Nurse educators' critical thinking: A mixed methods exploration

Acquisition of clinical reasoning skills by undergraduate nursing students in Malawi; towards the development of a middle-range theory: a qualitative study

INTRODUCTION

Acquiring clinical reasoning skills is essential for patient safety in nursing, and a lack of clinical reasoning skills can harm patients. However, teaching and learning clinical reasoning skills is not easy due to its complexity. Without a model, clinical reasoning is taught intuitively. Therefore, this study aimed to investigate how undergraduate nursing students acquire clinical reasoning skills towards the development of a middle-range theory.

METHODS

This study employed the grounded theory of systematic design underpinned by a social constructivism paradigm. Forty-eight (48) undergraduate nursing students were purposive, and 12 nurse educators were theoretically sampled. Nurse educators were full-time lecturers with two or more years of teaching experience who were willing to share their knowledge to promote clinical reasoning skills. Students in their third and fourth years were selected because of their completion of the three- to four-year educational process and their acquisition of essential knowledge and competencies. Twelve individual in-depth interviews and six focus group discussions were conducted with nurse educators and undergraduate nursing students, respectively. Two qualitative data analysis frameworks were employed to analyse the data: thematic analysis and grounded theory analysis. Ethical principles of respect for human dignity, beneficence and justice were observed.

RESULTS

Undergraduate nursing students reported that their clinical reasoning skills were acquired through automation while they utilized the nursing process. Through the themes, a new theory called 'a middle-range theory for the acquisition of clinical reasoning skills' was generated in the present study. The associated concepts were the environmental setting, type of curriculum, anchors and expected outcomes, which included individual and health care system indicators.

CONCLUSION

Teaching undergraduate nursing students how to reason clinically will help nurses adjust and solve problems in changing patients' situations. On the basis of the findings of this study, it is recommended that nursing students be equipped with adequate clinical reasoning skills before they graduate. Therefore, implementing the new model called 'a middle range theory for the acquisition of clinical reasoning skills' could foster the development of clinical reasoning skills from the start of the nursing training program.

Critical thinking level in nursing degree students according to sociodemographic and academic variables: A correlational study

AIMS

To determine the level of critical thinking of undergraduate nursing students during their clinical practice, as well as to identify the relationship between sociodemographic and academic variables.

BACKGROUND

Nursing degree programs should prioritize the development of critical thinking skills in their curriculum and regularly assess students to ensure the acquisition of core competencies.

DESIGN

Multicenter, descriptive, cross-sectional, correlational, descriptive study. Participants included were students from the Degree in Nursing enrolled during the academic year 2020-2021. Students were selected by convenience from three universities located in Catalonia, Spain. Data were collected from 429 students, with 98 being excluded due to incomplete data.

METHODS

Data were collected by administering the Nursing Critical Thinking in Students Questionnaire and an ad hoc form of sociodemographic and academic characteristics. The STROBE guidelines checklist were followed. The study involves a secondary analysis of data from a previous study that presented psychometric analysis.

RESULTS

No significant differences were observed in total Critical Thinking scores across various parameters including academic year, current situation, work experience in healthcare, previous academic training, family situation, or recent stressful events. On average, students demonstrated moderate critical thinking scores. However, statistically significant relationships emerged between critical thinking scores and gender (p=0.046), institution attended for undergraduate studies (p=0.019) and having satisfactory social relationships despite experiencing stressful events (p=0.330).

CONCLUSIONS

The study delves into the correlation between critical thinking skills and sociodemographic and academic factors, identifying students who may benefit from specific interventions and advocating for adaptable educational methods. It emphasizes the pivotal role of trust in fostering critical thinking in nursing education and suggests a connection between critical thinking and strong social relationships. In conclusion, evaluating critical thinking is crucial for addressing healthcare challenges, validating teaching strategies and promoting continuous improvement in nursing education.

Factors associated with the critical thinking ability among nursing students: An exploratory study in Iran

BACKGROUND AND OBJECTIVE

Critical thinking is a crucial skill in nursing that nursing students should apply in their work environment. It involves analyzing, evaluating, and interpreting information. It is used in various topics such as disease diagnosis, treatment planning and implementation, monitoring, and evaluation of results, problem-solving, and decision-making in emergencies. This study in Iran aimed to evaluate factors associated with nursing students' critical thinking ability.

