The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students

ISSUES AND INNOVATIONS IN NURSING EDUCATION

The relationship of critical thinking skills and critical thinking

dispositions of baccalaureate nursing students

Joanne Profetto-McGrath PhD RN

Assistant Professor, Faculty of Nursing, University of Alberta, Alberta, Canada

Received for publication 29 May 2002

Accepted for publication 20 April 2003

Correspondence:

Joanne Profetto-McGrath,

Faculty of Nursing,

3rd Floor,

Clinical Sciences Building,

University of Alberta,

Edmonton,

Alberta T6G 2G3,

Canada.

E-mail: [email protected]

PROFETTO-MPROFETTO-MccGRATH JGRATH J.. (2003)(2003) Journal of Advanced Nursing 43(6), 569–577

The relationship of critical thinking skills and critical thinking dispositions of

baccalaureate nursing students

Background. Critical thinking is essential to nursing practice; therefore, knowledge

and understanding of nursing students’ critical thinking skills (CTS) and related

dispositions are important to nurse educators. This paper presents the results of a

non-experimental study conducted in spring 1998, identifies implications for nurse

educators, and offers recommendations for future research.

Aim. The aim of the study was to investigate the CTS and critical thinking dispo-

sitions (CTD) of students enrolled in a 4-year baccalaureate programme at a uni-

versity in Western Canada.

Methods. The study used a cross-sectional design. Data collection occurred during

regularly scheduled classes. A volunteer sample of 228 students from all 4 years of

the baccalaureate programme completed a background/demographic questionnaire,

the California Critical Thinking Skills Test, and the California Critical Thinking

Disposition Inventory. The reliability of the test and inventory were established

using the Kuder Richardson 20 and Cronbach Alpha respectively. Both descriptive

and inferential statistical analyses were carried out.

Findings. Critical thinking mean scores increased from years 1 to 4 with the

exception of year 3. However, there was no statistically significant difference among

the four student groups. Although differences in critical thinking disposition scores

were not statistically significant, students’ scores differed significantly on the

systematicity subscale. There was a significant relationship between students’ overall

CTS and CTD scores.

Conclusions. Approximately 38% of the students in the current study had adequate

levels of CTS and 85Æ5% of the students had adequate levels of CTD. Results

indicate a need for students’ continued development in these areas. Dispositions are

crucial to critical thinking; without them critical thinking does not happen or may

be substandard.

Keywords: critical thinking, critical thinking dispositions, habits of mind, nursing

education, undergraduate baccalaureate nursing students

Introduction

If professional nurses are to succeed in fast-paced and

complex modern environments, they require critical thinking

skills (CTS) (Paul 1993, Higgs & Jones 2000). According to

Facione and Facione (1994), the education of all successful

professionals requires attention to practical experience, the

content of the discipline, and critical thinking. Several nursing

organizations in North America have included critical think-

ing as a curriculum requirement and/or outcome.

� 2003 Blackwell Publishing Ltd 569

Critical thinking is a significant component of nursing

education and integral to the discipline of nursing (Boychuk

Duchscher 1999, Bowles 2000). It is more important than

ever before, as nurses work with more acutely ill patients,

deal with complex technology, confront challenging ethical

issues, and cope with a constantly changing knowledge base

(Beeken 1997, Chenoweth 1998, Halpern 1998, Adams

1999, Smith-Blair & Neighbors 2000).

Experts have defined critical thinking in a number of

ways (Rane-Szostak & Fisher Robertson 1996, Daly 1998,

Profetto-McGrath & Myrick, unpublished paper). However,

the definition by Watson and Glaser (1964) remains the

most widely used. Broadly speaking, they view critical

thinking as a synthesis of attitudes, knowledge, and skills.

Meyers (1986) defines critical thinking as the ability to raise

appropriate questions and analyze solutions without neces-

sarily offering alternatives. Ennis’ (1987) definition of

critical thinking encompasses reflection and reasonableness,

while Brookfield (1987) views critical thinking not as an

‘abstract academic pastime’ (p. 14), but as an activity, that

is productive, positive, and lived. According to Ruggiero

(1990), decision-making, problem-solving, and purposeful

dialogues about controversial topics depend on critical

thinking, because it is a process to evaluate ideas. It is

needed to appraise statements accurately and evaluate the

soundness of a conclusion reached as a result of the

reasoning process. Paul (1992) describes critical thinking

as the ‘art of thinking about your thinking while you are

thinking in order to make your thinking better; more clear,

more accurate and more defensible’ (p. 11). According to

Paul, critical thinking is ‘disciplined, comprehensive, based

on intellectual standards, and, as a result, well-reasoned’

(1993, p. 20). Lastly, Profetto-McGrath and Myrick

(unpublished paper) describe critical thinking as ‘an active,

ongoing cognitive process of logical reasoning in which the

individual methodically explores and analyzes issues, inter-

prets complex ideas, considers all aspects of a situation and/

or argument and where appropriate follows with prudent

judgement’.

