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PubMed1988

"Thinking aloud" as a strategy to improve clinical decision making.

Although "thinking aloud" has been used as a research method to collect data about nurses' knowledge and cognitive processes, it has not been used widely for instruction. We suggest that thinking aloud can be an effective teaching strategy for staff development. Two techniques are described for incorporating thinking aloud into dialogue among experienced nurses and into mentoring activities between experts and novices. An excerpt from a transcript of one nurse's thinking aloud while making a triage decision is presented to illustrate the types of knowledge and cognitive processes that can be elicited and revealed by using this strategy. Potential educational benefits are identified, along with suggestions for implementing thinking aloud as an instructional method.

Decision Making↗

PubMed1995

Differences in divergent thinking as a function of handedness and sex.

The relationship between handedness and divergent thinking was explored in four studies. Experiment 1 (N = 556) used the Alternate Uses Test, Experiment 2 (N = 941) tested object synthesis, and Experiment 3 (N = 965) tested ideational flexibility. No difference as a function of handedness was found in Experiment 1, but in Experiments 2 and 3 divergent thinking was significantly related to handedness in males. Left-handed males had higher divergent thinking scores, and the scores rose systematically with increasing sinistrality. Handedness was not related to divergent thinking ability in females. Experiment 4 (N = 1,548) showed that these differences were not associated with superiority by left-handed individuals in convergent thinking. Interpretations based on altered neurological development due to factors such as fetal testosterone exposure are discussed.

Adolescent↗

PubMed1993

[Research-based thinking of nurses at the end of their basic nursing education].

The purpose of this study was to find out the level of research-based thinking that students have internalized during their professional education. The research-based thinking of students has been investigated by analyzing the study reports, they have made at the end of their professional education. "The research-based thinking" is evaluated from the perspective of a research consumer. So, the purpose of this study was not to evaluate the level of studies, but the basis of them. The data consisted of 51 study reports. The data was analyzed by using the content analysis and descriptive statistics. The content analysis was based on the set of general rules for research using deductive methods of approach. The students' problems in research-based thinking fell mainly into the following parts: (1) the students did not use previous studies to build up the frame and the problems of their study, the students used scientific publications limitedly, it seems that the knowledge had the same value to the students regardless of the reference they have taken it from; (2) the students had difficulties in connecting the empirical part of their study with theoretical or conceptual frame. In this study the results indicated, that Finnish nursing students' research-based thinking is not mature in their study-reports at the end of education. It seems important to do further research to be able to analyze the reasons for these findings and how education could be improved in the future.

Curriculum↗

PubMed1993

The role of worrisome thinking in the suppression of cardiovascular response to phobic imagery.

Speech-fearful subjects repeatedly imagined a phobic image while heart rate and subjective reports of fear were monitored. Subject groups differed according to the type of mental activity that preceded each image. One group thought about a relaxing situation (Relaxation) and one group engaged in worrisome thinking (General-Worry). Three other groups were pre-trained to worry during their pre-image mentation periods with an emphasis on: (a) the thoughts; (b) the images; or (c) the affect experienced during worry. Cardiovascular effects occurred only on the first image presentation. Thought-Worry produced significantly less heart rate response than did Relaxation; the other worry conditions fell nonsignificantly between these two groups. Within-group correlations between heart rate response to the image and the reported predominance of thought relative to imagery during the preceding mentation period showed that: (a) greater worrisome thinking in General-Worry was related to less cardiovascular response; and (b) greater relaxed thinking in Relaxation was associated with greater cardiovascular response. These results support the hypothesis that it is the worrisome thinking aspect of worry that may inhibit the emotional processing of phobic material and that Gray's mismatch theory of anxiety elicitation may account for these effects.

Adult↗

PubMed1985

Ruminative thinking. A distinctive sign of melancholia.

We propose that ruminative thinking, the tendency to dwell on the same thought or theme, is useful for distinguishing melancholic from nonmelancholic major depression. We demonstrate that the symptom can be rated reliably and that interview ratings are concordant with ward observation of the symptom. The frequency of ruminative thinking, rated retrospectively in a prior study, was 60% in 75 patients having autonomous depression while only 18% of 48 nonautonomous patients were so affected. In this study, we found that ruminative thinking, prospectively rated in 71 patients with unipolar major depression, was present in 53% of patients with DSM-III melancholia but only 11% of the nonmelancholic patients. The presence of ruminative thinking appears to be useful for making the diagnosis of melancholia and its definition may facilitate study of the psychobiology of this disorder.

