The concept of metacognition applied to nursing education: a scoping review
DOI:
https://doi.org/10.17267/2594-7907ijeh.2025.e6298Keywords:
Metacognition, Nursing, Nursing Students, Nursing EducationAbstract
ABSTRACT | INTRODUCTION: Metacognition, the awareness of one’s own cognitive processes, is a valuable skill for learning as it is related to clinical reasoning development and contributes to academic performance. Despite the importance of this topic, there are no scoping reviews about metacognition being related to nursing education. OBJECTIVE: Therefore, this review intended to map the application of metacognition as a concept in nursing education. METHODS: A scoping review was conducted following the Joana Briggs Institute recommendations. A total of 21 articles were selected based on eligibility criteria out of the 142 found on databases such as PubMed, Eric, SciELO and BVS. RESULTS: The findings revealed that metacognition has a broad application in nursing education, including the relationship between metacognition level and learning, teaching methods and skill development. Although nursing students did not reach the highest levels of metacognition, educational interventions were shown to have enhanced it, which positively impacted academic performance and essential nursing skill development. CONCLUSION: In that regard, metacognition seems to be critically important for the development of clinical reasoning, skills for clinical practice and the reduction of medical errors. Thus, this topic must be explored in higher education and scientific research, especially in longitudinal studies, which can verify the effects of metacognition on nursing education.
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References
1. Flavell JH. Metacognition and cognitive monitoring: A new area of cognitive–developmental inquiry. Am Psychol. 1979;34:906–11. https://doi.org/10.1037/0003-066X.34.10.906
2. Fleur DS, Bredeweg B, van den Bos W. Metacognition: ideas and insights from neuro- and educational sciences. NPJ Sci Learn [Internet]. 2021;6(1):1–11. Available from: https://www.nature.com/articles/s41539-021-00089-5
3. Asadzandi S, Mojtahedzadeh R, Mohammadi A. What are the Factors that Enhance Metacognitive Skills in Nursing Students? A Systematic Review. Iran J Nurs Midwifery Res. 2022;27(6):475–84. https://doi.org/10.4103/ijnmr.ijnmr_247_21
4. Nes AAG, Riegel F, Martini JG, Zlamal J, Bresolin P, Mohallem AGC, et al. Brazilian undergraduate nursing students’ critical thinking need to be increased: a cross-sectional study. Rev Bras Enferm. 2023;76:e20220315. https://doi.org/10.1590/0034-7167-2022-0315
5. Facione PA. Critical Thinking: What It Is and Why It Counts. Insight Assessment [Internet]. 2015. Available from: https://www.researchgate.net/publication/251303244_Critical_Thinking_What_It_Is_and_Why_It_Counts
6. Stark M, Fins JJ. The Ethical Imperative to Think about Thinking: Diagnostics, Metacognition, and Medical Professionalism. Camb Q Healthc Ethics. 2014;23(4):386–96. https://doi.org/10.1017/S0963180114000061
7. Corrao S, Argano C. Rethinking clinical decision-making to improve clinical reasoning. Front Med. 2022;9. https://doi.org/10.3389/fmed.2022.900543
8. Banning M. Clinical reasoning and its application to nursing: Concepts and research studies. Nurse Educ Pract. 2008;8(3):177–83. https://doi.org/10.1016/j.nepr.2007.06.004
9. NANDA International, Inc. Glossary of Terms [Internet]. Available from: https://nanda.org/publications-resources/resources/glossary-of-terms/
10. Woolley N. Nursing diagnosis: exploring the factors which may influence the reasoning process. J Adv Nurs. 1990;15(1):110–7. https://doi.org/10.1111/j.1365-2648.1990.tb01679.x
11. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. https://doi.org/10.1111/jan.14743
12. Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis [Internet]. Adelaide: JBI; 2024. Available from: https://synthesismanual.jbi.global
13. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32. https://doi.org/10.1080/1364557032000119616
14. Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119–26. https://doi.org/10.11124/JBIES-20-00167
