Nursing Process And Critical Thinking Review Test

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Welcome to our Nursing Process and Critical Thinking Review Test, a comprehensive tool designed to elevate your nursing expertise and decision-making abilities. This quiz is essential for nursing students and practicing nurses who aim to refine their assessment, planning, implementation, and evaluation skills, all through the lens of critical thinking. Our quiz meticulously covers all phases of the nursing process, integrating critical thinking scenarios that challenge you to apply theoretical knowledge in practical, real-world healthcare situations. You'll encounter a variety of question formats that probe your ability to analyze information, prioritize patient care, and make informed decisions quickly and effectively. Read more Whether you are preparing for your NCLEX exams, brushing up on your clinical practices, or seeking to enhance your professional development, this test provides the perfect opportunity to assess and improve your critical thinking and nursing process skills. Dive into our Nursing Process and Critical Thinking Review Test today to test your knowledge, sharpen your critical thinking, and ensure you're fully prepared to provide the highest quality of care in any nursing setting.

Nursing Process and Critical Thinking Questions and Answers

What is the "nursing process" select all that apply.

Organizational framework for the practice of Nursing

Systematic method by which nurses plan and provide care for patients

The application of the nursing process only applies to RN's and not LPN's

The Nursing Scope and Standards of Practice of the ANA outlines the steps of the nursing process

Rate this question:

ANA defines it as a"systematic dynamic process by which the nurse, through interaction with the client, significant others  and health care providers collect and analyzes data about the client

pHysical Check-up

Hospital evaluation

Which of the following is not true about Focused ASSESSMENT

When patient is critically ill or disoriented

When patient is unable to respond

Preferably early in the morning before breakfast.

When drastic changes are happening to a patient.

A synonym for significant data that usually demonstrate an unhealthy response. 

Interpretative

Headache, itchiness, warmth

Secondary source of data. (select all that apply) .

Diagnostic procedures

Medical record

Personal interview

Significant other

Which of the following is not a method of data collection?

BiograpHic data

Social media

Health history

If the first method of data collection is to conduct an interview, what is the second method?

Laboratory work

Diagnostic Tests

Performance of a pHysical examination

After establishing a database and before the identification of nursing diagnosis, what does a nurse do? 

Documentation of database

Analysis of database

Filing of database

Acquiring a database of information

Data Clustering

Analyzing signs and symptoms

Identifying patient statements

Grouping related cues together

Entering patient data in the computer

Deficient Fluid Volume (Select all that apply)

Dry skin and dry oral mucous

Decreased urine output

Which of the following refers to the definition of a Nursing Problem?

Nurse overload and nurse burnout

When the nurse calls in sick

Any health care condition that requires diagnostic, therapeutic, or educational actions.

Lose of employment

 Clinical judgment

Job description of a clinical nurse

Data collection

Health intervention

Components of a Nursing Diagnosis. Select all that apply  

Nursing diagnosis title or label

Definition of the title or label

Data clustering

Contributing, etiologic or related factors

Defining characteristics

Which of the following are true regarding nursing diagnosis? 

A nursing diagnosis is any problem related to the health of a patient

When writing a nursing diagnosis, place the adjective before the noun modified

A nursing diagnosis is usually the etiology of the disease

Both medical and nursing diagnosis can be converted into a nursing intervention.

Clear, precise description of a problem 

Intervention

Risk factors

Description of a problem

Analysis of a health issue

Possible illness

Circumstances that increase the susceptibility of a patient to a problem

Clinical cues, signs, symptoms that furnish evidence that the problem exists. 

Nursing diagnosis

How cues, signs and symptoms identified in patient's assessment are written

Diagnosed by

Explained by

Manifested by

"Constipation related to insufficient fluid intake manifested by increased abdominal pressure". What is the defining characteristic? 

Constipation

Insufficient fluid

Increased abdominal pressure

What is RISK NURSING DIAGNOSIS as described by NANDA-I?  Select all that apply

Human responses to health conditions/life processes that may develop in a vulnerable individual/family

Describes the symptoms of the disease

Supported by risk factors that contribute to increased vulnerability

Proof that the person is suffering from an illness

How many parts does a RISK NURSING DIAGNOSIS have?

Which of the following is a risk nursing diagnosis statement .

Risk for falls related to unstable balance

Constipated because of fecal impaction

Risk for Diarrhea

Constipation related to dehydration

Syndrome Nursing Diagnosis

An isolated disease with numerous symptoms

Numerous symptoms describing a single disease

Used when a cluster of actual or risk nursing diagnosis are predicted to be present

Numerous symptoms leading to an idiopathic disorder

Wellness Nursing Diagnosis

Absence of illness

Not strictly a diagnosis

Human responses to levels of good health in an individual, family or community

All of the above

Certain Physiologic complications that nurses monitor to detect their onset or changes in the patient's status.    

Collaborative problems

Clustered Syndrome

Signs of death

Potential complications: hypoglycemia.  This is a sample of what?

Syndromatic pathology

Definite Variance

Collaborative problem

Idiopathic etiology

Identification of a disease or condition by a scientific evaluation of physical signs, symptoms, history, laboratory test and procedures. 

Health Analysis

Nursing Problem

Medical Diagnosis

Difference between Medical and Nursing Diagnoses

Medical is etiology; Nursing is human response

Medical is disease; Nursing is the cause of disease

Medical is illness; Nursing is illness too

Medical is to heal the disease: Nursing is to discover the disease

Difference between a goal statement and an outcome statement

A good outcome statement is specific to the patient

Goals are general deadlines that are to be met

An outcome statement refers to what the nurse will do

Goals and Statements are practically the same

The purpose to which an effort is directed 

Which of the following statements describe a well-written patient outcome statement select all that apply.  .

Uses a measurable verb

Focuses on the completion of nursing interventions

Does not interfere with the medical care plan

Includes a time frame for patient reevaluation

A common framework that helps guide the prioritization of nursing tasks during the process of planning

Ericsson's psychosocial development

Maslow's hierarchy

Glasgow Scale

Bernoulli principle

Nursing interventions

Depend on the tasks delegated by the nursing supervisor

A sequence of prioritized tasks that describe a nurse's job

Activities that promote the achievement of the desired patient outcome

An act of taking care of the sick

Which of the following is not a Physician Prescribed intervention?

Ordering diagnostic tests

Drug administration

Performing wound care

Elevating an edematous leg

Which of the following is not a nurse-prescribed intervention?

Turning the patient every two hours

Providing a back massage

Offering a vitamin supplement

Monitoring a patient for complications

Which of the following statements about the nursing process is true. 

A nursing process is written together with a nursing care plan

A nursing care plan is a product of the nursing process

Both the nursing process and the nursing care plan are purely critical thinking strategies

The nursing process is not an accurate clinical theory

IN which of the following scenarios would a standardized nursing care plan be appropriate? 

Trauma center

Center for infection control

Intensive care unit

Maternity floor without a single Cesarean delivery

Prioritization of tasks belongs to which phase of the Nursing Process? 

Implementation

Documentation is a vital component of which phase of the nursing process?

Validation of patient outcome and goals, evidence based practice.

Past educational knowledge

Theoretical research

Expertise of specialists

Integration of research and clinical experience

Which of the following is not considered a standardized language in nursing?

