clinical reasoning cases in nursing case study 15

Clinical Reasoning Cases in Nursing

• 8th Edition - April 13, 2023
• Authors: Mariann M. Harding, Julie S. Snyder
• Language: English
• Paperback ISBN: 9780323831734 9 7 8 - 0 - 3 2 3 - 8 3 1 7 3 - 4
• eBook ISBN: 9780323831741 9 7 8 - 0 - 3 2 3 - 8 3 1 7 4 - 1

**Selected for Doody’s Core Titles® 2024 with "Essential Purchase" designation in Perioperative**Learn to make sound clinical nursing judgments with the concept-based, case study… Read more

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**Selected for Doody’s Core Titles® 2024 with "Essential Purchase" designation in Perioperative** Learn to make sound clinical nursing judgments with the concept-based, case study approach in Harding & Snyder’s Clinical Reasoning Cases in Nursing, 8th Edition. Awarded second place in the 2019 AJN Book of the Year Awards in the Medical-Surgical category, this time-tested case study resource is highly regarded for its clinically relevant and thought-provoking cases. Approximately150 true-to-life case studies cover all four clinical practice areas — medical-surgical, pediatric, OB/maternity, and psychiatric-mental health nursing — all organized to facilitate a conceptual approach to teaching and learning. Each case covers a common patient problem drawn from actual clinical experiences and written by nurses who are clinical experts and includes a strong focus on interprofessional collaboration competencies. Cases include integrated content on pharmacology, nutrition, and diagnostic/laboratory tests to encourage you to think critically about all aspects of patient care. The 8th edition has been updated throughout to reflect the most current standards of clinical practice, including readiness for practice in the COVID-19 era. Also new to this edition, concepts and terminology related to the Next Generation NCLEX® Exam (NGN) are introduced in the Preface and integrated throughout to help you prepare for the new exam.

• Approximately 150 case studies draw from actual clinical experiences in medical-surgical, pediatric, OB/maternity, and psychiatric-mental health clinical areas to help you learn to think clinically, prioritize, and deliver proactive nursing care.
• UNIQUE! Concept-based organization mirrors the growing popularity of concept-based curricula and conceptual approaches to teaching and learning in nursing education.
• Clinical judgment approach helps you learn to identify changes, anticipate possible complications, and initiate therapeutic interventions.
• Progressive case complexity builds on previous learning to help you gradually develop clinical judgment skills.
• Strong QSEN safety emphasis is highlighted with an icon to communicate "caution" or "safety."
• Icons identify questions that resemble new NCLEX-RN ® item types.
• Strong emphasis on sepsis and antibiotic resistance addresses the growing problem of sepsis (a recent Joint Commission "core measure") and antibiotic resistance, where appropriate.
• Cover Image
• Contributors
• Introduction
• Acknowledgments
• Table of Contents
• Chapter 1 Perfusion
• Case Study 1
• Case Study 2
• Case Study 3
• Case Study 4
• Case Study 5
• Case Study 6
• Case Study 7
• Case Study 8
• Case Study 9
• Case Study 10
• Case Study 11
• Case Study 12
• Case Study 13
• Case Study 14
• Case Study 15
• Case Study 16
• Case Study 17
• Case Study 18
• Case Study 19
• Case Study 20
• Case Study 21
• Case Study 22
• Chapter 2 Gas Exchange
• Case Study 23
• Case Study 24
• Case Study 25
• Case Study 26
• Case Study 27
• Case Study 28
• Case Study 29
• Case Study 30
• Case Study 31
• Case Study 32
• Case Study 33
• Case Study 34
• Case Study 35
• Case Study 36
• Case Study 37
• Case Study 38
• Case Study 39
• Case Study 40
• Case Study 41
• Chapter 3 Mobility
• Case Study 42
• Case Study 43
• Case Study 44
• Case Study 45
• Case Study 46
• Case Study 47
• Case Study 48
• Case Study 49
• Case Study 50
• Case Study 51
• Case Study 52
• Case Study 53
• Case Study 54
• Case Study 55
• Chapter 4 Digestion
• Case Study 56
• Case Study 57
• Case Study 58
• Case Study 59
• Case Study 60
• Case Study 61
• Case Study 62
• Case Study 63
• Case Study 64
• Case Study 65
• Case Study 66
• Case Study 67
• Chapter 5 Urinary Elimination
• Case Study 68
• Case Study 69
• Case Study 70
• Case Study 71
• Case Study 72
• Case Study 73
• Case Study 74
• Case Study 75
• Case Study 76
• Chapter 6 Intracranial Regulation
• Case Study 77
• Case Study 78
• Case Study 79
• Case Study 80
• Case Study 81
• Case Study 82
• Case Study 83
• Case Study 84
• Case Study 85
• Case Study 86
• Case Study 87
• Case Study 88
• Chapter 7 Metabolism and Glucose Regulation
• Case Study 89
• Case Study 90
• Case Study 91
• Case Study 92
• Case Study 93
• Case Study 94
• Case Study 95
• Case Study 96
• Case Study 97
• Case Study 98
• Case Study 99
• Case Study 100
• Chapter 8 Immunity
• Case Study 101
• Case Study 102
• Case Study 103
• Case Study 104
• Case Study 105
• Case Study 106
• Chapter 9 Cellular Regulation
• Case Study 107
• Case Study 108
• Case Study 109
• Case Study 110
• Case Study 111
• Case Study 112
• Case Study 113
• Case Study 114
• Case Study 115
• Chapter 10 Tissue Integrity
• Case Study 116
• Case Study 117
• Case Study 118
• Case Study 119
• Chapter 11 Cognition
• Case Study 120
• Case Study 121
• Case Study 122
• Chapter 12 Infection and Inflammation
• Case Study 123
• Case Study 124
• Case Study 125
• Case Study 126
• Case Study 127
• Case Study 128
• Case Study 129
• Chapter 13 Developmental
• Case Study 130
• Case Study 131
• Case Study 132
• Case Study 133
• Case Study 134
• Case Study 135
• Case Study 136
• Chapter 14 Reproductive
• Case Study 137
• Case Study 138
• Case Study 139
• Case Study 140
• Case Study 141
• Case Study 142
• Case Study 143
• Chapter 15 Mood, Stress, and Addiction
• Case Study 144
• Case Study 145
• Case Study 146
• Case Study 147
• Case Study 148
• Case Study 149
• Case Study 150
• Instructor Index to Case Studies
• No. of pages : 712
• Language : English
• Edition : 8
• Published : April 13, 2023
• Imprint : Elsevier
• Paperback ISBN : 9780323831734
• eBook ISBN : 9780323831741

Mariann M. Harding

Julie s. snyder.

