Cross-cultural validation of the Chinese version of the nurses’ ethical decision-making around end-of-life care scale: a cross-sectional study

BACKGROUND: In end-of-life care, nurses’ ability to make sound ethical decisions is critical to safeguarding patients’ dignity and quality of life. However, China still lacks a measurement tool tailored to this specific context for assessing such competence. This study, therefore, aimed to localize the Nurses’ Ethical Decision-Making around End-of-Life Care Scale (NEDM-EOLCS) into Chinese and to examine its psychometric characteristics among Chinese nurses. METHODS: A cross-sectional study design was conducted. The study was conducted between October 2024 and December 2024. The Chinese version of the NEDM-EOLCS scale was initially developed using the Brislin translation model, cross-cultural debugging, and a pre-survey tailored to Chinese linguistic and cultural contexts. 450 nurses completed the Chinese version of the NEDM-EOLCS scale. Exploratory factor analysis (EFA) was employed to analyse the data from Group 1 (n = 225) in order to elucidate the factor structure, whereas Group 2 data (n = 225) were subjected to confirmatory factor analysis (CFA) to verify the model’s suitability; additionally, convergent validity, discriminant validity, and reliability tests were carried out. RESULTS: A total of 450 nurses participated in the survey. The Scale-level Content Validity Index (S-CVI) was 0.98; EFA extracted three factors and explained 61.816% of the total variance; CFA confirmed that all the goodness-of-fit indices were acceptable. The Cronbach’s alpha of the Chinese version of the NEDM-EOLCS was 0.962, and the retest reliability coefficient was 0.896. The Chinese version of NEDM-EOLCS had 55 items in 3 dimensions. CONCLUSIONS: The Chinese version of NEDM-EOLCS is scientifically reasonable and has good reliability and validity. It can be used to investigate Chinese nurses’ ethical decision-making around end-of-life care.