Decision support strategies for bedside nursing clinical reasoning: A scoping review

Abstract

Background

Proficiency in clinical reasoning is crucial for achieving positive patient outcomes in healthcare. Nurses should take an active role in fostering their clinical reasoning skills. Bedside support strategies aim to offer practical, invaluable, and easily applicable resources for restructuring cognitive processes in situations of complex clinical demands.

Objective

This review aimed to map evidence on bedside decision strategies applied by nurses to support clinical reasoning.

Methods

The review followed the Joanna Briggs Institute recommendations for scoping reviews.

Information

Sources Studies were retrieved from Medline (PubMed), CINAHL (EBSCOhost), Web of Science Core Collection, Scopus, Cochrane CENTRAL, RCAAP (Repositórios Científicos de Acesso Aberto de Portugal), and Google Scholar. Studies published in Portuguese, English, Spanish, or Swedish, without imposing geographical or cultural restrictions were considered. Qualitative and quantitative studies on bedside decision strategies that support nursing clinical reasoning were included, while studies exclusively focused on education, case-specific content, or Artificial Intelligence applications were excluded.

Results

Out of 1889 results, 14 studies met the inclusion criteria. The studies were conducted in countries such as China, New Zealand, Norway, Brazil, Indonesia, Canada, Ireland, the United Kingdom, United States, and Australia, involving nurses, patients, and healthcare teams, with study designs ranging from qualitative research and cohort studies to quasi-experimental and theoretical analyses.These studies identified two key strategies: normative (following guidelines) and reflective (based on critical self-reflection).

Conclusions

Reflective strategies are widely used at the bedside, emphasizing the importance of adaptability in uncertain clinical environments. Despite Artificial Intelligence’s role in clinical decision-making, fostering critical thinking and decision-making skills in nurses remains essential.

Registration

OSF https://doi.org/10.17605/OSF.IO/H96VQ.

Tweetable abstract

A scoping review identified normative and reflective bedside strategies used by nurses to support clinical reasoning, highlighting the value of adaptability and critical thinking in complex care settings. #ClinicalReasoning #Nursing #PatientCare.