Clinical Reasoning Conceptualization Among Clinical Placement Supervisors and Strategies to Support Its Development in Nursing Students in Clinical Placements

Abstract

Introduction: Clinical reasoning (CR) is a fundamental competency that the next generation of nurses must develop to ensure the delivery of safe, high‑quality care. However, clinical placement supervisors report feeling insufficiently equipped to support the development of CR, to recognize difficulties associated with exercising this competency, and to address them effectively. This study aimed to explore the conceptions of CR held by undergraduate nursing clinical placement supervisors, as well as the pedagogical strategies they implement to support the development of this competency among students in clinical placements.

Method: A descriptive qualitative approach was used. An open‑ended questionnaire and semi‑structured interviews were employed to collect data from clinical placement supervisors. A content analysis, conducted according to L’Écuyer’s (1990) model, was used to identify supervisors’ conceptions of clinical reasoning, the pedagogical strategies they implemented, the clinical reasoning difficulties encountered by students in clinical placements, and the remediation measures used.

Results: A total of 13 clinical placement supervisors participated in the study. The analysis revealed a relatively vague understanding of clinical reasoning, which was generally perceived as a hypothetico‑deductive process. Only one participant mentioned the intuitive component of clinical reasoning. The main strategies used by participants to support the development of this competency among students were: 1) adapting to students’ levels; 2) asking them to conduct research; 3) questioning; and 4) discussing situations encountered in practice. Establishing connections emerged as the primary difficulty related to clinical reasoning. Remediation approaches essentially mirrored the same strategies used to provide support.

Discussion: The results highlight the need for education to clarify conceptions of clinical reasoning, to implement recognized pedagogical strategies, to identify students’ difficulties, and to put in place more systematic measures to address them. Enhancing support for clinical placement supervisors in guiding the development of students’ clinical reasoning—along with better integration of pedagogical strategies based on a clinical reasoning model, using a structured approach—will help optimize the quality of clinical training.