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Counterfactual thinking about controllable events.

When people think about what might have been, they mentally undo controllable rather than uncontrollable events. We report the results of two experiments in which we examined this controllability effect in counterfactual thinking. The experiments show that the mutability of controllable events is influenced by the perceived appropriateness or inappropriateness of the events. The first experiment shows that people change inappropriate controllable actions more than appropriate controllable ones. The second experiment shows that people mutate inappropriate controllable events whether the outcome is exceptional or normal with respect to intrapersonal habitual norms, and whether the outcome is positive or negative. We discuss the implications for alternative theories of counterfactual thinking.

Adult↗

Counterfactual thinking and decision making.

Recent research on counterfactual thinking is discussed in terms of its implications for decision making. Against a backdrop of the functional benefits of counterfactual thinking, two distinct types of bias, one liberal and one conservative, are discussed. Counterfactuals may cause decision makers to become liberally biased (i.e., capricious) in terms of tactics, but conservatively biased (i.e., rigid) in terms of long-term strategy. That is, counterfactuals may lead to short-term corrective changes that are needless and costly, but they may also lead to long-term overconfidence, blinding the decision maker to possible beneficial strategic adjustments. Recent research on counterfactual thinking, which is inherently multidisciplinary, is reviewed in light of a theoretical structure that posits two mechanisms by which counterfactual effects occur: contrast effects and causal inferences.

Decision Making↗

Wanted: nurses with critical thinking skills.

Knowing how to think, apply, analyze, synthesize, and evaluate are crucial skills for nursing professionals. Development of critical thinking skills requires educational involvement beyond the level of basic preparation. The diffusion of nursing knowledge afforded by continuing education in nursing makes it the perfect milieu for the enhancement and continuous development of critical thinking skills.

Clinical Competence↗

Teaching strategies to promote critical thinking skills in nursing staff.

The promotion of critical thinking skills necessary for safe, effective, state-of-the-art nursing care is discussed in this article. Definitions of critical thinking and inductive and deductive reasoning are explored. Benner's (1986) research, based on Dreyfus and Dreyfus' (1980) model of skill acquisition, provides a basis for the various strategies mentioned to teach critical thinking. Implementation and evaluation of these strategies are addressed.

Clinical Competence↗

A model for critical thinking within the context of curriculum as praxis.

The curriculum may be informed by a technical, practical, or emancipatory interest. Curricula informed by these three interests are referred to as curriculum as product, curriculum as practice, and curriculum as praxis (Grundy, 1989) respectively. When curricula are viewed from different perspectives, it is plausible to suggest that each perspective requires a different conceptualization of critical thinking. The literature search revealed that critical thinking has been equated with problem solving, which is congruent with a curriculum-as-product orientation. The purpose of this paper is to provide an overview of a conceptual model for critical thinking that is congruent with an orientation to the curriculum as praxis. The model is derived from the work of Freire (1972), Habermas (1972), and Grundy (1989). The key concepts of the model are knowledge, critical reflection, and action. There is a reciprocal relationship between knowledge and action, which is mediated by critical reflection.

Cognition↗

Issues in measuring critical thinking: meeting the challenge.

Recent changes in NLN criteria for accreditation highlight the need to measure growth in critical thinking (CT). Choosing the most appropriate methods to measure CT within a specific nursing program poses significant challenges for nurse educators. This article explores major issues in measuring critical thinking, including: a) developing a clear definition of this concept, b) matching the definition to program goals, c) using value-added assessment and d) deciding between norm versus criterion-referenced methods. Detailed discussion focuses on decisions that must be made regarding instrument selection. Issues such as reliability and validity of measures, sensitivity of test scores to expected growth, the importance of matching methods to program CT definition, and the need for adequate resources are described. Strengths and weaknesses of commercial instruments that measure critical thinking, as well as the alternative techniques of portfolios and performance assessment, are reviewed.

Clinical Competence↗

The effect of an innovative clinical teaching method on nursing students' knowledge and critical thinking skills.

The purpose of this quasi-experimental study was to determine the effect of an experimental clinical teaching method on nursing students' knowledge and critical thinking skills during clinical rotations in psychiatric nursing. Ausubel's Assimilation Theory of Learning provided the theoretical framework for this research. The subjects (N = 83) were from the baccalaureate nursing graduating classes of 1992 and 1993 of a medium-sized state university in the mid-atlantic region of the United States. The experimental clinical teaching method used computer-assisted instruction (CAI) throughout and a collaboration model (student-faculty-service) during initial clinical experiences. Knowledge was measured by the score for the psychiatric nursing component of the Mosby Assess Test and two parts of the National League for Nursing's (NLN) Psychiatric Exam (theory and total scores). Critical thinking was measured by two parts of the NLN's Psychiatric Nursing Exam (the score for assess, analyze, and evaluate as one measure and planning and implementation for the other measure). The comparison group scored significantly higher than the control group on assessing, analyzing, and evaluating (t = 2.15; p < .03), as well as planning and implementation (t = 2.33; p < .02), measures for critical thinking skills. However, there was no significant difference between the study groups with respect to knowledge. The findings support the appropriateness of Ausubel's Assimilation Theory with this clinical teaching method. Discussion relevant to the application of the study findings to nursing education and future research is presented.

