Volume 18, Issue 2 (2025)                   JMED 2025, 18(2): 129-143 | Back to browse issues page

Ethics code: 4000739

XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Salmani N, Bagheri I. A systematic review of methods for assessing clinical reasoning in nursing students. JMED 2025; 18 (2) :129-143
URL: http://edujournal.zums.ac.ir/article-1-2352-en.html
1- National Agency for Strategic Research in Medical Education, Tehran, Iran.
2- Faculty of Nursing and Midwifery, Research Center for Nursing and Midwifery Care, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. , imane.bagheri66@gmail.com
Abstract:   (259 Views)
Background & Objective: Nursing instructors can play a crucial role in enhancing students' clinical reasoning skills by evaluating them and offering timely, constructive feedback. Therefore, identifying effective clinical reasoning assessment tools is vital for accomplishing this objective. To this end, this study aimed to review the methods for assessing clinical reasoning in nursing students.
Materials & Methods: This systematic review was conducted in May 2024 using the keywords "Clinical Reasoning" and "Nursing Students." Eligible articles published in both English and Persian were systematically searched in various national and international online databases, including SID, Magiran, Scopus, Web of Science, PubMed, and ProQuest.
Results: A total of 2893 articles were retrieved from the initial search findings. After removing duplicates and irrelevant articles based on the inclusion criteria, a qualitative assessment was conducted using the Critical Appraisal Skills Programme (CASP), the Mixed Methods Appraisal Tool (MMAT), and the Joanna Briggs Institute (JBI) checklists. Ultimately, 20 articles on clinical reasoning assessment tools for nursing students were reviewed. The findings revealed that researchers utilize a range of tools to assess clinical reasoning, with the most common being the Nurses Clinical Reasoning Scale (NCRS), Script Concordance Tests (SCTs), key feature tests, Outcome-Present State Test (OPT), rubrics, and the triple jump exercise. However, the validity and reliability of the tools used and their acceptability and cost-effectiveness have not been assessed in the literature.
Conclusion: The findings indicated that the NCRS is the most commonly used assessment tool. Therefore, conducting psychometric evaluations of this tool in Iran is recommended. Furthermore, longitudinal studies are needed to evaluate the impact of clinical reasoning assessment tools on nursing students and explore how these tools can be effectively integrated into nursing curricula.

 
Full-Text [PDF 901 kb]   (106 Downloads) |   |   Full-Text (HTML)  (4 Views)  
Article Type : Review | Subject: Medical Education
Received: 2024/12/7 | Accepted: 2025/05/21 | Published: 2025/07/13

References
1. Connor DM, Durning SJ, Rencic JJ. Clinical reasoning as a core competency. Academic Medicine. 2020;95 (8):1166-71. [DOI]
2. Monajemi A, Adibi P, Arabshahi KS, et al. The battery for assessment of clinical reasoning in the Olympiad for medical sciences students. Iranian Journal of Medical Education. 2011;10 (5):1056-67.
3. Levett-Jones T, Hoffman K, Dempsey J, et al. The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’patients. Nurse Education Today. 2010;30(6):515-20. [DOI]
4. Luo QQ, Petrini MA. A review of clinical reasoning in nursing education: based on high-fidelity simulation teaching method. Frontiers of Nursing. 2018;5(3):175-83 [DOI]
5. Kuiper R, Pesut D, Kautz D. Promoting the self-regulation of clinical reasoning skills in nursing students. The Open Nursing Journal. 2009;3:76–85. [DOI]
6. Jensen R. Clinical reasoning during simulation: Comparison of student and faculty ratings. Nurse Education in Practice. 2013;13(1):23-8. [DOI]
7. Gonzalez L. Teaching clinical reasoning piece by piece: A clinical reasoning concept-based learning method. Journal of Nursing Education. 2018;57(12):727-35 [DOI]
8. Kuiper R, Heinrich C, Matthias A, Graham MJ, Bell-Kotwall L. Debriefing with the OPT model of clinical reasoning during high fidelity patient simulation. International Journal of Nursing Education Scholarship. 2008;5 (1) [DOI]
9. Harmon MM, Thompson C. Clinical reasoning in pre-licensure nursing students. Teaching and Learning in Nursing. 2015;10(2):63-70. [DOI]
10. Hunter S, Arthur C. Clinical reasoning of nursing students on clinical placement: clinical educators' perceptions. Nurse Education in Practice. 2016;18:73-9 [DOI]
11. Aitken LM. Critical care nurses' use of decision‐making strategies. Journal of Clinical Nursing. 2003;12(4):476-83 [DOI]