STUDY METHOD

Following the STROBE guidelines, an analytical cross-sectional study was conducted in Ardabil province, northwest Iran. The study collected data through convenience sampling at nursing schools in Ardabil province, with a sample of 246 nursing students participating. The data collected from a demographic information form and the Persian version of the Nursing Critical Thinking in Clinical Practice Questionnaire were analyzed using SPSS version 22.0 software.

RESULTS

The study found that the overall mean score of clinical critical thinking among nursing students was 313.87 ± 25.80 (range = 109-436). Based on this score, most students reported low (63%) or moderate (37%) clinical critical thinking levels. The highest and lowest mean scores between dimensions were related to the intellectual and cognitive (127.99 ± 13.30) and technical (17.25 ± 3.43), respectively. Multiple linear regression analysis revealed that semester and college were predictors of clinical critical thinking among nursing students. The selected predictors accounted for 19.3% of the total variance in clinical critical thinking scores (F = 9.396, p < 0.001).

CONCLUSION

The study results showed that nursing students could have performed better in critical thinking ability. The study suggests that nursing education programs should prioritize teaching critical thinking skills in clinical settings as it is an essential subject in nursing education. With significant changes in nursing clinical environments, enhancing clinical critical thinking can improve nursing student performance clinically. Therefore, one of the crucial learning objectives in a clinical nursing course is to develop clinical critical thinking skills for nursing students.

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.

Effect of concept mapping model on critical thinking skills of family medicine residents: A randomized controlled trial

BACKGROUND

The cognitive process of critical thinking (CT) involves the examination of the existing reasons and an analysis of the information to draw conclusions and make decisions. The goal of the study was to determine how concept mapping (CM) technique affects family medicine residents' capacity for critical thought.

MATERIALS AND METHODS

We conducted a randomized controlled trial among family medicine residents aged between 26 and 28 years. A total of 100 residents were involved; over the course of 3 months, 50 residents were exposed to the conventional teaching model and 50 residents to the CM model. Data was collected using California CT skills test (CCTST) modified Arabic version and a self-administered questionnaire. The primary intervention was teaching method, experimental group received CM lessons while control group had conventional lessons. First session was carried out at baseline and second session one week after baseline, whereas 3rd, 4th, and 5th sessions conducted at end of 1st, 2nd, 3rd months, respectively. Both groups were assessed at baseline and at end of 3rd month. Both groups were reassessed at end of three months. Quantitative data was presented as mean and SD, whereas frequencies and percentages used for qualitative data. Pre- and post-intervention CT scores for study groups were compared using t-test or Mann-Whitney U test, as appropriate. Groups were compared on pre- and post-intervention CT grades using Chi-square test.

RESULTS

Vast majority (98%) of participants were females, nearly half were 27 year old, and belonged primarily to urban areas (76%). There was no difference in the CT scores between the groups at baseline. The post-intervention CT scores for study group were statistically significantly higher (18.36±2.68) compared to control group (15.94±1.94) (P = 0.001).

CONCLUSION

The CM approach was superior to the conventional teaching approach in terms of improving CT.

Critical thinking abilities among newly graduated nurses: A cross-sectional survey study in China

AIM

The aim of this study is to describe critical thinking dispositions among newly graduated nurses with different educational background in China and to explore related factors.

DESIGN

A cross-sectional questionnaire survey.

METHODS

The data were collected using the Chinese Version of Critical Thinking Dispositions Inventory (CTDI-CV). Overall, 588 newly graduated nurses finally completed the survey. Spearman and Pearson's correlation coefficients were used to examine the correlation between the CDTI-CV and nurses' general characteristics.

RESULTS

In terms of open-mindedness, analysis and inquisitiveness subscales, significant differences were found among nurses based on three educational level. When dichotomizing total CTDI scores into high and low, nearly 80% of the respondents fell into low score group. Pressure from workplace was high for 68.4% of them. Significant correlation was found among the new graduated nurses' critical thinking ability and their age, education level, reading habit and attitude towards nursing profession.

