The authors, nursing faculty at a university in Hong Kong, reported on a case-study research that explored the diagnostic reasoning processes of nursing students in their last year of study (n = 20) from two different nursing schools. The Biggsâ€™ Study Process Questionnaire (SPQ) was used to evaluate study approach of the participants followed by completion and videotaping of three case scenarios with a Human Patient Simulator (HPS) and an interview following each scenario. Results showed no significant difference in study approaches between the two groups and no particular advantages from either of the two learning environments (nursing school or university). The reasoning processes of students are described and discussed in the article. While the study was not specific to HPS or their value or outcomes, simulations with HPS were used to allow and assist with the study of nursing studentsâ€™ reasoning and decision-making processes.