Upload
elita-fadhli
View
147
Download
0
Embed Size (px)
DESCRIPTION
nursing education
Citation preview
STRATEGIES FOR PROMOTING
CRITICAL THINKING IN NURSING EDUCATION
1 Introduction
Nursing education has changed dramatically since Florence Nightingale asserted the
importance of education and moral standards to fulfill the nurse’s role. Based on these
criteria, selected candidates were trained under a formalized training program of nurses
(Russel, 2000). In the years of Nightingale’s system, nursing education was taken at hospital-
based. However, it has been transferred into the higher education sector in the late of 20 th
century (Russel, 2000; Sutton, 1996). According to Hart (1985), this transfer was influenced
by the increase of expectation of high quality nursing care, the changes role of women in
society followed by economic efficiency, political reasons and the needs of trained staff.
Regarding the purposes of higher education, Quinn (2000) outlines two aims of
education for undergraduate program. Firstly, the specific aims related to particular subjects
like nurse and midwifery. Secondly, general aims for all undergraduate programs such as
“development in communication skill, problem-solving, critical thinking and evaluation”. For
postgraduate level, students are directed to asses and evaluate their professional practice. p.
79. Furthermore, Adams (1999) states that nursing education has to develop students’ ability
to make decisions and solve problems which are necessary in providing high quality nursing
care which is safe and promotes wellness. Again, according to Adams (1999) these skills are
rooted from critical thinking which builds skills in making decisions and solving problems.
Therefore, within the transfer of nursing education into university, nurse educators
have to create appropriate curriculum and develop innovative teaching strategies to facilitate
student’s critical thinking skills in learning process (Bell, et.al 2002). Requirement to
integrate critical thinking in nursing education was asserted since the National League for
Nursing Accreditation Commission and The Commission on Collegiate Nursing Education in
US has asked nursing schools to develop student’s critical thinking ability (Billings and
Hastead, 2005).
There are various meaning of critical thinking that has been formulated by experts
over the years (Myrick, 2002). Watson and Glaser (1980) define critical thinking as elements
of attitudes, knowledge and skill which involve inference; acknowledge the assumptions,
deduction, interpretation and evaluation of arguments. Meanwhile, Girot ( as quoted in
Banning, 2006) state that critical thinking is “a complex cognitive process requiring higher
order thinking and application to decision-making in practice”. Alfaro-LeFevre (1995)
describes that critical thinking in nursing field including outcome-directed, purposeful
thinking; promote nurses to not focus on assumption but make a decision based on evidence,
built on scientific approaches and principles; and needs methods to maximize potentiality of
human and compensate for difficulties that come from human nature. Moreover, Edwards
(2007) identify five concepts that include in critical thinking that are critical, analysis,
thinking, synthesis and creative.
In addition, based on American Philosophical Association Delphi report on critical
thinking in 1990, it was concluded that dispositional characteristics of critical thinking
(affective) is needed to develop this skill. It includes inquisitiveness, open-mindedness,
systematicity, analicity, truth seeking, self-confidence and maturity (Walker, 2003).
Even though the definition of critical thinking is diverse, there is no doubt that this
skill is essential in nursing education. (Profetto-McGrath, 2005; Koch and Speers,1997).
However, the implementation of teaching method to enhance critical thinking has several
challenges and difficulties that have to be encountered.
In order to explore the challenges and useful strategies to promote critical thinking, in
the following essay, the challenges in developing critical thinking would be presented
followed by several strategies to promote critical thinking in nursing education.
2 The challenges in developing critical thinking
The application of critical thinking in nursing education has been introduced in the
past few years which mean this concept is new in nursing education. Therefore; it is not easy
to shift the former teaching-learning methods into a new curriculum. Nurse educators have
experienced several challenges and difficulties in developing and assessing students’ critical
thinking skills (King and Shell, 2002).
Edwards (2007) identifies several problems that hamper development of critical
thinking skill. The first problem is there are numerous of literature of critical thinking which
is too theoretical and using complex language or jargon in the articles. It results in an
ambiguity to understand and to apply critical thinking concept into clinical practice.
Secondly, the various definition of critical thinking that caused by different perspective of
authors in viewing critical thinking creates some doubtful among nurse educators. Further,
Edwards (2007) assumes that the one cause of why critical thinking process is not employed
in clinical practice is the confusion of the term critical thinking, reflective practice and
decision-making.
The other difficulties in promoting critical thinking skill are found by Girot (1995).