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Clinical Reasoning Cases in Nursing, 8th Edition

**Selected for Doody’s Core Titles® 2024 with "Essential Purchase" designation in Perioperative** Learn to make sound clinical nursing judgments with the concept-based, case study approach in Harding & Snyder’s Clinical Reasoning Cases in Nursing, 8th Edition. Awarded second place in the 2019 AJN Book of the Year Awards in the Medical-Surgical category, this time-tested case study resource is highly regarded for its clinically relevant and thought-provoking cases. Approximately150 true-to-life case studies cover all four clinical practice areas — medical-surgical, pediatric, OB/maternity, and psychiatric-mental health nursing — all organized to facilitate a conceptual approach to teaching and learning. Each case covers a common patient problem drawn from actual clinical experiences and written by nurses who are clinical experts and includes a strong focus on interprofessional collaboration competencies. Cases include integrated content on pharmacology, nutrition, and diagnostic/laboratory tests to encourage you to think critically about all aspects of patient care. The 8th edition has been updated throughout to reflect the most current standards of clinical practice, including readiness for practice in the COVID-19 era. Also new to this edition, concepts and terminology related to the Next Generation NCLEX® Exam (NGN) are introduced in the Preface and integrated throughout to help you prepare for the new exam.

• Share to receive a discount off your next order
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VitalSource Bookshelf gives you access to content when, where, and how you want. When you read an eBook on VitalSource Bookshelf, enjoy such features as:

• Access online or offline, on mobile or desktop devices.
• Bookmarks, highlights and notes sync across all your devices.
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• Interactive notebook and read-aloud functionality.
• Look up additional information online by highlighting a word or phrase.

**Selected for Doody’s Core Titles® 2024 with "Essential Purchase" designation in Perioperative** Learn to make sound clinical nursing judgments with the concept-based, case study approach in Harding & Snyder’s Clinical Reasoning Cases in Nursing, 8th Edition. Awarded second place in the 2019 AJN Book of the Year Awards in the Medical-Surgical category, this time-tested case study resource is highly regarded for its clinically relevant and thought-provoking cases. Approximately150 true-to-life case studies cover all four clinical practice areas — medical-surgical, pediatric, OB/maternity, and psychiatric-mental health nursing — all organized to facilitate a conceptual approach to teaching and learning. Each case covers a common patient problem drawn from actual clinical experiences and written by nurses who are clinical experts and includes a strong focus on interprofessional collaboration competencies. Cases include integrated content on pharmacology, nutrition, and diagnostic/laboratory tests to encourage you to think critically about all aspects of patient care. The 8th edition has been updated throughout to reflect the most current standards of clinical practice, including readiness for practice in the COVID-19 era. Also new to this edition, concepts and terminology related to the Next Generation NCLEX ® Exam (NGN) are introduced in the Preface and integrated throughout to help you prepare for the new exam.

• UNIQUE! Concepts and terminology related to the Next Generation NCLEX® Exam (NGN) are introduced in the Preface and integrated throughout to help you prepare for the new exam. All questions for the NGN are highlighted with a special icon for quick reference.
• UPDATED! Content reflects the latest evidence-based clinical practice, including national and international treatment guidelines and the latest guidelines for COVID-19 and other infectious diseases.
• NEW! Additional case studies and expanded content in key areas includes breastfeeding, obstetric emergency (umbilical cord prolapse or abruptio placentae) with emergency C-section, sickle cell pain crisis, and head/neck trauma with tracheostomy.
• Expanded pharmacology content reflects the importance of a clear understanding of drug therapy on patient safety.
• Additional illustrations and expanded use of image-related question types visually reinforce the material, while also promoting clinical utility and patient diversity in a sensitive and clinically relevant way.
• Enhanced interprofessional collaboration content emphasizes the importance of identifying opportunities for collaboration with other health professions.
• Approximately 150 case studies draw from actual clinical experiences in medical-surgical, pediatric, OB/maternity, and psychiatric-mental health clinical areas to help you learn to think clinically, prioritize, and deliver proactive nursing care.
• UNIQUE! Concept-based organization mirrors the growing popularity of concept-based curricula and conceptual approaches to teaching and learning in nursing education.
• Clinical judgment approach helps you learn to identify changes, anticipate possible complications, and initiate therapeutic interventions.
• Progressive case complexity builds on previous learning to help you gradually develop clinical judgment skills.
• Strong QSEN safety emphasis is highlighted with an icon to communicate "caution" or "safety."
• Icons identify questions that resemble new NCLEX-RN ® item types.
• Strong emphasis on sepsis and antibiotic resistance addresses the growing problem of sepsis (a recent Joint Commission "core measure") and antibiotic resistance, where appropriate.

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Clinical Reasoning Cases in Nursing, 8th Edition

**Selected for Doody’s Core Titles® 2024 with "Essential Purchase" designation in Perioperative** Learn to make sound clinical nursing judgments with the concept-based, case study approach in Harding & Snyder’s Clinical Reasoning Cases in Nursing, 8th Edition. Awarded second place in the 2019 AJN Book of the Year Awards in the Medical-Surgical category, this time-tested case study resource is highly regarded for its clinically relevant and thought-provoking cases. Approximately150 true-to-life case studies cover all four clinical practice areas — medical-surgical, pediatric, OB/maternity, and psychiatric-mental health nursing — all organized to facilitate a conceptual approach to teaching and learning. Each case covers a common patient problem drawn from actual clinical experiences and written by nurses who are clinical experts and includes a strong focus on interprofessional collaboration competencies. Cases include integrated content on pharmacology, nutrition, and diagnostic/laboratory tests to encourage you to think critically about all aspects of patient care. The 8th edition has been updated throughout to reflect the most current standards of clinical practice, including readiness for practice in the COVID-19 era. Also new to this edition, concepts and terminology related to the Next Generation NCLEX® Exam (NGN) are introduced in the Preface and integrated throughout to help you prepare for the new exam.

• Share to receive a discount off your next order
• Share on Twitter

VitalSource Bookshelf gives you access to content when, where, and how you want. When you read an eBook on VitalSource Bookshelf, enjoy such features as:

• Access online or offline, on mobile or desktop devices.
• Bookmarks, highlights and notes sync across all your devices.
• Smart study tools such as note sharing and subscription, review mode, and Microsoft OneNote integration.
• Search and navigate content across your entire Bookshelf library.
• Interactive notebook and read-aloud functionality.
• Look up additional information online by highlighting a word or phrase.

**Selected for Doody’s Core Titles® 2024 with "Essential Purchase" designation in Perioperative** Learn to make sound clinical nursing judgments with the concept-based, case study approach in Harding & Snyder’s Clinical Reasoning Cases in Nursing, 8th Edition. Awarded second place in the 2019 AJN Book of the Year Awards in the Medical-Surgical category, this time-tested case study resource is highly regarded for its clinically relevant and thought-provoking cases. Approximately150 true-to-life case studies cover all four clinical practice areas — medical-surgical, pediatric, OB/maternity, and psychiatric-mental health nursing — all organized to facilitate a conceptual approach to teaching and learning. Each case covers a common patient problem drawn from actual clinical experiences and written by nurses who are clinical experts and includes a strong focus on interprofessional collaboration competencies. Cases include integrated content on pharmacology, nutrition, and diagnostic/laboratory tests to encourage you to think critically about all aspects of patient care. The 8th edition has been updated throughout to reflect the most current standards of clinical practice, including readiness for practice in the COVID-19 era. Also new to this edition, concepts and terminology related to the Next Generation NCLEX ® Exam (NGN) are introduced in the Preface and integrated throughout to help you prepare for the new exam.

