Further evidence of validity of the Nursing Decision Making Instrument: an Italian validation study

Further evidence of validity of the Nursing Decision Making Instrument: an Italian validation study


  • Beatrice Albanesi University Campus Bio-Medico of Rome
  • Rosario Caruso
  • Cristina Arrigoni
  • Anna De Benedictis
  • Irene Baroni
  • Giulia Villa
  • Federica Dellafiore


Nursing; Decision-making; Critical Thinking; Analytical Thinking; Intuitive Thinking; Instrument Development


Background and aim: This study aimed to provide the Italian version of the Nursing Decision Making Instrument (NDMI) and establish its content and face validity, construct validity, and reliability among Italian nurses.

Methods: A three phases validation, methodological and cross-sectional study was realized. Phase one referred to the cultural-linguistic translation of the NDMI into Italian (i.e., I- NDMI). Phase two aimed to obtain a good level of content and face validity (cut-off <0.70). Phase three involved a cross-section data collection amongst Italian nurses in assessing the construct validity and reliability of the I-NDMI.

Results: I-NDMI showed adequate content validity. Confirmatory factor analysis models supported the four-factorial structure of the I-NDMI (i.e., Intuition; Prevision; Assessment; Planning) in explaining data obtained from nurses. Moreover, the scale and each domain showed adequate internal consistency.

Conclusions: This study constituted an advancement in the psychometric testing of the NDMI. Future research should identify specific decision-making processes and their determinants to allow theoretically grounded interventions to improve decision-making among nurses.


Johansen ML, O'Brien JL. Decision Making in Nursing Practice: A Concept Analysis. Nurs Forum. 2016;51(1):40-48.

Lauri S, Salanterä S. Developing an instrument to measure and describe clinical decision making in different nursing fields. J Prof Nurs. 2002;18(2):93-100.

Simmons B. Clinical reasoning: concept analysis. J Adv Nurs. 2010;66(5):1151-1158.

Nibbelink CW, Brewer BB. Decision-making in nursing practice: An integrative literature review. J Clin Nurs. 2018;27(5-6):917-928.

Stinson KJ. Benner's Framework and Clinical Decision-Making in the Critical Care Environment. Nurs Sci Q. 2017;30(1):52-57.

Lauri S, Salanterä S, Chalmers K, et al. An exploratory study of clinical decision-making in five countries. J Nurs Scholarsh. 2001;33(1):83-90.

Banning M. A review of clinical decision making: models and current research. J Clin Nurs. 2008;17(2):187-195.

Tanner CA. Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ. 2006;45(6):204-211.

Hardy D, Smith B. Decision Making in Clinical Practice. Br. J. Anaesth. 2008;9(1), 19-21.

Thompson C, Aitken L, Doran D, Dowding D. An agenda for clinical decision making and judgement in nursing research and education. Int J Nurs Stud. 2013;50(12):1720-1726.

Miller EM, Hill PD. Intuition in Clinical Decision Making: Differences Among Practicing Nurses. J Holist Nurs. 2018;36(4):318-329.

Bjørk IT, Hamilton GA. Clinical decision making of nurses working in hospital settings. Nurs Res Pract. 2011.

Harbison J. Clinical decision making in nursing: theoretical perspectives and their relevance to practice. J Adv Nurs. 2001;35(1):126-137.

Dreyfus HL, Dreyfus SE, Athanasiou T. Mind over machine: The power of human intuition and expertise in the era of the computer. New York: Free Press;1986

Canova C, Brogiato G, Roveron G, Zanotti R. Changes in decision-making among Italian nurses and nursing students over the last 15 years. J Clin Nurs. 2016;25(5-6):811-818.

Valcarenghi D, Bagnasco A, Aleo G, et al. Exploring the Interaction Between Nursing Decision Making and Patient Outcomes in 2 European Cancer Centers: A Qualitative Study. Cancer Nurs. 2018;41(5):E40-E49.

Bottacini A, Scalia P, Goss C. Shared decision making in Italy: An updated revision of the current situation. Z Evid Fortbild Qual Gesundhwes. 2017;123-124:61-65.

Rattray J, Jones MC. Essential elements of questionnaire design and development. J Clin Nurs. 2007;16(2):234-243.

Brislin RW. Back-Translation for Cross-Cultural Research. J Cross-Cult Psychol. 1970;1(3):185-216.

