Research Progress of Clinical Reasoning Ability of Nurses
Journal: Advanced Journal of Nursing DOI: 10.32629/ajn.v6i3.4394
Abstract
Nurses' clinical reasoning ability is a core cognitive skill in nursing practice, which is directly related to the accuracy of clinical judgment, patient safety, and the improvement of nursing quality. With the in-depth advancement of China's medical and health system reform and the extensive implementation of high-quality nursing services, higher requirements have been put forward for nurses' professional qualities and decision-making abilities. However, due to the current lack of a systematic and contextualized clinical reasoning training framework in domestic nursing education and clinical training, nurses, especially those with less work experience, face problems such as lack of confidence in judgment and delayed decision-making in actual work. Therefore, this study conducts a review on the concept, assessment tools, influencing factors, and research status of nurses' clinical reasoning ability, aiming to provide a reference for relevant research on the cultivation of domestic nurses' clinical reasoning ability.
Keywords
clinical reasoning ability of nurses, reasoning ability, critical thinking, clinical decision making
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[40]Zhao Wen-xiao, Liu Yan-Li. Effects of virtual patients combined with simulation practice teaching on the cultivation of clinical reasoning ability of nursing undergraduates [J]. Nursing Research,2021,35(19):3511-3513.
[41]Liu Hui, Zhang Ruixia, Jing Mengjuan, et al. Teaching practice of rapid cycle deliberate practice to improve clinical reasoning ability of higher vocational nursing students: Taking health assessment course as an example [J]. Health Vocational Education, 2020,43(12):78-82.
[42]Li Wencui, Li Shengyun, Wang Yu, et al. Design and application of clinical reasoning ability training course based on dual system model for nursing postgraduates [J]. Chinese Journal of Nursing,2017,24(15):13-16.
[43]Feng M X. Development of script consistency test tool and its application in the assessment of clinical reasoning ability of nursing undergraduates [D]. Shandong University of Traditional Chinese Medicine,2024.
[44]Zhang Xin-li, Yang Xia, Feng Xia, et al. Construction and practice of clinical reasoning ability training system for standardized training nurses in emergency department [J]. Evidence-based Nursing,2024,10(11):1985-1989.
[2]Li Wencui, Li Shengyun, Wang Yu, et al. Design and application of clinical reasoning ability training course based on dual system model for nursing postgraduates [J]. Chinese Journal of Nursing,2017,24(15):13-16.
[3]Yu J, Wang J L, WANG M Y, et al. Reliability and validity of Chinese version of Self-rating Scale for Clinical Reasoning and Reflection in nursing students [J]. Chin J Medical Education, 2019, 39(7): 539-544.
[4]Kavanagh JM, Szweda C. A Crisis in Competency: The Strategic and Ethical Imperative to Assessing New Graduate Nurses' Clinical Reasoning. Nurs Educ
Perspect. 2017, 38 (2): 57-62.
[5]Gao Meihua. Current Situation and Influencing factors of clinical nurses' critical thinking [J]. China Nursing Management,2011,11(12):35-37.
[6]Feng Mengxuan, Qiao Yuanjing, Li Dandan, et al. Application status of script consistency test and its enlightenment to domestic nursing education [J]. Nursing Research,2023,37(13):2370-2374.
[7]Simmons B. Clinical reasoning: concept analysis[J]. J Adv Nurs, 2010,66(5):1151-8.
[8]Tanner CA. Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ. 2006, 45 (6): 204-11.
[9]Mohammadi-Shahboulaghi F, Khankeh H, HosseinZadeh T. Clinical reasoning in nursing students: A concept analysis. Nurs Forum. 2021, 56 (4): 1008-1014.
[10]Charlin B, Brailovsky C, Leduc C, et al. The Diagnosis Script Questionnaire: A New Tool to Assess a Specific Dimension of Clinical Competence. Adv Health Sci Educ Theory Pract. 1998, 3 (1): 51-58.
[11]Ganesan S, Bhandary S, Thulasingam M, et al.Developing Script Concordance Test Items in Otolaryngology to Improve Clinical Reasoning Skills: Validation using Consensus Analysis and Psychometrics. Int J Appl Basic Med Res. 2023, 13 (2): 64-69.
[12]Hamui M, Ferreira JP, Torrents M, et al.Prueba de concordancia de script: primera experiencia en pediatria de alcance nacional [Script Concordance Test: first nationwide experience in pediatrics]. Arch Argent Pediatr. 2018,116(1):e151-e155.
[13]Hu Jing. Revision and application of the Chinese version of Clinical Diagnostic Thinking Questionnaire [D]. Central South University,2012.
[14]FACIONEPA,FACIONE N C.The California critical thinking skills test[M].California Academic Press,1992:1.
[15]Peng Meici, Wang Guocheng, Chen Jile, et al. Reliability and validity of the Critical Thinking Disposition Inventory [J]. Chinese Journal of Nursing,2004,(09):7-10.
[16]Yang G M, Wei H Y, Wan L P, et al. Reliability and validity of Critical thinking inventory in medical students [J]. Journal of Zhengzhou University (Medical Edition), 2021,57(03):330-335.
[17]Lasater K. Clinical judgment development: using simulation to create an assessment rubric. J Nurs Educ. 2007, 46 (11): 496-503.
[18]Vreugdenhil J, Spek B. Development and validation of Dutch version of Lasater Clinical Judgment Rubric in hospital practice: An instrument design study. Nurse Educ Today. 2018, 62:43-51.
