Acquisition of clinical reasoning skills by undergraduate nursing students in Malawi; towards development of a middle-range theory : A qualitative study

Acquisition of clinical reasoning skills by undergraduate nursing students in Malawi; towards development of a middle-range theory : A qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Acquisition of clinical reasoning skills by undergraduate nursing students in Malawi; towards development of a middle-range theory : A qualitative study Omero. G. Mwale, Patricia. K. Mukwato, Marjorie .k. makukula This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4124334/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Apr, 2025 Read the published version in BMC Nursing → Version 1 posted 11 You are reading this latest preprint version Abstract Introduction: Acquisition of clinical reasoning skills is essential in nursing for patient safety. Lack of clinical reasoning skills in nursing can impose harmful consequences on the patient. However, teaching and learning clinical reasoning skills is not easy due to its complexity. Without a model, clinical reasoning is taught intuitively. Therefore, this study aimed at investigating how undergraduate nursing students acquire clinical reasoning skills, towards development of a middle-range theory. Methods: This study employed Grounded theory of systematic design underpinned by a social constructivism paradigm. The participants were undergraduate nursing students and nurse educators. Purposive sampling was used to sample the participants. Data were collected in six months using numerous methods of interviews, observations, and document review Twelve individual in-depth interviews and six focus group discussions were conducted. Data collection and initial data analysis occurred concurrently using a coding process, with comparative analysis. Results: The study revealed that undergraduate nursing students acquired clinical reasoning skills through automation while utilizing the nursing process. Through the themes, a new theory called ‘a middle-range theory for the acquisition of clinical reasoning skills’, was generated in this current study. The associated concepts were environmental setting, type of curriculum, anchors and expected outcomes which included individual and health care system indicators. Conclusion: Teaching undergraduate nursing students how to reason clinically will develop nurses who can adjust and solve problems in changing patient’s situations. Based on the findings of this study, it is recommended that nursing students be equipped with adequate clinical reasoning skills before they graduate. Therefore, implementing the new model called ‘a middle range theory for the acquisition of clinical reasoning skills’ could foster the development of clinical reasoning skills from the start of the nursing training program. Acquisition Clinical reasoning skills Undergraduate nursing student Nurse educator. Malawi. Figures Figure 1 Figure 2 Figure 3 Full Text Additional Declarations No competing interests reported. Tables 1 and 2 are available in the Supplementary Files section. Supplementary Files Table1.docx Table2.docx additionalfile.docx Cite Share Download PDF Status: Published Journal Publication published 14 Apr, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 19 Jul, 2024 Reviews received at journal 13 Jul, 2024 Reviewers agreed at journal 13 Jul, 2024 Reviewers agreed at journal 10 Jul, 2024 Reviews received at journal 16 Jun, 2024 Reviewers agreed at journal 31 May, 2024 Reviewers invited by journal 20 May, 2024 Editor invited by journal 22 Mar, 2024 Submission checks completed at journal 22 Mar, 2024 Editor assigned by journal 22 Mar, 2024 First submitted to journal 18 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4124334","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":283817519,"identity":"3c11d472-9790-4d20-ac42-836d7ec61db3","order_by":0,"name":"Omero. G. 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Adopted clinical judgement model (Tanner, 2006) to illustrate acquisition of clinical reasoning skills by undergraduate nursing students.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4124334/v1/2f433f4243708398a32b261d.jpg"},{"id":53658166,"identity":"a0df210b-4215-4821-ac98-f21228f23ad0","added_by":"auto","created_at":"2024-03-28 15:56:33","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":154537,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA middle- range theory for acquisition of clinical reasoning skills to guide teaching and learning of undergraduate nursing students in Malawi by Mwale 2024\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4124334/v1/bbe83282129aed3789e60bec.jpg"},{"id":53658168,"identity":"4def5050-b2e7-4fe0-9e33-872a1d6cdb06","added_by":"auto","created_at":"2024-03-28 15:56:33","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":123354,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIllustrative representation of summary of findings in \u0026nbsp;grounded theory \u0026nbsp;in accordance with Corbin \u0026amp; Strauss 2015).