Clinical practice placements in nursing education provide a platform for nursing students to apply theoretical knowledge to real patient care. Nursing knowledge encompasses both theoretical understanding (“knowing that”) and practical skills (“knowing how”) [1]. The nursing process, originally defined as “a systematic approach to care using the fundamental principles of critical thinking, client-centered approaches to treatment, goal-oriented tasks, evidence-based practice recommendations, and nursing intuition” [2], is recognized as an essential framework for applying nursing knowledge to enhance care quality [3]. The nursing process entails comprehending the rationale behind patients’ treatment plans, understanding pathophysiology, identifying patient problems, conducting suitable assessments, prioritizing and implementing care, and evaluating the outcomes of provided care [3]. However, students report difficulties in integrating theoretical knowledge into clinical practice [4,5], as well as challenges in gathering, assessing, and using patient data to develop nursing care that caters to patient needs [6].

Previous studies have demonstrated that nursing students’ self-efficacy is associated with their clinical performance, competence, and behavior during clinical practice placements [7-9]. Self-efficacy, a critical factor in academic success, refers to the confidence or belief in one’s abilities to successfully accomplish specific tasks and persist despite challenges [10,11]. According to Bandura [10], mastery experiences have a strong effect on a student’s self-efficacy development because they are the most authentic indicators of one’s capabilities. In contrast, experienced failures may impair students’ self-efficacy perceptions and result in avoidance behaviors [10].

Various factors, such as anxiety, stress, motivation, and the pedagogical atmosphere in the clinical setting, can potentially influence nursing students’ self-efficacy [12] and thus their clinical achievements [13-15]. A vital resource in promoting nursing students’ self-efficacy is emotional support from peers, academic educators, and clinical supervisors [10,12,16]. Hence, to enhance nursing students’ clinical learning, performance, and competence during clinical practice placements, it is crucial not only to equip students with a conducive clinical learning environment but also to assist them in boosting their self-efficacy to manage various challenges they might face [8]. As self-efficacy may predict clinical performance and behavior among nursing students, assessing students’ self-efficacy could be a valuable method to pinpoint those who may require additional support during clinical practice placements [17,18].

To assess students’ self-efficacy in clinical practice, validated instruments are necessary. The Self-Efficacy in Clinical Performance Scale (SECP) was designed to collect empirical data on nursing students’ self-efficacy in clinical performance [19]. The SECP explores students’ self-efficacy perceptions in performing different facets of the nursing process. Students are queried about their confidence in patient assessments, diagnosis and planning, implementation of care, and evaluation of provided care. Such insights are valuable for educators and clinical supervisors to identify areas requiring reinforcement and to create educational strategies to promote students’ self-efficacy, equip them for potential challenges, and ultimately enhance their clinical performance and competence. For these reasons, the SECP was selected for translation and validation into Norwegian in this study, given its established psychometric properties and relevance to clinical education settings [19]. As highlighted by Cheraghi et al [19], the SECP has demonstrated construct validity, internal consistency, and stability, ensuring consistent and reliable measurement of self-efficacy in clinical performance.

This study was initiated to address the need for culturally adapted and psychometrically validated tools to support educators in enhancing educational strategies in Norwegian nursing education. Therefore, the study aimed to translate the SECP from English into Norwegian and to evaluate its psychometric properties in a Norwegian academic context.

This study used a cross‐sectional survey design, including translating the SECP and testing its psychometric properties.

The original SECP, developed and validated by Cheraghi et al [19], is in Persian and consists of 37 items across 4 factors: assessment, diagnosis and planning, implementation, and evaluation. Each item is rated on an 11-point Likert scale, from 0 (“fully disagree”) to 10 (“fully agree”), where higher scores indicate greater levels of agreement, and lower scores indicate disagreement. The hypothesized 4-factor model and corresponding items in the SECP are presented in Table 1.

Permission to translate, validate, and use the SECP developers’ English and Persian versions of the instrument was obtained via email. The SECP was translated from their English version to Norwegian following six of a seven-step guideline suggested by Sousa and Rojjanasrirat [20] in the symmetrical translation approach: (1) forward translation, (2) synthesis of the forward translation, (3) backward translation, (4) synthesis of the backward translation, (5) cognitive debriefing, and (7) comprehensive psychometric testing. Step 6, preliminary psychometric testing, was omitted due to the lack of a bilingual population.

The forward translation was conducted independently by 2 translators, both registered nurses and researchers with expertise in the terminology of the area covered by the SECP. The translators were native Norwegian speakers and fluent in English. The 2 forward-translated versions were additionally compared with the original version of the instrument by a third independent translator, who was bilingual and bicultural. Any discrepancies in wording, sentences, and meanings were addressed and resolved through consensus among the translators and the last author (AAGN).

