Clinical decision making: validation of the nursing anxiety and self-confidence with clinical decision making scale (NASC-CDM ©) into Spanish and comparative cross-sectional study in nursing students

Daniel Medel; Tania Cemeli; Krista White; Williams Contreras-Higuera; Maria Jimenez Herrera; Alba Torné-Ruiz; Aïda Bonet; Judith Roca

doi:10.1186/s12912-024-01917-w

Clinical decision making: validation of the nursing anxiety and self-confidence with clinical decision making scale (NASC-CDM ©) into Spanish and comparative cross-sectional study in nursing students

BMC Nurs. 2024 Apr 24;23(1):265. doi: 10.1186/s12912-024-01917-w.

Authors

Daniel Medel¹, Tania Cemeli², Krista White³, Williams Contreras-Higuera⁴, Maria Jimenez Herrera⁵, Alba Torné-Ruiz^{1

6}, Aïda Bonet^{1

7}, Judith Roca^{1

7}

Affiliations

¹ Department of Nursing and Physiotherapy, University of Lleida, 2 Montserrat Roig, St., 25198, Lleida, Spain.
² Department of Nursing and Physiotherapy, University of Lleida, 2 Montserrat Roig, St., 25198, Lleida, Spain. tania.cemeli@udl.cat.
³ School of Nursing, Georgetown University, Washington, DC, USA.
⁴ Open University of Catalonia (UOC), Barcelona, Spain.
⁵ Department of Nursing, University Rovira Virgili, Tarragona, Spain.
⁶ Xarxa Assistencial Universitària de Manresa, Hospital Fundació Althaia, Manresa, Spain.
⁷ Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), Lleida, Spain.

Abstract

Background: Decision making is a pivotal component of nursing education worldwide. This study aimed to accomplish objectives: (1) Cross-cultural adaptation and psychometric validation of the Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale from English to Spanish; (2) Comparison of nursing student groups by academic years; and (3) Analysis of the impact of work experience on decision making.

Methods: Cross-sectional comparative study. A convenience sample comprising 301 nursing students was included. Cultural adaptation and validation involved a rigorous process encompassing translation, back-translation, expert consultation, pilot testing, and psychometric evaluation of reliability and statistical validity. The NASC-CDM© scale consists of two subscales: self-confidence and anxiety, and 3 dimensions: D1 (Using resources to gather information and listening fully), D2 (Using information to see the big picture), and D3 (Knowing and acting). To assess variations in self-confidence and anxiety among students, the study employed the following tests: Analysis of Variance tests, homogeneity of variance, and Levene's correction with Tukey's post hoc analysis.

Results: Validation showed high internal consistency reliability for both scales: Cronbach's α = 0.920 and Guttman's λ2 = 0.923 (M = 111.32, SD = 17.07) for self-confidence, and α = 0.940 and λ2 = 0.942 (M = 80.44, SD = 21.67) for anxiety; and comparative fit index (CFI) of: 0.981 for self-confidence and 0.997 for anxiety. The results revealed a significant and gradual increase in students' self-confidence (p =.049) as they progressed through the courses, particularly in D2 and D3. Conversely, anxiety was high in the 1st year (M = 81.71, SD = 18.90) and increased in the 3rd year (M = 86.32, SD = 26.38), and significantly decreased only in D3. Work experience positively influenced self-confidence in D2 and D3 but had no effect on anxiety.

Conclusion: The Spanish version (NASC-CDM-S©) was confirmed as a valid, sensitive, and reliable instrument, maintaining structural equivalence with the original English version. While the students' self-confidence increased throughout their training, their levels of anxiety varied. Nevertheless, these findings underscored shortcomings in assessing and identifying patient problems.

Keywords: Anxiety; Clinical decision-making; Nursing students; Reliability; Self confidence; Validity.