Contents lists available at ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/locate/nedt Rethinking clinical instruction through the zone of proximal development Lina D. Kantar ⁎ , Sawsan Ezzeddine, Ursula Rizk Rafic Hariri School of Nursing, American University of Beirut, Lebanon ARTICLE INFO Keywords: Scaffolding Zone of proximal development Clinical instruction Differentiated instruction ABSTRACT Background: The complexity of the learning environment and intricacy of nursing tasks make it difficult for students to learn without the assistance of an expert. Teaching in the zone of proximal development (ZPD) aims at positioning learners in the zone of what they can do and develop with assistance to reach full potential and independence. ZPD is deemed essential to understand how teaching and learning take place; however, its im- plications for clinical educators are limited and need further exploration. Objectives: This research study aimed at exploring the instructional strategies that preceptors use to guide and support the development of undergraduate nursing students, from what they are capable of doing with assistance to what they can become and do independently. Design: The qualitative multiple case study research design was used to gain insights into the teaching experi- ences of 18 nurse preceptors situated in three recognized hospitals in Lebanon. Methods: Each preceptor was interviewed face-to-face using questions that were developed from a three-hour observation. Vygotsky's learning principles formed the reference point for this study. Analytic induction and constant comparison of preceptors' responses were applied throughout the study to unravel assisted strategies that target the potential learning zones of the student. Results: Three assumptions emerged from the data to underpin the preceptors' assistive strategies that help move learners from a cannot-do-level to can do independently. The assumptions are: (1) learning from clinical ex- perience, (2) teaching beyond student ability, and (3) teaching for autonomy. In-depth analysis of both as- sumptions and strategies that focus instruction within each student's ZPD converged on a framework of three constructs: differentiated instruction, instructional scaffolding, and influencing a positive learning environment. Conclusion: It is imperative that clinical educators be most receptive to instruction that targets the student's ZPD, as the zone represents a potential phase in student learning. This study provides a ZPD framework for in- tensifying learning gains from clinical practice. 1. Background Nursing students learn about practice in a complex, ever-changing clinical environment, dominated by standards and accountability measures; all represent major challenges of clinical instruction. Amid these challenges and the relentless calls for linking theory with practice (McCarthy and Murphy, 2010; Paton, 2010; Sroczynski et al., 2012), optimizing learning remains the chief outcome of a nursing curriculum and a major expectation of clinical teaching (Oermann, 2016, 2018). Clinical instruction is addressed in a number of empirical studies, yet hardly explore how clinical educators focus instruction within the student's potential development zone (Pront et al., 2016; Sroczynski et al., 2012; Wass and Golding, 2014). This research study aimed at exploring clinical instruction of nurse preceptors to help move students along the learning continuum: from potential development zone through assistance and guidance to current development zone where they are able to do the tasks independently. Results from this study will contribute to the advancement of new concepts and insights regarding clinical instruction. The emergent constructs will guide both academia and service in the development of a curriculum that influences learning in practice. 1.1. Review of literature Vygotsky (1978) provided us with the Zone of Proximal Develop- ment (ZPD) as the means to understand the teaching learning process. ZPD is grounded in sociocultural learning; its major tenet is learning with the assistance of an expert. Although ZPD was developed as a teaching tool in Kindergarten through 12th grade, the tool is gaining acceptance in higher education to provide an essential understanding of https://doi.org/10.1016/j.nedt.2020.104595 Received 8 December 2019; Received in revised form 23 July 2020; Accepted 2 September 2020 ⁎ Corresponding author. E-mail addresses: La67@aub.edu.lb (L.D. Kantar), nursingschool@makassed.org.lb (S. Ezzeddine), ursula.rizk@balamand.edu.lb (U. Rizk). Nurse Education Today 95 (2020) 104595 0260-6917/ © 2020 Elsevier Ltd. All rights reserved. T