Delusions↗

PubMed2004

Thinking about craving: an experimental analysis of smokers' spontaneous self-reports of craving.

This study evaluated whether smokers generate spontaneous expressions of craving (i.e., expressions of an urge, craving, desire, want, or need) in response to cues designed to provoke a craving state. In a 2 (smoking deprivation: 1 and 12 h) x 2 (cue type: neutral, active) within-subjects design, smokers were asked to think aloud in an unstructured way (i.e., "describe everything you are thinking and feeling right now"). Results revealed a main effect for cue type on think-aloud craving responses: Smokers spontaneously generated a greater number of craving-related cognitions during active cue exposure compared with neutral cue exposure, both during both 1- and 12-h deprivation. This same pattern of effects was not found for a self-report assessment of craving, which was insensitive to cue-provoked changes in craving in the 1-h deprivation condition. These results suggest that smokers do spontaneously experience craving, independent of an explicit assessment of craving and that think-aloud methods may provide a novel assessment of craving that may be relatively more sensitive than self-report methods under some circumstances.

Adult↗

PubMed2006

Responsibility to continue thinking and worrying: evidence of incremental validity.

This two-part study examined the role of the responsibility to continue thinking, beliefs that one needs prolonged thinking about stressful problems, in the prediction of excessive worry. This construct is considered to reflect high levels of motivation to continue inflexible thinking and the use of rigid stop rules. In Study 1, 122 students completed questionnaires. A regression analysis revealed that responsibility accounted for a unique variance beyond negative meta-cognitive beliefs about worry. One hundred and fifty students participated in Study 2, where worry was regressed on emotional instability (Neuroticism), responsibility, and other worry-related cognitive variables (intolerance of uncertainty, positive/negative meta-cognitive beliefs, poor problem-solving orientation, and cognitive avoidance). Again, responsibility was a significant predictor, after controlling for emotional instability (Neuroticism) and other worry-related cognitions. These results indicate the incremental validity of the responsibility to continue thinking.

Adaptation, Psychological↗

PubMed2007

Predicting short-term outcome in well-being following suicidal behaviour: the conjoint effects of social perfectionism and positive future thinking.

This study investigated an integrative, psychological model of suicidality involving the relationship between perfectionism and future thinking to predict short-term outcome in well-being following a suicidal episode. Two hundred and sixty-seven adults hospitalized following a self-harm episode completed a range of clinical and psychological measures in hospital and were followed up approximately two months after discharge. Hierarchical regression analyses confirmed that, among the suicidal self-harmers who had a history of repetitive self-harm (n=65), outcome among low social perfectionists changed as a function of positive future thinking such that outcome was better for those high on positive thoughts compared with those low on positive future thoughts. There was no such positive change in outcome among the high social perfectionists. There were also no significant interactive effects evident among the non-repetitive self-harmers (n=61). These findings extend recent research to suggest that socially prescribed perfectionism and positive future thinking (but not negative future thinking) are implicated in outcome following repetitive suicidality. Implications for theory and clinical practice are discussed.

Adolescent↗

PubMed2026

The impact of artificial intelligence on critical thinking and clinical reasoning in health professions education: A systematic review and meta-analysis.

BACKGROUND: Critical thinking and clinical reasoning underpin healthcare professionals' ability to navigate uncertainties and deliver safe and effective care. With artificial intelligence (AI) advancement and growing adoption, AI-based educational tools are increasingly used to support these cognitive competencies' development. OBJECTIVE: To synthesize randomised and controlled clinical trials on AI-based educational tools in health professions education and examine their effects on critical thinking and clinical reasoning among health professions students. METHODS: Six electronic databases were searched from January 1, 2014 to July 28, 2025 was reviewed: PubMed, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, Embase and Web of Science. Two independent reviewers performed data extraction and quality assessment using standardized JBI checklists. The GRADE approach was used to assess the certainty of evidence. Studies were pooled via random-effects meta-analyses or narrative syntheses. RESULTS: Fourteen randomised controlled trials and seven controlled clinical trials were included (n = 21). Meta-analyses revealed small to medium effect sizes for the surrogate clinical reasoning outcomes of performance-based assessment scores (SMD 0.68; 95% CI [0.38, 0.98], p-value = 0.00; I2 = 38%) and knowledge test scores (SMD 0.39; 95% CI [0.09, 0.69], p-value = 0.01; I2 = 79%). Critical thinking and clinical reasoning skills and dispositions were narratively synthesized, with majority of included studies favouring AI-based interventions but the evidence had low to very low certainty. CONCLUSION: AI-based educational interventions may improve critical thinking and clinical reasoning among health profession students, but the evidence is very uncertain. This review offers preliminary insights but does not allow identification of optimal interventions or discipline-specific recommendations due to small sample sizes and substantial intervention heterogeneity. Further research is required to draw definitive conclusions. PROTOCOL REGISTRATION: CRD42025634074.