Girot’s study reveal two problems. First, the student’s abilities to encourage cognitive skills
are more emphasized in academic field rather than clinical practice. Second, in actual
practice, student’s critical thinking ability are assessed mostly by practitioners who do not
indicate expand this skill by themselves. Moreover, Billings and Halstead (1995)
acknowledge that mostly, faculty use traditional model in teaching which mainly dominate by
teacher. They claim that this model is not contributed to encourage critical thinking. The use
of teacher-centered in learning has produced students who are passive in learning process,
whereas, the ability to think critically will be growth when students engaged actively in
learning process (DeMarco, Hayward and Lynch, 2002). It is one of challenges for nurse
educators to create strategies that bring students into active learning style.
In addition, based on my own experience in Indonesia, the use of one-way
communication in teaching process is still common. May be, it is because the influence of
culture where students hesitate to communicate with teachers who is considered have to be
respected. It still influences attitude of students and relationship with teacher either in
classroom or in clinical practice.
On the other hand, nurse educators ‘attitude have an important role in learning
process. Mostly, teachers act in an authoritarian manner which is not conducive in learning
environment, while to develop critical thinking, disclosure relationship and consider students
as colleague are necessary.
3 Strategies for Promoting Critical Thinking
An integrative review that was conducted by Adams (1999) revealed that no consistent
indication that nursing education play a role to develop student’s ability to think critically.
This finding shows that the results of critical thinking development do not come yet. In order
to achieve the goals to develop students’ critical thinking ability, nurse educators have to
review their curriculum and lesson plans continuously. Faculty also needs to shift their
philosophy of teaching to support this process, while environment which free from risk to
support students to become active learners should be constructed as well. (Billings and
Halstead, 2005). Furthermore, some strategies in teaching-learning process have to be
expanded by finding reliable resources and employing relevant strategies to empower
students. Another way to discover new strategies is by conducting some research in nursing
education.
The following are some innovative strategies to promote critical thinking based on a lot
of research findings.
3.1 Active learning strategies.
Walker (2003) emphasizes that in critical thinking, an individual have to get involve in
thinking process actively. Abilities to analyze and evaluate information and inferences
indicate the engagement in critical thinking process. To develop these abilities certain
characteristics and self awareness are needed. Moreover, Walker (2003) discusses several
active learning strategies such as questioning, discussion, and written exercises.
3.1.1 Questioning
Nurse educators can use various questioning methods that enhance students to analyze
and synthesize the facts and concepts. Walker (2003) identify several words or sentence to
start the questions including the use of word “explain, compare, why, what is the best and
why, which is the best solution, do you agree or disagree”. Another type to encourage
students’ thoughts is by asking students who do not raise their hand. Further, he suggests to
not using questions which have only one point of view. Similarly, an ethnographic study
conducted by Twibell, Ryan and Hermiz (2005) reveals that in clinical instructor use multiple
questioning to encourage critical thinking. The use of series of simple question is considered
more useful rather than a general question. Skill to create high-level questions to stimulate
critical thinking needs to be learned either by educators or students.
Further, Profetto-McGrath, et.al (2004) undertook a study of the type of questions asking
by nurse educators and students a baccalaureate nursing program in Canada during first three
years of program. In this study they found that the type of questions was form low-level
questions including knowledge, comprehension and application). They suggested that nurse
educators and students should learn to formulate high-level questions that call for analysis,
synthesis and evaluation.
3.1.2 Classroom discussion and debate
Another strategy to enhance active learning according to Walker (2003) is classroom
discussion and debate. The controversial issues in debate can develop critical thinking.
Students are stimulated to perform strong arguments to defend their opinion. Galotti (as cited
in Walker ,2003) discusses strategy to observe student’s reasoning skill that. In this method,
students are instructed to work in pair and are given 4 reasoning tasks. Student who get the
tasks have to talk a lot while another student have to observe and write the key words.
3.1.3 Writing: assignments/informal journals
Written assignments give students opportunity to think critically. Oermann (as cited in
Walker 2003) state that the general rule for assignments which is used to promote critical
thinking is assignments should not too long paper. In clinical practice, written assignments
are also useful to develop critical thinking skill. For example: “review of nursing care plans, a
milieu assessment, clinical case study and management problems analysis” (Twibell, Ryan
and Hermiz , 2005).
