Metacognition within undergraduate nursing education: A scoping review

The aim of this scoping review was to identify and map available English evidence sources about metacognition within undergraduate nursing education, including how metacognition is defined, operationalized, and conceptualized, and the tools and methods used to assess it. Metacognition has gained attention in healthcare education due to its association with outcomes such as clinical reasoning, decision-making, adaptability, and lifelong learning. These outcomes are closely aligned with baccalaureate nursing competencies, however, there remains a lack of consolidated understanding around how metacognition is defined, studied, and applied within nursing education. This scoping review was conducted using the JBI guidelines, reported in accordance with the PRISMA-ScR guidelines, and the protocol was pre-registered on the Open Science Framework. Five databases were searched, including CINAHL, MEDLINE, Academic Search Complete, ERIC, and ProQuest Dissertations and Theses. This scoping review followed JBI methodology and PRISMA-ScR guidelines, with a protocol pre-registered on OSF. The search was completed on April 22, 2024. Records were screened in duplicate in two stages using predefined inclusion and exclusion criteria. Data were extracted and charted using a modified JBI template to capture study characteristics, the definitions, conceptualizations, operationalizations, and the assessment methods of metacognition. Findings were presented and summarized using tabular, diagrammatic, and narrative synthesis. The search yielded 1822 records, of which 46 met the inclusion criteria. Studies were published between 1992 and 2024, with most originating from the United States and employing quantitative or mixed methods designs. Metacognition was variably defined, operationalized, and conceptualized across studies and assessed using both validated tools and qualitative methods, reflecting diverse approaches to its understanding in undergraduate nursing education. Key gaps remain, including limited experimental research, population diversity, and global representation which underscores the need for more practice-aligned studies that explore metacognition within nursing education. • Metacognition is variably defined, conceptualized, and assessed in nursing education • Reflection and self-regulated learning are interconnected with metacognition • Studies of metacognition lack causality, diversity in study populations, and global perspectives • Metacognitive assessment tools lack confidence in interpretability of results, impacting generalizability of findings • A need for a distinctive nursing-specific lens to help define and enhance metacognition warrants further investigation