The Student-Nurse Educator Interactive Model: A Middle-Range Theory for the Acquisition of Clinical Reasoning Skills in Undergraduate Nursing Students

Abstract Introduction Clinical reasoning is a core competency in nursing practice because it supports safe clinical decision-making and improves patient outcomes. However, undergraduate nursing students in Malawi and across sub-Saharan Africa often demonstrate moderate to low levels of clinical reasoning. One key barrier is the absence of a contextually grounded theoretical model to guide how clinical reasoning should be taught and learned. Methods This paper presents the development and conceptual description of the Student-Nurse Educator Interactive Model (SNEIM), a new middle-range theory for the acquisition of clinical reasoning skills by undergraduate nursing students. The model was derived from a larger convergent parallel mixed-methods doctoral study conducted in Malawi. Model development used a grounded theory approach alongside a cross-sectional descriptive quantitative component. Data were collected over six months from undergraduate nursing students, including self-assessment using the Self-Assessment of Clinical Reflection and Reasoning (SACRR) tool, focus group discussions, and in-depth interviews with nurse educators, supported by a review of relevant documents. The grounded theory analysis used the constant comparative method, and thematic analysis guided the conceptual development of the model. Results Six themes informed the model's development: the influence of the classroom and clinical environment, the availability of meaningful learning and teaching opportunities, the importance of clinical assessment and feedback, the effect of limited role modelling, the need to strengthen the professional image of nursing, and the value of responsive care delivery systems. The SNEIM integrates these findings into five interdependent anchors that operate within a conducive clinical environment. These anchors include a relevant and responsive competency-based curriculum, collective collaboration between clinical and academic partners, qualified nurse educators who facilitate learning, student-centred learning, and accessible functional resources. The model proposes that engaging these anchors through the nursing process and clinical reasoning cycle produces personal-level outcomes such as critical thinking, reflection, and competent practice, as well as system-level outcomes including improved care quality, a more vibrant professional image, and strengthened clinical education. Conclusion The SNEIM offers a theoretically grounded and contextually relevant framework that can help nursing educators, curriculum designers, and healthcare policy-makers guide the development of clinical reasoning skills in undergraduate nursing programs. Empirical testing and longitudinal evaluation of the model are recommended to further confirm its usefulness and impact.