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PubMed2000

A consensus statement on critical thinking in nursing.

The purpose of this study was to define critical thinking in nursing. A Delphi technique with 5 rounds of input was used to achieve this purpose. An international panel of expert nurses from nine countries: Brazil, Canada, England, Iceland, Japan, Korea, Netherlands, Thailand, and 23 states in the U.S. participated in this study between 1995 and 1998. A consensus definition (statement) of critical thinking in nursing was achieved. The panel also identified and defined 10 habits of the mind (affective components) and 7 skills (cognitive components) of critical thinking in nursing. The habits of the mind of critical thinking in nursing included: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Skills of critical thinking in nursing included: analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge. These findings can be used by practitioners, educators and researchers to advance understanding of the essential role of critical thinking in nursing.

Affect↗

PubMed2001

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.

Cognition↗

PubMed2003

New pedagogies for teaching thinking: the lived experiences of students and teachers enacting narrative pedagogy.

The need to prepare students for a rapidly changing health care system sustains teachers' interest in developing students' thinking abilities at all levels of nursing education. Although significant effort has been directed toward developing efficient and effective strategies to teach thinking, this study explores the underlying assumptions embedded in any approach to teaching and learning and how these assumptions influence students' thinking. This study, using Heideggerian hermeneutics, explored how teachers and students experience enacting a new pedagogy, Narrative Pedagogy, and this article explains how enacting this pedagogy offers new possibilities for teaching and learning thinking. Two themes emerged from this analysis and are discussed: Thinking as Questioning: Preserving Perspectival Openness and Practicing Thinking: Preserving Fallibility and Uncertainty.

Education, Nursing↗

PubMed2005

Faculty perceptions of critical thinking in student clinical experiences.

Critical thinking is an essential skill for nurses who practice in complex health care systems. This study explored nursing faculty members' perceptions of teaching critical thinking to baccalaureate student nurses in clinical settings. Six clinical faculty members were interviewed using an ethnographic approach. Findings focus on two domain analyses that describe the nature of critical thinking and strategies to effectively teach it. Faculty members conceptualized critical thinking as "putting it all together" through information seeking, reflecting, assigning meaning, problem solving, predicting, planning, and applying information. Faculty members perceived that they teach critical thinking through a number of approaches that include asking questions, reviewing written products, conducting clinical conferences, and evaluating student journals. The findings of this study have implications for faculty who seek a clearer definition of critical thinking in nursing and a rich description of strategies to teach this skill.

Education, Nursing, Baccalaureate↗

PubMed2005

Teaching thinking and reaching the limits of memorization: enacting new pedagogies.

Contemporary practice environments are complex and require students and new graduates to possess high-level thinking capabilities to ensure patient safety and quality of care. To achieve this goal, many nurse educators are exploring new pedagogies (critical, feminist, phenomenological, and postmodern) to teach students the practices of thinking that contemporary clinical situations demand. These new pedagogies offer alternatives to the predominant use of conventional pedagogies, which emphasize students' memorization of content and its subsequent application in practice situations. This study, using Heideggerian hermeneutics, documents how teachers are using new pedagogies in ways that shift their attention to teaching thinking and away from devising strategies to help students memorize and apply more content. One of the themes that emerged from this study, Teaching Thinking and Reaching the Limits of Memorization, and two subthemes, Thinking AS Memorization and Recall, and Beyond Memorization: Thinking in Context are presented.

Education, Nursing↗

PubMed2002

Reflective journal writing: how it promotes reflective thinking in clinical nursing education: a students' perspective.

