Journal of Nursing Education

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Critical Thinking Ability of Nurse Educators and Nursing Students

Dorothy Hartley, RNCS, MSN; Virginia Aukamp, RN, PhD

Abstract

in 1987 the National League for Nursing (NLN) characterized the role of liberal education as foundational for the development of critical thinking (NLN, 1987). The NLN further stated that the baccalaureate nursing curriculum must reflect critical thinking and the synthesis of learning. It is not surprising, then, that nurse educators today are increasingly concerned with improving the critical thinking ability of nursing students. This becomes evident when reviewing the Cumulative Index of Nursing and Allied Health Literature (CINAHL). Critical thinking was not even listed in CINAHL until 1989. Since then more than 47 articles have been referenced under this heading.

Purpose

This study was conducted to measure the critical thinking ability of nurse educators and to compare these abilities to values already established for nursing students. The critical thinking ability of nurse educators was investigated because nurse educators are held accountable for improving the critical thinking ability of their students.

Literature Review

No research measuring the critical thinking ability of nurse educators was discovered during an extensive review of the literature, including a computer search of CINAHL from 1985 through 1991. Although the topic was not Usted until 1989, previous topics under decision making and problem solving were crossreferenced under critical thinking. Researchers investigating decision making and problem solving focused on nursing students and expert clinical nurses, but not on nurse educators (Benner & Tanner, 1987; Westfall, Tanner, Putzier, & Padrick, 1986).

The Watson-Glaser Critical Thinking Appraisal (Watson & Glaser, 1980) is the tool used consistently by researchers of critical thinking in nursing (Bauwens & Gerhard, 1987; Brooks & Shepherd, 1990; Gross, Takazawa, & Rose, 1987; Pardue, 1987; Sullivan, 1987). When reviewing the research on critical thinking it becomes evident that the results are mixed. It is unclear how stable critical thinking ability is, or if there is a point at which one has reached maximum potential. However, critical thinking ability does increase in some people over time (Watson & Glaser). This could be related to age, life experience, education, or other factors yet to be identified.

Several strategies for improving nursing students' critical thinking ability have been outlined (Kemp, 1985; Klaassens, 1988; Maiek, 1986; Müler & Malcolm, 1990; Schank, 1990; White, Beardslee, Peters, & Supples, 1990). One underlying assumption of these strategies is that critical thinking ability is a dynamic attribute that can be improved by nurse educators. Another assumption made by these strategists is that nurse educators are proficient in critical thinking themselves. However, no evidence was found in the literature to support this last assumption. For this reason the following research question was investigated.

Research Question

The question used in the study was: Is there a significant difference between the critical thinking ability of nurse educators and nursing students?

Instrument

The Watson-Glaser Critical Thinking Appraisal, Form A, is a self-administered, multiple-choice test that yields a total raw score of a subject's critical thinking ability as defined by Watson and Glaser (1980). The test contains 80 items that measure five subsets of 16 items each. These subsets are inference, recognition of assumptions, deduction, interpretation, and evaluation of arguments. The items include problems, statements, arguments, and interpretations of data similar to those that are encountered daily at work, in the classroom, and in the media. The test does not exceed a ninth-grade reading level (Watson & Glaser).

The operational definition of critical thinking used in this study was the definition set forth by Watson and Glaser (1980) in their instrument manual.

Methodology

Sample

Prior to the initiation of this study, the University of Missouri Institutional Review Board determined that participants were not at risk. Subjects were nurse educators selected…

in 1987 the National League for Nursing (NLN) characterized the role of liberal education as foundational for the development of critical thinking (NLN, 1987). The NLN further stated that the baccalaureate nursing curriculum must reflect critical thinking and the synthesis of learning. It is not surprising, then, that nurse educators today are increasingly concerned with improving the critical thinking ability of nursing students. This becomes evident when reviewing the Cumulative Index of Nursing and Allied Health Literature (CINAHL). Critical thinking was not even listed in CINAHL until 1989. Since then more than 47 articles have been referenced under this heading.

Purpose

This study was conducted to measure the critical thinking ability of nurse educators and to compare these abilities to values already established for nursing students. The critical thinking ability of nurse educators was investigated because nurse educators are held accountable for improving the critical thinking ability of their students.

