A comprehensive pedagogical strategy to cultivate clinical reasoning and problem-solving skills in nursing education

To evaluate the effectiveness of the StepUp Learning tool on problem-solving and clinical reasoning skills among first-year undergraduate nursing students.

While various pedagogical strategies aim to foster higher-order cognitive skills such as problem-solving and clinical reasoning, these efforts often lack a cohesive theoretical structure.

Controlled, quasi-experimental design.

Guided by Kolb's Experiential Learning Theory, 124 first-year students were assigned to intervention (n = 62) or control group (n = 62). Data normality and variance homogeneity were tested; parametric or non-parametric tests were used accordingly. The intervention involved interactive lectures, self-assessments via e-learning and short questions, videos with feedback, and high-fidelity patient simulation (HFPS). Outcomes were assessed at three time points using the self-reported Problem-Solving Inventory and Nurses' Clinical Reasoning Scale.

The intervention group showed significant improvements in problem-solving, reflected in the Approach-Avoidance Style (t = 2.88, p = 0.006) and Problem-Solving Confidence (t = 4.24, p < 0.001), and clinical reasoning (t = -6.16, p < 0.001). Repeated measures ANOVA confirmed these gains over time, whereas the control group showed no significant changes. After adjusting for baseline, ANCOVA revealed higher post-HFPS clinical reasoning scores in the intervention group (F(1121) = 9.01, p = 0.003). Within-group analyses showed significant pre- to post-HFPS improvements in problem-solving and clinical reasoning (all p < 0.001) for the intervention group only.

The StepUp Learning tool, grounded in Kolb's experiential learning cycle, effectively enhances problem-solving and clinical reasoning skills. The findings support the efficacy of a structured, multimodal educational framework that prepares nursing students for complex clinical practice.