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Creating a climate for critical thinking in the preceptorship experience.

The impact of the learning climate on students' ability to think critically during preceptorship cannot be underestimated. The success of students in learning to think critically rests largely with the tone set by preceptors and staff (Myrick 1998). Students must be led gently into the active role of discussing, dialoguing, and problem solving (Meyers 1986). They watch very carefully how respectfully preceptors and staff field their comments, quickly notice nonverbal cues that indicate how open, approachable and supportive the preceptors and the staff are to their questions and contributions, and then discern how valued they are as colleagues. When preceptors genuinely value, support, and work with students in the practice setting and staff accept them as part of the team, a climate that is conducive to learning and critical thinking is established. This is due to the fact that students feel safe enough to question, to challenge and be challenged, and to be creative in their problem solving. The purpose of this paper is threefold: a) to identify key factors in the preceptorship experience that contribute to the creation of a climate that is conductive to critical thinking; b) to provide important insights into the role of the preceptor and the staff within that context; and c) to discuss how nursing faculty can more actively contribute to ensuring that such a learning climate is achieved in the preceptorship experience.

Education, Nursing↗

Do thinking styles contribute to academic achievement beyond self-rated abilities?

This research identifies individual differences in academic achievement attributable to thinking styles over and above what can be explained by self-rated abilities. Participants were 209 university students from Hong Kong and 215 university students from mainland China. Participants responded to the Thinking Styles Inventory (Chinese version) that is based on Sternberg's theory of mental self-government (R. J. Sternberg, 1988). They also rated their own analytical, creative, and practical abilities on a 10-point scale based on R. J. Sternberg's (1985) triarchic theory of human intelligence. Participants' academic achievement scores were also used. The prediction that thinking styles statistically predict academic achievement was supported by data from both Hong Kong and mainland China. Academic achievement and thinking styles are related differently in the two groups. Implications of these findings for both teaching and research are discussed.

Achievement↗

Impoverished counterfactual thinking is associated with schizophrenia.

Counterfactual thoughts are mental representations of alternatives to past events. Recent research has shown counterfactual thinking to be a pervasive cognitive process in normal populations and has linked it to effective problem-solving and decision-making. The present research demonstrates that counterfactual thinking is impaired in schizophrenia patients relative to normal control subjects; this impairment was evident using measures of counterfactual thoughts as well as counterfactual-derived inferences. Furthermore, this impoverished counterfactual thinking partly mediated impaired social functioning experienced by schizophrenia patients. Given the convergence of neuropsychological evidence showing counterfactual deficits in frontal lobe patients and the documented frontal deficits in schizophrenia patients, future studies investigating a specific relationship between counterfactual thinking and frontal lobe function in schizophrenia patients would be a logical next step in this line of research.

Adult↗

Negative thinking: a key factor in depressive symptoms in Thai adolescents.

Negative thinking, self-esteem, parental bonding, and everyday stressors are factors related to depressive symptoms in studies conducted in the United States, but they have been rarely explored in Thailand. An understanding of factors influencing depressive symptoms in Thai youth will lead to the development of interventions to decrease depressive symptoms among this age group. The purpose of this study was to examine the effects of parental bonding, everyday stressors, self-esteem, and negative thinking on depressive symptoms among Thai adolescents. A random sample of 812 high school students in Chon Buri, Thailand, participated in the study. The prevalence of depressive symptoms varied from 20-21% depending on the measures used. Negative thinking was the best predictor of depressive symptoms in Thai adolescents. Negative thinking also mediated the effects of parental bonding, everyday stressors, and self-esteem on depressive symptoms.

Adaptation, Psychological↗

Evaluating bizarre-idiosyncratic thinking: a comprehensive index of positive thought disorder.

A summary of our method of assessing positive thought disorder, or bizarre-idiosyncratic thinking, from two short verbal tests is presented. This measure provides for standardized thought disorder assessments of: the overall presence and severity of thought disorder, and the type of disordered thinking shown. A definition and examples of bizarre-idiosyncratic thinking are provided, along with information on the reliability and validity of the scoring system. A method of establishing subject groups based on the severity of positive thought disorder also is presented--ranging from no thought disorder, to abnormal thinking, to severe formal thought disorder. This measure has been used to assess longitudinal changes in thought disorder symptoms over time and to evaluate relationships between thought disorder, other aspects of psychopathology (such as delusions), and adjustment in other areas of functioning across diagnostic groups.

Humans↗

Disordered thinking in schizophrenia: intermingling and loss of set.

