Measurement properties of self-reported clinical decision-making instruments in nursing: A COSMIN systematic review
Bibliographic record
Abstract
Background: Nurses' clinical decision-making, i.e., the data collection, analysis, and evaluation process through which they reach clinical judgements and makes clinical decisions, is at the core of nursing practice and essential to provide safe and quality care. Instruments to assess nurses' perceptions of their clinical decision-making abilities or skills have been developed for research and education. Thus, it is essential to determine the most valid and reliable instruments available to reflect nurses' self-reported clinical decision-making accurately. Objective: To evaluate the measurement properties of self-reported clinical decision-making instruments in nursing. Methods: A systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was conducted (PROSPERO registration: CRD42022364549). Five bibliographical databases were searched in July 2022 using descriptors and keywords related to nurses, clinical decision-making, and studies on measurement properties. Two independent reviewers conducted reference selection and data extraction. The evaluation of the instruments' measurement properties involved assessing the quality of the studies, the quality of each measurement property (i.e., validity, reliability, responsiveness), and the quality of evidence based on the COSMIN. Results: Nine instruments evaluated in eleven studies with registered nurses or nursing students from various clinical contexts were identified. Five of the nine instruments were originals; four were translations or adaptations. Most focused on analytical and intuitive decision-making, although some were based on clinical judgment and clinical reasoning theories. Structural validity and internal consistency were the most frequently reported measurement properties; other properties, such as measurement error, criterion validity, and responsiveness, were not assessed for any instruments. A gap was also identified in the involvement of nurses or nursing students in the instrument development process and the content validity assessment. Six instruments appear promising based on the COSMIN criteria, but further studies are needed to confirm their validity and reliability. Conclusions: The evidence regarding instruments to assess nurses' self-reported clinical decision-making is still minimal. Although no instruments could be recommended based on the COSMIN criteria, the Nurses Clinical Reasoning Scale had the most robust supporting evidence, followed by the adapted version of the Clinical Decision Making in Nursing Scale. Future efforts should be made to systematically assess content validity through the involvement of the target population and by ensuring that the results of other measurement properties, such as reliability, measurement error, or hypothesis testing, are rigorously assessed and reported. Tweetable abstract: Despite limited evidence, this COSMIN review identified six promising instruments to assess nurses' clinical #decision-making, especially the Nurses Clinical Reasoning Scale and an adaptation of the Clinical Decision Making in Nursing Scale. #nursingresearch #nursingeducation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.089 | 0.305 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.011 |
| Bibliometrics | 0.011 | 0.014 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".