Critical thinking as an outcome of nursing education. What is it? Why is it important to nursing practice?

Nursing students' view of critical thinking as 'Own thinking, searching for truth, and cultural influences'

INTRODUCTION

Students should enhance their ability to think critically as part of a process of whole-person development.

BACKGROUND

Within nursing education, students should employ critical thinking to ensure quality of patient care and patient safety.

AIM

The aim of this study was to explore the perspectives of nursing students on critical thinking.

DESIGN

A descriptive qualitative study.

METHODS

This was a focus group study involving 65 nursing students from one school of nursing. A total of eleven focus group interviews were conducted. The semi-structured interview guideline was used. All interviews were audio recorded, transcribed in Chinese and translated into English. Thematic analysis was adopted.

RESULTS

Three themes centred on critical thinking were discerned: own thinking, searching for truth, and cultural influences.

CONCLUSIONS

It is suggested that future studies be conducted on how these factors might affect critical thinking. In addition, multiple nursing schools could become involved in these studies to obtain rich data and enrich the picture of students' views on critical thinking. If nurses have more time to think about what is going on, they could think critically about what they are actually doing. This would help to protect the safety of patients and to reduce the occurrence of medical accidents.

The effect of critical thinking education on nursing students' problem-solving skills

THE AIM OF THE STUDY

The aim of this study is to examine the effect of critical thinking education on nursing students' problem-solving skills.

MATERIALS AND METHOD

This study was conducted with 93 nursing students, 49 in the control group and 44 in the education group. The California Critical Thinking Disposition Inventory and the Problem-solving Inventory were administered to them before and after 12 weeks of critical thinking education.

RESULTS

The education group's mean critical thinking score was 253.61 on the pretest and 268.72 on the posttest. This increase was statistically significant (p < .001). The posttest mean score of the control group fell to 258.18 on the posttest after a pretest mean score of 260.79, and this difference was statistically significant (p < .001). According to the posttest results, the problem-solving skills of education group increased significantly (p < .001), while the control group's score fell significantly (p < .001).

CONCLUSION

This study determined that critical thinking education improves problem-solving skills.

Writing a bachelor thesis generates transferable knowledge and skills useable in nursing practice

Generic skills or transferable skills have been discussed in terms of whether or not skills learned in one context can be transferred into another context. The current study was aimed to explore nurses' self-perceptions of the knowledge and skills they had obtained while writing a Bachelor's thesis in nursing education, their experience of the extent of transfer and utilization in their current work. Responding nurses (N=42) had all worked from 1 to 1.5 years after their final examination and had completed a questionnaire that was structured with open-ended questions. Only five nurses reported that they were unable to use any of the knowledge and skills they had obtained from writing a thesis. A majority of the nurses (37/42) could give many examples of the practical application of the skills and knowledge they had obtained. Our findings indicate that writing a thesis as part of an undergraduate degree program plays a major role in the acquisition and development of knowledge and skills which can subsequently be transferred into and utilized in nursing practice.

The effect of human patient simulation on critical thinking and its predictors in prelicensure nursing students

Human patient simulation (HPS) is becoming a popular teaching method in nursing education globally and is believed to enhance both knowledge and critical thinking.

OBJECTIVE

While there is evidence that HPS improves knowledge, there is no objective nursing data to support HPS impact on critical thinking. Therefore, we studied knowledge and critical thinking before and after HPS in prelicensure nursing students and attempted to identify the predictors of higher critical thinking scores.

METHODS

Using a one-group, quasi-experimental, pre-test post-test design, 154 prelicensure nursing students (age 25.7± 6.7; gender=87.7% female) from 3 schools were studied at the same point in their curriculum using a high-fidelity simulation. Pre- and post-HPS assessments of knowledge, critical thinking, and self-efficacy were done as well as assessments for demographics and learning style.

RESULTS

There was a mean improvement in knowledge scores of 6.5 points (P<0.001), showing evidence of learning. However, there was no statistically significant change in the critical thinking scores. A logistic regression with 10 covariates revealed three variables to be predictors of higher critical thinking scores: greater "age" (P=0.01), baseline "knowledge" (P=0.04) and a low self-efficacy score ("not at all confident") in "baseline self-efficacy in managing a patient's fluid levels" (P=.05).