• UNIQUE! Concepts and terminology related to the Next Generation NCLEX® Exam (NGN) are introduced in the Preface and integrated throughout to help you prepare for the new exam. All questions for the NGN are highlighted with a special icon for quick reference.
• UPDATED! Content reflects the latest evidence-based clinical practice, including national and international treatment guidelines and the latest guidelines for COVID-19 and other infectious diseases.
• NEW! Additional case studies and expanded content in key areas includes breastfeeding, obstetric emergency (umbilical cord prolapse or abruptio placentae) with emergency C-section, sickle cell pain crisis, and head/neck trauma with tracheostomy.
• Expanded pharmacology content reflects the importance of a clear understanding of drug therapy on patient safety.
• Additional illustrations and expanded use of image-related question types visually reinforce the material, while also promoting clinical utility and patient diversity in a sensitive and clinically relevant way.
• Enhanced interprofessional collaboration content emphasizes the importance of identifying opportunities for collaboration with other health professions.
• Approximately 150 case studies draw from actual clinical experiences in medical-surgical, pediatric, OB/maternity, and psychiatric-mental health clinical areas to help you learn to think clinically, prioritize, and deliver proactive nursing care.
• UNIQUE! Concept-based organization mirrors the growing popularity of concept-based curricula and conceptual approaches to teaching and learning in nursing education.
• Clinical judgment approach helps you learn to identify changes, anticipate possible complications, and initiate therapeutic interventions.
• Progressive case complexity builds on previous learning to help you gradually develop clinical judgment skills.
• Strong QSEN safety emphasis is highlighted with an icon to communicate "caution" or "safety."
• Icons identify questions that resemble new NCLEX-RN ® item types.
• Strong emphasis on sepsis and antibiotic resistance addresses the growing problem of sepsis (a recent Joint Commission "core measure") and antibiotic resistance, where appropriate.

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Clinical Reasoning In Nursing (Explained W/ Example)

Last updated on August 19th, 2023

In this article, we will cover:

What is Clinical Reasoning?

Definition of clinical reasoning in nursing.

• What is the concept of clinical reasoning?

Why is Clinical Reasoning Important in Nursing?

What are the types of clinical reasoning, what are the three elements of clinical reasoning, what are the steps of clinical reasoning, what is the importance of clinical reasoning and judgement in nursing, what is the difference between critical thinking and clinical reasoning, clinical reasoning in nursing example.

Clinical reasoning refers to the cognitive process that healthcare professionals, such as doctors, nurses, and other clinicians, use to analyze and make decisions about a patient’s condition and appropriate treatment.

It’s a complex and dynamic process that involves gathering and interpreting information from various sources, including patient history, physical examinations, laboratory tests, imaging studies, and the clinician’s own experience and knowledge.

Medicine, physical therapy, and occupational therapy were the first to introduce clinical reasoning to the healthcare disciplines. Since then, the nursing profession has used these strategies to improve patient care.

What is Clinical Reasoning in Nursing?

Clinical reasoning in nursing is dynamic and adaptive, as nurses continuously gather new information and adjust care plans based on patient responses.

It’s a crucial skill that guides nurses in providing safe, effective, and patient-centered care. Clinical reasoning involves the integration of clinical knowledge, critical thinking , and experience to address the complex and dynamic nature of patient situations.

It involves balancing medical knowledge with critical thinking , empathy, and ethical considerations to provide comprehensive and compassionate patient care.

Clinical reasoning in nursing refers to the cognitive process that nurses use to collect and assess patient information, analyze data, make informed judgments, and develop appropriate care plans.

What is the Concept of Clinical Reasoning?

Clinical reasoning is the cognitive process used by healthcare professionals to make informed decisions regarding patient care.

It encompasses tasks such as collecting information, analyzing data, identifying patterns, generating hypotheses, and making judgments for diagnosis and treatment.

Clinical reasoning blends science and intuition in medical practice. It combines evidence-based knowledge with experience-derived judgment to attain accurate diagnoses and treatments while addressing uncertainties.

As an essential component of clinical practice, clinical reasoning guides healthcare providers in delivering safe and effective patient care.

Clinical reasoning is important in nursing for several reasons. Some reasons are listed below.

Patient-Centered Care:

Clinical reasoning helps nurses tailor care plans to individual patients, considering their unique needs, preferences, and circumstances, leading to more personalized and effective care.

Safe and Effective Care:

It ensures that nurses make well-informed decisions based on thorough assessments, reducing the risk of errors and promoting patient safety.

Optimal Outcomes:

Through clinical reasoning, nurses can identify early signs of complications, make timely interventions, and contribute to better patient outcomes.

Nurtured Critical Thinking:

Clinical reasoning cultivates nurses’ critical thinking abilities, empowering them to dissect complex situations, appraise evidence, and make rational choices.

Efficient Resource Utilization:

It helps nurses prioritize care tasks, allocate resources effectively, and manage time efficiently, enhancing workflow and patient care delivery.

Evidence-Based Practice:

Nursing practice is constantly evolving with new research and evidence. Clinical reasoning involves integrating the latest evidence-based knowledge into decision-making, ensuring that care plans are aligned with the best available practices.

Complex Cases:

Nurses often encounter intricate patient cases; clinical reasoning equips them to navigate complexity, address multiple issues, and make comprehensive care plans.

Interdisciplinary Collaboration:

Effective clinical reasoning supports collaboration with other healthcare professionals, promoting well-rounded patient care.

Adaptation to Change:

In rapidly changing healthcare environments, clinical reasoning enables nurses to adapt to new information, technologies, and practices.

Critical Decision-Making:

Nurses face complex situations where quick and accurate decisions are critical. Clinical reasoning equips them with the ability to analyze data, identify patterns, and generate hypotheses. This enables nurses to make informed decisions about interventions, medications, and treatments, leading to effective care.

Early Detection and Prevention:

Through clinical reasoning, nurses can detect subtle changes in a patient’s condition that might signal complications or deterioration. This allows for early interventions, preventing potential health crises and improving patient prognosis.

Error Reduction:

Clinical reasoning encourages systematic thinking, reducing the likelihood of errors in administering medications, performing procedures, and assessing patients. This promotes patient safety and prevents adverse events.

Holistic Care:

Patient’s health is influenced by various factors beyond just medical conditions. Clinical reasoning enables nurses to consider the social, emotional, and psychological aspects of patients, promoting holistic care and overall well-being.

Ethical Dilemmas:

Nursing often involves ethical challenges. Clinical reasoning guides nurses in making ethically sound decisions by considering patients’ autonomy, values, and cultural beliefs.

Communication and Collaboration:

Clinical reasoning enhances nurses’ ability to communicate effectively with patients, families, and other healthcare professionals. It fosters collaboration by enabling nurses to articulate their assessments, interventions, and rationales clearly.

Professional Growth:

Developing strong clinical reasoning skills enhances nurses’ professional growth. It increases their confidence, competence, and ability to take on more complex patient cases and leadership roles.

In summary , clinical reasoning is an important component of nursing practice, allowing nurses to provide safe, effective, and patient-centered care.

It enables nurses to make informed decisions, improve patient outcomes, and navigate the dynamic and complex healthcare setting.

Clinical reasoning involves three key elements that healthcare professionals integrate to make informed decisions about patient care:

1. Patient Information:

This element encompasses all the relevant data about the patient’s medical history, current condition, symptoms, physical examination findings, diagnostic test results, and social and contextual factors.