12. Göransson KE, Ehnfors M, Fonteyn ME, Ehrenberg A. Thinking strategies used by registered nurses during emergency department triage. Journal of Advanced Nursing. 2008;61(2):163-72. [DOI]
13. Göransson KE, Ehrenberg A, Marklund B, Ehnfors M. Emergency department triage: is there a link between nurses’ personal characteristics and accuracy in triage decisions? Accident and Emergency Nursing. 2006;14(2):83-8. [DOI]
14. Lee J, Lee YJ, Bae J, Seo M. Registered nurses' clinical reasoning skills and reasoning process: a think-aloud study. Nurse Education Today. 2016;46:75-80 [DOI]
15. 15. NSW Ministry of Health. Patient Safety and Clinical Quality Program. [Online]. Available from: [Accessed: May 10, 2025]. [DOI]
16. Lapkin S, Levett-Jones T, Bellchambers H, Fernandez R. Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: a systematic review. Clinical Simulation in Nursing. 2010;6(6):207-22. [DOI]
17. Banning M. Clinical reasoning and its application to nursing: concepts and research studies. Nurse Education in Practice. 2008;8(3):177-83. [DOI]
18. Forsberg E, Georg C, Ziegert K, Fors U. Virtual patients for assessment of clinical reasoning in nursing—a pilot study. Nurse Education Today. 2011;31(8):757-62 [DOI]
19. Latha Damodaran SB, Jaideep Mahendra, Aruna S. Assessment of clinical reasoning in b sc nursing students. International Journal of Science and Research 2017;6(8):1792-4.
20. Forsberg E, Ziegert K, Hult H, Fors U. Clinical reasoning in nursing, a think-aloud study using virtual patients–a base for an innovative assessment. Nurse Education Today. 2014;34 (4):538-42. [DOI]
21. Cook DA, Triola MM. Virtual patients: a critical literature review and proposed next steps. Medical Education. 2009;43(4):303-11. [DOI]
22. Jael SA. Use of Outcome-Present state test model of clinical reasoning with Filipino nursing students: Loma Linda University Electronic Theses, Dissertations & Projects. 2016:387.
23. Ilgen JS, Humbert AJ, Kuhn G, et al. Assessing diagnostic reasoning: a consensus statement summarizing theory, practice, and future needs. Academic Emergency Medicine. 2012;19(12):1454-61. [DOI]
24. Daniel M, Rencic J, Durning SJ, et al. Clinical reasoning assessment methods: a scoping review and practical guidance. Academic Medicine. 2019;94(6):902-12. [DOI]
25. Al-Kadri HM, Al-Moamary MS, Roberts C, Van der Vleuten CP. Exploring assessment factors contributing to students' study strategies: literature review. Medical Teacher. 2012;34(1): 42-50. [DOI]
26. Epstein RM. Assessment in medical education. New England Journal of Medicine. 2007;356(4):387-96. [DOI]
27. Van der Vleuten C, Schuwirth L, Scheele F, Driessen E, Hodges B. The assessment of professional competence: building blocks for theory development. Best Practice & Research Clinical Obstetrics & Gynecology. 2010;24(6):703-19. [DOI]
28. van der Vleuten CP, Schuwirth L, Driessen E, Dijkstra J, Tigelaar D, Baartman L, Van Tartwijk J. A model for programmatic assessment fit for purpose. Medical Teacher. 2012;34(3):205-14 [DOI]
29. Lee J, Park CG, Kim SH, Bae J. Psychometric properties of a clinical reasoning assessment rubric for nursing education. BMC Nursing. 2021;20(1):1-9 [DOI]
30. Liou SR, Liu HC, Tsai HM, et al. The development and psychometric testing of a theory‐based instrument to evaluate nurses’ perception of clinical reasoning competence. Journal of Advanced Nursing. 2016;72(3):707-17. [DOI]
31. Cheng CY, Hung CC, Chen YJ, Liou SR, Chu TP. Effects of an unfolding case study on clinical reasoning, self-directed learning, and team collaboration of undergraduate nursing students: a mixed methods study. Nurse Education Today. 2024;137:106168 [DOI]
32. Hong S, Lee J, Jang Y, Lee Y. A cross-sectional study: what contributes to nursing students’ clinical reasoning competence? International Journal of Environmental Research and Public Health. 2021;18(13):6833. [DOI]
33. Hu F, Yang J, Yang BX, et al. The impact of simulation-based triage education on nursing students' self-reported clinical reasoning ability: a quasi-experimental study. Nurse Education in Practice. 2021;50:102949. [DOI]
34. Johnston S, Nash R, Coyer F. An evaluation of simulation debriefings on student nurses’ perceptions of clinical reasoning and learning transfer: a mixed methods study. International Journal of Nursing Education Scholarship. 2019;16(1):20180045 [DOI]
35. Marcomini I, Terzoni S, Destrebecq A. Fostering nursing students’ clinical reasoning: a QSEN-based teaching strategy. Teaching and Learning in Nursing. 2021;16(4):338-41 [DOI]
36. Taghizadeh Z, Ebadi A, Montazeri A, Shahvari Z, Tavousi M, Bagherzadeh R. Psychometric properties of health-related measures. Part 1: translation, development, and content and face validity. Payesh (Health Monitor). 2017;16(3):343-57.
