0.80, almost perfect agreement.²⁶ Any disagreements will be resolved through discussion, and if necessary, by consultation with a third reviewer. Reasons for full-text exclusion will be documented. The study selection process will be presented using a PRISMA flow diagram (figure 1).

Figure 1. Flow diagram of the study selection process. This figure presents the process of literature identification, screening, eligibility assessment and inclusion for the systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Data extraction

A standardised data extraction form will be developed and pilot-tested. Two reviewers will independently extract the following data: (1) Instrument characteristics, including author, year of publication, instrument name, country, theoretical framework, target population, mode of administration, recall period, number and structure of scales or items, response format, scoring method and range and original language and available translations; (2) Sample characteristics, including sample size, mean age, participant characteristics and study setting; (3) Psychometric properties, including content validity, structural validity, internal consistency, reliability, criterion validity, hypothesis testing for construct validity and responsiveness; (4) Interpretability and feasibility, including clarity of scoring, availability of normative data and time or resources required for administration. Missing data will be recorded as ‘–’.

Quality appraisal and evidence synthesis

Methodological quality assessment

The methodological quality of the included studies will be assessed using the COSMIN Risk of Bias checklist V.3.²⁰ The ‘worst score counts’ principle will be applied, whereby the lowest rating of any item within a measurement property determines the overall methodological quality rating for that property.²⁰ The following measurement properties will be evaluated: content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypothesis testing for construct validity and responsiveness.²⁷

Each item will be rated on a four-point scale: ‘very good’ (V), ‘adequate’ (A), ‘doubtful’ (D) and ‘inadequate’ (I). This review will primarily follow the COSMIN methodology for systematic reviews of PROMs. If other types of measurement instruments are ultimately included, the evaluation procedures will be adapted as appropriate in accordance with the general COSMIN principles and the specific characteristics of the instruments.²⁰

Evaluation of measurement properties

Two reviewers will independently evaluate the results of measurement properties for each included instrument, with cross-checking of all ratings. Disagreements will be resolved through discussion or, if necessary, by consultation with a third reviewer.

The results of each measurement property will be rated using the COSMIN criteria for good measurement properties V.2.0. The rating for each measurement property will be classified as ‘sufficient’ (+), ‘insufficient’ (−) or ‘indeterminate’ (?).²⁰

After rating individual studies, results for the same measurement property of the same instrument across different studies will be synthesised and their consistency will be examined. If the findings are consistent, the overall rating will be summarised as ‘sufficient’ (+), ‘insufficient’ (−) or ‘indeterminate’ (?). If, after synthesising the evidence, inconsistencies between studies cannot be explained, the overall rating will be classified as ‘inconsistent’ (±).²⁸

Evidence on the relevance, comprehensiveness and comprehensibility of instrument content will be considered where available. Information on construct definition, item generation, involvement of the target population and pilot testing during instrument development will also be included when evaluating the quality of instrument development and the evidence for content validity.²⁰

Grading the quality of evidence

The quality of evidence for each measurement property of each instrument will be graded using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE), as recommended by COSMIN.^{19 20} The assessment will consider risk of bias, inconsistency, imprecision and indirectness. The quality of evidence will initially be rated as ‘high’ and may be downgraded based on these factors, resulting in four levels: ‘high’, ‘moderate’, ‘low’ or ‘very low’.^{19 20} For certain measurement properties, such as structural validity and cross-cultural validity, imprecision will not be considered a reason for downgrading, as sample size requirements are already incorporated into the COSMIN Risk of Bias checklist.²⁰ However, for content validity, imprecision will be considered in conjunction with sample size and the adequacy of evidence.²⁰

After the results for each measurement property have been synthesised and the certainty of evidence has been graded, recommendations will be formulated separately for each instrument and each specific version. An instrument will be recommended for use when all relevant measurement properties are supported by high-certainty evidence of sufficient results. It will be recommended against use when at least one relevant measurement property is supported by high-certainty evidence of insufficient results. In all other cases, no recommendation will be made.²⁰ When several instruments are recommended, their methodological quality, feasibility and interpretability will also be considered to identify the most appropriate option. Feasibility considerations will include administration time, cost and the availability of a suitable language version. Interpretability will include the availability of information such as the minimal important change. If all instruments are recommended against use, suggestions may be made for improving the most promising instrument. If no recommendation can be made because the evidence is insufficient for all available instruments, the instrument most likely to receive a future recommendation may be identified together with priorities for further research. Such an instrument should have at least low-certainty evidence supporting sufficient content validity.^{19 20}

Discussion

This systematic review will identify and evaluate existing instruments for assessing GNC among nursing personnel. Following the COSMIN methodology, it will assess the methodological quality of studies on measurement properties, synthesise the evidence for each measurement property and grade the certainty of the evidence. The review will also summarise key instrument characteristics, including intended settings, interpretability and feasibility.

Recommendations will be developed by considering the overall ratings of the relevant measurement properties together with the corresponding certainty of evidence. When several instruments are supported by sufficient evidence, their target populations, intended settings, interpretability and feasibility will also inform instrument selection. This review will provide an overview of the current evidence on instruments for assessing GNC. It may support instrument selection in research, education and clinical practice and help identify areas requiring further validation or refinement.

Ethics and dissemination

As this study is a systematic review of published literature, ethical approval is not required. The findings will be disseminated through publication in a peer-reviewed journal and presented at both domestic and international academic conferences on geriatric nursing. For queries related to research ethics or integrity, the Clinical Medical Ethics Committee of Xiangya Hospital, Central South University may be contacted at: bioethics720@126.com.