Gathering comprehensive and accurate patient information is essential for forming an accurate understanding of the patient’s health status and needs.

2. Clinical Knowledge and Expertise:

Healthcare professionals draw upon their extensive medical knowledge, clinical experience, and expertise to interpret patient information.

This knowledge includes an understanding of anatomy, physiology, pathophysiology, pharmacology, and medical guidelines.

Clinical expertise is built over years of practice, exposure to a variety of cases, and ongoing learning.

3. Critical Thinking and Decision-Making Skills:

Critical thinking involves the analytical and logical thought processes that healthcare professionals use to evaluate patient information in the context of their clinical knowledge.

It includes the ability to identify patterns, assess potential diagnoses, consider alternative explanations, and weigh the pros and cons of different treatment options.

Effective decision-making is the outcome of critical thinking , as healthcare professionals choose the most appropriate course of action based on the available information.

These three elements are interdependent and work together to form the foundation of clinical reasoning.

Healthcare professionals integrate patient information with their clinical knowledge and expertise while applying critical thinking skills to reach accurate diagnoses, develop effective treatment plans, and provide high-quality patient care.

The balance between these elements varies based on the complexity of the clinical situation and the healthcare provider’s level of experience and expertise.

8 Stages of the Clinical Reasoning Cycle

Clinical reasoning involves several key steps:

1. Data Collection: Gathering relevant information about the patient’s medical history, symptoms, physical examination findings, and any diagnostic tests that have been conducted.

2. Pattern Recognition: Recognizing patterns and relationships in the collected data to identify potential diagnoses or issues. This involves comparing the patient’s presentation to previous cases and medical knowledge.

3. Hypothesis Generation: Formulating hypotheses or possible explanations for the patient’s condition based on the patterns and information observed. This step often involves generating a list of potential diagnoses that fit the available evidence.

4. Differential Diagnosis: Narrowing down the list of potential diagnoses by considering the likelihood of each condition and ruling out less likely options. This is where critical thinking and medical knowledge come into play.

5. Testing and Validation: Ordering further diagnostic tests or investigations to confirm or rule out specific diagnoses. This could include blood tests, imaging studies, biopsies, or other procedures.

6. Synthesis: Integrating the results of diagnostic tests and additional information to refine the diagnosis and treatment plan. This may involve adjusting the initial hypotheses based on new data.

7. Treatment Planning: Developing a comprehensive treatment plan that addresses the diagnosed condition, the patient’s unique circumstances, preferences, and any potential risks or benefits of various treatment options.

8. Monitoring and Adaptation: Continuously monitoring the patient’s progress and adjusting the treatment plan as needed based on how the patient responds and any new information that emerges.

Clinical reasoning requires a deep understanding of medical science, anatomy, physiology, and pathology, as well as the ability to apply this knowledge to real-world clinical scenarios.

It also involves critical thinking skills , logical reasoning, and the ability to handle uncertainty, as medical situations can be complex and patients may present with atypical symptoms.

Overall, clinical reasoning is a crucial skill for healthcare professionals, as it forms the foundation for making accurate diagnoses and providing effective patient care.

Clinical reasoning and judgment are of paramount importance in nursing for several reasons:

• Accurate Diagnosis and Treatment: Effective clinical reasoning enables nurses to accurately assess patients’ conditions, identify potential problems, and make informed decisions about appropriate interventions and treatments. Accurate diagnosis and treatment are crucial for improving patient outcomes and preventing complications.
• Patient Safety: Sound clinical judgment helps nurses recognize potential risks and make timely interventions to ensure patient safety. By identifying early signs of deterioration or complications, nurses can take appropriate actions to prevent adverse events.
• Individualized Care: Clinical reasoning allows nurses to tailor care plans to each patient’s unique needs, preferences, and circumstances. This patient-centered approach improves patient satisfaction and contributes to better treatment outcomes.
• Early Detection of Changes: Nurses often spend the most time with patients, which puts them in a prime position to notice subtle changes in a patient’s condition. Strong clinical reasoning skills enable nurses to detect these changes early and respond appropriately.
• Effective Communication: Nurses with strong clinical reasoning skills can communicate more effectively with patients, families, and interdisciplinary healthcare teams. They can convey complex medical information, treatment plans, and concerns in a clear and organized manner.
• Ethical Decision-Making: Clinical reasoning includes ethical considerations in decision-making. Nurses must weigh the ethical implications of their actions and decisions, especially when faced with complex situations that involve moral dilemmas.
• Resource Utilization: Effective clinical reasoning helps nurses allocate resources efficiently. By accurately assessing patient needs and prioritizing care, nurses can optimize the use of time, personnel, and equipment.
• Adaptation to Change: Healthcare is dynamic, and patients’ conditions can change rapidly. Nurses with strong clinical reasoning skills can adapt quickly to changing situations, making necessary adjustments to care plans and interventions.
• Continuity of Care: Nurses often play a critical role in ensuring continuity of care as patients transition between different healthcare settings. Effective clinical reasoning facilitates clear communication of patient information and ensures a smooth transition of care.
• Professional Growth: Developing clinical reasoning and judgment skills enhances a nurse’s professional growth. These skills are transferrable and applicable across various healthcare settings, allowing nurses to provide high-quality care regardless of the environment.
• Confidence and Job Satisfaction: Nurses who feel confident in their clinical reasoning abilities experience greater job satisfaction. Confidence comes from knowing that decisions are based on a solid foundation of knowledge, experience, and critical thinking.
• Advocacy: Nurses with strong clinical reasoning skills can effectively advocate for their patients, ensuring that their needs are met, their voices are heard, and their rights are respected within the healthcare system.
• Quality Improvement: Clinical reasoning plays a role in quality improvement efforts by identifying areas for improvement in patient care processes and outcomes.

In summary, clinical reasoning and judgment are essential for nurses to provide safe, effective, and patient-centered care.

These skills underpin the entire nursing process, enabling nurses to make informed decisions, communicate effectively, and positively impact patient outcomes and experiences.

Critical Thinking :

Critical thinking is a cognitive process that involves analyzing, evaluating, and synthesizing information, ideas, and arguments to make reasoned judgments and decisions.

It is a broader skill applicable to various aspects of life and professions, encouraging logical, evidence-based thinking and minimizing biases.

Critical thinking aims to enhance problem-solving, decision-making, and analytical abilities in a wide range of contexts beyond healthcare.

Clinical Reasoning:

Clinical reasoning, on the other hand, is a specialized form of critical thinking that is primarily focused on healthcare and clinical situations.

It specifically pertains to the cognitive process healthcare professionals, especially nurses and doctors, use to collect, assess, analyze, and apply information to make informed clinical judgments and decisions.

Clinical reasoning is crucial for providing safe and effective patient care, as it integrates medical knowledge, patient assessments, ethical considerations, and treatment planning.

Critical Thinking vs. Clinical Reasoning

Clinical reasoning can be categorized into different types or approaches. Each of which represents a particular way of thinking and making decisions in clinical practice.

