Background: Clinical decision-making constitutes a cornerstone of nursing practice and is recognized as a complex process that goes beyond the application of technical knowledge. This process is particularly relevant, as decisions related to pharmacological interventions have a direct and simultaneous impact on the health of the pregnant woman and the fetus or newborn. Methods: A narrative literature review was conducted to identify and synthesize evidence on educational strategies aimed at strengthening obstetric pharmacological decision-making in nursing. Findings: The reviewed literature emphasizes the integration of analytical reasoning and experiential learning as central components in strengthening obstetric pharmacological decision-making in nursing. Analytical reasoning supports systematic clinical assessment, protocol use, and evidence-based practice, while intuitive processes emerge from accumulated experience and pattern recognition. A persistent challenge identified is the gap between theoretical knowledge and its application in real clinical settings. Pharmacological decision-making is described as a complex process involving medication selection, safe preparation, accurate administration, and ongoing monitoring of clinical responses. Educational evidence highlights the effectiveness of situated learning and deliberate practice in contextualizing pharmacological knowledge and consolidating complex skills through repetition and feedback. Clinical simulation, together with technology-mediated strategies such as virtual simulation and interactive learning environments, plays a key role in providing realistic, standardized, and adaptable scenarios that enhance safe and reflective clinical decision-making in obstetric nursing education. Conclusion: Educational strategies that combine contextualized learning, repeated practice, and structured feedback are essential for strengthening safe pharmacological decision-making in obstetric nursing education.
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