(Continuation from p1. Critical Thinking in Undergraduate Nurses)
However, some statutory nursing bodies have sufficient confidence in the strength of the relationship between clinical decision making and CT to demand for CT as outcome of learning for accreditation (Simpson and Courtney,2002). This has stimulated the profession to take stock of its position with curriculum development regarding CT, in face to face and online educational modes (Legg, et. al., 2009; Mitchell and Batorski ,2009; Staib, 2005; Simpson and Courtney ,2002). This does however raise a point about the nature of CT as an outcome. Daly (1998) reflects that CT ability is a desirable outcome. If the definition reflects the complexity of human behaviour in CT, then to be able to implement CT skills is going to need not only cognition and knowledge, but the application of judgment to the individual situation in its context. In this way, CT could be seen as a process, rather than an outcome (Simpson and Courtney , 2002).
This issue needs to be resolved so that curriculum planners might have a better foundation for action. It is possible that the curriculum needs an introduction to CT, but also the integration of CT in the remaining parts of the curriculum. This would require an adult learning model (Tennant,2006; Knowles, et. al., 2005) in order to move towards a more transformative model of education to prepare students for the challenge of change (Gordon, 2009). This would give students the ability to construct knowledge according to the requirements of the individual context, which may strengthen clinical decision making. This also supports the work on the CT definition being multi-dimensional.
Multi-dimensional Definition of CT
The multi-dimensional definitions of CT reveal that cognitive aspects are important, but also that there are moral, judgmental and ethical aspects to be considered. For this, the personality of the student is a key factor (Profetto-McGrath ,2003; Tiwari ,2003; Ip, et. al., 2000). This also raises an issue of cultural aspects of CT skills, for research shows that where CT is considered outside of Western culture, differences emerge (Tiwari , 2003; Ip, et. al,. 2000).
In collective societies such as those found in Southeast Asia, the expression of CT may have profound implications. Willingness to argue in an academic sense is a precursor of CT (Schommer-Aikins and Easter, 2009), so that where culturally such willingness may be interpreted as going against cultural norms, then the development of CT skills may be restrained. This may be important when we need to consider Asian values to which most of the students are accustomed through their upbringing and socialization. There is thus a need to review this in detail, so that appropriate modifications may be made to the process of learning CT in order for it to be sensitive to the local customs and culture.
Conclusion
The articles reviewed show the significance of the work of Jones and Brown (1991) in defining CT as a complex human behaviour with cognitive, moral and personality dimensions. The method of investigating CT leads to caution about accepting the measurement of CT using positivistic scientific methods, whereas a feminist approach may be more inclusive. Further, while the Nursing profession is shown to have imbibed CT as an important part of its curriculum since the 1980s, the cultural implications for Southeast Asian countries for the teaching and learning of CT are yet to be addressed.
REFERENCE
Anderson, G.L. & Tredway, C.A. (2009). Transforming the nursing curriculum to promote critical thinking online. Journal of Nursing Education. 48(2):111-115.
Benner, P., Tanner, C.A. & Chesla, C.A. (1996). Expertise in nursing practice: caring, clinical judgment and ethics. New York: Springer.
Bethune, E. & Jackling, N. (1997). Critical thinking skills: the role of prior experience. Journal of Advanced Nursing. 26:1005-1012.
Cohen, L., Manion, L. & Morrison, K. (2007). Research methods in education. (6th ed). London: Routledge.
Daly, W.M. (1998). Critical thinking as an outcome of nursing education. What is it? Why is it important to nursing practice? Journal of Advanced Nursing. 28(2):323-331.
Duchscher, J.E.B. (1999). Catching the wave: understanding the concept of critical thinking. Journal of Advanced Nursing. 29(3):577-583.
Fero, L.J., Witsberger, C.M., Wesmiller, S.W., Zullo, T.G. & Hoffman, L.A. (2009). Critical thinking ability of new graduates and experienced nurses. Journal of Advanced Nursing. 65(1):139-148.