Some of the commonly recognized types of clinical reasoning include:

• Deductive Reasoning: This type of reasoning starts with a general principle or theory and applies it to a specific case. Healthcare professionals use deductive reasoning to make predictions or decisions based on established medical knowledge. For example, if a patient presents with a set of symptoms consistent with a well-known disease, the clinician may deduce that the patient likely has that disease.
• Inductive Reasoning: In contrast to deductive reasoning, inductive reasoning involves making generalizations or conclusions based on specific observations or cases. Clinicians use inductive reasoning to form hypotheses or theories from individual patient experiences. For instance, a nurse may notice a pattern of symptoms in several patients and develop a hypothesis about a potential new condition.
• Abductive Reasoning: Abductive reasoning combines elements of both deductive and inductive reasoning. It involves making educated guesses or hypotheses to explain observations or data that don’t fit neatly into established patterns. Clinicians use abductive reasoning when they encounter cases that don’t seem to fit existing diagnoses or models, and they generate plausible explanations to guide further investigation.
• Analytical Reasoning: This type of reasoning involves systematically breaking down a complex situation or problem into smaller parts to understand its components and relationships. Healthcare professionals use analytical reasoning to dissect complex patient cases, focusing on details and relationships to arrive at a diagnosis or treatment plan.
• Intuitive Reasoning: Intuitive reasoning relies on a healthcare professional’s experience, intuition, and gut feeling. It involves drawing on one’s own clinical experience and recognizing patterns that may not be immediately apparent. Intuitive reasoning is often employed in situations where rapid decision-making is necessary.
• Procedural Reasoning: Procedural reasoning focuses on the steps or processes needed to manage a clinical situation. It involves thinking about the sequence of actions required to address a patient’s needs. For example, a nurse may use procedural reasoning when administering medications, performing wound care, or carrying out other routine clinical procedures.
• Narrative Reasoning: Narrative reasoning involves considering the patient’s story, values, and context as essential components of clinical decision-making. It emphasizes understanding the patient’s perspective and tailoring care plans to the individual’s unique circumstances.
• Hypothetico-Deductive Reasoning: This approach involves generating and testing hypotheses systematically to arrive at a diagnosis. Healthcare professionals consider various possible diagnoses, then order specific tests to confirm or rule out each hypothesis.
• Pattern Recognition Reasoning: This type of reasoning relies on recognizing familiar patterns based on clinical experience and knowledge. Healthcare providers quickly identify common clinical presentations and apply established treatment protocols.

Emily Davis, a 68-year-old woman, is admitted to the medical unit with a diagnosis of Acute Exacerbation of COPD. She has a history of chronic obstructive pulmonary disease (COPD) and has been experiencing increased shortness of breath, cough, and decreased oxygen saturation levels.

How does your understanding of nursing fundamentals influence your clinical reasoning?

Nursing Action:

• Reflect on the nursing care provided to patients with COPD and respiratory distress.

• Review the pharmacologic treatments that will improve the patient’s COPD.

• Reflect the non-pharmacologic measures that will help to improve the patient’s respiratory distress.

• Determine the most appropriate assessments and interventions for managing respiratory distress in patients with COPD.

Implementation of Interventions:

• Assess Emily’s respiratory rate, depth, and effort, as well as oxygen saturation levels.

• Administer prescribed bronchodilators, and nebulization to improve airway patency.

• Elevate the head of the bed to promote better lung expansion.

• Encourage deep breathing exercises and effective coughing techniques.

• Consult with the physician to determine pharmacologic therapy

• Monitor Emily’s response to interventions and adjust care as needed. How does your understanding of pathophysiology guide your clinical reasoning?

• Knowledge of COPD’s pathophysiology helps anticipate complications and tailor interventions.

In this scenario, the nurse’s grasp of nursing fundamentals enables them to provide appropriate care for a patient with COPD.

By considering the patient’s history and symptoms, the nurse takes action to manage respiratory distress.

Implementing interventions such as bronchodilators and elevation of the head of the bed aligns with nursing knowledge.

Additionally, understanding the pathophysiology of COPD aids in predicting potential complications and choosing interventions to support the patient’s respiratory function.

• What is Critical Thinking in Nursing? (Explained W/ Examples)
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Clinical reasoning in nursing involves the skillful integration of medical knowledge, critical thinking , and patient assessment to make informed decisions about patient care.

It enables nurses to provide safe, effective, and patient-centered interventions while considering individual needs and complex healthcare situations.

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Clinical Reasoning Cases in Nursing - E-Book (8th ed.)

Mariann m. harding ,.

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**Selected for Doody’s Core Titles® 2024 with "Essential Purchase" designation in Perioperative** Learn to make sound clinical nursing judgments with the concept-based, case study approach in Harding & Snyder’s Clinical Reasoning Cases in Nursing, 8th Edition. Awarded second place in the 2019 AJN Book of the Year Awards in the Medical-Surgical category, this time-tested case study resource is highly regarded for its clinically relevant and thought-provoking cases. Approximately150 true-to-life case studies cover all four clinical practice areas — medical-surgical, pediatric, OB/maternity, and psychiatric-mental health nursing — all organized to facilitate a conceptual approach to teaching and learning. Each case covers a common patient problem drawn from actual clinical experiences and written by nurses who are clinical experts and includes a strong focus on interprofessional collaboration competencies. Cases include integrated content on pharmacology, nutrition, and diagnostic/laboratory tests to encourage you to think critically about all aspects of patient care. The 8th edition has been updated throughout to reflect the most current standards of clinical practice, including readiness for practice in the COVID-19 era. Also new to this edition, concepts and terminology related to the Next Generation NCLEX® Exam (NGN) are introduced in the Preface and integrated throughout to help you prepare for the new exam.

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Teaching Strategies for Developing Clinical Reasoning Skills in Nursing Students: A Systematic Review of Randomised Controlled Trials

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Background: Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients’ situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students. Methods: A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies. Results: Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies. Conclusions: This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students’ reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students’ learning and improve their clinical reasoning and cognitive skills.

1. Introduction

Clinical reasoning (CR) is a holistic cognitive process. It allows nursing students to accurately perceive patients’ situations and choose the best course of action among the available alternatives. This process is consistent, dynamic, and flexible, and it helps nursing students gain awareness and put their learning into perspective [ 1 ]. CR is an essential competence for nurses’ professional practice. It is considered crucial that its development begin during basic training [ 2 ]. Analysing clinical data, determining priorities, developing plans, and interpreting results are primary skills in clinical reasoning during clinical nursing practise [ 3 ]. To develop these skills, nursing students must participate in caring for patients and working in teams during clinical experiences. Among clinical reasoning skills, we can identify communication skills as necessary for connecting with patients, conducting health interviews, engaging in shared decision-making, eliciting patients’ concerns and expectations, discussing clinical cases with colleagues and supervisors, and explaining one’s reasoning to others [ 4 ].

Educating students in nursing practise to ensure high-quality learning and safe clinical practise is a constant challenge [ 5 ]. Facilitating the development of reasoning is challenging for educators due to its complexity and multifaceted nature [ 6 ], but it is necessary because clinical reasoning must be embedded throughout the nursing curriculum [ 7 ]. Such being the case, the development of clinical reasoning is encouraged, aiming to promote better performance in indispensable skills, decision-making, quality, and safety when assisting patients [ 8 ].

