The relationship of education to critical thinking ability and values among nurses: socialization into professional nursing

Cognitive-behaviour intervention for critical thinking disposition of religion and social science students

BACKGROUND

The dispositions of students towards critical thinking (CT) no doubt improve their clinical practice and performance. Hence, efforts to explore ways to help students become aware and conscious of the need for CT are imperative for their self-actualization, development, and improved professional practice. It is worrisome that in spite of the limited intervention addressing CT disposition challenges, scholars are yet to study the problem, especially in developing countries.

METHODS

In view of that, we assessed how CT disposition can be improved among students enrolled in cognitive-behavioral reflective training programme (CBRT-P) using a group-randomized control study with three months follow-up. To achieve this, 163 students were allocated to different groups. The recruited participants were exposed to CBRT-P.

RESULTS

Repeated-measures analysis performed shows that at the posttest, the mean CT disposition scores of the participants enrolled in CBRT-programme (treatment group) were significantly greater compared to the counterpart group that is the comparison group. At the third assessment, the mean score of the dependent measure consistently remained higher in favor of the experimental group.

CONCLUSION

Given the results, it is concluded that the treatment programme improves the CT disposition of students over time.

Measurement and Comparison of Nursing Faculty Members’ Critical Thinking Skills

Nursing faculty members strive to teach students to think critically. It has long been assumed that nursing faculty members are good at critical thinking because they are expected to teach these skills to students, but this assumption has not been well supported empirically. Faculty members question their ability to think critically and are unsure of their skills. The purpose of this study was to address this assumption by measuring nursing faculty members’ critical thinking skills and compare the faculty mean score to that of a student norming group, and to the mean scores of other nursing faculty studies. Findings can be used to increase nursing faculty members’ understanding of their critical thinking skills, prompt discussion about critical thinking skills, and to help faculty members address concerns and uncertainty about the concept of critical thinking. This study also helps establish an empirical basis for future research.

Exploring how new registered nurses construct professional identity in hospital settings

PURPOSE

To describe and explore the experiences that contribute to the construction of professional identity in hospital nurses 1 to 3 years postgraduation from nursing school.

METHODOLOGY

This qualitative study used in-depth interviewing and open-ended questions with a semistructured format. All interviews were audiotaped and transcribed. Twenty-one interviews were conducted with 16 participants. The researcher analyzed the data through the lens of symbolic interactionism.

RESULTS

The study identified various passage points as nurses progressed in establishing their professional identity in the first 3 years after graduation. These points required adaptation to stress to accomplish successful negotiation and included finding a niche, orientation, the conflict of caring, taking the licensure examination, becoming a charge nurse, and moving on. A sense of responsibility and the need for continual learning and perfection were inherent in all passage points.

CONCLUSION

The significance of this study rests in situational influences on the construction of identity, the need for balance and support in the practice environment, passage points in the first 3 years of practice, and the organizational need to support nursing empowerment and voice.

Critical thinking and patient outcomes: A review

There has been a multidisciplinary plethora of critical thinking definitions stemming from educators in 1912 1 through and inclusive of today. As nurses' roles change in response to the dynamics of managed care and an increase in use of biotechnology in health care, more is expected of them both in terms of psychomotor and cognitive skills. The American Association for Colleges of Nursing requires that critical thinking be reflected within academic nursing programs as a core competency for program accreditation. 2 Although critical thinking has been associated with and evaluated in regard to learning outcomes, little information exists which links critical thinking to patient outcomes. The purpose of this article is to provide a literature review of critical thinking and to explore a possible link between nurses' critical thinking and patient outcomes.

Nursing Reflections from Journaling During a Perioperative Internship

AN IMPORTANT CONCERN in nursing practice and education is the difficulties nurses experience as they transition into a new clinical area. THIS STUDY compared the reflective journals of 26 experienced and inexperienced nurses participating in a nine-week perioperative internship. THE STUDY examined self-regulated learning strategies used to enhance metacognitive critical thinking abilities.

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.

