Instruments for measuring clinical reasoning competence in current and future nurses based on COSMIN: A systematic review

IF 3.3 3区医学 Q1 NURSING

Nurse Education in Practice Pub Date : 2025-07-14 DOI:10.1016/j.nepr.2025.104474

Xiao Ren , Xiaohui Dong , Ye Tao , Xinyu Chen, Xianying Lu, Dingxi Bai, Qi Xue, Chaoming Hou, Jing Gao

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Abstract

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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基于COSMIN的衡量当前和未来护士临床推理能力的工具：系统综述

目的系统评价当前和未来护士临床推理评估工具的方法学质量和测量特性，为选择合适的工具提供循证依据。临床推理是安全护理的核心认知过程和关键能力。尽管有多种临床推理评估工具，但没有系统的综述根据既定的方法标准评估这些工具的测量特性，限制了基于证据的选择。根据基于共识的健康测量仪器选择标准（COSMIN）指南，系统地审查了设计测量特性。方法系统检索11个数据库，检索时间自数据库建立之日起至2025年3月31日（检索期：2024年10月- 2025年4月）。采用COSMIN偏倚风险检查表评估方法学质量，并根据COSMIN标准综合测量特性。两名训练有素的审稿人独立筛选研究，冲突通过共识解决。结果共纳入18项研究，评估了12种临床推理评估工具。没有仪器报告跨文化有效性、测量误差或反应性。根据COSMIN证据分级，韩国版临床推理评估量表（K-CRAR）为C类，其他量表为B类。结论在B类工具中，护士临床推理量表（NCRS）在结构效度、内部一致性和假设检验方面具有中等至高质量的证据。鉴于它的广泛使用，暂时推荐使用。未来的研究应全面评估其测量特性，特别是探索跨文化有效性和响应性。研究注册在PROSPERO上注册（CRD42024611032）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nurse Education in Practice NURSING-

CiteScore

5.40

自引率

9.40%

发文量

180

审稿时长

51 days

期刊介绍： Nurse Education in Practice enables lecturers and practitioners to both share and disseminate evidence that demonstrates the actual practice of education as it is experienced in the realities of their respective work environments. It is supportive of new authors and will be at the forefront in publishing individual and collaborative papers that demonstrate the link between education and practice.