Competent-level nurses' clinical reasoning: Difficulties and support for improvement from the perspective of nurses

Objective: This study clarified the difficulties of clinical reasoning (CR) and the support that promoted its improvement, as recognized by competent-level nurses (CLNs). Methods: Using a qualitative descriptive research design, this study recruited eight CLNs working at three general hospitals through convenience sampling. The participants were asked to recall "unexpected clinical situations they faced while interacting with patients in clinical practice or situations where they found it difficult to make a decision." In addition, participants were asked through semi-structured interviews to respond based on the specific circumstances of the cases they recalled. Results: Four categories of CR difficulty as recognized by CLNs were generated, and three categories of support that encouraged them to improve their CR were identified. Conclusions: Owing to the gap between ideals and reality, CR difficulty can cause CLNs to experience helplessness and low self-esteem, leading to an inability to provide high-quality care. CLNs often rely on the CR of their seniors. CR becomes particularly challenging when CLNs are inexperienced, when unexpected events occur, or when CLNs are busy. Support measures for improving CR included tracking and verbalizing thought processes and providing supplementary support for learning content. This study clarifies the specific support that CLNs need to improve their CR through experience.