Mi Yu; Young Eun; KA White; KyungJa Kang

doi:10.4040/jkan.2019.49.4.411

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Yu, Eun, White, and Kang: Reliability and Validity of Korean Version of Nursing Students’ Anxiety and Self-Confidence with Clinical Decision Making Scale

Original Article

J Korean Acad Nurs 2019;49(4):411-422.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.4.411

Reliability and Validity of Korean Version of Nursing Students’ Anxiety and Self-Confidence with Clinical Decision Making Scale

Mi Yu¹, Young Eun¹, KA White^2,, KyungJa Kang^3,

¹College of Nursing · Institute of Health Sciences, Gyeongsang National University, Jinju, Korea

²School of Nursing & Health Studies, Georgetown University, Washington D.C., USA

³College of Nursing, Jeju National University, Jeju, Korea

Address reprint requests to : Kang, KyungJa College of Nursing, Jeju National University, 102 Jejudaehak-ro, Jeju 63243, Korea Tel: +82-64-754-3752 Fax: +82-64-702-2686 E-mail: kkyungja@jejunu.ac.kr

Address reprint requests to : White, KA School of Nursing & Health Studies, Georgetown University, Box 571107, 3700 Reservoir Road, NW, Washington D.C. 20057, USA Tel: +1-202-687-3118 E-mail: krista.white@georgetown.edu

Received 18 January 2019 Revised 17 May 2019 Accepted 20 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to adapt, modify, and validate the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM^©) for Korean nursing students.

Methods

Participants were 183 nursing students with clinical practice experience in two nursing colleges. The construct validity and reliability of the final Korean version of the NASC-CDM^© were examined using exploratory and confirmatory factor analyses and testing of internal consistency reliability. For adaptation and modification, the instrument was translated from English to Korean. Expert review and a cross-sectional survey were used to test the instrument's validity.

Results

The Korean version of the NASC-CDM^© (KNASC-CDM) was composed of 23 items divided into four dimensions: (i) Listening fully and using resources to gather information; (ii) Using information to see the big picture; (iii) Knowing and acting; and (iv) Seeking information from clinical instructors. The instrument explained 60.1% of the total variance for self-confidence and 63.1% of the variance for anxiety; Cronbach's α was .93 for self-confidence and .95 for anxiety.

Conclusion

The KNASC-CDM can be used to identify anxiety and self-confidence in nursing students’ clinical decision-making in Korea. However, further research should be done to test this instrument, as it is classified differently from the original NASC-CDM^© version.

Keywords: Anxiety, Clinical Decision-Making, Nursing Students, Reliability and Validity

References

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Table 1.

General Characteristics of Participants (N=183)

Variables	Categories	n	%
Gender	Female	157	85.8
	Male	26	14.2
Age (yr)	M±SD	21.85±1.17
School year	3rd	91	49.7
	4th	92	50.3
Religion	Catholic	15	8.2
	Christian	20	10.9
	Buddhism	20	10.9
	Others	1	0.6
	No religion	127	69.4
Previous semester grade	<3.0	21	11.5
	3.0~3.9	145	79.2
	≥4.0	17	9.3

M=Mean; SD=Standard deviation.

Table 2.

Exploratory Factor Analysis (N=183)

