{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:54:08Z","timestamp":1792184048479,"version":"4.4.0"},"reference-count":81,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005716","name":"Babol University of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005716","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Open"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aimed to develop and psychometrically evaluate the Critical Reflection Competency in Delirium Care Scale (CRCDCS) among ICU nurses in Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This exploratory mixed\u2010methods study was conducted in Iran between June 2025 and March 2026 based on the eight\u2010step scale development framework proposed by DeVellis and Thorpe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Item generation was performed using a systematic literature review and semi\u2010structured interviews with 15 ICU nurses. Following qualitative and quantitative assessment of content and face validity, the preliminary 19\u2010item CRCDCS was administered to 700 ICU nurses. Participants were randomly allocated into two equal subsamples for exploratory factor analysis (EFA;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009350) and confirmatory factor analysis (CFA;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009350). Psychometric evaluation included parallel analysis (PA), exploratory graph analysis (EGA), convergent and discriminant validity, random forest modeling (RFM), and reliability assessment using Cronbach's alpha (\n                      <jats:italic>\u03b1<\/jats:italic>\n                      ), McDonald's omega (\n                      <jats:italic>\u03c9<\/jats:italic>\n                      ), intraclass correlation coefficient (ICC), and standard error of measurement (SEM).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      EFA identified a three\u2010factor structure comprising Analytical\u2013Evaluative Clinical Reflection (AECR), Person\u2010Centered Ethical Reflection (PCER), and Risk\u2010Oriented Preventive Reflection (ROPR), explaining 57.34% of the total variance. PA, EGA, and CFA supported the three\u2010factor model with excellent fit indices (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \/df\u2009=\u20091.14, CFI\u2009=\u20090.986, TLI\u2009=\u20090.984, RMSEA\u2009=\u20090.029, SRMR\u2009=\u20090.041). All factor loadings exceeded 0.40. Convergent and discriminant validity were confirmed. The scale demonstrated strong internal consistency (\n                      <jats:italic>\u03b1<\/jats:italic>\n                      \u2009=\u20090.876;\n                      <jats:italic>\u03c9<\/jats:italic>\n                      \u2009=\u20090.861) and good test\u2013retest reliability (ICC\u2009=\u20090.85, 95% CI: 0.82\u20130.91). RFM indicated that AECR items contributed most to the internal item\u2010set structure of the total score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The CRCDCS demonstrated sound internal structure, internal consistency, and test\u2013retest reliability among ICU nurses in this Iranian sample. Further research is needed to establish external criterion validity, predictive validity, and measurement invariance before broader application of the scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>The CRCDCS is a multidimensional instrument for assessing ICU nurses' critical reflective competence in delirium care, capturing analytical, ethical, and preventive dimensions of reflective practice. Pending further validation, the scale may inform the design of educational programs and clinical training aimed at strengthening reflective decision\u2010making in delirium care within critical care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>This study was reported in accordance with the GRAMMS guidelines for mixed\u2010methods research and the COREQ checklist for the qualitative component.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>No patient or public contribution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nop2.70818","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:10:02Z","timestamp":1789762202000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and Psychometric Evaluation of the Critical Reflection Competency in Delirium Care Scale (CRCDCS) Among Iranian ICU Nurses"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9366-1173","authenticated-orcid":false,"given":"Fahimeh","family":"Magsoodi","sequence":"first","affiliation":[{"name":"Student Research Committee, Nursing Care Research Center, Health Research Institute Babol University of Medical Sciences  Babol Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1940-1579","authenticated-orcid":false,"given":"Fatemeh","family":"Ghaffari","sequence":"additional","affiliation":[{"name":"Nursing Care Research Center, Health Research Institute Babol University of Medical Sciences  Babol Iran"},{"name":"Department of Nursing, Faculty of Medical Sciences Tarbiat Modares University  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_2_16_2_1","volume-title":"Standards for Educational and Psychological Testing","author":"American Educational Research Association","year":"2018"},{"key":"e_1_2_16_3_1","volume-title":"Standards for Educational and Psychological Testing","author":"American Educational Research Association, A. 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