Examining the Relationships Between Confirmation Bias, Self-Determination and Clinical Decision-Making in Hospital Nurses

Background/Objectives: Healthcare environments are rapidly evolving with advanced medical technologies, digital innovation, and accelerated medical informatization. In this context, nurses' accurate clinical judgment and decision-making have become increasingly important, particularly as cognitive biases can affect their critical thinking and self-determination. This study aimed to analyze the relationships between confirmation bias, self-determination, and critical thinking among hospital nurses, and to examine how confirmation bias influences clinical decision-making in nursing practice. Methods: This descriptive correlational study was conducted with 124 nurses from hospitals with more than 500 beds. Data were collected using structured questionnaires, including the Confirmation Bias Proneness Scale, General Motivation Scale, and Critical Thinking Disposition Scale. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression analysis. Results: The mean scores were 3.42±0.68 for confirmation bias, 4.86±0.92 for self-determination, and 3.78±0.54 for critical thinking. Confirmation bias showed significant negative correlations with self-determination (r=-.425, p<.001) and critical thinking (r=-.468, p<.001). Multiple regression analysis revealed that confirmation bias had significant negative effects on both self-determination (β=-.385, p<.001) and critical thinking (β=-.442, p<.001). Age, clinical experience, and education level showed significant positive effects on both variables. Conclusions: The findings indicate that confirmation bias significantly impairs nurses' self-determination and critical thinking abilities, with its impact being stronger than in other professions. These results suggest the need for systematic educational programs to help nurses recognize and overcome confirmation bias, particularly for those with less clinical experience. Furthermore, organizational efforts are needed to promote evidence-based practice and objective decision-making in clinical settings.