37. Deschênes M-F, Goudreau J. Addressing the development of both knowledge and clinical reasoning in nursing through the perspective of script concordance: an integrative literature review. Journal of Nursing Education and Practice. 2017;7(12):28-38. [DOI]
38. Thampy H, Willert E, Ramani S. Assessing clinical reasoning: targeting the higher levels of the pyramid. Journal of General Internal Medicine. 2019;34:1631-6. [DOI]
39. Belhomme N, Jego P, Pottier P. Gestion de l’incertitude et compétence médicale: une réflexion clinique et pédagogique. La Revue de Médecine Interne. 2019;40(6):361-7. [DOI]
40. Nouh T, Boutros M, Gagnon R, et al. The script concordance test as a measure of clinical reasoning: a national validation study. The American Journal of Surgery. 2012;203(4):530-4. [DOI]
41. Blanié A, Amorim M-A, Benhamou D. Comparative value of a simulation by gaming and a traditional teaching method to improve clinical reasoning skills necessary to detect patient deterioration: a randomized study in nursing students. BMC Medical Education. 2020;20:1-11 [DOI]
42. Damodaran L, Mahendra J, Aruna S, Dave PH, Little M. Exploration of clinical reasoning skills in undergraduate nursing students. NeuroQuantology. 2023;21(5):776 [DOI]
43. Dory V, Gagnon R, Vanpee D, Charlin B. How to construct and implement script concordance tests: insights from a systematic review. Medical Education. 2012;46(6):552-63. [DOI]
44. Leclerc A-A, Nguyen LH, Charlin B, Lubarsky S, Ayad T. Assessing the acceptability of script concordance testing: a nationwide study in otolaryngology. Canadian Journal of Surgery. 2021;64(3): 317. [DOI]
45. Hekmatipour N, Jooybari L, Sanagoo A. Can we use the “script concordance” test as a valid alternative method to evaluate clinical reasoning skills in nursing students? Iranian Journal of Medical Education. 2017;17:381-3.
46. Arisudhana GB, Anggayani AN, Kadiwanu AO, Cahyanti NE. Kemampuan penalaran klinis mahasiswa perawat tahun keempat pada masalah keperawatan medikal medah. Journal Center of Research Publication in Midwifery and Nursing. 2019;3(1):58-62. [DOI]
47. Arisudhana GA, Martini NM. Implementation of the blended learning method to enhance clinical reasoning among nursing students. Jurnal Keperawatan Soedirman. 2022;17(2):57-62 [DOI]
48. Forneris SG, Neal DO, Tiffany J, et al. Enhancing clinical reasoning through simulation debriefing: a multisite study. Nursing Education Perspectives. 2015;36(5):304-10 [DOI]
49. Hrynchak P, Glover Takahashi S, Nayer M. Key‐feature questions for assessment of clinical reasoning: a literature review. Medical Education. 2014;48(9):870-83 [DOI]
50. Hinchy J, Farmer E. Assessing general practice clinical decision-making skills: the key features approach. Australian Family Physician. 2005;34(12):1059-61.
51. D'Souza P, Renjith V, George A, Renu G. Rubrics in nursing education. International Journal of Advanced Research. 2015;3(5):423-8.
