Journal List > J Korean Acad Nurs > v.49(5) > 1136464

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

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.

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Figure 1.
Theoretical framework and hypothetical model.
jkan-49-601f1.tif
Figure 2.
Path diagram for the modified model.
jkan-49-601f2.tif
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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