Development and Validation of a Multidimensional Tool to Assess Nurses’ Clinical Decision-Making

Abstract Background Clinical decision-making is a critical aspect of nursing practice, influencing patient safety, care quality, and treatment outcomes. While various tools have been developed to assess decision-making skills in healthcare providers, a comprehensive, validated tool specifically for nurses' clinical decision-making is lacking. This study aims to develop and validate a multidimensional tool designed to assess nurses’ clinical decision-making. Methods The tool was developed through an extensive literature review, interviews with nurses, and expert consultations. A sample of 200 Iranian nurses participated in the validation process. Face validity and content validity were assessed using expert feedback and the Content Validity Index (CVI) and Content Validity Ratio (CVR). Construct validity was evaluated using Confirmatory Factor Analysis (CFA), while reliability was assessed through internal consistency (Cronbach’s alpha) and stability (Intraclass Correlation Coefficient - ICC). Results The final tool includes 40 items across six dimensions: Identification and Definition of Problem, Data Collection, Data Processing, Identifying and Evaluating Options, Selecting the Best Option, Planning for Action, and Implementation and Re-evaluation. The CVI was 0.95, and the CVR was 0.78, indicating strong content validity. CFA confirmed a six-factor structure with good model fit (Chi-square/df = 1.586, RMSEA = 0.054). The tool demonstrated excellent reliability, with a Cronbach’s alpha of 0.937 and an ICC indicating stability. Conclusions This newly developed tool provides a reliable, valid, and multidimensional measure for assessing nurses' clinical decision-making abilities. It can be used in clinical practice and research to better understand this critical skill, contributing to improved patient care and safety.