The Impact of Digital Culture, Digital Competence and Clinical Decision Support System Usability on Critical Care Nurses' Clinical Judgement: A Moderated Moderation Analysis

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BACKGROUND: In the context of increasingly digital healthcare systems, clinical judgement among critical care nurses is shaped not only by clinical experience but also by the broader digital environment. Digital culture, digital competence and clinical decision support systems (CDSSs) usability are pivotal factors influencing how nurses make timely, informed clinical decisions. However, the complex interplay among these factors remains underexplored. AIM: To examine the impact of digital culture on critical care nurses' clinical judgement, investigate the moderating role of digital competence and examine how CDSSs usability affects this moderation. STUDY DESIGN: This descriptive cross-sectional study was conducted among 550 critical care nurses working in 28 intensive care units across 10 hospitals located in Cairo and Alexandria in Egypt and Riyadh in Saudi Arabia. Data were collected via four validated instruments and analysed via moderated moderation analysis (PROCESS Models 1 and 3) to test direct and interaction effects among digital culture, digital competence, CDSSs usability and clinical judgement. RESULTS: Digital culture significantly predicted clinical judgement. This effect was moderated by digital competence, which enhanced the positive association. A significant three-way interaction revealed that the relationship was strongest when both digital competence and CDSSs usability were high. The full model explained 53.9% of the variance in clinical judgement capability. CONCLUSIONS: Digital culture enhances clinical judgement, particularly when supported by high digital competence and usable CDSSs. RELEVANCE TO CLINICAL PRACTICE: Clinical effectiveness in critical care nursing requires strong digital competence, a supportive digital culture and user-friendly CDSSs to enable accurate, timely and informed clinical judgement and decisions.