Critical Thinking to Ensure Clinical Reasoning



Critical Thinking and Academic Success

in a Practical Nursing Program

Alicia Lundstrom

William Carey University

Joseph and Nancy Fail School of Nursing

Hattiesburg, MS

Submitted in Partial Fulfillment

of NUR 646

Winter Term 2011

Table of Contents

Page

Abstract…...……………………………………………………………………………... 4

Dedication……………………………………………………………………………….. 5

Acknowledgements……………………………………………………………………… 6

List of Tables…………………………………………………………………………….. 7

List of Illustrations………………………………………………………………………. 8

Section I. Introduction………………………..………………………………………… 9

Background and Significance……………………………………………………. 9

Purpose………………………………………………………………………..…. 11

Project Questions……………………………………………………………….... 12

Hypotheses…….……………………………………………………………….... 12

Limitations……………………………………………………………………….. 13

Theoretical Framework………………………………………………………….. 14

Definitions of Terms…………...………………………………………………... 16

Summary………………………………………………………………………… 19

Section II. Review of Literature………………………………………………………… 21

Introduction……………………………………………………………………... 21

Theoretical Literature……………………………………………………………. 21

Research Literature……………………………………………………………… 32

Summary………………………………………………………………………… 38

Section III. Project Methods……………………………………………………………. 39

Introduction……………………………………………………………………… 39

Methodology…………………………………………………………………..... 39

Setting………………………………………………………………………….... 41

Sample...……………………………………………………………………….... 42

Procedure...…………………………………………………………………….... 42

Data Collection………………………………………………..…………. 42

Data Analysis………………………...………………………..……….... 43

Summary………...………………………………………………………………. 43

Page

Section IV. Project Outcomes……………………………………………………………. 44

Introduction…………………………………………………………………...….. 44

Discussion……………………………………………………………………..…. 44

Implications and Recommendations…...……………………………...…………. 50

Implications for Nursing Practice………………………………………… 50

Implications for Nursing Education………………………………………. 50

Implications for Nursing Research……………………………………….. 50

Summary………………………………………………………………………….. 51

References………………………………………………………………………………… 52

Appendices……………………………………………………………………………….. 56

Appendix A. Consent, President of the College…………………………………. 56

Appendix B. Consent, Dean of Healthcare Education………………………….. 57

Appendix C. Critical Thinking Data Collection Tool.…………………….……. 58

Abstract

In an effort to lower attrition and improve academic success, as well as meet the increasing demands of potential employers for competent nurses, it is essential for nurse educators to consider factors that may serve as valid predictors of academic success in the program of studies and licensure. The present study was a quantitative, descriptive, correlational, ex post facto design. The purpose was to assess associations among score on the HESI®A2 CTE, exit GPA, academic success (successful program completion), success meeting the benchmark HESI®Exit Exam score, and success on the National Council Licensure Examination – Practical Nursing (NCLEX®-PN) first write. A cohort of students (N=60) enrolled in a Practical Nursing program in a small community college in central Mississippi comprised the convenience sample. Data were collected via a retrospective records review. Results of the study suggest a statistically significant association (p.05). However, the setting for the study employed a licensed counselor who provided group stress management sessions and individual counseling sessions for students included in the study on an as needed basis (Tipton et al., 2008).

Research Literature

Quantitative studies of critical thinking as a predictor of success in pre-admission nursing students are very limited. Some of the reasons are difficulty in evaluating levels of critical thinking, the lack of nursing specific tools designed to measure critical thinking skills, and the assumption by professionals that success on the NCLEX®-PN identifies competency in critical thinking. While the majority of questions on the NCLEX®-PN are application and analysis level on Bloom’s Taxonomy, it is incorrect to assume that a student possesses adequate critical thinking capabilities to care for complex beings in complex environments based on these results (Romeo, 2010).

Research conducted in the Netherlands demonstrated the effect of critical thinking instruction in students required to make complex decisions and perform in complex environments. The research was composed of two field studies in crisis management situations for military personnel. In the first study, printed scenarios were presented to 16 officers of the Royal Netherlands Air Force. Eight of the officers were provided an additional instruction sheet explaining critical thinking. Results of the study indicated that the students who were provided with the critical thinking instruction sheet obtained higher grades than the group who did not receive the critical thinking instruction sheet; however, the results were not statistically significant (Helsdingen, Van den Bosch, Van Gog, & Van Merrienboer, 2010).

The second field study was implemented in a high fidelity simulation setting. Participants were divided into eight member teams, with one team receiving critical thinking instruction throughout the simulation scenario. According to investigator reports, the team that received the critical thinking instruction throughout the scenario scored significantly higher (M=2.88, SD=0.37, p≤.05) on the decision-making process portion of the simulation scenario test and the decision outcomes portion of the simulation scenario test (M=2.42, SD=0.36, p≤.05) than the control group. The results of the control group on the decision making process portion of the exam were M=2.20, SD=0.23 and the results on the decision outcomes portion of the exam were M=1.69, SD=0.39 (Helsdingen et al., 2010).

Although this study was not nursing-specific, findings supported the hypothesis that critical thinking and decision outcomes share a direct relationship. That is, the ability of a student to think critically directly influences the decisions that are made and ultimately, the effects of those decisions. This is a key concept in critical thinking instruction and evaluation for nurse educators.

Nursing education institutions face challenges in trying to prepare students to enter the complex world of the nursing profession, while ensuring that students enter the workforce with a passion for providing compassionate nursing care that endures throughout their career in nursing. A descriptive, correlational study performed by Zurmehly (2008) examined the relations of educational preparation, autonomy, and critical thinking to nursing job satisfaction. The study included a sample size of 140 registered nurses who practiced in medical-surgical, administrative, and home health care settings. The study utilized the WGCTA and the Minnesota Satisfaction Questionnaire (Zurmehly, 2008).

Data analysis revealed a statistically significant (r=.538, p ................
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