护理批判性思维研究的系统性回顾和展望

鉴于医疗护理背景所面临的挑战:人口老龄化、社会文化差异加大、医疗费用增加、医疗技术发展快速多样等情况,具有良好批判性思维的临床护理实践成为广大护理工作者的目标。批判性思维是美国本科护理教育课程中的核心能力之一[1]。护理教育者通过强调使用护理程序、探究和推理等方法来努力发展学生的批判性思维能力,临床护士则在实践中反思、从实践中学习,逐步建立在实践中的学习能力。1批判性思维及其在护理实践中的定义1.1批判性思维的定义护理学者首先认同批判性的思考是一个实践过程。近年来,以下几个定义在文献中被护理研究者使用较多。…     

护理本科生批判性思维倾向性的现状调查

目的 调查护理本科生批判性思维倾向性的现状.方法 整体抽取中国医科大学护理专业1年级至5年级本科生194人,应用中文版批判性思维能力测量表进行调查.结果 我校护理本科生批判性思维倾向性总平均288.41分,为正性批判性思维.结论 仍需有意识地对我校护理本科生的批判性思维倾向性进行科学的培养.     

不同层次护生批判性思维意向及影响因素的研究

目的了解不同护理教育对象批判性思维意向及影响因素,为制定有针对的批判性思维培养计划提供依据.方法采用横断面研究法调查比较本科、专升本、硕士护生的批判性思维意向和影响因素.结果三层次护生均达到批判性思维意向的最低要求(＞280分),但本科护生寻求真相和系统化能力、专升本寻求真相没达到最低要求(＜40分.硕士护生批判性思维均达到最低要求,但距能力强的标准还有差距;阅读地理、政治、电脑、科学和哲学类书籍对护生的批判性思维意向有正性影响.结论护生的批判性思维意向需要提高,应通过多种教学途径培养和提高护生的批判性思维能力,同时指导护生阅读有助于批判性思维发展的书籍.     

不同层次护生批判性思维意向及影响因素的研究

目的 了解不同护理教育对象批判性思维意向及影响因素，为制定有针对的批判性思维培养计划提供依据。方法 采用横断面研究法调查比较本科、专升本、硕士护生的批判性思维意向和影响因素。结果 三层次护生均达到批判性思维意向的最低要求（〉280分），但本科护生寻求真相和系统化能力、专升本寻求真相没达到最低要求（〈40分）。硕士护生批判性思维均达到最低要求，但距能力强的标准还有差距；阅读地理、政治、电脑、科学和哲学类书籍对护生的批判性思维意向有正性影响。结论 护生的批判性思维意向需要提高，应通过多种教学途径培养和提高护生的批判性思维能力，同时指导护生阅读有助于批判性思维发展的书籍。     

医学院校毕业生批判性思维能力调查分析

<正>批判性思维也称评判性思维,是对所学知识的性质、价值、真实性及精确性进行个人分析、评价、推理、解释及判断,并在此基础上进行合理的决策[1];是个体在复杂的情境中,能灵活地运用已有的知识和经验,对问题及其解决方法进行选择、识别、假设,在反思基础上分析、推理,做出合理判断和正确取舍的高级思维方法及形式。具备批判性思维能力有助于医护人员发现问题、分析问题和创造性地解决问题,是保障医疗服务质量的关键因素。批判性思维     

临床护士批判性思维能力与一般自我效能感的相关性

目的调查临床护士批判性思维能力现状、影响因素及其与一般自我效能感的相关性,为提高护理管理水平提供一定科学依据。方法 2010年12月—2011年3月选择2所上海交通大学医学院附属医院以及继续教育学院的临床护士425名,采用批判性思维量表及一般自我效能感量表进行调查。结果临床护士批判性思维能力平均总分>280分,为正性表现。分析能力、求知欲、认知成熟度、开放思想平均得分>40分,为正性特质。年龄、学历、职称、是否喜欢护理、是否定期阅读杂志和是否了解批判性思维与批判性思维能力水平有关。临床护士批判性思维能力与一般自我效能感呈显著正相关(r=0.528,P<0.01)。结论护理管理者可通过提高护士学历,加强个体职业认同感,培养良好阅读习惯,扩大对批判性思维的宣传以及加强护士自我效能感等途径来提高护士的批判性思维能力,从而更好地服务患者。     

