Critical thinking dispositions of nursing students in Asian and non-Asian countries: a literature review

The effect of "typical case discussion and scenario simulation" on the critical thinking of midwifery students: Evidence from China

BACKGROUND

Assessment ability lies at the core of midwives' capacity to judge and treat clinical problems effectively. Influenced by the traditional teaching method of "teacher-led and content-based", that teachers involve imparting a large amount of knowledge to students and students lack active thinking and active practice, the clinical assessment ability of midwifery students in China is mostly at a medium or low level. Improving clinical assessment ability of midwifery students, especially critical thinking, is highly important in practical midwifery education. Therefore, we implemented a new teaching program, "typical case discussion and scenario simulation", in the Midwifery Health Assessment course. Guided by typical cases, students were organized to actively participate in typical case discussions and to promote active thinking and were encouraged to practice actively through scenario simulation. In this study, we aimed to evaluate the effect of this strategy on the critical thinking ability of midwifery students.

METHOD

A total of 104 midwifery students in grades 16-19 at the West China School of Nursing, Sichuan University, were included as participants through convenience sampling. All the students completed the Midwifery Health Assessment course in the third year of university. Students in grades 16 and 17 were assigned to the control group, which received routine teaching in the Midwifery Health Assessment, while students in grades 18 and 19 were assigned to the experimental group, for which the "typical case discussion and scenario simulation" teaching mode was employed. The Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) and Midwifery Health Assessment Course Satisfaction Questionnaire were administered after the intervention.

RESULTS

After the intervention, the critical thinking ability of the experimental group was greater than that of the control group (284.81 ± 27.98 and 300.94 ± 31.67, p = 0.008). Furthermore, the experimental group exhibited higher scores on the four dimensions of Open-Mindedness (40.56 ± 5.60 and 43.59 ± 4.90, p = 0.005), Analyticity (42.83 ± 5.17 and 45.42 ± 5.72, p = 0.020), Systematicity (38.79 ± 4.70 and 41.88 ± 6.11, p = 0.006), and Critical Thinking Self-Confidence (41.35 ± 5.92 and 43.83 ± 5.89, p = 0.039) than did the control group. The course satisfaction exhibited by the experimental group was greater than that exhibited by the control group (84.81 ± 8.49 and 90.19 ± 8.41, p = 0.002).

CONCLUSION

The "typical case discussion and scenario simulation" class mode can improve the critical thinking ability of midwifery students and enhance their curriculum satisfaction. This approach carries a certain degree of promotional significance in medical education.

Stepping outside national borders: International active learning educational collaboration events

AIM

This paper discusses the benefits of international collaborations for advanced practice nursing education. It identifies new perspectives and innovative practices to enhance cultural competency.

BACKGROUND

Competent, well-trained advanced practice nurses (APNs) are necessary to provide high-quality and safe patient care, improve access to care, and address health disparities that are no longer geographically bound. In 2021, an international network of advanced practice educators established an active learning program to teach students their role in global citizenship and increase awareness of health disparities. APN students from Scotland, Wales, Minnesota, Houston, and Rotterdam participated in presentations, online discussions, and in-country scholarships.

SOURCES OF EVIDENCE

Growing health disparities have created the need for efficient international collaboration to develop new concepts, approaches, and bidirectional exchange of experiences, culture, and knowledge. Integrating global health into curricula engages students' curiosity and integrates education, research, practice, and leadership while improving cultural competency.

DISCUSSION

Forty-two students participated in the international presentations. The students strongly believed in the benefit of international collaboration and the need for a universal role for the advanced practice nurse. They responded positively to sharing cultural and clinical experiences.

CONCLUSION

The recent global health challenge supported the development of innovative methods to deliver education and created an opportunity for advanced practice students to develop cultural competence and critical thinking. Collaborative solutions are essential to education and healthcare as we move forward in the 21st century.

IMPLICATIONS FOR NURSING PRACTICE

Robust international collaborations have enabled the development of cultural competence and critical thinking. These are crucial elements for advanced practice roles.

Critical thinking education for dental schools in Asia: Perceptions of educators

Teaching competence in critical thinking is an important element of undergraduate dental curricula. The pedagogy for critical thinking education in Asia requires further discussion and neither the current situation nor the possible challenges are widely known from the perspectives of dental educators. Therefore, seven educators from four countries gathered online in the summer of 2021 to share the current situation and possible challenges. All the participants considered "critical thinking" was "important" (43%) or "very important" (57%), however, 86% mentioned that they faced challenges in delivering education in critical thinking. The challenges to delivering critical thinking education were insufficient time in the curriculum and lack of human resources; lack of information on appropriate teaching methods for the student population; and no established methods of assessment. How to teach and assess critical thinking therefore requires more brainstorming, and raising the awareness of educators to implement this education might be necessary.

A Technology-Supported Guidance Model to Support the Development of Critical Thinking among Undergraduate Nursing Students in Clinical Practice: A Concurrent, Exploratory, Flexible, Multi-Method Feasibility Study (Preprint)

BACKGROUND

There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP‑N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education.

