Barriers to the Development of Clinical Reasoning Skills among Coronary Care Nurses: A Qualitative Study

Touba Hosseinzadeh, Kian Norouzi Tabrizi, Masoud Fallahi‑Khoshknab, Hamidreza Khankeh, Forozan Shokooh


Background: Clinical Reasoning (CR) is a main professional competency for nurses which have significant contribution to sound clinical performance in critical clinical conditions. Nonetheless, evidence shows that nurses do not have the necessary competencies and thinking skills for managing complex conditions in critical care units. This study aimed at exploring the barriers to the development of CR skills among coronary care nurses.

Materials and Methods: Using conventional content analysis, this qualitative study was conducted in 2020 in the Coronary Care Unit (CCU) of Heshmat Subspecialty Heart Center in Rasht, Iran. Participants were 15 nurses, head nurses, nursing supervisors, nursing managers, and nursing instructors. Data were collected using semi‑structured interviews and were analyzed using conventional content analysis.

Results: The four main categories of the barriers to CR skill development among nurses were limited professional development, inefficient educational program, ineffective professional interactions, and limited professional self‑efficacy.

Conclusion: There are different personal, educational, professional, and interprofessional barriers to the development of CR skills among CCU nurses. Study findings can be used to develop effective strategies for supporting and developing nurses’ CR skills.


Clinical reasoning, Coronary care units, Nurses

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