The Values Profile of Nursing Undergraduate Students: Implications for Education and Professional Development

This study examined the values profile of 152 nursing undergraduate students, as measured by the 20 life and work values from the Values Scale, and compared their profiles to those from a comparable sample of 111 management undergraduate students. Results showed that Personal Development and Altruism are the most important values for this sample of nursing students. There also were several significant age effects related to six of the values. The results of the t tests showed that the nursing sample had a significantly higher mean on the Altruism value and lower means on the Life Style, Advancement, Autonomy, Authority, Creativity, Economic, and Risk values, compared to the management sample. Recommendations are offered for nurse educators and managers. Inevitably, values compel individuals to be and to act, both personally and professionally.

Preceptorship and Critical Thinking in Nursing Education

Although preceptorship is being used increasingly by nursing faculty in the practice setting, little is known about how preceptors teach and even less is known about how critical thinking is being fostered in that relationship. The purpose of this study was to examine the process used in preceptorship to develop and promote the critical thinking ability of baccalaureate nursing students. Using the grounded theory method, this study was conducted in a large tertiary care hospital. Participants included fourth-year baccalaureate nursing students (preceptees) and their staff nurse preceptors. Data collection was composed of semistructured interviews and observations of the preceptors and preceptees as they worked together in the practice setting. Secondary data sources included documents considered appropriate to the study (e.g., nurse notes, student journals). By constant comparative analysis of the data, the findings of this study revealed a process that reflects the enabling of students by preceptors to develop and promote their critical thinking ability in the practice setting.

Enhancing Metacognition Through the Reflective Use of Self-Regulated Learning Strategies

BACKGROUND

An important concern of nursing practice and education is the difficulty new graduates experience while making the transition from graduate nurse to practicing nurse.

METHOD

Using a comparative descriptive design, self-regulated learning strategies were used to enhance metacognitive critical thinking abilities as 32 new graduate nurses reflected during 8-week preceptorship programs.

RESULTS

Verbal protocol analysis revealed the majority of noun referents as metacognitive with thinking nouns increasing in rank from Week 1 to Week 8, present tense verbs were used most frequently with lower-level thinking phrases. Common themes in the narrative were knowledge observation, thinking strategies, judgments of self-improvement, judgments of competence, judgments of resources, self-reactions, and self-correction strategies.

CONCLUSIONS

New graduate nurses have unique circumstances to overcome in making a transition to the workplace, and having self-regulatory skills would enable this process. The data suggest nursing education and practice consider self-regulated learning prompts with new graduates to promote thinking strategies.

Professional Socialization of Baccalaureate Nursing Students: Can Students in Distance Nursing Programs Become Socialized?

Distance education programs may have difficulty socializing nursing students due to limited face-to-face student-faculty interaction. Socialized attitudes toward the nursing profession were assessed using two measures with three groups--senior BSN students enrolled at campus-based programs, senior BSN students enrolled in distance programs, and non-nursing students. The purpose of this analysis was to determine whether nursing students enrolled in distance programs had professional socialization outcomes comparable to nursing students enrolled in campus-based programs, and to examine the psychometric properties of two popular measures of professional socialization. Results indicated that students in the distance programs had higher scores than the campus-based nursing students, who, in turn, had higher scores than non-nursing students. A statistical interaction of RN status by program type indicated that health care experience was a critical factor in the socialization process. Of the two socialization measures examined, one had acceptable psychometric properties. These data suggest that health care and preceptorship experiences are important determinants of professional socialization and that students who opt for distance nursing programs graduate with socialization outcomes that are at least comparable to those of students who attend traditional programs.

Writing Multiple-Choice Test Items That Promote and Measure Critical Thinking

Faculties are concerned about measurement of critical thinking especially since the National League for Nursing Accrediting Commission cited such measurement as a requirement for accreditation (NLNAC, 1997). Some writers and researchers (Alfaro-LeFevre, 1995; Blat, 1989; McPeck, 1981, 1990) describe the need to measure critical thinking within the context of a specific discipline. Based on McPeck's position that critical thinking is discipline-specific, guidelines for developing multiple-choice test items as a means of measuring critical thinking within the discipline of nursing are discussed. Specifically, criteria described by Morrison, Smith, and Britt (1996) for writing critical-thinking multiple-choice test items are reviewed and explained for promoting and measuring critical thinking.

