The development and psychometric testing of a theory‐based instrument to evaluate nurses’ perception of clinical reasoning competence
Abstract
Aim: The purpose of the study was to develop and psychometrically test the Nurses Clinical Reasoning Scale. Background: Clinical reasoning is an essential skill for providing safe and quality patient care. Identifying pre‐graduates’ and nurses’ needs and designing training courses to improve their clinical reasoning competence becomes a critical task. However, there is no instrument focusing on clinical reasoning in the nursing profession. Design: Cross‐sectional design was used. This study included the development of the scale, a pilot study that preliminary tested the readability and reliability of the developed scale and a main study that implemented and tested the psychometric properties of the developed scale. Method: The Nurses Clinical Reasoning Scale was developed based on the Clinical Reasoning Model. The scale includes 15 items using a Likert five‐point scale. Data were collected from 2013–2014. Two hundred and fifty‐one participants comprising clinical nurses and nursing pre‐graduates completed and returned the questionnaires in the main study. The instrument was tested for internal consistency and test–retest reliability. Its validity was tested with content, construct and known‐groups validity. Results: One factor emerged from the factor analysis. The known‐groups validity was confirmed. The Cronbach's alpha for the entire instrument was 0·9. Conclusion: The reliability and validity of the Nurses Clinical Reasoning Scale were supported. The scale is a useful tool and can be easily administered for the self‐assessment of clinical reasoning competence of clinical nurses and future baccalaureate nursing graduates. Study limitations and further recommendations are discussed.
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The Nurses' Clinical Reasoning Scale, a 15-item 5-point self-report questionnaire originally developed by Liou et al., has established validity for use with undergraduate nursing students and an original internal-consistency Cronbach's α of 0.94.
“Clinical reasoning was measured using the Nurses’ Clinical Reasoning Scale (NCRS), a self-report questionnaire originally developed by Liou et al. [45]; its validity was established for use with undergraduate nursing students.”
The clinical reasoning competency instrument had reliability Cronbach's α = 0.94 in Liou et al.'s study and Cronbach's α = 0.93 in Joung and Han's study.
“The reliability of the instrument was Cronbach’s α = 0.94 in Liou et al.’s study [22], and Cronbach’s α = 0.93 in Joung and Han’s study [23].”
From Analysis of the effect of an artificial intelligence chatbot educational program on non-face-to-face classes: a quasi-experimental study (2022) · cites this paper as [22]
Clinical reasoning competence was measured using a 15-item, single-factor instrument developed by Liou et al. and validated in Korean by Jeong and Han.
“Clinical reasoning competence was measured using a 15-item, single-factor instrument developed by Liou et al. [28] and validated in Korean by Jeong and Han [29].”
From Development and effects of a chatbot education program for self-directed learning in nursing students (2025) · cites this paper as [28]
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- Authors
- Liou, S., Liu, H., Tsai, H., Tsai, Y., Lin, Y., Chang, C., & Cheng, C.
- Affiliations
- Chang Gung University of Science and Technology (TW)
- Chiayi Chang Gung Memorial Hospital (TW)
- Corresponding author
- Cheng, Ching‐Yu
- Venue
- Journal of Advanced Nursing
- Publisher
- Wiley
- Published
- 2015-10-12
- Volume
- 72
- Issue
- 3
- Pages
- 707-717
- ISSN
- 0309-2402 (ISSN-L)
- 1365-2648
- OpenAlex
- W2104387687
- Cited by
- 104
- References
- 43
- Citations by year
- 2026: 13 · 2025: 19 · 2024: 27 · 2023: 10 · 2022: 9 · 2021: 11 · 2020: 6 · 2019: 3 · 2018: 5 · 2016: 1
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Advanced Nursing (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Chang-Gung Medical Research Program (CMRPF6C0041)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Education › Health Education and Validation
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- clinical reasoning, scale development, psychometric properties, clinical reasoning model, clinical nurses, self-assessment, nursing competencies, instrument validation
- MeSH terms
- Adult, Attitude of Health Personnel, China, Clinical Competence, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Nurses, Pilot Projects, Psychometrics, Thinking, Reproducibility of Results
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