Author Identifier (ORCID)
Dhanya Anand Anil Kumar’s ORCID record 
Natasya Raja Azlan’s ORCID record Hugh Davies’s ORCID record Debbie Massey’s ORCID record Karen Strickland’s ORCID record
Abstract
Aims: Clinical reasoning is a critical skill for nurses, developing progressively through structured education and clinical experience. Simulation-based learning provides nursing students with a safe, immersive environment to develop this skill if it is thoughtfully designed and rigorously implemented. This review addresses a key gap in nursing education research by exploring methodological trends and key elements to consider for developing simulations to assess clinical reasoning in nursing students. Design: An integrative review using Whittemore and Knafl's framework. Data sources: Six databases (CINAHL, PubMed, ScienceDirect, MEDLINE, PsycInfo and Google Scholar) were searched for studies published from 2014 to September 2025. Review methods: The initial search identified 3290 articles. After duplicate removal and screening at the title and full text levels using predefined inclusion and exclusion criteria, 35 articles were selected for inclusion. All included articles were critically appraised using the Mixed Method Appraisal Tool. Results: Findings are presented in relation to the two review questions: we explored (1) the research methods used in simulation-based studies assessing clinical reasoning, and (2) the key design elements reported across these studies. Studies varied widely in research design, methodological quality, and theoretical grounding. Most focused on acute care simulation with undergraduate nursing students. Theoretical frameworks were inconsistently applied, and data collection approaches ranged from standardised clinical reasoning tools to researcher-developed measures and qualitative methods. Key design elements such as participant orientation, simulation modality, environment, instructional design, and debriefing were commonly reported, though their application differed substantially across studies. Conclusion: This review highlights considerable methodological variability in how simulation-based learning is designed, implemented, and evaluated to assess clinical reasoning. Greater theoretical alignment, clearer reporting of design elements, and strengthened methodological rigour are needed to advance the quality and comparability of simulation research in nursing education.
Keywords
clinical reasoning, integrative review, nursing education, simulation-based learning
Document Type
Journal Article
Date of Publication
2026
ISSN
15322793
Volume
167
Publication Title
Nurse Education Today
Publisher
Elsevier
School
School of Nursing and Midwifery
Funding Information
This Higher Degree of Research (HDR) candidature was supported under the Commonwealth Government's Research Training Program, and the financial assistance provided by the Australian Government is gratefully acknowledged.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.