Humans↗

PubMedDate not supplied

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

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

Adult↗

PubMed1996

Depressive thinking: changes in schematic mental models of self and world.

Alternative explanations for the changes in thinking associated with depression were examined. Depressive thinking could reflect a generalized increase in accessibility of negative constructs and memories, previously associated with depression. Alternatively, depressive thinking could reflect changes at a more generic level of cognitive representation, related to schematic mental models. To investigate contrasting predictions from these two explanations, depressed patients and non-depressed controls completed sentence stems involving social approval or personal achievement e.g. 'If I could always be right then others would-me'. Construct accessibility views predict that depression will be associated with more negative completions (e.g. 'dislike'). By contrast, the schematic model view predicts patients may give more positive completions (e.g. 'like'). This is because schematic models reflect inter-relationships between constructs, and, it is suggested, depression is associated with use of schematic mental models that imply closer dependence of personal worth/acceptance on success/approval than the models used in the non-depressed state. Predictions from the schematic model view were supported, confirming previous findings. Results suggest that depressive thinking reflects changes in the high level mental models used to interpret experience.

Adolescent↗

PubMed2006

A prospective study of dysfunctional thinking and the regulation of negative intrusive memories in bipolar 1 disorder: implications for affect regulation theory.

BACKGROUND: Cognitive behavioural therapy (CBT) has been implemented in bipolar (BP) disorder with varying degrees of success. The link between CBT for BP disorder and underlying theory is not clear. There have been attempts to identify a unique style of dysfunctional thinking in BP disorder analogous to that in unipolar (UP) disorder but this has suffered from a dearth of prospective studies controlling for mood and phase of illness. In this prospective study, we have examined whether dysfunctional thinking and the (dys)regulation of traumatic memories are trait vulnerability factors in BP versus UP mood disorders. METHOD: BP-1 and UP groups were followed-up from acute episode to recovery, and compared with a healthy control group. Measures of dysfunctional thinking and linked personality dimensions were taken, together with measures assessing autobiographical memory retrieval (AMT). The presence and control of intrusive memories of traumatic events in BP and UP disorder were assessed. RESULTS: Controlling for mood symptoms and phase of illness, the BP (but not the UP) group was largely indistinguishable from controls on dysfunctional thinking. Intrusive memories of traumatic events were present in 45% of the BP and 48% of the UP groups; and those without intrusions were more overgeneral on the AMT in all phases of illness. CONCLUSION: These findings are in line with the 'affect regulation' hypothesis for UP disorder and deliberate self-harm. This may help in understanding the mode of action of CBT in BP disorder and to further improve the therapy, primarily through the promotion of affective regulation, which is one component of the complex CBT intervention for BP disorder.

Adolescent↗

PubMed2005

Reflective thinking and mental imagery: a perspective on the development of posttraumatic stress disorder.

Reflective thinking occurs when information stored in long-term memory (LTM) is not sufficient to allow one to respond "automatically" to an object or event. Instead, stored information must be entered into working memory and a novel response or solution produced. In this article I argue that mental imagery plays a central role in this process, and that over the course of normal cognitive development the process of reflective thinking "programs" LTM so that an increasingly large number of tasks can be performed without reflective thinking. Normal cognitive development thus results in a decreasing reliance on imagery. However, if highly emotional images are formed, additional retrieval cues can be entered into LTM, making such images more likely to occur in the future. Such images induce arousal, similar to that induced by the actual event. This line of thinking leads to a novel perspective on the neurocognitive deficits that underlie the development of posttraumatic stress disorder, and may also help to explain some symptoms seen in hyperactivity, impulsiveness, and difficulties in self-control.

Brain↗

PubMedDate not supplied

Looking for adolescents' well-being: self-efficacy beliefs as determinants of positive thinking and happiness.

