1 Department of Nursing Management, Faculty of Nursing and Midwifery, Tehran Medical Science Islamic Azad University, Tehran, Iran

2 Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran, Department of Management, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran


BACKGROUND: Facilitating the healing process of patients with psychiatric disorders depends on
high‑quality mental health care and expert psychiatric nurses. A valid tool is required to objectively
evaluate the quality of performance and competency of psychiatric nurses. This systematic review
aimed to investigate and critique the psychometric properties of some psychiatric nursing clinical
competency assessment instruments with Consensus‑based standards for the selection of health
status measurement instruments (COSMIN) checklist and according to Preferred Reporting Items
for Systematic Reviews and Meta‑analyses (PRISMA).
MATERIALS AND METHODS: To retrieve published articles using Persian and English keywords
“psychiatric nursing,” “competence,” “competency,” “tool,” “checklist,” “scale,” “questionnaire,”
“psychiatric mental health nurse,” were searched in databases without time limitation. Then,
psychometric properties of selected instruments were evaluated using the COSMIN checklist and
reported according to the PRISMA statement.
RESULTS: Most of these tools did not entirely and desirably report psychometric properties. It is not
designed as a special tool for postgraduate psychiatric nursing.
CONCLUSION: The methodology of existing instruments does not meet the COSMIN checklist criteria;
therefore it needs to develop. To assess the competency of psychiatric nursing postgraduate, a tool
tailored to the cultural and social context and with acceptable psychometric properties is necessary.


