Nurse educators have become increasingly concerned about the development of skill in critical thinking. Not coincidentally, the new criteria for evaluation of Baccalaureate and Higher Degree Programs explicitly include critical thinking as one of the "required" outcomes of nursing education - "the students' skiïls in reasoning, analysis, research or decision-making relevant to the discipline of nursing" (NLN, 1992, p.26). It is apparent in this forward-looking document that emphasis on content-coverage is a thing of the past, and that we must attend to how we define critical thinking, what educational methods support its development, and how we can assure that students have achieved some acceptable level of skill.
It's little wonder that we may feel overwhelmed by the task. In the April 1991 issue of the Journal, KintgenAndrews summarized the somewhat perplexing literature on critical thinking and clinical judgment in nursing. According to her review, nursing education apparently has little impact on "generic" critical thinking, but does improve skill in clinical judgment. Moreover, KintgenAndrews points out that there is virtually no evidence of a relationship between measures of critical thinking and clinical judgment. This consistent finding of no relationship suggests some conceptual problems in our longstanding assumption that critical thinking can be operationalized in nursing as clinical judgment - problemsolving, decision-making, nursing process.
This issue of the Journal offers some help as we think about critical thinking. In Teacher Talk," Em Bevis tells the story of her journey from an adherence to (and, I might add, a noted authority on) a behavioral model of education to being an outspoken advocate of emancipatory models. Her story is wonderfully enlightening in its own right, but it also serves as an apt reminder about how adherence to the behavioral model eclipses some of our most important educational aims - one of which is critical thinking. Nursing's adoption of the behavioral model resulted in specification of behavioral objectives for every level, course, and even week or day - in an effort to attain and demonstrate to accreditors internal consistency of the program and logical progression of content. Critics of this model, including Bevis, contend that important learnings that could not be observed behaviorally, or leveled clearly, were either overlooked in nursing curricula or treated trivially.
The new accreditation criteria, if they are implemented in the spirit in which they were developed, offer us the opportunity to explore ways that critical thinking abilities may be developed and to avoid trivializing important intellectual skills. In the press to prepare for an accreditation visit, faculty may be tempted to take the pathway we know best - to define critical thinking as nursing process, or to adopt a standard measure such as the Watson-Glazer Critical Thinking Appraisal as the outcome measure. But we will not have learned anything new from our own self-study about what we might do differently to help our students develop critical thinking, nor will we have engaged ourselves in one of the more important aspects of critical thinking - embracing the critical spirit (Norris, 1985; Paul, 1987), to have the disposition to engage in critical thinking about one's critical thinking.
An example of the kind of work we need to be doing is offered in the article by Bowers and McCarthy in this issue. They describe the development of a pre-nursing issues course based on Perry's model of cognitive development, using writing-to-learn strategies. The information about his strategy is important but there are several other characteristics of this work that stand out: the faculty's willingness to listen to students' complaints about "relearning content" and to notice anew the students' not-uncommon behavior of psyching instructors, and their effort to reinterpret behaviors in a different light - an openness to new understanding of an age-old problem. Also evident in this article is an awareness of ways that our own actions may unintentionally contribute to students' difficulties with critical thinking; for example, these faculty changed the practice of adhering to only one correct answer to an exam question if students could present good arguments supporting their responses.
There is little doubt that helping students develop good critical thinking skills is one of our most important educational aims. It is also clear that there is much work to be done, both in understanding the complexity of critical thinking as it relates to nursing practice, and in developing relevant educational methods, both in teaching and outcome assessment. One of the purposes of accreditation is to "foster continuous development and improvement in the quality of educational programs." If, in the accreditation process, faculty feel compelled to take the easy, tried-and-true pathway, the goal of quality improvement will never be achieved.
NOTE: To support further work on critical thinking and clinical judgment, a future issue of Journal of Nursing Education will be devoted to these topics.
- Kintgen-Andrews, J. (1991). Critical thinking and nursing education: Perplexities and insights. Journal of Nursing Education, 30, 152-157.
- National League for Nursing. (1992). Criteria and guidelines for the evaluation of baccalaureate and higher degree programs in nursing. New York: Author, Publication Number 15-2474.
- Norris, S.P. (1985). Synthesis of research on critical thinking. Educational Leadership, 42(S\ 40-45.
- Paul, R. (1987). Dialogical thinking: Critical thought essential to the acquisition of rational knowledge and passions. In J.B. Baron & R.J. Sternberg (Eds.), Teaching thinking skills (pp. 127-148). New York: Freeman.