The unsettled nature of the general job market has led many individuals to rethink their career choices. Because nursing is viewed as a profession that offers opportunities for employment and advancement, individuals are electing to change careers and enter nursing. Such individuals often suffer financially as a result of career changes and need to reenter the job market as soon as possible. Consequently, more individuals are seeking programs that can hasten their entry into professional nursing at the baccalaureate level. In response to this need, an accelerated program was developed which allows students who have previous college credit to earn a baccalaureate degree in nursing (BSN) in less than 22 months. This type of program has been in existence since 1970 (Wu & Connelly, 1992). However, prevalence has increased because such programs access a normally untapped student population, build on previous academic and life experiences, and allow students to proceed at an accelerated pace.
The importance of developing critical thinking abilities in nursing graduates is emphasized in the National League for Nursing (NLN) criteria for accreditation (NLN, 1991). The nursing curriculum, taken as a whole, is expected to contribute to critical thinking ability. However, little has been written about the influence of accelerated nursing programs on graduates' abilities to think critically. Therefore, this study was conducted to evaluate the influence of an accelerated nursing curriculum on graduates' abilities to think critically.
There is a lack of consensus on a definition of critical thinking. Findings of a survey of deans and directors (Jones & Brown, 1991) demonstrated the respondents' lack of clarity about the operations of critical thinking. However, the lack of a discrete definition has not prevented educators from regarding critical thinking as an essential educational component. Critical thinking has most often been described as the ability to recognize the existence of a problem and select pertinent information for the solutions to a problem (Ennis, 1985; Frederickson, 1979). Paul (1993) differentiates critical thinking from linear problem-solving and maintains that information is evaluated as a process of negotiation between conjecture, perspective, and background. According to Watson and Glaser (1980), critical thinking is a composite of knowledge, attitudes, and skills. This composite is necessary to define problems, select pertinent information for solutions, recognize assumptions, formulate relevant hypotheses, draw conclusions, and judge the validity of inferences. The definition proposed by Watson and Glaser appears to be the most useful for nursing because of the practice focus of nursing education.
Not only is there a lack of consensus regarding a definition of critical thinking, but also conflicting results have been obtained about the effects of nursing education on critical thinking abilities. Studies presenting longitudinal data relevant to the influence of traditional baccalaureate nursing education on critical thinking have produced mixed results. Berger (1984) administered the WatsonGlaser Critical Thinking Appraisal (WGCTA) to 137 baccalaureate students as sophomores and again as seniors. There was a statistically significant increase in the post-test scores indicating an improvement in critical thinking ability. In an early pilot study to determine if critical thinking improved during the nursing course sequence, Frederickson (1979) administered the WGCTA to 14 baccalaureate students. A significant difference was found between the critical thinking scores of baccalaureate degree students when they entered the nursing sequence and scores obtained when the same students completed the nursing course sequence. Gross, Takazawa, and Rose (1987) also used the WGCTA to study critical thinking. Thirty-four upper division baccalaureate students took the test upon entry into their junior year and again upon completion of their senior year. This particular group of students had 2 years of general education prior to entry into nursing. The major finding of the study was the improvement in critical thinking over the course of the nursing program. The authors concluded that 2 years of nursing education significantly improved critical thinking. On the other hand, Bauwens and Gerhard (1987) found no significant differences between entry and graduation WGCTA scores of 159 students enrolled in an upper division BSN program.
Conflicting results also have been produced by studies of registered nurses enrolled in BSN completion programs. Sullivan (1987) used a pre-test/post-test design to investigate whether critical thinking improved during enrollment in a 2-year RN to BSN nursing program. The WGCTA was administered at the beginning and the end of the BSN program. For the 46 students, no significant differences were found between entry and exit. Miller (1992) also examined the influence of a baccalaureate RN completion program on the critical thinking skills of students. Students were tested upon entry and exit of the program using the WGCTA. Differences in the means of the pre-test and post-test were significant at the 0.05 level. These results support the expectation that overall critical thinking tends to improve during the student's academic experience.
The accelerated curriculum provides the opportunity to achieve the goal of entry into professional nursing more quickly. The philosophy of this creative approach builds on non-nurse college students' previous academic and life experiences, enabling them to accelerate and complete their undergraduate nursing preparation in a shorter period. But Watson and Glaser (1980) maintain that skill in applying attitudes and knowledge must be acquired. Given the short duration and special nature of an accelerated nursing program, it is unknown if accelerated students can achieve higher levels of critical thinking ability and values compared to those completing longer programs. The influence of the accelerated nursing curriculum in the improvement of critical thinking has not been widely addressed. Furthermore, it is not known how this group of students compare to traditional baccalaureate students upon entry into the nursing program.
