“Factors Influencing Clinical Reasoning in Moroccan Nursing Students: The Role of Self-Efficacy, Stress, And the Clinical Learning Environment”

Abstract

Introduction. Clinical reasoning (CR) is a key competence in nursing education, as it ensures the quality and safety of care. However, its acquisition during undergraduate training remains challenging, particularly in the Moroccan context, which is characterized by pedagogical and organizational constraints limiting students’ autonomy. This study aimed to examine the effect of individual factors (self-efficacy, perceived stress) and contextual factors (training satisfaction and clinical learning environment) on the development of CR.

Methods. A quantitative, cross-sectional, and analytical study was conducted with 311 second- and third-year students enrolled in the ISPITS institutions of the Tangier–Tétouan–Al Hoceima region. The data were collected using a single self-administered questionnaire that integrated several validated scales. Statistical analyses included descriptive, correlational, and regression tests, as well as mediation and moderation models (PROCESS v4.0, SPSS).

Results. Students demonstrated a moderate level of CR (M = 3.31; SD = 0.53). Self-efficacy emerged as the main predictive factor (β = 0.417; p < 0.001), explaining a substantial proportion of the variance (adjusted R² = 0.356). Satisfaction exerted a partial mediating effect (β = 0.0069; 95% CI [0.0000; 0.0203]). The year of study moderated the relationship between self-efficacy and reasoning, which was stronger among second-year students (β = 0.3732) compared to third-year students (β = 0.1818). Perceived stress was weakly correlated with reasoning (r = 0.128; p = 0.024) but not predictive. Finally, some dimensions of the clinical learning environment showed significant correlations, particularly group dynamics (r = 0.238) and learning opportunities (r = 0.213).

Conclusion. These findings highlight the need to strengthen academic self-confidence and to foster supportive and satisfactory clinical learning environments. They suggest integrating innovative pedagogical approaches that promote autonomy, critical reflection, and constructive stress management in order to enhance the acquisition of CR.