Critical thinking in nursing: Scoping review of the literature

Evaluation index system of core competence of Traditional Chinese Medicine nurse specialists: A qualitative evidence synthesis

BACKGROUND

Traditional Chinese Medicine nurse specialists, as the nursing team's core, crucially enhance service quality and spread Traditional Chinese Medicine culture, so strengthening their training based on core competencies is vital for advancing Traditional Chinese Medicine nursing internationally.

AIM

Integration of the core competency evaluation indexes of Traditional Chinese Medicine nurse specialists in different geographical regions.

DESIGN

A qualitative systematic review and evidence synthesis.

METHODS

6 English and 4 Chinese databases were systematically searched for studies related to the core competencies of Traditional Chinese Medicine nurse specialists. The JBI critical appraisal tool was used to evaluate the quality of the included literature. The extracted data were thematically integrated using Thomas and Harden's three-stage framework.

RESULTS

The review included 16 studies. The results can be summarized into 3 themes, 7 categories and 21 items. The themes included personality structure (personal qualities, professional qualities), competency structure (professional development competence, general personal competence, organizational and managerial competence) and knowledge structure (professional knowledge and skills, healthcare ethics and regulations).

CONCLUSIONS

The findings of this study have practical implications for the development of training and assessment programs for Traditional Chinese Medicine nurse specialists, providing a more comprehensive and systematic framework to guide professional development. It will be further applied to the training of Traditional Chinese Medicine nurse specialists in the future, serving to enhance the core competitiveness of Traditional Chinese Medicine nurse specialists and promote the development of Traditional Chinese Medicine nursing.

Psychometric properties of the nursing critical thinking in clinical practice questionnaire in clinical nurse educators

The Nursing Critical Thinking in Clinical Practice Questionnaire is an instrument designed to measure the critical thinking capacity of nurses working in clinical areas. However, there is little existing research on the potential applications of this instrument specifically in clinical nurse educators involved in the training of university nursing students. Therefore, we used a descriptive cross-sectional design to examine the psychometric properties of the questionnaire in clinical nurse educators. We evaluated the construct and convergent validity, assessed the reliability of the questionnaire, and performed a confirmatory factor analysis. A total of 639 clinical nurse educators took part in this study. Results of the Confirmatory Factor Analysis showed a good fit to the model (CFI 0.97, NFI: 0.95). The total Cronbach's alpha was 0.97. The four factors had an internal consistency > 0.7. The interclass correlation coefficient values were 0.78 [95% CI 0.75-0.81] for the whole instrument and 0.70-0.75 for the various dimensions, and all were statistically significant at p < 0.05. These findings suggests that the Nurse Critical Thinking in Practice Questionnaire is a useful tool for measuring critical thinking levels in clinical nurse educators. This enhances the knowledge of all agents involved in the learning process, making it easier to implement in clinical practice.Clinical Trial Registration: This study was prospectively registered at the two Institutional review boards.

The Folk Concept of Nursing in Australia: A Decolonising Conceptual Analysis

This article presents a conceptual analysis of the contemporary understanding of NURSING in Australia and proposes strategies for decolonisation. Through historical reflection and the lens of cultural safety and critical race theory, it examines some conditions which make up this concept, including "Florence Nightingale-influenced practices," "intellectual practitioners," and "whiteness in nursing." This analysis aims to identify conditions which we take to be necessary for the folk concept of NURSING to be satisfied and which result in negative outcomes. The article explores why these conditions are plausibly included in this concept and possible objections to their inclusion. These conditions, and subsequently the concept of NURSING, are then critiqued. In this conceptual analysis of NURSING in Australia, we explore three conditions. By critically examining these conditions through the lens of cultural safety and employing decolonising methodologies, the article sheds light on the complex interplay of historical legacies, contemporary practices and potential negative outcomes within the nursing profession. The conclusions drawn propose a shift toward decolonisation, advocating for a cultural safety framework to address historical injustices and highlights possible ways in which one might amend the concept of nursing to be more inclusive of Aboriginal and Torres Strait Islander people. The need for this change is emphasised by the acknowledgement of historical conditions that perpetuated racism and hindered equitable healthcare. Ultimately, the article advocates for a comprehensive decolonisation of the concept of NURSING in Australia, urging the nursing profession to implement cultural safety for the overall well-being of Aboriginal and Torres Strait Islander people. The authors of this article would like to acknowledge the people of the Dharawal and Dharug language group, who are the custodians of the unceded land we have worked on throughout this project. We would also like to acknowledge Aboriginal and Torres Strait Island people nationwide and warn them that some traumatic aspects of Aboriginal and Torres Strait Islander history are mentioned throughout this article. Always was, always will be, Aboriginal land. Two authors on this article identify as Aboriginal, while three do not. Two authors are registered nurses, one is an anthropologist, one is a philosopher and one is a historian.

Preregistration nursing students' motivation for speaking up for patient safety: An integrated literature review

AIM

The aim of this review was to uncover what motivates preregistration nursing students to speak up for patient safety during work integrated learning (WIL) and to develop an evidence-based safety motivation framework for use by educators, clinicians, and preregistration nursing students.

DESIGN

This study used an integrative literature review design guided by Whittemore and Knafl's methodological framework.

DATA SOURCES

Five research databases, CINAHL, MEDLINE, PubMed, Scopus, and Web of Science, were searched for relevant peer reviewed research literature published in English between January 2011 and January 2024. The use of MeSH terms "undergraduate nursing student," or "preregistration nursing student" and "speaking up," "patient safety," and "motivation," resulted in 489 search returns. Following application of filters and inclusion criteria fifty-four (n = 54) studies were identified as being relevant to the research aim.

REVIEW METHODS

The fifty-four (n = 54) research studies were reviewed using the JBI Critical Appraisal tool relevant to the study methodology. The JBI critical appraisal tools are checklists used to determine research quality, validity, results, and meaning. Following appraisal, 27 studies were included in the integrative literature review.

RESULTS

Authentic learning, view of self as a nurse, and positive work integrated learning experiences were found to be the primary motivators for preregistration nursing students to speak up for patient safety during work integrated learning. These three motivators provided the foundation for an evidence-based framework, underpinned by self-determination theory, that can be used to enhance preregistration nursing students' motivation to speak up for patient safety.

CONCLUSIONS

The integrative review design enabled the development of the evidence-based Safety Motivation Framework to support preregistration nursing students' during work integrated learning however missing from the literature was information about the lived experience of this group of students when speaking up for patient safety.

Utilizing nursing standards in electronic health records: A descriptive qualitative study

BACKGROUND

The electronic health record (EHR), including standardized structures and languages, represents an important data source for nurses, to continually update their individual and shared perceptual understanding of clinical situations. Registered nurses' utilization of nursing standards, such as standardized nursing care plans and language in EHRs, has received little attention in the literature. Further research is needed to understand nurses' care planning and documentation practice.

AIMS

This study aimed to describe the experiences and perceptions of nurses' EHR documentation practices utilizing standardized nursing care plans including standardized nursing language, in the daily documentation of nursing care for patients living in special dementia-care units in nursing homes in Norway.

METHODS

A descriptive qualitative study was conducted between April and November 2021 among registered nurses working in special dementia care units in Norwegian nursing homes. In-depth interviews were conducted, and data was analyzed utilizing reflexive thematic analysis with a deductive orientation. Findings Four themes were generated from the analysis. First, the knowledge, skills, and attitude of system users were perceived to influence daily documentation practice. Second, management and organization of documentation work, internally and externally, influenced motivation and engagement in daily documentation processes. Third, usability issues of the EHR were perceived to limit the daily workflow and the nurses' information-needs. Last, nursing standards in the EHR were perceived to contribute to the development of documentation practices, supporting and stimulating ethical awareness, cognitive processes, and knowledge development.

