title: Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory.
abstract: BACKGROUND
  Effective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skills. While a number of strategies have been implemented and tested to promote these skills, educators have not been able consistently to predict their development. Self-regulated learning theory suggests that this development requires concurrent attention to both the cognitive and metacognitive dimensions of reasoning in nursing care contexts.
  
  
  OBJECTIVE
  This paper reports on a study to explore the impact of self-regulated learning theory on reflective practice in nursing, and to advance the idea that both cognitive and metacognitive skills support the development of clinical reasoning skills.
  
  
  METHODS
  Integrative review of published literature in social science, educational psychology, nursing education, and professional education using the Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resource Information Center (ERIC), and American Psychological Association (PsychInfo) Databases. The search included all English language articles with the key words clinical reasoning, cognition, critical thinking, metacognition, reflection, reflective practice, self-regulation and thinking.
  
  
  RESULTS
  Reflective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skill acquisition. This skill acquisition is best accomplished through teaching-learning attention to self-regulation learning theory. A critical analysis of the literature in the areas of critical thinking and reflective practice are described as a background for contemporary work with self-regulated learning theory. It is apparent that single-minded attention to critical thinking, without attention to the influence of metacognition or reflection, is but one perspective on clinical reasoning development. Likewise, single-minded attention to metacognition or reflection, without attention to the influence of critical thinking, is another perspective on clinical reasoning development. While strategies to facilitate critical thinking and reflective practice have been used in isolation from each other, there is evidence to suggest that they are inextricably linked and come together with the use of self-regulated learning prompts.
  
  
  CONCLUSIONS
  Students and practising nurses are able to improve their cognitive and metacognitive skills in clinical contexts by using self-regulated learning strategies. The self-regulated learning model in nursing is offered to support teaching and learning of reflective clinical reasoning in nursing practice contexts.
authors.affiliation: School of Nursing, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA. kuiperr@uncw.edu
authors.forename: Ruth Anne
authors.initials: RA
authors.lastname: Kuiper
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pesut
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004506:Education, Nursing / Q000379:methods*; D006801:Humans; D008128:Logic; D012647:Self-Assessment; D013850:Thinking