Evaluation Of Clinical Decision-Making Perception of Nursing Students: The Aegean Region Case

Evaluation Of Clinical Decision-Making Perception of Nursing Students: The Aegean Region Case | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation Of Clinical Decision-Making Perception of Nursing Students: The Aegean Region Case Yelda CANDAN DONMEZ, Burcak SAHIN KOZE, Aylin DURMAZ EDEER, Yeliz CIGERCI, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5604771/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 May, 2025 Read the published version in BMC Nursing → Version 1 posted 6 You are reading this latest preprint version Abstract Background: The clinical learning environment is crucial for developing essential clinical decision-making skills in nursing students. This study examined nursing students' perceptions of clinical decision-making and the factors that impact it. Methods: A descriptive cross-sectional study was carried out using a self-administered questionnaire, which included a personal information form and the Clinical Decision-Making in Nursing Scale (CDMNS). The study was conducted across ten universities in the Aegean region. Data collection took place at times most convenient for the students, such as during class sessions or lunch breaks. Prior to participation, students were briefed on the study's objectives and procedures. Those who agreed to participate provided informed consent before completing the questionnaire. Researchers remained present while students filled out the questionnaire to clarify any questions they had. Results: A considerable proportion of students (72.6%) had never received formal education on clinical decision-making. The average CDMNS score was 140.24±17.04, aligning with findings from previous research. A statistically significant difference was observed in the total mean CDMNS score and sub-dimension scores (searching for alternatives, questioning goals and values, evaluating outcomes, seeking information, and objectively integrating new knowledge) based on the university attended (p<0.001). Conclusions: The findings suggest that nursing students in the Aegean Region demonstrated a moderate level of perceived clinical decision-making skills. To enhance these skills further, it is recommended that alternative educational approaches, such as simulation-based training, case study discussions, and mentoring programmes, be integrated into nursing education and their effectiveness assessed. Clinical Decision-making Decision Making Nursing Student Figures Figure 1 Figure 2 Introduction Clinical decision-making is a cornerstone of nursing practice, requiring nurses to consistently analyze patient data, prioritize care needs, and select appropriate interventions. It is defined as the process of selecting the best option from available alternatives, involving multiple cognitive steps, including problem identification and outcome evaluation [ 1 , 2 ]. In healthcare settings, clinical decision-making holds particular significance, especially for nurses who play a central role in direct patient care. Ineffective decision-making can result in negative consequences, such as medical errors, patient safety risks, and increased healthcare expenses. These potential outcomes highlight the necessity for precision and accountability in decision-making. In nursing, clinical decision-making entails applying professional expertise and skills, supported by clinical judgement, to provide high-quality patient care [ 3 , 4 ]. The adequacy of nurses' clinical decision-making has a direct impact on patient outcomes, highlighting its significance in both nursing education and professional practice [ 5 , 6 ]. Nurses play a critical role in monitoring changes in patients' conditions, prioritizing their care needs, and implementing suitable interventions [ 3 ]. Therefore, enhancing nurses' clinical decision-making abilities is vital for ensuring both patient safety and effective care delivery [ 7 – 10 ]. The integration of evidence-based practice is fundamental to clinical decision-making, as it ensures that decisions are informed by the most reliable research, clinical expertise, and patient preferences. Utilizing evidence in practice allows nurses to reduce risks and enhance care quality, ultimately leading to better patient outcomes. Clinical instruction is outlined to assist nursing understudies bridge the crevice between hypothetical information and viable hone, and the clinical learning environment serves as a key component of their instruction [ 11 ]. This environment not only enables students to apply theoretical concepts but also helps shape their professional identity by exposing them to real-world healthcare settings [ 11 ]. However, the quality of the clinical learning environment significantly shapes students' perceptions and experiences. A positive clinical learning environment, characterised by collaboration with staff, appreciation and opportunities for skill development, improves students' clinical decision-making skills [ 11 ]. For example, positive mentorship from experienced nurses and regular constructive feedback can significantly enhance students' confidence and critical thinking skills. Similarly, providing opportunities for independent decision making under appropriate supervision is essential for the development of clinical judgement. Conversely, factors such as hierarchical structures, deficiencies in practice guidelines and inadequate support can hinder students' learning and decision-making processes [ 6 ]. In addition, stress in the practice environment negatively affects nursing students' decision-making skills, highlighting the need for supportive and nurturing clinical environments [ 1 , 12 ]. Understanding nursing students' perceptions of clinical choice making and the components of that influence this process is crucial for optimising nursing education and practice. This study focuses primarily on nursing students' perceptions of their clinical decision-making skills, rather than their actual decision-making skills in practice. By assessing these factors, educators and healthcare institutions can tailor educational interventions to enhance students' decision-making skills and improve patient care outcomes [ 1 , 12 ]. In addition, evidence from such evaluations contributes to the existing body of nursing literature and provides valuable guidance for educators, nurses and nursing students alike. Research questions; What are the perceptions of nursing students in the Aegean region regarding their clinical decision making skills? What factors influence nursing students' perceptions of their clinical decision-making skills in the Aegean region? Aim The aim of this study was to assess nursing students' perceptions of clinical decision-making and the factors influencing the decision-making process. Methods Study design This study was carried out as descriptive cross-sectional research. Study setting and sample The study population comprised 6551 nursing students in their second, third, and fourth years at ten universities in the Aegean region between 2017 and 2018. The study sample included 3633 students who voluntarily agreed to participate in the research after being informed about its purpose and procedures. No probabilistic sampling method was applied; instead, a convenience sampling approach was used, as participation was based on willingness and availability. Data collection instruments Data were gathered using a 13 item Personal Information Form and the 40 item Clinical Decision-Making in Nursing Scale. Approval was obtained from the original researchers before using these instruments. a) Personal Information Form; Developed by the researchers based on existing literature, this form consists of 13 questions covering students' demographic details such as age, gender, income level, place of residence, self-assessment status, and whether they had received formal education on clinical decision-making. b) Clinical Decision-Making in Nursing Scale (CDMNS); This scale was originally developed by Jenkins (1983) [ 13 ] and later adapted for Turkish use by Durmaz Edeer and Sarıkaya, who confirmed its validity and reliability [ 3 ]. Designed specifically for nursing students in the United States, the scale evaluates students' perceptions of clinical decision-making based on their self-reported experiences. The reliability of the scale was measured using Cronbach’s alpha, which was reported as 0.83 in the original study [ 13 ], while the Turkish version of the CDMNS demonstrated a Cronbach’s alpha coefficient of 0.78. The CDMNS consists of 40 items distributed across four sub-dimensions: ‘Searching for alternatives or options,’ ‘Consideration of goals and values,’ ‘Evaluation of consequences,’ and ‘Searching for information and unbiased assimilation of new information.’ Each sub-dimension contains 10 items. Among the 40 items, 22 (1, 3, 5, 7, 8, 9, 10, 11, 14, 16, 17, 18, 20, 26, 27, 28, 29, 33, 35, 36, 37, 38) are positively worded, while 18 (2, 4, 6, 12, 13, 15, 19, 21, 22, 23, 24, 25, 30, 31, 32, 34, 39, 40) are negatively worded and require reverse scoring. Responses are recorded on a five-point Likert scale, where 5 = always, 4 = often, 3 = occasionally, 2 = seldom, and 1 = never. The total mean CDMN scale score ranges from 40 to 200, while sub-dimension scores range from 10 to 50. There is no predefined cut-off point; higher scores indicate a stronger perception of clinical decision-making ability, whereas lower scores reflect a weaker perception. The CDMNS was selected for this study due to its well-established reliability and validity in measuring nursing students' perspectives on clinical decision-making [ 3 , 13 ]. Data collection Data collection was conducted at times that would not interfere with the students’ academic responsibilities, such as during lunch breaks or after class sessions, but never during exams or active classroom instruction. Questionnaires were administered in designated areas outside of classrooms to ensure minimal disruption to the academic schedule. Prior to data collection, students were informed about the purpose of the study and how the data would be used. Participation was entirely voluntary; students who agreed to participate provided written informed consent. After signing the consent form, they completed the questionnaire. Researchers remained present throughout the process to address any questions or concerns the participants had. Completing the questionnaire took approximately 10–15 minutes. Ethical approval of the study Ethical approval for the study was granted by the chair of a university's scientific research and publication ethics committee (approval number: 06/03/2018-E.68353). All participants provided informed consent after being informed about the study’s purpose, their voluntary participation, and their right to withdraw at any time. The research was conducted in compliance with the ethical guidelines outlined in the World Medical Association’s Declaration of Helsinki for studies involving human subjects. Data analysis Data from the study were analysed using SPSS 25.0 (Statistical Package for the Social Sciences). Numbers and percentages were used for descriptive characteristics. In the evaluation of the data, the one-way ANOVA test was used to compare the total mean CDMNS scores and the sub-dimensions according to the year studied, the school and the place of residence, and the independent groups t-test was used for the paired comparison of the mean scores of the students according to their introductory characteristics (gender and taking courses in decision making). Forms with more than 20% missing data were excluded from the analysis. Results The mean age of the students participating in the study was 21.39 ± 1.73 years and the median age was 21 years. It was found that 74.3% of the students were female, 45.1% lived in the city center and 36.3% lived in the district. It was found that the average monthly income of the students was 798.89 ± 737.46 Turkish Liras, 0.8% of them had a monthly income below 100 Turkish Liras and 69.1% of the students' families' income was equal to their expenses. In addition, 37.0% of the students lived in government dormitories, 22.3% lived with their friends, 37.0% were in the second grade, 32.9% were in the third grade, only 5.8% repeated a year, and 72.6% did not attend a clinical decision-making course. When the factors influencing the students' clinical decision making were examined, it was found that 91.1% of knowledge level, 78.3% of previous experience, 58.1% of creative thinking, 57.4% of personal characteristics, 53.5% of environmental and situational stressors, 42.4% of time constraints, 34.4% of physical and mental illness and 32.1% of prejudice influenced clinical decision making. When the characteristics of the decision maker in the students' clinical decision making were examined, it was found that 85.4% had self-confidence, 81.1% took responsibility, 73.5% were able to focus on the problem, 64.9% were able to separate advantages and disadvantages, 49.9% were assertive and 35.6% were able to influence people. The total mean CDMNS score of the nursing students was 140.24 ± 17.04. The mean sub-dimension scores of the students were: searching for alternatives or options 36.32± 5.33, evaluating consequences 35.91± 5.70, searching for information and unbiased assimilation of new information 34.11± 4.25 and considering goals and values 33.89± 4.35 (Table 1 ). Table 1 Mean CDMNS and Subscale Scores of Nursing Students (n: 3633) CDMNS and Subscales Mean±sd Min. Max. Search for alternatives or options 36.32± 5.33 11.00 50.00 Canvassing of objectives and values 33.89± 4.35 10.00 49.00 Evaluation of consequences 35.91± 5.70 10.00 50.00 Search for information and unbiased assimilation of new information 34.11± 4.25 13.00 47.00 CDMNS Total 140.24± 17.04 45.00 187.00 Mean : Arithmetic mean, SD : Standard deviation, Min : Smallest value, Max : Greatest value Table 2 shows the clinical decision-making scores of nursing students according to the universities. A statistically significant difference was between the total mean CDMNS, searching for alternatives or options, exploring goals and values, evaluating consequences and searching for information and unbiased assimilation of new information sub-dimensions scores of nursing students according to the universities (p < 0.001). In the advanced analysis (Tukey's test), there was no significant difference between the total mean CDMNS scores of the "I" University and the "J" University, but a significant difference was formed with the other schools, the difference being attributed to the high mean scores of these two schools. The difference between the scores of the sub-dimensions of the acquisition of goals and values was attributed to the mean scores of the students studying at the University of "F". The scores of the students at this school are low. The difference between the scores of the "Evaluation of consequences" sub-dimension was attributed to the mean scores of the students studying at the "F" university and at the "C" university. The scores of students studying at these schools are low. Table 2 Clinical Decision-Making Scores of Nursing Students According to the Universities Schools Total CDMNS score Mean±sd Search for alternatives or options Mean±sd Canvassing of objectives and values Mean±sd Evaluation of consequences Mean±sd Search for information and unbiased assimilation of new information Mean±sd "I" University (n: 266) 149.28±14.81 38.64±4.41 35.83±3.61 38.98±5.07 35.81±4.11 "J" University (n: 370) 148.20±12.25 38.90±4.00 35.08±3.21 38.69±4.63 35.52±3.41 "D" University (n: 438) 145.15±16.09 37.98±5.20 34.69±3.73 37.35±5.71 35.11±4.03 "H" University (n: 288) 143.15±14.43 37.37±4.48 34.27±3.71 36.87±5.11 34.63±4.17 "A" University (n: 474) 143.02±13 ,. 