According to the outcomes-based education and training system of education (OBET) in the country and the South African Nursing Council, education should focus on "creating" reflective learners and practitioners. This article seeks to determine the effectiveness of reflective journal writing in promoting the reflective thinking of learners in clinical nursing education and to validate the guidelines described in a bigger study on how to facilitate reflective thinking using reflective journal writing. A qualitative, contextual, explorative, descriptive research design was used to determine the learners' perceptions on whether reflective journal writing did promote their higher-level thinking skills during the six-month placement in a psychiatric clinical practice using the reflective diaries. From a population of seventeen fourth-year students, six volunteered to participate in a focus group interview. The data was analysed by means of the descriptive method of open coding of Tesch (in Creswell, 1994:154-156). Positive and negative results from the perceptions of the participants and a literature review served as a basis for deducing and describing guidelines for the effective use of reflective journal writing in promoting reflective thinking in clinical nursing education. The positive perception was the development of problem-solving skills attained through reflection by using analytical critical thinking, synthesis and the evaluation of situations. Self-evaluation leading to intellectual growth and self-awareness indicated a positive perception. Negative perceptions were that reflective journal writing is time consuming, content based with a lack of clear expectations from the teacher, and distrust of students about the information written. Guba's model of ensuring trustworthiness in qualitative research as described in Krefting (1991:215-222) was employed. It is concluded that reflective journal writing in clinical nursing education does promote reflective thinking and learning. The use of the developed guidelines will minimise the negative perceptions. It is recommended that the guidelines be used in basic training at all levels of training to attain the objective of nursing education and training, which is to produce a critical, analytical thinker through reflection to improve practice.

Attitude of Health Personnel↗

PubMedDate not supplied

The geography of thinking.

People in different cultures are taught to think differently. How we gather information, process, rationalise, justify and communicate our ideas is culturally determined. Europe is divided between the pragmatic, inductive thinking of North Sea cultures and the rationalist thinking of the rest of the continent. Westerners and Asians have different mental skills and capacities deriving from the nature of written and spoken language, the relative importance of learning by rote or investigation and the social environment. Western children are expected to ask questions and test ideas for themselves, while in Asia it is unacceptable to question anyone senior in age or authority, including teachers. Westerners base thinking on reason; Asians base thinking on harmony. Whenever people of different cultures work together, different ways of thinking create barriers to understanding and communication. This applies to many spheres of work, including the medical profession.

Asia↗

PubMed2000

Early recognition of patient problems: a hermeneutic journey into understanding expert thinking in nursing.

The purpose of this study was to explicate the unconscious activity of early recognition of patient problems to better understand the thinking of expert critical care nurses. Multiple interviews were done with 15 peer-nominated expert critical care nurses. These nurses met specific inclusion criteria for expertise and the interviews were conducted over 9 months. Narrative accounts of critical incidents where early recognition of patient problems occurred were audiotaped and transcribed. The transcribed interviews were shared with the participants after each interview to stimulate reflection on their practice. Reflection on practice enriched subsequent interviews. A text comprising interview data was compiled and an interpretive approach based on the philosophy of human action developed by the author was used to interpret the activity of thinking behind the nurses' actions in the text. Interpretation of action revealed three common subplots or characteristics embedded in the nurses' thinking. The subplots included different types of information used in thinking, a mode of understanding situational meaning, and a temporal component of thinking in practice. The findings demonstrate an integrated model of situational understanding and informed action, thinking-in-action, similar to Aristotle's notion of practical wisdom.

Adult↗

PubMedDate not supplied

The theory of critical thinking of nursing.

Critical thinking is a thought process used by nurses for clinical decision-making. This descriptive correlational study focused on the relationships among critical thinking, decision-making, and clinical nursing expertise during a clinical simulation. A midrange theory, developed from Benner (1) and Paul (2), states that as novice nurses become experts and develop clinical expertise through experience and the acquisition of knowledge, critical thinking is developed and used for clinical decision-making. > A convenience sample of 149 nursing students, graduate nurses, and expert nurses was selected for the study. Critical thinking was measured with the Elements of Thought Instrument (ETI) and a decision score was calculated. Critical thinking and decision-making increased with the level of clinical expertise. Related demographics included college credits taken, years in nursing practice, and grade point average. The findings were consistent with the midrange Theory of Critical Thinking of Nurses.

Adult↗

PubMedDate not supplied

An examination of critical thinking in a self-care dialysis unit.

Nephrology nursing is more challenging than ever before. Faced with increasingly complex patients, fewer resources, and vast knowledge stores, nephrology nurses must be clear and focused in their thinking to make decisions using clinical judgment based in sound evidence to ensure best possible outcomes. To thrive in this environment, nurses must be able to think "critically," that is, think creatively and purposefully using reason and logic. It is critical thinking that helps define us as a profession, and enables us to understand and meet the needs of patients. In this article, an actual clinical scenario will be examined with an analysis of my initial thinking processes. An alternative approach to the scenario is suggested within the context of a critical thinking framework.

Clinical Competence↗

PubMedDate not supplied

Critical thinking in nursing education and practice as defined in the literature.

