ArticleInternational journal of nursing studies advances2026
Factors influencing clinical decision-making skills among nurses in Malaysia: A three-level general linear mixed-effects analysis.
Article in International journal of nursing studies advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Clinical decision-making skills are fundamental to safe and effective nursing practice. While prior studies have identified individual-level factors, they have often overlooked the hierarchical structure of nursing practice. Objective: This study aimed to investigate the complex determinants of clinical decision-making skills among Malaysian nurses at the individual, hospital-department, and regional levels using multilevel analysis. Design: A quantitative, cross-sectional study. Settings: Hospital departments across six diverse regions in Malaysia. Participants: A total of 796 registered nurses (response rate = 99.5%) from 40 hospital departments participated in the final analysis. Methods: A three-level mixed-effects regression model was used to analyse the nested data collected from a target sample of 800 nurses. Results: The sample was predominantly female (96%), with an average of 12.8 years of clinical experience. At the individual level, clinical decision-making scores were significantly predicted by higher critical thinking scores ( Conclusion: Clinical decision-making skills are shaped by a complex interplay of individual attributes and contextual factors. This research provides a foundation for developing targeted, multifaceted strategies in nursing education and policy to enhance professional competency and improve patient outcomes.
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