Nurse educators—still challenged by critical thinking

Educators are thwarted by inconsistent critical thinking definitions, poor understandings about measurable ways to teach critical thought processes, and a lack of reliable and valid nursing-specific assessment tools to effectively evaluate student reasoning. Standardized measures of students' critical thinking show contradictory measurement results. Assumptions that nurse educators possess highly evolved critical thinking skills need to be examined. It appears that continued attention and new approaches to critical thinking are still needed. More still needs to be known about relationships between the critical thinking abilities of the nursing faculty and the ways students are taught these skills through the curriculum and clinical experiences.     

Enhancing diagnostic reasoning skills in nurse practitioner students: a teaching tool

The Advanced Health Assessment course provides an opportunity to focus on critical thinking and diagnostic reasoning skills as students transition to the nurse practitioner role.The authors describe a structured teaching tool designed for faculty to use in facilitating diagnostic reasoning and clinical judgment.This tool gives faculty a format to use in the classroom or online for helping students decide which data to collect and which data are important in developing hypothesis driven differential diagnoses.     

Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study

Background

This paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the accuracy of nursing diagnoses. Knowledge sources can support nurses in deriving diagnoses. A nurse??s disposition toward critical thinking and reasoning skills is also thought to influence the accuracy of his or her nursing diagnoses.

Method

A randomised factorial design was used in 2008?C2009 to determine the effect of knowledge sources. We used the following instruments to assess the influence of ready knowledge, disposition, and reasoning skills on the accuracy of diagnoses: (1) a knowledge inventory, (2) the California Critical Thinking Disposition Inventory, and (3) the Health Science Reasoning Test. Nurses (n?=?249) were randomly assigned to one of four factorial groups, and were instructed to derive diagnoses based on an assessment interview with a simulated patient/actor.

Results

The use of a predefined record structure resulted in a significantly higher accuracy of nursing diagnoses. A regression analysis reveals that almost half of the variance in the accuracy of diagnoses is explained by the use of a predefined record structure, a nurse??s age and the reasoning skills of `deduction?? and `analysis??.

Conclusions

Improving nurses?? dispositions toward critical thinking and reasoning skills, and the use of a predefined record structure, improves accuracy of nursing diagnoses.     

Effective teaching: The 20-20-10-10 model

Academic nurse educators in prelicensure registered nursing programs may find it challenging to create effective teaching and learning activities to promote student development of critical thinking skills that lead to safe clinical judgments. Many faculty are experienced clinicians who are experts in their fields of clinical practice but lack formal training in teaching and assessment of adult learners. This article describes a teaching framework called the 20-20-10-10 model that creates a dynamic, engaging environment and inspires students to seek active inquiry.     

Clinical touch points: Using the PREP framework to improve critical thinking among pre-licensure nursing students

Clinical care plan assignments and the use of concept mapping traditionally incite critical thinking and clinical judgment skills for pre-licensure nursing students. An ongoing debate in the literature apropos the effective use of both tools, either used alone or collectively, and which tool best promotes increased critical thinking skills among nursing students. Typically, the use of both tools requires the student to complete at least some elements of the assignment outside of the clinical setting after the clinical experience concludes. Standard clinical tasks take precedence during the clinical experience leaving little to no time to complete paperwork such as care plans or concept maps. This paper reconnoiters the concepts of critical thinking and clinical judgment among pre-licensure nursing students, the techniques to enhance these critical skills, and proposes a framework to promote an innovative solution for nurse educators and students easily deployed during clinical experiences with assignment recommendations following the clinical experience.     

Critical thinking in clinical nurse education: Application of Paul’s model of critical thinking

Nurse educators recognize that many nursing students have difficulty in making decisions in clinical practice. The ability to make effective, informed decisions in clinical practice requires that nursing students know and apply the processes of critical thinking. Critical thinking is a skill that develops over time and requires the conscious application of this process. There are a number of models in the nursing literature to assist students in the critical thinking process; however, these models tend to focus solely on decision making in hospital settings and are often complex to actualize. In this paper, Paul’s Model of Critical Thinking is examined for its application to nursing education. I will demonstrate how the model can be used by clinical nurse educators to assist students to develop critical thinking skills in all health care settings in a way that makes critical thinking skills accessible to students.     

