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Congruency in defining critical thinking by nurse educators and non-nurse scholars.

This study investigated nurse educators' definition of the concept critical thinking. A sample of 201 baccalaureate nurse educators in midwest nursing programs completed a questionnaire identifying their perception of critical-thinking skills and characteristics, and their agreement with non-nurse critical-thinking experts on items often considered to be critical thinking. This study found that nurse educators agreed with non-nurse critical-thinking experts on the skills and dispositions; however, significant differences were found between nurse educators and non-nurse experts regarding concepts related to critical thinking. Nurse educators were more likely to identify researching, problem-solving, decision-making, and planning as critical thinking. Despite their assertion otherwise, it is apparent from this study that nurse educators have a different perception of critical thinking than scholars in other disciplines. This study suggests that practice disciplines such as nursing may perceive critical thinking differently than educators in nonpractice disciplines.

Attitude of Health Personnel↗

Dichotomous thinking in nuclear medicine technology.

Dichotomous thinking is the natural human tendency to think in a binary manner (either-or). Although it is natural, dichotomous thinking can be simplistic and may lead to a lack of consideration of alternatives. In nuclear medicine, a predominant use of dichotomous thinking can lead to a very elementary way of thinking that may produce technologists who do not question why or how things are done. Adaptation and survival in today's health care environment require complex ways of thinking. This article describes dichotomous thinking and its problems and pitfalls in nuclear medicine practice and education, and suggests that dichotomous thinking can be extended to dialectical (contradictory ideas) modes of thinking.

Attitude↗

Critical thinking: change during medical school and relationship to performance in clinical clerkships.

The development of critical thinking, the ability to solve problems by assessing evidence using valid inferences, abstractions, and generalizations, is one of the global goals advocated by most medical schools. This study determined changes in critical thinking skills between entry and near the end of the third year of medical school, assessed the predictive ability of a test of critical thinking skills, and assessed the concurrent validity of clerkship components and final grade. The Watson-Glaser Critical Thinking Assessment (WGCTA) was administered to one class of students at entry to medical school and near the end of year 3. Performance data for those students who completed their clinical clerkships on schedule were also recorded. Critical thinking improved modestly but significantly from entry to medical school to near the end of year 3. The ability of a critical thinking test to predict clerkship performance was limited; the correlation between WGCTA total score at entry and the components and final grade of five major clerkships ranged from near 0 to 0.34. The concurrent validity of clerkship components and final grade was also limited; correlations with WGCTA total score near the end of year 3 ranged between 0.08 and 0.49. The correlation between WGCTA total score and United States Medical Licensing Examination Step 2 was higher at year 3 than at medical school entry. Critical thinking skills improve moderately during medical school. Used alone, tests of critical thinking may be of limited value in predicting which students will be successful in clinical clerkships. Clerkship evaluation components and final grade have limited concurrent validity when a test of critical thinking is the criterion.

Clinical Clerkship↗

Active learning strategies to promote critical thinking.

OBJECTIVE: To provide a brief introduction to the definition and disposition to think critically along with active learning strategies to promote critical thinking. DATA SOURCES: I searched MEDLINE and Educational Resources Information Center (ERIC) from 1933 to 2002 for literature related to critical thinking, the disposition to think critically, questioning, and various critical-thinking pedagogic techniques. DATA SYNTHESIS: The development of critical thinking has been the topic of many educational articles recently. Numerous instructional methods exist to promote thought and active learning in the classroom, including case studies, discussion methods, written exercises, questioning techniques, and debates. Three methods-questioning, written exercises, and discussion and debates-are highlighted. CONCLUSIONS/RECOMMENDATIONS: The definition of critical thinking, the disposition to think critically, and different teaching strategies are featured. Although not appropriate for all subject matter and classes, these learning strategies can be used and adapted to facilitate critical thinking and active participation.

Journal Article↗

Critical thinking ability of associate, baccalaureate and RN-BSN senior students in Korea.