CONCLUSION

Nurses and nursing leaders need to be continuously involved and engaged in EHR documentation to safeguard development and implementation of relevant nursing standards.

Co-teaching in medicine and nursing in training nurse anesthetists: a before-and-after controlled study

BACKGROUND

Clarifying the effectiveness of co-teaching in medicine and nursing (CMN) is important as it is crucial in clinical practice to improve the quality of patient care and prognosis. In this study, we aimed to determine the efficacy of CMN in nurse anesthetist training.

METHOD

The study comprised a 6-month training session and a before-and-after controlled study. In total, 59 nurses were recruited. The first 30 nurses were enrolled in the conventional single-teaching in nursing (SN) group and only took nursing-related courses. The next 29 students were enrolled in the CMN group and received both general medical and nursing-specific curricula. Before and after training, medical and nursing collaboration competency scores and knowledge scores were compared between the two groups. At the end of the study, qualitative comments on teaching satisfaction and clinical reasoning skills improvement were queried, and content analysis was performed.

RESULTS

Participants in the CMN group outperformed those in the SN group in tests of medical and nursing collaboration abilities as well as knowledge. The CMN group outperformed the SN group in terms of teaching satisfaction evaluation, particularly in terms of fostering learning in the anesthetist specialty, improving clinical practice, fostering motivation, and influencing how people think about challenges at work. Furthermore, participants in the CMN group felt that their clinical reasoning abilities had improved.

CONCLUSION

In comparison to the SN group, the CMN group had enhanced outcomes of patient care, medical and nursing collaboration, and clinical reasoning skills.

Chinese version of Yoon Critical Thinking Disposition Instrument: validation using classical test theory and Rasch analysis

BACKGROUND

Despite the availability of a wide range of critical thinking instruments, there was no original design for nurses that has been translated into Chinese. However, only instruments designed specifically for the nursing discipline would be reliable. This study aimed to translate, culturally adapt, and validate the Yoon Critical Thinking Disposition Instrument in the Chinese context.

METHODS

A four-step translation process was implemented according to Word Health Organization guidelines, which included forward translation, expert panel review, backward translation, and pre-testing. Experts and nursing students participated in testing the validity and reliability of the Chinese version.

RESULTS

The translation of the instrument went smoothly. According to a confirmatory factor analysis, there was an acceptable fit for the seven-factor model. Content validity indices ranged from 0.6 to 1 at item level, and 0.94 at scale level. In addition, there was extremely high internal consistency and test-retest reliability in the translated instrument. There was a good fit for the items with both person and item reliabilities greater than 0.6 and a separation index of 2.19, respectively. The item location was identified from the wright map as not covering person ability, but the scale did not have a gender-related differential item functioning.

CONCLUSIONS

In this study, a critical thinking disposition instrument for nursing students was translated into Chinese for the first time. This translated instrument is a reliable tool with satisfactory validity and reliability. It could provide opportunities for building a cross-cultural understanding of critical thinking disposition.

The relationship between critical thinking and job performance among nurses: A descriptive survey study

AIM

This study investigated the relationship between nurses' critical thinking skills and job performance and whether critical thinking and its subdomains predict job performance.

BACKGROUND

It is expected that nurses may use critical thinking skills to provide evidence-based quality patient care in health care settings. However, there is limited evidence about whether critical thinking is related to job performance among nurses.

DESIGN

This was a descriptive, cross-sectional survey study.

METHODS

The study included 368 nurses working in the inpatient wards of a university hospital in Turkey. The survey included a demographic information questionnaire, the Critical Thinking Scale in Clinical Practice for Nurses and the Nurses' Job Performance Scale. The collected data were analysed using descriptive statistics, comparisons, reliability and normality tests, correlation and regression analysis.

RESULTS

Participating nurses got average scores from the critical thinking and job performance scale and sub-scales, and there was a positive, mid-level and statistically significant correlation between the scale scores. According to the multiple linear regression analysis results, personal critical thinking, interpersonal and self-management critical thinking and the total critical thinking scores positively affected the job performance scores of nurses.

CONCLUSION

As critical thinking predicts nurses' job performance, managers of hospitals and nursing services should consider training programs or activities to increase nurses' essential thinking competencies, thus improving clinical nurses' performances.

Critical thinking among institutional academic advisors and sociodemographic, professional and academic variables: A multicenter correlation study

BACKGROUND

In nursing education, essential skills include Critical Thinking (CT). There is scant evidence on how nurse educators could promote CT in students in a clinical context.

OBJECTIVE

To analyse the level of CT and correlated variables in healthcare nurses overseeing the clinicals of nursing undergraduates.

METHODS

The study population were all nurse educators for clinicals at hospitals with nursing undergraduates. To evaluate the CT skills of nurses the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 practice) was administered. Frequencies, percentages and measures of central tendency and scatter were obtained. A bivariate analysis was performed to analyze the correlation between the nurse educators' CT level and the sociodemographic, professional and academic levels. The nonparametric Mann-Whitney and Kruskal-Wallis tests were used to compare two independent groups. Statistical significance was defined as P < .05.

RESULTS

The total number of participants was 639. The highest mean CT level was seen in clinical nurses involved in undergraduate nursing instruction and with experience of up to 10 years (mean CT score = 372 (33.3), p = .007). Global CT levels were similar in women and men (mean CT score: 364 (31.9) in women and 358 (40.5) in men, p = .187), with statistically significant differences only observed in the intellectual and cognitive indicator (P = .022).

CONCLUSIONS

CT levels are high in teaching healthcare professionals in the clinical environment.

A Hybrid Methodology for the Evaluation of Clinical Practice in Final-Year Nursing Students

(1) Background: Clinical practice constitutes a scenario where the student approaches reality. The pedagogical relationship that is built between the nurse, the tutors and the student becomes important. And this requires intentional and reflective accompaniment. The principal objective was to design a hybrid-learner-centered training model requiring reflection and acquisition of specific skills. (2) Methodology: This was a prospective observational study using an intentional sample of 87 students. A hybrid model based on a dynamic virtual forum and Individual Improvement Plan (IIP) was constructed, evaluated using a self-completed questionnaire with a Likert scale. (3) Results: A model of accompaniment to the practices was built that allows for unifying a work plan. A transversal activity IIP was designed. A discussion forum was incorporated for each subject tutor. The analysis of the questionnaire showed that learning assessment, tutorials, virtual forums, self-assessment and satisfaction statistically differed. (4) Conclusions: The model allows students to be accompanied to acquire skills, knowledge, and attitudes and to develop critical thinking, as well as to improve the teaching quality of the practices of the Curriculum of the Nursing degree and to achieve their own competences through student-centered methodologies. This study was not registered.

Assessment of the psychometric properties of the Vietnamese version of the Critical Thinking Disposition Scale

BACKGROUND

The Critical Thinking Disposition Scale is a valid and reliable tool for assessing an individual's attitudes towards critical thinking. However, it is unclear if the scale can be used with Vietnamese nursing students.

OBJECTIVES

This study aimed to translate the scale into Vietnamese and examine the psychometric properties of the Vietnamese version of the Critical Thinking Disposition Scale (CTDS-V).

SETTINGS

Data were collected from senior nursing students at four universities in southern Vietnam in October and December 2022.

PARTICIPANTS

In total, 398 senior nursing students participated in this study.

METHODS

A cross-cultural adaptation of the CTDS-V was carried out with participants obtained through convenience sampling. Data were collected through an online survey. The study evaluated the validity of the CTDS-V by examining the content validity, concurrent validity, and construct validity, employing both Exploratory and Confirmatory Factor Analyses. The study also reported the internal consistency reliability using Cronbach's alpha and test-retest stability of the CTDS-V.