37.50±4.45 34.16±3.11 36.94±4.80 34.41±3.69 "G" University (n: 331) 141.94±14.49 37.02±4.71 34.08±3.36 36.32±5.23 34.50±3.80 "E" University (n: 442) 138.57±14.23 35.93±4.40 33.33±3.73 35.48±5.02 33.81±3.87 "B" University (n: 473) 138.05±16.88 35.66±5.19 33.53±4.05 35.16±5.39 33.68±4.08 "C" University (n: 204) 130.50±12.04 31.51±3.77 35.34±4.22 30.75±4.04 32.88±3.46 "F" University (n: 347) 121.60±20.92 30.73±5.80 29.59±6.97 30.75±5.72 30.52±5.31 F / p F: 97.736 p: 0.000 * F: 109.350 p: 0.000 * F: 59.946 p: 0.000 * F: 92.558 p: 0.000 * F: 48.060 p: 0.000 Mean : Arithmetic mean, SD : Standard deviation Table 3 shows the clinical decision-making scores of nursing students according to their classes. A statistically significant difference was reported between the mean scores of the nursing students for the total mean CDMNS score, searching for alternatives or options, canvassing goals and values, and evaluating consequences sub-dimensions according to their class. A statistically significant difference was found in the sub-dimension scores for seeking information and unbiased assimilation of new information according to students' grades (p > 0.05). In the advanced analysis (Tukey's test), the difference between the total mean CDMNS scores was attributed to the mean scores of the sub-dimension s of the second and third grade students, the difference between the sub-dimensions of the search for goals and values was attributed to the mean scores of the third and fourth grade students, the difference between the sub-dimensions of the evaluation of consequences was attributed to the mean scores of the second grade students. The difference in the sub-dimension scores for searching for alternatives or options was not due to any grade. Table 3 Clinical Decision-Making Scores of Nursing Students According to their Classes. Grades Total CDMNS score Mean±sd Search for alternatives or options Mean±sd Canvassing of objectives and values Mean±sd Evaluation of consequences Mean±sd Search for information and unbiased assimilation of new information Mean±sd 2nd grade (n: 1345) 141.24±18.12 36.61±5.45 33.93±4.70 36.38±5.87 34.31±4.54 3rd grade (n: 1195) 139.48±17.76 36.14±5.48 33.61±4.51 35.72±5.75 33.99±4.38 4th grade (n: 1093) 139.83±14.66 36.15±4.99 34.14±3.68 35.54±5.39 34.00±3.71 F / p F: 3,819 p: .022 * F: 3.259 p: .039 * F: 4.192 p: .015 * F: 7.505 p: .001 * F: 2.328 p: .098 Mean : Arithmetic mean, SD : Standard deviation Table 4 shows the clinical decision-making scores of nursing students according to their gender. The scores of the female students are higher than those of the male students. Our data showed that there was a statistically significant difference between the total mean CDMNS score and gender. Significant differences were also determined between the gender of nursing students and the mean scores of the sub-dimensions of seeking alternatives or options, considering goals and values, evaluating results, searching for information and assimilating new information impartially (p < 0.001). Table 4 Clinical Decision-Making Scores of Nursing Students According to Gender Gender Total CDMNS score Mean±sd Search for alternatives or options Mean±sd Canvassing of objectives and values Mean±sd Evaluation of consequences Mean±sd Search for information and unbiased assimilation of new information Mean±sd Female (n: 2701) 142.21±16.60 36.81±5.18 34.26±4.24 36.56±5.58 34.56±4.18 Male (n: 932) 134.52±17.03 34.87±5.50 32.80±4.49 34.02±5.62 32.81±4.21 T p t: 12.099 p: 0.000 * t: 11.949 p: 0.000 * t: 9,682 p: 0.000 * t: 9.402 p: 0.000 * t: 8.891 p: 0.000 * Mean : Arithmetic mean, SD : Standard deviation Table 5 shows the clinical decision-making scores of nursing students according to their status of taking a decision-making course. A significant difference was determined in terms of the total mean CDMNS score of nursing students according to their status of taking the decision-making course. The mean scores of the sub-dimensions of seeking alternatives or options, seeking purpose and value, and evaluating results also showed a statistically significant difference compared to taking the course before (p < 0.05). The mean scores of students who had previously taken a decision-making course were significantly higher in these sub-dimensions. However, there was no significant difference in the information seeking and unbiased and unprejudiced retrieval of new information sub-dimensions due to having previously taken the course (p > 0.05). No statistically significant difference was found between the mean scores of the sub-dimensions total CDMNS (p:.163), searching for alternatives or options (p:.317), seeking goals and values (p:.315), evaluating consequences (p:.172), and searching for information and unbiased assimilation of new information (p:.249) of the nursing students according to the income status of their families (p > 0.05). Table 5 Clinical Decision-Making Scores of Nursing Students According to the Prior Decision-Making Course Taking courses Total CDMNS score Mean±sd Search for alternatives or options Mean±sd Canvassing of objectives and values Mean±sd Evaluation of consequences Mean±sd Search for information and unbiased assimilation of new information Mean±sd Yes (n: 997) 141.72±16.96 36.83±5.19 34.18±4.23 36.37±5.80 34.33±4.22 No (n: 2636) 139.67±17.04 36.12±5.37 33.77±4.39 35.73±5.65 34.03±4.27 T p t: 3.237 p: 0.001 * t: 3.557 p: 0.000 * t: 2.534 p: 0.011 * t: 3.007 p: 0.003 * t: 1.878 p: 0.060 Mean : Arithmetic mean, SD : Standard deviation Table 6 shows the clinical decision-making scores of nursing students according to their residence places. A statistically significant difference was found between total mean CDMNS score, the search for alternatives or options, the exploration of goals and values, and the evaluation of consequences sub-dimension scores of the nursing students according to their place of residence (p < 0.001). In advanced analysis (Tukey's test) we found that the difference in total mean CDMNS scores came from students who stayed with their family. There was a significant difference between those who stayed with their family, those who stayed with their friends and those who lived at home alone in terms of the mean scores for the sub-dimensions seeking alternatives or options, assessing consequences and seeking information and taking in new information without bias. In the canvassing of objectives and values sub-dimension, a significant difference was found between those who stayed with their family and friends, those who stayed in the state dormitory and those who lived alone at home (p < 0.001). Table 6 Clinical Decision-Making Scores of Nursing Students According to Residence Places Place of stay Total CDMNS score Mean±sd Search for alternatives or options Mean±sd Canvassing of objectives and values Mean±sd Evaluation of consequences Mean±sd Search for information and unbiased assimilation of new information Mean±sd State dormitory (n: 1346) 140.31±16.68 36.28±5.22 33.90±4.20 35.99±5.55 34.13±4.23 Private dormitory (n: 501) 141.03±17.51 36.68±5.48 33.91±4.51 36.15±5.92 34.27±4.27 With family (n: 703) 142.71±17.12 36.95±5.34 34.53±4.16 36.52±5.82 34.69±4.30 With relative (n: 54) 138.77±16.25 35.83±5.13 33.85±4.06 35.38±5.75 33.70±4.10 With friend (n: 810) 138.30±16.51 35.82±5.27 33.50±4.48 35.31±5.51 33.65±4.03 Home alone (n: 219) 137.51±18.88 35.60±5.65 33.14±4.83 35.23±6.14 33.52±4.80 F p F: 6.535 p: 0.000 * F: 4.760 p: 0.000 * F: 5.706 p: 0.000 * F: 4.373 p: 0.001 * F: 5.633 p: 0.000 * Mean : Arithmetic mean, SD : Standard deviation Discussion The clinical decision-making process is a fundamental skill in professional nursing practice [ 14 ]. This process involves selecting the proper option for the nursing care and associating this choice with past experiences [ 15 ]. To provide safe and high-quality patient care, nursing students, who are the future healthcare professionals, must also have advanced clinical decision-making skills [ 4 , 16 ]. In this study, the total mean CDMNS scores of nursing students is 140.24±17.04. Considering that the maximum score that can be obtained from this scale is 200, it can be said that the average score of this study is at a good level. Similarly, the total mean CDMNS scores are reported as 125 ± 10.0 by Farčić, 147.72 ± 12.05 by Ahmed, and 141.91 ± 14.08 by Özden et al [15; 17; 10]. However, in Arkan et al.'s study, the total mean CDMNS score was 100.81 ± 18.69, and they evaluated this score as moderate [ 18 ]. The total mean CDMNS scores studies in the literature determine scores between (120–150) ande they are expressed as a good level. Therefore, we can say that our study also has a good level of total mean CDMNS score. In our study, the mean score of “Searching for alternatives or options” sub-dimension is 36.32± 5.33. The mean score of the “alternative or option search” sub-dimension was reported as 33.4 ± 3.8 in Farcíc’s study, 25.52 ± 5.38 in Ahmed’s study, and 36.96 ± 4.79 in Özden’s study [ 15 , 17 , 10 ]. It is seen that the mean scores of this sub-dimension are higher than the other sub-dimensions but are at the average value. This can be interpreted as nursing students may need approval because they do not yet have the authority to make independent decisions and therefore tend to evaluate all options. In our study, the lowest score (33.89± 4.35) was observed in the “Canvassing of objectives and values” sub-dimension. For the same sub-dimension, Arkan reported mean scores of 22.95 ± 5.19, Farčić 32.1 ± 4.2 and Ahmed 37.7 ± 3.7 [ 18 , 15 , 17 ]. “Canvassing of objectives and values”, ​​sub-dimension scores are also moderate in our sample. This may be due to the nursing students' lack of professional goal and value perception. In addition, nursing education in different universities may not have demonstrated equal competence in conveying common values ​​and goals to students. “Evaluation of consequences” sub-dimension score is 35.91± 5.70 in our sample. This is the second highest sub-dimension score in our study. Arkan reported the score as 26.54 ± 5.61 in same sub-dimension [ 18 ]. In Turkey, from the first year of undergraduate nursing education, students are asked to create nursing care plans for each patient they care for. This method aims to develop the critical thinking skills of students who create nursing care plans and get used to evaluating their results. The mean scores of this sub-dimension show that students' critical thinking skills and awareness are at a moderate level. “Search for information and unbiased assimilation of new information” sub-dimension is 34.11± 4.25 in our study. In Davoodi's study, it was determined that the same sub-dimension was the sub-dimension with the lowest mean score, with 21.74 ± 2.88 [ 19 ]. This score shows that the students in our sample have not fully developed their ability to search for information and assimilate new information objectively, since they are still in the education period. Decision making is defined as choosing from a series of options. Nurses are constantly making new decisions based on the outcomes of their care. Moreover, these decisions are often time limited. Considering that each sub-dimension can be scored between 10 and 50, it is seen that all sub-dimension score averages in our study are at moderate levels. Education level, self-confidence and sufficient professional knowledge positively affect nurses' decision-making skills. [ 20 ]. It can be thought that these characteristics of the students included in our study are not yet at the desired level and therefore their sub-dimension score averages are at a moderate level. In our study, the CDMNS was applied to nursing students who did not yet have working experience. In Farci ́c’s study nurses with more than 31 years of work experience had a total mean CDMNS score of 129.87 ± 17.84, as well as higher scores in all sub-dimensions [15]. When the scores of nurses with 31 years or more working experience are examined, it is obvious that the students in this study have very good CDMNS scores despite their lack of experience. As in the study conducted by Arkan et al., in our study, it is determined that the average score of inexperienced nursing students is at a good level. When students were asked about the characteristics that people who will make clinical decisions should have, the most emphasized characteristics were self-confidence (85.4%) and taking responsibility (81.1%). Farˇci'c et al., observed higher and significant (p = 0.003) clinical decision-making skills in nurses with longer working experience. However, no statistically significant relationship was detected between self-confidence and decision-making ability [ 15 ]. Hagbaghery et al. report that feeling competent and self-confident is necessary to make the right clinical decision. They also emphasize that institutional structure, nursing education and instructor support also affect this process [ 5 ]. The support students receive from the team in clinical environments affects their options evaluation and decision-making processes. In Wong's study, in which he examined the conditions that affect critical thinking and decision-making, simulation, case study, clinical experience, and guidance of clinical consultants were identified as strategies that support clinical decision-making [ 21 ]. Support received from the clinical counselor affects the clinical decisions positively. It is known that students' self-confidence increases in environments where instructors are involved in the learning process. In environments where students carry out their practices with awareness, their clinical decision-making skills also improve [ 22 ]. This study demonstrated that students' clinical decision-making skills were primarily influenced by their level of knowledge and previous experiences. It is well established that these factors play a crucial role in shaping decision-making abilities. Research conducted by Phillips et al. indicates that environmental conditions impact students' clinical decision-making skills by 75% [ 22 ]. Additionally, studies suggest that as students gain more knowledge and hands-on clinical experience, their ability to make informed decisions regarding individual patient care significantly improves [ 5 ]. Many uncontrollable variables such as stress can affect the total mean CDMNS scores of nursing students in different universities. In this research, students' total mean CDMNS and sub-dimension scores were examined according to universities. The total mean CDMNS scores of different universities were close to each other and statistically significant. In our country, nursing programs are supervised by a single center. The education plans of undergraduate nursing students at each university are similar. Undergraduate nursing education at each university is completed by taking a total of 240 ECTS at the end of 8 semesters. However, the content of the curriculum and the order of application may differ between universities. For example: While nursing