Factor-Item no.	Corrected item-total correlation	Self-confidence					Corrected item-total correlation	Anxiety
		M±SD		Component				M±SD	Component
		M±SD	1	2	3	4		M±SD	1	2	3	4
24	.56	3.92±1.07	.82	.11	.10	.17	.63	2.52±1.05	.10	.78	.13	.30
25	.58	3.57±0.92	.73	.27	.15	.01	.64	2.69±0.99	.29	.65	.18	.19
18	.56	3.85±1.05	.70	.18	.17	.32	.57	2.64±1.11	.05	.75	.14	.26
26	.57	3.71±0.89	.67	.30	.32	-.05	.74	2.57±0.91	.39	.65	.33	.11
19	.60	3.58±0.95	.66	.21	.19	.09	.62	2.74±0.95	.26	.69	.32	-.05
10	.60	3.75±0.98	.60	.19	.16	.25	.63	2.49±0.99	.45	.45	.21	.18
12	.58	3.74±0.89	.57	.24	.29	.28	.68	2.64±0.92	.39	.53	.24	.23
9	.63	4.39±1.05	.54	.13	.04	.36	.53	2.20±1.00	.38	.56	-.05	.16
2	.58	3.49±0.86	.31	.78	.04	.13	.73	2.85±1.02	.81	.29	.16	.16
4	.67	3.46±0.96	.20	.77	.15	.01	.67	2.95±1.00	.72	.24	.22	.15
3	.65	3.23±0.95	.21	.66	.21	.13	.67	3.02±1.06	.73	.20	.26	.16
1	.50	3.35±0.87	.27	.65	.13	.19	.69	2.92±1.07	.74	.26	.23	.13
6	.57	3.06±0.97	.07	.59	.32	.35	.67	3.14±1.01	.53	.13	.38	.38
13	.56	3.26±0.96	.14	.59	.30	.22	.69	3.07±1.01	.48	.16	.45	.37
7	.60	3.22±0.99	.23	.56	.32	.27	.67	3.21±1.05	.58	.14	.35	.36
20	.58	2.56±0.92	.01	.23	.80	.17	.59	3.92±1.11	.21	.09	.77	.24
17	.58	2.93±0.98	.28	.20	.80	-.02	.59	3.44±1.05	.23	.21	.76	.08
14	.60	3.08±1.01	.31	.24	.62	.05	.61	3.27±1.02	.26	.24	.70	.09
21	.51	3.23±1.03	.21	.16	.57	.40	.66	3.11±1.01	.19	.34	.48	.46
15	.64	3.28±0.81	.34	.21	.51	.25	.71	3.04±0.91	.30	.41	.49	.30
8	.60	3.48±1.09	.16	.28	.13	.79	.55	2.81±1.02	.27	.14	.12	.73
22	.58	3.70±0.94	.38	.11	.11	.74	.56	2.72±1.01	.05	.41	.15	.69
11	.63	3.51±0.98	.15	.41	.23	.55	.60	2.81±1.00	.31	.19	.19	.66
Eigen value			4.41	3.90	3.03	2.47			4.38	4.22	3.27	2.64
Explained			19.16	16.97	13.19	10.75			19.02	18.36	14.21	11.47
variance (%)
Cumulative			19.16	36.12	49.31	60.1			19.02	37.38	51.59	63.1

M=Mean; SD=Standard deviation; KMO=Kaiser-Meyer-Olkin; Self-confidence .91, Anxiety .93.

Bartlett’s test of sphericity: Self-confidence χ²=2156.08 (p<.0) Anxiety χ²=2449.24 (p<.001).

Table 3.

Convergent and Discriminant Validity (N=183)

Dimension	Item no.	Self-confidence								Anxiety
		. Standardized coefficient				Correlation (r)					VE			Correlation (r)
			VE	CR	AVE	Dimen-	Dimen-	Dimen-	Dimen-	Standardized coefficient -		CR	AVE	Dimen-	Dimen-	Dimen-	Dimen-
						sion 1	sion 2	sion 3	sion 4					sion 1	sion 2	sion 3	sion 4
Dimension 1	24	.79	0.44	.89	.50	1				.75	0.48	.89	.50	1
(Listening fully	25	.72	0.41							.73	0.45
and using	18	.78	0.44							.67	0.67
resources	26	.71	0.39							.80	0.29
to gather	19	.67	0.49							.71	0.45
information)	10	.64	0.57							.65	0.56
	12	.70	0.41							.72	0.41
	9	.56	0.75							.59	0.65
Dimension 2	2	.78	0.29	.88	.52	.68	1			.84	0.31	.90	.56	.77	1
(Using	4	.69	0.49							.75	0.44
information	3	.68	0.48							.77	0.45
to see the big	1	.70	0.39							.80	0.41
picture)	6	.69	0.51							.73	0.47
	13	.64	0.55							.71	0.51
	7	.71	0.47							.71	0.55
Dimension 3	20	.72	0.40	.84	.51	.67	.71	1		.70	0.64	.83	.50	.79	.81	1
(Knowing and	17	.80	0.35							.71	0.54
acting)	14	.66	0.57							.69	0.54
	21	.65	0.61							.71	0.51
	15	.64	0.39							.75	0.36
Dimension 4	8	.78	0.46	.79	.55	.67	.70	.58	1	.68	0.56	.73	.47	.75	.74	.77	1
(Seeking	22	.76	0.38							.70	0.52
information	11	.68	0.51							.69	0.52
from clinical
instructors)

VE= Variance of error; CR=Construct reliability; AVE=Average variance extracted.