15. Jou GI, Sperb TM. Metacognition as regulatory strategy of learning. Psicol Reflex Crit. 2006;19:177–85. https://doi.org/10.1590/S0102-79722006000200003
16. Versteeg M, Bressers G, Wijnen-Meijer M, Ommering BW, Beaufort AJ, Steendijk P. What Were You Thinking? Medical Students’ Metacognition and Perceptions of Self-Regulated Learning. Teach Learn Med. 2021;33(5):473–82. https://doi.org/10.1080/10401334.2021.1889559
17. Silva MG, Fernandes JD, Teixeira GAS, Silva RM. Contemporary formal nursing education process: challenges and perspectives. Texto Contexto Enferm. 2010;19:176–84. https://doi.org/10.1590/S0104-07072010000100021
18. Hsu LI, Hsieh SI. Factors affecting metacognition of undergraduate nursing students in a blended learning environment. Int J Nurs Pract. 2014;20(3):233–41. https://doi.org/10.1111/ijn.12131
19. Chen JH, Björkman A, Zou JH, Engström M. Self-regulated learning ability, metacognitive ability, and general self-efficacy in a sample of nursing students: A cross-sectional and correlational study. Nurse Educ Pract. 2019;37:15–21. https://doi.org/10.1016/j.nepr.2019.04.014
20. Chen SL, Sun JL, Jao JY. A predictive model of student nursing competency in clinical practicum: A structural equation modelling approach. Nurse Educ Today. 2020;95:104579. https://doi.org/10.1016/j.nedt.2020.104579
21. Jin M, Ji C. The correlation of metacognitive ability, self-directed learning ability and critical thinking in nursing students: A cross-sectional study. Nurs Open. 2021;8(2):936–45. https://doi.org/10.1002/nop2.702
22. Espindola CKN, Santos DBD, Nascimento LL, Matos RS, Silva SMD, Marion-Martins AD. Perfil metacognitivo de estudantes de enfermagem e desempenho acadêmico. Rev Enferm UFPE On Line [Internet]. 2021;15(2):1–16. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/244980/39181
23. Bektas I, Bektas M, Ayar D, Akdeniz Kudubes A, Sal S, Selekoglu OK, et al. The predict of metacognitive awareness of nursing students on self-confidence and anxiety in clinical decision-making. Perspect Psychiatr Care. 2021;57(2):747–52. https://doi.org/10.1111/ppc.12609
24. Choi E, Jeon J. Factors Influencing Problem-Solving Competence of Nursing Students: A Cross-Sectional Study. Healthcare (Basel). 2022;10(7). https://doi.org/10.3390/healthcare10071184
25. Kim S. The effect of metacognition and self-directed learning readiness on learning performance of nursing students in online practice classes during the COVID-19 pandemic period. Nurs Open. 2024;11(1):e2093. https://doi.org/10.1002/nop2.2093
26. Seidel-Fischer J, Trifunovic-Koenig M, Gerber B, Otto B, Bentele M, Fischer MR, et al. Interaction between overconfidence effects and training formats in nurses’ education in hand hygiene. BMC Nurs. 2024;23(1):451. https://doi.org/10.1186/s12912-024-02020-w
27. Lee S, Park H, Yu S. The mediating role of positive psychological capital in the relationship between metacognition and self-directed learning ability: A cross-sectional study. Nurse Educ Today. 2024;143:106385. https://doi.org/10.1016/j.nedt.2024.106385
28. Wang J, Jiao Y, Peng M, Wang Y, Guo D, Tian L. The relationship between personality traits, metacognition and professional commitment in Chinese nursing students: a cross-sectional study. BMC Nurs. 2024;23(1):729. https://doi.org/10.1186/s12912-024-02399-6
29. Gholami M, Moghadam PK, Mohammadipoor F, Tarahi MJ, Sak M, Toulabi T, et al. Comparing the effects of problem-based learning and the traditional lecture method on critical thinking skills and metacognitive awareness in nursing students in a critical care nursing course. Nurse Educ Today. 2016;45:16–21. https://doi.org/10.1016/j.nedt.2016.06.007
30. Lee MN, Nam KD, Kim HY. Effects of Simulation With Problem-Based Learning Program on Metacognition, Team Efficacy, and Learning Attitude in Nursing Students: Nursing Care With Increased Intracranial Pressure Patient. Comput Inform Nurs. 2017;35(3):145–51. https://doi.org/10.1097/cin.0000000000000308
31. Oh HK. Impact of Metacognition on Clinical Judgment and Competence in Simulation-Based Blended Learning. Int J Mob Blended Learn [Internet]. 2019;11(3):79–88. Available from: https://ideas.repec.org/a/igg/jmbl00/v11y2019i3p79-88.html