CONCLUSION

This study reveals that gains in knowledge with HPS do not equate to changes in critical thinking. It does expose the variables of older age, higher baseline knowledge and low self-efficacy in "managing a patient's fluid levels" as being predictive of higher critical thinking ability. Further study is warranted to determine the effect of repeated or sequential simulations (dosing) and timing after the HPS experience on critical thinking gains.

Self-confidence, gender and academic achievement of undergraduate nursing students

The aim of this study was to determine the self-confidence levels of nursing students and the factors related to such self-confidence. Data were obtained via a questionnaire for socio-demographic characteristics and a 'Self-Confidence Scale' prepared by the researchers. High self-confidence levels were noted in 78.6% of female students and 92.3% of male students. While 84.5% of second-year students had high self-confidence levels, this rate was 76% in fourth-year students. Female nursing students were significantly less self-confident than male students. Self-confidence should be nurtured in a caring nursing curriculum; however, there is a lack of clarity as to what confidence means, how it is perceived by students and what educators can do to instil self-confidence in nursing students.

Critical thinking dispositions among newly graduated nurses

AIM

The aim of the study was to describe critical thinking dispositions among newly graduated nurses in Norway, and to study whether background data had any impact on critical thinking dispositions.

BACKGROUND

Competence in critical thinking is one of the expectations of nursing education. Critical thinkers are described as well-informed, inquisitive, open-minded and orderly in complex matters. Critical thinking competence has thus been designated as an outcome for judging the quality of nursing education programmes and for the development of clinical judgement. The ability to think critically is also described as reducing the research-practice gap and fostering evidence-based nursing.

METHODS

A cross-sectional descriptive study was performed. The data were collected between October 2006 and April 2007 using the California Critical Thinking Disposition Inventory. The response rate was 33% (n = 618). Pearson's chi-square tests were used to analyse the data.

RESULTS

Nearly 80% of the respondents reported a positive disposition towards critical thinking. The highest mean score was on the Inquisitiveness subscale and the lowest on the Truth-seeking subscale. A statistically significant higher proportion of nurses with high critical thinking scores were found among those older than 30 years, those with university education prior to nursing education, and those working in community health care.

CONCLUSION

Nurse leaders and nurse teachers should encourage and nurture critical thinking among newly graduated nurses and nursing students. The low Truth-seeking scores found may be a result of traditional teaching strategies in nursing education and might indicate a need for more student-active learning models.

Are Asian international medical students just rote learners?

A wide variety of countries are seeking to attract international medical students. This could be due to the fact that their universities not only receive the economic benefit from these students, but also because they recognise the issues of cultural diversity and pedagogical practice. This review paper draws on literature to understand more fully the learning process of Asian international students. Whereas views on learning are different across cultures, medical school teachers must understand how Asian international students learn based on their culture. Two general themes emerged from the literature review: firstly culture's influence on learning and secondly memorisation versus understanding, both of which relate to the learning process of Asian international students. This study shows that Asian international students have a different approach to learning, which is not just about rote learning. Changes in attitudes towards Asian international students may stimulate the internationalisation of a more culturally sensitive form of medical education. The paper suggests further work on the area of appreciative thinking in order to identify the epistemological and ontological dimensions for a flexible approach to learning.

A study of critical reasoning in online learning: application of the Occupational Performance Process Model

This study examined the effect of an online guided independent study on critical reasoning skills. Twenty-one first-semester Master of Occupational Therapy students completed an online assignment designed to facilitate application of the Occupational Performance Process Model (Fearing & Clark) and kept reflective journals. Data from the journals were analyzed in relation to the three sets of questions, question type and results of the Watson-Glaser Critical Thinking Appraisal (WGCTA). This assignment appeared to be effective for enhancing awareness and use of critical reasoning skills. Differences in patterns of critical reasoning between students with high and low WGCTA scores and results of an inductive analysis of the journal entries are discussed. Future research investigating the types of feedback that effectively facilitate development of critical reasoning and whether students with high and low WGCTA scores might benefit from different types of instruction and/or feedback is recommended.