A research method

Patient does not achieve expected outcome

Similar to zoning

Not the same

Which of the following is not the role of the LPN/LVN in the nursing process?

Suggest interventions

Gather further data to confirm problems

Discuss details of the disease as part of patient education

Observe and report signficant cues

Which of the following are functions of managed care? Select all that apply. 

Provides control over health care services

Standardized diagnosis and treatment

Control Cost

Primary resource for patient advocacy

Clinical pathway

Nursing career development plan

Multidisciplinary action

A concept map for care plans

Specific location in a healthcare facility

A reflective reasoning process that guides a nurse in generating, implementing and evaluating approaches for dealing with client care and professional concerns

Nursing process

Critical thinking

Nursing care plan

Nursing logic

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ATI Critical Thinking Exit Exam Test Bank

ATI critical thinking exit exam test bank are questions that trigger thoughtful analysis. You should assess information and propositions by applying various cognitive abilities to arrive at well-founded, rational, and consistent conclusions within a specific context.

Rather than passively accepting assertions and final thoughts, you must have robust critical thinking skills to engage in questioning and examining the provided evidence. To pass this exam, you must seek logical associations among concepts, explore alternative explanations, and gauge the persuasiveness of presented arguments. Try Naxlex Nursing!

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critical thinking test for nursing school

Elevate your critical thinking skills for the ATI exit exam with Naxlex Nursing's unparalleled test bank! We offer over 900,000 critical thinking practice questions, ensuring you're well-prepared. Our expert tutors regularly refresh the test bank, providing a fresh learning experience. Naxlex offers you practice tests, study guides and flashcards to prepare for your ATI Exit Exam. Don't wait until the last minute. Prepare for your ATI exit early and avoid the last-hour rush.

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Nursing Test Banks

Comprehensive predictor exams, what's in the ati critical thinking exit exam.

A critical thinking exam presents a paragraph of information setting a scenario in the medical field. You're supposed to determine if the information is truthful from the statement. There are four ways the examiner tests your critical thinking;

Assumption:

In this scenario, the examiner wants you to evaluate the statement and conclude if the assumption is present . It's up to you to determine if the information provided has an assumption.

Example question : When administering medications, which statement is true regarding the "Five Rights" of medication administration?

a) Right patient means any patient who requests medication.

b) The right route ensures that the medication is administered as quickly as possible.

c) The right dose requires giving the highest possible dose to ensure effectiveness.

d) None of the options are correct.

Answer: (d) None of the options are correct.

Inference :

In the inference question, the examiner will present various inferences , and you will be asked to mention if the inferences are possibly true, absolutely true, possibly false, or absolutely false.

Question Example: When providing care to a patient, which statement regarding hand hygiene is true?

a) Hand hygiene is necessary only after direct contact with body fluids.

b) Hand hygiene should be performed before and after every patient interaction.

c) Hand hygiene can be skipped if gloves are worn.

d) Hand hygiene is primarily the responsibility of the nursing assistants.

Answer: b) Hand hygiene should be performed before and after every patient interaction.

Interpretation:

In this question type, the examiner asks you to interpret the passage in your own words and come up with a possible conclusion. You need to understand the information and create a conclusion based on the interpretation question.

Example Question : You are assessing a patient with a strict fluid restriction due to a medical condition. Upon reviewing the patient's intake and output records, you notice that the recorded fluid intake exceeds the prescribed limit consistently. What could be the possible reasons for this situation, and how should a nurse interpret and address it?

a) The patient is not adhering to the fluid restriction and is consuming liquids covertly.

b) Errors in recording or miscalculations in measuring the patient's fluid intake.

c) The healthcare provider has changed the patient's fluid restriction, but the records were not updated.

d) The patient's condition has worsened, requiring a relaxation of the fluid restriction.

e) The nursing staff intentionally provides additional fluids to improve patient comfort.

Correct Answer: The correct answer may vary based on the specific scenario and information available. However, a) The patient is not adhering to the fluid restriction and consuming liquids covertly, and b) Errors in recording or miscalculations in measuring the patient's fluid intake.

Analysis argument:

In such questions, you're presented with an argument, and you will determine if it's weak or strong. The argument that relates to a certain scenario is strong but weak if not directed.

Example Question:

In modern healthcare, the nurse's role has evolved significantly, with an increasing emphasis on technology and complex medical interventions. Analyze the following statement: "While technological advancements have undoubtedly improved patient care, they have also raised ethical concerns and potentially reduced the focus on holistic patient-centered care in nursing practice." Provide a well-structured argument supporting or refuting this statement, considering the ethical implications and the balance between technology and human touch in nursing.

Supercharge your critical thinking ATI exit exam preparation with Naxlex Nursing's extensive critical thinking test bank. Boasting a whopping 8,000+ questions, you'll never run out of practice. Our dedicated tutors constantly update the bank, guaranteeing a dynamic learning journey.

Explore our comprehensive offerings, including flashcards and study guides, at a reasonable price. Take charge of your success using Naxlex nursing study materials today and pass the ATI critical thinking exit exam. Contact Naxlex Nursing now.

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What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

critical thinking test for nursing school

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What is Critical Thinking in Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

critical thinking test for nursing school

critical thinking test for nursing school

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NCLEX Strategies: Critical Thinking & Rewording Questions

The NCLEX-RN®exam is not a test about recognizing facts. You must be able to correctly identify what the question is asking. Do not focus on background information that is not needed to answer the question. The NCLEX-RN®exam focuses on thinking through a problem or situation.

Now that you are more knowledgeable about the components of a multiple-choice test question, let’s talk about specific strategies that you can use to problem-solve your way to correct answers on the NCLEX-RN® exam.

Are you feeling overwhelmed as you read these words? Don’t be! We are going teach you a step-by-step method to choose the appropriate path. The Kaplan Nursing team has developed a decision tree that shows you how to approach every NCLEX-RN® exam question.

There are some strategies that you must follow on  every  NCLEX-RN®exam test question. You must  always  figure out what the question is asking, and you must  always  eliminate answer choices. Choosing the right answer often involves choosing the best of several answers that have correct information. This may entail your correct analysis and interpretation of what the question is really asking. So let’s talk about how to figure out what the question is asking.

Strategies for solving critical thinking and rewording questions on the NCLEX

  • Observation
  • Deciding what is important
  • Looking for patterns and relationships
  • Identifying the problem
  • Transferring knowledge from one situation to another
  • Applying knowledge
  • Discriminating between possible choices and/or courses of action
  • Evaluating according to criteria established

Steps for critical thinking and rewording questions on the NCLEX

Read each question carefully from the first word to the last word. Do not skim over the words or read them too quickly.

Look for hints in the wording of the question stem. The adjectives  most, first, best, primary,  and  initial  indicate that you must establish priorities. The phrase  further teaching is necessary  indicates that the answer will contain incorrect information. The phrase  client understands the teaching  indicates that the answer will be correct information.

Step 3.  Reword the question stem in your own words so that it can be answered with a  yes  or a  no , or with a specific bit of information. Begin your questions with  what ,  when , or  why . We will refer to this reworded version as the Reworded Question in the examples that follow.

If you can’t complete step 3, read the answer choices for clues.

NCLEX Practice Question 1

A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements  most  appropriately reflects how the nurse should document these findings?