Paul (1992), Facione et al. (1994), and Norris (1995)

believe that the education of good critical thinkers includes

the fostering of critical thinking dispositions (CTD), as well

as the development of critical thinking skills. According to

Facione (1997), the ‘disposition toward critical thinking is

best described as the consistent internal motivation to engage

problems and make decisions by using thinking’ (p. 13).

Ruggiero (1990) argues that individuals must be mentally

disciplined. He describes critical thinkers as honest individ-

uals who recognize their own limitations and view contro-

versies and problems as challenges rather than threats.

Critical thinkers are curious and patient when faced with

complex and confusing issues, open-minded, tolerant of

divergent views, and able to suspend judgement pending

additional evidence.

No studies investigated the relationship between CTS and

CTD in nursing students before the 1990s. Since Facione and

Facione’s (1992) development of the first instrument to

measure dispositional traits, some studies detailing this

relationship have been published. McCarthy et al. (1999)

and Colucciello (1997), who investigated the CTS and CTD

of baccalaureate nursing students, reported a significant

correlation between the two measures (r ¼ 0Æ24, P < 0Æ001

and r ¼ 0Æ32, P £ 0Æ01 respectively). In both studies, the CTS

and CTD were significantly higher for senior students when

compared with the scores of sophomores. Facione (1997)

published similar findings. She found a positive correlation

(r ¼ 0Æ201, P < 0Æ001) between the scores of 1557 students

who completed the California Critical Thinking Skills Test

(CCTST) and the California Critical Thinking Disposition

Inventory (CCTDI) at the beginning of their programmes and

a low positive correlation (r ¼ 0Æ169, P < 0Æ001) for 793

students at program completion. Moreover, based on two

samples totalling 200 students, the relationship between CTS

and CTD was reported by Facione et al. (1994) to be

r ¼ 0Æ66 and 0Æ67, P < 0Æ001. The purpose of the current

paper is to add to the body of research based on the use of the

CCTST and the CCTDI by presenting the results of a study

conducted in spring 1998 at a university in Western Canada.

In addition to presenting the results, implications for nurse

educators are identified, and recommendations for future

research are offered.

The study

Design

This non-experimental study used a cross-sectional design,

which allowed for the simultaneous collection and examina-

tion of data from four cohorts of students enrolled in years

1–4 of a baccalaureate programme at one point in time in

spring 1998. The cross-sectional study design was also useful

to explore the relationships and correlations of CTS and CTD

among the four cohorts of nursing students.

Aim

The aim of the study was to investigate the CTS and CTD of

students enrolled in a 4-year baccalaureate programme at a

Canadian university. The following questions guided the

study:

J. Profetto-McGrath

570 � 2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(6), 569–577

• What are the CTS and CTD of baccalaureate nursing stu-

dents?

• Do baccalaureate nursing students’ CTS and CTD scores

differ according to the number of years in the programme?

• Is there a relationship between baccalaureate nursing stu-

dents’ CTS and CTD scores?

Sample

Two hundred and twenty-eight (35%) of the 649 full-time,

undergraduate baccalaureate nursing students enrolled in the

4 years of the programme at the time of the study chose to

participate. Demographically (taking into account age, gen-

der, and level of academic preparation completed prior to

admission to the programme), this sample was comparable

with the population of nursing students registered in the

programme during spring 1998.

Procedure

After obtaining permission to access the population and

ethical approval to conduct the study, I sent a letter to all

nursing students and nurse educators in the programme

informing them of the study. Access to students was

prearranged with instructors assigned to teach the courses.

Students were visited once at the prearranged, scheduled class

time during the 7-week period available for data collection in

spring 1998. Using a fixed script, I explained the nature of the

study and their involvement before data collection. Students

who were present and consented to participate in the study

were given 75 minutes to complete three questionnaires.