Problem based learning - 'Bringing everything together' - A strategy for Graduate Nurse Programs

This article discusses a case study that was initiated by a Graduate Nurse Coordinator of an acute care inpatient hospital in Australia. It outlines the conceptualisation and creative implementation of a structured group problem based learning activity which was a component of a Graduate Nurse Program. The learning activity was based on the beliefs that knowledge acquisition today is an active process and should focus on the learner developing strategies to obtain, review and manage information. The learning activity implemented in this case study was valuable as it recognised the benefits that can be gained for the Graduate Nurse by ensuring the context of their teaching and learning activities is grounded in practical experiences. The learning activity aimed to prepare Graduate Nurses to cope with the multiple challenges faced as they enter the nursing profession by enhancing their skills of inquiry, problem solving and reasoning. The evaluation of this case study found that the incorporation of structured group problem based learning did promote the achievement of these educational outcomes with Graduate Nurses displaying critical thinking, clinical judgment and knowledge acquisition skills. An unexpected benefit of this activity for Graduate Nurses was the enhancement of clinical practice behaviours, such as communication and interactive skills. This case study describes the positive outcomes not only for Graduates Nurses in the application of their learning but also the wider benefits which can be gained for the organisation, patient care standards and the health care team. It is anticipated that this article will be an inspiration to others who are interested in implementing innovative teaching strategies into Graduate Nurse Programs.

A descriptive inquiry of the definitions of critical thinking and enhancers and barriers reported by nurses working in long-term care facilities

Critical thinking has been an outcome of nursing education since the 1980s. There remains a lack of agreement on definitions, methods of teaching, and methods of evaluation among practicing nurses. This study asked practicing nurses to define critical thinking. It also asked nurses to describe what work-related factors enhanced or posed barriers to the use of critical thinking in practice. Elements of the definitions presented were found to be consistent with current nursing definitions of critical thinking. Enhancers and barriers overlapped and were found to be consistent among the nurses at all facilities studied, with implications for continuing education and staff development.

A comparison of problem-based and traditional education on nursing students' critical thinking dispositions

Determining the critical thinking (CT) levels of students in undergraduate nursing schools is important in terms of establishing the methods of education that should be used. Although there is some evidence that active learning approaches like problem-based learning are effective in developing CT, the findings are inconclusive. This descriptive analytic study compared levels of critical thinking among senior nursing students (N=147) in two educational programs, one of which used a problem-based learning (PBL) model while the other used a traditional model. The California critical thinking disposition inventory (CCTDI) was used as a data collection tool. Comparisons between the groups were made using t-test analysis. There was a significant difference (p<0.05) between the critical thinking disposition scores of the seniors in the PBL school and those in the school implementing the traditional model. Analysis of sub-scale scores showed significant differences in truth-seeking and open-mindedness. These findings add to the evidence that the active and self-directed nature of PBL encourages students' ability to think critically, be tolerant of the ideas of others and evaluate conflicting information before reaching a conclusion.

Using Anonymized Reflection To Teach Ethics: a Pilot Study

Anonymized reflection was employed as an innovative way of teaching ethics in order to enhance students' ability in ethical decision making during a `Care of the Dying Patient and Family' module. Both qualitative and quantitative data were collected from the first two student cohorts who experienced anonymized reflection ( n = 24). The themes identified were the richness and relevance of scenarios, small-group work and a team approach to teaching. Students indicated that they preferred this style of teaching. This finding was verified by a postal questionnaire conducted four months later. The conclusions drawn from this study suggest that using anonymized reflection is an effective method for teaching ethics to nurses and indicates that learning about ethical issues in this way reduces uncertainties.

