Journal List > J Korean Acad Nurs > v.49(4) > 1131253

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

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.

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
1 2 3 4 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
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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