RESULTS

The CTDS-V had a good content validity index with a score of at least 0.85 for each item and an excellent overall content validity index of 0.96. Exploratory Factor Analysis identified two factors, critical openness, and reflective scepticism, with 11 items. Confirmatory Factor Analysis provided an acceptable fit model and supported the factor structure of the original scale. Cronbach's alpha coefficient of the scale was 0.88, and those of the two subscales were each 0.84. The test-retest stability of the CTDS-V was good with an intraclass correlation coefficient of 0.98 (95 % confidence interval = 0.96, 0.99).

CONCLUSIONS

This study indicated that the CTDS-V is a valid and reliable tool for assessing the critical thinking disposition of nursing students. The scale is short, rendering it feasible for regular use in education and research.

Fast thinking: How unconscious bias and binary language contribute to rationing of care to older persons

BACKGROUND

Binary or categorical thinking is a way of thinking in which the brain unconsciously sorts the masses of information it receives into categories. This helps us to quickly process information and keeps us safe through pattern recognition of possible threats. However, it can also be influenced by unconscious and conscious biases that inform our judgements of other people and situations.

OBJECTIVES

To examine nursing practice with older people through the lens of unconscious bias.

METHODS

In this critical analysis, using Kahneman's fast and slow thinking, we argue that nurses working with hospitalised older people often rely on thinking quickly in hectic work environments, which can contribute to unconscious and conscious bias, use of binary language to describe older persons and nursing tasks, and ultimately rationing of care.

RESULTS

Binary language describes older persons and their care simplistically as nursing tasks. A person is either heavy or light, continent or incontinent, confused or orientated. Although these descriptions are informed in part by nurses' experiences, they also reflect conscious and unconscious biases that nurses hold towards older patients or nursing tasks. We draw on explanations of fast (intuitive) and slow (analytical) to explain how nurses gravitate to thinking fast as a survival mechanism in environments where they are not supported or encouraged to think slow.

CONCLUSIONS

Nurses survival efforts in getting through the shift using fast thinking, which can be influenced by unconscious and conscious biases, can lead to use of shortcuts and the rationing of care. We believe that it is of paramount importance that nurses be encouraged and supported to think slowly and analytically in their clinical practice.

IMPLICATIONS FOR PRACTICE

Implications Nurses can engage in journaling and reflecting on their practice with older people to examine possible unconscious bias. Managers can support reflective thinking by supporting nurses through staffing models and encouraging conversations about person-centered care in unit practices.

Multilevel Modeling of Individual and Group Level Influences on Critical Thinking and Clinical Decision-Making Skills among Registered Nurses: A Study Protocol

Critical thinking and clinical decision-making are two essential components of nursing services. The practice of nursing requires both components at every level of nurses' daily tasks. This paper describes the protocol for an ongoing project, which aims to examine the prevalence of critical thinking and clinical decision-making among registered nurses and determine the factors that influence the skills at individual and group levels using a multilevel modeling approach. Survey data will be collected from approximately nine states, with nine general hospitals, nine district hospitals, one private hospital, and one educational hospital in Malaysia included. We aim to recruit 800 registered nurses working shifts in hospital settings. We will use questionnaires to measure the perceived nurses' knowledge, critical thinking skills, and clinical decision-making skills. The study will have three levels as the nurses are nested within the unit and further nested within the hospitals. This study will give an insight into the nursing profession today where critical thinking and clinical decision-making skills can play a significant role in patient safety and the quality of care in nursing practice.

Characteristics and processes of registered nurses' clinical reasoning and factors relating to the use of clinical reasoning in practice: a scoping review

OBJECTIVE

The objective of this review was to examine the characteristics and processes of clinical reasoning used by registered nurses in clinical practice, and to identify factors reported to relate to the use of clinical reasoning by registered nurses in clinical practice.

INTRODUCTION

Significant variability in the clinical reasoning of graduate registered nurses has been identified in research, with underdeveloped and unsafe clinical reasoning being linked to failure-to-rescue and sentinel events in the clinical setting. The identification of characteristics and processes of clinical reasoning, and factors relating to registered nurses' clinical reasoning when engaged in clinical practice, will increase understanding of the clinical reasoning requirements for undergraduate registered nurses and of potential factors that may affect their clinical reasoning.

INCLUSION CRITERIA

Studies including registered nurses who met the criteria for registered nurse registration in Australia and who used clinical reasoning to engage with health care consumers in all practice environments were eligible for inclusion.

METHODS

Eight databases were searched, with articles identified through CINAHL, MedNar, PubMed, Science Direct, ERIC, PsycINFO, Scopus, and ProQuest Dissertations and Theses. Database searches were conducted on December 31, 2020, and updated August 20, 2021, with primary qualitative and quantitative research studies in English from 2000 onwards considered for inclusion. Opinion papers, text, and reports were not included. Data were extracted based on the draft charting tool from the scoping review protocol, with results presented in tabular format and in a narrative summary.

RESULTS

The 29 qualitative and 5 quantitative research studies included in the scoping review utilized exploratory descriptive, descriptive rationalist, narrative, ethnography, correlational, observational, and grounded theory methodologies in their research designs. Observation, think-aloud sessions, questionnaires, surveys, interviews, and focus groups were used to collect data from the 1099 participants in 9 countries. Multiple concepts related to the characteristics (n=35) and processes (n=30) of clinical reasoning were detected in the research studies, with 5 categories identified: i) situation management, ii) data management, iii) interpreting, iv) implementing and evaluating, and v) professional practice, with an additional processes category identified (decision-making processes). The factors (n=26) reported to relate to clinical reasoning were categorized into environment of care, care requirements, professional practice, experience, knowledge, and decision-making processes. Connections between the various concepts were evident throughout the review.

CONCLUSIONS

The scoping review identified characteristics and processes of clinical reasoning, as well as factors reported to relate to clinical reasoning in all studies. The concepts that comprise the clinical reasoning of registered nurses in clinical practice must be considered in undergraduate registered nurse education. Registered nurses must complete their baccalaureate program with well-developed clinical reasoning to ensure safe clinical practice. Understanding the characteristics and processes of registered nurses' clinical reasoning in clinical practice, and the factors reported to relate to clinical reasoning, supports the creation of targeted resources for development and assessment of clinical reasoning.

Building consensus on critical thinking assessment tool for undergraduate nursing students in a socialist low-middle income country: A delphi study

Aim

We aimed to build consensus on a holistic critical thinking (CT) assessment tool involving cognitive skills and disposition for undergraduate nursing students in a socialist low-middle income country, Lao People's Democratic Republic (Lao PDR).

Background

University degree nursing education program in Lao PDR has been started since 2011 to strengthen the ability to think as professional nurse, and nursing regulations have progressively developed last decade. However, there are still few studies assessing the CT ability of nursing students in Lao PDR.

Design

Delphi study.

Methods

We conducted three rounds of Delphi survey of 14 panel members consisting of nursing faculty members and clinical supervisors. The first and second survey rounds involved a combination of a series of questionnaires and face-to-face interviews to obtain ideas or opinions about descriptions of the CT assessment tool. The third round was the meeting with 13 panel members to reach a consensus on the descriptions of the CT assessment tool.

Results

The number of descriptions changed from 29 to 30 under seven assessment criteria of the cognitive skills and from 34 to 32 under 10 assessment criteria of the habits of mind as disposition. The panel provided active comments on the descriptions in terms of social, cultural, and educational backgrounds. Especially the descriptions of criteria applying standards and creativity were discussed from practical viewpoints such as the hierarchical social structure in hospital, limited educational resources, and the cultural value of harmony.

