Metacognitive processes, situational factors, and clinical decision-making in nursing education: a quantitative longitudinal study

Objective: This study examined the longitudinal development of metacognitive skills and clinical decision-making abilities in nursing students, focusing on the interactions between metacognitive processes, situational factors, and individual differences.

Methods: A longitudinal, quantitative design was employed, following 185 third-year nursing students from a major university in China over one academic year. Data were collected at six time points using the Metacognitive Awareness Inventory, Nursing Decision-Making Instrument, and custom-designed clinical scenario assessments. Latent Growth Curve Modeling, Multilevel Modeling, and Moderation Analysis were used to analyze the data.

Results: Significant positive growth trajectories were observed for both metacognitive awareness (mean slope = 0.07, p < .001) and decision-making skills (mean slope = 0.08, p < .001). Metacognitive regulation emerged as the strongest predictor of decision-making outcomes (β = 0.188, p < .001 for quality; β = 0.168, p < .001 for efficiency). Task complexity negatively impacted decision-making quality (β = -0.129, p < .001), while time pressure more strongly affected efficiency (β = -0.121, p < .001). Cognitive style and emotional intelligence moderated the relationship between metacognitive processes and decision-making outcomes. The effectiveness of metacognitive strategies in mitigating the negative effects of situational factors varied across individuals and over time.

Conclusion: This study provides robust evidence for the complex interplay between metacognitive processes, situational factors, and individual differences in the development of clinical decision-making skills among nursing students. The findings highlight the importance of tailoring educational interventions to enhance specific metacognitive skills, particularly regulation, while considering the impact of situational factors and individual cognitive styles. These insights can inform the design of more effective, personalized approaches to nursing education, potentially enhancing the preparation of nursing students for the complexities of clinical practice.