Chinese Translation and Psychometric Testing of the Peripheral Intravenous Catheter Insertion Self-Confidence Scale

Chinese Translation and Psychometric Testing of the Peripheral Intravenous Catheter Insertion Self-Confidence Scale | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (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];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Chinese Translation and Psychometric Testing of the Peripheral Intravenous Catheter Insertion Self-Confidence Scale View ORCID Profile Zhenzhen He , Pei Yu , Xuejing Jia , Lianlian Hu , Zhijie Xue , View ORCID Profile YiQing Lü , View ORCID Profile Caroline Marchionni doi: https://doi.org/10.1101/2025.11.25.25341024 Zhenzhen He 1 The Second Hospital of Tianjin Medical University RN, BScN Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Zhenzhen He For correspondence: hezhenzhen618{at}outlook.com Pei Yu 1 The Second Hospital of Tianjin Medical University MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Xuejing Jia 1 The Second Hospital of Tianjin Medical University RN, MScN Find this author on Google Scholar Find this author on PubMed Search for this author on this site Lianlian Hu 2 Chongqing Youth Vocational &Technical College RN, MM Find this author on Google Scholar Find this author on PubMed Search for this author on this site Zhijie Xue 1 The Second Hospital of Tianjin Medical University RN, BScN Find this author on Google Scholar Find this author on PubMed Search for this author on this site YiQing Lü 3 Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Goodman Cancer Institute, McGill University, Cancer Research Programme, McGill University Health Centre MBBS, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for YiQing Lü Caroline Marchionni 4 Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University RN, MSc Admin, MSc A Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Caroline Marchionni Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background and Purpose There is no tool in China to evaluate self-confidence in peripheral intravenous catheter insertion,this study aims to translate the Peripheral intravenous Catheter Insertion Self-Confidence Scale (PVCS) into Chinese and evaluate its reliability and validity among nursing students. Methods The translation and validation followed Brislin’s model, including forward translation, back-translation, synthesis, expert review, and pre-testing to develop the Chinese version (C-PVCS). A convenience sample of 205 nursing students from Tianjin and Chongqing, China, was surveyed to assess reliability and validity Results The Chinese version of the PVCS (C-PVCS)comprises 15 items in two dimensions: theoretical knowledge self-confidence (5 items) and operational skills self-confidence (10 items). The scale’s Cronbach’s α coefficient was 0.979, the split-half reliability was 0.944, and the test-retest reliability was 0.985. The average scale-level content validity index (S-CVI/Ave) was 0.966, and the item-level content validity index (I-CVI) ranged from 0.875 to 1.000. Exploratory factor analysis extracted two common factors, with a cumulative variance explained of 85.839%. For confirmatory factor analysis, the structural equation model fitting indices showed that the root mean square error of approximation (RMSEA) was 0.077, and the chi-square/degree of freedom ratio (χ2/df) was 2.22. Conclusion The C-PVCS demonstrates excellent reliability and validity, making it a suitable tool for assessing nursing students’ self-confidence in peripheral intravenous catheter insertion. Introduction Peripheral intravenous catheter insertion is among the most common invasive procedures in clinical practice( LI,L et al, 2024 ). It is often used for short-term fluid and drug administration, and approximately 75%-95% of hospitalized patients require intravenous fluid therapy( Jacobs, 2022 ; Keleekai et al, 2016 ; LI,L. et al, 2024 ). In this context,self-efficacy refers to an individual’s belief in their ability to successfully complete a specific behavior or task( Cruz et al, 2023 ). whereas “self-confidence” refers to the belief that one has the ability to successfully perform peripheral intravenous catheter insertion. Research has shown a direct correlation between the level of self-confidence in peripheral intravenous catheter insertion and the first-attempt success rate( Keleekai et al, 2016 ). Catheter insertion failure not only causes fear, pain, and decreased satisfaction for the patient, but also leads to complications like hematoma and nerve damage, while increasing the rate of infection and delaying medication time, which in turn increases hospital costs( Marsh et al, 2021 ). Currently, there is no tool in China to evaluate self-confidence in peripheral intravenous catheter insertion. In 2023, Marchionni et al( Marchionni et al, 2024 )developed the PVCS by revising and combining instruments from Schuster et al( Schuster et al, 2016 ) and Engum et al( Engum et al, 2003 ). The scale has since been