OBJECTIVE

The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention.

METHODS

This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence.

RESULTS

Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention.

CONCLUSIONS

The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP‑N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/31646.

Trend of tendency to critical thinking among medical students in Tehran University of Medical Sciences, 2010-2015: A longitudinal study

BACKGROUND

Critical thinking is one of the goals of education. It is a criterion for academic accreditation in medical education by concentration on students' soft skills. Due to lack of basic information on critical thinking tendency in undergraduate medical program, this study aimed to determine the trend of tendency toward critical thinking of medical students in two phases: basic science (year 1) and preinternship (year 5) at Tehran University of Medical Sciences.

MATERIALS AND METHODS

This longitudinal descriptive-analytic study has been conducted in two phases (2010 and 2015); all 105 medical students were selected by accessible sampling method. Years of entrance to college was the inclusion criterion. The psychometric properties of The California Critical Thinking Dispositions Inventory (CCTDI) were confirmed, and then, the instrument was completed twice by participants. Data were analyzed by SPSS: 16 using student t-test, and paired t-tests.

RESULTS

There was a significant difference between genders of students (P < 0.05). Males were more disposed toward critical thinking than females. The significant increase was found between mean of truth-seeking in the second test compared to the first test; instead, the mean of inquisitiveness, analyticity and self-confidence and inquisitiveness was significantly decreased (P < 0.05). However, in other subscales, there were no significant differences between the 1^st and the 5^th year students (P > 0.05). The total score of the test in the second phase was lower than the first phase, which was not significant.

CONCLUSION

According to the findings, there is necessary to consider the critical thinking dispositions in medical students training programs and break down the barriers. Tendency toward critical thinking seems to be as prerequisite of critical thinking skills in undergraduate medical program.

Critical Thinking Cognitive Skills and Their Associated Factors in Chinese Community College Students in Hong Kong

The importance of fostering critical thinking (CT) in community college education has been recognized highly worldwide. However, limited studies have been conducted to investigate CT abilities among community college students in the Asian context. A cross-sectional correlational study was conducted with 209 Chinese community college students to assess the levels of CT cognitive skills and CT dispositions and to identify the associated factors. The California Critical Thinking Skills Test (CCTST), California Critical Thinking Disposition Inventory (CCTDI), and a questionnaire on the students’ socio-demographic and academic profiles were used. The results showed that the average level of CT cognitive skills was 17.82 ± 4.10, which was at the upper end of the moderate range. For CCTDI scores, the mean value was 278.81 ± 22.61 and positive disposition towards CT was shown in four subscales: open-mindedness, analyticity, confidence in reasoning, and inquisitiveness. From regression analysis, HKDSE total score (i.e., university entrance examination total score), CT subject grade level, CCTDI truth-seeking, and CCTDI analyticity were identified as the four significant factors associated with their CT cognitive skills. The findings provide significant implications when reviewing the program design and curriculum as well as the addition of CT elements in a separate course to promote students’ CT abilities for sustainable development.

A scoping review of clinical reasoning research with Asian healthcare professionals

Clinical reasoning is the thought process that guides practice. Although a plethora of clinical reasoning studies in healthcare professionals exists, the majority appear to originate from Western cultures. A scoping review was undertaken to examine clinical reasoning related research across Asian cultures. PubMed, SciVerse Scopus, Web of Science and Airiti Library databases were searched. Inclusion criteria included full-text articles published in Asian countries (2007 to 2019). Search terms included clinical reasoning, thinking process, differential diagnosis, decision making, problem-based learning, critical thinking, healthcare profession, institution, medical students and nursing students. After applying exclusion criteria, n = 240 were included in the review. The number of publications increased in 2012 (from 5%, n = 13 in 2011 to 9%, n = 22) with a steady increase onwards to 12% (n = 29) in 2016. South Korea published the most articles (19%, n = 46) followed by Iran (17%, n = 41). Nurse Education Today published 11% of the articles (n = 26), followed by BMC Medical Education (5%, n = 13). Nursing and Medical students account for the largest population groups studied. Analysis of the articles resulted in seven themes: Evaluation of existing courses (30%, n = 73) being the most frequently identified theme. Only seven comparative articles showed cultural implications, but none provided direct evidence of the impact of culture on clinical reasoning. We illuminate the potential necessity of further research in clinical reasoning, specifically with a focus on how clinical reasoning is affected by national culture. A better understanding of current clinical reasoning research in Asian cultures may assist curricula developers in establishing a culturally appropriate learning environment.

“Can East Asian Students Think?”: Orientalism, Critical Thinking, and the Decolonial Project

Amidst the increasing calls for the decolonisation of universities, this article interrogates the representation of East Asian students in Western academia. It is argued that East Asian students are often imagined in Orientalist ways, as can be evidenced by evaluating the depiction of East Asian students in academic publications. More specifically, it is suggested that common perceptions of East Asian students as lacking in critical thinking may unwittingly reinforce stereotypes that are rooted in historic narratives which depict East Asians as inferior to (white) Westerners. This article also explores the way in which East Asian academics and students may also subscribe to these Orientalist perceptions. Finally, this article offers a refutation of the stereotype that East Asian students struggle with critical thinking and it suggests that being more reflexive about the way that we imagine ethnic minority students should be a key component of our efforts to decolonise the university.