Billings and Halstead (2005) identify several steps in evaluating writing tasks, they are:
arrange the assignment with the final grading in mind, review the whole paper rather than
focus on grammar and style. Then, peer review of drafts, specifies criteria of grading, identify
students’ learning needs by giving the flexibility of the topic. Finally, review of students’
draft as the beginning assessment is important, it also assists teacher to recognize if any
problems emerges.
3.1.4 Case Study/Case-Based Instruction/Case Problem/Case Scenario
Case study is one of active learning strategies. According to Billings and Halstead
(2005), definition of case study is “in-depth analysis of a real-life situation as a way to
illustrate class content; applies didactic content and theory to real life, simulate life or
both”(p. 296). By using this method, nurse educators have to create well-designed scenarios
to provide opportunities for students to overcome the problems and relate it to their clinical
practice. Moreover, explain that nurse educators have to analyze the scenario to determine the
possibilities of student’s response in analyzing the scenario. Then, in class session nurse
educators have to give relevant questions and motivate students who prefer passive learning.
Giving corrections to misconceptions and provide a conclusion of the important parts.
In addition, state that case-based instruction can be focused either on student individually
or a group of students. Students can work together to find solutions of the complex cases.
Nurse educators play a role as facilitator and encourage students to analyze, do active
research, solve the problems and critiques other students their group.
From the result of their study of case-based instruction, DeMarco, Hayward and Lynch
(2002) found that this learning strategy enable students to solve the problems similar to the
real world situation. It is considered stimulate students to think critically, solve the problems,
make prioritize, work in team and value the task of nurse manager. Further, they conclude
that case-based instruction raise students ‘confidence about their lessons and expand
student’s knowledge from clinical field to the classroom.
3.2 Mind Mapping/Concept Mapping
Billings and Halstead (2005) define mind mapping or concept mapping as “learning
complex phenomenon by diagramming the concepts and sub concepts. Similarly, Gul and
Boman (2006) present that concept map is a general approach to elucidate the opinion about
an issue into a visual form.
Further, King and Shell (2002) state that concept mapping is a useful teaching approach
to develop critical thinking and the main goal of concept mapping is to synthesize pertinent
data. Then, they illustrate the process of mind mapping. For example, in clinical practice the
reason for “seeking help” is arranged as the center of map. Then other important data such as
nursing diagnoses, sign and symptoms, nursing intervention and other patient’s needs are
clustered and linked to the center. With the identification of concept and diagram, students
start to analyze the case and try to find other information and relationships between
components in the diagram and concept. By filling the gaps in diagram, students begin to
prepare a decision.
Hicks-Moore (2005) reports that students showed that the use of concept maps were
useful in preparing their clinical practice and it enhanced them to think critically. In the same
way, faculty recognized that this strategy was valuable because it allowed faculty to insight
the level of student understands and assisted faculty in assessing student’s performance.
On the other hand, the process in constructing concept mapping is assumed time
consuming, particularly when students have to prepare it for more than one patient. Yet, it
become easier when this method is practiced continuously (Hicks-Moore, 2005).
3.3 Problem-Based Learning (PBL)
According to Billings and Halstead (2005), problem-based learning is a method that
applied to the whole curriculum. In addition, Wilkie (2000) defines PBL as “an instructional
method in which students work in small groups to gain knowledge and acquire problem-
solving skills.” (p.11)
In PBL, students work in a small group and share the information with their friends.
During the interaction, students should perform openness and honesty (Baptiste, 2003). Frost
(1996) describes that an issue in PBL is delivered before learning session by using videos,
audio-tapes, a scenario or case notes.
Tiwari et, al (2006) reports that students who were taught used PBL method had higher
level of critical thinking disposition compared to students who attended lecture group.
Moreover, students in PBL class felt that this method enhanced them to analyze problems,
gain a critical methods to investigate data related to the issue and taught them work
systematically. In addition, Quinn (2000) explains that PBL is more useful in computer-
assisted learning. Within the use of simulation and case method, students are motivated to
formulate a set of care plan based on a basic data of patient in the computer.
However, the implementation of PBL spends amount of time for creating problem
situation, the exchanges roles between lecturer and students and students need clear
explanation about the roles (Billings and Halstead, 2005).
4 Conclusion
Indeed, the ability to think critically is essential in nursing education and many efforts
have been under taken by experts and scholars to develop it. Various strategies to promote
critical thinking have been discovered by a number of researchers.
However, there are a lot of constraints and challenges that requires our attention. The
process to implement strategies to facilitate critical thinking needs time and hard works. The
insight of concept of critical thinking is important and faculty which has the main role in
developing critical thinking should provide relevant training for the nurse educators, create
conducive learning environment and expand the curriculum that stimulate critical thinking for
students.