The purpose of this study was to compare the critical thinking ability of students enrolled in associate, baccalaureate, and Registered Nurse-Bachelor of Science in Nursing (RN-to-BSN) programs in Korea. The participants were 301 undergraduate nursing students. The instrument used for this study was the Watson & Glaser Critical Thinking Appraisal (WGCTA). The data were analyzed using descriptive statistics, t-test, and analysis of variance with Scheffe's multiple comparison. The average critical thinking ability score was 41.59. Bachelor of Science in Nursing (BSN) students scored significantly higher on critical thinking than the other 2 groups. Students < or = 22 years of age scored higher than the other age groups on critical thinking. This study provides preliminary evidence that the length and content of an educational program is as important as its focus on enabling students to develop their critical thinking abilities. This finding suggests a need to infuse critical thinking activities early in existing secondary school curricula as a way of encouraging students to develop their thinking abilities earlier.

Adult↗

Contribution of divergent thinking to community functioning in schizophrenia.

Fluency deficits have been associated with poor community functioning in patients with schizophrenia. In our previous study we demonstrated that the ability to generate higher-quality responses on tasks of divergent thinking as measured by several fluency tests was impaired in patients with schizophrenia. The purpose of the present study was to investigate the contribution of the deficits in divergent thinking to community dysfunction in schizophrenia. Forty Japanese outpatients with schizophrenia and 32 healthy control subjects were recruited for this study and assessed over a broad spectrum of the neurocognitive domain. Their capacity for divergent thinking was assessed by idea, design, and word fluency tests. Community functioning was assessed by using the Global Assessment of Functioning (GAF), the Life Assessment Scale for the Mentally Ill (LASMI), and the Social Functioning Scale (SFS). The results confirmed the qualitative deficits of divergent thinking in schizophrenia. Stepwise multiple regressions using neurocognitive and demographic/clinical variables as predictors revealed that the higher-quality response scores on the tasks of divergent thinking significantly contributed to community functioning. Moreover, the deficit on the verbal task of divergent thinking significantly contributed to impairment in the area of daily living, and the deficit on the nonverbal task of divergent thinking significantly contributed to impairment in the area of interpersonal relations. The results of this study reveal the importance and the possibility of cognitive remediation and cognitive training with strategies that target capacity for divergent thinking to improve community functioning in patients with schizophrenia.

Adult↗

Reliability of assessment of critical thinking.

Although clinical critical thinking skills and behaviors are among the most highly sought characteristics of BSN graduates, they remain among the most difficult to teach and assess. Three reasons for this difficulty have been (1) lack of agreement among nurse educators as to the definition of critical thinking, (2) low correlation between clinical critical thinking and existing standardized tests of critical thinking, and (3) poor reliability in scoring other evidences of critical thinking, such as essays. This article first describes a procedure for teaching critical thinking that is based on a consensus definition of 17 dimensions of critical thinking in clinical nursing practice. This procedure is easily taught to nurse educators and can be flexibly and inexpensively incorporated into any undergraduate nursing curriculum. We then show that students' understanding and use of these dimensions can be assessed with high reliability (coefficient alpha between 0.7 and 0.8) and with great time efficiency for both teachers and students. By using this procedure iteratively across semesters, students can develop portfolios demonstrating attainment of competence in clinical critical thinking, and educators can obtain important summary evaluations of the degree to which their graduates have succeeded in this important area of their education.

Attitude of Health Personnel↗

Teaching and evaluating critical thinking in respiratory care.

The capacity to perform critical thinking in respiratory care may be enhanced through awareness and education to improve skills, abilities, and opportunities. The essential skills for critical thinking in respiratory care include prioritizing, anticipating, troubleshooting, communicating, negotiating, decision making, and reflecting. In addition to these skills, critical thinkers exhibit certain characteristics such as critical evaluation, judgment,insight, motivation, and lifelong learning. The teaching of critical thinking may be accomplished though problem-based learning using an evidenced-based approach to solve clinical problems similar to those encountered in professional practice. Other traditional strategies such as discussion, debate, case study, and case presentations can be used. Web-based curriculum and technologic advances have created opportunities such as bulletin boards, real-time chats, and interactive media tools that can incorporate critical thinking. Many concerns and controversies surround the assessment of critical thinking, and individuals who administer critical thinking tests must be aware of the strengths and limitations of these assessment tools, as well as their relevance to the workplace. The foundational works reported in this article summarize the current status of assessment of critical thinking and can stimulate further investigation and application of the skills, characteristics, educational strategies, and measurement of critical thinking in respiratory care.

Allied Health Personnel↗

Facilitatory effect of thinking about movement on magnetic motor-evoked potentials.

