Objective

2

To explore the application of clinical decision-making matrix instructional design among orthopedic nursing interns and evaluate its impact on their clinical decision-making abilities and professional identity.

Methods

2

A total of 60 nursing interns at the Department of Orthopedics

First Affiliated Hospital of Air Force Medical University between May 2023 and July 2024 were selected as teaching subjects and randomly divided into an intervention group and a control group

with 30 participants in each group. The intervention group received the clinical decision-making matrix teaching through a three-stage approach: introduction and training

guided pract

ice

independent application and reflection

while the control group received conventional shadowing-based teaching. Quantitative assessments were conducted using the Clinical Decision-Making Ability Scale for Nurses and the Nursing Student Professional Identity Scale. Qualitative analysis was performed via teaching satisfaction questionnaires

semi-structured interviews (

n

=12)

and reflective journals (

n

=60). Two-factor repeated measures ANOVA and

t

-tests were conducted using SPSS 26.0.

Results

2

The total clinical decision-making ability score of the intervention group increased from 63.73±12.51 points upon entering the department to 103.19±8.61 points upon completing the rotation

surpassing that of the control group (between-group main effect

P

<

0.001

interaction effect

P

<

0.001). Scores across all dimensions increased

with notable increases in the decision-making plan and evaluation feedback dimensions. The total professional identity score exhibited a V-shaped pattern. In the teaching satisfaction survey

the intervention group scored higher than the control group in the dimensions of decision-making confidence promotion (4.25±0.69 vs. 3.85±0.84

P

=0.002) and professional identity promotion (4.15±0.73 vs. 3.82±0.85

P

=0.008). Qualitative analysis identified core themes such as the shift in cognitive frameworks from stress response to prospective reasoning and the evolution of professional roles from task executors to key decision-making collaborators

indicating that the matrix effectively enhanced their decision-making confidence and professional identity.

Conclusions

2

Clinical decision-making matrix teaching can improve the clinical decision-making abilities of orthopedic nursing interns and effectively promote the positive development of their professional identity

proving to be an effective teaching method. Future improvements may involve the digitalization of tools and the optimization of teaching pacing.