Conclusions

The holistic CT assessment tool that resulted from the consensus is anticipated to help Laotian nursing educators to assess undergraduate nursing students' CT ability more efficiently with confidence at both the university and hospitals continuously. Subsequent implementation of the CT assessment tool in a socialist low-middle income country is warranted.

Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review

AIM/OBJECTIVE

To report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing.

BACKGROUND

Clinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice.

DESIGN

A scoping review was conducted using the framework developed by Arksey and O'Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established.

METHODS

The studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text.

RESULTS

1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions.

CONCLUSIONS

Among the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.

Effects of Blended Simulation on Nursing Students' Critical Thinking Skills: A Quantitative Study

Introduction

Critical thinking is regarded as imperative to healthcare quality and patient outcomes; therefore, effective strategies in nursing education are required to promote students' critical thinking abilities, leading to their success in clinical work. Accordingly, simulation-based education has been suggested as a measure for achieving this goal.

Objective

The aim of this study was to explore whether a nursing education course with blended simulation activities (hands-on simulations with high-fidelity manikins and a web-based interactive simulation program) could increase nursing students' critical thinking skills.

Method

A quasiexperimental, one-group pretest and post-test design was utilized. Data were collected through premeasurement and postmeasurement using a critical thinking questionnaire and were analyzed using paired sample t-tests, independent sample t-tests, and the nonparametric Wilcoxon signed-rank test. The effect size was calculated using Cohen's d formula.

Results

Sixty-one nursing students (57 women and four men, mean age 30 years) participated in the study. Findings of the paired sample t-test showed a significantly higher mean score for posteducation than pre-education, indicating a significant change in nurses' critical thinking capabilities (p < .001). The results for Cohen's d formula ( - 0.87) of the mean scores between pre-education and posteducation indicated a large effect size. The Wilcoxon signed-rank test also showed a statistically significant increase in the students' critical thinking abilities between pre-education and posteducation measures (p < .001). No statistically significant differences were found in the mean score according to age or sex.

Conclusion

This study concluded that blended simulation-based education can increase nursing students' critical thinking capabilities. As a result, this study builds on the use of simulation as a measure for developing and promoting critical thinking abilities during nursing education.

Differences in Critical Thinking and Decision Making among Critical Care and Non-Critical Care Nurses

Critical thinking and decision-making are essential for nurses to identify and analyze judgments for nursing care. Hence, this study aims to determine critical thinking and clinical decision-making among critical and non-critical care nurses. A cross-sectional study was conducted among 237 nurses using a self-administered questionnaire. This study discovered that critical and non-critical care nurses had a modest level of critical thinking and clinical decision-making. The findings of this study can serve as a guide for nursing administration employees in implementing effective techniques to enhance the critical thinking skills of nurses in on-the-job training and orientation programs for nursing staff.

Bachelor nursing students´ and their educators´ experiences of teaching strategies targeting critical thinking: A scoping review

AIM

The objective of this scoping review was to review the published literature on existing teaching strategies targeting bachelor nursing students' critical thinking and explore how these strategies are described by students and educators. The research questions were: (i) Which teaching strategies are described in the literature targeting critical thinking among nursing students? and (ii) How are these teaching strategies described and experienced by students and/or nurse educators?

BACKGROUND

Critical thinking is integrated in the many clinical assignments and responsibilities with which registered nurses are faced. Therefore, it is important that nurse educators implement teaching strategies supporting bachelor nursing students' development of critical thinking to prepare them for their professional responsibilities.

DESIGN

Scoping review, Open Science Framework (OSF) registries DOI: 10.17605/OSF.IO/D89SB.

METHODS

The scoping review followed the six steps of Arksey and O'Malley (2005). Systematic searches were conducted using the databases PubMed, CINAHL, ERIC, ERC and PsycINFO. Eligible studies were quality assessed and text excerpts answering the research questions were analysed by a thematic analysis.

RESULTS

Our findings represent 19 published studies and can be understood according to two themes: the importance of the educational conditions and the impact of implemented teaching strategies. The first theme reflected not only the descriptions of important traits in the educational milieu facilitating the development of critical thinking but also the importance of how the content targeting such skills were delivered and organised. The second theme mirrored descriptions of how the students, through the teaching strategies, realized the need for collaboration to facilitate critical thinking. Further, it showed how the teaching strategies fostered professional growth and learning adaptation, by encouraging the students to question their knowledge and facilitating their development of clinical knowledge.

CONCLUSIONS

The strategies used in the facilitation of critical thinking need to incorporate collaboration and student-centredness, creating a relaxed climate where the educators can assist through guidance and support. This calls for the implementation of teaching strategies whereby both educators and students are active in facilitating the learning environment.

The experiences of nursing master's students with dialogic case-based learning in an evidence-based nursing course: A qualitative study

BACKGROUND

Evidence-based nursing (EBN) is a complex subject for teachers and students due to the abstract concepts involved. It requires combining theory with practice and is included in the major courses required for a master's education in many countries. Case-based learning (CBL), which is a student-centred teaching method, has been widely used in numerous disciplines because it can bridge the gap between theory and practice and foster critical thinking and communication skills. However, to adapt CBL to EBN coursework for a Master of Nursing degree, improve evidence-based practice (EBP) and enhance core competencies, the case design and operational procedures of CBL need to be further examined.

OBJECTIVES

To explore nursing master's students' experiences of dialogic CBL and case design and operational procedures regarding dialogic CBL.

DESIGN

A descriptive-qualitative study design was used.

SETTING AND PARTICIPANTS

The study was carried out in the nursing master's programme at a university in China. Twenty first-year nursing master's students who completed a 10-week EBN course were recruited using purposive sampling.

METHODS

Data were collected between September and December 2020 via in-depth semistructured interviews. The data were analysed using thematic analysis.

RESULTS

Four themes were identified: (1) 'learning theoretical EBN knowledge'; (2) 'improving clinical nursing ability'; (3) 'enhancing core competencies'; and (4) 'barriers to implementing dialogic CBL'.

CONCLUSIONS

The study provided a standardised CBL procedure based on students' experiences, which included preparation, group discussions, presentations, and teachers' feedback following the presentations, and these operational procedures were shown to be indispensable. The student experiences in this study should be referenced by nursing educators who apply this teaching method in other graduate and undergraduate nursing courses such as surgical nursing and nursing research.

Development and application of an online learning platform for nursing ethics: A teaching practice research

BACKGROUND

It is crucial to diversify the methods for clinical nurses to continue learning nursing ethics in that ethical decision-making ability in nursing is regarded as one of the core competencies in nursing practice.

OBJECTIVE

In response to nurses' learning needs for nursing ethics, this study built an online learning platform for the pertinent topic, and tested its effect on improving nurses' ethical decision-making ability and critical thinking ability.

DESIGN

A qualitative method was adopted to develop interventions, which were designed as a teaching practice research consisting of a study group and a control group.

PARTICIPANTS

A total of 93 nurses, including 20 interviewees and 30 in the study group and 43 in the control group.

METHOD

Qualitative methods were employed to understand the learning needs of nurses. The judgment about nursing decisions and the critical thinking disposition inventory, learning effectiveness questionnaire and learning software quality evaluation scale were used as research tools in this teaching practice research. The SPSS 25.0 was adopted to analyze data by paired sample t-test and independent sample t-test.

RESULTS

In the measurement of the judgment about nursing decisions scale, the study group scored higher than the control group. The critical thinking disposition inventory scale identified a similar result in the total score incorporating the four dimensions, including analyticity, systematicity, critical thinking self-confidence, inquisitiveness. There is a correlation between learning software quality and learning effect, with a correlation coefficient of 0.640.

