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Instruments for measuring clinical reasoning competence in current and future nurses based on COSMIN: A systematic
Xiao Ren1, Xiaohui Dong1, Ye Tao1
1School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Aim:
To systematically evaluate the methodological quality and measurement properties of clinical reasoning assessment instruments for current and future nurses, providing an evidence-based basis for selecting appropriate instruments.
Background:
Clinical reasoning is a core cognitive process and critical competence for safe nursing care. Despite multiple clinical reasoning assessment instruments, no systematic reviews have evaluated the measurement properties of these instruments against established methodological standards, limiting evidence-based selection.
Design:
Measurement properties are systematically reviewed according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.
Methods:
A systematic search of 11 databases was conducted from their inception to March 31, 2025 (Review period: October 2024-April 2025). Methodological quality was assessed using the COSMIN Risk of Bias Checklist and measurement properties were synthesized according to the COSMIN criteria. Two trained reviewers independently screened the studies, with conflicts resolved through consensus.
Results:
Eighteen studies evaluating twelve clinical reasoning assessment instruments were included. No instrument reported cross-cultural validity, measurement error, or responsiveness. Based on COSMIN evidence grading, the Korean version of the clinical reasoning assessment rubric (K-CRAR) received Category C, while others were Category B.
Conclusion:
Among Category B instruments, the Nurses Clinical Reasoning Scale (NCRS) has moderate to high-quality evidence for construct validity, internal consistency and hypothesis testing. Given its wide use, it is tentatively recommended. Future research should comprehensively assess its measurement properties, especially exploring cross-cultural validity and responsiveness.
Study Registration:
A protocol was registered on the PROSPERO (CRD42024611032).
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