Adult↗

Critical thinking: prevailing practice in baccalaureate schools of nursing.

This study describes the prevailing practice of NLN-accredited baccalaureate nursing programs with respect to the NLN-required outcome criterion of critical thinking. Currently accredited 4-year baccalaureate nursing programs scheduled for an accreditation site visit in the 1992 to 1993 and 1993 to 1994 academic years were invited to participate by providing a copy of the self-study report pages relevant to NLN Required Outcome Criterion 1: Critical Thinking. Of the 124 programs in the population, 55 used the newly approved accreditation criteria and provided the requested materials. This article describes the prevailing practices regarding the definition and evaluation/measurement of critical thinking.

Accreditation↗

Critical thinking: a model.

The emphasis on critical thinking in nursing has increased in response to the rapidly changing health care environment. This emphasis is underscored in nursing education by the National League for Nursing (NLN) accreditation process with the inclusion of a required outcome criterion related to the critical thinking abilities of baccalaureate nursing graduates. This article proposes a model and an accompanying process that can provide direction for nurse educators in the development and evaluation of nursing students' critical thinking abilities.

Accreditation↗

Discovering confidence in clinical reasoning and critical thinking development in baccalaureate nursing students.

The purpose of this preliminary investigation was to discover students' experiences of clinical reasoning and critical thinking development. Findings are reported from one group of baccalaureate nursing students participating in a clinical reasoning course. Narrative approaches were used to reveal how students experience their developing reasoning skills. Class videotapes and reflective logs in which students described their reasoning and responses to others' reasoning provided data. An interpretive phenomenological approach was used to derive a beginning understanding of the experiences of students' developing clinical reasoning and critical thinking. Confidence emerged as a significant aspect of students' experiences. This report of the investigation focuses on only one aspect of clinical reasoning and critical thinking, namely, students' perceptions of threats to confidence and ways of building confidence.

Adaptation, Psychological↗

Nursing education for critical thinking: an integrative review.

This integrative review summarizes 20 research studies reported from 1977 to 1995 that review change in the critical thinking abilities of professional nursing students. The Watson-Glaser Critical Thinking Analysis was used in 18 of 20 studies. The primary assumption was that critical thinking skills would increase during nursing education. However, the results of this review are mixed and contradictory. Possible reasons for these results are discussed.

Clinical Competence↗

Preceptorship and critical thinking in nursing education.

Although preceptorship is being used increasingly by nursing faculty in the practice setting, little is known about how preceptors teach and even less is known about how critical thinking is being fostered in that relationship. The purpose of this study was to examine the process used in preceptorship to develop and promote the critical thinking ability of baccalaureate nursing students. Using the grounded theory method, this study was conducted in a large tertiary care hospital. Participants included fourth-year baccalaureate nursing students (preceptees) and their staff nurse preceptors. Data collection was composed of semistructured interviews and observations of the preceptors and preceptees as they worked together in the practice setting. Secondary data sources included documents considered appropriate to the study (e.g., nurse notes, student journals). By constant comparative analysis of the data, the findings of this study revealed a process that reflects the enabling of students by preceptors to develop and promote their critical thinking ability in the practice setting.

Adult↗

"Covering content" and teaching thinking: deconstructing the additive curriculum.

For more than 25 years, reliance on conventional pedagogy has led nurse educators to persistently focus on what students need to learn to enter contemporary practice settings. Therefore, as biomedical and nursing knowledge grows and the health care system in which students will practice becomes increasingly complex, content is persistently added to nursing curricula, while little is taken out. An underlying assumption of this approach is that if important content is "covered," thinking necessarily follows. This study, using Heideggerian hermeneutics, examines the relationship between covering content and thinking by explicating the common experiences of teachers enacting interpretive pedagogies. One of the themes that emerged from this analysis is presented: "Covering Content" and Teaching Thinking: Deconstructing the Additive Curriculum.

Attitude of Health Personnel↗

Does service-learning increase cultural competency, critical thinking, and civic engagement?

To prepare for community engagement and partnerships with diverse communities, nursing students must understand the principles of service-learning, as well as the essential skills needed to work within a democracy. The purposes of these two pilot tests were to develop a 15-hour service-learning intervention; refine the 15-hour service-learning intervention; and explore whether participation in the intervention made a difference in the critical thinking, cultural competence, and civic engagement of nursing student participants. Although the sample was small (n = 14), results of paired t tests found that, after the intervention, critical thinking scores measured by the California Critical Thinking Disposition Inventory were significantly lower (t = -2.23, p = .04), particularly on the self-confidence subscale (t = 2.29, p = .039); cultural competence scores measured by the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals were significantly lower (t = 4.83, p = .000); and civic engagement scores significantly increased (t = -3.54, p = .004).