To investigate the facilitatory effect of thinking about movement on motor evoked potential (MEP) amplitude, we recorded MEPs in two test muscles during rest, with the subject thinking about contracting the test muscle but without subsequent contraction, and during 10% maximum voluntary contraction. Stimuli were delivered at 10% above resting motor threshold and at 90-100% stimulator output. H-reflexes, recorded in flexor carpi radialis, were obtained during rest and think conditions. MEP threshold was lower during the think condition (P = 0.004). At both stimulus intensities, median MEP amplitudes and areas were significantly (P < 0.001) larger during the think paradigm compared with rest. This effect was greater at the lower stimulus intensity. There was no significant difference in latency (P = 0.15). In 4/8 subjects, H-reflex amplitudes were mildly facilitated (P < 0.05) during the think condition. We conclude that thinking about movement without detectable EMG activity has a facilitatory effect on magnetic MEPs. The absence of a MEP latency shift between rest and think conditions and absence of a consistent increase in H-reflex amplitude suggests this effect occurs largely at the cortical level. In some subjects, however, an increase in spinal motoneuron excitability may also contribute.

Adult↗

Acute influences of estrogen and testosterone on divergent and convergent thinking in postmenopausal women.

Previous studies indicated an enhanced capability of divergent creative thinking in young women during the ovulatory phase, which expressed itself also by an increased dimensional complexity of ongoing electroencephalographic (EEG) activity. Considering the enhanced plasma levels of estrogen and testosterone characterizing the ovulatory phase, we tested whether short-term administration of estrogen or testosterone in postmenopausal women with constantly low levels of gonadal steroids induces similar changes in divergent thinking. In two placebo-controlled cross-over studies, healthy postmenopausal women (n=12, in each study, mean age 58 years, range 47-65 years) were treated transdermally over 3 days with estrogen and testosterone, respectively, at doses inducing plasma hormone concentrations comparable with those observed in young women around ovulation. Capabilities of divergent thought and convergent analytical thought, performance on motor perseveration, and verbal memory were examined. EEG activity was recorded while subjects performed on tasks of thinking and during mental relaxation. Estrogen impaired divergent thinking (p <0.01) and enhanced convergent thinking, motor perseveration, and memory for the initial word list (p <0.05 for all tests). In parallel, EEG dimensional complexity was reduced (p <0.05). Overall, these changes indicate an estrogen-induced shift from a "divergent" towards a more "convergent" mode of processing. However, overall less consistent, effects of testosterone were opposite to those of estrogen. It increased performance on some of the divergent thinking tasks (p <0.05), and tended to increase EEG dimensional complexity during divergent thinking. Data indicate a differential sensitivity of modes of thinking to short-term treatment with estrogen and testosterone in postmenopausal women.

Aged↗

Facilitatory effect of thinking about movement on motor-evoked potentials to transcranial magnetic stimulation of the brain.

Two experiments using transcranial magnetic stimulation (TMS) were undertaken to investigate facilitatory effects of thinking about a specific movement without voluntary discharges on motor-evoked potentials (MEP). First, surface electromyographic (EMG) responses from the abductor pollicis brevis were recorded with maximal stimulator output in the three conditions: the muscle being at rest, contracting with 10% of maximal muscle activity, and with the subject "only thinking" about thumb abduction (nine subjects). Median value of MEP amplitudes during "only thinking" was twice that at rest (P = 0.008) and one-half that during voluntary contraction (P = 0.008). Second, needle EMG responses from the first dorsal interosseus were compared at rest, during thinking about index finger abduction, and during TMS at threshold intensity. Four normal subjects were tested with stimulation of each cerebral hemisphere for a total of eight tests. The number of detectable MEP responses of 20 stimuli to one hemisphere was counted for each condition of rest or thinking. The mean MEP response rate during thinking (58%) was higher than that at rest (12%) (P < 0.005). These results demonstrate that thinking about a specific movement has facilitatory effects on MEP and that the degree of facilitation in thinking is smaller than in voluntary contraction.

Adult↗

Critical thinking, perceived health status, and participation in health behaviors.