In a study of schizophrenic thought pathology, potential loss of set and intermingling were examined. The responses of 36 acute psychiatric patients who showed intermingling were analyzed. Intermingling, frequently seen in the speech and thinking of schizophrenic patients, involves the blending of personal material from one's experiences into one's thinking and communication, leading to bizarre and inappropriate speech. The results indicated that intermingling frequently leads to some loss of goal-directed thinking, but not usually to complete loss of set. Patients adopt new sets based partly on the original topic and partly on their own personal idiosyncratic concerns. The apparent "looseness" of schizophrenic patients is based on thematic shifts to idiosyncratic ideas, often from the beginning of their responses, rather than on word-to-word associative looseness. Intermingling of personal concerns typically occurs in a nonfragmented fashion. Schizophrenics and other psychotic patients show significantly more intermingling of personal material in open and undisguised fashion, as though they do not recognize how inappropriate their intermingling appears. The results suggest that although the intrusion of personal material is task inappropriate, it still represents a form of systematic, goal-oriented thinking.

Adult↗

Sleep loss and "divergent" thinking ability.

Although much is known about the impact of sleep loss on many aspects of psychological performance, the effects on divergent ("creative") thinking has received little attention. Twelve subjects went 32 h without sleep, and 12 others acted as normally sleeping controls. All subjects were assessed on the figural and verbal versions of the Torrance Tests of Creative Thinking. As compared with the control condition, sleep loss impaired performance on all test scales (e.g., "flexibility," the ability to change strategy, and "originality," generation of unusual ideas) for both versions, even on an initial 5-min test component. In an attempt at further understanding of whether these findings might be explained solely by a loss of motivation, two additional short and stimulating tests were also used--a word fluency task incorporating high incentive to do well and a challenging nonverbal planning test. Performance at these tasks was still significantly impaired by sleep loss. Increased perseveration was clearly apparent. Apparently, 1 night of sleep loss can affect divergent thinking. This contrasts with the outcome for convergent thinking tasks, which are more resilient to short-term sleep loss.

Adult↗

Critical thinking in preclinical course examinations.

PURPOSE: To examine the relationship between preclinical medical school course examinations and critical-thinking skills by correlating examination results with the Watson-Glaser Critical Thinking Appraisal (WGCTA), an 80-item critical-thinking inventory. METHOD: The 196 students in the class of 1993 at the University of Texas Southwestern Medical Center at Dallas Southwestern Medical School were given the WGCTA during the second half of their freshman year. A composite WGCTA score and five subtest scores were calculated for each student. The course examinations were 25 tests, each with a majority of multiple-choice items, from courses given during the first two years of the school curriculum. The students' undergraduate grade-point average (GPAs), medical school GPAs, and Medical College Admission Test (MCAT) scores were also included in the analysis. Pearson product-moment correlations were calculated between the students' WGCTA scores and their examination scores, MCAT scores, and GPAs. RESULTS: Sixteen of the examinations--in the behavioral sciences, psychiatry, ethics, pathology, introduction to clinical medicine, genetics, endocrinology, and cell biology--had significant positive correlations with the WGCTA, as did MCAT scores and first-year GPAs. Correlations were more robust with the WGCTA subscales for interpretation (18 examinations), evaluation of arguments (15), and deduction (13), and less robust with the subscales for inference (7) and recognition of assumptions (3). CONCLUSIONS: The results suggest that objective multiple-choice examinations can at least partially reflect critical-thinking skills.

Educational Measurement↗

The influence of a baccalaureate program on traditional, RN-BSN, and accelerated students' critical thinking abilities.

Although there are multiple ways of achieving baccalaureate-level nursing education, all graduates must demonstrate critical thinking abilities to practice competently. The purpose of this study was to measure the changes in critical thinking abilities of students pursuing various pathways in the same baccalaureate nursing curriculum. Traditional, registered nurse-bachelor of science (RN-BSN), and accelerated students completed the Watson-Glaser Critical Thinking Appraisal (WGCTA) at the beginning and end of their nursing course sequence. Findings revealed a significant difference between the pre- and post-WGCTA scores of traditional students (t = -2.84, P = .007) and RN-BSN students (t = -2.28, P = .029), but not of accelerated students. Similarities between the curricular pathways that could account for the results were analyzed. Further research is needed to determine the best combination of liberal arts and nursing courses for the development of critical thinking abilities.

Adult↗

Using student writing assignments to assess critical thinking skills: a holistic approach.

This work offers an example of one school's holistic approach to the evaluation of critical thinking by using student writing assignments. Faculty developed tools to assess achievement of critical thinking competencies, such as analysis, synthesis, insight, reflection, open mindedness, and depth, breadth, and appropriateness of clinical interventions. Faculty created a model for the development of program-specific critical thinking competencies, selected appropriate writing assignments that demonstrate critical thinking, and implemented a holistic assessment plan for data collection and analysis. Holistic assessment involves the identification of shared values and practices, and the use of concepts and language important to nursing.