在读护理硕士研究生与专科护士批判性思维特质的比较

目的 了解我国全日制在读护理硕士研究生批判性思维特质的现状,将其与专科护士进行比较,以获得两者之间的差距,为探讨培养护理硕士研究生批判性思维的教育策略提供参考.方法 采用随机便利抽样、横断面调查的方法,运用彭美慈等的中文版批判性思维特质量表对我国8所高校全日制在读护理硕士研究生和广东省赴港进修10个月的专科护士进行调查.所有数据均采用SPSS 13.0软件进行统计学分析.结果 164名全日制在读护理硕士研究生的批判性思维特质量表总分为(294.84±30.62)分,具备正向批判性思维特质,但远低于专科护士的(304.83±32.93)分;两者在7个维度的比较中,除认知成熟度差异无统计学意义外,其他维度得分差异均具有统计学意义(P<0.01);"经常阅读护理有关杂志期刊以了解护理最新动向"对在读护理硕士研究生批判性思维特质有影响.结论 我国各高校应创造有利于学生批判性思维发展的环境,注重学生独立自主学习能力的培养,多阅读相关专业书籍,从科学发展的角度培养临床护理精英,提高病患照护品质,推动护理学科发展.     

批判性思维与护理本科教学

批判性思维是一种科学的思维方法，具有逻辑推理、深思熟虑、疑问态度、自主思维等特点。本文就批判性思维对护理专业的重要性，批判性思维的特点，批判性思维的培养，及有利于培养批判性思维的教学策略进行阐述。     

对本科护生开设护理评判性思维课程的探讨

培养大学生的评判性思维是近年来西方高等教育的一个热点话题，人们把评判性思维（critical thingking）看做是学习的一个不可分割的部分，与创造性思维并称为推动未来知识社会的两大主要动力。甚至有美国研究者提出学生批判性思维能力的发展“将决定生活质量及美国甚至整个世界的未来”^[1]。护理评判性思维是一门旨在提高护理专业学生批判性地思考、分析、推理和论证的课程，在我国护理高等教育中尚未见系统报道^[2]。郑州大学护理学院于2008年3月申请在护理本科生中开设护理评判性思维选修课，并进行了课堂教学效果的评价研究。现将该实践研究结果报告如下，以期推动护理批判性思维课程的建设和相关研究的深入发展。     

护理专业中批判性思维的界定及其在护理实践中的体现

鉴于批判性思维在护理专业中应用现状，从批判性恩维在护理实践中的重要性、定义、组成方面．对护理争业中批判性思维进行界定，并阐述了批判性思维在护理实践中的体现。     

Use of the Watson-Glaser Critical Thinking Appraisal with BSN students

The complexity and changing nature of nursing today requires proficiency in thinking skills to ensure knowledgeable, confident, creative, and sensitive decisions regarding client care. Nurse educators are faced with the task of promoting educational strategies to develop the abilities of nursing students to think critically in all health care settings (1). However, a lack of consensus on what characterizes critical thinking leads to difficulty in the development of instruments for adequate measurement. It is important to decide on a definition of critical thinking that faculty support and are willing to use in practice. The term is diversely defined in the literature. For example, Alfaro-LeFevre states that critical thinking in nursing "entails purposeful, goal directed thinking; aims to make judgments based on evidence (fact) rather than conjecture (guesswork); is based on principles of science and scientific method; requires strategies that maximize human potential and compensate for problems caused by human nature" (2). The authors of this study use a definition by Paul: "thinking about your thinking while you are thinking in order to make your thinking better, more clear, more accurate, more defensible" (3). The authors believe that the development and/or enhancement of critical thinking ability must be the result of conscious, deliberate activity throughout the nursing program. As the student matures, the ability to think critically will be manifested in decision making that reflects accurate assessment and resolution of problems. The nursing faculty selected an instrument to evaluate the critical thinking abilities of baccalaureate nursing students that had strong reliability and validity documented in the nursing literature: the total and subtest scores of the Watson-Glaser Critical Thinking Appraisal (WGCTA), Form A (4). The instrument was deemed to be congruent with the definition of critical thinking supported by the faculty.     

