An Integrative Review of Clinical Reasoning Teaching Strategies and Outcome Evaluation in Nursing Education

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This study explored teaching strategies used to promote clinical reasoning in nursing education and identify outcomes used to evaluate effectiveness.


The integrative review framework by Whittemore and Knafl (2005) was used in this study.


Strategies included simulation (n = 10); active learning strategies such as case studies, reflection, journaling, and collaborative learning (n = 13); teaching strategies such as think aloud or case studies with simulation (n = 12); and experiential or clinical experiences (n = 2). Although most studies used exams, worksheets (n = 19), or observations by clinical instructors (n = 2) to measure effectiveness, some studies (n = 8) also used surveys to measure student satisfaction, engagement, or perception; three studies measured the student’s ability to use the instrument.


Improving clinical thinking requires development of innovative, effective teaching strategies. Instruments that can accurately evaluate teaching and learning strategies are needed to advance this educational initiative and improve quality of care.

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