Abstract

Objective:

This study aimed to assess the current level of core competence among nurses working in infectious disease settings and to examine the influence of self-efficacy and self-directed learning competence on core competence.

Methods:

A total of 392 nurses specializing in infectious diseases were selected through convenience sampling. Data were collected using four instruments: a General Information Questionnaire, the Core Competence Scale for Infectious Disease Specialist Nurses, the Self-directed Learning Competence Scale for Nurses, and the General Self-efficacy Scale.

Results:

The mean core competence score among participants was 133.72 ± 24.06. The mean score for self-directed learning competence was 134.72 ± 25.35, and the mean score for self-efficacy was 30.17 ± 6.78. Core competence scores were positively correlated with both self-directed learning competence and self-efficacy. Multiple regression analysis identified hospital grade, job position, years of work experience, teaching experience, self-directed learning competence, and self-efficacy as significant factors associated with core competence (p < 0.05).

Conclusion:

Nurses engaged in infectious disease care demonstrated above-average core competence. Self-directed learning competence and self-efficacy were identified as primary influencing factors. Interventions aimed at enhancing these competencies may support nursing managers in strengthening workforce capacity in infectious disease care.

1 Introduction

Nurses specializing in infectious diseases play a critical role in delivering clinical care to patients and supporting efforts in the prevention and control of infectious diseases. In recent years, the field has been shaped by both significant challenges and emerging. The increasing incidence of emerging and re-emerging infectious diseases, such as COVID-19 and other novel pathogens, has placed substantial demands on healthcare systems and frontline nursing staff (1). Advances in medical technology, infection control strategies, and professional training systems have created new opportunities to enhance nursing practice and improve patient outcomes (2).

Core competence encompasses the set of knowledge, skills, and professional qualities required for effective clinical nursing practice (3). The concept of core competence was first introduced in nursing research in the United States and was later adapted by Chinese scholars to evaluate the competence of specialist nurses (4–6). Among infectious disease nurses, the core competence is closely associated with the quality of patient care and holds considerable importance for public health outcomes. Globally, research on nursing core competence has gradually shifted from general clinical competence to more specialized domains, including infection prevention and control, emergency response capacity, and interdisciplinary collaboration (7). Studies conducted in developed healthcare systems have highlighted the importance of continuous professional development in improving clinical performance and patient safety (8). In addition, increasing attention has been paid to psychological and behavioral factors, such as self-efficacy and self-directed learning ability, which are considered key determinants of professional competence and lifelong learning among nurses (9). Increasing evidence suggests that higher levels of self-efficacy are associated with improved clinical decision-making, adaptability, and resilience under high-pressure conditions, while self-directed learning ability plays a critical role in maintaining up-to-date knowledge and skills in rapidly evolving clinical environments (10). In China, several studies have examined the competence level of infectious disease specialist nurses and associated influencing factors (11). However, prior investigations predominantly relied on observer-rated questionnaires, and included a limited number of variables, which constrained the depth of analysis regarding interrelationships among influencing factors. Some investigations have explored associations between core competence, self-efficacy, and self-directed learning competence among clinical nurses (12). However, research specifically focusing on infectious disease nurses remains limited.

Given the unique competence requirements of infectious disease nurses, including expertise in infection prevention and control, and the ability to respond to epidemic outbreaks, the present study aimed to assess core competence levels in this population and to evaluate the impact of self-efficacy and self-directed learning competence. These findings aim to provide a scientific basis for developing targeted strategies to enhance core competence among nurses in infectious disease settings.

2 Participants and methods2.1 Participants

Between September and November 2024, nurses engaged in infectious disease care were selected from 10 general and specialized hospitals in North China, Central China, and South China through a convenience sampling method. Specifically, the project leader distributed the questionnaire to known contacts who were responsible for infectious disease departments in selected hospitals. These contacts then assisted in forwarding the questionnaire to eligible nurses within their departments for voluntary participation. Most of these included hospitals were tertiary (Grade III) general hospitals or specialized hospitals.

Inclusion criteria were: possession of a valid nurse qualification certificate, a minimum of 1 year of experience in infectious disease nursing, and voluntarily participation with provision of informed consent.

