Development and Psychometric of Nurses' Uncertainty in Clinical Decision-Making Scale : A Sequential Exploratory Study

Abstract

Introduction: One of the important skills for healthcare professionals is the ability to recognize and manage uncertainty. Uncertainty is an inseparable part of the clinical decision-making process, and nurses often encounter it. The existing tools for measuring uncertainty in nursing are either general or specific to certain units like the ICU, which do not cover the needs of nurses in all departments. Therefore, there is a need to design a specialized tool tailored to the "Iranian" context to measure uncertainty in clinical decision-making for nurses. This tool should be able to comprehensively and accurately measure uncertainty in clinical settings and help nurses make more confident decisions. Methods: This study was conducted using a mixed-methods approach with a sequential exploratory design. In the first phase, a qualitative study was carried out to elucidate the concept of uncertainty in clinical decision-making among nurses using a conventional content analysis approach. For this purpose, semi-structured interviews were conducted with 17 nurses working in educational and medical centers, selected through purposive sampling. In the next phase, the items for the instrument were generated based on the qualitative findings and a literature review. Subsequently, the face validity, content validity (determining the content validity ratio and index), construct validity (using exploratory factor analysis on 236 nurses working in selected educational and medical centers in Tabriz), internal consistency, stability (30 nurses), and convergent validity were assessed. Findings: Data analysis in the qualitative section led to the identification of four categories: "hard situation", "inadequate judgment", "emotional-burden" and "hard choice". After explaining the uncertainty in clinical decision-making, it was designed with 47 statements in a five-point Likert scale. The exploratory factor analysis indicated the existence of four factors with a total variance of 53.53 in the form of "hard situation" with a percentage of common variance of 24.89, "inadequate judgment" with a percentage of common variance of 15.03, "emotional burden", with a percentage of variance The 7.89 joint was named "hard choice" with a joint variance percentage of 5.67. There was a significant correlation between the uncertainty tool in nurses' clinical decision-making and the uncertainty tool of special department nurses (P ≥ 0.001 and r = 0.32). Cronbach's alpha coefficient of the final scale with 26 statements was 0.85 and the intraclass correlation coefficient for the scale was 0.91. 0 was obtained. Conclusion: This study addresses the need for further research to conceptualize and measure uncertainty in clinical decision-making among nurses, as this concept had not been comprehensively defined in previous studies. Based on the identified subscales, nurses described uncertainty in clinical decision-making as experiencing inadequate judgment and emotional burden when faced with difficult situations and making tough choices. The results of this study showed that the designed instrument has satisfactory face, content, and construct validity. This tool can directly help in assessing and increasing nurses' awareness of their level of uncertainty in clinical decision-making. Additionally, nursing managers can use this tool to understand the level of uncertainty among nurses in their institutions and plan accordingly to reduce the adverse effects of uncertainty.