AIMS: The present study is part of a longitudinal project aimed at identifying the personal characteristics and the developmental pathways conducive to successful adaptation from childhood to adulthood. The study examined the concurrent and longitudinal impact of self-efficacy beliefs on subjective well-being in adolescence, namely positive thinking and happiness. Positive thinking has been operationalized as the latent dimension underlying life satisfaction, self-esteem and optimism. Happiness has been operationalized as the difference between positive and negative affects, as they are experienced in a variety of daily situations. METHODS: In a group of 664 Italian adolescents, a structural model positing adolescents' emotional and interpersonal self-efficacy beliefs as proximal and distal determinants of positive thinking and happiness has been tested. RESULTS: Findings attest to the impact of affective and interpersonal-social self-efficacy beliefs on positive thinking and happiness both concurrently and longitudinally. CONCLUSIONS: Adolescents' self-efficacy beliefs to manage positive and negative emotions and interpersonal relationships contribute to promote positive expectations about the future, to mantain a high self-concept, to perceive a sense of satisfaction for the life and to experience more positive emotions.

Adolescent↗

PubMed1993

Thinking about strategies during, before, and after making a decision.

Two studies examined the impact of think-aloud and self-report instructions on the decision-making performance of young and older adults. Findings from Study 1 indicated that think-aloud instructions increased total time to decision for young and older adults but did not otherwise affect decision-making processes. Counter to predictions, the only significant interaction effect indicated that young adults in the think-aloud condition more frequently rechecked information than older adults. Findings from Study 2 confirmed the nonreactive nature of self-report methods. Despite potential age-related decrements in cognitive function, differences in functioning are not compounded and cannot be explained by the think-aloud or self-report instructions used by cognitive aging researchers.

Adult↗

PubMed1993

Humans' perceptions of animal mentality: ascriptions of thinking.

On rating scales, 294 students indicated whether it was reasonable to say that a dog, cat, bird, fish, and school-age child had the capacity for 12 commonplace human mental operations or experiences. Factor analysis of responses identified 2 levels of attributions, simple thinking and complex thinking. The child and all animals were credited with simple thinking, but respondents were much more likely to ascribe complex thinking to the child. (A pilot study with 8 animal-behavior professionals generally replicated these results.) Certain mental categories (e.g., emotion) were judged by students to be simple for all target types; others (e.g., conservation) were judged to be universally complex. Further factoring revealed articulate ascriptions for key mental categories. Play and imagine was seen as simple in the animals but complex for the child, but enumeration and sorting and dream were seen as simple in the child but complex for the animals.

Adult↗

PubMed1997

Critical thinking skills: the role of prior experience.

The critical thinking skills students bring with them on entering university courses will necessarily have a bearing on how they manage their studies and gain new knowledge. This study examined postgraduate nursing students' perceptions of their gains in critical thinking abilities through engagement in off-campus studies after three semesters of study. Data for the study were collected by survey methodology. Descriptive statistics were derived and correlation analyses performed using SPSSx. This study indicates that for most skills, the differences between those students with prior university experience and those without it in perceptions of change in skill ability were not marked. For most critical thinking skills, about one half or a little more of the students perceived an overall positive shift in their abilities. For some skills, however, there were marked differences in the proportion of students perceiving a shift in skill ability, and possible explanations are offered. The results also indicate that a considerable proportion of the students surveyed perceived a lack of critical thinking skill development. As a result questions can be raised about how off-campus students without prior university experience engage with tertiary studies. The implications of these findings in terms of the development of off-campus nursing course materials and student learning are discussed.

Adult↗

PubMed2004

Enhancing critical thinking in the preceptorship experience in nursing education.

BACKGROUND: To date no research has been conducted to examine the process used in the preceptorship experience to enhance critical thinking at the graduate level. This study provides data that could revitalize the preceptor/learner relationship and in turn influence future preceptorship programmes in graduate nursing education. AIM: The purpose of this study was to examine the preceptorship experience and its role in the enhancement of critical thinking in graduate nursing education. DESIGN: A grounded theory approach was employed, through semi-structured, tape-recorded interviews. Overall, 45 interviews were completed with graduate nursing students ranging in age from 26 to 53 years, and master's and doctorally prepared preceptors who ranged in age from 47 to 58 years. In addition, a journal of personal reflections was kept by each of the researchers. Analysis of data included the process of open coding, theoretical coding, selective coding, reduction and comparison. FINDINGS: Data revealed that a process, designated The Relational Process, occurred in the preceptorship experience to enhance the critical thinking ability of graduate nursing students. This process was found to be a complex, ongoing interpersonal dynamic between the graduate student and assigned preceptor. CONCLUSIONS: The relational process that emerged from this study indicates that specific preceptor behaviours are pivotal to the enhancement of critical thinking of graduate nursing students and ultimately impact on the success or failure of the preceptorship experience.

Adult↗