Beyond war and military medicine: social factors in the development of prosthetics

Reznick JS. Beyond war and military medicine: social factors in the development of prosthetics.Polytrauma is an immediate outcome of current warfare, and the need to investigate this condition is equally immediate. The value of historical analysis in this endeavor should not be underestimated. It is among the best tools we have to help ensure that current research and practice involve engagement with the social contexts of polytrauma as well as with the medical science of its treatment. This special communication provides historical perspective on certain aspects of the polytraumatic condition—namely, limb loss, prosthetic rehabilitation, and community reintegration after receiving a prosthesis. It discusses the influential role of societal factors in these areas to encourage greater understanding that the care of persons with polytrauma must involve critical thinking about their relationships to and participation in society as well as their treatment by medical science. This special communication also provides historical perspective to enrich appreciation of the value of history for the field of physical medicine and rehabilitation (PM&R), the PM&R clinician, and the PM&R clinical researcher. Readers will learn that historical knowledge puts PM&R research and practice into perspective, reminding us that rehabilitation should involve critical thinking not only about medicine, but also about social roles and the participation of people in society despite physical and psychologic challenges.     

Concept analysis of reflective thinking

The nursing practice is described as a scientific practice, but also as a practice where caring is important. The purpose of nursing education is to provide competent nursing practitioners. This implies that future practitioners must have both critical analytical thinking abilities, as well as empathy and moral values. Reflective thinking could probably accommodate these thinking skills. It seems that the facilitation of reflective thinking skills is essential in nursing education. The research question that is relevant in this context is: "What is reflective thinking?" The purpose of this article is to report on the concept analysis of reflective thinking and in particular on the connotative meaning (critical attributes) thereof. The method used to perform the concept analysis is based on the original method of Wilson (1987) as described by Walker & Avant (1995). As part of the concept analysis the connotations (critical attributes) are identified, reduced and organized into three categories, namely pre-requisites, processes and outcomes. A model case is described which confirms the essential critical attributes of reflective thinking. Finally a theoretical definition of reflective thinking is derived and reads as follows: Reflective thinking is a cyclic, hierarchical and interactive construction process. It is initiated, extended and continued because of personal cognitive-affective interaction (individual dimension) as well as interaction with the social environment (social dimension). to realize reflective thinking, a level of internalization on the cognitive and affective domain is required. The result of reflective thinking is a integrated framework of knowledge (meaningful learning) and a internalized value system providing a new perspective on and better understanding of a problem. Reflective thinking further leads to more effective decision making- and problem solving skills.     

本科护理专业学生应具备的素质要求

现代社会护理服务需求呈多元化、高品质化趋势发展,护理学本身又是一门集科学性、技术性、社会性和艺术性为一体的综合应用学科,它不仅要求本科护理学生具备精湛的技能、扎实的理论基础,还必须进一步加强多元文化护理能力、评判性思维能力、循证护理能力、科研能力业务素质等人文素质、心理素质、道德素质和身体素质的培养。提示本科护理教育只有注重学生综合素质的全面发展,才能适应现代护理发展的需求。     

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.     