An Evidence-Based Project for Evaluating Strategies to Improve Knowledge Acquisition and Critical-Thinking Performance in Nursing Students

This longitudinal, quasi-experimental study with 142 junior nursing students focused on measurement of learning outcomes in two areas: acquisition of knowledge and development of critical thinking skills. The variation in clinical teaching strategy (structured versus unstructured health pattern assessment) was the independent variable. Results indicated significant gains in both knowledge and critical thinking performance from the beginning to the end of the semester. The significant gains in critical thinking performance provides support to the assertion that domain-specific measures of critical thinking are needed in nursing education. Additionally, our results suggested that it was the interaction between learning strategy and the characteristics of the learner that was more significant in determining knowledge improvement than the particular strategy. As a result of this study, it is recommended that faculty develop and use an evidence-based model to support their decision making regarding teaching methodologies. This seems especially relevant for large, introductory clinical courses that use team teaching to achieve educational goals related to improvement in critical thinking or knowledge.

Infusing critical thinking into the nursing curriculum through faculty development

An important prerequisite to changes in an educational program's predominant philosophy and culture is systematic faculty development to begin and sustain the evolution. The authors describe how one nursing school implemented a faculty development program with the goal of infusing critical thinking strategies into courses throughout the curriculum.

Implementing differentiated practice: personal values and work satisfaction among hospital staff nurses

This project was part of a collaborative model for nursing staff development and student education. Personal values and work satisfaction of 49 staff nurses working on three hospital units were compared. One of the units employed differentiated practice. Results revealed high similarity in personal values among all nurses. Work satisfaction was significantly higher among nurses working on the unit employing differentiated practice. The importance of assessing personal values of nurses emerged as an important aspect of staff development, and differentiated practice appeared to be related to staff nurse satisfaction.

Dispositional Differences in Critical Thinking Related to Gender and Academic Major

Dispositional differences among several university majors and across gender were examined in this exploratory study, using Facione's California Critical Thinking Disposition Inventory. Participants were 334 baccalaureate undergraduates (121 males, 213 females) enrolled in majors classified as practice disciplines (i.e., nursing, education, business) and nonpractice disciplines (i.e., English, history, psychology). A MANCOVA with grade point average as a covariate was conducted for majors, indicating significant main effects for major. Highest scores generally were found in English, psychology, and nursing. When majors were grouped into practice and nonpractice disciplines, nonpractice had generally higher disposition scores, and female scores in both practice and nonpractice disciplines were higher than males on Open-Mindedness and Maturity.

Nursing Education for Critical Thinking: An Integrative Review

This integrative review summarizes 20 research studies reported from 1977 to 1995 that review change in the critical thinking abilities of professional nursing students. The Watson-Glaser Critical Thinking Analysis was used in 18 of 20 studies. The primary assumption was that critical thinking skills would increase during nursing education. However, the results of this review are mixed and contradictory. Possible reasons for these results are discussed.

Inquiry-based learning and critical thinking in an advanced practice psychiatric nursing program

The advanced practice psychiatric nurse must be prepared to meet the changing demands being placed on the nursing profession. Some changes are the product of health care reforms, especially managed care. Others are more fundamental, because continuing scientific advances drive rapid changes in the knowledge base required of mental health nurses. Curricular reforms initiated earlier this decade were intended to equip nurses with the problem-solving and critical-thinking skills required to deal with novel and complex situations in a rapidly changing healthcare system. This article describes how the Inquiry-Based Learning tutorial method attends to the mental processes of graduate students and fosters critical-thinking skills.

Inquiry-based learning as a teaching strategy for critical thinking

Changes in the healthcare system have prompted educators to rethink and revise nursing curricula. The National League for Nursing has outlined recommendations for the successful implementation of socially relevant curricula that reflect the diversity and plurality of local communities. Such revisions should better prepare graduates to function in a reformed healthcare system. Educational goals have shifted from curricula content to curricula outcomes. Beyond the mastery of content (which may quickly become outdated), the development of specific skills (critical thinking) and innovative responses to problems are now required of advanced practice nurses. Inquiry-based learning (IBL) offers an opportunity for graduate students to develop the necessary skills for effective practice. This article presents a model of IBL in graduate mental health education and an investigation of critical thinking skills as a possible outcome of the IBL method.