Steps to answer this practice question.

  • Read the question stem carefully.
  • Pay attention to the adjectives. Most appropriately tells you that you need to select the best answer.
  • Reword the question stem in your own words. In this case, it is, “What is the best charting for this situation?”
  • Because you were able to reword the question, the fourth step is unnecessary. You didn’t need to read the answer choices for clues.

NCLEX Practice Question 2

A construction worker is admitted to the hospital for treatment of active tuberculosis (TB). The nurse teaches the client about TB. Which of the following statements by the client indicates to the nurse that further teaching is necessary?

  •   Look for hints. Pay particular attention to the statement “further teaching is necessary.” You are looking for negative information.
  • Reword the question stem in your own words. In this case, it is, “What is incorrect information about TB?”
  • Because you were able to reword the question, the fourth step is unnecessary. You didn’t need to read the answer choices for clues to determine what the question is asking.

NCLEX Practice Question 3

A woman admitted to the hospital in premature labor has been treated successfully. The client is to be sent home on an oral regimen of terbutaline. Which of the following statements by the client indicates to the nurse that the client understands the discharge teaching about the medication?

  • Look for hints. Pay attention to the words client understands . You are looking fortrue information.
  • Reword the question stem. This question is asking, “What is true about terbutaline (Brethine)?”
  • Because you were able to reword this question, the fourth step is unnecessary. You didn’t need to obtain clues about what the question is asking from the answer choices.

[Next: NCLEX Strategies: Eliminate Incorrect Answer Choices ]

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Critical Thinking in Nursing: Tips to Develop the Skill

4 min read • February, 09 2024

Critical thinking in nursing helps caregivers make decisions that lead to optimal patient care. In school, educators and clinical instructors introduced you to critical-thinking examples in nursing. These educators encouraged using learning tools for assessment, diagnosis, planning, implementation, and evaluation.

Nurturing these invaluable skills continues once you begin practicing. Critical thinking is essential to providing quality patient care and should continue to grow throughout your nursing career until it becomes second nature. 

What Is Critical Thinking in Nursing?

Critical thinking in nursing involves identifying a problem, determining the best solution, and implementing an effective method to resolve the issue using clinical decision-making skills.

Reflection comes next. Carefully consider whether your actions led to the right solution or if there may have been a better course of action.

Remember, there's no one-size-fits-all treatment method — you must determine what's best for each patient.

How Is Critical Thinking Important for Nurses? 

As a patient's primary contact, a nurse is typically the first to notice changes in their status. One example of critical thinking in nursing is interpreting these changes with an open mind. Make impartial decisions based on evidence rather than opinions. By applying critical-thinking skills to anticipate and understand your patients' needs, you can positively impact their quality of care and outcomes.

Elements of Critical Thinking in Nursing

To assess situations and make informed decisions, nurses must integrate these specific elements into their practice:

  • Clinical judgment. Prioritize a patient's care needs and make adjustments as changes occur. Gather the necessary information and determine what nursing intervention is needed. Keep in mind that there may be multiple options. Use your critical-thinking skills to interpret and understand the importance of test results and the patient’s clinical presentation, including their vital signs. Then prioritize interventions and anticipate potential complications. 
  • Patient safety. Recognize deviations from the norm and take action to prevent harm to the patient. Suppose you don't think a change in a patient's medication is appropriate for their treatment. Before giving the medication, question the physician's rationale for the modification to avoid a potential error. 
  • Communication and collaboration. Ask relevant questions and actively listen to others while avoiding judgment. Promoting a collaborative environment may lead to improved patient outcomes and interdisciplinary communication. 
  • Problem-solving skills. Practicing your problem-solving skills can improve your critical-thinking skills. Analyze the problem, consider alternate solutions, and implement the most appropriate one. Besides assessing patient conditions, you can apply these skills to other challenges, such as staffing issues . 

A diverse group of three (3) nursing students working together on a group project. The female nursing student is seated in the middle and is pointing at the laptop screen while talking with her male classmates.

How to Develop and Apply Critical-Thinking Skills in Nursing

Critical-thinking skills develop as you gain experience and advance in your career. The ability to predict and respond to nursing challenges increases as you expand your knowledge and encounter real-life patient care scenarios outside of what you learned from a textbook. 

Here are five ways to nurture your critical-thinking skills:

  • Be a lifelong learner. Continuous learning through educational courses and professional development lets you stay current with evidence-based practice . That knowledge helps you make informed decisions in stressful moments.  
  • Practice reflection. Allow time each day to reflect on successes and areas for improvement. This self-awareness can help identify your strengths, weaknesses, and personal biases to guide your decision-making.
  • Open your mind. Don't assume you're right. Ask for opinions and consider the viewpoints of other nurses, mentors , and interdisciplinary team members.
  • Use critical-thinking tools. Structure your thinking by incorporating nursing process steps or a SWOT analysis (strengths, weaknesses, opportunities, and threats) to organize information, evaluate options, and identify underlying issues.
  • Be curious. Challenge assumptions by asking questions to ensure current care methods are valid, relevant, and supported by evidence-based practice .

Critical thinking in nursing is invaluable for safe, effective, patient-centered care. You can successfully navigate challenges in the ever-changing health care environment by continually developing and applying these skills.

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02.01 Critical Thinking

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If you have gone to one day of nursing school you understand that “critical thinking” is a buzzword.

Nursing schools love to talk about critical thinking.

The job of a nurse is essentially to take millions of data points and be able to arrive at a correct decision based on that data.

This is no easy task and there are few jobs which require this on the scale of nursing or with human lives in the balance.

What is Critical Thinking?

Critical thinking is defined as: Clear, rational thinking involving critique. Its details vary amongst those who define it. According to Barry K. Beyer (1995), critical thinking means making clear, reasoned judgments. During the process of critical thinking, ideas should be reasoned, well thought out, and judged. The National Council for Excellence in Critical Thinking defines critical thinking as the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.  Source .

So, while you are familiar with making decisions on a daily basis, most daily decisions do not require critical thinking (what color of shirt should I wear, what should I eat for dinner, etc).

It is a skill that can grow and develop with time and as you enter nursing school you are not expected to be an expert in the skill.

However, what you should understand is that critical thinking involves a level of decision making far beyond normal day to day decision making. With critical thinking you are analyzing, conceptualizing, and digging deep into the questions presented.

When it comes to nursing, often times you are presented with real life or death situations. You are presented with saving one patient or determining what the most important solution is to a highly complex problem.

Those nurses who develop advanced critical thinking skills find increased success in their careers.

Critical Thinking in Nursing

So let’s talk about critical thinking and how it applies to everything we are talking about here.

The NCSBN website states the following: Since the practice of nursing requires you to apply knowledge, skills and abilities, the majority of questions on the NCLEX are written at the cognitive level of apply or higher. And these questions, by nature, require critical thinking.

Answering these correctly will require you to do something with what you have learned, to manipulate previously learned material in new ways or find connections between many facts.

Again, since the majority of NCLEX questions fall into this category, this is exactly the type of questions you need to practice answering!

There it is again . . . the BUZZ word (critical thinking) . . . but once again no tips or information on what that means or how to develop it is given.

So let’s dive in and provide you with a simple framework and method for developing critical thinking.

