Elsevier

Nurse Education in Practice

Volume 30, May 2018, Pages 91-100
Nurse Education in Practice

Review
Measurement of critical thinking, clinical reasoning, and clinical judgment in culturally diverse nursing students – A literature review

https://doi.org/10.1016/j.nepr.2018.04.002Get rights and content

Highlights

  • Nursing students must demonstrate critical thinking and clinical reasoning.

  • Nursing students must demonstrate excellent clinical judgment during patient care.

  • Need culturally appropriate measurement tools for use with diverse nursing students.

  • Curriculum must be culturally appropriate to foster development of these skills.

  • Nurse educators must teach in culturally congruent manner.

Introduction

There is a need for nursing education globally to assist nursing students in developing the skills of critical thinking, clinical reasoning, and clinical judgment. Developing these skills will require that nursing students develop the ability to: (a) analyze collected data (critical thinking), (b) apply reasoning to the data obtained (clinical reasoning), and (c) appropriately act based on the specific situation (clinical judgment) (Victor-Chmil, 2013). It is expected that nursing students worldwide graduate with all three skills to meet diverse health needs, in both urban and remote areas, and to provide safe and effective patient care (Berkow et al., 2008; Cronenwett et al., 2007; International Council of Nurses, 2009; Lovett and Gidman, 2011). However, these skills may be exhibited and defined differently in various cultural groups (Lasater, 2011; Tian and Low, 2011). Effective evaluation of these skills will require measurement tools that are available and applicable for use with nursing students from all cultures. The purpose of this paper is to review recent literature to determine what measurement tools are available to evaluate critical thinking, clinical reasoning, and/or clinical judgment in nursing students from diverse cultures.

What is the relationship between culture and learning? If there is a relationship, would the effect of culture on learning also influence critical thinking, clinical reasoning, and/or clinical judgment? The cultural values of an individual will affect learning style preferences (Holtbrügge and Mohr, 2010). Students’ cultural values will also influence motivation, ways of thinking, respect for elders, group expectations, and style of communication, (Brown et al., 2013; Coburn and Weismuller, 2012; Frambach, Driessen, Beh and van der Vleuten, 2014). This influence may result in some students not speaking up in discussions or asking questions in class, as those behaviors may be considered unacceptable in some cultures (Frambach et al., 2014; Fung, 2014; Henze and Zhu, 2012).

Sommers (2014), in a review of the literature related to problem-based learning methods to promote critical thinking among nursing students from differing cultures, noted that there was very limited research in nursing that examined the relationship between culture and learning. A conclusion of that review was in order to prepare nursing graduates to meet patient care needs globally, nurse educators need to teach in a culturally congruent manner, and therefore, need to know more about how culture may affect learning (Sommers, 2014). To develop culturally sensitive and supporting learning environments that promote the development of the skills of critical thinking, clinical reasoning, and clinical judgment, it is vital that nurse educators understand how to work with the unique knowledge and skills of ethnically diverse students (Veal et al., 2012). This will include nurse educators being aware that students who have only been exposed to teacher-centered methods (i.e. lecture) may struggle when initially exposed to student-centered methods (i.e. flipped classroom, group work, team learning, problem-based learning) (Bestetti et al., 2014; Frambach et al., 2014; Gilligan and Outram, 2012; Hayes et al., 2015).

As approaches to learning are ingrained and shaped by an individual's culture, caution is required when using tools that were developed for Western cultures for use in non-Western learners (Brown et al., 2013). Carter, Creedy, and Sidebotham (2015), in their review of tools to measure critical thinking in nursing and midwifery students, noted that the measurement of critical thinking in some of the studies reviewed may have been influenced by the impact of culture on different learning environments. Therefore, it is important that any tools used to measure critical thinking, clinical reasoning, and clinical judgment are appropriately culturally contextualized during the translation process (Hwang et al., 2010; Shin et al., 2015a; Shin et al., 2014; Yu et al., 2013).

Section snippets

Search strategies

Electronic databases were searched for papers related to measurement tools that have been used to measure critical thinking, clinical reasoning, and/or clinical judgment in nursing students from diverse cultures. The databases of PubMed, CINAHL, ERIC, PsychINFO, and ProQuest databases were searched. The search was limited to recent articles and dissertations published between 2010 and 2016 that were accessible in the English language. The search terms used were “measurement” AND “critical

Results

Of the 53 papers that were reviewed, the majority (n = 38) measured critical thinking. Clinical reasoning was measured in four papers and clinical judgment was measured in eleven papers. There were five papers that focused on providing a literature review; four of these focused on critical thinking (Carter et al., 2015; Romeo, 2010; Salsali et al., 2013; Zuriguel Perez et al., 2015) and one focused on clinical judgment (Victor-Chmil and Larew, 2013). The other 48 papers focused on describing

Discussion

This review evaluated a total of 53 peer-reviewed papers to assist in determining what measurement tools are available to evaluate critical thinking, clinical reasoning, and/or clinical judgment with nursing students from diverse cultures. Measurement tools for critical thinking, clinical reasoning, and clinical judgment have been translated into languages other than English and have been used with nursing students from a variety of countries. When considering these measurement tools for use in

Conclusion

It will be important to modify teaching and learning strategies to meet the cultural needs of students as one way to improve the success of students from diverse cultures (Yoder, 2001). Meeting the challenging, complex, and unpredictable demands of today's healthcare needs will require that today's nursing graduates are able to critically think, to demonstrate appropriate clinical reasoning skills, and to demonstrate excellent clinical judgment in actual patient care situations.

Preparing

Ethical approval details

Not applicable.

Conflicts of interest

None.

Funding sources

None.

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    This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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