students at one university may start their internship in the first semester, those at another university may start their internship in the third semester. Differences between universities may vary depending on clinical practice conditions, educational opportunities, student characteristics and the number of advisors. Studies in the literature indicate that there may be differences arising from different countries, education systems, curriculum contents and application environments [ 23 ]. This study examined universities located in a specific region of the country and managed by a single center. Therefore, the curricula of the faculties are basically similar. The conditions required for graduation and the achievement targets are common. Although there are differences in the order of the education process, there are no regional curriculum differences. Therefore, the results obtained are important in terms of reflecting all schools in the specified region. In our study, universities providing nursing education in the Aegean region were examined. The data obtained suggest that there are differences between universities despite similar curricula. Planning common goals through regular meetings, sharing experiences, supporting and evaluating the development of educators continuously, concretely evaluating student achievements, examining the reasons of deficiencies and monitoring areas that need development can be useful in supporting students' decision-making skills in schools in the Aegean region. Therefore, the data of our study is important in terms of revealing the necessity of common education and application stages throughout the country. For this purpose, the targets related to the applications should be re-planned in line with the needs and should be applied in the same way in each university. Standard education methods that will support students' self-confidence and decision-making skills should be established, concrete assessment tools should be developed and used throughout the country. Globally, nursing programs employ various educational approaches, and numerous studies have evaluated nursing students' critical thinking skills. Although these studies attempt to explain class-level differences from different perspectives, no universally accepted conclusion has been established in the literature. Özden et al. compared CDMNS scores among second, third, and fourth-year students reported that second and fourth-year students had higher and similar mean scores [ 10 ]. Likewise, Barutçu’s research examining the relationship between nursing students' problem-solving skills and clinical decision-making levels found that second-year students had higher total mean CDMNS and sub-dimension scores compared to third and fourth-year students. It was suggested that second-year students had a greater sense of competence might lead to challenges in patient care [ 23 ]. In our country, undergraduate education is carried out in clinical environments with academic instructors. These instructors, who are also responsible from the theoretical education, work one-on-one in clinics with smaller groups of students in first years. In these stages second-year students work with fewer patients in clinical settings and can easily get consultancy from their academic instructors whenever they need. This may be the reason why second-year students had the highest average score in our study. It is thought that students who can reach their advisors at any time in the clinical environment and who have just received theoretical information can act more confidently because they feel the support of the faculty. The curriculum of all faculties included in the study consists of internship practices of 4th year students. All final year students work in clinical settings in their final year and mostly do their practices under the supervision of service nurses. This method aims to increase the collaboration of students approaching graduation with the clinical team and to support their self-confidence. In this stage, instructors mostly supervise the practices and the process. The responsibility for one-on-one practice is left to the service nurses. In this process, students who are alone with their future colleagues in a real working environment may sometimes feel inadequate. This situation may have reduced their decision-making skills. In our study, it was determined that the total mean CDMNS score increased again in the fourth grade. As we mentioned before, although the highest total mean CDMNS score was found in the second-grade students in our study, it shows that increasing knowledge and experience re-develop the decision-making skills of nursing students. We observed that total mean CDMNS scores which were low in the third-grade students, increased again as the duration of education increased. Literature finding are similar with our findings. Farˇci´c et al. determined that experienced nurses had higher total mean CDMNS and sub-dimension scores and the difference between them was statistically significant (p < 0.05) [ 15 ]. We interpreted this data as "the critical thinking skills of students increase as the time spent in clinical environments increases". Clinical experience affects clinical decision-making ability [ 24 ]. Although it is reported in the literature that students' clinical decision-making skills increase with clinical experience, in our study, it was observed that the clinical decision-making levels of senior students were lower than those of students in lower grades. We determined that second-year students had the highest total mean CDMNS score. Wiles et al. stated that students with new theoretical knowledge had higher practice confidence and decision-making skills [ 25 ]. The total mean CDMNS scores of the second-year students in our study may be higher because of the same reason. Canova et al. examined the CDMNS scores of nurses and nursing students between 1997, 2007 and 2012. They determined that although nurses collected patient data, physicians used this data more in decision-making processes. This situation also can be the reason for the gradual decrease in CDMNS scores of nurses and nursing students over the years [ 4 ]. In our study, the clinical decision-making levels of female students were determined to be higher than male students. Barutçu also found that there was a significant difference between the students' total mean CDMNS scores and their gender. He stated that the total mean CDMNS score and each sub-dimension score of female students were higher than male students and were statistically significant [ 23 ]. Özden's determined that gender had no effect on students' clinical decision-making levels [ 10 ]. Most individuals who choose the nursing profession in Turkey are women. Therefore, the number of female students in our study is higher. This can be the cause of high and significant total mean CDMNS and subscale scores of female students. We believe that this significant difference in terms of gender is due to the insufficient number of male nurses in this study. This study reveals that students who took courses about decision-making had significantly higher mean total CDMNS scores. Similarly, Özcan's study, where he evaluated the effect of critical thinking training on teacher candidates, determined that the provided training improved critical thinking skills [ 10 ]. In their study where Çalışkan and his colleagues evaluated the effects of the critical thinking course given to nursing students, it was determined that the students' critical thinking tendencies increased after the course [ 26 ]. Temel states that the critical thinking training given to university students through distance education positively affects their critical thinking skills and tendencies [ 27 ]. Davoodi et al. determined that nurses who received critical thinking training had higher total mean CDMNS scores and subgroup scores and the difference between them was statistically significant [ 19 ]. We did not examine when and by whom students took previously decision-making trainings. Therefore, the exact reasons for the difference between the scores of those who had received training before could not be determined. Insufficient number of clinical instructors, low self-efficacy, inappropriate clinical learning environment and stress negatively affect students' independent decision-making processes [ 28 ]. Students define stress as a factor that disrupts their practice, distracts their attention, and hinders their decision-making skills [ 28 ]. While the education method can effect decision-making skills in, being away from family and living alone also may have negatively affected decision-making skills. An analysis of students' clinical decision-making levels based on their living environment showed that those residing with their families had higher total mean CDMNS scores compared to other groups, with the difference being statistically significant. Research indicates a strong positive correlation between self-confidence and parental support [ 29 ]. Additionally, studies suggest that students who maintain a positive relationship with their families tend to develop stronger critical thinking skills [ 30 ]. The findings of this study highlight that students living with their families achieve higher total mean CDMNS scores and that family support plays a crucial role in enhancing critical thinking and decision-making abilities. It is evident that parental support has a positive impact on the critical thinking skills of nursing students. Limitations and Implications Despite some limitations, our findings provide important implications for future research and practice. One of the main limitations of this study is its cross-sectional design. This design may have been inadequate in correlating factors affecting clinical decision-making skills with outcomes. This study investigated nursing students' perceptions of clinical decision making. It should be noted that our study data are based on individual statements of a specific group. Therefore, it should be taken into consideration that it may not reflect clinical decision-making skills in real environments. The study was conducted in a specific region with undergraduate nursing students. Considering regional culture and student differences, generalization to other regions may be misleading. Therefore, the generalizability of our study results to all nursing faculties across the country may be limited. The number of male students in our study is small. Therefore, it may not be appropriate to make general inferences about gender differences. We did not examine when and by whom students took previously decision-making trainings. Therefore, the exact reasons for the difference between the scores of those who had received training before could not be determined. Further studies should be conducted to investigate the reason for this difference. Significance of the research This study is important because it examines the factors that affect the decision-making skills of nursing students. It emphasizes the effects of education level, previous knowledge and experience, and stress on the development of clinical decision-making skills. It shows that training aimed at developing problem-solving skills in nursing education should be early and continuous. It discusses the effects of team and social support on decision-making skills. Nursing students who are educated in environments where these conditions are provided can have strong problem-solving skills. Thus, the quality of patient care can be improved, and patient satisfaction can be increased. Conclusion This study highlighted the main factors affecting the clinical decision-making (CDM) skills of nursing students, with significant differences based on demographic, educational and environmental factors. The total mean CDMNS score of the students in our study was 140.24 ± 17.04 and was at a good level. A statistically significant difference in total mean CDMNS score was determined between universities The total mean CDMNS score of second-year students was the highest, but it dropped in the third grade and increased in fourth class again. The female students total mean CDMNS score was better than male students. The total mean CDMNS score of students who had prior decision-making were higher The total mean CDMNS score of students who lived with their family was higher The study findings are valuable in reflecting the importance of education, mentoring and a supportive environment in developing strong clinical decision-making skills. Recommendations In nursing education, it is very important to integrate decision-making courses into experiential learning opportunities. Theoretical and clinical training aimed at developing decision-making skills should be integrated into education curricula to improve students' clinical decision-making skills. A structured approach that includes tools such as decision-making algorithms, clinical reasoning cycles, and evidence-based practice guidelines should be systematically integrated into the nursing curriculum. Structured case-based discussions and scenario-based learning methods should be used to analyze thoughts and patient situations. In addition, students' self-confidence should be improved by providing a supportive environment based on collaboration in academic and clinical settings. Collaboration between education and health institutions should be increased, and a smooth transition from theoretical education to clinical practice should be provided. Students' decision-making skills should be strengthened with real-life scenarios. Nursing students should be trained to improve patient care outcomes through timely, accurate, and patient-centered interventions. Longitudinal studies examining the development of clinical decision-making skills from the first years of academic education should be planned. Studies examining the gender factor in decision-making skills should be conducted. Peer coaching programs, leadership training, awareness training and cognitive-behavioral techniques -Studies examining the effects of workload and stress management strategies on decision-making performance should be conducted. Application-specific modules, mentoring programs, and simulation-based training should be integrated into the nursing curriculum to improve students' clinical decision-making skills. Longitudinal studies should be planned to examine the development and change of clinical decision-making skills over time. All these studies should be expanded to include different populations and settings. In this way, the factors affecting clinical decision-making can be understood and integrated into nursing education. The findings from this study can be incorporated into nursing curricula through specific educational modules and mentoring programs. An educational structure integrated into three basic components should be established: (1) classroom-based theoretical education using case studies and interactive decision-making tools, (2) practical education using high-quality patient simulators and debriefing sessions, and (3) clinical mentoring programs where students are paired with experienced nurses and can practice decision-making in real time. Mentoring programs that pair students with experienced nurses can provide personalized guidance and practice in decision making in settings similar to real-life care settings. Additionally, clinical decision-making camps can be held to monitor students' progress and ensure that critical thinking and decision-making skills are strengthened throughout their education. Periodic skills assessments should be conducted, and competency checklists should be created. Planning common goals through regular meetings, sharing experiences, supporting and evaluating the development of educators continuously, concretely evaluating student achievements, examining the reasons of deficiencies and monitoring areas that need development can be useful in supporting students' decision-making skills in schools in the Aegean region. For this purpose, the targets related to the applications should be re-planned in line with the needs and should be applied in the same way in each university. Standard education methods that will support students' self-confidence and decision-making skills should be established, concrete assessment tools should be developed and used throughout the country. Declarations Ethics approval and consent to participate ; Prior to participation, all individuals provided informed consent for inclusion in the study. The research was conducted in compliance with the Declaration of Helsinki, and ethical approval was obtained from the Ethics Committee of Ege University (approval date and number: 06/03/2018-E.68353). Consent for publication: Not applicable. Funding: This study did not receive financial support from any public, commercial, or non-profit funding organizations. Author Contribution Study design: YCD, BSK, ADE, YC, EY, FG, NG, KK, BA, GOÇ, ZS, MYVGData collection: YCD, BSK, ADE, YC, EY, FG, NG, KK, BA, GOÇ, ZSData analysis: ADEStudy supervision: YCD, MYVGManuscript writing: YCD, ADE, BSK, ZSCritical revisions for important intellectual content: MYVG Acknowledgement We would like to thank all the students who agreed to participate in the study. Data Availability Availability of data and materials: The data that support the findings of this study are available from the authors upon reasonable request. References Yıldırım B, Özkahraman Ş. Decision Making Process in Nursing. Electron J Vocat Colleges. 