CONCLUSION

The online learning platform of nursing ethics built in this study has positive learning effects, and it demonstrates effectiveness to improve nurses' abilities in nursing ethics, decision-making and critical thinking. It is expected to be a viable way to improve the continuity of nurses' study of ethics.

Development and Evaluation of the "High-Up" Program for Enhancing the Nursing-Management Competency of Mid-Career Hospital Nurses: A Quasi-Experimental Study

The aim of this study was to develop an educational program to strengthen the nursing management competency of experienced nurses who are prospective nurse managers and then determine the effectiveness of the program. This quasi-experimental study was conducted from January to April 2021. A total of 22 nurses were assigned to the experiment group (mean age: 26.55 ± 1.30 years; 2 males, 20 females), and 20 were assigned to the control group (mean age: 27.55 ± 2.04 years; 20 females). The program, known as the "High-Up" program, comprised problem-based learning (PBL) and video lectures. In the experiment group, nurses discussed PBL cases through video conferences and applied problem-solving methods. The collected data were analyzed using the Friedman test and Wilcoxon rank-sum test (administered through SPSS). At four weeks after the intervention, the experiment group showed higher critical thinking tendency scores than the control group (pre-intervention score: 3.48 ± 0.36; post-intervention score: 3.71 ± 0.49; Z = -1.99, p = 0.046). The findings indicate that the "High-Up" program can enhance the nurse management competency of experienced nurses who need to prepare for nurse manager roles, and that it can also positively influence the performance of nursing organizations. However, it can be difficult to comprehensively enhance nursing management competency in a short period of time, meaning continuous education is required.

Nurses' perceptions of nursing education transformation and its impact on care delivery in Singapore

AIMS

To explore nurses' perceptions of the transformation in Singapore's nursing education and its impact on the delivery of nursing care.

BACKGROUND

Nursing education in Singapore has sailed through a sea of changes, from the apprenticeship model of training in hospitals to institutions of higher learning. Limited primary studies have explored the evolution of nursing education, and none have explored its impact on the delivery of nursing care, based on nurses' perceptions.

METHODS

A descriptive qualitative design with purposive and snowball sampling was used to recruit 18 experienced nurses from local teaching institutions and healthcare clusters. Semistructured individual face-to-face interviews were conducted using an interview guide. Data were analysed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Research reporting guideline was used to report the study.

FINDINGS

Five themes emerged: 'evolution of the nursing education approach', 'clinical learning environments', 'evaluation of changes in the nursing education approach', 'attitudes toward the provision of various levels of education' and 'influences of various competencies on the delivery of nursing care'.

CONCLUSION

Changes in teaching pedagogies, learning, assessment, curriculum structure, content and clinical learning environment were commonly reported, which provided insights into understanding nursing education transformation and its impact on nursing practice.

IMPLICATIONS FOR NURSING EDUCATION

The findings could better prepare nurses for the demanding needs of the contemporary healthcare landscape. Nurse educators and leaders should evaluate gaps in nursing education and implement strategies to improve students' learning experiences and outcomes.

IMPLICATIONS FOR NURSING POLICY

Policy-makers can draw on our findings to revise the core competencies guidelines and improve future training by supporting the healthcare needs of society.

Critical thinking among clinical nurses and related factors: A survey study in public hospitals

AIMS AND OBJECTIVES

The study investigated clinical nurses' critical thinking levels in public hospitals and related factors.

BACKGROUND

Since health care environments have become more complex, the critical thinking skills of clinical nurses are more important in daily problem-solving and decision-making processes. However, little research was conducted on this topic among clinical nurses.

METHODS

It was a cross-sectional study at five public hospitals between December 2018 and January 2019. The study followed the STROBE guideline. Data were collected from 559 nurses by a survey consisted of a data form and the Turkish version of the Nursing Critical Thinking in Clinical Practice Questionnaire.

RESULTS

Nurses' mean critical thinking scores were moderate level. Total critical thinking scores of the clinical nurses significantly differed according to education, hospital type, shift work, professional category and role. There was a significant effect on the total critical thinking scores of the clinical nurses according to variables.

CONCLUSION

This study found that critical thinking levels of nurses' working in clinical settings in public hospitals were moderate level. Hospital type, shift work, professional and educational level and role were significantly associated with clinical nurses' critical thinking levels.

RELEVANCE TO CLINICAL PRACTICE

This study provides evidence related to the levels of critical thinking of clinical nurses working in public hospitals. Since the critical thinking scores of the manager nurses, daytime working nurses' and nurses with bachelor's and master's degree education are higher, hospital managers may benefit from the study to implement effective strategies to improve the competence of critical thinking levels of nurses.

Intervention for Alleviating Clinical Inertia in the Management of Urinary Incontinence

PURPOSE

The purpose of this study was to determine whether clinical inertia exists in the care of patients with urinary incontinence and to test the effects of an educational intervention designed to alleviate inertia related to care of urinary incontinence.

DESIGN

Single-group, pretest/posttest design.

SUBJECTS AND SETTING

The sample comprised 132 participants practicing in 6 medical-surgical inpatient care units at an urban hospital in Almería, Spain; 66 (50%) were RNs, and all other participants were unlicensed assistive personnel. Most participants (87.9%) were female; their average age was 43.99 years (SD = 7.85 years).

METHODS

An educational intervention (online course) was provided. The main objective of the course was application of evidence-based knowledge for prevention and management of urinary incontinence in hospitalized patients. The course program comprised 3 didactic units: (1) introduction and evaluation of the patient with urinary incontinence, (2) care plans, and (3) instructions and rational use of absorbent products. Data collection included demographic and professional characteristics of respondents, desired results when caring for patients with incontinence, a medical record checklist, an occupational environment and satisfaction scale, and an assessment record of knowledge/skills and training activity satisfaction.

RESULTS

After comparing the pre- and posttest scores of knowledge on urinary incontinence, significant differences were found before and after the intervention (z = -14.113, P = .000). Specifically, analysis revealed differences in caring actions related to urinary incontinence (z = -14.248, P = .000) and differences in direct observation of urinary incontinence practice following the intervention (z = -14.326, P = .000).

CONCLUSIONS

Our findings indicate existence of inertia in nursing care for hospitalized patients with urinary incontinence. The educational intervention improved knowledge, observable nursing care activities related to incontinence management, and improved documentation of care.

Effects of a blended emergent research training programme for clinical nurses on nursing research competence and critical thinking (Part 2): A quasi-experimental study

AIMS AND OBJECTIVES

To evaluate the effects of a blended emergent research training programme for clinical nurses on research competence and critical thinking.

BACKGROUND

With the development of the nursing discipline and evidence-based nursing practice, nursing research competence is increasingly important for clinical nurses. Current nursing research training programmes cannot meet the needs of clinical nurses.

DESIGN

A quasi-experimental study.

METHODS

A total of 104 clinical nurses from two tertiary hospitals participated in this study. The intervention group received a blended emergent research training programme for clinical nurses, and the control group received no intervention. Nursing research competence and critical thinking were measured at baseline, after the intervention and three months after the intervention. The satisfaction with the training of clinical nurses in the intervention group was also measured after the intervention. Generalised linear mixed models were used to evaluate the effects of the intervention on outcome variables. Qualitative data were analysed by two researchers using the content analysis method. Our reporting complies with the TREND checklist.

RESULTS

The blended emergent research training programme for clinical nurses finally showed positive effects on nursing research competence and critical thinking. The effects lasted until three months after the training programme. 'Learner-centred Training', 'Skilled Trainers', 'Encouraging Training Environment' and 'Positive Outcomes' are the main categories generated from the qualitative data.

CONCLUSION

The blended emergent research training programme for clinical nurses could be used for clinical nurses' research education to improve their nursing research competence and critical thinking.

