Psychometric validation of the Chinese version of the ethical decision-making competence scale in mainland Chinese...

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.

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.

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.

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.