2011;165–73. https://doi.org/10.1111/jocn.14151 . Krishnan P. A philosophical analysis of clinical decision making in nursing. J Nurs Educ. 2018;57(2):73–8. https://doi.org/10.3928/01484834-20180123-03 . Durmaz Edeer A, Sarıkaya A. Adaptation of Clinical Decision Making in Nursing Scale to Undergraduate Students of Nursing: The Study of Reliability and Validity. Int J Psychol Educational Stud. 2015;2(3):1–9. https://doi.org/10.17220/ijpes.2015.03.001 . 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):811–8. 10.1111 / jocn.13101. Hagbaghery MA, Salsali M, Ahmadi F. (2004). The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study. BMC nursing, 3(1), 1–11. Retrieved from; http://www.biomedcentral.com/1472-6955/3/2 Al-Dossary RN, Kitsantas P, Maddox PJ. Clinical decision-making among new graduate nurses attending residency programs in Saudi Arabia. Appl Nurs Res. 2016;29:25–30. https://doi.org/10.1016/j.apnr.2015.05.008 . Campos DCFD, Graveto JMGDN. The role of nurses and patients' involvement in the clinical decision-making process. Rev Latinoam Enferm. 2009;17(6):1065–70. https://doi.org/10.1590/S0104-11692009000600021 . Sucu G, Dicle A, Saka O. (2012). Decision Making in Clinical Nursing: Decision-Making Models and Affecting Factors Journal of Education and Research in Nursing; 9 (1): 52–60. Retrieved from; https://jag.journalagent.com/jern/pdfs/JERN_9_1_52_60.pdf Deegan J. (2013). A view from the outside: Nurses' clinical decision making in the twenty first century. Australian Journal of Advanced Nursing, The, 30(4), 12–18. Retrieved from; https://search.informit.org/doi/epdf/ 10.3316/informit.405083351168144 Özden D, Özveren H, Gülnar E. Clinical Decision-Making Levels of Nursing Students and Affecting Factors. Dokuz Eylül Univ Nurs Fac Electron J. 2018;11(1):41–7. https://doi.org/10.4274/cjms.2021.2857 . Aktaş YY, Karabulut N. A Survey on Turkish nursing students' perception of clinical learning environment and its association with academic motivation and clinical decision making. Nurse Educ Today. 2016;36:124–8. https://doi.org/10.1016/j.nedt.2015.08.015 . Aydin N. (2011). The Use of Clinical Decision Support Systems in Nursing. Journal of Education and Research in Nursing. 8 (3): 59–63. Retrieved from; https://jag.journalagent.com/jern/pdfs/JERN_8_3_59_63.pdf Jenkins HM. (1983). Perceptions of decision making among baccalaureate nursing students as measured by the clinical decision making in nursing scale (Doctoral dissertation, University of Maryland, College Park). Retrieved from; https://www.proquest.com/dissertations-theses/perceptions-decision-making-among-baccalaureate/docview/303273267/se-2 Ilaslan E, Adıbelli D, Teskereci G, Uzen Cura S. (2023) Development of nursing students' critical thinking and clinical decision making skills, Teaching and Learning in Nursing 18 (2023) 152_159. https://doi.org/10.1016/j.teln.2022.07.004 Farčić N, Barać I, Lovrić R, Pačarić S, Gvozdanović Z, Ilakovac V. The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study. Int J Environ Res Public Health. 2020;17(9):3059. https://doi.org/10.3390/ijerph17093059 . O'Mara L, McDonald J, Gillespie M, Brown H, Miles L. Challenging clinical learning environments: Experiences of undergraduate nursing students. Nurse Educ Pract. 2014;14(2):208–13. https://doi.org/10.1016/j.nepr.2013.08.012 . Ahmed SM, El-hosany A, Sleem F. Clinical Decision-Making Ability among Students at Faculty of Nursing in Suez Canal University. Trends Nurs Health Care J VOL. 2022. https://doi.org/10.21608/tnhcj.2022.248085 . 4 1. Arkan B, Yılmaz D, Gökdere Çınar H, Uzun R. Clinical Decision-Making Levels of Nursing Students and Affecting Factors. Cyprus J Med Sci. 2022;7(6):738–44. https://doi.org/10.4274/cjms.2021.2857 . Davoodi A, Zamanzadeh V, Ghahramanian A, Onyeka TC, Jabbarzadeh F. Impact of integrated teaching-learning method on oncology clinical decision-making ability and cognitive learning of nursing students. BMC Med Educ. 2022;22:107. https://doi.org/10.1186/s12909-022-03168-2 . Beyaffers HA, Woldetsadik MT, Gizaw AB. Predictors of moral distress among nurses working in Jimma university medical center, south west Ethiopia. Front Nurs. 2020;7(4):369–77. https://doi.org/10.2478/FON-2020-0046 . Wong SHV, Kowitlawakul Y. Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students: A qualitative study. Nurse Educ Today. 2020;95:104600. https://doi.org/10.1016/j.nedt.2020.104600 . Phillips BC, Morin K, Theresa M. Clinical decision making in undergraduate nursing students: A mixed methods multisite study. Nurse Educ Today. 2021;97:104676. https://doi.org/10.1016/j.nedt.2020.104676 . Barutçu CD. The Effects of Problem-Solving Ability on Clinical Decision Making Levels in Nursing Students. Med J Sdu. 2019;26(1):22–9. https://doi.org/10.17343/sdutfd.422401 . Chen SL, Hsu HY, Chang CF, Lin ECL. An exploration of the correlates of nurse practitioners’ clinical decision-making abilities. J Clin Nurs. 2016;25(7–8):101624. https://doi.org/10.1111/jocn.13136 . Wiles LL, Simko LC, Schoessler M. What do I do now? clinical decision making by new graduates. J nurses Prof Dev. 2013;29(4):167–72. https://doi.org/10.1097/NND.0b013e31829aeab3 . Çalışkan N, Karadağ M, Durmuş İskender M, Aydoğan S, Gündüz CS. The Effect of Critical Thinking Course on Nursing Students' Critical Thinking Tendencies and Critical Thinking Motivations. Turkiye Klinikleri J Nurs Sci. 2020;12(4):544–51. https://doi.org/10.5336/nurses.2020-75126 . Temel H. The Ef fect of Critical Thinking Course Carry Out with Distance Education on Critical Thinking Skills and Dispositions. Int J Psychol Educational Stud. 2022;9(3):792–808. https://doi.org/10.52380/ijpes.2022.9.3.894 . Jahanpour F, Sharif F, Salsali M, Kaveh MH, Williams LM. Clinical decision-making in senior nursing students in Iran. Int J Nurs Pract. 2010;16:595–602. https://doi.org/10.1111/j.1440-172X.2010.01886.x . Husna Sy H, Hasanuddin N, Darmayanti N. The Relationship Between Self-Confidence And Parents' Support With Students' Self-Regulation At Smp It Ad Durrah. Int J Sci Technol Manage. 2023;4. https://doi.org/10.46729/ijstm.v4i5.937 . Kwambaza CP, Basela JM. Parents' practices in promoting pupils' critical thinking skills in pre-primary schools. Int J Didactical Stud. 2024;5(2):26210. https://doi.org/10.33902/ijods.202426210 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 May, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 21 Apr, 2025 Reviews received at journal 20 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviewers invited by journal 05 Apr, 2025 Submission checks completed at journal 05 Apr, 2025 First submitted to journal 04 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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16:05:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1486708,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5604771/v1/5cc79627-ee90-4a2a-b35c-de8fb524e161.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation Of Clinical Decision-Making Perception of Nursing Students: The Aegean Region Case","fulltext":[{"header":"Introduction","content":"\u003cp\u003eClinical decision-making is a cornerstone of nursing practice, requiring nurses to consistently analyze patient data, prioritize care needs, and select appropriate interventions. It is defined as the process of selecting the best option from available alternatives, involving multiple cognitive steps, including problem identification and outcome evaluation [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]. In healthcare settings, clinical decision-making holds particular significance, especially for nurses who play a central role in direct patient care. Ineffective decision-making can result in negative consequences, such as medical errors, patient safety risks, and increased healthcare expenses. These potential outcomes highlight the necessity for precision and accountability in decision-making. In nursing, clinical decision-making entails applying professional expertise and skills, supported by clinical judgement, to provide high-quality patient care [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. The adequacy of nurses' clinical decision-making has a direct impact on patient outcomes, highlighting its significance in both nursing education and professional practice [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. Nurses play a critical role in monitoring changes in patients' conditions, prioritizing their care needs, and implementing suitable interventions [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, enhancing nurses' clinical decision-making abilities is vital for ensuring both patient safety and effective care delivery [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. The integration of evidence-based practice is fundamental to clinical decision-making, as it ensures that decisions are informed by the most reliable research, clinical expertise, and patient preferences. Utilizing evidence in practice allows nurses to reduce risks and enhance care quality, ultimately leading to better patient outcomes. Clinical instruction is outlined to assist nursing understudies bridge the crevice between hypothetical information and viable hone, and the clinical learning environment serves as a key component of their instruction [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. This environment not only enables students to apply theoretical concepts but also helps shape their professional identity by exposing them to real-world healthcare settings [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, the quality of the clinical learning environment significantly shapes students' perceptions and experiences.\u003c/p\u003e\n\u003cp\u003eA positive clinical learning environment, characterised by collaboration with staff, appreciation and opportunities for skill development, improves students' clinical decision-making skills [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. For example, positive mentorship from experienced nurses and regular constructive feedback can significantly enhance students' confidence and critical thinking skills. Similarly, providing opportunities for independent decision making under appropriate supervision is essential for the development of clinical judgement. Conversely, factors such as hierarchical structures, deficiencies in practice guidelines and inadequate support can hinder students' learning and decision-making processes [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. In addition, stress in the practice environment negatively affects nursing students' decision-making skills, highlighting the need for supportive and nurturing clinical environments [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. Understanding nursing students' perceptions of clinical choice making and the components of that influence this process is crucial for optimising nursing education and practice. This study focuses primarily on nursing students' perceptions of their clinical decision-making skills, rather than their actual decision-making skills in practice. By assessing these factors, educators and healthcare institutions can tailor educational interventions to enhance students' decision-making skills and improve patient care outcomes [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition, evidence from such evaluations contributes to the existing body of nursing literature and provides valuable guidance for educators, nurses and nursing students alike.\u003c/p\u003e\n\u003cp\u003eResearch questions;\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003e\u0026nbsp;What are the perceptions of nursing students in the Aegean region regarding their clinical decision making skills?\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u0026nbsp;What factors influence nursing students' perceptions of their clinical decision-making skills in the Aegean region?\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch3\u003eAim\u003c/h3\u003e\n\u003cp\u003eThe aim of this study was to assess nursing students' perceptions of clinical decision-making and the factors influencing the decision-making process.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eThis study was carried out as descriptive cross-sectional research.\u003c/p\u003e\n\u003ch3\u003eStudy setting and sample\u003c/h3\u003e\n\u003cp\u003eThe study population comprised 6551 nursing students in their second, third, and fourth years at ten universities in the Aegean region between 2017 and 2018. The study sample included 3633 students who voluntarily agreed to participate in the research after being informed about its purpose and procedures. No probabilistic sampling method was applied; instead, a convenience sampling approach was used, as participation was based on willingness and availability.\u003c/p\u003e\n\u003ch3\u003eData collection instruments\u003c/h3\u003e\n\u003cp\u003eData were gathered using a 13 item Personal Information Form and the 40 item Clinical Decision-Making in Nursing Scale. Approval was obtained from the original researchers before using these instruments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea) Personal Information Form;\u003c/strong\u003e Developed by the researchers based on existing literature, this form consists of 13 questions covering students' demographic details such as age, gender, income level, place of residence, self-assessment status, and whether they had received formal education on clinical decision-making.