Instruments

The CCTST, CCTDI, and a background/demographic ques-

tionnaire were used to collect the data in this study. The

CCTST (Facione & Facione 1990) consists of 34 questions,

each with four response options, one of which is correct. The

test can be completed in 45 minutes. Each correct response is

assigned one point; therefore, scores can range from 0–34,

with higher scores reflecting stronger CTS. The CCTST

produces a total score and five subscales scores, which are:

analysis, evaluation, inference, deductive reasoning, and

inductive reasoning. These are defined in Table 1.

The Kuder Richardson 20 internal consistency reliability

measure for the CCTST has been reported at 0Æ68–0Æ70

(Facione & Facione 1994, Facione 1997, Bowles 2000).

Content validity rests on the association of the CCTST with

the American Philosophical Association (APA) Delphi Report

(Facione & Facione 1994). Construct validity is derived from

the 1990 National Expert Consensus Statement on Critical

Thinking and the Ideal Critical Thinker (Facione & Facione

1994, Rane-Szostak & Fisher Robertson 1996). Concurrent

validity testing is ongoing. To date, pretest results have been

Table 1 Definitions of critical thinking skills and dispositions (Colucciello 1997, Facione 1997)

Critical thinking skills Critical thinking dispositions

Analysis Analyticity

Determine significance, interpret meaning, and detect possible

inferential relationships

Demanding the application of reason and evidence and inclined to

anticipate consequences

Inference Open-mindedness

Bring together all the various elements needed to draw reasonable

conclusions, form conjectures and hypothesis

Tolerance of divergent views and willingness to seriously entertain

alternatives. Self-monitors for possible bias

Evaluation Truth-seeking

Assess the credibility of statements and strength of arguments.

Justify one’s reasoning based on relevant evidence, concepts

methods, or standards

Courageous desire for the best knowledge, even if such knowledge

may fail to support or undermine one’s preconceptions,

beliefs, or interests

Deductive reasoning Systematicity

The assumed truth of the set of premises purportedly necessitates

the truth of the conclusion

Valuing organization, focus, and diligence to approach problems at

all levels of complexity

Inductive reasoning Self-confidence

An argument’s conclusion is apparently warranted, but not

necessitated, by the assumed truth of its premises

Trusting one’s own reasoning skills and inclined to use these skills,

rather than other strategies, to respond to problems

Inquisitiveness

Curious and eager to acquire knowledge and learn explanations

even when the applications of the knowledge are not immediately

apparent.

Maturity

Prudence in making, suspending, or revising judgement

Issues and innovations in nursing education Critical thinking skills and related dispositions

� 2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(6), 569–577 571

correlated significantly with the college Grade Point Average

(GPA) (r ¼ 0Æ20, P < 0Æ001), the Scholastic Aptitude Test

(SAT) Verbal Score (r ¼ 0Æ55, P < 0Æ001), and the SAT

Math Scores (r ¼ 0Æ44, P < 0Æ001) (Facione 1990, p. 4). The

CCTST was correlated positively with the Watson and

Glaser Critical Thinking Assessment (WGCTA, r ¼ 0Æ405,

P < 0Æ001).

The CCTDI (Facione & Facione 1992) can be completed in

20 minutes and consists of 75 declarative statements with

nine to 12 items attributed to each of the subscales. The items

are interspersed throughout the inventory. The CCTDI uses a

6-point Likert scale in which 1 ¼ strongly agree and

6 ¼ strongly disagree. Based on a respondent’s answers, each

item is given a score from 1 to 6. Standardized scores are then

calculated for each subscale (subscale raw scores are multi-

plied by 10 and divided by the number of items on the

subscale). Individuals’ responses generated an overall score

and seven subscale scores: truth-seeking, open-mindedness,

analyticity, systematicity, confidence, inquisitiveness and

maturity (See Table 1 for definitions). The scores can range

from 5 to 60 for each subscale, giving a maximum inventory

score of 420 (60 points � 7 subscales). Scores above 350

reflect a strong disposition, scores between 280 and 350

indicate a positive inclination, and scores under 280 reflect an

overall deficiency in CTD (Facione 1997). The overall

Cronbach alpha internal consistency reliability coefficients

and the overall instrument alpha reliability for this study were

0Æ91. The Cronbach alpha coefficients of subscales were:

Truth-seeking 0Æ70; Systematicity 0Æ73; Inquisitiveness 0Æ84;

