Which digital education approaches most effectively enhance clinical reasoning in undergraduate nursing students: Protocol for a Network Meta-analysis

Background: Clinical reasoning is a core competency in nursing education, enabling students to make accurate and evidence-based clinical decisions. As digital-based learning expands, understanding the comparative effectiveness of different technology-enhanced educational approaches in improving clinical reasoning competence has become essential. However, existing evidence remains fragmented and inconsistent across the intervention types. Objective: This study aims to systematically evaluate and compare the effects of digital-based education interventions on clinical reasoning competence among undergraduate nursing students using a network meta-analysis. Methods: This protocol describes a systematic review and network meta-analysis conducted in accordance with the PRISMA-P and Cochrane Handbook guidelines. Randomized controlled trials will be included and analyzed in separate networks. The primary outcome is clinical reasoning competence; secondary outcomes include critical thinking and problem-solving abilities. Searches will be conducted in PubMed, Embase, CINAHL, Web of Science, and CENTRAL from their inception to December 31, 2025. A frequentist network meta-analysis will be performed using R (version 4.1.0) with the netmeta package. Standardized mean differences with 95% confidence intervals will be calculated based on arm-level data. Transitivity and consistency will be assessed using global and local approaches. Intervention rankings will be estimated using P-scores. The certainty of evidence will be assessed using the CINeMA framework and GRADE. Conclusions: This review will provide a comprehensive synthesis and comparative ranking of digital-based education interventions for improving clinical reasoning and related cognitive outcomes in nursing students. The findings will inform evidence-based decisions regarding the integration of effective digital educational strategies into nursing curricula.