1. McKnight SE. Mental health learning needs assessment:
Competency‑based instrument for best practice. Issues Ment
Health Nurs 2013;34:459‑71.
2. Govaerts MJ, Schuwirth LW, Pin A, Clement ME,
van der Vleuten CP. Objective assessment is needed to ensure
competence. Br J Midwifery 2001;9:156‑60.
3. Sheikhbahaeddinzadeh E, Ashktorab T. Clinical competence of
psychiatric nurse: A concept analysis in Rodgers ‘evolutionary
method. Iran J Psychiatr Nurs 2020;8:86‑103.
4. Robbins L, Hoke M. Using objective structured clinical
examinations to meet clinical competence evaluation challenges
with distance education students. Perspect Psychiatr Care
5. Naegle MA, Krainovich‑Miller B. Shaping the advanced practice
psychiatric‑mental health nursing role: A futuristic model. Issues
Ment Health Nurs 2001;22:461‑82
6. Adams S. Psychiatric mental health nursing: “A seat at the table.”
J Am Psychiatr Nurs Assoc 2015;21:34‑7.
7. Fukada M. Nursing competency: Definition, structure and
development. Yonago Acta Med 2018;61:1‑7.
8. Alaee Karahroudy F, Sheikhbahaeddinzadeh E. A comparison of
the psychiatric nursing masters curriculum in Iran and Canada.
Strides Dev Med Educ 2020;17:1‑6.
9. Vahedanian‑Azimi A, Rahimi A. Concept of spirituality:
A conventional content analysis. Qual Res J 2012;2:11‑9.
10. Adib Hajbaghery M, Eshraghi Arani N. Assessing nurses’ clinical
competence from Their own viewpoint and the viewpoint of head
nurses: A descriptive study. Iran J Nurs 2018;31:52‑64.
11. Negarandeh R, Pedram Razi S, KM. Effect of clinically competent
nurses services on safety and patients’ satisfaction in an
emergency department. HAYAT 2013;19:53‑64.
12. Ebadi A, Tabanejad Z, Pazokian M. Clinical competence
among MSc students of critical care nursing. Iran J Med Educ
13. Stockmann C, Diaz DA, Murphy D, Dever K, Marchini M, Huffman‑frazee J, et al. Development of a mental health
Objective Structured Clinical Examination (OSCE): A pilot
study. Simulation & Gaming ,2019;50:448-60. https://doi.
14. Mitchell ML, Henderson A, Groves M, Dalton M, Nulty D. The
Objective Structured Clinical Examination (OSCE): Optimizing
its value in the undergraduate nursing curriculum. Nurse Educ
Today 2009;29:398‑404.
15. WatsonR, Stimpson A, Topping A, Porock D. Clinical competence
assessment in nursing: A systematic review of the literature. J Adv
Nurs 2002;39:421‑31.
16. Shirinabadi Farahani A, Rassouli M, Yaghmaei F, Alavi Majd H.
Index for selecting an appropriate instrument to conduct research
in health sciences: Introducing the COSMIN checklist. JHPM
17. Andresen E. Criteria for assessing the tools of disability outcomes
research. Arch Phys Med Rehabil 2000;81 Suppl 2:S15‑20.
18. Bombardier C, Tugwell P. Methodological considerations in
functional assessment. J Rheumatol Suppl 1987;14 Suppl 15:6‑10.
19. Yazdani N, Sharif F, Elahi N, Ebadi A, Hosseini S. Psychometric
properties of quality of life assessment tools in morbid obesity:
A review of literature. Evid Based Care J 2017;7:7‑21.
20. Asar S, Jalalpour S, Ayoubi F, Rahmani M, Rezaeian M.
PRISMA; Preferred reporting items for systematic reviews and
meta‑analyses. J Rafsanjan Univ Med Sci 2016;15:63‑80.
21. RezaeianM. How to report studies relevant to diagnostic accuracy.
J Rafsanjan Univ Med Sci 2013;12:679‑80.
22. Rezaeian M. A review on the review studies within the health
domain. Res J Heal Syst 2014;9:1149‑57.
23. Lang T. Just who are we and what are we doing, anyway? Needed
research in medical writing. AMWA J 2009;24:106‑12.
24. Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J,
Patrick DL, et al. Protocol of the COSMIN study: COnsensus‑based
Standards for the selection of health Measurement INstruments.
BMC Med Res Methodol 2006;6:2.
25. Mokkinka LB, Terweea CB, Patrickb DL, Alonsoc J, Stratforde PW,
Knola, DL et al. The COSMIN study reached international
consensus on taxonomy, terminology, and definitions of
measurement properties for health-related patient-reported
outcomes. J Clin Epidemiol [Internet]. 2010;63(7):737–45.
26. Bondy KN, Jenkins K, Seymour L, Lancaster R, Ishee J. The
development and testing of a competency‑focused psychiatric
nursing clinical evaluation instrument. Arch Psychiatr Nurs
27. Mohtashami J, Salsali M, Pazargadi M, Manoochehri H,
Alavi Majd H. Developing and psychometric properties check list
of clinical competency in mental health nursing students. IJPN
28. Moskoei S, Mohtashami J, Ghalenoeei M, Nasiri M, Tafreshi MZ.
Development and psychometric properties rating scale of “clinical
competency evaluation in mental health nurses”: Exploratory
factor analysis. Electron Physician 2017;9:4155‑61.
29. Chen SC, Lee SK, Rong JR, Wu CC, Liu WI. The development
and psychometric testing on psychiatric nurses of a nurse case
management competence scale in Taiwan. J Nurs Res 2018;26:72‑9.
30. Feng D, Li H, Meng L, Zhong G. Development of a questionnaire
to assess nursing competencies for the care of people with
psychiatric disabilities in a hospital environment. Psychiatr Q
31. Mokkink LB, Boers M, van der Vleuten CP, Bouter LM, Alonso J,
Patrick DL, et al. COSMIN Risk of Bias tool to assess the quality
of studies on reliability or measurement error of outcome
measurement instruments: A Delphi study. BMC Med Res
Methodol 2020;20:293;
32. Mokkinka LB, Terweea CB, Patrickb DL, Alonsoc J, Stratforde PW,
Knola DL, et al. The COSMIN study reached international
consensus on taxonomy, terminology, and definitions of
measurement properties for health‑related patient‑reported
outcomes. J Clin Epidemiol 2010;63:737‑45.
33. M o k k i n k L B , P r i n s e n C A , P a t r i c k D L , A l o n s o J ,
Bouter LM, de Vet HC, et al. COSMIN Study Design checklist for
Patient-reported outcome measurement instruments. Amsterdam,
The Netherlands. 2019. J Nurs Meas 2021;29:1‑22.
34. Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J,
Patrick DL, et al. The COSMIN checklist for evaluating
the methodological quality of studies on measurement
properties: A clarification of its content. BMC Med Res Methodol
2010;18(10):28; 1‑8. [doi: 10.1186/1471‑2288‑10‑22].
35. Mokkink LB, Prinsen CA, Patrick DL, Alonso J, Bouter LM,
de Vet HC, Terwee CB. COSMIN Study Design Checklist
for Patient‑Reported Outcome Measurement Instruments.
Amsterdam, The Netherlands; 2019:1‑36
36. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL,
Dekker J, et al. Quality criteria were proposed for measurement
properties of health status questionnaires. J Clin Epidemiol
37. Cordier R, Chen YW, Speyer R, Totino R, Doma K, Leicht A, et al.
Child‑report measures of occupational performance: A systematic
review. PLoS One 2016;11:e0147751.
38. Kardong‑Edgren S, Adamson K, Fitzgerald C. A review of
currently published evaluation instruments for human patient
simulation. Clinical Simulation in Nursing. 2010;6 (1):e25‑35
39. Colton D, Covert R. Designing and Constructing Instruments for
Social Research and Evaluation. 1st ed. San Francisco: John Wiley
& Sons JB; 2007.
40. Prinsen CA, Mokkink LB, Bouter LM, Alonso J, Patrick DL,
de Vet HC, et al. COSMIN guideline for systematic reviews of
patient‑reported outcome measures. Qual Life Res 2018;27:1147‑57.
41. Polit DF, Yang F. Measurement and the Measurement of Change:
A Primer for the Health Professions. Philadelphia: Wolters
Kluwer; 2016. p. 147.
42. Kirwan B. A Guide to Practical Human Reliability Assessment.
London: CRC Press. 2017
43. Mokkink LB, de Vet HC, Prinsen CA, Patrick DL, Alonso J,
Bouter LM, et al. COSMIN risk of bias checklist for systematic
reviews of patient‑reported outcome measures. Qual Life Res
44. Taghizadeh Z, Ebadi A, Montazeri A, Shahvari Z, Tavousi M,
Bagherzadeh R. Psychometric properties of health related
measures. Part 1: Translation, development, and content and face
validity. J Iran Inst Health Sci Res 2017;16:343‑57.
45. Wallace J, Rao R, Haslam R. Simulated patients and objective
structured clinical examinations: Review of their use in medical
education., Adv Psychiatr Treat [Internet]. 2012;8:342–8.
46. Terwee CB, Prinsen CA, Chiarotto A, Westerman MJ, Patrick DL,
Alonso J, et al. COSMIN methodology for evaluating the content
validity of patient‑reported outcome measures: A Delphi study.
Qual Life Res 2018;27:1159‑70
47. Liu NY, Hsu WY, Hung CA, Wu PL, Pai HC. The effect of gender
role orientation on student nurses’ caring behaviour and critical
thinking. Int J Nurs Stud 2019;89:18‑23.