A comparison of critical thinking skills in standard and non-standard entry diploma students

Critical thinking is often seen as the hallmark of the educated professional.The conceptualization and measurement of critical thinking have been topics of much debate for over 70 years. This study reports a small scale comparative study of critical thi nking skills in standard and non-standard entry diploma students. A significantdifference in critical thinking skills between these groups at the point of entry was observed. There were no significant differences in critical thinking skills between the start of the course and the end of the common foundation course for both groups. This finding is consistent with many other studies investigating critical thinking in nurse education. The implications of these findings and the wider issue of the measur ement of critical thinking are discussed.     

Implementation and evaluation of critical thinking strategies to enhance critical thinking skills in Middle Eastern nurses

The purpose of this study was to develop, implement and evaluate critical thinking strategies to enhance critical thinking skills in Middle Eastern nurses. Critical thinking strategies such as questioning, debate, role play and small group activity were developed and used in a professional development programme, which was trialled on a sample of Middle Eastern nurses (n = 20), to promote critical thinking skills, encourage problem solving, development of clinical judgment making and care prioritization in order to improve patient care and outcomes. Classroom learning was transformed from memorization to interaction and active participation. The intervention programme was successful in developing critical thinking skills in both the nurse educators and student nurses in this programme. This programme successfully integrated critical thinking strategies into a Middle Eastern nursing curriculum. Recommendations are as follows: (1) utilize evidence‐based practice and stem questions to encourage the formulation of critical thinking questions; (2) support the needs of nurse educators for them to effectively implement teaching strategies to foster critical thinking skills; and (3) adopt creative approaches to (i) transform students into interactive participants and (ii) open students' minds and stimulate higher‐level thinking and problem‐solving abilities.     

Reliability of assessment of critical thinking.

Although clinical critical thinking skills and behaviors are among the most highly sought characteristics of BSN graduates, they remain among the most difficult to teach and assess. Three reasons for this difficulty have been (1) lack of agreement among nurse educators as to the definition of critical thinking, (2) low correlation between clinical critical thinking and existing standardized tests of critical thinking, and (3) poor reliability in scoring other evidences of critical thinking, such as essays. This article first describes a procedure for teaching critical thinking that is based on a consensus definition of 17 dimensions of critical thinking in clinical nursing practice. This procedure is easily taught to nurse educators and can be flexibly and inexpensively incorporated into any undergraduate nursing curriculum. We then show that students' understanding and use of these dimensions can be assessed with high reliability (coefficient alpha between 0.7 and 0.8) and with great time efficiency for both teachers and students. By using this procedure iteratively across semesters, students can develop portfolios demonstrating attainment of competence in clinical critical thinking, and educators can obtain important summary evaluations of the degree to which their graduates have succeeded in this important area of their education.     

Logic models used to enhance critical thinking

Over time, various methods have been used to stimulate critical thinking in undergraduate nursing students, and although many have been successful in helping students integrate the essential knowledge, experiences, and clinical reasoning that support practice, it is also useful to explore new methods. Faculty at the University of Hawaii at Manoa, School of Nursing and Dental Hygiene have taken an innovative approach of using logic models to further enhance critical thinking. This article presents an application of varying experiences and methods of using logic models to support the development of critical thinking and reasoning skills in nursing students. The processes in which logic models are used in the curriculum are described. The models are used to connect concepts from concrete to abstract levels in diverse and often nonlinear diagrams, guided discourse, and written assignments. The specific instructional methods used include concept mapping, concept papers, conceptual linking, and substruction.     