Open-mindedness, 0Æ64; Confidence, 0Æ82; Maturity, 0Æ70;

and Analyticity, 0Æ84. The grounding in the APA Delphi study

initially supported the CCTDI’s validity. Facione (1997, p. 12)

cites the work of Giancarlo to establish the validity of the

CCTDI. First, using the California Q-sort technique, Gian-

carlo tested the APA (1990) description of the ideal critical

thinker. Secondly, she investigated the association between

the CCTDI and ego-resilience and found a positive correlation

(r ¼ 0Æ58, n ¼ 198, P < 0Æ001) and between CCTDI and

openness to experience (r ¼ 0Æ37, n ¼ 198, P < 0Æ001). Ip

et al. (2000) found a positive correlation between the CCTDI

total score and term GPA (r ¼ 0Æ36, P < 0Æ01).

The CCTST and CCTDI are the most up-to-date instru-

ments available with acceptable levels of reliability and

validity. Both are easy to administer and deemed effective in

measuring CTS and CTD of baccalaureate nursing students.

Ethical considerations

The Ethics Review Board of the participating university

approved the study and the administration of the nursing

faculty gave permission to access the population of students.

Students were informed that participation in the study was

completely voluntary. Confidentiality was ensured through

the use of code numbers. Students were apprised that the

findings would be submitted for publication and presented at

conferences. Signed, informed consent was obtained from

each student prior to the administration of instruments.

Data analysis

The tests and inventories were computer-scored. Scores were

then transferred to the SPSS Version 6Æ1 for Windows

program. The reliability of the CTS test and the inventory

were established using the Kuder Richardson 20 and Cron-

bach Alpha respectively. Both descriptive statistics and

inferential statistical tests were used. Descriptive statistics

include the calculations of means, standard deviations, modes,

minimum and maximum scores, percentages, and confidence

intervals. These were used to describe and summarize the

data. The inferential statistical tests used were ANOVAANOVA and the

chi-squared test. ANOVAANOVA was used to test the mean differences

among nursing students in the 4 years of the programme (Polit

1996). The chi-squared test was used to establish whether a

relationship existed between the two major variables in this

study, CTD and CTS (Polit 1996). Prior to the calculation of

the chi-square, students’ CTD and CTS scores were summar-

ized in a contingency table with CTS scores grouped in four

categories along the vertical dimension on the left-hand side

(0–14, 15–17, 18–20, and 21–34) and CTD scores grouped in

five categories along the horizontal dimension (0–280, 281–

300, 301–320, 321–350, and 351–420). Each of the 20 cells in

the contingency table included a minimum of five cases,

except for one that contained only two cases. For all analy-

ses, the significance level was set at P ¼ 0Æ05 or less prior

to the data analysis phase.

Results

A total of 228 (35%) nursing students participated in the

study (Year 1, n ¼ 38; Year 2, n ¼ 53; Year 3, n ¼ 57; and

Year 4, n ¼ 80). Based on the information provided on the

biographical questionnaire, the majority of students were

female (n ¼ 204 or 89Æ5%), with a mean age of 22Æ6 years.

One hundred and three nursing students (45%) reported only

high school education prior to admission into the bacca-

laureate programme. Sixty-five (29%) reported that they had

completed university level, and the remainder of the sample

(n ¼ 60, 26%) reported the completion of some college

courses, a diploma/certificate or baccalaureate degree in

another field.

J. Profetto-McGrath


Students were asked to indicate their opinion about

critical thinking and being logical by choosing one of four

statements. One hundred and five students (46Æ1%) viewed

critical thinking and being logical as ‘extremely important’.

Eighty-nine (39Æ0%) viewed critical thinking and being

logical as ‘more important than most other things’, and 33

(14Æ5%) viewed these as ‘helpful, but not as nearly

important as lots of other things’. None (0%) of the nursing

students viewed critical thinking and being logical as ‘a

waste of time’.

Thirty-eight (16Æ7%) students from the sample were unable

to complete all 34 items on the CCTST within the 45 minutes

allotted. The average number of questions left unanswered by

the 38 students was 5. According to the instructions provided

by Facione and Facione (1994) in the CCTST manual, non-

selection constitutes an incorrect response; consequently a

mark of zero was assigned to a question left unanswered. Of

the 228 students who completed the CCTDI, only six

(2Æ63%) did not respond to all 75 items on the inventory.