[19]Roman-Cereto M, Garcia-Mayor S, Kaknani-Uttumchandani S, et al. Cultural adaptation and validation of the Lasater Clinical Judgment Rubric in nursing students in Spain. Nurse Educ Today. 2018, 64:71-78.
[20]Wang Min, Chen Jie, Chen Chen. Revision and evaluation of Lasater Clinical Judgment Scale [J]. Nursing Practice & Research,2020,17(06):8-10.
[21]ROYEENCB,MU K,BARRETT K,et al.Pilot investigation: Evaluation of clinical reflection and reasoning before and after workshop intervention[J].Innovationsin Occupational Therapy Education,2001:107-114.
[22]SEIFG A,BROWN D,ANNAN-COULTAS D. Fostering clinical-reasoning skills in physical therapist students through an interactive learning module designed in the moodle learning managemen system[J].Journal of Physical Therapy Education, 2013, 27 (3): 32-40.
[23]Liaw SY, Rashasegaran A, Wong LF, et al. Development and psychometric testing of a Clinical Reasoning Evaluation Simulation Tool (CREST) for assessing nursing students' abilities to recognize and respond to clinical deterioration. Nurse Educ Today. 2018, 62:74-79.
[24]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[J]. J Adv Nurs,2016,72(3):707-17.
[25]Notarnicola I, Rocco G, Iacorossi L, et al. Psychometric Evaluation of the Nurse Clinical Reasoning Scale: A Validation Study Among Italian Nurses. J Nurs Meas. 2024, 32 (2): 183-193.
[26]Hosseinzadeh T, Mirfarhadi N, Pouralizadeh M, et al. Psychometric properties of the persian version of the nursing clinical reasoning scale. Nurs Open. 2024, 11(1):e2041.
[27]Wang Y J. Current status of clinical reasoning ability and its correlation with self-directed learning ability of nurses in Class Grade A hospitals in Shenyang [D]. China Medical University,2018.
[28]Huang HM, Huang CY, Lin KC, et al. Development and Psychometric Testing of the Clinical Reasoning Scale Among Nursing Students Enrolled in Three Types of Programs in Taiwan. J Nurs Res. 2023, 31(2): e263.
[29]Bae J, Lee J, Choi M, et al. Development of the clinical reasoning competency scale for nurses. BMC Nurs. 2023, 22 (1): 138.
[30]Liu Z, Sun N, Chen C, et al. Comparative study of clinical reasoning competence and self-directed learning competence in nurses across varied years of experience. J Clin Nurs. 2025, 34 (3): 836-848.
[31]Noh S, Kang Y. The Relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses. Nurs Open. 2024 Aug; 11(8):e70003.
[32]Zhang Sa-Le, LI Ying, Niu Lulu, et al. Current status and Influencing factors of nurses' Clinical decision-making ability [J]. Chinese Medical Ethics,2024,37(7):798-806.
[33]Wang S, Ma J J, Zhao H, et al. Status quo and influencing factors of shared decision-making ability of 608 clinical nurses [J]. Chinese Journal of Nursing, 2020,32(12):68-73.
[34]Zhang Zhang, Kuang Qi-hua, Huang Xu-xia. Influencing factors and countermeasures of clinical decision-making ability of junior nurses [J]. General Nursing,2018,16(29):3596-3598.
[35]Chen Yue, Chen Cuiping, Xu Shuaishuai, et al. Current status analysis and countermeasures of nursing clinical decision-making consciousness of junior nurses in emergency and critical care Department [J]. Evidence-based Nursing,2020,6(12):1382-1387.
[36]Mohammadi F, Hosseini SK, Khazaei S, et al. Psychometrics assessment of clinical reasoning competency scale in nurses of critical care units. BMC Nurs. 2024, 23 (1): 733.
[37]Atalla ADG, El-Gawad Mousa MA, Hashish EAA,, et al. Embracing artificial intelligence in nursing: exploring the relationship between artificial intelligence-related attitudes, creative self-efficacy,and clinical reasoning competency among nurses. BMC Nurs. 2025, 24 (1): 661.
[38]Tordjman M, Liu Z, Yuce M, et al. Comparative benchmarking of the DeepSeek large language model on medical tasks and clinical reasoning. Nat Med. 2025, 31 (8): 2550-2555.
[39]Sandmann S, Hegselmann S, Fujarski M, et al. Benchmark evaluation of DeepSeek large language models in clinical decision-making. Nat Med. 2025, 31 (8): 2546-2549.
[40]Zhao Wen-xiao, Liu Yan-Li. Effects of virtual patients combined with simulation practice teaching on the cultivation of clinical reasoning ability of nursing undergraduates [J]. Nursing Research,2021,35(19):3511-3513.
[41]Liu Hui, Zhang Ruixia, Jing Mengjuan, et al. Teaching practice of rapid cycle deliberate practice to improve clinical reasoning ability of higher vocational nursing students: Taking health assessment course as an example [J]. Health Vocational Education, 2020,43(12):78-82.
[42]Li Wencui, Li Shengyun, Wang Yu, et al. Design and application of clinical reasoning ability training course based on dual system model for nursing postgraduates [J]. Chinese Journal of Nursing,2017,24(15):13-16.
[43]Feng M X. Development of script consistency test tool and its application in the assessment of clinical reasoning ability of nursing undergraduates [D]. Shandong University of Traditional Chinese Medicine,2024.
[44]Zhang Xin-li, Yang Xia, Feng Xia, et al. Construction and practice of clinical reasoning ability training system for standardized training nurses in emergency department [J]. Evidence-based Nursing,2024,10(11):1985-1989.
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