Exclusion criteria were: nurses who were on leave (maternity, sick, or personal) during the investigation period; participation in off-site training programs; and status as a trainee or student nurse.

This study included 13 general demographic variables, 5 dimensions from the Infectious Disease Specialist Nurse's Core Competence Scale, 4 dimensions from the Scale of Self-directed Learning Competence for Nurses, and 10 variables from the General Self-efficacy Scale. The sample size was estimated based on the rule of at least 10 participants per variable, with an additional 10% to account for potential invalid responses, resulting in a required sample size of 352 (13). To further ensure adequacy, the target sample size was increased to 387. Ultimately, a total of 392 questionnaires were collected. Ethical approval for this study was granted by the Ethics Committee of Shanxi Bethune Hospital (YXLL-2024-204).

2.2 Instruments2.2.1 General information questionnaire

This investigator-designed questionnaire collected demographic and professional background information, including hospital grade, hospital type, age, marital status, fertility status, educational background, professional title, job position, employment status, years of professional experience, teaching experience, participation in continuing education, and specialist nurse status.

2.2.2 Infectious disease specialist nurse's core competence scale

Developed by Wu et al., this scale consists of 34 items across 5 dimensions (11): professional development competence (11 items), infection prevention and control capacity (9 items), infectious disease nursing capacity (6 items), professional humanistic quality (5 items), and infectious disease epidemic response capacity (3 items). Items are rated on a 5-point Likert scale ranging from 1 (“very inconsistent”) to 5 (“very consistent”), yielding a total score ranging from 34 to 170. Higher scores reflect higher levels of core competence. Psychometric properties on the scale include a Cronbach's α coefficient of 0.806, test-retest reliability of 0.831, and content validity of 0.869.

2.2.3 Scale of self-directed learning competence for nurses

Developed by Xiao, this scale includes 34 items across 4 dimensions: self-motivation belief (14 items), task analysis (6 items), self-monitoring and regulation (10 items), and self-evaluation (4 items) (14). Items are rated on a 5-point Likert scale ranging from 1 (“completely inconsistent”) to 5 (“completely consistent”), with total scores ranging from 34 to 170. Higher scores indicate greater self-directed learning competence. The Cronbach's α coefficient is 0.944.

2.2.4 General self-efficacy scale

Compiled by Schwarzer et al., this scale comprises 10 items, each rated on a 4-point Likert scale from 1 (“completely incorrect”) to 4 (“completely correct”) (15). Total scores range from 10 to 40, with higher scores indicating stronger self-efficacy. The Cronbach's α coefficient is 0.87.

The complete version of the questionnaire is shown in Supplementary Material.

2.3 Data collection methods

Data collection was carried out using the Wenjuanxing platform integrated within WeChat. The study's objective and questionnaire procedures were communicated by the project leader to the department head or the head nurse of the infectious diseases unit. The questionnaire link was distributed to eligible nurses. Standardized instructions were provided within the questionnaire, and participants accessed the link and completed the questionnaire after providing informed consent electronically. Completion time ranged from approximately 15 to 20 min. A total of 399 questionnaires were collected; after excluding 7 containing logical errors, 392 valid responses were retained. The effective response rate was 98.24%.

2.4 Statistical analysis

Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Univariate analyses were conducted using independent-samples t tests or one-way analysis of variance. Pearson's correlation coefficients were calculated to examine associations among variables. Multiple linear regression analysis was conducted to identify factors influencing core competence. A p value < 0.05 indicated statistical significance.

3 Results3.1 Scores of core competence, self-directed learning competence, and self-efficacy among infectious disease nurses

The scores of core competence, self-directed learning competence, and self-efficacy among infectious disease nurses are presented in Table 1. Among the five dimensions of core competence, professional humanistic quality demonstrated the highest score, whereas professional development competence demonstrated the lowest score. Within the four dimensions of self-directed learning competence, self-motivation belief demonstrated the highest score, and self-evaluation demonstrated the lowest score.

