Comparative effects of pedagogical strategies for teaching the nursing process: Systematic review and network meta-analysis.

AIM: To evaluate the efficacy of active pedagogical strategies for teaching the nursing process compared to traditional teaching methods.

DESIGN

Systematic review with meta-analyses performed according to the recommendations of Cochrane Handbook and reported according to Preferred Reporting Items for Systematic Reviews and Metanalyses (PRISMA) Statement.

DATA SOURCES: Searches were carried out in February 2024 and updated in October 2025 in the databases Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature on Health Sciences, Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, Scopus and Web of Science. Free searches and searches in gray literature were performed in Google Scholar.

METHODS

The selection of studies and data extraction was performed independently by two reviewers. Data synthesis was performed through narrative synthesis and meta-analytic methods. Meta-analyses were conducted for knowledge, clinical reasoning, critical thinking and attitudinal skills.

RESULTS

Thirty-four studies involving undergraduate and graduate nursing students were included to evaluate the effectiveness of active teaching strategies in developing nursing process related competencies. The meta-analyses demonstrated that active learning strategies significantly improved knowledge (SMD = 0.95; p < 0.001; I2 = 80%), clinical reasoning (SMD = 0.48; p < 0.001; I2 = 43%), and attitudinal skills (SMD = 0.39; p = 0.004; I2 = 81%) when compared to traditional methods. There was no difference in critical thinking (SMD = 0.92; p = 0.074; I2 = 95%). Subgroup analyses showed that among the strategies evaluated, simulation consistently showed favorable results for knowledge, clinical reasoning, and attitudinal skills.

CONCLUSION

This study supports the effectiveness of active teaching strategies - particularly simulation - in enhancing learning outcomes associated with the nursing process. The findings emphasize the value of integrating structured, student-centered pedagogies in nursing curricula to foster core competencies.