Critical assumptions: thinking critically about critical thinking

The concept of critical thinking has been featured in nursing literature for the past 20 years. It has been described but not defined by both the American Association of Colleges of Nursing and the National League for Nursing, although their corresponding accreditation bodies require that critical thinking be included in nursing curricula. In addition, there is no reliable or valid measurement tool for critical thinking ability in nursing. As a result, there is a lack of research support for the assumptions that critical thinking can be learned and that critical thinking ability improves clinical competence. Brookfield suggested that commitments should be made only after a period of critically reflective analysis, during which the congruence between perceptions and reality are examined. In an evidence-based practice profession, we, as nurse educators, need to ask ourselves how we can defend our assumptions that critical thinking can be learned and that critical thinking improves the quality of nursing practice, especially when there is virtually no consensus on a definition.     

Science in the postmodern era: Postpositivism and research in medical education

An overview of recent developments in thinking about science, scientific knowledge, and research, in particular as related to research in medical education, is presented. This article describes the transition from the modern period of science, characterized by the positivist view, to the current postmodern period, which is characterized here in terms of critical realism and social constructivism. Critical realism and social constructivism reflect postmodern thought, by emphasizing that scientific knowledge is a human, social construction based on judgment and interpretation, rather than absolute truth about a perfectly knowable external reality. The implications of the postmodern view for research in medical education, including qualitative research, are considered.     

A new direction for cognitive development in nursing to prepare the practitioners of the future

The quest to improve metacognitive control of critical thinking abilities has gained increasing importance throughout the world during the past thirty years. Self-regulated learning, a concept within the construct of critical thinking, is currently receiving much attention from educational theorists. A self-regulated individual requires a dependable experiential knowledge base, uses cognitive critical thinking strategies in a reflective manner, and is affected by social and cultural influences. One purpose of this article is to review the significant legacy of cognitive research in nursing. The research is categorized according to the concepts of the self-regulation learning model; metacognitive self-regulation (critical thinking, information processing), behavioral self-regulation (reflective practice) and environmental self-regulation (social interaction, clinical context). Another purpose of the article is to explore some self-regulated learning techniques that could be used to improve metacognitive control of critical thinking abilities in practice situations. Nursing leaders in service and education should consider a new approach for cognitive development in practice, since the result could be outcomes that are more closely aligned with mandates of governing bodies, growth of the discipline and patient welfare.     

Focus groups as a tool for critical social research in nurse education

Focus groups are now widely adopted in qualitative health and social research, and have been increasingly used as a data-collection technique in nursing research. The focus group is not a new method, but its uses and procedures have been considerably revised in recent years. The aim of this paper is to present an overview of the focus group as a research tool in social science literature, followed by a more considered discussion on the use of focus groups in contemporary critical social science. It draws on this work to illustrate the potential of focus groups to address some of the political issues in social research, in particular the balance of power between researcher and researched, and the empowerment of under-represented groups. Advantages of the method in connecting the researcher with group perspectives and experiences that may be unexplored by other methods of data collection are discussed, and the 'collective conscience' is put forward as an appropriate resource in data analysis. It argues that the application of focus-group techniques can build on experiences and principles of working with or participating in groups. Focus groups are particularly applicable to research in nurse education, for involving diverse stakeholders in curriculum evaluation and development, and in ongoing appraisals of the student's perceptions of their experience, for which universities have tended to rely on survey approaches and structured questionnaires. The article ends by drawing some conclusions from the health and social research literature to inform nursing education research using focus groups.     

Enhancing critical thinking in paramedic continuing education

Critical thinking has become a buzzword, especially in medical education. The challenge is first to determine what skills compose critical thinking and what teaching techniques promote critical-thinking skills, and then to determine how to apply these techniques effectively and efficiently to a given population in the classroom. This article begins with a working definition of critical thinking and explores the parameters and skills implied or stated in the definition. Then a teaching environment constructed around a model of critical thinking and characteristics of the audience is described. A specific teaching method, suggested by research and designed to exercise critical-thinking skills, is then applied to a specific patient problem in a continuing education class. Preliminary outcomes are presented. The purpose of this article is to propose a productive and efficient educational method for promoting and enhancing critical-thinking skills appropriate for paramedic-level continuing education.