Development and Psychometric Testing of the Clinical Reasoning Scale Among Nursing Students Enrolled in Three Types of Programs in Taiwan

10.1097/jnr.0000000000000547

Hui-Man HUANG；Chu-Yu HUANG；Kuan-Chia LIN；Chia-Hui YU；Su-Fen CHENG

clinical reasoning ； nursing students ； confirmatory factor analysis

The Journal of Nursing Research

31卷2期（2023 / 04 / 01）

1 - 9

英文

Background: There is no instrument currently available to assess the essential nursing competency of clinical reasoning (CR). Purpose: The purpose of this study was to develop and test the psychometric properties of CR assessment instrument appropriate for use with nursing students across different types of programs. Methods: H. M. Huang et al.'s (2018) Framework of Competencies of Clinical Reasoning for Nursing Students was used to guide this study. Two rounds of Delphi study and confirmatory factor analysis (CFA) were conducted to test content and construct validity. Internal consistency was tested for reliability. Results: The four-domain, 16-item Likert-scale Clinical Reasoning Scale (CRS) was developed. One thousand five hundred four nursing students currently enrolled in three different types of nursing programs completed the CRS. The content validity index was .85-1.0, the CFA indicated goodness of fit, and the Cronbach's α score range was .78-89. Conclusion: The CRS is a valid and reliable tool for assessing CR in nursing students in different types of nursing program.