Nursing education is targeted at recognising clinical signs and symptoms, accurately assessing the patient, appropriately intervening, and evaluating the effectiveness of interventions. All these clinical processes require clinical reasoning, and it takes time to develop [ 9 ]. This is a significant goal of nursing education [ 10 ] in contemporary teaching and learning approaches [ 6 ].

Strategies to mitigate errors, promote knowledge acquisition, and develop clinical reasoning should be adopted in the training of health professionals. According to the literature, different methods and teaching strategies can be applied during nursing training, as well as traditional teaching through lectures. However, the literature explains that this type of methodology cannot enhance students’ clinical reasoning alone. Therefore, nursing educators are tasked with looking for other methodologies that improve students’ clinical reasoning [ 11 ], such as clinical simulation. Clinical simulation offers a secure and controlled setting to encounter and contemplate clinical scenarios, establish relationships, gather information, and exercise autonomy in decision-making and problem-solving [ 12 ]. Different teaching strategies have been developed in clinical simulation, like games or case studies. Research indicates a positive correlation between the use of simulation to improve learning outcomes and how it positively influences the development of students’ clinical reasoning skills [ 13 ].

The students of the 21st century utilise information and communication technologies. With their technological skills, organisations can enhance their productivity and achieve their goals more efficiently. Serious games are simulations that use technology to provide nursing students with a safe and realistic environment to practise clinical reasoning and decision-making skills [ 14 ] and can foster the development of clinical reasoning through an engaging and motivating experience [ 15 ].

New graduate nurses must possess the reasoning skills required to handle complex patient situations. Aware that there are different teaching methodologies, with this systematic review we intend to discover which RCTs published focus on CR in nursing students, which interventions have been developed, and their effectiveness, both at the level of knowledge and in increasing clinical reasoning skills. By identifying the different techniques used during the interventions with nursing students in recent years and their effectiveness, it will help universities decide which type of methodology to implement to improve the reasoning skills of nursing students and, therefore, obtain better healthcare results.

This study aims to identify and analyse randomised controlled trials concerning clinical reasoning in nursing students. The following questions guide this literature review:

Which randomised controlled trials have been conducted in the last eleven years regarding nursing students’ clinical reasoning? What are the purposes of the identified RCTs? Which teaching methodologies or strategies were used in the RCTs studies? What were the outcomes of the teaching strategies used in the RCTs?

2. Materials and Methods

This review follows the PRISMA 2020 model statement for systematic reviews. That comprises three documents: the 27-item checklist, the PRISMA 2020 abstract checklist, and the revised flow diagram [ 16 ].

2.1. Search Strategy

A systematic literature review was conducted on PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) up to 15th October 2023.

The PICOS methodology guided the bibliographic search [ 17 ]: “P” being the population (nursing students), “I” the intervention (clinical reasoning), “C” comparison (traditional teaching), “O” outcome (dimension, context, and attributes of clinical reasoning in the students’ competences and the results of the teaching method on nursing students), and “S” study type (RCTs).

The search strategy used in each database was the following: (“nursing students” OR “nursing students” OR “pupil nurses” OR “undergraduate nursing”) AND (“clinical reasoning” OR “critical thinking” OR “clinical judgment”). The filters applied were full text, randomised controlled trial, English, Spanish, and from 1 January 2012 to 15 October 2023. The search strategy was performed using the same process for each database. APP performed the search, and AZ supervised the process.

During the search, the terms clinical reasoning, critical thinking, and clinical judgement were used interchangeably since clinical judgement is part of clinical reasoning and is defined by the decision to act. It is influenced by an individual’s previous experiences and clinical reasoning skills [ 18 ]. Critical thinking and clinical judgement involve reflective and logical thinking skills and play a vital role in the decision-making and problem-solving processes [ 19 ].

The first search was conducted between March and September 2022, and an additional search was conducted during October 2023, adding the new articles published between September 2022 and September 2023, following the same strategy. The search strategy was developed using words from article titles, abstracts, and index terms. Parallel to this process, the PRISMA protocol was used to systematise the collection of all the information presented in each selected article. This systematic review protocol was registered in the international register PROSPERO: CRD42022372240.

2.2. Eligibility Criteria and Study Selection

The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary aim; (b) articles published in the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) RCTs. On the other hand, the exclusion criteria were studies conducted with students from other disciplines other than nursing, not random studies or review articles.

2.3. Data Collection and Extraction

After this study selection, the following information was extracted from each article: bibliographic information, study aims, teaching methodology, sample size and characteristics, time of intervention, and conclusions.

2.4. Risk of Bias

The two reviewers, APP and AZ, worked independently to minimise bias and mistakes. The titles and abstracts of all papers were screened for inclusion. All potential articles underwent a two-stage screening process based on the inclusion criteria. All citations were screened based on title, abstract, and text. Reviewers discussed the results to resolve minor discrepancies. All uncertain citations were included for full-text review. The full text of each included citation was obtained. Each study was read thoroughly and assessed for inclusion following the inclusion and exclusion criteria explained in the methodology. The CASP tool was utilised to appraise all included studies. The CASP Randomized Controlled Trial Standard Checklist is an 11-question checklist [ 20 ], and the components assessed included the appropriateness of the objective and aims, methodology, study design, sampling method, data collection, reflexivity of the researchers, ethical considerations, data analysis, rigour of findings, and significance of this research. These items of the studies were then rated (“Yes” = with three points; “Cannot tell” = with two points; “No” = with one point). The possible rates for every article were between 0 and 39 points.

2.5. Ethical Considerations

Since this study was a comprehensive, systematic review of the existing published literature, there was no need for us to seek ethical approval.

3.1. Search Results

The initial search identified 158 articles using the above-mentioned strategy (SCOPUS ® n = 72, PUBMED ® n = 56, CENTRAL ® n = 23, and EMBASE ® n= 7), and the results are presented in Figure 1 . After retrieving the articles and excluding 111, 47 were selected for a full reading. Finally, 17 articles were selected. To comply with the methodology, the independent reviewers analysed all the selected articles one more time after the additional search, and they agreed to eliminate two of them because this study sample included nursing students as well as professional nurses. Therefore, to have a clear outcome focused on nursing students, two articles were removed, and the very final sample size was fifteen articles, following the established selection criteria ( Figure 1 ). The reasons for excluding studies from the systematic review were: nurses as targets; other design types of studies different from RCTs; focusing on other health professionals such as medical students; review studies; and being published in full text in other languages other than Spanish or English.

Flowchart of screening of clinical reasoning RCTs that underwent review.

3.2. Risk of Bias in CASP Results

All studies included in the review were screened with the CASP tool. Each study was scored out of a maximum of 39 points, showing the high quality of the randomised control trial methodology. The studies included had an average score of 33.1, ranging from 30 to 36 points. In addition, this quantitative rate of the items based on CASP, there were 13 studies that missed an item in relation to assessing/analysing outcome/s ‘blinded or not’ or not, and 11 studies that missed the item whether the benefits of the experimental intervention outweigh the harms and costs.