The backward translation into English was carried out by 2 independent translators. One back translator was a registered nurse and researcher with expertise in the terminology of the area covered by the SECP, while the other was an English-language expert familiar with nursing terminology. Both back translators were native English speakers and were blinded to the original version of the instrument. The 2 back-translated versions were then compared by a third independent translator who was bilingual and bicultural. Any discrepancies in wording, sentences, and meanings were resolved through consensus among the translators and the last author (AAGN). The prefinal Norwegian version of the SECP was subsequently approved by the instrument developer.

The prefinal Norwegian version of the SECP was tested with a pilot group of 10 nursing students who had completed clinical practice and represented the target population [20,21]. Each student was asked to evaluate the instructions, response format, and the 37 items of the SECP using a dichotomous scale (clear or unclear). As no unclear issues were identified by the students, no revisions to the instrument were done [22]. Additionally, an expert panel of 10 members assessed the conceptual equivalence (clarity) of the instrument [21]. The panel comprised experienced nurses who were educators holding positions as assistant professors, associate professors, or professors—all registered nurses familiar with the terminology covered by the SECP. Following the same procedure as the pilot group, the panel identified no issues with conceptual equivalence. The expert panel also evaluated each item for content equivalence (relevance). As no items were rated as irrelevant, difficult to assess, or needing minor alteration, no further revisions were necessary [23]. The instrument was then deemed ready for psychometric testing.

The Norwegian Centre for Research Data approved the study (reference number 891608). Participation in the psychometric testing of the SECP (Norwegian version) was based on written informed consent and performed in accordance with the 2013 revised version of the Declaration of Helsinki [38]. Participation was voluntary, and participants’ rights were clearly outlined in the consent forms. Participants were informed about the nature and purpose of the study, as well as their right to withdraw at any time without any consequences. All data were deidentified and anonymized to ensure confidentiality. Participants were not compensated in any way for their involvement in the study.

Of the estimated 800 active nursing students invited to participate, 399 (49.9%) completed and returned the instrument. Answers were skewed toward the “fully agree” end of the scale. The respondents’ mean scores, skewness, and kurtosis are provided in Table 2.

The internal consistency indicators by factor level displayed values from 0.94 to 0.98, indicating high internal consistency. The mean score and internal consistency indicators for each factor are presented in Table 2.

The factor structure model of the SECP Norwegian version is presented in Figure 1. The content of the items is presented in Table 1.

All factor loadings within each factor in the model presented statistical significance and had acceptable values ranging from 0.44 to 0.82, except for item Q28, which presented significant results, but with a low factor loading of 0.28 (Table 3).

The square roots of the AVE values were equal to or lower than the correlations between the factors, indicating potential issues with discriminant validity, as shown in Table 4.

However, overall, the goodness-of-fit indices from the CFA confirmed the prehypothesized factor structure model, indicating acceptable construct validity. The exception was the significant P value, which means that the model did not obtain a perfect fit for the data. The goodness-of-fit indices are shown in Table 5.

The Norwegian version of the SECP demonstrated acceptability, internal consistency, and satisfactory construct validity.

The originally validated SECP is in Persian, and in this study, we translated the English version provided by the original SECP developers, Cheraghi et al [19], for which there was no prior validation. We found no other studies that had translated, adapted, or validated the SECP into other languages. Thus, we could not compare this study with studies from different linguistic and cultural contexts, apart from the original study by Cheragi et al [19]. This emphasizes the need for additional research to establish the SECP scale’s validity and reliability across diverse populations worldwide.

Additionally, individual characteristics of our participants, such as age or gender, were not collected, which could have provided a more comprehensive overview of the sample. Although the CFA results in this study confirmed the prehypothesized SECP model, it should be noted that having an acceptable fitting model with data from a single sample does not necessarily confirm that the model is correctly specified [47]. Furthermore, we did not evaluate the stability of the SECP (Norwegian version) over time. Therefore, we propose that future psychometric validation studies also include evaluations of the instrument’s test-retest reliability.

The SECP (Norwegian version) demonstrated its potential as a viable instrument for assessing self-efficacy in the current and required competencies of nursing students in clinical practice within Norwegian nursing education. Collecting data in these areas may be crucial to evaluate, develop, and enhance nursing students’ clinical performance. The SECP (Norwegian version) indicated internal consistency and acceptable construct validity in this study; however, future research should aim to confirm the factor structure of the SECP (Norwegian version) and evaluate its test-retest reliability.