translated and implemented in Turkey in 2024( Özbay et al, 2025 ). This study aims to translate this scale into Chinese and test its reliability and validity, providing a reliable tool for assessing the self-confidence level of nursing students in peripheral intravenous catheter insertion. Methods 1.1. Description of the Original Peripheral intravenous Catheter Insertion Self-Confidence Scale The original scale has three dimensions and 15 items. These are “learning self-confidence” (4 items), “preparation and securement self-confidence” (4 items), and “insertion self-confidence” (7 items). A 5-point Likert scale is used to evaluate the content, with options ranging from “strongly disagree” to “strongly agree”, corresponding to scores of 1 to 5, respectively. The scores for all items are summed to get a total score ranging from 15 to 75,a higher total score indicates greater self-confidence in peripheral intravenous catheter insertion. The overall Cronbach’s α coefficient of the scale is 0.89, with dimension αs ranging from 0.72 to 0.85, demonstrating good reliability. 1.2. Scale Translation and Cultural Adaptation 1.2.1. Scale Translation After obtaining email permission from the scale’s author, the translation was conducted following the Brislin translation model( GUO,J.Y. & LI,Z., 2012 ). ① Forward translation: One nursing master’s student with a CET-6 English level and one university English major teacher independently translated the original scale to create versions T-1 and T-2. ② Synthesis: A university nursing teacher systematically compared the original scale with T-1 and T-2 to produce a synthesized T-3 version. Three translators then discussed T-1, T-2, and T-3 to reach a consensus, forming the official forward-translated version T. ③ Back-translation: Two Ph.D. students in nursing separately translated the T version back into English, forming BT-1 and BT-2. A master’s student majoring in English then compared T with BT-1 and BT-2. After an in-depth discussion, a back-translated version, BT-3, was finalized. ④ Expert Committee Review: A committee consisting of three forward translators and three back-translators discussed and compared the original scale, forward-translated versions (T-1, T-2, T-3), and back-translated versions (BT-1, BT-2, BT-3). They revised any inappropriate or ambiguous expressions and, after reaching a consensus, selected the most appropriate wording to create the final back-translated version BT. ⑤ Original Author Review: The forward-translated T version and the back-translated BT version were sent to the original author for feedback and correction. After receiving a unified opinion, the Chinese version of the Peripheral intravenous Catheter Insertion Self-Confidence Scale was finalized. 1.2.2. Cultural Adaptation and Content Validity Check This study invited a group of eight experts with extensive academic backgrounds in nursing or education and long-term experience in nursing management to form an expert panel. They were tasked with conducting a cross-cultural adaptation and content validity evaluation of the scale. The expert panel included two deputy chief nurses, one chief physician in nephrology, two nursing education experts, and three clinical nurse managers. The panel consisted of two males and six females, with an average of 24-34 (25.87 ± 5.13) years of work experience. One expert held a doctoral degree, four held master’s degrees, and three held bachelor’s degrees. Two experts had senior professional titles, and three had vice-senior professional titles. The experts were asked to systematically evaluate the scale based on their work experience and expertise, focusing on the relevance of the scale items and the clarity of their expression. During the expert group review, special attention was paid to the cultural adaptability of the items. Some vocabulary and contextual expressions were adjusted to ensure they align with the cognitive habits and linguistic preferences of Chinese nursing students. Based on these revisions, the researchers further refined the scale, resulting in the C-PVCS. 1.2.3. Pre-survey This study conveniently selected 20 trainee nurses from a hospital in Tianjin to participate in a pre-survey using the Chinese version of the Peripheral intravenous Catheter Insertion Self-Confidence Scale. The inclusion criteria were: (1) currently enrolled nursing students who had systematically studied the peripheral intravenous catheter insertion course, and (2) had normal comprehension and communication skills and voluntarily participated in the study. The exclusion criterion was: nursing students who had not systematically studied the peripheral intravenous catheter insertion course. Before the study, the nurses were informed of the purpose and significance of the study and asked to scan a QR code via WeChat to complete the survey. During the survey, they were asked if they understood the scale’s meaning and if there was any ambiguity in the content, and their questions were answered immediately. The time required to complete the questionnaire was also recorded. Based on the pre-survey results, the final C-PVCS was determined. 