Clinical reasoning is a nursing competency necessary to make the best decision to deliver safe and effective care. A review of the literature shows a link between hazardous errors in patient care and poor clinical reasoning among nurses, and suggests that more study be given to best way to teach clinical reasoning. It is crucial that nurses today and of the future possess the clinical reasoning skills to provide increasingly complex patient care. This study tested the effect of the Outcome-Present State Test (OPT) Model of Clinical Reasoning on Filipino junior nursing students’ clinical reasoning scores on the Health Sciences Reasoning Test (HSRT). A two group, pretest and posttest, quasi-experimental design was used with a sample of 58 (28 control and 30 intervention) Filipino Baccalaureate junior nursing students. The intervention group followed the OPT model as an educational program while the control group had the usual nursing process curriculum for their two-week clinical experience in the orthopedic unit. The measure used was the Health Sciences Reasoning Test (HSRT), comprised of five dimensional scores: inferential, analysis, evaluation, induction, and deduction, and a cumulative score. The study findings showed no significant differences between the pretest and posttest within and between groups. The OPT Model of Clinical Reasoning, when used as a two-week intervention program, did not show significant improvement in nursing students’ clinical reasoning scores. Moreover, gender, general academic GPA and nursing coursework GPA were not related to the clinical reasoning scores (in the cumulative and across the five dimensions). Though these data may not be generalizable to the whole nursing student population, this study serves as a foundation for additional studies on clinical reasoning education programs. Future studies could benefit by expanding the time period in which the OPT model was used, increasing the sample size, and using measures of clinical reasoning other than the HSRT.

LLU Discipline





School of Nursing

First Advisor

Pothier, Patricia

Second Advisor

D'Errico, Ellen D.

Third Advisor

Ramal, Edelweiss

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Nursing - Decision Making; Students - Nursing

Subject - Local

Health Sciences Reasoning Test (HSRT); Filipino Nursing Students; Nursing Competency; Clinical Reasoning



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives

Included in

Nursing Commons