Critical thinking: A two-phase framework

This article provides a comprehensive review of how a two-phase framework can promote and engage nurses in the concepts of critical thinking. Nurse education is required to integrate critical thinking in their teaching strategies, as it is widely recognised as an important part of student nurses becoming analytical qualified practitioners. The two-phase framework can be incorporated in the classroom using enquiry-based scenarios or used to investigate situations that arise from practice, for reflection, analysis, theorising or to explore issues. This paper proposes a two-phase framework for incorporation in the classroom and practice to promote critical thinking. Phase 1 attempts to make it easier for nurses to organise and expound often complex and abstract ideas that arise when using critical thinking, identify more than one solution to the problem by using a variety of cues to facilitate action. Phase 2 encourages nurses to be accountable and responsible, to justify a decision, be creative and innovative in implementing change.

Critical thinking as an outcome of context-based learning among post RN students: a literature review

Increasingly complex needs and expanding roles in the delivery of health care require professional nurses to be capable critical thinkers and self-directed learners. Problem-based learning (PBL) is promoted as a mean to facilitate critical thinking (CT) in nursing students attending generic and post RN baccalaureate programs. The authors summarize and analyze nursing research and theoretical literature (1992-2005) related to four key topic areas: critical thinking, nursing education, PBL, and post RN education, to determine what is known about the impact of PBL on CT among post RN students. CINAHL, ERIC, Medline and PsychINFO databases were searched and based on the literature retrieved, there is no strong research evidence to suggest changes occur in baccalaureate nursing students' CT during their educational programs, including those using PBL. Similar results were found among post RN students although the literature on this topic is sparse. There is a need for additional research and ongoing development of valid and reliable instruments to measure CT in nurses to guide teaching and learning strategies that effectively facilitate CT among nursing students.

Demonstrating Holistic Clinical Judgment

There has been little research on what beginning yet competent clinical judgment "looks like" to preceptors, those individuals charged with evaluating the performance of new graduate nurses during the orientation/training process. This phenomenological study explicates how preceptors interpret clinical judgment in new nurses during their orientation to labor and delivery.

Teaching critical reflection skills for advanced mental health nursing practice: a deconstructive?reconstructive approach

AIM

This paper presents a literature review conducted to establish what was already known about critical reflection in the nursing literature and what work had been done on using a critical social theory framework as the basis for critical reflection.

BACKGROUND

Critical thinking emerged as a significant aspect of nursing education and practice in the late 1980s. It has been promoted as a means by which issues in clinical practice can be examined through a systematic process of exploration and reasoning. Traditionally, critical thinking has commonly involved an attempt to link practice with theory using a scenario or exemplar from practice to illustrate a practice dilemma. This process is often constructed as a retrospective narrative of events. This paper provides a deconstructive-reconstructive approach that differs from some traditional approaches by taking a critical social theory perspective with an emphasis on improving practice.

METHODS

The nursing literature reviewed was accessed through Cumulative Index of Nursing and Allied Health Literature (CINAHL). The search was restricted to English language and published between 1995 and 2005. Based on these findings, we developed a postgraduate advanced mental health nursing programme.

FINDINGS

There were 490 articles related to 'nursing' and 'critical thinking'; 34 articles related to 'nursing' and 'critical reflection'; 23 articles related to 'nursing' and 'critical social theory'; 15 articles related to 'mental health nursing' and 'critical thinking'; and two articles related to 'mental health nursing' and 'critical reflection'. In the programme we developed based on these findings, students were facilitated to deconstruct concepts and knowledge integral to their own practice. In the reconstructive phase, students implement a change project in clinical practice, supported by a mentor.

CONCLUSION

The deconstructive-reconstructive approach to the development of critical thinking skills provides advanced practitioner with the opportunity to integrate practice, theory and research.

Measuring Critical Thinking in Graduate Education

Accrediting and specialty organizations agree that a master's education expands critical thinking skills gained during undergraduate study, yet a review of literature revealed a lack of research measuring critical thinking of students enrolled in postbaccalaureate education in nursing and other fields. Of 35 studies retrieved, 17 were conducted on undergraduate nursing students, with the remainder spread across practicing RNs, and master's level students in physical therapy, business, medicine, and nursing. A critique of this research and recommendations for future study are presented.

