Publication: Development, validation, and evaluation of a clinical reasoning model for Malaysian nursing students
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Date
2025-11
Authors
Sze, Chai Li
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Abstract
The lack of clinical reasoning skills among newly graduated nurses poses significant risks, including delayed recognition of patient deterioration, inappropriate clinical interventions, and preventable adverse events. Developing clinical reasoning abilities in nursing students is essential for enhancing patient safety and care outcomes. This study aimed to design, validate, and evaluate a clinical reasoning model tailored for Malaysian nursing students using a mixed-methods approach with an exploratory sequential design across three phases. In Phase 1, a scoping review of relevant theories, teaching strategies, and assessment methods was conducted to inform the development of the model. In Phase 2, a preliminary clinical reasoning model was constructed and refined through expert and graduate nurse feedback. Content and face validation confirmed its clarity and relevance. Phase 3 involved implementing the finalised model with 58 nursing students. Outcomes were assessed using Key Feature Questions, case studies, clinical supervisor evaluations, and self-rated scales. Findings demonstrated a significant improvement in clinical reasoning, as indicated by increased Key Feature scores, enhanced performance in case studies, and higher evaluations from clinical supervisors. Small but positive changes were also seen in specific self-regulation subscales, suggesting early cognitive and reflective development. In conclusion, the proposed clinical reasoning model yielded significant gains in students’ clinical reasoning, as demonstrated through various assessment formats encompassing application, observation, and self-report measures. While gains in metacognitive and broader self-regulatory abilities were modest, the intervention offers a feasible and adaptable means to integrate clinical reasoning into undergraduate nursing education. It also lays the groundwork for future adoption of more advanced or resource-intensive pedagogical strategies, and supports the development of clinical reasoning skills essential for safe and competent nursing practice.