1.3. Reliability and Validity Testing 1.3.1. Participants The study participants were nursing students from three universities in Tianjin and Chongqing. The sample size calculation is based on the number of items in the scale, set at 5-10 times the number of scale items( WEI,Y.T. et al, 2025 ),plus 20% attrition (e.g., due to missing data and invalid questionnaires), targeting 94-188 samples (actual n=205). The inclusion and exclusion criteria were the same as those for the pre-survey and were approved by the hospital’s ethics committee. The ethics approval number was KY2025K394. 1.3.2. Survey Tools The survey tools consisted of a general information questionnaire for nursing students and the Chinese version of the Peripheral intravenous Catheter Insertion Self-Confidence Scale. The general information questionnaire, determined through literature review and group discussion, included gender, age, education level, number of venipunctures, clinical practice status, theoretical test scores, and practical skills test scores. 1.3.3. Data Collection Methods The content of the Chinese version of the Peripheral intravenous Catheter Insertion Self-Confidence Scale was entered into the Wenjuanxing software, with a setting that required all questions to be answered before submission. It was also set to allow only one submission per mobile phone. The questionnaires were distributed via a university teacher in Chongqing who sent a QR code to a class group, or by on-site QR code scanning for nursing students in clinical practice in a tertiary hospital in Tianjin. After the questionnaires were completed, the research team carefully reviewed them to ensure they were complete and valid and to check for incorrectly selected options. Two weeks later, 50 nursing students were randomly selected to complete the questionnaire again by scanning the QR code.During this period, there were no unexpected incidents, changes in the teaching environment, or training intervention events. 1.3.4. Analysis Methods of the Reliability and Validity Test 1.3.4.1. Item Analysis (1) Critical Ratio Method( LI,Z. et al, 2023 ): The difference in mean scores between the high-scoring group (top 27%) and the low-scoring group (bottom 27%) for each item was calculated. An independent samples t-test was used to verify if the difference was significant. If the significance level P 3.0, the item’s discriminative power was considered significant and thereby retained. (2) Correlation Coefficient Method( LI,Z. et al, 2023 ): The correlation coefficient between the total scale score and each item score was calculated to assess their relationship. Items with an absolute correlation coefficient of at least 0.4 and a P-value of less than 0.05 after significance testing were retained, and others were eliminated. 1.3.4.2. Validity Testing Validity was assessed using content validity and construct validity. (1) Content Validity: The Delphi method( Neupane & Bhattarai, 2024 ) was used for expert consultation to evaluate content validity. Experts rated the relevance and representativeness of the scale’s items on a scale from 0 to 4, with 0 being “not relevant” and 4 being “strongly relevant”. An item-level content validity index (I-CVI) of at least 0.78, an average scale-level content validity index (S-CVI/Ave) of at least 0.90, and a universal agreement content validity index (S-CVI/UA) of at least 0.8 indicate good content validity( ZHANG,C. & ZHOU,Y.X., 2020 ), suggesting that the scale comprehensively and accurately measures the intended concept. (2) Construct Validity: Construct validity tests the consistency between the measurement results and the theoretical framework. Before conducting factor analysis, the preconditions of the Kaiser-Meyer-Olkin (KMO) value and Bartlett’s Test of Sphericity must be met. A KMO value ≥ 0.8 and a Bartlett’s test P < 0.05 are considered suitable for exploratory factor analysis. Exploratory factor analysis used the principal component analysis method and the varimax rotation method. Dimensions were extracted based on an eigenvalue > 1, and items with a factor loading < 0.4 or high loadings on multiple factors were considered for deletion( JIA,X.J. & SHI,B.X., 2024 ). Confirmatory factor analysis used the maximum likelihood method to evaluate model fit. The criteria for judging the model were: an absolute fit index of chi-square/degree of freedom (χ2/df) < 3.000, a root mean square error of approximation (RMSEA) 0.900, which indicates a good fit of the structural equation model( YANG,E.M. et al, 2024 ). 