The List of References
Adams, L. (1999). Nursing Education for Critical Thinking: An Integrative Review. Journal
of Nursing Education, 38(3), 111.
Alfaro-Lefevre, R. (1995). Critical thinking in nursing: A practical approach. Philadelphia:
W.B. Saunders.
Babtiste, S. E. (2003). Problem-based learning: a self-directed journey. New Jersey: Slack
Incorporated.
Banning, M. (2006). Measures that can be used to instill critical thinking skills in nurse
prescribers. Nurse Education in Practice(6), 98-105.
Bell, M., Heye, M. L., Campion, L., Hendricks, P. B., Owens, B. L., & Schoonover, J.
(2002). Evaluation of a Process-Focused Learning Strategy to Promote Critical
Thinking. Journal of Nursing Education, 41(4), 175.
Billings, D. M., & Halstead, J. A. (2005). Teaching in Nursing (2nd ed.). St Louis, Missouri:
Elsevier Saunders.
DeMarco, R., Hayward, L., & Lynch, M. (2002). Nursing Students' Experiences With and
Strategic Approaches to Case-Based Instruction: A Replication and Comparison
Study Between Two Disciplines. Journal of Nursing Education, 41(4), 165.
Edwards, S. L. (2007). Critical thinking: A two-phase framework. Nurse Education in
Practice(7), 303-314.
Frost, M. (1996). An analysis of the scope and value of problem-based learning in the
education of health care professionals. Journal of Advanced Nursing, 24, 1047-1053.
Girot, E. A. (1995). Preparing the practitioner for advanced academic study: the development
of critical thinking. Journal of Advanced Nursing(21), 387-394.
Gul, R. B., & Boman, J. A. (2006). Concept mapping: A strategy for teaching and evaluation
in nursing education. Nurse Education in Practice(6), 199-206.
Hart, G. (1985). College-based education:background and bugs. Why it has happened. . The
Australian Nurses Journal, 15(4), 46-48.
Hicks-Moore, S. L. (2005). Clinical concept maps in nursing education: An effective way to
link theory and practice. Nurse Education in Practice(5), 348-352.
King, M., & Shell, R. (2002). Critical Thinking Strategies: Teaching and Evaluating Critical
Thinking With Concept Maps. Nurse Educator, 27(5), 214-216.
Koch, F. T., & Speers, A. T. (1997). It is time to move from the nursing process to critical
thinking. AORN Journal, 66(2), 318.
Myrick, F. (2002). Preceptorship and Critical Thinking in Nursing Education. Journal of
Nursing Education, 41(4), 154.
ProfettoMcGrath, J. (2005). Critical Thinking and Evidence-Based Practice. Journal of
Professional Nursing, 21(6), 364-371.
ProfettoMcGrath, J., Smith, K. B., Day, R. A., & Yonge, O. (2004). The questioning skills of
tutors and students in a context based baccalaureate nursing program. Nurse
Education Today(24), 363-372.
Quinn, F. M. (2000). Principles and Practice Of Nurse Education (4th ed.). London: Nelson
Thornes (Ltd).
Russell, R. L. (2000). Milestone in Australian nursing. In S. Daly. J, S & Jackson, D (Ed.),
Context of nursing (pp. 11-24). Sydney: Maclennan & Petty.
Sutton, F. (1996). Nursing Education: the marriage of two normative worlds-creating a
sustainable relationship. Nurse Education Today, 16(6), 443-449.
Tiwari, A., Lai, P., & Yuen, K. (2006). A Comparison of the effects of problem-based
learning and lecturing on the development of students' critical thinking. Medical
Education(40), 547-554.
Twibell, R., Ryan, M., & Hermiz, M. (2005). Faculty Perceptions of Critical Thinking in
Student Clinical Experiences. Journal of Nursing Education, 44(2), 71.
Walker, S. E. (2003). Active Learning Strategies to Promote Critical Thinking. Journal of
Athletic, 38(3), 263.
Watson, G., & Glaser, E. M. (1980). Watson-Glaser critical thinking appraisal manual. San
Antonio: The Psychological Corporation: Harcourt Brace Jovanovich, Inc.
Wilkie, K. (2000). The nature of problem-based learning. In S. W. In Glen, K (Ed.), Problem-
based learning: a new model for a new context? London: MacMillan Press Ltd.