Comparison of WGCTA Scores Before and After Nursing Courses
The purpose of this study was to evaluate the influence of an accelerated nursing curriculum on the students' abilities to think critically. The following questions were addressed in this study:
1. How do traditional BSN and accelerated BSN students compare with each other on the variable of critical thinking as measured by the WGCTA upon entry into the nursing program?
2. How do traditional BSN and accelerated BSN students compare with each other on the variable of critical thinking as measured by the WGCTA at the completion of the nursing program?
3. How do traditional and accelerated students compare on the WGCTA scores between the tests administered at the beginning of the nursing course sequence and those taken at the end?
This study was conducted at a private liberal arts university located in the midwest. The study was approved by the university Institutional Review Board. The convenience sample consisted of two groups of baccalaureate nursing students: traditional and accelerated. The traditional group of students (n=45) entered the fall semester and completed the program 32 months later. The traditional students ranged in age from 19 to 31 years (M=19.7). The accelerated group (n=43) entered the nursing program in the summer semester and completed the program in less than 22 months. Before beginning the program, this group had completed either a bachelor's degree in a non-nursing field or a minimum of 44 college credits. The accelerated students ranged in age from 20 to 48 years (M=26.7).
The WGCTA was used to measure the critical thinking abilities of the student nurses. Students completed the instrument at the beginning and the end of the course sequence. This 80-item seff-administered instrument contains five subsets: a) inference, b) recognition of assumptions, c) deduction, d) interpretation, and e) evaluation of arguments (Watson & Glaser, 1980, p. 10).
In this study, reliability for the total score of the WGCTA was established at 0.77 using the Spearman-Brown formula. This is consistent with the split-half reliability coefficients ranging from 0.69 to 0.85 reported by Watson and Glaser (1980, p. 10). Subset scores were not analyzed in this study.
Content validity of the WGCTA was reported by Watson and Glaser (1980). According to the developers, the instrument measured a sample of objectives determined by educators to be critical thinking indicators. Construct validity of the instrument also was established by Watson and Glaser who compared WGCTA scores of students exposed to a program designed to stimulate critical thinking with those who had not (Watson & Glaser, 1980, p. 11).
Using SPSS, t-test procedures were performed to compare the WGCTA scores of traditional and accelerated students. Findings revealed a significant difference (¿-value= -2.42, p=.017) between the test scores of the two groups on the WGCTA administered at the beginning of the nursing course sequence. The mean score of the WGCTA for the traditional students was 52.89 compared with the mean score of 56.67 for the accelerated students.
When the scores for the WGCTA administered at the end of the nursing course sequence were compared, no significant difference between the two groups (tvalue=-1.76, p=.082) was found. The mean score for the traditional students at the end of the nursing program was 55.52 compared with the accelerated students' mean score of 58.32.
To compare changes in critical thinking which occurred during the nursing program, t-test procedures were completed for each group. Findings revealed that for traditional students, there was a significant difference in the WGCTA scores between the tests administered at the beginning of the nursing course sequence and those given at the end. Although the WGCTA scores increased for the accelerated students, there was not a significant difference between the before and after nursing program scores (Table).
These findings support the assumption that students who have completed at least 44 college credits before beginning the nursing program are able to think more critically than the traditional college sophomore student. The accelerated students, therefore, were able to grasp the concepts related to nursing practice more quickly and matriculate through the program at a faster rate.
The significant increase in the WGCTA scores of the traditional students support the study findings of Berger (1984), Frederickson (1979), and Gross and colleagues (1987). The increase in scores is consistent with the expectation that nursing curricula do encourage the development of critical thinking abilities.
Although the WGCTA scores of accelerated students did increase from the beginning to the end of the nursing course sequence, the increase was not statistically significant. The reasons for this are unknown. One explanation may be the essence of the accelerated program. Critical thinking may take longer than 22 months to develop. It is possible that this pace does not lend itself to deep analysis of content and thus sacrifices further development of critical thinking abilities for speed coverage. According to Brigham (1993), reflecting on one's thoughts is vital in the development of critical thinking skills (p. 54).
The student population may provide another explanation. Most students in the accelerated program are changing careers and experiencing financial hardship. The need to complete their education and enter the nursing profession as quickly as possible is the reason for choosing an accelerated program. These students are focused on the "product" of the nursing program: a BSN. According to Jones and Brown (1993), however, critical thinking is process-oriented rather than product-oriented. This "product" focus may hinder further development of critical thinking skills in accelerated students during their matriculation through the nursing program.
As programs are developed to meet the needs of a diverse student population, further investigation is needed to determine methods which will increase critical thinking abilities. It may be helpful to identify additional characteristics which influence the critical thinking abilities of this student population. Also, evaluation of teaching strategies to determine which best enhance critical thinking abilities in both traditional and accelerated students is a priority.
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Comparison of WGCTA Scores Before and After Nursing Courses