RELEVANCE TO CLINICAL PRACTICE

The blended emergent teaching method could be considered as an effective method to provide an encouraging learning environment and promote learner-centred teaching for clinical nurses. The blended emergent research training programme could be used to improve nursing research competence and critical thinking of clinical nurses which are important for evidence-based nursing practice.

Stressors and Coping Strategies among Nursing Students during the COVID-19 Pandemic: Scoping Review

COVID-19 has impacted every aspect of life around the world. Nursing education has moved classes online. Undoubtedly, the period has been stressful for nursing students. The scoping review aimed to explore the relevant evidence related to stressors and coping strategies among nursing students during the COVID-19 pandemic. The scoping review methodology was used to map the relevant evidence and synthesize the findings by framing the research question using PICOT, determining the keywords, eligibility criteria, searching the CINAHL, MEDLINE, and PubMed databases for the relevant studies. The review further involved study selection based on the PRISMA flow diagram, charting the data, collecting, and summarizing the findings. The critical analysis of findings from the 13 journal articles showed that the COVID-19 period has been stressful for nursing students with classes moving online. The nursing students feared the COVID-19 virus along with experiencing anxiety and stressful situations due to distance learning, clinical training, assignments, and educational workloads. Nursing students applied coping strategies of seeking information and consultation, staying optimistic, and transference. The pandemic affected the psychological health of learners as they adjusted to the new learning structure. Future studies should deliberate on mental issues and solutions facing nursing students during the COVID-19 pandemic.

Nurses' critical thinking and clinical decision-making abilities are correlated with the quality of nursing handover

Critical thinking skills are instrumental for nurses to address patients complex situations and needs to ensure continuity of care. It's aimed to identify the relationship between nurses critical thinking and clinical decision-making abilities with the quality of nursing handover. A cross-sectional, descriptive correlational study was conducted with 205 nurses. Simple random sampling was used for participant recruitment. Data were collected by a questionnaire analyzed using Pearson's correlation test. In this study, nurses had good critical thinking, clinical decision-making abilities and handover quality. There is a strong relationship between critical thinking and clinical decision-making and the quality of nursing handover (p=0.001; r=0.384; r=0.247). This study confirms the relationships of nurses critical thinking and clinical decision-making abilities with the quality of nursing handover. Education level appears to have the largest influence, the results imply a need for nurses to have higher education.

Cultural adaptation and validation of an instrument about nursing critical thinking skills

OBJECTIVES

to validate the Nursing Critical Thinking in Clinical Practice Questionnaire regarding cultural aspects and metric properties.

METHODS

a methodological research carried out through cross-cultural adaptation, face and content validity, dimensional construct and known groups validity, test-retest reliability and internal consistency. 511 nurses from four hospitals participated in the study, of which 54 participated in retest.

RESULTS

the instrument validation for Brazilian Portuguese maintained equivalences, according to the original version. The dimensional validity demonstrated adjustment to the tetrafactorial structure of the original version (GFI=0.69). There were statistically significant differences in critical thinking skills between nurses with graduate degrees and who undertook training, reading articles, developing research and working in an institution with a longer time implementation of the Nursing Process. The instrument showed temporal stability (ICC 073-0.84; p<0.001) and adequate internal consistency (α=0.97).

CONCLUSIONS

the instrument proved to be valid and reliable for the studied population.

Automated essay scoring (AES) of constructed responses in nursing examinations: An evaluation

Nursing students' higher-level thinking skills are ideally assessed through constructed-response items. At the baccalaureate level in North America, however, this exam format has largely fallen into disuse owing to the labor-intensive process of scoring written exam papers. The authors sought to determine if automated essay scoring (AES) would be an efficient and reliable alternative to human scoring. Four constructed-response exam items were administered to an initial cohort of 359 undergraduate nursing students in 2016 and to a second cohort of 40 students in 2018. The items were graded by two human raters (HR1 & HR2) and an AES software platform. AES approximated or surpassed agreement and reliability measures achieved by the HR1 and HR2 with each other, and AES surpassed both human raters in efficiency. A list of answer keywords was created to increase the efficiency and reliability of AES. Low agreement between human raters may be explained by rater drift and fatigue, and shortcomings in the development of Item 1 may have reduced its overall agreement and reliability measures. It can be concluded that AES is a reliable and cost-effective means of scoring constructed-response nursing examinations, but further studies employing greater sample sizes are needed to establish this definitively.

Factors associated with the critical thinking ability of professional nurses: A cross-sectional study

Aim

To measure the level of critical thinking among Vietnamese professional nurses and to identify the related factors.

Design

A cross‐sectional design was used.

Methods

The total sample included 420 professional nurses. Data were collected from July to September 2019 in three public hospitals located in Southwestern Vietnam. The level of critical thinking was measured using the Vietnamese version of the Nursing Critical Thinking in Clinical Practice Questionnaire. The data were analysed using the independent Student's t tests, ANOVA, Pearson's correlation and regression analysis.

Results

Most of the participants had a low (48.3%) or moderate (45.5%) level of critical thinking. Age, gender, ethnicity, education level, health condition, duration of working as a nurse, duration of working in the current hospital, having heard the term “critical thinking” and work position had an impact on the critical thinking ability. Work position and gender explained 11% of the total variance in critical thinking ability.

The Vietnamese version of the nursing critical thinking in clinical practice questionnaire: Translation and psychometric evaluation

Aims

This study translated and evaluated the validity and reliability of the Vietnamese version of the Nursing Critical Thinking in Clinical Practice Questionnaire (N‐CT‐4 Practice (V‐v)).

Design

Forward‐ and back‐translation approach developed by Sousa and Rojjanasrirat (2011).

Methods

545 nurses were recruited based on convenience sampling and asked to complete the N‐CT‐4 Practice (V‐v) questionnaire for psychometric testing. Data were collected during June 2019 in three public hospitals located in Southwestern Vietnam. We evaluated translation equivalence, the item content validity index, floor/ceiling effects, construct validity, internal consistency reliability and test–retest reliability.

Results

The N‐CT‐4 Practice (V‐v) questionnaire retained the meaning of the original English version and was clear, explicit and easy for nurses to understand. The item content validity index was 1.0. There were no floor/ceiling effects. The Cronbach's alpha was 0.98. The intraclass correlation coefficient was 0.81. Confirmatory factor analysis indicated that this Vietnamese version fit the proposed model.

Development and psychometric testing of Reasoning Skills test for nursing student selection: An item response theory approach

AIMS

To develop and psychometrically test the Reasoning Skills (ReSki) test assessing undergraduate nursing applicants' reasoning skills for student selection purposes.

DESIGN

A methodological cross-sectional design was applied for the psychometric testing.

METHODS

The ReSki test was developed as part of a wider electronic entrance examination. The ReSki test included a case followed by three question sections assessing nursing applicants' reasoning skills according to the reasoning process. Item response theory was used for psychometric testing to assess item discrimination, difficulty and pseudoguessing parameters. The ReSki test was taken by 1056 nursing applicants in six Finnish Universities of Applied Sciences (28 May 2019).

RESULTS

In the development process, the expert evaluations indicated acceptable content validity. In the psychometric testing, the test reliability was supported by item variance, the theoretical structure was supported by the correlation coefficients and the applicant mean performance supported an acceptable overall test difficulty. The item response theory indicated variance between the items' difficulty and discrimination ranges. However, most of the wrong items failed at being functional distractors.

CONCLUSION

The ReSki test is a new and valid objective assessment of undergraduate nursing applicants' reasoning skills. The item response theory provided item-level information that can be used for further development of the test, especially related to the revisions needed for the distractor items to achieve the desired level of difficulty.