BACKGROUND: Critical thinking has been proposed as crucial for processing conflicting information when people make decisions about participation in health behaviors. The critical thinking of individuals about participation in health behaviors may depend on their perceived health status. OBJECTIVES: To examine the relations between critical thinking and participation in three categories of health behaviors, and to determine whether these relations are moderated by perceived health status. METHODS: A cross-sectional, correlational design was used to study a sample of 112 community-dwelling adults who resided in a large, urban Midwest community. The participants were women and men 18 to 90 years of age (mean, 55 +/- 20.47 years) who completed self-report, written questionnaires including the Test of Everyday Reasoning and the Health Practices Instrument. RESULTS: According to hierarchical multiple regression analyses, the relation between critical thinking and health promotion behaviors and the relation between critical thinking and secondary prevention behaviors were moderated by perceived health status, whereas the relation between critical thinking and health protection behaviors was not. CONCLUSIONS: The relation between critical thinking and participation in health behaviors depends on perceived health status and category of health behaviors. Researchers can explore the role of other variables (e.g., functional status and perceived susceptibility to disease) to explain why perceived health status moderates the relations between critical thinking and participation in various types of health behaviors differently.

Activities of Daily Living↗

Effects of a nursing literature reading course on promoting critical thinking in two-year nursing program students.

Critical thinking is essential for professional nursing practice. Promoting critical thinking with teaching strategies has been a focus of nursing education and nursing research. Reading and writing assignments are teaching strategies for fostering critical thinking ability. We developed a course with the emphasis on critical reading and writing. The purposes of this study were to explore the effect of the course and teaching strategies on promoting critical thinking and to understand the learning experience and perception of nursing students as part of the course assessment plan. Quasi-experimental design and purposive sampling were used. 170 students of a two-year nursing program were grouped into an experimental and a control group depending on whether or not they took the course. The change in critical thinking ability was evaluated and determined based on performance in an article critique test before and after the course. Data was collected with an assessment tool developed for the purposes of the research and was analyzed with descriptive statistics, paired t-test, and two-factor analysis of variance with repeated measures and content analysis. The findings were: (1) The scores on the critique test at the end of the course in both groups were significantly higher than before the course (p<.001). The improvement in score of the experimental group, however, was significantly higher than that of the control group (p<.001). (2) Changes in thinking pattern and learning attitude, as well as a feeling of growth and achievement, were found in content analysis of students' self-evaluation of their learning experience and perception. Critical thinking skills were applied while learning the course. The results not only provide evidence to support the positive effect of reading and writing assignments on critical thinking ability but also confirm the teaching and learning activity design for the course.

Attitude of Health Personnel↗

Children's thinking in the wake of Challenger.

OBJECTIVE: The Challenger spacecraft explosion in 1986 offered an opportunity to study the thinking of normal children after a sudden and distant disaster, differences in thinking among children of different levels of emotional concern and different ages, and changes in their thinking over time. METHOD: The authors studied six thinking patterns known to characterize childhood posttraumatic stress disorder and four additional hypothesized patterns in 153 randomly selected children of Concord, N.H. (who watched the explosion on television) and Porterville, Calif. (who heard about it later). They compared the structured-interview responses of the more involved (East Coast) and less involved (West Coast) children, of the latency-age children and the adolescents, and of the children initially (5-7 weeks after the explosion) and 14 months later. RESULTS: The children exhibited the 10 predictable thinking patterns. They initially defended themselves, denying the reality of the explosion. They later fantasized about it. They tried to cope by seeking additional information on their own, at home, and at school. Most children talked about Challenger, but a minority of the latency-age youngsters avoided related talk and thoughts. The adolescents experienced more paranormal thinking, philosophical changes, and negative attitudes. Over the year, omens, paranormal experiences, and Challenger-based fantasies tended to disappear, but negative views about institutions and the world's future held steady or increased. CONCLUSIONS: The children's thinking followed predictable patterns. A higher degree of emotional involvement (East Coast children) was strongly linked to these thinking patterns, as was being an adolescent. Distant disasters appear to set up commonalities of thought that might come to characterize certain generations of children.

Adaptation, Psychological↗

Critical thinking and nursing science: judgment, or vision?

For decades, critical thinking has been widely regarded as a concept and process of central importance in the practice of nurses and in their education. Numerous nursing textbooks heavily emphasize the development of critical thinking skills in students. The attention given to critical thinking in nursing parallels a reform movement that has had an impact on virtually all fields. Close attention to the ways in which critical thinking is addressed in nursing, however, reveals a starkly delimited view of its meaning within the discipline. This article questions whether the vision of critical thinking as a cornerstone of practice in nursing may need to be expanded. The discussion centers on three points: nursing theories and frameworks as ways to enrich critical thinking in nursing practice; the inadequacy of the model of critical thinking as an individual, analytical process; and possibilities that are cocreated when critical thinking is conceived as a creative/constructive, relational/dialogical process.