How to Critically Think in Nursing

While there are many frameworks and methods for developing critical thinking, here we will provide you with a basic 4 step method.

At the risk of sounding oversimplified, this simple method will allow you to cut through the clutter, think critically, and arrive at correct decisions in even the most complex of scenarios.

Essentially there are 4 steps to critical thinking . . . in nursing and in life . . . and developing the ability to critically think will work wonders in your life.

  • Suspend ALL Judgement
  • Collect ALL Information
  • Balance ALL Information
  • Make a Complete and Holistic Decision

critical thinking test for nursing school

Before diving into the four individual steps let’s point out the use of the word “ALL” in each of the steps.

This is important because few individuals can make decisions with this inclusive word. It literally means ALL. To make a complete and holistic decision based upon critical thinking you have to have and weight ALL information. Otherwise you are just making a regular old decision.

  •   Suspend All Judgement

You have to start by suspending all judgement. In other words, if you walk into a patients room and see them tachycardic an amature decision would be to run and grab the metoprolol to try to drop the heart rate.

An advanced clinician will WAIT until they have more information . . . not leaving the patient untreated . . . but not jumping freakishly into the WRONG treatment because they learned that tachycardia is bad . . .

Suspending judgement means that you don’t make a decision based upon the first sign. You also don’t walk into any situation of NCLEX question with a decision already made. You will treat all facts as equal until you can gather the needed information.

Not suspending judgment leaves you open to make biased decisions. This is detrimental in medicine and nursing. This will also result in poor success on nursing exams and the NCLEX.

As you read through nursing questions you must force yourself to refrain from jumping to conclusions until you have read the question in full. Do not allow yourself to assume what the question is asking or what the patient outcome is until you have read the question in full.

Obviously this sounds simple, but it is this step that, if missed, will through more nursing students and nurses off.

  • Collect All Information 

Now you must collect ALL information. This is clutch! Don’t make a decision until you have collected every piece of data that you need to collect . . . on a tachycardic patient you can check BP, temp, run an EKG, check urine output.

Think of this as data mining. You are looking to have every piece of information you can find to put the puzzle pieces together.

When it comes to taking nursing tests you only have one place that you can collect the information . . . and that is from the test question itself. Do not go looking outside of the question of infer any details that are not provided within the question.

One thing we have noticed students doing almost more than anything else on test questions is reading into them. Don’t do this. Gather all the information you can . . . and when it comes to NCLEX questions, the only place you can gather information is from the question itself.

  • Balance All Information

Now, balance all information. This means take all the data that you have and start weighing it to find out what is pertinent and what you can ignore. If the temp is 98.9 . . . it’s probably not the cause. If the BP is 74/56 are we looking at a volume issue?

In this step you are deciding what is important and what isn’t. While a pressure ulcer is important, if the patient is actively having a heart attack . . . it just doesn’t matter. At least, not until we take care of the MOST important issue.

NCLEX style questions will be FULL of extra information, things that you just really do not need to know to make a decision on the patient.

The NCSBN (who administers the NCLEX) in an effort to simulate real life nursing writes questions that include both important information and details that you just simply don’t need to know. It is your job to sift through the data and determine what you actually need to know.

Balancing means giving each data point a level of importance for your given patient. Some pieces of information will score much higher than others.

At this point you must all consider the implications of the possible options. Look at the available options and think to yourself, “if I choose this option, what happens next?”. As it relates to nursing, ask yourself these questions:

“Does this achieve a desired patient outcome?”

“If I do this and then go home, what happens to my patient?”

Forcing yourself to consider the implications allows you to look beyond the information presented and consider the RESULTS of your choices. Critical thinking thrives on looking beyond the presented data.

  • Make a Holistic Decision

Finally, make your decision . . . with all the data in and after looking over it all very closely you can begin to make your decision.

Your goal is to make the decision that best serves the patient and addresses their most immediate concerns.

Critical Thinking in Nursing and on the NCLEX®

Lastly, I just want to talk briefly about how this applies to NCLEX questions . . .

Here is an actual practice NCLEX question from our Nursing Practice Questions Program (or NPQ, as we like to call it)!

A 56-year-old male patient has been admitted to the cardiac unit with exacerbation of heart failure symptoms. The nurse has given him a nursing diagnosis of decreased cardiac output related to heart failure, as evidenced by a poor ejection fraction, weakness, edema, and decreased urinary output. Which of the following nursing interventions are most appropriate in this situation?

42% of the students that have taken this question have selected this answer:

Administer IV fluid boluses to increase urinary output

The problem with that answer is that it fails to weigh the most important issue facing this patient.

Test takers see urine output as low . . . and want to correct that quickly with fluids.

However, this is a CHFer . . . you can’t (shouldn’t) bolu especially during an exacerbation . . . you could send the patient into pulmonary edema and drastically impact their respiratory status.

So the lesson here. . . . in school, on the NCLEX, and on the clinical floor . . . slow down, stay calm and start thinking at an analysis level.

And I promise you this helps in “REAL” life too . . . not just in nursing. You will begin to be a tad more skeptical and deliberate with your decisions.

Here are a couple resources that will help you in the process of developing critical thinking.

  • CriticalThiking.org
  • US News 5 Tools
  • Thinking Fast and Slow
  • NPQ – Nursing Practice Questions

The process for developing critical thinking is slow and arduous. However, don’t be hard on yourself. According to  CriticalThiking.org  the vast majority of colleges are not appropriately incorporating critical thinking into the college classroom. This means that while you might not being taught the skill as you should . . . most people aren’t. Using the strategies outlined above will put you light years ahead of most.

The nurse that is able to follow these four steps is a tremendous asset on a clinical floor.

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View the FULL Transcript

Test taking for the nclex®.

The Test-Taking course is the best place to start when you’re trying to figure out how to navigate NCLEX®-Style questions. Nursing school presents a unique challenge when it comes to test-taking. You’re no longer just looking for the right answer - you’re now looking for the most right answer or multiple right answers. In this course, we break down how to understand what these questions are even asking you, and our best tips for how to answer them. We also provide some strategies for goal-setting, studying, and note-taking that are sure to set you up for success on your exams and on the NCLEX®.

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Introduction to Critical Thinking and Clinical Reasoning

  • Attitudes of Critical Thinkers
  • 7 Steps to Critical Thinking
  • Critical Thinking Practice
  • Clinical Reasoning in Action

Critical Thinking Quiz (6 Questions)

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1 . Question

Which of the following best describes a critical thinker?

  • Someone who struggles with reasoning and lacks emotional intelligence.
  • Someone who is fair-minded, non judgemental, and possesses integrity.
  • Someone who has some bias, but also has empathy for others.
  • Someone who maintains a positive attitude whilst in front of others.

2 . Question

What is the first step of critical thinking in a medical setting?

  • Ask questions
  • Identify the problem
  • Present your solution

3 . Question

What is the final step of critical thinking in a medical setting?

  • Identify the best solution
  • Determine data relevance
  • Analyze your decision

4 . Question

Should you expect to enter the field as an expert in clinical reasoning?

  • Yes, everyone learns these skills in school.
  • No, this skill develops over time and is based on knowledge and experience.
  • Yes, these skills are required for graduation.
  • No, these skills are not important to understand.

5 . Question

What is inductive reasoning?