As recommended by Facione et al. (1992), the missing

responses for all six students were handled by scoring the

mean raw item for the scale. This required ‘summing points

associated with answered items, dividing this sum by the

number of answered items, and using this mean for unan-

swered items’ (p. 11–12).

Critical thinking skills

The descriptive statistics resulting from the CCTST are

found in Table 2. The mean scores for each year were 16Æ7–

17Æ9, with a mean score of 17Æ4 out of a maximum of 34.

Mean scores increased from years 1–4 with the exception of

year 3. There was no statistically significant difference

among the groups (F ¼ 1Æ243, d.f.1 ¼ 3, d.f.2 ¼ 224,

P ¼ 0Æ295). The CCTST norms for undergraduate nursing

students suggest scores under 10 or >20 are rare (Facione

1997). In my study, only six (2Æ6%) of the students achieved

scores <10. However, 87 (38Æ1%) scored above 20,

indicating an adequate level of CTS among students who

participated.

Critical thinking dispositions

Mean CCTDI scores are reported in Table 3. Scores ranged

from 136 to 392; however, only four students (1Æ8%) scored

below 280 while 29 (12Æ7%) students scored above 350.

Thirteen (16%) of the year 4 students achieved scores >350,

whereas only one first year student achieved this. Students in

the 4 years of the programme showed no statistically signi-

ficant difference in CTD scores (F ¼ 0Æ822, d.f.1 ¼ 3, d.f.2 ¼224, P ¼ 0Æ483).

Table 2 Critical thinking scores for

years 1–4

Programme year

and Sample Mean SDSD Mode

95% confidence

interval for mean

Minimum–maximum

Lower

boundary

Upper

boundary

Year 1 n ¼ 38 17Æ1 4Æ5 18Æ0 15Æ6 18Æ6 9–30

Year 2 n ¼ 53 17Æ7 3Æ8 18Æ0 16Æ7 18Æ8 10–29

Year 3 n ¼ 57 16Æ7 4Æ3 14Æ0 15Æ6 17Æ8 8–24

Year 4 n ¼ 80 17Æ9 3Æ7 17Æ0 17Æ1 18Æ8 7–27

Total n ¼ 228 17Æ4 4Æ0 17Æ0 16Æ91 17Æ96 7–30

Minimum score achievable ¼ 0, maximum score achievable ¼ 34.

Table 3 Critical thinking dispositions

scores for years 1–4

Year and sample Mean SDSD Mode

95% confidence

interval for mean

Minimum–maximum

Lower

boundary

Upper

boundary

Year 1 n ¼ 38 304Æ2 32Æ1 270 293Æ5 315Æ0 210–379

Year 2 n ¼ 53 315Æ4 40Æ1 293 304Æ0 326Æ8 136–392

Year 3 n ¼ 57 313Æ5 27Æ2 295 306Æ2 320Æ8 252–360

Year 4 n ¼ 80 312Æ7 36Æ7 319 304Æ1 321Æ3 182–387

All years n ¼ 228 312Æ3 36Æ4 319 307Æ4 316Æ7 136–392

Minimum score achievable ¼ 41, maximum score achievable ¼ 420.



The mean scores achieved by all participants for each of the

seven CTD subscales are displayed in Table 4. A score above

50 on each subscale indicates strength in that disposition.

Scores between 40 and 50 indicate a positive inclination

toward critical thinking. Scores between 31 and 39 indicate

an ambivalent inclination, whereas scores <30 indicate a

negative tendency (Facione 1997).

The lowest mean score (37Æ6) was achieved for the truth-

seeking subscale. According to Facione et al. (1992), truth-

seeking gauges intellectual honesty, courage to acquire the

best knowledge, inclination to ask challenging questions, and

willingness to pursue evidence and proof regardless of where

it may lead. The participants scored highest in the inquisit-

iveness (48Æ9) and the open-mindedness (46Æ5) subscales. The

only statistically significant difference (F ¼ 3Æ582, d.f.1 ¼ 3,

d.f.2 ¼ 224, P ¼ 0Æ015) was found on systematicity, which is

an individual’s habit of being organized, orderly, focused,

and diligent in his or her pursuit of inquiry (Facione et al.

1992). Systematicity scores were higher for third and fourth

year students than for first and second year students.

Relationship between CTS and CTD

Results from this study indicate a significant relationship

between students’ CTS and CTD (v2 ¼ 9Æ37, P ¼ 0Æ014,

power > 0Æ80).

