Measurement and Assessment of the Chinese Version of the Nurse Ethical Decision-Making Competence Scale: A Translation and Validation Study

Wei Mi¹Qing Yang¹Xiaoli Quan²Fuyan Tan²Lu Wang³Yu Li⁴Keyang Zhou⁵Li Xixi^6*

• ¹Hunan University of Medicine, Huaihua, China
• ²Hunan University of Medicine General Hospital, Huaihua, China
• ³Luoyang Polytechnic, luoyang, China
• ⁴Guizhou University of Medicine, guizhou, China
• ⁵Zunyi Medical and Pharmaceutical College, Zunyi, China
• ⁶Suining Central Hospital, Suining, China

Introduction:With the accelerated innovation of the global healthcare system, cultivating confident moral decision-making abilities is of great significance in nursing education. However, in mainland China, the cultivation and assessment of nursing ethics are weak, and suitable assessment tools are scarce. Moreover, due to the diverse nursing education system, students have different ethical competence requirements, and existing assessment tools cannot meet the needs of all students. Methods:Approximately 1,407 nursing students from 4 schools and 30 tertiary general hospitals in Guizhou, Guangdong, Henan, and Hunan provinces were selected as the research subjects. The scale was translated, Also, the Chinese edition of the questionnaire was checked with internal consistency, split-half reliability, and test-retest confidence. The Delphi approach is applied to assess the effectiveness of the Chinese edition. Both exploratory and confirmatory factors were used to assess the structure effectiveness of the Chinese version. The PCA and Varimax Rotational Approach were employed in the Exploratory Factor Analysis, while SPSS 26 /SPSSAU was applied to confirm the results. 2 Results:The Chinese version of the Ethical Decision-Making Competence Scale consists of 25 items across four distinct dimensions, consistent with the original scale: Ethical Sensitivity, Ethical Judgment, Ethical Motivation, and Ethical Action. For reliability, the overall Cronbach's α coefficient of the scale is 0.946, with Cronbach's α coefficients of the four dimensions ranging from 0.869 to 0.904; the split split-half reliability is 0.933 and the test-retest reliability is 0.856, which shows that the internal consistency and time stability are excellent. The Scale Content Validity Index was 0.920 for validity indicating a satisfactory Content Validity. Exploratory Factor Analysis extracted four distinct factors, which were confirmed by Confirmatory Factor Analysis as Ethical Sensitivity, Ethical Judgment, Ethical Motivation, and Ethical Action—consistent with the theoretical structure of the original EDM-CS and Rest's Four-Component Model of ethical decision-making (Rest, 1983). All model fit indicators met the acceptable criteria. Discussion:The Chinese edition of Nurse Ethical Decision-Making Competence Scale is reliable and effective. It can be applied in the assessment of the moral decision making. It provides a reliable assessment tool for the quantitative measurement of nursing students' ethical decision-making competence in mainland China.