Strategies used for the promotion of critical thinking in nursing undergraduate education: A systematic review

Highlights

• The strategy most used was the problem based learning.

• Incorporating strategies that promote critical thinking requires pedagogical reflection of the teacher.

• Educational institutions consider the strategies that encourage critical thinking.

Abstract

Objective

Identifying the strategies used to promote critical thinking (CT) during undergraduate education in nursing courses.

Design

Systematic review.

Source of Data

Five electronic databases were searched without language, publication time or geographic filters.

Method

A systematic review of the literature. Including experimental studies that considered at least one teaching strategy to promote critical thinking of undergraduate students in Nursing courses. The search for studies occurred in three phases: title and summary review, complete text and implementation of a clinical form of selection according to predetermined criteria. All included studies were assessed for quality through a classification tool for experimental studies.

Results

Six studies were selected. The results were grouped into three key themes: an evaluation of the quality of the selected studies, characterization of the studies and the strategies used to promote critical thinking. All selected studies were in English, with significant conceptual similarity of Critical Thinking and dominance in choosing the approached theme during strategies in clinical nursing education with an emphasis on the nursing process.

Conclusions

The most widely used teaching intervention was Problem-Based Learning. Nursing education mediated by strategies that stimulate CT is considered a positive difference in undergraduate curriculums.

Introduction

Critical thinking (CT) has its conceptual roots in the fields of philosophy, psychology and education, since each of these disciplines have a clear definition for CT. Although there are differences in disciplinary points of view, CT is crucial to the process through which students must make judgments in their studies and in everyday life (Facione, 1990).

A frequently cited definition of CT was developed as a result of a Delphi study, which included 46 CT experts from the United States of America (USA) in the fields of philosophy, education, social sciences and physical sciences (Facione, 1990). CT was defined as “the judgment of intentional self-regulation which results in interpretation, analysis, evaluation and inference, as well as explanation of the evidential, conceptual, methodological, criteriological or contextual considerations upon which this judgment is based on” (Facione, 1990, 2).

In nurse education, educators have an extensive background of knowledge and understanding of the complexities of the learning and evaluation process. In 2000, Scheffer and Rubenfeld conducted a Delphi study to determine a more acceptable definition of CT directed to nursing knowledge and stated that critical thinking is an essential component of professional responsibility and quality of nursing care. Similar to the results of Facione, Scheffer and Rubenfeld, Hsieh and Hsu and Paul concluded that nursing students need to present habits of the mind, as well as cognitive skills (Facione, 1990, Scheffer and Rubenfeld, 2000, Hsieh and Hsu, 2013, Paul, 2014).

The habits of the mind mentioned include confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance and reflection. Cognitive skills are analyzing skills with the use of applying standards in seeking information and discriminating, logical thinking and transforming knowledge (Scheffer and Rubenfeld, 2000).

For nursing, CT enhances the ability of contemporary nurses to express high levels of meta-cognitive thinking skills in clinical reasoning, judgment, decision making and problem solving (Andreou et al., 2014).

By discussing the issues of CT in the nursing context, knowledge bases are developed and theoretical operationalization can be explored and tested. Thus, generating and promoting the application of nursing knowledge in practice requires CT being an inherent ability of nursing professionals.

As a result of all disciplines evolving according to the needs of society, the complexity of health care, the increased use of technology and increased acuity, patients need technical and clinical excellence in nurses. In turn, educational institutions must ensure their students develop these skills in order to provide quality patient care and the ability to reflect on their own attitudes, with the end goal being to promote CT (Raymond-Seniuk and Profetto-Mcgrath, 2011). These skills can make a difference in patient safety because it allows nurses to identify the main problem of the patient and to put the "right action for the right reason" into practice (Pitt et al., 2015, 127).

Patient safety is a cross-cutting theme among all healthcare professionals. Higher education institutions have promoted discussions about the quality of training of competent professionals who promote such safety. The ability of newly graduated health care professionals in thinking critically and intervening effectively is essential because of the known risks to patient safety. Thus, it is imperative that innovative teaching and evaluation methods are used to support CT development and improve performance results (Fero et al., 2010).

Thus, designers of nursing curricula has attempted to not only stimulate CT, but also to make sure that students have completed their nursing programs with well-developed CT skills (Pitt et al., 2015). In this context, the aim of this study to identify the strategies used to promote critical thinking during undergraduate education in Nursing courses.