Nursing students’ development of clinical competence through the use of reflection prompts based on the nursing process during clinical education: a qualitative longitudinal study

The aim of the study was to identify patterns in nursing students’ development of clinical competence through the use of reflection prompts based on the nursing process during their clinical education. This study’s design was a qualitative longitudinal small-scale intervention study with an inductive approach. Data were collected between November 2024 and January 2025 through 18 semi-structured individual interviews with six nursing students in their sixth semester during their final clinical placement. Each student was interviewed three times during their clinical education: before, during, and after using a card with reflection prompts. The data was analysed using a pattern-oriented analysis. The analysis resulted in four individual and shared patterns illustrating students’ development of clinical competence over time through the use of reflection prompts during their clinical education. The main patterns revealed that the reflection prompts enhanced understanding of the nursing process as an integrated part of clinical practice, developed independent reflective thinking in the professional role, and advanced a fundamental structure for nursing practice. Nevertheless, continual reflective supervision is an important prerequisite for optimal development. Reflection prompts based on the nursing process show a potential to support nursing students’ learning and development of clinical competence during their clinical education. Further research is needed to refine and strengthen the model and to explore how it can be implemented in nursing education.