1.3.4.3. Reliability Testing Reliability was tested using three methods. ① Internal Consistency Reliability: The most commonly used indicator is Cronbach’s α coefficient, which ranges from 0 to 1. A higher α value indicates better internal consistency. An α value of 0.80 or higher indicates good reliability( JIANG,Y. et al, 2005 ). ② Split-Half Reliability: The split-half reliability was calculated using the Spearman-Brown coefficient. A value greater than 0.70 indicates good split-half reliability( WANG,J.W. et al, 2025 ). ③ Test-Retest Reliability: Two weeks later, 50 undergraduate nursing students were randomly selected from the original participants to complete the questionnaire again. The Pearson correlation coefficient was used to test the correlation between the two sets of scores. A correlation coefficient > 0.75 indicates good test-retest reliability( LI,C. & XIN,L., 2008 ). 1.4. Statistical Methods The results obtained from Wenjuanxing were downloaded into an Excel spreadsheet. SPSS 27.0 and AMOS 29.0 software were used for data processing. Following statistical norms, quantitative data that met the normal distribution conditions were described using mean and standard deviation. Count data were presented using frequency statistics and percentages. The significance level was set at α=0.05. Results 2.1. Results of Cultural Adaptation and Pre-survey Based on cultural adaptation and pre-survey results, the revised content and reasons are shown in Table 1 . The pre-survey participants were aged 19-21, with four males and 16 females, and completion time between 1 and 4 minutes. View this table: View inline View popup Table 1 Content and Reasons for Scale Revision 2.2. General Information of the Participants A total of 205 nursing students participated in the questionnaire survey, and all were valid, with a 100% response and recovery rate. The results of the general information are detailed in Table 2 . View this table: View inline View popup Download powerpoint Table 2 General information of the nursing students (n = 205) 2.3. Item Analysis Results The CR values for each item ranged from 20.974 to 58.084, all significantly higher than 3, with a significance level of P < 0.001, indicating good discrimination for each item. The correlation coefficients between each item score and the total scale score ranged from 0.716 to 0.941, all greater than 0.4, with a significance level of P < 0.001. No items were eliminated. 2.4. Validity Test Results 2.4.1. Content Validity The I-CVI of the scale was 0.875-1.000, the S-CVI/UA was 0.866, and the S-CVI/Ave was 0.966. This indicates good content validity, and each item can effectively reflect the level of self-confidence in peripheral intravenous catheter insertion. 2.4.2. Construct Validity The KMO value was 0.951, and the chi-square for Bartlett’s test was 5125.413, with a P-value less than 0.001. All indicators showed that the scale’s data structure met the prerequisites for factor analysis and could effectively extract common factors. Based on an eigenvalue > 1, exploratory factor analysis extracted two common factors, which, combined with the scree plot results, led to the final determination of two factors. The cumulative variance explained was 85.839%, indicating a strong explanatory power for the original variables. Based on the content of the items, Factor 1 was named “Theoretical Knowledge” and Factor 2 was named “Operational Skills”.Items 4 and 5 had cross-loadings but were retained for content relevance. The rotated component matrix is shown in Table 3 . The fitting indexes of the structural equation model indicated that the initial model had a poor fitting effect. After adding residual path correction through the modification index (MI), the results of each fitting index were as follows: χ²/df=2.22, NFI=0.967, RFI=0.956, IFI=0.981, TLI=0.975, CFI=0.981, and RMSEA=0.077, suggesting that the model fits well. The modified structural equation model is shown in Figure 1 View this table: View inline View popup Table 3 Rotated component matrix of the Chinese version of the Peripheral Intravenous Catheter Insertion Self-Confidence Scale ( n = 205) Download figure Open in new tab Figure 1. Modified Structural Equation Model Diagram Note. F1=Theoretical Knowledge. F2=Operational Skills 2.5. Reliability Test Results The reliability test results for the Chinese version of the Peripheral intravenous Catheter Insertion Self-Confidence Scale were good. Internal consistency analysis showed that the total Cronbach’s α coefficient was 0.979. The Cronbach’s α coefficients for the “theoretical knowledge” and “operational skills” dimensions were 0.935 and 0.985, respectively. In the split-half reliability test, the total split-half reliability was 0.944. The split-half reliability coefficients for the two dimensions were 0.891 and 0.987. The test-retest reliability results showed a total test-retest correlation coefficient of 0.985. The test-retest reliabilities for the two dimensions were 0.984 and 0.973, respectively. All reliability indicators were at a high level. Discussion 3.1. The Chinese Version of the Peripheral intravenous Catheter Insertion Self-Confidence Scale Has Good Reliability Reliability is used to evaluate the consistency of measurement results from multiple measurements or under different conditions. A higher scale reliability indicates a more reliable and stable measurement tool( YE,W.Q. et al, 2023 ). The C-PVCS shows high reliability, with Cronbach’s α >0.93, split-half >0.89, and test-retest >0.97, indicating consistency and stability. 