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb) Clinical Decision-Making in Nursing Scale (CDMNS);\u003c/strong\u003e This scale was originally developed by Jenkins (1983) [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e] and later adapted for Turkish use by Durmaz Edeer and Sarıkaya, who confirmed its validity and reliability [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. Designed specifically for nursing students in the United States, the scale evaluates students' perceptions of clinical decision-making based on their self-reported experiences. The reliability of the scale was measured using Cronbach\u0026rsquo;s alpha, which was reported as 0.83 in the original study [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e], while the Turkish version of the CDMNS demonstrated a Cronbach\u0026rsquo;s alpha coefficient of 0.78. The CDMNS consists of 40 items distributed across four sub-dimensions: \u0026lsquo;Searching for alternatives or options,\u0026rsquo; \u0026lsquo;Consideration of goals and values,\u0026rsquo; \u0026lsquo;Evaluation of consequences,\u0026rsquo; and \u0026lsquo;Searching for information and unbiased assimilation of new information.\u0026rsquo; Each sub-dimension contains 10 items. Among the 40 items, 22 (1, 3, 5, 7, 8, 9, 10, 11, 14, 16, 17, 18, 20, 26, 27, 28, 29, 33, 35, 36, 37, 38) are positively worded, while 18 (2, 4, 6, 12, 13, 15, 19, 21, 22, 23, 24, 25, 30, 31, 32, 34, 39, 40) are negatively worded and require reverse scoring. Responses are recorded on a five-point Likert scale, where 5\u0026thinsp;=\u0026thinsp;always, 4\u0026thinsp;=\u0026thinsp;often, 3\u0026thinsp;=\u0026thinsp;occasionally, 2\u0026thinsp;=\u0026thinsp;seldom, and 1\u0026thinsp;=\u0026thinsp;never. The total mean CDMN scale score ranges from 40 to 200, while sub-dimension scores range from 10 to 50. There is no predefined cut-off point; higher scores indicate a stronger perception of clinical decision-making ability, whereas lower scores reflect a weaker perception. The CDMNS was selected for this study due to its well-established reliability and validity in measuring nursing students' perspectives on clinical decision-making [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData collection was conducted at times that would not interfere with the students\u0026rsquo; academic responsibilities, such as during lunch breaks or after class sessions, but never during exams or active classroom instruction. Questionnaires were administered in designated areas outside of classrooms to ensure minimal disruption to the academic schedule. Prior to data collection, students were informed about the purpose of the study and how the data would be used. Participation was entirely voluntary; students who agreed to participate provided written informed consent. After signing the consent form, they completed the questionnaire. Researchers remained present throughout the process to address any questions or concerns the participants had. Completing the questionnaire took approximately 10\u0026ndash;15 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eof the study\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval\u0026nbsp;for the study was granted by the chair of a university's scientific research and publication ethics committee (approval number: 06/03/2018-E.68353). All participants provided informed consent after being informed about the study\u0026rsquo;s purpose, their voluntary participation, and their right to withdraw at any time. The research was conducted in compliance with the ethical guidelines outlined in the World Medical Association\u0026rsquo;s Declaration of Helsinki for studies involving human subjects.\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eData from the study were analysed using SPSS 25.0 (Statistical Package for the Social Sciences). Numbers and percentages were used for descriptive characteristics. In the evaluation of the data, the one-way ANOVA test was used to compare the total mean CDMNS scores and the sub-dimensions according to the year studied, the school and the place of residence, and the independent groups t-test was used for the paired comparison of the mean scores of the students according to their introductory characteristics (gender and taking courses in decision making). Forms with more than 20% missing data were excluded from the analysis.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the students participating in the study was 21.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73 years and the median age was 21 years. It was found that 74.3% of the students were female, 45.1% lived in the city center and 36.3% lived in the district. It was found that the average monthly income of the students was 798.89\u0026thinsp;\u0026plusmn;\u0026thinsp;737.46 Turkish Liras, 0.8% of them had a monthly income below 100 Turkish Liras and 69.1% of the students' families' income was equal to their expenses. In addition, 37.0% of the students lived in government dormitories, 22.3% lived with their friends, 37.0% were in the second grade, 32.9% were in the third grade, only 5.8% repeated a year, and 72.6% did not attend a clinical decision-making course.\u003c/p\u003e \u003cp\u003eWhen the factors influencing the students' clinical decision making were examined, it was found that 91.1% of knowledge level, 78.3% of previous experience, 58.1% of creative thinking, 57.4% of personal characteristics, 53.5% of environmental and situational stressors, 42.4% of time constraints, 34.4% of physical and mental illness and 32.1% of prejudice influenced clinical decision making. When the characteristics of the decision maker in the students' clinical decision making were examined, it was found that 85.4% had self-confidence, 81.1% took responsibility, 73.5% were able to focus on the problem, 64.9% were able to separate advantages and disadvantages, 49.9% were assertive and 35.6% were able to influence people.\u003c/p\u003e \u003cp\u003eThe total mean CDMNS score of the nursing students was 140.24\u0026thinsp;\u0026plusmn;\u0026thinsp;17.04. The mean sub-dimension scores of the students were: searching for alternatives or options 36.32\u0026plusmn; 5.33, evaluating consequences 35.91\u0026plusmn; 5.70, searching for information and unbiased assimilation of new information 34.11\u0026plusmn; 4.25 and considering goals and values 33.89\u0026plusmn; 4.35 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eMean CDMNS and Subscale Scores of Nursing Students (n: 3633)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCDMNS and Subscales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMax.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSearch for alternatives or options\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e36.32\u0026plusmn; 5.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanvassing of objectives and values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e33.89\u0026plusmn; 4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation of consequences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e35.91\u0026plusmn; 5.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSearch for information and unbiased assimilation of new information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e34.11\u0026plusmn; 4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCDMNS Total\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e140.24\u0026plusmn; 17.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e187.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eMean\u003c/b\u003e: Arithmetic mean, \u003cb\u003eSD\u003c/b\u003e: Standard deviation, \u003cb\u003eMin\u003c/b\u003e: Smallest value, \u003cb\u003eMax\u003c/b\u003e: Greatest value\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the clinical decision-making scores of nursing students according to the universities. A statistically significant difference was between the total mean CDMNS, searching for alternatives or options, exploring goals and values, evaluating consequences and searching for information and unbiased assimilation of new information sub-dimensions scores of nursing students according to the universities (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the advanced analysis (Tukey's test), there was no significant difference between the total mean CDMNS scores of the \"I\" University and the \"J\" University, but a significant difference was formed with the other schools, the difference being attributed to the high mean scores of these two schools. The difference between the scores of the sub-dimensions of the acquisition of goals and values was attributed to the mean scores of the students studying at the University of \"F\". The scores of the students at this school are low. The difference between the scores of the \"Evaluation of consequences\" sub-dimension was attributed to the mean scores of the students studying at the \"F\" university and at the \"C\" university. The scores of students studying at these schools are low.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Decision-Making Scores of Nursing Students According to the Universities\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal CDMNS score\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSearch for alternatives or options Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanvassing of objectives and values Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEvaluation of consequences Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSearch for information and unbiased assimilation of new information Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"I\" University (n: 266)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149.28\u0026plusmn;14.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.64\u0026plusmn;4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.83\u0026plusmn;3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.98\u0026plusmn;5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.81\u0026plusmn;4.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"J\" University (n: 370)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148.20\u0026plusmn;12.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.90\u0026plusmn;4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.08\u0026plusmn;3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.69\u0026plusmn;4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.52\u0026plusmn;3.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"D\" University\u003c/p\u003e \u003cp\u003e(n: 438)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145.15\u0026plusmn;16.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.98\u0026plusmn;5.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.69\u0026plusmn;3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.35\u0026plusmn;5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.11\u0026plusmn;4.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"H\" University (n: 288)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143.15\u0026plusmn;14.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.37\u0026plusmn;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.27\u0026plusmn;3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.87\u0026plusmn;5.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.63\u0026plusmn;4.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"A\" University (n: 474)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143.02\u0026plusmn;13 ,.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.50\u0026plusmn;4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.16\u0026plusmn;3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.94\u0026plusmn;4.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.41\u0026plusmn;3.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"G\" University (n: 331)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141.94\u0026plusmn;14.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.02\u0026plusmn;4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.08\u0026plusmn;3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.32\u0026plusmn;5.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.50\u0026plusmn;3.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"E\" University (n: 442)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138.57\u0026plusmn;14.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.93\u0026plusmn;4.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.33\u0026plusmn;3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.48\u0026plusmn;5.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.81\u0026plusmn;3.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"B\" University (n: 473)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138.05\u0026plusmn;16.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.66\u0026plusmn;5.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.53\u0026plusmn;4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.16\u0026plusmn;5.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.68\u0026plusmn;4.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"C\" University (n: 204)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130.50\u0026plusmn;12.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.51\u0026plusmn;3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.34\u0026plusmn;4.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.75\u0026plusmn;4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.88\u0026plusmn;3.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"F\" University (n: 347)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121.60\u0026plusmn;20.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.73\u0026plusmn;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.59\u0026plusmn;6.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.75\u0026plusmn;5.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.52\u0026plusmn;5.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF / p\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF: 97.736\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF: 109.350\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF: 59.946\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF: 92.558\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF: 48.060\u003c/p\u003e \u003cp\u003ep: 0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eMean\u003c/b\u003e: Arithmetic mean, \u003cb\u003eSD\u003c/b\u003e: Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the clinical decision-making scores of nursing students according to their classes. A statistically significant difference was reported between the mean scores of the nursing students for the total mean CDMNS score, searching for alternatives or options, canvassing goals and values, and evaluating consequences sub-dimensions according to their class. A statistically significant difference was found in the sub-dimension scores for seeking information and unbiased assimilation of new information according to students' grades (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the advanced analysis (Tukey's test), the difference between the total mean CDMNS scores was attributed to the mean scores of the sub-dimension s of the second and third grade students, the difference between the sub-dimensions of the search for goals and values was attributed to the mean scores of the third and fourth grade students, the difference between the sub-dimensions of the evaluation of consequences was attributed to the mean scores of the second grade students. The difference in the sub-dimension scores for searching for alternatives or options was not due to any grade.