ItemTotal scoreMean item scoreTotal score of core competence133.72 ± 24.063.93 ± 0.71Professional development competence37.76 ± 10.573.43 ± 0.96Infection prevention and control capacity38.10 ± 6.794.23 ± 0.75Infectious disease nursing competence23.89 ± 4.603.98 ± 0.77Professional humanistic quality21.72 ± 3.544.34 ± 0.71Infectious disease epidemic response capacity12.24 ± 2.354.08 ± 0.78Total score of self-directed learning competence134.72 ± 25.353.96 ± 0.75Self-motivation belief56.28 ± 10.544.02 ± 0.82Task analysis23.52 ± 4.903.91 ± 0.79Self-monitoring and regulation39.52 ± 7.853.95 ± 0.79Self-evaluation15.41 ± 3.043.85 ± 0.76Total score of general self-efficacy30.17 ± 6.783.02 ± 0.68

Scores of core competence, self-directed learning competence, and general self-efficacy among infectious disease nurses (n = 392, ± s).

3.2 Differences in core competence scores by participant characteristics

Univariate analyses indicated significant differences in core competence scores across hospital grade, age, marital status, fertility status, professional title, job position, employment type, years of clinical experience, teaching experience, further education experience, and specialist nurse qualification (p < 0.05). Detailed results are presented in Table 2.

ItemNumber of nurses [n (%)]Total score (point, ±s)F/tpHospital grade4.5150.004Grade A secondary63 (16.07)124.97 ± 21.01Grade B secondary6 (1.53)129.00 ± 15.30Grade A tertiary321 (81.89)135.34 ± 24.37Grade B tertiary2 (0.51)164.00 ± 8.49Hospital category2.2180.137General hospital228 (58.16)135.25 ± 23.04Specialized hospital164 (41.84)131.59 ± 25.33Age5.0550.00221–30 years125 (31.89)127.82 ± 24.4131–40 years192 (48.98)134.73 ± 24.0141–50 years61 (15.56)141.03 ± 21.61>51 years14 (3.57)140.79 ± 21.29Marital status9.414< 0.001Unmarried101 (25.77)125.52 ± 22.52Married288 (73.43)136.35 ± 23.95Other3 (0.77)157.33 ± 17.01Fertility status4.7120.010None140 (35.71)128.76 ± 24.481169 (43.11)136.53 ± 22.77≥2 children83 (21.17)136.36 ± 24.84Education level2.4350.064Technical secondary school3 (0.77)128.33 ± 16.01Junior college26 (6.63)133.96 ± 23.00Undergraduate353 (90.05)133.18 ± 24.20Master's degree or above10 (2.55)153.70 ± 15.83Professional title5.902< 0.001Nurse71 (18.11)126.54 ± 23.97Nurse practitioner158 (40.31)131.05 ± 24.46Nurse-in-charge141 (35.97)137.78 ± 22.76Associate chief nurse16 (4.08)150.31 ± 17.37Chief nurse6 (1.53)149.50 ± 20.84Job position5.3990.001Clinical nurse359 (91.58)132.29 ± 24.07Nursing teaching position6 (1.53)148.83 ± 19.97Nursing management position23 (5.87)148.09 ± 18.30Nursing scientific research position4 (1.02)157.25 ± 12.69Employment nature9.509< 0.001Contract-based315 (80.36)131.78 ± 24.10Public institution67 (17.09)144.61 ± 21.77Other10 (2.55)121.80 ± 15.53Years of work experience4.966< 0.001 ≤ 2 years57 (14.54)125.81 ± 28.073–5 years79 (20.15)132.43 ± 22.07Hospital grade6–10 years77 (19.64)130.13 ± 24.6411–15 years100 (25.51)135.03 ± 23.49Above 15 years79 (20.15)142.57 ± 20.46Teaching experience23.943< 0.001Yes220 (56.12)138.83 ± 20.45No172 (43.88)127.19 ± 26.68Further education experience10.1100.002Yes118 (30.10)139.54 ± 22.58No274 (69.90)131.22 ± 24.28Specialist nurse certification5.6930.018Yes136 (34.69)137.68 ± 23.90No256 (65.31)131.62 ± 23.93

Core competence scores among infectious disease nurses by demographic and professional characteristics (n = 392).

