While critical thinking disposition, career awareness, and innovative skills are associated with clinical decision-making scores, these cross-sectional findings suggest that educational programs may consider exploring simulation-based training and cognitive strategies to support student decision-making in complex clinical scenarios.
Abstract
The complex and rapidly changing nature of modern healthcare environments requires future nurses to possess advanced competencies. While 21st-century skills are theoretically expected to enhance nursing students’ clinical reasoning, empirical research exploring this relationship remains scarce. This study aimed to determine the 21st-century skill levels of Generation Z nursing students and examine their association with clinical decision-making.
A cross-sectional correlational design was conducted in December 2025 at a faculty of nursing at a state university in Manisa, Turkey. Data were collected from 386 s-, third-, and fourth-year undergraduate nursing students using convenience sampling via online communication channels. Data collection tools included a sociodemographic form, the Multidimensional 21st Century Skills Scale (M21CSS), and the Nursing Decision-Making Instrument (NDMI-24). Descriptive statistics, independent samples t-tests, one-way ANOVA, Pearson correlation, and multiple linear regression analysis were performed.
The participants’ mean total score for 21st-century skills was 154 ± 20.57, indicating a good level, with the highest scores found in information and technology literacy and the lowest in social responsibility and leadership. The mean NDMI-24 score was 69.96 ± 2.98, positioning the students within a quasi-rational decision-making model. The multiple linear regression analysis revealed that the model explained 52.4% of the total variance in clinical decision-making (
R
2
= 0.524, Adjusted
R
2
=0.518,
F
(5,380) = 83.66,
p
< 0.001). Career awareness (β = 0.31,
p
< 0.001), critical thinking and problem-solving (
β = 0.24
,
p
< 0.001), entrepreneurship and innovation (β = 0.18,
p
< 0.001), and information and technology literacy (β = 0.11,
p
= 0.003) emerged as significant independent predictors predictors of NDMI-24 scores, indicating a shift toward intuitive or quasi-rational decision-making patterns. Although critical thinking showed a negative bivariate correlation with decision making, in the regression model it emerged as a significant positive predictor (β = 0.24,
p
< 0.001), indicating a suppressor effect when considered alongside career awareness and innovation.
Their clinical decision-making appears to align with a transitional, quasi-rational pattern. While critical thinking disposition, career awareness, and innovative skills are associated with clinical decision-making scores, these cross-sectional findings suggest that educational programs may consider exploring simulation-based training and cognitive strategies to support student decision-making in complex clinical scenarios.
In the 21
st
century, where information is at the tip of the fingers. Nurses' reasoning capacity is decreasing day by day, and it has to be changed by providing graduates a high- quality education and training them to reason critical. The study objective was to compare the clinical reflection and reasoning competencies of B.Sc. nursing students between colleges affiliated with the State Health University and Deemed-to-be Universities located in Mangalore, Karnataka, India.
In this study, a quantitative research approach was employed, with a non-experimental descriptive cross-sectional research design. The study population consisted of students enrolled in colleges affiliated with the State Health University and Deemed-to-be Universities located in Mangalore. A total of 260 students were selected as samples using a purposive sampling technique. The data was collected using the validated Self-Assessment of Clinical Reflection and Reasoning (SACRR) tool.
The findings indicate that B.Sc. nursing students from both health science universities possess adequate to high levels of clinical reflection and reasoning competencies across all domains. The overall proportion of students falling within the high to very high category was 89.2% in state health science and 89.4% in colleges deemed to be universities, indicating similar levels of overall clinical reflection and reasoning competencies.
This suggests that both types of universities provide a comparable learning environment in fostering clinical reflection and reasoning skills among nursing students. However, in order to receive good quality of nursing care, critical thinking needs to be prioritised. So, it is important that the nursing institutions expertise the students in providing care with critical thinking for the better treatment and recovery of patients.