Radical transformation: Embracing constructivism and pedagogy for an innovative nursing curriculum

To effectively navigate today's complex and rapidly changing health care environments, nurses require a high level of knowledge, sound psychomotor skills, diverse thinking and reasoning abilities, and a strong professional identity. The evidence showed that programs that offer students focused clinical practice experiences and offer students opportunities to ‘think like a nurse’ enable them to become sound practitioners. Faculty and staff at one mid-sized research-intensive university in Western Canada, engaged in an iterative process of rethinking the theoretical and pedagogical underpinnings of a BSN curriculum for educating nurses for the complexity of today's practice.Constructivist learning theory was chosen as the main underpinning of the revised curriculum. Furthermore, transformational learning theory guided the selection of several pedagogical approaches utilized throughout the program with the goal of inviting critical reflection and encouraging the development of competent, compassionate, ethical, and professional nurses. Additionally, we employed an innovative approach to clinical practicums where the process of learning is both integrated and intentional, and students are mentored to use prior knowledge in their decisions and clinical reasoning.     

Congruency in defining critical thinking by nurse educators and non-nurse scholars

This study investigated nurse educators' definition of the concept critical thinking. A sample of 201 baccalaureate nurse educators in midwest nursing programs completed a questionnaire identifying their perception of critical-thinking skills and characteristics, and their agreement with non-nurse critical-thinking experts on items often considered to be critical thinking. This study found that nurse educators agreed with non-nurse critical-thinking experts on the skills and dispositions; however, significant differences were found between nurse educators and non-nurse experts regarding concepts related to critical thinking. Nurse educators were more likely to identify researching, problem-solving, decision-making, and planning as critical thinking. Despite their assertion otherwise, it is apparent from this study that nurse educators have a different perception of critical thinking than scholars in other disciplines. This study suggests that practice disciplines such as nursing may perceive critical thinking differently than educators in nonpractice disciplines.     

Assessing the critical thinking skills of faculty: What do the findings mean for nursing education?

The purpose of this study was twofold: to determine the critical thinking skills of nurse faculty and to examine the relationship between epistemological position and critical thinking. Most participants reported having no education on critical thinking. Data were collected using the California Critical Thinking Skills Test (CCTST) and the Learning Environment Preferences (LEP). Findings from the CCTST indicated that faculty varied considerably in their ability to think critically; LEP findings suggested that participants had not reached the intellectual level needed for critical thinking. In addition, 12 faculty participated in one-hour telephone interviews in which they described experiences in which students demonstrated critical thinking. Despite a lack of clarity on the definition of critical thinking, faculty described clinical examples where students engaged in analysis, inference, and evaluation. Based on these findings, it is recommended that faculty transfer their ability to engage students in critical thinking in the clinical setting to the classroom setting. Benchmarks can be established based on the ability of faculty to engage in critical thinking.     

Retaining ethnic minority nursing students (REMNS): a multidimensional approach.

The under-representation of minority nurses in the nation is of critical concern for nurse educators. The high attrition rate of minority nursing students, on a local and national level, has not been effectively addressed. Project REMNS (Retaining Ethnic Minority Nursing Students), an innovative, comprehensive project, was designed to increase the retention of minority nursing students at Prairie View A&M University. Pre-clinical nursing students were provided strategies to improve critical thinking, stress management, and reading comprehension skills. This was accomplished by the development and implementation of content relevant computer modules on stress management, nutrition, and critical thinking. Implementation of Project REMNS resulted in an increased number of pre-nursing students admitted and retained in the nursing program.     