Caruso R, Arrigoni C, Groppelli K, et al. Italian version of Dyspnoea-12: cultural-linguistic validation, quantitative and qualitative content validity study. Acta Biomed. 2018;88(4):426-434.

Lawshe CH. Quantitative Approach to Content Validity. Pers. Psychol. 1975; 28:563- 575.

Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-467.

Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398-405.

Beckett C, Eriksson L, Johansson E, Wikström C. Multivariate Data Analysis (MVDA). Quality by Design. 2018;201-225.

Dellafiore F, Rosa D, Udugampolage NS, Villa G, Albanesi B. Professional values and nursing self-efficacy in the Italian context. Correlational descriptive study. Scand J Caring Sci [published online ahead of print, 2021 Mar 10].

Dellafiore F, Pittella F, Arrigoni C, et al. A multi-phase study for the development of a self-efficacy measuring scale for ostomy care nursing management. J Adv Nurs. 2020;76(1):409-419.

Hoyle RH. Structural equation modeling: Concepts, issues, and applications. Sage Publications, Inc; 1995.

Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107(2):238-246.

Tucker, L. R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38(1), 1–10.

Steiger JH. Structural Model Evaluation and Modification: An Interval Estimation Approach. Multivariate Behav Res. 1990;25(2):173-180.

Pavlov G, Maydeu-Olivares A, Shi D. Using the Standardized Root Mean Squared Residual (SRMR) to Assess Exact Fit in Structural Equation Models. Educ Psychol Meas. 2021;81(1):110-130.

IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

Muthén LK, Muthén BO. Mplus User's Guide. Sixth Edition. Los Angeles, CA: Muthén & Muthén. (1998-2011).

Weber S. A qualitative analysis of how advanced practice nurses use clinical decision support systems. J Am Acad Nurse Pract. 2007;19(12):652-667.

Benner P, Hughes RG, Sutphen M. Clinical Reasoning, Decision making, and Action: Thinking Critically and Clinically. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); April 2008.

Melin-Johansson C, Palmqvist R, Rönnberg L. Clinical intuition in the nursing process and decision-making-A mixed-studies review. J Clin Nurs. 2017;26(23-24):3936-3949.

Pearson H. Science and intuition: do both have a place in clinical decision making? Br J Nurs. 2013;22(4):212-215.

Rocco G, Affonso DD, Mayberry LJ, Stievano A, Alvaro R, Sabatino L. The Evolution of Professional Nursing Culture in Italy: Metaphors and Paradoxes. Glob Qual Nurs Res. 2014 Oct 8;1:2333393614549372.

Hoffman K, Donoghue J, Duffield C. Decision-making in clinical nursing: investigating contributing factors. J Adv Nurs. 2004;45(1):53-62.

Laschinger HK, Finegan J, Shamian J. The impact of workplace empowerment, organizational trust on staff nurses' work satisfaction and organizational commitment. Health Care Manage Rev. 2001;26(3):7-23.

Caruso R, Pittella F, Zaghini F, Fida R, Sili A. Development and validation of the Nursing Profession Self-Efficacy Scale. Int Nurs Rev. 2016;63(3):455-464.

Dellafiore F, Caruso R, Arrigoni C, et al. The development of a self-efficacy scale for nurses to assess the nutritional care of older adults: A multi-phase study. Clin Nutr. 2021;40(3):1260-1267.

Goethals S, Dierckx de Casterlé B, Gastmans C. Nurses' decision-making in cases of physical restraint: a synthesis of qualitative evidence. J Adv Nurs. 2012;68(6):1198-1210.

Van den Bulcke B, Piers R, Jensen HI, et al. Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool. BMJ Qual Saf. 2018;27(10):781-789. doi:10.1136/bmjqs-2017-007390.

Albanesi B, Marchetti A, D'Angelo D, et al. Exploring Nurses' Involvement in Artificial Nutrition and Hydration at the End of Life: A Scoping Review. JPEN. 2020;44(7):1220-1233.






Original articles: Health Professions 3/2021

How to Cite

Albanesi B, Caruso R, Arrigoni C, De Benedictis A, Baroni I, Villa G, et al. Further evidence of validity of the Nursing Decision Making Instrument: an Italian validation study. Acta Biomed [Internet]. 2021 Dec. 21 [cited 2024 Jul. 23];92(S2):e2021331. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/11773