Self-Confidence and Anxiety as Intervening Factors in Clinical Decision-Making in Newly Nursing Bachelor Graduates
American Journal of Nursing Science
Volume 8, Issue 2, April 2019, Pages: 59-67
Received: Oct. 22, 2018; Accepted: Mar. 5, 2019; Published: Mar. 27, 2019
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Beatriz Paulina Espinosa-Rivera, National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
Laura Morán-Peña, National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
María Aurora García-Piña, National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
Patricia González-Ramírez, National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
Cristina Margarita López-Ruíz, National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
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The Clinical Decision-Making (CDM) is essential for the nursing professional practice. However, newly nursing bachelor graduates are not always ready to make clinical decisions. Therefore, the identification of self-confidence and anxiety as emotional barriers during this process will allow teaching/learning strategies to generate educational strategies of teaching-learning that support its development. The objective is to evaluate the levels of self-confidence and anxiety in newly nursing bachelor graduates and compare them to each CDM´s dimension. The method for this study was descriptive, comparative and cross-sectional. The“Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale (NASC-CDM)” was applied. Results: It was found that 69% of the newly nursing bachelor graduates had a high level of self-confidence and 66% a low level of anxiety. Significant statistical differences were found in the levels of self-confidence of the newly nursing bachelor graduates in accordance with their employment situation; the averages in the anxiety level were higher, although there were no significant statistical differences. It can be concluded that the higher level of self-confidence possessed by the newly nursing bachelor graduates, the lower the level of anxiety, with the exception of those who have nursing working experience. It is necessary for nursing educators to emphasize the development of skills for knowing and acting, because students need to incorporate them cognitively and intuitively in the complete clinical scenario, in order to have one or more options of decision. The low self-confidence level and the high anxiety level are emotional barriers that intervene in CDM, because they block or interfere the assertive decision-making process. This explains why deliberative strategies have to be implemented in the curricular level.
Clinical Decision-Making, Newly Nursing Graduates, Self-Confidence, Anxiety
To cite this article
Beatriz Paulina Espinosa-Rivera, Laura Morán-Peña, María Aurora García-Piña, Patricia González-Ramírez, Cristina Margarita López-Ruíz, Self-Confidence and Anxiety as Intervening Factors in Clinical Decision-Making in Newly Nursing Bachelor Graduates, American Journal of Nursing Science. Vol. 8, No. 2, 2019, pp. 59-67. doi: 10.11648/j.ajns.20190802.14
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González Velázquez MS, Morán Peña L, Sotomayor Sánchez S, León Moreno Z, Espinosa Olivares A, Paredes Breña L. A comparative study of the ways of making decisions in recently enrolled and advanced nursing students. Perfiles educativos. 2011; 33:134-43.
Jefford E, Fahy K, Sundin D. Decision-Making Theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives. International Journal of Nursing Practice. 2011; 17(3):246-53.
Roche JP. A Pilot Study of Teaching Clinical Decision Making With the Clinical Educator Model. J Nurs Educ. 2002; 41(8):365-7.
Wang Y, Chien W-T, Twinn S. An exploratory study on baccalaureate-prepared nurses' perceptions regarding clinical decision-making in mainland China2011. 1706-15 p.
Aguilera-Rivera M, Morán-Peña L, Espinosa-Rivera BP, Galicia-Luna A, López-Ruíz CM, García-Piña MA. Experiences by nursing graduates in clinical decision-making. Rev. iberoam. Educ. investi. Enferm. 2017; 7(3):9-18.
Morán-Peña L, García-Piña MA, González-Ramírez P, Godínez-Bueno SY, Aguilera-Rivera M. Problem-solving and decision-making, essence of reflexive practice in nursing: A literature review. Enfermería Universitaria. 2016; 13(1):47-54.
Cameron ME, Schaffer M, Park H-A. Nursing students´ experience of ethical problems and use of ethical decision-making models. Nursing Ethics. 2001; 8(5):432-47.
White KA. The Development and Validation of a Tool to Measure Self-Confidence and Anxiety in nursing Students While Making Clinical Decisions. Las Vegas, Nevada: University of Nevada; 2011.
Chesser-Smyth PA, Long T. Understanding the influences on self-confidence among first-year undergraduate nursing students in Ireland. Journal of Advanced Nursing. 2013; 69(1):145-57.
Kukulu K, Korukcu O, Ozdemir Y, Bezci A, Calik C. Self-confidence, gender and academic achievement of undergraduate nursing students. Journal of Psychiatric and Mental Health Nursing. 2013; 20:330-35.
Chernomas WM, Shapiro C. Stress, Depression, and Anxiety among Undergraduate Nursing Students. International Journal of Nursing Education Scholarship. 2013; 10(1):255-66.
Standing M. Clinical judgement and decision making for nursing students. 2a ed. Standing SBaM, editor. London: SAGE; 2014.
ACCN. The Essentials of Baccalaureate Education for Professional Nursing Practice Whashington: American Association of Colleges of Nursing; 2008 [cited 2016 October 26]. Available from:
Iacobucci TA, Daly BJ, Lindell D, Griffin MQ. Professional values, self-esteem, and ethical confidence of baccalaureate nursing students. Nursing Ethics. 2012; 20(4):479-90.
Baxter P, Boblin S. Decision Making by Baccalaureate Nursing Students in the Clinical Setting. J Nurs Educ. 2008; 47(8):345-50.
Tadeu-Shinyashiki G, Costa-Mendes IA, Trevizan MA, Day RA. Professional socialization: students becoming nurses. Rev Latino-am Enfermagem. 2006; 14(4):1-10.
Darbyshire C, Fleming VEM. Governmentality, student autonomy and nurse education. Journal of Advanced Nursing. 2008; 62(2):172-9.
Benner P, Sutphen M, Leonard V, Day L. Educating nurses. A call for radical transformation. Vista Lane, Stanford, California: Jossey-Bass; 2010.
Amado-Martins JC, Negrão-Baptista RC, Dias-Coutinho VR, Mazzo A, Alves-Rodrigues, Costa-Mendes IA. Self-confidence for emergency intervention: adaptation and cultural validation of the Self-confidence Scale in nursing students. Rev Latino-am Enfermagem. 2014:1-8.
Sergeev I, Lipsky AM, Ganor O, Lending G, Abebe-Campino MG, Morose MA, et al. Training modalities and Self-Confidence building in performance of life-saving procedures. Military Medicine. 2012; 177(8):901-06.
Flores-Villavicencio ME, Troyo-Sanromán R, Valle-Barbosa MA, Vega-López MG. Anxiety and stress in nursing staff practice in a third-level hospital in Guadalajara. Revista Electrónica de Psicología Iztacala. 2010; 13(1):1-17.
Prato CA, Yucha CB. Biofeedback-assisted relaxation training to decrease test anxiety in nursing students. Nurs Educ Perspect. 2013; 34(2):76-81.
Shikai N, Shono M, Kitamura T. Effects of coping styles and stressful life events on depression and anxiety in Japanese nursing students: A longitudinal study. International Journal of Nursing Practice. 2009; 15(3):198-204.
Raile-Alligood M, Marriner-Tomey A. Modelos y teorías en enfermería. 7 ed. Barcelona: ELSEVIER; 2011.
Meléis AI. Transitions Theory Middle Range and Situation Specific Theories in Nursing Research and Practice. New York: Springer Publishing Company; 2010.
Bandura A. Self-efficacy: the exercise of control. New York: Freeman; 1998.
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