Research utilization among dental hygienists in Sweden--a national survey

Over the last decade evidence-based practice has become increasingly important in health care as an approach to improve patient outcomes. It is vital that dental hygienists, like other health professionals, use research findings to inform clinical practice. The objective of the present study was to investigate the extent of research utilization among dental hygienists in Sweden and to investigate the relationship between level of education and factors related to research utilization. A random sample of 261 dental hygienists in Sweden, 113 with 1 year and 148 with 2-year education, responded to a postal questionnaire covering various aspects of research utilization, i.e. their attitudes towards research, availability and support for the implementation of research findings, use of research in daily practice, their activity in seeking new research findings and their participation in a range of research-related activities. Dental hygienists with 2-year education had a more positive attitude towards research, used research to a greater extent and were more active in seeking new research findings than dental hygienists with 1-year education. Overall, relatively few dental hygienists reported that they implemented research findings in practice; the most frequently reported activity concerned reading research articles in professional journals. The conclusions are that the length of dental hygiene education is a key factor influencing the application of research findings to practice. One-year education appears to be inadequate to achieve evidence-based practice. Moreover, not even two years of formal education guarantees necessary competence in research for evidence-based dental hygiene practice.

Concept mapping: A strategy for teaching and evaluation in nursing education

In the past decade an increasing emphasis has been placed on the importance of critical thinking in nursing. Nurse educators are faced with the challenge of finding ways to promote and evaluate critical thinking in nursing students, and various teaching strategies have been identified to achieve this goal. Concept maps are considered a powerful metacognitive tool that can facilitate the acquisition of knowledge through meaningful learning. Hence concept mapping can be used to promote and evaluate critical thinking. Based on the published nursing literature, the scope of concept mapping is discussed in this paper as a teaching and evaluation strategy for critical thinking in nursing education.

Measures that can be used to instill critical thinking skills in nurse prescribers

Critical thinking is a pervasive skill that involves scrutinizing, differentiating, and appraising information and reflecting on the information gained in order to make judgements and inform clinical decisions. Studies inform us of the need for agreement on the approaches used to teach and measure critical thinking. Nurse prescribers undertake an advanced role that encompass the need to be able to make clinically based decisions about the appropriateness of a specific medication. This requires critical thinking attributes. A variety of teaching and learning approaches are offered which can be used by nurse educators to develop critical thinking skills in nurse prescribers.

Issues and innovations in nursing education

AIM

This paper reports a study describing and evaluating the outcomes of problem-based learning (PBL) programmes in nursing schools in South Africa in terms of the competence of graduates to solve problem in actual clinical settings, and comparing this competence with that of graduates from non-PBL programmes.

BACKGROUND

The nursing literature tends to equate problem-solving with patient-centred problems or the nursing process. However, it is also a skill used in managing the work role, working in a team and managing a health care unit. Problem-solving refers to the process of selectively attending to information in a patient care setting. The investigation of problem-solving in nursing is complicated by the complex relationships between different cognitive processes.

METHODS

A qualitative evaluation study, descriptive and comparative in nature, was carried out. In-depth interviews were held with graduates and their supervisors, asking them to identify problem-solving incidents in which they had been involved. Template analysis style and Benner's interpretive approach were used to analyse the data.

FINDINGS

The majority of the incidents described by the graduates (84%) were graded at the advanced beginner level or above. The majority of incidents at the novice level came from the non-PBL group. 'Using people skills' and 'being assertive' were the two problem-solving strategies most often used. The PBL group fared better than the non-problem-based group in the level of their problem-solving ability.

CONCLUSION

The findings of this study suggest that further research is warranted into the problem-solving abilities of PBL graduates, their personal development over time and at different stages of practice. In addition, it would be interesting to follow the development of their problem-solving abilities over time.

