Clinical reasoning in undergraduate nursing education: a scoping review

A systematic scoping review through a search strategy applied to the MEDLINE database, and an analysis of the material recovered by extracting data done by two independent reviewers. The extracted data were analyzed and synthesized in a narrative manner.

RESULTS

From the 1380 citations retrieved in the search, 23 were kept for review and their contents were summarized into five categories: 1) the experience of developing critical thinking/clinical reasoning/decision-making process; 2) teaching strategies related to the development of critical thinking/clinical reasoning/decision-making process; 3) measurement of variables related to the critical thinking/clinical reasoning/decision-making process; 4) relationship of variables involved in the critical thinking/clinical reasoning/decision-making process; and 5) theoretical development models of critical thinking/clinical reasoning/decision-making process for students.

CONCLUSION

The biggest challenge for developing knowledge on teaching clinical reasoning seems to be finding consistency between theoretical perspectives on the development of clinical reasoning and methodologies, methods, and procedures in research initiatives in this field.

Descriptors
Decision Making; Nursing; Education, Nursing; Review

Type of study and methodology	N	%*
1. Empirical (type)	14	51.8
1.1 Qualitative (design)	5	21.8
Content analysis	2	8.7
Ethnography	1	4.3
Action research	1	4.3
Grounded theory	1	4.3
1.2 Quantitative (design)	9	39.1
Cross-sectional / Analytical	3	11.1
Methodological development	2	8.7
Quasi-experimental (before and after)	2	8.7
Quasi-experimental with non-randomized control group	1	4.3
Cohort	1	4.3
2. Theoretical (type)	9	39.1
2.1 Case studies (design)	4	17.4
2.2 Opinion (design)	3	11.1
2.3 Review (design)	2	8.7
Total	23	100

Categories and subcategories	Type of study
Categories and subcategories	Empirical	Theoretical	Total
Teaching strategies related to the development of clinical reasoning/decision-making/critical thinking	2	6	8
Strategies for developing critical thinking^{(3,11 -16)}	2	5	7
Strategies for developing clinical reasoning(¹⁷17 Baldwing KB. Friday night in the pediatric emergency department a simulate exercise to promote clinical reasoning in the classroom.. Nurse Educ 2007;32(1):24-9.)	-	1	1
Relationship of variables involved in clinical reasoning/decision-making/critical thinking	4	1	5
Development of critical thinking(¹⁸18 Spelic SS, Parsons M, Hercinger M, Andrews A, Parks J, Norris J. Evaluation of critical thinking outcomes of a BSN program. Holist Nurs Pract. 2001;15(3):27-34.)	1	-	1
Relationship between the curriculum and critical thinking/ Development of critical thinking(¹⁹19 Beckie TM, Lowry LW, Barnett S. Assessing critical thinking in baccalaureate nursing students: a longitudinal study. Holist Nurs Pract. 2001;15(3):18-26.)	1	-	1
Relationship between thinking styles and creativity(²⁰20 Almansa P, López-Martinez O, Corbolán J, Limiñana-Gras RM. Thinking styles and creativity preferences in nursing. Creat Nurs. 2013;19(2):91-100.)	1	-	1
Relationship between reflective skills and sense of coherence between theory and practice by students(²¹21 Hatlevik IKR. The theory-practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap between theory and practice in initial nursing education. J Adv Nurs. 2011;68(4):868-77.)	1	-	1
Relationship between critical thinking and performance in professional accreditation examinations (NCLEX-RN)(²²22 Romeo EM. Quantitative Research on critical thinking and predicting nursing students' NCLEX-RN Performance.. J Nurs Educ 2010;49(7):378-86.)	--	1	1
The experience of developing clinical reasoning/decision-making/critical thinking	3	1	4
Learn how to make clinical decisions (factors that favor/encourage or discourage/disfavor; conditions in which learning occurs)(²³23 Young N. An exploration of clinical decision-making among students and newly qualified midwives. Midwifery. 2012;(28):824-30.)	1	-	1
Development of critical thinking(²⁴24 Yuan H, Williams BA, Fan L. A systematic review of selected evidence on developing nursing students' critical thinking through problem-based learning. Nurse EducToday. 2008;28(6):657-63.)	-	1	1
Understanding the experience of developing critical thinking, clinical reasoning and problem solving(²⁵25 Lake S, Mclnnes R. Exploring cognitive skill development in midwifery education. Nurse Educ Pract. 2012;12(5):264-8.)	1	-	1
Situations/contexts that demand critical thinking(²⁶26 Mun MS. An analysis of narratives to identify critical thinking contexts in psychiatric clinical practice. Int J Nurs Pract. 2010;16(1):75-80.)	1	-	1
Measurement of variables related to the clinical reasoning/decision-making/critical thinking	3	-	3
Measurement of intuition(²⁷27 Smith AJ. Continued psychometric evaluation of intuition instrument for nursing students. J Holist Nurs. 2006;24(2):82-9.-²⁸28 Demir Y, Denat Y, Khorshid L, Eser I. Cultural validation of the "Use of Intuition by Nursing Students Scale - Turkish version". J Transcult Nurs. 2013;23(4):369-76.)	2	-	2
Measurement of critical thinking(²⁹29 Stone CA, Davidson LJ, Evans JL, Hansen MA. Validity evidence for using a general critical thinking test to measure nursing students' critical thinking.. Holist Nurs Pract 2001;15(4):65-74.)	1	-	1
Theoretical model of the development of clinical reasoning/decision making/critical thinking	2	1	3
Model of mental schemata construction for the development of skills in solving problems concerning calculating medicine dosages(³⁰30 Weeks KW, Higginson R, Closhesy JM, Coben D. Safety in numbers 7: veni, vidi, duci: A grounded theory evaluation of nursing students' medication problem-solving schemata construction. Nurse Educ Pract. 2013;13(2):78-87.)	1	-	1
Model of relationship between variables that contribute to critical thinking(³¹31 Redding DA. The development of critical thinking among students in baccalaureate nursing education. Holist Nurs Pract 2001;15(4):57-64.)	-	1	1
Decision-making model(³²32 Brooks EM, Thomas S. The perception and judgment of senior baccalaureate student nurses in clinical decision making. ANS Adv Nurs Sci. 1997;19(3):50-69.)	1	-	1
Total	14	9	23

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[1] Corresponding author: Sáskia Sampaio Cipriano de Menezes Rua Teresina, 495, Adrianópolis CEP 69057-070 - Manaus, AM, Brazilsaskiasampaio@gmail.com