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4124334/v1/6944967a3c4de504a8af51ec.jpg"},{"id":81050909,"identity":"1da1c3e9-06da-41a5-9aa0-e5fc660a07ed","added_by":"auto","created_at":"2025-04-21 16:06:29","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":961145,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4124334/v1_covered_3f043498-b44e-4e3d-91c7-bdfba603aa5a.pdf"},{"id":53658164,"identity":"ce01312e-d9bd-40c3-a983-6ff307f9bbbe","added_by":"auto","created_at":"2024-03-28 15:56:33","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15559,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4124334/v1/d9809c664e3462d0080794ee.docx"},{"id":53658169,"identity":"5040517f-f153-44e9-805f-95a97a9f0464","added_by":"auto","created_at":"2024-03-28 15:56:33","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":15002,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4124334/v1/b88dc66375ad48d71da508d7.docx"},{"id":53658167,"identity":"6ada1b95-80ca-4635-a8d0-e51b98a836c8","added_by":"auto","created_at":"2024-03-28 15:56:33","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":16783,"visible":true,"origin":"","legend":"","description":"","filename":"additionalfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-4124334/v1/652a7a57060c5481ee133165.docx"}],"financialInterests":"\u003cp\u003eNo competing interests reported.\u003c/p\u003e\n\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e","formattedTitle":"Acquisition of clinical reasoning skills by undergraduate nursing students in Malawi; towards development of a middle-range theory : A qualitative study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Acquisition, Clinical reasoning skills, Undergraduate nursing student, Nurse educator. Malawi.","lastPublishedDoi":"10.21203/rs.3.rs-4124334/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4124334/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eAcquisition of clinical reasoning skills is essential in nursing for patient safety. Lack of clinical reasoning skills in nursing can impose harmful consequences on the patient. However, teaching and learning clinical reasoning skills is not easy due to its complexity. Without a model, clinical reasoning is taught intuitively. Therefore, this study aimed at investigating how undergraduate nursing students acquire clinical reasoning skills, towards development of a middle-range theory.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study employed Grounded theory of systematic design underpinned by a social constructivism paradigm. The participants were undergraduate nursing students and nurse educators. Purposive sampling was used to sample the participants. Data were collected in six months using numerous methods of interviews, observations, and document review Twelve individual in-depth interviews and six focus group discussions were conducted. Data collection and initial data analysis occurred concurrently using a coding process, with comparative analysis.\u003c/p\u003e\n\u003cp\u003eResults: The study revealed that undergraduate nursing students acquired clinical reasoning skills through automation while utilizing the nursing process. Through the themes, a new theory called ‘a middle-range theory for the acquisition of clinical reasoning skills’, was generated in this current study. The associated concepts were environmental setting, type of curriculum, anchors and expected outcomes which included individual and health care system indicators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Teaching undergraduate nursing students how to reason clinically will develop nurses who can adjust and solve problems in changing patient’s situations. Based on the findings of this study, it is recommended that nursing students be equipped with adequate clinical reasoning skills before they graduate. Therefore, implementing the new model called ‘a middle range theory for the acquisition of clinical reasoning skills’ could foster the development of clinical reasoning skills from the start of the nursing training program.\u003c/p\u003e","manuscriptTitle":"Acquisition of clinical reasoning skills by undergraduate nursing students in Malawi; towards development of a middle-range theory : A qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-28 15:56:28","doi":"10.21203/rs.3.rs-4124334/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-19T04:46:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-13T08:25:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261948477271005418371216371615836581176","date":"2024-07-13T07:46:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110313951327028769000305885384703358742","date":"2024-07-11T03:22:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-17T03:32:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96000388970319832986064677944297123122","date":"2024-05-31T10:41:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-20T10:15:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-22T17:48:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-22T17:46:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-22T17:46:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-03-18T15:15:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4106210e-85f1-4186-a3fb-96fa53318010","owner":[],"postedDate":"March 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-21T16:02:06+00:00","versionOfRecord":{"articleIdentity":"rs-4124334","link":"https://doi.org/10.1186/s12912-025-03064-2","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-04-14 15:57:55","publishedOnDateReadable":"April 14th, 2025"},"versionCreatedAt":"2024-03-28 15:56:28","video":"","vorDoi":"10.1186/s12912-025-03064-2","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03064-2","workflowStages":[]},"version":"v1","identity":"rs-4124334","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4124334","identity":"rs-4124334","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}