Structural Equation Modeling on Clinical Decision Making Ability of Nurses

Min Kyoung Park; Soukyoung Kim

doi:10.4040/jkan.2019.49.5.601

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Park and Kim: Structural Equation Modeling on Clinical Decision Making Ability of Nurses

Original Article

J Korean Acad Nurs 2019;49(5):601-612.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.5.601

Structural Equation Modeling on Clinical Decision Making Ability of Nurses

Min Kyoung Park¹, Soukyoung Kim^2,

¹Department of Nursing, Koje College, Geoje

²College of Nursing, Eulji University, Daejeon, Korea

Address reprint requests to : Kim, Soukyoung College of Nursing, Eulji University, 77 Gyeryong-ro 771beon-gil, Jung-gu, Daejeon 34824, Korea Tel: +82-42-259-1717 Fax: +82-42-259-1709 E-mail: ksy@eulji.ac.kr

Received 14 February 2019 Revised 23 July 2019 Accepted 23 July 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 construct and test a hypothetical model of clinical decision-making ability of nurses based on the Decision Making Process model and the Cognitive Continuum theory.

Methods

The data were collected from nurses working at 11 hospitals in Busan, Daejeon, and South Gyeongsang Province from June 30 to August 1, 2017. Finally, the data from 323 nurses were analyzed.

Results

The goodness-of-fit of the final model was at a good level (χ ²/df=2.46, GFI=.87, AGFI=.84, IFI=.90, CFI=.90, SRMR=.07, RMSEA=.07) and 6 out of 10 paths of the model were supported. The clinical decision-making ability was both directly and indirectly affected by task complexity and indirectly affected by experiences, autonomy, and work environment. Specifically, it was strongly directly affected by analytical competency but was insignificantly affected by intuitive competency. These variables accounted for 66.0% of clinical decision-making ability.

Conclusion

The nurses’ clinical decision-making ability can be improved by improving their analytical competency. Therefore, it is necessary to organize nursing work, create a supportive work environment, and develop and implement various education programs.

Keywords: Clinical Decision Making, Critical Thinking, Intuition, Nurses, Clinical Competency

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Figure 1.

Theoretical framework and hypothetical model.

Figure 2.

Path diagram for the modified model.

Table 1.

General Characteristics of Participants (N=323)

Variables	Categories	N	%	M±SD
Age (yr)	≤29	148	45.8	33.11±900
	30~39	97	30.0
	40~49	57	17.7
	≥50	21	6.5
Gender	Female	309	95.7
	Male	14	4.3
Marital status	Unmarried	179	55.4
	Married	143	44.3
	Others	1	0.3
Education level	College	113	35.0
	University	180	55.7
	Graduate school	30	9.3
Hospital type	Long term care hospita	al 72	22.3
	Hospital	62	19.2
	General hospital	127	39.3
	Tertiary hospital	62	19.2
Working	Medical unit	116	35.9
department	Surgical unit	61	18.9
	Intensive care unit	53	16.4
	Emergency room	46	14.2
	Others	47	14.6
Position	Staff nurse	259	80.2
	Charge nurse	39	12.1
	≥Head nurse	25	7.7
Total clinical experience (yr)	<1	24	7.4	8.19±6.72
	1≤~<3	61	18.9
	3≤~<5	42	13.0
	5≤~<10	86	26.6
	≥10	110	34.1

M=Mean; SD=Standard deviation.

Table 2.

Descriptive Statistics and Confirmatory Factor Analysis of Measurement Model (N=323)

Variable	Range	M±(SD)	Skewness	Kurtosis	AVE	CR
Task complexity	1~5	3.41±.63	-0.15	-0.08	.83	.94
Interdependence of task		3.63±.67	-0.22	-0.25
Variability of task		3.08±.75	0.11	-0.16
Diversity of task		3.52±.69	-0.27	0.04
Autonomy	1~5	2.78±.68	-0.13	-0.21	.76	.86
Personal development		2.77±.74	-0.08	0.14
Professional development		2.79±.77	-0.05	-0.17
Work environment	1~4	2.57±.45	0.03	0.49	.73	.93
Nursing participation in hospital affairs		2.57±.46	-0.08	0.39
Nursing foundations for quality of care		2.66±.42	-0.07	0.81
Nursing manage ability, leadership and support of nurses		2.87±.54	-0.44	0.89
Staffing and resource adequacy		2.08±.83	0.46	-0.43
Collegial nurse-physician relations		2.81±.60	-0.43	0.55
Analytic competency	1~5	3.60±.39	0.28	0.35	.76	.96
Intellectual eagerness/curiosity		3.66±.54	-0.27	1.20
Prudence		3.66±.56	-0.18	0.10
Self confidence		3.44±.53	0.04	-0.08
Systematicity		3.28±.59	-0.02	0.51
Intellectual integrity		3.89±.43	0.21	0.22
Healthy skepticism		3.49±.55	0.02	0.04
Objectivity		3.81±.49	-0.19	0.76
Intuitive competency	1~5	2.63±.54	0.19	0.69	.87	.87
Clinical decision making ability	1~5	3.58±.46	0.33	0.48	.75	.92
Evaluation and re-evaluation of consequences		3.42±.59	0.08	0.27
Canvassing of objective & values		3.60±.53	0.03	0.20
Search for information		3.69±.56	0.21	-0.14
Search for alternatives or options		3.61±.64	-0.04	0.28

AVE=Average variance extracted; CR=Construct Reliability.

Table 3.

Standardized Direct, Indirect, and Total Effects of the Modified Model (N=323

Endogenous variables	Exogenous variables	S.E.	C.R (p)	Direct effect (p)	Indirect effect (p)	Total effect (p)	SMC
Analytic competency	Task complexity	.05	4.90 (<.001)	.29 (.018)		.29 (.018)	.30
	Experience	.00	4.68 (<.001)	.26 (.015)		.26 (.015)
	Autonomy	.05	3.07 (.002)	.21 (.022)		.21 (.022)
	Work environment	.07	3.65 (<.001)	.24 (.018)		.24 (.018)
Intuitive competency	Task complexity	.06	1.64 (.102)	.17 (.102)		.17 (.102)	.07
	Experience	.00	-1.70 (.089)	-.17 (.053)		-.17 (.053)
Clinical decision making ability	Task complexity	.04	4.01 (<.001)	.23 (.005)	.18 (.022)	.41 (.012)	.66
	Experience	.00	1.56 (.119)	.08 (.127)	.20 (.008)	.28 (.009)
	Autonomy				.14 (.018)	.14 (.018)
	Work environment				.16 (.014)	.16 (.014)
	Analytic competency	.07	9.90 (<.001)	.69 (.020)		.69 (.020)
	Intuitive competency	.12	-1.49 (.137)	-.13 (.229)		-.13 (.229)

S.E.=Standard Error; C.R.=Critical Ratio; SMC=Squared Multiple Correlation.

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