3.2. The Chinese Version of the Peripheral intravenous Catheter Insertion Self-Confidence Scale Has Good Validity Validity refers to the degree to which a research tool reflects the content it is intended to study. A higher validity indicates that the scale more accurately reflects the studied content( DU,R.F. et al, 2020 ). The content validity study results showed that the scale’s I-CVI and S-CVI metrics exceed thresholds, indicating that the scale content can accurately reflect the level of self-confidence in peripheral intravenous catheter insertion. Construct validity reflects the scale’s internal factor structure. The exploratory analysis extract two common factors,compared to the original scale, after localization, combined the “preparation and securement self-confidence” and “insertion self-confidence” into a single “operational skills” dimension. Item 1 of the original scale was attributed to the “theoretical knowledge” dimension. This may be related to the cultural differences between China and the West and differences in teaching curriculum design. Catheter preparation and insertion both belong to the operational skills aspect, which is more consistent with the educational model for nursing students in China.Items 4 and 5 have high factor loadings on both dimensions. However, after repeated discussions by the expert group, it is considered that these two items are irreplaceable for measuring nursing students’ confidence in theoretical knowledge from the perspective of content validity, so it was decided to retain them 3.3. The Chinese Version of the Peripheral intravenous Catheter Insertion Self-Confidence Scale Has Good Application Value Peripheral intravenous catheter insertion is one of the most basic invasive operational skills in clinical practice, and it is a fundamental skill that nursing staff must master. Mastering this skill is crucial for improving clinical practice and patient safety( García-Expósito et al, 2021 ). The Peripheral intravenous Catheter Insertion Self-Confidence Scale can effectively identify nursing students with poor self-confidence, allowing for targeted training and interventions to improve their confidence and success rate.This scale can serve as a teaching assessment tool, guiding teaching staff to adopt targeted teaching interventions based on the score differences of nursing students in the two dimensions of “theoretical knowledge” and “operational skills”. For nursing students with insufficient confidence in theoretical knowledge, theoretical knowledge competitions or case analyses can be added; for those with insufficient confidence in operational skills, simulated practical training such as virtual simulation or OSCE (Objective Structured Clinical Examination) can be provided to systematically improve their confidence and skill levels. The C-PVCS addresses a gap in China, where prior studies used unvalidated tools( CHEN,M. R. & ZHANG,X., 2024 ; PENG,N. et al, 2020 ). Its items are specific and highly targeted, consists of multiple-choice questions, is easy to complete, takes 1-4 minutes to fill out, and is highly operable. it is practical for nursing education. Conclusion This study obtained the Chinese version of the Peripheral intravenous Catheter Insertion Self-Confidence Scale through translation, cultural adaptation, and a pre-survey, and tested its reliability and validity among nursing students. The Chinese version of the scale has good reliability and validity and can be used to evaluate the self-confidence level of nursing students in peripheral intravenous catheter insertion. This study uses convenience sampling, and the research subjects are mainly concentrated in specialist nursing students, and the sample size of undergraduate and graduate nursing students is small, which may affect the generality of the results. Future studies may consider expanding sample sizes and employing methods such as stratified sampling to improve sample representativeness. In addition, while we have retained some of the entries with double loading through expert opinion, this also suggests the need to further validate their structural validity in a wider sample in the future. The study subjects were nursing students, but future research could include newly hired nurses to explore its applicability and differences in self-confidence among that group. Data Availability All data produced in the present study are available upon reasonable request to the authors Acknowledgements We thank all nursing trainees for completing the surveys and their mentors for organising data collection. We also thank all colleagues at the Department of Nephrology, The Second Hospital of Tianjin Medical University, for helpful comments. References ↵ Chen , M. R. & Zhang , X . ( 2024 ). 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