Using vascular ulcers to teach cardiovascular risk assessment: An educational framework for nursing clinical reasoning using NANDA-I, NIC, and NOC

Background Undergraduate nursing students often struggle to integrate cardiovascular risk assessment into wound-care decision-making and to translate clinical cues into coherent care plans using NANDA International (NANDA-I) nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC). Vascular ulcer care provides a clinically relevant context in which students can learn to connect wound assessment with systemic vascular dysfunction, cardiovascular risk factors, and quality-of-life considerations. Methods A structured narrative review was conducted following SANRA and PRISMA 2020 elements adapted for narrative synthesis. Searches were performed in PubMed, SciELO, Dialnet, and Google Scholar and were complemented by clinical guidelines and documents issued by regional, national, and international healthcare organizations (2019–2025). Data were charted in a structured evidence matrix and narratively synthesised across five domains: cardiovascular pathophysiology and risk, quality of life, nurse-led interventions, standardized nursing classifications, and levels of prevention. These domains informed the development of the educational clinical-reasoning framework. Results Thirty studies were included. The synthesis integrated the well-established associations between vascular ulcers and cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, and smoking) with evidence on nurse-led strategies, including compression therapy, ankle–brachial index assessment, wound care, lifestyle counselling, self-care education, and psychosocial support.The synthesis was organised into a teaching-ready framework that maps patient cues and prevention levels (primary–quaternary) to selected NANDA-I diagnoses, NIC interventions, and NOC outcomes to support structured reasoning and documentation. Conclusions Positioning vascular ulcers as peripheral indicators of cardiovascular risk supports a prevention-oriented approach to nursing education. This framework offers a practical tool for teaching and assessing nursing clinical reasoning, enabling students to connect wound management with cardiovascular prevention using standardised nursing language.