IMPACT

What problem did the study address? The assessment of nursing applicants' reasoning skills is suggested, but there is a lack of admission tools. What were the main findings? The results provided support for the reliability and validity of the ReSki test. Item response theory indicated the need for further item-level improvement. Where and on whom will the research have an impact? The results may benefit higher education institutions and researchers when developing a test and/or student selection processes.

Critical thinking in nursing clinical practice, education and research: From attitudes to virtue

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science.

Levels, antecedents, and consequences of critical thinking among clinical nurses: a quantitative literature review

The purpose of this study was to obtain a more comprehensive understanding of critical thinking within the clinical nursing context. In this review, we addressed the following specific research questions: what are the levels of critical thinking among clinical nurses?; what are the antecedents of critical thinking?; and what are the consequences of critical thinking? A narrative literature review was applied in this study. Thirteen articles published from July 2013 to December 2019 were appraised since the most recent scoping review on critical thinking among nurses was conducted from January 1999 to June 2013. The levels of critical thinking among clinical nurses were moderate or high. Regarding the antecedents of critical thinking, the influence of sociodemographic variables on critical thinking was inconsistent, with the exception that levels of critical thinking differed according to years of work experience. Finally, little research has been conducted on the consequences of critical thinking and related factors. The above findings highlight the levels, antecedents, and consequences of critical thinking among clinical nurses in various settings. Considering the significant association between years of work experience and critical thinking capability, it may be effective for organizations to deliver tailored education programs on critical thinking for nurses according to their years of work experience.

Effect of Korean nursing students' experience of incivility in clinical settings on critical thinking

Clinical experience is essential to helping nursing students to achieve and practice professional knowledge and skills. Published reports indicate nursing students often experience incivility during clinical practice. The purpose of this study was to investigate nursing student incivility experience during their clinical rotations and the relationship of these experiences with their critical thinking dispositions. A cross-sectional descriptive correlational study design was utilized. Data were collected from junior (n = 195) and senior (n = 180) students in a Bachelor of Science in Nursing (BSN) program in Seoul, Korea between October 15, 2017 and November 20, 2017 using a self-administered survey. Three instruments were used in the survey: six sociodemographic questions, the 13-item Korean version of Uncivil Behavior in Clinical Nursing Education (K-UBCNE) and the 27-item Yoon Critical Thinking Disposition (YCTD) tool. Data analysis revealed junior students reported significantly more incivility from nurses than the senior students (p = .038) during clinical learning experiences. Among YCTD subscales, the Prudence (p = .007) and Self-Confidence critical thinking (p = .007) scores from the senior nursing students were significantly higher than the junior students' scores. No significant relationship was found between experience of incivility and critical thinking disposition scores. Based on the study results, nursing educators, staff nurses, and administrators/managers in nursing should identify incivility toward nursing students during clinical practicums and especially toward junior nursing students. Additional investigation of the relationship between critical thinking and experiences of incivility is warranted, including longitudinal investigations and qualitative studies among junior nursing students to understand their personal experience of incivility in the clinical setting. Findings could inform the development of targeted programs to reduce clinical incivility.

Teaching strategies and outcome assessments targeting critical thinking in bachelor nursing students: a scoping review protocol

INTRODUCTION

Applying critical thinking is essential for nursing students both in an academic and clinical context. Particularly, as critical thinking is a vital part of nurses' everyday problem-solving and decision-making processes. Therefore, regardless of the topic taught or the setting in which it is taught, it requires teaching strategies especially targeting students' critical thinking skills and abilities. One challenge with the latter is the difficulties to assess and evaluate the impact of such teaching strategies on the students' critical thinking disposition. Hence, our objective will be to review published literature on; existing teaching strategies and outcomes assessments targeting nursing students' critical thinking skills and abilities.

METHODS AND ANALYSIS

Our scoping review will be conducted in accordance with Arksey and O'Malley's framework for scoping studies. Search strategies will be developed in cooperation with an experienced librarian, and adjusted to each individual database for example, CINAHL, PubMed, PsycINFO, ERIC and ERC. A preliminary search in CINAHL was conducted on the 17th of July 2019. Peer-reviewed published studies conducted with a qualitative, quantitative or mixed method design and focussing our objectives, will be eligible for inclusion. Included studies will be quality assessed in accordance with their study design. Data will be charted using a standardised extraction form. The qualitative data will be presented through a thematic analyses, and the quantitative data by descriptive numerical analysis. Lastly, nurse educators and nursing students will be consulted for validation of the findings from the scoping review.

ETHICS AND DISSEMINATION

Under the Swedish Ethical Review Act (2003:460) this study does not need ethical clearance by a Regional Ethical Review Authority as it not includes any primary empirical data on biological material or sensitive information. The findings will be used to inform the design of a future study aiming to develop an, and subsequently evaluate it, educational intervention targeting teaching strategies focussing on nursing students' critical thinking skills and abilities.

The impact of an educational intervention on nursing students' critical thinking skills: A quasi-experimental study

AIM

In this study, we identified the impact of educational activities that focused on improving the competence and critical thinking skills of university nursing students.

DESIGN

A prospective quasi-experimental study was conducted, and assessments were conducted before and after the educational intervention, which consisted of seminars, lectures, case studies, and problem-solving activities.

METHODS

The Critical Thinking Questionnaire was used to collect data before and after the educational intervention between September 2017 and May 2018. The sample consisted of 112 first-year undergraduate students. To examine the data that were collected as a part of this quasi-experimental study, inferential statistics were used, and the results were tested against a significance level of P < 0.05.

RESULTS

The students obtained higher scores on the substantive dimension than on the dialogic one, and women scored higher than men. The educational intervention led to an improvement in every critical thinking skill across both dimensions, except listening and speaking skills, whereby men demonstrated a greater change in average scores for critical thinking skills.

CONCLUSIONS

The educational intervention improved the critical thinking skills of undergraduate students and had a greater impact on men than on women. This finding underscores the need for educational interventions that can enhance critical thinking skills. Developing these skills will improve future nurses' ability to make health care management decisions in a reflective, agile, and evidence-based manner.

Clinical nurses's critical thinking level according to sociodemographic and professional variables (Phase II): A correlational study

Critical thinking ability is one of the basic competencies of clinical nurse and is widely accepted as being associated with the provision of quality care, however, the few evidence-based data related to the relationship between level of critical thinking ability and nurses' sociodemographic and professional characteristics. The aim of this study was to identify the level of critical thinking among nurses in clinical practice according to sociodemographic and professional variables. Descriptive cross-sectional and correlational study was carried out in a sample of 339 nurses from medical, surgical and critical care units at a tertiary care hospital. This study is related to a previous publication that presents psychometric analysis. Data were compiled using the Nursing Critical Thinking in Clinical Practice Questionnaire and ad hoc form for the recording of sociodemographic and professional characteristics. The statistical analysis of the data was performed using frequency, Mann-Whitney U Test, Kruskal-Wallis Test, and Pearson's correlation coefficients. Nurses reported moderate levels of critical thinking. Older nurses, with 11-15 years of experience in the actual unit, with continuous shift work, a permanent contract and master's degree indicated a higher level of critical thinking. Critical thinking skills are related to certain socio-demographic and professional variables, particularly age, years of experience, shift work, type of contract and educational level.

Validation of data using RASCH analysis in a tool measuring changes in critical thinking in nursing students

BACKGROUND

In Australia there is no national examination to assess student competency with respect to critical thinking skills on graduation from undergraduate registered nurse program.

OBJECTIVES

To describe the use of Rasch analysis for the validation of a tool that measures critical thinking in nursing students in Australia.

DESIGN

A cross sectional survey was used to assess students' critical thinking.

