Enhancing Nurses' Clinical Decision-Making Confidence Through Dual Pathways of Self-Directed Learning: A Structural Equation Model

<b>Abstract</b>

<b>Background: </b>Nurses
operate in complex clinical environments demanding autonomous judgment,
emotional regulation, and interpersonal collaboration, yet the mechanisms
through which psychological and learning resources support clinical
decision-making confidence remain inadequately characterized.

<b>Objective: </b>To examine
the dual mediating roles of cognitive and relational self-directed learning in
the relationship between emotional intelligence and clinical decision-making
confidence among registered nurses.

<b>Design:</b> Cross-sectional survey study.

<b>Setting: </b>Multiple
medical schools and affiliated teaching hospitals across Eastern, Central, and
Western China.

<b>Participants: </b>1,478
registered nurses recruited via convenience sampling between June and August
2025.

<b>Methods: </b>Emotional
intelligence was assessed using the Wong and Law Emotional Intelligence Scale,
self-directed learning via a reorganized two-factor version of the Self-Rating
Scale of Self-Directed Learning, and clinical decision-making confidence via
the Clinical Decision-Making Self-Confidence Scale. Structural equation
modeling with bias-corrected bootstrapping (5,000 resamples) tested the
mediation hypotheses.

<b>Results: </b>Emotional
intelligence significantly predicted both cognitive self-directed learning (β =
0.643, p &lt; 0.01) and relational self-directed learning (β = 0.601, p
&lt; 0.01), as well as clinical decision-making confidence in both models. In
the model with cognitive self-directed learning as mediator, the indirect
effect was 0.339 (95% CI [0.273, 0.409]), representing 71.8% of the total
standardized effect. In the separate model with relational self-directed
learning as mediator, the indirect effect was 0.241 (95% CI [0.185, 0.302]),
representing 50.8% of the total standardized effect. Both pathways were
statistically significant.

<b>Conclusions: </b>Both
cognitive and relational self-directed learning are significant mediators of
the relationship between emotional intelligence and clinical decision-making
confidence. These findings support integrating emotional intelligence training
with self-directed learning development in nursing education programs.

<b>Keywords:</b> Clinical decision-making; Emotional
intelligence; Nursing; Self-directed learning; Structural equation modeling