Development and validation of the critical thinking disposition inventory for Chinese medical college students (CTDI-M)

BACKGROUND

This study aimed to develop and conduct psychometric testing of the Critical Thinking Disposition Inventory to measure the critical thinking disposition of Chinese medical college students.

METHODS

The study was conducted in two stages: (a) item generation, reliability analysis and exploratory factor analysis (EFA) and (b) confirmatory factor analysis (CFA) and testing of psychometric properties (Cronbach' s alpha, test-retest reliability and convergent validity). The subjects included 1035 Chinese medical college students. The test-retest reliability of the instrument was determined at a two-week interval (n = 61). A general linear regression model was developed to examine the predictive effects of gender, age and major on CT disposition. The data were analysed with SPSS 22.0 and Amos 21.0 during item development and the reliability and validity analyses. Vista was utilized for parallel analysis during the principal axis analysis.

RESULTS

Eighteen final items were sorted into 3 factors, which were identified as "Open-mindedness", "Systematicity/Analyticity" and "Truth-seeking", with cumulative variance of 41.37, 46.00 and 49.59%, respectively. The Cronbach's alpha was 0.924, and the factors' alphas ranged from 0.824 to 0.862. The correlational analysis indicated significant correlations between the subscales of the CTDI-CM and the total scores of the CTDI-CV, indicating modest evidence for the convergent validity of the CTDI-CM. Gender, age and education significantly predicted the CT disposition of Chinese medical students. Open-mindedness and Systematicity/Analyticity were higher for medical students than for nursing students.

CONCLUSIONS

This study presents a reliable and valid instrument for clinical thinking disposition. Future studies should explore other predictive factors of CT dispositions (e.g., cognitive/motivational) and criterion validity.

Critical Thinking Disposition of Nurse Practitioners in Taiwan

BACKGROUND

Critical thinking disposition (CTD) is crucial for nurse practitioners who face complex patient care scenarios. This study explored the CTD of nurse practitioners and related factors.

METHOD

The study was a cross-sectional descriptive design. A purposive sample was recruited from a medical center and its hospital branches in central Taiwan. A structured questionnaire was used to collect data from 210 nurse practitioners.

RESULTS

The participants obtained the highest average score on systematicity and analyticity. CTD had a significant positive correlation with fundamental knowledge readiness, professional knowledge readiness, and confidence in making clinical decisions. Professional knowledge readiness, education level, and on-the-job training predicted the score of the participants on overall CTD.

CONCLUSION

On-the-job training and education level may influence the CTD of nurse practitioners. Providing formal or on-the-job continuing education training to nurse practitioners may help enhance their CTD. J Contin Educ Nurs. 2017;48(9):425-430.

An integrated review of the correlation between critical thinking ability and clinical decision-making in nursing

AIMS AND OBJECTIVES

To explore whether there is a correlation between critical thinking ability and clinical decision-making among nurses.

BACKGROUND

Critical thinking is currently considered as an essential component of nurses' professional judgement and clinical decision-making. If confirmed, nursing curricula may be revised emphasising on critical thinking with the expectation to improve clinical decision-making and thus better health care.

DESIGN

Integrated literature review.

METHODS

The integrative review was carried out after a comprehensive literature search using electronic databases Ovid, EBESCO MEDLINE, EBESCO CINAHL, PROQuest and Internet search engine Google Scholar. Two hundred and 22 articles from January 1980 to end of 2015 were retrieved. All studies evaluating the relationship between critical thinking and clinical decision-making, published in English language with nurses or nursing students as the study population, were included. No qualitative studies were found investigating the relationship between critical thinking and clinical decision-making, while 10 quantitative studies met the inclusion criteria and were further evaluated using the Quality Assessment and Validity Tool. As a result, one study was excluded due to a low-quality score, with the remaining nine accepted for this review.

RESULTS

Four of nine studies established a positive relationship between critical thinking and clinical decision-making. Another five studies did not demonstrate a significant correlation. The lack of refinement in studies' design and instrumentation were arguably the main reasons for the inconsistent results.

CONCLUSIONS

Research studies yielded contradictory results as regard to the relationship between critical thinking and clinical decision-making; therefore, the evidence is not convincing. Future quantitative studies should have representative sample size, use critical thinking measurement tools related to the healthcare sector and evaluate the predisposition of test takers towards their willingness and ability to think. There is also a need for qualitative studies to provide a fresh approach in exploring the relationship between these variables uncovering currently unknown contributing factors.

RELEVANCE TO CLINICAL PRACTICE

This review confirmed that evidence to support the existence of relationships between critical thinking and clinical decision-making is still unsubstantiated. Therefore, it serves as a call for nurse leaders and nursing academics to produce quality studies in order to firmly support or reject the hypothesis that there is a statistically significant correlation between critical thinking and clinical decision-making.