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Decision-Making Scores of Nursing Students According to their Classes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrades\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal CDMNS score\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSearch for alternatives or options Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanvassing of objectives and values Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEvaluation of consequences Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSearch for information and unbiased assimilation of new information Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd grade (n: 1345)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141.24\u0026plusmn;18.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.61\u0026plusmn;5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.93\u0026plusmn;4.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.38\u0026plusmn;5.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.31\u0026plusmn;4.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd grade (n: 1195)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139.48\u0026plusmn;17.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.14\u0026plusmn;5.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.61\u0026plusmn;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.72\u0026plusmn;5.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.99\u0026plusmn;4.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4th grade (n: 1093)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139.83\u0026plusmn;14.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.15\u0026plusmn;4.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.14\u0026plusmn;3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.54\u0026plusmn;5.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.00\u0026plusmn;3.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF / p\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF: 3,819\u003c/p\u003e \u003cp\u003ep: .022 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF: 3.259\u003c/p\u003e \u003cp\u003ep: .039 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF: 4.192\u003c/p\u003e \u003cp\u003ep: .015 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF: 7.505\u003c/p\u003e \u003cp\u003ep: .001 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF: 2.328\u003c/p\u003e \u003cp\u003ep: .098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eMean\u003c/b\u003e: Arithmetic mean, \u003cb\u003eSD\u003c/b\u003e: Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the clinical decision-making scores of nursing students according to their gender. The scores of the female students are higher than those of the male students. Our data showed that there was a statistically significant difference between the total mean CDMNS score and gender. Significant differences were also determined between the gender of nursing students and the mean scores of the sub-dimensions of seeking alternatives or options, considering goals and values, evaluating results, searching for information and assimilating new information impartially (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Decision-Making Scores of Nursing Students According to Gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal CDMNS score\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSearch for alternatives or options Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanvassing of objectives and values Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEvaluation of consequences Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSearch for information and unbiased assimilation of new information Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale (n: 2701)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142.21\u0026plusmn;16.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.81\u0026plusmn;5.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.26\u0026plusmn;4.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.56\u0026plusmn;5.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.56\u0026plusmn;4.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (n: 932)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134.52\u0026plusmn;17.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.87\u0026plusmn;5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.80\u0026plusmn;4.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.02\u0026plusmn;5.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.81\u0026plusmn;4.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003c/p\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et: 12.099\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et: 11.949\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et: 9,682\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: 9.402\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et: 8.891\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eMean\u003c/b\u003e: Arithmetic mean, \u003cb\u003eSD\u003c/b\u003e: Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the clinical decision-making scores of nursing students according to their status of taking a decision-making course. A significant difference was determined in terms of the total mean CDMNS score of nursing students according to their status of taking the decision-making course. The mean scores of the sub-dimensions of seeking alternatives or options, seeking purpose and value, and evaluating results also showed a statistically significant difference compared to taking the course before (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mean scores of students who had previously taken a decision-making course were significantly higher in these sub-dimensions. However, there was no significant difference in the information seeking and unbiased and unprejudiced retrieval of new information sub-dimensions due to having previously taken the course (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). No statistically significant difference was found between the mean scores of the sub-dimensions total CDMNS (p:.163), searching for alternatives or options (p:.317), seeking goals and values (p:.315), evaluating consequences (p:.172), and searching for information and unbiased assimilation of new information (p:.249) of the nursing students according to the income status of their families (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Decision-Making Scores of Nursing Students According to the Prior Decision-Making Course\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaking courses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal CDMNS score\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSearch for alternatives or options Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanvassing of objectives and values Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEvaluation of consequences Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSearch for information and unbiased assimilation of new information Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (n: 997)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141.72\u0026plusmn;16.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.83\u0026plusmn;5.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.18\u0026plusmn;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.37\u0026plusmn;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.33\u0026plusmn;4.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (n: 2636)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139.67\u0026plusmn;17.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.12\u0026plusmn;5.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.77\u0026plusmn;4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.73\u0026plusmn;5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.03\u0026plusmn;4.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003c/p\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et: 3.237\u003c/p\u003e \u003cp\u003ep: 0.001 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et: 3.557\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et: 2.534\u003c/p\u003e \u003cp\u003ep: 0.011 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et: 3.007\u003c/p\u003e \u003cp\u003ep: 0.003 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et: 1.878\u003c/p\u003e \u003cp\u003ep: 0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eMean\u003c/b\u003e: Arithmetic mean, \u003cb\u003eSD\u003c/b\u003e: Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows the clinical decision-making scores of nursing students according to their residence places. A statistically significant difference was found between total mean CDMNS score, the search for alternatives or options, the exploration of goals and values, and the evaluation of consequences sub-dimension scores of the nursing students according to their place of residence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In advanced analysis (Tukey's test) we found that the difference in total mean CDMNS scores came from students who stayed with their family. There was a significant difference between those who stayed with their family, those who stayed with their friends and those who lived at home alone in terms of the mean scores for the sub-dimensions seeking alternatives or options, assessing consequences and seeking information and taking in new information without bias. In the canvassing of objectives and values sub-dimension, a significant difference was found between those who stayed with their family and friends, those who stayed in the state dormitory and those who lived alone at home (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Decision-Making Scores of Nursing Students According to Residence Places\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of stay\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal CDMNS score\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSearch for alternatives or options Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCanvassing of objectives and values Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEvaluation of consequences Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSearch for information and unbiased assimilation of new information Mean\u0026plusmn;sd\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState dormitory (n: 1346)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140.31\u0026plusmn;16.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.28\u0026plusmn;5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.90\u0026plusmn;4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.99\u0026plusmn;5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.13\u0026plusmn;4.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate dormitory (n: 501)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141.03\u0026plusmn;17.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.68\u0026plusmn;5.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.91\u0026plusmn;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.15\u0026plusmn;5.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.27\u0026plusmn;4.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith family (n: 703)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142.71\u0026plusmn;17.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.95\u0026plusmn;5.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.53\u0026plusmn;4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.52\u0026plusmn;5.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.69\u0026plusmn;4.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith relative (n: 54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138.77\u0026plusmn;16.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.83\u0026plusmn;5.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.85\u0026plusmn;4.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.38\u0026plusmn;5.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.70\u0026plusmn;4.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith friend\u003c/p\u003e \u003cp\u003e(n: 810)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138.30\u0026plusmn;16.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.82\u0026plusmn;5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.50\u0026plusmn;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.31\u0026plusmn;5.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.65\u0026plusmn;4.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome alone (n: 219)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137.51\u0026plusmn;18.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.60\u0026plusmn;5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.14\u0026plusmn;4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.23\u0026plusmn;6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.52\u0026plusmn;4.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF: 6.535\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF: 4.760\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF: 5.706\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF: 4.373\u003c/p\u003e \u003cp\u003ep: 0.001 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF: 5.633\u003c/p\u003e \u003cp\u003ep: 0.000 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eMean\u003c/b\u003e: Arithmetic mean, \u003cb\u003eSD\u003c/b\u003e: Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe clinical decision-making process is a fundamental skill in professional nursing practice [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This process involves selecting the proper option for the nursing care and associating this choice with past experiences [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To provide safe and high-quality patient care, nursing students, who are the future healthcare professionals, must also have advanced clinical decision-making skills [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, the total mean CDMNS scores of nursing students is 140.24\u0026plusmn;17.04. Considering that the maximum score that can be obtained from this scale is 200, it can be said that the average score of this study is at a good level. Similarly, the total mean CDMNS scores are reported as 125\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0 by Farčić, 147.72\u0026thinsp;\u0026plusmn;\u0026thinsp;12.05 by Ahmed, and 141.91\u0026thinsp;\u0026plusmn;\u0026thinsp;14.08 by \u0026Ouml;zden et al [15; 17; 10]. However, in Arkan et al.'s study, the total mean CDMNS score was 100.81\u0026thinsp;\u0026plusmn;\u0026thinsp;18.69, and they evaluated this score as moderate [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The total mean CDMNS scores studies in the literature determine scores between (120\u0026ndash;150) ande they are expressed as a good level. Therefore, we can say that our study also has a good level of total mean CDMNS score.