  • A reasoning that involves noticing cues, making generalizations, and creating hypotheses.
  • A type of critical thinking that begins with a general premise or principle in order to come to a specific conclusion.

6 . Question

What is deductive reasoning?

  • The “why” behind a given problem
  • A special case
  • “Top -down thinking”
  • Thinking that involves noticing cues

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Ati teas & critical thinking for nursing.

All Associate Degree Nursing Traditional RN applicants must take the ATI TEAS exam which is administered by the Testing Services department (Rogers Student Center on the TJC main campus OR TJC West).

What is the TEAS?

The ATI TEAS (Test of Academic Skills) is a standardized test covering a variety of areas relevant to healthcare education, including reading, mathematics, science, English, and language usage. The TEAS exam is designed specifically to assess a student’s preparedness to enter the health science fields. Read more about the ATI TEAS exam format.

What is Critical Thinking?

This  test  measures the ability to conceptualize, apply, analyze and evaluate information in order to reach a meaningful conclusion. This  test  comprises four question sets. Each question set has a time limit of three minutes and contains one question.

ATI TEAS and Critical Thinking Exam Requirements

The Nursing program has multiple pathways that might have different entrance exam requirements. Download the Admission Guidelines to get more information on entrance exam requirements:

Vocational Nursing Admission Guidelines

Traditional RN Admission Guidelines

Steps to Registering For the TEAS & Critical Thinking Exams:

1. Create a student account with ATI at www.atitesting.com

  • Click “create account” which is found on the right side of the home screen.
  • Select “Tyler JC Nursing TEAS” from the Institutions drop-down menu.
  • Create your username and password.
  • Keep this login information in a safe place; as this information will be required on the day of the test.  

2. To make an appointment with the Testing Center please go to tjctesting.setmore.com  (Please note some firewalls may block directly linking to this site. If this happens to you, please open a browser and type in "TJCTesting.Setmore.com" and link to our booking page through this alternative option)

3. When you arrive for your appointment, you need to pay a $25.00 proctoring fee. Payment can be made at the Testing Center. The Testing Center will accept checks, credit cards, money orders, or cash payments. Make sure you have the following items at your appointment:

  • ATI Username and Password
  • Appointment Confirmation Email
  • Proctor Fee Receipt
  • Valid Photo ID  

4. Once you are logged in to your ATI account and the proctor has entered in the password code, you will be required to make an online payment of $75 to ATI for the TEAS exam and $57.65 (taxes included) for the Critical Thinking exam  NOTE: This will require a credit card or gift card. No debit cards are allowed. You need to pay before proceeding with the exam.  

5. The ATI TEAS & Critical Thinking exams could take 5 hours. Due to the length of the exam, we will not start a new TEAS exam within 4 hours of closing. For closing hours, you can visit  www.tjc.edu/testing .

ATI TEAS Exam Results

You can access your exam scores by logging into your ATI student account at www.atitesting.com . Click on the “my results” tab in the top menu, this takes you to the proctored assessment page. You can then access your assessment report on any of your completed exams.

Please visit the How to Apply section for instructions on submitting your ATI TEAS scores for your ADN application.

Accommodations

Students with disabilities that wish to request testing accommodations should contact Margaret Rapp, Disability Services Director, RSC 308, (903) 510 2878. To provide reasonable testing accommodations, requests must be made at least two weeks before the testing date. 

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Creative Ways to Enhance and Assess Critical Thinking in Nursing Students

Affiliation.

  • 1 About the Author Kimberly C. Parker, DNP, RN, is a clinical instructor, University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama. For more information, contact her at [email protected].
  • PMID: 34107521
  • DOI: 10.1097/01.NEP.0000000000000830

Nursing students should be challenged to implement critical thinking decisions regarding conclusions they implement for patient care. This article reinforces common techniques and introduces new practices to teach critical thinking. Many ways are currently recognized utilizing an assortment of techniques. The concepts from an escape room are a great way to deliver opportunities for students to practice this skill and can be provided economically and easily. Being creative in managing these concepts will offer an exciting chance to introduce critical thinking for your students.

Copyright © 2021 National League for Nursing.

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Conflict of interest statement

The author has declared no conflict of interest.

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  • A mixed method evaluation of an integrated course in improving critical thinking and creative self-efficacy among nursing students. Liu T, Yu X, Liu M, Wang M, Zhu X, Yang X. Liu T, et al. Nurse Educ Today. 2021 Nov;106:105067. doi: 10.1016/j.nedt.2021.105067. Epub 2021 Jul 24. Nurse Educ Today. 2021. PMID: 34329962
  • On target: a model to teach baccalaureate nursing students to apply critical thinking. Brock A, Butts JB. Brock A, et al. Nurs Forum. 1998 Jul-Sep;33(3):5-10. doi: 10.1111/j.1744-6198.1998.tb00216.x. Nurs Forum. 1998. PMID: 9987332
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  • The Effect of Concept Maps on Undergraduate Nursing Students' Critical Thinking. Garwood JK, Ahmed AH, McComb SA. Garwood JK, et al. Nurs Educ Perspect. 2018 Jul/Aug;39(4):208-214. doi: 10.1097/01.NEP.0000000000000307. Nurs Educ Perspect. 2018. PMID: 29629932 Review.
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  • Carroll W.. Artificial intelligence, critical thinking and the nursing process. Online Journal of Nursing Informatics, Winter, 2019, 23, 2.
  • Gambrill E. (2019). Critical thinking and the process of evidenced-based practice. Oxford University Press.
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  • Probst B. (2015). Critical thinking in clinical assessment and diagnosis. Assessment and Diagnosis in Action. 10.1007/978-3-319-17774-8_13 - DOI
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Teaching Strategies for Developing Clinical Reasoning Skills in Nursing Students: A Systematic Review of Randomised Controlled Trials

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Data are contained within the article.

Background: Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients’ situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students. Methods: A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies. Results: Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies. Conclusions: This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students’ reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students’ learning and improve their clinical reasoning and cognitive skills.

1. Introduction

Clinical reasoning (CR) is a holistic cognitive process. It allows nursing students to accurately perceive patients’ situations and choose the best course of action among the available alternatives. This process is consistent, dynamic, and flexible, and it helps nursing students gain awareness and put their learning into perspective [ 1 ]. CR is an essential competence for nurses’ professional practice. It is considered crucial that its development begin during basic training [ 2 ]. Analysing clinical data, determining priorities, developing plans, and interpreting results are primary skills in clinical reasoning during clinical nursing practise [ 3 ]. To develop these skills, nursing students must participate in caring for patients and working in teams during clinical experiences. Among clinical reasoning skills, we can identify communication skills as necessary for connecting with patients, conducting health interviews, engaging in shared decision-making, eliciting patients’ concerns and expectations, discussing clinical cases with colleagues and supervisors, and explaining one’s reasoning to others [ 4 ].

Educating students in nursing practise to ensure high-quality learning and safe clinical practise is a constant challenge [ 5 ]. Facilitating the development of reasoning is challenging for educators due to its complexity and multifaceted nature [ 6 ], but it is necessary because clinical reasoning must be embedded throughout the nursing curriculum [ 7 ]. Such being the case, the development of clinical reasoning is encouraged, aiming to promote better performance in indispensable skills, decision-making, quality, and safety when assisting patients [ 8 ].