3.3. Data Extraction

Once the articles had undergone a full reading and the inclusion criteria were applied, data extraction was performed with a data extraction table ( Appendix A ). Their contents were summarised into six different cells: (1) CASP total points result, (2) purpose of this study, (3) teaching strategy, (4) time of intervention, (5) sample size, and (6) author and year of publication. After the review by the article’s readers, fifteen RCTs were selected. Of the fifteen, the continent with the highest number of studies was Asia, with 53.33% of the studies (n = 8) (Korea n = 4, Taiwan n = 2, and China n = 2), followed by Europe with 26.66% (n = 4) (Turkey n = 2, Paris n = 1, and Norway n = 1), and lastly South America with 20% (n = 3), all of them from Brazil.

3.4. Teaching Strategies

Different teaching strategies have been identified in the reviewed studies: simulation methods (seven articles) and learning programmes (eight articles). There are also two studies that focus on comparing different teaching methodologies.

3.4.1. Clinical Simulation

The simulation methods focused on in the studies were virtual simulation (based on mobile applications), simulation games, and high-fidelity clinical simulation. Of the total number of nursing students in the studies referring to clinical simulations, 43.85% were in their second year, while 57.1% were senior-year students. The most used method in the clinical simulation group was virtual simulation, and 57.14% of studies included only one-day teaching interventions.

Virtual simulations were used to increase knowledge about medication administration and nasotracheal suctioning in different scenarios [ 21 ], to evaluate the effect of interactive nursing skills, knowledge, and self-efficacy [ 11 ], and to detect patient deterioration in two different cases [ 22 ]. Simulation game methodology was used to improve nursing students’ cognitive and attention skills, strengthen judgment, time management, and decision-making [ 14 ].

Clinical simulation was used to develop nursing students’ clinical reasoning in evaluating wounds and their treatments [ 12 ], to evaluate and compare the perception of stressors, with the goal of determining whether simulations promote students’ self-evaluation and critical-thinking skills [ 23 ], and also to evaluate the impact of multiple simulations on students’ self-reported clinical decision-making skills and self-confidence [ 24 ].

3.4.2. Learning Programs

Different types of learning programmes have been identified in this systematic review: team-based learning, reflective training programs, person-centred educational programmes, ethical reasoning programmes, case-based learning, mapping, training problem-solving skills, and self-instructional guides. Of the total number of nursing students in the studies referring to learning programs, 57.1% were junior-year students, while 43.85% were in their senior year.

Team-based learning is a learner-centred educational strategy that promotes active learning to improve students’ problem-solving, knowledge, and practise performance. It can be implemented in small or large groups divided into teams with an instructor and reading material based on case scenarios [ 25 ]. Reflective training is based on a new mentoring practise to explore, think about, and solve problems actively during an internship. During the reflective training program, the mentors lead students to uncover clinical nursing problems through conversations with them and discussing feedback for their professional portfolios [ 26 ]. The person-centred educational programme focuses on how nursing students perceive individualised care, using design thinking to improve their perception. The use of design thinking gave the students opportunities to apply their theoretical knowledge of the person-centred program to plan innovative solutions that may effectively resolve real-life situations [ 27 ]. Another educational programme identified is the ethical reasoning program, and the aim of this is to improve nursing students’ handling of ethical decision-making situations [ 28 ], engaging the students in complex ethical clinical situations based on real cases.

Case-based learning was used to explore and demonstrate the feasibility of implementing unfolding cases in lectures to develop students’ critical-thinking abilities [ 29 ]. The web-based concept mapping of nursing students was also investigated to determine its impact on critical-thinking skills [ 30 ]. Training problem-solving skills were used to find out how it affected the rate of self-handicapping among nursing students [ 31 ]. And the last article evaluated the effect of the self-instructional guide to improve clinical reasoning skills on diagnostic accuracy in undergraduate nursing students [ 32 ].

4. Discussion

Although 158 studies were initially identified, only 15 articles were finally included in this review. The excluded articles were mainly from other disciplines other than nursing and used a less rigorous study design than RCT.

The three longest interventions were developed in Asia [ 26 , 28 , 29 ]. The longest was 300 h in duration, through one year [ 30 ]. These interventions were based on learning programs, case-based learning, person-centred care (PCC), and reflective training programs. However, it is important to take into account that Asian nursing curriculum programmes are different from European or United States curriculum because their internship is carried out only during the last academic degree year, while in Europe, following the European directive 2005/36/CE, 2013/55/UE nursing education requirements of 4600 h (2300 h of clinical practice) is carried out along the 3–4 years of the academic degree [ 33 ]. On the other hand, the intervention with the biggest sample was 419 nursing students [ 30 ], 210 in the experimental group, and 209 in the control group, and the one with the lowest sample was 51, with 24 students in the control group and 27 in the intervention group [ 32 ]. Therefore, all the included studies had a good sample size.

This systematic review has detected different methodologies to help nursing students improve their reasoning and decision-making skills. Virtual simulation was the most frequently used teaching method, both as a mobile application and as a serious game. In terms of its effectiveness in a study carried out in Taiwan, the use of a mobile application resulted in significantly higher knowledge scores, better skill performance, and higher satisfaction in students than traditional paper materials [ 21 ]. Virtual simulation [ 11 , 14 , 21 ] has also proven to be an effective tool for enhancing knowledge and confidence in recognising and responding to rapidly deteriorating patients, but studies that combined two educational strategies were more effective [ 29 ], like clinical simulation combined with another teaching strategy such as lectures or videos [ 12 ].

An interactive learner-centred nursing education mobile application with systematic contents effectively allowed students to experience positive practical nursing skills [ 11 ]. However, in a study comparing serious game simulation versus traditional teaching methods, no significant difference was found immediately or in the month following the training [ 22 ], but serious games can improve nursing students’ cognitive skills to detect patient deterioration and to make safe decisions about patient care [ 14 ]. Although the innovative teaching method was well received by the students, who expressed higher levels of satisfaction and motivation [ 22 ]. We can affirm that the development of a mobile application and its application can be effectively used by nursing students at all levels [ 11 ]. However, the performance of all these studies was measured on its short-term outcomes, only 40 min [ 21 ], 2 h [ 22 ], and 1 week [ 11 , 14 ] of intervention, and was performed with a mean sample size of 97 nursing students.

The data obtained in a study developed in Brazil [ 12 ] confirm that clinical simulation is effective for the development of nursing students’ clinical reasoning in wound evaluation and treatment and that clinical simulation in conjunction with other educational methods promotes the acquisition of knowledge by facilitating the transition from what the student knows to rational action. Moreover, the high-fidelity simulation strategy increases the perception of stressors related to a lack of competence and interpersonal relationships with patients, multidisciplinary teams, and colleagues compared with the conventional practice class in the skill laboratory. This increase was related to the students’ capacity for self-evaluation and critical reflection, concerning their learning responsibility and the need to acquire the required skills for patient care [ 23 ]. However, in the case of the effect of multiple simulations on students, there are no differences found between the double-versus single-scenario simulations [ 24 ]. The intervention time in these three studies was 30 min [ 23 ], 3.5 h [ 12 ], and 4 days [ 24 ]; then the time used to implement the intervention can determine the results obtained.

