Validation of the Dutch version of the Nurses Clinical Reasoning Scale to evaluate nurses’ perception of clinical reasoning competence

Abstract

Background: Clinical reasoning is the fundamental base of clinical practice. It guides nurses in gathering, assessing, interpreting information, and generating hypotheses. Clinical reasoning is of significant importance for patient safety and is an essential element of competence. The Nurses Clinical Reasoning Scale (NCRS) was developed as an evaluation tool for the self-assessment of clinical reasoning competence. To date, the validity and reliability of the translated Dutch version of the NCRS (D-CRS) has yet to be determined. Aim/RQ: This study aims to test the validity and reliability of the D-CRS for clinical nurses working in the Netherlands. Method: This study had a quantitative, descriptive, retrospective cross-sectional research design. A secondary analysis using consisting data of a sample of clinical nurses working in a University Medical Center and a general hospital (N= 515) was conducted. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were used to assess construct validity. Reliability was assessed with Cronbach’s alpha. Results: CFA did not provide the hypothesized one-factor structure. EFA showed a two-factor structure. A one-factor model based on 2 factors with high factor correlation (>0.70) was shown to be valid based on Comparative Fit Index (CFI=0.95), Tucker-Lewis Index (TLI=0.94) and reliable based on Cronbach’s alpha=0.94. However, Root Mean Square Error of Approximation (RMSEA) did not indicate a good model fit. Conclusion: The D-CRS showed good reliability and acceptable validity based on CFI/TLI when it is used as a scale to assess clinical reasoning skills in Dutch clinical nurses working in a general and University Medical Center in the Netherlands. Recommendations: Although the D-CRS should be investigated further in future research, it could be a useful tool for Dutch nurses and their health care managers to assess and improve nurses’ clinical reasoning skills in clinical practice.