Nursing education is targeted at recognising clinical signs and symptoms, accurately assessing the patient, appropriately intervening, and evaluating the effectiveness of interventions. All these clinical processes require clinical reasoning, and it takes time to develop [ 9 ]. This is a significant goal of nursing education [ 10 ] in contemporary teaching and learning approaches [ 6 ].

Strategies to mitigate errors, promote knowledge acquisition, and develop clinical reasoning should be adopted in the training of health professionals. According to the literature, different methods and teaching strategies can be applied during nursing training, as well as traditional teaching through lectures. However, the literature explains that this type of methodology cannot enhance students’ clinical reasoning alone. Therefore, nursing educators are tasked with looking for other methodologies that improve students’ clinical reasoning [ 11 ], such as clinical simulation. Clinical simulation offers a secure and controlled setting to encounter and contemplate clinical scenarios, establish relationships, gather information, and exercise autonomy in decision-making and problem-solving [ 12 ]. Different teaching strategies have been developed in clinical simulation, like games or case studies. Research indicates a positive correlation between the use of simulation to improve learning outcomes and how it positively influences the development of students’ clinical reasoning skills [ 13 ].

The students of the 21st century utilise information and communication technologies. With their technological skills, organisations can enhance their productivity and achieve their goals more efficiently. Serious games are simulations that use technology to provide nursing students with a safe and realistic environment to practise clinical reasoning and decision-making skills [ 14 ] and can foster the development of clinical reasoning through an engaging and motivating experience [ 15 ].

New graduate nurses must possess the reasoning skills required to handle complex patient situations. Aware that there are different teaching methodologies, with this systematic review we intend to discover which RCTs published focus on CR in nursing students, which interventions have been developed, and their effectiveness, both at the level of knowledge and in increasing clinical reasoning skills. By identifying the different techniques used during the interventions with nursing students in recent years and their effectiveness, it will help universities decide which type of methodology to implement to improve the reasoning skills of nursing students and, therefore, obtain better healthcare results.

This study aims to identify and analyse randomised controlled trials concerning clinical reasoning in nursing students. The following questions guide this literature review:

Which randomised controlled trials have been conducted in the last eleven years regarding nursing students’ clinical reasoning? What are the purposes of the identified RCTs? Which teaching methodologies or strategies were used in the RCTs studies? What were the outcomes of the teaching strategies used in the RCTs?

2. Materials and Methods

This review follows the PRISMA 2020 model statement for systematic reviews. That comprises three documents: the 27-item checklist, the PRISMA 2020 abstract checklist, and the revised flow diagram [ 16 ].

2.1. Search Strategy

A systematic literature review was conducted on PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) up to 15th October 2023.

The PICOS methodology guided the bibliographic search [ 17 ]: “P” being the population (nursing students), “I” the intervention (clinical reasoning), “C” comparison (traditional teaching), “O” outcome (dimension, context, and attributes of clinical reasoning in the students’ competences and the results of the teaching method on nursing students), and “S” study type (RCTs).

The search strategy used in each database was the following: (“nursing students” OR “nursing students” OR “pupil nurses” OR “undergraduate nursing”) AND (“clinical reasoning” OR “critical thinking” OR “clinical judgment”). The filters applied were full text, randomised controlled trial, English, Spanish, and from 1 January 2012 to 15 October 2023. The search strategy was performed using the same process for each database. APP performed the search, and AZ supervised the process.

During the search, the terms clinical reasoning, critical thinking, and clinical judgement were used interchangeably since clinical judgement is part of clinical reasoning and is defined by the decision to act. It is influenced by an individual’s previous experiences and clinical reasoning skills [ 18 ]. Critical thinking and clinical judgement involve reflective and logical thinking skills and play a vital role in the decision-making and problem-solving processes [ 19 ].

The first search was conducted between March and September 2022, and an additional search was conducted during October 2023, adding the new articles published between September 2022 and September 2023, following the same strategy. The search strategy was developed using words from article titles, abstracts, and index terms. Parallel to this process, the PRISMA protocol was used to systematise the collection of all the information presented in each selected article. This systematic review protocol was registered in the international register PROSPERO: CRD42022372240.

2.2. Eligibility Criteria and Study Selection

The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary aim; (b) articles published in the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) RCTs. On the other hand, the exclusion criteria were studies conducted with students from other disciplines other than nursing, not random studies or review articles.

2.3. Data Collection and Extraction

After this study selection, the following information was extracted from each article: bibliographic information, study aims, teaching methodology, sample size and characteristics, time of intervention, and conclusions.

2.4. Risk of Bias

The two reviewers, APP and AZ, worked independently to minimise bias and mistakes. The titles and abstracts of all papers were screened for inclusion. All potential articles underwent a two-stage screening process based on the inclusion criteria. All citations were screened based on title, abstract, and text. Reviewers discussed the results to resolve minor discrepancies. All uncertain citations were included for full-text review. The full text of each included citation was obtained. Each study was read thoroughly and assessed for inclusion following the inclusion and exclusion criteria explained in the methodology. The CASP tool was utilised to appraise all included studies. The CASP Randomized Controlled Trial Standard Checklist is an 11-question checklist [ 20 ], and the components assessed included the appropriateness of the objective and aims, methodology, study design, sampling method, data collection, reflexivity of the researchers, ethical considerations, data analysis, rigour of findings, and significance of this research. These items of the studies were then rated (“Yes” = with three points; “Cannot tell” = with two points; “No” = with one point). The possible rates for every article were between 0 and 39 points.

2.5. Ethical Considerations

Since this study was a comprehensive, systematic review of the existing published literature, there was no need for us to seek ethical approval.

3.1. Search Results

The initial search identified 158 articles using the above-mentioned strategy (SCOPUS ® n = 72, PUBMED ® n = 56, CENTRAL ® n = 23, and EMBASE ® n= 7), and the results are presented in Figure 1 . After retrieving the articles and excluding 111, 47 were selected for a full reading. Finally, 17 articles were selected. To comply with the methodology, the independent reviewers analysed all the selected articles one more time after the additional search, and they agreed to eliminate two of them because this study sample included nursing students as well as professional nurses. Therefore, to have a clear outcome focused on nursing students, two articles were removed, and the very final sample size was fifteen articles, following the established selection criteria ( Figure 1 ). The reasons for excluding studies from the systematic review were: nurses as targets; other design types of studies different from RCTs; focusing on other health professionals such as medical students; review studies; and being published in full text in other languages other than Spanish or English.

An external file that holds a picture, illustration, etc.
Object name is healthcare-12-00090-g001.jpg

Flowchart of screening of clinical reasoning RCTs that underwent review.

3.2. Risk of Bias in CASP Results

All studies included in the review were screened with the CASP tool. Each study was scored out of a maximum of 39 points, showing the high quality of the randomised control trial methodology. The studies included had an average score of 33.1, ranging from 30 to 36 points. In addition, this quantitative rate of the items based on CASP, there were 13 studies that missed an item in relation to assessing/analysing outcome/s ‘blinded or not’ or not, and 11 studies that missed the item whether the benefits of the experimental intervention outweigh the harms and costs.