Discussion

Contrary to the findings of my study, in which there was no

statistically significant difference among the 4 years of the

programme, McCarthy et al. (1999) found that fourth year

students’ scores were significantly higher than those of second

year students [t (237) ¼ 4Æ1, (P < 0Æ001)]. Colucciello (1997)

also established a statistically significant difference (F ¼ 6Æ63,

P < 0Æ05) in CTS among students at five academic levels,

however, as in my study, mean CCTST scores did not increase

with each academic level. The lack of a statistically significant

difference among students in the 4 years of the programme

may be associated, in part, with their cognitive development.

McGovern and Valiga (1997) believe that cognitive growth

and development is associated with the ability to engage in

critical thinking. Using Perry’s (1970) four categories of

cognitive and intellectual development (dualism, multiplicity,

relativism and commitment), Valiga (1983) and McGovern

and Valiga (1997) investigated nursing students’ development.

Although there was growth in participants’ cognitive devel-

opment during the programme, most students remained at the

earlier dualistic or multiplistic stages of development. These

findings suggest that cognitive development requires more

time than the 4 years required to complete a baccalaureate

programme. Other factors such as instruction, amount of

direction provided, openness conveyed by nurse educators,

and learning styles are also crucial in CTS and cognitive

development (McGovern & Valiga 1997).

It is reassuring that the majority (195 or 85Æ5%) of students

in this current study achieved CTD scores of 280–350

because ‘critical thinking dispositions are essential for the

development of higher-order critical thinking and learning’

(Colucciello 1999, p. 295). The lack of a statistically

significant difference in CTD among students enrolled in

the 4 years of the programme may be related to such factors

as participants’ cognitive development and the convenience

and cross-sectional nature of the sample.

The highest mean score among the seven CTD was for

inquisitiveness (48Æ9), which reflects curiosity and eagerness

to obtain knowledge even when it may not have immediate

use. This finding is both encouraging and desirable. In a

practice discipline, such as nursing, it is important that

students maintain a curious nature and continue the pursuit

of knowledge. As Facione et al. (1995, p. 4) argue, ‘Since the

knowledge base for competent…nursing practice continues to

Table 4 Critical thinking subscales

disposition scores for years 1–4 (n ¼ 238)

Subscales Mean SDSD Mode

95% confidence

interval for mean

Minimum–maximum

Lower

boundary

Upper

boundary

Truth-seeking 37Æ6 6Æ9 38 36Æ4 38Æ5 13–56

Open-mindedness 46Æ5 5Æ9 43 45Æ7 47Æ3 26–60

Analyticity 45Æ8 5Æ5 44 45Æ1 46Æ5 15–58

Systematicity 42Æ4 7Æ2 45 41Æ5 43Æ4 13–59

Confidence 44Æ7 7Æ6 46 43Æ7 45Æ6 14–60

Inquisitiveness 48Æ9 7Æ2 52 48Æ0 50Æ0 10–60

Maturity 46Æ1 7Æ4 49 45Æ1 47Æ1 13–60

Minimum score achievable: truth-seeking and open-mindedness ¼ 5, analyticity, systematicity,

inquisitiveness and maturity ¼ 6, confidence ¼ 7, maximum score achievable ¼ 60.

J. Profetto-McGrath


expand, a deficit in inquisitiveness would signal a fundamen-

tal limitation of one’s own potential to develop expert

knowledge and professional practice’.

Most students’ scores reflected an ambivalent or negative

inclination toward truth-seeking. Facione et al. (1995) believe

that not being attuned to evidence different from one’s own

view sustains professional practice that does not reflect or

respond to changes in its theory base. Lack of truth-seeking

behaviours may endanger clients if nurses do not pay

attention to evidence that points to missed diagnoses or cues

indicating changes in status. These low scores invite the

question, ‘Why are undergraduate nursing students not

disposed to seeking the truth?’ Colucciello (1997) attributes

students’ weaknesses to didactic-oriented teaching, in which

students are expected to learn volumes of information

presented in lectures. During lectures, students may assume

a passive stance, thus limiting the opportunity for exchange

of knowledge, discussion and inquiry. My teaching experi-

ence suggests that students struggle when encouraged to raise

questions or discuss issues presented in the context of

lectures. When asked about this behaviour, students indicated

that some nurse educators did not foster learning environ-

ments that welcomed questions, while others regarded

questions as inconveniences in time-constrained courses. As

a result, some students learned not to probe and/or question

what they were told.