\u003c/p\u003e \u003cp\u003eIn our study, the mean score of \u0026ldquo;Searching for alternatives or options\u0026rdquo; sub-dimension is 36.32\u0026plusmn; 5.33. The mean score of the \u0026ldquo;alternative or option search\u0026rdquo; sub-dimension was reported as 33.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 in Farc\u0026iacute;c\u0026rsquo;s study, 25.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38 in Ahmed\u0026rsquo;s study, and 36.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79 in \u0026Ouml;zden\u0026rsquo;s study [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It is seen that the mean scores of this sub-dimension are higher than the other sub-dimensions but are at the average value. This can be interpreted as nursing students may need approval because they do not yet have the authority to make independent decisions and therefore tend to evaluate all options.\u003c/p\u003e \u003cp\u003eIn our study, the lowest score (33.89\u0026plusmn; 4.35) was observed in the \u0026ldquo;Canvassing of objectives and values\u0026rdquo; sub-dimension. For the same sub-dimension, Arkan reported mean scores of 22.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.19, Farčić 32.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 and Ahmed 37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. \u0026ldquo;Canvassing of objectives and values\u0026rdquo;, ​​sub-dimension scores are also moderate in our sample. This may be due to the nursing students' lack of professional goal and value perception. In addition, nursing education in different universities may not have demonstrated equal competence in conveying common values ​​and goals to students.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Evaluation of consequences\u0026rdquo; sub-dimension score is 35.91\u0026plusmn; 5.70 in our sample. This is the second highest sub-dimension score in our study. Arkan reported the score as 26.54\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61 in same sub-dimension [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In Turkey, from the first year of undergraduate nursing education, students are asked to create nursing care plans for each patient they care for. This method aims to develop the critical thinking skills of students who create nursing care plans and get used to evaluating their results. The mean scores of this sub-dimension show that students' critical thinking skills and awareness are at a moderate level.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Search for information and unbiased assimilation of new information\u0026rdquo; sub-dimension is 34.11\u0026plusmn; 4.25 in our study. In Davoodi's study, it was determined that the same sub-dimension was the sub-dimension with the lowest mean score, with 21.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This score shows that the students in our sample have not fully developed their ability to search for information and assimilate new information objectively, since they are still in the education period.\u003c/p\u003e \u003cp\u003eDecision making is defined as choosing from a series of options. Nurses are constantly making new decisions based on the outcomes of their care. Moreover, these decisions are often time limited. Considering that each sub-dimension can be scored between 10 and 50, it is seen that all sub-dimension score averages in our study are at moderate levels. Education level, self-confidence and sufficient professional knowledge positively affect nurses' decision-making skills. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It can be thought that these characteristics of the students included in our study are not yet at the desired level and therefore their sub-dimension score averages are at a moderate level.\u003c/p\u003e \u003cp\u003eIn our study, the CDMNS was applied to nursing students who did not yet have working experience. In Farci ́c\u0026rsquo;s study nurses with more than 31 years of work experience had a total mean CDMNS score of 129.87\u0026thinsp;\u0026plusmn;\u0026thinsp;17.84, as well as higher scores in all sub-dimensions [15]. When the scores of nurses with 31 years or more working experience are examined, it is obvious that the students in this study have very good CDMNS scores despite their lack of experience. As in the study conducted by Arkan et al., in our study, it is determined that the average score of inexperienced nursing students is at a good level.\u003c/p\u003e \u003cp\u003eWhen students were asked about the characteristics that people who will make clinical decisions should have, the most emphasized characteristics were self-confidence (85.4%) and taking responsibility (81.1%). Farˇci'c et al., observed higher and significant (p\u0026thinsp;=\u0026thinsp;0.003) clinical decision-making skills in nurses with longer working experience. However, no statistically significant relationship was detected between self-confidence and decision-making ability [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Hagbaghery et al. report that feeling competent and self-confident is necessary to make the right clinical decision. They also emphasize that institutional structure, nursing education and instructor support also affect this process [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe support students receive from the team in clinical environments affects their options evaluation and decision-making processes. In Wong's study, in which he examined the conditions that affect critical thinking and decision-making, simulation, case study, clinical experience, and guidance of clinical consultants were identified as strategies that support clinical decision-making [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Support received from the clinical counselor affects the clinical decisions positively. It is known that students' self-confidence increases in environments where instructors are involved in the learning process. In environments where students carry out their practices with awareness, their clinical decision-making skills also improve [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study demonstrated that students' clinical decision-making skills were primarily influenced by their level of knowledge and previous experiences. It is well established that these factors play a crucial role in shaping decision-making abilities. Research conducted by Phillips et al. indicates that environmental conditions impact students' clinical decision-making skills by 75% [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Additionally, studies suggest that as students gain more knowledge and hands-on clinical experience, their ability to make informed decisions regarding individual patient care significantly improves [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany uncontrollable variables such as stress can affect the total mean CDMNS scores of nursing students in different universities. In this research, students' total mean CDMNS and sub-dimension scores were examined according to universities. The total mean CDMNS scores of different universities were close to each other and statistically significant. In our country, nursing programs are supervised by a single center. The education plans of undergraduate nursing students at each university are similar. Undergraduate nursing education at each university is completed by taking a total of 240 ECTS at the end of 8 semesters. However, the content of the curriculum and the order of application may differ between universities. For example: While nursing students at one university may start their internship in the first semester, those at another university may start their internship in the third semester. Differences between universities may vary depending on clinical practice conditions, educational opportunities, student characteristics and the number of advisors. Studies in the literature indicate that there may be differences arising from different countries, education systems, curriculum contents and application environments [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This study examined universities located in a specific region of the country and managed by a single center. Therefore, the curricula of the faculties are basically similar. The conditions required for graduation and the achievement targets are common. Although there are differences in the order of the education process, there are no regional curriculum differences. Therefore, the results obtained are important in terms of reflecting all schools in the specified region. In our study, universities providing nursing education in the Aegean region were examined. The data obtained suggest that there are differences between universities despite similar curricula. Planning common goals through regular meetings, sharing experiences, supporting and evaluating the development of educators continuously, concretely evaluating student achievements, examining the reasons of deficiencies and monitoring areas that need development can be useful in supporting students' decision-making skills in schools in the Aegean region. Therefore, the data of our study is important in terms of revealing the necessity of common education and application stages throughout the country. For this purpose, the targets related to the applications should be re-planned in line with the needs and should be applied in the same way in each university. Standard education methods that will support students' self-confidence and decision-making skills should be established, concrete assessment tools should be developed and used throughout the country.\u003c/p\u003e \u003cp\u003eGlobally, nursing programs employ various educational approaches, and numerous studies have evaluated nursing students' critical thinking skills. Although these studies attempt to explain class-level differences from different perspectives, no universally accepted conclusion has been established in the literature. \u0026Ouml;zden et al. compared CDMNS scores among second, third, and fourth-year students reported that second and fourth-year students had higher and similar mean scores [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Likewise, Barut\u0026ccedil;u\u0026rsquo;s research examining the relationship between nursing students' problem-solving skills and clinical decision-making levels found that second-year students had higher total mean CDMNS and sub-dimension scores compared to third and fourth-year students. It was suggested that second-year students had a greater sense of competence might lead to challenges in patient care [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our country, undergraduate education is carried out in clinical environments with academic instructors. These instructors, who are also responsible from the theoretical education, work one-on-one in clinics with smaller groups of students in first years. In these stages second-year students work with fewer patients in clinical settings and can easily get consultancy from their academic instructors whenever they need. This may be the reason why second-year students had the highest average score in our study. It is thought that students who can reach their advisors at any time in the clinical environment and who have just received theoretical information can act more confidently because they feel the support of the faculty. The curriculum of all faculties included in the study consists of internship practices of 4th year students. All final year students work in clinical settings in their final year and mostly do their practices under the supervision of service nurses. This method aims to increase the collaboration of students approaching graduation with the clinical team and to support their self-confidence. In this stage, instructors mostly supervise the practices and the process. The responsibility for one-on-one practice is left to the service nurses. In this process, students who are alone with their future colleagues in a real working environment may sometimes feel inadequate. This situation may have reduced their decision-making skills.\u003c/p\u003e \u003cp\u003eIn our study, it was determined that the total mean CDMNS score increased again in the fourth grade. As we mentioned before, although the highest total mean CDMNS score was found in the second-grade students in our study, it shows that increasing knowledge and experience re-develop the decision-making skills of nursing students. We observed that total mean CDMNS scores which were low in the third-grade students, increased again as the duration of education increased. Literature finding are similar with our findings. Farˇci\u0026acute;c et al. determined that experienced nurses had higher total mean CDMNS and sub-dimension scores and the difference between them was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. We interpreted this data as \"the critical thinking skills of students increase as the time spent in clinical environments increases\".\u003c/p\u003e \u003cp\u003eClinical experience affects clinical decision-making ability [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Although it is reported in the literature that students' clinical decision-making skills increase with clinical experience, in our study, it was observed that the clinical decision-making levels of senior students were lower than those of students in lower grades. We determined that second-year students had the highest total mean CDMNS score. Wiles et al. stated that students with new theoretical knowledge had higher practice confidence and decision-making skills [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The total mean CDMNS scores of the second-year students in our study may be higher because of the same reason. Canova et al. examined the CDMNS scores of nurses and nursing students between 1997, 2007 and 2012. They determined that although nurses collected patient data, physicians used this data more in decision-making processes. This situation also can be the reason for the gradual decrease in CDMNS scores of nurses and nursing students over the years [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, the clinical decision-making levels of female students were determined to be higher than male students. Barut\u0026ccedil;u also found that there was a significant difference between the students' total mean CDMNS scores and their gender. He stated that the total mean CDMNS score and each sub-dimension score of female students were higher than male students and were statistically significant [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. \u0026Ouml;zden's determined that gender had no effect on students' clinical decision-making levels [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Most individuals who choose the nursing profession in Turkey are women. Therefore, the number of female students in our study is higher. This can be the cause of high and significant total mean CDMNS and subscale scores of female students. We believe that this significant difference in terms of gender is due to the insufficient number of male nurses in this study.