The impact of critical thinking training using critical thinking cards on clinical decision-making of CCU nurses

Introduction

Due to the complexity of the situation and rapid changes in patients' clinical status in intensive care units, it is necessary to teach decision-making skills to nurses, alongside critical thinking. The aim of this study was to evaluate critical thinking training by using critical thinking cards on clinical decision-making of nurses in cardiac care units (CCU).

Methods

In this quasi-experimental study, 74 CCU nurses from the selected hospitals affiliated to Ahvaz and Dezful Universities of Medical Sciences were selected based on the inclusion criteria and were assigned to either the intervention or the control group by using permuted block randomization. The data were entered into SPSS V22 and analyzed.

Results

There was no statistically significant difference between the demographic characteristics of the two groups (P < 0.05). The mean total score of nurses' clinical decision-making before training sessions in the intervention group was calculated to be 141.59 ± 10.76, which was lower compared to a score of 148.56 ± 10.95 in the control group (P = 0.011). Therefore, covariance analysis was used to modify the results. The mean total score of nurses' clinical decision-making after the training in the intervention group was calculated as 163.82 ± 8.83, indicating a significant increase compared to a score of 154.50 ± 11.25 in the control group (P < 0.001).

Conclusion

The findings of the present study show that the education of critical thinking by using the critical card tool leads to improved clinical decision-making in CCU nurses.

Development of critical thinking skills of undergraduate students throughout the 4 years of nursing degree at a public university in Spain: a descriptive study

OBJECTIVE

To analyse the critical thinking skills of students enrolled in the four academic years of the nursing degree at a public university belonging to the European Higher Education Area.

DESIGN

Cross-sectional, quantitative, descriptive study. Using the Critical Thinking Questionnaire to analyse the critical thinking skills in their substantive and dialogic dimension.

SETTING

Faculty of Nursing, Valladolid Public University in Spain, belonging to the European Higher Education Area.

PARTICIPANTS

The sample consisted of 215 first-year, second-year, third-year and fourth-year undergraduate nursing students.

MAIN OUTCOMES

The students of the four academic years were positively disposed towards critical thinking. The students of the final courses obtained higher average scores.

RESULTS

The study sample was 215 students, 19.1% men/80.9% women. The average score in the substantive dimension (3.81±0.53 points) was higher than that in the dialogic dimension (3.48±0.51 points) (p<0.001). They had a greater ability in listening and speaking (3.77±0.61 points) with respect to writing (3.65±0.61 points) and reading (3.52±0.43 points) (p<0.001). There are significant differences in the critical thinking average scores across academic years.

CONCLUSIONS

Nursing students displayed a greater critical thinking ability in its substantive dimension compared with the dialogic one. This reflects a greater ability in actions related to provide reasons and evidence that support their point of view. Identifying critical thinking skills in nursing students will help establish specific teaching methodologies focused on improving these skills.

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.

Professional development in clinical teaching: An action research study

OBJECTIVE

Clinical supervisors, who support and assess health students' clinical learning, encounter many challenges. Professional development opportunities for clinical supervisors to overcome the challenges are available but are often designed to meet organisational and tertiary provider administrative needs, rather than the needs of intended target groups.

DESIGN

A qualitative action research study was designed to include a group of Australian nursing clinical supervisors in the design and implementation of meaningful professional development activities.

PARTICIPANTS

Ten clinical supervisors, from one organisation, participated in three meetings to explore shared challenges and create solutions to resolve these challenges.

RESULTS

Over a seven-month period in 2018-2019 data revealed clinical supervisors in this study experienced a variety of tensions. Participants prioritised three opposing tensions that were of shared concern; Doing and Thinking; Educator and Clinician and Negotiating and Challenging. Being able to visualise and articulate these tensions helps to empathise with the role complexity that clinical supervisors experience, and this led to the production of solutions which validate and advocate for the role and the values.

CONCLUSION

The group created innovative solutions such as podcasts, posters, banners and flyers to assist them to harmonise the tensions and work more effectively in their role.

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

INTRODUCTION

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

BACKGROUND

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

AIM

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

DESIGN

A descriptive qualitative study.

METHODS

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

RESULTS

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

CONCLUSIONS

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