Nursing clinical reasoning cognitive strategies used in a learning-by-concordance modality: A qualitative descriptive study

Deschênes, M.-F., Lechasseur, K., Caty, M.-È., Fernandez, N. et Lavoie, P. (2026). Nursing clinical reasoning cognitive strategies used in a learning-by-concordance modality: A qualitative descriptive study. Nurse Education in Practice, 91 . Article 104676. ISSN 1471-5953 DOI 10.1016/j.nepr.2025.104676

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Résumé

Abstract

Aims
The primary aim of this study is to describe the cognitive strategies employed by nursing students during a Learning-by-Concordance (LbC) activity. A secondary aim is to compare these strategies with those used by experienced nurses.

Background
Technological advancements have facilitated the integration of diverse pedagogical modalities into nursing education. However, the mechanisms by which digital modalities support the development of cognitive strategies for clinical reasoning remain insufficiently understood.

Design
A descriptive qualitative design was adopted.

Methods
Content analysis was used to identify and describe the cognitive strategies mobilized during the LbC activity. This was complemented by a frequency analysis to compare the strategies used by students and experienced nurses.

Results
A total of 46 participants were recruited: 10 novice students, 16 intermediate students and 20 experienced nurses, including 13 rehabilitation nurses and 7 nurse educators. Findings revealed that some cognitive strategies—such as identifying salient data, seeking additional information and forming relationships between data—were more frequently employed. Student responses varied in precision and length, while nurses’ responses tended to include detailed contextualization of nursing hypotheses. Educators’ responses often emphasized procedural rules and provided clarifications related to the proposed hypotheses.

Conclusions
The results underscore the importance of adapting the LbC modality to better support the cognitive strategies essential for clinical reasoning in nursing. Three pedagogical variations are proposed: (1) structuring activities around illness and nursing scripts; (2) integrating think-aloud strategies; (3) fostering interactivity through individual and collaborative group work.

Type de document:	Article
Mots-clés libres:	Clinical reasoning Learning by concordance Pedagogical modality Cognitive strategies Decision-making Script theory
Date de dépôt:	18 févr. 2026 18:47
Dernière modification:	18 févr. 2026 18:47
Version du document déposé:	Version officielle de l'éditeur
URI:	https://depot-e.uqtr.ca/id/eprint/12603

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