Shycil Mathew, Princia Fernandes, Josvita Dsouza et al.· Journal of Health and Allied...· 0 citations
Introduction. Problem-solving skills and the use of Standardized Nursing Languages (SNLs) are essential for clinical reasoning in nursing education, yet their relationship has been insufficiently explored. This study aimed to describe nursing students’ characteristics alongside their problem-solving skills, compare these across program years, and identify predictors of their knowledge of the nursing process and SNLs, with a specific focus on problem solving. Methods. A prospective observational study was conducted in 2024–2025 among undergraduate nursing students in a public university in Italy. Data were collected through an online survey including a knowledge test on SNLs, the Positions on Nursing Diagnosis scale, and the Problem-Solving Inventory (PSI). Descriptive statistics, ANOVA, correlation analyses, and multiple linear regression were performed. Results. A total of 352 students participated (87.5% female; mean age 22.79). Knowledge levels did not significantly differ across academic years. Higher knowledge was associated with better academic performance, stronger intention to use nursing diagnoses, and higher PSI-Self-Assurance, while larger class size and male sex were negatively associated with knowledge. Regression analysis identified PSI-Self-Assurance, intention to use nursing diagnoses, class size, and sex as significant predictors (R² = 0.11). Discussion. Knowledge of the nursing process and SNLs appears to be more strongly influenced by motivational and cognitive factors than by academic progression alone. Confidence in problem-solving and intentional engagement with nursing diagnoses emerge as key elements in supporting diagnostic reasoning.
Roberta Morandini, A. Bonacci, Andrea Gazzelloni et al.· Interdisciplinary Journal of...· 0 citations
Comparing critical thinking abilities among students in the Diploma III, Bachelor of Nursing, and Professional Nursing programs at Institut Kesehatan Payung Negeri Pekanbaru suggests that the three programs had similar critical thinking profiles at the time of measurement.
Gita Adelia, Esperanza Zuriguel Pérez, Imelda Rahmayunia Kartika et al.· An Idea Health Journal· 0 citations
Aim: The aim of the study was to quantitatively assess reflective capacity among nursing students and to examine the expression of its dimensions in the clinical learning environment.Material and Methods: A cross-sectional quantitative study design was used. A purposive sample of 177 nursing students enrolled in the Nursing programme in Slovenia participated in the study. Data were collected between October and December 2025 using the Reflective Practice Questionnaire. The study used the 16-item reflective capacity subscale, which includes four dimensions: reflection-in-action, reflection-on-action, reflection with others, and self-appraisal. Data were collected through an anonymous online survey (1KA). Statistical analyses were performed using SPSS 29. Descriptive statistics were calculated, and internal consistency was assessed using Cronbach’s alpha. Due to non-normal data distribution, non-parametric tests were applied, including the Wilcoxon signed-rank test, Friedman test, Mann–Whitney U test, Kruskal–Wallis test, and Spearman’s correlation coefficient.Results: The results showed a relatively high level of reflective capacity among nursing students (Mdn = 4.56). Based on median values, the highest scores were observed in reflection with others and self-appraisal, while the lowest were found for reflection-in-action. Differences between reflective capacity dimensions were not statistically significant (χ²(3) = 2.399, p = 0.494). No significant differences were observed between full-time and part-time students or across years of study (p > 0.05). Age was not significantly associated with reflective capacity, except for a weak negative correlation with reflection with others (ρ = −0.193, p = 0.011). Students who perceived reflection as important for their professional development and those interested in additional practical training demonstrated significantly higher levels of reflective capacity (p < 0.05).Conclusion: The findings indicate that nursing students demonstrate a relatively high level of reflective capacity, particularly in collaborative reflective processes. Reflective practice appears to be an important component of clinical learning and professional development in nursing education.Implication for nursing practice: Structured reflective activities, mentoring conversations, and guided reflection in clinical environments may strengthen students’ clinical judgement, professional responsibility, and quality of patient care.
Iris Ruzzier, Sabina Ličen, Mitja Zdovc et al.· Global Nursing Insights· 0 citations
Nursing students demonstrated a developing but not yet fully clinically competent and readiness for professional practice which mirrors the theoretical foundational competence with strength in communication and should address the emotional unpreparedness and the used of medical equipment and technologies.
Rosemarie D Vista, Najd Hamed Alenzi, Samia Ali Alanzi et al.· Journal of Frontiers in Mult...· 0 citations
The results of the data analysis showed a significant relationship between laboratory learning and student self-confidence, which means that the better the laboratory learning, the higher the students' self-confidence, with a moderate strength of relationship.
R. E. Nurhidayah, Erniyati, Reisy Tane et al.· Caring: Indonesian Journal...· 0 citations
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