Literature Review

No research measuring the critical thinking ability of nurse educators was discovered during an extensive review of the literature, including a computer search of CINAHL from 1985 through 1991. Although the topic was not Usted until 1989, previous topics under decision making and problem solving were crossreferenced under critical thinking. Researchers investigating decision making and problem solving focused on nursing students and expert clinical nurses, but not on nurse educators (Benner & Tanner, 1987; Westfall, Tanner, Putzier, & Padrick, 1986).

The Watson-Glaser Critical Thinking Appraisal (Watson & Glaser, 1980) is the tool used consistently by researchers of critical thinking in nursing (Bauwens & Gerhard, 1987; Brooks & Shepherd, 1990; Gross, Takazawa, & Rose, 1987; Pardue, 1987; Sullivan, 1987). When reviewing the research on critical thinking it becomes evident that the results are mixed. It is unclear how stable critical thinking ability is, or if there is a point at which one has reached maximum potential. However, critical thinking ability does increase in some people over time (Watson & Glaser). This could be related to age, life experience, education, or other factors yet to be identified.

Several strategies for improving nursing students' critical thinking ability have been outlined (Kemp, 1985; Klaassens, 1988; Maiek, 1986; Müler & Malcolm, 1990; Schank, 1990; White, Beardslee, Peters, & Supples, 1990). One underlying assumption of these strategies is that critical thinking ability is a dynamic attribute that can be improved by nurse educators. Another assumption made by these strategists is that nurse educators are proficient in critical thinking themselves. However, no evidence was found in the literature to support this last assumption. For this reason the following research question was investigated.

Research Question

The question used in the study was: Is there a significant difference between the critical thinking ability of nurse educators and nursing students?

Instrument

The Watson-Glaser Critical Thinking Appraisal, Form A, is a self-administered, multiple-choice test that yields a total raw score of a subject's critical thinking ability as defined by Watson and Glaser (1980). The test contains 80 items that measure five subsets of 16 items each. These subsets are inference, recognition of assumptions, deduction, interpretation, and evaluation of arguments. The items include problems, statements, arguments, and interpretations of data similar to those that are encountered daily at work, in the classroom, and in the media. The test does not exceed a ninth-grade reading level (Watson & Glaser).

The operational definition of critical thinking used in this study was the definition set forth by Watson and Glaser (1980) in their instrument manual.

Methodology

Sample

Prior to the initiation of this study, the University of Missouri Institutional Review Board determined that participants were not at risk. Subjects were nurse educators selected from NLN-accredited baccalaureate nursing education programs in Missouri (NLN, 1991). The programs were listed in random order and testing proceeded from program to program until an appropriate sample was obtained, A sample size of 50 nurse educators was necessary to ensure that the values obtained were representative of the population being examined. This was determined by calculating a confidence interval (Polit & Hungler, 1987). With a sample size of 50 there is 95% certainty that the mean score is accurate to within 2 points of the population mean.

Eleven NLN-accredited baccalaureate nursing programs in Missouri were contacted before the appropriate sample size was achieved. One program declined to participate, citing a lack of volunteers. Thus 10 programs, or 67% of the NLNaccredited baccalaureate nursing programs in Missouri, were represented in the final sample.

Six of the participating programs were state supported, and four were private institutions. The schools had a combined enrollment of 838 generic students and 749 BSN completion students. They employed 127 full-time and 27 part-time nurse educators.

The 50 participants in this study were all full-time nurse educators involved in both clinical and classroom instruction. The majority were white females (92% white, 98% female). They had an average of 22.4 years of experience as registered nurses and 12.8 years of experience as nurse educators. Fifty eight percent had their MSN while 42% had their PhD, EdD, or other higher degree.

Consistent values on the WatsonGlaser Critical Thinking Appraisal have been obtained from baccalaureate nursing students. When the Watson-Glaser Critical Thinking Appraisal was revised in 1980, Forms A and B were normed for 651 baccalaureate nursing students from the south, west, and midwest. The following values were obtained: X = 57.3, SD = 7.9 (Watson & Glaser, 1980). These values are consistent with those obtained by Gross, Takazawa, and Rose in 1987 (X = 57.9, SD = 8.22, N = 34) and Sullivan in 1987 (X = 57.0, SD = 8.70, N = 46).

The values obtained by Sullivan (1987) were used to represent baccalaureate nursing students in this study because they were more current than those obtained by Watson and Glaser ( 1980), and the sample size of 46 most closely approximated the sample of 50 nurse educators.

