Evaluation of an Instrument to Measure Knowledge and Decision-Making Skills of Newly Graduated Nurses Managing Diabetes-Related Ketoacidosis of Adults

BACKGROUND: Newly graduated nurses often experience challenges in managing diabetes-related ketoacidosis, yet few validated instruments are available to assess their knowledge and decision-making in this high-acuity condition. This study was conducted to establish the content validity and psychometric properties of the modified Test of Registered Nurses' Knowledge and Decision-Making Processes in the Management of Adults with Diabetic Ketoacidosis (TKDM Short Form). A secondary goal was to examine the applicability of the instrument across two onboarding educational modalities to ensure the tool performs consistently in varied learning environments. METHOD: The study used a two-phase design. Phase I involved expert content validation of the TKDM Short Form. Phase II consisted of psychometric testing with pretests and posttests during onboarding. Participants were exposed to either fully immersive virtual reality or traditional education. Analyses included item performance, internal consistency, and factor analysis to evaluate reliability and validity while assessing instrument stability across the two modalities. RESULTS: Content validity was strong. Pretest reliability was acceptable for both knowledge and decision-making. Posttest reliability was lower. CONCLUSION: The TKDM Short Form shows promise as an educational assessment tool.