Adult↗

Logic models used to enhance critical thinking.

Over time, various methods have been used to stimulate critical thinking in undergraduate nursing students, and although many have been successful in helping students integrate the essential knowledge, experiences, and clinical reasoning that support practice, it is also useful to explore new methods. Faculty at the University of Hawaii at Manoa, School of Nursing and Dental Hygiene have taken an innovative approach of using logic models to further enhance critical thinking. This article presents an application of varying experiences and methods of using logic models to support the development of critical thinking and reasoning skills in nursing students. The processes in which logic models are used in the curriculum are described. The models are used to connect concepts from concrete to abstract levels in diverse and often nonlinear diagrams, guided discourse, and written assignments. The specific instructional methods used include concept mapping, concept papers, conceptual linking, and substruction.

Attitude of Health Personnel↗

[Development of a critical thinking disposition scale for nursing students].

PURPOSE: The purpose of this study was to develop a critical thinking disposition scale for nursing students. METHOD: The developmental process was construction of a conceptual framework, development of preliminary items, verification of content validity, development of secondary items, verification of construct validity and extraction of final items. The conceptual framework and first preliminary 60 items were obtained through a review of relevant literature and the development of critical disposition scales by 10 researchers who had been studying critical thinking for one year. These items were reviewed by five specialists for content validity and finally 55 items were chosen. The data was collected from October 1 to 15, 2004 and was analyzed using factor analysis and Cronbach's alpha with the SPSS program. The subjects were composed of 560 Bachelor of Science nursing students from 8 nursing schools. RESULT: There were 35 final items which were sorted into 8 factors. The factors were identified as 'intellectual integrity(6 items)', 'creativity(4 items)', 'challenge(6 items)', 'open-mindedness(3 items)', 'prudence(4 items)', 'objectivity(4 items)', 'truth seeking(3 items)' and 'inquisitiveness(5 items)'. The cumulative percent of variance was 55.107%. The reliability of the scale, Cronbach's alpha was .892 and the factors' ranged from .562-.836. CONCLUSION: The result of this study could be used for measuring critical thinking dispositions of nursing students. However, for further validity and reliability, repeated research is necessary.

Adult↗

Using simulation to teach critical thinking skills. You can't just throw the book at them.

Critical thinking is essential in critical care practice. How to define, measure, and teach thinking are subjects of debate with no clearly proven method for doing so. Simulation as a teaching strategy appears to hold great promise for teaching critical thinking. Sophisticated simulators allow real patient situations to be replicated in a safe environment for practice and learning. Research is needed to support this theory. Dr. Gaba, a pioneer in the use of simulation, said "No industry in which human lives depend on the skilled performance of responsible operators has waited for unequivocal proof of the benefit of simulation before embracing it." Embracing simulation in academic and clinical education is appropriate, but efforts must continue to evaluate this strategy.

Critical Care↗

The relationship between critical thinking and decision-making in respiratory care students.

INTRODUCTION: Respiratory therapists evaluate the condition of their patients, make decisions about the appropriateness of the treatment plan, provide care, and evaluate the outcomes of their decisions. To practice effectively they must think critically and make appropriate decisions. As educators make curriculum changes to improve students' decision-making (DM) skills, strategies to develop critical thinking (CT) have been proposed as one method of achieving that goal. This approach is based on the hypothesis that a positive relationship exists between DM and CT. The present study examines the relationship between CT and DM in respiratory care students. If there is a positive relationship between CT and DM, respiratory care training programs might improve the DM skills of future practitioners by providing instruction that improves CT. METHODS: Using a correlational research design, DM scores from the Clinical Simulation Self-Assessment Examination (CSSAE) were compared with scores from the Watson-Glaser Critical Thinking Appraisal for 143 graduating respiratory care students from 10 programs. Program directors completed a questionnaire and were then interviewed about the methods they employ to develop CT and DM in their students. RESULTS: A significant correlation between CT and DM was found for 110 students completing the Secure Form of the CSSAE (r = 0.32, p < 0.01). All programs used case studies and clinical simulations, and most used role modeling, computer-assisted instruction, patient rounds, small group discussion, and study skills courses. No differences were identified in the use of the CT and DM development strategies by different programs. CONCLUSIONS: The findings support the belief that students with strong CT proficiency make better clinical decisions. Assessment of CT proficiency could be used as one part of a process for evaluating prospective students and faculty for respiratory care programs. Program directors and faculty felt that case studies and clinical simulations are important strategies.

Adult↗