Results

The nurse educators had a higher level of critical thinking ability than did the nursing students, as measured by the Watson-Glaser Critical Thinking Appraisal (t=3.13, df=94, p<.005).

The mean Watson-Glaser score for the nurse educators in this study was 62.46, with a standard deviation of 8.34. Although an initial significance level of p<,05 was selected by convention, it was found that the results were highly significant at the p<.005 level.

Discussion

These results support the assumption that nurse educators possess greater critical thinking ability than nursing students. However, certain limitations restrict the generalization of these findings to all nurse educators and nursing students.

The most obvious limitation is the small sample size. Although the values for nursing students have been established by repetitive trials, no previous values were established for nurse educators. The nurse educators in this study represent only 50 nurse educators from baccalaureate nursing programs in Missouri. Therefore the results should not be generalized to all baccalaureate educators or to nurse educators in diploma or associate degree programs.

Based on the results of this study, it is appropriate for nurse educators to continue to investigate techniques that improve nursing students' critical thinking ability. Further research in this area may necessitate the development of a tool that measures critical thinking ability in situations specific to nursing. A tool such as this would more accurately reflect the impact of nursing education on critical thinking ability.

Nurses today are required to process information and make complex decisions. It is essential that nurses continue to monitor and participate in research on critical thinking. Nursing practice will improve as the critical thinking ability of nurses is fully developed. Nurse educators play a vital role in this process.

Recommendations for further research include:

1. Establish the critical thinking ability of nurse educators more clearly by repeating this study, using a larger sample.

2. Measure the critical thinking ability of nurse educators throughout other areas of the country.

3. Compare the critical thinking ability of a random sample of nurse educators and nursing students from the same nursing programs.

References

  • Bauwens, E.E., & Gerhard, G.G. (1987). The use of the Watson-Glaser critical thinking appraisal to predict success in a baccalaureate nursing program. Journal of Nursing Education, 26, 278-281.
  • Benner, P., & Tanner, C. (1987). Clinical judgment: How expert nurses use intuition. American Journal of Nursing, 87, 23-31.
  • Brooks, K.L., & Shepherd, J.M. (1990). The relationship between clinical decision making skills in nursing and general critical thinking abilities of senior nursing students in four types of nursing programs. Journal of Nursing Education, 29, 391-399.
  • Gross, Y.T., Takazawa, E.S., & Rose, CL. (1987). Critical thinking and nursing education. Journal of Nursing Education, 26, 317-323.
  • Kemp, V.H. (1985). Concept analysis as a strategy for promoting critical thinking. Journal of Nursing Education, 24, 382-384.
  • Klaassens, E.L. (1988). Improving teaching for thinking. Nurse Educator, 13(6), 15-19.
  • Malek, CJ. (1986). A model for teaching critical thinking. Nurse Educator, 11(6), 20-23.
  • Miller, M.A., & Malcolm, N.S. (1990). Critical thinking in the nursing curriculum. Nursing and Health Care, 11(2), 67-73.
  • National League for Nursing. (1987). Characteristics of baccalaureate education in nursing. (Publication No. 15-1758). New York: Author.
  • National League for Nursing. (1991). Baccalaureate and master's degree programs in nursing accredited by the NLN 1991 1992. (Publication No. 15-1310). New York: Author.
  • Pardue, S.F. (1987). Decision-making skills and critical thinking ability among associate degree, diploma, baccalaureate, and master's prepared nurses. Journal of Nursing Education, 26, 354-360.
  • Polit, D.F., & Hungler, B.P. (1987). Nursing research: Principles and methods (3rd ed.). St. Louis: Lippincott.
  • Schank, M.J. (1990). Wanted: Nurses with critical thinking skills. The Journal of Continuing Education in Nursing, 21, 86-89.
  • Sullivan, E.J. (1987). Critical thinking, creativity, clinical performance, and achievement in R.N. students. Nurse Educator, 12(2), 12-16.
  • Watson, G., & Glaser, E. (1980). Watson-Glaser critical thinking appraisal manual. New York: Harcourt, Brace & World.
  • Westfall, U.E., Tanner, CA., Putzier, D., & Padrick, K.P. (1986). Activating clinical inferences: A component of diagnostic reasoning in nursing. Research in Nursing & Health , 9, 269-277.
  • White, N.E., Beardslee, N.Q., Peters, D., & Supples, JM. (1990). Promoting critical thinking skills. Nurse Educator, 15(5), 16-19.

10.3928/0148-4834-19940101-09

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