Association Between Clinical Reasoning Competency and Learning Behavior Among Undergraduate Nursing Students: A Cross-Sectional Study Publisher Pubmed



Armandpishe S ; Salehpooremran M ; Rahimzadeh M ; Saeidi S ; Jafari F ; Banazadeh M
Source: BMC Medical Education Published:2026

Abstract

Background: Nursing competence relies on clinical reasoning (CR), which necessitates both cognitive and metacognitive skills. The effectiveness of CR in nursing practice depends on the enhancement of both cognitive and metacognitive skills. Comprehending and developing students’ learning behavior (LB) is crucial for enhancing these skills, as learning behavior has a direct impact on the way students manage their cognitive processes. Assessing CR competency and identifying educational factors are essential for designing effective training programs. This study aimed to investigate the association between CR competency and learning behavior among undergraduate nursing students. Methods: This cross-sectional descriptive study recruited 270 undergraduate nursing students from May 15, 2023, to May 30, 2024. The nurse clinical reasoning scale and the learning behavior questionnaire were used to assess undergraduate nursing students’ self-perceived CR competency and LB. Results: The mean CR competency score (51.49 ± 10.71) indicated moderate competency, positively correlated with total LB score (r = 0.564, p < 0.001), and with subscales of LB (p < 0.001). Seventh-semester female students and strong enthusiasm for nursing exhibited higher CR competency scores. A hierarchical regression analysis revealed that student LBs (strategy, motivation, and satisfaction) were significantly associated with CR competency. These 3 variables account for 31.5% of the variance observed in CR competency, suggesting that students’ subscales of LB play a crucial role in developing their CR competency. In contrast, the subscale measuring attitude and the demographic characteristics of students were not significantly associated with their CR competency. Conclusion: Students’ CR competency was significantly associated with effective LBs, the presence of motivation, satisfaction with learning experiences, and enthusiasm for nursing. Attitude alone does not show a strong association with CR competency. Although the cross-sectional design limits causal interpretation and confounding variables require consideration, these findings suggest that comprehensive educational approaches addressing learning behavior may effectively enhance CR skills. Nursing programs should adopt effective learning strategies and advanced simulation techniques, improve clinical learning environments, and create motivational initiatives. Longitudinal studies are warranted to establish temporal relationships and causal mechanisms. Employing structural equation modeling and machine learning to elucidate the complex interrelationships among variables that impact CR competency is advisable. © The Author(s) 2026.