3.3. Data Extraction

Once the articles had undergone a full reading and the inclusion criteria were applied, data extraction was performed with a data extraction table ( Appendix A ). Their contents were summarised into six different cells: (1) CASP total points result, (2) purpose of this study, (3) teaching strategy, (4) time of intervention, (5) sample size, and (6) author and year of publication. After the review by the article’s readers, fifteen RCTs were selected. Of the fifteen, the continent with the highest number of studies was Asia, with 53.33% of the studies (n = 8) (Korea n = 4, Taiwan n = 2, and China n = 2), followed by Europe with 26.66% (n = 4) (Turkey n = 2, Paris n = 1, and Norway n = 1), and lastly South America with 20% (n = 3), all of them from Brazil.

3.4. Teaching Strategies

Different teaching strategies have been identified in the reviewed studies: simulation methods (seven articles) and learning programmes (eight articles). There are also two studies that focus on comparing different teaching methodologies.

3.4.1. Clinical Simulation

The simulation methods focused on in the studies were virtual simulation (based on mobile applications), simulation games, and high-fidelity clinical simulation. Of the total number of nursing students in the studies referring to clinical simulations, 43.85% were in their second year, while 57.1% were senior-year students. The most used method in the clinical simulation group was virtual simulation, and 57.14% of studies included only one-day teaching interventions.

Virtual simulations were used to increase knowledge about medication administration and nasotracheal suctioning in different scenarios [ 21 ], to evaluate the effect of interactive nursing skills, knowledge, and self-efficacy [ 11 ], and to detect patient deterioration in two different cases [ 22 ]. Simulation game methodology was used to improve nursing students’ cognitive and attention skills, strengthen judgment, time management, and decision-making [ 14 ].

Clinical simulation was used to develop nursing students’ clinical reasoning in evaluating wounds and their treatments [ 12 ], to evaluate and compare the perception of stressors, with the goal of determining whether simulations promote students’ self-evaluation and critical-thinking skills [ 23 ], and also to evaluate the impact of multiple simulations on students’ self-reported clinical decision-making skills and self-confidence [ 24 ].

3.4.2. Learning Programs

Different types of learning programmes have been identified in this systematic review: team-based learning, reflective training programs, person-centred educational programmes, ethical reasoning programmes, case-based learning, mapping, training problem-solving skills, and self-instructional guides. Of the total number of nursing students in the studies referring to learning programs, 57.1% were junior-year students, while 43.85% were in their senior year.

Team-based learning is a learner-centred educational strategy that promotes active learning to improve students’ problem-solving, knowledge, and practise performance. It can be implemented in small or large groups divided into teams with an instructor and reading material based on case scenarios [ 25 ]. Reflective training is based on a new mentoring practise to explore, think about, and solve problems actively during an internship. During the reflective training program, the mentors lead students to uncover clinical nursing problems through conversations with them and discussing feedback for their professional portfolios [ 26 ]. The person-centred educational programme focuses on how nursing students perceive individualised care, using design thinking to improve their perception. The use of design thinking gave the students opportunities to apply their theoretical knowledge of the person-centred program to plan innovative solutions that may effectively resolve real-life situations [ 27 ]. Another educational programme identified is the ethical reasoning program, and the aim of this is to improve nursing students’ handling of ethical decision-making situations [ 28 ], engaging the students in complex ethical clinical situations based on real cases.

Case-based learning was used to explore and demonstrate the feasibility of implementing unfolding cases in lectures to develop students’ critical-thinking abilities [ 29 ]. The web-based concept mapping of nursing students was also investigated to determine its impact on critical-thinking skills [ 30 ]. Training problem-solving skills were used to find out how it affected the rate of self-handicapping among nursing students [ 31 ]. And the last article evaluated the effect of the self-instructional guide to improve clinical reasoning skills on diagnostic accuracy in undergraduate nursing students [ 32 ].

4. Discussion

Although 158 studies were initially identified, only 15 articles were finally included in this review. The excluded articles were mainly from other disciplines other than nursing and used a less rigorous study design than RCT.

The three longest interventions were developed in Asia [ 26 , 28 , 29 ]. The longest was 300 h in duration, through one year [ 30 ]. These interventions were based on learning programs, case-based learning, person-centred care (PCC), and reflective training programs. However, it is important to take into account that Asian nursing curriculum programmes are different from European or United States curriculum because their internship is carried out only during the last academic degree year, while in Europe, following the European directive 2005/36/CE, 2013/55/UE nursing education requirements of 4600 h (2300 h of clinical practice) is carried out along the 3–4 years of the academic degree [ 33 ]. On the other hand, the intervention with the biggest sample was 419 nursing students [ 30 ], 210 in the experimental group, and 209 in the control group, and the one with the lowest sample was 51, with 24 students in the control group and 27 in the intervention group [ 32 ]. Therefore, all the included studies had a good sample size.

This systematic review has detected different methodologies to help nursing students improve their reasoning and decision-making skills. Virtual simulation was the most frequently used teaching method, both as a mobile application and as a serious game. In terms of its effectiveness in a study carried out in Taiwan, the use of a mobile application resulted in significantly higher knowledge scores, better skill performance, and higher satisfaction in students than traditional paper materials [ 21 ]. Virtual simulation [ 11 , 14 , 21 ] has also proven to be an effective tool for enhancing knowledge and confidence in recognising and responding to rapidly deteriorating patients, but studies that combined two educational strategies were more effective [ 29 ], like clinical simulation combined with another teaching strategy such as lectures or videos [ 12 ].

An interactive learner-centred nursing education mobile application with systematic contents effectively allowed students to experience positive practical nursing skills [ 11 ]. However, in a study comparing serious game simulation versus traditional teaching methods, no significant difference was found immediately or in the month following the training [ 22 ], but serious games can improve nursing students’ cognitive skills to detect patient deterioration and to make safe decisions about patient care [ 14 ]. Although the innovative teaching method was well received by the students, who expressed higher levels of satisfaction and motivation [ 22 ]. We can affirm that the development of a mobile application and its application can be effectively used by nursing students at all levels [ 11 ]. However, the performance of all these studies was measured on its short-term outcomes, only 40 min [ 21 ], 2 h [ 22 ], and 1 week [ 11 , 14 ] of intervention, and was performed with a mean sample size of 97 nursing students.

The data obtained in a study developed in Brazil [ 12 ] confirm that clinical simulation is effective for the development of nursing students’ clinical reasoning in wound evaluation and treatment and that clinical simulation in conjunction with other educational methods promotes the acquisition of knowledge by facilitating the transition from what the student knows to rational action. Moreover, the high-fidelity simulation strategy increases the perception of stressors related to a lack of competence and interpersonal relationships with patients, multidisciplinary teams, and colleagues compared with the conventional practice class in the skill laboratory. This increase was related to the students’ capacity for self-evaluation and critical reflection, concerning their learning responsibility and the need to acquire the required skills for patient care [ 23 ]. However, in the case of the effect of multiple simulations on students, there are no differences found between the double-versus single-scenario simulations [ 24 ]. The intervention time in these three studies was 30 min [ 23 ], 3.5 h [ 12 ], and 4 days [ 24 ]; then the time used to implement the intervention can determine the results obtained.