SETTINGS

One Australian university.

PARTICIPANTS

Seventy-four first year and third year nursing students participated in the project.

METHODS

Nursing students at one university were requested to undertake a multiple choice question survey to determine their level of critical thinking. The survey tool was validated using Rasch analysis software.

RESULTS

Rasch analysis enabled identification of the difficulty of each question, enabling the assessment to identify difference between students and for each student cohort. The use of Rasch analysis demonstrated marked differences in the students' critical thinking abilities, showing higher levels of critical thinking for third year students with greater ability to answer the more difficult questions.

CONCLUSION

Rasch analysis enables the matching of test questions to the cognitive skill level of students, and is a useful tool for validating multiple choice questionnaires. Use of this method of analysis can provide a robust assessment in which questions are matched to the level of the learner and enable differentiation between high and low achieving students.

Self-reflection and critical thinking: the influence of professional qualifications on registered nurses

Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (β = 0.24, t = 4.141, p < .001). Qualifications also affected self-reflection with insight (β = 0.11, t = 1.808, p > .05) and critical thinking (β = 0.18, t = 3.143, p < .001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight.

Practice and effectiveness of "nursing case-based learning" course on nursing student's critical thinking ability: A comparative study

BACKGROUND

Case-based Learning was an effective and highly efficient teaching approach that was extensively applied in education systems across a variety of countries. Critical thinking ability is an important indicator for access the study ability for baccalaureate nursing education.

OBJECTIVES

The study aimed to explore the effect of "nursing case-based learning" course on the critical thinking ability of nursing student.

PARTICIPANTS

A total of 80 students who were in Junior were included in this study. The experimental group included 40 students who selected "nursing case-based learning" course. The control group included 40 students who selected the traditional teaching course.

METHODS

The critical thinking disposition inventory (CTDI-CV) was used to evaluate the effects of the critical thinking abilities during the 1st week (pre-test), the 9th week (mid-test), and the 18th week (post-test).

RESULTS

There are no statistically significant differences between two groups in the pre-test thinking abilities (P > 0.05). After nine weeks, the critical thinking abilities of experimental group were significantly higher than control group (P < 0.05). Three obtained time-points had statistically significant differences of control and experimental group (P < 0.05).

CONCLUSION

The "nursing case-based learning" was an effective course to develop the critical thinking abilities of nursing students. Strict instructional design was the guarantee for the smooth implementation of "nursing case-based learning" course.

Critical thinking: A comparative analysis between nurse managers and registered nurses

AIM

To analyse the levels of critical thinking among nurse managers and registered nurses and to explore the association between these levels and socio-demographic and occupational factors.

BACKGROUND

Critical thinking is an essential skill in advanced clinical nursing. However, few studies to date have explored critical thinking levels in nurse managers or compared them with those recorded in registered nurses.

METHODS

A randomized sample of 44 nurse managers and 295 registered nurses from a tertiary hospital in Barcelona participated in this study. The Nursing Critical Thinking in Clinical Practice Questionnaire was used to measure the level of critical thinking. The data were analysed using multivariate analysis by logistic regression.

RESULTS

Levels of critical thinking were higher in nurse managers than in registered nurses. Age, work shift schedule and educational level were associated with a higher level of critical thinking in nurse managers and were predictor factors.

CONCLUSIONS

This study identified age, work shift schedule and educational level as factors that impact on the acquisition of critical thinking skills among nurse managers.

IMPLICATIONS FOR NURSING MANAGEMENT

This study provides substantive evidence of the levels of critical thinking among nurse managers. When introducing strategies to enhance these skills, the associated occupational factors should be taken into account.

Enhancing Critical Thinking Via a Clinical Scholar Approach

BACKGROUND

Safety, quality improvement, and a systems perspective are vital for nurses to provide quality evidence-based care. Responding to the call to prepare nurses with these perspectives, one school of nursing used a clinical scholar approach, enhanced by systems engineering to more intentionally develop the ability to clinically reason and apply evidence-based practice.

METHOD

A two-group, repeated-measures control trial was used to determine the effects of systems engineering content and support on nursing students' clinical judgment and critical thinking skills.

RESULTS

Findings indicated this approach had a positive effects on student's clinical judgment and clinical reasoning skills. This approach helped students view health care issues from a broader perspective and use evidence to guide solution development, enhancing the focus on evidence-based practice, and quality improvement.

CONCLUSION

Intentional integration of an evidence-based, systems perspective by nursing faculty supports development of nurses who can function safely and effectively in the current health care system. [J Nurs Educ. 2017;56(11):679-682.].

Development of an Australian nursing critical thinking tool using a Delphi process

AIM

To develop a critical thinking assessment tool for Australian undergraduate nurses.

BACKGROUND

Critical thinking is an important skill but difficult to assess in nursing practice. There are often many responses a nurse can make to a clinical problem or situation. Some responses are more correct than others and these decisions have an impact on a patient's care and safety. Differences in a response can relate to the depth of knowledge, experience and critical thinking ability of the individual nurse.

DESIGN

This study used a Delphi process to develop five clinical case studies together with the most appropriate clinical responses to 25 clinical questions.

METHOD

The Delphi technique was undertaken using the Qualtrics survey tool between October 2016-January 2017. A panel of 13 nursing experts from various geographical locations in Australia participated in the study to review the case scenarios and answers to questions posed. Four rounds of participation were required to achieve a minimum of 80% agreement between participants. Participants were asked to rank answers for 25 multi-choice questions based on the correct nursing management of case scenarios provided and provide feedback as to the accuracy and relevance of the scenarios and answers.

RESULTS

Four rounds of Delphi questions were required to reach consensus on the correct wording and answers for the scenarios. Five case studies have been developed with nursing responses to patient management in rank order from most correct to least correct.

CONCLUSION

Use of the tool should provide confidence that a nurse has met a certain level of critical thinking ability.

Measuring critical thinking in pre-registration midwifery students: A multi-method approach

OBJECTIVE

Test the concurrent validity of three newly developed tools (student self-rating, preceptor rating, and reflective writing) that aim to measure critical thinking in midwifery practice.

DESIGN

A descriptive matched cohort design was used.

SETTING

Australian research intensive university offering a three year Bachelor of Midwifery programme.

SAMPLE

Fifty-five undergraduate midwifery students.

METHODS

Students assessed their ability to apply critical thinking in midwifery practice using a 25-item tool and a 5-item subscale in Motivated Strategies for Learning Questionnaire. Clinical preceptors completed a 24-item tool assessing the students' application of critical thinking in practice. Reflective writing by students was assessed by midwifery academics using a 15-item tool. Internal reliability, and concurrent validity were assessed. Correlations, t-tests, multiple regression and confidence levels were calculated for the three scales and associations with student characteristics.

RESULTS

The three scales achieved good internal reliability with a Cronbach's alpha coefficient between 0.93 and 0.97. Matched total scores for the three critical thinking scales were moderately correlated; student/preceptor (r=0.36, p<0.01); student/reflective writing (r=0.38, p<0.01); preceptor/reflective writing (r=0.30, p<0.05). All critical thinking mean scores were higher for students with a previous degree, but only significant for reflective writing (t (53)=-2.35, p=0.023). Preceptor ratings were predictive of GPA (beta=0.50, p<0.001, CI=0.10 to 0.30). Students' self-rating scores were predictive of year level (beta=0.32, p<0.05, CI=0.00 to 0.03).

CONCLUSION

The student, preceptor, and reflective writing tools were found to be reliable and valid measures of critical thinking. The three tools can be used individually or in combination to provide students with various sources of feedback to improve their practice. The tools allow formative measurement of critical thinking over time. Further testing of the tools with larger, diverse samples is recommended.