Academic journal article Journal of Nursing Measurement

Psychometric Properties of the Clinical Decision-Making Self-Confidence Scale

Academic journal article Journal of Nursing Measurement

Psychometric Properties of the Clinical Decision-Making Self-Confidence Scale

Article excerpt

Background and Purpose: Nurses' self-confidence in handling acute patient deterioration events may influence decision-making capabilities and implementation of lifesaving interventions during such events. The study purpose is to provide further psychometric testing of the Clinical Decision-Making Self-Confidence Scale (CDMSCS). Methods: The psychometric properties and factor structure of the CDMSCS was examined. Results: A two-factor solution was discovered for the CDMSCS. Construct validity was further supported by statistically significant differences between registered nurses and nursing students' self-confidence level in handling deterioration events. Cronbach's alpha coefficients were acceptable for the subscales and instrument. Conclusion: The CDMSCS is a valid and reliable instrument. Future studies should focus on establishing test-retest reliability and to determine factor loadings of subscale items to retain or delete cross-loading items.

Keywords: acute patient deterioration; factor analysis; nurses; self-confidence; psychometric testing

Acute patient deterioration events occur within hospital settings, especially within medical-surgical nursing units (Cohn et al., 2004; Peters & Boyde, 2007). Patients with multiple, complex health diagnoses are the most vulnerable to experience these types of events, including respiratory distress, chest pain, and altered mental status (Bright, Walker, & Bion, 2004). Researchers have found that early warning signs precede acute patient deterioration events 8-12 hr prior to the event (Buist, Bernard, Nguyen, Moore, & Anderson, 2004; Fuhrmann, Lippert, Perner, & Ostergard, 2008; Hillman et al., 2001; Kause, Smith, Pyrtherch, Parr, Flabouris, & Killman, 2004). Interestingly, health care professionals do not consistently identify early warning signs in a timely manner resulting in failure to rescue situations (Hillman et al., 2005; Thompson et al., 2008).

Because most acute patient deterioration events occur within medical-surgical nursing units, medical-surgical nurses are often the first health care professionals to recognize and respond to acute patient deterioration events (Gombotz, Weh, Mitterndorfer, & Rehak, 2006). Medicalsurgical nurses work within a dynamic and often chaotic environment that requires quick information processing and clinical reasoning skills to identify potential patient problems. Nurses' self-confidence in handling acute patient deterioration events may influence decisionmaking capabilities and implementation of lifesaving interventions during such events.

Researchers have conducted numerous studies measuring health care professionals' (Barnsley et al., 2004; Boots, Egerton, McKeering, & Winter, 2009; Dayal et al., 2009; Liaw, Scherpbier, Rethans, & Klainin-Yobas, 2012; Plant, van Schaik, Sliwka, Boscardin, & O'Sullivan, 2011; Sergeev et al., 2012; Turner, Likkassen, Bakker, Draaisma, & ten Cate, 2009) and non-health care professionals' (Bray, Balaquer, & Duda, 2004; Chemers, Hu, & Gracia, 2001;Woodman & Hardy, 2003) self-confidence/self-efficacy levels in performing skills/tasks. In health care professionals, researchers have demonstrated that higher self-confidence levels are associated with better skill performance and clinical decision-making (Boots et al., 2009; Dayal et al., 2009; Plant et al., 2011; Sergeev et al., 2012; Turner et al., 2009), although the literature also reflects contradictions to these findings (Barnsley et al., 2004; Liaw et al., 2012).

In studies of non-health care professionals, researchers have demonstrated that more confident athletes perform significantly better in competitive sporting events than less confident athletes (Bray et al., 2004; Woodman & Hardy, 2003). A link has been found between students' higher self-confidence and students' academic success including better classroom performance, lower stress, better health, and overall satisfaction and commitment to remain in school (Chemers et al. …

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