Gopee, N. (2002). Demonstrating critical analysis in academic assignments. Nursing Standard. 16(35):45-52, 54-55.
Girot, E.A. (2000). Graduate nurses: critical thinkers or better decision makers? Journal of Advanced Nursing. 31(2):288-297.
Gordon, M. (2009). Toward a pragmatic discourse of constructivism: reflections on lessons from practice. Educational Studies. 45:39-58.
Greenwood, J. (2000). Critical thinking and nursing scripts: the case for the development of both. Journal of Advanced Nursing. 31(2):428-436.
Hill, M. (2008). Social research philosophies: a brief introduction. Northumbria University: unpublished handout.
Horan, K.M. (2009). Using the human patient simulator to foster critical thinking in critical situations. Nursing Education Perspectives. 30(1):28-30.
Ip, W.Y., Lee, D.T.F., Chau, J.P.C., Wootton, Y.S.Y. & Chang, A.M. (2000). Disposition towards critical thinking: a study of Chinese undergraduate nursing students. Journal of Advanced Nursing. 32(1):84-90.
Johns, C. (1995). Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing. 22:226-234.
Jones, S.A. & Brown, L.N. (1991). Critical thinking: impact on nursing education. Journal of Advanced Nursing. 16:529-533.
Knowles, M.S., Holton III, E.F. & Swanson, R.A. (2005). The adult learner. (6th ed). Amsterdam: Elsevier Butterworth Heinemann.
Ku, K.Y.L. (2009). Assessing students’ critical thinking performance: urging for measurement using multi-response format. Thinking Skills and Creativity. 4:70-76.
Kyung, R.S. (1998). Critical thinking ability and clinical decision making skills among senior nursing students in associate and baccalaureate programmes in Korea. Journal of Advanced Nursing. 27:414-418.
Legg, T.J., Adelman, D. & Levitt, C. (2009). Constructivist strategies in online distance education in nursing. Journal of Nursing Education. 48(2):64-69.
Mitchell, A.W. and Batorski, R.E. (2009). A study of critical reasoning in online learning: application of the Occupational Performance Process Model. Occupational Therapy International. [DOI:10.1002/oti.272. Accessed 8 April 2009].
Northumbria University. (2009). Research skills: approaches to evidence and enquiry. Unpublished handout. Northumbria: Northumbria University.
Profetto-McGrath, J. (2003). The relationship of critical thinking skills and critical thinking disposition of baccalaureate nursing students. Journal of Advanced Nursing. 43(6):569-577.
Ravert, P. (2008). Patient simulator sessions and critical thinking. Journal of Nursing Education. 47(12):557-562.
Rush, K.L., Dyches, C.E., Waldrop, S. & Davis, A. (2008). Critical thinking among RN to BSN distance students participating in human patient simulation. Journal of Nursing Education. 47(1):501-507.
Schommer-Aikins, M. & Easter, M. (2009). Ways of knowing and willingness to argue. The Journal of Psychology. 143(2):117-132.
Simpson, E. & Courtney, M. (2002). Critical thinking in nursing education: literature review. International Journal of Nursing Practice. 8:89-98.
Staib, S. (2005). Teaching and measuring critical thinking. Journal of Nursing Education. 42(11):498-508.
Tennant, M. (2006). Psychology and adult learning. (3rd ed). London: Routledge.
Tiwari, A., Avery, A. & Lai, P. (2003). Critical thinking disposition of Hong Kong Chinese and Australian nursing students. Journal of Advanced Nursing. 44(3):298-307.
About the Author: D Hayes, RN, BEd (Hons) is the Senior Education Officer of the MAHSA University College. His article is a reworking of previously prepared material. He wishes to extend his acknowledgement to Associate Professor Zahrah Saad, Dean of the Faculty of Nursing, MAHSA University College, and Dr Maureen Sookhoo and her colleagues of Northumbria University, UK for giving him encouragement and inspiration to consolidate this review.