Humans↗

Critical thinking of beginning baccalaureate nursing students during the first clinical nursing course.

The development of critical thinking is an essential component of baccalaureate nursing education and yet little is known about beginning nursing students' critical thinking abilities in making clinical decisions. The purpose of this study was to describe the critical thinking of seven beginning baccalaureate nursing students during their first clinical nursing course. Qualitative methodology using the case study approach was used to describe students' critical thinking from their perspectives. Sources of data for describing students' critical thinking included reflective journal writing, interviews, and the researcher's nonparticipatory lab observations. Paul's (1993) dimensions of reasoning were used as a framework to describe students' critical thinking. Four major themes revealed through the data analysis were: development of the professional self-perspective, development of a perfectionist perspective, development of a caring perspective, and development of a self-directed learning perspective. The descriptive nature of the study indicated that beginning students do indeed think critically. Opportunities for dialogue in a supportive environment are instrumental in facilitating students' critical thinking and growth as reflective practitioners.

Adult↗

Teaching clinical reasoning as a thinking frame.

OBJECTIVE: Clinical reasoning concepts can be viewed as descriptions of mental operations or as a thinking frame--a structure to organize and support clinical thinking. This study examined an approach for teaching clinical reasoning as a thinking frame to occupational therapy students. METHOD: A quasi-experimental, pretest-posttest design was used with a convenience sample of 10 undergraduate occupational therapy seniors. All participants (a) acquired the thinking frame of clinical reasoning concepts through explicit instruction and (b) practiced that thinking frame with an external aid--the Clinical Reasoning Case Study Format. The accuracy of participants' definitions of clinical reasoning concepts before and after this learning experience were examined to assess their acquisition of the thinking frame. The content of clinical reasoning case studies were examined to assess students' application of the thinking frame to clinical situations. RESULTS: Wilcoxon signed rank tests done on presemester and postsemester definitions ratings indicated that the latter were rated significantly higher than the former for (a) narrative reasoning (p = .008), (b) procedural reasoning (p = .005), (c) interactive reasoning (p = .006), (d) pragmatic reasoning (p = .008), and (e) conditional reasoning (p = .01). The content of participants' clinical reasoning case studies indicated that they were able to apply clinical reasoning concepts. CONCLUSION: The results suggest that using a clinical reasoning thinking frame to organize clinical observations is an effective way to help entry-level occupational therapy students learn and apply clinical reasoning concepts.

Adult↗

Mental tools for thinking about DNA technologies in new ways.

OBJECTIVE: To investigate the nature of creative thinking in biomedical science with specific applications to molecular pathologies and DNA technologies. DATA SOURCES: Accounts of breakthroughs and inventions contained in autobiographies, biographies, interviews, and archival sources. STUDY SELECTION: Discoveries that have altered, or may yet alter, basic textbook accounts of biomedical sciences for which appropriate data sources exist. DATA EXTRACTION: Approximately 1000 data sources were analyzed, both within appropriate sciences and in other creative fields, such as the arts. DATA SYNTHESIS: The current analysis is based on a framework described in our previous book, Sparks of Genius, which outlines a general approach to understanding creative thinking. CONCLUSIONS: Creative thinking in all disciplines depends on a common mental "toolkit" that consists of 13 fundamental tools: observing, imaging, abstracting, pattern recognition, pattern forming, analogizing, body thinking, empathizing, dimensional thinking, modeling, playing, transforming, and synthesizing. Scientists recognize and solve problems by observing data that break the patterns established by theories; exploring a system by creating an abstract model with which they can play; and transforming data into feelings, sounds, and other forms that create surprising analogies to already-understood principles. The result of such personal thinking is knowledge combined with sensation and emotion--feeling and understanding synthesized into complete awareness. We illustrate some of these modes of thinking with reference to recent breakthroughs in DNA-related areas and suggest ways in which the use of "tools for thinking" can increase the probability of making further discoveries in the biomedical sciences.

Biotechnology↗