52. Gouifrane R, Lajane H, Belaaouad S, Benmokhtar S, Lotfi S, Dehbi F, Radid M. Effects of a blood transfusion course using a blended learning approach on the acquisition of clinical reasoning skills among nursing students in Morocco. International Journal of Emerging Technologies in Learning. 2020;15(18):260-9. [DOI]
53. Hosseini A, Keshmiri F, Rooddehghan Z, Mokhtari Z, Gaznag ES, Bahramnezhad F. Design, implementation and evaluation of clinical pharmacology simulation training method for nursing students of Tehran school of nursing and midwifery. Journal of Medical Education and Development. 2021;16(3):151-162. [DOI]
54. Brookhart SM. How to create and use rubrics for formative assessment and grading: Ascd; 2013.
55. Stanley T. Using rubrics for performance-based assessment: a practical guide to evaluating student work. Routledge; 2021: 162.
56. Stevens DD, Levi AJ. Introduction to rubrics: an assessment tool to save grading time, convey effective feedback, and promote student learning. Routledge; 2023 [DOI]
57. Ramazanzadeh N, Ghahramanian A, Zamanzadeh V, Valizadeh L, Ghaffarifar S. Development and psychometric testing of a clinical reasoning rubric based on the nursing process. BMC Medical Education. 2023;23(1):98. [DOI]
58. Ramazanzadeh N, Ghahramanian A, Zamanzadeh V, Valizadeh L, Ghaffarifar S. Development and psychometric testing of a clinical reasoning rubric based on the nursing process. BMC Medical Education. 2023;23(1):98 [DOI]
59. Kim JY, Kim EJ. Effects of simulation on nursing students' knowledge, clinical reasoning, and self-confidence: a quasi-experimental study. Korean Journal of Adult Nursing. 2015;27(5):604-11. [DOI]
60. Son HK. Effects of simulation with problem-based learning (S-PBL) on nursing students’ clinical reasoning ability: based on Tanner’s clinical judgment model. BMC Medical Education. 2023;23(1):601 [DOI]
61. Kuiper RA, Pesut DJ. Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self‐regulated learning theory. Journal of Advanced Nursing. 2004;45(4):381-91 [DOI]
62. Kautz D, Kuiper R, Bartlett R, Buck R, Williams R, Knight-Brown P. Building evidence for the development of clinical reasoning using a rating tool with the outcome-present state-test (OPT) model. Southern Online Journal of Nursing Research. 2009;9(1):1-8.
63. Seo YH, Eom MR, editors. The effect of simulation nursing education using the outcome-present state-test model on clinical reasoning, the problem-solving process, self-efficacy, and clinical competency in Korean nursing students. Healthcare; 2021;9(3):243 [DOI]
64. Kautz DD, Kuiper R, Pesut DJ, Knight-Brown P, Daneker D. Promoting clinical reasoning in undergraduate nursing students: application and evaluation of the outcome present state test (OPT) model of clinical reasoning. International Journal of Nursing Education Scholarship. 2005;2(1). [DOI]
65. Van Der Vleuten CP. The assessment of professional competence: developments, research, and practical implications. Advances in Health Sciences Education. 1996;1(1):41-67. [DOI]
66. Smith RM. The triple-jump examination as an assessment tool in the problem-based medical curriculum at the university of Hawaii. Academic Medicine. 1993;68(5):366-72. [DOI]
67. Khanyile T, Mfidi F. The effect of curricula approaches to the development of the student’s clinical reasoning ability. Curationis. 2005;28(2):70-6 [DOI]
68. Moghadam MP. The effect of triple-jump examination (TJE)-based assessment on clinical reasoning of nursing interns in Zabol during 2017-2018. Education. 2012;2010. [DOI]
69. Koivisto J-M, Multisilta J, Niemi H, Katajisto J, Eriksson E. Learning by playing: a cross-sectional descriptive study of nursing students' experiences of learning clinical reasoning. Nurse Education Today. 2016;45:22-8. [DOI]
70. Yauri I. Improving student nurses’ clinical-reasoning skills: implementation of a contextualized, guided learning experience. JKP: Jurnal Keperawatan Padjadjaran. 2019;7(2):152-63.
71. de Sá Tinôco JD, Cossi MS, Fernandes MI, Paiva AC, de Oliveira Lopes MV, de Carvalho Lira AL. Effect of educational intervention on clinical reasoning skills in nursing: a quasi-experimental study. Nurse Education Today. 2021;105:105027. [DOI]
72. Forsberg E, Kristina Z, Håkan H, Uno F. Assessing progression of clinical reasoning through virtual patients: An exploratory study. Nurse education in practice. 2016; 16(1): 97-103.‏ [DOI]
73. Georg C, Karlgren K, Ulfvarson J, Jirwe M, Welin to assess students' clinical reasoning when encountering virtual patients. Journal of Nursing Education. 2018; 57(7), 408-415 [DOI]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.