Development of the ethical decision-making competence scale

Background: Developing confident capacity for ethical decision-making is vital in nursing education. However, no tool examines nursing students’ competence in ethical decision-making. Aim: This study aimed to develop an Ethical Decision-Making Competence Scale (EDM-CS) to assess ethical care decision-making competencies in nursing students. Participants and research context: Original items were obtained by employing a focus group and the Delphi method. A cross-sectional design was used to confirm the items remained on the scale. Additionally, the scale’s reliability and validity were assessed. The EDM-CS was completed by 498 nursing students. An exploratory factor analysis (EFA) was used to examine the factor structure based on data from group 1 (n = 250). A second-order confirmatory factor analysis (CFA) was used to examine the model’s fitness based on data from group 2 (n = 248). This study was conducted between August 2022 and July 2023. Ethical considerations: The Institutional Review Board of Chung Shan Medical University Hospital approved this study’s design and procedure. Results: From the original 34 items, nine were deleted in the EFA. Thus, the EDM-CS had 25 items and a four-factor structure (ethical judgement, ethical sensitivity, ethical motivation, and ethical action), which explained 60.97% of the total variance. A second-order CFA identified a second-order factor termed ‘ethical decision-making competence’ with 18 items (root mean square residual = 0.052). The EDM-CS scores correlated significantly and positively with the scores on the Scale of Protective Factor-24 (r = 0.47, p <.001), which indicated good convergent validity. Cronbach’s alpha coefficient of the final EDM-CS was 0.90 and ranged from 0.73 to 0.80 for the four subscales. Discussion and conclusion: The EDM-CS was validated to fit the data adequately. It can be used to evaluate clinical nursing students’ ethical decision-making abilities and to develop education strategies to improve their ethical care competence.