The questioning skills of tutors and students in a context based baccalaureate nursing program

This paper explores, describes and compares the types and levels of questions asked by 30 randomly selected tutors (nurse educators) and their 314 students in context-based learning tutorial seminars in a Canadian baccalaureate nursing program. Thirty 90-min seminars were audio taped, transcribed and coded using a Questioning Framework designed for this study. The framework includes types and levels of questions, related wording and examples. The results of this study indicate that the majority of questions asked by tutors and students in the first three years of the program were framed at the low level (knowledge, comprehension, and application) and were aimed at seeking yes/no responses and factual information more so than probing. Although these questions are important to facilitate the teaching/learning process, educators and students need to increase the number of questions requiring analysis, synthesis, and evaluation as well as questions that involve probing, exploration, and explanation - questions believed to activate and facilitate critical thinking skills. Recommendations include the need for students and tutors to be taught how to question, the creation of a supportive environment for questioning and the use of appropriate strategies to teach the use of higher order questions. Future research using a cross sectional longitudinal design and qualitative approaches are also recommended. This study has direct implications for enhancing student learning and the development of nurse educators.

The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students

BACKGROUND

Critical thinking is essential to nursing practice; therefore, knowledge and understanding of nursing students' critical thinking skills (CTS) and related dispositions are important to nurse educators. This paper presents the results of a non-experimental study conducted in spring 1998, identifies implications for nurse educators, and offers recommendations for future research.

AIM

The aim of the study was to investigate the CTS and critical thinking dispositions (CTD) of students enrolled in a 4-year baccalaureate programme at a university in Western Canada.

METHODS

The study used a cross-sectional design. Data collection occurred during regularly scheduled classes. A volunteer sample of 228 students from all 4 years of the baccalaureate programme completed a background/demographic questionnaire, the California Critical Thinking Skills Test, and the California Critical Thinking Disposition Inventory. The reliability of the test and inventory were established using the Kuder Richardson 20 and Cronbach Alpha respectively. Both descriptive and inferential statistical analyses were carried out.

FINDINGS

Critical thinking mean scores increased from years 1 to 4 with the exception of year 3. However, there was no statistically significant difference among the four student groups. Although differences in critical thinking disposition scores were not statistically significant, students' scores differed significantly on the systematicity subscale. There was a significant relationship between students' overall CTS and CTD scores.

CONCLUSIONS

Approximately 38% of the students in the current study had adequate levels of CTS and 85.5% of the students had adequate levels of CTD. Results indicate a need for students' continued development in these areas. Dispositions are crucial to critical thinking; without them critical thinking does not happen or may be substandard.

Valuing both critical and creative thinking in clinical practice: narrowing the research-practice gap?

BACKGROUND

Nurturing critical thinking skills in the classroom is considered an important educational activity. It is believed that critical thinking skills are transferable and that they can be applied in practice when appraising, evaluating and implementing research. That more nurses than ever before have been judged academically knowledgeable in research has not guaranteed the transfer of such knowledge to practice.

AIM OF THE PAPER

This paper discusses some of the reasons for the failure to narrow the gap between research and practice. In particular we argue that, if nurses are encouraged to develop creative and generative thinking alongside their critical thinking skills, then the art of nursing will have fuller representation in education, research and practice.

DISCUSSION

The successful development of critical thinking skills for academic purposes does not necessarily mean that these skills are used in practice in relation either to research or clinical decision-making. This suggests that the transferability of critical thinking skills is less than straightforward. Indeed, there has been little narrowing of the research-practice gap since students started to learn critical thinking for academic purposes. However, we propose that thinking skills can be encouraged in the context of practice and that regular educational events, such as journal clubs, can contribute to developing critical thinking in the practice environment.

CONCLUSIONS

The research-practice gap will reduce only if research becomes part of practitioners' ideology, which includes the art and science of nursing. Critical and creative thinking are prerequisites to narrowing the disjuncture between research and practice, and we suggest that educators and practitioners explore structured ways of meeting together to appraise literature as a possible means of making use of their thinking and knowledge in clinical practice.

Preceptor questioning and student critical thinking

Questioning is fundamental to student learning. Not only does it enable students to elevate their level of thinking, but in the process it also affords them the opportunity to deal with their world intelligently. The practice setting is an environment rich in opportunity for enabling critical thinking through the use of questioning. In the preceptorship experience, preceptors are in a prime position to use questioning behaviors that can challenge the way preceptees think, encourage them to justify or clarify their assertions, promote the generation of original ideas, explanations, or solutions to patient problems, provide mental and emotional tools to help resolve dilemmas, promote discussion, and evaluate learning. This article discusses the importance of preceptor questioning for the development and promotion of student critical thinking. Contextually, the authors draw on the findings of a recent study in which preceptor questioning of the knowledge base, decision making, and actions of the preceptee were found to directly bring about or trigger their critical thinking. This article allows for some further reflection on that process and its contribution to the enhancement of the preceptorship experience.