The only statistically significant difference in the scores of

the seven dispositions was on the systematicity subscale. The

scores on this disposition suggest that as students progress

through the 4 years of the programme they develop an

organized, orderly, focused, and diligent pursuit of inquiry.

The focus of individual courses and programme expecta-

tions may play a role in fostering systematicity. Review of

several course syllabi and assignment guidelines revealed

that systematicity was valued and expected by nurse

educators.

The significant positive relationship between CTS and

CTD supports the findings from previous studies reported by

Colucciello (1997), Facione (1997) and McCarthy et al.

(1999). Although further research studies are needed, these

findings appear to affirm that both CTS and dispositions are

essential for individuals to be effective critical thinkers.

Study limitations

The sample was composed of an accessible sample from the

population of students enrolled in the programme. Only 35%

of the population chose to participate in the study, which

may suggest selection bias. However, the characteristics of

the sample were comparable with those of the population of

students at the time of the study. Daily fluctuations in the

students’ mood and diverse classroom environmental condi-

tions may have influenced participants’ concentration and

response accuracy. The cross-sectional design did not permit

the assessment of CTS and CTD in the same students over

time. Based on these limitations, these findings should be

generalized with caution.

Conclusions

Results of this study indicate that most students in this

sample have adequate levels of CTS and CTD and that these

relate positively and significantly to one another. Results also

suggest, however, that students need continued development

in these areas. Dispositions or habits of mind are crucial to

critical thinking and many experts assert that without

positive dispositions toward critical thinking, it does not

happen or may be substandard. The following recommenda-

tions are offered to nurse educators and researchers.

Implications for nurse educators

First, nurse educators must be knowledgeable about CTS and

dispositions and strategies to assess them. This knowledge

can guide educators to use activities and strategies best suited

for students’ development of CTS, as well as the dispositions

congruent with the ideal critical thinker. Secondly, nurse

educators need to scrutinize curriculum frameworks, course

elements, and teaching strategies to ascertain if and how these

various components reflect the encouragement or obstruction

of CTS and dispositions. Finally, nurse educators must

implement a variety of strategies to foster CTS and CTD.

These include, but are not limited to, debates, reflective

journals, analytical and position papers, role modelling,

Socratic questioning, concept maps, and research projects.

Each strategy must be clearly aimed at facilitating CTS and

dispositions.

Recommendations for researchers

First, longitudinal studies are needed to ascertain baccalaure-

ate students’ CTS and CTD from programme entry to exit,

and 1 and 5 years following graduation. Secondly, to

determine the relationship between students’ CTS, CTD

and clinical practice behaviours, correlation studies must be

carried out. Studies are also needed to ascertain the teaching

and learning strategies that best foster CTS and CTD. Finally,

studies using Perry’s (1970) schemes are required to deter-

mine the relationship between nursing students’ CTS and

CTD and their levels of intellectual and ethical development.



Nursing students who think critically are processing and

forming ideas, rather than memorizing, duplicating the ideas

of others, or accepting without critical thought what they

hear or read. Nurses need CTS to continue searching for

clarity and striving for answers. Moreover, critical thinking

enjoins us to search for answers and beckons us to examine

ideas that confront us. Critical thinking is central to

excellence in nursing education, practice, and research.

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What is known about this topic

• Critical thinking is an important attribute in nursing,

thus an expected outcome of many nursing education

programmes and a standard of numerous professional

groups/associations.

• Critical thinking, a complex phenomenon, has been

studied by experts of various disciplines, including

nursing, but there is lack of consensus about its defini-

tion and measurement.

• Of the instruments available to measure critical think-

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ment tool has been the most commonly used by nurse

researchers although it has yielded equivocal results.

What this paper adds

• This study reports on the use of two relatively new tools

in the field of critical thinking, the California Critical

Thinking Skills Test (CCTST) and California Critical

Thinking Disposition Inventory (CCTDI).

• Use of the CCTST and CCTDI with a group of under-

graduate nursing students indicated a significant and

positive relationship between CTS and certain disposi-

tions, strengthening the call for nurse educators to

facilitate students’ development of these skills and dis-

positions.

• Further research using the CCTST and CCTDI must be

conducted in a variety of settings, with different popu-

lations, and in combination with measurements of other

important skills/processes, such as clinical judgement.

J. Profetto-McGrath


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The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students