Critical thinking is frequently discussed in nursing education and nursing practice literature. This article presents an analysis of the concept of critical thinking as it applies to nursing, differentiating its use in education and practice literature. Three computerized databases (CINAHL, MEDLINE, and EBSCO) were searched for the years 1981 to 2002, using the keywords critical thinking. References were stratified into two 11-year periods (1981-1991, 1992-2002) to identify changes in the concept over time and integration of the concept differentially into nursing education and nursing practice. A random sample of literature from each stratum was coded for definitions, attributes, surrogate terms, referents, antecedents, and consequences of critical thinking. Critical thinking as a nursing concept has matured since its first appearance in the literature. It is well defined and has clear characteristics. However, antecedents and consequences are not well defined, and many consequences are identical to attributes and surrogate terms. Additional work is needed to clarify the boundaries of the concept of critical thinking in nursing.

Accreditation↗

PubMedDate not supplied

Perceived barriers to teaching for critical thinking by BSN nursing faculty.

The ability to think critically is considered an essential skill of nursing graduates and competent nursing practice. Yet, the literature reports that teachers are having difficulty teaching for critical thinking and that critical thinking is lacking in new nursing graduates. This research study sought to identify barriers to the implementation of critical thinking teaching strategies by nursing faculty currently teaching in generic baccalaureate programs in Tennessee. Surveys were mailed to 262 nursing faculty; 194 were returned, and 175 were usable. Students' attitudes and expectations represented the single greatest barrier to the implementation of critical thinking teaching strategies, followed by time constraints and the perceived need to teach for content coverage. Recommendations to support and encourage faculty to teach for critical thinking are outlined.

Adult↗

PubMed2006

Predictive validity of critical thinking skills and disposition for the national board dental hygiene examination: a preliminary investigation.

The objective of this study was to determine if preexisting critical thinking skills and critical thinking disposition predict student performance on the National Board Dental Hygiene Examination (NBDHE). The predictive value of critical thinking skills scores and disposition (habits of mind, attitudes, and character attributes) scores were examined above that provided by traditional predictors: entering grade point average, age, and total number of college hours at entry into the dental hygiene program. Seventy-six first-year dental hygiene students from three baccalaureate dental hygiene programs participated in this study. Participants' preexisting general critical thinking skills and disposition were assessed during the first week of classes in their respective baccalaureate level programs using the California Critical Thinking Skills Test (CCTST) and California Critical Thinking Disposition Inventory (CCTDI). At the completion of their two-year educational program, the CCTST and CCTDI were administered a final time, and students' scores on the multiple-choice and case-based NBDHE were obtained. A series of hierarchical multiple regression analyses demonstrated that CCTST scores explained a statistically significant (p<.05) proportion of variance in students' multiple-choice and case-based NBDHE scores, above and beyond that explained by other predictor variables. Although CCTDI scores were not a significant predictor of either outcome measure, CCTST is a good predictor of student performance on high-stakes qualifying examinations and may have utility for student selection and retention.

Adult↗

PubMedDate not supplied

The evaluation of students' reflective writing for evidence of critical thinking.

The purpose of this study was to establish interrater reliability of the Critical Thinking Scale (CTS), a teacher-accessible tool designed to measure the critical thinking of baccalaureate nursing students as evidenced in their reflective writing about their practice experiences.The study is an extension of an earlier pilot test of the CTS. Graduating students from a nursing program at a small liberal arts college were asked to write about a significant practice experience encountered during their last clinical course. Three teachers used the CTS to independently evaluate the students' writing. California Critical Thinking Skills Test (CCTST) scores provided a standard measure of critical thinking. Results indicated statistically significant positive relationships between the CCTST total critical thinking score and mean teacher ratings using the CTS. Meaningfully significant interrater reliability ratings for the CTS were also found. With further development, the CTS has promise as an appropriate tool to evaluate students' reflective writing for evidence of critical thinking.

Adult↗

PubMedDate not supplied

Critical thinking, educational preparation, and development of moral judgment among selected groups of practicing nurses.

