Critical thinking is a frequently used but somewhat elusive term. Ask 10 nurse educators to define critical thinking and you will likely receive 10 different definitions. Few are able to give a precise definition of the term. Although the importance of critical thinking to safe, effective nursing care is agreed on, we cannot seem to agree on its definition. Paul and Elder (2014) described critical thinking as the ability to identify problems, ask relevant questions, gather and evaluate evidence, recognize and consider alternative solutions, and effectively communicate with others for optimal outcomes. All too often, students struggle to grasp the concept of critical thinking and they struggle even more to improve their critical thinking skills. Educators need a variety of methods to help students develop critical thinking skills; methods to inspire deep learning, analysis, and problem solving; and methods that are suited to the learning orientation of adult learners.
Quantitative literacy (QL) is one such method. The Association of American Colleges and Universities (2014) described QL as:
a “habit of mind,” competency, and comfort in working with numerical data. Individuals with strong QL skills possess the ability to reason and solve quantitative problems from a wide array of authentic contexts and everyday life situations. They understand and can create sophisticated arguments supported by quantitative evidence, and they can clearly communicate those arguments in a variety of formats (using words, tables, graphs, mathematical equations, etc., as appropriate).
In short, QL is the ability to understand, interpret, evaluate, and apply numerical data, as well as the ability to communicate mathematical ideas in various formats. On a practical level, QL uses basic mathematical, statistical, and problem-solving skills and promotes logical thinking. Although it may seem that QL is only of importance to science, technology, engineering, and mathematics (STEM) majors, it is important for all students. Along with inquiry and analysis, critical and creative thinking, and teamwork and problem solving, QL is one of the Liberal Education and America's Promise essential learning outcomes developed by the Association of American Colleges and Universities (2011, p. 7).
Although proficiency in reading, writing, and basic mathematical skills has always been an expectation of general education, until recently less attention has been paid to the ability to understand and use numerical data. QL skills are not usually taught in mathematics courses; more often, they are learned through the course of life. Yet, we live in a world of numbers: political headlines, indicators of global warming, advertisements, public health concerns. In Mathematics and Democracy: The Case for Quantitative Literacy, Lynn Arthur Steen (2001) stated, “The world of the twenty-first century is a world awash in numbers” (p. 1). Often, those numbers are interpreted for us. Some may see this as a convenience; however, a drawback exists. What if those interpretations are incorrect? What if they are biased? Depending on the viewpoint, data can be used to promote or discredit products and concepts; it can also be interpreted to inform or influence.
The impact of data in our professional and personal lives is immense. When census data are analyzed, incidence and prevalence rates are determined, or algorithms for medication regimens are developed, we are using and creating data. In fact, many of us use our QL skills on a daily basis without realizing it. When we consider credit card offers with various interest rates, when we contemplate buying or selling stocks, when we read nutrition labels and interpret that information for a specific diet, or when we ponder the risk-to-benefit ratio of medical procedures, we are utilizing our quantitative literacy skills.
This teaching strategy is grounded in the overlap of critical thinking and QL and was designed to channel QL skills in an intentional manner: for the purpose of enhancing the critical thinking skills of undergraduate nursing students.
The fact that QL is a habit of mind that requires (a) complex reasoning and inquiry, (b) data analysis, manipulation, and interpretation, (c) creating solutions to real-world problems, and (d) effectively communicating information makes it an ideal method for enhancing the critical thinking skills of adult learners. In effect, QL provides students with a mechanism to apply their developing critical thinking skills in a manner that actually develops the skill set. With this teaching strategy, as students use their QL skills, their critical thinking skills are enhanced.
QL is most effective when the skills are taught, learned, and used within significant, concrete settings. Abstractions or constructs that have no context are quickly forgotten. Wenner et al. (2009) recommended the following when teaching QL skills to entry-level students: placing the concepts in context, using a variety of numerical depictions, having students work in groups, using technology as appropriate, and solving meaningful problems that are relevant to the course content.
With all of that in mind, QL was integrated into the curriculum of the Maternal–Newborn Nursing course at an urban community college with a diverse student population. Most (83%) of the 23 students in the class were women; 91% were between the ages of 21 and 40 years, 9% were between the ages of 41 and 50 years; 39% identified as Black/African American, 26% identified as Asian, 17% identified as Hispanic/Latino, 17% identified as White, and 1% identified as Other.
The course is 7 weeks long and occurs during the second semester of the nursing curriculum. Each QL learning activity used learner-centered, team-based learning. For consistency and as a means of linking didactic instruction with clinical experience, students worked on classroom QL assignments in their clinical groups (i.e., four to five students per group).