Clinical Competence↗

Thought disorder or allusive thinking in the relatives of schizophrenics? A response to Callahan, Madsen, Saccuzzo, and Romney.

Romney and Saccuzzo et al. (J Nerv Ment Dis 176:364-367; 368-371, 1988) disagreed concerning the need for further studies investigating the presence of thought disorder and associative cognitive dysfunction in relatives of schizophrenics. Saccuzzo et al. were concerned at the variations in the results of previous studies. Methodological issues relevant to such variation are discussed. It is pointed out that the study (McConaghy J Neurol Neurosurg Psychiatry 22:243-246, 1959) initiating psychometric investigation of cognitive processes of relatives of schizophrenics was based on the belief that what was familially transmitted was not thought disorder, but a nonpathological looseness of associations, shown also by a percentage of normal subjects. This looseness was later termed allusive thinking. It was considered that allusive thinking acted as an inherited predisposition to schizophrenia. It required the addition of impairment of abstract thinking to constitute the characteristic thought disorder originally described by Bleuler. To account for the significant degree of thought disorder found in 6% to 12% of normal subjects, some researchers now accept that thought disorder exists in normal subjects on a continuum with schizophrenic thought disorder. It is suggested that replication of a later study demonstrating familial transmission of allusive thinking in university students and their parents could aid in clarifying the significance of the findings of increased incidence of looseness of associations in the families of schizophrenics.

Association↗

Catheter-related sepsis in the neonate: thinking critically about a persistent problem.

Catheter-related sepsis (CRS) is a clinical problem gaining increasing attention in the literature. Before strategies for reducing the incidence of CRS can be identified, a consistent definition of the problem must be developed. Critical thinking is an intellectual process used to reflect upon a topic of interest. The critical thinking process provides a framework for comprehensive analysis of patient care problems. The article describes the critical thinking process and proposes a model of critical thinking for practicing nurses. This model is applied to the development of comprehensive definitions for CRS that may be used by neonatal nurses for clinical and research purposes.

Catheterization, Central Venous↗

Teaching strategies for critical thinking.

Critical thinking is a phase that is being heard frequently in nursing education. Nurse educators are encouraged to teach students to think critically because of the higher-order thinking skills that are required in our complex health care delivery system. The challenge to educators is the selection, development, and implementation of appropriate teaching strategies. This article describes a variety of strategies for teaching critical thinking within the context of nursing.

Computer-Assisted Instruction↗

Addressing the National League for Nursing critical-thinking outcome.

The National League for Nursing outcome-oriented accreditation process challenges nursing faculty to think about teaching and evaluating critical thinking. In a survey of schools of nursing, the authors found that programs are using standardized measures and individualized assessments to address the criterion. Their greatest difficulty involves decisions about measuring critical thinking. School administrators identified a variety of approaches effective for helping faculty. The authors provide insight and ideas for nursing faculty involved with critical thinking in the curricula.

Accreditation↗

Evaluating critical thinking in clinical practice.

Although much has been written about measurement instruments for evaluating critical thinking in nursing, this article describes clinical evaluation strategies for critical thinking. Five methods are discussed: 1) observation of students in practice; 2) questions for critical thinking, including Socratic questioning; 3) conferences; 4) problem-solving strategies; and 5) written assignments. These methods provide a means of evaluating students' critical thinking within the context of clinical practice.

Clinical Competence↗

A qualitative tool for critical thinking skill development.

Quantitative measures were not meeting the needs of faculty for evaluating critical thinking among Baccalaureate of Science Nursing students. The authors discuss the critical thinking self-reflection tool that was developed for teaching critical thinking and qualitatively evaluating changes over time with established interrater reliability and content validity. The tool is consistent with the concepts of critical thinking in the curriculum and was implemented systematically in all clinical nursing courses.

Education, Nursing, Baccalaureate↗

Measuring critical thinking: one step forward, one step back.

When critical thinking was identified as an explicit program outcome by the National League for Nursing in 1991, nursing programs were thrust into frenzied activity defining critical thinking and selecting instruments to evaluate it. This drove research on the measurement of critical thinking among nursing programs and the concomitant search for reliable and valid methodologies to systematically assess changes in critical thinking in their students. Although the ultimate goal of this process was curricular improvement, nearly 15 years later, faculty struggle to make sense of the data they have.

Attitude of Health Personnel↗

Developing nurses' critical thinking skills with concept mapping.

Observations and research in educational and practice settings suggest new nurses are not using critical thinking skills. Teaching strategies traditionally focused on linear modes of thinking--no longer as helpful in today's complex and crisis-driven contexts. Concept mapping has promise of promoting higher levels of thinking and may develop critical thinking--and decision-making skills--in less time and without intensive oversight by staff instructors. A case example is used to demonstrate the design of a concept map.

Adult↗