1. Kao, C. C.,Chao, H. L.,Liu, Y. H.,Pan, I. J.,Yang, L. H.,Chen, W. I.(2022).Psychometric testing of the newly developed competence scale for clinical nurses.The Journal of Nursing Research,30(2),e198.
   連結：
2. Kim, S. M.,Kim, J. H.,Kwak, J. M.(2022).Psychometric properties of the Korean version of the Nursing Profession Self-Efficacy Scale.The Journal of Nursing Research,30(2),e197.
   連結：
3. Adamson, K.(2016).Rater bias in simulation performance assessment: Examining the effect of participant race/ethnicity.Nursing Education Perspectives,37(2),78-82.
4. Adamson, K. A.,Gubrud, P.,Sideras, S.,Lasater, K.(2012).Assessing the reliability, validity, and use of the Lasater clinical judgment rubric: Three approaches.Journal of Nursing Education,51(2),66-73.
5. Alfaro-LeFevre, R.(2019).Critical thinking, clinical reasoning, and clinical judgment: A practical approach.Elsevier.
6. Al-Moteri, M.,Plummer, V.,Cooper, S.,Symmons, M.(2019).Clinical deterioration of ward patients in the presence of antecedents: A systematic review and narrative synthesis.Australian Critical Care,32,411-420.
7. American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf
8. Aubart, F. C.,Papo, T.,Hertig, A.,Renaud, M. C.,Steichen, O.,Amoura, Z.,Braun, M.,Palombi, O.,Duguet, A.,Roux, D.(2021).Are script concordance tests suitable for the assessment of undergraduate students? A multicenter comparative study.Revue de Medecine Interne,42(4),243-250.
9. Brown, T. A.(2015).Confirmatory factor analysis for applied research.Guilford Press.
10. Burns, N.,Grove, S.,Sutherland, S.(2020).The practice of nursing research: Appraisal, synthesis, and generation of evidence.Elsevier.
11. Grave, S.,Cipher, D.(2017).Statistic for nursing research: A workbook for evidence-based pratice.Elsevier.
12. Griffits, S.,Hines, S.,Moloney, C.,Ralph, N.(2017).Characteristics and processes of clinical reasoning in nurses and factors related to its use: A scoping review protocol.JBI Database of Systematic Reviews and Implementation Reports,15(12),2832-2836.
13. Hong, S.,Lee, J.,Jang, Y.,Lee, Y.(2021).A cross-sectional study: What contributes to nursing students' clinical reasoning competence?.International Journal of Environmental Research and Public Health,18(13),6833.
14. Huang, F. M.(2009).Theory and application of structural equation modeling.Wunan.
15. Huang, H. M.,Huang, C. Y.,Lee-Hsieh, J.,Cheng, S. F.(2018).Establishing the competences of clinical reasoning for nursing students in Taiwan: From the nurse educators' perspectives.Nurse Education Today,66,110-116.
16. Hunter, S.,Arthur, C.(2016).Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions.Nurse Education in Practice,18,73-79.
17. Jang, A.,Song, M.,Kim, S.(2021).Development and effects of leukemia nursing simulation based on clinical reasoning.International Journal of Environmental Research and Public Health,18(8),4190.
18. Jarvelainen, M.,Cooper, S.,Jones, J.(2018).Nursing students' educational experience in regional Australia: Reflections on acute events. A qualitative review of clinical incidents.Nurse Education in Practice,12(31),188-193.
19. Kavanagh, J. M.,Szweda, C.(2017).A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses' clinical reasoning.Nursing Education Perspectives,38(2),57-62.
20. Killam, L. A.,Luhanga, F.,Bakker, D.(2011).Characteristics of unsafe undergraduate nursing students in clinical practice: An integrative literature review.Journal of Nursing Education,50(8),434-446.
21. Klenke-Borgmann, L.,Cantrell, M. A.,Mariani, B.(2020).Nurse educators' guide to clinical judgment: A review of conceptualization, measurement, and development.Nursing Education Perspectives,41(4),215-221.
22. Kline, R. B.(2015).Principles and practice of structural equation modeling.Guilford Press.
23. Lasater, K.(2007).Clinical judgment development: Using simulation to create an assessment rubric.Journal of Nursing Education,46(11),496-503.
24. Levett-Jones, T.,Hoffman, K.,Dempsey, J.,Jeong, S. Y.,Noble, D.,Norton, C. A.,Roche, J.,Hickey, N.(2010).The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students' ability to identify and manage clinically ‘at risk’ patients.Nurse Education Today,30(6),515-520.
25. Liou, S. R.,Liu, H. C.,Tsai, H. M.,Tsai, Y. H.,Lin, Y. C.,Chang, C. H.,Cheng, C. Y.(2016).The development and psychometric testing of a theory-based instrument to evaluate nurses' perception of clinical reasoning competence.Journal of Advanced Nursing,72(3),707-717.
26. Manetti, W.(2018).Sound clinical judgment in nursing: A concept analysis.Nursing Forum,54(1),102-110.
27. Mariani, B.(2021).The COVID-19 pandemic and the launch of a new era of education research.Nursing Education Perspectives,42(2),68.
28. Menezes, S. S.,Corrêa, C. G.,Silva Rde, C. G.,Cruz Dde, A.(2015).Clinical reasoning in undergraduate nursing education: A scoping review.Revista da Escola de Enfermagem da USP,49(6),1037-1044.
29. Mohammadi-Shahboulaghi, F.,Khankeh, H.,HosseinZadeh, T.(2021).Clinical reasoning in nursing students: A concept analysis.Nursing Forum,56(4),1008-1014.
30. National Council State Boards of Nursing. (2019). Clinical judgment measurement model. https://www.ncsbn.org/14798.htm
31. National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner core competencies content. https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf
32. Nayer, M.,Glover Takahashi, S.,Hrynchak, P.(2018).Twelve tips for developing key-feature questions (KFQ) for effective assessment of clinical reasoning.Medical Teacher,40(11),1116-1122.
33. Nunnally, J. C.(1967).Psychometric theory.McGraw-Hill.
34. Polit, D. F.,Beck, C. T.(2017).Nursing research generating and assessing evidence for practice.Lippincott Williams & Wilkins.
35. Román-Cereto, M.,García-Mayor, S.,Kaknani-Uttumchandani, S.,García-Gámez, M.,León-Campos, A.,Fernández-Ordóñez, E.,Ruiz-García, M. L.,Martí-García, C.,López-Leiva, I.,Lasater, K., Morales-Asencio, J. M.(2018).Cultural adaptation and validation of the Lasater clinical judgment rubric in nursing students in Spain.Nurse Educator Today,64,71-78.
36. Shin, H.,Park, C. G.,Shim, K.(2015).The Korean version of the Lasater clinical judgment rubric: A validation study.Nurse Education Today,35(1),68-72.
37. Simmons, B.(2010).Clinical reasoning: Concept analysis.Journal of Advanced Nursing,66(5),1151-1158.
38. Tanner, C. A.(2006).Thinking like a nurse: A research-based model of clinical judgment in nursing.Journal of Nursing Education,45(6),204-211.
39. Victor-Chmil, J.,Larew, C.(2013).Psychometric properties of the Lasater clinical judgment rubric.International Journal of Nursing Education Scholarship,10(1),1-8.
40. Vierula, J.,Talman, K.,Hupli, M.,Laakkonen, E.,Engblom, J.,Haavisto, E.(2021).Development and psychometric testing of reasoning skills test for nursing student selection: An item response theory approach.Journal of Advanced Nursing,77(5),2549-2560.
41. Vreugdenhil, J.,Spek, B.(2018).Development and validation of Dutch version of Lasater clinical judgment rubric in hospital practice: An instrument design study.Nurse Education Today,62,43-51.
42. Yang, F.,Wang, Y.,Yang, C.,Zhou, M. H.,Shu, J.,Fu, B.,Hu, H.(2019).Improving clinical judgment by simulation: A randomized trial and validation of the Lasater clinical judgment rubric in Chinese.BioMed Central Medical Education,19(20),1-6.