The focus of this descriptive study was the relationship between critical thinking, educational preparation, and level of moral judgment in 79 practicing nurses. The Watson-Glaser Critical Thinking Appraisal Test was used to measure critical thinking; information on the participating nurses' educational preparation was obtained from a personal information sheet. Moral judgment was measured by Rest's Defining Issues Test. The hypothesis that critical thinking would be positively related to moral judgment was tested by Pearson product moment correlation; the obtained coefficient of .5326 was significant at the .001 level. The hypothesis that there would be a difference between professional and technical nurses' moral judgments was tested through a one-way analysis of variance. The F ratio (F [1,77] = 9.6) was significant beyond the .01 level. Data also supported the hypothesis that critical thinking and educational preparation would predict greater variance in moral judgment than either variable alone, which was tested through multiple regression analysis (F [2,75] = 18.3, p = .01). Critical thinking and education together accounted for 32.9 percent of the variance in moral judgment. Implications of the findings are discussed for nursing research, practice, and education.

Adult↗

PubMed1997

Suicidal thinking in community residents over eighty.

OBJECTIVE MAIN OBJECTIVE: to study the relationship between suicidal thinking and both cognitive impairment and depression. DESIGN: Random sample selected for interview, all of whom were a cohort in a pre-existing epidemiological study of dementia. SETTING: Community residents. PATIENTS AND OTHER PARTICIPANTS: Participants aged over 81. Study excluded the following: moved out of area/died/ too frail/severe communication difficulties/refused interview, refusal by GP/family/carers, 300 names selected at random from database. 170 eligible participants approached: 31 refused, 125 interviewed, 125 informants approached for interview; 118 interviewed. MAIN OUTCOME MEASURES: CAMDEX, 15-item Geriatric Depression Scale (GDS), and Scale for Suicidal Ideation (SSI) (including informant versions of latter 2 scales). RESULTS: 9 people showed suicidal thinking, all women: 6 had clinical evidence of cardiovascular/cerebrovascular disease. Those with suicidal thinking showed higher CAMDEX depression scores, weaker strength of the wish to go on living, higher rates of expressing wish to die and higher rates of depressive illness and mixed DAT/multi-infarct dementia as primary psychiatric diagnoses. No significant associations between suicidal thinking and GDS scores, Alzheimer-type dementia alone, awareness of memory difficulties or severity of dementia. CONCLUSIONS: Results show association between suicidal thinking and both depression and mixed DAT/multi-infarct dementia, but do not support an association between suicidal thinking and awareness of memory problems/severity of dementia. Given the methodological limitations, the significance of the results should be viewed with caution. Further exploration of the role of cerebrovascular disease in depressive disorder is suggested.

Activities of Daily Living↗

PubMed1977

Is disordered thinking unique to schizophrenia?

To provide data on several issues related to disordered thinking in schizophrenia, 200 acutely ill psychiatric patients (including 55 schizophrenics) were evaluated on four instruments to assess thought pathology (the Object Sorting Test, the Rorschach Test, a social comprehension test, and a proverbs test). Patients were assessed at two phases of their disorders (the acute phase and the phase of partial recovery). The results suggest (1) disordered thinking is not unique to schizophrenia; (2) distinctions between mild and severe levels of thought pathology are important; and (3) disordered thinking is influenced by acute psychopathology and acute upset. Inferential evidence suggests (4) disordered thinking fits along a continuum with normal thinking; (5) "thought disorders" are not a discrete, separate entity, standing apart from other aspects of thinking; and (6) older concepts about primary symptoms in schizophrenia need reexamination.

Acute Disease↗

PubMed1997

Ruminative thinking in older inpatients with major depression.

Ruminative thinking, the tendency to dwell on particular ideas or themes, can be a prominent part of the phenomenology of major depression, but it rarely has been the focus of empirical research. We attempted to replicate (in adult psychiatric inpatients age > or = 50 years with DSM-III-R major depression) the previously published finding that ruminative thinking was associated with melancholia and with psychosis. In our sample, these associations were not present. In addition, we explored the relationships of ruminative thinking to specific areas of thought content (e.g., suicidal ideation, somatic worry), cognitive function and overall functional status; ruminative thinking was not associated with suicidal ideation, but was associated with greater somatic worry and with poorer functional status, although these associations were not independent of overall depressive severity. A substantial proportion of subjects were unable to complete the cognitive measures; ruminative thinking was independently associated with inability to complete these tasks. We conclude that ruminative thinking is a meaningful and common clinical phenomenon among severely depressed older inpatients. Further investigations in inpatients and other populations examining its relationships to other phenomenology, to course and outcome, and to putative underlying mechanisms of depression are warranted.

Adult↗