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Background <p>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.</p> Aims <p>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.</p> Design <p>An explanatory sequential mixed-methods design.</p> Methods <p>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, <i>n</i> = 102) receiving the closed-loop training or a control group (2 units, <i>n</i> = 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.</p> Results <p>Quantitative results showed that the intervention group had significantly higher LCJR scores (<i>t</i> = 12.917, <i>p</i> &lt; 0.01), post-intervention and delayed post-test theoretical and practical, GSES, and CTDI-CV scores (all <i>p</i> &lt; 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.</p> Conclusion <p>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.</p> Clinical trial number <p>Not applicable.</p>

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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

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  • 出版模式：

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  • 发表日期：

    2026年6月17日

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  • Yao Ning Zhuang,
  • Zhen Mei Xu,
  • Dan Dan Lin,
  • Qing Qing Zhan,
  • Yi Yuan Chen,
  • Bin Qin Lin,
  • Shu Fen Ke

摘要

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.