\u003c/p\u003e \u003cp\u003eThis study reveals that students who took courses about decision-making had significantly higher mean total CDMNS scores. Similarly, \u0026Ouml;zcan's study, where he evaluated the effect of critical thinking training on teacher candidates, determined that the provided training improved critical thinking skills [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In their study where \u0026Ccedil;alışkan and his colleagues evaluated the effects of the critical thinking course given to nursing students, it was determined that the students' critical thinking tendencies increased after the course [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Temel states that the critical thinking training given to university students through distance education positively affects their critical thinking skills and tendencies [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Davoodi et al. determined that nurses who received critical thinking training had higher total mean CDMNS scores and subgroup scores and the difference between them was statistically significant [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. We did not examine when and by whom students took previously decision-making trainings. Therefore, the exact reasons for the difference between the scores of those who had received training before could not be determined.\u003c/p\u003e \u003cp\u003eInsufficient number of clinical instructors, low self-efficacy, inappropriate clinical learning environment and stress negatively affect students' independent decision-making processes [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Students define stress as a factor that disrupts their practice, distracts their attention, and hinders their decision-making skills [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. While the education method can effect decision-making skills in, being away from family and living alone also may have negatively affected decision-making skills. An analysis of students' clinical decision-making levels based on their living environment showed that those residing with their families had higher total mean CDMNS scores compared to other groups, with the difference being statistically significant. Research indicates a strong positive correlation between self-confidence and parental support [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Additionally, studies suggest that students who maintain a positive relationship with their families tend to develop stronger critical thinking skills [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The findings of this study highlight that students living with their families achieve higher total mean CDMNS scores and that family support plays a crucial role in enhancing critical thinking and decision-making abilities. It is evident that parental support has a positive impact on the critical thinking skills of nursing students.\u003c/p\u003e\n\u003ch3\u003eLimitations and Implications\u003c/h3\u003e\n\u003cp\u003eDespite some limitations, our findings provide important implications for future research and practice. One of the main limitations of this study is its cross-sectional design. This design may have been inadequate in correlating factors affecting clinical decision-making skills with outcomes. This study investigated nursing students' perceptions of clinical decision making. It should be noted that our study data are based on individual statements of a specific group. Therefore, it should be taken into consideration that it may not reflect clinical decision-making skills in real environments.\u003c/p\u003e \u003cp\u003eThe study was conducted in a specific region with undergraduate nursing students. Considering regional culture and student differences, generalization to other regions may be misleading. Therefore, the generalizability of our study results to all nursing faculties across the country may be limited.\u003c/p\u003e \u003cp\u003eThe number of male students in our study is small. Therefore, it may not be appropriate to make general inferences about gender differences.\u003c/p\u003e \u003cp\u003eWe did not examine when and by whom students took previously decision-making trainings. Therefore, the exact reasons for the difference between the scores of those who had received training before could not be determined. Further studies should be conducted to investigate the reason for this difference.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSignificance of the research\u003c/h2\u003e \u003cp\u003eThis study is important because it examines the factors that affect the decision-making skills of nursing students. It emphasizes the effects of education level, previous knowledge and experience, and stress on the development of clinical decision-making skills. It shows that training aimed at developing problem-solving skills in nursing education should be early and continuous. It discusses the effects of team and social support on decision-making skills. Nursing students who are educated in environments where these conditions are provided can have strong problem-solving skills. Thus, the quality of patient care can be improved, and patient satisfaction can be increased.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlighted the main factors affecting the clinical decision-making (CDM) skills of nursing students, with significant differences based on demographic, educational and environmental factors.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eThe total mean CDMNS score of the students in our study was 140.24\u0026thinsp;\u0026plusmn;\u0026thinsp;17.04 and was at a good level.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eA statistically significant difference in total mean CDMNS score was determined between universities\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eThe total mean CDMNS score of second-year students was the highest, but it dropped in the third grade and increased in fourth class again.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eThe female students total mean CDMNS score was better than male students.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eThe total mean CDMNS score of students who had prior decision-making were higher\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eThe total mean CDMNS score of students who lived with their family was higher\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe study findings are valuable in reflecting the importance of education, mentoring and a supportive environment in developing strong clinical decision-making skills.\u003c/p\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eRecommendations\u003c/h2\u003e\n\u003cp\u003eIn nursing education, it is very important to integrate decision-making courses into experiential learning opportunities. Theoretical and clinical training aimed at developing decision-making skills should be integrated into education curricula to improve students' clinical decision-making skills. A structured approach that includes tools such as decision-making algorithms, clinical reasoning cycles, and evidence-based practice guidelines should be systematically integrated into the nursing curriculum. Structured case-based discussions and scenario-based learning methods should be used to analyze thoughts and patient situations. In addition, students' self-confidence should be improved by providing a supportive environment based on collaboration in academic and clinical settings. Collaboration between education and health institutions should be increased, and a smooth transition from theoretical education to clinical practice should be provided. Students' decision-making skills should be strengthened with real-life scenarios. Nursing students should be trained to improve patient care outcomes through timely, accurate, and patient-centered interventions. Longitudinal studies examining the development of clinical decision-making skills from the first years of academic education should be planned. Studies examining the gender factor in decision-making skills should be conducted. Peer coaching programs, leadership training, awareness training and cognitive-behavioral techniques -Studies examining the effects of workload and stress management strategies on decision-making performance should be conducted. Application-specific modules, mentoring programs, and simulation-based training should be integrated into the nursing curriculum to improve students' clinical decision-making skills. Longitudinal studies should be planned to examine the development and change of clinical decision-making skills over time. All these studies should be expanded to include different populations and settings. In this way, the factors affecting clinical decision-making can be understood and integrated into nursing education.\u003c/p\u003e\n\u003cp\u003eThe findings from this study can be incorporated into nursing curricula through specific educational modules and mentoring programs. An educational structure integrated into three basic components should be established: (1) classroom-based theoretical education using case studies and interactive decision-making tools, (2) practical education using high-quality patient simulators and debriefing sessions, and (3) clinical mentoring programs where students are paired with experienced nurses and can practice decision-making in real time. Mentoring programs that pair students with experienced nurses can provide personalized guidance and practice in decision making in settings similar to real-life care settings. Additionally, clinical decision-making camps can be held to monitor students' progress and ensure that critical thinking and decision-making skills are strengthened throughout their education. Periodic skills assessments should be conducted, and competency checklists should be created.\u003c/p\u003e\n\u003cp\u003ePlanning common goals through regular meetings, sharing experiences, supporting and evaluating the development of educators continuously, concretely evaluating student achievements, examining the reasons of deficiencies and monitoring areas that need development can be useful in supporting students' decision-making skills in schools in the Aegean region.\u003c/p\u003e\n\u003cp\u003eFor this purpose, the targets related to the applications should be re-planned in line with the needs and should be applied in the same way in each university. Standard education methods that will support students' self-confidence and decision-making skills should be established, concrete assessment tools should be developed and used throughout the country.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e ; Prior to participation, all individuals provided informed consent for inclusion in the study. The research was conducted in compliance with the Declaration of Helsinki, and ethical approval was obtained from the Ethics Committee of Ege University (approval date and number: 06/03/2018-E.68353).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study did not receive financial support from any public, commercial, or non-profit funding organizations.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eStudy design: YCD, BSK, ADE, YC, EY, FG, NG, KK, BA, GO\u0026Ccedil;, ZS, MYVGData collection: YCD, BSK, ADE, YC, EY, FG, NG, KK, BA, GO\u0026Ccedil;, ZSData analysis: ADEStudy supervision: YCD, MYVGManuscript writing: YCD, ADE, BSK, ZSCritical revisions for important intellectual content: MYVG\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank all the students who agreed to participate in the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAvailability of data and materials: The data that support the findings of this study are available from the authors upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYıldırım B, \u0026Ouml;zkahraman Ş. 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Parents' practices in promoting pupils' critical thinking skills in pre-primary schools. Int J Didactical Stud. 2024;5(2):26210. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.33902/ijods.202426210\u003c/span\u003e\u003cspan address=\"10.33902/ijods.202426210\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Clinical Decision-making, Decision Making, Nursing, Student","lastPublishedDoi":"10.21203/rs.3.rs-5604771/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5604771/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe clinical learning environment is crucial for developing essential clinical decision-making skills in nursing students. This study examined nursing students' perceptions of clinical decision-making and the factors that impact it.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA descriptive cross-sectional study was carried out using a self-administered questionnaire, which included a personal information form and the Clinical Decision-Making in Nursing Scale (CDMNS). The study was conducted across ten universities in the Aegean region. Data collection took place at times most convenient for the students, such as during class sessions or lunch breaks. Prior to participation, students were briefed on the study's objectives and procedures. Those who agreed to participate provided informed consent before completing the questionnaire. Researchers remained present while students filled out the questionnaire to clarify any questions they had.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA considerable proportion of students (72.6%) had never received formal education on clinical decision-making. The average CDMNS score was 140.24±17.04, aligning with findings from previous research. A statistically significant difference was observed in the total mean CDMNS score and sub-dimension scores (searching for alternatives, questioning goals and values, evaluating outcomes, seeking information, and objectively integrating new knowledge) based on the university attended (p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe findings suggest that nursing students in the Aegean Region demonstrated a moderate level of perceived clinical decision-making skills. To enhance these skills further, it is recommended that alternative educational approaches, such as simulation-based training, case study discussions, and mentoring programmes, be integrated into nursing education and their effectiveness assessed.\u003c/p\u003e","manuscriptTitle":"Evaluation Of Clinical Decision-Making Perception of Nursing Students: The Aegean Region Case","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-10 06:17:59","doi":"10.21203/rs.3.rs-5604771/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-21T06:07:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-20T19:16:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156468629566867621000931648319493399579","date":"2025-04-08T03:29:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-05T22:07:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-05T07:36:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-04-04T21:21:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e585d319-6c8b-46e7-a2fd-4e0321e7cfee","owner":[],"postedDate":"April 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T16:00:35+00:00","versionOfRecord":{"articleIdentity":"rs-5604771","link":"https://doi.org/10.1186/s12912-025-03123-8","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-05-02 15:57:28","publishedOnDateReadable":"May 2nd, 2025"},"versionCreatedAt":"2025-04-10 06:17:59","video":"","vorDoi":"10.1186/s12912-025-03123-8","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03123-8","workflowStages":[]},"version":"v1","identity":"rs-5604771","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5604771","identity":"rs-5604771","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}