Daily attendance and a basic appraisal of participation in each activity were recorded by the instructor. Group work was structured so that students held each other accountable for participation: student assessment of each assignment included an evaluation of the other group members' participation. That feedback was compiled, made anonymous, and provided to each student by the instructor during individual self-assessment review sessions. Groups were allowed to self-assign tasks (e.g., online researcher, recorder, reporter, graph-creator, editor); however, students were required to rotate tasks with each assignment. Because this was an in-class exercise conducted solely for pedagogical purposes, institutional review board approval was not required. Outcomes were documented; however, interviews were not recorded.
Three data-based, contextual assignments were designed, each requiring critical thinking at the application level or higher, in accordance with the cognitive domain of Bloom's taxonomy.
The first assignment examined the impact of poverty on infant mortality rate (IMR). Each group was assigned one state within the United States. After researching IMR and poverty rates, each group created a graph depicting the association of IMR with the poverty rate of that state and they wrote a summary of their interpretation of the data and their inferences of the potential causes and outcomes of that state's IMR.
The second assignment involved Apgar scoring, drawing inferences from the antepartum/intrapartum history, assessing the efficacy of resuscitative efforts, and determining subsequent nursing care needs of low- and high-risk neonates. This assignment required students to analyze and correlate data and other ancillary information from the maternal history with the current status of the neonate and then develop a plan of care for the baby.
For the third assignment, students were provided fetal/newborn growth charts and Ballard neuromaturational assessment data of several high-risk neonates. Their assignment was to then create the antepartum/intrapartum physiologic and psychosocial history of the mother. This assignment required interpreting the assessment data, integrating various antepartum and intra-partum etiologies, reconciling outcomes with risk factors, and creating a cohesive, comprehensive patient history.
Due to the inherent challenges of measuring student attention and engagement, and a strict departmental grading policy, formative assessment was deemed to be the best means of assessing student attention and engagement, student learning, and efficacy of the teaching strategy. Rubrics were designed not only to grade each assignment but also to gauge the progressive development of critical thinking skills. Summative evaluation of student learning was based on examination questions that correlated with the aforementioned assignments.
Overall, students were attentive and engaged throughout; they reported a better understanding of data interpretation and how those interpretations can be used in support of, or opposition to, a particular position. Each assignment revealed enhanced and ongoing development of their critical thinking and problem-solving skills. Students were intrigued by the information revealed as they researched IMR and poverty data. The assignment sparked rich discussions about the underlying socioeconomic, political, and cultural factors impacting national and international IMR. The second assignment required more guidance on the part of the instructor, as the students connected didactic instruction to their interpretation of the clinical data. Although students deemed the third assignment the most challenging (“we had to think backwards”), they created detailed patient histories that were plausible and directly related to the minimal information provided. Summative evaluation via application and analysis-level examination questions also revealed enhancement of critical thinking skills.
An added benefit was that at the end of the course, three students with self-reported “math anxiety” expressed feeling more confident when working with numbers. Incorporating QL into the course also encouraged evidence-based practice in a manner that fosters self-discovery of information and lifelong learning.
We live in data saturated era. QL can transform the way we teach and the way we learn, as well as the way we interact with the large volume of data encountered on a daily basis. Recent surveys indicate that employers are seeking employees with both critical thinking and QL skills (Association of American Colleges and Universities, 2011). Nurse educators are in an optimal position to teach and enhance those skills as both critical thinking and QL are easily integrated into nursing courses. In addition to the learning activities of this project, other opportunities to incorporate QL into nursing curricula include:
- Interpretation of trends and outliers in medical research data and analysis of health-related advertisements in a nursing research course.
- Creation of graphics depicting the influence of medication protocols on laboratory results in a nursing pharmacology course or in a medical–surgical nursing course.
- Use of quality control data (i.e., safety risk factors, medication errors, resource allocation) for quality improvement planning in a nursing management course.
Although currently a lack of research exists on the use of QL in nursing education, options for pedagogical and andragogical research abound. In light of the positive outcome of this project, QL definitely has a place in nursing education.
- Association of American Colleges and Universities. (2011). The LEAP vision for learning. Outcomes, practices, impact and employers views. Washington, DC: Author.
- Association of American Colleges and Universities. (2014). Quantitative literacy VALUE rubric. Peer Review, 16(3). Retrieved from https://www.aacu.org/value/rubrics/quantitative-literacy
- Paul, R. & Elder, L. (2014). The miniature guide to critical thinking concepts and tools. Tomales, CA: Foundation for Critical Thinking Press.
- Quantitative Literacy Design Team. (2001). The case for quantitative literacy. In Steen, L.A. (Ed.), Mathematics and democracy: The case for quantitative literacy (pp. 1–22). Princeton, NJ: NCED.
- Wenner, J.M., Baer, E.M., Manduca, C.A., Macdonald, R.H., Patterson, S. & Savina, M. (2009). The case for infusing quantitative literacy into introductory geoscience courses. Numeracy, 2(1), 1–23. http://dx.doi.org/10.5038/1936-46126.96.36.199 doi:10.5038/1936-46188.8.131.52 [CrossRef]