Critical thinking ability and clinical decision-making skills among senior nursing students in associate and baccalaureate programmes in Korea

This study compared Korean senior nursing students enrolled in associate degree programs (n = 119) and baccalaureate programs (n = 115) on measures of critical thinking ability and clinical decision-making skills. Samples were drawn from three associate degree programmes and four baccalaureate programmes accredited by the Korean Ministry of Education. 'Critical thinking ability' was determined by the Watson-Glaser Critical Thinking Appraisal and 'clinical decision-making' in nursing was measured by the Nursing Performance Stimulation Instrument. Independent sample t-tests comparing the associate degree group (mean score 41.98) and baccalaureate group (mean score 47.22) on the critical thinking measure yielded significant mean differences favouring the baccalaureate group. The baccalaureate group (mean score 26.53) also scored significantly higher than the associate degree group (mean score 23.49) on clinical decision-making. Within the total sample (n = 234) the relationship between critical thinking and clinical decision-making was weak but significant (r = 0.19, P = < 0.003).

Evaluating Critical Thinking Skills of Baccalaureate Nursing Students

This study evaluates the critical thinking skills of students enrolled in a baccalaureate nursing program, using the WGCTA, for the classes of 1993 through 1996. Scores were obtained at entry and at end of junior and senior years. The mean entry WGCTA score was 56 for all four classes; however, the 1995 and 1996 classes had significantly higher scores than the class of 1994. Critical thinking scores were higher at entry for older students and students who had completed another education degree; however, critical thinking scores were lower for students who had previous nursing experience. After adapting for age, previous degree, and nursing experience, no significant differences in the WGCTA scores from entry to end of junior and senior years emerged for the classes of 1993, 1994, 1995. Critical thinking skills have become the hallmark of education. The National Education Goal Panel has advocated for an increase in the ability to think critically, communicate effectively and solve problems (Banta, 1993). In turn, the nursing profession has incorporated these goals of higher education into its educational programs. The National League for Nursing (NLN) includes the measurement of critical thinking as a required outcome in the evaluation and accreditation of baccalaureate and higher degree programs in nursing. This critical thinking outcome must reflect the student's skill in analysis, reasoning, research, or decision making as these skills relate to the nursing discipline (National League for Nursing, 1992). To meet the NLN's critical thinking outcome criterion, nursing programs must have a method of evaluating this skill. Many programs use the Watson-Glaser Critical Thinking Appraisal (WGCTA), which is a standardized instrument. The College of Nursing at the University of Arkansas for Medical Sciences (UAMS) adopted this instrument to evaluate the critical thinking skills of students in the baccalaureate nursing program.

Clinical reasoning strategies used during care planning

This descriptive study provides insight into home health nurses' thinking processes as they planned care for chronically ill clients. The author interviewed five experienced home health nurses to elicit think-aloud data about 10 different chronically ill clients, obtaining 20 interviews. The researcher used verbal protocol analysis, a content analysis interpretive strategy, to unravel the concepts and label the cognitive processes used in the thinking task of planning nursing care. The following cognitive strategies were discovered: hypothesizing, cue logic, framing, reflexive comparison, prototype case reasoning, and testing. Findings support the importance of content, clinical context, and experience whenever reasoning to plan care. Findings did not support problem-solving models of thinking such as the nursing process. The findings for this study are applicable to staff development and education programs. Theoretical models of clinical reasoning need to be further developed and tested.

