Developing and validating instruments for measuring critical thinking and clinical decision-making constructs for nurses in Malaysia
Critical Thinking (CT) and Clinical Decision-making (CDM) are two important skills for nurses to provide a quality nursing care. Hence, the aims of this research were to: (i) develop a questionnaire on Critical Thinking and Clinical Decision- Making Scale (CT & CDMS); (ii) determine the valid...
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| Format: | Thesis |
| Language: | English |
| Published: |
2020
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| Subjects: | |
| Online Access: | http://eprints.usm.my/47909/1/10.%20NUR%20HIDAYAH%20BINTI%20ZAINAL%20%40%20MUHAMAD-S-SKM000517%28R%29-24%20pages.pdf |
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| Summary: | Critical Thinking (CT) and Clinical Decision-making (CDM) are two important
skills for nurses to provide a quality nursing care. Hence, the aims of this research
were to: (i) develop a questionnaire on Critical Thinking and Clinical Decision-
Making Scale (CT & CDMS); (ii) determine the validation study of CT & CDMS.
The initial version of CT & CDMS was developed based on two models: 4-Circle
Critical Thinking Model and Conflict-Theory Model of Decision-making. During the
pre-testing stage, the nursing expert professionals were involved to obtain the content
validity and the language experts were involved in consensus for face validity. Next,
the instrument was distributed to 16 nurses, in order to gather their comments, and
check the consistency in their responses. Subsequently, the researcher distributed the
questionnaire to gather data from 200 respondents. Using data from pilot study, the
researcher performed the Exploratory Factor Analysis (EFA) through IBM-SPSS 24.0
in order to assess the usefulness of every item. Based on the results from EFA, the
researcher rearranged the questionnaire accordingly and performed field study survey
where another 200 respondents were sampled. Using the data from field study, the
researcher performed the Confirmatory Factor Analysis (CFA) procedure through
IBM-SPSS-AMOS 23.0 in order to validate the instrument for construct validity,
convergent validity, discriminant validity and composite reliability. Overall,
judgement from the expert showed that 36 items from two constructs with CVR value
of 1.00. However, after refinement, the instrument had 38 items retained with the
mean I-CVI level for the relevance, clarity and simplicity scale for CT construct was
1.00, the S-CVI/UA was 1.00 and mean expert proportion was 1.00. However, the
mean I-CVI level for the ambiguity scale for CT construct was 0.99, the S-CVI/UA
was 0.95 and mean expert proportion was 0.99. Meanwhile, the mean I-CVI level for
the relevance, clarity, simplicity and ambiguity scale for CDM construct was 0.99, the
S-CVI/UA was 0.95 and mean expert proportion was 0.99. In addition, the face
validity showed good comprehensibility and feasibility. The EFA procedure has
reduced the items from 38 to 21. Meanwhile, the CFA procedure has confirmed the
construct validity through the fitness indexes namely Chi square/df (2.111), CFI
(0.965), TLI (0.951) and RMSEA (0.075) for the CT construct while Chi square/df
(1.992), CFI (0.980), TLI (0.972) and RMSEA (0.071) for the CDM construct. Overall
CT & CDM produced very good internal consistency with Cronbach’s alpha value of
0.865 and 0.891 for factor 1 and factor 2 for CT and 0.945 and 0.841 for factor 1 and
factor 2 for CDM construct respectively. The convergent validity for the construct was
achieved through Average Variance Extracted (AVE) value of 0.834 for CT and 0.907
for CDM. Four factors extracted by EFA consist of 21 items were named as Critical
Characteristic, Critical Knowledge, Decision Abilities and Decision Accuracy. Thus,
the CT & CDMS was concluded to be a reliable and validated instrument in measuring
the level of critical thinking and clinical decision-making of nurses in clinical settings. |
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