The influence of concept mapping on critical thinking in baccalaureate nursing students

This article describes a quasi-experimental study that used a pretest-posttest design with a control group to evaluate the effectiveness of concept mapping in developing critical thinking skills in baccalaureate nursing students. A convenience sample (n = 76) was randomly assigned to experimental (n = 44) and control (n = 32) groups. The experimental group was taught to use concept mapping of patient information to prepare for clinical experiences. The control group was taught to use traditional nursing care plans. Critical thinking skills were measured with the California Critical Thinking Skills Test, which yielded six scores: an overall score and five subscales (analysis, evaluation, inference, deductive reasoning, and inductive reasoning). A significant difference (p <.05) was found between the mean pretest and posttest scores and each subscale. Post hoc tests found differences between groups to be insignificant, while various differences within a group were significant. Experimental-group scores improved significantly (p <.05) on the overall score and the analysis and evaluation subscales, while control-group scores improved significantly only on the evaluation subscale and declined significantly on the inference subscale. The findings suggest that concept mapping is effective in helping students develop critical thinking skills.     

Concept analysis and critical thinking: a complementary relationship in nursing

The purpose of this paper is to demonstrate the relationship between the concept analysis process and critical thinking skills in nursing. Utilizing a discursive essay approach, it is argued that the concept analysis technique enhances critical thinking. The steps of the concept analysis are analyzed as to the inherent cognitive operations that represent critical reasoning processes. Reflecting on an experience with undergraduate nursing students, the technique of concept analysis is evaluated as a didactic activity that enhances critical thinking. It is concluded that both processes complement each other in the rethinking of nursing and in confronting challenging practice situations.     

Extended immersive simulation to develop nontechnical skills: Content analysis of students' views

BackgroundThe purpose of undergraduate nursing education is the preparation of graduates for clinical practice. Despite this focus, graduates are often unprepared for independent practice, particularly in the use of skills such as time management, delegation and critical thinking in clinical situations. This paper reports on students’ views of using extended, immersive simulation to consolidate the use of both technical and nontechnical skills in preparing them for independent nursing practice.AimTo investigate students’ views on the value of extended, immersive simulation in preparing them for independent practice as registered nurses.MethodsCross-sectional research involving content analysis of open-ended survey questions. The study involved comments from 287 final year nursing students conducted at a university in Western Australia.FindingsThemes related to critical thinking, the role of the registered nurse, communication, time management, teamwork and leadership were identified through the content analysis. Students believed exposure to extended simulation facilitated development of the essential skills required to practise independently and helped them prepare for the role of a registered nurse. Many expressed the wish for this type of simulation to be included throughout all years of the nursing curriculum.DiscussionStudents need experience in clinical situations where they are challenged to use multiple skills simultaneously to develop the expertise required of registered nurses. The ability to practise independently, and take responsibility for decisions made in complex ward conditions, is not currently required of students on clinical placements. Simulation is a way to fill this void in nursing education to enable students to experience the full role of a registered nurse.ConclusionBased on our findings nursing students believed that extended, immersive simulation was an effective method of supporting students as they undertake the full responsibilities of registered nurses to enable them to be safe and effective practitioners on commencement of the registered nurse role.     

Critical thinking skills of baccalaureate nursing students at program entry and exit

Most nurse educators would agree that critical thinking is an essential competency for the professional nurse in today's ever-changing health care environment. In fact, critical thinking has been identified as an integral component of professional nursing practice and has been incorporated in accreditation guidelines (1-3). As a result of this imperative, professional programs of nursing must explicate a clear definition of critical thinking, identify specific learning outcomes reflective of critical thinking abilities, and select appropriate ways to measure the achievement of these outcomes in graduating students. Although much has been written about the need for critical thinking skills, the concept and measurement of critical thinking within the context of nursing education has not yet been clearly defined (4-6). As a result, nursing programs are developing their own conceptual definitions of critical thinking and using a variety of methods to measure outcomes (5). The authors caution that to ensure validity of findings, the instruments used must reflect the individual program's definition of the concept. In most cases, outcomes have been assessed using a cross-sectional design that compares students at different levels or types of programs or are measured as an end-of-program outcome. While such designs can provide educators with knowledge of students' critical thinking abilities at a particular point in the educational process, longitudinal data are needed to assess the effects of the educational program.