Table 4.

Criterion Validity (N=183)

Variables	Dimension	M±SD	KNASC-CDM
			Self-confidence r (p)					Anxiety r (p)					State anxiety r (p)	Self-efficacy r (p)
			D1	D2	D3	D4	total	D1	D2	D3	D4	total
Self-	D1	3.81±0.72	1
confidence	D2	3.38±0.67	.67	1
			(<.001)
	D3	3.07±0.67	.60	.685	1
			(<.001)	(<.001)
	D4	3.56±0.84	.57	.65	.53	1
			(<.001)	(<.001)	(<.001)
	Total	3.46±0.61	.84	.88	.82	.83	1
			(<.001)	(<.001)	(<.001)	(<.001)
Anxiety	D1	2.56±0.74	-.60	-.37	-.32	-.26	-.46	1
			(<.001)	(<.001)	(<.001)	(<.001)	(<.001)
	D2	2.97±0.78	-.37	-.52	-.37	-.30	-.46	.74	1
			(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)
	D3	3.27±0.74	-.32	-.42	-.62	-.28	-.48	.67	.73	1
			(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)
	D4	2.78±0.81	-.26	-.37	-.29	-.58	-.46	.61	.66	.60	1
			(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)
	Total	2.90±0.66	-.44	-.48	-.46	-.42	-.53	.87	.90	.86	.84	1
			(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)
State anxiety		42.80±9.00	-.33	-.29	-.23	-.23	-.32	.36	.29	.26	.28	.35	1
			(<.001)	(<.001)	(.002)	(.002)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)
Self-efficacy		57.80±7.65	.30	.38	.33	.28	.38	-.34	-.39	-.40	-.34	-.42	-.54	1
			(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)	(<.001)

M=Mean; SD=Standard Deviation; KNASC-CDM=Korean nursing anxiety and self-confidence with clinical decision making; D=Dimension.

Table 5.

Reliability Test of Final Instrument; KNASC-CDM (N=183)

Dimension	Item no.	Item	Cronba ach’s α
Dimension	Item no.	Item	Self-Confidence	Anxiety
Dimension 1		Listening fully and using resources to gather information	.88	.89
8 items	9	Active listening skills
	10	Assessing nonverbal cues
	12	Decide if information from family is important
	18	Ask addition questions to get more information
	19	Correlate physical assessment findings with the client’s nonverbal cues
	24	Ask the client’s significant other/family questions
	25	Evaluate if decisions influenced client satisfaction
	26	Incorporate personal things I know about the client
Dimension 2		Using information to see the big picture	.87	.90
7 items	1	See important patterns in the gathered information
	2	Identify clinical information related to current problem
	3	See the full clinical picture
	4	Recall knowledge relates to the current problem
	6	Interpret the meaning of a specific assessment findings
	7	Evaluate clinical decision improved laboratory findings
	13	Use knowledge of anatomy and physiology to interpret information
Dimension 3		Knowing and acting	.82	.84
5 items	14	Act on intervention based on intuition
	15	Analyze the risks of interventions
	17	Make a clinical decision to solve the client’s problem independently
	20	Implement an accurate intervention
	21	Use knowledge of diagnostic tests to create a decision
Dimension 4		Seeking information from clinical instructors	.78	.73
3 items	8	Realize need to talk with instructor to sort-out assessment findings
	11	Realize need to review a protocol, procedure
	22	Realize the need to talk with instructor or the staff about interventions
Total			.93	.95

KNASC-CDM=Korean nursing anxiety and self-confidence with clinical decision making.

^* Full-text of items is copyrighted and is not provided. They may be used with permission. To obtain the full KNASC-CDM scale, contact the instrument developer Dr. Krista A. White (United States, kawhite4288@gmail.com), Dr. Yu, Mi (Korea, yumi825@gnu.ac.kr).

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