The different learning methods have an impact on various learning outcomes and students’ variables. Team-based learning [ 25 ], reflective training [ 26 ], the person-centred education programme [ 27 ], web-based concept mapping [ 30 ], and teaching cognitive-behavioural approaches [ 31 ] have proven to be effective in enhancing problem-solving abilities, knowledge, and reasoning processes and consequently improving the quality of nursing practical education. Team-based learning increased problem-solving ability scores significantly, while those in the control group decreased [ 25 ]. Reflective training, developed in China based on the new mentoring approach, was effective in encouraging nursing students to explore, think about, and solve problems actively during an internship, consequently improving their disposition for critical thinking [ 26 ]. A person-centred education programme using design thinking can effectively improve how nursing students perceive individualised care. Using design thinking allowed the students to apply their theoretical knowledge of the programme to plan innovative solutions that may effectively resolve real health problems [ 27 ]. These programmes were developed in 5 or 6 days [ 27 , 31 ], 1 week or 3 weeks [ 25 , 30 ], and 1 year [ 26 ].

The education programme focused on improving ethical decision-making had statistically significant improvements in nursing students’ self-efficacy in communication confidence, complex ethical decision-making skills, and decreased communication difficulty [ 28 ]. Case-based learning was more effective with lectures than without them in developing students’ critical thinking abilities [ 29 ]. This study was one of the longest developed with 300 h during one school year. This long-term learning intervention could have a positive impact on this study sample. Therefore, the time of the learning intervention could be a limitation in the studied RCTs. The one-time self-instruction guide was ineffective in impacting students’ diagnostic accuracy in solving case studies [ 32 ], and it is possible that only one day of intervention is not enough.

Studies have shown that problem- and team-based learning [ 25 , 31 ] are more beneficial than traditional teaching [ 29 ], as they enhance nursing skills and improve problem-solving abilities, clinical performance, communication competencies, critical thinking, and self-leadership.

Researchers generally agree that clinical reasoning is an important ability and one of the most important competencies for good nursing practise to ensure optimal patient outcomes [ 29 ] and to recognise and address patient deterioration effectively. However, effective communication is crucial in clinical reasoning. It is required to establish a rapport with patients, conduct health evaluations, make collaborative decisions, and discuss clinical cases with colleagues and supervisors. Developing clinical reasoning skills during training is essential to improving nursing professionals’ practice. To enhance clinical reasoning abilities, nursing schools should integrate simulations at every level of education to ultimately improve patient care. Improving nursing students’ preparation will impact the quality of patient care. In addition, new innovative teaching methodologies based on the use of technology could be a motivational driver in nursing clinical reasoning [ 22 ].

5. Limitations

This systematic review did not perform a search on CINAHL. Although most of the journals included in this database are included in MEDLINE, this should be addressed in the future because of the relevance of the database to nursing research. The results of the included studies could have also been influenced by the different times of the interventions and the different contexts. In addition, the reviewers have identified other studies published in languages other than those required by the inclusion criteria. It seems that many articles are published by Asian researchers, but some of them are not in English, so they cannot be analysed.

6. Conclusions

As society progresses, the new generation of nursing students poses a challenge; new technologies are ingrained in their daily lives with access to increasingly advanced technologies like artificial intelligence, and we must adapt training to capture their interest and increase their learning skills. The utilisation of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students’ reasoning skills. As a result, it is crucial to incorporate these tools into the learning process to maintain students’ interest, motivation, and satisfaction in education. Clinical simulation is particularly important in the training of students in terms of clinical performance. Still, it is necessary to add another teaching method to increase the efficacy of clinical simulations. Therefore, nursing schools should evaluate their current teaching methods and consider integrating or modifying new technologies and methodologies that can help enhance students’ learning, improve their clinical reasoning and cognitive skills, and potentially improve nursing students’ ability to affect patient care positively. By doing so, students will be better equipped to provide high-quality patient care in the future.

Funding Statement

This research received external funding from the European programme Eramus +2021-1-BE02-KA220-HED-000023194.

Author Contributions

Conceptualisation, A.P.-P. and A.Z.; methodology, A.P.-P. and A.Z.; formal analysis, A.P.-P.; writing—original draft preparation, A.P.-P.; writing—review and editing, A.Z.; visualisation, A.Z.; supervision, A.Z. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

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Clinical Reasoning Cases in Nursing - E-Book 7th Edition, Kindle Edition

• NEW & UNIQUE! Concept-based organization mirrors the growing use of concept-based curricula and conceptual approaches to teaching and learning in nursing education.
• NEW! 20 all-new cases and four extensively-revised cases that address important contemporary healthcare issues and allow for better coordination with Giddens, HESI, and other exemplar lists.
• NEW! Updated content throughout reflects the latest evidence-based clinical practice, including national and international treatment guidelines.
• NEW! Enhanced focus on interprofessional collaboration identifies opportunities for interprofessional collaboration are discussed.
• NEW! Greater consistency with the NCLEX Exam includes revisions like the elimination of most drug trade names and the inclusion of Canadian lab values.
• Enhanced QSEN safety emphasis is highlighted with a "target" icon to communicate "caution" or "safety."
• NEW! Increased emphasis on sepsis and antibiotic resistance throughout that addresses the growing problem of sepsis (a new Joint Commission "core measure") and antibiotic resistance where appropriate throughout.
• NEW! Improved answer spacing ensures that space left for answers reflects what is actually needed.
• ISBN-13 978-0323527361
• Edition 7th
• Sticky notes On Kindle Scribe
• Publisher Mosby
• Publication date December 24, 2018
• Language English
• File size 13042 KB
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About the author, product details.

• ASIN ‏ : ‎ B07MP11GPL
• Publisher ‏ : ‎ Mosby; 7th edition (December 24, 2018)
• Publication date ‏ : ‎ December 24, 2018
• Language ‏ : ‎ English
• File size ‏ : ‎ 13042 KB
• Simultaneous device usage ‏ : ‎ Up to 4 simultaneous devices, per publisher limits
• Text-to-Speech ‏ : ‎ Enabled
• Screen Reader ‏ : ‎ Supported
• Enhanced typesetting ‏ : ‎ Enabled
• X-Ray ‏ : ‎ Not Enabled
• Word Wise ‏ : ‎ Not Enabled
• Sticky notes ‏ : ‎ On Kindle Scribe
• Print length ‏ : ‎ 690 pages
• Page numbers source ISBN ‏ : ‎ 0323527361
• #28 in Medical & Surgical Nursing (Kindle Store)
• #203 in Medical & Surgical Nursing (Books)

About the author

Mariann m. harding phd rn cne.

Mariann Harding has been a registered nurse for 36 years and a nurse practitioner for 32 years. She is a Professor of Nursing at Kent State University Tuscarawas and is the Nursing Program Director. She has several years of experience in intensive care nursing and in oncology, including time at the National Institutes of Health. As a faculty, she has taught in LPN, associate degree, and RN-BSN programs. Her primary research and pedagogical interests lie in using active learning strategies to promote student success. She is a member of Sigma Theta Tau, Organization for Associate Degree Nursing, Christian Nurses Fellowship, and the Ohio and National Leagues for Nursing. Mariann grew up in a small town in Ohio, where she resides with her husband, Jeff. She enjoys traveling to see her daughters, Kate and Sarah, reading, cooking, and performing volunteer work. She is on the board of directors for the Stark and Muskingum Lakes Chapter of the American Red Cross and is the Acadamic Services Coordinator for the Northern Ohio Region of the Red Cross.

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