Which digital education approaches most effectively enhance clinical reasoning in undergraduate nursing students: Protocol for a Network Meta-analysis

Abstract

Background Clinical reasoning is a core competency in nursing education, enabling students to make accurate and evidence-based clinical decisions. As digital-based learning expands, understanding the comparative effectiveness of different technology-enhanced educational approaches in improving clinical reasoning competence has become essential. However, existing evidence remains fragmented and inconsistent across the intervention types. Objective This study aims to systematically evaluate and compare the effects of digital-based education interventions on clinical reasoning competence among undergraduate nursing students using a network meta-analysis. Methods This protocol describes a systematic review and network meta-analysis conducted in accordance with the PRISMA-P and Cochrane Handbook guidelines. Randomized controlled trials will be included and analyzed in separate networks. The primary outcome is clinical reasoning competence; secondary outcomes include critical thinking and problem-solving abilities. Searches will be conducted in PubMed, Embase, CINAHL, Web of Science, and CENTRAL from their inception to December 31, 2025. A frequentist network meta-analysis will be performed using R (version 4.1.0) with the netmeta package. Standardized mean differences with 95% confidence intervals will be calculated based on arm-level data. Transitivity and consistency will be assessed using global and local approaches. Intervention rankings will be estimated using P-scores. The certainty of evidence will be assessed using the CINeMA framework and GRADE. Conclusions This review will provide a comprehensive synthesis and comparative ranking of digital-based education interventions for improving clinical reasoning and related cognitive outcomes in nursing students. The findings will inform evidence-based decisions regarding the integration of effective digital educational strategies into nursing curricula.