32. Donaldson S. Building Metacognition and Thinking Using a Deliberate Approach. Collect Essays Learn Teach. 2020;13:12–24. https://doi.org/10.22329/celt.v13i0.6009
33. Millanzi WC, Kibusi SM. Exploring the effect of problem-based facilitatory teaching approach on metacognition in nursing education: A quasi-experimental study of nurse students in Tanzania. Nurs Open. 2020;7(5):1431–45. https://doi.org/10.1002/nop2.514
34. Lovell C, Elswick RK Jr, McKay SW, Robins J, Salyer J. Visual Arts in Nursing Education: An Inventive Interprofessional Initiative to Cultivate Metacognitive Awareness in Beginning Nursing Students. J Holist Nurs. 2021;39(2):135–43. https://doi.org/10.1177/0898010120962903
35. Rashwan ZI, Busebaia TJ, Al-Sabbagh AS, Eweida RS. Effect of guided reciprocal peer questioning strategy on pediatric nursing students’ self-esteem and metacognitive awareness: Current approach and future directions. Nurse Educ Today. 2021;107:105153. https://doi.org/10.1016/j.nedt.2021.105153
36. Li S, Ala M, Mao D, Wang A, Wu C. Effect of a Nursing Comprehensive Skill Training Course (NCST-C) on Nursing Students’ Metacognitive Awareness: A Quasi-experimental Study. Asian Nurs Res. 2022;16(5):275–81. https://doi.org/10.1016/j.anr.2022.10.003
37. Al-Moteri M. Metacognition and learning transfer under uncertainty. Int J Nurs Educ Scholarsh. 2023;20(1). https://doi.org/10.1515/ijnes-2023-0038
38. Schraw G, Dennison RS. Assessing Metacognitive Awareness. Contemp Educ Psychol. 1994;19(4):460–75. https://doi.org/10.1017/S0963180114000061
39. Siqueira MAM, Gonçalves JP, Mendonça VS, Kobayasi R, Arantes-Costa FM, Tempski PZ, et al. Relationship between metacognitive awareness and motivation to learn in medical students. BMC Med Educ. 2020;20(1):393. https://doi.org/10.1186/s12909-020-02318-8
40. Salari M, Hamzah R, Hambali Z. Meta-Cognitive Strategies and Nursing Students’ Achievement. J Educ Vocat Res [Internet]. 2013;4(6):169–73. Available from: https://ideas.repec.org/a/rnd/arjevr/v4y2013i6p169-173.html
41. Shin IS, Kim JH. The effect of problem-based learning in nursing education: a meta-analysis. Adv in Health Sci Educ. 2013;18:1103-20. https://doi.org/10.1007/s10459-012-9436-2
42. Jeppesen KH, Christiansen S, Frederiksen K. Education of student nurses – A systematic literature review. Nurse Educ Today. 2017;55:112–21. https://doi.org/10.1016/j.nedt.2017.05.005
43. Medina MS, Castleberry AN, Persky AM. Strategies for Improving Learner Metacognition in Health Professional Education. Am J Pharm Educ. 2017;81(4):78. https://doi.org/10.5688/ajpe81478
44. Immonen K, Oikarainen A, Tomietto M, Kääriäinen M, Tuomikoski AM, Kaucic BM, et al. Assessment of nursing students’ competence in clinical practice: A systematic review of reviews. Int J Nurs Stud. 2019;100:103414. https://doi.org/10.1016/j.ijnurstu.2019.103414
45. Sáiz-Manzanares MC, Escolar-Llamazares MC, González ÁA. Effectiveness of Blended Learning in Nurding Education. Int J Environ Res Public Health. 2020;17(5):1589. https://doi.org/10.3390/ijerph17051589
46. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78(8):775–80. https://doi.org/10.1097/00001888-200308000-00003
47. Graber M. Metacognitive Training to Reduce Diagnostic Errors: Ready for Prime Time? Acad Med [Internet]. 2003;78(8):781. Available from: https://journals.lww.com/academicmedicine/fulltext/2003/08000/metacognitive_training_to_reduce_diagnostic.4.aspx
48. Royce CS, Hayes MM, Schwartzstein RM. Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Acad Med. 2019;94(2):187–94. https://doi.org/10.1097/ACM.0000000000002518
49. Iskander M. Burnout, Cognitive Overload, and Metacognition in Medicine. Med Sci Educ. 2019;29(1):325–8. https://doi.org/10.1007/s40670-018-00654-5
50. Kayalar A, Hiçdurmaz D. Effects of metacognitions, self-compassion, and difficulties in emotion regulation on psychological resilience in oncology nurses. Eur J Oncol Nurs. 2024;70:102568. https://doi.org/10.1016/j.ejon.2024.102568
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This work is licensed under a Creative Commons Attribution 4.0 International License.