The different learning methods have an impact on various learning outcomes and students’ variables. Team-based learning [ 25 ], reflective training [ 26 ], the person-centred education programme [ 27 ], web-based concept mapping [ 30 ], and teaching cognitive-behavioural approaches [ 31 ] have proven to be effective in enhancing problem-solving abilities, knowledge, and reasoning processes and consequently improving the quality of nursing practical education. Team-based learning increased problem-solving ability scores significantly, while those in the control group decreased [ 25 ]. Reflective training, developed in China based on the new mentoring approach, was effective in encouraging nursing students to explore, think about, and solve problems actively during an internship, consequently improving their disposition for critical thinking [ 26 ]. A person-centred education programme using design thinking can effectively improve how nursing students perceive individualised care. Using design thinking allowed the students to apply their theoretical knowledge of the programme to plan innovative solutions that may effectively resolve real health problems [ 27 ]. These programmes were developed in 5 or 6 days [ 27 , 31 ], 1 week or 3 weeks [ 25 , 30 ], and 1 year [ 26 ].

The education programme focused on improving ethical decision-making had statistically significant improvements in nursing students’ self-efficacy in communication confidence, complex ethical decision-making skills, and decreased communication difficulty [ 28 ]. Case-based learning was more effective with lectures than without them in developing students’ critical thinking abilities [ 29 ]. This study was one of the longest developed with 300 h during one school year. This long-term learning intervention could have a positive impact on this study sample. Therefore, the time of the learning intervention could be a limitation in the studied RCTs. The one-time self-instruction guide was ineffective in impacting students’ diagnostic accuracy in solving case studies [ 32 ], and it is possible that only one day of intervention is not enough.

Studies have shown that problem- and team-based learning [ 25 , 31 ] are more beneficial than traditional teaching [ 29 ], as they enhance nursing skills and improve problem-solving abilities, clinical performance, communication competencies, critical thinking, and self-leadership.

Researchers generally agree that clinical reasoning is an important ability and one of the most important competencies for good nursing practise to ensure optimal patient outcomes [ 29 ] and to recognise and address patient deterioration effectively. However, effective communication is crucial in clinical reasoning. It is required to establish a rapport with patients, conduct health evaluations, make collaborative decisions, and discuss clinical cases with colleagues and supervisors. Developing clinical reasoning skills during training is essential to improving nursing professionals’ practice. To enhance clinical reasoning abilities, nursing schools should integrate simulations at every level of education to ultimately improve patient care. Improving nursing students’ preparation will impact the quality of patient care. In addition, new innovative teaching methodologies based on the use of technology could be a motivational driver in nursing clinical reasoning [ 22 ].

5. Limitations

This systematic review did not perform a search on CINAHL. Although most of the journals included in this database are included in MEDLINE, this should be addressed in the future because of the relevance of the database to nursing research. The results of the included studies could have also been influenced by the different times of the interventions and the different contexts. In addition, the reviewers have identified other studies published in languages other than those required by the inclusion criteria. It seems that many articles are published by Asian researchers, but some of them are not in English, so they cannot be analysed.

6. Conclusions

As society progresses, the new generation of nursing students poses a challenge; new technologies are ingrained in their daily lives with access to increasingly advanced technologies like artificial intelligence, and we must adapt training to capture their interest and increase their learning skills. The utilisation of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students’ reasoning skills. As a result, it is crucial to incorporate these tools into the learning process to maintain students’ interest, motivation, and satisfaction in education. Clinical simulation is particularly important in the training of students in terms of clinical performance. Still, it is necessary to add another teaching method to increase the efficacy of clinical simulations. Therefore, nursing schools should evaluate their current teaching methods and consider integrating or modifying new technologies and methodologies that can help enhance students’ learning, improve their clinical reasoning and cognitive skills, and potentially improve nursing students’ ability to affect patient care positively. By doing so, students will be better equipped to provide high-quality patient care in the future.

StudySample
Size
Time
Intervention
Teaching StrategiesPurpose of the RCTsCASP
Maurício et al., 2022 [ ]n = 511 daySelf-Instructional GuideTo evaluate the effect of the Self-Instructional Guide for Clinical Reasoning on the diagnostic accuracy of undergraduate nursing students.36
Calik and Kapucu 2022 [ ]n  =  601 weekSimulation gameEvaluated the efficacy of serious games using pre- and post-tests.36
Zhang et al., 2017 [ ]n = 15712 monthsReflective training programTo evaluate the effects of reflective training for nursing students on their critical thinking disposition.35
Chang et al., 2021 [ ]n = 11040 minMobile applicationTo test the hypothesis that nursing students who used a mobile learning app would have significantly higher levels of knowledge about nasotracheal suctioning and medication administration and a better development of skill performance in medication administration.35
(Virtual simulation)
Blanié et al., 2020 [ ]n= 1462 hGaming and traditional methodsTo compare a traditional teaching method with gaming to improve the clinical reasoning skills necessary to help nursing students detect patient deterioration.35
Bilik et al., 2020 [ ]n = 4191 weekWeb-based concept mapping educationTo investigate the impact of web-based concept mapping education on nursing students’ critical-thinking and concept-mapping skills.34
Zarshenas et al., 2019 [ ]n = 902 h for 6 daysProblem-solvingTo investigate how training problem-solving skills affected the rate of self-handicapping among nursing students.33
Svellingen et al., 2021 [ ]n = 1464 days in 3 yearsClinical simulationTo evaluate the impact of multiple simulations on students’ self-reported clinical decision-making skills and self-confidence.33
Kim and Suh 2018 [ ]n = 721 weekMobile applicationTo determine if a mobile application improved students’ skills and knowledge.33
(virtual simulation)
Park et al., 2021 [ ]n = 1052 h for 5 daysEducation programTo develop a feasibility programme for providing foundational knowledge and skills about patient-centred care to fourth-year undergraduate nursing students using the design-thinking approach.32
Pai et al., 2022 [ ]n = 1018 h for 14 weeksPerson-centred education programTo investigate the impact of an ethical decision-making framework on ethical decision-making and communication self-efficacy in nursing students.32
Silva et al., 2020 [ ]n = 783.5 h for one dayClinical simulationTo analyse the effect of clinical simulation on the development of clinical reasoning and on nursing students’ acquisition of knowledge of wound evaluation and treatment.31
Boostel et al., 2018 [ ]n = 5230 minClinical simulationTo compare and evaluate the perception of stressors by nursing students before and after a high-fidelity conventional laboratory practise class or clinical simulation.30
Hong and Yu, 2017 [ ]n = 122300 hCased-based learningTo compare and explore the effectiveness of two styles of case-based learning methods, unfolding nursing cases and unusual nursing cases, implemented in lectures for developing nursing students’ critical-thinking abilities.30
Kim et al., 2016 [ ]n = 632 h weekly for 3 weeksTeam-based learningTo examine the effects of TBL on learning outcomes and the problem-solving ability (knowledge and clinical performance) of Korean nursing students.30

Funding Statement

This research received external funding from the European programme Eramus +2021-1-BE02-KA220-HED-000023194.

Author Contributions

Conceptualisation, A.P.-P. and A.Z.; methodology, A.P.-P. and A.Z.; formal analysis, A.P.-P.; writing—original draft preparation, A.P.-P.; writing—review and editing, A.Z.; visualisation, A.Z.; supervision, A.Z. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

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