ArticleFrontiers in medicine2026
Psychometric validation of the Chinese version of the ethical decision-making competence scale in mainland Chinese nursing students.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: With the rapid transformation of global healthcare systems, ethical decision-making competence has become a critical component of nursing education. However, in mainland China, the assessment of nursing ethics remains underdeveloped, and validated instruments applicable across diverse educational levels are limited. Methods: A total of 1,407 nursing students from four provinces in China were recruited. The Ethical Decision-Making Competence Scale (EDM-CS) was translated and culturally adapted through forward translation, synthesis, back-translation, expert review, and pilot testing. Reliability was assessed using Cronbach's alpha, split-half reliability, and test-retest reliability. Validity was examined through content validity indices, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity, and Heterotrait-Monotrait (HTMT) ratios. Results: The Chinese EDM-CS retained the original four-factor structure. The overall Cronbach's alpha coefficient was 0.946, with subscale coefficients ranging from 0.869 to 0.904. Split-half reliability was 0.933 and test-retest reliability was 0.856. The item-level content validity index ranged from 0.833 to 1.000, and the scale-level content validity index was 0.920. EFA extracted four factors explaining 71.07% of the total variance, with factor loadings ranging from 0.730 to 0.846 and no salient cross-loadings. AVE values ranged from 0.518 to 0.711, CR values ranged from 0.870 to 0.907, and HTMT ratios ranged from 0.486 to 0.818. Conclusion: The Chinese version of the EDM-CS demonstrates robust psychometric properties and provides a standardized, theoretically grounded instrument for assessing ethical decision-making competence among nursing students in mainland China. The findings support the cross-cultural applicability of Rest's Four-Component Model and provide empirical support for nursing ethics education and evaluation in mainland China.
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