Clinical reasoning is the cognitive process and strategies used to understand the significant patient data to identify and diagnose actual or potential problems in order to make competent clinical decisions that will affect patient outcomes (Fonteyn & Ritter, 2000). The purpose of the study was to determine if implementing the Outcome-Present State Test Model of Clinical Reasoning with guided reflection activities was an effective method to improve clinical reasoning skills in senior nursing students at a large southeastern university. The overall research questions involve comparing participants Health Sciences Reasoning Test scores before and after implementation of the OPT Model as clinical paperwork, secondly the experimental group was given a guided reflection activity to complete in conjunction with use of the OPT Model during clinical experience. Kolb’s Experiential Learning Theory is the theoretical framework used throughout this study. Nursing education has historically blended didactic learning with clinical experiences to transfer knowledge. The OPT offers a frame to organize thoughts and guides the learner to decide what data is important to each patient situation. This study reports the findings for 62 senior nursing students that completed the HSRT prior to implementation of the OPT Model and a guided reflection activity. Clinical instructor’s scored participants using the Lasater’s Clinical Judgment Rubric each week. There were no statistically significant differences between the experimental group and the control group. The only statistically significant difference that was identified was in the Lasater’s Clinical Judgment Rubric scores between week one and week 2, and week 3 and week 4.