3.3 Correlation between core competence, self-directed learning competence and self-efficacy

Pearson's correlation analysis indicated that the total core competence scores was positively correlated with both self-directed learning competence and self-efficacy (p < 0.001). These findings are presented in Table 3.

ItemTotal nurses' self-directed learning competence scoreGeneral self-efficacySelf-motivation beliefTask analysisSelf-monitoring and regulationSelf-evaluationTotal core competence score0.795**0.663**0.811**0.736**0.755**0.677**Professional development competence0.635**0.572**0.633**0.610*0.608**0.541**Infection prevention and control capacity0.691**0.555**0.724**0.618**0.653**0.572**Infectious disease nursing competence0.750**0.632**0.757**0.696**0.715**0.663**Professional humanistic quality0.707**0.510**0.748**0.624**0.660**0.594**Infectious disease epidemic response capacity0.751**0.610**0.754**0.703**0.719**0.659**

Correlations among core competence, self-directed learning competence, and general self-efficacy among infectious disease nurses (n = 392).

3.4 Multivariate analysis of factors influencing core competence

A multivariate linear regression analysis was conducted to identify factors associated with core competence. The total core competence score was entered as the dependent variable. Independent variables included those found to be significant in the univariate analysis, along with the total scores of self-directed learning competence and self-efficacy. Variable coding details are presented in Table 4. Regression analysis results indicated that hospital grade, job position, years of work experience, teaching experience, self-directed learning competence, and self-efficacy were significant influencing factors of core competence among infectious disease nurses (p < 0.05), as presented in Table 5.

VariableAssignmentHospital grade1 = Grade A secondary; 2 = Grade B secondary; 3 = Grade A tertiary; 4 = Grade B tertiaryAge group1 = 21–30 years old; 2 = 31–40 years old; 3 = 41–50 years old; 4 = >51 years oldMarital status1 = Unmarried; 2 = Married; 3 = OtherFertility status1 = 0; 2 = 1; 3 = 2; and aboveProfessional title1 = Nurse; 2 = Nurse practitioner; 3 = Nurse-in-charge; 4 = Associate chief nurse; 5 = Chief nurseJob position1 = Clinical nurse; 2 = Nursing teaching position; 3 = Nursing management position (head nurse, deputy head nurse, etc.); 4 = Nursing scientific research positionEmployment nature1 = Contract-based; 2 = Public institution; 3 = OtherYears of work experience1 ≤ 2 years; 2 = 3–5 years; 3 = 6–10 years; 4 = 11–15 years; 5 = >15 yearsTeaching experience1 = Yes; 2 = NoFurther education experience1 = Yes; 2 = NoSpecialist nurse role1 = Yes; 2 = NoSelf-directed learning competenceOriginal value inputGeneral self-efficacyOriginal value input

Coding of independent variables for multivariate linear regression analysis.

VariableBSETPB 95% CICollinearity diagnosticsLower boundUpper boundToleranceVIF(Constant)29.0957.9743.649< 0.00113.41644.775Hospital grade2.3741.0122.3470.0190.3854.3630.7811.281Age group−0.9731.484−0.6560.513−3.8921.9460.3293.037Marital status1.2872.1880.5880.557−3.0165.5900.4552.198Fertility status0.5361.3110.4080.683−2.0433.1140.4692.131Professional title0.0691.1790.0590.953−2.2492.3870.4252.353Job position3.6601.3982.6170.0090.9106.4100.7171.395Employment nature−1.0461.562−0.6700.503−4.1172.0250.8101.235Years of work experience2.4360.8652.8160.0050.7354.1370.3253.077Teaching experience−6.2071.690−3.672< 0.001−9.530−2.8830.6281.592Further education experience0.3221.6720.1930.847−2.9653.6090.7511.331Role of the specialist nurse−3.0341.576−1.9250.055−6.1330.0650.7851.274Self-directed learning competence0.6600.04215.567< 0.0010.5770.7430.3842.607General self-efficacy0.3490.1592.1900.0290.0360.6630.3802.630