Critical thinking in nursing education: literature review

The need for critical thinking in nursing has been accentuated in response to the rapidly changing health-care environment. Nurses must think critically to provide effective care while coping with the expansion in role associated with the complexities of current health-care systems. This literature review will present a history of inquiry into critical thinking and research to support the conclusion that critical thinking is necessary not only in the clinical practice setting, but also as an integral component of nursing-education programmes to promote the development of nurses' critical-thinking abilities. The aims of this paper are to: (i) review the literature on critical thinking; (ii) examine the dimensions of critical thinking; (iii) investigate the various critical thinking strategies for their appropriateness to enhance critical thinking in nurses; and (iv) examine issues relating to the evaluation of critical-thinking skills in nursing.

The holism in critical thinking. A concept analysis

In nursing, critical thinking is particularly important because of its potential impact on patient care. With the rapid changes in health care and the influx of new technology, nurses must be able to use critical thinking to make decisions that provide optimal patient care. The rapid, dynamic changes occurring in the health care setting have dictated a stronger, more comprehensive, holistic way of arriving at decisions than the traditional nursing process. This more comprehensive, holistic approach is called critical thinking. Nurses must be able to engage in critical thinking to handle the onslaught of continuous procedural and technological changes. Critical thinking has become such a key component in learning that the National League for Nursing requires that graduates be able to demonstrate critical thinking. This article is a concept analysis of critical thinking using the Walker and Avant model.

The development of an alternative method in the assessment of critical thinking as an outcome of nursing education

RATIONALE

Critical thinking is currently a highly valued educational outcome throughout the educational spectrum, but particularly so in relation to higher and professional education. Nursing education worldwide is also embracing the construct critical thinking as a desirable educational outcome, to the extent that some commentators refer to the importance of critical thinking in nursing as a given. The body of evidence relating to the impact that nursing education has upon the development of critical thinking is currently inconclusive. Many commentators claim that this may be because the instruments used in many studies are not sufficiently domain-specific.

STUDY AIMS

The primary purpose of this descriptive-illuminative study was to explore and develop an alternative domain-specific method for identifying critical thinking in student nurses' reasoning processes.

DESIGN

A longitudinal multimethod design incorporating across-method triangulation has been utilized for this purpose. Data collection from a group of student nurses involved the combination of the Watson and Glaser (1991) critical thinking appraisal test and a researcher developed think aloud technique incorporating a videotaped client simulation, a cognitive task and stimulated recall strategy.

FINDINGS

Findings indicate no significant differences in pre and postprogramme Watson-Glaser mean scores. With regard to the think aloud evidence the sample consistently displayed evidence of reasoning that reflected an absolutist epistemology portraying limited evidence of critical thinking. In instances where more complex reasoning was demonstrated there was evidence to suggest that metacognitive strategies may contribute to this phenomenon.

CONCLUSIONS

The findings make a further contribution to the assessment of critical thinking and raise interesting challenges to future curriculum development in nursing education, assessment of learning and nursing practice.

Critical thinking: toward a nursing science perspective

Critical thinking is an important phenomenon in nursing science because of its implications for education, practice, and the advancement of nursing knowledge. As a context-dependent, evolving life process, critical thinking appears to be congruent with assumptions and principles of SUHB. Thus, it may be asserted that critical thinking arises within the mutual process of human and environment and thus is a pattern manifestation of the human-environment field process. Before this assertion can be fully accepted, however, much investigation is needed. Nurse scholars are called upon to re-examine critical thinking and to consider possibilities that, until now, have been neglected or unimagined. To date, the positivistic view of critical thinking has yielded limited information. Nurse scientists, therefore, have an opportunity to extend and refine knowledge of critical thinking by embarking upon new and exciting avenues of discovery.