A proposed framework for teaching and evaluating critical thinking in nursing

Critical thinking is now an explicit National League for Nursing outcome requirement for nursing education programs, and all nursing faculty currently are expected to teach and evaluate critical thinking. However, most of the related literature is theoretical and not on the practical level that might be directly usable by faculty. This article presents a beginning framework developed by a faculty task force at the Indiana University School of Nursing for teaching and evaluating critical thinking. The conceptual definition of critical thinking underlying the framework reflects the efforts of several hundred experts from various disciplines, is maximally inclusive, and lends itself well to operationalization in the nursing context. The task force made two assumptions for this project: first, that the principles of rational thinking are essentially the same at every educational level, although the expertise expected of students at different educational levels certainly differs; and, second, that at this time a focus on operational as opposed to theoretical definitions for the six identified components of critical thinking (interpretation, analysis, evaluation, inference, explanation, and self-regulation) would be particularly useful for faculty and student understanding.

The perception and judgment of senior baccalaureate student nurses in clinical decision making

This descriptive, exploratory study sought to validate Brooks's theory of intrapersonal perceptual awareness, a middle-range theory derived from King's interacting systems framework and to extend King's work by making perception (sensory and intuitive), judgment (cognitive and affective), and decision making explicit concepts in the personal system. The results supported the theory's central premise and clarified the interaction between perception and judgment but did not support bringing perception, judgment, and decision making into the personal system as proposed. Self emerged as the core concept, and the results are used to recommend a proposed reconceptualization of King's personal system as self.

Enhancing critical thinking with case studies and nursing process

Challenged to enhance critical thinking concepts in a sophomore nursing process course, faculty expanded the lecture format to include group explorations of patient case studies. The group format facilitated a higher level of analysis of patient cases and more sophisticated applications of nursing process. This teaching strategy was a positive learning experience for students and faculty.

Critical Thinking: A Model

The emphasis on critical thinking in nursing has increased in response to the rapidly changing health care environment. This emphasis is underscored in nursing education by the National League for Nursing (NLN) accreditation process with the inclusion of a required outcome criterion related to the critical thinking abilities of baccalaureate nursing graduates. This article proposes a model and an accompanying process that can provide direction for nurse educators in the development and evaluation of nursing students' critical thinking abilities.

Factors Associated with Critical Thinking Among Nurses

The ability to think critically is increasingly hypothesized to play an important role in a nurse's ability to function competently in complex health care settings. This cross-sectional exploratory survey used secondary data (Gendrop, 1989) to assess the critical thinking ability of a convenience sample of 160 nurses from two urban hospitals. Four variables hypothesized to be associated with critical thinking ability were explored: age, level of education, years of nursing experience, and area of expertise in nursing. Critical thinking was assessed using the Watson Glaser Critical Thinking Appraisal Tool (WGCTA). Study findings suggest that age and years of experience were negatively correlated with critical thinking ability. However, the level of education was positively related to critical thinking. Future needs for research were identified and implications for nursing education and practice were provided.

Critical thinking as an educational outcome: an evaluation of current tools of measurement

Critical thinking, an outcome criterion of the National League for Nursing and the Council of Baccalaureate and Higher Degree Programs, is an abstract skill difficult to measure. The authors provide a comprehensive review of four instruments designed to measure critical thinking and summarize research in which the tools were used. Analysis of this information will empower nursing faculty members to select a critical-thinking instrument that is individualized to the needs of their respective nursing programs.

Role socialization of graduating student nurses: impact of a nursing practicum on professional role conception

This study examined graduating student nurse role conception changes that occurred during a concentrated clinical preceptorial. A Nursing Role Conceptions Questionnaire was administered to nursing students before (n = 44) and immediately after (n = 41) a 4-week Nursing Practicum; to the students' staff nurse clinical teaching associates (n = 34); and to nursing program faculty (n = 18). Respondent perceptions of ideal nursing behaviors and actual nursing behaviors within three major nursing roles (professional, service, and bureaucratic) were identified and differences between ideal and actual scores (role discrepancy) were calculated. Findings showed that student role orientation in selected areas changed from a faculty role orientation to a staff nurse role orientation over the 4-week period. The Practicum seemed to effectively facilitate role socialization of graduating student nurses into the work setting, easing the necessary transition from education to practice.

Initial nursing assessment and management of burn-injured children

Following a burn injury, children can deteriorate very quickly and prompt accurate assessment by the accident and emergency nurse is therefore essential. This article outlines the initial assessment and management of paediatric burns.