Work

Effects of a closed-loop “Subspecialty-mind Mapping-Rolling Quiz” model based on cognitive load theory on the clinical decision-making ability of ICU nurses: a mixed-methods study

Year: 2026

Type: article

Abstract: BACKGROUND: In intensive care unit (ICU), traditional training models fail to meet the integrated cognitive demands. Additionally, subspecialty training and mind mapping have rarely been applied with a unifying theoretical framework for knowledge retention. AIMS: Based on the Cognitive Load Theory and experiential learning cycle, this study aimed to construct and validate a closed-loop training model (Subspecialty-Mind Mapping-Rolling Quiz) to enhance ICU nurses' clinical decision-making, knowledge retention, self-efficacy and critical thinking. DESIGN: An explanatory sequential mixed-methods design. METHODS: The quantitative phase was a cluster randomized controlled trial conducted in a tertiary teaching hospital in China. A total of 196 nurses from 4 ICU units were randomly assigned by unit to either an intervention group (2 units, n = 102) receiving the closed-loop training or a control group (2 units, n = 94) receiving traditional training from January to September 2025. Participants' Lasater Clinical Judgment Rubric (LCJR), theoretical and practical examination, General Self-Efficacy Scale (GSES), Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) scores, and knowledge retention rates were compared at pre-intervention, post-intervention (6 months), and at a 3-month follow-up. All 196 nurses completed the study. In the qualitative phase, 16 participants were sampled for semi-structured interviews. RESULTS: Quantitative results showed that the intervention group had significantly higher LCJR scores (t = 12.917, p < 0.01), post-intervention and delayed post-test theoretical and practical, GSES, and CTDI-CV scores (all p < 0.05). Qualitative analysis identified four themes: reconstruction of cognitive schema, shift in learning identity, sustained activation of metacognition and incentives coexisting with challenges in implementation.These themes provided insights into the mechanisms behind the quantitative improvements. CONCLUSION: The Subspecialty-Mind Mapping-Rolling Quiz enhanced ICU nurses' clinical decision-making, knowledge retention, self-efficacy, and critical thinking ability. By fostering knowledge internalization and contextualized retrieval, this model serves as an effective and theoretically grounded training solution. CLINICAL TRIAL NUMBER: Not applicable.

Source: BMC Nursing

DOI: 10.1186/s12912-026-04846-y